Home Visiting and Early Interventions: How Two Cities Prioritized Maternal Health and Early Childhood Development
- Issue Areas
- Early childhood
For children growing up in low-income households, the research is clear: one of the strongest predictors of a stable, prosperous life as an adult is entering kindergarten “ready to learn.”
Unfortunately, fewer than half of children from low-income families are prepared for kindergarten, compared to 75 percent of children from higher income families. These early disparities tend to worsen as children grow older–children who struggle in kindergarten are less likely to read at grade level in 3rd grade, less likely to demonstrate math proficiency in middle school, less likely to graduate from high school, and less likely to be employed as adults.
Given these stakes, few investments can have a greater impact on upward mobility than improving rates of kindergarten readiness for children from lower-income households.
Fortunately, local leaders across the country are increasingly investing in evidence-based approaches to support kindergarten readiness.
Two kinds of strategies have emerged as particularly potent. First, supports for new and expecting parents can improve maternal health while helping children meet developmental milestones. Second, special interventions and curricula designed for infants and toddlers can boost children's cognitive and social-emotional development, helping them build critical skills.
For local leaders seeking to improve life for generations to come, these proven strategies generate some of the highest “social returns” currently known to research.
Investing in supports for new and expecting parents
An evidence-based approach to improving kindergarten readiness begins with supporting maternal and child health.
Maternal and infant health outcomes in the United States are significantly worse than those of peer countries, with particularly poor health outcomes for Black women. High-quality home visiting programs are a proven way to improve health outcomes for mothers and their young children.
These programs provide health care and guidance to mothers in their homes before they give birth, and continue to provide in-home care to mothers and their babies for up to two years after a child is born. Rigorous research demonstrates that home visiting programs can reduce preterm births, cultivate stronger language development, and strengthen executive functioning, among other outcomes that contribute to kindergarten readiness.
Part of why home visiting programs are so successful is that they eliminate many logistical barriers for expecting mothers to receive care. Successful programs tend to employ highly-trained professionals to deliver healthcare, like registered nurses or licensed social workers. Many programs feature programming in group and one-on-one settings, which helps new mothers build relationships with one another while also allowing for customized care. And successful programs often operate in strong partnership with community-based organizations, which strengthens referral networks and ensures culturally-responsive services.
In 2013, low-income mothers of color and their babies in Birmingham (AL) were experiencing some of the worst health outcomes in the nation. Recognizing that change was necessary, local leaders partnered with a national home visiting program, Nurse-Family Partnership.
To launch in Birmingham, the Jefferson County Department of Health and the University of Alabama - Birmingham (UAB) formed a partnership, with UAB providing a pipeline of skilled nurses for home visiting and the administrative capacity to manage the program as it grew. The Department of Health and UAB worked closely with local clinics, schools, and community organizations to build a robust network for patient recruitment and referrals.
The program has delivered significant results. As of 2021, Birmingham participants are 3.4% less likely to have pre-term births than the countywide average, and participating mothers are 12.5% more likely to be employed one year after giving birth. As of 2023, child immunization rates by age two are 14% higher than the statewide rate.
As of 2021, Birmingham participants are 3.4% less likely to have pre-term births than the countywide average, and participating mothers are 12.5% more likely to be employed one year after giving birth.
Investing in early childhood curricula
While maternal and infant health forms the foundation for healthy child development, interventions that enhance early literacy, language comprehension, and cognitive development are also powerful ways to better prepare children for kindergarten. These programs can be delivered in classrooms, childcare centers, or at home, and often provide instruction for both children and their parents.
For early childhood curricula and interventions to be effective, evidence increasingly shows that they should be domain-specific, targeting early math skills, language development, or social emotional skills. They should incorporate play-based learning, which helps children learn while cultivating their creativity, self-efficacy, and language development. And interventions should also include some structured components that are guided by teachers or parents, which foster social-emotional and problem solving skills.
In 2016, kindergarteners from low-income families in Virginia Beach (VA) were significantly less likely to enter kindergarten ready to learn than their peers from higher-income families. To address this issue, civic leaders partnered with the Bloomberg Philanthropies’ What Works Cities Initiative to replicate the LENA model, a successful language and cognitive-development program that first started as Providence Talks in Providence (RI).
The main idea of Virginia Beach Talks is simple but effective: the more toddlers hear adults talk and the more they are talked to by adults, the stronger their cognitive development. Research shows that “conversational exchanges” between toddlers and adults helps toddlers develop language capability and builds critical comprehension skills. Virginia Beach Talks employs a speech “pedometer,” which measures the number of verbal exchanges between parents and their child over the course of a day.
To replicate the Providence Talks program, Virginia Beach’s Department of Economic Development created a dedicated team focused on implementation, known as Virginia Beach GrowSmart. The team committed itself to collecting data and monitoring progress, a process strengthened by the program’s use of speech pedometers. And the team was able to build strong partnerships across departments and stakeholders, including schools, libraries, recreational centers, health facilities, child care programs, and more.
As of 2022, Virginia Beach Talks had helped over 1,100 families. Children who began Virginia Beach Talks with delayed language development experienced a 75 percent increase in conversational turns per hour once starting the LENA model, helping them develop critical language skills.
Taking Action
For local leaders seeking to improve economic mobility in their communities over the long term, focusing on kindergarten readiness is a powerful place to start. Supports for new and expecting parents by way of home visits and proven early childhood curricula and interventions can be potent approaches for achieving better outcomes in this domain. Nurse-Family Partnership and Virginia Beach Talks are just two examples of solutions that have achieved significant results.
Looking for similar, evidence-based solutions to promote kindergarten readiness? The Economic Mobility Catalog contains dozens of examples, including the following: