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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Risk-Appropriate Perinatal Care.

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Strategy. Home Visiting Program/Healthy Families America

Approach. Establish a family home visiting program beginning in the prenatal period

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Overview. A home visiting model - HFA services begin prenatally for right after birth. Family support workers provide voluntary, intensive services for 3 to 5 years. (HFA).

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some 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):

  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
  • Safety of Care. This study promotes avoidance of preventable harm to patients during healthcare delivery.
  • Mortality Prevention. This strategy addresses factors that are associated with preventing death, particularly premature death from preventable causes.

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 pregnant women and families facing increased risks enrolled in the HFA home visiting program. (Measures program reach and alignment with focus population)
  • Number of home visits conducted by family support workers during the prenatal period. (Assesses service delivery and early intervention)

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

PROCESS MEASURES:

  • Percent of home visits that followed the HFA model's recommended frequency and duration based on each family's individual needs. (Evaluates fidelity to evidence-based model)
  • Percent of family support workers who completed required HFA training and demonstrated competency in core skills. (Assesses workforce development and quality assurance)

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

PROCESS MEASURES:

  • Number of community partnerships established to support the engagement, referral, and comprehensive service needs of HFA families. (Shows integration efforts and collaborative networks)
  • Number of quality improvement projects implemented to enhance the performance of the HFA program. (Evaluates continuous improvement efforts and linkages with broader health goals)

OUTCOME MEASURES:

  • Number of participating families experiencing full-term, healthy birth outcomes. (Measures clinical impact on perinatal health)
  • Number of families who completed the full 3 to 5 year program and achieved their self-identified goals. (Assesses long-term program impact and family outcomes)

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

PROCESS MEASURES:

  • Percent of eligible families from various communities enrolled in the HFA program. (Evaluates access and strategic deployment of resources)
  • Percent of family support workers who represent the key characteristics of the communities served. (Assesses competence and representation)

OUTCOME MEASURES:

  • Percent reduction in gaps for prenatal care access and birth outcomes between HFA participants and non-participants from similar backgrounds. (Measures health impact)
  • Percent reduction in rates of adverse childhood experiences among children in HFA families compared to community-level rates. (Assesses community-level impact)

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 HFA - Healthy Families America (HFA). Great childhoods begin at home.

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.