Improving Adolescent Parenting: Results From a Randomized Controlled Trial of a Home Visiting Program for Young Families

Objectives. Our aim was to estimate the effects of Healthy Families Massachusetts, a statewide home visiting program serving first-time adolescent parents, on parenting, child development, educational attainment, family planning, and maternal health and well-being.Methods. We used a randomized controlled trial design to randomly assign the 704 participants to a group receiving home visiting services or a control group. Between 2008 and 2012, telephone and in-person interviews were conducted and administrative data obtained at 12 and 24 months after enrollment. Intention-to-treat analyses compared group differences across 5 outcome domains: parenting, child health and development, educational and economic achievement, family planning, and parental health and well-being.Results. The home visiting program had a positive influence on parenting stress, college attendance, condom use, intimate partner violence, and engagement in risky behaviors. No negative findings were observed.Conclusions. A paraprofessional home visiting program specifically targeting young mothers appears effective in domains of particular salience to young parents and their infants and toddlers. Expanding participation in the program appears a worthy goal for program administrators and policymakers.Home visiting to promote the well-being of infants, toddlers, and their parents has gained increasing public attention over the past 30 years, moving from a promising service to one with considerable evidence supporting its continued implementation and future expansion.1–3 This change in status was codified in 2010 with the authorization of the Maternal, Infant, and Early Childhood Home Visiting Program within the Affordable Care Act (Pub L No. 111–148). At least 75% of the funds for this program, which supports home visiting in at-risk communities, are reserved for programs implementing one of the 17 service models designated as evidence based by the Home Visiting Evidence of Effectiveness initiative of the US Department of Health and Human Services.4 In addition, thousands of individual home visiting programs operate under myriad auspices across the country.The sole unifying feature across the 17 evidence-based models is the locus of service delivery. Otherwise, there is great variability in program goals (e.g., reducing child maltreatment, enhancing birth outcomes), service modalities (e.g., a single postpartum visit, weekly visits over 5 years), staffing (e.g., paraprofessionals, nurses), and target populations (e.g., high risk, universal).5Across and within evidence-based models, impact findings also vary widely. For the domains in which meta-analyses have detected effects (e.g., parenting; child health, development, and school readiness; maternal health and well-being; education and economic self-sufficiency; family violence),6–13 the story line is inconsistent, providing accumulating but scattershot evidence supporting home visiting as a general service approach5,14 rather than a single, uniform enterprise. Indeed, a review of home visiting evaluation findings suggests measured, nuanced, and context-specific interpretations that should guide program developers, frontline staff, and researchers in articulating and measuring what is achievable and meaningful, program to program, for the populations and communities served.15In this study, we assessed impact results from a randomized, controlled trial of Healthy Families Massachusetts (HFM), the only universal statewide home visiting program that specifically targets and wholly serves first-time young parents; reflecting the Five-Tiered Approach to evaluation,16,17 we detailed program processes, model fidelity, participants’ use of the program, and profiles of relationships between home visitors and clients. Here we describe the main program effects 12 and 24 months after enrollment on 28 indicators grouped into 5 outcome domains: parenting, child development, education, family planning, and maternal health and well-being.