1. Intersect the research agenda with broader issues of parenting and child development. Evaluation has been disconnected from developmental research; this is a partnership that needs to be developed.

  2. Perform theory-driven evaluation. The need to have informed theory guide the development and evaluation of programs was mentioned by others at the workshop, including Appelbaum, who said, “We will fight endless battles unless we set a common goal of what we have to report on -- on what the shared goals of home visiting are and what we expect out of this strategy.”

  3. Invest in dissemination. Build an institution to facilitate information sharing. Share information on a continual basis to ensure that different home visiting models inform each other and to identify common themes across programs, as well as issues that are unique to specific goals and strategies.

  4. Develop less fragmented approaches to training. It is time to move beyond training modules that are constructed anew and tailored to specific model programs toward greater cross-fertilization and refinement based on what we know now to be the most effective approaches to training home visitors with widely varying backgrounds.

  5. Do not “research, demonstrate, and dilute.” Home visiting programs have tended in the past to get watered down when they are expanded, rendering an effective model program ineffective. The conditions for scaling up need to be fully understood, especially in light of the current policy context. Can a program in one setting apply to other settings? Is implementation compromised when a program is scaled up?

  6. Take a hard look at alternative ways to support parenting and reinforce parenting skills. Home visiting can take the lead in contributing to other approaches.

Home visiting programs might strengthen their effectiveness if they examined and explicitly stated the theory of behavior change on which they are based. In addition, they need to determine if home visiting as a method of service delivery has a specific theory of change that ties all home visiting programs together. In any case, programs need to base their goals and expectations solidly on their theory of change. In fact, it may be best to think of home visiting not as a programmatic model, but rather as a set of principles.

This is an important moment in the history of home visiting. Home visiting programs are under intense scrutiny while simultaneously these programs are being adopted around the country. Although some are concerned that mixed evaluation evidence will prevent policymakers from making additional investments in this strategy, others see it as a catalyst for self-scrutiny and ongoing improvement. As noted by Lisbeth Schorr, of the Harvard Project on Effective Services, recent evidence “provides a marvelous array of tantalizing clues that we can use to improve both programs and policies.” Whatever one’s vantage point, the contemporary challenge is to identify home visiting’s most useful and effective niche among the array of intervention strategies that can be deployed to help young children and families.



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