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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Medical Home: Personal Doctor or Nurse.

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Strategy. Home Visiting Programs

Approach. Implement home visiting programs, particularly for families with young children, to provide support and guidance on various aspects of child health

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Overview. Home visiting programs for families with young children can provide support and guidance on various aspects of child health, including the importance of having a personal doctor or nurse. Home visitors can help families schedule appointments, connect with healthcare providers, and reinforce the benefits of regular medical care. A home visiting model that focuses on family support,[1] collaboration between between nurse home visitors and primary care providers,[2], and home-based primary care particularly for children with medical complexity[3] can improve service delivery for children and families and help optimize healthcare utilization with trusted providers. The benefits of home visiting for children and their families are well documented and may also be a way to create connections to a personal doctor or nurse.

Evidence. Expert Opinion. Strategies with this rating are recommended by credible, impartial experts, guidelines, or committee statements; these strategies are consistent with accepted theoretical frameworks and have good potential to work. Often there is literature-based evidence supporting these strategies in related topic areas that indicate this approach would prove effective for this issue. Further research is needed to confirm effects in this topic area.

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 evidence-based home visiting programs established for families with young children. (Measures expansion of services supporting child health and connection to medical homes)
  • Number of families with young children actively participating in home visiting programs. (Assesses reach and engagement in services that promote regular healthcare)

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

PROCESS MEASURES:

  • Percent of home visiting programs consistently implementing evidence-based practices for child health promotion. (Assesses alignment with proven effective strategies)
  • Percent of families participating in collaborative goal-setting for child health during home visits. (Measures implementation of family-centered approach in health planning)

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

PROCESS MEASURES:

  • Number of families reporting increased comfort in accessing and utilizing primary care services after home visiting. (Assesses program impact on healthcare engagement)
  • Number of families showing increased understanding of child health and healthcare navigation after home visits. (Evaluates impact on health literacy and family support)

OUTCOME MEASURES:

  • Number of communities showing improved child health indicators after implementing home visiting programs. (Assesses population-level health improvements linked to the strategy)
  • Number of policy or systems changes supporting integration of home visiting with primary care services. (Evaluates broader impact on child health systems)

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

PROCESS MEASURES:

  • Percent of families reporting increased comfort in accessing and utilizing primary care services after home visiting. (Assesses program impact on healthcare engagement)
  • Percent of families showing increased understanding of child health and healthcare navigation after home visits. (Evaluates impact on health literacy and family support)

OUTCOME MEASURES:

  • Percent of communities showing improved child health indicators after implementing home visiting programs. (Assesses population-level health improvements linked to the strategy)
  • Percent of policy or systems changes supporting integration of home visiting with primary care services. (Evaluates broader impact on child health systems)

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] Barboza, M., Kulane, A., Burström, B., & Marttila, A. (2018). A better start for health equity? Qualitative content analysis of implementation of extended postnatal home visiting in a disadvantaged area in Sweden. International journal for equity in health, 17(1), 1-9.

[2] Williams, V. N., Lopez, C. C., Tung, G. J., Olds, D. L., & Allison, M. A. (2022). A case study of care co‐ordination between primary care providers and nurse home visitors to serve young families experiencing adversity in the Northwestern United States. Health & Social Care in the Community, 30(4), 1400-1411.

[3] Lin, E., Scharbach, K., Liu, B., Braun, M., Tannis, C., Wilson, K., & Truglio, J. (2020). A multidisciplinary home visiting program for children with medical complexity. Hospital Pediatrics, 10(11), 925-931.

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.