Programs that Work
Family Support and Parenting Education in the Home
Healthy and Safe Children
Children not experiencing physical, psychological or emotional abuse
Children experiencing good physical health
Age of Child
Early Childhood (0-8)
Type of Setting
Community-Based Service Provider
Health Care Provider
Type of Service
Type of Outcome Addressed
Child Abuse and Neglect
Evidence Level (What does this mean?)
Proven / Promising
The Family Support and Parenting Education in the Home Program was developed in 1964 to serve poor children in the city of Baltimore. A woman from the participants' community served as a home visitor for new parents, with the goal of encouraging parental compliance with well-child visits, referring parents to support services when necessary, and discussing child development and parenting skills. The first home visit was made within seven to ten days of the child's birth, and nine subsequent visits were made before the child's second birthday. The program was an augmentation of the Children and Youth (C&Y) program, which operated health clinics for families with children ages 0-18 in inner city Baltimore.
Healthy black neonates weighing more than 2,000 grams and their mothers ages 18 or older were involved in the study.
The Children and Youth (C&Y) health clinics provided well-child care for parents in inner-city Baltimore, and they served as the location of the family support and parenting education program study. Parents of healthy infants enrolled in C&Y clinics for health services were randomized to treatment (N=143) and control (N=147) groups. Treatment and control groups were comparable on measures of demographic characteristics, risk status as determined by C&Y staff members at intake, and Medicaid eligibility.
The treatment group received 10 total home visiting services focused on parenting, child development, and encouraging timely well-child visits at the C&Y clinics. The control group had access to the same well-child visits, but did not receive any support through home visitation. To encourage attendance, home visits were scheduled to occur immediately prior to scheduled well-child clinic visits. Six mothers refused participation in the study, and 27 of the 290 participants (12 treatment and 15 control subjects) were lost to follow-up (Hardy and Streett, 1989).
Key Evaluation Findings
Health care service utilization
- There was no significant difference between treatment and control groups in visits to the C&Y clinic for health care.
- Significantly more children in the treatment group had completed the appropriate amount of preventative care for their age (88 percent versus 69 percent).
- Fewer children in the treatment group had delayed preventive care, defined as immunizations given one or more months beyond the proper age (6 versus 14 percent).
Child illness, injury, abuse, and neglect
- There was no significant difference between treatment and control groups in the number of incidents of closed head trauma.
- In the treatment group, the incidence of chronic otitis media, an ear infection commonly associated with upper respiratory tract infections and associated with a lack of compliance with medications and/or follow-up appointments, was less than half that of the control group (21 versus 55 percent).
- Treatment group participants also had significantly lower rates of severe diaper rash than control group participants (21 versus 34 percent).
- Suspected abuse and neglect (as determined by C&Y staff) was significantly lower in the treatment group (1.5 percent in the treatment group versus 9.8 percent in the control group).
- Illness or accident requiring hospitalization was also significantly lower in the treatment group (6.1 versus 15.2 percent).
Health clinics or other child and family service organizations
No information available
The family support and parenting education program was designed as a way to lend informal support on issues such as child development and parenting strategies, rather than to intervene in psychosocial issues per se. The home visitors linked mothers to additional support services when necessary. The home visits were conducted prior to scheduled well-child visits, with the goal of encouraging attendance.
The program employed home visitors who resided in the target community. They worked in collaboration with a social worker and were provided brief trainings on the content of the home visits.
The home visitors used a parenting education curriculum designed to deliver age-appropriate information to parents on parenting, child safety, health care, and immunizations. Mothers were also given calendars with developmental milestones, dates and times of clinic visits, and important telephone numbers included. Pamphlets on child care were also distributed.
Issues to Consider
While the evaluation of this program used a randomized control design, the program improved an intermediate outcome that has an unknown relationship to the benchmark of interest. Specifically, this program received a "promising" rating for the indicator Children not experiencing physical, psychological, or emotional abuse. Suspected abuse was impacted by participation in the treatment group, but the criteria for suspected abuse were not described, nor were the number of cases of actual abuse.
A notable aspect of this program is that it appears to have improved outcomes with a very small number of visits (10) and a relatively low-skill workforce, relative to many current models of home visiting. The results are at least suggestive that a low-cost, low-intensity home visiting program might have some impact on important indicators of early childhood well-being.
There is limited information about program implementation and the types of training that were offered to the home visitors, and about the content of their home visits.
The program was implemented in Baltimore, Maryland, in the 1960s and is not currently operating.
No information available
There are no replication materials available for this program.
Hardy, J. B., and R. Streett (1989). "Family support and parenting education in the home: An effective extension of clinic-based preventive health care services for poor children."
Journal of Pediatrics,