In order to develop a comprehensive assessment of the efficacy and effectiveness of home visiting programs, it is important to collect enough information about participants to analyze the effects of the program on various types of subgroups. The assessment should also measure multiple child and family outcomes at various points in time.
In addition, there is still a need to determine which program components are essential and which produce the greatest long-term results. Evidence shows that multidimensional home visiting programs – those that address the life course development of the mother, family life, child caregiving and the child’s overall development – last long after the program ends.
Implementing home visiting programs carries its own set of difficulties. Families may not always accept enrolment in the program or they may leave the program before the scheduled end date, thus missing out on the full number of planned visits in the program. Recent research suggests that participation rates can be greatly improved by integrating home visiting programs into a broad, diversified system. When intensive home visiting services are partnered with a group- or community-based service program, the proportion of new parents who use prevention services can increase dramatically.
As with any publicly funded service, cost is an important aspect of these programs. Even though the professional level of service provided may vary greatly among home visiting programs, there is little variation in the cost of programs themselves. However, the benefit-cost ratio does differ from one program to the next, depending on the duration of the impact. Programs with a lifetime impact have a higher benefit-cost ratio than those with a limited short-lived impact.
The social cost of major societal problems should not be underplayed. Child abuse costs Canada an estimated $15 billion per year. When viewed in this context, current public investments in home visiting and other early childhood development (ECD) programs are relatively minor.
When it comes to policy development, there is a demand-supply imbalance. There will never be enough service providers available to reach every family in need through one-on-one home-visiting programs. Targeted home-visiting programs cannot address all families at risk for child maltreatment. This fact highlights the need to reduce the size of the population that requires one-on-one targeted and clinical services through effective universal and targeted programs that reach larger groups of families at a population level.
There is a growing consensus that Canada needs a comprehensive ECD system. We need to evaluate public policy at the system level, placing the effectiveness of home visiting programs within the larger context of other ECD programs. There is also a recognized need for a national resource network to support rigorous longitudinal evaluation of ECD investments.
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