Lee, H., Crowne S., Estarziau M., Kranker K., Michalopoulos C., Warren A., Mijanovich T., Filene J. H., Duggan A., and Knox V. (2019). The Effects of Home Visiting on Prenatal Health, Birth Outcomes, and Health Care Use in the First Year of Life, Final Implementation and Impact Findings from the Mother and Infant Home Visiting Program Evaluation-Strong Start (OPRE Report, 2019-08). [Study 2-HFA contrast]. Washington, DC, Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. https://www.acf.hhs.gov/sites/default/files/documents/opre/mihope_stron…
| Screening decision | Screening conclusion | HomVEE procedures and standards version |
|---|---|---|
| Passes screens | Eligible for review | Version 2 |
| Rating | Design | Attrition | Baseline equivalence | Compromised randomization | Confounding factors | Valid, reliable measure(s) |
|---|---|---|---|---|---|---|
| High | Randomized controlled trial | Low | Not assessed for randomized controlled trials with low attrition |
No | No |
Yes |
The Mother and Infant Home Visiting Program Evaluation-Strong Start (MIHOPE-Strong Start) included two evidence-based home visiting models; this review focuses on Healthy Families America (HFA). Findings in the manuscript that are pooled across various home visiting models are ineligible for review because HomVEE only reviews findings that isolate the effects of a specific model. Information on sample sizes, further information about findings, and information necessary to demonstrate equivalence of the intervention and comparison groups is based on correspondence with the authors.
| Study participants | The Mother and Infant Home Visiting Program Evaluation-Strong Start (MIHOPE-Strong Start) is a national evaluation of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program for families enrolled in Medicaid or the Children’s Health Insurance Program. MIHOPE-Strong Start study participants were recruited from local programs that primarily served Medicaid beneficiaries from 2012 to 2015. Participants were eligible for the MIHOPE-Strong Start evaluation if they were no more than 32 weeks pregnant, were age 15 or older, spoke English or Spanish proficiently, and met the relevant eligibility criteria for the local home visiting model. A total of 1,028 participants were recruited for the study through Healthy Families America (HFA) programs and randomly assigned to either the HFA home visiting intervention group (569 participants) or the comparison condition (459 participants). Up to 848 participants recruited for the study through HFA programs were included in the analyses: 466 in HFA and 382 in the comparison group. Similarly, up to 1,036 children of these participants were included in the analyses: 575 in HFA and 461 in the comparison group. Outcomes were measured at childbirth and when children were 12 months old. For MIHOPE-Strong Start participants recruited through HFA programs, 18 percent of women were of Mexican origin, 15 percent were another Hispanic ethnicity, 30 percent were White, 28 percent were Black, and 9 percent were another race. Thirty-six percent had less than a high school diploma at study entry. At enrollment, the average age of participants recruited through HFA programs was 24. |
|---|---|
| Setting | The study took place in 17 states: California, Georgia, Illinois, Indiana, Iowa, Kansas, Massachusetts, Michigan, Nevada, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Washington, and Wisconsin. The evaluation selected 37 local program affiliates that operated Healthy Families America (HFA) and met program eligibility criteria. |
| Intervention services | As described in this manuscript, Healthy Families America (HFA) consists of activities designed to assess family needs, educate and support parents, and refer families to community services. The content and delivery of HFA vary, but the intervention has historically focused on preventing child maltreatment and is typically geared toward families at risk of child maltreatment or with behavioral health issues. Families enroll in HFA prenatally or within the first three months after a child’s birth. Eighty-four percent of families assigned to the intervention group received at least one home visit. Families participated in home visits for an average of 9.2 months and received an average of 24 visits. |
| Comparison conditions | Women assigned to the comparison group were not eligible to receive Healthy Families America (HFA) services. They received information about other appropriate services in their local community. |
| Subgroups examined |
This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report). There were no subgroups reported in this manuscript. |
| Funding sources | This research was supported by the Administration for Children and Families, funded by the U.S. Department of Health and Human Services under a competitive award, Contract No. HHS-HHSP23320095644WC. |
| Author affiliation | Authors are affiliated with MDRC and subcontractors James Bell Associates, Johns Hopkins University, Mathematica, and New York University. HomVEE is not aware of any relationship between the authors and the home visiting model developer or distributor. |
| Peer reviewed | No |
Clinicaltrials.gov Identifier: NCT02076204. Study registration was assessed by HomVEE for Clinicaltrials.gov beginning with the 2014 review, and for other registries beginning with the 2021 review.
Findings that rate moderate or high
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Admitted to neonatal intensive care unit (%) |
FavorableUnfavorable or ambiguousNo Effect |
HFA vs. Resource referral RCT (MIHOPE-Strong Start), 2012-2015, United States, full sample |
Birth |
1,036 infants | Not reported | Not reported | Difference = 0.02 | Not available | Not statistically significant, p= 0.44 |
|
| High | Any emergency department visits (%) |
FavorableUnfavorable or ambiguousNo Effect |
HFA vs. Resource referral RCT (MIHOPE-Strong Start), 2012-2015, United States, full sample |
12 months old |
1,036 infants | Not reported | Not reported | Difference = 0.00 | Not available | Not statistically significant, p= 0.96 |
|
| High | Any nonbirth hospitalizations (%) |
FavorableUnfavorable or ambiguousNo Effect |
HFA vs. Resource referral RCT (MIHOPE-Strong Start), 2012-2015, United States, full sample |
12 months old |
1,036 infants | Not reported | Not reported | Difference = -0.02 | Not available | Not statistically significant, p= 0.16 |
|
| High | Average number of well-child office visits |
FavorableUnfavorable or ambiguousNo Effect |
HFA vs. Resource referral RCT (MIHOPE-Strong Start), 2012-2015, United States, full sample |
12 months old |
1,036 infants | Not reported | Not reported | Difference = 0.14 | Not available | Not statistically significant, p= 0.39 |
|
| High | Infant was breastfed at hospital discharge (%) |
FavorableUnfavorable or ambiguousNo Effect |
HFA vs. Resource referral RCT (MIHOPE-Strong Start), 2012-2015, United States, full sample |
Birth |
807 infants | Not reported | Not reported | Difference = -0.03 | Not available | Not statistically significant, p= 0.32 |
|
| High | Low birth weight (< 2,500 grams) (%) |
FavorableUnfavorable or ambiguousNo Effect |
HFA vs. Resource referral RCT (MIHOPE-Strong Start), 2012-2015, United States, full sample |
Birth |
935 infants | Not reported | Not reported | Difference = 0.02 | Not available | Not statistically significant, p= 0.51 |
Negative effect is favorable to the intervention. |
| High | Preterm birth (< 37 weeks) (%) |
FavorableUnfavorable or ambiguousNo Effect |
HFA vs. Resource referral RCT (MIHOPE-Strong Start), 2012-2015, United States, full sample |
Birth |
935 infants | Not reported | Not reported | Difference = 0.01 | Not available | Not statistically significant, p= 0.68 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Any smoking during third trimester (%) |
FavorableUnfavorable or ambiguousNo Effect |
HFA vs. Resource referral RCT (MIHOPE-Strong Start), 2012-2015, United States, full sample |
Birth |
848 mothers | Not reported | Not reported | Difference = -0.01 | Not available | Not statistically significant, p= 0.31 |
Negative effect is favorable to the intervention. |