Evidence over the years has demonstrated the clear impact of public health nurse (PHN) home visits on outcomes of those raising infants and children: PHNs save lives and improve health and social outcomes—not just in the short term, but for decades to come.1–3 The family home visiting articles in this special issue of AJPH (Ballard et al., p. S298; Huling et al., p. S306) extend and advance intervention effectiveness knowledge for PHN family home visiting practice. They also demonstrate that PHNs are ready and willing to do whatever it takes to provide effective, high-quality, life-changing care and transparently document outcomes to prove quality and effectiveness.
In this era of extreme accountability and transparency for health care professionals, PHNs serve as leaders and exemplars of what can be done with nursing data to demonstrate effectiveness and value. PHNs have been generating useful, valid, and reliable data through routine documentation for more than two decades—consistently validating positive family home visiting outcomes in program evaluation and research.3–5 Based on an extensive body of literature across home visiting programs, translations of PHN family home visiting evidence to practice in everyday public health have been highly successful and should continue. Indeed, the public health system would be well advised to add PHN family home visiting to any population of interest to enhance outcomes and reduce downstream social and financial costs. What, then, is preventing the widespread deployment of PHN family home visiting to address the complex health and social needs of those at highest risk for poor outcomes?
First, consider that although we affirm PHN family home visiting’s effectiveness, we are slow to acknowledge and trust that it is the PHN—who is highly educated, emotionally available, and greatly connected—who makes the intervention effective.4,5 Instead, we put our trust in “evidence-based programs” that diminish the role of the PHN to that of a technician who delivers a scripted intervention. Expanding PHN family home visiting programs depends on trusting and respecting the capability of skilled PHNs and supporting their ability to tailor interventions to each person. This is fundamental to expanding the availability of PHN family home visiting, simply because funding mechanisms require PHNs to be prepackaged in expensive, restrictive evidence-based programs rather than embedded as expert interventionists acting in the fabric of the public health system to improve the public’s health.
Second, let us question the notion that evidence-based PHN family home visiting services should be available only as replicated evidence-based research programs. Such replication is a costly process often accompanied by burdensome requirements of accreditation and oversight as well as extensive, time-consuming data collection protocols. This results in siphoning of resources away from the PHNs and public health agencies and into the external programs, thereby reducing funds available to pay PHNs to do the work. Furthermore, such models have restrictive eligibility requirements that are in opposition to the mission of many public health departments: to serve those who need services in their jurisdictions. In fact, PHN family home visiting is effective for a broad range of family home visiting groups and needs,1–5 and to deny effective services to those who are in need in the name of program fidelity is unethical.
Finally, let us acknowledge the truth in the data generated by PHNs and support the most trusted profession to practice to the full extent of its licensure in our communities. PHNs are equipped and ready to do so, but the systems in which PHNs must function need to take a hard look at political assumptions and willingness to act on the evidence PHNs have provided. PHNs have long accepted the responsibility of demonstrating intervention effectiveness; this is the message that the Ballard et al. and Huling et al. articles affirmed once again. It is time to listen.
ACKNOWLEDGMENTS
The author commends and thanks the countless public health nurses working with family home visiting clients to improve health and social outcomes over many generations.
CONFLICTS OF INTEREST
The author has no funding or affiliation-related conflicts of interest to report.
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