Based on growing evidence that both intellectual and emotional development begin at, if not before, birth, voluntary home visitation programs for pregnant women and families with children under age 5 have spread gradually over the past couple of decades. Now they appear poised to multiply more quickly if health care reform containing dedicated federal funding passes Congress this fall.
Under these home visitations, professionals or paraprofessionals visit households to work on such issues as improved parenting skills, reducing risk for child abuse, promoting prenatal and early childhood health, and preparing children to succeed in school.
President Obama has proposed funding such programs in his 2010 budget, and Congress has included funding provisions in the health reform bills. Any new federal policy has the potential to bring new dollars and new structure to the field. “What is essential is that federal resources are used to improve the quality of existing programs,” says Kay Johnson, a consultant and author of two national reports on state home visiting programs.
Many teen parents are among those considered in need of such services, which can include parenting education, life skills development, and referral to child care, health, and other services.
Such programs number well over 4,000 in 40 states. Deborah Daro, research fellow at Chapin Hall at the University of Chicago, testified before Congress in June that an estimated 400,000 to 500,000 young children and their families nationwide receive such services each year.
Citing several studies, Daro told the House Ways and Means Subcommittee on Income Security and Family Support that “although positive outcomes continue to be far from universal, families enrolled in these home visitation programs, as compared to participants in a formal control group or relevant comparison population, report fewer acts of abuse or neglect toward their children over time, engage in parenting practices that support a child’s positive development, and make life choices that create more stable and nurturing environments for their children.”
However, the mixed results of evaluations provide reason for caution. A recent report in the Future of Children journal concludes that “researchers have found little evidence that home-visiting programs directly prevent child abuse and neglect. But home visits can impart positive benefits for families,” including better parenting practices that lead to “improved child well-being.”(See Report Roundup.)
About half of the 40 states that have passed legislation to fund a system of home visitation spend an aggregate of about $250 million nationwide, Johnson says. Funding sources have included Medicaid, Temporary Assistance for Needy Families (TANF), the Title V Maternal and Child Health Block Grant, state funds and local education funds, she says.
Chapin Hall at the University of Chicago hosted a webinar last month, “Evidence-Based Systems of Home Visitation: Opportunities for Replication and State Innovation,” featuring some of the people and programs in this story. To listen to the webinar and view the materials, go to http://www.chapinhall.org/events/governing, and click on the webinar title.
The competing House and Senate versions of health care legislation contain funding for home visitation in the range of $100 million to $150 million for 2010, increasing to $500 million to $700 million by 2013. Congress would be required to provide states funding to offer voluntary programs for first-time mothers, Johnson says. That would represent a sea change for the field, says Daro, who remembers the early 1990s when Hawaii had the only statewide program.
A significant issue, Johnson says, will be whether the legislation explicitly endorses the most rigorously tested program model, the Nurse-Family Partnership, or takes the approach of most states in creating a network that’s based on several program models, such as the more widespread Parents as Teachers.
While promoted by the Obama administration, the idea of home visitation has significant Republican support, most notably from Sen. Kit Bond (R-Mo.), whose support when he was governor of Missouri helped to launch the St. Louis-based Parents as Teachers. But the notion of dedicated federal funding has critics on the conservative side of the aisle, who see the concept as intrusive.
For a federally funded program to succeed, Daro says the most important factor will be continuing evaluations. “If all we do is invest in more home visitation programs, I don’t think we’re going to achieve the grand goals: Reduce child abuse and neglect, have your child come to school ready to learn,” she says.
Freelance journalist Ed Finkel is based in Chicago.