Investments in home visiting programs for young children and their parents are increasing nationwide, with a particular emphasis on evidence-based programs. This study evaluates the effectiveness of the First Born Program (FBP) in improving child health outcomes in the first year of life. FBP is a home visitation program that combines specially trained parent educators and health care professionals to provide parents and families with information, training, and access to resources designed to promote early childhood development. All services are free and offered to all first-time families. Services may begin at any time during pregnancy or up to two months after the baby’s birth and may continue until the child is three years old. In addition, a nurse postpartum home visit is offered to the parents of all participating newborns.

The primary innovation of the FBP is that it delivers services using a team of parent educators and a registered nurse.  The home visiting curriculum and activities are divided between the medical professionals and parent educators in a way that takes advantage of medical skills where necessary, and reserves non-medical functions for the parent educators. This approach is appealing because so many areas where vulnerable children are concentrated also have shortages of health professionals. Moreover, this staffing mix costs less than using only nurses, the staffing structure that some argue is key to the success of home visiting programs.

This study addresses the following questions: 1) Do children participating in the First Born Program have improved health outcomes such as reduced emergency room visits or hospitalizations compared to children not receiving program services? 2) What are the potential health cost savings from First Born Program participation?

To identify the effects of program participation, this study conducted a randomized-controlled trial of the program offered to all new parents in Santa Fe County, New Mexico. Families referred to the program were randomized on a rolling basis to treatment or comparison group status as home visiting slots became available. Over 100 children are in each study group. We conduct both an intent-to-treat analysis as well as a treatment on the treated analysis. Some families were randomized and enrolled in the program but did not receive any program services, so they are included in the intent-to-treat group. We use family interview data on reported health status and behaviors at the 12-month interview that asks the caregiver respondent about the child’s first year of life. Where any significant differences are measured between the treatment and comparison groups, we will analyze the expected costs saved compared to the program cost to determine if benefits outweigh costs to achieve early health outcomes.