In the historical timeline presented here, major developments in services offered in the United States from the early 1500s to the twenty-first century, are presented. Services such as outdoor relief, almshouses, and early instances of home visiting that developed in the United States at first mirrored those of Europe. By the middle of the twentieth century innovations in home-based services were occurring in the United States, especially in terms of services provided for young children. At the present time, home visiting services for families with infants and young children are supported by almost every state. This timeline includes services developed for the poor, sick, and immigrant, as well as women and infants, and reflects the dramatic increase in attention to home visiting that began in the twentieth-first century.
Across time, people in need have received care in their own home by family, friends, and neighbors. Service for the poor, in particular, has roots in many world religions and in ancient civilizations. Assistance was provided in the home because this was the only option before the days of institutional care. Formal home care can be dated to Elizabethan England, when services were provided to paupers in their own homes (Fink, Wilson, & Conover, 1963). In the United States, home care can be dated back to colonial America, when care was provided by family and others in the community. When institutional care did become available, home care was often seen as more desirable. Home visiting has most often been prompted by conditions of illness, poverty, or maternal and infant care. Services tended to be initiated and provided by local communities, with nurses, social workers, and teachers being the major providers. Health care was also provided by physicians in the home. Since the time of established institutions for providing care for the sick and those in poverty, advantages and disadvantages of such services have been debated, with beliefs swinging back and forth, between the value of home-based services versus institutional care.
During the 1700s, the United States was primarily a rural country and families were generally self-sufficient. Home care was provided by family and neighbors, and there was little access to trained medical workers. In urban areas many of the more privileged in American society reached out to help others in need, following a practice that was prevalent in Great Britain. Aimed at assisting individuals in need, these efforts were also seen as a benefit to society by helping to reduce crime and poverty.
By the end of the 1700s, communities began to gradually develop more formal support when informal support could not adequately provide for the many needs experienced by families. One solution had been the practice of “outdoor relief” (outside the doors of an institution) to enable individuals to remain in their own homes, but this practice became too expensive to maintain and consequently governments began to build poor houses, almshouses, town farms, or other settings where the indigent were housed. These poor houses were the precursors to the development of settlement houses in the 19th century. In addition to providing for the indigent, communities developed residential settings to provide for the needs of orphans, the mentally ill, and the elderly.
A number of events in the early 1800s were designed to promote the development and welfare of vulnerable sections of society. Hospitals, for example, were at first places people went when they had no other options. They often served the poor and the elderly, while those who were better off financially were more likely to be cared for by relatives in the home. Hospitals in the United States can be dated to the early 1800s, expanding around the time of the Civil War. Physicians throughout this century continued to provide home-based medical services, traveling by foot, horseback or buggy.
In 1821, an innovative effort in home visiting was initiated by Madame de Montale, who sought to have a religious association “specifically devoted to the sick of all classes in their homes” (1982, p.3). This initial effort floundered, but her followers were dedicated to this need and reassembled, placing themselves under the direction of Josephine Potel, their first spiritual director, and seeking recognition as a religious community from the Catholic Church. During 1824 these women came together in Paris to mark the beginning of their congregation, named “Sisters of Bon Secours”, with the goal of caring for and nursing the sick and dying in their homes. The work of Bon Secours resulted in positive regard and the congregation expanded their services internationally, first in Ireland in 1861 and later in London and Scotland. They were invited in 1881 to Baltimore, where they began the first organized efforts of visiting homes to provide nursing services. Later they set up a convent, and the Bon Secours Hospital in Baltimore.
A relevant development in the 1850s was the promotion of kindergartens based on the educational ideals of Friedrich Froebel in Germany. These educational ideas related to young children attracted considerable attention in the United States, and Chicago became the hub of kindergarten-related educational activity for children. Kindergartens also began to be associated with public schools, charity, and work done at the settlement houses. Alice Putnam became the leader of this activity in Chicago when she started the Kindergarten Study Club in 1874, later becoming director of the Chicago Froebel Association Training School. Kindergartens were well-received because Froebel’s principles of focusing on overall child development appealed to the residents and workers of settlement houses.
Florence Nightingale,one of the most influential figures in the development of nursing schools, opened the Nightingale Training School for Nurses at St. Thomas’ Hospital in London in 1860. She not only pioneered nursing as a worthy profession for women, but also placed an emphasis on educating women who lived in rural areas about hygiene and sanitation practices. Her work with the sick, especially those who were both sick and poor, led her to associate the importance of home care with nursing care. Her beliefs are reflected in the following quote from one of her reports: “Never think that you have done anything effectual in nursing in London till you nurse, not only the sick poor in workhouses, but those at home.” She worked to involve rural health missioners so that they could teach good hygiene and sanitation practices to women living in rural areas (Florence Nightingale on public health care by Florence Nightingale and Lynn McDonald, p. 607).
Octavia Hill began work in the poor London neighborhoods during the late Victorian period. Concerned mainly with housing, she purchased several houses and not only collected rent from the tenants, but also discussed with them their concerns. Her goal was to change the attitudes and habits of poor people, an approach now seen as paternalistic. As government services for the poor became more prevalent, her approach of not accepting alms or charity for the poor lost support, but her contributions helped foster the profession of social work (http://historyofsocialwork.org/eng/details.php?cps=3&canon_id=135).
Home visits evolved and flourished during the progressive era in America from 1870 to the 1920s. Their promotion was influenced not only by increasing interest in nursing care, but also by the establishment of settlement houses and the kindergarten movement, as well as by the promotion of compulsory public education. Active participants in these movements worked for the welfare of children, families and communities, and used community-home visits as an outreach strategy. The quality of neighborhoods was believed to directly affect the welfare of children; consequently community visits were combined with home visits to create a more holistic environment for child care. Home visitors worked to build strong rapport and acceptance among families, especially immigrant families, as they helped them learn about the American culture and child development. Visiting teachers were sought by schools to help with school attendance and to promote the compulsory school attendance policies.
The first hospitals and schools of nursing in the United States have a long history. Two of the earliest hospitals -, Blockley of Philadelphia (originally the Philadelphia Almshouse founded in 1731/1732) and Bellevue Hospital in New York (founded in 1730) - developed schools of nursing. The Bellevue Hospital School of Nursing was established in 1873, following on Nightingale’s principles of nursing. In 1889 the Johns Hopkins School of Nursing was established, also based on the principles of Nightingale.. Over the next century, in both Europe and the United States, a variety of public and private hospitals were established and formal schools of nursing began to be associated with these hospitals. This formal training in nursing led to increases in home visits by nurses.
In 1874 a landmark event influenced child care laws both in America and internationally. Marietta Wheeler, a social worker, and Henry Berg, then president of American Society of Prevention of Cruelty to Animals, publicized the situation of Mary Ellen Wilson, an eight year old living with her abusive parents. Her testimony of abuse in the New York Supreme Court dramatically increased awareness of child abuse and neglect, leading to governmental rules and regulations to improve the lives of children. Mary Ellen’s story led to the formation of the New York Society for the Prevention of Cruelty to Children and brought wide-spread attention to children’s rights. More than 100 years later, home visiting would become a major strategy aimed at reducing child abuse and neglect.
Toynbee Hall was established in East London in 1884 as the first university settlement house. It was founded by Samuel Barnett, an Anglican priest, based on the ideas of Arnold Toynbee, who promoted university extension efforts by reaching out to deprived communities (http://historyofsocialwork.org/eng/details.php?cps=4&canon_id=136). Its goal was to be part of a social reform movement designed to reduce poverty and promote social inclusion. Workers, often university students, “settled” or resided in deprived areas so that they would gain knowledge of the conditions of those who lived in the community in order to assist them. The philosophy of Toynbee Hall influenced the development of settlement houses not only in England, but also in the United States, and it remains in service today
Stanton Coit opened the first American settlement house on the lower east side in New York, based on his experiences of living at Toynbee Hall for several months. The tenement where he settled formed the Neighborhood Guild in 1887, and in May 1891 became known as the University Settlement House (http://www.socialwelfarehistory.com/people/coit-stanton/). University Settlement House is still in operation, remaining true to its original purpose to strengthen communities and strengthen families (http://www.universitysettlement.org/us/).
Visiting nurses began working in Philadelphia and Boston in 1887, and 15 years later in Baltimore.
Both Jane Addams and Ellen Gates Starr visited the Toynbee Settlement Hall in London and, inspired by the potential that these houses had in the development of the poor, they worked to replicate what they saw in Chicago. Their efforts resulted in the establishment in 1889 of Hull House, which became the most well-known settlement house in the United States http://www.encyclopedia.chicagohistory.org/pages/1135.html). It offered numerous practical classes for immigrants in the surrounding neighborhoods by the residents of Hull House. Addams was also concerned with the broader issues of social justice and reform, addressing such topics as juvenile courts, reducing the causes of poverty and crime, and working towards women’s rights.
In 1893 the Henry Street Settlement, another well-known settlement house, was developed by Lillian Wald in New York. Wald had a broad agenda for nursing, seeing nursing as combining direct patient care with health teaching. She invented the term public health nursing to emphasize the community value of nurses, and is considered the founder of public health nursing. Wald provided home nursing care with her colleague, Mary Brewster, and facilitated the Visiting Nurse Service (another name for the Henry Street Settlement) that grew from 2 nurses in 1893 to 92 in 1913, becoming the model for visiting nurse groups today (http://www.workingnurse.com/articles/lillian-wald-founded-public-health-nursing). She attended the New York Hospital’s School of Nursing in 1889, and later published The House on Henry Street (1911) and Windows on Henry Street (1934). Wald’s strong beliefs about nursing are reflected in her statement, “Nursing is love in action, and there is no finer manifestation of it than the care of the poor and disabled in their own homes.”
Settlement homes laid the foundation for visiting teachers and social workers in the United States and also played a very important role in public welfare by helping indigent, mostly immigrant populations. They catered to the vulnerable in society – unwed mothers, widows with children, orphans and neglected children - providing food, shelter and education to help the residents improve their lives. Settlement houses became a hub of educational and cultural activity, as women volunteers mingled with the resident population and developed a symbiotic relationship where they encouraged the sharing of culture and knowledge. The volunteers conducted regular community-home visits to assist the resident immigrants in adapting to the American way of life and culture, besides assisting them in child care.
The first official social work class was offered by Columbia University in 1898, enabling those interested in charity work to receive professional training in working with the poor and mentally ill. Since that time, social workers have advanced the work of private and charitable organizations to serve those in need, including those who are abused, neglected, sick, disabled, or poor (See Baker, 1998, for a look at the first 100 years of social work).
The term social worker has been credited to economist and educator Simon N. Patten to apply to friendly visitors and settlement house residents. Patten, a promoter of the social work profession, believed in the principle of “economics of abundance” rather than the “economics of scarcity” and saw group social action as necessary to reach the goals of food, clothing and housing for everyone (http://michael-hudson.com/2011/10/simon-patten-on-public-infrastructure-...).
When schools began to became associated with settlement houses, visiting teachers helped children and their families understand the importance of education, and encouraged school attendance. As more schools began to be associated with settlement houses, visiting teachers became mediators between schools and homes. As part of their job they visited with families and children, became acquainted with the cultures that families practiced, and learned about the neighborhoods. With the information they gained through direct contact with families, they helped classroom teachers better understand the children in schools, enabling them to give assistance to children who needed special help.
Mary E. Richmond’s landmark book on home visiting, Friendly Visiting among the Poor: A Handbook for Charity Workers was published in 1899 - the first detailed examination of the preparation of home visitors. Richmond describes her purpose by writing: “This little volume is intended as a handbook for those who are beginning to do charitable work in the homes of the poor, whether as individuals or as representatives of some church, or of some religious society, . . .. The term "friendly visitor" does not apply to one who aimlessly visits the poor for a little while, without making any effort to improve their condition permanently or to be a real friend to them” (Richmond, M.E., Preface, pp. v). Her book is a valuable source for understanding the early beliefs about home visiting and recommendations for the practice of home visitors. Richmond developed a set of “relief principles” that continue to have relevance for today, including the need to offer individual services in the privacy of the home. (See the following website for the complete electronic copy of Richmond’s book: http://www.gutenberg.org/cache/epub/24841/pg24841.html).
The Progressive Era continued in the United States in the early 1900s, marked by the expansion of settlement houses in New York, Chicago, and the Midwest. The expansion of settlement houses also influenced the work of visiting nurses, visiting teachers, and social workers (all of whom saw a growth in services during the first part of the century and a move towards more formal recognition of their work).
In 1909, President Roosevelt called the first White House Conference on the Care of Dependent Children, an initiative that helped raise national awareness of serious situations many children were facing, including the detrimental effects of institutionalization as well as abuse and neglect. This Conference led to an acknowledgment of the importance of family and home life for children, influencing the initiation of the Children’s Bureau and the widow’s pension movement. These two developments emphasized the need to address the welfare of children from all classes and from low-income, mother-led households to ensure that resources were provided for a better quality home life for children.
Also in 1909 Metropolitan Life, whose business objective was to insure America’s workers, was challenged by Lillian Wald to take a larger, more humanitarian perspective. As a result, MetLife Vice President Haley Fiske announced that "insurance, not merely as a business proposition, but as a social program," providing health care to policy owners, would be the future policy of the company. Nurses from the Henry Street Settlement House began visiting policy holders who were acutely ill. Started in 1909 on a three month experimental basis, the program was later extended throughout New York, becoming a model for urban reform. Described as the largest such endeavor by a public or private organization, it provided approximately 20 million policy holders in the United States and Canada free nursing care before ending in 1953, as the demand for these services decreased (https://www.metlife.co/about/corporate-profile/metlife-history/helping-healing-people/index.html).
Mary E. Richmond continued to significantly influence the practice of home visiting. In her book, Social Diagnosis, she provided a systematic methodology and identified the content of providing services. “Her first principle was that care had to focus on the person within her or his situation. Building on extensive research, she developed what she labelled ‘social diagnosis’. Her famous circle diagram visualised the correspondence of client and environment. Richmond identified six sources of power that are available to clients and their social workers: sources within the household, in the person of the client, in the neighbourhood and wider social network, in civil agencies, in private and public agencies” (www.historyofsocialwork.org). Richmond’s views were a precursor of the system theory that has since become popular in social work and other professions as a theoretical framework for understanding individuals within families and their environments.
Handbook of Settlements, written by two settlement house pioneers – Robert Archer Woods and Albert J. Kennedy – was published by the Russell Sage Foundation of New York.
A study of truancy in Chicago, reported by Breckinridge and Abbott (1912), identified numerous social situations that contributed to truancy. The authors observed that concerns such as truancy were more social concerns of the community than educational, because they could affect the overall quality of community life. They recommended that school social workers help with these concerns by working with families.
Following World War I, a reduction in funding for reform efforts and a restriction of immigration to the United States influenced both settlement house work as well as outreach to families in their own homes. Social workers also began a shift from providing services in the community and in settlement houses, to providing case work in clinic settings. Nursing was also undergoing a change, with many nurses moving toward work in clinics and hospitals. Though public health nurses continued to serve in communities, the field was characterized by small independent local government and private agencies. Questions were being raised about the most effective way to provide community services. During the 1920s to the 1940s, demonstration projects and studies showed that a coordinated system of public health services would eliminate duplication and improve services. As a result, nursing leaders called for comprehensive, coordinated services, but the necessary support for this agenda was not available for it to move forward (http://www.nursing.upenn.edu/nhhc/Pages/WhatisaPublicHealthNurse.aspx).
In 1922 Mary E. Richmond published a sanother influential book titled What is social casework? An introductory description, that helped conceptualize the role of home visitors, including school social workers.
Two federal efforts during this time period encourage home visiting. In the early 1920s the Child Welfare League of America (CWLA) was founded, with a goal of improving public policy related to the wellbeing of children and their families. Providing parents with education through home visits has been one of its major strategies.
In 1935 the Social Security Act (SSA) was passed to provide for old-age benefits and to help the states make better provision for aged persons, blind persons, dependent and crippled children, maternal and child welfare, public health, and the administration of unemployment compensation laws. As part of this Act, the Title V Maternal and Child Health Program was funded, providing a foundation for the health of the nation’s mothers, women, children, and youth, with direct consequences for influencing the provision of nursing and social work services. Another aspect of the SSA was to put in place services for helping the poor elderly outside of poorhouses, a service frequently met through home visiting.
By contrast, other shifts occurring in the United States supported institutional care. As medical care evolved, physicians began to provide more services in offices, clinics, and hospitals. For both physicians and nurses the move towards clinic and hospital work continued, influenced by improved hospital care and the increased confidence of patients in such care. The medical community also found it more cost-effective for patients to come to hospitals and clinics rather than to provide care in the home. As a strong sign of the changes taking place, the successful visiting nurse program that Metropolitan Life started in 1909 was discontinued, as services shifted to institutional care.
In the 1960s the United States experienced an upswing in interest for home visiting services due to a combination of concerns. These concerns included children growing up in poor families (which often placed them at risk for poor health and educational outcomes), the need for maternal and child health programs, and the need to address child abuse and neglect.
The War on Poverty became one of the most significant events influencing home visiting, but several preschool initiatives predated this initiative, as professionals began to recognize the detrimental effects that growing up in poverty had on children’s educational success. To reach out to children, two approaches were possible. One was a home-based approach where home visitors met families in their own homes to provide parenting education, similar to services of the early settlement house workers. The second approach was to provide a center-based preschool program with direct services to children. These foci on parenting and early childhood education were to become the driving forces in the resurgence of home visiting services in the United States through the remainder of the twentieth century and into the twentieth-first century.
Susan Gray collaborated with Rupert Klaus to launch the Early Training Project in 1961, a preschool intervention and home visiting program for low-income children. It was designed to remediate academic delays through the elementary school years that could be related to low family income. Children started the program at age three-and-a-half, attending a summer preschool. Home visiting took place for once a week. In these home sessions, paraprofessionals brought materials that would promote school success and taught mothers how to effectively use these items with their children (Gray, 1971).
The High/Scope Perry Preschool Project was started by David Weikert in 1962 as the focus of an on-going longitudinal study of 123 high-risk African American children led by the High/Scope Educational Research Foundation. Its goal was to identify the causes and cures of academic underperformance of students in Ypsilanti, one of Michigan’s poorest neighborhoods. Children attended the preschool Monday through Friday for two and a half hours per day over a two-year period and teachers visited with the children’s families at their home each week. Children who participated in this study have been followed longitudinally into their adult years. As reported by Schweinhart (2003), by age 27 the intervention children of the longitudinal study had completed a higher level of schooling, had higher levels of general literacy, reported greater levels of income, and were linked to economic benefits, such as justice system costs, when compared to the no-program group. This research study has been a significant influence on government funding for early childhood intervention programs for children from backgrounds of poverty.
Possibly the most significant influence on home visiting, education, and health during this time was brought about by the War on Poverty in 1964, initiated by President Lyndon Johnson’s Administration. This multifaceted federal effort was designed to reduce poverty through both health and education endeavors. Education, in particular, was seen as a critical component of ending poverty and numerous educational opportunities were initiated, including Project Head Start, Follow Through, Job Corps, and Upward Bound.
The Office of Economic Opportunity initiated Project Head Start in 1965 as an eight-week summer program for children between the ages three and five, believing that education could help end the cycle of poverty for these children. Head Start was designed to not only provide educational opportunities to children, but also to provide health, nutrition, and family support services (Zigler & Valentine, 1979). Not long afterwards, Head Start evolved into a year-long public preschool program with parents having the option to receive services at either a Head Start preschool center or at their home. Head Start has served 29 million children, birth to age 5, since it was initiated. It was funded to serve approximately one million children and pregnant women in 2011.. Extensive research on its efforts can be found on its website (http://www.acf.hhs.gov/programs/ohs/). (See 1996 for the initiation of Early Head Start)
Within this heightened awareness of the detrimental effects of poverty on educational achievement, many other educators and researchers began to design intervention services for children from low income families in order to facilitate their chances for school success while reducing poor health outcomes. These children were often described as “at risk” and interventions were designed to increase the positive trajectory of their developmental outcomes.
In 1965, Phyllis Levenstein developed a model for a home-based, literacy-focused intervention called the Mother-Child Home Program (MCHP), founded by the Verbal Interaction Project. The aim of this program was to reach out to low-income families with young children to provide services that would meet the children’s early cognitive development needs. Home visitors, called toy demonstrators, modeled positive verbal communication with children to encourage parent-child interactions and left books and toys for the families to use (Madden, O”Hara, & Levenstein, 1984; Levenstein, Levenstein, Shiminski, & Stolzberg, 1998). Later named the Parent-Child Home Program, this program has been recognized as an evidenced-based home visiting intervention (http://homvee.acf.hhs.gov/document.aspx?rid=1&sid=15).
In 1966 Ira Gordon began a series of research endeavors as part of the Parent Education Program (PEP). He was one of the first university-based psychologists to develop home visiting programs aimed at helping low-income mothers become more competent teachers of their infants and young children, with the goal of facilitating intellectual and social development. Paraprofessional home visitors were taught to demonstrate home-learning activities to parents so parents could use these activities to promote their children’s development. The goal was not only developing the parents’ role as primary teachers for their infant children, but also helping the paraprofessionals develop stronger parenting skills (Rubin, Olmsted, & Wetherby, 1980). In 1967 Gordon initiated the Parent Education Follow Through Program, to provided additional support for children in Head Start during their elementary school years. Home visits were made by parent educators to encourage parental involvement in their children’s education (Rubin, Olmsted, & Wetherby, 1980).
Another major influence was the interest in addressing the needs of children with disabilities, often accomplished through outreach to families in their own homes. In 1968 The Handicapped Children's Early Education Program (HCEEP) was established to fund model demonstration projects for the delivery of special education and related services to young children with disabilities, from birth through the third grade (http://ectacenter.org/ecprojects/history.asp). Renamed the Early Education Program for Children with Disabilities (EEPCD) in 1990, this program supported the development and demonstration of high quality services for children with disabilities and their families.
In the late 1960s, home visiting programs were also being established outside of the United States. The Home Instruction for Parents of Preschool Youngsters (HIPPY) was first launched in Israel in 1969, . HIPPY’s work focused primarily on parent involvement and school readiness for children 3 to 5 years. HIPPY was first implemented in the United States in 1984 (see 1984).
The Portage Project was started in 1969 in response to The Handicap Children’s Early Education Program (HCEEP), developing a curriculum and materials for home visitors. The Portage Guide focuses on children with disabilities from birth to age three, while the New Portage Guide extends its services to children up to age six. The Portage Project is in operation both in the United States and internationally, to help parents identify developmental needs of their children and use strategies to address their children’s needs (The Portage Project).
The 1970s saw increased research interest in home visiting as a strategy to reach families with young children. Another major development during this decade was the passage of the Child Abuse Prevention and Treatment Act of 1974, designed to address child abuse and neglect. A second federal project funded during this decade was the Education of All Handicapped Children's Act of 1975 (P.L. 94-142), that provided educational services for children with disabilities. Other experimental projects were also conducted during this decade, including Project CARE, the first Nurse-Family Partnership intervention, and Project 12-Ways.
Home visiting has played a critical role in addressing child abuse and neglect since the 1970s due in large measure to the work of Henry Kempe, who was instrumental in the early recognition and identification of child abuse. His early efforts to spread awareness of child abuse included the establishment of the initial Child Protection Teams, now known as the Kempe Child Protection Team, and the identification of The Battered Child Syndrome. In 1972, the Kempe Center was founded for the treatment of abused children, as well as for training professionals and researchers in techniques for treating individuals subject to maltreatment and neglect (The Kempe Foundation for the Prevention and Treatment of Child Abuse and Neglect). In 1976, the Kempe Family Stress Inventory (KFSI), a psychological interview, was developed to determine if parents are at risk for parenting difficulties, such as child maltreatment.
The Child Abuse Prevention and Treatment Act of 1974 (CAPTA) (P.L.93-247) was funded to provide financial assistance for a demonstration program for the prevention, identification, and treatment of child abuse and neglect. It authorized limited government research into child abuse prevention and treatment, and created the National Clearinghouse on Child Abuse and Neglect Information. This Act was amended by the Child Abuse Prevention and Treatment and Adoption (CAPTA) Reform Act of 1978 (P.L. 95-266) to develop a plan for facilitating coordination among agencies, and to establish research priorities as well as to establish centers for the prevention, identification, and treatment of child sexual abuse. CAPTA, reauthorized by Congress every 5 years, provides support to communities for prevention strategies such as parenting education and home visiting.
Hawaii’s Healthy Start Project (HSP) was initiated as a child abuse prevention program started in 1975 on the island of Oahu, and later spread throughout the state. Services were originally provided by the Hawaii Family Stress Center with funding from the National Center on Child Abuse and Neglect, for families already known to child protective services (CPS). A child abuse and prevention program was also initiated for families at risk of abuse and neglect. In both situations home visits were provided by trained paraprofessionals. Hawaii’s HSP is based on Kempe’s approach to identifying potentially abusive and neglectful parenting, as well as on the writings of Selma Fraiberg that focus on the role of parents in young children’s development (ref) (http://www.princeton.edu/futureofchildren/publications/docs/09_01_03.pdf). HSP uses home visitors to help families move from abusive and neglectful parenting behaviors to positive practices that can promote healthy child development. It has been used in other states and also as a model for the national Healthy Families America program, now spread across the United States.
The Education of All Handicapped Children's Act of 1975 (Public Law 94-142) was passed by the US government to help ensure that students with disabilities receive a free appropriate public education. This Act was influenced by increasing interest ineducation, based in part from concerns of the 1960s with poverty and detrimental environmental influences on children’s cognitive development. (Within the Act, reference was made to services by school social workers.) Now known as the Individuals with Disabilities Education Act (IDEA), it addresses the educational needs of children with disabilities from birth to age 18 or 21.
ZERO TO THREE was established as a national nonprofit organization to promote the health and development of infants and toddlers. It works to inform, train, and support professionals, policy makers and parents through a range of professional activities and research, including activities relevant for home visitors.
In the late 1970s, three experimental studies addressing home visiting programs were initiated. One was developed by David Olds, which focused on nurse home visiting for first-time, low income mothers and their children. Now called the Nurse-Family Partnership (NFP), this program was examined in three randomized trials: in Elmira, New York in 1977, in Memphis, Tennessee, in 1998, and Denver, Colorado, in 1994. The program was designed to improve pregnancy outcomes and child health and development. It was also designed to help parenting create positive life-course outcomes by focusing on first time parents, and providing home visits by registered nurses during pregnancy and the first two years of life (Olds, Henderson Jr., & Kitzman, 1994). Numerous research studies have been conducted on this home-visiting model, demonstrating positive maternal and child outcomes related to health, education, and economic self-sufficiency. NFP has a national office in Denver, Colorado (http://www.nursefamilypartnership.org/about) and has been identified by HomVEE as an evidenced-based home visiting program (http://homvee.acf.hhs.gov/document.aspx?sid=14&rid=1&mid=1)
Another experimental study, Project CARE, was initiated in 1978 as part of a randomized experimental study comparing daycare and home visiting for children from low income families to promote social and academic competencies. This study was one of the earliest efforts to evaluate home visiting effects (Wasik, Ramey, Bryant, & Sparling, 1990), comparing the effects of a center-based child care program with a parent-focused home visiting program. Although this study became one of several that did not find home visiting alone was sufficient to bring about significant changes in children’s cognitive outcomes, it helped raised interest in home visiting interventions.
In 1979 Project 12-Ways was initiated in Carbondale, Illinois, to help families experiencing child abuse and neglect. It was based on an ecological-behavioral prevention and intervention model for child maltreatment, and included 12 services that parents could receive, depending upon an initial assessment. These services could include addressing health risks for children, parent-child interactions, job findings, money management, and stress reduction (Wesch & Lutzker, 1991). This project was later evaluated in California under the name Project SafeCare, using three of the main 12-Ways components: child health care, positive parent-child interactions, and home safety and accident prevention.
The 1980s saw the initiation of new home visiting approaches and new target populations, as well as the expansion of efforts initiated during the 1970s.
The Parents as Teachers (PAT) program was developed by Mildred Winter in Missouri, as a way to reach out to all parents with a young child in order to promote the child’s social and cognitive development. Services were offered to all parents regardless of income level by home visitors using a relationship-based, parent focused program. Services were targeted for parents with children prenatally to kindergarten, with a focus on improving parenting practices, preventing child abuse and neglect, and increasing children’s school readiness and success.. Today, Parents as Teachers has programs across the United States and in other countries, and it provides training to home visitors in the PAT curriculum. Its national office is in St. Louis, Missouri and its staff provides training nationally and internationally. PAT has been identified by HomVEE as an evidenced-based home visiting program (http://homvee.acf.hhs.gov/document.aspx?sid=16&rid=1&mid=1)
In 1984, the home visiting procedures of Project CARE (see 1978) were expanded for implementation in the Infant Health and Development Program, a national randomized study of low birth weight infants conducted in eight university/medical school settings (Gross et al., 1993). The home visiting component was to help parents develop ways to foster their child’s cognitive, social, and physical development, as well as to help parents enhance their own problem solving and coping skills (REF). This study was one of the first to collect systematic information on home visits by having the visitors report details of their visits *(ref chapters by Wasik and by Bryant?). This project also helped raise the visibility of home visitors in providing parenting education.
In 1984, HIPPY was introduced in the United States from Israel, where it originated in 1969. Its goal is to enhance educational enrichment for children and for parents, especially those experiencing issues such as low education, poverty, or social isolation. HIPPY programs have all followed the same model: a developmentally appropriate curriculum, a focus on teaching through role play, programs staffed by home visitors from the community, supervision by a professional coordinator, and home visits interspersed with group meetings
Research findings suggest positive treatment effects on child expressive language skills and parent involvement in the home, as well as a correlation between parent participation and child expressive language outcomes for children at-risk for poor school readiness (http://homvee.acf.hhs.gov/document.aspx?sid=13&rid=1&mid=1).
In 1986 the infant and toddler component was added, known as Part C of IDEA, to provide services for families with children between infancy and age 3, who qualify for early intervention based on disabilities. The five developmental areas for infant and toddler disabilities are cognitive development, physical development (including vision and hearing), communication development, social or emotional development, and adaptive development. Part C of IDEA is intended to reduce the cost and need for special education, maximize independent living, and minimize chances of institutionalization. Because services are required to be provided in natural environments to the maximum extent possible, home visiting is a common service strategy for Part C of IDEA. Individualized Family Service Plans (IFSP) are planned for the infants, toddlers, and families who are receiving services (http://www.nectac.org/partc/partc.asp#overview).
The Prenatal and Infancy Nurse Home Visitation Program, (later named The Nurse Family Partnership) conducted its second randomized experimental study in Memphis, TN, in 1988, recruiting women from prenatal clinics who had no previous live births, who were less than 25 weeks pregnant, and who had at least two risk conditions: were unmarried, completed fewer than 12 years of education, and were unemployed. One intervention group received nurse home visiting during pregnancy, while another intervention group received services both prenatally and postnatally through the child’s second birthday. Participants in the intervention group were primarily African-American women and their children.
The 1990s saw the development of new home visiting models as well as renewed interest in home visiting by teachers. Examples of home visiting models initiated during this time period are the Healthy Start Program and Healthy Families America. The HIPPY program was introduced from Israel, and Early Head Start was funded by the federal government. Strong professional interest was noted by publications regarding home visiting procedures and summaries of research outcomes.
The Individuals with Disabilities Education Act in 1990, a renaming of the Education of All Handicapped Children's Act of 1975 (P.L. 94-142), was passed to ensure services not only to school age children with disabilities, but also to infants, toddlers, and children ages three through five. Families of infants and toddlers were to have an Individual Family Service Plan (IFSP) developed with a service coordinator that included not only the needs of the child with disabilities, but the needs of the family. IFSP plans and follow up with families areoften conducted through home visits. The implementation of IFSP led to interest in home visiting procedures.
Project SafeCare was a 4-year, in-home, research and intervention program that provided parent training to families of children at-risk for maltreatment, and families of children who were victims of maltreatment. Parents were trained in treating children's illnesses and maximizing their own health-care skills (Health), positive and effective parent–child interaction skills (Parenting), and maintaining low hazard homes (Safety).
The Healthy Start Program was established in 1991 to reduce the rate of infant mortality and improve perinatal outcomes. Funded by the U.S. Department of Health and Human Services (HHS)’s Health Resources and Services Administration (HRSA), it provides grants to communities with high infant mortality rates. It also addresses the significant disparities in maternal and child health realized by racial and ethnic minorities. Services include direct outreach, health education, case management, depression screening and referral. It collaborates with other state and local programs to improve maternal and child health. Healthy Start was authorized by the Congress through the Children’s Health Act of 2000. Today it takes a life-span approach to working with women and their families, by working to reduce disparities in access and utilization of health services (http://mchb.hrsa.gov/about/dhsps.htm).
Healthy Families America (HFA) is a national home visiting model developed in 1992 that seeks to help families with histories of trauma, violence, mental health and/or substance abuse issues, who are at risk for child abuse or neglect. The program was established by Prevent Child Abuse America and was modeled on the Hawaii Healthy Start program. HFA focuses on teaching positive parenting and promoting child development. HFA services are intensive, long term (3-5 years) and provided on a voluntary basis. Procedures include an assessment of family needs and services provided by family support workers. HFA programs depend on collaboration with other family support organizations to provide comprehensive services to families in need, including ensuring that families have a medical provider and helping families identify the needs of their infants and children. HFA is grounded in research ranging from randomized control trials to quasi-experimental designs that have found several positive outcomes. HFA has been demonstrated to reduce child maltreatment, improve parent-child interactions, increase school readiness, decrease welfare dependency, and increase access to health care. It has been identified as an evidenced-based program by HomVEE. http://homvee.acf.hhs.gov/document.aspx?sid=10&rid=1&mid=1.
The Future of Children, a publication of the Lucile and David Packard Foundation, published its first volume focused entirely on home visiting. This volume served to raise awareness of home visiting as a potentially significant means of reaching out to families and young children.
In 1994, HIPPY was introduced in the United States from Israel where it originated in 1969. Its goal was to enhance educational enrichment for children and parents, especially those experiencing issues such as low education, poverty, or social isolation. HIPPY USA programs have all followed the same model with the following features: a developmentally appropriate curriculum, a focus on teaching through role play, programs staffed by home visitors from the community, supervision by a professional coordinator, and home visits interspersed with group meetings
Research findings suggest positive treatment effects on child expressive language skills and parent involvement in the home, as well as a correlation between parent participation and child expressive language outcomes for children at-risk for poor school readiness.
The third large scale study of the Nurse Family Partnership was initiated in Denver, Colorado, and included a comparison of nurse home visitors with paraprofessional visitors.
Early Head Start (EHS), established in 1995, evolved from Head Start's long history of providing services to infants and toddlers through Parent Child Centers, Comprehensive Child Development Centers (CCDPs) and Migrant Head Start programs. Its mission has been to promote healthy prenatal outcomes for pregnant women, enhance the development of infants and toddlers to age three, and promote healthy family functioning. Early Head Start is designed to enhance children’s physical, cognitive, emotional, and social development. It also addresses parent needs by helping them become more self-sufficient and by providing a range of the social services including parent education. Services are based on the needs of the community and family, and may be either home-based services, center-based, or a combination of services.
The Parent-Teacher Home Visit Project was initiated in California in 1998 as a way to create stronger parent-teacher relationships. Begun through a collaboration of state and local teacher organizations, district leaders, and a faith-based community organization, home visits were conducted by teachers to build partnerships and trust, with a goal of leading to student academic and social success (www.pthvp.org/index/php/sacramento-region/history). Teachers in this program are trained across all grades and serve K-12 students and their families. This model has expanded throughout the state of California, and by 2012 a total of 13 states had initiated programs based on the Parent Teacher Home Visit Project.
In 1999 the Future of Children, a publication of the Lucile and David Packard foundation, provided several in-depth reports of the home visiting research. An analysis of these reports led to the conclusion that the benefits of home visiting for parents and children are mixed. Some positive outcomes were obtained, but overall the results were not strong. Recommendations were made calling for improvements in the implementation and quality of home visiting services. One response to this significant publication was the convening of several national home visiting programs, leading to the creation of the National Forum on Home Visiting.
The first decade of the twentieth-first century also saw other significant advances in home visiting, including the expansion of the national offices for a number of home visiting models. Home visiting was seen as a way to improve maternal and child health; reduce child injuries, abuse and neglect; improve school readiness and achievement; reduce crime or domestic violence; improve family economic self-sufficiency; and improve coordination and referrals. One of the most significant changes was the focused attention on evaluating home visiting as an evidenced-based intervention.
Administrators, researchers, and practitioners from six national programs were convened to address concerns regarding the impact of home visiting reported in the 1999 publication of the Future of Children. Programs included Early Head Start, Healthy Families America, Home Instruction for Parents of Preschool Youngsters (HIPPY), Parents as Teachers (PAT), Parent-Child Program (PCP), and Nurse-Family Partnership (NFP). The initial meetings led to the creation of a national forum on home visiting. (http://futureofchildren.org/futureofchildren/publications/journals/journal_details/index.xml?journalid=49) Operating until 2007, this Forum was the first national effort to bring together the leadership of the major home visiting models providing services to families and young children. The Forum’s objectives were to improve the quality of home visiting services, develop benchmarks that could improve program quality, and develop a better understanding of the role of home visiting in fostering child development and helping families. Beginning in 2000, the Home Visit Forum developed a set of strategic goals that could lead to improvement in services. The work of the Forum was also instrumental in building a stronger foundation for national funding for home visiting programs. (See http://www.hfrp.org/other-research-areas/home-visit-forum for additional information).
The Nurse-Family Partnership National Service Office was established in 2003, and aided in establishing NFP programs throughout the United States. Research on the NFP continues through the Prevention Research Center for Family and Child Health at the University of Colorado, Denver (http://www.nursefamilypartnership.org/). By 2010, NFP as an evidence-based model had been launched in 32 states (http://www.ucdenver.edu/academics/colleges/medicalschool/departments/pediatrics/research/programs/prc/Pages/PreventionResearchCenter.aspx)
In 2004 a new teacher home visiting program was developed in Missouri, that used home visiting to improve communication and help families understand that schools and teachers share similar goals for the children they teach. The program focuses on increasing academic achievement through partnership between the parents and teachers.
One of the most significant events related to research in the field of home visiting was the funding to establish the evidence base for home visiting programs serving young children and their families. Launched in the fall of 2009, the Home Visiting Evidence of Effectiveness (HomVEE) project was funded to “conduct a thorough and transparent review of the home visiting research literature and provide an assessment of the evidence of effectiveness for home visiting program models that serve families with pregnant women and children from birth to age 5” http://homvee.acf.hhs.gov/document.aspx?rid=5&sid=20&mid=2. The HomVEE review is conducted by Mathematica Policy Research (http://www.mathematica-mpr.com/) guided by an interagency group of the Department of Health and Human Services (HHS). HomVEE’s efforts have resulted in the most extensive and comprehensive set of information on home visiting programs serving children and families in the United States. Detailed information is available on the development of these programs: the model description, procedures and training, staffing, and evidence. Beyond the compilation of this information, including detailed analyses of program effects, its existence sets a high standard for future researchers and program developers, as well as providing funders with information valuable for decision making (Http://homvee.acf.hhs.gov/).
Several significant advances in the field of home visiting have occurred since 2010, raising its visibility with policy makers, practitioners, and researchers. Among these advances are the following:
- extensive documentation of the evidence of home visiting services by the Home Visiting Evidence of Effectiveness (HomVEE) (http://homvee.acf.hhs.gov/),
- funding to increase the evidence-base of home visiting, including funding to promising programs to help document their effectiveness,
- large scale federal funding through the Patient Protection and Affordable Care Act that established a grant to provide $1.5 billion over five years for implementing evidence-based home visiting programs,
- significantly increased national attention to home visiting for families with young children, exemplified by the initiation of the Home Visiting Summit in 2011 to bring together policy makers, researchers, home visitors, program directors, and funders to dvance the field of home visiting,
- Pew Home Visiting Campaign that has funded numerous efforts for advancing research and practice in home visiting.
Large scale federal funding through the Patient Protection and Affordable Care Act of 2010 (H.R. 3590) authorized the Maternal, Infant, and Early Childhood Home Visiting program (MIECHV). This program aims to facilitate collaboration and partnership at the Federal, State and community levels, to improve health and development outcomes for at-risk children through evidence-based home visiting programs (http://mchb.hrsa.gov/programs/homevisiting/). The Act provides for $1.5 billion in funding over 5 years and requires grantees to use evidenced-based program models. Specific outcomes for maternal and child health were specified, including maternal and child health, childhood injury prevention, school readiness and achievement, crime or domestic violence, family economic self-sufficiency, and coordination with community resources and supports. The program is administered by the Health Resources and Services Administration (HRSA) in collaboration with the Administration for Children and Families (ACF), both agencies of the U. S. Department of Health and Human Services (HHS).
The Pew Home Visiting Campaign helps states advance effective policies for home visiting funding, administration and accountability by working in states “where key policy makers and advocates are determined to increase families’ access to voluntary home visiting programs that are shown to achieve meaningful outcomes.” The Pew Home Visiting Campaign has developed a model policy framework with six policy elements that are critical to strengthening home visiting program effectiveness and accountability. The six components *[make a link to the six components listed below] seek to align state home visiting investments with many of the requirements set out in the federal government’s Maternal, Infant, and Early Childhood Home Visiting Program. *
- Clearly define the purpose and expected outcomes of the home visiting program.
- Invest in home visiting models that have a proven record of success.
- Track public dollars.
- Monitor and evaluate publicly funded programs to ensure effectiveness.
- Target at-risk communities and/or high-risk populations.
- Invest enough money to reach all eligible families.
In 2010, the Pew Center on the States conducted a survey of state agency leaders to prepare an inventory of state home visiting programs in all 50 states and the District of Columbia. This significant report, States and the New Federal Home Visiting Initiative: An Assessment from the Starting Line, in combination with the Pew Home Visiting Inventory, provided the most comprehensive picture of home visiting in the United States for families with children from birth to age five, creating a detailed national overview of home visiting programs, models and funding. These data provide a comprehensive baseline from which to evaluate continuing efforts in home visiting.
The PEW Foundation, in collaboration with *(provide names) funded the first National Summit on Home Visiting in 2011 to bring together policy makers, researchers, home visitors, program directors, and funders to *(find and give the purpose). This summit provided the first large scale gathering across home visiting models of professional researchers, directors, policy makers, and practitioners in home visiting in the United States. For more information provided by the Pew Center visit http://www.health.state.mn.us/divs/fh/mch/fhv/documents/PEWHVSummary.pdf
The Pew Foundation supported a study of home visiting by states and the new federal home visiting initiative. The study noted that when states made investments in voluntary home visiting programs they rarely used evidenced-based research in their policy decisions. Furthermore, the study concluded that the oversight and funding being provided for home visiting services were inadequate to ensure effective home visiting services for at-risk families http://www.pewtrusts.org/our_work_report_detail.aspx?id=85899363457&category=921.
The Home Visiting Research Network at Johns Hopkins has been funded “to help improve the lives of mothers, infants and young children by strengthening home visiting service models; developing innovative research methods; translating research into policy and practice; and supporting the professional development of the next generation of home visiting researchers” (http://www.hopkinschildrens.org/Home-Visiting-Research-Network-Established-at-Hopkins.aspx).