Mother and Infant Home Visiting Program Evaluation
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Women's Studies |
| Therapuetic Areas: | Reproductive |
| Healthy: | No |
| Age Range: | 15 - Any |
| Updated: | 2/8/2019 |
| Start Date: | October 2012 |
| End Date: | September 2022 |
Mother and Infant Home Visiting Program Evaluation (MIHOPE
MIHOPE is a multi-state study of home visiting programs authorized under the Maternal,
Infant, and Early Childhood Home Visiting (MIECHV) program. The study is required by the
federal Patient Protection and Affordable Care Act of 2010 (ACA), which created the MIECHV
program. It is being conducted by MDRC under contract to the Administration for Children and
Families within the US Department of Health and Human Services. In conducting the research,
MDRC has subcontracted portions of the research to Mathematica Policy Research, Johns Hopkins
University, Columbia University, University of Georgia, and James Bell Associates.
MIHOPE is seeking to randomly assign about 4300 families nationally to home visiting services
or to a comparison group that will receive referrals to other services in the community. The
study is seeking to include 88 local home visiting programs (sites) that are funded through
MIECHV in approximately 12 states. In Washington, the study plans to randomly assign
approximately 360 families across 6 home visiting program sites. Data will be collected from
families, local home visiting programs, and state and federal administrative data systems to
assess the effects of the programs on family outcomes and to learn more about how the
programs are run. Sites included in the evaluation will be using one of four national service
models (Nurse Family Partnership, Healthy Families America, Parents as Teachers, and Early
Head Start—Home Visiting Option) that states have chosen for most of their MIECHV funding.
MIHOPE will inform the federal government about the effectiveness of the MIECHV program in
its first few years of operation, and it will provide information to help states develop and
strengthen home visiting programs in the future. Research findings will be disseminated
through a report to Congress in 2015; reports on program impacts, implementation, and on the
relationship between program features and program impacts; journal articles; and practitioner
briefs.
Infant, and Early Childhood Home Visiting (MIECHV) program. The study is required by the
federal Patient Protection and Affordable Care Act of 2010 (ACA), which created the MIECHV
program. It is being conducted by MDRC under contract to the Administration for Children and
Families within the US Department of Health and Human Services. In conducting the research,
MDRC has subcontracted portions of the research to Mathematica Policy Research, Johns Hopkins
University, Columbia University, University of Georgia, and James Bell Associates.
MIHOPE is seeking to randomly assign about 4300 families nationally to home visiting services
or to a comparison group that will receive referrals to other services in the community. The
study is seeking to include 88 local home visiting programs (sites) that are funded through
MIECHV in approximately 12 states. In Washington, the study plans to randomly assign
approximately 360 families across 6 home visiting program sites. Data will be collected from
families, local home visiting programs, and state and federal administrative data systems to
assess the effects of the programs on family outcomes and to learn more about how the
programs are run. Sites included in the evaluation will be using one of four national service
models (Nurse Family Partnership, Healthy Families America, Parents as Teachers, and Early
Head Start—Home Visiting Option) that states have chosen for most of their MIECHV funding.
MIHOPE will inform the federal government about the effectiveness of the MIECHV program in
its first few years of operation, and it will provide information to help states develop and
strengthen home visiting programs in the future. Research findings will be disseminated
through a report to Congress in 2015; reports on program impacts, implementation, and on the
relationship between program features and program impacts; journal articles; and practitioner
briefs.
MIHOPE includes two groups of participants. First, the study will include 4300 women across
88local home visiting programs (sites) in 12 states. Women will be randomized so that half
can receive home visiting services and half are in a control group that receives referrals to
other services in the community. Local home visiting programs chosen for the study must meet
the following criteria: (1) they have been in operation for at least two years, (2) they are
receiving funds through the MIECHV program, (3) they are operating one of the four
evidence-based models described earlier, and (4) there is enough need for the program's
services that they can provide a control group without reducing the number of families that
receive home visiting.
Families will be recruited as follows. Mothers will be identified as eligible for a local
home visiting program by staff from that program, using the program's current procedures. If
the mother appears to be eligible for MIHOPE (based on the mother's age and pregnancy status
or child's age), the home visiting staff will mention that a study is going on and that
someone from the study team would like to be in touch to explain the study and to see if the
mother is interested in participating. The home visiting program will then enter the mother's
address and phone number. In addition, the home visiting program will provide Mathematica
with the mother's name and date of birth and the child's date of birth for purposes of making
sure the family is not already in the study or has not previously declined to participate in
the study. The MDRC Institutional Review Board has determined that a partial authorization of
the HIPAA Authorization requirement is warranted for use of the mother's information for
sample recruitment.
Study field staff will attempt to contact the family and schedule a visit to explain the
study, request their participation, and obtain informed consent for research activities.
Potential study participants will be asked to sign two consent forms at the beginning of the
study: one to participate in the study and to allow the team to collect administrative and
survey data, and a second to be video-recorded during two home visits, if assigned to the
home visiting group. Mothers are also providing consent to allow us to collect information
from the home visiting programs about the services they receive and information from the
government on various information, including Medicaid records, vital records, child welfare
records, and employment and earnings information from the National Database of New Hires. If
an applicant is a non-emancipated minor, assent will be obtained and written consent will be
obtained from her parent or guardian if the parent or guardian is in the home at the time of
the recruitment visit. If the parent or guardian is not in the home, verbal consent will be
obtained. If verbal consent is provided, the parent or guardian will be mailed a copy of the
assent form that the woman signed and that explains what the research entails.
After consent has been provided, study staff in the family's home will initiate a call to the
study's survey operations center for purposes of administering a one-hour survey. The family
baseline survey will include information on several domains specified in the ACA: newborn
health; parental health and well-being; parenting practices, attitudes, and beliefs; domestic
violence; history with the criminal justice system; family economic self-sufficiency; and
referral and coordination of social services. In addition, the baseline survey will collect
information on demographics and household composition to describe the study sample, and will
collect information on demographics and household composition to describe the study sample,
and will collect contact information for family members or friends who can help locate the
family at follow-up if they move. The survey also contains information about the parent's
expectations regarding the home visiting program, which will inform research on program
implementation. While the mother is completing the baseline survey by phone, the study field
staff will conduct the Home Observation for Measuring the Environment (HOME) to assess the
quality and amount of stimulation that the child receives in the home as well as observations
of the home environment. At the end of the telephone survey, the interviewer will hang up and
determine whether the family is assigned to the program (home visiting program) or control
group (comparison group that will receive referrals to other services in the community); the
result of random assignment will be sent by automated email to the point of contact at the
local program.
A second round of data will be collected when the child is 15 months old. These include: (1)
a one-hour telephone interview (the family follow-up survey), (2) a 30-minute video-recording
of the mother and child playing with some toys (the Three Bags task), (3) a direct assessment
of the child's receptive language skills (expected to take 40 minutes), (4) measurement of
the child's weight and height and the mother's weight (expected to take 5 minutes), and (5)
observations of the family's home environment, which will not add time to the data collection
procedures. Finally, data will be collected from three state systems: (1) Medicaid, (2) vital
records, and (3) child welfare. Follow-up data collection plans have been approved by the
federal Office of Management and Budget.
The family follow-up survey will include information on several domains specified in the ACA:
infant and child health; child development; parental health and well-being; parenting
practices, attitudes, and beliefs; domestic violence; history with the criminal justice
system; family economic self-sufficiency; and use of social services. Survey questions will
focus on outcomes for which previous studies of home visiting have found effects and on
outcomes that would not be available from other sources (such as administrative records).
Follow-up data collection will also include several types of data collected in the family's
home:
1. Direct assessments of children's receptive language skills will be done using the
Preschool Language Scales-5 Auditory Comprehension Scale (PLS-5), which is an
individually administered test that assesses the child's ability to understand language.
The child will sit on the mother's lap while the field interviewer administers this
test. At 15 months, toddlers' spoken language capabilities are only just beginning to
develop. For this reason, the Auditory Comprehension subtest of the PLS-5 will be used.
The Auditory Comprehension cluster measures a child's ability to be attentive and
respond to stimuli in the environment and to comprehend basic vocabulary or gestures.
2. During the follow-up visit, field staff will have a measuring tape and a weighing scale
when they conduct field visits, which they will use to obtain both the mother's weight
and the child's height and weight. Direct measurements of the child's weight and length
will provide information on whether the child's growth is within a normal range or
exhibits early signs of unhealthy growth trajectories (i.e., risk of obesity or
under-development). Measurement of the mother's weight along with self-reported height
will provide information on whether the mother is obese, which is associated with a host
of other health problems. When measuring weight, if the child is willing, the field
interviewer will ask him or her to stand on the weighing scale by him or herself. If the
child is unwilling to do so, then the staff person will obtain the mother's weight and
then ask her to pick up the child and stand on the scale with the child. The mother's
weight will then be subtracted from this total weight to obtain the child's weight.
These measures are being collected out of concern that the mother may not accurately
report her own weight and may not know her child's current weight and height.
3. The Home Observation for Measuring the Environment (HOME) - described under baseline
data collection -- will be conducted again at follow-up.
4. The three bags task, a direct observation of parent-child interactions, will be
conducted. This assessment is intended to capture the parenting constructs of parental
sensitivity, cognitive stimulation, positive regard, intrusiveness, negative regard,
detachment, relationship quality (degree of relatedness and mutual engagement), and
boundary dissolution (parent's inability to maintain an appropriate role in his or her
interaction with child). From this task, children's behaviors towards the parent will
also be gathered in the context of the parent-child interaction, including engagement
with the parent, sustained attention, and negativity towards the parent.
In addition, the study is asking approximately 500 home visitors and 100 supervisors in the
85 sites to enroll in the study. Some supervisors may also see families and carry a caseload,
acting in the capacity of both supervisor and supervisor. Program staff will be identified by
a local program manager and sent emails by the study team asking them to enroll in the study.
Home visitors and supervisors will be asked to complete a 75-minute web-based survey around
the time that the site enters the study. The home visitor and supervisor baseline surveys
will collect information on staff characteristics and on staff perceptions of organizational
factors related to service delivery; employment, supervision and program outcomes; staff
beliefs about home visitor roles and responsibilities, ratings of her or his own training and
skills in supervising staff to carry out activities; ratings of her or his own ability to
secure supervision and professional consultation; and demographics and individual background
characteristics. Individuals who are both home visitors and supervisors will be asked to
complete a survey that combines elements of the home visitor and supervisor surveys, and
lasts about 105 minutes. Because the surveys include sensitive information, home visitors and
supervisors will be asked to consent to the survey and home visitors will be asked to consent
to videotaped interactions with families. Home visitors and supervisors will be asked to
provide consent through a web-based application before completing the web-based surveys.
Home visitors and supervisors will be asked to complete a 75-minute web-based survey again a
year after enrolling in the study. Staff who are both home visitors and supervisors will be
asked to complete a 105-minute web-based survey again a year after enrolling in the study.
Staff follow-up surveys parallel the baseline surveys. They will measure malleable respondent
characteristics and perceptions of organizational factors related to service delivery.
MIHOPE will have an additional three follow-up surveys, which are intended to allow
additional, longer-term data collection from original study participants. The intent is that
MIHOPE will involve annual follow-up family surveys around the time the child turns 2 ½, 3 ½,
and 4 ½ years of age. At those three points in time, the mother - or the child's primary
caregiver if the mother is not available - would be asked to take part in a short survey. The
survey will include about 15 minutes of questions on topics such as child and parental
health, parenting style, child development, and social services used. The caregiver will also
be asked to provide updated contact information, as well as share information about people
who may know how to locate her in the future. As needed, the study team will also obtain
informed consent for the continued collection of state administrative records.
Note: The list of primary study outcomes was revised in September 2015 based on presentation
to the study's advisory committee. Study analyses will not begin until 2017.
88local home visiting programs (sites) in 12 states. Women will be randomized so that half
can receive home visiting services and half are in a control group that receives referrals to
other services in the community. Local home visiting programs chosen for the study must meet
the following criteria: (1) they have been in operation for at least two years, (2) they are
receiving funds through the MIECHV program, (3) they are operating one of the four
evidence-based models described earlier, and (4) there is enough need for the program's
services that they can provide a control group without reducing the number of families that
receive home visiting.
Families will be recruited as follows. Mothers will be identified as eligible for a local
home visiting program by staff from that program, using the program's current procedures. If
the mother appears to be eligible for MIHOPE (based on the mother's age and pregnancy status
or child's age), the home visiting staff will mention that a study is going on and that
someone from the study team would like to be in touch to explain the study and to see if the
mother is interested in participating. The home visiting program will then enter the mother's
address and phone number. In addition, the home visiting program will provide Mathematica
with the mother's name and date of birth and the child's date of birth for purposes of making
sure the family is not already in the study or has not previously declined to participate in
the study. The MDRC Institutional Review Board has determined that a partial authorization of
the HIPAA Authorization requirement is warranted for use of the mother's information for
sample recruitment.
Study field staff will attempt to contact the family and schedule a visit to explain the
study, request their participation, and obtain informed consent for research activities.
Potential study participants will be asked to sign two consent forms at the beginning of the
study: one to participate in the study and to allow the team to collect administrative and
survey data, and a second to be video-recorded during two home visits, if assigned to the
home visiting group. Mothers are also providing consent to allow us to collect information
from the home visiting programs about the services they receive and information from the
government on various information, including Medicaid records, vital records, child welfare
records, and employment and earnings information from the National Database of New Hires. If
an applicant is a non-emancipated minor, assent will be obtained and written consent will be
obtained from her parent or guardian if the parent or guardian is in the home at the time of
the recruitment visit. If the parent or guardian is not in the home, verbal consent will be
obtained. If verbal consent is provided, the parent or guardian will be mailed a copy of the
assent form that the woman signed and that explains what the research entails.
After consent has been provided, study staff in the family's home will initiate a call to the
study's survey operations center for purposes of administering a one-hour survey. The family
baseline survey will include information on several domains specified in the ACA: newborn
health; parental health and well-being; parenting practices, attitudes, and beliefs; domestic
violence; history with the criminal justice system; family economic self-sufficiency; and
referral and coordination of social services. In addition, the baseline survey will collect
information on demographics and household composition to describe the study sample, and will
collect information on demographics and household composition to describe the study sample,
and will collect contact information for family members or friends who can help locate the
family at follow-up if they move. The survey also contains information about the parent's
expectations regarding the home visiting program, which will inform research on program
implementation. While the mother is completing the baseline survey by phone, the study field
staff will conduct the Home Observation for Measuring the Environment (HOME) to assess the
quality and amount of stimulation that the child receives in the home as well as observations
of the home environment. At the end of the telephone survey, the interviewer will hang up and
determine whether the family is assigned to the program (home visiting program) or control
group (comparison group that will receive referrals to other services in the community); the
result of random assignment will be sent by automated email to the point of contact at the
local program.
A second round of data will be collected when the child is 15 months old. These include: (1)
a one-hour telephone interview (the family follow-up survey), (2) a 30-minute video-recording
of the mother and child playing with some toys (the Three Bags task), (3) a direct assessment
of the child's receptive language skills (expected to take 40 minutes), (4) measurement of
the child's weight and height and the mother's weight (expected to take 5 minutes), and (5)
observations of the family's home environment, which will not add time to the data collection
procedures. Finally, data will be collected from three state systems: (1) Medicaid, (2) vital
records, and (3) child welfare. Follow-up data collection plans have been approved by the
federal Office of Management and Budget.
The family follow-up survey will include information on several domains specified in the ACA:
infant and child health; child development; parental health and well-being; parenting
practices, attitudes, and beliefs; domestic violence; history with the criminal justice
system; family economic self-sufficiency; and use of social services. Survey questions will
focus on outcomes for which previous studies of home visiting have found effects and on
outcomes that would not be available from other sources (such as administrative records).
Follow-up data collection will also include several types of data collected in the family's
home:
1. Direct assessments of children's receptive language skills will be done using the
Preschool Language Scales-5 Auditory Comprehension Scale (PLS-5), which is an
individually administered test that assesses the child's ability to understand language.
The child will sit on the mother's lap while the field interviewer administers this
test. At 15 months, toddlers' spoken language capabilities are only just beginning to
develop. For this reason, the Auditory Comprehension subtest of the PLS-5 will be used.
The Auditory Comprehension cluster measures a child's ability to be attentive and
respond to stimuli in the environment and to comprehend basic vocabulary or gestures.
2. During the follow-up visit, field staff will have a measuring tape and a weighing scale
when they conduct field visits, which they will use to obtain both the mother's weight
and the child's height and weight. Direct measurements of the child's weight and length
will provide information on whether the child's growth is within a normal range or
exhibits early signs of unhealthy growth trajectories (i.e., risk of obesity or
under-development). Measurement of the mother's weight along with self-reported height
will provide information on whether the mother is obese, which is associated with a host
of other health problems. When measuring weight, if the child is willing, the field
interviewer will ask him or her to stand on the weighing scale by him or herself. If the
child is unwilling to do so, then the staff person will obtain the mother's weight and
then ask her to pick up the child and stand on the scale with the child. The mother's
weight will then be subtracted from this total weight to obtain the child's weight.
These measures are being collected out of concern that the mother may not accurately
report her own weight and may not know her child's current weight and height.
3. The Home Observation for Measuring the Environment (HOME) - described under baseline
data collection -- will be conducted again at follow-up.
4. The three bags task, a direct observation of parent-child interactions, will be
conducted. This assessment is intended to capture the parenting constructs of parental
sensitivity, cognitive stimulation, positive regard, intrusiveness, negative regard,
detachment, relationship quality (degree of relatedness and mutual engagement), and
boundary dissolution (parent's inability to maintain an appropriate role in his or her
interaction with child). From this task, children's behaviors towards the parent will
also be gathered in the context of the parent-child interaction, including engagement
with the parent, sustained attention, and negativity towards the parent.
In addition, the study is asking approximately 500 home visitors and 100 supervisors in the
85 sites to enroll in the study. Some supervisors may also see families and carry a caseload,
acting in the capacity of both supervisor and supervisor. Program staff will be identified by
a local program manager and sent emails by the study team asking them to enroll in the study.
Home visitors and supervisors will be asked to complete a 75-minute web-based survey around
the time that the site enters the study. The home visitor and supervisor baseline surveys
will collect information on staff characteristics and on staff perceptions of organizational
factors related to service delivery; employment, supervision and program outcomes; staff
beliefs about home visitor roles and responsibilities, ratings of her or his own training and
skills in supervising staff to carry out activities; ratings of her or his own ability to
secure supervision and professional consultation; and demographics and individual background
characteristics. Individuals who are both home visitors and supervisors will be asked to
complete a survey that combines elements of the home visitor and supervisor surveys, and
lasts about 105 minutes. Because the surveys include sensitive information, home visitors and
supervisors will be asked to consent to the survey and home visitors will be asked to consent
to videotaped interactions with families. Home visitors and supervisors will be asked to
provide consent through a web-based application before completing the web-based surveys.
Home visitors and supervisors will be asked to complete a 75-minute web-based survey again a
year after enrolling in the study. Staff who are both home visitors and supervisors will be
asked to complete a 105-minute web-based survey again a year after enrolling in the study.
Staff follow-up surveys parallel the baseline surveys. They will measure malleable respondent
characteristics and perceptions of organizational factors related to service delivery.
MIHOPE will have an additional three follow-up surveys, which are intended to allow
additional, longer-term data collection from original study participants. The intent is that
MIHOPE will involve annual follow-up family surveys around the time the child turns 2 ½, 3 ½,
and 4 ½ years of age. At those three points in time, the mother - or the child's primary
caregiver if the mother is not available - would be asked to take part in a short survey. The
survey will include about 15 minutes of questions on topics such as child and parental
health, parenting style, child development, and social services used. The caregiver will also
be asked to provide updated contact information, as well as share information about people
who may know how to locate her in the future. As needed, the study team will also obtain
informed consent for the continued collection of state administrative records.
Note: The list of primary study outcomes was revised in September 2015 based on presentation
to the study's advisory committee. Study analyses will not begin until 2017.
Inclusion Criteria:
- Eligible for home visiting program selected to be in the study
- At least 15 years old
- Pregnant or have a child under 28 weeks old
Exclusion Criteria:
- women already enrolled in home visiting (for example, with an older child)
- children in foster care in sites using EHS program model
- homeless families in sites using EHS program model
- women who speak neither English or Spanish
We found this trial at
1
site
