Review of Research on Home Visiting for Pregnant Women and Parents of Young Children

In this paper, David Olds and Harriet Kitzman review the results of the experimental literature concerning the effectiveness of home visiting programs in improving the lives of children and families. Their extensive review concentrates on randomized trials, that is, those most methodologically rigorous studies of all in which families are randomly assigned to two groups, typically to receive either (1) home visiting services (the experimental group) or (2) care as usual (the control group). Olds and Kitzman further focus on just those studies in which the effects of home visiting can be teased apart from the effects of other sorts of services (for example, medical care and child care). Thus, their review does not include some of the studies that are mentioned by other authors (for example, Powell and Weiss) in their articles for this journal issue or described in the Appendix (page 205). Nevertheless, the review is very comprehensive. The authors summarize results of 31 home visiting programs that have focused on preventing preterm delivery and low birth weight; improving the outcomes of infants born preterm or low birth weight; or serving low-income families or families at risk for child maltreatment. Tables 2, 3, and 4 depict the results of studies on outcomes including changes in parental behavior, home environment, child development and behavior, child abuse, rates of preterm and low birth weight births, and health care utilization. The authors conclude that home visiting is a promising approach, but all too often the promise has not been clearly demonstrated. Indeed, results suggest that home visiting programs in the past have benefited some families but not others and have improved some outcomes but not others. Olds and Kitzman suggest that these differences in effectiveness may be the result of several characteristics of the home visiting programs, including their comprehensiveness of purpose and goals, level of staffing, frequency of visits, and the populations they are designed to serve. In general, the authors suggest that programs which are comprehensive in focus, have frequent visits, are staffed by well-trained professionals, and serve families that are initially at elevated risk for poor outcomes are more likely to demonstrate success. The authors conclude that carefully designed home visiting programs should continue to receive support.