ECONOMIC REPORT OF THE PRESIDENT

improving parental behavior and children’s outcomes, these programs can
benefit children and parents in the long run.
One well-established program, the Nurse Family Partnership, provides
first-time, low-income mothers with home visits during pregnancy
through their child’s second birthday. A longitudinal evaluation of the program
found that participants who were randomly assigned to receive home
visitation services, compared with women who only received prenatal and
well-child clinic care, waited longer after the birth of their first child before
having a second child; had lower receipt of cash transfers; and exhibited
lower rates of arrest, drugs and alcohol abuse, and child abuse (Olds et al.
1997). The children of mothers who received home visitation services were
also less likely to be arrested, consumed less alcohol, had fewer behavioral
problems, had fewer sexual partners, smoked fewer cigarettes, and were less
likely to run away compared to children of mothers in the control group
(Olds et al. 1998). These studies measured outcomes at age 15, indicating
that the program impacts were sustained in the medium term.
A more recent analysis of the Nurse Family Partnership program
examined its impacts on children’s cognitive abilities and found improvement
by age 6 among children whose mothers participated in the program.
These early cognitive gains were attributable to improvements in the home
environment and in parenting behavior, as well as to greater self-esteem and
lower anxiety among mothers, and they translated into improved language
and math abilities and fewer school absences at age 12 (Heckman et al. 2014).
Some home visitation programs are provided as part of the Federal
Head Start preschool program (described further below). A recent study
finds that Head Start programs that incorporated frequent home visitation
were particularly effective at improving non-cognitive outcomes compared
with other Head Start programs (Walters 2015). Other models of home
visitation programs are also showing promising results, with 19 models
meeting the Department of Health and Human Services’ (HHS) criteria
for evidence-based home visiting programs (Administration for Children
and Families 2015). Ongoing data collection will allow for further rigorous
evaluation and help expand the knowledge base of the most effective home
visitation programs.
Based on the mounting evidence that home visiting programs have
significant positive impacts on children’s cognitive outcomes, Federal support
for home visitation programs was introduced in 2008 and was further
expanded under the Affordable Care Act two years later. This ACA expansion
was extended with bipartisan support through March 2015, and the
President proposed expanding and extending funding for another 10 years
in his 2013 State of the Union address. The Medicare Access and CHIP
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