At a December briefing hosted by the National Prevention Science Coalition, Dr. David Olds, Professor of Pediatrics, Nursing, and Public Health at the University of Colorado shared some good news about a family-based poverty prevention approach: Low-income, first-time mothers who were visited at home regularly by a nurse had better prenatal health outcomes, relied less on government assistance like TANF and food stamps, and had better diets and decreased tobacco use compared to a control group.
The Nurse-Family Partnership, an evidence-based community health program, was designed to improve pregnancy outcomes for low-income, first-time single mothers, as well as children’s health and development and parental health and economic self-sufficiency. The program was tested in Elmira, NY, Memphis, TN, and Denver, CO over nearly 40 years, and participants in each city, though demographically unique, experienced similarly positive results.
The idea behind the partnership was simple: nurses would conduct home visits to at-risk mothers in prenatal and infancy, providing recommendations and assistance about care for their newborns. Nurses would be partnered with interested mothers about halfway through their first pregnancy, and would remain a regular visitor for up to 2 years following the baby’s birth.
Among children from all three pilot cities, nurse-visited homes saw decreases in children’s injuries, increases in children’s language and school readiness, and decreases in cases of child abuse and neglect from ages 0-15. Due to the piloted program’s impacts on mothers and children, the Nurse-Family Partnership has been replicated throughout the US and now serves over 31,000 families in 43 states.
Home Visits Aren’t Just for Nurses
Home visiting as prevention and intervention has been tested not only in medical field but also in the realm of education. Many states, districts, and individual schools have experimented with visits by teachers to students’ homes, citing a range of potential benefits. When it comes to education-based home visits, what types of outcomes are occurring amongst students, parents, and teachers? What are the barriers to implementing a routine home visit program?
Home Visits: Good for Parents and Teachers
School leaders have cited numerous goals in implementing home visiting programs in their communities, the most fundamental being to forge school and family links. Melissa Brown, assistant superintendent for the Sacramento, CA City Unified School District, began a voluntary teacher program 9 years ago with relationship building in mind: “Starting the year off with teacher visits to students’ homes, with such visits serving as invitations to parents to become partners in the children’s education, is in fact, one of the easiest ways to establish relationships.” So far, Brown has been pleased by the district’s home visits results.
For the parents, the visits provide an opportunity to break down barriers, to understand how to relate and feel connected to the school and their children’s experience. Teachers not only can develop personal connections with parents, but also gain useful insight about how to approach each students’ learning progress in school. Brown cited one such instance: During a home visit of a student who repeatedly failed to complete assignments, the teacher learned that the only place the child had to do homework was on top of the toilet seat. Additionally, the child had no materials at home. After this home visit, the teacher began providing more tools in the classroom for the student.
Students Benefit, Too
In a 2015 study by Johns Hopkins, researchers found that students whose teachers visited them at home were less likely to be absent and more likely to read at grade level. The study examined 4,700 students from 12 Washington DC elementary schools who partook in a family engagement program run by the Flamboyan Foundation. Flamboyan developed the Family Engagement Partnership, an intensive, capacity-building intervention in response to input and feedback from DC families, teachers and school leaders. The FEP was piloted with 5 schools in DC during the 2011-2012 school year, and expanded to 27 public and charter schools by 2014-2015. In addition to the aforementioned student outcomes of better attendance and reading comprehension, teachers at FEP schools scored higher on their effectiveness in lessons, responding to student understanding, and developing students’ higher-level understanding than did teachers at comparable schools.
Carol Sharp, director of parent services for the Sacramento Schools, noticed changes immediately after the first teacher home visits. Sharp cited increases in state scores, improvements in attendance, reduction in vandalism and a drop in student suspensions. (In 1997, the year before home visits began in Sacramento, the District suspended 140 students. In 1998, only 60 students were suspended). Of course, it is challenging to prove that these positive outcomes were caused solely by the teacher home visits, yet long-term research of the program by Dr. Geni Cowan of California State University backs up a number of Sharp’s observations.
Training and Logistics
Districts who have initiated home visit programs have varied in their funding sources and implementation plans. In Sacramento, funding was distributed from the district initially, and later on, the state of California. California voted to provide money for teacher stipends to participate in the Nell Soto Parent/Teacher Involvement Program. Now, teachers are trained by members of the Sacramento Area Congregations Together (ACT), a coalition of 30 faith-based local groups. Training involves preparation for what teachers might see in homes, discussions of cultural barriers, and includes themes like listening, relationships, academics and capacity building. Under this model, teachers visit the students’ home twice a year, and visits last about an hour. Often visiting in pairs, teachers explain to parents what their children are learning, offer information about getting involved and provide contacts for school and community resources. The teachers also encourage children to show them where they study and allow parents to ask questions.
The DC home visits program is funded through the Flamboyan Foundation, a private family foundation. Other districts have received funding from outside organizations, like the Rotary Club in Iowa City, Iowa. In some cases, Title I programming funds from the federal government can cover training for home visits. And districts like Greenville County in South Carolina have received grants from local universities and charitable organizations.
Investing in a Home Visit Program
Despite the encouraging evidence that teachers visiting families at their homes forges relationships and improves student outcomes, barriers to starting programs and getting individuals to buy-in exist. Concerns about funding, finding time for teacher training, and managing family and teacher schedules are valid. Reluctance from skeptical parents or teachers to participate in this intervention is another real concern.
Evidence from districts that have implemented home visits into their routine of family engagement and academic intervention is reason enough for policymakers to consider education-based home visits legislation. With Health and Human Services awarding $386 million to support families through the Maternal, Infant and Early Childhood Home Visiting Program last February, it seems Washington has acknowledged the power and importance of this intervention. With the joint support and efforts of education and research leaders, funding for teachers coming to a living room near you could be next.
*For more on evidence-based policy-making, see Kyle Hayes’ piece on page 11 of the 2015 Public Purpose Magazine.