Implementation of a Universal Family Connection and Referral Strategy


A universal family connection and referral strategy is a service in which the intervention is available to all families within a community, regardless of income, socioeconomic status, or demographic characteristics. The service is intended to provide initial screenings to assess the mother and newborn child and connect or refer them to services if needed. These services can differ depending on the strategy, but could include, but are not limited to, screenings and referrals for maternal depression, early care and education, and child health and developmental services. For example, Family Connects, a universal home visiting program, is delivered to all families within a community with a newborn, providing between one and three nurse home visits beginning at about three weeks of age.

This indicator can be measured initially by examining a set of indicators related to implementation progress. Once implementation is in-process, regular monitoring of the annual number of children and families served can be initiated.


Several national organizations compile information about home visiting in states and territories, including universal home visiting programs in some states:

  • The Association of State and Tribal Home Visiting Initiatives (ASTHVI) has 2017-2018 fact sheets for states and territories, which include each state’s home visitation policies.
  • The Home Visiting Evidence of Effectiveness (HomVEE) project funded by the U.S. Department of Health and Human Services provides a review of the evidence of the effectiveness of home visiting models. The website includes information on each of the models and an assessment of their effectiveness, as well as information on the implementation of each model.
  • The National Home Visiting Resource Center has 2016 fact sheets on evidence-based home visiting services in states and territories.

Some home visiting programs are considered universal models, designed to serve all families in a community. Two of those universal home visiting models are

  • Family Connects: All families within a community are provided with one to three nurse home visits; newborns and mothers are screened and assessed, and referrals for services are made if determined necessary.
  • Parents as Teachers: This is designed to provide universal access to services for families in a community, although many affiliates focus on specific high-need populations of families instead. Families receive a minimum of monthly visits and both a family-centered assessment and a child screening are completed to then connect families with resources.
  • Review different universal family connection and referral strategies to determine which one is best for your community.
  • Establish leadership support and capacity building.
  • Identify funding opportunities and target locations (i.e., health care centers, hospitals, early care centers, and education centers) to start implementing the strategy.
  • Secure funding for universal family connection and referral strategy.
  • Begin initial implementation in target location(s).
  • Set short-term targets for number or percent of families to serve initially.
  • Develop a logic model or approach to move from initial implementation to full implementation.
  • Set long-term targets for expanding the strategy to make it universal.
  • Establish a community-wide data system* for tracking the number of families being served and referrals.

*Note: Please refer to the Data Systems Progress Indicator for more information

Research Rationale

Family Connects (formerly Durham Connects) has been evaluated through multiple randomized controlled trials, funded by the National Institutes of Health and the Duke Endowment, and was found to have benefits for the mother and child, as well as a return on investment for the community. More recently, the Pew Home Visiting Campaign commissioned evaluations of home visiting models, including a randomized controlled trial of Durham Connects. The evaluation found that mothers and children participating in Durham Connects had more positive parenting behaviors, less maternal depression, improved connections to community resources, improved rates of high-quality child care utilization, and reduced mother-reported use of emergency health care at six months.1 For more information, please refer to the full report.

  • 1. Excerpted from The Pew Home Visiting Campaign