Home visitation is defined as a process by which health services are provided to a family in its own home over a sustained period of time (Wasik et al. 1990). The practice of visiting families in the home is based on the assumptions that parents are the most important people in the lives of children and the home is the most important setting for children. The goal of home visitation is to help parents enhance the child’s development by providing support and knowledge. However, in order for the parents to respond effectively to their children, attention has to also be focused on their own needs. Parents who are concerned about basic needs such as housing or food, or who are affected by other stressors, will have a hard time caring for their children (Wasik et al. 1990). In this regard, the goals of home visitation and case management are fundamentally synergetic as both include longitudinal and comprehensive interventions with parents to promote the health and well-being of the family. Thus, the home visitor’s role in delivering comprehensive care to families is consistent with the role of a case manager who mobilizes resources to address the multiple needs of children and families.

Home visitation programs have been implemented in the United States since the 19th century as a way to address the health care needs of women and children (Weiss 1993). Public health nurses, social workers, or other trained staff provided ongoing in-home health education to women and children, primarily in urban settings. This approach to health care continued in the 20th century where the focus was on families with special needs such as premature or low birth-weight infants, children with developmental delays, and teenage parents. The accumulating evidence about the potential benefits of home visitation programs prompted the Council on Child and Adolescent Health to later endorse home visitation programs as an effective way to improve health outcomes for children and families (American Academy of Pediatrics 1998). The American Academy of Pediatrics encourages pediatricians to recognize that home visitation programs can supplement office- based care and be part of Medical Home concept that provides a continuum of care. Pediatricians are encouraged to support referrals of high-risk parents to home visitation programs as early as possible. Suggestions are also made for advocacy in order to support funding for quality home visitation programs.

Family Tip

Access to a Home Visitation Program may be offered by the health care provider or can be obtained by contacting the member services number on the health insurance card. The Affordable Care Act in 2010 allocated $1.5 billion to expand home visitation programs in the United States so most likely these programs are available in your community.

Healthcare Professional Tip

Health care professionals can refer families to home visitations program by contacting the individual’s health plan or identifying other programs in the community.

There are many maternal, infant and early child models of home visitation programs that are implemented across the United States. The U.S. Department of Health and Human Services has identified several home visitation programs with evidence of effectiveness (U.S. Department of Health and Human Services 2013). These programs vary in their focus but they all involve regular home visits by paraprofessionals, social workers or nurses. Some of the more known programs include the following:

Healthy Families America (HFA). HFA is a national evidence-based program in 40 states, District of Colombia, and all five US territories that works with families beginning during prenatal care and can extend as long as three to five years after the child has been born. Paraprofessionals implement the program based on three critical program elements: service initiation, service content, and staff characteristics. These home visits, which are conducted on a weekly to biweekly schedule, focus on supporting parents, the child-parent interactions and educating parents to prevent child maltreatment (Healthy Families America 2014).

Nurse Family Partnership (NFP). NFP is a program for first time, low income mothers that has been implemented in 32 states. This program is delivered by registered nurses who create a foundation for strong families by supporting the mothers and encouraging them to have a healthy pregnancy. The registered nurse visits the home once a week for the first month then taper to biweekly until the child is born. For the first six weeks after the child is born, visits resume to weekly and then continue biweekly until the child is approximately twenty months old. Leading up to the child’s second birthday, there are four final visits that occur monthly (Nurse-Family Partnership 2014).

Healthy Start. Healthy Start programs, which are implemented in 38 states, the District of Columbia and Puerto Rico, focus on at-risk families during the first year of the infant’s life (National Healthy Start Association 2014). This program is delivered by paraprofessionals who address parent-child interactions and identify a reliable support figure for the child. The intensity of home visitation vary in frequency of visits depending on the client (McCurdy 2005).

Early Head Start. Early Head Start is a federal program that has been implemented in all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands. This program focuses on child development, family development, community building and staff development in low income families with infants and toddlers, and pregnant women and their families. There are four different program options: center-based services, home-based services, family child care services, and combination services which include both home and center based services. On average, the home-based services include a visit from a paraprofessional twice per month to deliver the child-focused program to help the parents support their child’s development (Love et al. 2005).

Parents as Teachers. Parents as Teachers program is being utilized in all 50 states and six other countries. This program focuses on preventing child abuse, providing a solid foundation for school success for children, giving parents the tools to increase knowledge of child development and fostering growth and learning, and develop home-school-community partnerships (Parents as Teachers 2014). This program has monthly regularly scheduled home visits by certified parent educators, parent group meetings, periodic developmental screenings and referrals to community services. The target populations of this program are parents and their children (beginning prenatally and continuing until the child is three to five years of age), parents who are teenagers, and parents whose children attend child care centers (Wagner et al. 2002).

All of the home visiting programs involve at-risk families and seek to foster a better child-parent bond. With the exception of the Healthy Start program, all other four programs begin with prenatal patients. While the frequency of the program and the deliverer of the program vary, they all have the same fundamental focus on the relationship between the parent and child in order to create an environment where the parents feel better equipped to care for and nurture their child.

Other home visitation programs that are also part of the U.S. Department of Health and Human Services include Child FIRST, Early Intervention Program for Adolescent Mothers, Early Start (New Zealand), Family Check-Up, Healthy Steps, Home Instruction for Parents of Preschool Youngsters (HIPPY), Oklahoma Community-Based Family Resource and Support Program, and Play and Learning Strategies (PALS) (U.S. Department of Health and Human Services 2013).

Family Tip

Several Home Visitation Programs may be available in the community. Consult a health care provider about the best fit for the patient and the family. Some of the programs are available based on a geographic area.

Healthcare Professional Tip

Several Home Visitation programs may be in the community. Become familiar with the focus of these programs to ensure the best fit for your patients.

Several reviews of the literature were conducted to examine evidence about the effectiveness of home visitation programs in improving maternal) and child outcomes. For example, a review of prenatal home visiting programs was conducted to determine the effectiveness of prenatal home visitation for improving prenatal care utilization and preventing preterm birth and low birth weight (Issel et al. 2011). The review included 28 studies comparing outcomes of women who received prenatal home visiting with women who did not. Fourteen of the studies used a randomized controlled design. Another systematic review evaluated the effectiveness of paraprofessional home visitation programs in improving developmental and health outcomes of children from disadvantaged families (Peacock et al. 2013). The review included 21 randomized controlled trials. A systematic review of studies was also conducted to examine evidence regarding home visitation and outcomes of preterm births (Goyal et al. 2013). The review included 17 studies of which 15 were randomized controlled trials. The reviews have documented the following outcomes:

Prenatal Effects

Postnatal Effects

Long Term Effects

Overall, studies support that home visitation programs promote parent-child interaction, utilization of prenatal care, and developmental and health outcomes of young children from disadvantaged families. However, some studies did not document statistically significant benefits, especially in the area of child abuse and neglect. Additionally, the reviewers identify common methodological limitations such as limited sample size, high attrition rates that may have contributed to biases, and lack of statistical information to allow a meta-analysis. Further studies using rigorous designs and measures including program intensity, are needed to examine the role of home visitation in improving maternal and child outcomes.

Family Tip

Discuss with the health care provider the best Home Visitation to select from the programs that are available in the patient/patient family’s community. Information can be requested to help make an informed decision.

Healthcare Professional Tip

Become familiar with the outcomes of Home Visitation programs and support referrals to programs that were adequately evaluated and have documented evidence for improving outcomes. Be willing to participate in evaluating these programs in your community.