Inside Home Visiting Programs

In this article, Douglas Powell illustrates the wide variation that exists among home visiting programs in their content, theory, and operation. He presents a framework for discussing these key variables. Several specific programs are highlighted as examples of various program designs. In most instances, Powell cites well-established programs that have national headquarters and have been replicated at many sites. Some of these are described more fully in the Appendix (page 205). Although some of these well-established programs have been evaluated for effectiveness using quasi-experimental methods, only one (the Mother-Child Home Program) has been evaluated employing the more rigorous technique of random assignment. Therefore, most of the programs cited in this article and in the Appendix are not included in David Olds’s and Harriet Kitzman’s review of the research literature in this journal issue, which is limited to randomized trials. Nevertheless, Powell makes the point that many of the key elements of program design which he identifies are useful in conceptualizing potential or analyzing existing evaluations, and the Olds and Kitzman review does indeed mention some of the same key dimensions (for example, staffing pattern and intensity of services). The programs discussed in this article are only a small sample of the thousands of such programs in existence in the United States today. The frequency of each type of program is not known. Box 1 summarizes a survey conducted in 1988 which attempted to document the distribution of a large sample of home visiting programs along many of the dimensions discussed by Powell. Finally, this article describes the range of options in designing home visiting programs. It does not recommend a particular approach but concludes with a discussion of the need for research that will disentangle the conditions under which diverse approaches to home visiting are beneficial.