DOI: 10.3886/icpsr37847
title: Mother and Infant Home Visiting Program Evaluation-Strong Start (MIHOPE-Strong Start), United States, 2012-2017
title: Archival Version

description: 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.
description: Mother and Infant Home Visiting Program Evaluation-Strong Start (MIHOPE-Strong Start) used a rigorous research design to assess the effectiveness of home visiting services. Families recruited into the two studies 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. Random assignment was intended to ensure that the two groups were similar in all respects when they entered the studies except that one had immediate access to evidence-based home visiting. Following best practices in a random assignment study, the effects of being assigned to receive evidence-based home visiting are estimated by comparing outcomes for the entire program and control groups. Both studies also collected extensive information about home visiting service implementation to describe the families served, the policies and support in place for home visitors to provide services, the quantity and content of the actual services provided to families, and the ways those services varied.
description: <strong>Family Baseline Survey-Study Intake Data:</strong> The family baseline data set is primarily comprised of the family's demographic and household characteristics data from the family baseline surveys, which were conducted at the time of study entry with the expectant mother (from October 2012 through September 2015). These data are supplemented with study intake, vital records, and Medicaid data about characteristics of the mother at baseline. Study participants who enrolled at a Mother and Infant Home Visiting Program Evaluation (MIHOPE) site were given the MIHOPE family baseline survey even if they were also eligible for MIHOPE-Strong Start. Those who were enrolled at a MIHOPE-Strong Start site took the MIHOPE-Strong Start family baseline survey. The MIHOPE survey includes most items in the MIHOPE-Strong Start survey plus many others. <strong>Community Characteristics Data:</strong> The sociodemographic characteristics of communities are based on the families' census tracts where they resided at time of study intake. The census tract data are from the U.S. Census Bureau's 2014 American Community Survey (ACS) five-year estimates. <strong>Home Visitor Survey Data:</strong> Some local home visiting programs that recruited families for MIHOPE were included in the MIHOPE-Strong Start analyses as well. Home visitors based in local programs participating in MIHOPE took the MIHOPE home visitor survey, while those in local programs that participated only in MIHOPE-Strong Start took the MIHOPE-Strong Start survey. The surveys were completed between October 2012 and October 2015 and provide data on the home visitor's demographics as well as past and current work experiences. The home visitor staff survey data set contains responses from questions that were asked in both surveys and those that were asked in just one survey but were comparable to questions in the other survey. <strong>Local Program Data:</strong> Most of the local program-level data come from the program manager surveys that were conducted with the program manager at each of the local programs included in MIHOPE-Strong Start. The program manager survey data set is supplemented with selected site log data and 2014 American Community Survey (ACS) five-year estimates data. <strong>Service Delivery Data:</strong> The service delivery data are available for families in the program group. These data were primarily collected through family service logs for families enrolled in programs participating in MIHOPE. The logs provide information on dosage and visit content and were completed between November 2012 and July 2016. For families that were enrolled in a local home visiting program that participated in MIHOPE-Strong Start, service delivery information was collected through model, state, or site level Management Information Systems (MIS). These MIS data span June 2014 through December 2016. <strong>Vital Records Data</strong> Vital records data collected include birth certificate data for births that occurred from December 2012 through April 2016 from the 17 states in the study, as well as fetal death certificate data from 7 study states. Most of the states used the 2003 revisions of the U.S. Standard Certificate of Live Birth and U.S. Standard Report of Fetal Death. These data provide information on the infant and the mother's health and healthcare events at or around the infant's delivery. <strong>Medicaid Data:</strong> Medicaid enrollment and use data from 17 states provide information on maternal and infant Medicaid-paid health care use and coverage from January 2011 to May 2017. These data include fee-for-service claims and managed care encounters, depending on the health care system in the state. They also provide follow-up data on Medicaid coverage and utilization of the mother and infant at birth, such as the length of the hospital stay and NICU admissions, as well as in the first year, including emergency department visits and well-child office visits.
description: Response Rates: Family baseline survey: 100 percent Home visitor survey: 78 percent Program manager survey: 100 percent
description: Presence of Common Scales: 10-item version of the Center for Epidemiological Studies-Depression Scale (CES-D) Conflict Tactics Scale (CTS) Generalized Anxiety Disorder 7-Item (GAD-7) Revised Conflict Tactics Scale (CTS2) Women's Experience with Battering (WEB) Scale
description: Mother and Infant Home Visiting Program Evaluation-Strong Start (MIHOPE-Strong Start) included 2,900 families and 66 local programs across 17 states, as well as 2 evidence-based models: Healthy Families America (HFA) and Nurse-Family Partnership (NFP). 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 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.
description: Datasets: DS0: Study-Level Files DS1: Family Baseline Survey - Study Intake Data DS2: Community Characteristics Data DS3: Home Visitor Survey Data DS4: Local Program Data DS5: Service Delivery Data DS6: Vital Records Data DS7: Medicaid Data
description: Local home visiting programs and participants across 17 states. Participants were pregnant women in the first 32 weeks of their pregnancies, recruited from local programs that served primarily Medicaid beneficiaries.
description: computer-assisted telephone interview (CATI); web-based surveyFor additional information on the Mother and Infant Home Visiting Program Evaluation-Strong Start (MIHOPE-Strong Start), visit the MIHOPE-Strong Start study website.