The first 5 years of life are the building blocks for children’s future health, development, and academic achievement. In fact, children’s early experiences and interactions with adults shape brain development and serve as the foundation for subsequent learning. Early childhood home visiting empowers parents and caregivers to meet their family’s needs and to engage more fully in their children’s care and growth. It also helps them remove barriers to doing so. Participation benefits adults and children alike.

As a two-generation approach, home visiting has the potential to improve outcomes across a range of domains, such as child health, school readiness, parent economic well-being, and parenting practices. The evidence base for home visiting, including its cost effectiveness, is strong and growing. Below are examples of home visiting’s demonstrated impact on critical needs (see sources at bottom of page):

Cost

Studies have found a return on investment of $1.80 to $5.70 for every dollar spent on home visiting. This strong return on investment is consistent with established research on other types of early childhood interventions.

Healthy Pregnancies

Home visitors work with expectant caregivers to ensure optimal care in pregnancy. Pregnant women who participate in home visiting are more likely to access prenatal care and carry their babies to term—and less likely to have babies with low birthweight—compared to other pregnant women.

Healthy Babies

Home visitors educate parents on infant caregiving practices. This support can contribute to babies’ overall health. For example, some research has identified higher rates and duration of breastfeeding among mothers participating in home visiting, compared to nonparticipants; breastfeeding has likewise been associated with children’s cognitive development, and positive maternal and child health outcomes.

 

Safe Homes

Home visitors can improve child safety by increasing parents’ awareness of potential safety hazards, such as improper car seat use, lead exposure, and shaken baby syndrome. Participating parents implement more safety practices (e.g., safe sleep) and mobilize more resources toward their child than nonparticipants. Participants’ children are also less likely to need emergency medical care compared with children in families who do not participate in home visiting.

Nurturing Relationships

Home visitors teach parents how to engage with their children in positive, nurturing, and responsive ways, thus reducing child maltreatment. Families participating in home visiting have fewer Child Protective Services (CPS) reports than families who do not receive home visiting. Participating parents also show more positive parenting practices and interactions with their children—and less hostile or coercive parenting styles—compared to their peers.

Optimal Early Learning and Academic Success

Home visiting can benefit children’s overall health, development, and well-being. Children whose families participate in home visiting receive more stimulation and support for learning, and more reading time with their parents, compared to children of nonparticipants. Services can also improve the quality of the home environment. In the long run, children of home visiting participants demonstrate improved early language and cognitive development, greater math and reading achievement, reduced absenteeism rates, and decreased in-school and out-of-school suspensions compared to their peers.

Thriving Parents

Home visitors help parents set goals to support their parenting, mental health, financial, and educational well-being. This support can translate to better education and employment outcomes. Compared with their counterparts, parents enrolled in home visiting have higher monthly incomes, are more likely to be enrolled in school, and are more likely to be employed. For mothers in particular, home visiting improves physical and mental health, and reduces depressive symptoms and parenting stress. Several studies show that participating parents are more likely to be enrolled in school or training activities, and to be employed, than nonparticipants—activities that can lead to greater earnings in the long term.

 

 

Sources by Domain

Introduction
Adirim, T., & Supplee, L. (2013). Overview of the federal home visiting program. Pediatrics, 132(Supplement 2), S59–S64.
Institute of Medicine and National Research Council. (2000). From neurons to neighborhoods: The science of early childhood development (J. P. Shonkoff & D. A. Phillips, Eds.) National Academies Press. https://doi.org/10.17226/9824
Shonkoff, J. P., Garner, A. S., Siegel, B. S., Dobbins, M. I., Earls, M. F., McGuinn, L., Pascoe, J., Wood, D. L, & Committee on Early Childhood, Adoption, and Dependent Care. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246.

Cost
Karoly, L. A., Greenwood, P. W., Everingham, S. S., Hoube, J., Kilburn, M. R., Rydell, C. P., Sanders, M., & Chiesa, J. (1998). Investing in our children: What we know and don’t know about the costs and benefits of early childhood interventions. RAND Corporation. https://www.rand.org/pubs/monograph_reports/MR898.html 
Masse, L. N., & Barnett, W. S. (2002). A benefit-cost analysis of the Abecedarian early childhood intervention. In H. M. Levin & P. J. McEwan (Eds.), Cost-effectiveness and educational policy (pp. 157–173). Eye on Education, Inc.
Pew Center on the States. (2011). Policy framework to strengthen home visiting programs. http://www.pewtrusts.org/~/media/legacy/uploadedfiles/pcs_assets/2011/ HomeVisitingmodelpolicyframeworkpdf.pdf

Healthy Pregnancies
Issel, L. M., Forrestal, S. G., Slaughter, J., Wiencrot, A., & Handler, A. (2011). A review of prenatal home-visiting effectiveness for improving birth outcomes. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 40(2), 157–165.
LeCroy, C. W., & Lopez, D. (2020). A randomized controlled trial of Healthy Families: 6-month and 1-year follow-up. Prevention Science21(1), 25–35. https://doi.org/10.1007/s11121-018-0931-4
Lutenbacher, M., Elkins, T., Dietrich, M. S., & Riggs, A. (2018). The efficacy of using peer mentors to improve maternal and infant health outcomes in Hispanic families: Findings from a randomized clinical trial. Maternal and Child Health Journal22(S1), 92–104. https://doi.org/10.1007/s10995-018-2532-z
Mersky, J. P., Janczewski, C. E., Plummer Lee, C. T., Gilbert, R. M., McAtee, C., & Yasin, T. (2020). Home visiting effects on breastfeeding and bedsharing in a low-income sample. Health Education & Behavior48(4), 488–495. https://doi.org/10.1177/1090198120964197
Victora, C. G., Horta, B. L., de Mola, C. L., Quevedo, L., Pinheiro, R. T., & Gigante, C. (2015). Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: A prospective birth cohort study from Brazil. The Lancet Global Health, 3(4), e199–e205.
Williams, C. M., Cprek, S., Asaolu, I., English, B., Jewell, T., Smith, K., & Robl, J. (2017). Kentucky Health Access Nurturing Development Services home visiting program improves maternal and child health. Maternal and Child Health Journal, 21(5), 1166–1174. https://doi.org/10.1007/s10995-016-2215-6

 

Safe Homes
Goodman, W. B., Dodge, K. A., Bai, Y., Murphy, R. A., & O’Donnell, K. (2021). Effect of a universal postpartum nurse home visiting program on child maltreatment and emergency medical care at 5 years of age: A randomized clinical trial. JAMA Network Open4(7). https://doi.org/10.1001/jamanetworkopen.2021.16024
Kilburn, M. R., & Cannon, J. S. (2019). Home visiting for first-time parents: Community innovation. The Future of Children29(1), 81–97. https://doi.org/10.1353/foc.2019.0004
LeCroy & Lopez, 2020.
Lutenbacher et al., 2018.
Michalopoulos, C., Faucetta, K., Hill, C. J., Portilla, X. A., Burrell, L., Lee, H., Duggan, A., & Knox, V. (2019). Impacts on family outcomes of evidence-based early childhood home visiting: Results from the Mother and Infant Home Visiting Program Evaluation (OPRE Report No. 2019-07). Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. https://www.acf.hhs.gov/sites/default/files/documents/opre/mihope_impact_report_final20_508_0.pdf

Nurturing Relationships
Chaiyachati, B. H., Gaither, J. R., Hughes, M., Foley-Schain, K., & Leventhal, J. M. (2018). Preventing child maltreatment: Examination of an established statewide home-visiting program. Child Abuse & Neglect79, 476–484. https://doi.org/10.1016/j.chiabu.2018.02.019
Del Grosso, P., Hargreaves, M., Paulsell, D., Vogel, C., Strong, D. A., Zaveri, H., Angus, M. H., Coffee-Borden, B., Cole, R., Barrett, K., Boller, K., & Daro, D. (2011). Building infrastructure to support home visiting to prevent child maltreatment: Two-year findings from the cross-site evaluation of the Supporting Evidence-Based Home Visiting Initiative. Children’s Bureau, Administration on Children, Youth and Families, U.S. Department of Health and Human Services.
Easterbrooks, M. A., Kotake, C., & Fauth, R. (2019). Recurrence of maltreatment after newborn home visiting: A randomized controlled trial. American Journal of Public Health109(5), 729–735. https://doi.org/10.2105/ajph.2019.304957
Goodman et al., 2021.
LeCroy & Lopez, 2020.
Michalopoulos et al., 2019.

Optimal Early Learning and Academic Success
Lahti, M., Evans, C. B. R., Goodman, G., Schmidt, M. C., & LeCroy, C. W. (2019). Parents as Teachers (PAT) home-visiting intervention: A path to improved academic outcomes, school behavior, and parenting skills. Children and Youth Services Review99, 451–460. https://doi.org/10.1016/j.childyouth.2019.01.022
LeCroy & Lopez, 2020.
Michalopoulos et al., 2019.
Olds, D. L., Kitzman, H., Hanks, C., Cole, R., Anson, E., Sidora-Arcoleo, K., Luckey, D.W., Henderson, C.R., Holmberg, J., Tutt, R.A., &  Stevenson, A. J. (2007). Effects of nurse home visiting on maternal and child functioning: Age-9 follow-up of a randomized trial. Pediatrics, 120(4), e832–e845.
Raikes, H. A., Robinson, J. L., Bradley, R. H., Raikes, H. H., & Ayoub, C. C. (2007). Developmental trends in self regulation among low-income toddlers. Social Development, 16(1), 128–149


Thriving Parents
Chazan-Cohen, R., Raikes, H. H, & Vogel, C. (2013). Patterns of impacts for home-based, center-based, and mixed-approach programs. Monographs of the Society for Research in Child Development, 78(1): 93–109.
Jones Harden, B., Chazan-Cohen, R., Raikes, H., & Vogel, C. (2012). Early Head Start home visitation: The role of implementation in bolstering program benefits. Journal of Community Psychology, 40(4), 438–455.
LeCroy, C. W., & Krysik, J. (2011). Randomized trial of the Healthy Families Arizona home visiting program. Children and Youth Services Review, 33(10), 1761–1766.
Landsverk, J., Carrilio, T., Connelly, C. D., Ganger, W. Slymen, D., Newton, R., Leslie, L., & Jones, C. (2002). Healthy Families San Diego clinical trial: Technical report. The Stuart Foundation, California Wellness Foundation, State of California Department of Social Services: Office of Child Abuse Prevention.
LeCroy & Lopez, 2020.
Love, J. M., Eliason, E., Ross, C. M., Schochet, P. Z., Brooks-Gunn, J., Paulsell, D., Boller, K., Constantine, J., Vogel, C., Fuligni, A. S., & Brady-Smith, C. (2002). Making a difference in the lives of infants and toddlers and their families: The impacts of Early Head Start. Volumes I-III: Final technical report [and] appendixes [and] local contributions to understanding the programs and their impacts. Head Start Bureau, Administration for Children, Youth and Families, Administration for Children and Families, U.S. Department of Health and Human Services. https://files.eric.ed.gov/fulltext/ED472186.pdf
Lutenbacher et al., 2018.
Michalopoulos et al., 2019.
Olds, D. L., Henderson Jr., C. R., Tatelbaum, R., & Chamberlin, R. (1988). Improving the life-course development of socially disadvantaged mothers: A randomized trial of nurse home visitation. American Journal of Public Health, 78(11), 1436–1445.
Sama-Miller, E., Akers, L., Mraz-Esposito, A., Zukiewicz, M., Avellar, S., Paulsell, D., & Del Grosso, P. (2018). Home visiting evidence of effectiveness review: Executive summary (OPRE Report No. 2018-113). Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. https://www.acf.hhs.gov/sites/default/files/documents/opre/HomVEE_Executive%20Summary%20October%202018_0.pdf