Preventing Adverse Childhood Experiences: A Framework for Culturally Responsive Home Visitation

Introduction: Adverse childhood experiences (ACEs) are associated with negative health and developmental outcomes, which can persist across generations. Home visitation is a key strategy to support families impacted by ACEs. Yet, evidence-based home visitation models may not fully capture the complexities, including culture, involved in preventing intergenerational ACEs. Methods: Using a critical narrative review approach, data were extracted from the Maternal, Infant, and Early Childhood Home Visiting program and PubMed databases related to theoretical foundations and features of 13 evidence-based home visitation models. Results: Ten theories underpinned the models, predominantly focused on behavioral correction. Nurse-led models and ACEs measurement were rare. Cultural responsiveness varied widely. Discussion: The findings highlight a gap between home visitation frameworks and the factors that influence exposure to and prevention of ACEs. The proposed Culturally Responsive Home Visitation framework integrates equity, resilience, and service integration to guide research, practice, and policy aimed at preventing intergenerational ACEs.