Rigorous social science evaluations of home-visiting programs designed to improve parenting and reduce child maltreatment convinced President Barack Obama’s administration to initiate a multi-billion-dollar federal program to expand a particular model of home visiting. Supporters of other models reacted by lobbying Congress and the administration to fund other program models as well. In the resulting compromise, programs with the strongest evidence of success would receive the most money, and those with modest evidence of success would get some but less money. All programs that are funded would be subject to continuous evaluation using rigorous methods to ensure continuing good results. At least in this case, policy makers are focused on social science evidence and are using it to identify and support the most successful programs.
A major goal of social science is to influence public policy by generating practical knowledge that can help policy makers make informed decisions. This is especially true of social scientists who study children. Over the past four decades, they have developed increasingly reliable methods to test whether programs affect children’s behavior and development and if so, whether their effects are long-lasting. Stripped to its basics, the model that developmental scientists follow is to identify an important social problem, design a treatment for the problem (or for preventing the problem), and test whether the treatment produces the desired outcome. In some cases, the findings can be used to calculate the benefits and costs of large-scale implementation, thereby providing policy makers with arguably the most direct and pertinent information they need to make sound decisions about public spending.
Just such a scenario is now playing out in the nation’s capital. In his budget blueprint released in February 2009, President Barack Obama recommended spending up to $8 billion over the next ten years on a nurse home-visiting program aimed at helping poor mothers learn parenting behaviors that would boost their children’s development. Tracing the early history of this proposal as Congress prepares for legislative action illustrates both the trials and triumphs of social scientists’ efforts to produce evidence to shape public policy.
What, Exactly, Are Home-Visiting Programs?
First, some background. Home-visiting programs come in all shapes and sizes. There are a host of program models, many with written curriculums, trained staff, and elaborate financing arrangements. Some programs already serve thousands of children. Individual programs vary dramatically with respect to children’s age, risk status of families served, range of services offered, and intensity of the intervention as measured by the frequency and duration of the home visiting. They also vary by who makes the visits, usually either a trained paraprofessional or a professional nurse, teacher, or social worker. Nor do all programs have the same goals. Some aim specifically to reduce child maltreatment, whereas others focus on improving children’s health and developmental outcomes. What they all share is the view that services delivered in a family’s home will have a positive impact on parenting, which in turn can influence the long-term development of the child.
Although home-visiting programs have been around for more than a hundred years, many newer programs developed since the 1960s use sophisticated evaluation methods to test their effectiveness. The best programs with the strongest reputations have been evaluated using randomized clinical trials (RCTs), which have recently been recognized by the National Academies as providing “the highest level of confidence” in program efficacy or failure. RCTs randomly assign families eligible for a program either to an experimental group, which receives the treatment, or to a control group, which does not; evaluators collect information about parents and children in both groups over many years during and after the treatment. Random assignment ensures that both groups are initially equivalent, thereby assuring that any differences in parenting or child outcomes between the groups over time are attributable to the treatment. There is widespread—but not universal—agreement in the scholarly world that RCTs are the gold standard of program evaluation. If programs have not been evaluated by random assignment, according to the National Academies, “evidence for efficacy or effectiveness cannot be considered definitive, even if based on the next strongest designs.”