BY: AIF STAFF
A decade ago, Congress created the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program to provide at-risk pregnant mothers and families with in-home services to help them develop parenting skills so their children are raised in physically, socially, and emotionally healthy environments.
MIECHV was originally authorized for five years as part of the Affordable Care Act, though the idea originated with Republican Senators who developed the Education Begins At Home Act, and Congress provided $1.5 billion in initial funding. Since then, the program has been reauthorized on a bipartisan basis and over time, its effectiveness has grown and more and more families and children have benefitted.
The story of MIECHV is one worth telling, as it provides a model for policymakers to look toward as Congress develops evidence-based strategies to tackle the pressing problems facing families and communities.
Put succinctly, MIECHV is administered by the federal government through grants to states, territories, and tribes allowing these entities to create voluntary programs, backed by data and evidence, which help families and parents build happy and healthy homes for children. The goals of the program, as defined by the federal government, are to support efforts that “improve maternal and child health, prevent abuse and neglect, encourage positive parenting, and promote child development and school readiness.”
Broadly speaking, as described by the Health Resources and Services Administration, MIECHV gives parents the tools necessary to raise children in a productive way with customized care and individual, in-person assistance:
“When a family chooses to participate in a home visiting program in their community, they have regular, planned visits with a trusted and caring professional. Home visitors help parents learn how to improve their family’s health and provide the best opportunities for their children. They encourage use of positive parenting techniques and help promote early learning in the home. Home visitors provide information and guidance on a wide range of topics including breastfeeding, safe sleep practices, injury prevention, nutrition, and childcare solutions. In addition, home visitors identify and assess family strengths and risks. They screen children for developmental delays, which can facilitate early diagnosis and intervention for autism and other developmental disabilities. They also help ensure that parents have support to care for their children.”
The First Five Years Fund summarized the program well, stating:
“Evidence-based home visiting programs, like those made possible by MIECHV, pair families with limited support and resources with trained home visitors such as nurses, social workers, and educators. Home visitors meet with families at home and work with families from pregnancy through their child’s kindergarten entry to help lay the foundation for the health, education, development, and economic self-sufficiency of the entire family. Visits by caring, experienced professionals can turn good intentions into good parenting, breaking generations-long cycles of poverty, addiction, abuse, and despair.”
MIECHV grants focus on providing assistance to states, localities, and tribes so they can assist the most vulnerable children and families in our communities. Consider some of the program’s statistics:
- In FY2018, 71% of participating families had incomes 100% below the federal poverty rate.
- 3 out of every 4 families participating were enrolled in Medicaid and the Children’s Health Insurance Program.
- Many of the parents who received help via MIECHV had a high school education or less, some struggled to provide adequate child care, and others had a history of substance abuse.
MEICHV has been so impactful, as the Center on Budget and Policy Priorities said, because it prioritizes the “use of home visiting models with demonstrated effectiveness while providing states important flexibility to tailor their approach to their local communities’ needs.” Grantees had to incorporate proven models when creating their individual visitation programs, and then had to demonstrate that their programs were helping families and children in a half-dozen ways:
- Improved maternal and newborn health
- Reduced child injuries, neglect, and abuse
- Improved school readiness and achievement
- Reduced crime or domestic violence
- Improved family economic self-sufficiency
- Improved coordination and referrals for community resources
As the Center on Budget and Policy Priorities elaborated, MIECHV puts “a high premium on evidence-based family support programs, providing most of its funds to support rigorously evaluated programs for which there’s well-documented evidence of success. These programs have proven an effective strategy for strengthening families and saving money over the long term. Research shows they can lead to reduced health care costs, reduced need for remedial education, and increased family self-sufficiency.”
This evidence-based approach has been successful and MIECHV is making a tangible difference in every state in the nation. Because of the program, in-home visits were conducted in nearly 900 counties in FY2018 and in FY2019, the program served over 154,000 parents and children and conducted more than 1,000,000 home visits.
In recent years, states have seen meaningful results after launching their programs and subsequently tweaking them based on the evidence, and parents and children are benefitting. In addition to the immediate impacts of better health outcomes for young children and lower rates of neglect, abuse and violence, MIECHV’s longer-term benefits were detailed in a reported titled, Evidence on the Long-Term Effects of Home Visiting Programs. Some of the longer-term benefits of the program include:
- “Evidence-based early childhood home visiting appears to be cost-effective in the long term. Home visiting programs incur costs right away, but participating parents and children can see improved outcomes over their lifetimes. As a result, benefits generally exceed costs over longer periods of time.
- “Early childhood home visiting has improved outcomes for parents and children across a wide range of child ages, outcome areas, and national models. Statistically significant estimated effects have been found for families after they no longer are receiving home visiting services, with evidence of effectiveness for families with children up to 21 years old. Studies have found effects in many of the outcome areas that MIECHV aimed to influence, including maternal and child health, parenting, child development, family economic self-sufficiency, child maltreatment, and intimate partner violence.
- “The largest benefits from evidence-based early childhood home visiting come through reduced spending on government programs and increases in individual earnings. Home visiting can increase parents’ earnings in the longer term by reducing maternal alcohol abuse and increasing parents’ high school graduation rates. Home visiting can increase children’s earnings in the long term by reducing child maltreatment. Home visiting programs appear to reduce government spending in the longer term by reducing families’ need for public assistance programs.”
As part of the Bipartisan Budget Act of 2018, which was negotiated by American Idea Foundation President and Former Speaker of the House Paul Ryan, MEICHV was funded and reauthorized through 2022 with a further emphasis on evidence and results. As the National Council of State Legislatures noted:
“The new model authorizes states to use up to 25 percent of their grant funds to enter into public-private partnerships called pay-for-success agreements. This financing model requires states to pay only if the private partner delivers improved outcomes. The bill also requires improved state-federal data exchange standards and statewide needs assessments.
“The MIECHV program emphasizes that seventy-five percent of the federal funding must go to evidence-based home visiting models, meaning that funding must go to programs that have been verified as having a strong research basis. To date, 18 models have met this standard. Twenty-five percent of funds can be used to implement and rigorously evaluate models considered to be promising or innovative approaches. These evaluations will add to the research base for effective home visiting programs. In addition, the MIECHV program includes a strong accountability component requiring states to achieve identified benchmarks and outcomes. States must show improvement in the following areas: maternal and newborn health, childhood injury or maltreatment and reduced emergency room visits, school readiness and achievement, crime or domestic violence, and coordination with community resources and support.”
MIECHV was built on a sound premise: States, tribes, and territories would create individual programs by using evidence-based home visitation models that had already been proven to increase standards of living and improve health outcomes. They could then tailor their individual programs to meet the unique needs of parents and children, letting the evidence and data drive their decision-making. As this occurred, the federal government stood ready to fund and support their efforts, while also taking steps to ensure that data and information would be collected and analyzed to better inform future efforts. Ultimately, this allowed service providers and grantees to build on success, which in turn, has yielded more tangible benefits to the parents and children who participate in the program. As the program has grown and aged, Congress has continued to make meaningful improvements so evidence always informs this life-changing program.
The American Idea Foundation believes that the condition of your birth should not determine the outcome of your life, and the MIECHV program provides a worthwhile example of how the federal government, working in tandem with researchers and organizations at the state and local level, can ensure that all children have the opportunity to succeed and lead productive lives. It is an approach that should be replicated as we work to meet other pressing policy challenges.