The voices of Urban Institute's researchers and staff
August 28, 2017

Geographic data reveal gaps in home visiting services

August 28, 2017

Early childhood home visiting programs benefit caregivers and their children. Participating adults receive help becoming financially self-sufficient and are more likely to be employed or enrolled in school than their counterparts. Infants whose mothers are enrolled in home visiting are more likely to be born full term and to grow up in safer home environments.

Despite this demonstrated effect, evidence-based home visiting programs are in less than half of US counties, leaving many eligible families unable to access services. States have limited funding and must piece together federal, state, and private dollars to serve families they consider a priority. Geography can also pose a challenge, especially in rural areas where home visitors travel long distances to see one family. The reach of home visiting varies widely from state to state, which is explored further in the 2017 Home Visiting Yearbook.

Examining coverage by county

In Kentucky, eligible new parents can receive home visiting through the Health Access Nurturing Development Services Program, no matter which county they live in. Smaller states like Connecticut and Rhode Island also have home visiting programs in every county. But this widespread availability is not the norm. In most states, evidence-based home visiting programs are found in 25 to 75 percent of counties.

Patterns of coverage by county paint a picture of home visiting availability, but they overlook differences in geographic size, population, and service. Georgia and North Carolina have a similar population size, but Georgia residents are spread across 159 counties compared with North Carolina’s 100. Moreover, a single county could have one evidence-based program that serves 40 families or three programs that serve 400.

Taking a closer look: Mississippi’s home visiting needs and services

Across the country, the number of potential beneficiaries exceeds the number of families served. But some areas have higher needs than others. Many families in Mississippi could benefit, as 64 percent of potential beneficiaries in the state met at least one of five home visiting targeting criteria in 2015:

  • 35 percent of families were in poverty
  • 32 percent were headed by a single mother
  • 14 percent had parents without a high school diploma  

Mississippi families also reported several poor outcomes that home visiting aims to prevent, including preterm births, infant mortality, and child emergency room visits because of an accident or injury. Despite the state’s substantial need, only 703 of 181,100 families received home visiting services in 2015 through one of the state’s 18 local implementing agencies.

Many more families across the United States—including those identified as high priority—could benefit from home visiting. Understanding geographic disparities can help those looking to strengthen and expand services know where to concentrate their efforts.

This post was also published by the National Home Visiting Resource Center.

Cara Turpin, left, a home visitor with Healthy Families East Tennessee, visits with Kristi Diffin and her daughter Melodie at Kristi's home in Jacksboro, TN. Photo by Lydia Thompson/Urban Institute.


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