	Introduction

Home visiting is a strategy for delivering support and services to families or individuals in their homes. While home visiting may also be used to address needs of the chronically ill or elderly, this report deals exclusively with home visiting as a service strategy for families with young children or those who are expecting children. There are a variety of early home visiting models. These models typically seek to positively impact one or more child or family outcomes across three main domains: maternal and child health; early childhood social, emotional, and cognitive development; and family/parent functioning. Some estimates suggest that, at any point in time, as many as 400,000 to 500,000 families may be receiving early childhood home visitation services. Depending on the particular model of early childhood home visitation being used, the visitors may be specially trained nurses, other professionals, or paraprofessionals; visits may begin during a woman's pregnancy or later; and the visits may continue, regularly, until the child reaches his/her second birthday or enters school. Participation of families is voluntary. This appears to be driven in some part by newer research on how the human brain develops and, specifically, the significance of the prenatal and early childhood environments to later life. Further, at least since the 1960s, a variety of early childhood home visiting models have undergone many assessments and evaluations intended to test how effectively they achieve their goals. Overall, while researchers have cautioned that home visiting is not a panacea, they have generally encouraged its use as part of a range of strategies intended to enhance and improve early childhood. Apart from this research effort (described below), the federal government currently supports some ongoing programs in which home visitation is a primary strategy for achieving program goals (e.g., Early Head Start), others in which support for home visiting is explicitly permitted or strongly suggested by the program's statutory authority (e.g., Maternal and Child Health Block Grant and Promoting Safe and Stable Families), and still others where the broad purposes of the program allow use of funds for some or all of the activities supported by home visitation programs (e.g., Temporary Assistance for Needy Families (TANF), Medicaid). A number of legislative proposals to provide more support for home visitation programs have been offered, and the health care reform proposals passed by the House in November 2009 ( H.R. 3962 ) and Senate in December 2009 ( H.R. Proposed Grants to States for Home Visitation in Health Care Legislation

Health care reform bills passed, separately, in the House and in the Senate would establish a program of grants to states to support expanded delivery of evidence-based home visitation services to families with young children and those expecting children. There is no current law program that provides grants to states exclusively for the purpose of funding home visiting programs. Maternal and Child Health Block Grant
The Maternal and Child Health Block grant (Title V of the Social Security Act) is a public health program that seeks to (1) ensure access to and improve the quality of health care for mothers and children, especially those with low income or limited availability of care; (2) reduce infant mortality; (3) provide and ensure access to comprehensive prenatal and postnatal care to women (especially low-income and at-risk pregnant women); (4) increase the number of children receiving health assessments and follow-up diagnostic and treatment services; (5) provide and ensure access to preventive and child care services as well as rehabilitative services for certain children; (6) implement family-centered, community-based systems of coordinated care for children with special health care needs; and (7) provide toll-free hotlines and assistance in applying for services to pregnant women with infants and children who are eligible for Medicaid. States receiving funds under Part C are expected to establish such a council.
Health care reform legislation passed by the House in November 2009 (H.R. 3962) and in the Senate in December 2009 (H.R. 3590) would authorize and provide funds for grants to states to provide home visiting services, on a voluntary basis, to families with young children. (For a comparison of selected provisions in those proposals, see Table 4). There is no current law program that provides grants to states exclusively for home visiting programs. The Obama Administration requested authorization and funding for such a program as part of its FY2010 budget request. This proposal was not included in the President's FY2011 budget request, although the Administration has indicated its expectation that the pending health care reform legislation will be enacted.
Home visiting is a strategy for delivering support and services to families or individuals in their homes. This report deals exclusively with home visiting as a service strategy for families with young children or those expecting children. There are a variety of early childhood home visitation models. These models typically seek to positively impact one or more outcomes across three main domains: maternal and child health; early childhood social, emotional, and cognitive development; and family/parent functioning. Depending on the particular model of early home visitation being used, the visitors may be specially trained nurses, other professionals, or paraprofessionals. Visits, which often occur weekly, may begin during a woman's pregnancy or some time after the birth of a child and may continue until the child reaches his/her second birthday (in some cases) or enters kindergarten. Participation of families is voluntary.
Early childhood home visitation programs are in operation in all 50 states and the District of Columbia. The current combined public and private annual investment in these services has been estimated at between $750 million and $1 billion. This funding supports services for an estimated 400,000-500,000 families, or about 3% of all families (17.4 million) with children under six years of age. In addition to private and state and local public funds provided for early childhood home visitation, a number of federal programs have been tapped to support home visitation programs. Among others, these include Medicaid, the Temporary Assistance for Needy Families block grant, the Social Services Block Grant, the Promoting Safe and Stable Families program, Community-Based Grants to Prevent Child Abuse and Neglect, Even Start, Part C early intervention services for infants under the Individuals with Disabilities Education Act, the Maternal and Child Health Block Grant, Healthy Start, and Early Head Start.
The current popularity of early childhood home visitation draws, in some measure, from newer research on how the human brain develops and, specifically, the significance of prenatal and early childhood environments to later life outcomes. Further, since at least the 1960s, a variety of home visiting programs have undergone evaluations to test their effectiveness. While the results have been mixed, some research has shown results that promise both immediate and longer term benefits to children and their families, including improvements in birth outcomes, enhanced child cognitive development and academic success, and strengthened child-parent interactions. Overall, researchers caution that home visiting is not a panacea, but many have encouraged its use as part of a range of strategies intended to enhance and improve early childhood. This report will be updated as warranted.