Seven-month Pilot of an Integrated, Continuous Evaluation, and Quality Improvement System for a State-Based Home-Visiting Program

The objective of this study is to report the findings of a 7-month pilot for an integrated system evaluating a state-wide
home visiting program. A cross-sectional study design was used to determine baseline process and outcome measures for Tennessee’s
home visiting program which provides services to families, from pregnancy through 5-years-old. Baseline process measures included:
time to initiate service after referral; frequency, duration and intensity of visits; completion of continuous assessment;
and time from identification of a need to referral. The baseline outcome measures included: needs of eligible services (e.g. developmental screenings, WIC); prenatal care utilization; biological risks (prematurity; low birth weight); tobacco use
and second-hand smoke exposure; and family planning utilization. During the pilot, 3,794 families were enrolled, representing
68% (± 1.5%) of incoming referrals. Enrollment dropped from 82% (90 days) to 69% (120 days); 52% of the families received
a visit every month. Ninety percent of families had at least one full assessment after enrollment; 60% occurred within the
first 60 days. Over 92% of outgoing referrals were made within 7 days. Immunization status (70%) is below the state level
(80.8%). A quarter of the infants enrolled in the program are low birth weight and premature (state level 9.2%). Current tobacco
use by the prenatal population is 16% compared to the state, 19.7%. The HUGS program serves high risk/high need clients and
is consistent with other national home visiting models that have shown higher levels of attrition and lower levels of visits
than intended by the model.