Home visiting programs in the U.S. have developed to enhance child health and welfare, through education, health, and community service programs. Research into the effectiveness of such programs shows that they improve child, parent, and family outcomes; reduce child abuse; enhance child health and educational outcomes; and improve parental behavior, parenting skills, and life skills. Researchers conclude that such programs may have some limited effectiveness in addressing certain goals, if programs are well implemented and goals are clearly defined. However, some programs have shown little or no effect, and research has shown that some programs may not be effectively implemented, either.
Keywords Child Abuse; Child Outcomes; Child Welfare; Comprehensive Child Development Program; Evaluation; Hawaii's Head Start; Head Start; Healthy Families America (HFA); Home Instruction Program for Preschool Youngsters (HIPPY); Home Visit; Implementation; Nurse Home Visitation Program; Parents as Teachers; Parenting Skills
What are Home Visits?
Home visits have been historically considered a positive way to enhance life outcomes for children of poor or disenfranchised families. Teachers, nurses or social workers are recruited to visit families with children and to provide information and resources to improve child and parent educational outcomes, enhance parental life and work skills, assist with parenting, enhance parent and child mental health outcomes and provide other useful guidance.
Home visits have been considered a useful way to maintain relationships with families who may otherwise be unengaged with schools, preschools, or health services. They are meant to enhance family and community relationships and reduce attrition in programs by removing issues such as transportation and child care problems as barriers to participation. A wide range of such programs have been implemented, as part of health, education, or community programs, yet evaluations have shown that results may be poor or limited, even when programs are strongly developed and well implemented.
History of Home Visits
Gomby, Culross, and Berman (1999) report that home visiting involves programs which "send individuals into the homes of families with young children and seek to improve the lives of the children by encouraging changes in the attitudes, knowledge, and/or behavior of the parents" (Introduction). These practices extend "back to Elizabethan times in England, [were] endorsed by nurse Florence Nightingale, and [have existed] in the United States since at least the 1880s" (Gomby et al., 1999, Introduction).
Bhavnagri and Krolikowski (2007) have written a detailed report on the history of home visits. They note that when home visiting began in the U.S., professionals visited not only the individual family, but also the whole neighborhood and community. Visitors would purchase supplies in local stores, communicate with neighbors, and walk through the community, become integrated into the community, and understand the whole community context for the child in their care.
These visitors were also trained to promote community development, encouraging better sanitary conditions, improved play areas for children, and initiate on the part of parents and families to improve conditions in their area. The visits were considered "a unified strategy used by early childhood pioneers to address the needs of the children, their families, and their communities in order to promote the total development of young children," (Bhavnagri & Krolikowski, 2007, Introduction).
During the reform, or Progressive era (about 1890 to 1920), according to Bhavnagri and Krolikowski, (2007) reformers believed that improving the environment could reduce poverty and other unhealthy outcomes for immigrants and the poor. Waves of immigrants caused expansion and reform in schools, since "the schools' role was to provide a common experience for these immigrant children from diverse backgrounds so that they could all become responsible citizens able to take part in a democracy" (Bhavnagri & Krolikowski, 2007, Eradication of Poverty).
Bhavnagri and Krolikowski suggest that three social justice reform movements entwined and were responsible for a growth in home visits.
The teachers who worked for philanthropic kindergartens, residents who worked for settlement houses, and visiting teachers who worked for public schools all had an overarching, common agenda - to promote the well-being of children, families, and communities through home-community visits (Bhavnagri & Krolikowski, 2007, Social Justice Movements).
Kindergarten teachers were especially involved in home visits initially, and Bhavnagri and Krolikowski (2007) detail several ways in which the visits were influential beyond explaining to parents what was going on in the classroom:
• Teachers talked about appropriate child rearing methods
• Teachers discussed child health, nutrition, development, with parents
• Parents began to understand play as an educational activity
• Teachers helped parents become effective advocates for neighborhood improvement
• Teachers helped parents find necessary resources (such as welfare services) (Kindergarten Movement's Contribution).
Visits were often as much about building social relationships with the children and their families as they were about educating families, and about social reform, and may have helped encourage children to stay in school and enhance their own futures. Through home visits, teachers might improve the lot of other children in the family, improve the economic and living conditions of each family, and contribute to community improvement overall. The intentions of the early reformers have been carried through to home visiting programs in effect today.
Home Visits Today
The comprehensive early childhood program Head Start, for example, makes use of home visits, as a way to bridge cultural gaps and bring parents into the school community. "Head Start teachers are required to make at least two home visits for each student during each school year, in addition to regular parent-teacher conferences at school," reports Steele-Carlin (2001, p. 1). She notes that kindergartens often require a home visit by teachers before school starts as well.
Steele-Carlin (2001) states that "Programs that provide time and funding for teachers to visit students and parents on their own turf are a way for teachers to learn more about their students, get the parents more involved in their kids' education, and bridge cultural gaps that might occur between student and teacher" (p. 1). That bridging of cultural gaps today tends to lean more towards a teacher gaining understanding of where a child is coming from: historically, home visiting may have focused more on bringing immigrant families to an understanding of what was expected in American schools.
Although Steele-Carlin (2001) reports, anecdotally that "most teachers report their home visits have a lasting effect on the child, the parent, and parent-teacher communication" (p. 1) more intensive research examinations of these programs have indicated limited short- or long-term improvements in outcomes.
Current home visiting programs may focus on a range of areas as well. Bhavnagri and Krolikowski, (2007) report that "many programs for young children are now family focused, and educators do regular home visits" (Lesson Two) especially in early childhood special education programs. They note also, that "the current philosophical approach to working with young children is to provide support services and enable families to optimally utilize resources" (Lesson Two). Further, they suggest that working with families has been shown to be effective for enhancing achievement among low-income or at-risk children.
However, there is extensive evidence to show that such programs may not be as effective as proponents hope, and that even when they are effective, conditions must be replicated exactly to reproduce any positive effects.
Are Home Visiting Programs Effective?
In a descriptive study, Meyer and Mann (2006) found that teachers reported a perception that home visits improved their relationships with children in their classes, and with their families; as well as improving the teacher's understanding of the child's home context. Anecdotal and descriptive reports of programs do tend to be positive on both sides. However, experimental and quasi-experimental studies have shown more mixed results.
Behrman (1999) summarized the results of several studies and reports somewhat modest results:
Several home visiting models produced some benefits in parenting or in the prevention of child abuse and neglect on at least some measures. No model produced large or consistent benefits in child development or in the rates of health-related behaviors such as immunizations or well-baby check-ups… . All programs struggled to implement services as intended by their program models (Statement of Purpose).
He concludes that too much has been expected of these programs, and that goals should be more focused in the future, with expectations lowered. He also recommends that home visits be part of a broader range of services offered to parents and families; and that program quality and implementation be upgraded.
A Program Example
Gomby et al. (1999) reviewed six home visiting program models and studies of those models, to determine which were effective. They note that up to 550,000 children may be enrolled in the programs they studied alone (which means many more children nationwide may participate in similar programs), and that among home visiting programs, they chose these six because they have been studied most, and they are "among the relatively few that have been evaluated in rigorous randomized trials" (Introduction).
They also conclude that:
In most of...
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