The articles in this special issue are convincing with regard to the efficacy of early home visiting in families with infants. Such programs act positively in a variety of risk populations: low socioeconomic status, psychosocial risk, some maternal depressions, and are yet to be fully tested in family violence and a wider set of maternal depression. Depending on the program, some form of home visiting in these studies is at regular and frequent intervals Νe.g., once a week or biweekly for 9 -24 months, mostly beginning in the first months or even prenatallyΝ. The visits are carried out by ΝusuallyΝ nurses ΝBoris et al., Lyons-Ruth & Easterbrooks, Olds, and Zeanah et al.Ν, or by psychologists and social workers ΝAmmaniti et al.Ν. The home visitors always receive pretraining and regular supervision. They are invariably women, often mature women Ν43.9 years in the Zeanah et al. studyΝ. Such studies are shown to have a positive effect on a wide variety of mental health and other problems. Depending on the program, positive effects can be shown on the sensitivity of maternal behavior, the richness in the perception of the child, the mother's affective state, early maternal and child health, and future health-related life options. The specifics of these salutary changes are included in each article.
The success of these programs has an obvious economic aspect. Their cost/benefit advantage and feasablilty to society are excellent. Olds, quite correctly, wishes to move certain programs out of the research phase and into the domain of public policy. The cummulative effect of this special issue leads in the same direction. Furthermore, the nature of these programs is entirely in the spirit of accepted community action. There is nothing alien about it Νat least in the United States; see Ammaniti's, this issue, comments about ItalyΝ.
These studies raise another question that is not answered here but hovers in the air. Putting aside questions of cost/benefit, does any form of therapy/education Νe.g., psychodynamic therapy, cognitive or behavioral therapies, or classes for mothersΝ have better or as good results as does home visiting with these populations? My impression of the literature is no! And such a conclusion raises a bunch of other questions, such as: Why do these programs work and how? I believe that there is a quiet theoretical revolution taking place, of which these studies are a part. Let us suppose that such home-visiting programs, in these popula-