Home-based program: Difference between revisions

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{{short description|Home visiting services for young children in the United States}}

[[Home care|Home visiting]] programs for families with [[Early childhood|young children]] have received [[Federal government of the United States|Federal government]] support in the United States. A range of programs have been implemented, with evaluation of their effectiveness in terms of health, social and educational outcomes.

Home Visiting, often called "voluntary home visiting," is a state strategy for connecting expectant parents and parents of young children with a designated support person, like a trained nurse, social worker, or early childhood specialist. States make voluntary home visiting available to families in need so they have the supports and resources that they need to drive improvements in outcomes for babies. Funded with state budget dollars and funds provided through the federal Maternal, Infant and Early Childhood Home Visiting Program (as well as with private funds in many states), evidence-based Home Visiting is an increasingly utilized tool in states human services.<ref>{{cite web|title=<i>What Is Home Visiting?</i> Alliance for Early Success|url=https://earlysuccess.org/home-visiting/|access-date=August 15, 2022}}</ref>

==History==

In 2010, the federal [[Affordable Care Act]] initiated the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV)that inallocates order$1.5 billion over five years to states that voluntarily provide families with young children with evidence-based home visiting programs. It aims to establish a positive and improved outcomesoutcome in health, education, and wellbeingreduced of[[child youngabuse]] childrenin families. Home visiting has already been in practice in every state.<ref name="ncsl_a">Tweedle, Mark. National Conference of State Legislature. [http://www.ncsl.org/documents/cyf/HomeVisitingPPT.pdf Home Visiting Power Point]. Retrieved Oct 20, 2013.</ref> While passed during the administration of [[President Barack Obama]], the program is widely viewed as bipartisan. MIECHV was reauthorized in a bipartisan budget bill in 2015 and signed by [[President Donald Trump]].<ref>{{cite web|title=<i>What Is Home Visiting?</i> Alliance for Early Success|url=https://earlysuccess.org/home-visiting/|access-date=August 15, 2022}}</ref> By the end of its first decade after being formalized in MIECHV, voluntary home visiting had been implemented in all 50 states, the District of Columbia, 5 territories, 25 tribal communities, and 51 percent of U.S. counties.<ref>{{cite web|title=<i>What Is Home Visiting?</i> Alliance for Early Success|url=https://earlysuccess.org/home-visiting/|access-date=August 15, 2022}}</ref>

==Purpose of enactment==

The purpose of federal funding is to identify the most effective early childhood home visiting programs and strengthen them with standards that will produce measurable and efficient outcomes. BeginningAs withof theOctober programs2013, inception17 instates have introduced 32 bills on Home Visiting Programs before legislature. Beginning September 2010, the Department of [[Health and Human Services]] (HHS) awardsawarded grants to states to develop and implement an early childhood home visitation program to promote.<ref name="ncsl_b">National Conference of State Legislature. [http://www.ncsl.org/documents/health/NCSLVisitGrants.pdf NCSL Fact Sheet on Health Reform. Grants for Early Childhood Home Visitation programs]. Retrieved Oct 20, 2013.</brref>

# 1. Improvements in maternal and prenatal health</br>,

# 2. Infant health</br>,

# 3. Child health and development</br>,

# 4. Parenting related to child development outcomes</br>, and

5. School readiness in child abuse, neglect and injuries.

# School readiness in child abuse, neglect and injuries<ref name="ncsl_b">National Conference of State Legislature. [http://www.ncsl.org/documents/health/NCSLVisitGrants.pdf NCSL Fact Sheet on Health Reform. Grants for Early Childhood Home Visitation programs]. Retrieved Oct 20, 2013.</ref>

==Programs==

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Home visiting services aim to support families who are most disadvantaged, or at risk. This population includes first time parents, low-income parents, single or teen parents, as well as parents with substance abuse or addictions, or mental health issues such as maternal depression.

==Benefit==

=Home Visiting Outcomes=

===Evidence-Based Practices===

[[Evidence-based practice]] means that there has been a set of standards of practices established from clinically proved trials and researches that produced consistently improved outcomes. Individual clinician's training and organizational and systems changes could influence the implementation of clinical guidelines.<ref>Glanz, K., Rimer, B.K., Viswanath, K. (Eds.) (2008). Health Behavior and Health Education (4th edition). San Francisco, CA: Jossey-Bass. Chapter 14, Diffusion of Innovations (pp 313–334).</ref> The review of home visiting programs reports that intensive and frequent visits from trained professionals to families from the prenatal stage up to the second or third years of the child's life produces a positive and improved outcome in maternal and child's health.

===DemonstratedEvidence-based Outcomespractices===

[[Evidence-based practice]] means that there has been a set of standards of practices established from clinically proved trials and researches that produced consistently improved outcomes. Individual clinician's training and organizational and systems changes could influence the implementation of clinical guidelines.<ref>Glanz, K., Rimer, B.K., Viswanath, K. (Eds.) (2008). Health Behavior and Health Education (4th edition). San Francisco, CA: Jossey-Bass. Chapter 14, Diffusion of Innovations (pp 313–334).</ref> The review of home visiting programs reports that intensive and frequent visits from trained professionals to families from the prenatal stage up to the second or third years of the child's life produces a positive and improved outcome in maternal and child's health. The frequency could be as often once a week to at least once or twice every month in the beginning stage of home visits.<ref name="ncsl" />

Quality home visiting programs help parents provide safe and supportive environments for their children, and over time, families and home visitors build strong relationships that lead to lasting benefits for families. Benefits include:

===Evidence-Based Practices===

# Improved Maternal and Child Health</br>During and after pregnancy, home visiting programs promote maternal health by helping mothers schedule regular doctor’s visits, improve diets, reduce stress levels, and quit smoking or substance abuse. Babies benefit as well. One study found that mothers who participated in a home visiting program were half as likely to have a baby born low-birthweight, which greatly reduced these babies risk for health and developmental problems.<ref>{{cite web|title=<i>Benefits of Home Visiting Programs</i> Child and Family Research Partnership, University of Texas|url=https://childandfamilyresearch.utexas.edu/top-5-benefits-home-visiting-programs|access-date=August 15, 2022}}</ref>

Quality practices offered by well-trained home visitors in Home Visiting Programs have been shown to be effective in these areas: lower number of low [[birth weight]] babies, 50% decrease in child abuse or neglect, 25% increase in reading and math test grades in 1-3 grades, 60% increase in high school graduation rate. If trained visitors diligently follow the standards, the cost-benefit studies have demonstrated returns of investment from $1.75 to $5.70 on every dollar spent.<ref name="ncsl_a" />{{unreliable source?|date=May 2014}}

# Improved School Readiness</br>Home visiting programs promote positive parenting practices that help parents better prepare their children for school.Parents enrolled in home visiting programs are more likely to have a safe play environment at home, provide age-appropriate books, and engage children in structured teaching activities. Home visiting programs have also demonstrated long-term, positive impacts on children’s academic achievement.<ref>{{cite web|title=<i>Benefits of Home Visiting Programs</i> Child and Family Research Partnership, University of Texas|url=https://childandfamilyresearch.utexas.edu/top-5-benefits-home-visiting-programs|access-date=August 15, 2022}}</ref>

# Improved Child Safety</br>Home visiting programs are associated with reduced rates of child maltreatment and injuries. In one program, children of participating families experienced 40 percent fewer injuries between the ages of two to four, and they were 35 percent less likely to visit an emergency room compared to children not enrolled. Mothers who participate in home visits also have lower stress levels and increased sensitivity during interactions with their children.<ref>{{cite web|title=<i>Benefits of Home Visiting Programs</i> Child and Family Research Partnership, University of Texas|url=https://childandfamilyresearch.utexas.edu/top-5-benefits-home-visiting-programs|access-date=August 15, 2022}}</ref>

# Improved Economic Self-Sufficiency</br>Mothers with higher levels of education typically can work more hours, drive higher family income levels, and provide more cognitively stimulating home environments for their children. Participating in a home visiting program has been demonstrated to lead to higher rates of enrollment and more hours spent in educational or training programs.<ref>{{cite web|title=<i>Benefits of Home Visiting Programs</i> Child and Family Research Partnership, University of Texas|url=https://childandfamilyresearch.utexas.edu/top-5-benefits-home-visiting-programs|access-date=August 15, 2022}}</ref>

#Reduced government expenditures.</br>Many economists argue short- and long-term benefits of home visiting programs largely outweigh the overall costs incurred from implementation. RAND found that high-fidelity home visiting programs for at-risk families have a $5.70 return for every tax dollar spent from reduced spending for health care and welfare services. Another study of a home visiting program in Durham, North Carolina reported saving $3.00 for every $1.00 spent on the program during an infant’s first six months due to reduced emergency care visits.<ref>{{cite web|title=<i>Benefits of Home Visiting Programs</i> Child and Family Research Partnership, University of Texas|url=https://childandfamilyresearch.utexas.edu/top-5-benefits-home-visiting-programs|access-date=August 15, 2022}}</ref>

== Cost==

===Federal funding===

Social Security Act, Title V, Section 511 (42 USC 711)<ref>{{cite web|title=Home Visiting|url=https://mchb.hrsa.gov/maternal-child-health-initiatives/home-visiting-overview|publisher=Maternal and Child Health Bureau}}</ref> states to conduct a statewide assessment on needs of the at-risk population to be eligible for the grant award. It also requires states to achieve “quantifiable, measurable improvements” on the five areas of family life, listed above. HHS appropriates $100 million for fiscal year 2010, $250 million for FY 2011, $350 million for FY 2012, $400 million for FY 2014. 3% of available funding is reserved to fund Indian Tribes.<ref name="ncsl_b" />

===Responsibility of States===

States also must file a report to the Secretary of HHS on the progress of the program, which must show improvements on at least four areas at the end of the first three-year period. HHS holds authority to terminate the grant to any states that fail to comply or demonstrate improvements. A final report must be submitted to HHS, no later than December 31, 2015.<ref name="ncsl_b" />

==ReferencesBibliography==

{{reflist}}

* [http://www.ncsl.org/research/human-services/child-care-and-early-education-legistation-database.aspx Early Care and Education Legislation Database]. Retrieved Oct 22, 2013. Updated October 21, 2013.