Journal Issue: Home Visiting: Recent Program Evaluations Volume 9 Number 1 Spring/Summer 1999
Statement of Purpose
The primary purpose of The Future of Children is to disseminate timely information about major issues related to children's well-being, with special emphasis on providing objective analysis and evaluation, translating existing knowledge into effective programs and policies, and promoting constructive institutional change. This publication is intended to complement, not duplicate, the kind of technical analysis found in academic journals and the general coverage of children's issues by the popular press and special interest groups.
In 1993, we published an issue of The Future of Children that focused on home visiting programs for families with young children. Since then, the number of such programs has blossomed as has the research conducted to assess their effectiveness. Several home visiting programs have gathered attention in the intervening years as significant models for services: Parents as Teachers, the Home Instruction Program for Preschool Youngsters, Hawaii's Healthy Start, Healthy Families America, the Nurse Home Visitation Program, and the Comprehensive Child Development Program. This journal issue reports the results of recent evaluations of these programs, some of which were funded through grants by The David and Lucile Packard Foundation. The journal also includes appendices that describe the programs in detail and summarize the results of additional evaluations of several of those programs.
This issue of The Future of Children is different therefore than our typical issue; rather than being a broad literature review, each article is a report on a single program, evaluated in two or more sites, and contains more technical data than is typically reported in our journal articles. We have taken this approach because we believe the results of these evaluations are important and that combining them in a single, detailed volume will be helpful to policymakers, practitioners, and researchers.
The results summarized in this journal issue illustrate the difficulty of changing lives of children and parents who live in conditions of disadvantage. Results varied widely across program models, program sites, and families, and across the domains of human experience the programs are designed to address. For example, several home visiting models produced some benefits in parenting or in the prevention of child abuse and neglect on at least some measures. No model produced large or consistent benefits in child development or in the rates of health-related behaviors such as immunizations or well-baby check-ups. Only two program models included in this journal issue explicitly sought to alter mothers' lives, and, of those, one produced significant effects at more than one site, when assessed with rigorous studies. All programs struggled to implement services as intended by their program models and, especially, to engage families in the programs. For instance, families typically received only about half the number of home visits that they were scheduled to receive, and many families received only 20 to 40 hours of services over the course of several years.
We recommend that practitioners and policymakers embrace modest expectations for these programs; no single service strategy can accomplish all the goals that these programs have been mounted to address (promote good parenting, prevent child abuse and neglect, promote children's health and development, and change the course of mothers' lives). We believe that home visiting programs are best funded as one of a range of services offered to families with young children. We urge that existing home visiting programs, in partnership with researchers, focus on improving the quality and implementation of their services.
We will continue to monitor and support evaluation and program improvement efforts in this field. For example, in March 1999, the National Academy of Sciences Board on Children, Youth, and Families held a meeting to explore home visiting programs, and we will report on that meeting in an upcoming issue of The Future of Children. Our intention is to encourage informed debate about this strategy for delivering services to children and families. To this end, we invite correspondence to the Editor.