It would be hard to find a more popular strategy for supporting at-risk parents than home visiting — a series of voluntary (in-home) sessions with the family that focus on parenting, child development and other family-identified goals. Home visiting is so universally lauded that Congress passed a bipartisan resolution declaring “National Home Visiting Week” earlier this year. Republican Rep. Darin LaHood (R-Ill.) described home visiting as a program “built on decades of research” that serves as “a national model for how social programs should operate, focusing on results”; Democratic Rep. Judy Chu (D-Calif.) endorsed home visiting for its “proven track record of improving outcomes.“
The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, which helps states pay for home visiting, is set to reach $800 million in 2027 — a 60% increase from just four years ago. More than half of states are now using federal Family First Prevention Services Act dollars, along with state matching funds, to support home visiting programs. Family First was designed to fund services that keep children out of foster care. Since foster care entry among young children is driven almost entirely by abuse and neglect, programs funded by law should reduce child maltreatment.
So, what is the evidence that home visiting programs actually prevent child abuse and neglect?
When Congress authorized MIECHV, it included a mandate for an impact evaluation that came to be known as the Mother and Infant Home Visiting Program Evaluation (MIHOPE). MIHOPE is a longitudinal, randomized controlled trial that followed 4,229 families across 12 states. Four home visiting models were included: Early Head Start, Healthy Families America, Nurse-Family Partnership (NFP), and Parents as Teachers. According to the research team, all four “place a high priority on preventing and reducing child maltreatment.”
Early MIHOPE findings showed that home visiting had negligible effects when children were 15 months old. So it was with interest — and skepticism—that we read the recent federal press release for MIHOPE’s kindergarten (ages 5 to 7) follow-up claiming “statistically significant, long-term effects” that included “improvements in families’ economic circumstances, reduced family conflict and violence, better maternal mental and behavioral health, and strengthened parent-child interactions.”
Those upbeat toplines don’t match what’s in the report itself. The latest MIHOPE results offer no evidence of meaningful program effects on family, maternal or child outcomes. The Coalition for Evidence-Based Policy’s No-Spin Evidence Review of the evaluation described the differences touted as “significant” as “the equivalent of moving the average child or mother from the 50th to the 51st percentile.” Claimed impacts would constitute a miniscule return on a multibillion-dollar investment, and even those small effects may be statistical noise.
The evaluation only enrolled mothers who had already expressed interest in receiving home visiting, and excluded the 5% of interested mothers who were considered so high-risk that it would be unethical to assign them to the control group. If the program could not achieve any positive impacts for the most motivated mothers, it is even harder to imagine that home visiting is a viable tool for preventing entries to foster care. A large body of research shows low uptake and engagement in voluntary services among families most at risk of child protection involvement; home visiting is no exception.
The purported effects come from what’s called omnibus testing, a method used to assess whether the overall pattern of outcomes differed between the home visiting and control groups. In the context of child abuse and neglect, the MIHOPE team reported a significant home visiting program effect for the research question: “Did home visiting affect conflict, violence, aggression, and maltreatment?”
The omnibus test for that question included nine items. Three of those were direct indicators of child maltreatment — substantiated abuse, substantiated neglect, and hospitalizations for injuries or ingestions — all based on administrative data. Each of the three individual effect estimates was near zero and statistically insignificant. Only one of the nine outcomes was statistically significant: A maternal self-report measure of intimate partner violence.
Some may argue that documenting the prevention of maltreatment through administrative indicators is also imperfect, and that home visiting may influence possible “precursors” to child maltreatment, such as parental stress and material hardship. Yet, an almost identical pattern is evident for every other research question in this evaluation where positive effects are asserted: the individual outcome estimates are small and insignificant, with a small omnibus finding typically driven by one or two measures from the caregiver survey.
For example, the research team claims that home visiting had overall positive effects on “Maternal Mental Health and Behavioral Health at Kindergarten.” But the only individual measure that differed between the treatment and control groups was “perceived social support,” a self-reported measure. This same individual item – perceived social support – then re-appears in their omnibus test finding to claim improved “Maternal Coping Strategies and Parenting Behaviors.”
The fact that purported effects appear driven by a small number of caregiver-reported items raises at least two additional issues. First, attrition: In the kindergarten follow-up, more than 40% of the original sample was missing from the caregiver survey and direct child assessments; only 31% had completed teacher surveys. Generally, attrition at this scale is problematic for studying interventions because families’ experiences with the program may influence who stays in the study.
Second, the caregiver survey is subject not only to social desirability bias but also to awareness effects. Parents obviously understood that they were assigned to the treatment group (i.e., home visiting) rather than the control group and may have tailored their responses accordingly. The analysis also excludes data for mothers who lost custody over time, a situation particularly relevant to understanding child abuse and neglect, and of concern given that the MIHOPE team reported significantly more CPS contact prior to study entry among those in their retained home visiting group than in the control group.
Conclusions based on caregiver self-report are particularly suspect given that no corroborating findings emerge from other data sources. Except for employment, none of the outcomes measured with administrative records — including child abuse and neglect — differed. Although we were unable to arrive at an exact count from information released in the report, it would appear that more than half of all individual measures came from the caregiver survey.
There is mounting evidence that home visiting does not reduce or prevent child maltreatment and may have very modest effects on parenting generally. Even NFP, often held up as the most robust home visiting program, shows limited or null effects for a range of outcomes. Unfortunately, the Trump administration characterized the newest MIHOPE findings as further confirmation that these programs work, stating “our investments in Maternal, Infant, and Early Childhood Home Visiting programs deliver a better future for American children and families.”
Worse, NFP, Healthy Families America and Parents as Teachers will all continue to be listed as “well-supported” on the Family First Act’s clearinghouse — the list of programs approved for open-ended federal funding to prevent foster care entry.
Why? To receive a designation as “well-supported,” review criteria only requires two studies that show at least one “sustained favorable effect” on any outcome. Once a program meets that threshold — absent a claim of error or fraud — no amount of accumulated null evidence will lead to its removal from the clearinghouse.
Likewise, once a program meets the federal criteria for designation as an evidence-based home visiting program, it stays there even if every subsequent study finds no effects. Neither the Family First Act clearinghouse, nor the federal home visiting standards, consider the magnitude of reported impacts when selecting programs for inclusion.
This is not harmless. When the effects of social programs are oversold, we stifle innovation and divert scarce dollars away from the development of new interventions and adaptations that could better meet the needs of vulnerable children and their families. The absence of any detectable effects on child maltreatment should be sobering for legislators and administrators who have been told that early home visiting is a proven strategy and sound investment in preventing child abuse and neglect.
Correction: This op-ed originally described the No-Spin Evidence Review as a project of the Arnold Foundation. While the foundation financially supports it, the review is a project of The Coalition for Evidence-Based Policy.
