Maternal Infant Health Outreach Worker (MIHOW)®

Model Effectiveness
Evidence Based Model
MIECHV Eligible

17

Manuscripts

Released in 2002 through 2021

3

Manuscripts

Impact studies rated high or moderate quality

Services intended at ages
Prenatal
0-6 months
07-11 months
12-23 months
24-35 months
Favorable results from well-defined research
Child health
Linkages and referrals
Maternal health
Positive parenting practices

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The Maternal Infant Health Outreach Worker (MIHOW) Program is a parent-to-parent intervention that is designed to improve prenatal care, birth weight, infant care, family dynamics, parenting skills, child development, life skills, and community development. MIHOW targets economically disadvantaged and geographically and/or socially isolated families with children birth to age 3.

Where to find out more

Effectiveness

This model meets criteria established by the U.S. Department of Health and Human Services for an evidence-based home visiting model.

Does not meet criteria for an evidence-based home visiting model for Indigenous peoples and communities.

Extent of Evidence

For more information about manuscripts, search the research database.

For more information on the criteria used to rate research, please see details of HomVEEʼs methods and standards.

17

Manuscripts

Released in 2002 through 2021

6

Manuscripts

Eligible for review

3

Manuscripts

Impact studies rated high or moderate quality

Note: When an individual manuscript reports findings from multiple studies, HomVEE reviews each study as a distinct manuscript. In these rare instances, HomVEE counts that manuscript multiple times in this table, once for each study identified, screened, and reviewed by HomVEE.

Summary of Findings

To see details on each manuscript HomVEE reviewed in well-designed research, click on the manuscript counts in the table.

Favorable:
A finding showing a statistically significant impact on an outcome measure in a direction that is beneficial for children and parents.

No effect:
Findings are not statistically significant.

Unfavorable:
A finding showing a statistically significant impact on an outcome measure in a direction that may indicate potential harm to children and/or parents.

Outcomes Manuscripts Favorable Findings No Effects Findings Unfavorable Findings
Child development and school readiness Not measured - - -
Child health View 3 Manuscripts 4 18 2
Family economic self-sufficiency Not measured - - -
Linkages and referrals View 2 Manuscripts 3 0 0
Maternal health View 3 Manuscripts 10 8 0
Positive parenting practices View 2 Manuscripts 31 7 0
Reductions in child maltreatment Not measured - - -
Reductions in juvenile delinquency, family violence, and crime Not measured - - -

Research Characteristics

Well-designed impact studies about this model included participants with the following characteristics:

Race/Ethnicity

Hispanic or Latino
100.00%

Maternal Education

Less than a high school diploma
75.62%
High school diploma or GED
18.23%
Some college or Associate's degree
2.74%
Bachelor's degree or higher
2.55%
Unknown
0.83%

Well-designed impact studies about this model were conducted in the following locations:

  • South
  • Tennessee
Enrollment in means-tested programs
45.44%

Implementation

In this section:

Overview

Theoretical approach, intended population, and targeted outcomes.

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Support Availability

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Service Delivery

Model services, adaptions and enhancements, model intensity and length.

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Requirements

Staffing and organizational requirements.

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Overview

Theoretical approach

The Maternal Infant Health Outreach Worker (MIHOW) model is based on systems theory, which views human behavior as the collective impact of multiple interrelated systems. To understand and assist individual program participants, MIHOW considers how participants are affected by families, organizations, societies, and other systems in which they are involved.

Community health workers (called outreach workers) from the local area serve as home visitors. These outreach workers assess all the systems at play in participants’ lives and then strive to strengthen those systems to help participants meet their goals. Outreach workers help bolster participants’ individual systems (immediate social environment), advocate for participants within larger systems, and support participants’ efforts to improve the systems in which they are involved. By training parents in the community to serve as outreach workers, MIHOW aims to generate broader system change.

MIHOW is a community- and strengths-based model focused on community development. It emphasizes that outreach workers and program participants are equal members of the community with a mutual investment in one another. The model links the parenting experiences of community members with community partners and the university that developed the model.

Intended population

MIHOW primarily serves families with low incomes who are experiencing stress and isolation. Families enroll prenatally and receive home visits until the child is 36 months old.

Targeted outcomes

MIHOW works to improve child and maternal health outcomes, increase use of linkages and referrals to medical and social services, and build positive parenting skills.

Highlights

Populations Intended
Families with low-income
Services intended at ages
Prenatal
0-6 months
07-11 months
12-23 months
24-35 months

Support Availability

Implementation support availability

MIHOW is a partnership between Vanderbilt University School of Nursing (VUSN) and community-based organizations. VUSN and MIHOW regional consultants work with local sites during initial recruitment, training, and supervision of outreach workers; on case management issues; and on networking with other agencies.

MIHOW also provides local sites with ongoing technical assistance and sustainability assistance:

  • MIHOW monitors site progress through site visits, phone calls, and meetings. It also provides additional training and advising when problems arise.
  • MIHOW tailors sustainability assistance to match each site’s infrastructure and needs.

Highlights

Locations where model has been implemented
Within the U.S.

Service Delivery

Model services

The core components of MIHOW are (1) home visits, (2) case management and advocacy, (3) parent education, (4) role modeling for positive parent-child interaction, (5) health and developmental screening, (6) information about and referrals to medical and social services, and (7) peer support groups.

The outreach workers listen to parents’ concerns; educate parents about nutrition, health, and child development; model positive parenting practices; and provide links to medical and social services. MIHOW is flexible and can be tailored to the needs of the sponsoring agency and community.

The month-by-month MIHOW Home Visit Guides (The Prenatal Period, The First Year of Life, The Second Year of Life, and The Third Year of Life) provide outreach workers with objectives and strategies for each visit to improve maternal health behaviors, birth outcomes and early child health, nutrition (obesity prevention and reduction), problem-solving skills, goal setting, and self-advocacy. Outreach workers are also provided with REACH - The Five Step Recipe for a Home Visit, a pocket-size laminated quick reference card that lists the essential elements of an effective home visit.

Model intensity and length

MIHOW includes monthly home visits that last approximately one hour. It also includes opportunities for group interaction. Participants enroll in the program during pregnancy and receive visits until their child’s third birthday.

Adaptations and enhancements

There are currently no adaptations or enhancements to the model.

Highlights

Language that the program is available in
Spanish
Other language
Maximum program duration
Three years or more
Visit frequency
Monthly or less frequently
Delivery Method Supported
Supports hybrid in-person and virtual service delivery

Requirements

Staffing requirements

MIHOW outreach workers are trained to implement the model, and staffing arrangements are tailored to the needs of individual sites. Some sites employ full-time outreach workers, and other sites use part-time workers. Sites must also employ an outreach worker supervisor.

Outreach workers must be from the local community and have at least a high school diploma or equivalent, a positive parenting history, and a similar background to program participants. In addition, outreach workers must demonstrate an understanding of the community and an acceptance of people different from themselves, including people with different religious beliefs, sexual orientations, socioeconomic status, and race.

There are no education or experience requirements for supervisors. However, the model recommends that supervisors have a bachelor’s degree or one year of experience with supervision. MIHOW recommends supervisors use reflective supervision, and at a minimum, they are required to complete the following activities:

  • Hold one-on-one meetings with outreach workers at least monthly
  • Provide individual and group opportunities for outreach workers to share successes and concerns
  • Respond to concerns promptly and constructively
  • Evaluate and be evaluated by the outreach workers annually

The MIHOW leadership team provides group support to supervisors during the MIHOW annual conference.

This model requires outreach workers to participate in pre-service training. Outreach workers must complete 40 hours of core training, shadow an experienced outreach worker, and receive an individual assessment from a supervisor. New supervisors must complete pre-service training with their staff and, for the first six months, participate in monthly one-hour check-ins with a member of the MIHOW leadership team. Please contact the model developer for additional information about the pre-service training requirement.

This model offers the following ongoing professional development:

  • Monthly training—Local sites are responsible for monthly training of outreach workers on MIHOW-specific competencies for outreach workers and local needs.
  • Annual conference—Each year, supervisors and outreach workers gather for three days of workshops, networking, and team building.
  • Biennial Site Leaders’ Meeting—Supervisors gather every other year for networking, reflection, planning, evaluation, and training.
  • Regional training—Regional consultants coordinate three training sessions per region each year for outreach workers and provide consultation to sites.

Please contact the model developer for additional information about ongoing professional development requirements.

Organizational requirements

Local MIHOW programs are sponsored by child care centers, primary health care facilities, or nonprofit community agencies. Organizations implementing the model should value community health workers; embrace MIHOW’s strength-based approach; and have the administrative capacity to provide space, quality supervision, support services, and long-term sustainability for the site. Potential sites must complete a report indicating how their agency and community of interest fit the MIHOW criteria.

MIHOW requires sites and outreach workers to each meet a set of ongoing fidelity guidelines. Please contact the model developer for additional information about these guidelines.

Highlights

Minimum education requirement
High school diploma or GED

HomVEE requests input and feedback from the model developers on their profiles. The information in this implementation profile reflects feedback, if provided, from this model’s developer as of the above date. HomVEE reserves the right to edit the profile for clarity and consistency. The description of the implementation of the model(s) here may differ from how the model(s) was implemented in the manuscripts reviewed to determine this model’s evidence of effectiveness. Model developers are encouraged to notify HomVEE of any changes to their contact information on this page.