Past and Future of Home Visiting (From the Pew Summit)

Liza Holland, a consultant working with the Prichard Committee, shares this post:

At the recent Pew Quality in Home Visiting Summit 2015, Deb Daro, a Chapin Hall Senior Research Fellow at the University of Chicago, shared a brief history of home visiting, along with thoughts on next steps to strengthen this highly effective strategy for early childhood support services.

Home visiting as a means of providing support to parents has it roots in rural history, harkening back to Mary Breckinridge out on a horse in Kentucky at the turn of the 20th century doing home visiting. Building on a long tradition, in the early 1980’s, states began to implement government-supported programs targeting a variety of intervention strategies. This decade saw the development of a wide array of models across the US.

In the 1990’s, there was a trend towards new national models, which could be replicated, and a need for real data to support outcomes. This time period saw an impressive expansion in home visiting, but a growing friction among the various models being implemented.

The first decades of the 2000s brought a spirit of collaboration, and a focus on high quality evidence for policy and practice decisions. The Pew campaign began and allowed true discussion at a national level. Advocates began to initiate efforts for broad federal policy in this area. After the introduction of a few bills that did not get anywhere, the Obama administration included home visiting in the 2010 agenda, eventually leading to the inclusion of Maternal, Infant, and Early Childhood Home Visiting (MIECHV) in the Affordable Care Act.

The MIECHV program was set up as a state and federal partnership and brought several key innovations, including supporting replication of evidence based programs. it required a shared management plan, emphasized improved home visiting quality, and focused the field on outcomes and benchmarks. MIECHV funding allowed states to vastly expand their infrastructure and take proven programs to scale in their states.

Today, Daro shares some concerns for the field. She feels we may be pushing Home Visiting as a solution to everything. Although a quality strategy, it will not solve all of societies complex problems. She is concerned about the field loosing focus and experiencing a bit of mission drift. She worries we are using data for accountability rather than learning. This is still a fairly young field and we need to keep exploring the best options for delivery. And finally, we may be too focused on federal funding – “The cake is the state level - fed is the icing”, said Daro.

Going forward, we need to keep making basic improvements in the revision of benchmarks and continue with the Pew Data work. We need to expand learning opportunities and support new research findings. Daro would like to see improvements in MIECHV dynamic elements and greater collaboration. She supports more critical thinking and better balance. We need to dispel the myth that only some families need help. EVERYBODY needs help with parenting.

Overall, would like to see the same investment into entrance to life as we do for exit (aged services).

Daro’s walk through history was a rousing kickoff to 2 days of learning, networking and collaboration around home visiting issues, sponsored by the Pew Charitable Trusts. Pew has had a significant impact on the home visiting field since the campaign initiated. Working in the areas of public advocacy, having developed a model policy framework, research and information sharing, Pew has been a true leader in the development of home visiting nationally.

Pew chose to work with Kentucky as one of their key states to ensure that legislation was enacted to ensure support of a continuing, quality home visiting program in Kentucky's HANDS initiative.