Theoretical foundations of a program of home visitation for pregnant women and parents of young children

This article reviews the theoretical foundations of a program of prenatal and early childhood home visitation that has been tested and refined over the past two decades while it was examined in a series of three randomized trials. It describes the role that theories of self-efficacy, human attachment, and human ecology have played in shaping the content and clinical methods of the program. The program was designed to improve: (1) the outcomes of pregnancy; (2) qualities of parental caregiving (and associated child health and developmental outcomes); and (3) maternal life-course development (helping women return to school, find work, and plan future pregnancies). Each of the theoretical perspectives provides insights into different aspects of parents' and children's lives that the visitors attempted to support in their efforts to prevent a set of interrelated health and developmental problems that compromise mothers' prenatal health, their own life-course development, and the health and development of their children. While adhering to a common core, the program content and methods evolved over each of three trials and were reflected in program protocols that increasingly were connected in more explicit ways to their theoretical foundations.