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TOC Alert

Journal of ZERO TO THREE: National Center for Infants, Toddlers,
and Families               


January 2013


January 2013 Volume 33 No. 3

Strengthening Home Visiting Through Research


New Research Strengthens Home Visiting Field: The Pew Home Visiting Campaign

Libby Doggett

Extensive research has shown that home visiting parental education programs improve child and family outcomes, and they save money for states and taxpayers. Now, the next generation of research is deepening understanding of those program elements that are essential to success, ways to improve existing models, and factors to consider in tailoring home visiting to local contexts and particular target populations. All new parents need good information about their child’s development to help them through the stress and uncertainty that come with having a baby. Years of research have shown that this vital support can be provided, in part, by formal parent-education programs called “home visiting.”


Assessing Quality in Home Visiting Programs

Jon Korfmacher, Audrey Laszewski , Mariel Sparr, and Jennifer Hammel

Defining quality and designing a quality assessment measure for home visitation programs is a complex and multifaceted undertaking. This article summarizes the process used to create the Home Visitation Program Quality Rating Tool (HVPQRT) and identifies next steps for its development. The HVPQRT measures both structural and dynamic features of program quality and provides a comprehensive look into how home visiting services are delivered. While additional research is underway for further testing and refinements, the initial research suggests that the HVPQRT is a promising instrument for home visiting stakeholders who strive to increase service quality.



Toward Population Impact From Home Visiting

Kenneth A. Dodge , W. Benjamin Goodman, Robert Murphy, Karen J . O’Donnell , and Jeannine M. Sato

Although some home visiting programs have proven effective with the families they serve, no program has yet demonstrated broader impact on an entire county or state population. This article describes the Durham Connects program, which aims to achieve broad county-level effects by coalescing community agencies to serve early-intervention goals through a Preventive System Of Care and by delivering universal, short-term, postnatal nurse home visiting services. Evaluation of Durham Connects occurred through a randomized controlled trial of all 4,777 births in Durham, NC, over an 18-month period. The results indicated that, by 6 months old, Durham Connects infants had 18% fewer emergency room visits and 80% fewer overnight stays in the hospital than did control families. A broad effect is achievable if a program attends to the challenges of community partnership, universal reach and assessment, rigorous evaluation, and strategies for sustaining funding.



Does Home Visiting Benefit Only First-Time Mothers?: Evidence From Healthy Families Virginia

Lee Huntington and Joseph Galano

It is a common assumption that mothers who have had previous births would participate less fully and have poorer outcomes from early home visitation programs than would first-time mothers. The authors conducted a qualitative and quantitative study to test that assumption by measuring three aspects of participation: time in the program, the number of home visits, and the intensity of services. The study also assessed three outcomes: immunizations, the home environment, and subsequent births. Data from more than 4,000 participants at Healthy Families Virginia sites indicate that mothers who had had previous births participated and benefitted similarly to first-time mothers. These findings suggest a need for future research to better understand the conditions under which home visiting works, and they have policy implications concerning the value of universal home visitation.


Effectiveness of Home Visiting as a Strategy for Promoting Children’s Adjustment to School

Kristen Kirkland

A growing body of evidence suggests that involving families in home visiting services promotes positive experiences during the initial years of a child’s life; however less is known about whether or not the benefits continue to accrue after a child enters school. This article describes the results of a study examining the effectiveness of an evidence-based home visiting program in promoting children’s academic adjustment. The findings suggest that home visiting programs can produce positive effects on children’s academic adjustment and that changes in earlier parenting practices may play an important role in explaining how home visiting influenced these later outcomes.


Home Visiting Processes: Relations With Family Characteristics and Outcomes

Carla A. Peterson, Lori A. Roggman, Beth Green, Rachel Chazan-Cohen, Jon Korfmacher, Lorraine McKelvey, Dong Zhang, and Jane B. Atwater

Variations in dosage, content, and family engagement with Early Head Start (EHS) home visiting services were examined for families participating in the EHS Research and Evaluation Project. Families were grouped by characteristics of maternal age, maternal ethnicity, and level of family risk. All home visiting variables were related differentially to both family characteristics and outcomes but in different ways for different groups. Results highlight the importance of documenting home visiting processes across and within families as well as using this information to guide programming and support home visitors in order to maximize the effectiveness of home visiting programs.


Also in This Issue:

  • This Issue and Why It MattersStefanie Powers , Monica Herk, and Andrea Hewitt


  • LettersWhat Our Readers Have to Say


  • New Opportunities and Directions in Home Visiting Research and Evaluation—Lauren H. Supplee , Robin L. Harwood, Nancy Geyelin Margie , and Aleta L. Meyer

The authors describe the research and evaluation activities connected to the new Maternal, Infant and Early Childhood Home Visiting program. The goal of these activities is to provide information on federal, state, and local efforts to strengthen programs by providing much needed knowledge on the best ways to support the implementation of home visiting programs at multiple levels—with families, home visitors, supervisors, organizations, and others. The collection of research and evaluation activities has a strong emphasis on capacity building, both for grantees and for the research community as a whole. This article aims to support the dissemination of research to the practice community by highlighting the resources currently available and to come.


  • Federal Home Visiting Under the Affordable Care Act—Kathleen Strader, Jacqueline Counts , and Jill Filene

The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program is part of The Patient Protection and Affordable Care Act and provides $1.5 billion over 5 years to states, territories, and tribes with the goal of delivering evidence-based home visiting services as part of a high-quality, comprehensive early childhood system that promotes health and well-being for pregnant women, parents, caregivers, and children from birth to 5 years old. The authors share promising results through anecdotal information from families, states, and tribes on progress made thus far.


  • PERSPECTIVES —Maternal Engagement in Home Visiting: The MOM ProgramJerilynn Radcliffe and Donald F. Schwarz

The MOM Program is an innovative home visiting program whose aim is to empower low-income urban mothers to obtain health and early intervention services for their children. The authors discuss a recent evaluation of the MOM program which sought to examine maternal involvement in the program.  The results raise important questions and call for larger efforts to more fully understand how to effectively mitigate the negative effects of poverty on children’s health and development and to promote the well-being of all children, particularly those living in poverty. 


  • PERSPECTIVES —Reflective Practice: Look, Listen, Wonder, and RespondDeborah J . Weatherston

The author explores the reflective components of observation, listening, wondering, and response. Together, these components invite parents to discover who their babies are as well as to understand the importance of nurturing relationships, past and present, to development, growth, and change. Of equal interest, reflective practice offers Infant Mental Health home visitors opportunities to explore the meaning and mystery of early relationship development, to understand early experience, and to feel again the warmth or promise of relationships, personal and professional, as they engage and support others through their work




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