Moving Home Visiting Forward: Lessons and Directions from Pennsylvania’s MIECHV Evaluation

For the last five years, PolicyLab has collaborated with Pennsylvania’s Office of Child Development and Early Learning to evaluate the Commonwealth’s home visiting system. Our partnership on this large-scale evaluation is the result of strong congressional desire to understand how the expansion of evidence-based home visiting services through the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program is impacting the lives of families across the country. As our team nears the end of the evaluation, we would like to share what we have learned and where we are going next.

What is home visiting?

Maternal and child home visitation programs concentrate on improving health outcomes for children during their crucial early childhood development. The programs connect families in need of support with trained professionals for home visits on a regular basis prenatally and for up to two years following a new birth. The programs—which have several different implementation models—provide prenatal and postpartum support and cover topics like how to have a healthy pregnancy, child health and development and economic self-sufficiency. Home visitors identify and address physical, social and mental health needs of both the child and caregivers. Though the programs have federal support, local implementing agencies—such as county health departments, nursing associations, community-based organizations and health system—operate them in communities.

What did we learn?

After five years compiling over a decade’s worth of birth certificates and other administrative data and traversing the state to hear from more than 150 stakeholders, we have learned a lot from our rigorous evaluation of how the home visiting program expansion has worked for Pennsylvania families. Here’s what we know:

  • Families are highly satisfied with the services they receive through home visiting programs. Clients reported developing close relationships with their home visitors who support them emotionally throughout their first pregnancies, child birth and their baby’s critical early years. Families rely on their home visitors to provide high-quality health information and serve as an accurate resource for pregnancy and parenting questions and connections to community resources.
  • Families feel participation in home visiting programs helps socially and mentally prepare their children for school. Having a long-term relationship with a regular home visitor helps guide parents on key development milestones and educational activities, as well as help introduce children to adults outside of the family to prepare them for pre-k and beyond.
  • Families living in rural areas particularly value how the program enables social connectedness and ameliorates feelings of isolation. Rural families especially appreciate programs that offer parent-to-parent gathering places and family nights.

What were the biggest successes of program expansion?

  • Additional MIECHV funding has resulted in innovative program implementation and adaptation. For example, some home visiting sites co-located multiple home visiting models to strategically benefit the organization and families within the community. Co-locating with a health care entity also improved clients’ rates of prenatal and well-child visits.
  • When compared to Medicaid-eligible children across the state, children of home visiting clients were more likely to be diagnosed with a special health care need, perhaps suggesting effective screening practices and successful engagement of high-needs families into services.
  • Relative to mothers residing in areas without home visiting programs, we found that mothers living in places with the greatest availability of services had a higher likelihood of quitting smoking, receiving adequate prenatal care and bringing their child for recommended well-child visits.

This work has also helped identify areas that need additional attention, defining the focus of our future efforts working collaboratively with the Commonwealth:

  • We found that, across all models, children of mothers engaged in home visiting programs were more likely to visit the emergency department or receive inpatient care for abuse or injury. Though this is concerning, it is important to note that 1) the majority of injuries to home visited children were minor—bruises, abrasions and lacerations—and 2) while children of home-visited families were at greater risk of experiencing abuse, this does not suggest home visiting causes abuse. Instead, these finding reflect the difficulty many service professions and programs have faced in having an impact reducing child abuse.
  • Interviews with staff and families highlighted multiple factors potentially impacting programs’ abilities to prevent child injury and abuse. For example, we learned that injuries often happen when children are under the care of others, including male caregivers and grandparents. Since moms are the primary target of services, there is a real opportunity here for enhanced home visiting curricula to include an assessment of the quality of a family’s child care options and engage other primary caregivers in services.

Program evaluation, continuous quality improvement efforts and curriculum adaptations are vital to shaping service delivery as we strive to better serve families. MIECHV represents an incredibly innovative funding mechanism that has certainly succeeded in expanding services to families and deepening the literature on home visiting. It is moving the field forward, allowing us to highlight areas of success and identify where we can do better meeting families where they are and improving their health and well-being.

To learn more about PolicyLab’s evaluation and next steps the Commonwealth is taking based on our findings, we invite you to watch a webinar we recently conducted together. And if you’re interested in learning more about home visiting or seeing if a program funded by the Office of Child Development and Early Learning is available in your county, please visit: http://www.pa-home-visiting.org/pafamilysupport/.