Whole Family Well-Being: Upstream Home Visiting 



  • Cate Wilcox, Maternal and Child Health Section Manager and Title V Director, Public Health Division, Oregon Health Authority


  • Alicia Leatherman, Administrator, Early Childhood Home Visiting and Maternal and Infant Wellness, Bureau of Maternal, Child and Family Health, Ohio Department of Health (ODH)



The Oregon Universal Home Visiting (UoHV) Initiative – is a voluntary home visiting program provided by a registered nurse who conducts home visits for all mothers and newborns within two weeks of birth. The program is intended to strengthen and support families by providing holistic supportive services such as physical and mental health wellness checks, lactation support, and assessments for social determinates of health such as food security, transportation access and child care planning to ensure families have their needs identified and met.

  • Legislation passed in 2019 under SB 526 to develop, implement, and sustain home visiting for all families of newborns. SB 526 also required all commercial health benefit plans to cover this service.

UoHV was developed to focus on primary “upstream” prevention for children and families- offering 1-3 home visits after birth. UoHV universally offers families support before any form of child maltreatment may occur.


Through a January 2019 Executive Order, Governor DeWine created the Governor’s Advisory Committee on Home Visitation with a goal of examining how to increase the state’s home visiting programs and expand programs across the state. The committee presented 20 recommendations aimed at tripling the number of families served through evidenced based home visiting services.

From these recommendations, Ohio leveraged State and federal funding to upscale and expand four evidenced based home visiting models by utilizing:

  • State and federal Medicaid funding to expand the Nurse Family Partnership program from 6 counties in 2020 to 26 counties in 2022.
  • Referrals for Families First Prevention services and Parents as Teachers programs through local public children’s services agencies.
  • Leverage existing State prevention services, in partnership with Ohio’s Department of Jobs and Family Services (ODJFS) to provide expansion grants – awarding $1.26 million creating 850 slots for families.

Key Takeaways

Strategies for Governors’ consideration when pursuing enhancements for home visiting programs:

Explore opportunities to blend/braid funding streams:

  • State general funds can support:
    • State level infrastructure (including staff)
    • Start-up funding through expansion grants to local agencies.
  • Medicaid and commercial health benefits plans.
  • IV-E Families First Prevention & MIECHV funds.


  • Coordination between State and local government is key to success: In Ohio’s State general funds assist local agencies by providing expansion “startup” grants to bring more providers and programs on-line to support increased slots.
  • In Oregon, Early Learning Hubs (ELH) serve a group of counties and help coordinate services for families while local public health officials perform home visits and assessments.


COVID-19 caused setbacks in program implementation, primarily due to issues maintaining the necessary workforce capacity.

  • Because OH offers Medicaid benefits on a fee-for-service basis, the state increased hourly billable rates for services to boost wages, and attract and retain workers.
  • Ohio also re-aligned the State’s work requirements to match those of the program’s evidence-based, which reduced barriers to entry for potential workers, increasing the number of eligible potential employees.

Questions To Consider As Next Steps

  1. How might your state better leverage home visiting services as a prevention tool across child welfare, MCH, and other human services fields?
  2. What opportunities exist to capitalize on home visiting services to support benefits delivery for other programs?
  3. Home visiting can act as an important component of a State’s early childhood system as an early access point for families to get referred to services. How can home visiting better collaborate or support your State’s early childhood system?

Additional Resources On Home Visiting