 | This article needs to be updated.(May 2018) |
Home visiting programs for families with young children have received Federal government support in the United States. A range of programs have been implemented, with evaluation of their effectiveness in terms of health, social and educational outcomes.
In 2010, the federal Affordable Care Act initiated the Maternal, Infant, and Early Childhood Home Visiting Program that allocates $1.5 billion over five years to states that voluntarily provide families with young children with evidence-based home visiting programs. It aims to establish a positive and improved outcome in health, education, and reduced child abuse in families. Home visiting has already been in practice in every state. [1]
The purpose of federal funding is to identify the most effective early childhood home visiting programs and strengthen them with standards that will produce measurable and efficient outcomes. As of October 2013, 17 states have introduced 32 bills on Home Visiting Programs before legislature. Beginning September 2010, the Department of Health and Human Services (HHS) awarded grants to states to develop and implement an early childhood home visitation program to promote. [2] 1. Improvements in maternal and prenatal health, 2. Infant health, 3. Child health and development, 4. Parenting related to child development outcomes, and 5. School readiness in child abuse, neglect and injuries.
Several national Home Visiting Programs have developed and attained standards for successful training and home visiting cases for home visitors as well as for the program supervisors. States and local programs may use these models to establish a program but some local programs also may customize and tailor their programs according to their local needs by utilizing local resources and institutions. Local programs may follow some of elements from the national programs and integrate them, which create varieties of practice models, depending on the needs and availability of the local communities. The local models may not have evidence of consistent outcomes.
The seven federally approved home visiting models are:
There are other programs also in review for federal approval. When states apply and are granted of the federal funds, federal legislation provides guidelines on how to specifically distribute the money. For example, at least 75% of the funds must be apportioned on programs that follow one of the approved home visiting models. The rest of the money may be allocated for “promising approaches”, where they have shown some evidence of effectiveness, but yet to have strong assessment of evidence. Local programs may apply for funding in this classification. [10]
Home visitors are trained professionals who focus on early childhood and maternal health; they may be nurses, social workers, or early childhood specialists with additional training. Their scope of practice includes children and maternal health, parenting and family education, child abuse and neglect. Home visitors provide education and resources to parents in multiple layers, such as educating on normal trajectory of early childhood, identifying abnormal development or modifying problematic behavior, offering referrals to community resources, such as Medicaid, job training, employment services, or food assistance. They also provide mental health counseling to parents who may have substance abuse problems, or maternal depression.
Home visiting services aim to support families who are most disadvantaged, or at risk. This population includes first time parents, low-income parents, single or teen parents, as well as parents with substance abuse or addictions, or mental health issues such as maternal depression.
Evidence-based practice means that there has been a set of standards of practices established from clinically proved trials and researches that produced consistently improved outcomes. Individual clinician's training and organizational and systems changes could influence the implementation of clinical guidelines. [11] The review of home visiting programs reports that intensive and frequent visits from trained professionals to families from the prenatal stage up to the second or third years of the child's life produces a positive and improved outcome in maternal and child's health. The frequency could be as often once a week to at least once or twice every month in the beginning stage of home visits. [10]
Quality practices offered by well-trained home visitors in Home Visiting Programs have been shown to be effective in these areas: lower number of low birth weight babies, 50% decrease in child abuse or neglect, 25% increase in reading and math test grades in 1-3 grades, 60% increase in high school graduation rate. If trained visitors diligently follow the standards, the cost-benefit studies have demonstrated returns of investment from $1.75 to $5.70 on every dollar spent. [1] [ unreliable source? ]
Social Security Act, Title V, Section 511 (42 USC 711) [12] states to conduct a statewide assessment on needs of the at-risk population to be eligible for the grant award. It also requires states to achieve “quantifiable, measurable improvements” on the five areas of family life, listed above. HHS appropriates $100 million for fiscal year 2010, $250 million for FY 2011, $350 million for FY 2012, $400 million for FY 2014. 3% of available funding is reserved to fund Indian Tribes. [2]
States also must file a report to the Secretary of HHS on the progress of the program, which must show improvements on at least four areas at the end of the first three-year period. HHS holds authority to terminate the grant to any states that fail to comply or demonstrate improvements. A final report must be submitted to HHS, no later than December 31, 2015. [2]
The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of the U.S. people and providing essential human services. Its motto is "Improving the health, safety, and well-being of America". Before the separate federal Department of Education was created in 1979, it was called the Department of Health, Education, and Welfare (HEW).
Head Start is a program of the United States Department of Health and Human Services that provides comprehensive early childhood education, health, nutrition, and parent involvement services to low-income children and families. The program's services and resources are designed to foster stable family relationships, enhance children's physical and emotional well-being, and establish an environment to develop strong cognitive skills. The transition from preschool to elementary school imposes diverse developmental challenges that include requiring the children to engage successfully with their peers outside the family network, adjust to the space of a classroom, and meet the expectations the school setting provides.
Foster care is a system in which a minor has been placed into a ward, group home, or private home of a state-certified caregiver, referred to as a "foster parent", or with a family member approved by the state. The placement of a "foster child" is normally arranged through the government or a social service agency. The institution, group home, or foster parent is compensated for expenses unless with a family member. In some states, relative or "Kinship" caregivers of children who are wards of the state are provided with a financial stipend.
A form of child abuse, child neglect is an act of caregivers that results in depriving a child of their basic needs, such as the failure to provide adequate supervision, health care, clothing, or housing, as well as other physical, emotional, social, educational, and safety needs. All societies have established that there are necessary behaviours a caregiver must provide for a child to develop physically, socially, and emotionally. Causes of neglect may result from several parenting problems including mental disorders, unplanned pregnancy, substance use disorder, unemployment, over employment, domestic violence, and, in special cases, poverty.
School nursing, a specialized practice of public health nursing, protects and promotes student health, facilitates normal development, and advances academic success. School nurses, grounded in ethical and evidence-based practice, bridge the gap between health care and education, provide care coordination, advocate for quality student-centered care, and collaborate to design systems that allow individuals and communities to develop their full potentials. A school nurse works with school-aged children in the educational setting. Students experiencing illness or injury during the school day often report to the school nurse for assessment. Administering routine medications, caring for a child with a virus, or stabilizing a child until emergency services arrive after a more serious injury may all be a part of the job requirements. School nurses are well positioned to take the lead for the school system in partnering with school physicians, community physicians, and community organizations. They facilitate access to Medicaid and the State Children's Health Insurance Program to help families and students enroll in state health insurance programs and may assist in finding a medical home for each student who needs one.
The Administration for Children and Families (ACF) is a division of the United States Department of Health and Human Services (HHS). It is headed by the Assistant Secretary of Health and Human Services for Children and Families. It has a $49 billion budget for 60 programs that target children, youth and families. These programs include assistance with welfare, child support enforcement, adoption assistance, foster care, child care, and child abuse. The agency employs approximately 1,700 staff, including 1,200 federal employees and 500 contractors, where 60% are based in Washington, DC, with the remaining in regional offices located in Boston, New York City, Philadelphia, Atlanta, Chicago, Dallas, Kansas City, Denver, San Francisco, Missouri and Seattle.
The Health Resources and Services Administration (HRSA) is an agency of the U.S. Department of Health and Human Services located in North Bethesda, Maryland. It is the primary federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable.
The United States Children's Bureau is a federal agency organized under the United States Department of Health and Human Services' Administration for Children and Families. Today, the bureau's operations involve improving child abuse prevention, foster care, and adoption. Historically, its work was much broader, as shown by the 1912 act which created and funded it:
The said bureau shall investigate and report to [the Department of Commerce and Labor] upon all matters pertaining to the welfare of children and child life among all classes of our people, and shall especially investigate the questions of infant mortality, the birth-rate, orphanage, juvenile courts, desertion, dangerous occupations, accidents and diseases of children, employment, legislation affecting children in the several states and territories.
Child abuse is physical, sexual, emotional and/or psychological maltreatment or neglect of a child, especially by a parent or a caregiver. Child abuse may include any act or failure to act by a parent or a caregiver that results in actual or potential harm to a child and can occur in a child's home, or in organizations, schools, or communities the child interacts with.
Health visitors are professional individuals engaged in public health work within the domestic setting, predominantly found in countries with state-funded health systems. They are distinct from district nurses, who provide clinical healthcare, domestically.
Early childhood intervention (ECI) is a support and educational system for very young children who have been victims of, or who are at high risk for child abuse and/or neglect as well as children who have developmental delays or disabilities. Some states and regions have chosen to focus these services on children with developmental disabilities or delays, but Early Childhood Intervention is not limited to children with these disabilities.
Child Protective Services (CPS) is the name of an agency in many states of the United States responsible for providing child protection, which includes responding to reports of child abuse or neglect. Some states use other names, often attempting to reflect more family-centered practices, such as department of children and family services (DCFS). CPS is also sometimes known by the name of department of social services, though these terms more often have a broader meaning.
A parent education program is a course that can be followed to correct and improve a person's parenting skills. Such courses may be general, covering the most common issues parents may encounter, or specific, for infants, toddlers, children and teenagers. These courses may also be geared towards parents who are considering having a child, or adopting one, or are pregnant.
Substance abuse prevention, also known as drug abuse prevention, is a process that attempts to prevent the onset of substance use or limit the development of problems associated with using psychoactive substances. Prevention efforts may focus on the individual or their surroundings. A concept that is known as "environmental prevention" focuses on changing community conditions or policies so that the availability of substances is reduced as well as the demand. Individual Substance Abuse Prevention, also known as drug abuse prevention involves numerous different sessions depending on the individual to help cease or reduce the use of substances. The time period to help a specific individual can vary based upon many aspects of an individual. The type of Prevention efforts should be based upon the individual's necessities which can also vary. Substance use prevention efforts typically focus on minors and young adults – especially between 12–35 years of age. Substances typically targeted by preventive efforts include alcohol, tobacco, marijuana, inhalants, coke, methamphetamine, steroids, club drugs, and opioids. Community advocacy against substance use is imperative due to the significant increase in opioid overdoses in the United States alone. It has been estimated that about one hundred and thirty individuals continue to lose their lives daily due to opioid overdoses alone.
The Maternal and Child Health Bureau (MCHB), is one of six Bureaus within the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services located in Rockville, Maryland.
Calvin C.J. Sia was a primary care pediatrician from Hawaii who developed innovative programs to improve the quality of medical care for children in the United States and Asia. Two particular programs have been implemented throughout America: the Medical Home concept for primary care that has been promoted by the American Academy of Pediatrics and the federal Emergency Medical Services for Children program administered by the U.S. Department of Health and Human Services’ Health Resources and Services Administration, Maternal and Child Health Bureau. His Medical Home model for pediatric care and early childhood development began to take root in several Asian countries in 2003.
Nurse-Family Partnership (NFP) is a non-profit organization operating in the United States that connects mothers pregnant with their first child with registered nurses, who provide home visits until the child's second birthday. NFP intervention has been associated with improvements in maternal health, child health, and economic security.
Foster care is the term used for a system in which a minor who has been made a ward is placed in an institution, group home, relative placement, or private home of a state certified caregiver. The placement of the child is usually arranged through the government or a social-service agency. The institution, group home, or foster parent is paid. The state via the family court and child protection agency stand in loco parentis to the minor, making all legal decisions, while the foster parent is responsible for the day-to-day care of the minor. The foster parent is remunerated by the state for their services.
Kenneth Dodge is the William McDougall Distinguished Professor of Public Policy and Professor of Psychology and Neuroscience at Duke University. He is also the founding and past director of the Duke University Center for Child and Family Policy and founder of Family Connects International.
The Healthy Families Parenting Inventory (HFPI) is an assessment instrument used by early childhood educators and home visitors in the United States and internationally to measure change in nine parenting domains. The HFPI has been used extensively with the home visitation model to assess parent-focused outcomes in federal- and state-supported home visitation programs, and is used to assess the likelihood of child maltreatment.