Designing a Home Visiting Framework for Families in Public and Mixed-Income Communities

Marla McDaniel, Caroline Heller, Gina Adams, and Susan J. Popkin October 2014 Early childhood is an important developmental period and a valuable time to positively affect a child’s life (National Research Council and Institute of Medicine 2000). It is also a vulnerable period for children in poverty and a time when large developmental disparities begin. Very young children in public housing are exposed to some of the deepest poverty in the United States, but they are usually out of reach of most interventions that might help. Home visiting programs that support and connect pregnant women and new mothers to educational and other early childhood resources hold promise for reaching vulnerable families. Some models have demonstrated positive effects on such dimensions of well-being as maternal health, child development, school readiness, parenting practices, and family economic self-sufficiency. Home visiting programs have also been linked to reductions in child maltreatment, juvenile delinquency, and family violence (Avellar et al. 2014). But these programs are not common in public housing communities. Since 2011, the Urban Institute has partnered with several local public housing agencies and service providers to evaluate an innovative two-generation model working with families in public and mixed-income housing. The Housing Opportunity and Services Together (HOST) demonstration has provided services to parents and school-age children with promising results (box 1). But l ocal community partners have become increasingly concerned about the need to reach families earlier, before their children have entered elementary school. After assessing the communities’ needs, it became clear that an early childhood home visiting program would be the most appropriate strategy. This brief was spurred by our interest in identifying appropriate home visiting models for two HOST sites in Chicago, Illinois, and Portland, Oregon. Because the existing home visiting models and literature did not sufficiently address some of the target sites’ unique needs, Urban Institute researchers sought and received funding through the Institute’s Low-Income Working Families project to convene a working group in fall 2013 to discuss how to design a home visiting framework for these communities. LOW-INCOME WORKING FAMILIES INITIATIVE BRIEF Designing a Home Visiting Framework for Families in Public and Mixed-Income Communities Working-group participants included 16 home visiting experts and key resident service staff from two housing authorities participating in HOST. (See the final section of this brief for a list of meeting participants.) This brief describes some of the key issues that program planners and early childhood leaders may need to consider in designing appropriate and responsive home visiting programs for families in public and mixed-income housing. It describes lessons and guidance from the meeting participants, including several who have developed, implemented, and studied home visiting programs across the country. BOX 1 What Is HOST? Since 2011, the Urban Institute has been studying whether intensive two-generation case management services for families living in public and mixed-income housing communities can improve family well-being and stability. The HOST demonstration’s goal has been to address caregivers’ primary obstacles to self-sufficiency—including untreated physical and mental health problems, addictions, limited educational attainment, and weak connection to employment—while integrating services and supports for children and youth. The services for children and youth focus on addressing the needs of school-age children and adolescents. One unique aspect of the HOST model is that it involves a partnership with local housing agencies and social service providers who develop the intensive two-generation supportive services for the most-vulnerable residents. The HOST model includes regular home visits and counseling and connects and refers families to outside services. Why Focus on Young Children in Public and Mixed-Income Housing? Many public housing communities are quite troubled, suffering from all the ills of chronic disadvantage: violence, disorder, and economic and social isolation. Adult residents are often unemployed or underemployed, and residents may have poorly managed physical and mental health problems. Children and youth are also in danger of injury, neglect, and educational failure (Popkin et al. 2000; Popkin et al. 2010). Ample evidence suggests the children are also at risk of developmental delays and delinquency (Popkin, Leventhal, and Weismann 2010). The federal government has recognized public housing’s problems for many years and has implemented broad efforts over the past three decades to improve both physical conditions and the life chances of residents. The federal HOPE VI program and other initiatives transformed public housing in the early 1990s, pr