The Effects of Home Visiting on Prenatal Health, Birth Outcomes, and Health Care Use in the First Year of Life

Improving birth outcomes among socioeconomically disadvantaged women has been a long-standing policy goal. One potential approach to improving birth outcomes is home visiting, which provides pregnant women and families who have young children with education and support, assessment, and referrals to community services. A few prior studies of evidence-based home visiting models — specifically, Healthy Families America (HFA) and Nurse-Family Partnership (NFP) — revealed some improvements in low birth weight and preterm birth. However, these results have not been found in all prior studies of the models’ examinations of birth outcomes and were conducted years ago, from the late 1970s through the early 2000s. Given that both families and local programs have changed since those studies were completed, a new test of whether home visiting programs can improve birth outcomes was warranted.

The Mother and Infant Home Visiting Program Evaluation-Strong Start (MIHOPE-Strong Start) was launched in 2012 to test whether evidence-based home visiting provided during pregnancy improves birth outcomes, prenatal health, and health care use in infancy. Specifically, the MIHOPE-Strong Start analysis includes 2,900 families across 66 local HFA and NFP home visiting programs in 17 states. The Administration for Children and Families partnered with the Centers for Medicare and Medicaid Services and the Health Resources and Services Administration to sponsor MIHOPE-Strong Start. MDRC conducted the evaluation in collaboration with James Bell Associates, Johns Hopkins University, Mathematica Policy Research, and New York University. This report presents final implementation and impact results from the study. A separately published report from the Mother and Infant Home Visiting Program Evaluation (MIHOPE) presents program effects on a wider range of family outcomes and for two additional evidence-based models.