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No Place Like Home: State Home Visiting Policies and Programs

Whether convinced by mounting scientific evidence or prodded by political pressure, policymakers throughout the country have been placing more emphasis on early child development in recent years. As a result, many states and communities have set up home visiting programs through which new parents can receive child-rearing guidance at home from trained nurses and other pediatric professionals.

In her study No Place Like Home: State Home Visiting Policies and Programs, Kay Johnson finds that although states and local communities vary in their approach to home visiting, they face similar challenges-setting realistic program expectations, coordinating efforts of multiple agencies, and assuring the quality of services provided. The study, which was supported by The Commonwealth Fund, was based on a survey of states with child home visiting programs aimed primarily at low-income families.

Several trends in recent years have led many states to invest substantially in home visiting programs, among them a growing public awareness of research into infant and brain development, a stronger focus on early education and school preparedness, and state expansions of child health insurance coverage. Of the 42 states that responded to the survey, 37 reported they operate home visiting programs. Three other states have quality improvement or technical assistance projects that support a range of locally based programs.

Eager to establish home visiting services in their state, child advocates and state officials often use all evidence at their disposal in selling the concept to lawmakers, says the report. In the process, however, they often promise greater results than can be achieved. States may need to narrow program objectives and limit expectations for child outcomes. Another key issue facing states is the coordination of multiple home visiting programs and the services each provides.

The report recommends that states establish a continuum of early childhood services addressing a wide range of needs, from pregnancy planning and prenatal services to infant assessments and parent education. At the same time, it calls for greater emphasis on quality and for new mechanisms to improve interagency coordination.

Facts and Figures

  • States' most frequently cited reasons for launching home visiting programs are: improving parenting skills (81%), enhancing child development (76%), and preventing abuse and neglect (71%).
  • These states spend the most on home visiting: Florida, Illinois, Michigan, New York, Ohio, Oklahoma, and Washington. Each has budgeted $10 million to $50 million a year for one or more programs.
  • Thirty-five of the 49 programs studied are currently or will soon be undergoing a formal evaluation to assess performance and determine family participation and retention rates.

Publication Details



No Place Like Home: State Home Visiting Policies and Programs, Kay A. Johnson, The Commonwealth Fund, May 2001