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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Breastfeeding.

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Strategy. Early Childhood Home Visiting Programs

Approach. Create a home visiting program for expecting and new parents

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Overview. In early childhood home visiting programs, trained personnel regularly visit expectant parents and families with young children experiencing health disparities and barriers to healthcare access and provide them with information, support, and/or training regarding child health, development, and care based on families' needs. Home visitors can be nurses, social workers, parent educators, paraprofessionals, lay workers from within the community, or others. Home visiting often begins prenatally and continues during the child's first two years of life, but may also begin after birth, last only a few months, or extend until kindergarten.[1,2]

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective. These strategies have been tested in multiple robust studies in a variety of populations and settings with consistently positive results, both on their own and in combination with other strategies. (Clarifying Note: The WWFH database calls this "scientifically supported evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).
  • Environmental Health. This strategy improves the impact of physical, chemical, and biological factors in the environment on health.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Community Organizing (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of at-risk families recruited and enrolled in the home visiting program. (Measures reach and scale of the program's engagement efforts.)
  • Number of home visits completed by program staff. (Quantifies the volume and intensity of the core program service delivered.)
  • Number of community referral partners actively sending families to the home visiting program. (Tracks the breadth of outreach and collaboration with other agencies.)

OUTCOME MEASURES:

  • Number of participating families who receive the intended dosage of visits based on program model. (Assesses fidelity to the program's service delivery standards.)
  • Number of home visits where breastfeeding education and support is provided. (Measures the frequency of integrating breastfeeding content into visits.)
  • Number of families referred to and connected with additional community resources by home visitors. (Captures the program's role in facilitating access to wraparound supports.)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of home visitors who complete core training and demonstrate proficiency in required skills. (Assesses workforce development and quality assurance efforts.)
  • Percent of home visiting content and materials that are evidence-based and aligned with professional guidelines. (Measures the use of scientifically-validated practices.)
  • Percent of home visits that include an observational assessment of parent-child interactions. (Tracks adherence to a key quality component of home visiting models.)

OUTCOME MEASURES:

  • Percent of participating parents who demonstrate improved parenting knowledge and skills. (Measures the program's impact on parental competencies.)
  • Percent of participating mothers who initiate breastfeeding and continue for at least 6 months. (Assesses the program's influence on breastfeeding practices.)
  • Percent of families who complete the full intended length of program participation. (Captures retention and family engagement in the program over time.)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of memoranda of understanding established between the home visiting program and healthcare providers. (Assesses formal care coordination and referral protocols.)
  • Number of participating families who create a family goal plan with their home visitor. (Measures use of a family-centered intervention planning process.)
  • Number of group socializations and parent education events held in addition to individual home visits. (Tracks supplemental group-based enrichment and peer support activities.)

OUTCOME MEASURES:

  • Number of participating children receiving recommended developmental screenings and immunizations. (Captures the program's impact on preventive child health services.)
  • Number of participating mothers screened for postpartum depression and referred for treatment as needed. (Assesses behavioral health promotion and early intervention.)
  • Number of families who show improvement on measures of economic self-sufficiency (e.g., employment, education). (Measures the program's two-generation impact.)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • - Percent of participating families who reflect the racial, ethnic, and linguistic diversity of the focus population. (Assesses cultural responsiveness and equitable access.)
  • - Percent of home visitors who receive ongoing reflective supervision and professional development. (Measures investment in workforce support and retention.)
  • - Percent of program continuous quality improvement efforts that directly involve parents and community partners. (Tracks authentic engagement in program design and evaluation.)

OUTCOME MEASURES:

  • - Percent reduction in child maltreatment rates among home visiting participants, compared to local averages. (Captures impact on a key child safety metric.)
  • - Percent of high-need geographic areas in the community that are reached by the home visiting program. (Assesses saturation and targeting of services based on risk factors.)
  • - Percent of participating children assessed as kindergarten-ready, compared to overall school district rates. (Measures long-term impact on school readiness and early learning.)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Health Resources and Services Administration (HRSA). The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program: Partnering with parents to help children succeed. MIECHV program national program brief 2017.

2 Sama-Miller E, Akers L, Mraz-Esposito A, et al. Home visiting evidence of effectiveness review: Executive summary. Washington, DC: Office of Planning, Research and Evaluation (OPRE), Administration for Children and Families (ACF), US Department of Health and Human Services (US DHHS); 2017.

3 Yonemoto N, Dowswell T, Nagai S, Mori R. Schedules for home visits in the early postpartum period. Cochrane Database of Systematic Reviews. 2017;(7):CD009326.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.