Maternal Infant Health Outreach Worker (MIHOW)®

MODEL
EFFECTIVENESS

Evidence-based model

MIECHV eligible

21
Manuscripts

Released in 2002 through 2025

3
Manuscripts

Impact studies rated high or moderate quality

Services intended at ages
Prenatal
0-6 months
7-11 months
12-23 months
24-35 months
Favorable results from well-designed 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 community-based home visiting model designed to support low-income families experiencing stress or social and geographic isolation. Families enroll during pregnancy and receive ongoing home visits until the child is age 36 months. MIHOW operates as a partnership between the Vanderbilt University School of Nursing and local community-based organizations. Vanderbilt University holds the model’s registered trademark.

MIHOW promotes positive maternal and child health outcomes by strengthening parent-child relationships, building caregivers’ confidence, and increasing caregivers’ knowledge of child development. The model connects families to medical providers, community resources, and social services so families can access the care and support they need.

Trained community health workers, known as outreach workers, deliver MIHOW services. Outreach workers share cultural and community connections with the families they serve. Through monthly home visits, outreach workers provide education, encouragement, role modeling, and strengths-based support.

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 Native 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.

21
Manuscripts

Released in 2002 through 2025

7
Manuscripts

Eligible for review

3
Manuscripts

Impact studies rated high or moderate quality

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.

Ambiguous findings are excluded from this table. An ambiguous finding is a statistically significant impact on an outcome measure in a direction that is not clearly beneficial for or potentially harmful 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. The evidence for effectiveness for the model may include additional studies that did not report this participant information.

Race/Ethnicity

The race and ethnicity categories may sum to more than 100 percent if Hispanic ethnicity was reported separately or respondents could select two or more race or ethnicity categories.

Hispanic or Latino
100%

Maternal Education

Less than a high school diploma
76%
High school diploma or GED
18%
Some college or Associate's degree
3%
Bachelor's degree or higher
3%
Unknown
1%

Other Characteristics

This data is only reported if known for at least 50 percent of participants in well-designed impact studies of the model.

Enrollment in means-tested programs
45%

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

  • Tennessee

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) Program began in Appalachia in 1982.

MIHOW is based in systems theory—the understanding that individuals are influenced by multiple interconnected systems. A caregiver’s health, well-being, and decision making are shaped not only by personal factors, but also by family relationships, community networks, service organizations, healthcare systems, and broader social conditions. MIHOW intentionally works within and across these systems to promote lasting change.

MIHOW outreach workers strive to improve systems to help caregivers meet their goals by:

  • Strengthening individual and family systems. Outreach workers help build and reinforce caregivers’ closest support networks and home environments. For example, outreach workers may encourage healthy communication about parenting and co-parenting, help a caregiver find people they trust to model positive parent-child interactions and support routines that promote child development and maternal well-being. 
  • Advocating for caregivers within larger systems. Outreach workers help caregivers navigate and access healthcare, social services, early childhood programs, and other community resources. For example, outreach workers may help caregivers schedule prenatal or pediatric appointments, complete applications, or accompany caregivers to appointments for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) or Medicaid. 
  • Supporting caregivers in improving the systems around them. MIHOW seeks to build caregivers’ confidence and self-advocacy skills so they can positively influence the systems they participate in. For example, outreach workers may coach caregivers on how to request workplace accommodations during pregnancy, advocate for their child’s early intervention services, prepare questions for service or healthcare professionals, or participate in community efforts related to local resources available to families.

MIHOW services are community-centered and build on the strengths, cultural wisdom, assets, and resilience of caregivers and families. The model recognizes that outreach workers bring valuable experience and community knowledge that strengthen their connection with caregivers.

Intended population

MIHOW primarily serves families with low incomes who may be experiencing stress or social and geographic isolation during pregnancy and early parenthood. The families may include caregivers who have recently moved to a new state, immigrants who have recently arrived in the country without established support networks, or individuals facing cultural or language barriers. 

MIHOW prioritizes enrollment during pregnancy to provide early support and time to build a trusting relationship between outreach workers and caregivers. Services continue until the child is age 36 months. 

Enrollment is not limited to first-time parents and MIHOW serves caregivers with more than one child. When eligible, families may remain in the program across multiple pregnancies.

Intended outcomes

MIHOW works to achieve the following outcomes: 

  • Improve maternal and child health outcomes. MIHOW promotes early and consistent prenatal care to support healthy pregnancies and birth outcomes. By enrolling families during pregnancy, outreach workers encourage mothers to initiate prenatal care early and follow healthcare providers’ recommendations, including maintaining healthy nutrition, taking prenatal vitamins, monitoring fetal growth and development, and managing chronic health conditions. After the child’s birth, caregivers continue receiving education and support related to postpartum recovery, maternal mental health, infant feeding, safe sleep practices, immunizations, developmental milestones, and adherence to well-child visit schedules. 
  • Connect families to medical and social services. MIHOW seeks to strengthen caregivers’ access to essential healthcare and community resources. Outreach workers are trained to keep their knowledge of local services, eligibility requirements, and referral processes up to date. They build collaborative relationships with community partners and use a structured referral and follow-up system to help caregivers access needed services. 
  • Build positive parenting skills. MIHOW supports caregivers in developing nurturing, responsive, and developmentally appropriate parenting practices. By demonstrating skills, completing guided activities, and holding reflective conversations, outreach workers help caregivers understand child development, strengthen attachment with their child, and build confidence in their parenting abilities.

Highlights

Populations intended
Families with low-income
Services intended at ages
Prenatal
0-6 months
7-11 months
12-23 months
24-35 months

Support Availability

Implementation support availability

MIHOW operates as a partnership between Vanderbilt University School of Nursing and local community-based organizations. MIHOW provides comprehensive support to local programs to help them implement the model effectively. This support includes:

  • Initial and ongoing training to familiarize staff with the MIHOW model and its core practices;
  • Guidelines and support for recruitment, including outreach workers and site leaders (supervisors);
  • Reflective supervision for outreach workers and site leaders to strengthen practice, build professional growth, and promote quality service delivery; 
  • Guidance on case management and strategies to connect families with community resources;
  • Outreach strategies for engaging caregivers; Approaches for connecting with healthcare providers, social service agencies, and local organizations; 
  • Best practices for overall program implementation, quality, and fidelity.

MIHOW offers peer networking calls for site leaders twice a month to support long-term success and collaboration among local programs. These calls allow programs to:

  • Share experiences and strategies with other sites; 
  • Discuss challenges and successes in implementing the model; 
  • Receive guidance tailored to their site’s infrastructure, capacity, and identified needs. 

To maintain quality and model integrity, MIHOW requires site leaders and outreach workers to adhere to established fidelity guidelines. Additional information about expectations for fidelity is available from the model developer.

Highlights

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

Service Delivery

Model services

MIHOW offers monthly home visits as its primary service. These visits include:

  • Parent education to support caregiving skills, healthy routines, and positive decision making; 
  • Role modeling for positive parent–child interaction; demonstrating nurturing, responsive, and developmentally appropriate practices; 
  • Health and developmental screenings to monitor maternal and child health and identify areas where additional support may be needed.

MIHOW also helps families by:

  • Sharing information and connecting families to medical and social services; 
  • Facilitating access to peer support groups and community resources.

Outreach workers use month-by-month guides to consistently plan and conduct home visits. These guides outline objectives and strategies for each visit, and follow REACH: The MIHOW Five-Step Recipe for a Home Visit (for more information about this resource, please contact the model developer).

During visits, outreach workers seek to actively listen to caregivers’ concerns and provide education and guidance on:

  • Nutrition, including obesity prevention and healthy eating habits; 
  • Health, including maternal health behaviors, birth outcomes, and preventive care; 
  • Child development, including early learning, social-emotional growth, and developmental milestones.

These services are designed to improve caregivers’ problem-solving skills, goal setting, and self-advocacy, as well as the family’s overall well-being. Outreach workers also conduct routine health and development screenings to monitor maternal and child health.

Although in-person home visits are preferred, MIHOW offers virtual visits upon request or when it is not possible to deliver services in person.

In addition to home visits, MIHOW offers opportunities for group engagement and peer support, such as parenting workshops, support circles, and community events.

Model intensity and length

Home visiting requirements: 

MIHOW provides monthly home visits lasting about one hour each. These visits are structured to allow enough time for building trust, providing education, observing parent–child interactions, and addressing caregivers’ questions and concerns. Outreach workers tailor the content and pacing of each visit to meet the family’s needs and goals. Although monthly visits are the standard, MIHOW allows for additional visits or intensified support for families with higher needs or during transitional periods, such as postpartum recovery, illness, or changes in family circumstances. 

Service duration: 

Services continue from enrollment during pregnancy until the child is age 36 months.

Tailored services and enhanced models

MIHOW is designed to be flexible and responsive to the needs of local sites and the communities they serve. Although core components of the model must be implemented with fidelity, local sites may tailor service delivery approaches to reflect community strengths, culture, language, and available resources. There are no formal adaptations or enhancements to the model beyond its standard framework.

Implementation with Indigenous peoples and communities

MIHOW has not been implemented in Native communities.

Highlights

Program is available in other language(s)
Arabic
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

Education and supervisory requirements:

Staff. MIHOW outreach workers are trained to implement the model and serve as home visitors. Staffing arrangements are tailored to individual site capacity and community needs. Some sites employ full-time outreach workers, whereas others employ part-time staff. Each site must also employ a designated site leader to provide oversight, supervision, and program support. The site leader monitors fidelity through monthly calls with the model developer, reviewing annual plans and training calendars, and overseeing data collection.

Education and experience. Outreach workers must:

  • Be from the local community;
  • Have at least a high school diploma or the equivalent;
  • Be able to demonstrate a positive parenting history in a description of their own attitudes and actions regarding their experience related to pregnancy and caregiving of infants and young children;
  • Share a similar background and experience with participating caregivers;
  • Show understanding of the local community and respect for individuals from different backgrounds.

There are no formal education requirements for site leaders; however, the model recommends they hold at least a bachelor’s degree or have at least one year of supervisory experience.

Supervision. MIHOW recommends that site leaders use reflective supervision to promote fidelity to the model, support professional growth, and foster high-quality service delivery. At a minimum, site leaders are required to complete the following activities:

  • Hold one-on-one meetings with outreach workers at least monthly and evaluate their performance; 
  • Provide individual and group opportunities for outreach workers to share successes and concerns; 
  • Respond to concerns promptly and constructively; 
  • Be evaluated by the outreach workers annually. 

Training and Professional Development:

Pre-Service Training. The model requires both outreach workers and site leaders to participate in pre-service training before implementing services.

  • Outreach workers must complete 40 hours of core training, shadow an experienced outreach worker, and receive an individual assessment from their supervisor.
  • Site leaders must complete pre-service training alongside their staff and participate in a four-hour site leader training (virtual or in person). 

Additional information about pre-service training requirements is available from the model developer. 

Ongoing Professional Development. MIHOW recommends that outreach workers and site leaders participate in ongoing professional development to maintain fidelity and strengthen program quality. Opportunities include: 

  • Monthly training. Local sites provide monthly training aligned with MIHOW—emphasizing specific competencies for outreach workers and community needs.
  • Networking calls. Site leaders must engage in biweekly peer networking calls with members of the MIHOW leadership team and other site leaders. 
  • Annual conference. Site leaders and outreach workers from all sites gather for three days of workshops, networking, reflection, and team building.
  • Biennial site leaders’ meeting. Site leaders meet every two years for networking, reflection, strategic planning, evaluation, and advanced training.

Additional information about ongoing professional development requirements is available from the model developer.

Organizational requirements

Local MIHOW programs are typically implemented by nonprofit community agencies, child care centers, or primary healthcare organizations.

Organizations implementing MIHOW should:

  • Value and support the role of community health workers;
  • Embrace MIHOW’s strengths-based philosophy; 
  • Demonstrate administrative capacity to provide office space, quality supervision, support services, and long-term sustainability.

Prospective sites must complete an organizational readiness report outlining how their agency and community align with MIHOW criteria. Additional information about this tool is available from the model developer. 

Sites are encouraged to attain affiliation status by demonstrating they are compliant with all ten MIHOW standards. A site review is conducted to determine the site’s fidelity to the MIHOW model.

Highlights

Minimum education requirement
High school diploma or GED
Professional certification required for home visitors
No

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. HomVEE reserves the right to edit the profile for clarity and consistency. The description of the implementation of the model here may differ from how the model 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.