How Effective Is Home Visiting?

The Patient Protection and Affordable Care Act established a Maternal, Infant, and Early Childhood Home Visiting Program that provides $1.5 billion over five years to states to establish home visiting programs for at-risk pregnant women and children from birth to age 5. The Act stipulates that 75 percent of the funds must be used for home visiting programs with evidence of effectiveness based on rigorous evaluation research.

Home Visiting Evidence of Effectiveness (HomVEE) was launched in fall 2009 to conduct a thorough and transparent review of the home visiting research literature and assess evidence of effectiveness for home visiting programs that serve families with pregnant women and children from birth to age 5. Mathematica conducted the review under the guidance of a U.S. Department of Health and Human Services (HHS) interagency working group composed of representatives from the following:

• Office of Planning, Research, and Evaluation, Administration for Children and Families (ACF)
• Children’s Bureau, ACF
• Centers for Disease Control and Prevention
• Health Resources and Services Administration
• Office of the Assistant Secretary for Planning and Evaluation

The HomVEE review provides information about which home visiting programs have evidence of effectiveness as required by the legislation and defined by HHS, as well as detailed information about the samples of families who participated in the research, outcomes measured in each study, and implementation guidelines for each program.

To implement a thorough and transparent review of the home visiting research literature, the team annually conducts a broad literature search, screens studies for relevance, prioritizes program models for the review, rates the quality of impact studies with eligible designs, assesses the evidence of effectiveness for each program, reviews implementation information for each program, and addresses potential conflicts of interest.

The literature search was limited to research on programs that used home visiting as the primary service delivery strategy and offered home visits to most or all participants. The search was also limited to research on home visiting programs that aimed to improve outcomes in at least one of the following eight domains specified in the legislation:

• Child health
• Child development and school readiness
• Family economic self-sufficiency
• Linkages and referrals
• Maternal health
• Positive parenting practices
• Reductions in child maltreatment
• Reductions in juvenile delinquency, family violence, and crime