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“This program model is now both well-conceived and well-tested. Some questions, nevertheless, remain about several aspects of the program. While we have attempted to integrate theoretical perspectives with both individual and environmental emphases, the resulting framework and program has emphasized individual determinants of development to a greater degree than may be desirable, especially given the levels of deprivation and hostility that characterize many under-class, crime-ridden urban environments. To date, we know little about how this type of program might work in communities with vastly different social and economic resources for families than those found in Elmira, Memphis, and Denver. A series of secondary analyses of the Memphis and Denver data is being conducted to examine the extent to which neighborhoods with high rates of crime and poverty further condition the impact of the program.” “Moreover, we know little about how differences in the levels of community services affect program process and outcome. To what extent are the effects of the program dependent upon the existing system of health and human services? To what extent might the program effects be enhanced in locales where a greater portion of the families' basic needs are assured? And to what extent would the effects of the program be diminished if the existing system were depleted further? Visitors depend upon linking families with other needed services but often find that those services are in scant supply, leading some experts to take the position that home visits are necessary but not sufficient for child health and development (Chamberlin, 1980; Weiss, 1993).” “Finally, we acknowledge that the current model of preventive intervention is limited with respect to addressing certain individual characteristics of parents as well. The visitors in each of the programs have encountered parents with major mental illness, such as depression and schizophrenia. The problems posed with this population can be considerable. The model calls for linking mentally ill parents with treatment services in the community, of course, but such services often not readily available. Moreover, barriers frequently exist to individuals' use of those services that are available. Administrators of home visitation programs may choose to hire their own mental health professionals to ensure treatment of these parents, may intensify the search for effective mental-health services through better linkages with primary care providers, or may try to directly improve the availability of mental health services in their community.”
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