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Reauthorizing MIECHV & Recognizing Evidence-Based Successes in Fighting Poverty

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By: AIF Staff

The American Idea Foundation has long believed that Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program provides a useful example of how the government can move towards evidence-based programming and better allocate resources to more effectively fight poverty. As this home-visitation program is considered for reauthorization by Congress later this year, the American Idea Foundation will push lawmakers to reward MIECHV’s data-driven approach and understand the impact it is having in communities across the country.

MIECHV is a time-intensive, customized approach to helping parents from before their child’s birth through the first years of the child’s life. The First Five Years Fund summarized the program’s approach 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 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, to help families and parents build happy and healthy homes for children. It is results-based and has been subject to more rigorous evaluations than any other single poverty-fighting program.

At a recent hearing held by the House Ways and Means Committee, Congresswoman Jackie Walorski of Indiana highlighted the program’s success – and the reasons for it, saying in part:

“MIECHV is a program that gets results. This program builds upon decades of research that proves home visits by a nurse, social worker, or other trained professional during pregnancy and in the first years of a child’s life help prevent child abuse and neglect, support positive parenting, improve maternal and child health, and promote child development and school readiness….

“The program is now up for reauthorization again this year. What makes MIECHV unique is that funding is tied to evidence. Most federal programs operate in a black box. Less than $1 out of every $100 the government spends is backed by even the most basic evidence that the money is being spent wisely. Unlike most federal social welfare programs, we know what outcomes taxpayers can expect from our investments in MIECHV. This program serves as a model for how other programs for low-income families should be funded.

“For a home visiting model to earn taxpayer support, an evaluation must prove the program has demonstrated significant, positive outcomes such as preventing child abuse and neglect, improving maternal and child health, and improving economic independence…. As we turn to reauthorization, Republican priorities include providing a full 5-year reauthorization to give states and implementing organizations the certainty they need to conduct long-term planning.

“We aim to raise awareness of MIECHV’s high-quality outcomes to promote this time-tested program. And, we must apply lessons learned during the pandemic, specifically from the success of remote visits that grew efficiency while preserving the positive outcomes we expect from this evidence-based model.

“Few federal social programs have been evaluated to determine if they are working, and almost none have conditioned funding on evidence of effectiveness. When we spend limited taxpayer dollars to help those in need, we must ensure we’re investing in programs that deliver results.”

Without question, MIECHV is a bipartisan success story, supported by the administrations of Presidents Bush, Obama, Trump, and now Biden. Most recently, the Biden Administration announced millions in grants via the American Rescue Plan. There was a tremendous amount wrong with the American Rescue Plan, but funding MIECHV at more robust levels was right.

The evidence of MIECHV’s positive impact on children and families has been well-documented and the American Idea Foundation’s visit to a South Carolina Nurse Family Partnership program provided a visual testament to the difference its making in people’s lives.  

To learn more about the program’s impact, watch: Lessons from the Front Lines of South Carolina.

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 leaders work to meet other pressing policy challenges.   

On “Hardly Working” podcast, Ryan discusses why evidence-based policymaking is essential to fight poverty effectively

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By: AIF Staff

Washington, DC – Earlier this week, American Idea Foundation President Paul Ryan was a featured guest on theHardly Working podcast. The podcast, hosted by Brent Orrell and produced by the American Enterprise Institute (where Ryan is a visiting fellow), focuses on the future of workforce development and on how policymakers can help individuals meet the diverse needs of the 21st century economy.

During the podcast interview, Speaker Ryan and Orrell discussed using evidence-based solutions to break through partisan gridlock, the amazing accomplishments of the Nurse-Family Partnership program, and other ways to successfully fight poverty.

Listen to the entire interview here or by clicking the icon below. Highlights of the conversation, edited slightly for clarity, follow.

The genesis & aims of the American Idea Foundation:

“After I retired as Speaker of the House, I wanted to focus on some of the things I really cared about which are poverty and strategies to improve our fight against poverty. I wanted to help go after poverty’s root causes and help break the cycle of poverty. There are different kinds of poverty, but I wanted to focus on intergenerational poverty and it’s just a perfect segue to what we are talking about which is the last law I wrote in Congress. It’s this thing called the Evidence Act.

“It’s a bill that I did with Senator Patty Murray. We founded this [Evidence-Based Policymaking] Commission and we got the idea from Jim Sullivan at Notre Dame, economists at their Laboratory for Economic Opportunities, and Raj Chetty, an economist at Harvard…. We put Ron Haskins from the Brookings Institution in charge of it because I wanted to make sure this was not seen as some Republican thing, but rather just a good thing. The Commission gave us its results, we took them and put them in a bill and got it through Congress….

“Now, academic researchers can look at the data and see what works and what doesn’t and then get the government to actually measure the results of programs, the effectiveness of programs, and whether something works or not.  [It helps] get the muscle memory built in the minds not just of the bureaucracy, but of policymakers and of philanthropy to focus on evidence-based policymaking, so that we can bypass the ideological loggerheads….

“So, my foundation is basically focused on what I would call center-right ideas for fighting poverty and restoring civil society and reproducing upper mobility that we aspire to as Americans. It’s called the American Idea Foundation and I’d say the “American Idea,” or at least what we think of, is that the condition of your birth should not determine the outcome of your life.

“America is the only country founded on natural rights. It’s a beautiful thing. We are the only country that’s founded on an idea and it’s the job of Americans to pass this on to every generation.

“My foundation is trying to do that by making sure that we’re [using] evidence as a policy-making barometer and as a tool in government and out of government. Then [we’re trying to support] those things that connect the private sector, the public sector, and the philanthropic sector to get capital into poor communities, to get the private sector into poor communities.”

An evidence-based success story: The Nurse-Family Partnership program

“I’ve been to the Nurse-Family Partnership programs in Kenosha and Racine and I was just down in rural South Carolina last month touring [their program]…. The Nurse-Family Partnership is where a nurse partners with an expectant mom and they become very close. They become friends and the nurse effectively acts like a mother or a mentor – that’s probably a better word, a mentor to the expectant mother to help her figure out what you have to do to have a healthy pregnancy. The nurse says these are the vitamins, this the diet, these are the things you don’t do, these are the things you do, and here’s how you get prepared. No one else would tell [these mothers] this and then after they’ve had the baby, they help them for [two] years… with all those other things in infancy and it has huge impacts on a child’s development.

“The program has been subjected to randomized controlled trials (RCTs) and we’ve been running evidence and analytics on this program for years. I first got involved with it in the George W. Bush Administration which grew the program. President Obama was enamored with it and they expanded it and then President Trump saw it and he reauthorized it. So, it grew under Bush, Obama, and Trump, three very different Presidents.

“It’s a program that just has really good evidence that proved [its concept]. It’s teaching women who are having babies…. how to be good moms and how to raise those kids and how to do so at a really critical stage of development from pre-birth to three years old.

“It’s extremely successful. Those nurses and those moms become extremely close, and they help these moms really ratchet themselves up the ladder of life, up the escalator of upward mobility, and get them on a really good path, putting their life together so the mother is better off. And if she’s going to be better off, we all know and it’s really clear that her child is going to be better off.

“This is an example of a government program and of civil society working to actually alter people’s trajectory and change society for the better…. For moms who’ve never had a baby and who didn’t know how to raise a baby, there is a good program that actually works. And if we prove that it works, then let’s fund it and let’s take the money from the programs that have been proven not to work and use that so we don’t actually net increase spending.”

Focusing on outcomes, not dollars spent, to better fight poverty:

“For lack of a better phrase, the War on Poverty got gripped by an ideology and because of that ideology, we started to measure success by throwing money at problems. We measured success by inputs like money or creating new programs.

“In many ways, they created this notion of “just let the government do it” if we’re trying to fight poverty and trying to get people out of poverty. [It was a notion of] don’t worry, pay your taxes, the government has got this figured out. [The government] will create programs to deal with this, as if that is a perfectly decent substitute for communities, for mediating institutions, for people helping fix problems person to person or community to community. They decided big is better. [They decided] the federal government is more efficient and they can just design programs and therefore materialistically [the government] can solve this problem.

“It blew up in our faces. It created a lot of dependency and it backfired. Materially taking people out of poverty, from a technical perspective by throwing money at the problem – sure, you can do that — but have we really created a society enriched with upward mobility, with people living the best versions of their lives and becoming the best versions of themselves? Did these policies do that? No.

“I think what is missing is the sense of community, the sense of solidarity, the mediating institutions that civil society provides. We displaced people participating in helping the lives of one another…. You can’t just substitute [government] for the private sector and for economic growth, wage growth, competition for labor, innovation, opportunity, social capital and all that comes with it.

“I think we went down this path in the War on Poverty of just getting rid of the secret sauce that makes all this stuff work and substituting all of it for more programs, more money, more dependency and [we’ve seen] predictable results.”

Strengthening civil society in an era of digitization and polarization:

“We are in real trouble right now because of digitization. I think we are living more artificial lives on our electronic devices and it is actually bringing atrophy to these mediating institutions — our churches, our civic organizations, the place and space where we live our lives, the space between our government and ourselves.

“And there’s also capital. Obviously, you have to have investment. You have to have organizations that promote civil society and all these things that help people realize their humanity and that work with one another to do that….

“The best thing I can come up with is we have to revitalize those institutions and revitalize civil society. We have to revitalize those non-government organizations and, since we’re becoming less religious as well, it is these non-government organizations that connect us and give us a sense of value and pride in helping other people. They give us this common good sense of community. If you’re raising kids — and I’ve got two that still have to get through high school, you’re really involved in this stuff but once you’re done with that, everybody leaves and that’s what’s sort of happening in society today.

“I wish I could say there’s a government program or a bill with the capacity to fix this but there really isn’t a way other than to have a good, healthy, growing economy so people have discretionary income, so they have more hours at home, working on these parts of their community.”

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Panel: Ryan & Policy Experts Discuss How to Improve the Child Welfare System through Evidence and RCTs

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By: AIF Staff

Earlier this week, the American Idea Foundation and the University of Notre Dame’s Lab for Economic Opportunities (LEO) hosted a virtual policy panel examining how evidence-based child welfare programs can assist younger Americans meet their short-term needs and be oriented for long-term success. The panel discussion, moderated by former Speaker Paul Ryan, featured perspectives from leading academics, practitioners, and thought-leaders who are working on innovative social programs targeted to at-risk youth and their families.

Throughout the conversation, the panelists reinforced the importance of assisting America’s youth by utilizing evidence-based strategies and interventions with track records of success. The conversation highlighted how building supporting evidence for social programs is a long-term, collaborative effort between policymakers, researchers, and academics, all of whom share the same goal of helping children and families out of poverty.

Joining Speaker Ryan in conversation were:

  • Bill Evans, Keough-Hesburgh Professor at the University of Notre Dame
  • Erin Kelley-Siel, Chief Office of Expansion and Policy, Friends of the Children
  • David Sanders, Executive Vice President of Systems Improvement, Casey Family Foundation

Video of the panel discussion is available here. Notable excerpts from the conversation, edited lightly for clarity, follow.

Speaker Ryan: Evidence-based reforms to our child welfare system are necessary & overdue

“The child welfare system works with some of the most vulnerable members of our society. And, for too long, its treatment of our children has been a scandal.

“Until recently, policymakers have ignored the child welfare space. The recent passage of the Family First legislation was the first major reform to this area since the early 1980s. This isn’t for a lack of problems in the system. Far too many children are taken out of their homes too quickly, while other children are left to languish in difficult situations.

“Thankfully, there are a number of hardworking individuals in this space working to provide safe, permanent homes to children in need. And, even more importantly, we are working to prevent the need for youth to enter the foster care system in the first place.

“Unfortunately, one of the major issues with this space, like many others, is the lack of evidence on what works and what doesn’t work. And, even where there is evidence, it is all too difficult for caseworkers to identify programs that work. It’s one reason why the American Idea Foundation is working on a user-designed clearinghouse that would enable case workers to identify programs that work and easily refer families and children to them. As the Family First legislation continues to be implemented, we will continue to need individuals to do the hard work of developing an evidence base for programs that are successful.

“We have, in some other areas, seen ways that policymakers have overcome some of the challenges that these topics present. For example, the American Idea Foundation recently visited a Nurse-Family Partnership program in South Carolina. This program has solved a number of these issues – they developed an evidence base, they have scaled their programs, and they have federal legislation, called MIECHV, which was started under President Bush and continued on under Presidents Obama and Trump.

“It surpassed political parameters because it was carried forward with a body of evidence that proved it’s a good way to run this program. This is what we’re trying to do with the American Idea Foundation clearing house and it is exactly what LEO does on a day-to-day basis. These are the types of programs that policymakers need to be looking at and that’s why I’m so excited about the panelists that we have.”

Erin Kelley-Seil: Friends of the Children’s ‘secret sauce’ is love, building a base of evidence is a time-consuming but worthwhile endeavor

“First of all, for those who may not know, Friends of the Children is a national nonprofit, and what we do is we invite children and families who are facing the greatest obstacles when their children are between the ages of 4-6, and we give them a paid, professional, salaried mentor to work alongside that child and family from that time in their development all the way through high school graduation. We are a 30-year-old non-profit. We’re currently in 24 locations so we’re close to meeting our goal of 25 locations and really the Family First legislation has been very catalytic for what we do.

“We currently have a randomized control trial underway that’s focused on our outcomes. The trial will be one of the longest in the country that ever will happen. By the time it is completed, it will take 17 years and as I mentioned, we are a 12-plus year intervention and we have preliminary evidence of favorable effects of our program.

“We also had a qualitative study that was funded by the Casey Foundation that looked specifically at our foster care impact because historically for us, 40% of the youth that we are serving have experienced either formal foster care or informal kinship care and 100% are at-risk when using factors to assess children who are most in need of programs.

“Even with all this evidence – and you have with decades of third-party evaluation that has been underway, our advisors and researchers in the evaluation space from the University of Washington who are focused on evidence-based practice said you still don’t have enough to make it on to the Family First Clearinghouse. It was actually well-timed and painful, but really well-timed because it led us to talk about scaling and innovation. We had been innovating with regard to our model… and we had early impact data so the [RCT] thought process really wasn’t hard for us. It was because evaluation has been part of our DNA. For us, the [RCT] was a natural extension of what we were already doing now. Many of us that work here are still a little bit frustrated because we thought we would have had enough evidence to make it on the Family First Clearing House but we’re grateful for the chance to work with LEO.”

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“We really believe there are three things that I’ll say that are the secret sauce. Let me just pick one or two. We have a paid professional in their lives and they stay with them for the long haul. We just believe those kids that are at the most risk need a longer duration of service than a 12-month service intervention. These are families who have been hurt by generational poverty and systemic obstacles and that is who we’re really working to serve.

“We actually had a researcher tell us once that our secret sauce is love. We build relationships. The mentors in our program have enough agility and adaptability to highly individualize their service approach and so everything we do is really grounded in love and one of our core values is to build relationships.

“The average tenure of one of our mentors is five to six years so when we introduce ourselves and our caregivers to families, we say that you should expect to have probably two mentors in the life cycle of your child and part of that, for us, is modeling and making a healthy transition. We’re working, as I mentioned, with a lot of youth who have had a lot of transitions in their lives and modeling that as an adult and building social capital for them with more than one adult is part of our model.”

Professor Bill Evans: Amid opioid epidemic, Notre Dame’s Laboratory for Economic Opportunities is helping local child welfare providers develop evidence of success

“If we take a look at children in foster care, there’s probably no group in the United States that has worse economic outcomes just in terms of basic socio-economic indicators, like the graduation rate from high school, the percentage that go on to college, the income levels at age 30, this group performs incredibly poorly across all different characteristics so we have to figure out not only how to deal with them when they’re in foster care but how to help them adjust as they are moving from foster care to early adulthood. We made some great legislative changes in 2018. We expanded the foster care program, but we really haven’t spent much time evaluating what’s going on with that at all.

“I think more children are at risk than ever before because of the opioid crisis, and some preliminary estimates are about 90,000 people died from drug overdoses in the past year, 20,000 more than the previous year. Some of our own work suggests there is about 1.5 million kids that are living away from their parents because the opioid crisis, so the risk to these kids is incredibly staggering. We have to figure out what works, but… we know very little about what policies can do to change these levers….

“For example, across states, the structure of the foster care system is quite different. In some states, it’s all government-run. In some states, it is privatized. In some states, it’s a mixture of the two. We have very little information about whether outcomes are different across states because of the way that these systems are structured. And that would seem to be a fundamental question to identify: Are we getting different outcomes based on the way this program is structured?

“We know very little about the extension of benefits to people after they age out or after they turn 18 and whether they’re on extended benefits or not, are better things happening with regard to outcomes?  So, if we can, at least within legislative circles when we adopt these changes, require that there’ll be some evaluation program set aside to look at effectiveness, that would be useful.

“Recent legislation was passed trying to encourage the evaluation of federal programs but the way we found that change is actually occurring was primarily by working with courageous, local agencies. The local social service groups that have innovative programs and that are helping children out are willing to put the program under the microscope and allow people to examine it through randomized controlled experiments and determine whether the program is working or not. This is the group that we found to be the most receptive to evaluation so the more that we could work with local social service agencies that are actually engaged in helping us see who is at risk, I think the better off we’re going to be…. We need to figure out ways to encourage governments at all levels to take a look at these programs and get a better sense of what is working and what is not.”

Professor Bill Evans: Partnerships with researchers and social service providers are critical to evaluating programs

“The first part is to have you convinced that you want to be part of the RCT and given all the barriers, I think the way in which we do this at LEO is a pretty good model. Social service organizations are there to provide services. They don’t necessarily have the skills to do an evaluation. They might understand how to do it, but it’s not their job. Our job isn’t to provide social service to youths. Our job is to evaluate programs and to understand incentives and understand outcomes. And so, the partnership between an academic institution and social service providers can be a lot more than the sum of its parts.

“When we do an evaluation, we typically are taking on all the costs of tracking clients in order to do surveys or trying to find administrative data that allows us to track outcomes. We don’t want to interfere with the provision of services at all and it’s too much of a burden for the organization to take on those costs, so we’re going to pick up those costs now. Most of the time, we’re looking for projects we think are going to move the needle on poverty so eventually, we think we’re going to be able to find funding from the federal government or foundations that are going to help pay for the research costs. But I think that this dual nature of “you’re providing services and we’re providing evaluation” is a good way to think about it.

“One thing I’ll say about academics is that academics are looking for good ideas — that’s our business, and finding great partners out there where we could move the needle in this particular sector has been amazing. When we started and were trying to figure out one way that we can be different from other poverty labs across the country, we decided we were going to be different was in examining ideas are at the local level, where people are interacting with the client and a lot of times, there was no way for those ideas to bubble up. And so, what we’re trying to do is to put some empirical content on those great ideas.

“We are finding these people and finding these groups that not only have the good ideas but also have the bandwidth to actually do an evaluation — because sometimes it’s difficult and so we have a whole group that tries to find the innovative providers and tries to find the people that have quality staff who have the enthusiasm and the willingness to take a look under the hood.

“The second question was about cost. One thing that is useful when you’re doing an evaluation is you learn a lot of things about the way that the program operates. One of our evaluations was on emergency financial assistance for homelessness and what we found is that the people that are receiving the greatest benefits are those people that are actually the most at risk. Therefore, if you want to have a bigger impact, you actually had to target the program a lot more to lower income families, and maybe be more aggressive funneling money to that specific group. And so, if the goal is to try to have as much impact with fixed dollars that you have, a lot of times what you learn along the way can be very beneficial….

“I think the process of evaluation gets you thinking about how can I make my program better and who is benefiting the most? Are there specific character traits that are going to benefit most from the intervention? It gets you thinking in that way and making evaluation a much more important part of your day-to-day operation.”

David Sanders on how federal policymakers can assist social service providers by incentivizing evaluation and evidence:

“I think, first, the federal government needs to encourage payments for the things that we know work and I think that there are many sound ways of doing this, but I’ll give two examples.

“You mentioned earlier the concern about too many children being removed from their homes and at the same time too many children being left in dangerous situations. Well, the process in the health protection system is to do an investigation and that investigation is to determine the needs of the family and as far as I know, we have done little if any research on the effectiveness of if   investigations accomplish exactly what we want them to. Yes, we paid for the investigation without question but did it accomplish what we wanted it to do?

“A second example is congregate care. Until Families First, a child could stay in congregate care for as long as the agency decided that they needed to be in here and they would be paid by the federal government for that. We have little, if any, evidence that congregate care actually works beyond a certain period of time, but we will pay for it regardless of what the evidence suggests.

“I think, first and foremost, we should actually pay for things that are accurate. Second, I think when we find that there are effective support programs that we also pay for them and that we do it quickly…. If innovations are demonstrated to work, they need to move quickly into the field and be supported and we should really offset that by not paying for things that we know don’t work.”

Speaker Ryan on the next steps of the Evidence Act and linking federal agencies with practitioners and researchers

“I toured the Nurse Family Partnership in Kenosha, Wisconsin many years ago and saw the results of my own eyes, not just anecdotally, but I saw the data, because it was the one program that the federal government actually used evidence. It is more or less why we wrote this bill, called the Evidence Act, that is in place now. To your point David, I couldn’t have said it better myself.

“Let’s go find out what works. Let’s find what works and by the way, since money and dollars are finite, take from what we now know does not work and put those dollars into what does work. We’re just now on the cusp of what I would call a “research renaissance” to learn about those things. And where this matters the most, and why the American Idea Foundation is focusing on this area, is because our children are the area that is in the greatest need. It also has the biggest potential to make the biggest difference.”

This panel discussion was part of a quarterly series of policy conversations hosted by the American Idea Foundation to draw attention to evidence-based policies aimed at expanding economic opportunities. Past policy conversations have focused on building a 21st century workforce, reforming the Earned Income Tax Credit, reducing recidivism and promoting 2nd chances, and properly implementing Opportunity Zones. 

Note: Former Speaker Paul Ryan is a visiting lecturer at the University of Notre Dame.