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Journal Issue: Home Visiting Volume 3 Number 3 Winter 1993

Richard E. Behrman


We believe that policy development regarding many of the important issues affecting children today can benefit from comprehensive and multidisciplinary discussion. Toward this end, The Future of Children focuses on selected topics through a series of articles representing different perspectives.

We chose the topic of home visiting programs for pregnant women and families with newborns for several reasons. Although home visiting is certainly not a new program idea, there has been increasing enthusiasm for it in recent years, with large initiatives being launched or recommended at the federal level and in many states. In addition, it is a service model which has been evaluated extensively. We believed that it was timely to develop a publication which would describe existing programs and lessons learned from research, as well as present perspectives about future directions from some of the leading analysts of early intervention programs.

The primary purpose of the first four articles in this issue is to offer a comprehensive description of the current status of home visiting programs and their evaluation. In the first article, Douglas Powell describes the wide variation in content, theory, and operation that exists among home visiting programs in this country. Next, Sheila Kamerman and Alfred Kahn describe home visiting programs in Europe, focusing especially on the more comprehensive programs in Denmark and England.

The third and fourth articles describe what research has shown about home visiting programs. The article by David Olds and Harriet Kitzman presents a comprehensive review of the literature describing randomized trials in which home visiting programs have been evaluated for effectiveness. The authors analyze these trials and discuss both the lessons learned from this research and their implications for future program design and further research.

Next, Steven Barnett reviews the handful of available cost-benefit and cost-effectiveness studies of home visiting and urges that economic analysis be included in most, if not all, major research of home visiting programs.

The next six articles in the journal highlight the authors' recommendations for expanding and/or improving home visiting programs. In the first of these articles, Heather Weiss reviews the history of home visiting programs and argues that home visits are a necessary but not sufficient component of all programs seeking to serve families and young children. She recommends a national commitment to establishing universal home visiting which would be part of a network of comprehensive community-based services for children and families.

The article by Craig Ramey and Sharon Landesman Ramey sets forth a framework for thinking about the health and development of young children and implications for designing home visiting programs. Next, Barbara Hanna Wasik focuses on the critical issue of staffing and discusses both staff qualifications and staff needs for preservice and in-service training and support.

The next two articles discuss the diversity among families served by home visiting programs and the challenges this diversity presents. Robert Halpern describes the difficulties in creating effective home visiting programs to serve multiply vulnerable families. He asserts that these programs have been shaped and constrained by societal factors, including the tendency to use services as a substitute for adequate incomes and economic opportunity and ambivalent attitudes toward poor families.

In another article, Diana Slaughter-Defoe focuses on the importance of making home visiting programs responsive to the cultural context of participating families. To illustrate this idea, she discusses some of its implications for the design of home visiting programs intended to serve African-American families.

Finally, the journal issue concludes with a discussion by Richard Krugman of the recommendation by the U.S. Advisory Board on Child Abuse and Neglect to implement a national program of universal home visiting as a strategy for preventing child abuse and neglect.

We are grateful to Michael Wald, professor of law at Stanford University and now deputy general counsel of the U.S. Department of Health and Human Services, and to Craig Ramey, director of the Civitan Research Center, for their advice and assistance as special advisors to this issue. They worked closely with our staff issue editors, Deanna Gomby and Carol Larson, to shape this publication. We also appreciate the assistance of Cheri Gaither and Linda Laird in manuscript preparation.

As always, we welcome your comments on this journal issue. We hope that it will assist many people as they consider and plan for the expansion of home visiting programs.