Building Home Visiting Systems

By Stephanie Schmit

Home visiting has a strong evidence base. Rigorous research supports the effectiveness of several models at promoting strong parenting skills and children’s health and development, as well as streamlining family support and child development services. Home visiting programs can also improve child health and development, increase children’s school readiness, enhance parents’ ability to support their children’s development, and improve family economic self-sufficiency.  In the long run, this leads to fewer children in the social welfare, mental health, and juvenile corrections systems, creating considerable cost savings for states.

The Evidence-Based Home Visiting (EBHV) Program was created in 2008 to prevent child maltreatment, leading to fewer children in the social welfare system. The Children’s Bureau (CB) within the Administration for Children and Families (ACF) at the U.S. Department of Health and Human Services funded 17 cooperative agreements to provide the necessary infrastructure for widespread adoption, implementation, and sustaining of evidence-based home visitation programs that aim to prevent child maltreatment. A recent evaluation, released by CB in partnership with Mathematica Policy Research and Chapin Hall at the University of Chicago, examined whether systems change occurred, whether models were implemented with fidelity, and implementation strategies and challenges.

The evaluation highlights key lessons learned since 2008: (1) challenges in completing home visits at recommended levels of intensity, (2) challenges in maintaining enrollment; (3) challenges in assessing the quality of the home visitor-participant relationship; (4) the need for flexibility in program management and evaluation during times of uncertainty; (5) the importance of feeding program-level experiences and data into system-level decisions and improvement plans; and (6) the central role of positive relationships and collaboration among partners.

The critical takeaway from the evaluation is the importance of building infrastructure and promoting better coordination across programs. Some states have made infrastructure investments in online tools for data collection or assessment or have made other efforts to: improve coordination within the home visiting system and the broader early childhood system; develop the programs’ workforce; or increase fidelity to models. Most of these efforts require continuing investments. The Maternal Infant and Early Childhood Home Visiting (MIECHV) Program has been highly valuable in helping states build infrastructure and expand EBHV’s reach to many additional participants, as well as promoting increased use of evidence-based programs more broadly and mechanisms for accountability. A number of states now have statewide infrastructures that support adoption of common outcomes across programs; they are also implementing initiatives to continuously monitor program quality.

The MIECHV program and other federal investments have been critical to developing sustainable, statewide home visiting systems and connecting them to the overarching early childhood system. Federal investment is an essential support of state system building which, when done thoughtfully and with the proper inputs, is comprehensive and ensures the broader early childhood system includes home visiting. Successful states have brought together diverse stakeholders and community interests to decide which home visiting models to implement, how to measure program outcomes, how to use this opportunity to create a more coordinated early childhood system, and how to put systems in place to support high-quality implementation of evidence-based models.  Congress should continue federal investment in home visiting to sustain these efforts to build statewide infrastructure and bring critical services to children and their families.