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State-based Home Visiting
Strengthening Programs Through State Leadership

Author: Kay Johnson
Publication Date: March 2009

Executive Summary

A home visiting program may be distinguished by asking three questions: Does the program design assume home visits as the primary method for delivering the intervention? Are a majority of services delivered (or a majority of clients served) through home visits? Are staff trained to deliver services and supports through home visits?

Introduction

Home visiting for families with young children is a longstanding strategy offering information, guidance, risk assessment, and parenting support interventions at home. The typical “home visiting program” is designed to improve some combination of pregnancy outcomes, parenting skills and early childhood health and development, particularly for families at higher social risk.

This report is designed to help inform the field about two central questions related to home visiting:

  1. Are states investing in home visiting in ways that promote improved outcomes for young children?
  2. How, in this context, do they meet the needs of those facing the greatest social and developmental risks?

The report describes the results of an NCCP survey and a roundtable discussion, each designed to increase knowledge about state-based home visiting programs, that is, those administered, managed, or coordinated by state governments.

Survey Design, Methods, and Results

The study focused on two core questions:

  1. What is the overall approach? For example, do state agencies administer, fund local jurisdictions directly, or provide technical assistance)?
  2. Has the state undertaken interagency planning regarding home visiting and how has that planning occurred?

For each program, we examined:

  • purpose, structure and approach;
  • authority/management;
  • linkages to other programs;
  • funding – sources and budgets;
  • intervention design and support; and
  • evaluation and outcomes.

In total, 46 states submitted survey responses, and of these 40 reported having one or more state-based home visiting programs.

Key Findings

  • State-based home visiting programs were reported by 40 states, representing 70 distinct programs. Most states described one or two state-based home visiting programs. Five states reported on three or more home visiting programs, including Pennsylvania, Virginia, Illinois, Massachusetts, and Oregon.
  • Seventeen programs across 14 states are using widely recognized home visiting program models. These included the: Healthy Families America, HIPPY, Nurse-Family Partnership, and Parents as Teachers. Interagency planning efforts were reported for 34 states. Fifteen states reported a focus on developing a continuum of home visiting services based on family risks and needs.
  • Across 10 states, 16 programs use federal funding alone.
  • Thirty-one states reported using general revenues not used for matching (such asappropriations for education, health, child welfare, etc.).
  • The aggregate support for the 30 states reporting specific budget levels for 55 programs reached more than $250 million in funds allocated.
  • In 31 states, 55 programs use an approach intended to provide more intensive services to families with identified risks and needs.

How States are Strengthening Home Visiting

States are using two key strategies to improve the effectiveness and cost-effectiveness of home-based services. One strategy is to improve linkages and aim for a more seamless continuum of services. A second strategy is to focus on improving the quality of home visiting services, which might take the form of improved training and supervision for staff, better data collection, enhanced evaluation, or other activities. Both require leadership and each has the potential to maximize available resources.

Recommendations

National Leadership

National leaders, both public and private can to assist home visiting programs and ultimately families through:

  • the creation of multi-state learning collaboratives;
  • more research on how to effectively deliver different models of service;
  • federal leadership to support state and local programs;
  • federal legislation that supports state home visiting efforts; and
  • an increase in the understanding of the role and limits of home visiting in the early childhood agenda.

State-level Leadership

State leaders can improve the quality of home visiting services, more effectively replicate model programs, and link home visiting programs to other efforts focused on promoting optimal early childhood health and development by:

  • implementing deliberate strategies, policies and program designs to achieve quality and improved child and family outcomes from their investments in home visiting;
  • strengthening mechanisms for interagency and cross-program coordination;
  • helping communities and programs align the home visiting intervention with family needs;
  • supporting a continuum of early childhood services that can address a wide range of family needs and achieve results in a cost-effective manner;
  • refining and narrow program objectives and outcome measures;
  • promoting quality and assuring staff training and supervision;
  • analyzing current spending on home visiting programs to blend funding where appropriate; and
  • supporting research and data systems that expand knowledge of programs and gaps.