Hello Baby: Implementing and Adapting a Prevention Initiative

Background & Purpose: Infants spend more of their childhood being raised by someone other than their parents than children of any other age group. The Allegheny County Department of Human Services (Pittsburgh, PA) has reimagined the services targeting this very high-risk population. Using research evidence to better shape how services are presented to families with newborns, Hello Baby uses broad scale risk assessment to connect new parents with a system of supports. While the initiative is universal, the risk assessment differentiates families by tier, offering voluntary services commensurate with their risk of foster care placement (i.e., Priority, Family Support, and Universal tiers). The aim is to reduce maltreatment investigations, substantiated investigations, and placements. The adaptive implementation study seeks to establish whether and to what extent programmatic additions and changes occurred at a level compatible with having a countywide effect on the outcomes.

Methods: The implementation evaluation employs quantitative and qualitative measures of what the County put in place organized around the process, quality, capacity, and outcomes framework. Process speaks to what Hello Baby actors did, quality refers to whether work of actors was done well, and capacity refers to whether Hello Baby was substantial enough programmatically to have what might be called a plausible causal effect. For the qualitative component, we conducted interviews with 81 key informants and focus groups with 40 parents between 2020 and 2024. The quantitative data consist of encounter data (i.e., outreach, enrollment, and engagement) chronologically sequenced to measure Hello Baby’s reach in terms of outreach, enrollment, and engagement among all families with babies born since Hello Baby launched in 2020.

Results: By 2023, 79% of Priority tier families and 66% of Family Support tier families were successfully contacted by Hello Baby outreach staff. To accomplish this, the County fortified the outreach process in ways that have proved successful in both increasing the number of families reached and decreasing the time it takes to reach them. A large share of families (41% in the Priority tier, 22% in the Family Support tier) reached decided to enroll in Hello Baby by 2023, exceeding the County’s goal of enrolling 30% of Priority tier families. A substantial subset of enrolled families (36% in the Priority tier, 30% in the Family Support tier) engage further, using services related primarily to case management and accessing concrete supports for basic needs. Hello Baby had additional success engaging Priority tier families in clinical relationships.

Conclusions & Implications: The hypothesis for any initiative is that the prescribed changes will lead to changes in outcomes. The Hello Baby outcome study demonstrates significant reductions in child protective services involvement, but if implementation is weak, then positive outcomes have no teeth – how are administrators to maintain or scale the success without an implementation roadmap? In this case, we have strong and precise evidence of robust implementation after a period of process adaptations and capacity investments. Taken together, the two sides of the evaluation contribute to the broader discussion of evidence use and the connection to outcomes.