MIHOPE Across the Years: Insights from Evaluating the MIECHV Program

• In Event: Federal Goals, State Realities: What Home Visiting Evidence Reveals About State Variation in Family Outcomes

Abstract

Introduction / Background
Early childhood home visiting programs are designed to affect a wide range of maternal, family, and child outcomes across multiple areas. The federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program represents the largest national investment in evidence-based early childhood home visiting. The Mother and Infant Home Visiting Program Evaluation (MIHOPE) is the federal government’s congressionally mandated evaluation of MIECHV, designed to rigorously assess how home visiting was implemented in the early years after the Program’s inception (from 2012-2017) and whether it improves outcomes for families and children over time. As policymakers increasingly rely on evidence to guide decisions about sustaining and strengthening home visiting, synthesizing lessons across MIHOPE’s multiple study phases is critical.

Purpose / Research Question
This paper synthesizes findings across the full body of MIHOPE’s implementation and impact analyses to examine: (1) How were the models implemented and were family characteristics associated with service delivery? and (2) What patterns of impacts emerge across maternal, family, and child outcomes from infancy through kindergarten?

Methods
MIHOPE is a large-scale, longitudinal randomized controlled trial that enrolled 4,229 mothers and infants between 2012 and 2015 across 12 states and 88 local programs implementing one of four evidence-based models: Early Head Start–Home-based Option, Healthy Families America, Nurse-Family Partnership, and Parents as Teachers. Families were randomly assigned to receive access to home visiting services or to a control group. Data collection included administrative records, surveys, direct assessments, and qualitative interviews. Analyses examined implementation fidelity, service delivery, and impacts when children were 15 months old, 2.5 and 3.5 years old, and in kindergarten/first grade. In addition to individual outcome analyses, MIHOPE employed statistical methods that assess patterns of effects across multiple domains to capture the multifaceted goals of home visiting. 

Results / Findings
MIHOPE findings show that local programs generally adhered to model guidelines, though there was substantial variation for individual families in visit frequency, duration, and content. Families with greater needs participated in fewer visits on average, but, as home visiting is designed to do, programs tailored services to address complex challenges such as mental health, substance use, and intimate partner violence. Impact analyses indicate modest early effects on several family outcomes, consistent with prior home visiting research. Over the longer term, MIHOPE identified benefits in maternal mental and behavioral health, parent–child interactions, family relationships, and economic circumstances, while results for children’s outcomes were mixed. Examining patterns of effects across outcome domains revealed broader benefits than analyses focused on single outcomes alone.

Conclusion / Implications
Taken together, MIHOPE’s findings demonstrate both the promise and the complexity of federally funded home visiting. Though average impacts are modest, programs are able to adapt services to address families’ diverse needs, with implications for strengthening implementation and retention strategies to better support families facing the greatest challenges.The results also underscore the importance of considering multi-domain outcome patterns when interpreting program effectiveness, enabling a more complete understanding of how home visiting may generate meaningful benefits that are distributed across multiple aspects of well-being.

Author

• Ximena A Portilla, MDRC
  Presenting Author