Why Congress Should Reauthorize Home Visiting

In 2010, Congress established a bipartisan Maternal, Infant, and Early Childhood Home Visiting program, which today is known by its acronym: MIECHV (pronounced “Mc-Vee”).¹ This program has funded evidence-based home visiting programs in every state, 25 tribal communities, and several U.S. territories that target at-risk families who volunteer to participate, including teenage, first-time, single, or low-income parents who are pregnant or have newborns or young children.² Home visitors, typically social workers, nurses, or child development specialists, visit families in their homes on a weekly or monthly basis for the first few years of a child’s life and offer everything from practical parenting information (like how to breastfeed and why you should read aloud to your child) and advice for building strong parent-child bonds to developmental screenings and referrals to other community services that could benefit the family.³ And even in its short lifespan, it has already proven to be incredibly effective at improving outcomes for these parents and their kids. But unless Congress acts to reauthorize MIECHV before the end of this month, the program’s funding will dry up—leaving states in a lurch and children and parents vulnerable. Reauthorizing MIECHV should be an absolute no-brainer for the 114th Congress—it’s good for kids, parents, and taxpayers—and they should act before time runs out.

It’s Good for Kids.

MIECHV expands services to kids in need across the country…

Before this law was enacted, 46 states had home visiting programs of their own (either state-run or through state-funded non-profits), but most of them were only able to serve a tiny percentage of their at-risk families.⁴ In fact, as of 2010, only 3% of children living below 125% of the poverty line received a home visit.⁵ But by 2012, only two years into the MIECHV program, it was estimated that the number of participants per year in home visiting programs tripled and the number of actual home visits quadrupled.⁶ The Brookings Institution characterizes the expansion of services under MIECHV as “unprecedented in scale.”⁷ MIECHV funding allowed states to establish infrastructure or expand already existing home visiting services to serve more kids in need—and according to a recent study by the Center for American Progress and the Center for Law and Social Policy, almost every grantee considers this expansion of services to be one of their greatest successes.⁸ Because of MIECHV, more kids have access to the home visiting services that can get them off to a good start in life—which is crucial for socio-emotional and brain development, future academic and professional success, and upward mobility. Cutting off the program’s funding would not only nip future expansion plans in the bud, but could potentially also cut off existing services for kids in need.

…And those services can change children’s futures.

The expansion of home visiting services is crucial for improving kids’ chances and giving them the best opportunity to be upwardly mobile in life:

• Children who participate in a home visiting program have better newborn health and are more likely to be breast fed and immunized.⁹
• They are less likely to be injured, maltreated, or need to visit the emergency room (one MIECHV-funded program reports its participants are 40% less likely to need medical attention for injuries from ages 2-4 and 35% less likely to need to visit the emergency room).¹⁰
• Their parents are more likely to read to them, repeat nursery rhymes, or sing songs to them—activities that are vital to early brain development and for nascent language skills.¹¹
• And home visiting programs teach parents how to establish positive attachment relationships with their children, which in turn improve cognitive function and socio-emotional skills overtime.¹²

For example, children who participate in the Nurse-Family Partnership (a MIECHV-approved home visiting program model), have an 8% higher GPA in math and reading in grades one through six and have higher achievement test scores in those subject areas by age 12.¹³ Another home visiting program, Healthy Families New York, reports that its participants are nearly twice as likely as other at-risk 1st graders to be able to follow directions, finish assignments on time, and work well with others.¹⁴ Few federal programs are capable of simultaneously addressing the health, parenting, academic, and socio-emotional needs of at-risk kids in the first crucial years of life, and to do so with such strong documented results is almost unheard of. MIECHV reauthorization should be an easy lift for Members of Congress on both sides of the aisle—if there’s one thing Republicans and Democrats should be able to agree on, it’s giving kids the best chance to succeed in life.

It’s Good for Parents.

MIECHV gives parents the support they need by coordinating community services through home visits…

MIECHV doesn’t just fund the expansion of valuable services, however—it also assists states and communities in working across agencies to build infrastructure and relationships that improve the process by which at-risk families receive a wide variety of assistance.¹⁵ By connecting home visiting services with those provided by departments of health and human services, education, or child welfare, MIECHV establishes a one-stop shop for families in need.¹⁶ One way this is done in many states is via a coordinated intake system that serves as a single entry point to recruit and screen families for existing services that can meet their full spectrum of needs. The relationships that MIECHV fosters allow home visitors to streamline referrals to other community services that can be a lifeline for at-risk families—everything from food stamps and children’s health insurance to job training and treatment for substance abuse or mental health. These intake systems—for which many grantees say MIECHV is the primary funding source—reduce duplication of services, highlight gaps where families may fall through the cracks, expand the reach of social services, and increase the capacity of home visiting programs, which can then focus on providing great services rather than advertising to the community.¹⁷ MIECHV ensures at-risk parents are getting the help they need to raise their children to have a better life—whether they need coaching on positive parenting or assistance navigating the complicated social safety net that can help lift their families out of poverty.

…And those visits make them better parents and more self-sufficient.

Children aren’t the only ones who benefit from participating in home visiting programs:

• MIECHV requires states to show they are using the money to (among other things) improve maternal health and family self-sufficiency, build relationships with other community resources and means of support, and/or reduce domestic violence.¹⁸
• Mothers who participate in the Nurse-Family Partnership, for instance, are more likely to quit smoking and less likely to have additional children while in their teens or early 20s, and fathers are 46% more likely to be present in the home.¹⁹
• Parents also report being less stressed thanks to home visiting programs and the services and advice they provide—undoubtedly leading to better interactions and relationships with their children.²⁰

But the benefits of home visiting programs funded by MIECHV go far beyond the four walls of the home. Evidence-based programs, like those supported by MIECHV, have been shown to increase family self-sufficiency and economic security.²¹ Families who participate rely less frequently on government assistance programs like Temporary Assistance for Needy Families (TANF) and the Supplemental Nutrition Assistance Program (SNAP).²² One study in Memphis, Tennessee found that at-risk women who participated in a home visiting program when their children were babies were less reliant on public assistance programs when those children were kindergarten-aged—needing SNAP for only 9.67 months compared to 11.5 months and TANF for only 7.21 months rather than the 8.96 months needed by similar moms who did not participate in home visiting programs.²³ In Arizona, moms who signed their families up for the Healthy Families Arizona program were five times more likely than other similarly-situated mothers to be enrolled in school or job training programs.²⁴ With benefits this significant and wide-ranging, failing to reauthorize MIECHV wouldn’t just restrict the next generation’s chance of upward mobility—it would reduce their parents’ chances of becoming economically secure and self-sufficient and deny them the resources they need to be better parents. That’s bad policy and bad politics.

It’s Good for Taxpayers.

MIECHV mandates effectiveness and accountability in home visiting programs…

States and the federal government were both spending money on home visiting programs before MIECHV—just not as effectively and without any accountability. One survey found that only 30% of funds were spent on models with proven track records of success, nearly a third of programs didn’t know how many families they served, almost two-thirds didn’t know how much money they spent per family, 44% didn’t track any outcomes, and less than half of spending targeted at-risk or low-income families.²⁵ MIECHV’s implementation changed all of that:

• Every state is now required to conduct a needs assessment to identify and target the most at-risk families.²⁶
• 75% of all funding must be spent on evidence-based home visiting programs that have been proven “effective” by documenting improvements in child development and school readiness, child health, family economic self-sufficiency, linkages and referrals to other services, maternal health, positive parenting practices, reduction in child maltreatment, or reduction in juvenile delinquency, family violence, or crime.²⁷
• MIECHV also builds in room for innovation by allowing states to use the remaining 25% of funds to create new programs that meet the needs of their specific communities.²⁸ That means South Carolina can focus on maternal depression, while Louisiana seeks to extend mental health care to kids under age 5, and Texas tries to identify new ways to get fathers more involved.²⁹ Importantly, all of these innovative efforts must also collect data and be evaluated for effectiveness.³⁰
• And since MIECHV improved the communication between states, the most effective new interventions and ideas can more easily spread from local efforts in single states to nationwide successes.³¹
• Under MIECHV, states are required—and given the resources necessary—to evaluate and measure the effects of their home visiting programs, ensuring that they are being administered efficiently and achieving the desired outcomes.³²
• As a final backstop to ensure MIECHV is as effective and accountable as possible, its enacting legislation requires a rigorous evaluation of the program as a whole—the Mother and Infant Home Visiting Program Evaluation, from which the first results should be available later this year.³³

We already know from state reporting, studies of individual programs, and qualitative family data that MIECHV is working—it would be a shame to let funding run out right before we get the proof of just how well it works.³⁴

…And that reduces costs for taxpayers and leads to beneficial outcomes for society at large.

Taxpayers benefit from MIECHV too—not only can they rest assured that their tax dollars are being spent in the most effective way, but for every one tax dollar invested in home visiting programs, up to $5.70 is saved thanks to the reduction in future costs from child abuse and neglect, poor health, and academic struggles.³⁵ A study in Tennessee found that government savings over a 12-year home visiting program more than paid for the cost of services—with the government needing to spend $1,113 less on welfare, food stamps, and Medicare for every participating mother.³⁶ In North Carolina, the Durham Connects home visiting program pays for itself in just the first three months of a baby’s life by reducing the need for government medical assistance.³⁷ Children who participate in home visiting programs are also less likely to need expensive remedial education.³⁸ And the Nurse-Family Partnership program reports its participants are 59% less likely to be arrested by the age of 16—that’s good news for our wallets, our public safety, our overcrowded criminal justice system, and the kids who now will have a chance at a more successful future.³⁹ If Republicans in control of Congress are eager to cut waste and unnecessary spending, they aren’t going to find it in MIECHV.

Conclusion

Addressing America’s mobility crisis is no easy feat—but reauthorizing MIECHV should be. The program serves as one of our nation’s earliest prevention efforts against the struggles too many at-risk children face growing up, and its record of success couldn’t be clearer. MIECHV gives vulnerable children a chance at success, helps their moms and dads be better parents and more self-sufficient, and pays back taxpayers in savings and results. For once, everybody wins. Early childhood education is a bipartisan issue, and MIECHV reauthorization should be no different. Republicans love its focus on parenting and the home, Democrats love the way it expands access to and better connections between social services, and taxpayers love its results. The price tag is minuscule for what we’re purchasing—a good start and a bright future for kids, parents, and this country.