CFRP Working Paper Series | W15007

From Randomized Controlled Trials to Community-Level Change: What Should Be Expected When Taking Home Visiting Programs to Scale?

April 2015

Cynthia Osborne, Kaeley Bobbitt, Ni Yan, and Arya Ansari

The University of Texas at Austin | LBJ School of Public Affairs | Child and Family Research Partnership

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Though home visiting programs have rapidly expanded across the country as an evidence-based policy choice for supporting families with young children, selecting an evidence-based model is not a guarantee of effectiveness. This paper is the first step in understanding whether these evidence-based programs can produce the change expected of them—what outcomes can be expected if the effects of large-scale implementation efforts mirrored those found in the programs’ RCTs? A thorough review of the research related to parenting outcomes for four evidence-based home visiting programs participating in MIECHV was conducted. To provide additional context for the findings from the reviewed studies, the findings, significant and null, from each of the reviewed studies were synthesized and then compared to both the professional recommendations or standards and similar estimates from the population. In general, the research shows that home visiting programs have the greatest, albeit still modest, effect on parents’ support for children’s learning and in reducing the prevalence of child maltreatment, but that these effects are strongest for the most disadvantaged program participants. The research provides little support for the effect of home visiting programs on early health behaviors including prenatal care, breastfeeding, or well-child visits, or on reducing the use of harsh parenting. Implications for policy and future implementation efforts are discussed.

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