Mother and Infant Home Visiting Program Evaluation (MIHOPE) - Strong Start

The study's conceptual framework has three broad aspects: (1) inputs (factors influencing service delivery), (2) outputs (services delivered) and (3) outcomes for families. Each site in MIHOPE-Strong Start will use either the NFP or HFA home visiting model.

Community resources provide a foundation from which programs operate and are considered an input that influence how services are provided to families. In particular, these determine the outside referral services available to home visiting programs and the opportunities available to families in both the program and control groups. By connecting pregnant women with services, home visiting programs can change mothers' health care use, health behaviors, and health status, which in turn can lead to improvements in birth outcomes. In communities where services are limited, however, home visiting programs may have limited capacity to improve mothers' connections to such supports. Furthermore, a program's ability to improve outcomes is influenced by the "treatment differential," or the difference between service receipt among families who receive home visiting and families who do not receive home visiting. The more that control group members receive services that are similar to those provided by HFA and NFP, the smaller the "treatment differential." Community context also includes community characteristics that could affect norms toward use of social services and health care, or other influences on control group help-seeking and program group responses to home visiting programs. These contextual factors can affect program impacts in both positive and negative directions. The service model defines the program plan. It includes information such as the intended goals of the home visiting program; the expected frequency, duration, and content of home visits; and intended linkages with other services.

The MIHOPE-Strong Start implementation study will document the extent to which the two evidence-based models and their local counterparts have defined clear, coherent, and well-specified service plans for helping parents to obtain prenatal care, other services needed to reduce the risk of poor birth outcomes, and infant health care in the first year of life - a critical prerequisite to delivering services that could affect these outcomes.

In MIHOPE-Strong Start, the "service model" can be defined at two levels: the service model is defined by the national evidence-based model and then it may be refined or adapted by the agency that is operating a local program. It is important to clearly understand how HFA and NFP define their models since these models showed efficacy in prior research. At the same time, local programs often deliberately adapt models to fit their local contexts. Given inconsistent impacts on birth outcomes in past studies, in fact, such adaptations could be one path to improvements in program impacts.

There are multiple organizational influences on how a home visiting program defines its service model and its implementation system. These organizations include the local program operator, the purveyor of the evidence-based model that has been adopted (HFA or NFP), the state MIECHV (Maternal, Infant, and Early Childhood Home Visiting Program) grantee (if the site is participating in MIECHV), and community organizations with which the local agency collaborates.