Mother and Infant Home Visiting Program Evaluation-Strong Start (MIHOPE-Strong Start), United States, 2012-2017

Mother and Infant Home Visiting Program Evaluation-Strong Start (MIHOPE-Strong Start) was a large-scale evaluation that rigorously tested the effectiveness of evidence-based home visiting in improving birth and health outcomes during pregnancy and in the year after birth. Local programs included in the study's analysis implemented one of two evidence-based models: Healthy Families America (HFA) or Nurse-Family Partnership (NFP). These models were chosen because earlier evaluations found some evidence of their having positive impacts on birth outcomes. The Office of Planning, Research, and Evaluation (OPRE) of the Administration for Children and Families (ACF) partnered with the Center for Medicare and Medicaid Innovation (CMMI) of the Centers for Medicare and Medicaid Services (CMS) and the Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration (HRSA) to sponsor the study. MIHOPE-Strong Start was part of the CMMI's Strong Start for Mothers and Newborns Initiative, which evaluated whether enhanced, nonmedical prenatal interventions, when provided in addition to routine medical care, have the potential to improve birth outcomes and reduce health care costs for women enrolled in Medicaid or the Children's Health Insurance Program (CHIP). Under contract with OPRE, MDRC conducted MIHOPE-Strong Start in collaboration with James Bell Associates, Johns Hopkins University, Mathematica, and New York University. The analysis for MIHOPE-Strong Start included 2,899 women and 66 local programs (37 HFA and 29 NFP programs) operating across 17 states: California, Georgia, Illinois, Indiana, Iowa, Kansas, Massachusetts, Michigan, Nevada, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Washington, and Wisconsin. Women were eligible for MIHOPE-Strong Start if they were pregnant and at least 8 weeks from their due date. The MIHOPE-Strong Start analysis included a subset of families and local programs that were recruited for MIHOPE, the national evaluation of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. Specifically, the MIHOPE-Strong Start impact analysis included information on 46 local home visiting programs and 1,845 families that were initially recruited for MIHOPE but met the MIHOPE-Strong Start eligibility criteria. An important distinction between MIHOPE-Strong Start and MIHOPE is that MIHOPE included only programs receiving MIECHV funding, while MIHOPE-Strong Start included both MIECHV and non-MIECHV-funded programs. In both studies, families were randomly assigned either to an evidence-based home visiting program or to a control group who was given information on other services available in the community. The random assignment design was intended to create program and control groups that were similar when women entered the study, so that systematic differences in the outcomes of interest observed between the two groups can be attributed to the home visiting services rather than to the preexisting characteristics of the women.