Toward a Better Home-Visiting System in North Carolina

Blog | October 30, 2018

Source: UNC-Chapel Hill Jordan Institute for Families

Recently there has been progress toward expanding evidence-based home visiting parent support programs, a recommendation of many NCIOM task forces.


Research has long shown the positive impact of home visiting programs on children and families. These programs, which generally focus on home visits to expecting and new parents and provide medical, parenting, and social support, have been shown to reduce child maltreatment and improve infant and maternal health for participating families. Programs in which nurses or other health care professionals visit parents and children in their homes to assess child and maternal health and offer support can also reduce parental stress, improve families’ economic self-sufficiency, and decrease medical costs for families. [1 ,2]


North Carolina Home Visiting Summit, October 22-23. Photo by Michelle Ries.

On October 22-23, home visiting practitioners and early childhood experts convened at the Home Visiting Summit, hosted by Smart Start, the UNC-CH Jordan Institute for Families, and the North Carolina Division of Public Health. Summit attendees heard the results of a new study out of the Jordan Institute aimed at assessing the state of home visiting programs in North Carolina. Researchers developed a comprehensive assessment of North Carolina home visiting programs and worked with additional stakeholders to review the study results and develop recommendations for a statewide home visiting leadership structure and strategic plan. These recommendations included suggested actions on exploring new funding streams, supporting home visiting workforce, assessing community capacity for specific models, and improving service coordination.


With the recent pilot of Medicaid coverage of home visiting models in two counties, NC Medicaid is looking at the costs and benefits of making home visiting a Medicaid-covered service. In July 2018, NC Medicaid launched two pilot home visiting initiatives, in Cleveland and Johnston counties. The pilots use Medicaid funds to pay for home visiting programs; the Cleveland County pilot will use the Nurse-Family Partnership model, and Johnston County will use a hybrid model focused on high-risk pregnancies. NC Department of Health and Human Services has estimated the per-visit cost to Medicaid at $83.72, for a total projected expense in Cleveland County of $251,160, and $92,090 in Johnston County. Results of the pilot will be reported back to the North Carolina legislature.


Progress is being made toward expanding access and improving a service that has been shown to positively impact our youngest children and their families, as supported by previous work of the NCIOM. At the Summit, plenary speaker Deb Daro (Senior Research Fellow at Chapin Hall, University of Chicago) identified the unique advantage of home visiting programs over other types of services: “When a parent brings someone to a clinical setting, you get one snapshot, but when you go to their home, you see the reality in which their everyday life is framed,” she said. “You can meet the other people that come into that home. You can have a situation to be able to do a more holistic assessment of the well-being of that child and understand what kind of supports families need.”




[1] Dodge K, Goodman B. Durham Connects Impact Evaluation Final Report: Pew Center on the States.

University of California Irvine website. Published May 31, 2012.

[2] MacMillan HL, Wathen CN, Barlow J, Fergusson DM, Leventhal JM, Taussig HN. Interventions to

prevent child maltreatment and associated impairment. Lancet. 2009;373(9659):250-266.