Home visiting programs aim to help low-income parents enhance their parenting skills and improve a host of early health and developmental outcomes for young children. Programs match families with professionals and paraprofessionals who visit families in their home during pregnancy and throughout early childhood. CFRP is building an extensive body of research on the effectiveness and value of home visiting programs as an early childhood intervention.
The Family First Prevention Services Act provides states the opportunity to allocate federal child welfare funding to primary child maltreatment prevention efforts, including providing home visiting services to teens in state conservatorship who are pregnant or parenting. In light of this new funding opportunity, this brief provides a primer on considerations for serving teen parents in state care with home visiting, with a focus on pregnant and parenting mothers. The brief includes a background of the unique needs that pregnant and parenting teens and teens in care face, an overview of home visiting models that are well-suited to serve this unique population, and implementation considerations for selecting and administering home visiting to best serve pregnant and parenting youth in care.
The Texas Department of Family and Protective Services (DFPS) Prevention and Early Intervention (PEI) Division contracted with the Child and Family Research Partnership (CFRP) at the LBJ School of Public Affairs at The University of Texas at Austin to conduct a study of home visiting services in Texas. The study examined the changes in delivery of services and the evolving needs of families and Texas Home Visiting (THV) providers during the COVID-19 pandemic. Through surveys and focus groups, CFRP collected original data from THV program leads and home visitors from the 30 MIECHV-funded Parents as Teachers (PAT), Home Instruction for Parents of Preschool Youngsters (HIPPY), and Nurse-Family Partnership (NFP) programs in Texas.
Voluntary home visiting programs support and educate expectant parents and families of young children to improve maternal and child health, support child development, and increase family economic self-sufficiency. Though the programs have rapidly expanded across the country over the last four decades as an evidence-based policy choice for supporting families with young children, selecting an evidence-based model does not ensure effectiveness. Implementation is also a key determinant of whether or not children and families benefit from these programs. CFRP is conducting a long-term implementation evaluation of the Texas Home Visiting Program (THV), one of the largest federally-funded home visiting programs in the country. The overarching focus of the evaluation is to understand the factors that advance or limit the successful implementation of evidence-based home visiting programs and the ability of programs to produce positive outcomes for families with young children. Findings and lessons learned from this evaluation continue to inform the state’s efforts to expand THV and will contribute to the larger implementation science knowledge base.
Research indicates that evidence-based home visiting programs should benefit the families through improvements in maternal and child health, parenting attitudes and behaviors, better cognitive and social-emotional outcomes for children, and a lower incidence of child abuse and maltreatment. However, existing federal and state performance measures do not measure all of the ways participation in home visiting programs is related to positive outcomes for children and families. Given the high level of federal and state investment in evidence-based home visiting programs, identifying the extent to which home visiting programs provide value for families and children, even if the families do not complete the program, is important for demonstrating home visiting as a sound investment. The Texas Department of Family and Protective Services Prevention and Early Intervention Division continues to invest in home visiting programs as an important support for families and has prioritized understanding the ways in which home visiting programs provide value for families. CFRP is conducting an evaluation to identify the ways in which home visiting programs provide value to participating families and how these benefits vary across family and program factors. CFRP is assessing the parents and children at multiple time points and combining the assessments with administrative data to measure the benefits families gain from varying levels of program participation.
Evidence-based home visiting programs have positive effects on child and family wellbeing, but the evidence varies widely across program models. To further understand the value these programs provide for Texas families, the Texas Department of Family and Protective Services Prevention and Early Intervention Division has asked CFRP to look further into the impacts of the Texas Home Visiting Program (THV). CFRP is conducting an exploratory yet rigorous evaluation with the overarching goal of examining the longer-term or distal value that THV programs provide for families. The evaluation will focus specifically on children’s school readiness and child maltreatment in the years after families complete or exit home visiting programs. The evaluation also will examine how school readiness and child maltreatment vary based on important family and program factors, such as the family’s needs when entering the program and the family’s length of time enrolled in the program. This evaluation (DHVVE-II) is an extension of a previous evaluation, DHVVE-I (Describing Home Visiting’s Value Evaluation), which sought to identify the shorter-term or proximal value that home visiting programs provide for families by measuring outcomes during the program or soon after completion or exit. DHVVE-I examined key short-term outcomes such as parent engagement and interaction, parenting stress and efficacy, discipline strategies, and family self-sufficiency. Expanding on the findings from DHVVE-I, DHVVE-II will provide valuable information about the longer-term value that home visiting program’s provide for families.
One of the keys to successful implementation of evidence-based home visiting programs is the capacity to recruit, enroll, and retain participants in the model’s target population. Because home visiting programs target high-need families, keeping them engaged in the program is difficult. Attrition is common across home visiting programs, with an average of 50 percent of families leaving prior to completing the program. However, little is known about how families leave home visiting programs or why they leave. Thus CFRP is studying how, when, and why families leave home visiting programs; which families are the most likely to leave; and how father involvement in the programs relates to family retention. This understanding will enhance the ability of home visiting programs to improve child and family outcomes.
The Family Connects (FC) program is an evidence-based nurse home visiting program supporting newborns and their families. FC functions as a screening and triage tool to identify families in need of support, and connect them with resources in the community. Previous evaluations of FC have indicated fewer infant emergency care episodes as well as more community connections, more positive parenting behaviors, participation in higher quality child care, and lower rates of anxiety for mothers participating in the FC model. Family Connects is currently being implemented in five states – Iowa, Maryland, North Carolina, Oregon, and Minnesota – and is now being piloted in Texas. CFRP is working with the Episcopal Health Foundation and United Way for Greater Austin to assist with the implementation of FC in Austin. CFRP is assessing the assets, opportunities, and resources for new mothers and their infants in the Austin community, identifying both gaps and areas of overlap in services, and laying the framework and data system that supports program implementation and allows stakeholders to determine the impacts of the program.