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- What are the effects of MIECHV-funded early childhood home visiting programs across a wide array of domains (maternal health, family economic self-sufficiency, parenting, child maltreatment, child health, and child development)?
- Are the effects of home visiting larger among some types of families than others?
- How do the effects of home visiting programs vary with the features of local home visiting programs and the services families receive?
Children develop fastest in their earliest years, and the skills and abilities they develop in those years lay the foundation for their future success. Similarly, early negative experiences can contribute to poor social, emotional, cognitive, behavioral, and health outcomes both in early childhood and in later life. One approach that has helped parents and their young children is home visiting, which provides individually tailored support, resources, and information to expectant parents and families with young children. Many early childhood home visiting programs aim to support the healthy development of infants and toddlers and work with low-income families, in particular, to help ensure their well-being.
In 2010, Congress authorized the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program by enacting section 511 of the Social Security Act, 42 U.S.C. § 711, which also appropriated funding for fiscal years 2010 through 2014. Subsequently enacted laws extended funding for the program through fiscal year 2022. The program is administered by the Health Resources and Services Administration in collaboration with the Administration for Children and Families within the U.S. Department of Health and Human Services (HHS). The legislation also required an evaluation of the program in its early years, which became the Mother and Infant Home Visiting Program Evaluation (MIHOPE). The evaluation, which is studying the effects of evidence-based home visiting, is being conducted for HHS by MDRC in partnership with James Bell Associates, Johns Hopkins University, Mathematica Policy Research, the University of Georgia, and Columbia University.
Key Findings and Highlights
- There are positive effects of home visiting programs that participated in MIHOPE, and they are generally similar to but somewhat smaller than the average effects found in past studies. Of 12 outcomes the study focused on, 4 had estimated effects that are statistically significant. No outcome area stands out as one where home visiting programs had large effects.
- Differences in effects among the evidence-based home visiting models are generally consistent with the models’ focuses. For example, Parents as Teachers produced the largest increase in parental supportiveness and Nurse-Family Partnership produced the largest reduction in emergency department visits for children, although the differences are sensitive to the statistical methods used.
- Effects on family outcomes do not vary much by family characteristics, suggesting that home visiting is not having larger effects for different types of families. The effects may vary in ways that were not examined in this report.
- Effects were generally consistent across local programs. In addition, differences in the way programs were implemented were not associated with differences in effects, and families who received more home visits did not benefit more than other families. In short, local programs were equally effective across different settings and with different implementation features.
MIHOPE is focused on the four evidence-based models that 10 or more states chose in their fiscal year 2010 plans for MIECHV funding: Early Head Start — Home-based option (EHS), Healthy Families America (HFA), Nurse-Family Partnership (NFP), and Parents as Teachers (PAT). It includes 88 local home visiting programs in 12 states. More than 4,200 women who were pregnant or had children less than six months old were randomly assigned to a MIECHV-funded home visiting program or to a control group that was provided with information on services in the community.
Information was collected consistently across evidence-based models. Information on program implementation comes from surveys administered to mothers when they entered the study; information provided by home visitors and supervisors on the services they provided to families; surveys of home visitors, supervisors, and local program managers; and interviews with evidence-based model developers and state MIECHV administrators. For the analysis of program effects, information comes from surveys conducted with mothers when they entered the study and around the time their children were 15 months old. The study also draws on observations of mothers and children playing with toys (the Three Bags and Clean-Up tasks), observations of the home environment, direct assessments of children’s receptive language skills, state Medicaid and administrative child welfare data, and employment and earnings data from the National Directory of New Hires.
Michalopoulos, Charles, Kristen Faucetta, Carolyn J. Hill, Ximena A. Portilla, Lori Burrell, Helen Lee, Anne Duggan, and Virginia Knox. 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.
- Early Head Start – Home-based option
- Healthy Families America
- Nurse Family Partnership
- Parents as Teachers
- Maternal, Infant, and Early Childhood Home Visiting program