Universal versus Targeted

Historically home visiting programs have been developed to serve both universal and targeted populations. Among the earliest home visiting services have been those provided to all parents of a newborn, regardless of income, educational, or employment status. These programs have been provided by public health nurses, but are also provided by other professional and paraprofessional home visitors. In contemporary American society as well as in many other countries, universal services continue to be provided, most often for parents of a newborn. The time of a child’s birth is recognized as an optimal one for encouraging positive, responsive parenting practices and providing knowledge about child development as well as emotional support to families during a potentially stressful time. Providing in-home knowledge and support about parenting can help families get off to a good start and potentially reduce the likelihood of poor developmental outcomes, poor health care, abuse and neglect, or maternal depression. 

The provision of targeted services has dramatically increased over the past forty to fifty years based on interest in reaching out to families who might already be at risk for poor maternal and child outcomes based on unemployment, low education or low income, or immigration status, or who might be living in high risk neighborhoods. Interest in home visiting increased considerably in the 1960s as a means to reach out to families whose children were at risk for poor academic outcomes. Early programs also reached out to families at high risk for child maltreatment, or poor maternal and child health. These targeted programs have not only continued to increase but they also comprise a large number of model programs serving parents and young children.

Researchers have addressed the question of whether services should be provided in a targeted manner to high risk families, or should be offered universally (see Neil B Guterman, 1999). At the present time, we have insufficient empirical data to state unequivocally that one approach is more effective than another. In fact, when we add to the discussion the wide variety of programs for at-risk families, it becomes clear that as of the present time we can’t specify one of these approaches are more successful than another. The financial costs of such programs, as well as the potential for influencing significant parental and child outcomes, provide a strong rationale for examining these two strategies in more depth in future investigations.