Home Visiting: The Expansion of an Idea 


Investing in home-based services for pregnant women and new parents is a topic of high interest. Of the myriad ways to reach out to young children and their parents, home visiting has surfaced as a uniquely promising approach for promoting the early intervention mission.

These features include:

Reaching new parents in a nonstigmatizing manner: Outside of public education, prenatal and obstetric care are among the most broadly accessed services in the United States. Offering home visiting within a health care framework engages new parents without requiring them to be singled out as facing unique difficulties. Similarly, all parents share a common interest in preparing their children for later learning and insuring they are well positioned to nurture their child’s healthy development and early learning.

Minimizing barriers to accessing service: Accessing any intervention can be daunting, particularly for parents lacking experience and skills in navigating complex service delivery systems. Home visiting helps parents overcome barriers to service access and connects families with appropriate supports in a timely manner.

Individualizing the message: Home visiting providers tailor their messages to fit a parent’s specific knowledge, skills, cultural beliefs, and learning style. Personalizing services is particularly important given the racial, ethnic, and socioeconomic diversity of a state’s new parent population.

Opportunities to evaluate the home environment and engage other caregivers: Delivering services within a participant’s home offers a unique opportunity to determine the physical safety of a child’s most proximate environment. Repeated home visits allow for a more nuanced assessment of the home’s general stability, relationships among family members, and availability of informal and formal supports.

Since the early 1970s, home visiting programs have proliferated in the United States. They have been promoted as a strategy to engage parents in their young child’s early learning, to insure a new mother and her infant have access to a high-quality medical home, and to address parental and contextual challenges that place a young child at risk for child maltreatment or poor developmental outcomes. Changes to federal policy in 1989 allowed states to use Medicaid dollars to support early home visiting. Over the past 40 years, several states, such as Arkansas, Delaware, Florida, Hawaii, Kentucky, Minnesota, Missouri, Rhode Island, Vermont, and West Virginia, have used these funds, and state-generated resources, to expand home visiting programs they found promising or establish at least one new parent initiative to support a parent concerned about how she might best care for her children. Federal investments in home visiting also were available through the Child Abuse Prevention and Treatment Act (CAPTA). In the 2003 CAPTA reauthorization, voluntary home visiting was identified as one of the core Community-Based Child Abuse Prevention (CBCAP) program services included in Title II of the Act.

In 2010, Congress passed the Maternal, Infant and Early Childhood Home Visiting Program (MIECHV) as part of the Patient Protection and Affordable Care Act (ACA). The bill provided for a $1.5 billion public investment to assist states, territories, and tribal entities in replicating evidence-based, targeted home visiting programs and building a comprehensive early childhood system to promote the health and safety of pregnant women, children ages 0–8, and their families. This legislation, while dramatically increasing home visiting services across the country, benefited from the early replication work achieved by states, often working in partnership with one or more national home visiting models.

This video provides a visual of how home visiting has spread throughout the country as seen through the lens of five evidence-based home visiting models. These five include four of the oldest and most widely available models in the country (Healthy Families America, Home Instruction for Parents of Preschool Youngsters – HIPPY, Nurse Family Partnership, and Parents as Teachers) as well as one of the newer models gaining increased attention (SafeCare). The video does not represent all investments—either state or federal—in home visiting at any point in time. Rather, it illustrates the date at which each model’s current affiliate agencies began enrolling families. Collectively, the video illustrates how these five models have expanded over the years and how communities increasingly gained access to a greater array of home visiting options.The continued expansion of home visiting and the ability to provide families with access to an array of strategies is essential if the approach is to achieve its goal of providing all parents the capacity they need to insure their child’s healthy development and safety.

Source: Chapin Hall at the University of Chicago

Available at: https://vimeo.com/134656037

One of the Best Gifts for a Baby: Head Start Health Services Newsletters


One of the most important things women can do for their babies is eat healthy foods during pregnancy. Eating and drinking whole-grain products, fruits and vegetables, low-fat milk and milk products, lean meats, and other nutritious items during pregnancy gives babies a strong start in life. This issue provides information Early Head Start staff can share with pregnant women. The issue also includes descriptions of assistance programs that provide nutrition risk assessment, counseling, and education as well as access to supplemental nutritious foods.

Source: Early Childhood Learning and Knowledge Center, National Center on Health

Available at: http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/health/docs/health-services-newsletter-201505.pdf

Healthy and Ready to Learn: The Importance of Health Services in Head Start


By Marco Beltran

When you think about a high-quality early childhood program, what does it look like? Does it look different for children from low-income families? Very few early childhood programs are designed to address the complex needs of their communities. Yet, Head Start, which serves pregnant women and children ages birth to 5 from low-income families, is designed to address the individual child, family, and community.

Low-income families may face a lack of safe housing, food insecurity, and unsteady employment. They may not have access to a continuous source of medical and dental care, or live in neighborhoods with community violence or substance abuse. Research tells us that poverty is closely linked to poor developmental, physical, and mental health outcomes. In fact, growing evidence shows that educational achievement disparities start to take place early in a child’s life.

Unless these disparities are addressed, children from low-income families are less likely to escape the cycle of poverty. Research also shows that young children from families with incomes at 200 percent of poverty and below are significantly behind their more advantaged peers in cognitive development as early as age 2. This developmental achievement gap continues as children enter school.

The urgency placed on programs like Head Start to address disparities in early learning and school readiness is reinforced by the changing demographics of families with young children. U.S. poverty rates are increasing for families with young children. In terms of health outcomes, a family’s income status has a direct effect on access to health care and good overall health.

Studies show that low-income children don’t always receive all of their required immunizations. This puts them at a higher risk for preventable infections and long-term illness. They have less access to a continuous source of medical and dental care. As a result, when a child gets sick, their parent or guardian is more likely to go to an emergency room where there is no continuity of care and the out of pocket fees are higher. They also tend to miss more school days because of illness, putting them further behind their more advantaged peers in terms of educational achievement.

Health disparities appear among communities of color and low-income families in terms of insurance coverage and food insecurity. In particular, asthma rates are higher in black and Hispanic children and these children tend to have poorer health outcomes related to asthma. However, Head Start has the unique opportunity to address these types of health and educational disparities for the families we serve.

Head Start was initially launched in 1965 by President Lyndon Johnson as result on the “War on Poverty.” It was designed to help preschool-aged children prepare for school by reducing the effects of poverty. It addresses the “whole” child’s social, emotional, health, and nutritional needs.

Dr. Robert Cooke was a pediatrician and expert member of the initial Head Start Steering Committee. He believed that in order for the eight-week Head Start program to be effective in preparing children for school, it must include health services as well as education and social services activities. His recommended health services included the following, many of which are still required today:

  • Ensuring needed medical assessments, dental examinations, and immunizations
  • Assisting in the provision of eyeglasses and hearing aids
  • Establishing continuity of health services, including a medical and dental home
  • Developing family awareness around community health resources
  • Establishing sound nutritional practices in the home
  • Sharing of pertinent health information to school systems
  • Screening for special needs, problems, and strengths

Almost 50 years later, the Office of Head Start has not diverged from its original purpose: “To promote school readiness by enhancing the social and cognitive development of low-income children through health, education, nutrition, social, and other services.” Building upon our history, we have a developed a health vision for Head Start that says, “Head Start will ensure that all children are healthy and ready for school.”

Marco Beltran is a Program Specialist for the Office of Head Start. This blog is crossposted from the ACF Family Room blog.

Source: Early Childhood Learning and Knowledge Center

Available at: http://eclkc.ohs.acf.hhs.gov/hslc/hs/news/blog/ready-to-learn.html

Toddlers in Early Head Start: A Portrait of 2-Year-Olds, Their Families, and the Programs Serving Them 


This report describes findings from the second wave of data collection for the Early Head Start Family and Child Experiences Survey (Baby FACES) conducted by Mathematica Policy Research. Baby FACES is a longitudinal study in 89 Early Head Start programs around the country. Baby FACES follows two cohorts of children through their time in Early Head Start, starting in 2009, the first wave of data collection. The Newborn Cohort includes 194 pregnant mothers and newborn children. The 1-year-old Cohort includes 782 children who were approximately 1 year old (10 to 15 months). This report focuses primarily on children in the 1-year-old Cohort who were 2 years old in 2010. However, the technical appendix provides information on the Newborn Cohort (when children were 1 year old). The report addresses the following questions:1. What is Early Head Start? What are the program models employed, staff qualifications, and other important program features and characteristics?2. What specific services are delivered to families and what is their quality?3. What are the characteristics of the families Early Head Start serves in terms of their demographic, household, and family characteristics; their needs; and their risk factors?4. How are Early Head Start children and families faring over time?5. How many children and families leave the program early? When do exits occur and what do families experience while they are enrolled?

Source: Office of Planning, Research & Evaluation, Administration for Children and Families

Available at: http://www.acf.hhs.gov/programs/opre/resource/toddlers-in-early-head-start-a-portrait-of-2-year-olds-their-families-and-the-programs-serving-them

Healthy Habits for Happy Smiles Series

January 2014

This series of handouts for pregnant women and parents of infants and young children provides simple tips on oral health issues. Head Start and Early Head Start staff are encouraged to share the handouts with families to promote good oral health. The handouts are available in English and Spanish.

Source: Early Childhood Learning and Knowledge Center

Available at: http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/health/oral-health/education-activities/healthy-habits.html

MCH Navigator: A Training Portal for MCH Professionals

Georgetown University’s MCH Navigator and MCH Library are pleased to support the Association of Maternal and Child Health Programs (AMCHP) with this list of online trainings and resources for use by the Title V workforce in addressing cultural and linguistic competency as a way of addressing health disparities, health equity, and removing barriers to care.

Source: U.S. Maternal and Child Health Bureau

Available at: http://www.mchnavigator.org/trainings/cultural-competency.php