Reality Check: Can the Effects of Home Visiting Programs Found in RCTs be Replicated in the Real World?

CFRP Working Paper | W15006

April 2015  
PDF version

Voluntary home visiting programs support and educate expectant parents and families of young children. Over the last four decades, several home visiting programs have undergone rigorous tests of their effectiveness. Though the positive effects of home visiting programs are generally small, these programs have been heralded by many as a key model of early intervention capable of producing long lasting effects for children and families and ending the cycle of poverty and are receiving unprecedented support as an evidence-based initiative. But what should we expect from evidence-based programs? Should we expect the evidence base to be replicated across large and diverse community samples that may differ from the geographic and population context in which the original evaluations were conducted? Should we expect the programs to be implemented exactly as they were in the RCTs?

The purpose of this paper is to review the evidence base for three widely-used home visiting programs that have met the federal criteria for evidence-based to highlight the limits to both the internal and external validity of the evidence and to provide a case study as a point of comparison using data from a large, statewide implementation effort. Our review of the external validity of the evidence base indicates that home visiting programs are being expected to do far more than what their evidence base suggests is possible. The findings from the case study are discussed as is the importance of aligning expectations for evidence-based programs’ success with the strength and validity of the evidence.

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