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Rural Health Information Hub

Home-Based Programs

Home-based programs allow children and families to receive one-on-one support through home visits from healthcare providers, social service providers, or other community supporters. While home visits target children, parents, or families holistically, they often help educate and empower parents or caretakers with strategies to improve their family's health. Home-based programs allow service providers the flexibility to meet families where they are, tailoring support to meet their unique needs. Parents and caregivers, particularly those with infants or young children, may prefer to receive services in the comfort of their own homes.

Home visits often address social determinants of health that indirectly affect a child's health and well-being. For example, some models incorporate assistance related to employment and transportation. Home-based programs may be especially beneficial for families experiencing substance use or other behavioral health issues, because receiving support from the privacy of one's home can help reduce the negative impact of stigma.

Home-based programs can be particularly beneficial in rural communities, where long distances to healthcare or community centers and limited transportation options are barriers to accessing services. Evidence indicates that home visiting programs reduce child maltreatment, reduce child injury, improve parenting, and improve economic security. The Community Preventive Service Task Force (CPSTF) recommends home-based programs for improving asthma symptoms among children and reducing the number of school days missed due to asthma, as well as home visits to improve vaccination rates.

Examples of Home-Based Models

The Turtle Mountain Tribal Home Visiting Program is implementing the Parents as Teachers curriculum in Rolette County, North Dakota. A community needs assessment found young families were facing challenges related to poverty, education, and substance use disorders. While there were some services already available in the community, not many of these services were for families with infants or young children. The home visiting program offers parenting education and resources to support child development and family stability. Program data have reported an increase in the recommended number of well-child visits attended, a decrease in the percentage of children reported to Child Protective Services, and an increase in development screenings.

Healthy Families America is an evidence-based home visiting program with sites in 38 states. Families enrolled in the program receive services for a minimum of three years and are paired with home visitors that are chosen based on their ability to establish strong and trusting relationships with the family. The program is designed to build healthy parent-child relationships by helping with family goal planning, accessing healthcare, providing referrals to community resources, and offering parent support groups.

Early Head Start Home-Based Option, available in all 50 states, aims to enhance the development of infants and very young children as well as to strengthen family functioning. The program offers one home visit each week per family for a minimum of 46 visits per year. The home visits last about 90 minutes each. The program also offers opportunities for monthly small group socializations with other participating families.

Considerations for Implementation

Family engagement. Often, home-based programs target families dealing with challenging life circumstances, such as poverty or domestic violence. Families in these situations may be overwhelmed with other problems and therefore unable to fully commit to an intervention. Additionally, home visits can feel invasive which may prevent families from fully engaging. One way to keep families engaged in a program is by establishing a good, trusting relationship between program staff and the family.

Staffing. Home visiting programs need well-trained, experienced staff who are able to build strong relationships with families. However, these personnel may be hard to recruit and retain in rural settings. Low pay, stressful work conditions, and potentially long travel distances may contribute to staffing challenges for home-based programs.

Cultural factors and language. Home visiting programs often address fundamental beliefs about parenting — beliefs that are heavily influenced by culture. Home visiting programs should consider cultural factors and language with pairing home visitors with families. Home visiting personnel should be familiar with the various cultures in their communities and able to communicate with families in a clear and effective way.

For more examples and information on home visiting programs, see Home Visiting Programs to Overcome Transportation Barriers in the Rural Transportation Toolkit.

Program Clearinghouse Examples

Resources to Learn More

Maternal, Infant, and Early Childhood Home Visiting Program
Introduces the Health Resources and Services Administration's (HRSA) home visiting grant program in partnership with the Administration for Children and Families (ACF) for developing and implementing evidence-based, voluntary infant and early childhood programs to support and improve child development and health.
Organization(s): Health Resources and Services Administration (HRSA)

Early Childhood Home Visiting Programs and Health
Provides an overview of early childhood home visiting programs for new and expectant parents. Offers information supporting maternal and child health, child safety, food security, and positive parenting skills. Includes discussion of research relevant to home visiting and health.
Author(s): Heather Sandstrom
Organization(s): Health Affairs
Date: 4/2019