Home Visiting: An Effective Strategy for Improving Outcomes for Children and Families

By simultaneously addressing the needs of both the infant and the mother, we can have a greater impact on children so that they can thrive.


In an excellent article in the Huffington Post, Jonathan Cohn beautifully lays out the data and history of home visitation as a key intervention in tackling poverty for children and their families. We are huge fans of home visitation as a strategy to improve numerous outcomes for infants and their mothers.


For us – this two-generation approach gives us hope; by simultaneously addressing the needs of the infant and their mom, we can have a greater impact and create an opportunity for families to thrive.


It’s been well documented that the first three years of life play a critical role in how a child’s brain develops. We’ve come a long way since the nature versus nurture debate – and for so many DC children – the nurture piece (the environment) seems to play a more negative role in how they thrive in their family and neighborhood settings. Cohn writes “…genes provide the blueprint for smarts, skills and sensibilities, but experiences determine how the body interprets that blueprint -- and early experiences seem to matter the most.”


So here is where nurture –one’s family and care environments-- impacts one’s ability to thrive. Infants living in poverty are subject to significant stress from their environment, and Cohn highlights the physiological impact the toxic stress can have on infants. “When babies are in distress, mild or severe, their bodies respond by releasing hormones that prepare the body for external threats -- by increasing blood flow to muscles, for example, or heightening awareness ….. occasional stimuli and in the presence of nurturing caregivers, they are harmless and even useful. It’s how children first learn to calm down, to show patience and to overcome new challenges. But when adversity persists and when loving adults aren’t around to provide comfort or care, the hormones remain at elevated levels. Over time, they can distort and stunt development of brain matter, going so far as to interfere with the way a child’s body translates its own genetic code into new neural pathways.”


Given the effects that toxic stress can have on children, we are grateful that we have community-based partners implementing evidence-based home visiting programs in the District to mitigate the effects of poverty on children’s development while supporting parents.


Through the federal Maternal, Infant and Early Childhood Home Visiting (MIECHV) grant program, the District of Columbia Department of Health funds three evidence-based models: Healthy Families America (HFA)[1], Parents as Teachers (PAT)[2] and Home Instruction for Parents of Preschool Youngsters (HIPPY)[3]. While these programs vary slightly in their target populations and some services provided, they are all grounded in decades of research and demonstrate positive outcomes for participating families. By working with children and families at home in their natural setting, home visitors are able to deliver a broad set of supports:

  • Trained home visitors provide culturally-competent education that encourages positive parenting and parent-child attachment.  Healthy Families America and Parents as Teachers home visitors work with parents to model parent-child interactions and activities.  Prior to birth, they teach parents what to expect in the first few months and later they coach parents through talking and communicating with their children.[4],[5]
  • Home visitors also educate parents about child development and monitor children’s growth and progress. Participants in the Healthy Families America complete and review the Ages and Stages Questionnaire with their home visitor to ensure that their children are on track developmentally.[6] PAT requires regular hearing, vision and developmental screenings.[7]
  • Parents receive tangible techniques from home visitors to promote early learning and school readiness. HIPPY integrates role play into their sessions with parents. This provides an opportunity for parents with literacy challenges to acquire techniques for creating learning environments at home with guidance from the home visitor. [8]
  • Additionally, home visitors are also trained to identify other family needs and refer for services like child care, job training and adult health services.  HFA requires that families are linked to a medical home; home visitors track that children receive vaccines, screenings and well-child visits. [9]


Moreover, home visits beginning during the prenatal period can ensure that expectant mothers are linked to vital health services.  We know that quality prenatal services beginning in the first trimester allow health care providers to screen for potential health risks and developmental issues  Providers can also advise expectant mothers on proper nutrition, exercise, and behaviors that may jeopardize their unborn child’s health while pregnant. Children whose mothers receive late or no prenatal care are at a greater risk for serious health problems: they are three times more likely to be born underweight and five times more likely to die. Children born preterm or with low birth weight have an increased risk of developmental delays and cognitive impairment that can last into adulthood. Health costs for a baby born prematurely or underweight average $49,000 for the first year compared to $4,551 for a healthy birth.


Given the substantial evidence to support home visiting, DC Action continues to advocate for increased access to these services in our city. These proven, multifaceted programs focused on prevention can reduce toxic stress. By serving parents and children through robust home visiting services, we can work to break the cycle of poverty by promoting health, education and stability.