Challenges and Best Practices for Scaling Home Visiting Programs

Strum the American heartstrings, and you'll hear a familiar triad of affections: baseball, apple pie, and parenthood. Americans are eager parents—our birth rates, while falling, remain well above many other developed countries.

We so revere the practice of parenting, however, that we generally accept that it must necessarily be sacred to the point of magic. “You can’t legislate morality,” goes the truism; most legislators put “parenting” in that same category. In education debates, it's common to hear folks resign themselves to the standard of American parenting. They assume that nothing can be done to improve ineffective parents' approach to childrearing. If policymakers are uncomfortable reforming local education practices, they’re almost always unwilling to touch parents’ sphere of influence—the home.

Notwithstanding this general current, some have suggested that home visiting programs targeted at improving American parenting could make a big difference in children’s lives. There is some evidence that these programs can, among other things, lower kids’ chances of becoming teen parents and/or dropping out of school. As so often is the case, however, this research often detects results for programs with limited scope and projects their potential effects for the entire country—assuming that the program could be expanded without diluting its quality.

It’s easy to care about parenting—and to want to make it better. But it’s somewhat more difficult to build and scale effective home visiting programs that can change American parents’ practice for the better.

A recent Mathematica study digs into the challenges of faithfully implementing, scaling up, and sustaining home visiting programs. It investigated the effects of the Supporting Evidence-Based Home Visiting to Prevent Child Maltreatment initiative. The program funded organizations to design and implement programs by selecting from a set of five evidence-based home visiting models (Healthy Families America, the Nurse-Family Partnership, Parents as Teachers, SafeCare, and Triple P).

The study found that grantees successfully met a number of “fidelity standards.” They were usually successful at “hiring and training appropriate staff, obtaining appropriate referrals, delivering most of the planned visits, and covering the planned content during the home visits.” However, many struggled to maintain consistent contact with family partners at the level of intensity required by the various home visiting models. In technical terms, grantees sometimes struggled to maintain the requisite “intensity” of the home visiting model(s) they had chosen and to retain families participating in the program.

Fortunately, the study discovered ways that some programs were able to respond to these challenges. Above all, grantees that built an “infrastructure” for planning, collecting data, and ensuring sustainability were somewhat more likely to guarantee that expanding programs were implemented faithfully and effectively. They found some evidence that effective gathering and transparent use of data helped programs to think carefully about the state of their implementation work.

With federal home visiting programs under scrutiny—and facing elimination without congressional action—this research is particularly timely (click here for more from CLASP). It echoes what we usually find when considering public investments in early education: new initiatives need to be both well-funded and supported by systems to collect effectiveness data. It’s easy to care about parenting—and to want to make it better. But it’s somewhat more difficult to build and scale effective home visiting programs that can change American parents’ practice for the better. Fortunately, this study shows that “somewhat more difficult” does not mean “impossible."