Society for Social Work and Research 19th Annual Conference: The Social and Behavioral Importance of Increased Longevity

January 14 - 18, 2015

Home visiting programs in the U.S. are receiving unprecedented support at both the state and federal levels. According to a recent survey conducted by the Pew Center on the States, in the 2010 fiscal year, states allocated $1.4 billion for home visiting programs. That same year, Congress established the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV), which offered states, jurisdictions, and American Indian tribes $1.5 billion in formula grant funding over five years to support the expansion and development of home visiting programs. Importantly, states were required to spend at least three-quarters of the federal funds on home visiting models that met federal standards of evidence-based effectiveness (DHHS, 2013). More recently, as a part of his 2013 State of the Union address, President Barack Obama called on Congress to extend and expand evidence-based home visiting programs as a part of his comprehensive, early learning agenda.

That a national initiative has brought the importance of evidence-based practice to the forefront of public policy is a triumph for social science and demonstrates the importance of rigorous program evaluation. Building a national home visiting initiative entirely on the basis of evidence generated by RCTs and experimental designs, however, provides little guidance on how to replicate the model at sufficient scale to create change visible at the national level. Evidence-based programs may increase the probability of improved outcomes, but it does not guarantee them for numerous reasons. Most of the evidence comes from small-scale and controlled efficacy trials with limited external validity and there is less evidence of impacts at scale. Implementing programs with fidelity to the model is critical to whether the programs can produce their intended effects, but there is little research on how to achieve quality on-the-ground implementation.

Taking advantage of data from the evaluation of the Texas Home Visiting Program (THV), one of the largest MIECHV-funded programs, this symposium brings together three perspectives on translating the evidence-base of home visiting programs into outcomes for children and families. In the first, the author takes a closer look at the evidence evaluated by the federal government to determine which home visiting programs were evidence-based. The review suggests that although home visiting programs are associated with a range of positive outcomes for children and families, expecting the same results when the programs are taken to scale may be overly-optimistic. The second paper analyzes data from THV to show how the characteristics of the families being served create implementation challenges. The characteristics of families that make them eligible for the programs also make it difficult for home visitors to deliver the programs with fidelity. The third paper uses a mixed-methods approach to assess the factors that influence whether fathers participate in the programs, and identify strategies for increasing father participation.  Effective strategies for increasing father participation include flexible scheduling, adapting curriculum for fathers, and helping parents understand the benefits of father involvement for their child. Different strategies are needed to engage romantically involved and non-romantic fathers.