Association for Public Policy Analysis & Management

Panel: Improving Birth and Other Outcomes: Findings on Home Visiting and Other Programs

(Family and Child Policy)

Despite major advancements in the past century, rates of adverse birth outcomes in the United States remain high. In 2009, about 12 percent of infants born in the United States were born prematurely, and roughly 8 percent were classified as low birth weight. Preterm and low-birth-weight infants are at greater risk for mortality and numerous health and developmental problems during the first year of life and beyond, and poor birth outcomes can result in financial and emotional tolls on families. Healthy births, in turn, begin with the health, well-being, and resources of mothers and families, including having adequate access to supportive services and, from the prenatal period on, education to promote positive parenting, health behaviors, and home environments. In an effort to improve birth outcomes and reduce adverse health outcomes for mothers and infants enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), the Center for Medicare and Medicaid Innovation (CMMI) developed the Strong Start for Mothers and Newborns (Strong Start) initiative. The four-year initiative is examining whether nonmedical prenatal interventions, when provided in addition to routine medical care, can improve the health outcomes and health care use of pregnant women and newborns and can decrease the costs of medical care during pregnancy and delivery and over the first year of a child’s life. Results could be used to influence reimbursement for these interventions under Medicaid. This panel will present the latest findings from this important federal initiative. The Strong Start initiative actually includes two national evaluations. In one, the Urban Institute is studying program implementation and family impacts of 27 programs implementing one of three evidence-based enhanced prenatal care approaches: maternity care homes, group prenatal care, and birth centers. In the second, a team led by MDRC is studying program implementation and impacts for families for 67 local programs operating one of two national models of home visiting: Healthy Families America and the Nurse-Family Partnership. Two presentations in this panel will describe early findings from the two studies. In both evaluations, study participants face a number of challenges, including low educational attainment, food insecurity, and high rates of depressive symptoms at intake. Both also present evidence on program implementation that suggests local programs are designed to support women with these risk factors. In addition, preliminary evidence from the Urban Institute study suggests the interventions are succeeding in producing better birth outcomes compared to national benchmarks. Both evaluations are relying on administrative records from state Medicaid and vital records systems to examine the effects of the interventions on birth outcomes and maternal and child health care. The use of administrative records has been proposed more broadly as a potentially cost-effective way of obtaining reliable information on outcomes for participants of social policy evaluation. The third presentation will describe the challenges faced in acquiring those data in MIHOPE-Strong Start, raising questions about the potential to realize the goals of cost-effective data acquisition.