Child poverty, child maltreatment, and child health and development are major public policy issues. By the end of the Great Recession in 2009, as many as one in four children under the age of five were living in poverty and six million children were subject to child maltreatment reports in America. For decades, evidence-based home visiting (EBHV) programs have provided effective early interventions for preventing child maltreatment and promoting child and family outcomes to pregnant women and families with children age birth to five years old. Despite this, no widespread federal policies or funding supported home visiting before 2010. Through the Patient Protection and Affordable Care Act (ACA), the federal government invested $1.5 billion in home visiting with the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) initiative. While many articles examine the effectiveness of home visiting and call attention to the unprecedented features of MIECHV, this article applies the multiple streams framework to illuminate the unique social and political contexts culminating in the inclusion of MIECHV in ACA. The findings in this article are significant for policy analysts, advocates, and program developers and for establishing policies requiring evidence-based practices.

中文翻译：

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联邦对循证幼儿家访的投资：多源分析

儿童贫困、儿童虐待以及儿童健康与发展是主要的公共政策问题。到 2009 年大衰退结束时，美国有多达四分之一的五岁以下儿童生活在贫困中，六百万儿童受到虐待儿童的报道。几十年来，循证家访 (EBHV) 计划为孕妇和有 5 岁以下儿童的家庭提供了有效的早期干预措施，以防止虐待儿童并促进儿童和家庭的结局。尽管如此，在 2010 年之前，没有广泛的联邦政策或资金支持家访。 通过患者保护和平价医疗法案 (ACA)，联邦政府投资了 15 亿美元用于母婴和幼儿家访 (MIECHV) 的家访倡议。虽然许多文章研究了家访的有效性并引起人们对 MIECHV 前所未有的特征的关注，但本文应用多流框架来阐明独特的社会和政治背景，最终将 MIECHV 纳入 ACA。本文的发现对于政策分析师、倡导者和项目开发人员以及制定需要循证实践的政策具有重要意义。