16 Research on Home Visiting

“The research question about home visiting is not “does it work?” but “for whom does it work, under what circumstances.”

—Jones Harden, Chazan-Cohen, Raikes, and Vogel (2012)

Research on home visiting programs and the Early Head Start (EHS) home-based program option demonstrates that home visiting is a complex endeavor. Positive outcomes of child development, family well-being, positive parenting, health, school success, and economic stability appear in different degrees, in different program models, for different populations. Nonetheless, home visiting is proving to be an effective form of early intervention and parenting support through numerous, rigorous evaluation studies.

In 1996, the Department of Health and Human Services launched a large-scale evaluation of EHS by randomly assigning qualifying families at 17 sites nationally to participate and looking at their social, psychological, developmental, and academic outcomes compared to a matched control group. Families in the control group were able to receive any services available to them. The evaluation followed families over five time points, according to the child’s age: 14 months, 24 months, 36 months, prekindergarten, and fifth grade. Here are some of their findings.

Family Demographics and Family Engagement

"Mental health was related to general and specific engagement, suggesting that home visitation may be effective in addressing underlying mental health issues of parents but also illustrating that the operative component is whether the home visitor is able to successfully engage the mother."

—Raikes et al. (2006)

Family characteristics predict family engagement in home visiting programs.[3]

  • Teens and single mothers get somewhat fewer services.

  • Mobile families have a shorter duration in the program.

  • Families of a child with a disability stayed longer and were more engaged.

  • Non-English-speaking Hispanics were more engaged.

  • African Americans received fewer child-focused experiences. White families received more services but were not more engaged.

  • Families with more risk factors received fewer child-focused experiences

  • Child Outcome Findings

Child-focused experiences are the best indicator of positive school readiness outcomes.

“Certainly, quality of engagement and child focus in the visit are inextricably bound to quantity of visits and these features can only occur within the context of regular home visits.”

—Jones Harden et al. (2012)

At 36 months for EHS children, the home-based model had positive effects on:

  • child engagement with the parent in semistructured play;

  • the likelihood of an individualized education plan;

  • standardized cognitive test scores;

  • emergency room visits due to accident or injury;

  • cognitive and language development;

  • parental support for cognitive and language development;

  • home environments, which were robustly related to the extent of child-focused activity during the home visit;

  • compliance with immunization and well-child visits;

  • ongoing contact with the medical home; and

  • ongoing follow-up and support with children with special needs.[1][2]

At prekindergarten, EHS children in the home-based model had positive effects on:

  • child engagement during parent–child play;

  • social behavior problems;

  • positive approaches toward learning;

  • standardized test scores on problem solving; and

  • attending a formal preschool program.[1]

[1]: Brenda Jones Harden, Rachel Chazan-Cohen, Helen Raikes, and Cheri Vogel, “Early Head Start Home Visitation: The Role of Implementation in Bolstering Program Benefits,” Journal of Community Psychology 40:4 (2012): 438–455 (wileyonlinelibrary.com/journal/jcop). DOI: 10.1002/jcop.20525.

[2]: Early Head Start Research and Evaluation Project (EHSRE), 1996–2010: Project Overview, available at http://www.acf.hhs.gov/programs/opre/research/project/early-head-start-research-and-evaluation-project-ehsre-1996-2010

[3]: Helen Raikes, Beth Green, Jane Atwater, Ellen Kisker, Jill Constantine, and Rachel Chazan-Cohen, “Involvement in Early Head Start Home Visiting Services: Demographic Predictors and Relations to Child and Parent Outcomes,” Early Childhood Research Quarterly 21 (2006): 2–24,