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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Forgone Health Care.

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Strategy. Home Visiting

Approach. Utilize home visiting program to increase and expedite utilization of needed health care services, such as early intervention

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Overview. Home visiting programs, particularly for families with infants and young children, can provide support and guidance on various aspects of child health, including the importance of seeking preventive and acute care. Home visitors can also help families schedule appointments, connect with healthcare providers, and reinforce the benefits of regular medical care. Studies report higher numbers of medical appointments and more compliant immunization histories for families of low birth weight preterm infants at high risk for poor health outcomes after discharge from a hospital NICU[1] and greater utilization of early intervention services during two important developmental time points[2] due to home visiting. Evidence suggests that home visiting is an effective way to ensure that children and their families are receiving care in a timely and supportive manner.

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Direct Care (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of families enrolled in home visiting programs that include health care coordination and service linkage. (Measures reach of intervention.)
  • Number of home visits conducted to assess child health needs, provide education, and facilitate connections to care. (Captures dose of intervention.)
  • Number of home visitors trained to deliver evidence-based health promotion, care coordination, and service navigation support. (Assesses workforce capacity.)

OUTCOME MEASURES:

  • Number of children who receive recommended developmental screenings and early intervention services through home visiting programs. (Measures impact on preventive care.)
  • Number of families who establish connections to medical homes and regularly access well-child care as a result of home visiting. (Captures impact on care continuity.)
  • Number of children with developmental delays or disabilities who achieve improved outcomes through early intervention accessed via home visiting. (Indicates impact on child development.)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of home visiting encounters that include comprehensive assessment of child health needs and family strengths and risks. (Measures fidelity to assessment practices.)
  • Percent of home visiting staff who demonstrate cultural competence and deliver services in a linguistically appropriate manner. (Assesses cultural responsiveness.)
  • Percent of home visiting programs that use quality improvement methods to continuously enhance service delivery and outcomes. (Captures commitment to improvement.)

OUTCOME MEASURES:

  • Percent of children enrolled in home visiting who are up-to-date on all recommended preventive health care services and immunizations. (Measures preventive care impact.)
  • Percent of families who report increased knowledge, skills, and confidence in managing their children's health needs as a result of home visiting. (Assesses family empowerment.)
  • Percent of children with chronic health conditions who achieve better management and control through support provided by home visitors. (Captures impact on care quality and outcomes.)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of cross-sector partnerships (e.g., healthcare, early childhood, social services) established to strengthen home visiting service delivery and impact. (Measures collaborative infrastructure.)
  • Number of policies and funding streams that support the integration of home visiting into early childhood systems of care. (Assesses enabling environment.)
  • Number of home visiting programs that scale evidence-based models and best practices to reach more families in need. (Captures spread and scale.)

OUTCOME MEASURES:

  • Number of communities that achieve sustained improvements in child health outcomes and equity through home visiting initiatives. (Measures population health impact.)
  • Number of home visiting programs that demonstrate positive return on investment through reduced healthcare costs and improved child outcomes. (Captures economic impact.)
  • Number of successful home visiting innovations and insights disseminated and adopted across communities and states. (Assesses field-building impact.)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of home visiting programs that prioritize outreach and enrollment of families experiencing the greatest health disparities. (Measures equity focus.)
  • Percent of home visiting staff and leadership who reflect the linguistic, cultural, and lived experiences of the communities they serve. (Assesses workforce diversity and representation.)
  • Percent of home visiting programs that engage families and community partners in co-designing and improving services to meet unique needs. (Captures participatory design practices.)

OUTCOME MEASURES:

  • Percent reduction in disparities in maternal and child health outcomes between families receiving home visiting services and comparison populations. (Measures equity impact.)
  • Percent of children from historically marginalized communities who reach developmentally appropriate milestones through home visiting support. (Captures equity in child development.)
  • Percent increase in community-wide awareness, trust, and utilization of home visiting and early childhood services among underserved populations. (Assesses community engagement and equity.)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] McKelvey, L. M., Lewis, K. N., Beavers, J., Casey, P. H., Irby, C., & Goudie, A. (2021). Home Visiting for NICU Graduates: Impacts of Following Baby Back Home. Pediatrics, 148(1), e2020029397.

[2] Bowers, K., Folger, A. T., Zhang, N., Sa, T., Ehrhardt, J., Meinzen-Derr, J., Goyal, N. K., Van Ginkel, J. B., & Ammerman, R. T. (2018). Participation in Home Visitation is Associated with Higher Utilization of Early Intervention. Maternal and child health journal, 22(4), 494–500.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.