Early childhood home visiting programs

In early childhood home visiting programs trained personnel regularly visit at-risk expectant parents and families with young children and provide them with information, support, and/or training regarding child health, development, and care based on families’ needs. Home visitors can be nurses, social workers, parent educators, paraprofessionals, lay workers from within the community, or others. Home visiting often begins prenatally and continues during the child’s first two years of life, but may also begin after birth, last only a few months, or extend until kindergarten (HRSA-MIECHV 2017, Sama-Miller 2017).

Expected Beneficial Outcomes (Rated)

  • Reduced child maltreatment

  • Reduced child injury

  • Improved cognitive skills

  • Improved social emotional skills

  • Improved parenting

  • Improved birth outcomes

  • Improved maternal health

  • Improved economic security

Other Potential Beneficial Outcomes

  • Improved prenatal care

  • Reduced hospital utilization

  • Reduced rapid repeat pregnancies

  • Increased use of contraception

  • Reduced intimate partner violence

Evidence of Effectiveness

There is strong evidence that early childhood home visiting programs prevent child maltreatment (Sama-Miller 2017, , Selph 2013, Peacock 2013, , , CG-Violence) and injury (, Roberts 1996), and improve children’s cognitive and socio-emotional development (Sama-Miller 2017, MDRC-Michalopoulos 2017, Peacock 2013, , ). Early childhood home visiting programs have also been shown to improve birth outcomes (Sama-Miller 2017, Peacock 2013, Issel 2011), maternal health (Sama-Miller 2017), parenting behaviors and attitudes (Sama-Miller 2017, , , ), and increase family economic self-sufficiency (Sama-Miller 2017, MDRC-Michalopoulos 2017). Effects are often sustained until children reach age 7 (MDRC-Michalopoulos 2017).

Home visiting programs have been shown to reduce maternal postpartum depression in the US (Sama-Miller 2017) and internationally (). Home visiting begun prenatally may increase use of prenatal care (Sama-Miller 2017, Issel 2011), improve infant health, increase vaccination (Sama-Miller 2017, El Fadl 2016, Peacock 2013, CG-Violence), and reduce infant visits to the emergency room (). Some home visiting programs for preterm babies appear to improve physical growth and reduce hospitalization (). Visits begun postnatally may improve infant health and increase exclusive breastfeeding, particularly with frequent visits; however, they may not reduce child mortality or improve maternal health ().

Programs for teenage mothers may reduce rapid repeat pregnancies (, ), and increase use of contraception (). Home visiting programs for mothers who have been abused appear to reduce intimate partner violence (, ). An evaluation of the Family Spirit program suggests home visiting can improve child development, school readiness, maternal health, and parenting practices among American Indian families (Mraz Esposito 2017). Home visiting programs may not be successful, and may even be harmful, when participants abuse drugs or alcohol ().

Longer term and more intense interventions, supervision of home visitors, and fidelity monitoring appear to increase positive effects on child maltreatment (, Selph 2013, CG-Violence) and cognitive outcomes (). Programs delivered by licensed professionals appear to have stronger effects on children’s cognitive outcomes than programs delivered by paraprofessionals or non-professionals. However, research regarding home visiting and child maltreatment does not consistently indicate that one type of provider delivers the most effective interventions. Additional evidence is needed to confirm the most effective method of implementation for any particular outcome of interest (, Selph 2013, , CG-Violence).

Home visiting interventions are cost-effective in the long term, benefiting disadvantaged families and increasing economic sufficiency and stability (MDRC-Michalopoulos 2017).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

The federal Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV), administered by the Health Resources and Services Administration provides states, territories and tribal communities with funding to implement early childhood home visiting models that have been approved through the US Department of Health and Human Services’ (DHHS) Home Visiting Evidence of Effectiveness (HomVEE) review (HRSA-Home visiting). In fiscal year 2016, 893 counties received grants from the MIECHV program; about a half of grantee counties were rural (HRSA-MIECHV 2017).

As of August 2017, 20 home visiting models that meet DHHS criteria for evidence-based program models (Sama-Miller 2017), for example, Healthy Families America (HFA), Nurse-Family Partnership (NFP), Parents as Teachers (PAT-Home visiting), and Early Head Start-Home Visiting (EHS-Home based).

Implementation Resources

US DHHS-Home visiting - US Department of Health and Human Services (US DHHS). Child Welfare Information Gateway. Home visiting.

DC HealthCheck - District of Columbia's HealthCheck Training & Resource Center. Home visiting toolkit.

HRSA-Home visiting - Health Resources and Services Administration (HRSA). Home visiting.

US DHHS-HomVEE - US Department of Health and Human Services (US DHHS). Home Visiting Evidence of Effectiveness (HomVEE).

US DHHS ACF-Tribal HV - US Department of Health & Human Services (US DHHS), Administration for Children & Families (ACF). Tribal home visiting (HV).

Citations - Evidence

* Journal subscription may be required for access.

CG-Violence - The Guide to Community Preventive Services (The Community Guide). Violence.

Roberts 1996 - Roberts I, Kramer MS, Suissa S. Does home visiting prevent childhood injury? A systematic review of randomised controlled trials. BMJ. 1996;312(7022):29-33.

Issel 2011 - Issel LM, Forrestal SG, Slaughter J, Wiencrot A, Arden H. A review of prenatal home-visiting effectiveness for improving birth outcomes. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2011;40(2):157-65.

MacLeod 2000* - MacLeod J, Nelson G. Programs for the promotion of family wellness and the prevention of child maltreatment: A meta-analytic review. Child Abuse & Neglect. 2000;24(9):1127-49.

Sweet 2004* - Sweet MA, Appelbaum MI. Is home visiting an effective strategy? A meta-analytic review of home visiting programs for families with young children. Child Development. 2004;75(5):1435-56.

Cochrane-Turnbull 2012* - Turnbull C, Osborn DA. Home visits during pregnancy and after birth for women with an alcohol or drug problem. Cochrane Database of Systematic Reviews. 2012;(1):CD004456.

Kendrick 2000* - Kendrick D, Elkan R, Hewitt M, et al. Does home visiting improve parenting and the quality of the home environment? A systematic review and meta analysis. Archives of Disease in Childhood. 2000;82(6):443-51.

Cochrane-Kendrick 2013* - Kendrick D, Mulvaney CA, Ye L, et al. Parenting interventions for the prevention of unintentional injuries in childhood. Cochrane Database of Systematic Reviews. 2013;(3):CD006020.

Peacock 2013 - Peacock S, Konrad S, Watson E, Nickel D, Muhajarine N. Effectiveness of home visiting programs on child outcomes: A systematic review. BMC Public Health. 2013;13:17.

Selph 2013 - Selph SS, Bougatsos C, Blazina I, Nelson HD. Behavioral interventions and counseling to prevent child abuse and neglect: A systematic review to update the U.S. Preventive Services Task Force recommendation. Annals of Internal Medicine. 2013;158(3):179–90.

Cochrane-Lopez 2015* - Lopez LM, Grey TW, Hiller JE, Chen M. Education for contraceptive use by women after childbirth. Cochrane Database of Systematic Reviews. 2015;(7):CD001863.

Casillas 2016* - Casillas KL, Fauchier A, Derkash BT, Garrido EF. Implementation of evidence-based home visiting programs aimed at reducing child maltreatment: A meta-analytic review. Child Abuse and Neglect. 2016;53:64-80.

MDRC-Michalopoulos 2017 - Michalopoulos C, Faucetta K, Warren A, Mitchell R. Evidence on the long-term effects of home visiting programs: Laying the groundwork for long-term follow-up in the Mother and Infant Home Visiting Program Evaluation (MIHOPE). Washington, DC: Manpower Demonstration Research Corporation (MDRC). 2017.

Goyal 2013* - Goyal NK, Teeters A, Ammerman RT. Home visiting and outcomes of preterm infants: A systematic review. Pediatrics. 2013;132(3):502-516.

Cochrane-Dennis 2013* - Dennis CL, Dowswell T. Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database of Systematic Reviews. 2013;(2):CD001134.

El Fadl 2016 - El Fadl RA, Blair M, Hassounah S. Integrating maternal and children’s oral health promotion into nursing and midwifery practice - A systematic review. PLOS ONE. 2016;11(11):e0166760.

RAND-Kilburn 2017* - Kilburn MR, Cannon JS. Home visiting and use of infant health care: A randomized clinical trial. Pediatrics. 2017;139(1):e20161274.

Cochrane-Yonemoto 2017* - Yonemoto N, Dowswell T, Nagai S, Mori R. Schedules for home visits in the early postpartum period. Cochrane Database of Systematic Reviews. 2017;(7):CD009326.

Maravilla 2016* - Maravilla JC, Betts KS, Abajobir AA, Couto e Cruz C, Alati R. The role of community health workers in preventing adolescent repeat pregnancies and births. Journal of Adolescent Health. 2016;59(4):378-390.

Prosman 2015* - Prosman GJ, Lo Fo Wong SH, van der Wouden JC, Lagro-Janssen ALM. Effectiveness of home visiting in reducing partner violence for families experiencing abuse: A systematic review. Family Practice. 2015;32(3):247-256.

Sharps 2016* - Sharps PW, Bullock LF, Campbell JC, et al. Domestic violence enhanced perinatal home visits: The DOVE randomized clinical trial. Journal of Women’s Health. 2016;25(11):1129-1138.

Mraz Esposito 2017 - Mraz Esposito A, Coughlin R, Malick S, et al. Assessing the research on home visiting program models implemented in tribal communities - Part 1: Evidence of effectiveness. Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, US Department of Health and Human Services; 2017.

Sama-Miller 2017 - Sama-Miller E, Akers L, Mraz-Esposito A, et al. Home visiting evidence of effectiveness review: Executive summary. Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, US Department of Health and Human Services; 2017.

Citations - Implementation Examples

* Journal subscription may be required for access.

NFP - Nurse-Family Partnership (NFP). Helping first-time parents succeed.

PAT-Home visiting - Parents as Teachers (PAT). Universal access home visiting.

HFA - Healthy Families America (HFA). Great childhoods begin at home.

HRSA-Home visiting - Health Resources and Services Administration (HRSA). Home visiting.

EHS-Home based - Early Head Start National Resource Center (EHS). Home-based option.

HRSA-MIECHV 2017 - Health Resources and Services Administration (HRSA). The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program: Partnering with parents to help children succeed. MIECHV program national program brief 2017.

Sama-Miller 2017 - Sama-Miller E, Akers L, Mraz-Esposito A, et al. Home visiting evidence of effectiveness review: Executive summary. Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, US Department of Health and Human Services; 2017.

Date Last Updated

Feb 14, 2018