Evidence from a Randomized Controlled Trial of Child First
Ideas and Evidence
Three Ways States Can Strengthen Home Visiting
This commentary was originally published by Route Fifty.
The COVID-19 pandemic has had an impact on our way of life across the board, and recent research suggests there may be startling effects on our littlest ones. Since the beginning of the outbreak and school and daycare closures, toddlers are speaking less and experiencing more language delays. What’s more, parents are increasingly worried about young children’s behavioral and social-emotional issues.
The pandemic, in particular, created unprecedented challenges for families who experience poverty. Closures made it difficult for parents—particularly primary caregivers—to continue working in-person jobs, contributing to increased poverty, food insecurity, and adult depression.
But there is a preexisting approach that can help combat these challenges. Home visiting has long been used to provide in-home educational and clinical support to boost maternal mental and physical health, strengthen parenting, and aid young children’s social-emotional and cognitive development. Nationwide, home visiting programs—run largely by nurses, clinicians, and paraprofessionals with backgrounds in child development—served about 321,000 families in 2021. Last year, Congress doubled funding for the Maternal, Infant, and Early Childhood Home Visiting program (MIECHV), expanding services to an additional 165,000 families.
As states make decisions about deploying these funds, here are three strategies they can use to strengthen services for children and caregivers.
Build Robust Partnerships with Local Programs
Enrollment in home visiting fell during the pandemic, a trend that many programs attributed to drops in referrals from other agencies. As home visiting programs recover from the pandemic, they may need to strengthen recruitment to increase families’ take-up of services. Doing so can also help programs find and serve the most disadvantaged families, who research shows may benefit most from home visiting.
One potentially useful recruitment strategy is developing strong partnerships with a diverse set of local programs serving families experiencing poverty—like public housing authorities and medical providers.
In 2021, New York City launched “New Family Home Visits,” a home visiting program for families in public housing. The program pairs families with home visitors from the city’s Nurse-Family Partnership and its Newborn Home Visiting program to support them with breastfeeding, provide them with cribs and diapers, and help them access community and health services. Through this effort—which has just begun—the city aims to link 7,000 families with young children to home visiting services in the coming year.
Other programs like SMART Beginnings are trying to recruit families directly from pediatricians’ offices during regular visits. A recent study found that when families participated in services at their pediatricians’ offices, they were substantially more likely to then participate in the home visiting component of the program.
Invest in Telehealth Services to Complement In-Home Supports
By necessity, telehealth became the norm for providing home visiting services during the pandemic. Nationally, more than two-thirds of home visits happened virtually in 2021. Even now as most home visiting programs are back to operating in person, telehealth appears to be playing a bigger role than ever before. And the reason is clear: It’s a flexible and accessible approach that can reach more families and help them stay engaged in services.
Recent experimental work by our team at MDRC, a social policy research organization, found that, when integrated with in-person supports, telehealth can continue to promote better outcomes for families in some domains. In a recently published study, we compared families from Connecticut and North Carolina who were randomly assigned to receive one home visiting program called Child First—delivered both in-person and virtually during the pandemic—to families receiving other home visiting services in their community. The hybrid model of Child First reduced substance abuse, job loss, and residential mobility among parents and caregivers.
Importantly, however, we did not find any benefits of the hybrid home visiting model on children.
Recent research has found that about 70 percent of home visitors have reported difficulty engaging children and keeping them in view during virtual parent-child interactions. About half of home visitors also found it difficult to see caregivers during virtual interactions with children. Although much more research is needed, investing in telehealth to complement in-person visits may be a helpful approach for expanding the reach and impact of home visiting programs during the pandemic recovery.
Support and Strengthen the Home Visiting Workforce
Home visitors’ dedication to their work may not be enough to overcome the low levels of pay they currently receive, which they report as the top reason for leaving the field. Home visitors’ median pay for full-time work equates to about $37,000 a year, which is slightly below the national median income.
Investing federal funds in home visitors’ compensation may be an important step in supporting and stabilizing the workforce. For example, recent research done in Virginia has found that providing end of year bonuses of $1,500 actually doubled retention among child care workers, a workforce that is similar in makeup to home visitors.
If directly increasing pay is not feasible, some localities have begun increasing compensation in other ways. In Iowa, the T.E.A.C.H.-Family Support scholarship through the Iowa Association for the Education of Young Children provides family support workers, including home visitors, funds to pursue higher education. The scholarship can go toward tuition, books, travel, and even paid time off. Participants receive a bonus after successfully completing one year of the program. In 2021, 93 percent of scholarship recipients stayed in their jobs and saw a 16 percent increase in their wages.
As states look to the future, they can use increased federal funding to help home visiting programs reach more families, provide flexible services that achieve high levels of engagement and ensure that programs—and the home visiting workforce more broadly—continue to grow stronger over time.
Mervett Hefyan is a Research Associate and Meghan McCormick is a Senior Research Associate at MDRC.