REVISITING HOME VISITING
Delivering services to mothers and infants in their homes has been a popular strategy for providing assistance and support for over a century. Today, home visiting programs designed to address a wide array of objectives are proliferating in states and communities around the country. Unlike their early predecessors, however, they have become the subject of intense study. Numerous evaluations have been conducted to help practitioners and policymakers understand the conditions under which this strategy is most effective, for which families, and for which objectives.
On March 8-9, 1999, the Board on Children, Youth, and Families of the National Research Council and Institute of Medicine, with funding from the David and Lucile Packard Foundation, held a workshop for practitioners, policymakers, and researchers to discuss recent evaluation evidence on the effectiveness of home visitation programs. The goals of the workshop were to: (1) portray the diversity of home visiting interventions; (2) consider the conditions under which, for whom, and for which outcomes a home visiting strategy is or is not effective; (3) place the existing knowledge about home visiting in the context of other pertinent basic and intervention research literatures; and (4) identify the most promising avenues for future research and policy. The workshop was not designed to generate specific recommendations about home visiting or to promote specific approaches. Rather, the intent was to broaden the discussion about home visiting from one focused on specific programs to one focused on the basic goal that all home visiting programs have in common -- namely, to improve the lives of children and families.
The workshop was scheduled to coincide with the release of the Spring/Summer 1999 issue of The Future of Children, a Packard Foundation publication, titled “Home Visiting: Recent Program Evaluations.” That journal issue summarizes selected evaluations of six major home visiting models that are being replicated around the country and that are among the most rigorously studied -- Healthy Families America, Parents as Teachers, Hawaii’s Healthy Start program, the Comprehensive Child Development Program, the Home Instruction Program for Preschool Youngsters, and the Nurse Home Visitation Program --and assesses the current state of knowledge concerning the effectiveness of home visiting programs (Gomby et al., 1999). The workshop was designed to more fully explore and to extend to home visiting more broadly the issues raised by The Future of Children synthesis. Neither the workshop nor this report reiterates the extensive information contained in the Packard Foundation’s journal issue.
The first day of the workshop was designed to address the question: “What can we say today about home visiting?” and acknowledge that home visiting is not an intervention per se, but rather a context for intervention. Panel presentations addressed the standards of evidence that are used to evaluate home visiting programs, new meta-analytic work on home visiting evaluations, and the strength and implications of the new findings regarding the conditions under which home visiting strategies are more or less effective. The second day of the workshop was designed to examine the broader context in which home visiting interventions operate, including discussions of poverty, maternal depression, child abuse and neglect, and cultural and linguistic diversity, and to bring experiences from other forms of intervention to bear on home visiting.