Evolution and impact of home visitation programs

The evolution of home visitation programs in the United States has an extensive history, dating back to as early as the eighteenth century with care of the poor within their homes. Home visitation with RNs is well funded, evidence-based, and has a lengthy track record of success in addressing health concerns, such as maternal and infant health, parenting skills, improved education and employment, and reduction in child maltreatment and abuse. However, home visiting programs vary and teachers, church workers, general health care workers, parish nurses, and others provide services with anecdotal success but without evidence-based outcomes; but the majority of service is now provided by lay persons in the community. Service duration in all types of home visitation programs ranges from only one or two visits over a period of weeks to monthly visits over several years. Home visiting programs are not without barriers and include lack of knowledge about program evaluation and inherent failure to measure outcomes, community makeup and influence, availability of financial and social resources, and the relationship between client, family and those conducting visits. As it has in the past, future direction of home visiting programs will be significantly shaped by these barriers and other unidentified situations and issues as the outcomes emerge. The evolution of home visitation programs in communities with few resources will continue with the development of faith-based programs as the funds dwindle, needs of the populations continue to exist, and resourceful communities become educated as they desire to save the children.