The Future of Children, Princeton - Brookings: Providing research and analysis to promote effective policies and programs for children.

Home visiting programs developed because of a widely held belief that this strategy offered unique benefits. By definition, home visiting occurs in a family's home. It therefore affords the visitor an opportunity to view the child and parents in the environment in which they live, to understand better their individual needs, and to tailor services to meet these needs more effectively than is possible in a group setting. Because home visitors bring services to a family rather than requiring the family to come to the service providers, home visiting programs can reach families who otherwise might not receive services. (See the articles by Weiss and by Ramey and Ramey in this journal issue.) Home visiting programs can also connect families with other services in the community such as medical care or employment training. Finally, home visiting can foster special relationships between the visitor and the family, which can provide additional benefits.

This common rationale, however, has not led to uniformity in home visiting programs. In fact, most of the authors in this journal issue have emphasized the diversity among current home visiting programs in both their structure and goals. Four of the authors in this journal issue extensively discuss this diversity. (See the articles by Powell, Ramey and Ramey, Wasik, and Weiss; see also Appendix.) As these articles describe, home visiting programs today show great variety in the experience and backgrounds of their staffs (professional, paraprofessional, or volunteer home visitors); their clients (everyone within a given service area, or specifically targeted subgroups such as teen mothers or low-income families); the intensity and duration of services they provide; their administrative auspices (stand-alone programs, services offered under the auspices of another agency such as a county health department or school district, or programs based on a national model and affiliated with a national headquarters that provides technical assistance); and the extent to which home visiting is the primary service provided or other services, such as medical care and center-based child care, are also provided.

Perhaps most significant, the goals of home visiting programs vary. Some programs focus on a single goal, such as preventing low birth weight births, while others focus on multiple goals, such as promoting a child's physical health and cognitive development and preventing child abuse, in addition to preventing low birth weight births. Still others take an even more comprehensive approach, seeking to address the needs of other family members.

Home visiting programs also differ in the strategies used to achieve their goals. Some deliver a curriculum within the home visit itself. Others use the home visit primarily to serve outreach, case-finding, needs assessment, or information and referral purposes. Still others are a hybrid, in which all families are screened and referred to other services if appropriate and some or all continue to receive home visiting services.

This diversity has provided a rich history of experimentation in how best to implement home visiting. However, as will be discussed, this diversity also makes it difficult to generalize lessons learned from one program to another and from one community to another.