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What are Home Visiting Programs Doing?

Home visiting programs help families address social and economic issues, such as poverty, while also encouraging individual behavior change that will support parental well-being as well as healthy early child development.[1] MIHOPE is the first study to examine the characteristics of the local programs being operated under the Home Visiting Program and how they are implemented. The current report looks at the specific goals of local programs and how they are set up to help improve outcomes for parents and their babies.

In general, MIHOPE has found agreement across program models that home visiting generally includes (1) information gathering, such as screening for family risks, (2) education and support for parents, and (3) referrals for needed services. Furthermore, programs typically focus on both mothers and their children. Home visitors are generally well-educated (75% have a bachelor’s degree or higher) and feel adequately trained, although 56% of home visitors participating in MIHOPE had less than one year of experience in home visiting prior to their current job.

Based on interviews with representatives of the four national home visiting models in MIHOPE, surveys with 80 local program managers, and surveys of 422 home visitors, MIHOPE found:

  • The four evidence-based national models and local home visiting programs generally place high priority on improving family outcomes in the areas emphasized by the Home Visiting Program. They most consistently reported placing high priority on positive parenting behavior, child abuse and neglect prevention, child preventive care, and child development, with over 95% of local program managers and the national home visiting model developers ranking these issues as high priorities.
  • All four of the national home visiting models and all local programs encourage home visitors to observe parent-child interactions and provide feedback, and 90% of home visitors feel adequately trained to use positive child behavior management techniques.
  • 99% of local home visiting programs report using caregiver goal-setting and problem-solving techniques to support parents in the home.
  • The majority of local programs also report that they place high priority on improving economic self-sufficiency (83%) and on maternal health and well-being outcomes, such as behavioral health (78%), birth spacing (66%), and prenatal health (84%), as well as on intimate partner violence (81%). At least one-quarter of local programs report that they have increased their emphasis in one or more of these particular areas as a result of the Home Visiting Program.
  • Nearly all local programs require home visitors to conduct formal screenings for maternal mental health (95%) and child developmental delay (99%), and many local programs provide staff with support to work with the family when these screening indicate an issue, with support provided via written staff protocols (35% for mental health and 54% for developmental delays) or supervisory consultation (53% for mental health and 39% for developmental delays).
  • About three-quarters of programs expect home visitors to conduct assessments of parents’ substance abuse, intimate partner violence, and parenting behaviors. Fewer than 60% of home visiting programs have formal protocols for addressing each of these challenges, but 73% of home visiting programs have expert consultants available to support home visiting staff in addressing issues or situations beyond their skills and expertise. Prior studies have found such experts are associated with stronger program implementation.[2]
  • The greatest training needs (each reported by 25%-30% of home visitors) are how to recognize and deal with problem alcohol or other drug use, how to recognize and deal with mental health issues, and how to access health care coverage for parents and children.
  • 66% of home visiting programs receive referrals through formal agreements with WIC clinics, hospitals, schools, child welfare agencies, prenatal clinics, or health departments in their community; 43% of programs receive referrals through a centralized intake system.

Home visiting programs are diverse, operating somewhat differently depending on their program model and the needs of their community. At the same time, these early MIHOPE results suggest that the goals and infrastructure of most local home visiting programs are consistent with the expectations and goals of MIECHV as laid out in federal legislation. Specifically, programs aim and are designed to help parents in a broad array of areas, consistently including parenting and early child development, prevention of abuse and neglect, and child preventive care, and, to more varying extents, economic self-sufficiency, prenatal health and birth outcomes, maternal health, family planning, behavioral health, and intimate partner violence.


[1] Gomby, Deanna S. 2000. “Promise and Limitations of Home Visitation.” JAMA 284, 11: 1,430-1,431.

[2] Fixsen, Dean L., Sandra F. Naoom, Karen A. Blase, Robert M. Friedman, and Frances Wallace. 2005. Implementation Research: A Synthesis of the Literature. Tampa, FL: Louis de la Parte Florida Mental Health Institute, National Implementation Research Network.