Session: The Promise of Home Visiting Programs in Improving Child Well-Being and Preventing Child Maltreatment (Society for Social Work and Research 29th Annual Conference)

Over 310,000 families received early childhood home visiting services in 2023 (National Home Visiting Research Center, 2023). Home visiting programs have been associated with numerous positive outcomes for both children and parents, though the strength of those associations vary by the type of program and the context. Many programs show favorable reductions in the incidence of child maltreatment and home visiting programs have been promoted as maltreatment primary prevention programs. This symposium explores new and innovative research within home visiting programs.

Many families enrolled in home visiting programs are considered "at-risk" and/or low-income. However, little research attempts to understand how material hardship can impact the effectiveness of home visiting programs. Study #1 details outcomes from a randomized control trial testing the efficacy of an infant mental health home visiting treatment model. The study found that positive outcomes of the intervention were correlated with the incomes of the mothers. Specifically, it found that incomes of mothers with distorted or disengaged caregiving representations of their child were substantially lower than incomes of mothers with more balanced representations. These lower income mothers also had children with lower attachment security scores. The study provides further evidence that the ecological context of a family, particularly at low-income levels, may negatively influence parental reflectivity and infant attachment security.

Study #2 was a quasi-experimental study that aimed to increase financial security among families with low income participating in home visiting programs in order to reduce adverse childhood experiences and increase family protective factors. The control group families received Parents as Teachers (PAT) home visiting services, while treatment group families received information about the Earned Income Tax Credit, in conjunction with PAT. Findings were promising, suggesting positive impacts of the program and movement on indicators proximal to the intervention.

While studies examining the causal outcomes of home visiting programs are important, so too is a greater understanding of how home visiting "success" is defined on the ground. Study #3 was a state-wide, cross-model study that employed concept mapping to learn about dimensions of success as defined by families and home visiting professionals. Findings were that both families and professionals prioritized family-centered outcomes over program-centric metrics. Study #4 describes how parents perceived quality in home visiting programs, as well as how program directors use feedback from parents to improve program quality. Findings were that families' definitions of quality shaped their program engagement. Combined, these studies suggest that family-centered outcomes at exit as well as a focus on family participation in service provision could promote family autonomy and support the adoption of flexible, precision-based home-visiting practices.

Home visiting programs are promising ways to engage marginalized and vulnerable families in preventative interventions. The studies presented in this symposium suggest numerous ways that these programs could be strengthened, including by directly addressing the material conditions of the families. Incorporating more of a family-centered focus, in both operationalizing "success" and "quality" in home visiting evaluations may also yield a better understanding of how these programs actually work for families.