Who enrolls in home visiting prenatally and how does this impact child and family outcomes in the first year of life?

Abstract

The present study used integrated data from statewide vital statistics and home visiting data and the Precision Paradigm with a bioecological-cumulative disadvantage framework to examine prenatal enrollment and child and family outcomes in home visiting programs. The integrated data system (IDS) provided access to a comprehensive set of child and family characteristics (i.e., low maternal education, single motherhood, teen motherhood, late start to prenatal care, first-time motherhood, tobacco use, large family, poverty, and low social support) and home visiting program information (i.e., child and family outcomes derived from the Life Skills Progression assessment, adverse birth outcomes from birth records, up to date well-child exams, and program completion). Informed by the Precision Paradigm, advanced methodologies including logistic regression supported the investigation to understand how home visiting works, for whom, and toward which outcomes. Findings documented the protective value of prenatal enrollment for families below 150% of the FPL and those with low or no social support. It also demonstrated that certain families were more likely to enroll prenatally, including families speaking languages other than English, mothers with less than 12 years of education, teen moms, first-time moms, families under 150% of the FPL, and families with low social support. Finally, the study identified patterns highlighting strengths and needs in rural areas. Findings suggest that prenatal enrollment could be a useful tool for increasing program engagement for families with certain risks and families with higher cumulative risks. Implications for policy and practice are discussed.