What is Home Visiting?

Home visiting is a prevention strategy designed to improve the health and well-being of expectant families and families with young children. Home visiting programs typically serve under-resourced communities that face greater risks and barriers to achieving positive maternal and child health outcomes. Families choosing to participate in home visiting programs partner with home visiting professionals to set and achieve goals that improve their family's well-being.1

Home visiting professionals work with families in their homes, virtually, or at a location of their choice. Home visitors offer direct services and link families to community resources. Home visiting is a two-generation approach, delivering both caregiver and child-oriented services focused on a variety of areas, including:

  • Child health and well-being
  • Child development and school readiness
  • Positive caregiver-child relationships
  • Caregiver health and well-being
  • Family education and employment
  • Family functioning

States, territories, the District of Columbia, and tribal organizations implement home visiting models that match the needs of their communities using varied funding streams, including the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program. MIECHV recognizes 21 home visiting models as evidence-based.2 Evidence-based home visiting programs operate in all 50 states, the District of Columbia, 5 territories, and 22 tribal communities.3

Home Visiting as a Setting for Cardiovascular Disease Prevention

Poor cardiovascular health (CVH) contributes to high levels of morbidity and mortality in the United States, with profound health disparities by race/ethnicity, socioeconomic status, and geography. CVH deteriorates across the lifespan, with accumulating disease risk factors beginning in early childhood, requiring new clinical and public health strategies to improve the nation's cardiovascular health.4 Health promotion in pregnancy and early childhood is essential for establishing healthy CVH trajectories across the life span.5

Sustained improvement in CVH requires two-generation strategies in settings where those at elevated risk for poor CVH already receive care. Home visiting offers an opportunity to connect with expectant families, parents and young children at a time when all families need support. MIECHV-funded local programs often serve high need communities where many families have low levels of education; high levels of public assistance and food insecurity; tobacco, alcohol or drug use; and depressive symptoms.6 Evidence-based home visiting programs work with families to achieve a wide variety of health and health-related outcomes, and multiple studies highlight the effectiveness of partnering with home visiting programs to offer behavioral and lifestyle interventions to address factors associated with CVH, such as obesity.7,8

Evidence-Based Home Visiting Models in ENRICH

The seven Clinical Centers will implement the ENRICH CVH intervention in the context of the following evidence-based home visiting models:

  • Family Check-Up

    (FCU) works with families of children aged two months to 17 years. FCU focuses on families with children who are at risk for conduct problems and academic challenges and who face familial adversity including socioeconomic disadvantages and parental depression. FCU is a strength-based, family-centered intervention that aims to reduce children's behavioral problems, academic difficulties, and emotional problems, and to improve maternal depression, parental involvement, and positive parenting.9
    In 2021, FCU operated across 15 states.
    ENRICH Clinical Centers partnering with FCU: University of Pittsburgh (sites in Pennsylvania)

  • Healthy Families America

    (HFA) works with pregnant and parenting families of children prenatally up to age 5 years. HFA aims to cultivate and strengthen nurturing parent-child relationships, promote healthy childhood growth and development, and enhance family functioning by reducing risk and building protective factors.3
    In 2021, HFA operated in 582 local agencies across 38 states and the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands. HFA provided 907,262 home and virtual visits to 66,883 families.3
    ENRICH Clinical Centers partnering with HFA: Cal Poly/Brown University (sites in California and Rhode Island) & Northwestern University (sites in Illinois and Indiana)

  • Nurse-Family Partnership

    (NFP) works with pregnant families and their children until age 2 years. NFP aims to improve pregnancy outcomes by helping to improve prenatal health; child health and development through promoting sensitive parenting; and parents' life trajectories by helping to plan subsequent pregnancies, continue education, and find work.3
    In 2021, NFP operated in 276 local agencies across 40 states and the U.S. Virgin Islands. NFP provided 567,357 home and virtual visits to 53,045 families.3
    ENRICH Clinical Centers partnering with NFP: Penn State University (sites in Pennsylvania) & University of Colorado (sites in Colorado)

  • Parents as Teachers

    (PAT) works with pregnant and parenting families of children prenatally up to kindergarten entry. PAT aims to increase parent knowledge of child development, improve parenting practices, provide early detection of developmental delays and health issues, increase children's school readiness, and prevent child maltreatment.3
    In 2021, PAT operated in 934 local agencies across 48 states and the District of Columbia. PAT provided 962,640 home and virtual visits to 81,520 families.3
    ENRICH Clinical Centers partnering with PAT: Cal Poly/Brown University (sites in California), Northwestern University (sites in Illinois), University of Alabama Birmingham (sites in Alabama) & Washington University (sites in Missouri)

    • Additional Resources

    References

    1. Minkovitz CS, O'Neill KM, Duggan AK. (2016). Home visiting: A service strategy to reduce poverty and mitigate its consequences. Academic Pediatrics, 16(3 Suppl), S105-11. doi: 10.1016/j.acap.2016.01.005.
    2. Early Childhood Home Visiting Models: Reviewing Evidence of Effectiveness. OPRE #2021-185. 2021. https://homvee.acf.hhs.gov/sites/default/files/2022-02/opre-homvee_summary_brief_feb2022.pdf
    3. National Home Visiting Resource Center. (2022). 2022 Home Visiting Yearbook. James Bell Associates and the Urban Institute.
    4. Karmali KN, Lloyd-Jones DM. (2014). Achieving and maintaining cardiovascular health across the lifespan. Current Epidemiology Reports, 1, 75-81.
    5. Goff DC, Buxton DB, Pearson GD, Wei GS, Gosselin TE, Addou EA, et.al. (2019). Implementing the National Heart, Lung, and Blood Institute's Strategic Vision in the Division of Cardiovascular Sciences. Circulation Research, 124, 491-497.
    6. Duggan A, Portilla XA, Filene JH, Crowne SS, Hill CJ, Lee H, Knox V. Implementation of Evidence-Based Early Childhood Home Visiting: Results from the Mother and Infant Home Visiting Program Evaluation. OPRE Report 2018-76A. 2018. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.
    7. Haire-Joshu D, Schwarz CD, Steger-May K, Lapka C, Schechtman K, Brownson RC, Tabak RG. (2018). A randomized trial of weight change in a national home visiting program. American Journal of Preventive Medicine, 54, 341-351.
    8. Salvy SJ, Dutton GR, Borgatti A, Kim YI. (2018). Habit formation intervention to prevent obesity in low-income preschoolers and their mothers: A randomized controlled trial protocol. Contemporary Clinical Trials, 70, 88-98.
    9. Implementing Family Check-Up for Children. https://homvee.acf.hhs.gov/implementation/Family%20Check-Up%C2%AE%20For%20Children/Model%20Overview