Tracy grabbed her two bags full of supplies and walked up the front steps of the duplex. The door flew open, and three grinning boys peered out at her. "Hey guys, good to see you!" She greeted them warmly. The boys pulled her into the house with a yell. " Mom, Tracy's here!" After giving the boy's mother a hug, Tracy sat at the kitchen table, and the boys watched as she pulled this week's activity out of her bags. Tracy is a Head Start homevisitor who meets with families on a weekly basis providing a valuable educational resource for needy children and parents in her community.

As a method for delivering services to needy or disenfranchised families, new attention is being given to homevisiting programs such as the program sponsored by Head Start. Effective homevisiting models have reported success with health issues, such as early intervention programs, and psychosocial issues, including child abuse and neglect. Tracy's parenting experience and early childhood training give her the knowledge to help this mother with the daily trials of parenting active preschoolers. In addition, Tracy is able to provide information on nutrition, health care, and learning activities that encourage school readiness. Through her consistent visiting, dedication, and willingness to accept the family "on their own turf," Tracy has built the trust and confidence of the family. In the same way that one might ask for advice from a trusted relative or friend, this parent feels comfortable sharing problems with Tracy and asking for help before a problem becomes overwhelming. However, effective homevisiting is much more than just a weekly meeting with a new friend.

The winter 1993 issue of The Future of Children, published by the David and Lucile Packard Foundation, analyzes the practice of homevisiting and discusses principles and quality indicators that might guide future programs, including:

Addressing a broad spectrum of family needs. Programs that are flexible and able to assist the family with multiple issues will have greater impact than those with a single focus.
Providing greater intensity and duration of services. Families who received weekly visits and were linked to other services within the community were more successful than families who were visited monthly.

Using professional staff as homevisitors. Programs where staff members were dedicated and well-trained, including people with bachelor's, master's, or nursing degrees, were more successful than programs using laypeople with little training as homevisitors.

Setting realistic, individual goals for the family. Homevisitors who are sensitive to the unique characteristics of the clients are able to assist the family with developing achievable goals, and they see greater progress.

Another critical component to a successful homevisiting program is supporting the concept that families have strengths, are resourceful, and can change when they are encouraged to do so. The interpersonal relationship that grows between the homevisitor and the family or parent is a core factor that influences the family to build upon their strengths. The homevisitor seeks to develop this relationship by modeling consistent, dependable behavior and respecting confidentiality while setting limits on inappropriate actions. The homevisitor also helps the family achieve their goals while promoting the parent's self-esteem.

In European countries such as Denmark and Great Britain, homevisiting is often universal, and every family of a newborn will receive several homevisits. However, in the United States, a homevisitor is frequently paired with a family who is feeling the impact of multiple issues such as poverty, abuse or neglect, racism, handicap, or limited literacy. Homevisiting programs cannot, nor should they be expected to, solve difficult social problems that affect all of society. Rather, the primary goal of the homevisitor is to focus on the parent or caregiver and assist him or her in becoming more effective in parenting. The homevisitor works with parents to find ways to solve problems that affect their family.

The pattern of homevisiting will vary depending on program goals and will be tailored to family needs. The point of entry to the program may begin with a family referral by a health care or service provider, educator, neighbor, or friend. The family may or may not know about the referral, but the homevisitor will meet with the family, explain the program, and obtain the parent's consent to participate, as well as provide clarification of the program's goals. Voluntary involvement is important since homevisiting programs are more likely to be successful when participation is not mandatory.

Once the parent has expressed the desire to participate, regular homevisits of 45 to 90 minutes will be scheduled. Some families may receive homevisits for as long as 3 years. The first few visits center on goal setting for the family, intake or assessment information, and building trust between the visitor and parent. Later visits intermix discussion of prepared educational activities with discussion of community resources that can assist the family with obtaining their goals. Quarterly evaluations are helpful for both the visitor and the family as they assess their progress and make changes as needed. During later stages, homevisiting is gradually reduced as the family prepares to leave the program. A homevisitor is successful when the family no longer needs the regular support provided through the program and the parent has become more effective in his or her role.

Studies have suggested a number of long-term cost benefits of homevisiting programs, including reduced need for expensive health care such as hospitalization and emergency room visits. Other benefits include reductions in government services, such as AFDC and food-stamp payments, and an increase in the capacity for the parent to become economically independent (Future of Children, 1993, pp. 84-85). The evidence is compelling for states such as Massachusetts, where a broad collaborative of child and family advocates recently proposed The Newborn Home Visiting Bill. This bill will establish universal homevisiting to all first-time parents under the age of 21 and will allow for visits to continue, for certain families, until the child is 3 years old. There is a broad-based, bipartisan support for the bill, since it is estimated that for every $3 spent on prevention, such as homevisiting, the state saves approximately $6 on child welfare services, medical care, or other special services, as well as strengthening a parent's parenting skills, knowledge, and self-confidence.

For more information:

HIPPY USA
53 West 23rd St., 5th Floor
New York, NY 10010
Telephone: 212-645-4048

Parents as Teachers National Center, Inc.
9274 Olive Blvd.
St. Louis, MO 63132
Telephone: 314-432-4330

National Center on Family Literacy
Waterfront Plaza, Suite 200
325 West Main St.
Louisville, KY 40202-4251
Telephone: 502-584-1133

Even Start Programs
U.S. Department of Education
400 Maryland Ave. SW
Washington, DC 20202-6132

Children's Trust Fund
Attn: Suzin Bartley and Shereen Tyrrell
294 Washington St., Suite 640
Boston, MA 02108
Telephone: 617-727-8957

Sources:

The Future of Children: Homevisiting, 3(3). (1993). Los Altos, CA: The Center for the Future of Children, The David and Lucile Packard Foundation.

The children's community bridge project: A manual for homevisiting. (1994). Concord NH: State of New Hampshire, Dept. of Health and Human Services.