Resource: Home Visit Risk Assessment

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Home Visit Risk Assessment

This is a risk assessment for staff who are conducting home visits.

Visits usually take place in the summer term to help build relationships and prepare parents and pupils for transition into reception.

Each staff member must read and sign.

When educators or school professionals conduct home visits as part of their teaching or school-related responsibilities, conducting a risk assessment beforehand is invaluable for several reasons:

Safety of the Educator : The primary reason is to ensure the safety of the educator or school staff visiting the home. The home environment may be unfamiliar, and there could be potential hazards or situations that could pose a threat.

Safety of the Child and Family : The risk assessment can also identify any hazards or issues that might impact the student and their family. By noting these, the educator can discuss them with the school or relevant authorities if necessary.

Building a Productive Relationship : When families see that educators are taking steps to ensure everyone’s well-being, it can foster a sense of trust and mutual respect. This can make the home visit and subsequent interactions more productive.

Effective Planning : By being aware of potential risks, educators can plan their visits more effectively. For instance, they might choose to visit at specific times or ensure that another adult is present.

Professional Responsibilities : Educators have a duty of care not only towards their students but also towards themselves. Conducting a risk assessment demonstrates due diligence in upholding this responsibility.

Legal and Institutional Compliance : Schools or educational institutions may have specific protocols or guidelines about home visits. A risk assessment helps ensure compliance with these guidelines and can provide documentation if any issues or disputes arise later.

Emotional and Social Considerations : Beyond physical risks, a home visit risk assessment can also consider potential emotional or social challenges, such as cultural sensitivities, that might affect the visit.

Feedback and Continuous Improvement : Regular risk assessments can provide feedback to educational institutions about the challenges faced during home visits. This can guide training and policy decisions to enhance the safety and effectiveness of future visits.

In summary, a risk assessment for home visits in teaching ensures that educators can conduct their tasks effectively, safely, and sensitively. It’s a proactive measure that upholds the well-being of all involved parties and ensures that home visits achieve their intended educational outcomes.

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History and Development of Home Visiting in the United States

Social justice movements before 1950, the war on poverty and prevention of child maltreatment, expansion of home visiting in recent decades, home visiting outside the united states, poverty, child health, and home visiting, national evaluation and evidence of effectiveness, home visiting and the medical home, recommendations and position statement, community pediatricians, large health systems, managed care organizations, and accountable care organizations, researchers, the aap endorses and promotes the following general policy positions and advocacy strategies:, conclusions.

  • Lead Authors
  • Council on community Pediatrics Executive Committee, 2016–2017
  • Council on Early Childhood Executive Committee, 2016–2017
  • Committee on Child abuse and Neglect, 2016–2017

Early Childhood Home Visiting

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

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James H. Duffee , Alan L. Mendelsohn , Alice A. Kuo , Lori A. Legano , Marian F. Earls , COUNCIL ON COMMUNITY PEDIATRICS , COUNCIL ON EARLY CHILDHOOD , COMMITTEE ON CHILD ABUSE AND NEGLECT , Lance A. Chilton , Patricia J. Flanagan , Kimberley J. Dilley , Andrea E. Green , J. Raul Gutierrez , Virginia A. Keane , Scott D. Krugman , Julie M. Linton , Carla D. McKelvey , Jacqueline L. Nelson , Emalee G. Flaherty , Amy R. Gavril , Sheila M. Idzerda , Antoinette “Toni” Laskey , John M. Leventhal , Jill M. Sells , Elaine Donoghue , Andrew Hashikawa , Terri McFadden , Georgina Peacock , Seth Scholer , Jennifer Takagishi , Douglas Vanderbilt , Patricia G. Williams; Early Childhood Home Visiting. Pediatrics September 2017; 140 (3): e20172150. 10.1542/peds.2017-2150

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High-quality home-visiting services for infants and young children can improve family relationships, advance school readiness, reduce child maltreatment, improve maternal-infant health outcomes, and increase family economic self-sufficiency. The American Academy of Pediatrics supports unwavering federal funding of state home-visiting initiatives, the expansion of evidence-based programs, and a robust, coordinated national evaluation designed to confirm best practices and cost-efficiency. Community home visiting is most effective as a component of a comprehensive early childhood system that actively includes and enhances a family-centered medical home.

Recent advances in program design, evaluation, and funding have stimulated widespread implementation of public health programs that use home visiting as a central service. This policy statement is an update of “The Role of Preschool Home-Visiting Programs in Improving Children’s Developmental and Health Outcomes” (2009) and summarizes salient changes, emphasizes practical recommendations for community pediatricians, and outlines important national priorities intended to improve the health and safety of children, families, and communities. 1 By promoting child development, early literacy, school readiness, informed parenting, and family self-sufficiency, home visiting presents a valuable strategy to buffer the effects of poverty and adverse early childhood experiences that influence lifelong health.

The term “home visiting” refers to an evidence-based strategy in which a professional or paraprofessional renders a service in a community or private home setting. Home visiting also refers to the variety of programs that employ home visitors as a central component of a comprehensive service plan. 2 Early childhood home-visiting programs may be focused on young children, children with special health care needs, parents of young children, or the relationship between children and parents, and they can use a 2-generational strategy to simultaneously address parental and family social and economic challenges. 3  

Home-visiting programs vary widely with regard to target populations and goals. Many successful home-visiting models are directed toward mothers and infants in high-risk groups, such as adolescent mothers and single-parent families. Other models concentrate on specific populations, such as recently incarcerated adolescents, children with special needs, or immigrants. Some programs are designed to identify risk factors, such as environmental hazards and maternal mental health, but others include mentoring, coaching, and other therapeutic interventions. Many employ independently licensed health professionals, but others depend on trained paraprofessionals (including community health workers) drawn from the communities they serve. Community-based care coordination (including housing, transportation, and nutritional support) often are service components. Integration with the family-centered medical home (FCMH) has been a recent focus for program improvement and medical education. 4  

Home visiting began in the United States in the 1880s as an activity of each of 3 social justice movements. Derived from the British models developed a few decades earlier, home visitors were deployed to promote universal kindergarten, improve maternal-infant health through public health nursing, and support impoverished immigrant communities as part of the philanthropic settlement house movement. From the late 19th through the early 20th century, teachers and public health nurses visited communities and families to provide in-home education and health care to urban women and children. These efforts were based on the assumptions still held that education is the most powerful strategy to lift children out of poverty and that the lifelong health of families in immigrant and poor neighborhoods is improved by addressing the social and economic aspects of health and disease. 5  

From the Great Depression through World War II, funding for social initiatives decreased and philanthropic support for home visitors declined. After the relatively prosperous postwar period, renewed interest developed in antipoverty activities, including home visiting, especially in the context of the Civil Rights Movement. In the 1960s, home visiting became an important component of the government’s so-called War on Poverty. Home visiting was and remains integral to programs such as Head Start, although it is applied on a limited basis compared with Early Head Start, for which home visiting is a central service component. A decade later, many home-visiting programs shifted to include case management, intending to help families achieve self-sufficiency and link them to other broad community support services. 6 Improving school readiness, moderating poverty-related social risk determinants, reducing environmental safety hazards, and promoting population-based health remain core goals of contemporary home visiting.

In the last quarter of the 20th century, home visiting gained renewed attention as a strategy for the prevention of child abuse and neglect, promotion of child development, and improvement of parental effectiveness. C. Henry Kempe, MD, called for a home visitor for every pregnant mother and preschool-aged child in his 1978 Abraham Jacobi Memorial Award address. 7 He suggested that integral to every child’s right to comprehensive care is the assignment of a home health visitor to work with the family until each child began school. The visionary pediatrician who developed the concept of the medical home, Cal Sia, MD, reiterated Kempe’s call to action in his 1992 Jacobi Award address 8 based on his experience with Hawaii’s Healthy Start Program, which is an innovative, statewide home-visiting initiative to prevent child abuse and neglect. Another pioneer in modern home visiting, David Olds, PhD, initiated the Nurse-Family Partnership (NFP) with families at risk in Elmira, New York, in 1978. 1  

Before 2009, at least 22 states recognized the critical role of home visitors within statewide systems for at-risk pregnant mothers, infants, and toddlers from birth to 5 years old. States legislated funding for home-visiting programs while insisting on proof of effectiveness, fiscal accountability, and continuous quality improvement. Even during the Great Recession that followed the US financial crisis of 2007 to 2008, some state governments enacted home-visiting legislation to ensure long-term sustainability through innovative financing mechanisms and the strategic allocation of limited public resources.

In 2009, the American Recovery and Reinvestment Act (Public Law Number 111-5) included $2.1 billion for the expansion of Head Start and Early Head Start (including the home-visiting components of Early Head Start) to benefit young children in low-resource communities. The next year, the Patient Protection and Affordable Care Act of 2010 (ACA) (Public Law Number 111-148) designated $1.5 billion, allocated over 5 years, for the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV). The Health Resources and Services Administration currently administers the MIECHV in collaboration with the Administration for Children and Families. The allocations to states, territories, and tribal entities are designed to support the implementation and evaluation of evidence-based home-visiting programs regarding specified goals and objectives. All 50 states, the District of Columbia, and 5 US territories have home-visiting programs. 9 In addition, ACA funding provides support for home-visiting initiatives to serve American Indian and Alaskan native children through the Tribal MIECHV program. 10  

Nineteen home-visiting models have met the criteria of the US Department of Health and Human Services (HHS) for evidence of effectiveness through the Home Visiting Evidence of Effectiveness (HomVEE) review. Supported by federal grants through the MIECHV, states receive funding to implement 1 or more evidence-based models designated eligible by the MIECHV that best meet the needs of particular at-risk communities. The program objectives must improve outcomes that are statutorily defined and must include increased family economic self-sufficiency, improved health indicators (eg, a reduction in health disparities) in target populations, and improved school readiness. After 2013, potential program outcomes were expanded to include reductions in family violence, juvenile delinquency, and child maltreatment. 11 A review of 4 common programs illustrates the range of measurable outcomes. Healthy Families America identifies family self-sufficiency as a principal objective measured by a reduction of dependence on public assistance. 12 Early Head Start and other home-visiting programs focus on the promotion of child development and positive family relationships. NFP is designed to improve prenatal health, maternal life course development, and positive parenting. 13 Parents as Teachers promotes child development and school readiness. 14  

Home visiting for families with young children is an early intervention strategy in many industrialized nations outside of the United States. In several European countries, home health visiting is provided at no cost to the family, participation is voluntary, and the service is embedded in a comprehensive maternal and child health system. 3 While visiting young mothers at home, public health nurses in other countries provide many child health-promotion services that are provided by pediatricians in the United States. For instance, Denmark established home visiting in 1937 after a pilot program showed lower infant mortality rates linked with the services of home visitors. France provides universal prenatal care and home visits by midwives and nurses, who educate families about smoking, nutrition, drug use, housing, and other health-related issues.

The Early Start program in New Zealand targets families with 2 or more risk factors on an 11-point screening measure that includes parent and family functioning. Randomized controlled trials showed improvement in access to health care, lower hospitalization rates for injuries and poisonings, longer enrollment in early childhood education, and more positive and nonpunitive parenting. 15 , 16 The Dutch NFP program, VoorZorg, was found to reduce victimization and perpetration of self-reported intimate partner violence during pregnancy and 2 years after birth among low-educated, pregnant young women, 17 and there were fewer reports of child abuse. At 24 months, measurable improvements were evident in the home environments of participating families, and the children exhibited a significant reduction in internalizing symptoms. 18  

Paraprofessionals (ie, trained but unlicensed lay people) are often employed as home visitors in low-resource areas of the world. In Haiti, for example, community health workers trained by Partners in Health improve the care of those with HIV, multidrug-resistant tuberculosis, and such waterborne illnesses as cholera. In southern Mexico and other areas in Central America, “promotoras de salud,” or community health workers, coordinate with lay midwives to care for expectant mothers in rural, isolated, and other low-resource regions. Promotoras are deployed in many regions in the United States and have been recognized by HHS for their ability to reduce barriers and improve access to culturally informed and linguistically appropriate health care. 19  

More than 1 in 5 young children in the United States live in families with incomes below the federal poverty level, and more than 2 in 5 live at less than twice that level. 20 Living at or below 200% of the federal poverty level places children, 21 especially infants and toddlers, at high risk for adverse early childhood experiences that lead to lifelong detrimental effects on health, education, and vocational success. 22 Home visitors can help families attain economic self-sufficiency by linking them to community support services (such as quality preschool) while encouraging parents to enroll in training opportunities that lead to employment. Although they differ in structure, targeted populations, and intended outcomes, high-quality home-visiting programs deliver family support and child development services that provide a foundation for physical health, academic success, and economic stability in vulnerable families that are at risk for the adverse effects of poverty and other negative social determinants of health.

By applying multigenerational interventions, home visiting may improve child health and family wellbeing in many domains. Individual neuroendocrine-immune function, behavioral allostasis, and relational health are all established in the first 3 years of life, 23 when home visiting is most often applied. 24 The emerging science of toxic stress indicates that poverty and its accompanying problems, such as food insecurity, may disrupt the architecture and function of the developing brain. 25 , 26 Home visitors have the opportunity to assess risk and protective factors in families, identify potential adversity, and intervene at the earliest opportunity. By promoting supportive relationships, reducing parental stress, and increasing the likelihood of positive experiences, home visiting may help avoid the deleterious behavioral and medical health outcomes associated with child poverty. 27 , – 31  

Young mothers in poverty disproportionately suffer moderate to severe symptoms of maternal depression, elevating the risk of poor developmental and educational outcomes for their children. 32 Almost 1 in 4 mothers who are near or below the federal poverty level experience significant depression, but few obtain appropriate treatment. In-home cognitive behavioral therapy is a novel treatment modality for maternal depression that has proved to be effective in early trials. 33 Combining in-home cognitive behavioral therapy with other home-visiting programs, such as Early Head Start, that promote positive parenting and infant development provides a model of 2-generational care that has the potential to mitigate the effects of poverty and improve both family financial stability and school readiness. 34  

Home-visiting programs are most effective when they are components of a community-level, comprehensive early childhood system that reaches families as early as possible with needed services, accommodates children with special needs, respects the cultures of the families in the communities, and ensures continuity of care in a continuum from prenatal life to school entry. 35 , 36 An early childhood system may include safety-net resources (such as supplemental food and subsidies for housing, heating, and child care), adult education, job training, cash assistance, quality child care, early childhood education, and preventive health services. 37 Communicating the strengths and risk factors of individual families to the FCMH may further increase the coordination of care and efficient use of services. 38  

When the MIECHV program was established by the ACA, HHS established the HomVEE review of the research literature on home visiting. 11 Results of that review are used to identify home-visiting service delivery models that meet HHS criteria for evidence of effectiveness because, by statute, at least 75% of the funds available from the ACA are to be used for programs that use service delivery models that are evidence based. The HomVEE conducts a yearly literature search to identify promising studies of home-visiting models. It includes only studies that are considered to meet quality standards on the basis of overall design (only randomized controlled trials or quasiexperimental studies are included) and design-specific criteria. Studies that meet criteria for entry are then assessed for outcomes in the following 8 domains, as defined by HHS:

Child health;

Maternal health;

Child development and school readiness;

Reductions in child maltreatment;

Reductions in juvenile delinquency, family violence, and crime;

Positive parenting practices;

Family economic self-sufficiency; and

Linkages and referrals.

To meet HHS criteria for evidence of effectiveness, home-visiting models must demonstrate favorable outcomes in either 1 study with results in 2 or more domains or 2 studies with significant benefits in the same domain. To be included, study designs must meet evaluation quality standards, and outcomes need to show statistically significant benefits using nonoverlapping analytic samples. As of April 2017, the 18 models that meet these standards (along with 2 programs that do not meet criteria for implementation) with target populations, ages of participants, and outcomes for which there is evidence are listed in Table 1 . 11  

Home-Visiting Programs Meeting HHS Criteria for Evidence of Effectiveness (as of April 2017)

Reference: https://www.mathematica-mpr.com/our-publications-and-findings/publications/home-visiting-evidence-of-effectiveness-review-executive-summary-april-2017 . Descriptions of specific home-visiting programs by state can be accessed at: https://homvee.acf.hhs.gov/models.aspx .

Outcomes: (1) child health; (2) maternal health; (3) child development and school readiness; (4) reductions in child maltreatment; (5) reductions in juvenile delinquency, family violence, and crime; (6) positive parenting practices; (7) family economic self-sufficiency; and (8) linkages and referrals.

A rapidly expanding evidence base documents the benefits of high-quality home-visiting programs, especially when they are integrated in a comprehensive early childhood system of care. 39 Home visiting has been shown to increase children’s readiness for school, promote child health (such as vaccine rates), and enhance parents’ abilities to promote their children’s overall development. There is evidence that home visiting reduces the risk of both child abuse and unintended injury. 16 , 40 Maternal health is improved by more frequent prenatal care, better birth outcomes, and early detection and treatment of depression. 41 Outcome studies have established the effectiveness of home visiting by nurses or community health workers in reducing child maltreatment, 42 improving birth outcomes, 43 and increasing school readiness. 44  

A close examination of the evidence of effectiveness published in 2015 by the HomVEE review provides additional insights about the potential benefits and limitations of current models of home visiting. 11 Of the 44 models assessed in 2015, 19 showed improvements in at least 1 primary outcome measure, and 15 had favorable effects on secondary measures. These results are consistent with both the broad scope of many of the models as well as the likelihood that improvements in 1 domain sometimes lead to benefits in another (eg, positive parenting improving child development). All 19 models that showed positive results had evidence of sustained benefits for at least 1 year after enrollment.

In addition to the 19 models approved in 2015, 8 of the 25 that were not approved had evidence of benefit, perhaps because of stringent criteria for study quality and number. Even among programs showing positive outcomes, there was not a high level of consistency across domains. For example, only 7 of 19 models demonstrated benefits in the same domain across 2 or more studies. Many effect sizes were fairly small (approximately 0.2 SDs) but comparable to those seen in many studies of programs located in other settings (eg, early child education). 45 However, modest effect sizes in studies concerning developmental delay can result in important population-level effects given the high proportion of children in low-income families (nearly 20%) meeting criteria for early intervention services. 46 , 47  

Longitudinal studies within the HomVEE review of the NFP have shown improvements in adolescent mental health, in middle school achievement, over substance use and/or criminality immediately after high school, as well as in overall maternal and child mortality. 48 , – 50 Other studies document the persistence of beneficial outcomes after population-level scaling. A study of Durham Connects (also known as Family Connects) showed more than 80% participation and 84% adherence among all mothers delivering in Durham, North Carolina, during an 18-month period. 51 Researchers in this study, using rigorous methodology, documented important and beneficial effects on child health, including a 59% reduction in emergency medical care, an increase in positive parenting, successful linkages to community services, and improved maternal mental health. In addition, a large-scale study of SafeCare home-based services showed reductions in reports to child protective services after a scale-up of the program in Oklahoma. 52 These beneficial outcomes of rigorous program evaluation counterbalance other studies that found little or no benefit after a scale-up, such as the finding of reduced implementation fidelity and limited benefit after scaling up Hawaii’s Healthy Start Program. 53  

Other studies document the capacity of home visiting to successfully target specific high-risk populations and implement interventions of varying intensity specific to the intended outcome. For example, Computer-Assisted Motivational Intervention, when applied in combination with home visiting, successfully reduced subsequent pregnancies among pregnant teenagers. 54 Other 2-generational interventions, including Family Spirit (which targets American Indian teen-aged mothers) and Family Check-Up (which targets young mothers with depression), improved behavioral problems in infants and young children as well as the mental health of the young mothers. 55 , – 57  

Finally, the outcomes documented by the HomVEE need to be considered in the context of a number of meta-analyses and systematic reviews that have been conducted other than the HomVEE. One of the most cited is a meta-analysis that documented significant benefits across 4 broad domains, including child development, child abuse prevention, childrearing, and maternal life course. 58 Benefits were maximized when specific rather than general populations were targeted, when interventions used professionals versus paraprofessionals, and when interventions were more specifically focused on parental rather than child wellbeing. 59 , – 61  

Integration of home visiting with the medical home expands the multidisciplinary team into the community, enhancing the goals of communication, coordination of care, and comprehensive care. With effective leadership, the pediatric or FCMH may become a community hub that connects early education and child development activities with health promotion to support maximum outcomes for children and families. The Institute for Healthcare Improvement has described the triple aim as improvement of the health of populations, improvement of the quality of care and experience of each patient, and the reduction of per capita cost. The history of home visiting also reveals another triple aim of improving health, preparing children for education, and reducing poverty. An advanced medical home that reaches out to the community by collaborating with or integrating a high-quality home-visiting program has the potential of meeting both sets of triple aims. 62 , 63  

Some important factors that are common among home-visiting programs that are also characteristic of an FCMH include an emphasis on relationships, the provision of culturally informed care, coordination with other community support agencies, an emphasis on strength-based assessments, and collaboration with families to support self-identified goals. Of particular importance is the relationship that develops between the visitor and the family engaging in a natural environment and the consequent improvement in the relationships among family members. 64 As more has been learned about toxic stress and its negative effect on the life trajectory, close and nurturing relationships have emerged as a most important protective factor. The home visitor can extend the support of the medical home into the community and provide an important link for the family to the relationship with a compassionate pediatric practitioner while improving family relational health. 65  

The integration or colocation of home visiting with the medical home presents many opportunities for synergy and collaboration. The joint statement from the Academic Pediatric Association and the American Academy of Pediatrics (AAP) regarding integration of the FCMH with home visiting emphasizes the potential for coordinated anticipatory guidance, improved early detection, and enhanced community involvement. 66 Recommendations in the joint statement include integrated, computerized record systems; the creation of a joint registry; coverage of home visiting by payers, including Medicaid and the Children’s Health Insurance Program; and supporting the evaluation of coordination between an FCMH and home visiting. In a collaborative model, referrals between a pediatric practitioner and the home visitor may constitute a warm handoff (face-to-face introduction), increasing the likelihood that family concerns are communicated and addressed. For example, a home visitor has the opportunity to complete developmental screening with the parent in a child’s natural environment. The results of screening may be communicated to the pediatric practitioner for use and comparison with the developmental assessment during health-promotion visits. A shared chronic condition care plan facilitates common therapeutic goals, linkages to community resources, and follow-up on referrals. Particularly helpful have been home-visiting strategies for children with diabetes or asthma. Researchers have associated home visiting with improvements in symptoms, urgent care use, and family quality of life. 67  

Home visiting may be used effectively as an adjunctive strategy in comprehensive community-based programs serving children. Although not approved for MIECHV funding, Healthy Steps for Young Children is a comprehensive primary-care model that may include on the treatment team a home visitor who supports positive parenting, provides in-home developmental assessment, and links the family more strongly to the medical home. 68 The example of Healthy Steps illustrates the significant potential benefits from improved collaboration between the medical home and community home-visiting programs. These include common documentation, centralized intake services, strength-based assessments, colocation of home visitors in the pediatric practice, and multidisciplinary team meetings convened by the practice. Through these coordinated activities, home visitors are in partnership with the medical home to build parental resilience, promote child development, and support healthy family relationships. 66 , 69 Other models that similarly employ home visiting as an adjunctive strategy, such as the Health Resources and Services Administration’s Bridging the Word Gap Research Network 70 , 71 and the New York City Council’s City’s First Readers program, exemplify systematic linkages among the medical home, home-visiting programs, and other community-based services with early childhood education. 63 , 72  

Because home-visiting models and programs cross many health systems and involve many funding sources, this policy divides recommendations into the following 3 levels: community pediatricians, large health systems, and researchers. The section concludes with AAP-supported federal and state advocacy strategies.

Provide community-based leadership to promote home-visiting services to at-risk young mothers, children, and families;

Be familiar with state and local home-visiting programs and develop the capacity to identify and refer eligible children and pregnant mothers;

Consider opportunities to integrate or colocate home visitors in the FCMH;

Recognize home-visiting programs as an evidence-based method to enhance school readiness and reduce child maltreatment;

Recognize home visiting as a promising strategy to buffer the effects of stress related to the social determinants of health, including poverty; and

Serve as a referral source to home-visiting programs as a strategy to engage families in services and strengthen the connection between home visiting and the medical home.

Develop a continuum of early childhood programs that intersects or integrates with the FCMH;

Ensure that home-visiting programs are culturally responsive, linguistically appropriate, and family centered, emphasizing collaboration and shared decision-making;

Ensure that all home-visiting programs incorporate evidence-based strategies and achieve program fidelity to ensure effectiveness;

Support the use of trained community health workers, especially in lower-resourced, tribal, and immigrant communities; and

Develop training and certification programs for community health workers to ensure quality and fidelity to program expectations.

Improve understanding of how to engage difficult-to-reach and high-risk communities and populations, including immigrant families, families with low literacy and/or health literacy and limited English proficiency, families that are socially isolated, and families living in poverty in evidence-based home-visiting programs;

Improve understanding of how to take successful programs to scale while maintaining fidelity;

Improve understanding of how to optimize links between evidence-based home-visiting programs and the medical home;

Determine the degree to which the medical home and strategies using multidisciplinary and integrated interventions can provide added value to and synergy with evidence-based home-visiting programs;

Determine the degree to which home-visiting programs can augment the medical home in the prevention or mitigation of chronic disease, such as asthma and obesity, and associated morbidities;

Improve understanding of how to tailor the implementation of evidence-based home-visiting programs to diverse populations with heterogeneous strengths and challenges; and

Investigate and establish the cost-effectiveness and return on investment of home-visiting programs as well as program components.

The continuation and expansion of federal funding for evidence-based home-visiting programs;

Public support for the dissemination of home-visiting programs that meet the HomVEE criteria for evidence of effectiveness as well as other programs with early and promising evidence of potential effectiveness;

The establishment of state systems that integrate home-visiting infrastructure (such as data collection and evaluation) into a comprehensive early childhood service system;

Coordination across state agencies and health systems that serve young children to build an efficient and effective infrastructure for home-visiting programs;

The simplification and standardization of referral processes in and among states to improve the coordination of care and integration of home-visiting services with the medical home; and

The inclusion of home-visiting experience in community pediatrics education and exposure by residents and medical students to the evidence of effectiveness of home-visiting models.

The objectives of contemporary home-visiting programs have strong roots in public health, early childhood education, and antipoverty efforts. Home visiting has expanded rapidly in the recent past, with the current generation of programs providing strong evidence of effectiveness in many domains of family life. Rigorous national outcome evaluations substantiate that home-visiting programs are effective in the promotion of healthy family relationships, improvement of overall child development, prevention of child maltreatment, advancement of school readiness, and improvement of maternal physical and mental health. By linking families to opportunities such as employment and continuing education, home visiting increases family economic stability and thereby is a successful antipoverty strategy. Home-visiting programs have shown the most effectiveness when they are components of community-wide, early childhood service systems. With pediatrician leadership, the FCMH can serve as the hub for coordinating community-based, family support programs at the intersection of early education with public health promotion designed to help children avoid the lifelong effects of early childhood adversity.

American Academy of Pediatrcs

Patient Protection and Affordable Care Act

family-centered medical home

US Department of Health and Human Services

Home Visiting Evidence of Effectiveness

Maternal, Infant, and Early Childhood Home Visiting Program

Nurse-Family Partnership

Dr Duffee was intimately involved with the concept, organization, and design during the early phases of writing, he reviewed the contributions of the other authors, consolidated the contributions (along with his own) into the final product, took responsibility for responding to comments and direction from staff and the Board of Directors, and reviewed the references in detail to ensure that the evidence supports the recommendations; and Drs Kuo, Legano, Mendelsohn, and Earls assisted with revisions; and all authors approve the final manuscript as submitted.

This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

Policy statements from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. However, policy statements from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent.

The guidance in this statement does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

FUNDING: No external funding.

L ead A uthors

James H. Duffee, MD, MPH, FAAP

Alan L. Mendelsohn, MD, FAAP

Alice A. Kuo, MD, PhD, FAAP

Lori Legano, MD, FAAP

Marian F. Earls, MD, MTS, FAAP

Council on c ommunity Pediatrics Executive Committee , 2016–2017

Lance A. Chilton, MD, FAAP, Chairperson

Patricia J. Flanagan MD, FAAP, Vice Chairperson

Kimberley J. Dilley, MD, MPH, FAAP

Andrea E. Green, MD, FAAP

J. Raul Gutierrez, MD, MPH, FAAP

Virginia A. Keane, MD, FAAP

Scott D. Krugman, MD, MS, FAAP

Julie M. Linton, MD, FAAP

Carla D. McKelvey, MD, MPH, FAAP

Jacqueline L. Nelson, MD, FAAP

Jacqueline R. Dougé, MD, MPH, FAAP – Chairperson, Public Health Special Interest Group

Kathleen Rooney-Otero, MD, MPH – Section on Pediatric Trainees

Camille Watson, MS

Council on Early Childhood Executive Committee , 2016– 20 17

Jill M. Sells, MD, FAAP, Chairperson

Elaine Donoghue, MD, FAAP

Marian Earls, MD, FAAP

Andrew Hashikawa, MD, FAAP

Terri McFadden, MD, FAAP

Alan Mendelsohn, MD, FAAP

Georgina Peacock, MD, FAAP

Seth Scholer, MD, FAAP

Jennifer Takagishi, MD, FAAP

Douglas Vanderbilt, MD, FAAP

Patricia Gail Williams, MD, FAAP

Laurel Murphy Hoffmann, MD – Section on Pediatric Trainees

Barbara Sargent, PNP – National Association of Pediatric Nurse Practitioners

Alecia Stephenson – National Association for the Education of Young Children

Dina Lieser, MD, FAAP – Maternal and Child Health Bureau

David Willis, MD, FAAP – Maternal and Child Health Bureau

Rebecca Parlakian, MA – Zero to Three

Lynette Fraga, PhD – Child Care Aware

Charlotte Zia, MPH, CHES

Committee on Child a buse and Neglect , 2016–2017

Emalee G. Flaherty, MD, FAAP

Amy R Gavril, MD, FAAP

Sheila M. Idzerda, MD, FAAP

Antoinette “Toni” Laskey, MD, MPH, MBA, FAAP

Lori A. Legano, MD, FAAP

John M. Leventhal, MD, FAAP

Harriet MacMillan, MD – American Academy of Child and Adolescent Psychiatry

Elaine Stedt, MSW – Department of Health and Human Services Office on Child Abuse and Neglect

Beverly Fortson, PhD – Centers for Disease Control and Prevention

Tammy Hurley

Competing Interests

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Home Visitor Safety

Home visitor being welcomed at front door.

You can work with other program administrators and community resources to implement policies, procedures, and strategies that can contribute to home visitors’ and families’ safety in unsafe situations. As you put safety plans and measures in place, keep the following concepts in mind [ 5 ]:

Sometimes situations, such as crises, arise that pose some degree of risk to the safety of family members and home visitors.  The potential for physical harm exists in any emotionally charged crisis. Staff should never overlook or discount that potential.

Home visitors’ skills in handling a potentially dangerous situation shape intervention decisions. Sometimes home visitors find themselves faced with, or caught up in, a family situation that is too complex or too dangerous for them to address directly. At such times, it is critical to recognize that the situation is beyond their intervention abilities and to discuss alternatives with their supervisor.

The best predictor of impending danger is behavior. Safety measures are called for if a family member's current or past behavior includes violent/abusive acts, threats of harm, criminal activities, the use of addictive substances, signs of a serious emotional disorder, or threats of suicide. These measures are needed at several points in the intervention process: before face-to-face visits with the family, during face-to-face visits, and as part of referral and follow-up services.

Home visitors must always be aware of behaviors and situations that signal danger. Some violent incidents may be predicted, but many helping professionals fail to recognize signs of potential violence. Signs of loss of control and impending danger include expressions of anger and hostility. Staff may also sense that a situation is dangerous; know the family has access to guns or other weapons; be aware of violent acts or threats by family friends or relatives; and recognize mounting tension, irritability, agitation, brooding, and/or limit testing in family members.

Home visitors must be and feel safe if they are to support families. Home visitor safety can and must be addressed at many levels. The threat of violence does not occur only in the homes of families or in high-crime neighborhoods, but also in seemingly secure workplaces. Work conditions favorable to violence prevention require action at management, supervisory, and personal levels.

Some general strategies that you may consider include the following:

  • Have home visitors work in pairs, particularly when they go to more dangerous neighborhoods. Accompany home visitors, if needed.
  • Forge a relationship with the local police department. When police are aware of home visitors’ presence in the community, they may be able to provide protection such as self-defense training and alerts as to potentially hazardous events in the community.
  • Provide cell phones, beepers, or other communication devices. Work with finance and other program staff to ensure the budget covers this equipment.
  • Involve families in home visitor safety. They often know of potential safety hazards in the neighborhood (e.g., high-crime areas, gang activity) and can inform home visitors of the safest way to travel through the area.
  • Work with program administrators and community resources to develop crisis protocols and make sure home visitors are aware of them. Provide opportunities for home visitors to review and practice implementing protocols. Topics may include child abuse/child neglect, substance misuse, violence in the neighborhood, and the presence of a contagious disease.
  • Make sure that you or another administrator is “on call” whenever a home visitor is in the field, including after hours and weekends, so that home visitors can get an immediate response when needed.
  • Make sure you know home visitors’ schedules. This should include family names and contact information, date and time of visit, and when to expect the home visitor to return. 

In addition, you might encourage home visitors to do the following [ 4 ]:

  • Trust their instincts. If they feel something is not right or see something in the home that makes them uncomfortable (e.g., physical or verbal violence, alcohol/drug use, evidence of firearms, or the presence of an acutely intoxicated individual), follow established protocols and leave, if necessary. Encourage home visitors to say to the parent, “Maybe this isn’t a good time for a visit. Let’s reschedule.” Before going on future visits, encourage home visitors to talk with you about how to ensure their safety in the home. Work with home visitors to talk with the parent about the issues that made them feel uncomfortable and to make referrals if needed.
  • Wear comfortable shoes.
  • Get clear directions to the neighborhood and the home or apartment building, especially for new visits. Take a practice drive to make sure the directions work. Confirm how to enter the home if it is a duplex or apartment.
  • Ask families where it is best to park, and park as close to the home as possible. Always park in well-lit areas. If it is not possible for the home visitor to park in a safe place, discuss other options, such as meeting the family in another setting or being driven and picked up by a co-worker.
  • Put any important or valuable items in the trunk of the car before arriving for the visit. Avoid carrying and wearing expensive items.
  • Contact parents before a visit so they can be on the lookout for the home visitor.
  • If no one answers the door, sit in the car or drive around the block rather than wait at the door. Make sure to specify the amount of time home visitors should wait if a family is not home as part of your home visit protocol.
  • Make sure home visitors’ cars are in good working order and that there is plenty of gas in the tank.
  • Organize belongings so they do not have to take time to search for them. For example, when they leave a home visit, they should have their keys in hand.

4 Rebecca Parlakian and Nancy Seibel, Help Me Grow Home Visitor Curriculum (Cuyahoga County, OH: Help Me Grow of Cuyahoga County, 2005).

5 Head Start Bureau, “Assessing Family Crisis.” Excerpts from Training Guides for the Head Start Learning Community: Supporting Families in Crisis (Washington, DC: Department of Health and Human Services, Administration for Children and Families, Administration for Children, Youth and Families, 2000), https://eclkc.ohs.acf.hhs.gov/mental-health/article/assessing-family-crisis.

Resource Type: Article

National Centers: Early Childhood Development, Teaching and Learning

Program Option: Home-Based Option

Last Updated: May 22, 2023

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Home Visits 101

Home visits can be a valuable tool for increasing parents’ involvement in their kids’ education. Here’s how you can get started.

A teacher and a parent meet at a cafe.

Teachers often find themselves wondering why their efforts at organizing opportunities for parents to become more involved in classroom activities do not pan out. They send written reminders home with their students, make phone calls, email, and text. When their repeated attempts to communicate with parents are left unanswered, many teachers become discouraged and begin making negative assumptions about parents’ involvement.

Home visits can establish positive contact and communication with families. They are not a replacement for parent-teacher conferences, but are a process through which teachers demonstrate their support for students’ families by visiting the home environment or an alternative location where the family feels at home and comfortable. Home visits should originate from a sincere desire to assist and work with families (see examples of two teachers’ best and worst home visits ). Home visits promote proactive interactions through which teachers provide authentic support while recognizing families’ strengths.

For teachers interested in conducting home visits, here is some guidance for getting stated.

Do Your Research

Teachers may be reticent to implement home visits because of the time commitment and effort involved. There are many testimonials from teachers and families about successful home visits, but without systemic school and district support, a teacher’s ability to carve out time during the school day to conduct home visits is limited.

For those who are determined, being well-informed about the benefits and rewards as well as the challenges of home visits is important. Once teachers commit to making home visits, they can take steps to research, plan for, implement, and document the process.

Know Your Families

One consideration is learning about students’ families, their communities and neighborhoods, languages and/or cultural differences, and work schedules. Being culturally responsive when conducting home visits communicates respect while demonstrating genuine interest in families’ rich heritages.

Investigating how others have conducted home visits is important if you want to create a process that is doable, realistic, and beneficial to students and their families.

Plan Strategically

Teachers who regularly conduct home visits advise establishing contact with parents before the school year begins. Some home visit models emphasize the benefits of teachers pairing up , traveling together to students’ homes, and introducing themselves to parents during the summer. The first visit should focus on building a relationship, extending support, and actively listening to parents’ concerns and insights. For transparency and safety, the home visit schedule (including location, time, and date) should be provided to school staff.

Be Flexible

Parents may not always feel comfortable meeting in the home. Alternative locations such as a local library, a quiet café, or even a fast-food restaurant may be appropriate venues for family-centered visits. Being flexible may also mean meeting on weekends, before schools begins, or at the end of the school day. Home visits planned in advance allow teachers to pair up strategically to coordinate visits when they have students who are siblings or who live in the same neighborhood.

Focus on Strengths

A teacher who enters the home with a nonjudgmental attitude views the home through the eyes of the family living there and sees the family’s strengths. A culturally responsive approach and appropriate, equity-minded language convey trust and respect. And if the teacher has concerns about the student, they can use the sandwich feedback technique to voice concerns sandwiched between strengths-based praise that is concrete and genuine.

Create an Action Plan

Actively listening to parents’ insights, concerns, and ideas for their child demonstrates authentic interest and respect. On a first home visit, teachers should not take notes since the act of collecting information may arouse parents’ distrust or suspicion. Rather, the teacher can ask parents if they have questions and take mental notes, and then, at a later time, create a voice memo or write out notes of what was discussed.

Before subsequent home visits, teachers can inform parents that they will take notes about concerns or ideas that arise from the discussion. These notes may build on other school-centered meetings and provide a plan of action upon which the teachers and parents can build.

Report Back

One way to remain accountable to students’ families is to maintain, revisit, and keep current the plan of action generated jointly by the teacher and family. Finding out from parents which method of correspondence is most effective and then checking in regularly with them about mutually established goals for the child provides both teachers and parents an open, ongoing platform through which to communicate and interact.

Home visits are a great beginning to positive communication and relationships between teachers and their students’ families. Establishing a strong foundation through home visits is only a first step—nurturing these relationships through consistent communication is critical to maintaining them.

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Impacts of Home Visiting Programs on Young Children’s School Readiness

Grace Kelley, PhD, Erika Gaylor, PhD, Donna Spiker, PhD SRI International, Center for Education and Human Services, USA January 2022 , 2nd rev. ed.

Introduction

Home visiting programs are designed and implemented to support families in providing an environment that promotes the healthy growth and development of their children. Programs target their services to families and caregivers in order to improve child development, enhance school readiness, and promote positive parent-child interactions. Although programs differ in their approach, populations served and intended outcomes, high-quality home visiting programs can provide child development and family support services that reduce risk and increase protective factors.    Home visiting programs addressing school readiness are most effective when delivered at the community level, through a comprehensive early childhood system that includes the supports and services that ensure a continuum of care for all family members across the early years.  School readiness includes the readiness of the individual child, the school’s readiness to support children, and the ability of the family and community to support early child development, health, and well being. In addition to home visiting services, appropriate referrals to community services, including to preschool programs, offer a low-cost universal approach that increases the chances of early school success. This comprehensive approach to home visiting as a part of a broad early childhood system has been identified as an effective strategy to help close the gap in school readiness and child well-being associated with poverty and early childhood adversity. 1,2 

Home visitation is a type of service-delivery model that can be used to provide many different kinds of interventions to target participants. 3,4 Home visiting programs can vary widely in their goals, clients, providers, activities, schedules and administrative structure. They share some common elements, however. Home visiting programs provide structured services:

  • in a home a  ;
  • from a trained service provider;
  • in order to alter the knowledge, beliefs and/or behaviour of children and caregivers or others in the caregiving environment, and to provide parenting support. 5

Home visits are often structured to provide consistency across participants, providers, and visits and to link program practices with intended outcomes. A visit protocol, a formal curriculum, an individualized service plan, and/or a specific theoretical framework can be the basis for activities that take place during home visits. Services are delivered in the living space of the participating family and within their ongoing daily routines and activities. The providers may be credentialed or certified professionals, paraprofessionals, or volunteers, but typically they have received some form of training in the methods and topical content of the program so that they are able to act as a source of expertise and support for caregivers. 6 Finally, home visiting programs are attempting to achieve some change on the part of participating families—in their understanding (beliefs about child-rearing, knowledge of child development), and/or actions (their manner of interacting with their child or structuring the environment, ability to provide healthy meals, engage in prenatal health care)—or on the part of the child (change in rate of development, health status, etc.). Home visiting also may be used as a way to provide case management, make referrals to existing community services including early intervention for those with delays and disabilities, or bring information to parents or caregivers to support their ability to provide a positive and healthy home environment for their children. 3,4,7

Data about the efficacy of home visiting programs have been accumulating over the past several decades. The federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program launched in the U.S. in 2012 and its accompanying national Mother and Infant Home Visiting Program Evaluation (MIHOPE)  (which included 4 models - Early Head Start’s Home-based option, Healthy Families America, Nurse-Family Partnership, and Parents as Teachers), and the Home Visiting Evidence of Effectiveness (HoMVEE) reviews has contributed much new data about program features, implementation, and impacts. 8-12 More of the research has  used randomized controlled trial (RCT) or quasi-experimental designs, with multiple data sources and outcome measures, and longitudinal follow-up. These studies, along with older reviews,  and recent meta-analyses have generally found that home visiting programs produce a limited range of significant effects and that the effects produced are often small. 4,13,14 Nevertheless, a review of seven evidence-based home visiting models showed all seven to have at least one study with positive impacts on child development and school readiness outcomes. 13 Detailed analyses, however, sometimes reveal important program effects. For example, certain subsets of participants may experience long-term positive outcomes on specific variables. 15,16 These results and others suggest that in assessing the efficacy of home visiting programs, it is important to include measures of multiple child and family outcomes at various points in time and to collect enough information about participants to allow for an analysis of the program effects on various types of subgroups. Averaging effects across multiple studies is currently seen as an inadequate approach to understanding what works for whom. 17

Other difficulties when conducting or evaluating research in this area include ensuring the equivalency of the control and experimental groups in randomized controlled trials (RCTs), 18 controlling for participant attrition (which may affect the validity of findings by reducing group equivalence) and missed visits (which may affect validity by reducing program intensity), 19 documenting that the program was fully and accurately implemented, and determining whether the program’s theory of change logically connects program activities with intended outcomes.

Research Context

Because home visiting programs differ in their goals and content, research into their efficacy must be tailored to program-specific goals, practices, and participants. (See also chapter by Korfmacher and coll. ) In general, home visiting programs can be grouped into those seeking medical/physical health outcomes and those seeking parent-child interaction and child development outcomes. The target population may be identified at the level of the caregiver (e.g., teen mothers, low-income families) or the child (e.g., children with disabilities). Some programs may have broad and varied goals, such as improving prenatal and perinatal health, nutrition, safety, and parenting. Other programs may have narrower goals, such as reducing the incidence of child abuse and neglect. Program outcomes may focus on adults or on children; providers frequently cite multiple goals (e.g., improved child development, parent social-emotional support, parent education). 10  

In this chapter, we focus on the effectiveness of home visiting programs in promoting developmental, cognitive, and school readiness outcomes in children. The majority of home visiting services and research have focused on the period prenatally through 2 to 3 years and thus have not measured long-term impacts on school readiness and school achievement, but some of the more recent studies have done follow up into elementary school. However, most of the available studies have examined the impact on these outcomes indirectly through changes in parenting practices and precursors to successful school success (i.e., positive behaviour outcomes including self-regulation and attention).

Key Research Questions

Key research questions include the following:

  • What are the short-term and long-term benefits experienced by participating families and their children relative to nonparticipating families, particularly for children’s school readiness skills and parenting to support child development?
  • What factors influence participation and nonparticipation in the program?
  • Do outcomes differ for different subgroups?

Research Results

Recent advances in program design, evaluation and funding have supported the implementation of home visiting as a practical intervention to improve the health, safety and education of children and families, mitigating the impact of poverty and adverse early childhood experiences. 3 Although program approaches and quality may vary, there are common positive effects found on parenting knowledge, beliefs, and/or behaviour and child cognitive, language, and social-emotional development. In order to achieve the intended outcomes, programs need to have clearly defined interventions and outcome measures, with a process to monitor quality. 20  Recent research has begun to focus on how measures to assess quality can be used to monitor programs and program improvement efforts. 21,22  

A review of seven home visiting program models across 16 studies conducted over a decade ago that included rigorous evaluation components and measured child development and school readiness outcomes concluded positive impacts on young children’s development and behaviour. Six models showed favourable effects on primary outcome measures (e.g., standardized measures of child development outcomes and reduction in behaviour problems). 23 Only studies with outcomes using direct observation, direct assessment, or administrative records were included. More recent reviews also show relatively small effects on developmental outcomes, but authors noted that “modest effect sizes in studies concerning developmental delay can result in important population-level effects given the high proportion of children in low-income families (nearly 20%) meeting criteria for early intervention services”. 3  A rigorous review conducted more recently in 2018 identified 21 home visiting models that met criteria of being an evidence-based model. 11 That review concluded that 12 of the models had evidence for favorable impacts on child development and school readiness outcomes. Recent and continuing research has been focusing on families with infants and toddlers living in poverty who are at higher risk for adverse early childhood experiences (ACES) that can lead to lifelong negative effects on physical and emotional health, and  educational success. 3,24 For example, the Adverse Childhood Experiences study indicates that traumatic experiences in early childhood can have lifelong impacts on physical and mental health. Data from this study indicate that children with 2 or more adverse experiences are more likely to repeat a grade. Home visiting programs can mitigate the effects of toxic stress, enhancing parenting skills and creating more positive early childhood experiences. 24,25 This research points to the importance of targeted home visiting programs to families who are experiencing stress and a recent meta-analysis of home visiting with such families indeed shows decreases in both social-emotional problems and stressful experiences. 26  

Problems identified in earlier reviews completed in the 1990s still plague this field, however, including that many models have limited rigorous research studies. In many of the studies described in previous and more recent reviews and meta-analyses, programs struggled to enroll, engage, and retain families. When program benefits are demonstrated, they usually accrued only to a subset of families originally enrolled in the programs, they rarely occurred for all of a program’s goals, and the benefits were often quite modest in magnitude. 27    The generally small effects on outcomes averaged across studies have led researchers to call for precision home visiting research to look at what works for whom. 17,28 (Also see chapter by Korfmacher and coll .).

Research into the implementation of home visiting programs has documented a common set of difficulties across programs in delivering services as intended. (See also Paulsell chapter ) First, target families may not accept initial enrollment into the program. Two studies that collected data on this aspect of implementation found that one-tenth to one-quarter of families declined invitations to participate in the home visiting program. 29,30 In another study, 20 percent of families that agreed to participate did not begin the program by receiving an initial visit. 19 Second, families may not receive the full number of planned visits. Evaluation of the Nurse Family Partnership model found that families received only half of the scheduled number of visits. 31 Evaluations of the Hawaii Healthy Start and the Parents as Teachers programs found that 42 percent and 38 percent to 56 percent of scheduled visits respectively were actually conducted. 29,32 Even when visits are conducted, the planned curriculum and visit activities may not be presented according to the program model, and families may not follow through with the activities outside of the home visit. 33,34 Recent research has begun to examine how technical assistance and training supports delivered to home visiting program supervisors and home visitors can improve model fidelity. 35 (See Paulsell chapter. )  In a review of home visiting research in the 1990s, Gomby, Culross, and Berman 27 found that between 20 percent and 67 percent of enrolled families left home visitation programs before the scheduled termination date. More recent studies continue to show a persistent problem with families leaving the program and not engaging in visits as intended by program developers. For example, in the MIHOPE evaluation, about 28% of families left MIHOPE home visiting programs within six months, while about 55% were still receiving about two visits per month after a year. 9 With only about half of families remaining after one year, many families were only receiving half of the intended number of visits. 8 Studies of Early Head Start also show that families with the greatest number of risk factors are the most likely to drop out which was also observed in the recent MIHOPE study. 36  

The assumed link between parent behaviour change and improved outcomes for children has received mixed research support. In other words, even when home visitation programs succeed in their goal of changing parent behaviour, these changes do not always appear to produce significantly better child outcomes in the short term, but in some cases appear to have an impact in the long term. 37,38  Examples include a study of the Home Instruction Program for Preschool Youngsters (HIPPY) model with low-income Latino families showing changes in parenting practices and better third-grade math achievement and positive impacts on both math and reading achievement in fifth grade. 39,40 Earlier evaluations of HIPPY found mixed results regarding program effectiveness. In some cohorts, program participants outperformed nonparticipants on measures of school adaptation and achievement through second grade, but these results were not replicated with other cohorts at other sites.

Both older and more recent reviews of home visiting programs described above included only studies using rigorous designs and measurement and a number of models show significant impacts on child development and school readiness outcomes. The Early Head Start model used a RCT design to study the impact of a mixed-model service delivery (i.e., center-based and home-visiting) on developmental outcomes at 2- and 3-year follow-up. Overall, there were small, but significant gains on cognitive development at 3 years, but not 2 years. More recent Early Head Start evaluations find positive impacts at ages 2 and 3 on cognition, language, attention, behaviour problems, and health and on maternal parenting, mental health, and employment outcomes, with better attention and approaches toward learning and fewer behavior problems at age 5 than the control group, but no differences on early school achievement. 41 Nonexperimental follow-up showed, however, that those children who went on to attend preschool after EHS did have better early school achievement. Studies of the Nurse Family Partnership model followed children to 6 years and found significant program effects on language and cognitive functioning as well as fewer behaviour problems in a RCT study. 42 In addition, evaluations of Healthy Families America have shown small, but favourable effects on young children’s development. 43,44  

Home visiting programs focusing on supporting parents’ abilities to promote children’s development explicitly appear to impact children’s development positively. One meta-analysis found that programs that taught parent responsiveness and parenting practices found better cognitive outcomes for children. 4 A meta-analysis of RCTs found that the most pronounced effect for parent-child interactions and maternal sensitivity can be improved in a shorter period of time, where effects of interventions on child development may take longer to emerge. 45 Several studies find longer-term impacts on parenting and associated positive effects for child outcomes. In a RCT of a New York Healthy Families America program, the program reduced first grade retention rates and doubled the number of first graders demonstrating early academic skills for those participating in the program. 2 And at least one recent longitudinal study of Parents as Teachers found positive school achievement and reduced disciplinary problems in early elementary school along with increased scores on parent measures of interactions, knowledge of child development, and family support. 46

Other studies were unable to document program impacts on parenting and home environment factors that are predictive of children’s early learning and development through control group designs. An evaluation of Hawaii’s Healthy Start program found no differences between experimental and control groups in maternal life course (attainment of educational and life goals), substance abuse, partner violence, depressive symptoms, the home as a learning environment, parent-child interaction, parental stress, and child developmental and health measures. 43 However, program participation was associated with a reduction in the number of child abuse cases.   

Other models show mixed impacts. A 1990’s RCT evaluation of the Parents as Teachers (PAT) program also failed to find differences between groups on measures of parenting knowledge and behaviour or child health and development. 32 Small positive differences were found for teen mothers and Latina mothers on some of these measures. However, another RCT study with the Parents as Teachers Born to Learn curriculum did find significant effects on cognitive development and mastery motivation at age 2 for the low socioeconomic families only. 47  Furthermore, a more recent RCT in Switzerland found that children receiving the PAT program had improved adaptive behavior and enhanced language skills at age 3 with the most high-risk children also having reductions in problem behaviours. 48 A randomized controlled trial of Family Check-Up demonstrated favourable impacts on at risk toddlers’ behaviour and positive parenting practices. 49

Randomized controlled trials (RCTs) have also shown that programs are more likely to have positive effects when targeted to the neediest subgroups in a population. For example, in the Nurse Family Partnership model children born to mothers with low psychological resources had better academic achievement in math and reading in first through sixth grade compared to their control peers (i.e., mothers without the intervention with similar characteristics). 50,51 (See also updated information in the Donelan-McCall & Olds chapter ).

The largest RCT of a comprehensive early intervention program for low-birth-weight, premature infants (birth to age three), the Infant Health and Development Program, included a home visiting component along with an educational centre-based program. 52 At age three, intervention group children had significantly better cognitive and behavioural outcomes and improved parent-child interactions. The positive outcomes were most pronounced in the poorest socioeconomic group of children and families and in those who participated in the intervention most fully. In follow-up studies, improvements in cognitive and behavioural development were also found at age 8 and 18 years for those in the heavier weight group. 53 The Chicago Child-Parent  Center Program also combined a structured preschool program with a home visitation component. This program found long-term differences between program participants and matched controls. Participating children had higher rates of high-school completion, lower rates of grade retention and special education placement, and a lower rate of juvenile arrests and impacts lasting into adulthood. 54-56 Another example showing more intensive programming has larger impacts is the Healthy Steps evaluation showing significantly better child language outcomes when the program was initiated prenatally through 24 months. 57 Early Head Start studies cited earlier also show that combining home visiting with later preschool attendance will yield better school readiness impacts than home visiting alone. Finally, there is a need to look at how home visiting could be beneficial for improving school outcomes when combined with a preschool program as in a recent study with families in Head Start programs that found reduced need for educational and mental health services in third grade. 58 These studies suggest that a more intensive intervention involving the child directly may be required for larger effects on school readiness to be seen with home visiting as one part of a more comprehensive approach.

Conclusions

Research on home visitation programs has not been able to show that these programs alone have a strong and consistent effect on participating children and families, but modest effects have been repeatedly reported for children’s early development and behaviour and parenting behaviours and discipline practices. Programs that are designed and implemented with greater rigour seem to provide better results. Home visitation programs also appear to offer greater benefits to certain subgroups of families, such as low-income, single, teen mothers.

These conclusions support recent attention to use of research designs that look at more differentiation of the program models and components to match the needs of the families aimed at improving child development and other outcomes. Precision home visiting uses research to identify what aspects of home visiting work for which families in what circumstance, resulting in programs that target interventions to the needs of particular families. 17  

Future research needs to examine the role of evidence-based home visiting within a more comprehensive system of services across the first five years of life.  It can be an initial cost -effective strategy to build trusting relationships and support early positive parenting that will improve children’s development over the long run because families will have increased likelihood of enrolling their children in preschool programs and use other needed child and family supports. 

Furthermore, efficacy research needs to include longitudinal designs and simultaneously include cost-benefit studies to demonstrate the long-term cost savings that will build public support for both early home visiting programs and a more comprehensive early childhood system. 

The recent Covid-19 pandemic brought to light the disparities and inequities of our early childhood service systems (as well as our later education systems). This state of affairs also has reinforced the benefit of more authentic participatory approaches in research and evaluation to identify what works and for whom.  Research and evaluation that includes various stakeholders, from those who are affected by an issue to those that fund the programs, promises to provide insights and perspectives that can strengthen the impact of home visiting programs. 

Implications

Programs that are successful with families at increased risk for poor child development outcomes tend to be programs that offer a comprehensive focus—targeting families’ multiple needs—and therefore may be more expensive to develop, implement, and maintain. In their current state of development, home visitation programs alone do not appear to represent the low-cost solution to child health and developmental problems that policymakers and the public have hoped for for decades. However, as the field continues to research more precision approaches that match program components to child and family needs, add the needed assistance and professional development supports to ensure model fidelity, and incorporate home visiting programs within a comprehensive early childhood system across the first five years of life, more consistent and positive results for participating target families are to be expected.

For high risk families with multiple challenges and levels of adversity, home visiting programs can serve to encourage families to take advantage of preschool programs available to them and their children and increase their participation in other family support programs during the preschool through 3 rd grade years 59 to further support school readiness outcomes. 

Dodge KA, Goodman WB, Murphy R, O'Donnell K, Sato J. Toward population impact from home visiting. Zero Three . 2013;33(3):17-23.

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Michalopoulos C, Faucetta K, Hill CJ, Portilla XA, Burrell L, Lee H, Duggan A, Knox V. Impacts on family outcomes of evidence-based early childhood home visiting: Results from the Mother and Infant Home Visiting Program evaluation . Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services; 2019. OPRE Report 2019-07.

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Avellar S, Paulsell D, Sama-Miller E, Del Grosso P. Home visiting evidence of effective-ness review: Executive summary. Washington, DC: Office of Planning Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services;2013.

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Karoly LA, Greenwood PW, Everingham SS, et al. Investing in our children: What we know and don't know about the costs and benefits of early childhood interventions . Santa Monica, CA: RAND Corporation;1998. MR-898-TCWF.

Olds DL, Eckenrode J, Henderson CR Jr, Kitzman H, Powers J, Cole R, Sidora K, Morris P, Pettitt LM, Luckey D. Long-term effects of home visitation on maternal life course and child abuse and neglect: 15-year follow-up of a randomized trail. JAMA . 1997;278(8):637-643.

Supplee LH, Duggan A. Innovative research methods to advance precision in home visiting for more efficient and effective programs. Child Development Perspectives . 2019;13(3):173-179.

Olds DL. Prenatal and infancy home visiting by nurses: From randomized trials to community replication. Prevention Science . 2002;3(3):153-172.

Wagner M, Spiker D, Linn MI, Gerlach-Downie S, Hernandez F. Dimensions of parental engagement in home visiting programs: Exploratory study. Topics in Early Childhood Special Education . 2003;23(4):171-187.

Finello KM, Terteryan A, Riewerts RJ. Home visiting programs: What the primary care clinician should know. Current Problems in Pediatric and Adolescent Health Care. 2016;46(4):101-125.

Korfmacher J, Frese M, Gowani S. Examining program quality in early childhood home visiting: From infrastructure to relationships. Infant Ment Health Journal . 2019;40(3):380-394.

Roggman LA, Cook GA, Innocenti MS, Jump Norman VK, Boyce LK, Olson TL, Christiansen K, Peterson CA. The Home Visit Rating Scales: Revised, restructured, and revalidated. Infant Ment Health Journal . 2019;40(3):315-330.

Paulsell D, Avellar S, Sama Martin E, Del Grosso T. Home visiting evidence of effectiveness: Executive summary. Princeton, NJ: Mathematica Policy Research;2010.

Williams PG, Lerner MA, Council on Early Childhood, Council on School Health. School Readiness. Pediatrics . 2019;144(2):e20191766.

McKelvey LM, Whiteside-Mansell L, Conners-Burrow NA, Swindle T, Fitzgerald S. Assessing adverse experiences from infancy through early childhood in home visiting programs. Child Abuse and Neglect . 2016;51, 295–302.

van Assen AG, Knot-Dickscheit J, Post WJ, Grietens H. Home-visiting interventions for families with complex and multiple problems: A systematic review and meta-analysis of out-of-home placement and child outcomes. Children and Youth Services Review . 2020;114:104994.

Gomby DS, Culross PL, Behrman RE. Home visiting: Recent program evaluations-analysis and recommendations. Future Child . 1999;9(1):4-26.

Condon EM. Maternal, Infant, and Early Childhood Home Visiting: A Call for a Paradigm Shift in States' Approaches to Funding. Policy, Politics, & Nursing Practice . 2019;20(1):28-40.

Duggan AK, McFarlane EC, Windham AM, Rohde CA, Salkever DS, Fuddy L, Rosenberg LA, Buchbinder SB, Sia CC. Evaluations of Hawaii's Healthy Start Program. Future Child . 1999;9(1):66-90.

Olds DL, Henderson CR, Jr., Kitzman HJ, Eckenrode JJ, Cole RE, Tatelbaum RC. Prenatal and infancy home visitation by nurses: Recent findings. Future Child . 1999;9(1):44-65.

Korfmacher J, Kitzman H, Olds DL. Intervention processes as predictors of outcomes in a preventive home visitation program. Journal of Clinical Child & Adolescent Psychology . 1998;26(1):49-64.

Wagner MM, Clayton SL. The Parents as Teachers Program: Results from two demonstrations. Future Child. 1999;9(1):91-115.

Baker AJL, Piotrkowski CS, Brooks-Gunn J. The Home Instruction Program for Preschool Youngsters (HIPPY). Future Child . 1999;9(1):116-133.

Hebbeler KM, Gerlach-Downie SG. Inside the black box of home visiting: A qualitative analysis of why intended outcomes were not achieved. Early Childhood Research Quarterly . 2002;17:28-51.

Chen W-B, Spiker D, Wei X, Gaylor E, Schachner A, Hudson L. Who gets what? Describing the non‐supervisory training and supports received by home visiting staff members and its relationship with turnover. American Journal of Community Psychology . 2019;63:298-311.

Roggman L, Cook G, Peterson CA, Raikes H. Who drops out of Early Head Start home visiting programs? Early Education & Development . 2009;19:574-579.

Caughy MO, Huang K, Miller T, Genevro JL. The effects of the Healthy Steps for Young Children Program: Results from observations of parenting and child development. Early Childhood Research Quarterly . 2004;19(4):611-630.

Minkovitz CS, Strobino D, Mistry KB, Scharfstein DO, Grason H, Hou W, Ialongo N, Guyer B. Healthy steps for young children: Sustained results at 5.5 years. Pediatrics . 2007;120(3):658-668.

Nievar A, Brown AL, Nathans L, Chen Q, Martinez-Cantu V. Home visiting among inner-city families: Links to early academic achievement. Early Education and Development. 2018;29(8):1115-1128.

Nievar MA, Jacobson A, Chen Q, Johnson U, Dier S. Impact of HIPPY on home learning environments of Latino families. Early Childhood Research Quarterly. 2011;26:268-277.

Love JM, R. C-C, Raikes H, Brooks-Gunn J. What makes a difference: Early Head Start evaluation findings in a developmental context. Monographs of the Society for Research in Child Development . 2013;78((1):vii-viii):1-173.

Olds DL, Kitzman H, Cole R, Robinson J, Sidora K, Luckey DW, Henderson CR Jr, Hanks C, Bondy J, Holmberg J. Effects of nurse home-visiting on maternal life course and child development: Age 6 follow-up results of a randomized trial. Pediatrics . 2004;6(6):1550-1559.

Caldera D, Burrell L, Rodriguez K, Crowne SS, Rohde C, Duggan A. Impact of a statewide home visiting program on parenting and on child health and development. Child Abuse and Neglect. 2007;31(8):829-852.

Landsverk J, Carrillo T, Connelly CD, et al. Healthy Families San Diego clinical trial: Technical report. San Diego, CA: The Stuart Foundation, The California Wellness Foundation, State of California Department of Social Services: Office of Child Abuse Prevention; 2002.

Rayce SB, Rasmussen IS, Klest SK, al. e. Effects of parenting interventions for at-risk parents with infants: a systematic review and meta-analyses. BMJ Open 2017.

Lahti M, Evans CBR, Goodman G, Schmidt MC, LeCroy CW. Parents as Teachers (PAT) home-visiting intervention: A path to improved academic outcomes, school behavior, and parenting skills. Children and Youth Services Review. 2019;99:451-460.

Drotar D, Robinson J, Jeavons L, Lester Kirchner H. A randomized, controlled evaluation of early intervention: The Born to Learn curriculum. Child: Care, Health & Development. 2009;35(5):643-649.

Schaub S, Ramseier E, Neuhauser A, Burkhardt SCA, Lanfranchi A. Effects of home-based early intervention on child outcomes: A randomized controlled trial of Parents as Teachers in Switzerland. Early Childhood Research Quarterly. 2019;48:173-185.

Shaw DS, Dishion TJ, Supplee L, Gardner F, Arnds K. Randomized trial of a family-centered approach to the prevention of early conduct problems: 2-year effects of the family check-up in early childhood. Journal of Consulting and Clinical Psychology. 2006;74(1):1-9.

Olds DL, Kitzman H, Hanks C, Cole R, Anson E, Sidora-Arcoleo K, Luckey DW, Henderson CR Jr, Holmberg J, Tutt RA, Stevenson AJ, Bondy J. Effects of nurse home visiting on maternal and child functioning: Age-9 follow-up of a randomized trial. Pediatrics . 2007;120(4):e832-e845.

Kitzman HJ, Olds DL, Cole RE, Hanks CA, Anson EA, Arcoleo KJ, Luckey DW, Knudtson MD, Henderson CR Jr, Holmberg JR. Enduring effects of prenatal and infancy home visiting by nurses on children: Follow-up of a randomized trial among children at age 12 years. Archives of Pediatric Adolescent Medicine . 2010;164(5):412-418.

Gross RT, Spiker D, Haynes CW, eds. Helping low birth weight, premature babies . Stanford, CA: Stanford University Press; 1997.

Mallik S, Spiker D. Effective early intervention programs for low birth weight premature infants: Review of the Infant Health and Development Program (IHDP). In: Tremblay RE, Barr RG, Peters RD, eds. Encyclopedia on early childhood development [online]. Montreal, Quebec: Centre of Excellence for Early Childhood Development; 2016.

Reynolds AJ, Temple JA, Robertson DL, Mann EA. Long-term effects of an early childhood intervention on educational achievement and juvenile arrest: A 15-year follow-up of low-income children in public schools. JAMA . 2001;285(18):2339-2346.

Reynolds AJ, Richardson BA, Hayakawa M, Englund MM, Ou S-R. Multi-site expansion of an early childhood intervention and school readiness. Pediatrics . 2016;138(1):1-11.

Reynolds AJ, Temple JA, Ou S-R, Arteaga IA, White BAB. School-based early childhood education and age-28 well-being: Effects by timing, dosage, and subgroups. Science . 2011;333(6040):36-364.

Johnston BD, Huebner CE, Anderson ML, Tyll LT, Thompson RS. Healthy steps in an integrated delivery system: Child and parent outcomes at 30 months. Archives of pediatrics & adolescent medicine. 2006;160(8):793-800.

Bierman KL, Welsh J, Heinrichs BS, Nix RL. Effect of preschool home visiting on school readiness and need for services in elementary school: A randomized clinical trial. JAMA Pediatrics . 2018;172(8):e181029-e181029.

Magnuson K, Schindler HS. Parent programs in pre-k through third grade. Future Child . 2016;26(2):207-223.

Note: a Services are brought to the family and settings may include the family’s home, or another mutually agreed upon location such as community center, park, or public library. More recently, due to the pandemic, programs have relied on virtual methods or conducting a home visit remotely via digital devices.   

How to cite this article:

Kelley G, Gaylor E, Spiker D. Impacts of Home Visiting Programs on Young Children’s School Readiness. In: Tremblay RE, Boivin M, Peters RDeV, eds. Spiker D, Gaylor E, topic eds. Encyclopedia on Early Childhood Development [online].  https://www.child-encyclopedia.com/home-visiting/according-experts/impacts-home-visiting-programs-young-childrens-school-readiness . Updated: January 2022. Accessed March 4, 2024.

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How to Create a Risk Assessment in Schools

How to Create a Risk Assessment in Schools

In this article

Whilst children are more likely to have an accident than any other age group, some accidents involving children, particularly in school, could be preventable if proper procedures are followed. Furthermore, during the period 2019-22, the Health and Safety Executive in Great Britain found that there were an estimated 1,450 work-related injuries in educational settings, highlighting the necessity of risk assessments to control these incidents.

What is a school risk assessment?

A school risk assessment is an assessment carried out by members of staff in a school in order to understand the potential hazards to health and safety in the school setting. A school may have multiple risk assessments for multiple scenarios, such as experiments in a science lab, or going on a school trip. Risk assessments are created and used to help teachers and members of staff understand how they can keep children safe in line with the national health and safety guidelines. Carrying out a risk assessment is not aimed at ensuring that there are no risks, as this would be impossible. Instead, it is designed to make sure that measures are in place to reduce risks to health and safety as much as possible.

According to the government website, all schools must appoint a ‘competent’ person to make sure that the health and safety responsibilities of the school are being met, and that risk management is being continually assessed and updated.

Risk should be assessed in the following scenarios, but is not limited to these:

  • Managing health infections and outbreaks.
  • Staff injury and accidents.
  • Pupil injury and accidents.
  • Visitor injury and accidents.
  • Residential visits.
  • School trips and off-site activities.
  • Transitioning to online learning.

Day-to-day risk should be assessed too, such as activities within the school day.

These activities include but are not limited to:

  • PE lessons.
  • Science experiments.
  • Transitioning between lessons.
  • Fire alarm/drills.
  • Detentions.
  • Assemblies.
  • Operational routines such as setting up and cleaning.

Risk Assessment in Schools

Why are risk assessments necessary?

Risk assessments are necessary as they demonstrate that the school is taking action to meet the statutory requirements for health and safety. According to health and safety law in England and Wales, schools are obligated to ensure that a record is kept of all risk assessments. Risk assessments identify who may be at risk in a particular scenario, what the risk may be and what has been put in place to reduce the risk. It is an effective and preventative method, keeping schools prepared for worst-case scenario instances. Furthermore, risk assessments are useful and necessary for other staff to understand their roles and responsibilities in a given scenario.

If risk assessments are not carried out, or are carried out ineffectively, the hazards that children and staff could face, without the appropriate measures put in place to reduce the risk of harm, could result in injury, and even fatalities. Risk assessments are one of the most important procedures an educational setting can undertake.

Who are risk assessments for?

Risk assessments in a school setting are not just undertaken to protect children from harm but serve to protect everyone in the school setting or on residential trips. This includes teachers and teaching staff, supply teachers, kitchen staff, admin and operations staff, visitors and anyone else who may visit the site.

Risk assessments also ensure that staff are doing their job properly to control the risks that may occur. Should the risks occur, staff will have a readily available protocol to follow.

Risk assessments also support vulnerable children and staff. For example, a risk assessment for a school trip would assess the risk to children and staff with disabilities, those with food allergies, and those with behavioural needs. It would ensure that, where necessary, separate provisions would be made to minimise the risk posed to those individuals.

Who creates risk assessments?

Usually in schools, the headteacher would have the final say on risk assessments, though they do not necessarily create them to begin with. Risk assessments may be delegated to those in the responsible remit, and may be collaborative, as they involve different teams. For example, the admin or HR lead might create risk assessments related to processes concerning that particular remit, such as working from home, a risk assessment for strikes, or event planning in the school. The facilities lead might create risk assessments for PE equipment storage, the stairs and corridors and pest control.

If a risk assessment is being created for a singular instance, such as a trip, the risk assessment might draw on existing risk assessments for trips and visits but should be tailored to the visit. Usually, the person leading the trip would create the risk assessment.

School Trip

How do you create a risk assessment?

Your school may have their own template to follow when it comes to creating risk assessments. This is an indicative guide to creating a risk assessment, which can be used alongside your school’s risk assessment guidelines:

Describe the activity

Think about the activity, right from start to finish. Describe the elements that make up the activity, including any movement of pupils, and transport or equipment used, any food. Describe who will be participating in the activity, and any needs that participants may have.

Identify the risks/hazards posed

After listing the different elements of the activity, you will be able to identify the risks at each stage. For example, you may have identified using a coach as part of the activity. A potential risk may be that students will stand up on the coach, fail to wear their seatbelts, use mobile phones and share food.

Identify who might be at risk from these hazards

After the risks have been identified, you should then consider who might be harmed in these instances. For example, all students and staff could be harmed if safety protocol on the coach is not followed, and students with allergens may be at risk of a reaction from food opened on the coach.

Rate the likelihood, severity and overall risk

Next, it is important to identify which risks are probable and which are unlikely to happen. For each risk, rate the likelihood of it happening, from low, medium and high, and do the same for the severity of the occurrence should it happen. Finally, make a judgement about the overall risk, from low, medium and high. Even if you have scored an element of the assessment as low risk, that does not mean control procedures should not be put into place. The terms ‘low, medium and high’ can be replaced with any other measure of ranking, such as ‘mild, moderate and severe’.

Outline the control procedures

You should make reference to any legal requirements, school guidelines and good practice, and look at any previous risk assessment control procedures that may be useful to minimise the risk and its occurrence. Many of the risks identified will result in extra staff supervision as a control measure, and first aid in the case of minor injuries. In some cases, extra equipment will be needed. Any risks that have a high probability of occurring should be thoroughly assessed, with step-by-step measures put in place to avoid them or reduce the chance of them happening. You should consider the number of staff who are trained in first aid .

Make any extra recommendations

Think of any additional recommendations for each risk. For example, perhaps staff involved need additional training on a particular topic.

Can risk assessments be used again?

In short, yes, risk assessments can be used again, so long as they are relevant. Risk assessments should be stored and archived when they are no longer useful or effective. If they are still effective but outdated, they should be updated with any changes that have occurred, either to legislation, staff additions or loss, or any equipment or site updates. Furthermore, incidents or accidents may have occurred since the risk assessment was created, meaning that would change the rating of a particular risk.

Who can help with risk assessments?

  • When creating and updating risk assessments, you should refer to the government’s guidance on Health and Safety: Responsibilities and Duties for Schools , to understand any updates on health and safety requirements.
  • The Health and Safety Executive outlines many factors concerning health and safety in educational settings.
  • The government provides additional guidance on emergency planning in educational settings .

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Rose is a qualified teacher with six years of experience teaching in secondary schools and sixth forms across London. Before this, she worked as a communications officer in the Cabinet Office. Outside of work, Rose can be found researching topics of interest and spending time abroad.

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An F.B.I. Informant, a Bombshell Claim, and an Impeachment Built on a Lie

How an unverified accusation became a lightning rod in the impeachment push against president biden..

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Featuring Michael S. Schmidt

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A single piece of unverified intelligence became the centerpiece of a Republican attempt to impeach President Biden.

Michael S. Schmidt, an investigative reporter for The Times, explains how that intelligence was harnessed for political ends, and what happened once it was discredited.

On today’s episode

home visit risk assessment primary school

Michael S. Schmidt , an investigative reporter for The New York Times, covering Washington.

Against a white sky, Joe Biden and Hunter Biden walk down the stairs from an airplane. They are both wearing black coats and sunglasses.

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Ignoring warnings, Republicans trumpeted a now-discredited allegation against President Biden.

Analysis: An informant’s indictment undercuts Republicans’ impeachment drive.

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Michael S. Schmidt is an investigative reporter for The Times covering Washington. His work focuses on tracking and explaining high-profile federal investigations. More about Michael S. Schmidt

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COMMENTS

  1. St Peter'S School Home Visit Policy and Procedure

    Reasons for home visits: Home visits are important in helping the school to make contact with new or hard to reach Ps/Cs/Gs. They are particularly useful as they enable the Ps/Cs/Gs to still have contact with the school, but in their own environment. Home visits are to be used when: • Students are refusing to come into school

  2. PDF Alexandra Primary School

    Primary School, we use home visits to support information gathering for both parents and ... Where home visits take place, a risk assessment should be completed in advance. This will identify any concerns about potential risks and appropriate measures to be taken. If specific information is known

  3. Conducting home visits safely

    Risk assessment: generic template and guidance. EYFS: home visits. Conducting safe and well checks. Stress: risk assessments. Know what is best practice when planning a home visit, so you can make sure staff are carrying out home visits safely. Plus, see examples of risk assessments.

  4. PDF Generic Risk Assessments For School Educational Visits

    Generic Risk Assessments For School Educational Visits 1. All educational visits 2. Travel on educational visits 3. Residential visit accommodation 4. Use of tour operator or provider of activities 5. Ski trips 6. School exchange visit with a school abroad 7. Walks in normal country 8. Walks in remote terrain 9. River walks, gorge or stream

  5. Home Visit Risk Assessment

    Home Visit Risk Assessment. This is a risk assessment for staff who are conducting home visits. Visits usually take place in the summer term to help build relationships and prepare parents and pupils for transition into reception. Each staff member must read and sign. When educators or school professionals conduct home visits as part of their ...

  6. PDF Home Visits Procedures

    • A full risk assessment should also be completed following the first visit, and if necessary updated after each subsequent visit, which will form the basis of any further home visits that are required. The risk assessment must be signed off by a member of the senior leadership team. After every visit, the relevant school

  7. Interactive Risk Assessments for Primary Schools

    Tool 4 of the Guidelines contains a series of risk assessment templates for primary schools. The templates list some of the most common hazards identified in the school environment and their associated risks. The templates also list a range of control measures that could be in place to eliminate such hazards or reduce their risks.

  8. Conducting home visits procedure

    Prepare for home visit. Follow any preparatory steps contained within the Home visit risk management plan (i.e. check parent or carer availability, ensure controls are in place). the destination of the home visit (specific address and name of the family) communication details (e.g. call in/text in times).

  9. Early Childhood Home Visiting

    High-quality home-visiting services for infants and young children can improve family relationships, advance school readiness, reduce child maltreatment, improve maternal-infant health outcomes, and increase family economic self-sufficiency. The American Academy of Pediatrics supports unwavering federal funding of state home-visiting initiatives, the expansion of evidence-based programs, and a ...

  10. Staff and visitors: risk assessments

    Staff and visitors: risk assessments. Know what is best practice when planning a home visit, so you can make sure staff are carrying out home visits safely. Plus, see examples of risk assessments. Be clear on your requirements around risk assessments for new and expectant mothers in your school, and see an example template from a local authority.

  11. Home Visitor Safety

    Home visitors must be and feel safe if they are to support families. Home visitor safety can and must be addressed at many levels. The threat of violence does not occur only in the homes of families or in high-crime neighborhoods, but also in seemingly secure workplaces. Work conditions favorable to violence prevention require action at ...

  12. PDF Number Home visits risk assessment

    Risk Assessment for Red Kite Learning Trust Schools and Services. Due for review following new Government guidance and or annually Issue Date: Version: Page 1 of 9 Assessment Title: Ref. Home visits risk assessment Number School Name: School Address: TNCP Cluster Team Office Base: Meadowfield Primary School, Halton Moor Avenue, LS9 0JY

  13. PDF Lanesend Primary School Home Visits Policy 2020

    Risk Assessment for Home Visits in line with Home visit Policy 2020-2021, including EYFS, Attendance, Wellbeing or by request of a senior member of staff. Benefits (aims, objectives, intended outcomes) To build a warm and caring relationship with the children and families before the child starts school.

  14. PDF OUR SCHOOL VISION

    Where home visits take place, a risk assessment should be completed in advance. This will identify any concerns about potential risks and appropriate measures to be taken. If specific information is known about families, this should be added to the risk assessment. EYFS home visits will always take place with staff in pairs.

  15. Home Visits 101

    Teachers who regularly conduct home visits advise establishing contact with parents before the school year begins. Some home visit models emphasize the benefits of teachers pairing up, traveling together to students' homes, and introducing themselves to parents during the summer. The first visit should focus on building a relationship ...

  16. PDF st G. Sargeant Before every new home visit

    Assessment Title: Home visits risk assessment Ref. Number School Name: School Address: TNCP and Harrogate Cluster Team Temple Newsam Office Base: Meadowfield Primary School, Halton Moor Avenue, LS9 0JY Harrogate Office Base: Rossett School, Green Lane, Harrogate, HG2 9JP Date Assessment Undertaken: Name of Assessor (print): Assessor Signature ...

  17. PDF GUIDANCE FOR PROGRAMS THAT CONDUCT IN-HOME VISITS

    GUIDANCE FOR PROGRAMS THAT CONDUCT IN-HOME VISITS ("Home Visitor" refers to a person who provides program services to individuals/families in their homes.) has had close contact with a person with probable or confirmed COVID-19, the in-person home visit must be canceled. • Clean/sanitize hands consistent with CDC guidance prior to ...

  18. Home visiting: Impact on school readiness

    Home visits are often structured to provide consistency across participants, providers, and visits and to link program practices with intended outcomes. ... Six models showed favourable effects on primary outcome ... Effect of preschool home visiting on school readiness and need for services in elementary school: A randomized clinical trial ...

  19. PDF Risk Assessment for Home Visits

    Unannounced Visits There will be circumstances for example, high risk safeguarding concerns, when an unannounced visit is required to ensure the person's safety or ascertain their views. Can this be carried out by another agency for example a Police welfare check, or jointly with police or health colleagues?

  20. How to Create a Risk Assessment in Schools

    A school risk assessment is an assessment carried out by members of staff in a school in order to understand the potential hazards to health and safety in the school setting. A school may have multiple risk assessments for multiple scenarios, such as experiments in a science lab, or going on a school trip. Risk assessments are created and used ...

  21. Risk Assessments

    Sports Results Spring 2024. Year 2 Teeth - 13/02/2024. Y5 School Nurse and Career Workshops and Y1 Mental Health Week. Clever Never Goes. Show Racism the Red Card. Sports Results Autumn 2023. Year 1 Church Visit. Year 4 Church Visit. Stars in Our Schools 2023.

  22. EYFS: home visits

    Take a look at the following examples to see how other schools approach home visits. Stoke Park Primary has a home visit policy that explains the benefits of home visits. It also contains guidance for staff carrying them out, including. Find advice around conducting home visits in the EYFS, as well as examples of policies from other schools.

  23. What is a Risk Assessment? (Primary School Risk Assessment ...

    Risk Assessment. A classroom risk assessment is a professional document that identifies potential hazards and how to manage these. It provides a plan to follow if something does go wrong. Part of health and safety compliance, a classroom risk assessment is usually part of a wider risk management strategy. All schools should have one of these.

  24. An F.B.I. Informant, a Bombshell Claim, and an Impeachment Built on a

    For more audio journalism and storytelling, download New York Times Audio, a new iOS app available for news subscribers. Hosted by Michael Barbaro Featuring Michael S. Schmidt Produced by Rikki ...