Impacts of a Home Visiting Program Enhanced with Content on Healthy Birth Spacing

Abstract

Objectives This study sought to determine the impact of Healthy Families Healthy Futures (HFHF) enhanced with Steps to Success (STS). HFHF is a structured home visiting program for teen parents in Houston that focuses on improving parenting skills and preventing child abuse. HFHF enhanced with STS includes content and activities aimed to reduce repeat pregnancies within 24 months after the first child’s birth. Methods The study team recruited 248 young mothers for the study, primarily through local health clinics and schools, and then randomly assigned them to either a treatment group that was eligible to participate in HFHF enhanced with STS or to a control group. The control group was not offered any other program through the study. Outcomes were measured by a survey administered 12 months after program intake, in five domains aligned with the program’s logic model: (1) exposure to information related to program content, (2) contraception knowledge, (3) contraception use, (4) enhanced family functioning, and (5) child health and development. To estimate program impacts, we used ordinary least squares regression, controlling for demographics and baseline measures of the outcome variables, if available. We use both frequentist approaches (calculations of statistical significance) and Bayesian posterior probabilities to interpret the findings. Results HFHF enhanced with STS significantly (p < .05) impacted exposure to information on parenting and birth control, with effects of 20.8 and 15.4 percentage points, respectively. Using Bayesian posterior probabilities, there is an 85% chance that the program had a favorable effect on these outcomes. We also calculate a probability of 77% that the program had a favorable impact on long-acting reversible contraceptive (LARC) use, but a probability of 89% that the program reduced knowledge of birth control pills; these two results were not statistically significant (p = .17 and .10, respectively). Conclusions for Practice These findings are primarily favorable and consistent with the program content and goals. Smaller than anticipated sample sizes due to recruitment challenges increased the chances for random error to affect the ability to detect statistically significant differences on many of our other outcomes; Bayesian posterior probabilities can therefore aid in interpreting the impact estimates. More research of this promising model is warranted.

Supporting Expectant and Parenting Teens: New Evidence to Inform Future Programming and Research

“…The systematic review found that some programs increased contraceptive use, with some effects sustained more than 9 months after the program ended. These results are supported by findings from a well-conducted randomized controlled trial of Healthy Families Healthy Futures enhanced with Steps to Success, a home visiting program for teen parents, which found suggestive evidence of increases in use of long-acting reversible contraceptives among the treatment group (Zief et al 2020b , this issue). Finally, consistent with other research (Corcoran and Pillai 2007 ), the systematic review found programs reduced repeat pregnancies or births, particularly rapid repeat pregnancies or births that occurred within 24 months of prior births (Harding et al 2020 , this issue).…”

“…This supplement makes important contributions to both research and practice related to serving teen parents. Two impact studies, one of which was a replication study, and a systematic review, which included other recent studies funded by the U.S. Department of Health and Human Services in addition to a broader range of studies, illustrate that there are effective programs for promoting positive outcomes for teen parents (Zief et al 2020a , b , this issue; Harding et al 2020 , this issue). Researchers observed impacts on key aspects of teen parents’ self-sufficiency: educational progress, use of contraception, and reductions in repeat pregnancies or births.…”

“…The studies in this supplement use a range of qualitative and quantitative methods to provide insight into serving expectant and parenting teens. In addition to more traditional research methods, some studies use innovative methods such as presenting Bayesian impact estimates alongside traditional impact estimates (Zief et al 2020b , this issue), using a quasi-experimental design based on administrative data (Zief et al 2020a , this issue), conducting “ripple effect mapping” to gather stakeholder perceptions of program benefits (Workman and Browder 2020 , this issue), and using social network analysis to understand partner relationships (Purington et al 2020b ). Three articles specifically describe how to implement these innovative methods and can contribute to the toolkit for evaluators of programs to support expectant and parenting teens.…”

“…The evaluation of the New Heights school-based program used a rigorous difference-in-differences design based on administrative data to determine effects on teen mothers’ educational outcomes (Zief et al 2020a , this issue). The article in this supplement shares lessons learned from implementing this rigorous quasi-experimental method, including the importance of having a well-specified logic model to identify potential outcomes that can be measured with administrative data, getting staff buy-in to enhance understanding of program implementation, and building strong partnerships between program staff and evaluators (Zief et al 2020a , this issue). Through using extant administrative data, maternal and child health programs may be able to obtain rigorous evaluations at reasonable cost (Zief et al 2020a , this issue).…”

“…Similarly, staff struggled to understand and integrate content on reducing repeat teen births when implementing the Healthy Families Healthy Futures enhanced with Steps to Success home visiting program (Zief et al 2020b , this issue). In both cases, the programs had to provide more training and supervision than staff initially expected (Asheer et al 2020a , this issue; Pressfield et al 2020 , this issue; Zief et al 2020b , this issue). Strategies for ensuring adequate staff training and support included setting up technical assistance calls to provide opportunities for sites to do more intentional, concrete planning about implementation (Asheer et al 2020a , this issue); having program managers provide targeted one-on-one feedback based on observing program implementation as part of ongoing monitoring (Asheer et al 2020b , this issue; Aufrichtig et al 2020 , this issue); and actively cultivating a culture of collaboration among program staff (Asheer et al 2020b , this issue).…”