Expanding Early Childhood Home Visitation Services in the United States to Reach More Vulnerable Families: A Backward Mapping Analysis

Early childhood home visitation (ECHV) in the United States is a voluntary service providing health and social support to low-income families who are experiencing, or at risk for experiencing, adversities such as adolescent pregnancy, poverty, and child maltreatment. The federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program funds the delivery of evidence-based early childhood home visits, but these services are chronically under-utilized despite a substantial capacity for enrollment. Of particular concern are the families likely to encounter adversity but are unable to access services due to rigid criteria for participation. Using the theory of backward mapping developed by Richard Elmore, this paper analyzes the implementation of the MIECHV Program policy to identify possible factors responsible for the under-utilization of funded services. We explore issues related to the referral process, enrollment criteria, and attrition challenges for evidence-based ECHV models with recommendations for a centralized intake system, qualitative inquiry, and universal postpartum home visits.