Home-based program

Home Visiting, often called "voluntary home visiting," is a state strategy for connecting expectant parents and parents of young children with a designated support person, like a trained nurse, social worker, or early childhood specialist. States make voluntary home visiting available to families in need so they have the supports and resources that they need to drive improvements in outcomes for babies. Funded with state budget dollars and funds provided through the federal Maternal, Infant and Early Childhood Home Visiting Program (as well as with private funds in many states), evidence-based Home Visiting is an increasingly utilized tool in states human services.

History

In 2010, the federal Affordable Care Act initiated the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) in order to establish positive and improved outcomes in health, education, and wellbeing of young children. Home visiting has already been in practice in every state. While passed during the administration of President Barack Obama, the program is widely viewed as bipartisan. MIECHV was reauthorized in a bipartisan budget bill in 2015 and signed by President Donald Trump. By the end of its first decade after being formalized in MIECHV, voluntary home visiting had been implemented in all 50 states, the District of Columbia, 5 territories, 25 tribal communities, and 51 percent of U.S. counties.

Purpose of enactment

The purpose of federal funding is to identify the most effective early childhood home visiting programs and strengthen them with standards that will produce measurable and efficient outcomes. Beginning with the programs inception in 2010, the Department of Health and Human Services (HHS) awards grants to states to develop and implement an early childhood home visitation program to promote:

1. Improvements in maternal and prenatal health
   
2. Infant health
   
3. Child health and development
   
4. Parenting related to child development outcomes
   
5. School readiness in child abuse, neglect and injuries

Programs

Several national Home Visiting Programs have developed and attained standards for successful training and home visiting cases for home visitors as well as for the program supervisors. States and local programs may use these models to establish a program but some local programs also may customize and tailor their programs according to their local needs by utilizing local resources and institutions. Local programs may follow some of elements from the national programs and integrate them, which create varieties of practice models, depending on the needs and availability of the local communities. The local models may not have evidence of consistent outcomes.

The seven federally approved home visiting models are:

1. Early Head Start – Home Based Option
2. Family Check Up
3. Healthy Families America (HFA)
4. Healthy Steps
5. Home Instruction Programs for Preschool Youngsters (HIPPY)
6. Nurse-Family Partnership (NFP)
7. Parents as Teachers (PAT)

There are other programs also in review for federal approval. When states apply and are granted of the federal funds, federal legislation provides guidelines on how to specifically distribute the money. For example, at least 75% of the funds must be apportioned on programs that follow one of the approved home visiting models. The rest of the money may be allocated for “promising approaches”, where they have shown some evidence of effectiveness, but yet to have strong assessment of evidence. Local programs may apply for funding in this classification.

Implementation

Home visitors

Home visitors are trained professionals who focus on early childhood and maternal health; they may be nurses, social workers, or early childhood specialists with additional training. Their scope of practice includes children and maternal health, parenting and family education, child abuse and neglect. Home visitors provide education and resources to parents in multiple layers, such as educating on normal trajectory of early childhood, identifying abnormal development or modifying problematic behavior, offering referrals to community resources, such as Medicaid, job training, employment services, or food assistance. They also provide mental health counseling to parents who may have substance abuse problems, or maternal depression.

Target

Home visiting services aim to support families who are most disadvantaged, or at risk. This population includes first time parents, low-income parents, single or teen parents, as well as parents with substance abuse or addictions, or mental health issues such as maternal depression.

Home Visiting Outcomes

Evidence-Based Practices

Evidence-based practice means that there has been a set of standards of practices established from clinically proved trials and researches that produced consistently improved outcomes. Individual clinician's training and organizational and systems changes could influence the implementation of clinical guidelines. The review of home visiting programs reports that intensive and frequent visits from trained professionals to families from the prenatal stage up to the second or third years of the child's life produces a positive and improved outcome in maternal and child's health.

Demonstrated Outcomes

Quality home visiting programs help parents provide safe and supportive environments for their children, and over time, families and home visitors build strong relationships that lead to lasting benefits for families. Benefits include:

1. Improved Maternal and Child Health
   During and after pregnancy, home visiting programs promote maternal health by helping mothers schedule regular doctor’s visits, improve diets, reduce stress levels, and quit smoking or substance abuse. Babies benefit as well. One study found that mothers who participated in a home visiting program were half as likely to have a baby born low-birthweight, which greatly reduced these babies risk for health and developmental problems.
2. Improved School Readiness
   Home visiting programs promote positive parenting practices that help parents better prepare their children for school.Parents enrolled in home visiting programs are more likely to have a safe play environment at home, provide age-appropriate books, and engage children in structured teaching activities. Home visiting programs have also demonstrated long-term, positive impacts on children’s academic achievement.
3. Improved Child Safety
   Home visiting programs are associated with reduced rates of child maltreatment and injuries. In one program, children of participating families experienced 40 percent fewer injuries between the ages of two to four, and they were 35 percent less likely to visit an emergency room compared to children not enrolled. Mothers who participate in home visits also have lower stress levels and increased sensitivity during interactions with their children.
4. Improved Economic Self-Sufficiency
   Mothers with higher levels of education typically can work more hours, drive higher family income levels, and provide more cognitively stimulating home environments for their children. Participating in a home visiting program has been demonstrated to lead to higher rates of enrollment and more hours spent in educational or training programs.
5. Reduced government expenditures.
   Many economists argue short- and long-term benefits of home visiting programs largely outweigh the overall costs incurred from implementation. RAND found that high-fidelity home visiting programs for at-risk families have a $5.70 return for every tax dollar spent from reduced spending for health care and welfare services. Another study of a home visiting program in Durham, North Carolina reported saving $3.00 for every $1.00 spent on the program during an infant’s first six months due to reduced emergency care visits.

Cost

Federal funding

Social Security Act, Title V, Section 511 (42 USC 711) states to conduct a statewide assessment on needs of the at-risk population to be eligible for the grant award. It also requires states to achieve “quantifiable, measurable improvements” on the five areas of family life, listed above.

Responsibility of States

States also must file a report to the Secretary of HHS on the progress of the program, which must show improvements on at least four areas at the end of the first three-year period. HHS holds authority to terminate the grant to any states that fail to comply or demonstrate improvements.

Bibliography

• Early Care and Education Legislation Database. Retrieved Oct 22, 2013. Updated October 21, 2013.