MIECHV: The Importance of Diversity and Flexibility

By Stephanie Schmit

The Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) is a federal and state partnership that supports family- and child-related home visiting programs in every state. MIECHV prioritizes use of home visiting models with demonstrated effectiveness while providing states important flexibility to tailor their approach to their local communities’ needs.

A rigorous review of research has identified to date 14 home visiting models that meet the evidence-based criteria. These results are highlighted in a new Office of Planning, Research, and Evaluation (OPRE) brief. The home visiting models target different populations and support a variety of interventions.  Recognizing the diversity of needs among high-risk families, 41 states have implemented more than one evidence-based model.

This week, CLASP submitted testimony for the record to the House Committee on Ways and Means Subcommittee on Human Resources about the Maternal Infant and Early Childhood Home Visiting Program. Our testimony stressed the importance of maintaining choice among many evidence-based models and maintaining states’ flexibility to spend a quarter of the funds on promising approaches. Both of these provisions ensure that home visiting programs are able to meet the diverse needs of low-income, vulnerable families. 

All evidence-based models provide voluntary, home-based services to families with young children, but they differ with respect to whom they reach and what services they provide. Most models target parents or children with particular risk factors, including low-income parents, first-time mothers, teen parents, and children exhibiting developmental concerns. Some models allow mothers to enroll prenatally, while others provide services post-birth based on the child’s age.  Models may provide services for one year or may continue based on need or until a child reaches a certain age.  The goals of each model vary and include improving child and/or parental health, addressing school readiness, fostering healthy child development, and improving family self-sufficiency.  The activities that occur during visits vary by model and are informed by the model’s goals.  Examples of home-visiting activities include: parent education, referrals to community resources, activities to support and encourage parent-child interaction, and screenings for parents and children to identify additional potential risk.  The frequency of visits with families varies by model but is often weekly or every other week. 

Several home visiting models target families who are vulnerable because they are experiencing challenges that put children at risk for unhealthy development, such as economic hardship, child abuse and neglect, and parental depression. The specific goals vary depending on which model is being used, but typically home visiting programs seek to improve family outcomes for both adults and children by strengthening the parent-child relationship for some or all of the years between the prenatal period and kindergarten entry. Having multiple options is critical because families are incredibly diverse and many models target only those who meet specific criteria. States can choose to employ multiple models within their state to best meet the needs of their unique populations. 

Currently, MIECHV allows states to spend up to 25 percent of their funds on promising approaches that must be rigorously evaluated. This allows states to foster innovation, use locally grown models, and meet the needs of families in their most vulnerable communities when existing evidence-based models prove incompatible. That flexibility also lets states use and evaluate models that do not yet meet requirements, allowing these alternative approaches to work their way towards becoming evidence-based.

Additionally, it allows for the incorporation of new findings as they become available from the clinical research.  It encourages reaching new populations who may fall between the cracks in existing models.  (For example, some evidence suggests that mothers who are depressed and their young children—who are at great risk of learning and development problems in the absence of intervention and therefore should be a high priority for states —are difficult for traditional models to serve but can be very well-served by enhancements that have been tested only on a limited basis.) Further, funding flexibility encourages a philosophy of continuous improvement as the program develops.

The MIECHV program has been essential for the development of statewide home visiting systems that have the necessary infrastructure to support lasting, effective programs for vulnerable children and families. Congress took an important step by extending MIECHV and will need to show continued support for this important program next year. CLASP urges continued congressional support to ensure these families keep receiving services that enhance parenting and aid in young children’s early development—critical components of future success.