Association for Public Policy Analysis & Management

Home visiting is a long-standing service delivery strategy used to promote positive maternal and child health and development.  With the recent investment of federal funding for the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program authorized by the Affordable Care Act, policymakers have questioned the effectiveness of different program models and have invested resources in identifying the most essential components of successful home visiting programs.  Building a strong evidence base for home visiting that identifies achievable outcomes for specific populations is an important next step.

This six-year evaluation employs mixed methods to assess the implementation of a locally developed home visiting program in Los Angeles and associated outcomes within a quasi-experimental design.  Findings presented are based on a longitudinal survey and home observation designed to examine family and child outcomes at 12, 24 and 36 months postpartum.

The study includes an intervention group of mothers who received home visiting (n = 454) and a comparison group of mothers who live in the same community but were not offered enrollment in the program (n = 280).  About 28 percent of the intervention group enrolled in the program prenatally whereas the remaining sample enrolled postpartum at the birth hospital.  Home visiting services were offered up to 9 months postpartum.  The comparison group was recruited using hospital birth records and WIC enrollment lists.  Approximately 90 percent of mothers in the full sample are Latino, 70 percent are immigrants, and only half have at least a high school diploma.

At 12 months, we find that participants have higher quality home environments with more learning materials, higher engagement in home learning activities, and children at reduced risk of developmental delay, particularly in the area of social-emotional skills. Several measures are sustained at 24 and 36 months, where the intervention group continues to demonstrate greater child social competence and communication skills, as well stronger maternal responsiveness and encouragement. In addition, several differences emerge with time suggesting that families who received the intervention experience lower parental stress and demonstrate stronger maternal teaching and affection.  More favorable outcomes are observed for mothers enrolling prenatally, those who complete the program, and for single mothers.  Having at least a high school degree benefited mothers in terms of improving the quality of their home environment and their parenting interactions.

The significant effects reflect the outcomes expected given the target population and the dosage and objectives of the home visiting program.  These results confirm qualitative findings indicating that while mothers highly value the program, form strong bonds with parent coaches, and perceive improved breastfeeding and parenting skills, the program’s medium-intensity model falls short of meeting the needs of high-risk mothers. 

The results have implications for the design and implementation of home visiting programs nationally, highlighting links between the intensity of a home visiting model, the population served, and potential outcomes in parenting quality and child well-being.