The MIHOPE Randomized Controlled Trial (RCT), evaluating...
Home Visiting for At-Risk Families, Delivered Under the Federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program
Reviewed
HHS/OPRE (September 2025) published new findings of a major RCT of federally-funded home visiting programs for at-risk families with young children. Despite the positive portrayal of results in the study overview, the study found negligible impacts on child and family outcomes, averaged across four home visiting program models, at the 5-7 year follow-up when most children were in kindergarten.
Relevant Excerpts from the Study Overview:
To examine the potential long-term effects of the MIECHV Program on children and families, MIHOPE [Mother and Infant Home Visiting Program Evaluation] included a follow-up when children were in kindergarten….
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Because home visiting programs address a broad range of outcomes related to maternal, family, and child well-being, impacts were estimated on 66 outcomes. This report examines the effectiveness of home visiting across groups of outcomes organized into eight pre-specified topical research questions, using omnibus tests to look beyond effects on individual outcomes.
MIHOPE found statistically significant and positive effects of home visiting for the five research questions that measured maternal and family well-being outcomes. The results of omnibus tests indicate that home visiting had favorable effects on outcomes more readily impacted by direct interactions or services provided by home visitors. These include (1) maternal coping strategies and parenting behaviors that could be improved through direct interaction between parents and home visitors; (2) maternal mental and behavioral health; (3) parent-child interactions; (4) a constellation of outcomes related to conflict, violence, aggression, and maltreatment; and (5) families’ economic circumstances.
MIHOPE found some evidence of positive effects of home visiting for the three research questions related to child functioning outcomes. The result of the omnibus test for children’s social-emotional functioning in the home context was statistically significant and positive. A similar pattern of effects emerged on outcomes related to children’s social-emotional functioning in school settings, but the omnibus test result was not statistically significant, potentially due to the smaller sample of teachers who reported on these measures. The omnibus test result was also not statistically significant for the research question related to children’s cognitive, language, and math skills.
The kindergarten follow-up demonstrates the potential value of using groups of outcomes to interpret and understand effects across the many areas of family functioning that home visiting programs address. Using this analytical method, the study found favorable effects of home visiting on six of the research questions, indicating that MIECHV-funded home visiting programs resulted in improvements for families five to seven years after study enrollment in outcome areas cited in the MIECHV authorizing legislation.
To examine the potential long-term effects of the MIECHV Program on children and families, MIHOPE [Mother and Infant Home Visiting Program Evaluation] included a follow-up when children were in kindergarten (approximately five to six years after women enrolled in the study).
* * *
Because home visiting programs address a broad range of outcomes related to maternal, family, and child well-being, impacts were estimated on 66 outcomes. This report examines the effectiveness of home visiting across groups of outcomes organized into eight pre-specified topical research questions, using omnibus tests to look beyond effects on individual outcomes.
MIHOPE found statistically significant, but very small, positive effects of home visiting for the five research questions that measured maternal and family well-being outcomes. The results of omnibus tests indicate that home visiting had favorable effects on outcomes more readily impacted by direct interactions or services provided by home visitors. These include (1) maternal coping strategies and parenting behaviors that could be improved through direct interaction between parents and home visitors; (2) maternal mental and behavioral health; (3) parent-child interactions; (4) a constellation of outcomes related to conflict, violence, aggression, and maltreatment; and (5) families’ economic circumstances. The average effect size ranged from 0.028 to 0.031 across these five questions – which means that the program would have moved the average child or mother in the control group from the 50th to the 51st percentile, had they been assigned to receive home visiting.
MIHOPE found some evidence of positive, but very small, effects of home visiting for the three research questions related to child functioning outcomes. The result of the omnibus test for children’s social-emotional functioning in the home context was statistically significant and positive, with a minor effect (0.046). A similar pattern of effects emerged on outcomes related to children’s social-emotional functioning in school settings, but the omnibus test result was not statistically significant, potentially due to the smaller sample of teachers who reported on these measures. The omnibus test result was also not statistically significant for the research question related to children’s cognitive, language, and math skills.
The kindergarten follow-up demonstrates the potential value of using groups of outcomes to interpret and understand effects across the many areas of family functioning that home visiting programs address. Using this analytical method, the study found favorable
very small
effects of home visiting on six of the research questions, indicating that MIECHV-funded home visiting programs resulted in
only marginal
improvements for families five to seven years after study enrollment in outcome areas cited in the MIECHV authorizing legislation.
No-Spin’s Study Overview
Large, high-quality RCT of home visiting services for at-risk families with young children, delivered under the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, finds negligible impacts on child and family outcomes at the 5-7 year follow-up. The study report focuses on the average impacts across four program models, but the impacts for each individual model also appear to be small or modest.
Program and Study Design:
- This is a large, ongoing RCT, with a sample of 4,102 families across 12 states. The RCT is evaluating four MIECHV-funded home visiting program models - Parents as Teachers, Healthy Families, Early Head Start, and Nurse-Family Partnership.
- The programs vary in key features, but all provide home visits (e.g., by a paraprofessional or nurse) to at-risk families that are expecting or have recently given birth. Families entered the study when their children were under six months old or in utero.
- For this latest report on kindergarten-age outcomes, the study organized its 60 prespecified outcome measures into 8 prespecified research questions, and conducted an omnibus test of statistical significance for the set of outcomes within each question.
- Based on careful review, this is a high-quality RCT (e.g., baseline balance, prespecified outcomes and analyses, use of well-established measures of child and parent outcomes, moderate attrition for most outcomes).
Findings:
- 5-7 years after study entry – when most children were in kindergarten – the study found that home visiting produced negligible effects for each of the eight research questions, as shown in the following table. (For reference, an effect size of 0.03 is the equivalent of moving the average child or mother from the 50th to the 51st percentile.)
Research Question | Effect Size [1] | Statistically Significant? |
Did home visiting affect maternal coping strategies and parenting behaviors resulting from interaction with home visitors? | 0.028 | Yes |
Did home visiting affect maternal mental and behavioral health? | 0.027 | Yes |
Did home visiting affect parent-child interactions? | 0.025 | Near-significant (p<0.10) |
Did home visiting affect conflict, violence, aggression, and maltreatment? | 0.024 | Yes |
Did home visiting affect families’ economic circumstances? | 0.031 | Yes |
Did home visiting affect children’s social-emotional functioning in the home context? | 0.046 | Yes |
Did home visiting affect children’s social-emotional functioning in school settings? | 0.059 | No |
Did home visiting affect children’s cognitive, language, and early math skills? | 0.008 | No |
[1] The effect size shown is the average effect across the set of outcomes within each research question.
- The average effect size across the six statistically significant or near-significant effects was 0.03.
- The study does not clearly report the effect sizes for each of the four home visiting models individually. However, it appears the model-specific effects are small or modest given that (as the report shows) few reached statistical significance. We have asked the study authors if they can share the model-specific effect sizes.
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