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The Precision Paradigm

The Precision Paradigm

For the past few decades, home visiting impact research has typically estimated average effects of full home visiting models, as shown in Figure 1.

Figure 1. Traditional Home Visiting Research Paradigm

We know that the families who enroll in home visiting are very different from one another, that local programs operate in communities that are very different from one another, that many families do not engage in services, and that average impacts have remained small over the past few decades.

To strengthen family engagement and home visiting’s benefits for families, we need a different approach to research. We need to focus on interventions within and across home visiting models. We need to answer the question,

What works best, for which families, in which contexts, why and how?
This requires a framework that includes mediators — mechanisms of actions and target behaviors — as well as family engagement and other moderators of impacts, as shown in Figure 2.

Figure 2. Precision Paradigm


This framework reflects the shift in intervention science toward precision. Within home visiting, we need to specify the framework in alignment with science and with the perspectives of home visiting stakeholders.

For additional details, and an example of the Precision Paradigm, please see the video “How HARC Members are Building the New HV Research Paradigm” from our 2021 Collaborative Science of Home Visiting Meeting.

Building the Precision Paradigm – How You Can Be Involved

Over the next year, we are working to build out each component of the paradigm. To that end, we are consulting with varied stakeholder groups, from families and front-line staff, to researchers, to policy makers and funders.

We are currently looking for intervention researchers with expertise developing and/or evaluating interventions that address one or more of the following areas: birth outcomes, parenting to promote child development and social-emotional well-being, maternal psychosocial well-being, cardiovascular health of mothers and children, and family economic well-being.

Intervention researchers will serve as consultants on our project and will be asked to provide their views on theories of behavior change and on each component of the Precision Paradigm. In the coming months, we will expand our pool of consultants to include other types of stakeholders.

If you are interested in being involved, please email Kay O’Neill at