Early-childhood and prenatal home visiting programs are a widely used approach to make sure families have the support and services they need. Home visits can improve parents’ knowledge and skills, help develop social support systems, and they can significantly improve access to education, health, and community services.
As in so many other areas of human services, federal and state policymakers have placed huge emphasis on evidence of effectiveness. Implementing, replicating, and scaling evidence-based home visiting program models is crucial for capturing and maintaining state and federal funding, not to mention ensuring that home visiting programs lead to desired outcomes.
So, where can you find information on evidence-based models and what should you look for in evaluating an existing program’s adherence to best practice? Here are a few starting points.
In 2009 the federal government launched the Home Visiting Evidence of Effectiveness (HomVEE) program. The goal of this program has been to conduct a thorough and transparent review of the home visiting research literature in order to identify and evaluate evidence-based models that have proven effective.
HomVEE has already identified over 20 evidence-based home visiting programs (and their work is ongoing). If you’re looking for a model to replicate or inform your own program evaluation and ongoing development, the HomVEE list is the best place to start. For example,
- Early Intervention Program (EIP) for Adolescent Mothers targets pregnant Latina and African American adolescents and is designed to help young mothers gain social competence and achieve program objectives by teaching self-management skills, techniques for coping with stress and depression, and skills to communicate effectively with partners, family, peers, and social agencies.
- Family Check-Up® For Children focuses on high-risk families and is designed as a preventative program model to help parents address typical challenges that arise with young children before these challenges become more serious or problematic.
- Family Spirit® is designed for Native American mothers and their children and aims to promote mothers’ parenting, coping, and problem-solving skills to address factors such as demographic challenges, family-of-origin problems, and personal stressors.
- Health Access Nurturing Development Services (HANDS) Program targets first-time pregnant mothers or parents with children up to 3 months old who have multiple challenges, such as single parenthood, low income, substance abuse problems, or being victims of abuse or domestic violence. It is designed to prevent child maltreatment, improve family functioning, facilitate positive pregnancy and child health outcomes, and maximize child growth and development.
- Parents as Teachers (PAT)® serves families for at least two years between pregnancy and kindergarten and it’s goals are to provide parents with child development knowledge and parenting support, provide early detection of developmental delays and health issues, prevent child abuse and neglect, and increase children’s school readiness.
- Home Instruction for Parents of Preschool Youngsters (HIPPY) partners with parents to prepare their children for success in school, particularly those most at risk because of poverty, limited education and English proficiency.
The HomVEE reports are great resources for identifying successful evidence-based home visiting programs for duplication. Not only have the models been thoroughly evaluated for effectiveness, but HomVEE provides implementation guidance and information. They also provide contact information for the model’s developers or other stakeholders who can answer questions and provide additional information.
Because each program has been evaluated in multiple studies, they are also great starting points for identifying useful metrics and approaches to measuring outcomes. Whether you are building a new program, looking to expand and scale an existing program, or simply looking to improve your current case management and data collection systems, your program is best served by identifying strong, proven metrics. In turn, strong metrics can help you demonstrate your success in implementing an evidence-based home visiting program.
Of course, the HomVEE program has only evaluated a limited set of models. But, we know there may be many other successful programs that have not had the benefit of being as thoroughly evaluated. For many programs, the starting point is identifying useful best practices to inform internal evaluations and ongoing development.
Dr. Nancy Goodban at UC Davis recently published a compilation of best practices for evidence-based home visiting programs, developed collaboratively with home visiting professionals. Her lists are a great starting point when evaluating your existing programs and considering what data you need to be collecting and considering.
As you look at your own programs, consider how well it adheres to best practices for the Program Approach, Program Structure, and Staffing criteria.
Program Approach Best Practices
- The program adheres to a set of principles that are clear and in writing.
- Services provided reflect the program’s principles as well as its mission, goals, and outcomes.
- Relationships are recognized as the cornerstone of home visiting services.
- Families are respected; the program identifies and builds on the family’s strengths.
- The program demonstrates flexibility, working to achieve program goals while at the same time addressing family-identified needs.
- The program empowers the family to be better able to meet its own needs.
- The program has a clear understanding of its “theory of change” that describes the impact of program services on families.
- The program uses interventions that have been proven effective based on theory, research, or outcomes measured by the program.
Program Structure Best Practices
- The program has a well-defined mission and goals that are in writing and are understood by staff and families.
- The program has a clearly defined target population in alignment with its mission and goals.
- The home visiting program is part of a system of services and provides access to a comprehensive array of services, either directly or through referrals.
- The program provides home visitors with access to a multidisciplinary team to confer on cases.
- The program works collaboratively and creatively to identify and stretch scarce resources to meet client needs.
- The program is flexible and evolves in response to changes in the community and system of services.
- Services are culturally competent and responsive to the backgrounds of the families served.
- Caseloads are a manageable size to allow for sufficient intensity and duration to achieve program goals.
- The program has an ongoing method of assuring the quality of its services.
- The program measures its impact on families in a variety of ways.
- Family input is sought for program development and improvement, and program improvement is responsive to family input and feedback.
Staffing Best Practices
- Home visitors receive initial training on how to work with families and on the program principles, mission, goals, and outcomes.
- Home visitors are able to forge and maintain supportive but professional relationships with families.
- The home visitor understands and respects personal and professional boundaries.
- Home visitors receive ongoing training in their area of expertise (such as early literacy, child development, or family violence) and support.
- Home visitors receive structured ongoing supervision.
- Home visitors can describe the desired program outcomes including the specific positive outcomes anticipated to occur within the family, such as connection to local resources or improved mental health.
- Home visitors are competent in intervening with families to achieve the program’s goals and objectives.
- Home visitors are culturally competent and responsive to the backgrounds of the families served.
When done right, home visits are a powerful tool for supporting families and protecting children. It’s been proven to reduce abuse and injuries and improve important short and longer-term outcomes related to women’s prenatal health; parenting behaviors and skills; children’s health and health care coverage and use; children’s development and school readiness, and family economic self-sufficiency.
We hope that as you evaluate, build and work to improve your own programs, we can support these critical outcomes, and make capturing and hanging on to critical funding that much easier.