The Children’s Services Council of Palm Beach County is an independent entity established by county vote in 1986 to plan, fund, and evaluate prevention and early intervention services.
Among the numerous programs the Council has supported to date, the Healthy Beginnings System was established in 2009. Healthy Beginnings provides screening, prevention, and early intervention services to pregnant women and newborns and their mothers. Participants may be at risk due to challenges such as poverty, limited health-care access, poor nutrition, homelessness, domestic violence, and substance abuse. Included in the Healthy Beginnings System is a suite of home visiting services geared toward improving outcomes for pregnant women, mothers of infants, and children ages 0 to 5.
Evaluating the Healthy Beginnings System in Palm Beach County
The Children’s Services Council contracted with Metis to conduct a multi-year rigorous evaluation of the three major home visiting services offered within the Healthy Beginnings System:
- Healthy Families Florida, an evidence-informed model
- Nurse-Family Partnership, an evidence-based model
- Healthy Beginnings Nurses (HBN) Prenatal Plus, a locally-developed program which served pregnant women who were not eligible for the other home visiting programs
The purposes of the Metis study were to document fidelity of implementation and the contexts that may have affected outcomes, and determine the impacts of services on targeted and secondary outcomes. The study, which spanned four years, investigated the following components of the Healthy Beginnings System’s implementation:
- An individual program and across-program impact study of the three major home visiting services (Year 1)
- An implementation and contextual study of the Healthy Beginnings System of Care (Year 2)
- An impact and fidelity study of the new HBN Prenatal Plus program (Year 3)
- An expansion/replication study of the three major programs (Year 4)
Data for the study were collected via primary collection techniques such as surveys and interviews with participants, staff, and stakeholders, as well as literature/document reviews. Extant data sources such as the Florida Bureau of Vital Statistics, the Florida Department of Children and Families, and proprietary data systems in use by the Children’s Council, Nurse-Family Partnership, and the Ounce of Prevention Fund of Florida were also mined for demographic, behavior, and outcome data.
The impact studies included outcome comparisons of participating expecting mothers with those from well-matched comparison groups of non-participants using propensity score matching techniques. Multiple linear and logistic regression analyses of data from the matched samples were used to determine the impacts of each target program, as well as possible differential effects experienced by subgroups of participants (e.g., racial/ethnic background, marital status). In addition, descriptive and dosage analyses were conducted to determine the relationship between program implementation, participation, and outcomes for participating mothers.
Observed Impacts Confirm Benefits of Healthy Beginnings
At the start of the evaluation, all three home visiting programs displayed strong positive outcomes. Particularly notable was that all three increased the incidence of healthy births, a sentinel outcome for the Children’s Services Council. Also, the significant findings for the HBN Prenatal Plus program established a body of empirical evidence for the efficacy of the program. Evaluation findings documented its impact on outcomes, such as increasing the adequacy of prenatal care and reducing the risk of postnatal depression.
Likewise, the annual implementation studies showed favorable staff and client perceptions of the home visiting programs. Overall, the study showed the quality and efficacy of the CSC’s home visiting programs, suggesting that its investments in them were a sound decision.