The Affordable Care Act (ACA) included a major federal investment in home visitation programs, which support new and expectant mothers by sending trained workers and/or health professionals into homes.
Experts told the House Ways and Means Subommittee on Human Resources last week that the investment should continue, with reasonable expectations.
The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program was created in the ACA, and guaranteed $1.5 billion in funds for home visitation programs between 2010 and 2014.
States and counties can use MIECHV funds mostly to support 14 approved forms of home visitation; a quarter of the funding is set aside to test “promising” new models. Certain models of home visiting, including the Nurse Family Partnership (NFP) and Child First, have demonstrated a positive impact on preventing emergency room visits and suspected child maltreatment.
The program will sunset without a reauthorization before next year.
“With the reauthorization of that program pending, it’s time to review whether it is really making that hoped-for difference,” said Ways and Means Chairman David Reichert, in his announcement of the hearing.
The investment has likely yielded significant social impact, but may be too inclusive of unproven programs and lacks evidence of cost savings, according to the testimony of representatives from two public policy organizations.
The Coalition for Evidence-Based Policy “strongly supports” the reauthorization of MIECHV, said President Jon Baron, who said the program differentiated itself from many federal programs by limiting spending to certain models that have been rigorously tested.
Baron also suggested that a the list of allowable models could be further pared to exclude those with evaluations showing “statistically significant” results but no “policy or practical importance.”
He named four models that lacked evidence of strong results: Healthy Steps; Healthy Families America; Parents as Teachers; and the Comprehensive Child Development Program, which was actually developed by HHS.
Rand Corporation Economist M. Rebecca Kilburn told the subcommittee that a “diverse set of home visiting models” can improve outcomes for individual families. She expects the federal evaluation of MIECHV to reveal potential broader impacts, such as a measurable drop in entitlement spending or the size of a foster care system.
“Despite the large growth of in-home visiting funding at the national and state levels, not enough families are currently served to be able to detect impacts in population level data,” Kliburn said.
And while some cost-benefit analyses show return on investment, she said, only five of the 14 MIECHV models have even been subjected to a cost-benefit analysis.
The first results of the MIECHV evaluation should be released in 2015.
The committee heard direct reflections on the impact of home visiting from Crystal Towne, a nurse home visitor with the Nurse Family Partnership in Yakima Valley, Wash., and Sherene Sucilla, one of her clients.
Sucilla had spent her teenage years in foster care and was 10 weeks pregnant when she began the two-year, 64 appointment commitment with NFP. She credited Towne with helping her continue her education, strengthen her family and connect her to a career.
“As I look toward my future, I don’t think my family would be where we are today without her support,” Sucilla said.
“Stories like Sherene’s are just a glimpse of the impact that Nurse-Family Partnership has on low-income, first-time parents,” Towne said. “NFP can help break the cycle of poverty by empowering young mothers to become knowledgeable parents.”
Click here to read all of the testimony from the hearing.
John Kelly is the editor-in-chief of The Chronicle of Social Change.