Home Visiting Programs to Overcome Transportation Barriers
Home visiting is a strategy to connect directly with people who are at high risk or who are less likely to get
health and social services from clinics or service agencies. Key populations targeted for home visiting programs
include seniors, pregnant and postpartum mothers, and families with infants or young children. By bringing
healthcare and other resources directly to the patient in an accessible, comfortable environment, home visiting
programs can support
healthy child development and can help seniors remain independent among other positive results. Often,
these models employ community health workers to conduct home visits.
Examples of Rural Home Visiting Programs
First Steps Early Head Start provides home
visiting services to 75 children in the rural mountains of Cañon City, Colorado as part of the Early Head Start home-based program option. The program
includes weekly home visits and monthly social activities for parents and children, serving pregnant women
and families with children up to age 3. Like other Head Start programs, eligibility is generally
Native American Professional Parent Resources (NAPPR) provides early intervention services to
families in New Mexico. Their tribal home
visiting program uses the Parents as
Teachers model and provides special services that begin before birth for young parents, fathers,
and custodial grandparents. In addition to basic education about infant care and development, the
program also facilitates opportunities for families to explore traditional language learning and
child rearing practices in a community setting.
Mountain Empire Older Citizens is an Area Agency on Aging located in southwest Virginia. It
provides a number of community services, including Mountain
Empire PACE (Program of All-Inclusive Care for the Elderly), a nationally-recognized healthcare
model for frail seniors. This program provides wrap-around services to support the independent living
among older adults, including home visitation for nutrition, physical therapy, personal care, and
Archer Health Center received a Centers for Medicare and Medicaid Services Health Care Innovation
Award to fund a home visitation program for residents in northern Dona Ana County, New Mexico. The
innovative program uses nurse health educators and community health workers to target patients with
chronic disease, vulnerable seniors, homebound individuals, young children, and other hard to reach
Prosser Public Hospital District (PPHD) received a Centers for Medicare and Medicaid Services Health Care
Innovation Award to fund their Community
Paramedic Program. PPHD serves a large, rural population in eastern Washington State
that faces difficulties accessing services from long distances. The Community Paramedics Program uses
community resource paramedics to follow-up with patients suffering from chronic conditions to make
sure they follow discharge instructions, clarify medication instructions and provide referrals.
Considerations for Implementation
In some cases, high-risk families who could benefit from home visiting services may be unwilling to
permit access to their homes. These may include families experiencing challenges such as substance
use, domestic violence, or other complex problems. Home visitors who are unwelcome can consider
identifying a neutral location to meet away from the home.
It is important to provide support to home visiting staff, who often work with families dealing
with challenging issues. This can include regularly scheduled contact with a supervisor and opportunities
to meet with other home visitors to share successes, brainstorm solutions to challenges, and offer
Safety is of utmost importance for home visitors who may travel long distances alone to visit
rural families. Programs should implement policies and procedures to address this issue, such as:
A ban on carrying large amounts of cash or medications in the car
A requirement that visitors share routes with supervisors
Policies about how to protect patient privacy
Guidance on how to deal with aggressive or unfriendly family animals.
If possible, program managers should also provide de-escalation training to help home visitors
identify and prevent interpersonal conflicts.
The long distances between homes or between communities may present logistical challenges that
could make it difficult to implement some safety practices like visiting a home in pairs or meeting in-person
with supervisors or other home visitors.
Community health workers often are the home visitors in rural communities. The Rural Health Information Hub
Community Health Workers Toolkit contains additional
implementation considerations including how to conduct a needs assessment and how to increase staff retention.
Program Clearinghouse Examples
Resources to Learn More
Home Visiting Evidence of Effectiveness (HomVEE)
The HomVEE program was created to identify evidence-based and effective home visiting programs for pregnant
women and children up to age 5. This website provides descriptions of the reviewed programs, as well as
information about outcomes and implementation. It will be useful for federal Maternal, Infant, and Early
Childhood Home Visiting (MIECHV) grantees, who must invest a certain proportion of their funding into
Organization(s): U.S. Department of Health & Human Services, Administration for
Children & Families
Home Visitor Safety Guide
This resource provides practical safety tips and guidance for home visitors who may be exposed to dangerous or
threatening situations. It outlines steps that can be taken before, during, and after the visit and provides a
sample outreach site safety assessment form that can be used by supervisors to prepare for a visit.
Organization(s): Oregon Health Authority, Public Health Division