This presentation will describe how early childhood home visiting programs can support the reduction of family risk factors and the strengthening of protective factors to reduce the likelihood of child abuse and neglect. This file is for educational purposes only and is not meant for reproduction.

1. 2nd Annual Conference
September 4, 2013

2. Reducing Risks of Child Abuse and Neglect
through Home Visiting
This project was supported in part by the Governor’s Office for Children and Families through U.S. Department of Health and Human
Services, Health Resources and Services Administration, Affordable Care Act, Maternal, Infant, and Early Childhood Home Visiting (MIECHV)
Program (CFDA 93.505). Points of view or opinions stated in this document are those of the author(s) and do not necessarily represent the official
position or policies of the Governor’s Office for Children and Families or the U.S. Department of Health and Human Services, Health Resources
and Services Administration, Affordable Care Act, Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program (CFDA 93.505).

3. Objectives
To increase knowledge of early childhood home visiting:
 Program design, goals and outcomes.
 Program practices leading to outcomes related to reducing
the risk of child abuse and neglect.
 Evidence of effectiveness in achieving outcomes.
 Best practices for implementing home visiting programs in
communities to achieve intended outcomes.

4. Home Visiting Programs
 Provide home visits as the primary service delivery strategy.
 Offer services on a voluntary basis.
 Offer services to pregnant women or children birth to 5 years.
 Target participant outcomes that include:
 Maternal and child health.
 Child injuries, child maltreatment, and reduction of ER visits.
 Improvements in school readiness and achievement.
 Reduction in crime or domestic violence.
 Improvements in family economic self-sufficiency.
 Improvements in coordination/referrals for resources/support.
DHHS, HRSA, ACA, MIECHV FOA (HRSA-10-275)

5. Components of Home Visiting Programs
 Program standards/requirements
 Defined points of program entry
 Home visits of specified frequency
 Trained home visitors and supervisors
 Regular supervision
 Use of curriculum

6. Home Visiting Eligibility
 Expectant parents/families with children birth to five
 First time parent
 Less than 28 weeks pregnant
 Low income
 Lack of housing
 Less than age 21
 Less than 12 years of education,
 Unemployed
 Parent alcoholism, drug abuse, depression
 Parental history of child abuse or neglect
 Children with developmental delays/disabilities

7. Home Visiting Program Model Goals/Focus
 Early Head Start-Home Based (EHS-HB)
 Enhance the development of infants and toddlers while
strengthening families. Provide culturally competent child
development and parent support services, emphasizing the role of
the parent-child relationship.
 Healthy Families America (HFA/HFG)
 Build and sustain community partnerships to systematically
engage overburdened families in home visiting services
prenatally or at birth. Cultivate and strengthen nurturing
parent-child relationships. Promote healthy childhood growth
and development. Enhance family functioning by reducing risk
and building protective factors.

8. Home Visiting Program Model Goals/Focus
 Nurse Family Partnership (NFP)
 Improved pregnancy outcomes. Improved child health &
development. Improved maternal life course development.
 PAT (PAT)
 Increase parent knowledge of early childhood development and
improve parenting practices. Provide early detection of
developmental delays and health issues. Prevent child abuse
and neglect Increase children’s school readiness and school
success
 SafeCare
 Provide direct skill training to parents in child behavior
management and planned activities training, home safety
training, and child health care skills to prevent child
maltreatment.

9. Home Visiting Model Standards for Service
Program Point of Entry Duration of
Service
Intensity of Service
EHS-HB
Pregnancy – child 3 yrs. Pregnancy – 3 yrs. 1 visit /wk.
HFG Pregnancy – child 2 wks./3 mos. Pregnancy – 5 yrs. 1 visit /wk. – 1 visit/qtr.
NFP
Prior to 28th week of pregnancy Pregnancy – 2 yrs. 1 visit/wk. – 1 visit/2 wks.
PAT
Pregnancy – child 3 yrs. Pregnancy - 5 yrs. 1 visit/2 wks.
SafeCare Birth – child 5 years Program 18 – 20 wks. 1 visit/wk.

10. Home Visiting Activities
 Offering parenting and child development information
 Promoting parent-child interaction
 Providing observation, feedback and support
 Offering information on health and safety and
addressing health and safety concerns
 Conducting assessments and screenings
 Providing referrals/linkages to resources based on family
needs
 Supporting parent in setting and accomplishing goals
 Providing opportunities to participate in parent group
activities

11. Home Visiting Principles
 Family Centered
 Culturally Competent
 Strength Based
 Relationship Based

12. Risk Factors for Child Abuse and Neglect
 Children younger than 4 years of age
 Parent’s lack of understanding child’s needs, child
development and parenting skills
 Substance abuse and/or mental health issues
 Parental characteristics: young age, low
education, single parenthood, low income
 Social isolation
 Family disorganization, dissolution and violence
 Parenting stress
http://www.cdc.gov/violenceprevention/childmaltreatment/riskprotectivefactors.html

13. Strengthening Families Protective Factors
 Parental resilience
 Social Connections
 Concrete Support in Times of Need
 Knowledge of Parenting and Child Development
 Social Emotional Competence of Children
http://www.cssp.org/reform/strengthening-families/the-basics/protective-factors

14. Reducing Risks – Building Protective Factors
Risk Factors Activities Protective Factors
Parent’s lack of
understanding child’s
needs and development
Parenting and child
development information
Assessments & screening
Promote PCI
Knowledge of parenting
and child development
SE competence of child
Substance abuse/mental
health issues
Assessments & screening
Information on health
and safety
Referrals/linkages
Parental resilience
Concrete support
Low education/low
income
Goal setting
Referrals/linkages
Parental resilience
Concrete support
Social isolation Home visits
Parent group activities
Referrals/linkages
Social Connections

15. Georgia Home Visiting Video
Home Visiting Program Promotional Video MIECHV
This project was supported in part by the Governor’s Office for Children and Families through U.S. Department of
Health and Human Services, Health Resources and Services Administration, Affordable Care Act, Maternal, Infant, and
Early Childhood Home Visiting (MIECHV) Program (CFDA 93.505). Points of view or opinions stated in this document
are those of the author(s) and do not necessarily represent the official position or policies of the Governor’s Office for
Children and Families or the U.S. Department of Health and Human Services, Health Resources and Services
Administration, Affordable Care Act, Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program (CFDA
93.505).

16. HV
Program
Positive
Parenting
Maternal
Health
Child
Health
Reduce
CAN
Child
Development
/School
Readiness
Family
Economic
Self Sufficiency Reduce DV
Linkages
Referrals
EHS - HB X X X X
HFG X X X X X X X X
NFP X X X X X X X
PAT X X
SafeCare
Augmented X X
SafeCare
Home Safety X
Evidence of Effectiveness
www.homvee.acf.hhs.gov

17. Research Findings for Child Abuse and Neglect
HomVee (www.homvee.acf.hhs.gov)
 EHS-HB: Physical punishment
 HFA: Psychological aggression frequency, mild physical assault
frequency, common corporal/verbal
punishment, neglect, frequency very serious physical
abuse, frequency harsh parenting, frequency non-violent
discipline
 NFP: # ER visits for accidents & poisonings, # injuries &
ingestions in physicians record, substantiated reports CAN, #
health care encounters injuries/ingestions, # days hospitalized
for injuries, onset of neglect
 SafeCare Augmented: Non-violent discipline, post-enrollment
referral to child welfare for domestic violence

18. Research Findings for Child Abuse and Neglect
California Evidence Based Clearinghouse for
Child Welfare (www.cebc4cw.org)
 Ratings: Strength of Research Evidence 1-5 and Child
Welfare Relevance 3 Levels – High Medium Low
 EHS: 3 Promising Research Evidence /Medium - Child Welfare
 HFA: 1 Well-Supported by Research/ Medium – Child Welfare
 NFP: 1 Well-Supported by Research/ Medium – Child Welfare
 SafeCare: 2 Supported by Research/ High – Child Welfare

19. Implementing Home Visiting Programs
 Community – Program Fit
 Program model evidence of effectiveness.
 Synergy between model’s outcomes and community needs.
 Community resources to maintain model fidelity.
 Qualified applicant’s to meet model’s staff qualifications.
 Approximate cost per family per year.
www.zerotothree.org Home Visiting Community Planning Tool
 Program Model Fidelity
 Adherence to service model.
 Service exposure or dosage.
 Quality/manner of service delivery.
 Participant response to engagement.
 Understanding of essential program elements.
http://www.implementationscience.com/content/2/1/40

20. Home Visiting Model Websites
 EHS-HB: http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/
ehsnrc/Early%20Head%20Start/home-based-model
 HFA: www.healthyfamiliesamercia.org
 NFP: www.nursefamilypartnership.org
 PAT: www.parentsasteachers.org
 SafeCare: http://publichealth.gsu.edu/968.html

21. Marcia Wessels, MPH
Director of TA and Training
Great Start Georgia
Center for Family Research
The University of Georgia
marciaw@uga.edu

22. 2nd Annual Conference
September 4, 2013