Federal Home Visiting Program can be Improved to Better Meet Needs of Families

Julie Kapp, PhD

Compared with other countries, the United States often falls short on many maternal and child health outcomes. A federal program known as Maternal, Infant, and Early Childhood Home Visiting (MIECHV) is designed to give pregnant women and families resources to help them raise healthy children.

However, a team led by researchers at the University of Missouri School of Medicine examined an aspect of the initiative and found areas that could be strengthened to improve the program, and ultimately, the health of mother and child.

The multibillion-dollar MIECHV program was formed as part of the 2010 Patient Protection and Affordable Care Act. It provides funding to organizations that offer home visiting services to improve maternal-child health. These organizations are required to demonstrate improvements over time, and the MIECHV program monitors this progress through specific benchmarks.

“Our country has one of the highest infant mortality rates compared with peer countries, so it’s vital that this program mobilize the right resources in the most effective ways possible,” said Julie Kapp, PhD, associate professor of health management and informatics at the MU School of Medicine and an author of the study. “While the MIECHV program as a whole and the federal initiatives around maternal-child health are trying to take the right steps to help families, our research suggests there may be ways to improve upon their implementation.”

The MIECHV program has established six benchmarks for organizations to demonstrate improvement, which can ultimately impact funding decisions. The research team evaluated the evidence for one benchmark, “Maternal and Newborn Health,” which is broken down into six measurable sub-categories, or constructs.

  1. Preterm birth
  2. Breastfeeding
  3. Depression screening
  4. Well-child visits
  5. Postpartum care
  6. Tobacco cessation referrals

Using a federally established database called the Home Visiting Evidence of Effectiveness, or HomVEE, the team reviewed literature to determine whether or not these constructs are supported by evidence-based research.

“We were surprised to find that only three of the six constructs — preterm birth, breastfeeding and well-child visits — are supported by established research,” said Sofia Campos with the global consulting and digital services provider ICF, a co-author of the review. “Of the 59 articles we reviewed, only 14 measured outcomes aligned with any of the six constructs. None of the articles directly measured depression screening, postpartum care or tobacco cessation referrals. That means that we have no evidence from this key library that home visiting actually improves these maternal and child health outcomes.”

While only three of these six federally mandated constructs is supported by a federal library of evidence-based home visiting research, the team identified 16 other non-mandated constructs that have evidence of home visiting improving maternal-child health. These constructs include maternal depression symptoms and psychological outcomes, use of community resources, emergency visits and more.

“Based on our review, we recommend that the process for establishing these constructs include evaluation of the evidence-based research,” Kapp said. “By setting goals that have been proven to improve the health of mother and child, MIECHV can make more positive, sustained changes for hundreds of thousands of families nationally. Additionally, more confident funding decisions can be made when informed by performance measures that are evidence-based.”

The review, “The Evidence Base for the Maternal, Infant and Early Childhood Home Visiting Program Constructs,” recently was published in Public Health Reports, the official journal of the Office of the U.S. Surgeon General and the U.S. Public Health Service. In addition to Kapp and Campos, study authors also include Eduardo Simoes, MD, chair of the Department of Health Management and Informatics at the MU School of Medicine. The review was funded by the Health Resources and Services Administration of the U.S. Department of Health and Human Services (D89MC2791501). The authors of the study declare that they have no conflict of interest. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.