Association for Public Policy Analysis & Management

MIHOPE-Strong Start is the largest random assignment study to date to examine the effectiveness of home visiting services on improving birth outcomes and infant and maternal health care use for expectant mothers. The study includes local home visiting programs that use one of two national evidence-based models that have been effective at improving birth outcomes: Healthy Families America (HFA) and Nurse-Family Partnership (NFP). Sponsors of the study are the Center for Medicare and Medicaid Innovation (CMMI) of the Centers for Medicare and Medicaid Services (CMS); the Office of Planning, Research and Evaluation (OPRE) in the Administration for Children and Families (ACF); and the Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration (HRSA). MDRC is conducting the study in partnership with James Bell Associates, Johns Hopkins University, Mathematica Policy Research, and New York University.

This presentation will provide an early peek at the characteristics of families and local home visiting programs in the study. Specifically, results will present descriptive information on 1,221 families for whom data are available, representing about 40 percent of the final sample, and discusses select characteristics of the local programs participating in the study. To provide context for understanding the types of families and local programs described, the presentation will also discuss the process by which the study team recruited local programs for participation. Among the key findings to be presented are the following:

• Information from 67 local home visiting programs across 17 states will contribute to the study’s analyses. The MIHOPE-Strong Start program recruitment team employed a structured process over two years to recruit 20 programs into the study to supplement 47 similar HFA and NFP programs enrolled through a companion study called the Mother and Infant Home Visiting Program Evaluation (MIHOPE).

• Families in the study face a number of challenges, especially as expectant parents. The average participant, at the time of study entry, was young (half were under age 21), and one in two reported experiencing food insecurity in the past year. About 40 percent reported symptoms of depression or anxiety. Only 8 percent of the sample reported smoking during pregnancy, although 20 percent reported that smoking occurred in the home, which indicates potential in-utero exposure to secondhand smoke.

• The local programs serving these families are putting a high priority on outcomes that are relevant for improving infant and maternal health, and they have the implementation system support in place to carry out their service plans. Notable areas where local programs differed include intended caseload sizes; policies on screening for mental health, substance use, and intimate partner violence; and policies for providing education and support when problems are detected. These differences may affect services that are delivered.

These results lay the groundwork for the study’s final report, which will examine how local program implementation processes predict actual service delivery, describe impacts of home visiting on family outcomes, and link program implementation to program impacts.