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Journal Issue: Home Visiting Volume 3 Number 3 Winter 1993

Home Visiting: Analysis and Recommendations
Deanna S. Gomby Carol S. Larson Eugene M. Lewit Richard E. Behrman

Introduction

The idea of sending visitors into families' homes to provide information, health care, or psychological or other support services is not new. As Wasik describes in her article in this journal issue, home visiting has existed since Elizabethan times in England. It has existed in the United States since at least the 1890s in a variety of forms, for a variety of purposes, and to serve a wide range of families. As the quotes above exemplify, home visiting has been promoted as a service for all families living in distress, for families participating in health, education, or social support programs, or, even more broadly, for families to give every child the best possible start in life.

Home visiting programs are more popular today than ever. Health or social service programs for families and children in thousands of communities across the nation offer home visiting,4 and statewide home visiting programs exist in Hawaii and Missouri. Based on independent totals from just those programs described in the Appendix in this journal issue, as many as 200,000 children and families each year are enrolled in programs that employ home visiting as a significant part of what they do. Existing programs are funded through many public and private sources, including the federal Departments of Education and Health and Human Services. Calls for additional home visiting programs have come in recent years from commissions and expert panels5-8 and the U.S. General Accounting Office has examined home visiting carefully in two recent reports.9,10 At least nine bills that would have employed home visiting were introduced into consideration during the 102nd session of Congress,11 and one (Children of Substance Abusers Act, see Appendix) was passed and signed into law, although no funds were appropriated. New initiatives employing home visiting are being launched in 1993 by the Centers for Disease Control and Prevention and the federal Maternal and Child Health Bureau (see Appendix). Finally, in 1993, President Clinton signed legislation to authorize the spending of close to $1 billion over five years for family preservation and family support services in the states—services that will likely include home visiting.

As Powell points out in his article in this journal issue, however, home visiting is not a single, specific, uniformly defined service, but rather a strategy for service delivery. Home visiting is used today to serve many different populations and to achieve many different goals. This journal issue focuses on those programs that send visitors to the homes of pregnant women or families with young children, typically up to about three years of age, although a few programs that serve children up to age five or six are also discussed. The goals of the programs discussed here are primarily preventive in nature and typically seek to prevent preterm or low birth weight births, to promote healthy child development or school readiness, or to prevent child abuse. We have not focused on the thousands of programs which use home visiting for the purposes of family preservation,12 child sexual abuse treatment,13 or traditional child welfare case work.

This journal issue reviews what has been learned from the extensive experience with home visiting. As summarized in this Analysis, research has shown that home visiting programs can have positive effects for some families and children (see the article by Olds and Kitzman in this journal issue). However, the research is limited in scope and findings are mixed. In many evaluations, no beneficial effect was documented. Furthermore, research and experience imply that to secure even modest beneficial effects via home visiting is not a simple task. Successful programs require careful planning and attention to the needs and circumstances of participating families, as well as thorough preparation and continuing support and supervision for staff.

We believe that research findings are promising enough to recommend that the use of home visiting should be further expanded and the evaluation of home visiting should be continued. This could be done through demonstration projects in particular communities or through large-scale state or national initiatives. Two of the authors in this journal (Weiss and Krugman) recommend the latter approach. We do not make a recommendation about which strategy is most appropriate at this time. Our hope is that this journal issue will help inform those decisions. However, we do believe that there are some important principles that emerge from past experience and research which should guide any expansion of home visiting programs. These principles are discussed at the end of this Analysis. First, however, we highlight some of the topics discussed more fully in the articles in this issue: the diversity of today's home visiting programs, the challenge of home visiting, and the lessons learned from research about home visiting.