Griffin Discusses Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program with Experts

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GRIFFIN: Mr. Baron, I wanted to focus a little bit on HIPPY USA, which although it serves many folks across the country, it is based in Little Rock, which is my district, the Second Congressional District in central Arkansas. HIPPY stands for Home Instruction for Parents of Preschool Youngsters. HIPPY USA. They are operating both in rural and urban areas. I wanted to ask you, Mr. Baron, when you're reviewing your models for effectiveness, are you seeing any differences between the outcomes in rural areas versus urban areas, and if so, what do you attribute those differences too?

JON BARON: It's interesting that there have been scientific evaluations of home visiting. Randomized trials have been done in both rural and urban areas. One of the Nurse Family Partnership studies was done in upstate New York in a rural, primarily white population, and that one was found to have very large effects, as long as 15 years after the study began, for the treatment compared to the control group. Big decreases for the children of the mothers, for instance, in rates of criminal activity and other rates of child maltreatment, and so on. But some of the other studies have been done, another good study, where a Nurse Family Partnership randomized trial was done in Memphis, Tennessee. An urban [study], also found large effects, but different. The effects may vary for a variety of reasons. It might be the women in upstate New York, there was a larger population of smokers than in Memphis. And then the third trial was also done in Denver, also in an urban population. What was most impressive about those sets of studies was that effects were found across different ethnicities, rural versus urban, they were different effects from the different studies. It could have been because the populations were different.

GRIFFIN: Ms. Lowell, I think you referred to the fact that different programs or different methods are used to reach different outcomes. Different families have different needs, and I was wondering, and either you, Ms. Lowell, or Mr. Baron, when you look at these different programs are there some programs or methods that work in certain areas, urban areas for example, that don't work as well in rural--have you seen anything to indicate that in different parts of the country?

DARCY LOWELL: First of all it has to do with the uniqueness of each family, and that if you really do a good assessment and you really understand what the needs of that family are, you're going to be the most successful because you are going to be able to target your intervention specifically to the needs of the family. As you [fellow witnesses Chrystal Towne and Sheren Sucilla] described so beautifully, it's about what that family needs.

GRIFFIN: So with each of the different models or programs or methodologies that flexibility exists? With each of them they try to take the particular family's circumstances into account and there's a certain flexibility there?

LOWELL: I think that each model does it in their own way, but I think that different models have different capabilities. For instance, in Connecticut we work in partnership with other home visiting. We have another big home visiting program. And so we often get referrals from that other home visiting program because they have a paraprofessional model. They know that if they are working with a mom that is really depressed or one who has domestic violence that they are not really the right model to work with that family, so they will refer them to us and we will do a very close transfer so that we will then take that family, or a child who is having major behavior problems. But I think that each of us has the same idea that these are very family-focused kinds of interventions and in that sense I think that everyone is trying to do that--really understand who their families are.

GRIFFIN: So there is some degree of nimbleness, if you will, to allow for tweaks in changes, if, it sounds like, through transfers or what have you, if things aren't working exactly as maybe one thought.

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