Home visitation services represent one of the dominant early prevention strategies targeting physical child abuse and neglect in the United States and in a growing number of other nations. As the name implies, home visitation services provide services to families directly in their homes, most typically during the perinatal and early childhood phases of the children’s lives. Home visitation programs are varied in the specific activities and strategies employed, and seek to promote an array of positive family and child developmental outcomes, including the early prevention of physical child abuse and neglect. Typically home visitation programs initiate services very early in the life of a child, often at birth or even shortly before birth. With regard to physical child abuse and neglect prevention, families are usually engaged in services prior to any identified abuse and/or neglect (unlike child protective services), and therefore home visitation services are most appropriately categorized as a primary or secondary (and sometimes universal or selective) prevention strategy. As no maltreatment has yet been identified, home visitation services identify families via universal service systems, such as the health care system, and are therefore designed to be nonstigmatizing and voluntary.
Service activities focus on ways of strengthening families that promote positive parenting patterns and child developmental trajectories and, in so doing, aim to reduce risk for future physical child abuse and/or neglect. Most typically, direct services focus on ways of supporting the development of a healthy parent–child attachment through parenting guidance, education, and skill development. As well, home visitors often focus efforts on helping families with information and support around infant health, home safety, and environmental challenges, and home visitors often link families up with needed resources and supports in the local community. Services are typically available during the first few years of each child’s life, and taper off as families’ risks and stated goals are addressed over time. Depending upon the program type, home visitors may be nurses, social workers, or paraprofessionals with intensive training in the role.
Although home visitation services have emerged rather rapidly over the last several decades, the idea and practice of providing services directly in the homes of at-risk families is far from new. Home health visiting services date at least as far back as Florence Nightingale’s pioneering work in the 1860s in Britain, and it was a home visitor who was responsible for finding little Mary Ellen in a New York City tenement in 1874, leading to the establishment of the world’s first child protection organization, the New York Society for the Prevention of Cruelty to Children.
The most recent impetus for the rapid emergence and expansion of home visitation services targeting positive child developmental outcomes, including child maltreatment risk reduction, rests on the convergence of at least three interrelated threads of developing scientific evidence. The first is the growing evidence base pointing out the uniquely important period of early childhood in shaping later life functioning, including findings on the rapid and “building block” development of neurobiological systems, the establishment of primary psychosocial competencies, and, importantly, the development of primary emotional attachments with caregivers. The second is the evidence pointing out the inordinate risk children face for physical child abuse and neglect during their earliest years of life, particularly in their most devastating and sometimes fatal forms. Finally, there is the growing evidence base on home visitation services themselves, which continues to indicate that, in the right circumstances and under careful scientific scrutiny, early home visitation services can indeed serve as an effective vehicle to avert child abuse and neglect before it occurs.
A series of carefully executed studies have reported reductions in physical child abuse and neglect risk as a result of home visitation, although the evidence base is far from uniform, underscoring a need to carefully design and implement such services with quality evaluations and with a close fit to the problem and family need. Nonetheless, a series of careful reviews of the evidence base have pointed out that home visitation services, when delivered properly, have been linked to a modest but discernable reduction of risk for future physical child abuse and neglect. Policymakers have increasingly turned to home visitation services not only as a preventive mechanism for child maltreatment and problems stemming from child maltreatment (such as juvenile delinquency and crime, and later life mental health and school problems); the appeal of home visitation services also stems from their potential to yield significant cost savings to the public, as some reports have suggested that home visitation, when successful in averting child maltreatment, can also avert much greater public costs associated with an array of publicly funded systems of child welfare, criminal justice, education, and health care.
Two notable home visitation program initiatives explicitly targeting child maltreatment prevention in the United States are the Nurse Family Partnership program developed and studied by David Olds and colleagues of the University of Colorado Health Sciences Center, and the Healthy Families America initiative of Prevent Child Abuse America that supports the development of programs based on the Healthy Start program model, originally established in Hawaii. Especially noteworthy are findings reported by Olds and colleagues indicating not only some reduction in physical child abuse and neglect associated with home visitation services, but also improvements in a wide array of maternal outcomes in select subgroups of mothers and developmental outcomes that are still noticeable when the children have reached 15 years of age. These and other promising findings have added momentum to the expansion of home visitation programs in the United States and internationally.
While not a panacea, home visitation services targeting child abuse and neglect prevention have demonstrated they can successfully engage and support large proportions of families who may benefit, and can prevent significant proportions of physical child abuse and neglect. As of this writing, early home visitation services remain the dominant and most promising child maltreatment prevention strategy on the horizon.
- Guterman, N. B. (2000). Stopping child maltreatment before it starts: Emerging horizons in early home visitation services. Thousand Oaks, CA: Sage.
- Wasik, B., Bryant, D. M., & Lyons, C. M. (2001). Home visiting: Procedures for helping families. Thousand Oaks, CA: Sage.
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