Abstract
Home visiting programs are an increasingly popular mechanism for providing a broad set of early prevention supports to high-risk families. A key intended outcome for these programs is to support maternal and child health by helping families increase access to and use of preventive health care services. For many community-based home visiting programs, however, there is less evidence of positive outcomes in the health care domain. The current study used a randomized trial conducted in a statewide early childhood home visiting program, Healthy Families Oregon (HFO), to examine program impacts on families’ use of preventive health care services. The study recruited a large sample of participants (n = 1438 HFO families and n = 1289 controls) and utilized state agency health insurance and medical records as the primary data source. There were challenges in providing services in alignment with an intent-to-treat research design, leading to the need to take alternative approaches to analyzing effects of service receipt on outcomes. Results found that while there were no significant differences in health care access or utilization in the intent-to-treat models, positive outcomes were found when propensity score matching was used to limit the program sample to those who actually received services. Further, within the program group, children who were enrolled for longer had fewer gaps in health insurance coverage and received more well-baby visits and immunizations compared to those with less service. The role of the home visitor in helping families navigate the complexities of publicly funded health care is discussed. Investments in professional development strategies that can increase staff expertise in this area and improve family retention may be needed to more effectively achieve intended health outcomes.
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Notes
Programs were allowed to request this if there was an imminent concern for the safety of mother or baby. Research staff reviewed requests and granted 97% of requests; in all, 113 families (4% of eligible families) were exempted from the study.
Note that we also computed the total number of visits received by each family; however, this variable was highly correlated with the Duration variable (r = .897, p < .001); therefore, duration was chosen for further analysis.
Note that a “gap” was defined only for those with at least some coverage during the study period and did not include periods of lack of coverage that preceded their first insurance enrollment date. Gaps of less than 1 day were not considered meaningful gaps in access and therefore were not included.
Less conservative cutoffs for defining the “home visited” group were considered for the PSM models; however, even increasing to two home visits received resulted in substantially smaller sample sizes; therefore, we elected to use a single home visit as the criterion.
Note that although families were clustered within home visitors, we did not have data that would have allowed us to estimate or control for this potential nesting effect in our analyses.
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This research was supported by grant no. 90CA1782 from the Children’s Bureau, U.S. Department of Health & Human Services.
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Green, B., Sanders, M.B. & Tarte, J.M. Effects of Home Visiting Program Implementation on Preventive Health Care Access and Utilization: Results from a Randomized Trial of Healthy Families Oregon. Prev Sci 21, 15–24 (2020). https://doi.org/10.1007/s11121-018-0964-8
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DOI: https://doi.org/10.1007/s11121-018-0964-8