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Assessing the Research on Home Visiting Program Models Implemented in Tribal Communities

September 29, 2017
Home Visiting
Assessing the Evidence: Home Visiting Evidence of Effectiveness, 2011-2020 | Learn more about this project
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  • Pages 116
  • Published 2017


A portion of the federal funds that support home visiting for mothers and young children are designated specifically for supporting home visiting in tribal communities. Therefore, policymakers and program administrators need to know what research has learned about home visiting in these communities. This series of reports compiles and summarizes the findings of that research.

The Home Visiting Evidence of Effectiveness (HomVEE) project is a systematic review of home visiting research (detailed information and results are available at To assess the evidence of effectiveness of culturally relevant models that have been implemented in tribal communities, HomVEE conducted a systematic review focusing specifically on studies relevant to tribal communities.

The evidence base on home visiting in tribal communities is fairly small. The HomVEE tribal review has identified 49 effectiveness studies of home visiting program models either used in tribal communities or that included a sizable share (10 percent or more) of American Indian and Alaska Native (AIAN) families. Forty-one percent of these used a sufficiently rigorous study design to provide unbiased estimates of program impacts. (The more rigorous the design, the more likely it is that a study’s impacts were caused by the program model itself, rather than by other factors.) Only six of them specifically examined the effect of a program model with tribal populations (meaning the studies included samples made up entirely of AIAN participants or reported findings by tribal community affiliation).

Part 2 of the report in the Related Documents section of this page focuses on “Lessons Learned about Implementation and Evaluation”.

Research Questions

  1. 1 What research is available on home visiting in tribal communities, and what does it say about how home visiting is implemented in tribal communities and how it affects them?
  2. 2 What lessons about program development, implementation, and adaptation in tribal communities can be drawn from this body of research?
  3. 3 What next steps does this research suggest for program developers and researchers working on home visiting in tribal communities?


The legislation authorizing the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program (Social Security Act, Title V, § 511 (42 U.S.C. § 711)) sets aside 3 percent of the total appropriation (authorized in § 511(j)) for grants to federally recognized tribes (or a consortia of tribes), tribal organizations, or urban Indian organizations. The legislation requires the tribal grants, to the greatest extent practicable, to be consistent with the requirements of the MIECHV Program grants to states and territories (authorized in § 511(c)). The Tribal MIECHV Program aims to support the development of AIAN children and families through the implementation of high quality, culturally relevant home visiting programs using models that have demonstrated evidence of effectiveness.

The Office of Planning, Research and Evaluation at the Administration for Children and Families, U.S. Department of Health and Human Services (HHS) contracts with Mathematica Policy Research to conduct the HomVEE project. HomVEE conducted its initial systematic review focusing specifically on studies relevant to tribal communities in fall 2010. As the research literature on home visiting program models studied with tribal populations grows, HomVEE updates the review.

Key Findings and Highlights

The effectiveness studies and implementation research included in the HomVEE tribal review offer important lessons about program development, adaptation, and implementation that could be useful to the Tribal MIECHV Program awardees or other tribal organizations interested in implementing home visiting program models. Such lessons include the following:

  • Collaborate with tribal communities from the onset, beginning in the pre-implementation phases and continuing throughout service delivery;
  • Recruit culturally sensitive staff;
  • Use data to inform quality improvement;
  • Remain flexible; and
  • Align program with participant needs.

Based on issues identified in the studies reviewed, HomVEE offers the following considerations to support the development and replication of home visiting programs for tribal communities:

  • Model developers should provide detailed information about model specifications and minimum requirements, and create fidelity standards for core model elements;
  • Researchers should examine the challenges of implementation and whether and how they can be met; and
  • Programs should provide detailed information about how they adapt national home visiting models, including how they engage with home visiting model developers to design, implement, and evaluate adaptations.

To help overcome the obstacles to conducting research in tribal communities identified in the studies reviewed, HomVEE suggests that evaluators consider doing the following:

  • Use a utilization-focused participatory evaluation approach;
  • Evaluate promising program models using rigorous research methods;
  • Use more focused, culturally relevant, valid, and reliable measures; and
  • Apply lessons from the general HomVEE review, such as adjusting for multiple comparisons to reduce the risk of identifying statistically significant findings by chance.


The HomVEE tribal review involved the following steps:

  1. Conducting a broad literature search on home visiting program models either used in tribal communities or that include a sizable share (10 percent or more) of AIAN families;
  2. Screening the studies for relevance;
  3. Rating the effectiveness studies as high, moderate, or low based on their ability to produce unbiased estimates of a program model’s effects;
  4. Examining the impacts in high- and moderate-rated studies on AIAN populations and identifying program models that meet the HHS criteria for “an evidence-based early childhood home visiting service delivery model” in AIAN populations; and
  5. Gathering information about home visiting program model implementation, such as target outcomes and staff training and qualifications, from all studies eligible for the review of home visiting in tribal populations.


Mraz Esposito, A., Coughlin, R., Malick, S., Sama-Miller, E., Del Grosso, P., Kleinman, R., & Paulsell, D. (2017). Assessing the research on home visiting program models implemented in tribal communities—Part 1: Evidence of effectiveness. Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Last Reviewed: April 29, 2019