Early Childhood Home Visitation

Research Gaps

Prior to and during the literature review and data analysis, the review team and the Community Preventive Services Task Force attempt to address the key questions of what interventions work, for whom, under what conditions, and at what cost. Lack of sufficient information often leaves one or more of these questions unanswered. The Community Guide refers to these as "research gaps." Research gaps can be pulled together in the form of a basic set of questions to inform a research agenda for those in the field.

Identified Research Gaps

Although we have demonstrated the effectiveness of home visitation in the prevention of child maltreatment, evidence on the other outcomes assessed (violence by children, violence by parents, and intimate partner violence) was insufficient to determine effectiveness. Further research on the effectiveness of home visitation in the prevention of these outcomes would clarify other possible benefits of this intervention. Findings of large, but statistically nonsignificant, effect sizes for some of these outcomes suggest that studies may be of low statistical power; we believe that larger sample sizes should be considered. Suicidal behavior by visited children and diverse forms of victimization should also be assessed as outcomes in home visitation programs. Follow-up studies should determine long-term as well as short-term effects.

The evidence we reviewed indicates a benefit of home visitation for the reduction of child maltreatment in populations that have been shown to be at elevated risk of maltreatment. The population that might benefit is a large one. In 1999, 33% of the 3.6 million births in the United States were to single mothers, 12% were to teen mothers, and 22% were to mothers with less than a high school education; 43% of births—approximately 1.7 million—were to mothers with at least one of these characteristics (B. Hamilton, National Center for Health Statistics, “personal communication,” Sept. 9, 2002). Given such a large need, it will be useful to conduct research, perhaps in the form of demonstration projects, to make the intervention more effective. Because the visitation programs reviewed are heterogeneous and differ in content, organization, personnel, intensity, and other characteristics, questions that should be addressed include:

• What number, spacing, and duration of home visits is optimal for cost-effective programs that are acceptable to visited families?
• What training for professional and paraprofessional home visitors maximizes cost-effectiveness?
• What circumstances enhance the effectiveness of paraprofessional visitors (e.g., educational background and origin)?
• How should the curriculum of home visits be organized, in terms of:
  • structure?
  • specific components and contents?
• How strong is the need for program fidelity (i.e., degree of adherence to initially proposed curriculum and schedule) for the reduction of violent behaviors?
• What is the utility of additional components, such as parent support groups, child daycare, enhanced pediatric care, free transportation to appointments, and linkage with social support services?
• What are the essential components of home visitation programs, and what components are dispensable?
• What populations are most likely to benefit from home visitation programs and what program characteristics are most important for specific populations?

Evidence review

Bilukha O, Hahn RA, Crosby A, et al. The effectiveness of early childhood home visitation in preventing violence: a systematic review. Am J Prev Med 2005;28(2S1):11-39.