and (2) potential actions, needs, or barriers that affect primary care–public health integration in the area.
One of the provisions of the Patient Protection and Affordable Care Act (ACA) creates the Maternal, Infant, and Early Childhood Home Visiting Program (referred to here as the Home Visiting Program). While the term “home visiting” can have different meanings in different contexts, it generally refers to a trained professional who visits a new mother in her home to provide advice and support and assess the home environment for the newborn. This provision of the ACA is based on years of work suggesting that home visiting for at-risk families can prevent child abuse and neglect, promote child development, increase parental support and effectiveness, and assist in reducing health disparities (Chapman et al., 1990; Duggan et al., 2000; Olds et al., 1997, 2004). In 2009, the American Academy of Pediatrics endorsed home visiting as an early-intervention strategy that benefits children, and encouraged the development of comprehensive programs that target at-risk families and involve professionally trained home visitors (AAP, 2009).
The aim of the grant-based Home Visiting Program is to go beyond individual patient care to include care for families that live in high-risk communities. Nurses, social workers, or other trained professionals visit at-risk families in their homes and connect them to health care or other services, such as early education, child abuse prevention, or nutrition assistance. The law requires that states conduct statewide needs assessments to identify at-risk communities, defined as communities with high concentrations of certain types of health risks among children, adolescents, and families. State assessments also must determine the quality of existing programs and their capacity to carry out home visiting and consider the gaps that exist in such programs. Based on the results of these assessments, the Department of Health and Human Services (HHS) is directed to make grants to early childhood home visiting programs to promote improvements in health and socioeconomic status and reduce community and family risks.
The Home Visiting Program represents a strong opportunity for integration of primary care and public health because the health care service delivered is not based on an illness or in response to a person seeking care, but instead is aimed at prevention and wellness for all members of a community. This program is administered by HRSA in collaboration with the Administration for Children and Families (ACF), but could be strengthened through collaboration with CDC. The following section examines the Home Visiting Program according to the principles of integration outlined in Chapter 2 and highlights opportunities for HRSA and CDC.