Early childhood home visiting is a voluntary service delivery strategy that aims to support the health and well-being of parents or caregivers and their young children (from birth to age five). The service is available to many expectant parents and families with young children—either through universal home visiting programs, which are already in place in several countries globally, or through targeted approaches focused on families with low incomes and/or those in priority populations.
There are numerous potential positive impacts of home visits on child health and development, maltreatment prevention, and family economic self-sufficiency. However, those improvements are limited by low enrollment among eligible families and by high attrition.
A new report by our partners at Child Trends describes the findings from an evidence review that examined strategies to enhance recruitment and uptake of families into home visiting services. While this report focuses on the home visiting landscape nationally, researchers paid specific attention to home visiting in New Mexico and Los Angeles County, where the Foundation’s Early Childhood Development Initiative has focused our investments and programming.
The strategies and recommendations were summarized into four themes:
- Messaging & Outreach: Increase public awareness of and interest in home visiting. This theme includes efforts to improve and expand public awareness and understanding of home visiting, universal outreach, and incentives for participation.
- Responsiveness & Flexibility: Tailor program practices to meet family needs and preferences and reduce barriers. This theme includes selecting home visiting models that reflect local cultures, ensuring flexibility in timing and location of visits, and prioritizing families’ preferences and goals.
- Referral Partnerships: Foster a referral network and establish efficient referral processes. This theme includes efforts to increase referrals to home visiting among individuals or agencies that interact with expectant parents or new caregivers—especially individuals and/or agencies who are already trusted by families and serving families affected by negative social determinants of health.
- Programmatic Efforts: Increase home visiting program capacity pertaining to effective, strategic recruitment and uptake. This theme includes the hiring, training, and engagement work that home visiting programs can do to invest in more robust recruitment and uptake.
Researchers say additional research is needed
Researchers observed that the evidence base for effective strategies related to recruitment and uptake is limited. Many of the strategies they describe in the report are recommended or are currently being implemented, but because quantitative findings are scarce, evidence that they directly affect recruitment or uptake is limited. Report authors say more rigorous quantitative evidence would strengthen understanding of the most effective strategies.
Strategies for improving recruitment and uptake
With those caveats, the researchers identified the most highly recommended strategies for promoting recruitment and uptake:
- Intentionally foster ongoing relationships with referral agencies. This strategy is already implemented widely, yet resources in this review highlighted innovative practices to facilitate these relationships and streamline providers’ referral processes using technology (e.g., a centralized intake platform for all referrals).
- Promote universal access to “light-touch” home visiting models. There is emerging evidence that families who participate in a universally available, short-term home visiting program are more likely to enroll in other home visiting programs. These programs may introduce families to home visiting and its benefits before requiring a commitment and motivate them to enroll in a similar program for continued support.
- Demonstrate flexibility and responsiveness to families in terms of the timing, location, and content of home visiting services. Regardless of the model being implemented, prioritizing what the family needs will build the relationship and buy-in for continued participation.
- Integrate community members into home visiting recruitment and uptake efforts. Strategies include hiring an outreach coordinator from the community served, engaging community members to assist with refining the way home visiting is messaged and described, and recruiting home visiting graduates to engage in peer-to-peer recruitment and to check in on families who are missing visits.
Report authors note that to implement any of these strategies well and in a sustainable manner, home visitors and home visiting programs would need additional support, such as additional staff or training.
Read the full report here.
