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Home Visiting Programs

 CONTENTS

(links to source documents are in the postings below)

1. Effectiveness of Home Visiting Programs - HomVEE
2. Home Visiting Implementation Guidelines - HomVEE
3. Child Well-Being Home Visiting Programs - California Evidence-Based Clearinghouse

4. MIHOPE - Impacts on Family Outcomes of Evidence-Based Early Childhood Home Visiting

5. MIECHV Program: Summary of Benchmark Measures Selected by Grantees

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Home Visiting Evidence of Effectiveness (HomVEE)
Primary Outcome Measures - March 2018

The Patient Protection and Affordable Care Act, signed into law in 2010, established a new program designed to improve outcomes for at-risk pregnant women and mothers and children from birth through age 5: the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV). MIECHV offers funding to states and territories to provide home visiting services.

The HomVEE review only includes program models that use home visiting as the primary mode of service delivery and aim to improve outcomes in at least one of the eight domains specified in the legislation. These domains are

(1) maternal health;

(2) child health;

(3) positive parenting practices;

(4) child development and school readiness;

(5) reductions in child maltreatment;

(6) family economic self-sufficiency;

(7) linkages and referrals to community resources and supports; and

(8) reductions in juvenile delinquency, family violence, and crime.

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Implementation Guidelines for Home Visiting Models Included in the HomVEE Review
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This table provides an overview of the implementation guidelines for the home visiting models included in the HomVEE review. Here are the field descriptions: 

  • In existence for 3 years?

Model operated for at least 3 years; model does not have to be operating when reviewed by HomVEE.

  • Associated with national organization or institution of higher education?

National organization or institution of higher education includes non-U.S. based institutions.

  • Minimum requirements for frequency of visits?

Model is considered to have minimum requirements for frequency of visits if developer provides guidance about minimum number of visits required or recommended.

  • Minimum education requirements for home visitors?

Model is considered to have minimum education requirements for home visitors if model specifies that the home visitors must have at least a high school degree or GED or higher.

  • Supervision requirements for home visitors?

Model is considered to have minimum supervision requirements for home visitors if model requires that home visitors participate in supervision. Model does not need to specify the mode of supervision (such as group or individual meetings) or the frequency of supervision to meet this requirement.

  • Pre-service training for home visitors?

A model is considered to require pre-service training for home visitors if home visitors are required to complete any training requirements prior to initiating home visiting. Model does not have to offer training, certified trainers, or training materials to meet this requirement.

  • Fidelity standards for local implementing agencies (IAs)?

Model is considered to have fidelity standards for IAs if the model specifies any standards IAs must meet on an ongoing basis.

  • System for monitoring fidelity?

Model is considered to have a system for monitoring fidelity if includes a formal or informal process by which the model developer monitors fidelity or guidance for IAs about how to monitor fidelity (including a self-assessment process).

  • Specified content and activities for home visits?

Model is considered to have specified content and activities for home visits if the model requires IAs follow a specific curriculum or has a specified protocol outlining the topics that home visitors should cover either by visit or by developmental milestones. If IAs can select a curriculum or design their own content, the answer is No.

California Evidence-Based Clearinghouse for
Child Well-Being -- Home Visiting Programs
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RB5-RB8 created the above chart to summarize California's assessment of home visiting programs. The source document can be found here.     

 

  • Blank Cells - the program was not rated under the topic area                                                                                                

  • Red:  1 - 2 or more Random Controlled Trails (RCTs) with positive outcomes (Rating 1)

  • Green: 1 RCT with positive outcomes (Rating 2)

  • Peach: No RCTs but has acceptable alternative research designs, with positive outcomes (Rating 3)

  • Grey: Any number of RCTs but they indicate no effect (Rating 4)

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MIHOPE - Impacts on Family Outcomes of

Evidence-Based Early Childhood Home Visiting

 

 

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.

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.

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.

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:

  • 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

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.

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.

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. 

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. 

MIHOPE Final Report January 2019.PNG
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(MIECHV) Program: Summary of Benchmark Measures Selected by Grantees

An overview of 56 approved Home Visiting benchmark plans. Constructs with the highest degree of alignment across grantees include:

Maternal Depressive Symptoms: About 86% of grantees are using the Edinburg Postnatal Depression Scale (EPDS) to measure maternal depressive symptoms. Although there is alignment in use of the tool, there is diversity among grantees in the population being assessed: over half (57%, n=32) of the performance measures focus on mothers during the postpartum period while a significant number (34%, n=19) focus on all mothers, including those that are pregnant and those with infants or young children.

Well-Child Visits: The overwhelming majority of grantees are focusing on adherence to a recommended well-child visit schedule (98%, n=55), with American Academy of Pediatrics (AAP)/Bright Futures being the most common adherence schedule selected (25%, n=14).

Child and Mother Visits to Emergency Department: All grantees are using an outcome measure to capture visits to the emergency department, with most (91%, n=51) relying on parent self-report of visits.

Information/Training on Prevention of Child Injuries: All grantees are using a process measure to capture information and training on the prevention of child injuries, with most (96%, n=54) focusing on the provision of information about child injuries.

Child Injuries: All grantees are using an outcome measure for child injuries. Most grantees are relying on parent self-report (91%, n=51) of injuries.

Reported, Substantiated, and First-Time Victim of Child Maltreatment: All grantees are using an outcome measure for reported, substantiated, and first time victim of child maltreatment. Most grantees are using administrative data to assess these constructs (89%, 96%, and 96% respectively).

Child Communication, Language, and Emergent Literacy: All 56 grantees are using the Ages and Stages Questionnaire-3 (ASQ-3) to screen for developmental concerns related to child communication.

Child Cognitive Skills: All 56 grantees are using the ASQ-3 to screen for delays related to child cognitive skills.

Arrests and Convictions: Grantees have the option of choosing either the crime constructs (arrests and convictions) or the domestic violence constructs (screenings, referrals and safety plans). The two grantees that selected the crime constructs proposed an outcome measure.

Screening for Domestic Violence: All grantees examining domestic violence (n=54) are relying on process measures to capture screening for domestic violence, referrals for domestic violence services, and completion of a safety plan.

Number of Memoranda of Understanding (MOU) to Increase Coordination of Resources and Referrals:

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