Association for Public Policy Analysis & Management

Among the many approaches that have been used to address the multiple risks that disadvantaged families with young children face, home visiting has garnered particular attention in recent years. The Affordable Care Act greatly expanded the availability of home visiting through creating the Federal Home Visiting Program. Through this Program, states were to fund national models with rigorous evidence of effectiveness, and to make a priority of services to improve a broad range of outcomes related to parental and child health and well-being, parenting, economic self-sufficiency, and domestic violence.

Despite a long history of research on home visiting, one of the inherent challenges to examining the implementation of programs and their impacts on families is that home visiting is a uniquely individualized and decentralized service -- making it difficult to monitor, study, and manage performance.

The Mother and Infant Home Visiting Program Evaluation (MIHOPE) – which is the mandated evaluation of the Home Visiting Program-- takes advantage of this decentralized nature by using a study design that will exploit the variation across 88 sites, roughly 400 home visitors, and over 4000 families to deliver critical lessons to both policymakers and practitioners. Key questions include:

• How are the broad range of Home Visiting Program goals translated from the national down to the local staff level for an essentially decentralized service like home visiting?
• Do differences in services result in different benefits for families?
• Do some families appear to benefit more than others?
• How do programs that produce larger impacts differ from programs with fewer impacts?

This presentation will focus on early findings from MIHOPE, examining the process for selecting at risk communities, national models, and local programs; exploring the types of families that ended up enrolling in local programs; and describing key facets of the local programs service plans and implementation supports to address a spectrum of child, parent, and family outcomes.  We find that:

• States used initial Home Visiting Program funds primarily to expand the use of four evidence-based home visiting models in at-risk communities and, as intended, targeted counties with high risk indicators, such as poverty, child maltreatment, and premature birth.

• As intended, the local programs funded by the Home Visiting Program serve a group of mothers with many needs. When they entered the study, more than 30 percent of women had symptoms of depression, more than three-quarters had no more than a high school diploma, and a tenth reported being the victim of intimate partner violence.

• Local programs funded by the Home Visiting Program are generally designed to help parents support the healthy development of infants and toddlers. However, some outcomes – including maternal health and behavioral health – appear to be of lower priority, and were areas where perceived training was not universally strong.

In sum, the variation seen in how programs are structured in these early findings suggests that the study is on track to provide a rich set of lessons in the near-future, and to advance thinking about how to structure evaluations to maximize learning while maintaining research rigor.