The Value of Expanding Home Visiting to More Families

The question of which families to target with home visiting services is crucial. In an ideal world, home visiting would be available to any family that wanted extra support, regardless of risk status or income. However, the realities of limited funding and resources force policymakers and practitioners to assess which families are most likely to receive the greatest benefit from home visiting. There has been a widespread, though not universal, assumption in the field that first-time, at-risk mothers and their children receive the greatest benefit. Two recently released Pew-commissioned studies shed new light on this assumption.

Two reports examine whether families besides those of first-time, at-risk mothers benefit from home visiting:

  • Positive return on investment for a universal access home visiting program: A randomized controlled trial of Durham Connects, a universal access home visiting program in Durham County, North Carolina, found that mothers and children assigned to Durham Connects had more positive parenting behaviors, less maternal depression, fewer overnights in the hospital for the child, and reduced use of emergency medical services. This last result alone created a return on investment of $1.59 for every dollar spent on the program by the time the child reached six months of age. Download the executive summary and full report.
  • Home visiting benefits families of non-first-time moms, too: A comparison of outcomes for first-time mothers and mothers with two or more children participating in Healthy Families Virginia found that both types of families benefited equally in terms of higher childhood immunization rates, better home environments, and greater spacing between pregnancies. Download the executive summary and full report.

Policy and Practice Implications

  • These results suggest that it may be time to revisit the assumption that home visiting services should be targeted on the basis of demographic factors alone, such as whether a mother is having her first child or lives in poverty. More sensitive assessments of risk, such as those that can be determined through a short-term universal access program, may be more effective at identifying families that will most benefit from more intensive home visiting.
  • While the results of the two studies highlighted here are suggestive, we need to learn more about which services most benefit which families, so that we can more effectively target services where they have the greatest impact. This will require experimenting with different eligibility criteria, carefully tracking the home visiting services provided to the families, and then analyzing which services lead to the best outcomes for different types of families.
  • Ultimately policymakers’ criterion should be: which investments of public dollars create the greatest positive impact per dollar spent. For each state or locality, the answer to this question will likely require a portfolio of various home visiting services tailored to the community’s specific needs.

The two reports are part of a new body of studies commissioned by Pew with the aim of expanding and deepening the evidence base for home visiting. The research was made possible by generous support from the Doris Duke Charitable Foundation and the Children’s Services Council of Palm Beach County. These findings are exclusively the work of the commissioned researchers and do not necessarily reflect the views of Pew or the other funders.

About FSA

Home visitation & parent education programs providing a continuum of quality, research-based, & curriculum driven services to support families & children prenatally through age 5.
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