School readiness is far more than knowing letters and numbers. Researchers widely conceptualize it as a multidimensional construct spanning five core domains: physical well-being and motor development, social and emotional development, approaches to learning, language development, and general knowledge and cognition. Each domain captures a different facet of a child’s capacity to thrive in a classroom. Motor skills support engagement with learning environments, emotional regulation underpins classroom behavior, curiosity and persistence fuel learning itself, expressive and receptive vocabulary enables communication, and early numeracy and memory form the scaffolding for later academics. Decades of research have linked readiness at school entry to higher standardized test scores, fewer suspensions and grade retentions, and even long-term advantages in employment, income, and health, making it a central concern for scientists, practitioners, and policymakers alike.

Home visiting, meanwhile, has grown into a major pillar of American early childhood policy. The federal Maternal, Infant, and Early Childhood Home Visiting program, known as MIECHV, funds evidence-based models across states, territories, and tribal communities. These models differ dramatically in staffing, dosage, curriculum, and goals. Some, such as Home Instruction for Parents of Preschool Youngsters and Parents as Teachers, explicitly target early learning and school readiness as primary outcomes. Others, including Nurse-Family Partnership and Attachment and Biobehavioral Catch-up, center on maternal health, parenting, or caregiver-child attachment, treating school readiness as a downstream benefit. Families who enroll often confront poverty, family violence, substance misuse, or maternal depression—challenges that can constrain their capacity to support development and that complicate efforts to evaluate program effectiveness, since participating families differ systematically from those who do not enroll.

To untangle this complex landscape, a team at the University of Alabama at Birmingham conducted a scoping review guided by the Preferred Reporting Items for Scoping Reviews, or PRISMA-ScR, framework. The researchers searched four major databases—CINAHL Plus, Embase, PubMed, and Scopus—for articles published between January 2016 and April 2025, a window chosen to capture the contemporary home visiting landscape during MIECHV’s expansion and reauthorization. The initial search yielded 9,776 articles, with an updated search adding 1,121 more. After removing duplicates and screening more than 10,000 titles and abstracts, the team reviewed 76 full-text articles and ultimately included 20 studies meeting strict criteria: each had to examine a home-based or home visiting intervention delivered in the participant’s residence in the United States, serve children from birth through kindergarten, and assess school readiness at school entry.

The included studies were methodologically robust, with thirteen employing randomized controlled trials, alongside quasi-experimental designs, a mixed-method study, a meta-analysis, and a program evaluation. They spanned diverse geographic regions, from Arizona and Michigan to Texas, Pennsylvania, and multi-state samples, and covered a wide array of models, including Parents as Teachers, Infant Mental Health Home Visiting, HIPPY, Attachment and Biobehavioral Catch-up, PC TALK, homeBase, Minding the Baby, REDI-P, Early Steps to School Success, and INSIGHT Responsive Parenting. Yet despite this breadth, the studies converged on a narrow slice of the readiness construct. Language and literacy and social-emotional development were the most frequently measured and most consistently improved domains, while physical well-being, sensory-motor development, and approaches to learning were largely neglected. Common assessment tools included the Preschool Language Scales-Fifth Edition, the Peabody Picture Vocabulary Test, the Vineland-II, and the Ages and Stages Questionnaire.

The evidence on effectiveness was mixed but generally encouraging. Parents as Teachers programs were associated with gains in child language and social-emotional skills, as well as improved parenting efficacy and home safety practices. Infant Mental Health Home Visiting buffered the negative effects of maternal adverse childhood experiences on toddler language competence and improved communication skills. HIPPY interventions produced improved language and literacy outcomes, with children showing equal or higher school readiness scores and sustained academic achievement compared to nonparticipants. Across models, the strongest and most consistent effects appeared in language and social-emotional domains. However, several randomized trials reported null or modest findings, and the strength of effects depended heavily on the specific model, implementation fidelity, and family context—a reminder that home visiting is not a monolithic intervention but a diverse family of programs with different populations, curricula, visit frequencies, and theoretical orientations.

Only five of the twenty studies explicitly tested contextual moderators of program effectiveness, and all of them operated at the individual, family, or program level. The identified moderators included parent academic expectations—parents’ beliefs about their child’s future reading, math, and learning performance—program language, child sex and temperament, implementation fidelity, and home visiting intensity. Higher fidelity and greater visit intensity were associated with stronger gains in children’s language, social, and emotional development. These findings reinforce that home visiting outcomes are context-dependent and sensitive to how well intervention content and delivery align with family characteristics and program quality, but they also expose how narrow the field’s analytical lens has been.

That narrowness constitutes the review’s most consequential finding. Although school readiness is shaped by influences operating across multiple ecological levels—neighborhood conditions, social and economic policies, access to community resources, and structural inequities—none of the included studies examined moderators at the community or structural level. The authors argue this leaves a critical gap: scientists currently lack evidence about how concentrated poverty, housing stability, local service availability, libraries, child care supply, state policy environments, funding models, immigration and language access policies, or systemic racism may condition the effectiveness of home visiting for readiness outcomes. The evidence base, in other words, has tested moderation almost exclusively where it is easiest to measure—at the level of the child, the family, and the program—while ignoring the broader systems that ecological theory says matter profoundly.

The review also highlights a methodological problem that undermines the field’s cumulative power. Because studies define and measure school readiness so differently, comparing findings across studies or quantifying home visiting’s population-level impact is extraordinarily difficult. The authors call for a shared conceptual model and standardized measurement framework, similar to harmonization efforts that have strengthened evidence in other areas of early childhood research. They also propose concrete research priorities: linking participant data to geocoded community indicators such as social vulnerability indices and early care and education access; modeling policy and implementation environments, including MIECHV funding stability and workforce capacity, as higher-level moderators; and testing equity-focused moderators such as linguistic access, discrimination exposure, and transportation barriers to clarify for whom and under what structural conditions home visiting delivers its greatest gains.

The authors acknowledge limitations, noting that school readiness is an expansive topic in which each domain could sustain its own review, and that their analysis excluded interventions delivered in clinical or academic settings such as Healthy Steps or Head Start, as well as child health factors like birth outcomes and longer-term academic outcomes in primary and secondary school. Still, the overarching message is clear. Home visiting programs show genuine promise for strengthening language, literacy, and social-emotional development at school entry, but inconsistent definitions, uneven measurement, and an almost total neglect of community and structural context limit what the field can confidently conclude. Establishing a shared understanding of school readiness and systematically examining multilevel moderators, the authors argue, are critical next steps for building responsive home visiting services that give every child a strong start.

Subject of Research: The relationship between home visiting programs and children's school readiness at school entry

Article Title: School Readiness and Home Visiting: A Scoping Review of Definitions, Outcomes, and Contextual Moderators

Article References: School Readiness and Home Visiting: A Scoping Review of Definitions, Outcomes, and Contextual Moderators. (n.d.). https://doi.org/10.1007/s10643-026-02343-0

Image Credits: AI Generated

DOI: 10.1007/s10643-026-02343-0

Keywords: school readiness, home visiting, early childhood, scoping review, MIECHV, language development, social-emotional development, HIPPY, Parents as Teachers, contextual moderators, early childhood education, kindergarten