Home visitation for pregnant women and parents of young children.

Many of the most pervasive, intractable, and costly problems faced by high-risk women and young children in our society today are a consequence of adverse maternal health-related behaviors (such as cigarette smoking, drinking, and drug use during pregnancy), dysfunctional infant care giving, and stressful environmental conditions that interfere with individual and family functioning. These problems include low birth weight, child abuse and neglect, childhood injuries, unintended and closely spaced pregnancy, and reduced economic self-sufficiency on the part of parents. Evidence is accumulating that these problems can be reduced with comprehensive programs of prenatal and infancy home visitation by nurses. While we are witnessing a renaissance of interest in home visitation as a means of addressing these problems, the recommendations of various health and human service advisory groups about the structure of proposed home-visitation initiatives are uncoordinated and frequently inconsistent with the empirical evidence. Home visitation is a promising strategy, but only when the program meets certain standards. The more successful programs contain the following: (1) a focus on families at greater need for the service, (2) the use of nurses who begin during pregnancy and follow the family at least through the second year of the child's life, (3) the promotion of positive health-related behaviors and qualities of infant care giving, and (4) provisions to reduce family stress by improving the social and physical environments in which families live.