Evaluation of First Born Program

In order to conduct a rigorous evaluation of the FBP, a collaboration was established by the LANL Foundation, the RAND Corporation, and researchers at LANL, the FBP, and the University of New Mexico (UNM). An Evaluation Steering Committee comprised of officials from state agencies, epidemiologists from Indian Health Services, New Mexico scholars, and other stakeholders is also advising the evaluation team. The team, led by Dr. Rebecca Kilburn, represents some of the leading scholars in the nation in areas of program evaluation and home visiting research.

The evaluation currently includes two main components. First is an implementation study that uses site-level data from all FBP sites (Grant, Rio Arriba, Los Alamos, Socorro, Bernalillo, Valencia and Santa Fe counties) to inform other communities who are adopting home visiting programs. The information provided by this study will include:

• Which recruiting methods have the sites found most fruitful?
• What are the most common barriers to enrolling a family
   and how can these be overcome?
• Do most referrals come at the prenatal stage or at birth?
• What is the average length of time that families stay in the
   program, and what factors are associated with attrition?
• What are reasonable assumptions about take-up rates,
   number of families leaving the program each month,
   average number of visits per family per month, number
   of missed appointments, etc.?
• What are other barriers to success or lessons learned at
   these sites that can help other programs?

The second component of the evaluation is an impact study that uses random assignment to compare the outcomes of families that participate in the Santa Fe FBP to families who did not participate. The fundamental research questions that guide the impact evaluation are:

• Are the ultimate outcomes—in areas such as health,
   development, and education of both the child and
   parents—of FBP participants better than those of the
   comparison group?
• Are the intermediate outcomes—related to behaviors,
   knowledge, and interaction—of FBP participants better
   than those of the comparison group?
• Do the intermediate outcomes mediate the ultimate
   outcomes of interest?
• How do participant characteristics or other influences
   moderate the effects of the FBP?
• How does variation in participation in the FBP—such as
   number of home visits or staff turnover—relate to
   outcomes?

Products and Dissemination

The LANL Foundation plans to disseminate the findings from this evaluation to policymakers and the research communities in New Mexico and across the country. Funds have also been included in the budget for policymaker presentations at the monthly RAND Congressional Briefing Series in Washington, D.C., the Grantmakers for Children, Youth and Families national meeting, and to New Mexico lawmakers, officials, etc. Dissemination of findings to researchers will focus on publishing journal articles in addition to presentations at professional meetings such as the Association for Public Policy Analysis and Management and public health conferences. The RAND Corporation will produce a series of articles on different aspects of the findings, such as lessons learned from implementation in all FBP sites, birth outcomes, outcomes for one- and two-year-old children, and cost effectiveness. The FBP Evaluation Steering Committee is also participating in the dialogue on home visiting in New Mexico by contributing to the work of the Legislative Finance Committee, the Home Visiting Work Group, etc.

The FPB approach to promoting health tests a potential paradigm shift from the way that healthcare services are typically delivered in New Mexico and in the rest of the U.S. The FBP represents a reorientation of child and human services toward early investment and prevention and away from attempting to “treat” poor outcomes later in the life cycle. Other research suggests that shifting resources towards investment early in people’s lives has the potential to produce better outcomes, save taxpayers’ money, and improve quality of life.