At first, she was surprised by the parent's anger toward their children. “How am I going to be helpful here?” home visitor Ashley Maddox wondered. Unsure how to handle this situation, she talked with her program manager who helped her “adjust my lens to see things from a different perspective,” she says, and she kept trying. 

It was an adjustment and a commitment that led to something good. After working with the family for some time, the parent recently shared with Maddox that they are "no longer just always angry and tense because I know that's not helpful for my children."

In microcosm, the experience tells the story of home visiting programs: meeting parents and families where they are — both literally and psychologically — to help them reach their own goals of being the best parents they can be while improving the health and well-being of children and parents.

Maddox is a Healthy Families Georgia “home visitor” in Columbus, an affiliate of Healthy Families America (HFA). Along with a Parents as Teachers program, the two evidence-based services are offered through UGA Cooperative Extension in Muscogee County. Throughout Georgia, there are 40 home-visiting programs in over 60 counties that also include Early Head Start and Nurse-Family Partnership programs.

Maddox has been with the Columbus program for 10 years after working as a preschool teacher. “I knew that I had passion for children, and I had passion for building families,” she says of her decision to join HFA. “I love how the healthy families’ framework sets it up to where we're not really telling the moms and dads what to do and what they're doing wrong, but we're supporting them and how they want to parent their child.”

Consider the angry parent. Maddox could have challenged them on their behavior. But “we are using a strengths-based model,” Maddox explains. In this case, that means she had to overlook the parent's harshness — something that was hard for her to see — in favor of finding a strength she could build on. She paid attention to the things this parent did that were positive and pointed them out. A deficit approach not only shuts down a family’s willingness to participate, but it can also pile on stress and decrease their motivation to do better.

Something for everyone

While home visiting programs are meant to help those facing stressors and challenges that might impact developing children, the programs can also be useful for others such as all first-time parents and those in the military.

Families are referred to the programs by hospitals, doctors and others, and in most counties, a First Steps coordinator determines their eligibility before referring them on to a home visiting program.

Home visitor Rafaelina Sanchez says anyone could benefit, and she should know. She was a client herself 14 years ago. As a single mom with a 2-year-old, she was eligible for food assistance, which qualified her for home visiting.

“I wish that this program would have been available to me back when I was back home in New York City,” she said about parenting her older daughters. Now with a bachelor’s degree in elementary education and a master’s degree in early childhood education, she has used her personal experience and education in her work with the Parents as Teachers program.

“Some people see me as a social worker,” Sanchez says, “and I make sure I tell them I’m not a social worker. I'm here to help you learn how to better interact with your child, to help your child learn better.” Parents as Teachers’ larger goal is to support families so that children are “ready to learn” by the time they enter school. But getting to that goal means finding ways of supporting the parents and families in whatever way is needed.

In providing that support, Sanchez says she can fulfill different roles for the family. Which roles? “Just about everything,” she says. “A friend. I can be a sister figure, mother figure in some cases.”

It is this kind of support that comes from really knowing a family and their needs that enables home visitors to support and guide families to build on strengths rather than push them along a predetermined path.

What home visitors do

Home visitors have a variety of tools at their disposal including assessments that give them an idea of a child’s developmental progress and things like depression in parents. Healthy Families Columbus program manager Villacia Jones says through this broad approach, “we're enhancing that family functioning by reducing the risk of child abuse and neglect and building on those protective factors.”

Once it is determined they meet the criteria for the service, participants opt-in to the program. “Sometimes we'll have families that are on board, and they say yes … right away,” explains Tammy Keith, the Parents as Teachers’ program supervisor in Columbus. Then other times, some “come back around and say, ‘I know I told you no, but now I’m interested,’” she adds because they realize they need help after the reality of being a parent sets in.  

In the Parents as Teachers program, “our goal is to at least be able to give them two years of service,” explains Keith, but “we hope to keep them all the way till they go to school,” she adds, meaning that some families will be in the program for up to five years.

In both programs, home visitors have a curriculum they can draw from based on the needs of individual families. But while curriculum is available to use with parents, there is not a single path. Instead, home visitors tailor their visits to the needs of the family.

If assessments show an opportunity for improvement in a particular area such as low empathy toward an infant or if a parent asks for help with a particular problem, “I would go into my curriculum and find some supporting material to address that with mom,” explains Maddox. The needs of the family drive what the home visitors provide.

While clients are typically a mother and child in the target age range, home visitors can end up working with parents on improvements of any aspect of family life that benefits other children or the family as a whole. “We're never sure when we get that family who's going to benefit most,” says Keith, “but we know that if they stay with us, something’s benefiting the whole family.”

Making home visiting work

In Columbus, home visiting is an “outreach of the University of Georgia,” says County Extension Coordinator Rhea Bentley, who oversees the services provided through UGA Extension in the area. Congress funds home visiting in Georgia through the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program, and the programs are managed through the Georgia Department of Public Health and supported by UGA’s Center for Family Research (CFR).

“CFR is what makes us tick,” says home visitor Maddox. For 22 years, the center has provided vital support to Georgia’s home visiting programs. Working with the Georgia DPH, “Our team tries to make Georgia's home visiting network as strong and impactful as it can be,” says CFR’s associate director, Anita Brown. That includes providing ongoing training in home visiting methods and assessment, performance monitoring for programs, and technical assistance with data collecting and reporting.

“These federal compliance requirements can be very onerous and take a lot of time away from serving families,” Brown says. “We try to take that burden as much as we can so they can focus on the families,” though she admits local programs still have to work hard to meet the reporting expectations.

Part of that reporting burden is because home visiting is constantly evaluated to ensure it actually has an impact. It does. HFA families have 48% fewer low birth weight babies, for example, and Parents as Teachers participation has been demonstrated to result in a 22% decreased likelihood of child maltreatment substantiations among many other positive outcomes in both programs.

The determination to bring those kinds of outcomes to the families who most need them drives most home visitors in their work. It kept Ashley Maddox going as she worked with the harsh parent she could not imagine helping, and as home visitor Sanchez says, “I look at this job like a mission in my life.”

Learn more about how CFR supports home visiting.