House Calls

By Linda Jacobson

Two years ago, Ohio launched Early Start, a program that sends trained caseworkers into the homes of infants and toddlers considered at risk of abuse, neglect, or developmental problems.

In an effort to encourage initiative and creativity, the state gave the 30 participating counties freedom to run the program as they wished. But the result, state officials found, was a tremendous variation in the return Ohio received on its $1,200-per-family investment.

In one county, a home visitor had an unmanageable caseload of 100 families. In another, the average visit...