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Original Investigation
August 6, 2018

Effect of Preschool Home Visiting on School Readiness and Need for Services in Elementary School: A Randomized Clinical Trial

Author Affiliations
  • 1Department of Psychology, Pennsylvania State University, University Park
  • 2Prevention Research Center, Pennsylvania State University, University Park
  • 3Human Development and Family Studies, University of Wisconsin–Madison, Madison
JAMA Pediatr. 2018;172(8):e181029. doi:10.1001/jamapediatrics.2018.1029
Key Points

Question  Were the benefits of a preschool home visiting program sustained through third grade, and did they reduce the need for educational and mental health services?

Findings  In this randomized clinical trial that included 200 families (n = 200 children), preschool home visiting promoted gains in child academic performance, social-emotional adjustment, and reduced home problems in third grade. Intervention-related improvements in these 3 domains mediated significant reductions in child need for educational and mental health services.

Meaning  Promoting the school readiness of children from low-income families with preschool home visiting programs may be a strategic way to improve public health and well-being.


Importance  Home visiting programs targeting the school readiness of preschool children (age range, 4-5 years) show promise in short-term and quasi-experimental studies but rarely are evaluated with rigorous designs and follow-up assessments.

Objectives  To examine the sustained effects of a preschool home visiting program on child and family competencies and on child need for services 4 years later.

Design, Setting, and Participants  In a randomized clinical trial, individual families with preschool children were assigned to receive the Research-Based and Developmentally Informed–Parent home visiting program (REDI-P) (intervention group) or math home learning games in the mail (control group). Follow-up assessments occurred in third grade. Families were recruited from 24 Head Start centers in 3 Pennsylvania counties serving rural and urban areas. Four-year-old children from 200 low-income families participated. Families were recruited in fall 2008 and fall 2009. The follow-up data used were collected in spring 2013 and spring 2014. The analyses were conducted in 2016 to 2017.

Interventions  REDI-P visits followed a well-specified curriculum, with 10 home visits during preschool and 6 booster visits in kindergarten. Parents received coaching to enhance parent-child relationships and home learning materials to support child development and school readiness.

Main Outcomes and Measures  Intervention focused on boosting competencies in academic performance and social-emotional adjustment and reducing child problems at home. Direct assessments, teacher ratings, and parent reports were collected. In addition, third-grade teachers recorded all services that children needed and received at school.

Results  Two hundred participating children (110 [55.0%] white, 52 [26.0%] black, and 38 [19.0%] Latino; 112 [56.0%] male) had a mean (SD) age of 4.45 (0.29) years at the start of intervention. Third-grade outcomes were available for 153 (76.5%) of the initial sample and revealed statistically significant effects on multiple measures in each competency domain. In addition, REDI-P reduced child need for educational and mental health services at school. Significant effect sizes were small to moderate, averaging approximately one-third of 1 SD (Cohen d = 0.27 to 0.45). Mediation models demonstrated that intervention effects on services were accounted for by intervention effects on the targeted competencies.

Conclusions and Relevance  REDI-P produced sustained benefits evident 4 years after intervention, significantly reducing child need for school services. The results of this study appear to validate the value of preschool home visiting as a strategy to help close the gap in school readiness and child well-being associated with poverty.