Home Visiting, An Opportunity to Reduce Toxic Stress


In a recent New York Times Op-Ed, David Bornstein emphasized the importance of understanding the negative influence that toxic stress has on children’s long-term health and social outcomes. Bornstein defines toxic stress as prolonged exposure to stress without adequate parental support, and explains that children who experience toxic stress are at an increased risk for negative outcomes over time, including suicide, smoking, and teen pregnancy. Bornstein highlights the critical role that parents play in protecting children from the harm that chronic stress has on their development.

An article by Andrew Garner in Pediatrics supports Bornstein’s contention that a healthy and emotionally supportive parent-child relationship reduces the risk for toxic stress, and highlights the ways that policy interventions can improve child outcomes by mitigating the toxic stress children experience. Garner states:

 “Future efforts to minimize the effects of childhood adversity should focus on expanding the capacity of caregivers and communities to promote (1) the safe, stable, and nurturing relationships that buffer toxic stress, and (2) the rudimentary but foundational social-emotional, language, and cognitive skills needed to develop healthy, adaptive coping skills. Building these critical caregiver and community capacities will require a public health approach with unprecedented levels of collaboration and coordination between the healthcare, childcare, early education, early intervention, and home visiting sectors.”

In Texas, these interventions are already happening. The Texas Home Visiting Program (THV), which CFRP is evaluating, is an example of a program that aims to build the critical caregiver and community capacities described in Garner’s article and to thereby reduce children’s exposure to toxic stress. Home visiting programs can help caregivers and children who face adversity find healthy and adaptive ways to react to and cope with stress which, in turn, can reduce children’s susceptibility to poor health and social outcomes, and maladaptive coping behaviors later in life. Researchers have found that home visiting programs are an effective way to reduce the risk of maternal depression, child maltreatment, and children’s behavior problems. They are also positively linked to children’s language, vocabulary, and cognitive development. Increasing father involvement, which is one of the goals of THV, is also instrumental to fostering positive family and child outcomes. In addition, THV supports the development of Early Childhood Comprehensive Systems, which facilitate the efficient delivery of health and social services to children and families at the community level.

-Cyndy Karras, M.A., Graduate Research Assistant


  1. Ammerman, R.T., Putnam, F.W., Altaye, M., Teeters, A.R., Stevens, J., & Van Ginkel, J.B. (2013). Treatment of depressed mothers in home visiting: Impact on psychological distress and social functioning. Child Abuse and Neglect, 37(8), 544-554.
  2. Avellar, S.A., & Supplee, L.H. (2013). Effectiveness of home visiting in improving child health and reducing child maltreatment. Pediatrics, 132(2), 90-99.
  3. Cowan, P.A., Cowan, C.P., Pruett, M.K., Pruett, K., & Wong, J.J. (2009). Promoting fathers’ engagement with children: Preventive interventions for low-income families. Journal of Marriage and Family, 71, 663-679.
  4. Garner, A.S. (2013). Home visiting and biology of toxic stress: Opportunities to address early childhood adversity. Pediatrics, 132(2), 65-73.