program aims to promote children’s development by: (1) empowering parents and increasing their feelings of competence and confidence, (2) giving children a solid foundation for school success, (3) preventing and reducing child abuse, and (4) developing home-school-community partnerships on behalf of children. In contrast, the Nurse Home Visitation Program’s goals are to: (1) improve pregnancy outcomes for first-time mothers, (2) improve child health and development, and (3) improve families’ economic self-sufficiency (see Gomby et al., 1999 for a fuller description of the six home visiting models mentioned earlier).
The diversity of goals, designs, and philosophies makes generalizations about home visiting difficult to draw. Anne Cohn Donnelly, of the Kellogg School of Management at Northwestern University, asked, “Should we be looking at home visiting, which is how the intervention is being delivered, or should we be looking at the [intended] outcomes, which is what the program is trying to accomplish?”
In part because home visiting strategies have been applied to so many different objectives, there is a growing tendency to think that a home visitor can address all the challenges a family faces. Heather Weiss, of the Harvard Family Research Project, has previously noted, “There is a long history of setting up home visiting as a silver bullet -- the panacea for poverty -- and of subsequent disappointment, reconsideration, and revamping of the role home visits can play in ameliorating the effects of poverty” (Weiss, 1993). Workshop participants cautioned that it is important to remember that, when broken down into its day-to-day working parts, home visiting is based on individuals (the home visitors) making connections with other individuals (families targeted for services) and effecting behavioral changes. Effecting behavioral change is a daunting challenge that requires the delivery of learning activities that are appropriate for both the caregiver and the child. Moreover, it is not uncommon for home visiting programs to target families who are otherwise unable or unmotivated to utilize services available in their communities. Lack of motivation to change is a major barrier to producing better outcomes.
Although this approach can potentially have an impact on individual families (those who are motivated to change), home visiting alone is an inadequate means of addressing a multiply determined societal problem such as poverty. As Melmed observed, “We should not expect to change lives dramatically, particularly by visiting people sometimes once or twice a month. But we should expect to make a dent, to make their lives and the lives of their children at least a little bit better, taking small steps towards change.”
Not only is there great diversity from one home visiting model to another, but there is also a tremendous amount of variability within a single program. This is due in part to the need to individualize services to meet each family’s needs. However, visitors’ different understandings of program goals and approaches also contribute to variable program delivery. Amy Baker, of the Children’s Village in Dobbs Ferry, New York, and evaluator of the Home Instruction Program for Preschool Youngsters, noted that, despite the fact that the Home Instruction Program for Preschool Youngsters is a structured program with a core curriculum, her research revealed that the staff held very different ideas about the program. Some staff viewed it as a school readiness program, so spent more time reviewing the program materials with the parent, while others saw its purpose as community outreach and spent more time linking the