Understanding and Expanding the Reach of Home Visiting (HV-REACH) Project

Mathematica, funded by the Administration for Children and Families (ACF) Office of Planning, Research, and Evaluation (OPRE) in the U.S. Department of Health and Human Services (HHS) will collect descriptive information for the Understanding and Expanding the Reach of Home Visiting (HV-REACH) project. The study team will conduct qualitative case studies in up to seven purposively selected centralized intake systems that refer families to Early Childhood Home Visiting programs. Centralized intake systems are a single entry point that use outreach and screening to identify families with needs and provide referrals to the home visiting program that best fits those needs. Existing centralized intake systems use a range of methods, and their definitions and applications can vary widely.

The goal of the case studies is to provide an in-depth understanding of the features of centralized intake systems, how they reach potentially eligible families, and how they support and expand the enrollment of families in early childhood home visiting (ECHV) programs. Understanding and explaining how staff think different features of these systems influence family and staff experiences of outreach, screening, referral, and enrollment processes can potentially lead to opportunities for program improvement efforts, technical assistance, or changes to centralized intake system processes. For instance, ACF and their partner, the Health Resources and Services Administration (HRSA), can use information about different centralized intake systems to develop policy and program guidance. In addition, the public-including current centralized intake systems, staff from localities considering implementing them, and technical assistance providers who work with centralized intake systems-can use information from the case studies about (1) successfully implementing or enhancing existing centralized intake systems, or (2) utilizing new outreach or referral pathways to expand enrollment to families not consistently reached. For example, staff from localities considering implementing centralized intake systems can understand different staffing and governance structures that might work in their contexts. Researchers can also use the information to plan future studies of centralized intake systems that examine the outcomes of these systems.

Data collection will begin in fall 2024. The study team will conduct virtual or in-person site visits, with semi-structured interviews and document collection, to understand different features of these systems and family and staff experiences with outreach, screening, referrals, and enrollment processes.

The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program, an evidence-based service delivery model, can support child and maternal health, child development and school readiness, and family economic self-sufficiency, and help reduce child abuse and neglect. Early childhood home visiting (ECHV) programs collectively reached about 278,000 families in the United States in 2021, while MIECHV-funded programs reached about 71,000 families (Health Resources and Services Administration \[HRSA\], 2022; National Home Visiting Resource Center \[NHVRC\], 2022). However, many more families are eligible for and could benefit from these programs. In conducting the Understanding and Expanding the Reach of Home Visiting (HV-REACH) project, the Administration for Children and Families (ACF) aims to deepen understanding of how home visiting can better reach families, including: (1) families who are not recruited in the first place; (2) families who are recruited for home visiting but do not enroll; (3) families who enroll, but never engage to receive services; and (4) families who are recruited and engage initially, but end their participation early.

By streamlining screening and referral processes, centralized intake systems may help improve enrollment of families across different referral pathways. These types of systems have been in existence for decades and have become increasingly widespread in recent years (National Evidence-Based Home Visiting Model Alliance \[NHVMA\], 2018; Roberts et al., 1996). However, no studies have systemically documented the various types of systems. In addition, the ways in which home visiting programs interact with the systems and the influence these systems have on family experiences around outreach, screening, referrals, and enrollment-particularly for those that are underserved or may be missed by a system's referral pathways-is largely unknown.

The HV-REACH project will conduct qualitative case studies to provide an in-depth understanding of the features of centralized intake systems, how they reach potentially eligible families, and how they support and expand the enrollment of families in ECHV programs. To carry out the case studies, the HV-REACH study team will conduct virtual or in-person site visits in up to seven sites. A site includes an organization or organizations that run a selected centralized intake system and one or two associated home visiting programs that receive referrals from the selected centralized intake system. The study team defines a home visiting program as an organization that delivers ECHV services. The study team will purposively select up to seven sites that fall into different models of identified centralized intake systems-for example, triage model, shared decision-making, and market (NHVMA, 2018). Recruitment will cease after seven sites agree to participate.

Each site visit will include one round of semi-structured interviews with administrators or other staff at the centralized intake system organization(s) (up to 6 respondents per site), home visiting program directors and other staff responsible for overseeing outreach and enrollment (up to 4 respondents per site from up to two different home visiting programs), home visitors and other staff responsible for conducting outreach and enrollment (up to 6 respondents in up to 4 interviews per site), and families who were referred to home visiting through the selected centralized intake systems (up to 6 respondents per site). The study team will purposively select respondents to provide a range of perspectives on the study's research questions.

The results are not intended to promote statistical generalization to different sites or service populations beyond the sample. The research team does not intend for this information to be used as the principal basis for public policy decisions.

Eligibility Criteria:
Inclusion Criteria:

* Centralized intake administrator or other staff at selected centralized intake system organization
* Program director at home visiting program or other staff responsible for overseeing outreach and enrollment at home visiting program associated with selected centralized intake system
* Home visitor at home visiting program or other staff responsible for conducting outreach and enrollment at home visiting program associated with selected centralized intake system
* Families referred to home visiting through selected centralized intake system at home visiting program associated with selected centralized intake system

Exclusion Criteria:

* Does not meet the inclusion criteria