Home visiting programs vary dramatically in their underlying theoretical models, the characteristics of target families, the number and intensity of visits prescribed, the duration of the program, the curriculum and approaches and the degree to which they are specifically described in a manual, the fidelity of program implementation, and the background and training of visitors.
With so many variables involved, it is no surprise that the effects of home visiting programs have also been variable. Several reviews have concluded that home visiting can be an effective strategy to promote health and development outcomes of children from socially disadvantaged families, while other studies have reported no impact. Even when parent behaviour is altered, improvements in child outcomes are not always seen.
According to available research, better outcomes are achieved when home visiting programs are based on theories of development and behaviour change, target empirically derived risk factors, employ more highly trained visitors (such as nurses) and follow a well-constructed curriculum across the series of visits.
For even greater effects, more intensive intervention directly with the child may be required.
The effects of home visiting programs can extend beyond child outcomes. Some programs have been shown to have positive outcomes on the following:
-
Family planning – a reduction in closely spaced pregnancies and the total number of pregnancies;
-
Prenatal health behaviour – an improved diet and reductions in tobacco and other substance abuse;
-
Maternal functioning – a reduction in mothers’ impairment from substances; fewer arrests and convictions; an increased likelihood for the mother to be involved in a stable relationship; and greater use of formal and informal social supports;
-
Family self-sufficiency – greater participation in the workforce and reduced time on government aid programs;
-
Parenting – more positive parenting attitudes and mother-child interactions;
-
Child safety – fewer hazards and fewer visits to emergency rooms; reductions in child hospitalizations for injuries and ingestions and for primary care for sensitive conditions; reduced child abuse and neglect.
A two-year follow-up to the Early Head Start National Demonstration Project shows that mothers involved in the study were more supportive, more sensitive, less detached and more likely to extend play to stimulate cognitive development, language and literacy. They also reported using spanking less often and using milder forms of discipline with their children. These results were more likely in families enrolled in programs that employed home visitation services as opposed to those enrolled in programs that relied exclusively on centre-based services. The most ideal situation, however, seemed to be programs that offered a combination of home and centre-based services; these showed the strongest gains.
Research indicates that home visiting programs can produce positive effects among youth. A study of a prenatal and infancy home visiting program showed long-term treatment-control differences in arrests, convictions/probation violations, emergent use of alcohol and tobacco and promiscuous sexual activity among 15-year-olds’ whose mother were identified as being at greater risk because they were low-income and unmarried at registration.
See also...
|