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Federal Home Visitation Spending is Promising within Reason, Experts Tell Ways & Means

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.

TAGS: child welfare, family services, Federal funding, home visitation, maternal, MIECHV, parenting, Ways and Means

Comments

  1. April 15, 2014, 6:35 am

    [...] federal home visiting programs under scrutiny—and facing elimination without congressional action—this research is particularly timely (click here for more from CLASP). It echoes what we usually [...]

  2. April 15, 2014, 6:16 am

    [...] federal home visiting programs under scrutiny—and facing elimination without congressional action—this research is particularly timely (click here for more from CLASP). It echoes what we [...]

  3. Alison Gee
    April 10, 2014, 11:22 am

    April 2, 2014
    Statement by Scott Hippert, President and CEO
    Parents as Teachers National Center, St. Louis, Missouri.

    “Parents as Teachers (PAT) has a strong 30-year history of providing parenting education and family engagement services to families, and now reaches families in all 50 states and more than 100 tribal communities. PAT’s approach and curriculum, targeted to the most vulnerable families, has demonstrated outcomes in school readiness, and has been chosen by local communities and agencies in 30 states and 13 tribes to provide these services with MIECHV funds.

    “Parents as Teachers delivers an evidence-based approach for home visiting and supports federal investments in interventions that deliver results. Through its Home Visiting Evidence of Effectiveness (HomVEE) review, the Department of Health and Human Services has conducted a thorough and transparent review of the home visiting research literature and provided an assessment of the evidence of effectiveness for home visiting programs models that target families with pregnant women and children from birth to age 5. Parents as Teachers meets the HomVEE criteria, with favorable outcomes in four of the six measured outcome domains.

    Additionally, Parents as Teachers’ MIECHV programs, along with three other models, currently is being rigorously evaluated through the MIHOPE study. PAT also is engaged in a rigorous evaluation of implementation in tribal communities through a Department of Education Investing in Innovations grant. Finally, in addition to the statistically significant results from four randomized control trials, we have 23 years of independent evaluations of home-based PAT programs that demonstrate the effectiveness of our approach, and local and state evaluations have found positive results in outcomes relevant to school success, including school achievement, attendance and out-of-school suspension.

    “Unlike other models which serve only first-time moms, or single parent or teens, PAT affiliates engage with families in a much broader way. We work with families as early as during pregnancy and on through kindergarten entry. Our program is culturally adaptable to work in many different environments. In short, we engage with a broader array of families, in ways that are best-suited to their family environment, and over a longer period of time, to ensure greater depth of knowledge and increased likelihood of continued positive outcomes.

    “We could not be more proud of our history, our effectiveness with families, and our evidence-based model.”

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