Home Visiting Research and Evaluation Snapshot

The home visiting field has engaged in research and evaluation for decades, generating a rich literature on the effects of home visiting. Studies have found home visiting impacts on child development, school readiness, family economic self-sufficiency, maternal health, reductions in child maltreatment, child health, positive parenting practices, juvenile delinquency, family violence, and crime.[1] While effects have varied across studies, overall the research indicates that home visiting has had modest benefits for families on average. [2],[3] However, there are still significant gaps in our understanding — and still more to learn if we want to keep improving the effectiveness and efficiency of services.

For instance, evaluations of home visiting prior to 2015 rarely collected detailed information on the services provided to families, resulting in a lack of information on what services are actually delivered and how. This lack of implementation information makes it difficult to know whether impacts on particular outcomes of interest are associated with implementation or features of the home visiting model. [4] Most studies also tend to evaluate single models, so little is known about aspects of home visiting that may be important across models. Most studies have generally included relatively small samples, making it difficult to examine impacts for subgroups of families or examine differences between local programs. [5] Finally, there are also gaps in our understanding of the home visiting workforce and the infrastructure needed to support effective home visiting programs and services.[6]

[1] Administration for Children and Families, U.S. Department of Health and Human Services. (n.d.). Home Visiting Evidence of Effectiveness Review (HomVEE). https://homvee.acf.hhs.gov/outcomes

[2] Michalopoulos, C., Faucetta, K., Hill, C. J., Portilla, X. A., Burrell, L., Lee, H., Duggan, A., & Knox, V. (2019). Impacts on Family Outcomes of Evidence-Based Early Childhood Home Visiting: Results from the Mother and Infant Home Visiting Program Evaluation (OPRE Report #2019-07). Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. /opre/resource/impacts-family-outcomes-evidence-based-early-childhood-home-visiting-results-mother-infant-home-visiting-program-evaluation   

[3] Filene, J. H., Kaminski, J. W., Valle, L. A., & Cachat, P. (2013). Components Associated with Home Visiting Program Outcomes: A Meta-Analysis. Pediatrics, 132(2), S100-S109. https://doi.org/10.1542/peds.2013-1021H

[4] Duggan, A., Portilla, X. A., Filene, J. H., Crowne, S. S., Hill, C. J., Lee, H., & Knox, V. (2018). Implementation of Evidence-Based Early Childhood Home Visiting: Results from the Mother and Infant Home Visiting Program Evaluation (OPRE Report #2018-76A). Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. /opre/resource/implementation-evidence-based-early-childhood-home-visiting-results-mother-infant-home-visiting-program-evaluation

[5] Michalopoulos, C., Faucetta, K., Hill, C. J., Portilla, X. A., Burrell, L., Lee, H., Duggan, A., & Knox, V. (2019). Impacts on Family Outcomes of Evidence-Based Early Childhood Home Visiting: Results from the Mother and Infant Home Visiting Program Evaluation (OPRE Report #2019-07). Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. /opre/resource/impacts-family-outcomes-evidence-based-early-childhood-home-visiting-results-mother-infant-home-visiting-program-evaluation   

[6] Sandstrom, H., Benatar, S., Peters, R., Genua, D., Coffey, A., Lou, C., Adelstein, S., & Greenberg E. (2020). Home Visiting Career Trajectories: Final Report (OPRE Report #2020-11). Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. /opre/resource/home-visiting-career-trajectories

In setting home visiting research and evaluation priorities, ACF takes into account legislative requirements and Congressional interests; the interest and needs of ACF, HRSA, HHS, and Administration leadership; program office staff and leadership; ACF partners; the populations served; researchers; and other stakeholders. ACF routinely interacts with these stakeholders through a variety of engagement activities. These activities inform our ongoing research and evaluation planning processes.

Who

• Federal partners in HHS and other agencies, such as the Health Resources and Services Administration (HRSA), the Centers for Medicare and Medicaid Services (CMS), and the National Institutes of Health (NIH)
• State, territory, tribal, local, and non-profit home visiting administrators and staff
• Home visiting training and technical assistance providers
• Home visiting model developers
• Researchers and policy experts
• National organizations, such as the National Alliance of Home Visiting Models, the Association of State and Tribal Home Visiting Initiatives, the Home Visiting Applied Research Collaborative, and the Home Visiting Network Advisory Committee
• Partners in other health and human services programs, such as early care and education, child development, health care, child welfare, family self-sufficiency, family violence prevention, mental health, and substance use prevention and treatment

How

• Conferences and meetings, such as the National Home Visiting Summit, the National Alliance of Home Visiting Models meetings, the Home Visiting Network Advisory Committee meetings, the Home Visiting Applied Research Collaborative Annual Meeting, and other national conferences for early childhood policy and practice
• MIECHV All Grantee Meeting
• Engagement with home visiting training and technical assistance networks
• Surveys, focus groups, interviews, and other activities conducted as part of research and evaluation studies
• Structured mechanisms for broad stakeholder engagement, such as requests for comment through the Federal Register and the Secretary’s Advisory Committee on the Maternal, Infant, and Early Childhood Home Visiting Program Evaluation

1. Who is participating in MIECHV-funded programs and how are they faring?
2. How are MIECHV-funded home visiting programs being implemented, and what can be done to improve implementation?
3. Does MIECHV help participants (i.e., are participants better off than nonparticipants) overall and are there differences in impacts for subgroups?
4. What is the relationship between program implementation and child and family outcomes?
5. What is the evidence of effectiveness for home visiting models?
6. How can MIECHV support capacity building in the home visiting field around research and evidence? 

• Approaches to Father Engagement and Fathers’ Experiences in Home Visiting Programs (Fathers in Home Visiting): described (1) approaches that home visiting programs use to engage fathers, (2) challenges staff face in doing this work and strategies they use to overcome these challenges, and (3) benefits of fathers’ participation in home visiting from both the perspective of the fathers and the program staff. (#2)
• Assessment and Mapping of Community Connections in Home Visiting (AMC-HV): designed a prototype for a tool to enhance home visiting stakeholders’ understanding of the relationships between home visiting programs and other community service providers, such as those offering mental health services, child care, substance use services, etc. (#2)
• Family-Level Assessment and State of Home Visiting (FLASH-V): is examining how families are selected to receive home visiting services in MIECHV-funded home visiting programs, and how programs at capacity decide to whom to offer available openings. (#1) (#2)
• Home Visiting Career Trajectories (HVCT): describes the early childhood home visiting workforce, jobs, and career pathways, including how programs recruit and retain staff and the opportunities and challenges that exist for professional development and training of home visiting program staff. (#1) (#2)
• Home Visiting Evidence of Effectiveness (HomVEE) Review : is a transparent, systematic review of the evidence of effectiveness of home visiting program models serving pregnant women and young children birth to age 5. (#2) (#5)
• Human Services Programs in Rural Contexts (HSPRC): is identifying opportunities for strengthening the capacity of human services programs to promote the economic and social well-being of individuals, families, and communities in rural contexts. It includes all human services programs within HHS, with a particular focus on Healthy Marriage and Responsible Fatherhood (HMRF), Temporary Assistance for Needy Families (TANF), Health Professions Opportunity Grants (HPOG), and MIECHV programs. (#1) (#2)
• The Mother and Infant Home Visiting Program Evaluation (MIHOPE): is the legislatively mandated evaluation of MIECHV. MIHOPE examined the implementation of MIECHV-funded programs and is examining effects of MIECHV-funded programs on a wide array of child and family outcomes (including maternal health, family economic self-sufficiency, parenting, child maltreatment, child health, and child development) at multiple points in time. (#1) (#2) (#3) (#4)
• The Multi-Site Implementation Evaluation of Tribal MIECHV (MUSE): is a mixed-methods, multi-site evaluation that is building the knowledge base regarding implementation of home visiting in tribal communities by exploring how program planning and implementation relate to quality of services and near-term outcomes. (#1) (#2)
• Touchpoints for Addressing Substance Abuse in Home Visiting (Touchpoints): is examining how home visiting programs engage and support families around prevention, treatment, and recovery from substance use issues. (#2) (#5)
• Tribal Early Childhood Research Center (TRC): Through partnerships with Tribal MIECHV, Head Start, Early Head Start, and child care practitioners and researchers, the TRC works to advance research into young children’s development and early childhood programs and to facilitate the translation of research findings to inform early childhood practice with American Indian and Alaska Native children and families. (#6)
• Tribal Home Visiting Evaluation Institute (TEI): provides technical assistance to promote rigorous and relevant performance measurement, data management, continuous quality improvement (CQI), and evaluation activities in the Tribal MIECHV Program. (#6)

The broad questions listed above will continue to drive much of ACF’s research and evaluation activity in this area. Future activities will also be informed by emerging findings from ongoing research and evaluation activities, other learning activities, and continued engagement with home visiting stakeholders.

Examples of activities planned for the next few years include:

• Completing Kindergarten follow-up data collection (surveys, administrative data, and direct assessments of children and families) with children and families participating in MIHOPE
• Conducting surveys and interviews to (1) learn about the impact of COVID-19 on families residing in communities that are at risk and are typically served by MIECHV, (2) inform ACF’s and HRSA’s continued response during the pandemic to the needs of the populations they serve, and (3) provide context for analyses of the MIHOPE Kindergarten follow-up data
• Developing conceptual models and reviewing current research, measures, and practice in (1) professional well-being and (2) reflective supervision to advance understanding of how to support and strengthen the early childhood home visiting workforce
• Conducting additional analyses of quantitative survey data on topics related to the home visiting workforce, such as training needs, indicators of professional well-being, program management practices, and caseload size