Toward Population Impact from Home Visiting.

Abstract

Although some home-visiting programs have proven effective with the families they serve, no program has yet demonstrated an impact at the population level. We describe the <i>Durham Connects (DC)</i> initiative, which aims to achieve population impact by coalescing community agencies to serve early-intervention goals through a Preventive System Of Care and by delivering a universal, short-term, postnatal nurse home-visiting program. The home-visitor delivers brief intervention, assesses family needs in 12 domains, and connects the family with community resources to address individualized family needs. Evaluation of <i>DC</i> occurred through a population randomized controlled trial of all 4,777 births in Durham, NC, over an 18-month period. <i>DC</i> was implemented with high penetration and high fidelity. Impact evaluation indicated that by age 6 months, <i>DC</i> infants had 18 percent fewer emergency room visits and 80 percent fewer overnights in the hospital than did control families. We conclude that population impact is achievable if a program attends to challenges of community partnership, universal reach and assessment, rigorous evaluation, and models for sustaining funding.