Support and Engage

Creating Ripple Effects

Among the risk conditions typically seen in many of the families targeted for services in home visiting programs are high rates of poverty, low education levels, substance use, domestic and community violence, mental health concerns (both diagnosed and undiagnosed) in the parents, histories of family trauma, and geographic and social isolation. Many of these risk characteristics were described in the Adverse Childhood Experiences (ACE) study of 17,000 adults as powerful determinants of later adverse outcomes in physical health, mental health, education, risk behaviors, and social well-being (Anda et al., 2006; Anda & Felitti, 2014; Chapman et al., 2004; Dube, Anda, Felitti, Edwards & Williamson, 2002), in addition to premature death (Felitti et al., 1998). Infant and early childhood prevention and intervention programs, including home visiting, are designed to support families and improve their capacity to buffer young children from the toxic stresses that may be created by adverse conditions and to reduce educational and health disparities (Garner, 2013). Home visiting offers opportunities for parents with their own adverse childhood histories to develop a new understanding of positive relationships and to become positive buffers in their children’s lives. However, immersion in the realities of the challenges of family living situations can lead to stress and burnout in home visiting professionals. The high rates of mental health concerns in many of the families being served adds to the burden of individual home visitors in managing the time needed to effectively support families while meeting all other program requirements. Mechanisms such as consultation and support for home visitors on critical concerns related to family mental health, and opportunities for additional community supports such as that provided through the Family Café can reduce stressors in families and program staff, improve staff and family retention, and enhance child outcomes. Ripple effects creating positive impacts are thus seen through the provision of support at multiple levels, from the program level to the family level to the child level.



Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J.D,, Whitfield, C., Perry, B.D., Dube, S.R,, & Giles, W.H. (2006). The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry & Clinical Neuroscience, 256(3), 174-186.

Anda, R. F., & Felitti, V. J. (2014). The repressed role of adverse childhood experiences and adult medical care and inter-personal violence. Symposium on Child Abuse and IPV. Pasadena, CA.

Chapman, D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R., Edwards, V. J., & Anda, R. F. (2004). Adverse childhood experiences and the risk of depressive disorders in adulthood. Journal of Affective Disorders, 82(2), 217-225.

Dube, S.R., Anda, R.F., Felitti, V.J., Edwards, V. J., & Williamson, D.F. (2002). Exposure to abuse, neglect, and household dysfunction among adults who witnessed intimate partner violence as children: implications for health and social services. Violence & Victims, 17(1), 3-17.

Felitti, V. J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V., . . . & Marks J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, 245–258.

Garner, A. (2013). Home visiting and the biology of toxic stress: Opportunities to address early childhood adversity. Pediatrics, 132(S2), S65-S73. doi: 10.1542/peds.2013-1021D