Opportunities for Achieving Enhanced Home Visiting through Place-Based Integration of Early Childhood Supports

Statement of Problem

Without good childhood health, development, safety and parenting engagement, children may not develop the foundation they need for lifelong health and well-being. Since the passage and investment of $1.5 billion in the Maternal, Infant and Early Childhood Home Visiting program (MIECHV) in 2010, home visiting programs have become key structural components of communities across the country in addressing these factors. Researchers have well documented the benefits of home visiting models, including improved maternal and child health indicators, school readiness, parenting satisfaction and connection to social services. 

The unprecedented increase of funding for key MIECHV models has created greater demand for public health-trained nursing staff to serve as home visitors. For vulnerable families with both medical and social complexities, these nurses provide preventive health services and health education, serve as care coordinators, and facilitate and maintain engagement with community health and social services. However, delivering effective training to nurses and sustaining competitive salaries is difficult, creating a need for new ways to encourage nurse applicants and retention of nurse staffing. As a result, pediatric primary care has become a promising venue to improve salary competitiveness and attract a wider range of nurse candidates given the duality of the role and the exposure to the health care system.

While the value of a nurse shared-staff model to families, communities and health care systems is untested, evidence suggests that such a model might potentiate health benefits, system efficiencies and cost savings. Longitudinal and controlled research studies have shown home visiting services have positive impacts on families’ health care utilization, adherence to well-child visit guidelines, immunizations, child safety and healthy physical and emotional development. Therefore, with this project we’re seeking to develop innovative models that take into consideration local contextual circumstances that impact these outcomes and that seek to engage the community and health care systems able to facilitate these effects in a comprehensive and coordinated approach.


In order to create efficiencies in service delivery and improve the overall health and well-being of patients, particularly pregnant women and their children, this project will create an integrated cross-sector early childhood support system for families that includes evidence-based home visiting services, pediatric primary care and quality child care. By embedding public health home visiting nurses within the primary care system, this project aims to expedite family engagement with nurse home visitors while simultaneously encouraging appropriate preventive and acute health care utilization.

An equally important system of care that is vital to the safety and well-being of children and can offer a unique perspective into a family’s overall care and coordination of services is early education – specifically quality child care centers that serve infants and toddlers. Through this pilot project, quality child care providers will improve communication and coordination of care by identifying opportunities to eliminate barriers and duplication of efforts across systems that impact families and service delivery.

The pilot model will be a place-based initiative aimed to strengthen how services are delivered to families within their communities. We will accomplish this through 1) embedding public health home visiting nurses within Children’s Hospital of Philadelphia’s primary care system, 2) facilitating child care enrollment for home-visited families and 3) building a sustainable model of early childhood family supports through effective engagement with key decision-makers in early childhood systems in Philadelphia and Pennsylvania.

We hypothesize that by expediting family engagement with evidence-based home visiting programs and quality child care services and supporting home-visited families within the health care system, we will improve appropriate preventive and acute health care utilization and the healthy development and safety of children.

Next Steps

PolicyLab researchers will conduct a 12-month planning period followed by a three-year implementation period. Among the planning activities, researchers will develop an advisory board and engage key stakeholders to encourage involvement in the development of the pilot project. After piloting the program, we will evaluate its effectiveness and prospects for sustainable funding.

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. Opportunities for Achieving Enhanced Home Visiting through Place-Based Integration of Early Childhood Supports  [Online] Available at: http://www.policylab.chop.edu [Accessed: plug in date accessed here]. 

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