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Maternal, Infant, & Early Childhood Home Visiting Program is an Evidence-Based Success Story

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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: 

  1. Improved maternal and newborn health
  2. Reduced child injuries, neglect, and abuse
  3. Improved school readiness and achievement
  4. Reduced crime or domestic violence
  5. Improved family economic self-sufficiency
  6. 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.   

Improving Evidence in Policing

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By: AIF Staff

The recent protests surrounding the murder of George Floyd and Rayshard Brooks are the latest and most visible reminders that policing power is one of the most critical responsibilities we give the State in our free society. Its importance cannot be overstated –citizens are unable to go about their daily lives if they are living in fear of violence. And more often than not, police officers are leaders in our communities, who selflessly undertake the vital role of keeping citizens safe from crime and illicit activity. 

The challenges that police officers face while doing their jobs are large, and they are given powers that are commensurate with those challenges. However, with that power comes the expectation that the police will use their power responsibly. 

As the last few weeks have shown, there are many ideas on how to improve policing and how to preserve the trust between the police and the communities they serve. House Democrats have introduced the Justice in Policing Act, Senator Tim Scott and his Republican colleagues have offered the JUSTICE Act, and the President has offered solutions via an Executive Order. These are all positive contributions to a long overdue, and much needed, conversation about how we ensure that our laws are enforced equally and that proper oversight is given to the law enforcement officials in whom we entrust these important responsibilities. Our country has put off having this difficult, but necessary conversation for too long and as a result, countless lives have been lost and meaningful progress has been delayed. 

A critical piece that should not be overlooked in our current discussion about policing reform is the importance of allowing evidence and data to drive improvements in policing strategies. As policymakers look to improve policing operations and reduce preventable abuses of authority, they will need a roadmap to understand what actually works in this space. In order to develop this roadmap, both the Administration and the Congress should build on other programs that have developed a body of evidence around what works, and then, on a bipartisan basis, determine the optimal level and allocation of funding for those programs.

As Congressman Will Hurd said in a recent op-ed: “The way we solve these broader issues isn’t by defunding the police but by ensuring they do better.” The best way to determine if departments are in fact doing better, is by increasing and strengthening the amount of evidence and data related to their work. 

Increasing the utilization of reporting, evidence, and data is not a new concept, and the federal government has successfully done this before. One example to look towards is the Maternal, Infant and Early Childhood Visitation program. This program, created under President Bush, codified under President Obama, and reauthorized under President Trump, provides for a tiered-evidence funding model where new interventions are tested, promising interventions are scaled up, and proven interventions are funded at higher levels. This model has led to the successful funding of nurse-family partnerships and it gives policymakers a template to follow in the pursuit of evidence-based policing strategies.   

As Congress works toward improving policing outcomes, they should create a tiered-funding model at the National Institutes of Justice to identify and fund policing practices that reduce violence and improve officer safety. All levels of government are going to be rolling out new public safety practices or incorporating reforms that have been pushed for years, as governments do so, they should ensure police departments are actually achieving the goals that are being pursued.

To help advance the conversation about compiling better data and evidence in policing, former Speaker Paul Ryan, the President of the American Idea Foundation, sent the following letter to Attorney General William Barr. As Ryan said in the letter: 

“Our nation’s law enforcement officials have one of the most difficult occupations in our society. They are given immense powers to complete those tasks and have a responsibility to uphold the public’s trust by equally applying our laws. In light of this power and responsibility and to improve its efforts, we urge the DOJ to prioritize learning how best to continue guaranteeing the safety of our citizens and law enforcement personnel.”

Without question, we need to act decisively to prevent police officers from abusing their authority and from harming the very citizens that they swore an oath to protect. But as we do this, lawmakers should also push to increase the amount of data and reporting around techniques and strategies and create a repository of good ideas that have proven to work in communities around the country. 

Given the immense responsibility that we place in our law enforcement officers, increasing the amount of evidence and data collected with their efforts will ultimately help the police and their fellow citizens, who they serve and protect, achieve a more equitable system of justice.  

One Community at a Time, Opportunity Zones begin to Germinate

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June 16, 2020

By: AIF Staff

In his “farewell address,” American Idea Foundation President and former Speaker of the House, Paul Ryan noted:

“You all know that finding solutions to help people lift themselves out of poverty is a personal mission for me. I think we have made real progress here in a relatively short time…. We have begun to break this monolith. New opportunity zones, part of tax reform, will bring more investment to distressed communities….

“I believe firmly that solving our poverty challenges once and for all will require not just a great undertaking, but a great rethinking of how we help the most vulnerable among us. It begins with realizing that the best results come from within communities, where solutions are tailored and targeted for people’s needs. This battle will be won soul-to-soul and eye-to-eye.”

In keeping with its mission to advance data-driven solutions that expand economic opportunities, the American Idea Foundation has pushed for the proper development of opportunity zones, which were created as part of the 2017 Tax Cuts and Jobs Act.

As articulated by the Department of Housing and Urban Development, opportunity zones, which can be found in all 50 states and the District of Columbia, are economically distressed census tracts that are eligible for preferential tax treatment. As tax experts, Cesar Conda and Ryan Ellis wrote: There are “42,000 such communities in the United States today…. They are both urban and rural, home to Americans of all races. Poor whites in Appalachia will be beneficiaries of the same Opportunity Zone law as poor blacks in Chicago or poor Indians in South Dakota.”

Opportunity Zones, as designed by the author of the provision, Senator Tim Scott of South Carolina, “incentivize long-term investment in low-income and distressed communities by offering a deferral of capital gains taxes for investors.”

In 2018, Speaker Ryan described the incentives of Opportunity Zones succinctly, saying: “With these opportunity zones, we are essentially offering private investors a set of incentives. The longer you maintain your investment in these areas, the more tax benefits you receive. Right now, we have $6 trillion of unrealized capital that can be deployed to help alleviate poverty in distressed communities and improve people’s lives.”

As Conda and Ellis noted:

“Investors get three big tax benefits by rolling their gains into Opportunity Funds. First, they get tax deferral on the gains they roll in. Currently, that deferral is available through 2026, but if Opportunity Zones are successful there is every reason to believe Congress will extend this. Second, investors can “step up” their basis in their deferred capital gain by up to 15 percent provided they keep the money in an Opportunity Fund for at least seven years. Finally, an investor in an Opportunity Fund asset who holds the investment for at least 10 years pays a 0 percent capital gains tax upon sale, to the extent the gains are derived from the Opportunity Zone asset.

The promise of opportunity zones is that they will draw investment to areas around the country that need it most, and that investment will lead to rejuvenation and revitalization. At their best, opportunity zones will be locally-driven and serve as tools of reclamation rather than gentrification.

As the Economic Innovation Group noted: “Capital alone is not a strategy…. Going forward, state and local leaders are responsible for devising the strategies that will take these few new lines of the tax code and turn them into something that unlocks opportunity for local residents and entrepreneurs.”

The roll-out of opportunity zones has been deliberate, as these projects require relationships with local, state, and federal actors, but all across America, there is reason for hope that these zones will help communities rise up in unique ways. Forbes, in conjunction with the Sorensen Impact Center, highlighted a collection of the most promising projects underway across the United States.

Some other examples of how Opportunity Zones are improving communities around the country and allowing people to recognize their version of the American Dream include:

–          Paterson, New Jersey: As columnist Chris Slevin said, “New Jersey has 169 Opportunity Zones, which carry an average poverty rate of 25 percent and a median family income of $48,000, on average. About 738,000 New Jerseyans live in these zones. In many of these communities, the ongoing challenge of redeveloping brownfield sites has made it harder to attract capital in recent decades.”

But the incentives provided by Opportunity Zones are attracting investors who are able to clean up the brownfields and environmentally-damaged land, allowing for further community development to take hold. As Democrat Senator Cory Booker said: “I see really the perspective from New Jersey and I’m seeing a lot of different groups: impact investors, people that have a social mission. There are some businesses that have a charitable foundation and (are) looking for ways to create a multiplier effect with their investment, which is exciting.”

New Jersey’s business and government leaders have made sure to take a step-by-step approach to developing opportunity zones, remembering that they are designed to thoughtfully rejuvenate communities with sustained investment and care.

–          Provo, Utah: In announcing the state’s initial Opportunity Zones, Governor Gary Herbert described the program’s goals as “economic prosperity for all Utahns. Opportunity Zones will go a long way in helping to support growth in economically-distressed areas throughout the state. By working with these communities, the zones will attract more businesses and new investment.”

HUD Secretary Ben Carson said recently that Utah’s Opportunity Zones, “look like the 22nd century.”  A local business owner in Provo noted, “the opportunity zone designation did serve as a sort of accelerant when it came to finding outside investors for the companies, most of which simply move to different buildings on the same large campus that Hall Labs exists on, so they continue to benefit Provo’s economy.” 

As the Provo Daily Herald said: “If you are a small business owner, you are someone who … could take advantage of this … we’re trying to build this platform to not only provide temporal assistance to those who need it, but really match them with potential investors should they have a project that they feel warrants it.”

–          Baltimore, Maryland: In the Charm City, the opportunity zones were selected based on need and around anchor projects that could serve as hubs for revitalization. One project, features a concert hall amid “a stretch of industrial buildings and vacant lots on Russell Street that the city wants to transform into an entertainment district.” As former Baltimore Mayor Catherine Pugh detailed at a Kemp Forum on Opportunity Zones, the city is more ready than any other to begin developing these promising parts of the city.

–          Erie, Pennsylvania: As the Wall Street Journal noted, “Erie was one of the first cities to jump on the federal-opportunity zone program, creating a 58-page prospectus and identifying a dozen “shovel ready” projects, including the renovation of a 133-unit downtown hotel. Redevelopment would have happened with or without the opportunity-zone program, city leaders say, but the tax breaks will speed the process.” Erie’s promise is receiving further recognition, as it received one of the Forbes’ Opportunity Zone awards.

–          Brooklyn Center, Minnesota: The Brooklyns Building is owned by the city’s Economic Development Authority and the incubator is going to focus on helping minority- and immigrant-owned startup companies. The project is designed to grow with the community’s involvement, and it was recently recognized by the Minnesota Opportunity Collective for its potential.

The rollout of Opportunity Zones has been accompanied by passionate debate, which is a good thing. It ensures that policymakers at the local, state, and federal level will work to design projects as the law intended. Because evidence and data should help drive decisions, it was encouraging to see a bipartisan group of Senators introduce legislation strengthening the reporting requirements for opportunity zones. As Senator Todd Young of Indiana said upon its introduction, “Our bill will help strengthen Opportunity Zones by increasing transparency within the program and creating metrics to measure and improve on its success.”

The promise of Opportunity Zones is directly connected to local entrepreneurs working within their communities and developing synergistic relationships with elected officials. As communities build themselves up one project at a time, lives can be improved and dreams can be realized in a sustainable and bottom-up way. As opportunity zones continue to germinate, the American Idea Foundation will ensure they comport with the original spirit and intent of the law.