A Nationally Representative Study of Early Childhood Home Visiting Service Use in the United States.

Early childhood home visiting (HV) services are expanding broadly across the United States. Supported by federal policy, HV is now an integral part of maternal and child health services. However, no nationally representative estimate of HV use is available and no research has compared HV use across states. The 2011/12 National Survey on Children's Health was used to estimate the national and state prevalence of HV use for children 0-3 years. Generalized linear mixed modeling was used to predict HV use. An estimated 2,137,044 US children and families received HV during pregnancy and up to child age of 3 years. State HV prevalence range was 3.7-30.6 %. Nationally, 19.1 % of children below the federal poverty line received HV services. Although family poverty increased the odds of receiving HV services, higher rates of child poverty at the state level predicted less use of HV services. Important predictors of HV use include infant/child need factors (health risk, adverse experiences), predisposing factors (family size), and enabling factors (insurance type). This study provides the first estimates of national and state HV service use. Although findings indicate HV services are targeted to children at elevated risk for poor physical or developmental outcomes, our estimates show the vast majority of at-risk children did not receive HV services, including more than 80 % of low-income children, 76 % of preterm infants, and 57 % of very low birth weight infants. Increasing HV service availability could decrease negative health outcomes for young children.