This is a special edition of Rigorous Evidence – a bi-monthly email newsletter of the Coalition for Evidence-Based Policy (a nonprofit, nonpartisan organization). Click here for the full pdf version.
HHS’s Maternal, Infant, and Early Childhood Home Visiting Program:
Which Program Models Identified by HHS As “Evidence-Based” Are Most Likely To Produce Important Improvements in the Lives of Children and Parents?
The nonprofit, nonpartisan Coalition for Evidence-Based Policy strongly supports the new HHS Home Visiting program, which incorporates key evidence-based approaches that we have promoted through our work with Congressional and Executive Branch policy officials. The program – whose total funding over FY 2010-2014 is $1.5 billion – awards grants to states to implement early childhood home visiting programs, and is required by law to reserve at least 75 percent of its funding for “evidence-based” program models.
However, evidence suggests that the program’s overall effectiveness will depend critically on which program models are implemented by the states. HHS has identified eight models as currently meeting the standard for “evidence-based” in the program’s authorizing statute, based on an HHS-sponsored evidence review carried out by Mathematica Policy Research. However, the statutory standard focuses on whether rigorous evaluations have found that the model produces statistically-significant effects, but not on whether these effects have policy or practical importance. As discussed below, we believe the evidence shows wide variation among the eight models in the importance of their effects, and that the program’s overall impact in improving people’s lives therefore depends critically on which models are implemented by the states.
We have therefore rated the eight models on the following criterion: How much confidence does the evidence provide that, if a state were to replicate the model faithfully in a similar population, it would produce important improvements in the lives of at-risk children and parents? Our ratings build on Mathematica’s findings about (i) which studies are of “high” quality (i.e., most likely to provide unbiased estimates of the model’s effects); and (ii) whether those studies show statistically-significant effects (i.e., meet the statutory standard). We add the further condition of whether those effects are important (e.g., sizable decrease in children’s hospitalizations, or sustained increase in school success).
Our ratings – and reasoning behind them — are summarized briefly in the attachment (8½ pages plus references), LINKED HERE.
The following table provides a guide on the program model, and the level of confidence that the model will produce important life improvement:
| Nurse-Family Partnership | STRONG |
| Early Intervention Program | MEDIUM |
| Family Check-Up | MEDIUM |
| Early Head Start – Home Visiting | LOW |
| Healthy Families America | LOW |
| Healthy Steps | LOW |
| Parents as Teachers | LOW |
| Home Instruction Program for Preschool Youngsters | Insufficient evidence |
We note that the Coalition is a neutral, objective party in assessing the evidence. We are a foundation-supported nonprofit organization with broad experience reviewing evidence for Congress and the federal agencies. We have no affiliation with any program models in home visitation or any other policy area.