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A Look At Home Visiting

Research findings that the best child development occurs within families where all members have adequate support provide a strong rationale for home intervention services. Home visiting also affords a unique opportunity to understand young children and their families in the context of their natural environments and to tailor services to address their individually identified needs efficient). Recent efficacy studies of home-visiting programs have produced mixed and modest results, and home visiting is being questioned as an effective mechanism for service delivery.

However, the home is only a location for intervention services. Many recent evaluations of home-visiting programs have employed rigorous experimental designs but have failed to document the actual nature and content of home visits, the diversity of programs and populations being served, or a theory of how and why a program might work. Thus, groundwork often has not been thoughtful enough to ensure that processes and outcomes are being measured adequately. Guralnick has suggested that "second-generation" program efficacy studies must examine what about a program works for whom.

A Look at Child Development Services for Two Families

Iowa State University researchers have collaborated with Mid-Iowa Community Action, Inc. (MICA) to document the process and content of interventions delivered to 77 families through home visits. Two families receiving Early Head Start services illustrate the notion that home visiting as a service delivery model is complex and not homogenous across families even within a single program.

Observational data describing the process and content of home visits were collected by research staff who accompanied interventionists to families' homes. Observational data were summarized to present the percentages of overall time spent on content areas (for example, child development topics, family topics) and in specific intervention arrangements (for example, facilitating parent-child interaction, providing information). These data were combined with program documentation of hours of home visiting received to calculate total numbers of hours, or dosage, of specific intervention strategies implemented with individual families.

Rita and Kandy are two young mothers who received home-visiting services from MICA's Early Head Start program from late 1996 through 1998; these two women are similar to many other participants in MICA's Early Head Start program. Rita and Kandy were each parenting one child (both of whom were born during summer 1996), as were approximately half of participating families. Rita and Kandy each had a high school diploma, as did the middle one-third of other program participants. Each lived in a small, rural community. Both women were single, as were half of MICA's Early Head Start participants; however, Kandy lived with her son's father during part of this time. Despite many similarities, these two families received very different Early Head Start services.

Both families received home visits from a Child Development Specialist (CDS) and a Family Development Specialist (FDS), and both families received similar numbers of home visits from August 1996 through 1998. However, Rita's family received far more child development services than did Kandy's family. Rita's family received 113 home visits (160 hours), but 65 of these visits (99 hours) were made by the CDS. Kandy's 109 visits were split almost evenly between CDS visits (55 visits and 68 hours) and FDS visits (54 visits and 61 hours).

Closer examination of the content and process of intervention services delivered through these home visits reveals even greater differences. Not surprisingly, CDS visits for both families focused primarily on child-related content; however, child-related content was an important element of FDS visits as well. Rita's CDS visits focused on child-related content 51 percent of the time, translating into 51 total intervention hours with this focus. Rita's FDS visits focused on child-related content 23 percent of the time, accounting for an additional 14 hours of child-related intervention. Further examination reveals that the CDS spent 19 hours and the FDS spent 5 hours engaging Rita's son and supporting his interactions directly by teaching the child themselves, modeling interactions for Rita, or coaching Rita's interactions with her son. In contrast, Kandy received 51 hours of child-related intervention-43 hours from the CDS and 9 hours from the FDS. Interventionists working with Kandy's family spent 18 hours during home visits engaging her son directly.


Seemingly, greater emphasis on a specific content area and/or strategy should translate into more powerful intervention outcomes in the targeted area(s). However, an established theory of change should guide intervention design and implementation for both programs, as well as for individual families. Furthermore, systematic study of the links between intervention activities, outcomes, and contexts is necessary to refine intervention services effectively and to guide policy recommendations adequately.

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