Portland State University 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.edu Jerod Tarte, M.A. NPC Research, Inc.

Research Project Goals & Objectives Conduct 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 & Sample Study 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 Studies Administrative Data: 2-year Intent To Treat 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 received Short term child and parent outcomes 11/4/2015

12 Month Interview Outcomes 1. + Early School Readiness + Daily reading to children in HFO + More frequent developmentally supportive parent-child activities in HFO 2. + Healthy Child Development HFO families were more likely to report that their child received a developmental screening in the past year 11/4/2015

12 Month Outcomes + Parenting and Risk Reduction HFO 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 assigned BUT: 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 families Lose “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 367 (out of 2,667) children had a founded or unfounded report Not Significantly Different 11/4/2015

In full sample, 101 children were placed out of home – 3.7% overall Effects on Visited vs Non Visited Families – Placement Outcomes (N=40 children) In full sample, 101 children were placed out of home – 3.7% overall 11/4/2015

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

Subgroup Differences on Founded Reports 11/4/2015

Effects on Other Service Utilization Full Randomized Sample More likely to be enrolled TANF 1st time (45.2% vs. 39.1%) More days SNAP/food stamps (488 vs. 464 days) Self Sufficiency No differences in OHP enrollment or utilization, immunizations, well baby, ER HFO more likely to receive AOD TX (4.9% vs. 3.8%) Health & Well Being 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 babies More medical claims for mothers and babies More 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 visit Fidelity 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 visiting 60% received 75% of expected visits 11/4/2015

Duration in HFO Makes a Difference Families who remained in services longer were: Less likely to be teen mothers More likely to have been screened prenatally More likely to have relationship problems at screening Families who remained in services longer had: Fewer days of TANF Fewer days employment assistance More SNAP More OHP coverage More Immunizations More well baby visits 11/4/2015

Take Aways & Next Steps Overall, findings consistent with other large-scale randomized studies of HFA – NY, MA Early modest impacts on parenting, service utilization Strong 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 risks 81% of unfounded reports during enrollment Need for ongoing follow up to track outcomes NFP, EHS, + HFA studies show CW outcomes later, when children are 4, 5, + years old Cost savings are seen 7-9+ years later

Identified Implementation Issues “Drop off” between screening, initial acceptance, and enrollment Intensity and duration ongoing challenges Serving higher risk (4+), depressed, and prentally screened families may be particularly important 11/4/2015