HHS/OPRE published new findings of a major RCT of federally-funded home visiting programs for at-risk families with young children. Quick take: The average impact across the 4 programs on child & mother health & other outcomes is negligible at child age 2.5-3.5y. However, the study hasn't yet reported impacts of the 4 programs individually, where positive findings are quite possible.(Continued below.)

Program and Study Design:

  • This is a large RCT (N=4,215 families) evaluating 4 programs - Parents as Teachers, Healthy Families, Early Head Start, & Nurse-Family Partnership.

  • The programs vary in key features, but all provide home visits (e.g., by a paraprofessional or nurse) to at-risk families that are expecting or have recently given birth. Families entered the study when their children were under 6 months old or in utero.

  • Based on careful review, this is a mostly well-conducted RCT. It has high sample attrition, but within WWC standards for "tolerable" risk of bias at the age 2.5 follow-up & tolerable with caveats at the age 3.5 follow-up.

Findings:

  • At child age 2.5-3.5y, the study found that the average impact across the programs was negligible on the 6 primary outcomes, related to maternal & child health, family economic self-sufficiency, and discipline practices/strategies (see table above).

Comment:

  • These findings are disappointing but not surprising. Prior RCTs have found weak or no impacts for 3 of the 4 programs - all but Nurse Family Partnership (NFP). So disappointing average impacts across the 4 are to be expected even if NFP is effective (as discussed here).

  • At this follow-up (age 2.5-3.5), the study did not report impacts for the 4 programs individually (for valid reasons related to sample attrition), but it apparently plans to do so at the forthcoming kindergarten follow-up - so stay tuned and cross fingers.

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