Testing the Effectiveness of Healthy Families Oregon: Summary of 1 & 2 Year Outcomes - PowerPoint Presentation

Slide1

Testing the Effectiveness of Healthy Families Oregon: Summary of 1 & 2 Year Outcomes Best Beginnings Meeting 1/14/2016

Beth L. Green, Ph.D.

Portland State University bgreen@pdx.eduJerod Tarte, M.A.NPC Research, Inc.

Research Project Goals & ObjectivesConduct a large-scale randomized

study of Oregon’s Healthy Families Oregon (HFO) program examining effects on substantiated maltreatment rates and other key outcomes in administrative data

Conduct a detailed cost-benefit analysis of HFO examining program investments & outcome costs Develop & disseminate a web-based cost analysis tool to develop readiness & understanding of cost analysis in home visiting programs 11/4/2015

RCT: Target Population & SampleStudy implemented in 7 of Oregon’s HFO programs, selected for high implementation +

many unserved eligible families

Random assignment happened at initial eligibility screening (Feb 2010-Feb 2012). Eligibility = first time parent, 2+ Risk Factors on “New Baby Questionnaire” (or substance abuse, depression)Most screenings done at birth Final full sample n=2667 (1438 program, 1289 control)11/4/2015

Methodology – Two Outcome StudiesAdministrative Data: 2-year Intent To T

reat design (n=2667): Child welfare data, Medicaid billing records data, substance abuse treatment data, enrollment in self-sufficiency programs, criminal justice (arrests)

Interview Sample: 1 year follow up telephone interview with n=803 (403 HFO, 400 control): Home visiting & parenting services receivedShort term child and parent outcomes11/4/2015

12 Month Interview Outcomes1. + Early School Readiness+ Daily reading to children in HFO+ More frequent developmentally

supportive parent-child activities in HFO2.

+ Healthy Child DevelopmentHFO families were more likely to report that their child received a developmental screening in the past year11/4/2015

12 Month Outcomes+ Parenting and Risk ReductionHFO families had less total stress (measured on the short form Parenting Stress Index), and in particular, lower parenting-related stress

Some results were more positive for families more risk factors

11/4/2015

More Positive Results for Higher Risk?

11/4/2015

Administrative Data Approaches Intent to Treat Group –everyone randomly assignedBUT: 44% of randomized never got a first home visit, many never contacted/located after screening and initial interest..

Created 2 additional comparison groups

to compare families with got a visit vs. controls/non visited familiesLose “gold standard” design; but statistically controlled for baseline differences between groups. Visited families were more likely to be Hispanic (33% vs. 22%)More likely to be depressed (23% vs. 13%)More likely to report trouble paying for basic needs (82% vs. 78%)11/4/2015

Effects on Child Welfare Reports Full Randomized Sample

11/4/2015

367 (out of 2,667) children had a founded or unfounded reportNot Significantly Different

Effects on Visited vs Non Visited Families – Placement Outcomes (N=40 children)11/4/2015

In full sample, 101 children were placed out of home – 3.7% overall

Were There Differences for Any Subgroups of Families? Subgroups:Hispanic vs. Non HispanicSpecific Risk Factors present/not present

Subgroup Differences on Founded Reports

11/4/2015

Effects on Other Service UtilizationFull Randomized Sample

11/4/2015

Service Outcomes for Visited Families Controlling for baseline differences, visited families (compared to non-visited) had:More days TANF (187 vs. 167)More days employment services (111 vs. 89.2)

More days OHP coverage for mothers and babiesMore medical claims for mothers and babiesMore well baby visits (6.4 vs. 6.1)

Fewer arrests (2.4% vs. 4.3%)

Implementation Analysis Low rate of HFO enrollment in randomized group 44% (636 of 1489) families got 1 visitFidelity concerns (examples):42% of families received L1 for 6 months or more

Average duration was 15 months (range 0-24)12% received < 90 days of home visiting60% received 75% of expected visits

11/4/2015

Duration in HFO Makes a DifferenceFamilies who remained in services longer were:Less likely to be teen mothersMore likely to have been screened prenatallyMore likely to have relationship problems at screening

Families who remained in services longer had:Fewer days of TANF

Fewer days employment assistanceMore SNAPMore OHP coverageMore Immunizations More well baby visits11/4/2015

Take Aways & Next StepsEarly modest impacts on parenting, service utilizationStrong evidence for early surveillance and reporting by HFO visitors

89% of founded reports were when they were not receiving home visits

More founded reports on families with specific risks81% of unfounded reports during enrollmentNeed for ongoing follow up to track outcomesNFP, EHS, + HFA studies show CW outcomes later, when children are 4, 5, + years oldCost savings are seen 7-9+ years laterOverall, findings consistent with other large-scale randomized studies of HFA – NY, MA

Identified Implementation Issues“Drop off” between screening, initial acceptance, and enrollmentIntensity and duration ongoing challengesServing higher risk (4+), depressed, and prentally screened families may be particularly important

11/4/2015