About Home Visiting

Home Visiting Programs

The advantages of prevention in early childhood, especially with families living in disadvantaged communities, to improve health outcomes in later life is keenly researched.

Home visiting as a delivery model for early childhood services has proliferated since the 1990s and the types of programs have varied in their structure and enrolment criteria. Home visiting programs can be broadly grouped into three levels of prevention:

  1. Universal Home Visiting Programs. These programs are targeted to a whole population group. That is, they are made available to all families, regardless of estimated risk of child-related health or social problems. Examples of such programs include the Universal Health Home Visits provided under the NSW Health Supporting Families Early Maternal and Child Health Primary Health Care Policy and the Healthy Child Programme in England. See more information under Universal Child and Family Health Services.

  2. Indicated Home Visiting Programs. These programs focus on individuals who are identified as having an increased risk of developing problems related to specific factors but who do not meet the diagnostic criteria for the disorder at that time. For example, a mother who is having trouble breastfeeding who would benefit from a brief period of support from a Lactation Consultant or Peer Support Program.

  3. Selective Home Visiting Programs. These programs focus on individuals or subgroups of the population whose risk of developing a disorder are higher than average, as evidenced by biological, psychological or social risk factors. These families need more sustained or intensive support. Examples of such programs include the MECSH Program.

Click to open up larger image

Source: Based on Figure 1 from Cowley S, Kemp L, Day C, Appleton J. Research and the organisation of complex provision: conceptualising health visiting services and early years programmes. Journal of Research in Nursing 2012;17:108-24

This diagram illustrates the place for different types of practitioner in a health visiting service across the three levels of prevention. Families with the highest capacity are at one end of the continuum, and those with the lowest at the other.

Nurse Health visitor direct input - provision delivered by the nurse health visitor

Nurse Health visitor indirect input - provision arranged by or through nurse health visitors

Broader resource system - accessed through referral and includes formal and informal provision through health, local government and

Personal capacity and resources - includes emotional, cognitive, practical/physical and social resources available to the individual/ family, indicating strengths, capacity or resilience.

Home visiting service models for early childhood services provided by professionals are a formal and structured process of engaging with families. Parents and children are visited at home, usually during the child’s first two years but some programs commence antenatally, and trained professionals (such as child and family health nurses or social care practitioners) provide a combination of information, support or training to promote child development and improve maternal and child outcomes.

Universal Child and Family Health Services

Universal home visiting is a service that is mainstream and for every family with a newborn child. The underlying principle of universal health services for children and families is equity of access to antenatal care and well-child services so every child has the opportunity for optimal growth and development in their formative years.

Universal child and family health services form part of the comprehensive network of primary health care services for families and children across NSW. The focus of care is on promoting the health of children and their families through the use of a partnership relationship and an anticipatory guidance approach. Services are primarily psychosocial in nature and should be delivered on a continuous rather than episodic basis. Universal child and family health services offer a range of services for children and their families that includes:

  • providing information and support on a broad range of child and family issues; and
  • early identification of, and assistance with, issues such as parenting difficulties, infant feeding difficulties, postnatal distress and depression, and child protection.

Universal services may be delivered in two main settings:

  • Centre-based activities including early childhood health clinics and group programs.
  • Home visiting including the universal postnatal home visiting for mothers of newborn infants. Universal services may also include home visiting over the short term to address specific health issues, such as breastfeeding, settling or postnatal depression.

A study investigating the feasibility of implementing a national Framework for Family and Child Health Services in Australia commenced in 2010. The study is known as Child Health Researching Universal Services (CHoRUS) and is being conducted in three phases. Phase three of the study commenced in October 2011.