State Home Visiting Programs - Position Statement

I. ASTHO Supports State Home Visiting Programs

The Association of State and Territorial Health Officials (ASTHO) supports state and territorial health agency leadership and collaboration in state home visiting programs, with the ultimate goal of promoting healthy child development and improved health outcomes for children, women, and families in the United States.

II. ASTHO Recommends:

• Integrating state and local public health agencies into a coordinated state home visiting program to promote family health and early childhood development.
• Continuously supporting the work of state and territorial health agency leadership to provide more seamless services to families by improving collaboration across public health programs such as maternal and child health (MCH), primary care, HIV, injury prevention, oral health, chronic disease and behavioral health.
• Creating a comprehensive approach to family needs by integrating and coordinating MCH services and social and medical programs such as WIC, Title X Family Planning, and services to children with special health care needs.
• Assuring health disparities are addressed by incorporating approaches that positively affect the social determinants of health, such as changes to the environments in which families live.
• Collaborating with local public health programs and services that are implemented through local public health departments
• Continuously supporting leadership at the state‐level as they identify regions of greatest need, streamline services, and promote interagency involvement and cooperation.
• Working in cooperation with Medicaid and Early Periodic Screening, Diagnosis, and Treatment to leverage funding and resources.
• Continued funding to ensure that all high‐risk families are being served.
• Awarding federal funding to states through a formula that is equitable and sustainable to build state and local infrastructure and capacity.
• Supporting the identification, sharing, and adoption of promising practices to address the wide variety of needs within states and create the opportunity to demonstrate whether promising practices can be considered model practices.
• Supporting rigorous quality improvement and program evaluation practices to demonstrate program effectiveness, including continuous quality improvement measures in home visiting to demonstrate effectiveness, cost savings or neutrality, and seamless provision of services through training, data collection, and evaluation of evidence‐based programs to make the case for future investments in home visiting.
• Building public awareness, messaging and education to increase public will and support for home visitation.

III. Background: Home Visiting

Home visiting programs have been used since the 1880s to deliver medical, public health, and social services to women, children, and their families in their homes.¹ Home visitors – typically a professional (e.g. nurse) or paraprofessional (e.g. trained former participant of the program or community leader) – regularly visit homes of young children, usually ages zero to five, and their families for a few months to several years, depending on the program. Professional home visitors assess the health and social needs of the family, offer parenting education, and serve as a link to community services. Paraprofessional home visitors make observations about environmental and safety issues within the household and the ability of the family to access services. They also connect the family to health and social services.² Evidence‐based home visitation programs can be an effective method of delivering preventative health and social services to individuals that are at high‐risk for negative health outcomes, including child maltreatment and mental health disorders.³

Throughout the United States, there are 70 state administered or managed home visiting programs in 40 states and territories. Fifty‐six of these programs are administered by a state or territorial health agency, of which five are jointly administered by the health agency and another agency. State‐based home visiting programs not administered by health agencies, are overseen by departments of education, early care and education, mental health, human services, and children's trust funds.⁴

On March 23, 2010, the Patient Protection and Affordable Care Act (PPACA)⁵ was signed into law. The Maternal, Infant and Early Childhood Home Visiting Program, Sec. 2951, created a new section of the Title V Maternal and Child Health Block Grant that gives grants to states to deliver services under early childhood home visiting programs. The purpose of the funding is to improve maternal and child health, school readiness, and socioeconomic status and to reduce child abuse, neglect, and injuries. PPACA provides a total of $1.5 billion over the next five years to support state home visiting programs. Priority is given to families identified as high risk based on health, education and socioeconomic factors.

Approval History

ASTHO Position Statements relate to specific issues that are time sensitive, narrowly defined, or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate Policy Committees and approved by the ASTHO Board of Directors. Position statements are not voted on by the full ASTHO membership.

Access Policy Committee Review and Approval on October 19, 2010.

Board of Directors review and approval on December 6, 2010.

Policy expires on December 6, 2013.

For further information about this Position Statement, please contact ASTHO Access Policy staff at access@astho.org .

Notes

1. Ferguson G. ed, et al. Home Visitor Training Manual: Minnesota Training Partnership. Chapter 2: Introduction to Home Visiting. Minnesota Department of Health. 2001. Handout 1‐1 – 1‐4. Accessed: http://www.health.state.mn.us/divs/fh/mch/HOMEcurriculum/HomeCurriculum.pdf
2. Korfmacher J, O'Brien R, Hiatt S, and Olds D. Differences in program implementation between nurses and paraprofessionals providing home visits during pregnancy and infancy: a randomized trial. Am J Public Health. 1999 December; 89(12): 1847–1851.
3. U.S. Congressional Research Service. Home Visitation for Families with Young Children (R40705; July 5, 2009), by Emilie Stoltzfus and Karen E. Lynch. Text in: LexisNexis® Congressional Research Digital Collection; Accessed: November 2, 2010
4. Johnson K. (2009). National Center for Children in Poverty. State‐based Home Visiting: Strengthening programs through state leadership.
5. Patient Protection and Affordable Care Act. Pub. L. 111‐148. 23 March 2010. 42 USC 18001 http://thomas.loc.gov/cgi%E2%80%90bin/bdquery/z?d111:H.R.3590.