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Home Visiting Services

Benefits

For families with infants and young children at risk for developmental delays or who have special health care needs, home visiting programs may be able to provide some direct services and referrals to other helpful services. Home visitors may teach parents about feeding, developmental milestones, medical issues, parent-infant bonding, and other topics. These programs benefit the children by improving health and development; preventing abuse; improving readiness for school; and showing families how to access other available services based on eligibility. Families benefit by improving maternal health, reducing domestic violence, creating family self-sufficiency, and increasing access to other available health and social services. Home visiting programs can help families find public health insurance, food banks, employment counseling, and other services. Families are encouraged to tell their primary care clinician about any home visiting services they are receiving and to ask the home visiting program to send reports and results of developmental screenings to the doctor’s office to reduce duplicating efforts.

Program Types

There are a variety of home visiting programs with different eligibility requirements, services, and strengths. The programs may utilize registered nurses, therapists, other professionals, para-professionals, volunteers, or some combination of home visitors to provide services. The types of professionals, eligibility, and available services will depend on the type (or model) and funding. Funding may come from federal grants, state funding, universities, local organizations, or donations. In some states, limited funding may limit the services that are available for home visits, who is eligible, and which cities are able to offer programs from year to year.
While a list of evidence-based Home Visiting Models (HRSA MCH) can be found through the Maternal and Child Health Bureau, a few of the most common models that are used in multiple locations in the United States will be described on this page. Other home visiting programs also exist. Local health departments, universities, or community organizations may use modified versions of some of these programs, or may have their own programs.

Eligibility

The State Home Visiting Websites (HRSA MCH) links to the state contact, usually the state health department, for one type of federal grant that supports home visiting programs. Parents who want to find out if they are eligible for home visiting services can contact the state organization to find local programs or contact the local programs directly.
Each home visiting program uses different methods to identify families that may benefit from their services. Programs offered by local health departments may identify moms with premature infants from birth certificate information or Medicaid records. The primary care clinic or the parents can also contact local organizations to request services. Families that may have concerns about letting a stranger into their home can ask the organization for details about what to expect and how to identify the home visitor. The home visitor will usually call parents to set up an appointment before going to the home for a visit.

Program Descriptions

Early Head Start - Home-Based

Early Head Start (EHS) Home-Based Model
These programs serve low-income families with children from birth to age three. A portion of children served by Early Head Start have identified disabilities. Home visiting services supplement the center-based services. Families generally receive one visit, usually 90 minutes long, per week for about eleven months. With Head-Start's strong focus on supporting the family, visits help make sure the family is functioning well, that families are connected to community services for low-income families, that mothers are healthy, and that the development of infants and toddlers is being supported and monitored. The Head Start staff usually provides developmental screenings for the children and activities that promote maternal-child bonding and development.

Healthy Families America (HFA)

The model for these programs was developed by Prevent Child Abuse America. Healthy Families America serves families with certain risk factors such as low income, single parents, and a history of adverse childhood experiences, child abuse, domestic violence, substance abuse, or mental health issues. Visits usually begin before birth or at the time of the infant’s birth. The one-hour visits occur weekly for six months; after that, the visits may be less frequent for the remaining three to five years, depending on the specific program. With a strong focus on preventing child abuse, including breaking the cycle of child abuse, these programs help build family relationships, encourage mother-child bonding, and support healthy child development. While the programs help connect families to a variety of medical and other community services, they are usually particularly familiar with available social services.

Healthy Steps for Young Children

These programs serve families with children up to age three. The programs offer two, three, or five home visits at specific ages and support healthy development. The Healthy Steps for Young Children Specialist works with a pediatric or family practice physician. The child receives well-child check-ups with developmental screenings. The programs also offer information telephone lines to answer child development questions; provide referral for specialists or community services as needed; provide health and behavior information for parents; and partner with Reach Out and Read to provide books for the family. These programs combine best- or promising-practice models of pediatric care, developmental screening, literacy, and home visiting.

Home Instruction for Parents of Preschool Youngsters (HIPPY)

These programs serve families with children ages three through five and provide group meetings to supplement home visits. The one-hour weekly home visits usually occur during the school months. The two-hour group meetings occur at least six times per year. Home Instruction for Parents of Preschool Youngsters (HIPPY) supports the idea that families are the first and primary teachers for their children. Structured curriculum and role-playing help families that may lack financial resources, formal education, or English literacy to develop the skills they need in order to teach their children. While a three-year program is recommended, a two-year program option is available. These programs focus on literacy and school-readiness.

Nurse-Family Partnership (NFP)

These programs serve pregnant women, with visits beginning usually in the first few weeks of the second trimester, and follow the infant up to age two. The Nurse-Family Partnership (NFP) program is designed for low-income families and first-time mothers. Upon enrollment, weekly visits, usually just over 1 hour long, are provided during the first month, and continue for six weeks after the birth of the newborn. Every-other week visits are provided at other times, except for during the last four months before the child’s fourth birthday, when the visits will be monthly. One of the characteristics of the Nurse-Family Partnership is that home visitors are registered nurses. The program provides only home visits with no center-based services. Since the home visits begin during pregnancy, the program provides support and resources to help improve the outcome of the pregnancy, and then provides support for the newborn and new mother. Close monitoring of the infant's growth and development are provided along with teaching mothers how to care for infants and offering referrals to community services for low-income families.

Parents as Teachers (PAT)

To be included in PAT services, families must meet specific eligibility requirements and population characteristics. These requirements are based on local needs, which might include income, literacy, substance abuse history, child abuse risk, child health risks, or other criteria. Some Parents as Teachers (PAT) programs enroll women during pregnancy, while other programs may enroll families after the birth of the child and services may be offered up to the child’s enrollment in kindergarten. The programs provide home visits from parent educators, monthly group meetings, and developmental and health screenings, and they connect families to local resources. The programs support the idea that families are the first and primary teachers for their children. Structured curricula are available and programs may offer resource libraries and other educational materials for families. These programs may exist within other organizations, such as Early Head Start. While all families will receive a minimum of ten hour-long visits, families with greater risks or needs may receive visits twice a month. These programs focus on literacy, school readiness, and healthy child development.

Play and Learning Strategies (PALS)

Parent and Child Learning System (PALS) infant curriculum is designed to help parents improve positive interactions and bonding with their children. The program enrolls families with infants between five months and one year old and provides ten sessions. The version of the program for toddlers enrolls families with children eighteen months to three years old and provides twelve sessions. The visits are usually 90 minutes long and are conducted by trained parent educators. These programs are suggested to be provided through existing organizations with a similar mission, such as Early Head Start, Head Start, and other nonprofit organizations.

SafeCare Augmented

An adaptation of SafeCare, called SafeCare Augmented, meets the criteria established by the Department of Health and Human Services (DHHS) for an “evidence-based early childhood home visiting service delivery model," serving families who have risk factors for child abuse or a history of child abuse. These programs are a version of the 12-Step model and focus on parent-child interactions, child health, and home safety for children from birth to five years old. Eighteen to twenty visits are provided, either weekly or every other week, and each visit lasts up to two hours. While the 12-Step model utilizes professional counselors, in the SafeCare model home visitors are not required to have a certain level of education. However, the Augmented model includes additional training in motivational interviewing, where the home visitor supports the parent’s motivation to change, as well as identifying and responding to risk factors for child abuse and neglect, including mental health conditions and substance abuse.

Resources

Information & Support

For Parents and Patients

Home Visiting Models (HRSA MCH)
List and links to descriptions for various types evidence-based home visiting programs (models); Health Resources and Services Administration Maternal and Child Health.

State Home Visiting Websites (HRSA MCH)
Links to state contacts for home visiting programs.

Early Head Start (EHS) Home-Based Model
The Early Head Start (EHS) Home-Based Model is one of eight evidence-based home visiting models selected for the Affordable Care Act Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program.

Prevent Child Abuse America
Nonprofit organization that provides information to help providers and parents help prevent child abuse.

Healthy Families America
Home visiting program for families at risk for adverse childhood experiences.

Healthy Steps for Young Children
Home visiting program for families with children at risk for developmental delays.

Home Instruction for Parents of Preschool Youngsters (HIPPY)
Home visiting program to support early learning for young children.

Nurse-Family Partnership (NFP)
Nurse home visiting program for first-time mothers.

Parents as Teachers (PAT)
Home visiting program to help with child development and literacy.

Services

Early Intervention Part C programs may also provide in-home services along with their other services.

Child Abuse Prevention

See all Child Abuse Prevention services providers (64) in our database.

Departments of Health, Local

See all Departments of Health, Local services providers (72) in our database.

Departments of Health, State

See all Departments of Health, State services providers (20) in our database.

Head Start/Early Head Start

See all Head Start/Early Head Start services providers (57) in our database.

Home Visiting

See all Home Visiting services providers (38) in our database.

For other services related to this condition, browse our Services categories or search our database.

Authors

Author: Alfred Romeo, RN, PhD - 12/2013
Reviewing Authors: Gina Pola-Money - 1/2014
Shena McAuliffe, MFA - 1/2014
Tina Persels - 12/2013
Content Last Updated: 3/2014