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- What services did families receive in home visiting programs?
- How are characteristics of families, home visitors, local programs, other home visiting stakeholders (such as the federal MIECHV program and evidence-based models) and communities associated with differences in the services that families received?
Children develop fastest in their earliest years, and the skills and abilities they develop in those years help 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. Children growing up in poverty tend to be at greater risk of encountering adverse experiences that negatively affect their development. One service strategy that has improved these outcomes is early childhood home visiting, which provides information, resources, and support to expectant parents and families with young children, typically infants and toddlers, in their home environments.
A substantial literature has provided evidence of home visiting impacts on family functioning, parenting, and child outcomes. However, there are many gaps in knowledge about home visiting programs, including a lack of information on program implementation. Evaluations of home visiting have rarely collected detailed information on the services provided to families, so it is difficult to know whether impacts on particular outcomes of interest are associated with implementation or features of the home visiting model.
With that in mind, this implementation research report describes the local programs, home visiting staff, and families who participated in the Mother and Infant Home Visiting Program Evaluation (MIHOPE), a national evaluation of the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program launched in 2011. This national evaluation is systematically examining how program features and implementation systems are associated with services delivered and impacts across four of the home visiting models designated as evidence-based by the U.S. Department of Health and Human Services: Early Head Start – Home-based option, Healthy Families America, Nurse-Family Partnership, and Parents as Teachers.
The purpose of this research is to provide detailed information on the actual services provided to families and how those services vary depending on the characteristics of families, home visitors, local programs, other home visiting stakeholders, and communities. Further analyses that will be published in a subsequent report will build on this analysis to learn about how implementation features are associated with program impacts. Together, these publications will inform current and future efforts to strengthen home visiting services and their benefits for families.
Key Findings and Highlights
- The MIECHV-funded local programs served families in disadvantaged communities with high levels of risk. Mothers participating in MIHOPE tended to be young, economically disadvantaged, and exhibited a variety of risks that could affect their children’s development.
- Similar to prior research, families in MIHOPE participated in home visiting for eight months on average, which is less than expected by the four evidence-based models in the study. More disadvantaged families tended to participate for a shorter time than other families.
- Local programs focused on improving parenting and child development outcomes, areas historically emphasized by all four of the evidence-based models. A majority of visits discussed these topics. Home visitors attended more training and felt most well supported and effective in improving parenting and child development, compared with other areas.
- Services related to sensitive topics were tailored to family needs. Home visitors addressed sensitive topics, such as substance use, mental health, or intimate partner violence, more often with families who were more likely to need help in these areas, compared with other families. Home visitors who attended training on these topics addressed them more often with families.
MIHOPE was designed to study home visiting effectiveness in local programs as they operated under the auspices of the MIECHV program and includes 88 local programs that use one of four evidence-based home visiting models: Early Head Start – Home-based option, Healthy Families America, Nurse-Family Partnership, and Parents as Teachers.
Since it can be difficult to compare many outcomes across a broad range of children’s ages, MIHOPE included only families in which the mother was age 15 years or older and was pregnant or her focal child was less than 6 months old. The MIHOPE research team chose this age range for children because the majority of MIECHV-funded local programs aimed to enroll women during pregnancy or shortly after childbirth. To provide reliable estimates of the effects of home visiting programs, the MIHOPE team randomly assigned families who were interested in and eligible for a MIECHV-funded local program participating in MIHOPE, and who consented to be in the study, to either the MIECHV-funded local program or a control group that was referred to other appropriate services in the community. From October 2012 to October 2015, a total of 4,229 families entered the study. Over the course of MIHOPE, 11 families withdrew from the study for a final analytical sample of 4,218 families (2,104 in the program group; 2,114 in the control group).
For the implementation research analysis, the samples of interest are the 2,104 families randomly assigned to the MIHOPE program group and the staff at all 88 local programs. The entire period of implementation research data collection lasted from September 2012 to June 2016. Implementation research activities included family surveys and observations of families’ home and external environments at baseline, family service logs, observations of home visitor-family interactions, staff surveys, semi-structured qualitative interviews with home visitors, training logs, supervision logs, inventories of community services, surveys and interviews with evidence-based model developers, and reviews of local program and evidence-based model documents.
Duggan, Anne, Ximena A. Portilla, Jill H. Filene, Sarah Shea Crowne, Carolyn J. Hill, Helen Lee, and Virginia Knox (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.
- Continuous quality improvement
- Early Head Start – Home-based option
- General Educational Development certificate
- Healthy Families America
- Mother and Infant Home Visiting Program Evaluation
- The Maternal, Infant, and Early Childhood Home Visiting program
- Management information system
- Memorandum of understanding
- Nurse-Family Partnership
- Parents as Teachers