Early childhood home visiting programs
In early childhood home visiting programs trained personnel regularly visit at-risk expectant parents and families with young children and provide them with individually-tailored information, support, and/or training. Depending on families’ needs, programs may cover child health, development, and care, and connect families with relevant resources and services, such as supporting health care insurance enrollment or temporary housing1, 2, 3. Home visiting programs vary depending on their intended participants, primary intervention goals, service providers, and program length and frequency of visits4. Home visiting service providers can be nurses, social workers, doulas, parent educators, paraprofessionals, lay workers from within the community, or others. Home visiting often begins prenatally and continues during the child’s first two years of life; however, sometimes programs begin after birth, last for only a few months, or extend until kindergarten5, 6.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced child maltreatment
Reduced child injury
Improved cognitive skills
Improved social emotional skills
Improved parenting
Improved birth outcomes
Improved maternal health
Improved economic security
Increased vaccination
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Improved prenatal care
Reduced hospital utilization
Reduced rapid repeat pregnancies
Increased use of contraception
Reduced intimate partner violence
What does the research say about effectiveness?
There is strong evidence that early childhood home visiting programs prevent child maltreatment6, 7, 8, 9, 10, 11, 12, 13 and injury11, 12, 14, and improve children’s cognitive and socio-emotional development6, 9, 12, 15, 16, 17, 18. Early childhood home visiting programs have also been shown to improve birth outcomes6, 9, 19, 20, 21, 22, maternal health6, parenting behaviors and attitudes6, 16, 23, 24, and increase family economic self-sufficiency6, 15. Effects are often sustained until children reach age seven15.
Home visiting programs have been shown to reduce maternal postpartum depression in the U.S.6, 13 and internationally25. Home visiting begun prenatally may increase use of prenatal care6, 20, improve infant health, increase vaccination2, 6, 9, 10, 26, 27, and reduce infant visits to the emergency room11, 12, 28. Home visiting programs led by doulas may lead to improved infant care by parents17, 29. Some home visiting programs for preterm babies appear to improve physical growth and reduce hospitalization16. Visits begun postnatally may improve infant health and increase exclusive breastfeeding, particularly with frequent visits; however, they may not reduce child mortality or improve maternal health30.
Programs for teenage mothers may reduce rapid repeat pregnancies19, 31, 32 and increase use of contraception31. In some circumstances, home visiting programs appear to reduce intimate partner violence33, 34, 35 and help reduce mothers’ potential involvement with the criminal justice system18. Some home visiting programs have been shown to be effective in improving math and language skills in children18, 36, especially when they are tailored to support language development37, 38. Home visiting programs may not be successful, and may even be harmful, when participants abuse drugs or alcohol39. Findings from a short-term home visiting program in Massachusetts suggest interventions may increase the likelihood that families who could benefit from longer-term home-visiting or early intervention services are enrolled in such services1. Another Massachusetts-based home visiting program suggests it may decrease the chances enrolled mothers will experience homelessness when their children are preschool-aged3.
Longer term and more intense interventions, supervision of home visitors, and fidelity monitoring appear to increase positive effects on child maltreatment7, 8, 10 and cognitive outcomes24. Programs delivered by licensed professionals, even when implemented by community agencies, appear to have stronger effects on children’s cognitive outcomes than programs delivered by paraprofessionals or non-professionals13. Additionally, programs that intentionally include fathers may be more effective at improving family relationships and increasing program retention40. However, research regarding home visiting and child maltreatment does not consistently indicate that one type of provider delivers the most effective interventions, only that child maltreatment rates go down as home visiting is implemented more broadly41. Additional evidence is needed to confirm the most effective method of implementation for any particular outcome of interest7, 8, 10, 24, including improving quality of life and reducing hospitalizations for children with asthma42.
Home visiting interventions are cost-effective in the long term, benefiting disadvantaged families and increasing economic sufficiency and stability15. Programs that target specific populations have been shown to be cost effective, including when they target families of low-birthweight babies43 and families with children diagnosed with asthma44.
Innovations by tribal communities participating in the Tribal Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) improved program efficacy, including unique community engagement and recruitment and retention strategies, expanding the case management roles of home visitors, specifically employing paraprofessional home visitors, and practical advances to streamline evaluation approaches45.
How could this strategy advance health equity? This strategy is rated potential to decrease disparities: supported by some evidence.
There is some evidence early childhood home visiting programs have the potential to decrease disparities in maternal and child health outcomes for families with racially-minoritized backgrounds and those with low incomes. These effects may be stronger when programs are tailored for specific populations with worse health and birth outcomes. However, available evidence suggests the complex and pervasive impacts of structural racism can limit the potential of home visiting programs to address disparities1, 11, 53.
Home visiting programs led by community health workers (CHWs) have been shown to reduce disparities in maternal and child health outcomes, including prenatal care utilization, preterm birth, and low birthweight, when tailored for minoritized women and families, including Native women, women having their first baby, teens, women with less than a high school education, women in rural border counties21, and Black families22. Such programs can also decrease disparities in vaccination rates among these groups who have historically had lower vaccination rates27. CHW-led home visiting programs tailored to patients with asthma, who are disproportionately Black or Hispanic and with low incomes, may reduce disparities in asthma outcomes and may reduce Medicaid costs44. An evaluation of the Family Spirit program for and by Native populations appears to improve child development, school readiness, maternal health, and parenting practices among participants36.
The maternal and infant mortality rates, low birthweight outcomes, and teen pregnancy rate in the U.S. are higher than in any other developed country29, 54, 55. There are stark disparities in maternal outcomes and maternal mortality between women who are Black or American Indian and Alaska Native (AI/AN) and those living in rural areas compared to women who are white or live in urban areas54, 56, 57. Racial bias and discrimination in maternity care negatively impact outcomes for Black women54 and many pregnant people in rural areas, particularly in the Midwest or the South, live in counties with no obstetricians or maternity care centers, severely restricting their access to care58. Preterm birth is approximately 50% higher among Black births than white births, low birthweight is almost double for Black infants, and infant mortality is more than twice as high59. Teen pregnancies are associated with higher rates of neonatal and infant mortality, with the highest rates among infants born to Black teens60. Teen pregnancies also have a higher risk of complications including preterm birth and low birthweight60.
Structural racism, systemic inequalities in access to education, employment, and housing, and marginalizing experiences of poverty and discrimination all challenge the ability of home visiting programs to address health disparities4, 44. Home visiting programs may have stronger effects for families from non-minoritized backgrounds11. This may be because home visiting programs can have difficulty reaching and enrolling families whose primary language is not English1, or that families experiencing more structural inequalities may be more likely to drop out of programs due to those barriers4. Experts suggest program frameworks need to center health equity to be able to respond to patients’ needs, interests, and concerns and minimize the structural factors that contribute to inequalities and persistent disparities53.
What is the relevant historical background?
Access to and receipt of sexual and reproductive health education and services, such as that provided by home visiting programs, as well as high quality medical care in the preconception and prenatal periods, are essential components to prevent adverse birth outcomes22, particularly for pregnant women who are younger, from racially minoritized groups, or from families with lower incomes, who are at higher risk19. Nurse-led home visiting programs in the U.S. began in the late 1800s as a way to develop parents’ skills, they focused on prevention and early intervention to address growing health disparities in child mortality61, while community health worker (CHW) programs, which became more popular in the 1960s and 1970s as part of social justice movements62, were designed to expand access to care, including maternal and child health services, for communities geographically distant from or unfairly excluded from mainstream health care because of race, ethnicity, or poverty63. Several of today’s major evidence-based home visiting programs began in the same era, including the Nurse-Family Partnership, to improve maternal and child health outcomes among families with low incomes53.
The Maternal, Infant and Early Childhood Home Visiting (MIECHV) program was authorized by Congress in 2010 and allocates over $400 million a year to intensive home visiting programs53. In 2019, there were 9 million pregnant women and families with children under six years old and not yet in kindergarten from racially minoritized groups and geographies, with low incomes or facing other structural inequalities; only 3% were served through evidence-based home visiting programs64.
Equity Considerations
- What community partnerships could help home visiting programs in your community offer comprehensive family support services? What program components are important to your local families with low incomes? To families identifying as a racial or ethnic minority? How can your community support home visiting programs so they can provide these services?
- How could your community increase access to high quality evidence-based home visiting programs for children from families with low incomes? For children identifying as a racial or ethnic minority?
- Which populations in your community have lower rates of home visiting program adherence? What supports and outreach activities might help reduce those disparities?
- What disparities in health care access and maternal and birth outcomes exist in your community? How do systemic factors such as residential segregation and poverty contribute to these disparities?
- What knowledge, skills, and abilities do families and children with low incomes in your community already have? How can your local home visiting programs be structured to highlight and build on those strengths?
Implementation Examples
The federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, administered by the Health Resources and Services Administration (HRSA) provides states, territories and tribal communities with funding to implement early childhood home visiting models that have been approved through the U.S. Department of Health and Human Services’ (DHHS) Home Visiting Evidence of Effectiveness (HomVEE) review46. In fiscal year 2024, almost $4.5 million was awarded to all 50 states, the District of Columbia, and five U.S. territories from the MIECHV program46. In fiscal year 2023, 92% of participating families had household incomes at or below 200% of the Federal Poverty guideline, 58% of adult participants had a high school education or less, and 60% of the 1,033 counties served were rural47. The program saw improvements in early language and literacy activities, postpartum care, developmental screenings, and well-child visits47.
As of January 2025, there are 24 home visiting models that meet DHHS criteria for evidence-based program models46, for example, Healthy Families America48, Nurse-Family Partnership49, Parents as Teachers50, and Early Head Start-Home Visiting51.
Additionally, HRSA administers Healthy Start through its Maternal and Child Health Bureau. Compared to MIECHV, which focuses on early childhood development and allows states to choose a model to fit their community needs, Healthy Start is its own model that focuses on reducing infant deaths and enhancing mothers’ health52. As of 2024, it funds 115 projects providing services in 37 states, the District of Columbia, and Puerto Rico that are tailored to the needs of their communities to help reduce differences in rates of infant death and maternal health outcomes52.
Implementation Resources
‡ Resources with a focus on equity.
US DHHS-HomVEE - U.S. Department of Health and Human Services (U.S. DHHS). Home Visiting Evidence of Effectiveness (HomVEE).
HRSA-Home visiting - Health Resources and Services Administration (HRSA). Home visiting.
US DHHS ACF-Tribal HV‡ - U.S. Department of Health and Human Services (U.S. DHHS), Administration for Children and Families (ACF). Tribal Maternal, Infant, and Early Childhood Home Visiting (MIECHV).
DC HealthCheck - District of Columbia's HealthCheck Training & Resource Center. Home visiting toolkit.
Footnotes
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1 Kotake 2023 - Kotake, C., Fauth, R. C., Stetler, K., Goldberg, J. L., Silva, C. F., & Manning, S. E. (2023). Improving connections to early childhood systems of care via a universal home visiting program in Massachusetts. Children and Youth Services Review, 150, 106995.
2 Green 2018 - Green, B., Sanders, M. B., & Tarte, J. M. (2020). Effects of home visiting program implementation on preventive health care access and utilization: Results from a randomized trial of Healthy Families Oregon. Prevention Science, 21(1), 15–24.
3 Stargel 2018 - Stargel, L. E., Fauth, R. C., & Easterbrooks, M. A. (2018). Home visiting program impacts on reducing homelessness among young mothers. Journal of Social Distress and the Homeless, 27(1), 89–92.
4 Jester 2022 - Jester, J. M., Rosenblum, K. L., Muzik, M., Niec, L. N., Stringer, M. K., Handelzalts, J. E., Brophy-Herb, H. E., Stacks, A. M., Weatherston, D. J., Torres, C., Julian, M. M., Lawler, J. M., Barron, C., Brophy-Herb, H. E., Erickson, N. L., Fitzgerald, H. E., Huth-Bocks, A. C., Jester, J. M., Julian, M. M., … Weatherston, D. J. (2023). Demographic and psychological factors that predict retention in infant mental health home visiting. Early Childhood Research Quarterly, 62, 64–75.
5 HRSA-MIECHV 2017 - Health Resources and Services Administration (HRSA). The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program: Partnering with parents to help children succeed. MIECHV program national program brief 2017.
6 OPRE-Sama-Miller 2017 - Sama-Miller E, Akers L, Mraz-Esposito A, et al. Home visiting evidence of effectiveness review: Executive summary. Washington, D.C.: Office of Planning, Research and Evaluation (OPRE), Administration for Children and Families (ACF), U.S. Department of Health and Human Services (U.S. DHHS); 2017.
7 Casillas 2016 - Casillas KL, Fauchier A, Derkash BT, Garrido EF. Implementation of evidence-based home visiting programs aimed at reducing child maltreatment: A meta-analytic review. Child Abuse and Neglect. 2016;53:64-80.
8 Selph 2013 - Selph SS, Bougatsos C, Blazina I, Nelson HD. Behavioral interventions and counseling to prevent child abuse and neglect: A systematic review to update the U.S. Preventive Services Task Force recommendation. Annals of Internal Medicine. 2013;158(3):179–90.
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10 CG-Violence - The Guide to Community Preventive Services (The Community Guide). Violence.
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12 OPRE-Michalopoulos 2019 - Michalopoulos, C., Faucetta, K., Hill, C. J., Portilla, X. A., Burrell, L., Lee, H., Duggan, A., & Knox, V. (2019). Impacts on family outcomes of evidence-based early childhood home visiting: Results from the Mother and Infant Home Visiting Program Evaluation (OPRE Report 2019-07). Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.
13 Dodge 2019 - Dodge, K. A., Goodman, W. B., Bai, Y., O’Donnell, K., & Murphy, R. A. (2019). Effect of a community agency-administered nurse home visitation program on program use and maternal and infant health outcomes: A randomized clinical trial. Journal of the American Medical Association Network Open, 2(11), e1914522.
14 Cochrane-Kendrick 2013 - Kendrick D, Mulvaney CA, Ye L, et al. Parenting interventions for the prevention of unintentional injuries in childhood. Cochrane Database of Systematic Reviews. 2013;(3):CD006020.
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16 Goyal 2013 - Goyal NK, Teeters A, Ammerman RT. Home visiting and outcomes of preterm infants: A systematic review. Pediatrics. 2013;132(3):502-516.
17 Edwards 2020 - Edwards, R. C., Vieyra, Y., & Hans, S. L. (2020). Maternal support for infant learning: Findings from a randomized controlled trial of doula home visiting services for young mothers. Early Childhood Research Quarterly, 51, 26–38.
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22 Anthony 2021 - Anthony, E. R., Cho, Y., Fischer, R. L., & Matthews, L. (2021). Examining the causal impact of prenatal home visiting on birth outcomes: A propensity score analysis. Maternal and Child Health Journal, 25(6), 947–955.
23 Kendrick 2000 - Kendrick D, Elkan R, Hewitt M, et al. Does home visiting improve parenting and the quality of the home environment? A systematic review and meta analysis. Archives of Disease in Childhood. 2000;82(6):443-51.
24 Sweet 2004 - Sweet MA, Appelbaum MI. Is home visiting an effective strategy? A meta-analytic review of home visiting programs for families with young children. Child Development. 2004;75(5):1435-56.
25 Cochrane-Dennis 2013 - Dennis CL, Dowswell T. Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database of Systematic Reviews. 2013;(2):CD001134.
26 El Fadl 2016 - El Fadl RA, Blair M, Hassounah S. Integrating maternal and children’s oral health promotion into nursing and midwifery practice - A systematic review. PLOS ONE. 2016;11(11):e0166760.
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28 RAND-Kilburn 2017 - Kilburn MR, Cannon JS. Home visiting and use of infant health care: A randomized clinical trial. Pediatrics. 2017;139(1):e20161274.
29 Hans 2018 - Hans, S. L., Edwards, R. C., & Zhang, Y. (2018). Randomized Controlled Trial of Doula-Home-Visiting Services: Impact on Maternal and Infant Health. Maternal and Child Health Journal, 22(S1), 105–113.
30 Cochrane-Yonemoto 2021 - Yonemoto, N., Nagai, S., & Mori, R. (2021). Schedules for home visits in the early postpartum period. Cochrane Database of Systematic Reviews, 2021(7).
31 Cochrane-Lopez 2015 - Lopez LM, Grey TW, Hiller JE, Chen M. Education for contraceptive use by women after childbirth. Cochrane Database of Systematic Reviews. 2015;(7):CD001863.
32 Maravilla 2016 - Maravilla JC, Betts KS, Abajobir AA, Couto e Cruz C, Alati R. The role of community health workers in preventing adolescent repeat pregnancies and births. Journal of Adolescent Health. 2016;59(4):378-390.
33 OPRE-Niland 2022 - Niland, K., Zukiewicz, M., & Sama-Miller, E. (2020). What the evidence says: Intimate partner violence and home visiting (OPRE Report #2020-19). Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Washington, DC.
34 Prosman 2015 - Prosman GJ, Lo Fo Wong SH, van der Wouden JC, Lagro-Janssen ALM. Effectiveness of home visiting in reducing partner violence for families experiencing abuse: A systematic review. Family Practice. 2015;32(3):247-256.
35 Sharps 2016 - Sharps PW, Bullock LF, Campbell JC, et al. Domestic violence enhanced perinatal home visits: The DOVE randomized clinical trial. Journal of Women’s Health. 2016;25(11):1129-1138.
36 OPRE-Mraz Esposito 2017 - Mraz Esposito A, Coughlin R, Malick S, et al. Assessing the research on home visiting program models implemented in tribal communities - Part 1: Evidence of effectiveness. Washington, D.C.: Office of Planning, Research and Evaluation (OPRE), Administration for Children and Families (ACF), U.S. Department of Health and Human Services (U.S. DHHS); 2017.
37 Henwood 2020 - Henwood, T., Channon, S., Penny, H., Robling, M., & Waters, C. S. (2020). Do home visiting programmes improve children’s language development? A systematic review. International Journal of Nursing Studies, 109, 103610.
38 Raikes 2023 - Raikes, H., Chazan-Cohen, R., Harden, B. J., Byrd, J., Svoboda, E., Welch, G., Esteraich, J., Deming, J., Duncan, A. D., & Escalante, E. (2023). Evidence of the effectiveness of a home visiting model in rural communities: Early Steps to School success. Early Childhood Research Quarterly, 63, 299–312.
39 Cochrane-Turnbull 2012 - Turnbull C, Osborn DA. Home visits during pregnancy and after birth for women with an alcohol or drug problem. Cochrane Database of Systematic Reviews. 2012;(1):CD004456.
40 Burcher 2021 - Burcher, S. A., Corey, L. A., Mentzer, K. M., Davis, L., McNamee, H., Horning, M. L., Brown, S. J., & Shlafer, R. J. (2021). Family home visiting and fathers: A scoping review. Children and Youth Services Review, 128, 106132.
41 Kim 2024 - Kim, H., Song, E.-J., & Windsor, L. (2024). Evidence-Based Home Visiting Provisions and Child Maltreatment Report Rates: County-Level Analysis of US National Data From 2016 to 2018. Child Maltreatment, 29(1), 176–189.
42 Cochrane-O’Connor 2025 - O’Connor, A., Hasan, M., Sriram, K. B., & Carson-Chahhoud, K. V. (2025). Home-based educational interventions for children with asthma. Cochrane Database of Systematic Reviews, 2025(2).
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44 Mahin 2024 - Mahin, M., Guo, J., Warner, M., Dottin, M., Olsen, N., & Marshall, E. T. (2024). Projected cost savings of a community health worker model for asthma home visits in the Massachusetts pediatric Medicaid population. Preventing Chronic Disease, 21, 240028.
45 Barlow 2018 - Barlow, A., McDaniel, J. A., Marfani, F., Lowe, A., Keplinger, C., Beltangady, M., & Goklish, N. (2018). Discovering frugal innovations through delivering early childhood home-visiting interventions in low-resource tribal communities. Infant Mental Health Journal, 39(3), 276–286.
46 HRSA-Home visiting - Health Resources and Services Administration (HRSA). Home visiting.
47 HRSA-MIECHV 2024 - Health Resources and Services Administration. (2024). Maternal, infant, and early childhood home visiting program: 2024 Program brief. U.S. Department of Health and Human Services. Retrieved March 4, 2025.
48 HFA - Healthy Families America (HFA). Great childhoods begin at home.
49 NFP - Nurse-Family Partnership (NFP). Helping first-time parents succeed.
50 PAT-Home visiting - Parents as Teachers (PAT). Evidence-based home visiting.
51 EHS-Home based - Early Head Start National Resource Center (EHS). Home-based option.
52 HRSA-Healthy Start - U.S. Department of Health and Human Services, Health Resources and Services Administration Bureau of Maternal & Child Health. (2025). Healthy Starts. Retrieved March 4, 2025.
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55 CDC-About teen pregnancy - Centers for Disease Control and Prevention (CDC). About teen pregnancy.
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60 CDC-Woodall 2020 - Woodall AM, Driscoll AK. Racial and ethnic differences in mortality rate of infants born to teen mothers: United States, 2017-2018. Data Brief no. 3761. Centers of Disease Control and Prevention (CDC), National Center for Health Statistics. 2020.
61 Beatson 2020 - Beatson, R., Molloy, C., Perini, N., Harrop, C., & Goldfeld, S. (2021). Systematic review: An exploration of core componentry characterizing effective sustained nurse home visiting programs. Journal of Advanced Nursing, 77(6), 2581–2594.
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63 Perry 2014b - Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: An overview of their history, recent evolution, and current effectiveness. Annual Review of Public Health. 2014;35:399-421.
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