Many workshop participants spoke about the need to view home visiting programs and evidence of their effectiveness in the context of the larger community of which they are a part. As stated by Deborah Daro, of the National Center on Child Abuse and Prevention Research in Chicago, Illinois, and an evaluator of the Healthy Families America program, “home visiting is a portal, [which can and should be used] to introduce families to broader systems of support.” It is not unusual for the same program implemented in different sites to yield different effects, indicating the significant role played by the many factors that impinge on a given program in a given neighborhood.
A home visiting program that exists in a community with other quality intervention programs and services to support it will be better able to help families and demonstrate success. Similarly, families that live in a supportive and financially stable environment may be better able to benefit from what home visiting programs have to offer. As observed by Gina Barclay-McLaughlin, of the Chapin Hall Center for Children in Chicago, Illinois, parents seem to think differently about their interactions with their children when they move from a financially depressed area to a more affluent community, and they may be more likely to put into practice the information they learned earlier from home visitors.
The embeddedness of home visiting programs has not been examined carefully, nor explicitly considered as a crucial feature of program design. Yet growing awareness of the importance of this broader context in determining program success may serve to reframe how both program designers and evaluators consider the place and role of home visitation approaches to service delivery.
The role of the home visitor in linking families to other services in the community is extremely important, and one that other approaches to intervention do not necessarily fulfill. This is especially true when a family is dealing with mental health issues, such as maternal depression, substance abuse, or domestic violence. Carrilio described a new concept in home visiting programs that institutionalizes and facilitates case management services. In this design, the home visitor is the main point of contact with the family and is supported by a multidisciplinary group called the Family Support Team. This team is composed of a variety of specialists, including but not limited to, a nurse, a mental health specialist, a substance abuse specialist, and a child development specialist. These specialists often accompany home visitors on home visits and are available to home visitors as a resource. One advantage to this arrangement is that it helps put issues such as substance abuse in the forefront of home visitors ’ minds. Because the families get to know the entire team, it is also one way of providing continuity for the families despite the high turnover of home visitors.