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Maternal, Infant, and Early Childhood Home Visiting Program

Recognizing the importance of promoting healthy development for children and improving maternal health, HHS’s Health Resources and Services Administration (HRSA), in collaboration with the ACF, invests in the Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program.  As part of the Affordable Care Act, the MIECHV program is designed to:

  1. strengthen and improve the programs and activities carried out under Title V of the Social Security Act;
  2. improve coordination of services for at-risk communities; and
  3. identify and provide comprehensive services to improve outcomes for families who reside in at-risk communities.

Under MIECHV, HRSA supports formula and competitive grants to states, territories, and tribes to provide evidence-based home visiting services for pregnant women and children from birth to age five.  Nurses, teachers, social workers or other trained staff work with families in their home to help parents succeed by teaching them positive parenting skills, helping them to identify any developmental or health issues, and connecting parents with community supports and services they may need to support their children’s healthy development.

Evidence Standards and Evaluation:

As part of the grant funding, states are expected to use at least 75 percent of their funds to implement evidence-based models, and up to 25 percent of the funds toward promising new approaches and adaptations that will be evaluated through rigorous methods to build on the existing evidence base.

In order to support states in selecting appropriate evidence-based models, HRSA and ACF conducted the Home Visiting Evidence of Effectiveness (HomVEE) review.  Through the review, home visiting models have been identified with strong evidence of effectiveness, as defined by:

  • at least one high- or moderate-quality impact study with favorable, statistically significant impacts in two or more of the eight outcome domains;
  • at least one of the impacts is from a randomized controlled trial and has been published in a peer-reviewed journal; and
  • at least one of the impacts was sustained for at least one year after program enrollment.

Studies that examine the impact of a home visiting model using quantitative data and statistical analyses are reviewed and rated as “high”, “moderate” or “low.” The study-level ratings provide a measure of how well the study design could provide unbiased estimates of model impacts.

The “high” rating is reserved for:

  • random assignment studies with low attrition of sample members and no reassignment of sample members after the original random assignment, and
  • single case and regression discontinuity designs that meet the What Works Clearinghouse (WWC) design standards.

The moderate rating applies to:

  • random assignment studies that, due to flaws in the study design or analysis (for example, high sample attrition), do not meet all the criteria for the high rating;
  • matched comparison group designs; and
  • single case and regression discontinuity designs that meet WWC design standards with reservations.

Studies that do not meet all of the criteria for either the high or moderate ratings are assigned the low rating.

MIECHV grantees are expected to demonstrate quantifiable, measurable improvement for the populations participating in the program, in the following benchmark areas:

  • improved maternal and newborn health,
  • prevention of child injuries, child abuse, or maltreatment, and reduction of hospital emergency department visits,
  • improvement in school readiness and achievement,
  • reduction in crime or domestic violence,
  • improvements in family economic self-sufficiency, and
  • improvements in the coordination and referrals for other community resources and supports.

The MIECHV program is also being evaluated nationally through the legislatively mandated Mother and Infant Home Visiting Program Evaluation (MIHOPE).