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Rural Health Information Hub

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 income-dependent.
  • 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 skilled nursing.
  • The Ben 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 residents.
  • 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 emotional support.

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 evidence-based programming.
Organization(s): U.S. Department of Health & Human Services, Administration for Children & Families

Oregon's 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
Date: 5/2014