Home Visits

Home visiting programs in the U.S. have developed to enhance child health and welfare, through education, health, and community service programs. Research into the effectiveness of such programs shows that they improve child, parent, and family outcomes; reduce child abuse; enhance child health and educational outcomes; and improve parental behavior, parenting skills, and life skills. Researchers conclude that such programs may have some limited effectiveness in addressing certain goals, if programs are well implemented and goals are clearly defined. However, some programs have shown little or no effect, and research has shown that some programs may not be effectively implemented, either.

Keywords Child Abuse; Child Outcomes; Child Welfare; Comprehensive Child Development Program; Evaluation; Hawaii's Head Start; Head Start; Healthy Families America (HFA); Home Instruction Program for Preschool Youngsters (HIPPY); Home Visit; Implementation; Nurse Home Visitation Program; Parents as Teachers; Parenting Skills

Overview

What are Home Visits?

Home visits have been historically considered a positive way to enhance life outcomes for children of poor or disenfranchised families. Teachers, nurses or social workers are recruited to visit families with children and to provide information and resources to improve child and parent educational outcomes, enhance parental life and work skills, assist with parenting, enhance parent and child mental health outcomes and provide other useful guidance.

Home visits have been considered a useful way to maintain relationships with families who may otherwise be unengaged with schools, preschools, or health services. They are meant to enhance family and community relationships and reduce attrition in programs by removing issues such as transportation and child care problems as barriers to participation. A wide range of such programs have been implemented, as part of health, education, or community programs, yet evaluations have shown that results may be poor or limited, even when programs are strongly developed and well implemented.

History of Home Visits

Gomby, Culross, and Berman (1999) report that home visiting involves programs which "send individuals into the homes of families with young children and seek to improve the lives of the children by encouraging changes in the attitudes, knowledge, and/or behavior of the parents" (Introduction). These practices extend "back to Elizabethan times in England, [were] endorsed by nurse Florence Nightingale, and [have existed] in the United States since at least the 1880s" (Gomby et al., 1999, Introduction).

Bhavnagri and Krolikowski (2007) have written a detailed report on the history of home visits. They note that when home visiting began in the U.S., professionals visited not only the individual family, but also the whole neighborhood and community. Visitors would purchase supplies in local stores, communicate with neighbors, and walk through the community, become integrated into the community, and understand the whole community context for the child in their care.

These visitors were also trained to promote community development, encouraging better sanitary conditions, improved play areas for children, and initiate on the part of parents and families to improve conditions in their area. The visits were considered "a unified strategy used by early childhood pioneers to address the needs of the children, their families, and their communities in order to promote the total development of young children," (Bhavnagri & Krolikowski, 2007, Introduction).

During the reform, or Progressive era (about 1890 to 1920), according to Bhavnagri and Krolikowski, (2007) reformers believed that improving the environment could reduce poverty and other unhealthy outcomes for immigrants and the poor. Waves of immigrants caused expansion and reform in schools, since "the schools' role was to provide a common experience for these immigrant children from diverse backgrounds so that they could all become responsible citizens able to take part in a democracy" (Bhavnagri & Krolikowski, 2007, Eradication of Poverty).

Bhavnagri and Krolikowski suggest that three social justice reform movements entwined and were responsible for a growth in home visits.

The teachers who worked for philanthropic kindergartens, residents who worked for settlement houses, and visiting teachers who worked for public schools all had an overarching, common agenda - to promote the well-being of children, families, and communities through home-community visits (Bhavnagri & Krolikowski, 2007, Social Justice Movements).

Kindergarten teachers were especially involved in home visits initially, and Bhavnagri and Krolikowski (2007) detail several ways in which the visits were influential beyond explaining to parents what was going on in the classroom:

• Teachers talked about appropriate child rearing methods

• Teachers discussed child health, nutrition, development, with parents

• Parents began to understand play as an educational activity

• Teachers helped parents become effective advocates for neighborhood improvement

• Teachers helped parents find necessary resources (such as welfare services) (Kindergarten Movement's Contribution).

Visits were often as much about building social relationships with the children and their families as they were about educating families, and about social reform, and may have helped encourage children to stay in school and enhance their own futures. Through home visits, teachers might improve the lot of other children in the family, improve the economic and living conditions of each family, and contribute to community improvement overall. The intentions of the early reformers have been carried through to home visiting programs in effect today.

Home Visits Today

The comprehensive early childhood program Head Start, for example, makes use of home visits, as a way to bridge cultural gaps and bring parents into the school community. "Head Start teachers are required to make at least two home visits for each student during each school year, in addition to regular parent-teacher conferences at school," reports Steele-Carlin (2001, p. 1). She notes that kindergartens often require a home visit by teachers before school starts as well.

Steele-Carlin (2001) states that "Programs that provide time and funding for teachers to visit students and parents on their own turf are a way for teachers to learn more about their students, get the parents more involved in their kids' education, and bridge cultural gaps that might occur between student and teacher" (p. 1). That bridging of cultural gaps today tends to lean more towards a teacher gaining understanding of where a child is coming from: historically, home visiting may have focused more on bringing immigrant families to an understanding of what was expected in American schools.

Although Steele-Carlin (2001) reports, anecdotally that "most teachers report their home visits have a lasting effect on the child, the parent, and parent-teacher communication" (p. 1) more intensive research examinations of these programs have indicated limited short- or long-term improvements in outcomes.

Current home visiting programs may focus on a range of areas as well. Bhavnagri and Krolikowski, (2007) report that "many programs for young children are now family focused, and educators do regular home visits" (Lesson Two) especially in early childhood special education programs. They note also, that "the current philosophical approach to working with young children is to provide support services and enable families to optimally utilize resources" (Lesson Two). Further, they suggest that working with families has been shown to be effective for enhancing achievement among low-income or at-risk children.

However, there is extensive evidence to show that such programs may not be as effective as proponents hope, and that even when they are effective, conditions must be replicated exactly to reproduce any positive effects.

Are Home Visiting Programs Effective?

In a descriptive study, Meyer and Mann (2006) found that teachers reported a perception that home visits improved their relationships with children in their classes, and with their families; as well as improving the teacher's understanding of the child's home context. Anecdotal and descriptive reports of programs do tend to be positive on both sides. However, experimental and quasi-experimental studies have shown more mixed results.

Behrman (1999) summarized the results of several studies and reports somewhat modest results:

Several home visiting models produced some benefits in parenting or in the prevention of child abuse and neglect on at least some measures. No model produced large or consistent benefits in child development or in the rates of health-related behaviors such as immunizations or well-baby check-ups… . All programs struggled to implement services as intended by their program models (Statement of Purpose).

He concludes that too much has been expected of these programs, and that goals should be more focused in the future, with expectations lowered. He also recommends that home visits be part of a broader range of services offered to parents and families; and that program quality and implementation be upgraded.

Applications

A Program Example

Gomby et al. (1999) reviewed six home visiting program models and studies of those models, to determine which were effective. They note that up to 550,000 children may be enrolled in the programs they studied alone (which means many more children nationwide may participate in similar programs), and that among home visiting programs, they chose these six because they have been studied most, and they are "among the relatively few that have been evaluated in rigorous randomized trials" (Introduction).

They also conclude that:

In most of the studies … programs struggled to enroll, engage, and retain families. When program benefits were demonstrated, they usually accrued only to a subset of the families originally enrolled in the programs, they rarely occurred for all of a program's goals, and the benefits were often quite modest in magnitude (Gomby et al., 1999, Introduction).

Goals of the programs they studied included:

• Improving parenting skills

• Promoting healthy childhood development

• Preventing child abuse and neglect

Two programs focused specifically on mothers in order to encourage deferring subsequent pregnancy and returning to school or work. Programs ranged in start date from during pregnancy to early in childhood, number of visits to parents varied, as did the length of the programs.

Findings were somewhat modest, with only one of the programs demonstrating benefits:

None of the major evaluations … found that home visiting produced benefits in immunization rates or in the number of well-child visits, or, for CCDP, the number of medical or dental visits in comparison with a control group.

All of the major evaluations … assessed children's development using standardized tests, and some employed multiple measures or reported the results of multiple subscales of a single test. None found significant effects on all or even a majority of the measures employed, and many revealed no positive effects at all (Gomby et al., 1999, Analyzing the Results).

They concluded that some programs indicated the greatest success among families who had expressed the lowest feelings of control to start with (e.g, those that may need it most). They also conclude that home visiting programs may help to reduce child abuse and incidences of violence in the home, yet reporting on this is difficult, since a) abuse is often not reported, and b) incidences of abuse within already limited study groups was small enough to begin with that it would be hard to show greatly significant change within the groups.

Problems with Implementation

Implementation of programs was a critical issue in assessing program success, and was often not well done. Gomby et al (1999, Analyzing the Results) report that among the studies reviewed, families

• Only received about half the intended number of home visits

• Did not regularly attend group meetings

• Attrition could be quite high (ranging from 20% to as high as 67%)

Other issues which make evaluation difficult in these programs include high staff turnover, and the wide range of goals, methods, and implementation success.

Gomby et al (1999) recommend that research should focus on improving the quality of programs and the quality of implementation, while determining who can benefit most from which programs, when they are faithfully implemented. Further, they conclude that while services to improve the lives of young children are essential, they must be evaluated for success, and administered within a whole-community context, often with other programs included.

Further Insights

Some Specific Program Findings

Nurse Home Visits

A study of prenatal home visiting by nurses to enhance child health outcomes (Olds et al., 1999) finds that highly qualified personnel are necessary to ensure beneficial effects, and that it makes sense to target the children needing care most. Again, faithful implementation is recommended for best results.

Hawaii's Healthy Start

An evaluation of Hawaii's Healthy Start Program, (Duggan et al, 1999) to prevent child abuse and neglect, and promote health and development of children in at-risk families, found that after two years of a 3-year program, results were somewhat mixed. The program was evidently effective in:

• Reducing abuse within families;

• Decreasing maternal stress, while increasing effective parenting skills; and

• Linking families to medical care.

They had not found evidence of positive outcomes related to mental health, overall life skills of mothers, or learning environment for the child.

Parents as Teachers Program

An evaluation of two sites (Wagner & Clayton, 1999) implementing the Parents as Teachers Program (which is designed to educate parents, during home visits, on parenting skills and child development) determined that there were some positive effects on parent knowledge and behavior, although no positive effects on child outcomes overall.

Analysis of subgroups, however, showed that children in Spanish-speaking Latino families benefited most from the program, especially when it was combined with case-management services to help mothers. The more intense the service provided in this subgroup, the greater benefit to the children.

Melmed (2006) states that parents in the program have been shown to be more confident and knowledgeable of parenting skills and child development, while children score higher on school readiness and standardized assessments of reading, math and language.

The Home Instruction Program for Preschool Youngsters (HIPPY)

A series of research studies (Baker, Piotrkowski, & Brooks-Gunn, 1999) over 10 years on The Home Instruction Program for Preschool Youngsters (HIPPY) found varied effectiveness across program sites and cohorts. HIPPY is designed to help parents with limited formal education prepare their children for school. Research showed that the experience of the program for parents (e.g. different implementation) could vary between and within sites, which may explain the inconclusive findings.

The Comprehensive Child Development Program

The Comprehensive Child Development Program (CCDP) "was a two-generation program that employed case management and home visiting to assure low-income children and their parents of a range of educational, health, and social services" (St. Pierre & Layzer, 1999, Abstract).

Families were assessed over five years for impact on early childhood education, child and family health, life course of the mother, family economic status and health (child and family), but no significant positive effects were found.

Healthy Families America (HFA)

An evaluation of the Healthy Families America (HFA) program (Daro & Harding, 1999) found limited success of the program, primarily in the area of enhanced parent-child interactions. They note that evaluation was challenging, mainly due to attrition.

Healthy Families Arizona

A report by Melmed (2006) states that Healthy Families Arizona, which is designed to address parent-child interaction, child health and development, and prevent child abuse and neglect, was shown to impact parents positively: "parents showed significant improvements in parent-child behavior, parenting competence, problem solving, use of resources, and decreased depression" (p. 4). It is not clear what impact this had on child-related outcomes, though.

Early Head Start

Melmed (2006) also reports on findings concerning Early Head Start, stating that although it is not identified as a home visiting program, it does contain a strong element of home-based work:

EHS programs can use a home-based approach, a center-based approach, or a combination of the two. The EHS evaluation results for home-based programs showed that, when compared to a control group, parents in the programs demonstrated:

• More positive impacts with regard to providing more stimulating environments,

• Gaining a greater knowledge of child development, and

• Reporting less parental stress.

Children in the program showed:

• Stronger vocabulary development at age 24 months compared with control group children,

• Were more strongly engaged with their parents during play at this age, and,

• In programs that fully implemented the head start performance standards, showed positive impacts on child cognitive and language development at age 36 months (Melmed, 2006, p. 4).

Home Visiting as an Intervention in Infant Mental Health

Home visiting can also be considered a method of enhancing infant mental health (FSU, 2006.). A meta-analysis of programs (Sweet & Appelbaum, 2004) to address infant mental health issues concluded that there were:

• Modest improvements in parental attitudes, education (maternal) and parenting behavior.

• No differences in wages, stress, or dependence on welfare, or actual child abuse.

The FSU Harris Institute Fact Sheet (2006) summarizes findings of various studies and concludes that:

• Child cognitive outcomes were better if the visitors were professionals rather than paraprofessionals or nonprofessionals, but

• Paraprofessionals produced the best outcomes in reducing child abuse.

• Longer programs were associated with better cognitive outcomes for children, but

• Length of program was otherwise unrelated to program benefits.

• The average age of the child was not related to any of the outcome measures (FSU, 2006, p. 2).

Conclusion

Home visiting programs are intended to address a variety of early childhood issues, including health, mental health, cognitive and social development, maternal life outcomes, maternal stress, family economic success and other outcomes.

Research on the success of these programs is somewhat inconclusive, possibly a result of differing implementation of programs, widespread goals, attrition of study subjects, or ineffectiveness of programs. It seems likely that influence on parental outcomes is stronger than influence on child outcomes through parent mediation; and that programs may benefit the children and families who need them most.

Researchers and policy analysts generally suggest that home visiting programs can work best when they are very clearly defined, very well implemented, and evaluated on an ongoing basis. Melmed (2006), for example, summarizes "key elements of effective home visiting," as follows:

• Clearly defined goals and objectives,

• Home visitors who know how to reach these goals and objectives,

• Careful recruitment and training of home visitors,

• Rigorous, ongoing evaluation and improvement efforts, and

• Collaboration with other community organizations.

Terms & Concepts

Comprehensive Child Development Program: CCDP was a home-visiting program designed to enhance all aspects of a child's development, which focused on educating two generations: the parents and child.

Hawaii's Healthy Start: Hawaii's Healthy Start Program is designed to enhance child health and development and reduce risk of abuse and neglect for children in families at risk.

Head Start: Head Start is a comprehensive, federally funded early childhood development program that includes a strong home visiting component to enhance family connection to the education process, and to facilitate family use of community resources to improve child outcomes.

Healthy Families America (HFA): HFA programs around the country are aimed at improving parent-child interactions, children's development, and maternal social support; improving health care status and utilization, preventing child abuse and neglect, and improving maternal life course outcomes.

Home Instruction Program for Preschool Youngsters (HIPPY): HIPPY is a 2-year, home-based program designed to help parents prepare 4- and 5-year-old children for school.

Implementation: Implementation concerns how faithfully a program is put into action in the field compared to its proposed and stated activities. If implementation varies across sites and programs, it can be difficult to effectively evaluate the program.

Nurse Home Visitation Program: The Nurse Home Visitation program was an extended home visit program in which nurses visited mothers during pregnancy and up until their children turned two, to enhance pregnancy outcomes, children's development and health outcomes, and economic outcomes for families.

Parents as Teachers: Parents as Teachers is a home visiting program that serves families from prenatal through kindergarten entry. It focuses on teaching parents to enhance early childhood development and reduce abuse and neglect.

Bibliography

Baker, A. J. L., Piotrkowski, C.S., & Brooks-Gunn, J. (1999.) Home visiting: The home instruction program for preschool youngsters (HIPPY). The Future of Children, 9 . Princeton, NJ: Woodrow Wilson School of Public and International Affairs; Princeton-Brookings Institute. Retrieved November 19, 2007, from http://www.futureofchildren.org/pubs-info2825/pubs-info_show.htm?doc_id=70386 Behrman, R. (1999.) Statement of purpose. Home visiting: Recent program evaluations. The Future of Children, 9 . Princeton, NJ: Woodrow Wilson School of Public and International Affairs; Princeton-Brookings Institute. Retrieved November 19, 2007, from http://www.futureofchildren.org/pubs-info2825/pubs-info_show.htm?doc_id=70386

Behrman, R., Gomby D.S., & Cultross, P.L. (Eds.) (1999.) Home Visiting: recent program evaluations. Future of Children, 9 . Woodrow Wilson School of Public and International Affairs Princeton, NJ: Princeton-Brookings Institute. Retrieved November 19, 2007, from http://www.futureofchildren.org/pubs-info2825/pubs-info_show.htm?doc_id=70386

Bhavnagri, N. P. & Krolikowski, S. (2007.) Home-community visits during an era of reform (1870-1920). ECRP, 2 . Retrieved November 15, 2007, from Early Childhood Research & Practice http://ecrp.uiuc.edu/v2n1/bhavnagri.html

Byrd, D. R. (2012). Conducting successful home visits in multicultural communities. Journal of Curriculum & Instruction, 6, 43-54.Retrieved December 15, 2013, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=76115682&site=ehost-live

Daro, D.A., & Harding, K.A. (1999.) Healthy families America: Using research to enhance practice. The Future of Children, 9 . Princeton, NJ: Woodrow Wilson School of Public and International Affairs; Princeton-Brookings Institute. Retrieved November 19, 2007, from http://www.futureofchildren.org/pubs-info2825/pubs-info_show.htm?doc_id=70386

Duggan, A. K., McFarlane, E.C., Windham, A.M., Rohde, C.A., Salkever, D.S., Fuddy, et al. (1999.) Home visiting: An evaluation of Hawaii's Healthy Start Program. The Future of Children, 9 . Princeton, NJ: Woodrow Wilson School of Public and International Affairs; Princeton-Brookings Institute. Retrieved November 19, 2007, from http://www.futureofchildren.org/pubs-info2825/pubs-info_show.htm?doc_id=70386

FSU Harris Institute for Infant Mental Health Training. (2006.) Home visiting as an intervention in infant mental health [Fact Sheet]. Retrieved November 19, 2007, from http://www.cpeip.fsu.edu/resourceFiles/resourceFile_105.pdf

Gomby, D.S., Culross, P.L., & Behrman, R.E. (1999) Home visiting: Recent program evaluations-analysis and recommendations. The Future of Children, 9 . Princeton, NJ: Woodrow Wilson School of Public and International Affairs; Princeton-Brookings Institute. Retrieved November 19, 2007, from http://www.futureofchildren.org/pubs-info2825/pubs-info_show.htm?doc_id=70386

Manz, P. (2012). Home-based head start and family involvement: An exploratory study of the associations among home visiting frequency and family involvement dimensions. Early Childhood Education Journal, 40, 231-238. dRetrieved December 15, 2013, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=77330839&site=ehost-live

Manz, P. H., Lehtinen, J., & Bracaliello, C. (2013). A case for increasing empirical attention to head start's home-based program: An exploration of routine collaborative goal setting. School Community Journal, 23, 131-144. Retrieved December 15, 2013, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=91527256&site=ehost-live

Melmed, M. (2006.) Statement of zero to three policy center. Submitted to the

Meyer, J., Mann, M., & Becker, J. (2011). A five-year follow-up: Teachers' perceptions of the benefits of home visits for early elementary children. Early Childhood Education Journal, 39, 191-196. Retrieved December 15, 2013, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=63040404&site=ehost-live

Education and Workforce Committee Subcommittee on Education Reform, U.S. House of Representatives Sept. 27, 2006. Retrieved November 19, 2007, from http://www.zerotothree.org/site/DocServer/ZTT_EBAH_Testimony_09_27_06.pdf?docID=1290

Meyer, J. & Mann, M. (2006.)Teachers' perceptions of the benefits of home visits for early elementary children. Early Childhood Education Journal, 34 , 93-97. Retrieved November 19, 2007 from EBSCO Online Database Academic Search Premier. http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=22089797&site=ehost-live

Olds, D., Henderson, C.R., Kitzman, H.J, Eckenrode, J.J., Cole, R.E., & Tatelbaum, R.C. (1999.) Prenatal and infancy home visitation by nurses: Recent findings. The Future of Children, 9 . Princeton, NJ: Woodrow Wilson School of Public and International Affairs; Princeton-Brookings Institute. Retrieved November 19, 2007, from http://www.futureofchildren.org/pubs-info2825/pubs-info_show.htm?doc_id=70386

Robert G. St.Pierre, R. G., & Layzer, J.I. (1999.) Using home visits for multiple purposes: The comprehensive child development program. The Future of Children, 9 . Princeton, NJ: Woodrow Wilson School of Public and International Affairs; Princeton-Brookings Institute. Retrieved November 19, 2007, from http://www.futureofchildren.org/pubs-info2825/pubs-info_show.htm?doc_id=70386

Smith, S. (2013). Would you step through my door?. Educational Leadership, 70, 76-78. Retrieved December 15, 2013, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=87529524&site=ehost-live

Steele-Carlin, S. (2001.) Teacher visits hit home. Education World. Retrieved November 16, 2007, from http://www.educationworld.com/a_admin/admin/admin241.shtml

Sweet, M. A., & Appelbaum, M. I. (2004). Is home visiting an effective strategy? A meta-analytic review of home visiting programs for families with young children. Child Development, 75 , 1435-1456.

Wagner, M. M., & Clayton, S.L. (1999.) Home visiting: Parents as teachers program: Results from two demonstrations. The Future of Children, 9 . Princeton, NJ: Woodrow Wilson School of Public and International Affairs; Princeton-Brookings Institute. Retrieved November 19, 2007, from http://www.futureofchildren.org/pubs-info2825/pubs-info_show.htm?doc_id=70386

Zero to Three. (2007.) Home visiting: Supporting babies and families where they live. Washington, DC: Zero to Three. Fact Sheet, January 2007.

Suggested Reading

Barnet, B., Jiexin, L., DeVoe, M., Alperovitz-Bichell, K., & Duggan, A.K. ( 2007.) Home visiting for adolescent mothers: Effects on parenting, maternal life course, and primary care linkage. Annals of Family Medicine, 5 , 224-232. Retrieved November 19, 2007 from EBSCO Online Database Academic Search Premier. http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=25372675&site=ehost-live

Bartu, A., Sharp, J., Ludlow, J., & Doherty, D. A. (2006). Postnatal home visiting for illicit drug-using mothers and their infants: A randomised controlled trial. Australian & New Zealand Journal of Obstetrics & Gynaecology, 46 , 419-426. Retrieved November 19, 2007 from EBSCO Online Database Academic Search Premier. http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=22063023&site=ehost-live

Black, M. M., & Kettinger, L. (2000). Mother-infant interaction: Effects of a home intervention and ongoing maternal drug use. Journal of Clinical Child Psychology, 29 , 424-431.

Geyelin Margie, N., & Phillips, D.A. (Eds.). (1999.) Revisiting home visiting: Summary of a workshop. Board on Children, Youth, and Families, National Research Council and Institute of Medicine. Washington, DC: National Academy Press.

Olds, D., Henderson, C. R., Jr., Cole, R., Eckenrode, J., Kitzman, H., Luckey, D., et al. (1998). Longterm effects of nurse home visitation on children's criminal and antisocial behavior. Journal of the American Medical Association, 280 , 1238-1244.

Schuler, M. E., Nair, P., & Black, M. (2002). Ongoing maternal drug use, parenting attitudes, and a home intervention: Effects on mother-child interaction at 18 months. Journal of Developmental Behavioral Pediatrics, 23 (2), 87-94.

Shaw, E., Levitt, C., Wong, S., & Kaczorowski, J. (2006.) Systematic review of the literature on postpartum care: Effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health. Birth: Issues in Perinatal Care, 33 , 210-220. Retrieved November 19, 2007 from EBSCO Online Database Academic Search Premier. http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=22063577&site=ehost-live

Shonkoff, J., & Phillips, D. (Eds.) (2000). From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press.