MIHOPE - Impacts on Family Outcomes of

Evidence-Based Early Childhood Home Visiting

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In 2010, Congress authorized the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, which started a major expansion of evidence-based home visiting programs for families living in at-risk communities. MIECHV 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 authorizing legislation required an evaluation of the program, which became the Mother and Infant Home Visiting Program Evaluation (MIHOPE), conducted for HHS by MDRC with James Bell Associates, Johns Hopkins University, Mathematica Policy Research, the University of Georgia, and Columbia University.

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MIHOPE was designed to learn whether families benefit from MIECHV-funded early childhood home visiting programs, and if so, how. The study includes the four evidence- based models that 10 or more states chose in their initial MIECHV plans in fiscal year 2010-2011:

• Early Head Start — Home-based option,

• Healthy Families America,

• Nurse- Family Partnership, and

• Parents as Teachers.

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MIHOPE is the first study to include these four evidence-based models. To provide rigorous evidence on the MIECHV-funded programs’ effects, the study randomly assigned about 4,200 families to receive either MIECHV-funded home visiting or information on community services.

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The overarching goal of MIHOPE is to learn whether families and children benefit from MIECHV-funded early childhood home visiting programs as they operated from 2012 through 2017, and if so, how. The study is examining a broad range of outcome areas mentioned in the authorizing legislation:

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• Prenatal, maternal, and newborn health

• Child health and development, including child maltreatment

• Parenting skills

• School readiness and child academic achievement

• Crime and domestic violence

• Family economic self-sufficiency

• Referrals and service coordination​

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There are positive effects for families in MIHOPE. Most estimated effects are similar to but somewhat smaller than the average found in past studies of individual home visiting models. Estimated effects are statistically significant for 4 of the 12 confirmatory outcomes: the quality of the home environment, the frequency of psychological aggression toward the child, the number of Medicaid-paid child emergency department visits, and child behavior problems. Overall, for 9 of the 12 confirmatory outcomes, program group families fared better than control group families on average, which is unlikely to have occurred for the study sample if the home visiting programs made no true difference in family outcomes.

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However, no outcome or outcome area stands out as having consistently large effects. In addition, the effects are generally smaller than those found in past studies, although it is important to note that MIHOPE differs from those studies in many respects. For example, most of those studies were conducted in a single local area rather than including sites across the country, and some were conducted many years ago, when similar services were less likely to be available to control group families. In addition, previous studies each examined only one evidence-based model, and might have chosen outcomes where those models were expected to make the largest differences.

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The home visiting programs included in MIHOPE did not have a significant effect on children’s receptive language skills.  At 15 months, children’s ability to produce language is just beginning to develop.  It continues to develop rapidly over the course of the second year of life.  Therefore, MIHOPE assessed only receptive language skills for this early follow-up period.  Receptive language skills include children’s ability to be attentive and respond to stimuli in the environment and to comprehend basic vocabulary or gestures. 

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Children’s average receptive language skills standard scores were about 96 for both the program and control group, which represents a percentile rank of 39.  (That percentile rank means that the average child in MIHOPE performs as well as or better than 39% of the children of the same age in the overall population.)  As mentioned above, children’s early language development has been linked to later cognitive and language outcomes, and to school readiness and later achievement.  But none of the previous studies of home visiting examined effects solely on receptive language skills, so it is difficult to place this finding into the larger literature.  One relevant piece of evidence is that one study of Early Head Start found a statistically significant impact on vocabulary at 12 months of age.