Visits and Calls with Local Program Directors

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Length of time for instrument: 3.00 hours

ATTACHMENT 4: MIHOPE VISITS AND CALLS WITH LOCAL
PROGRAM DIRECTORS
2/22/2012

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Draft AGENDA for Meeting with Local Program Staff
Thank you for taking time to meet with the MIHOPE study team. As a reminder, the U.S.
Department of Health and Human Services has contracted with MDRC to evaluate the federal
Maternal, Infant and Early Childhood Home Visiting program (MIECHV). We expect this
meeting to take one and a half hours. We will be using the meet to answer your questions about
the study and to learn more about your state and local program sites in order to help us choose
states and sites for the evaluation. As you may remember, the MIECHV legislation requires this
national evaluation and your state provided assurances about your willingness to participate in
the evaluation, if selected. All information provided in these discussions will be kept private to
the extent permitted by law.
Participants: (names of all those attending)
I. Introductions
II. Study overview and discussion


Project description



Research questions and study design



Benefits of participation



Roles and responsibilities



MIHOPE timeline



Steps for site selection

III. Discussion of key site information (see detailed list of topics below)


Administrative structure



Recruitment and enrollment schedule



Data systems



Other research feasibility questions

IV. Next steps
Adjourn

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Slide 1

Slide 2

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


Project description and management for
MIHOPE
MIHOPE research questions and study design
Benefits of participation
Roles and responsibilities of participation
MIHOPE timeline
Stages for state/program site selection

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Slide 3

Mother and Infant Home Visiting
Program Evaluation






Large-scale evaluation of the effectiveness of
home visiting models supported by MIECHV
Includes 85 program sites in 12 states
nationwide
Focuses on models serving at-risk expectant
families and infants to 6 months

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Slide 4

Sponsored by: U.S. Department of Health and Human
Services, Administration for Children and Families,
Office of Planning Research and Evaluation (OPRE) and
Health Resources and Services Administration (HRSA)
Authorization: Maternal, Infant and Early Childhood
Home Visiting Program (MIECHV), Patient Protection and
Affordable Care Act of 2010

Project Team:
 MDRC
 James Bell Associates
 Johns Hopkins University
 Mathematica Policy Research

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Slide 5

MIHOPE is designed to answer three main
questions:
◦ How do local programs operate and who are the
families who participate?
◦ Do MIECHV services make a difference in the lives
of the families that are served?
◦ What are the costs of running a home-visiting
program?

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Slide 6






Evidence-based models supported with
MIECHV funding
Models serving expectant families or those
with infants
Models selected for implementation by at
least 10 states
Models:
◦
◦
◦
◦

Early Head Start-Home Visiting
Healthy Families America
Nurse Family Partnership
Parents as Teachers

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Slide 7

Analysis

of state needs assessments

Effectiveness

study

o Reports variation in impacts for sites and
populations with different characteristics
o Incorporates study of health disparities and
outcomes
o Includes implementation study

Economic

evaluation
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Slide 8











National recognition for your state and
MIECHV program
Builds strong evidence base to inform home
visiting policy decision making
Provides information on what differences
home visiting programs make
Funds to support staff participation in
research activities
Provides program and state feedback about
program participation
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Slide 9






A lottery-like process to place individuals into
a program group and a comparison group
Increases the likelihood that groups have
similar characteristics on average before
treatment, so the differences over time in the
outcomes for the groups is more likely the
effect of the program services offered to the
program group
Allows you to measure the impacts (effects) on
outcomes for each group, not for individuals in
the groups

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Slide 10






Fair and equitable way to determine who
receives program services
More reliable way to measure program effects
than statistical controls alone
Widely used in social service settings
Endorsed by:
◦
◦
◦
◦
◦

The Department of Health and Human Services
The Office of Management and Budget
The Department of Labor
The Department of Education
Other federal and private agencies

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Slide 11

Educational Attainment
Outcome (%)

ChalleNGe

Comparison

Difference

Has High School diploma or GED

71.8

55.5

16.2***

HS Diploma

30.3

26.6

3.7

GED

56.9

34.5

22.4***

34.9

18.8

16.1***

Earned any college credit

Employment in the Past 12 Months

Employed

88.4

84.5

3.9*

Earnings ($)

13,515

11,248

2,266***

Number of months employed

8.1

7.2

0.9***

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Slide 12



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

Operating location that can recruit approx. 60
families in 12-15 months and provide
services to 30
Has more than 2 years experience offering
home visiting services
Is offering at least 1 of the 4 models selected
for evaluation
Would be willing to implement research
procedures

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States:
 Facilitate agency’s recruitment of program sites
 Help negotiate access to state administrative records for
purposes of the study
Programs:
 Recruit and enroll 60 couples (30 in the program group
and 30 in the comparison group)
 Staff and administration participate in interviews and
surveys
 Provide program records such as staffing, training, and
cost information
 Complete and submit program participation logs
 Facilitate home visits videotaped by research staff (9
families, 2 visits each)
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Slide 14








Explain research design and provide training
on research procedures
Enroll program participants in the study and
collect consent forms
Collect data through surveys, interviews,
observations, and program and
administrative records
Provide funding to programs to offset costs
of research participation
Analyze data, provide results, and
disseminate information
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Slide 15

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Slide 16










Meet with study team to learn more about the
evaluation and provide information
Discuss research design and reach agreement
on roles and responsibilities
Prepare for research enrollment and data
collection
Implement evaluation procedures
Study team monitors research procedures
and provides feedback
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Slide 17

Phase 1
 Site recruitment and selection: 2012
 Enroll families in the evaluation: mid
2012 through 2014
 Report to Congress on characteristics of
enrolled families: 2015
Phase 2 (date is tentative)
 Report on program impacts: 2017

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Slide 18

If you would like additional information about
logo

please contact us at:
[email protected]
[email protected]
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DISCUSSION TOPICS ABOUT KEY SITE INFORMATION
Thank you for taking time to meet with the MIHOPE study team. As a reminder, the U.S.
Department of Health and Human Services has contracted with MDRC to evaluate the federal
Maternal, Infant and Early Childhood Home Visiting program (MIECHV). We expect this
meeting to take one and a half hours. We will be using the meet to answer your questions about
the study and to learn more about your state and local program sites in order to help us choose
states and sites for the evaluation. As you may remember, the MIECHV legislation requires this
national evaluation and your state provided assurances about your willingness to participate in
the evaluation, if selected. All information provided in these discussions will be kept private to
the extent permitted by law.

Discussion Topics about Key Site Information
Administrative Structure


Organizational structure of administering agency; governing boards; other programs
operating in same agency; how long organization and home visiting programs have been
in operation; expected stability of non-MIECHV funding



Service Delivery Structure; # home visitors; supervision; training; staff qualifications of
HVs; length of time HVs delivered model; staff turnover rate



Intensity of program services; duration; frequency of contact; rate of program attrition.



Ways MIECHV funds are being used; hiring new home visitors; expanding caseload of
existing home visitors



Local context; alternative community services, specifically presence of other homevisiting programs or center-based programs.



Other evaluation activities going on at organization or within home visiting program



Timing of program model recertification



For EBHV sites: As grants end, are you continuing with MIECHV funds?

Recruitment and Enrollment Schedule


Target population; race/ethnicity; military; other special populations, such as teens, foster
kids, immigrant families etc.



Marketing and outreach; methods used to recruit; length of recruitment period; type of
referral sources; most common referral sources; any families that are exempted from
intake process (i.e. immediately get into program)

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

Screening and intake process; any centralized activities; summary of number of families
and timing from applicant through intake; exceptions made to the intake process;
evidence of demand (waitlists, lotteries)



Enrollment; total number enrolled; ways families are notified; referrals elsewhere if not
enrolled

Data Systems


Type of management information systems used at local program site (i.e. How are the
systems used? What goes in them and when?)

Other research feasibility questions


Concerns about the buy-in of local program referral sources?



Concerns about service contrast?



Concerns about sufficient pool?



Concerns about random assignment?

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Project Description
(INSERT MIHOPE LOGO)
Mother and Infant Home Visiting Program Evaluation
Home visiting programs are recognized as an important strategy for providing support services to families
with young children. Programs are diverse, widely used across the country, and generally aim to provide
information, referrals, and parenting support to reduce child maltreatment, improve maternal and child
health, and improve early school readiness. The recent growth in federal funding to support the scale up
of evidenced-based programs provides an unprecedented, critical opportunity for program and research
collaboration at the Federal, State, and community levels.
The Mother and Infant Home Visiting Program Evaluation (MIHOPE) is sponsored by the U.S.
Department of Health and Human Services, Administration for Children and Families and the Health
Resources and Services Administration. This evaluation, mandated by the Patient Protection and
Affordable Care Act of 2010 (PPACA) (P.L. 111-148), is designed to build knowledge for policymakers
and practitioners about the effectiveness of the new federally funded Maternal, Infant and Early
Childhood Home-Visiting Program (MIECHV) in improving outcomes for at-risk children and families.
The Study. The experimental study includes: an analysis of the state needs assessments that were
provided in the state MIECHV applications; an effectiveness study that includes an impact analysis to
measure what difference home visiting programs make for the at-risk families they serve, focusing on
areas like prenatal, maternal, and newborn health, child development, parenting, domestic violence, and
referrals and service coordination. The effectiveness study will also include an implementation analysis
that will examine how the program models operate in their local and state contexts and describe the
families who participate; and an economic analysis that will examine the financial costs of operating the
programs. A special goal of this study is the linking of implementation strategies to program impacts, thus
informing the field about the types of program features or strategies that might lead to even greater
impacts on families. For example, understanding how, and at what level, the average family participates
in the program will provide context to any variation in impacts we find in the health of families. The
primary data used in the study is expected to be collected by the research team through surveys, review of
administrative records, interviews, observations, and staff logs.
Selection and Enrollment. Sites in the evaluation will operate one of four models that meet HHS’
criteria for evidence-based models and were chosen by at least 10 states for their MIECHV programs:
Early Head Start – Home Visiting, Healthy Families America, Nurse Family Partnership, and Parents as
Teachers. Approximately 85 local home visiting program sites in 12 states will be selected to participate.
Participating sites will recruit families, will determine family eligibility criteria and, among those who are
eligible, will use a lottery-like process, also known as random assignment, to select which families to
enroll in home visiting services. The use of random assignment means that each program will need to
have more people eligible for services than can be enrolled into home visiting. The research team will
work with each program to build on their existing outreach and assessment processes to help recruit
enough families. All families in the lottery will be invited to participate in the evaluation. Those selected
for home visiting services will form the program group, and those not selected will form a comparison
group. The research team will monitor both groups over time to see if differences emerge in the outcome
areas mentioned above. A total of 5,100 families are expected to participate in the study.
Benefits to Participation. Participating in a study like MIHOPE includes the following benefits: (1)
Recognition to your state and MIECHV programs distinguishing your practices and demonstrating your

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commitment to rigorous research on program effectiveness; (2) A strong evidence base to inform public
funding of home visiting and national family policies; (3) Facts about what difference home visiting
programs make, who they make more difference for, and why; and (4) Feedback about program and state
program participation; and (5) Funds to support staff participation in research activities.
Project Timeline. Study enrollment and data collection will begin in 2012. Data gathered from the initial
information provided by families and staff will be published in a report to Congress in 2015. There are
plans for follow up through 2018.
The Study Team. The study will be conducted by a team of organizations: MDRC (the lead), James Bell
Associates, Johns Hopkins University, and Mathematica Policy Research. For more information please
contact: [email protected] or [email protected].

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(INSERT LOGO)
MIHOPE Frequently Asked Questions
Results of the Mother and Infant Home Visiting Program Evaluation (MIHOPE) will provide
important input into the national debate about policies and practices designed to improve the
well-being of at-risk families and children. The Administration for Children and Families, the
Health Resources and Services Administration, and the study team are working out the details of
the study design. Below are answers to some questions states and their implementing agencies
may have about the study.

How will state and local programs be selected for the study and how many will be
selected?
Local programs in the evaluation will reflect the national diversity of communities implementing
MIECHV programs and the populations they serve. Local programs will operate one of four
models that meet HHS’ criteria for evidence-based models and that were chosen by at least 10
states for their MIECHV programs: Early Head Start – Home Visiting, Healthy Families
America, Nurse Family Partnership, or Parents as Teachers. Approximately 85 local home
visiting program sites in 12 states will be selected to participate. Some types of states (for
example, those that have never operated one of these home visiting program models before) may
be excluded from consideration. States with a larger number of local program sites or greater
diversity within state of urban and rural locations might have a greater chance of being selected
in order to ensure that the study includes a sufficient number of diverse families.

Is participation in the study required, and will information be kept confidential?
As a condition of receipt of the MIECHV funds, states had to provide assurances that, if asked,
they would participate in the legislatively-mandated evaluation. Participation by families in
evaluation sites is voluntary, and families may opt out of any and all data collection activities.
All information collected from program staff and families will be kept private to the extent
allowed by the law.

If the program models are already considered evidence-based, why is this study
necessary?
Previous studies of the effectiveness of home visiting programs have found some positive
effects, but research methods have been inconsistent across studies of different program models.
Prior studies also often lack information about how services were delivered and which kinds of
families experience the greatest benefits. In addition, states’ MIECHV programs are operating
under different conditions than the programs in many prior studies, with different supports and
requirements. This new study will provide information about programs as they operate under
MIECHV. It will systematically gather standard information about nearly 5,100 families across
all of the evidenced-based models. The study will use a mix of research methods to analyze
states’ needs assessments, measure the effects of home visiting programs overall and across
programs and populations, examine how program features are associated with service delivery

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and impacts, and analyze the economic costs of operating home visiting programs. Most
critically, this study answers the call from legislators for on-going research to inform federal
funding of home visiting programs.

Will the study mean that programs serve fewer families than before?
No, a local program site’s participation in the study should have no bearing on the number of
families it serves. Those programs participating in the evaluation will need to have more families
apply than they can serve. Many home visiting programs are only able to work with a fraction of
the families and children in their communities who might benefit from these services. The study
is looking for local programs that can recruit at least 60 eligible families in 12-15 months to be
entered into a lottery-like process called random assignment to select half of the families to
enroll in home visiting services. The families who are not selected for home visiting will form a
comparison group and may be referred to other services in the community. As necessary, the
research team will work closely with each program to build on their existing outreach and
assessment processes to help recruit additional families.

Is it unethical to use random assignment to decide which families receive
services?
No, it is not unethical to use random assignment to determine who receives services. Many
people see random assignment as a fair way to allocate scarce program slots when there are more
eligible applicants than a program can serve. In fact, some families not selected for the program
may be more willing to accept that this was due to the “flip of a coin” rather than to their
personal characteristics. Before it is finalized, the study design will be reviewed by an
Institutional Review Board to ensure that families in the study will be treated fairly.

How will random assignment affect a program’s normal intake procedures?
To the extent possible, programs will follow their normal intake procedures. The study team will
work to develop a process that minimizes the disruption of program operations as much as
possible. For example, the staff who assess parents for eligibility into the program will not be
expected to enroll families into the study or collect data for the study. After eligibility is
determined, a research team member will collect information needed by the study and conduct
the lottery process. The local program will then begin to provide services to those families who
are randomized into the group that receives program services. The study team selected by HHS
has extensive experience with studies of this type and is sensitive to the needs and concerns of
program operators.

What data will programs provide to the study team?
Programs will not have to collect any special information from families. Most data about
families in the study are expected to come from surveys conducted with families in the program
and comparison groups by the study team. However, the study also plans to collect information
about how the program operates in each local site. This may include gathering program policies
and administrative records, interviews with state administrators, videotaped observations of
selected home visits, annual web-based surveys of local staff, and weekly completion of web-

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based activity logs by home visitors and supervisors. Home visiting program staff may be asked
to host a program visit by the research team.

Who will be doing the study?
The Department of Health and Human Services selected a team of four organizations to conduct
the study: MDRC (the lead), James Bell Associates, Johns Hopkins University, and Mathematica
Policy Research. The team collectively has extensive experience designing and carrying out
innovative large-scale national random assignment evaluations of social service programs. Team
members are also responsible for much of the most recent research on home visiting programs,
including the Design Options for Maternal, Infant, and Early Childhood Home Visiting
Evaluation (DOHVE), the Home Visiting Evidence of Effectiveness (HomVEE) review, local
and cross-site evaluations of Supporting Evidenced-Based Home Visiting Initative (EBHV), as
well as random assignment studies of home visiting programs in Alaska, Hawaii, and New
Jersey.

How can I contact the study team?
For more information please contact: [email protected] or [email protected]

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Interested in being a MIHOPE site?
The Mother and Infant Home Visiting Program Evaluation (MIHOPE) research team is looking
for home visiting programs to participate in a large-scale evaluation. Home visiting programs are
recognized as an important strategy for providing support services to families with young
children. Programs are diverse, widely used across the country, and generally aim to provide
information, referrals, and parenting support to reduce child maltreatment, improve maternal and
child health, and improve early school readiness. The recent growth in federal funding to support
the scale up of evidenced-based programs provides an unprecedented, critical opportunity for
program and research collaboration at the Federal, State, and community levels.
The U.S. Department of Health and Human Services, Administration for Children and Families
and the Health Resources and Services Administration are sponsoring MIHOPE. The study,
mandated by the Affordable Care Act, is designed to build knowledge for policymakers and
practitioners about the effectiveness of the new federally funded Maternal, Infant and Early
Childhood Home-Visiting Program (MIECHV) in improving outcomes for at-risk children and
families.

What are the benefits of my program participating?
 Recognition to your program distinguishing your practices and demonstrating your
commitment to rigorous research on program effectiveness.
 A strong evidence base to inform public funding for home visiting and national family
policies.
 Knowledge about what difference home visiting programs make, for whom they make more
difference, and why.
 Feedback about program participation.
 Funds to support staff participation in research activities.

What types of programs are needed?
 Operating at least one of four models that meet HHS’ criteria for evidence-based models:
Early Head Start - Home Visiting, Healthy Families America, Nurse Family Partnership, or
Parents as Teachers.
 Experienced offering home visiting services for two years or more.
 Can recruit at least 60 new families within a 12-15 month time period and provide services to
at least 30 families.
 Willing to implement research procedures.

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What steps are involved with participation in the evaluation?
 Step 1. Meet with the study team to learn more about the evaluation and provide
information. Through a series of telephone calls and in-person meetings, study team
members will contact state level organization and later implementing agencies to describe the
study and learn more about the local MIECHV programs. This information will be used to
help the team choose which states and sites will be included in the evaluation. Each
telephone call is expected to last one hour and in-person meetings are expected to last half a
day. The study team and federal partners will use the information shared to determine the
locations that are a good fit for the study. As you may remember, the MIECHV legislation
requires this national evaluation and your state provided assurances about your willingness to
participate in the evaluation, if selected.
 Step 2. Discuss the research design and reach agreement on roles and responsibilities.
The study team will meet with local program sites (e.g. their leadership, staff, referral
sources, and any other appropriate individuals) to further discuss what participation in the
study would mean and begin to design research procedures. Agreements will be executed
between the local program and the study team to describe the roles and responsibilities of
each during the course of the study.
 Step 3. Prepare for research data collection. The study team will work with program staff
from each local program site to finalize the research procedures. The study team will provide
materials and train appropriate staff on how to implement the process.
 Step 4. Implement evaluation procedures. The study team will enroll families into the
study. Most data about families in the study are expected to come from surveys conducted
with families by the study team. However, some data may come from the local program sites.
This may include videotaped observations of selected home visits, annual web-based surveys
of local staff, and weekly completion of web-based activity logs by home visitors and
supervisors. All information collected for the evaluation will be kept private to the extent
allowed by law.
 Step 5. Monitor and provide feedback. The study team will monitor the research
procedures and provide assistance as needed. Program implementation data will be shared
periodically. The study team will visit the program to complete implementation research
activities.

MIHOPE_ Site Participation Overview