Smart Scale Up: Expanding Home Visiting with Fidelity

Background

October 2013 – September 2017

This project evaluates Wisconsin’s Family Foundations Home Visiting (FFHV) Program, which coordinates home visiting programs across 15 counties and 4 tribal regions. The study examines whether Wisconsin’s evidence-based home visiting services are associated with expected client and program outcomes in 6 benchmark areas: (a) maternal and child health, (b) child injuries, child abuse and neglect, and emergency department visits, (c) school readiness, (d) domestic violence, (e) family economic self-sufficiency, and (f) coordination and referrals for other community supports and resources. Cross-sectional and time-series data will be analyzed to assess benchmark outcomes across participating programs.

Interpretations of results will be enhanced by evaluating implementation fidelity. Data will be collected from multiple sources to assess whether programs are implementing services with fidelity, and whether greater fidelity is positively correlated with client and program outcomes.  Three categories of program fidelity will be assessed: (1) adherence to model structure and processes, (2) staffing expectations, and (3) client characteristics and experiences.

Reinforcing the quasi-experimental study of statewide outcomes, this project launched The Healthy Families Study, a randomized trial of two home visiting programs at the Milwaukee Health Department. One program, Empowering Families of Milwaukee (EFM), implements the Healthy Families of America curriculum. The EFM program begins prenatally and lasts up to three years postpartum. The second program, Parents Nurturing and Caring for their Children (PNCC), is a Medicaid benefit that is available to eligible clients up to 60 days postpartum. In addition to the two experimental arms, a third quasi-experimental study arm is composed of families who were referred to the Health Department for services but did not enroll. Participants in all three study conditions complete assessments at four time points for a 12-month period, capturing change over time in maternal and child health, parenting practices, and child development.