Overview: TIER has deep expertise in the areas of family support and home visiting programs and initiatives. For the past two decades, TIER has worked with national, state, and local program partners to evaluate existing home visiting programs, plan for new home visiting programs, and engage in home visiting system-building initiatives. TIER has strong ties with the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, both locally and nationally, and has been the lead evaluator for the Massachusetts MIECHV program since its inception, including implementation studies, quasi-experimental studies, needs assessments, and participation in two Coordinated State Evaluations. TIER also conducted a longitudinal randomized controlled trial of Healthy Families Massachusetts (HFM), the largest home visiting program in Massachusetts, and continues to conduct applied mixed methods evaluation studies with HFM partners.
Learn more about each of these evaluations by clicking on the arrows.
Adaptation and Use of Evidence-Based Home Visiting for Justice System-Involved Young Mothers
Project years: 2017–2020
Description: Funded by the Annie E. Casey Foundation, this multi-phase project explored opportunities and challenges with adapting evidence-based home visiting for young parents who are involved in the criminal justice system. The project included secondary analyses of outcomes from the Massachusetts Healthy Families Evaluation, qualitative studies of home visiting programs in Florida and Massachusetts, and a national scan of home visiting programs offering services to parents involved in the criminal justice system.
Publications:
National Scan of Home Visiting Programs for Justice System-Involved Parents
Engagement and Retention of Fathers in Home Visiting in Massachusetts: Lessons from the Field
Project years: 2019–2021
Description: Funded by the Home Visiting Applied Research Collaborative (HARC), this exploratory qualitative study described the techniques home visitors use to engage fathers, how fathers’ engagement in home visiting is expressed, and the benefits to families of father engagement in home visiting.
Publications:
Father Engagement in Home Visiting: Lessons from Massachusetts
Evaluation of Early Intervention Parenting Partnerships Program
Project years: 2018–2023
Description: Funded by the Massachusetts Department of Public Health, TIER conducted a mixed methods evaluation of the Early Intervention Parenting Partnerships (EIPP) program. EIPP is a multidisciplinary home visiting program that provides health screenings, education, counseling, and service coordination to expectant parents and families who experience pregnancy-related risk factors such as inadequate prenatal care or social risk factors including insufficient basic resources, depression, or violence in the home. The three-year evaluation comprised a quasi-experimental study examining whether EIPP improved families’ connections to preventive health care (postpartum visits, well-child visits) and early intervention, a qualitative study of EIPP services, and a social return on investment analysis.
Publications:
Timeliness of Early Identification and Referral of Infants with Social and Environmental Risks
Evaluation of FIRST Steps Together
Project years: 2020–2021
Description: Funded by the Tufts Initiative on Substance Use and Addiction and the Massachusetts Department of Public Health, this study examined how FIRST (Families In Recovery SupporT) Steps Together, a home visiting program delivered by peer recovery specialists cross-trained in parenting support, uniquely supports parents in recovery from substance use disorder. The evaluation included qualitative interviews and focus groups with staff and families and a pilot of measures to examine parents’ satisfaction with the program, recovery capital, and parenting protective factors over time.
Publications:
Evaluation of Healthy Families Massachusetts
Project years: 2008-2018
Description: TIER has conducted several independent evaluations of Healthy Families Massachusetts (HFM). The Massachusetts Healthy Families Evaluation-Phase 2 (MHFE-2), funded by the Children’s Trust of Massachusetts and the Massachusetts Department of Public Health, was a longitudinal randomized controlled trial of over 700 mothers and their children that followed families until the focal child was about 8 years of age. The evaluation was designed to determine the extent to which HFM achieved its five stated goals, understand mothers’ experiences with parenting, and explore program implementation across HFM sites.
Currently, TIER partners with the Children’s Trust to support them with an array of HFM evaluation activities including a return on investment study, a study of depression screening and referrals for fathers enrolled in HFM, and a mixed methods evaluation of the Family Financial Pilot, a guaranteed income pilot based at the Springfield HFM program.
Selected publications:
Measuring Program- and Individual-Level Fidelity in a Home Visiting Program for Adolescent Parents
Heterogeneity Among Adolescent Parents and Home Visiting Program Outcomes
The Massachusetts Healthy Families Evaluation Phase 2 (MHFE-2): Time 6 Summary Report
Getting to the Warm Hand-off: A Study of Home Visitor Referral Activities
Recurrence of Maltreatment After Newborn Home Visiting: A Randomized Controlled Trial
Evaluation of the Healthy Families Massachusetts Partnership with Legal Key Partnership for Health and Justice
Project years: 2021–2026
Description: Healthy Families Massachusetts (HFM) has collaborated with Legal Key Partnership for Health and Justice (formerly Medical Legal Partnership Boston—MLPB) since 2015 to build capacity among home visitors to address barriers and challenges families face (e.g., eviction, custody loss, immigration-related matters) through legal problem-solving before situations escalate into legal crises. TIER has been conducting a mixed methods evaluation of this collaboration, including in-depth coding and analysis of textual data from HFM’s management information system and focus groups and interviews with home visitors and families who have benefited from the HFM-Legal Key collaboration.
Publications:
Massachusetts Maternal, Infant, and Early Childhood Home Visiting Program Innovation Grant Evaluation
Project years: 2022–2024
Description: In partnership with the Massachusetts Maternal, Infant, and Early Childhood Home Visiting Program (MA MIECHV), TIER conducted a mixed methods implementation and outcomes evaluation of the MIECHV Equity Data Dashboard. The evaluation explored the processes through which the Dashboard was developed; how local implementing agencies (LIAs) engaged with the Dashboard; and the extent to which the Innovation improved LIAs’ capacity to make data-driven decisions that led to more equitable service delivery.
Massachusetts Maternal, Infant, and Early Childhood Home Visiting Program Needs Assessment
Project years: 2019–2020
Description: Funded by the Massachusetts Department of Public Health, TIER conducted the needs assessment for the Massachusetts Maternal, Infant, and Early Childhood Home Visiting Program (MA MIECHV). The goals of the needs assessment were to: (1) identify communities to be prioritized for MA MIECHV funding; (2) identify the quality and capacity of existing programs or initiatives for early childhood home visiting in the state; and (3) discuss the state’s capacity for providing substance use treatment and counseling services to individuals and families in need of such treatment or services. TIER’s broader aims were to generate a comprehensive understanding of the needs of families with young children across Massachusetts to determine whether existing family support programs and services are sufficient to meet families’ needs and identify strategies to strengthen the state’s early childhood systems of care.
Publications:
Massachusetts Maternal, Infant, and Early Childhood Home Visiting (MA MIECHV) 2020 Needs Assessment
Maternal, Infant, and Early Childhood Home Visiting Program Coordinated State Evaluation (Cohort 1): Family Engagement
Project years: 2021–2025
Description: In partnership with the Massachusetts Maternal, Infant, and Early Childhood Home Visiting Program (MA MIECHV) and other MIECHV awardee teams, TIER conducted a 4-year study of family engagement. Guided by an Evaluation Working Group comprised of home visitors and parents receiving home visiting in Massachusetts, TIER developed a survey administered to families participating in MA MIECHV programs to examine why families initially enroll in home visiting in Massachusetts, the degree to which the home visiting services they received are aligned with these reasons, and whether alignment was related to their engagement in the program.
Maternal, Infant, and Early Childhood Home Visiting Program Coordinated State Evaluation (Cohort 2): Workforce Development
Project years: 2024–2028
Description: In partnership with the Massachusetts Maternal, Infant, and Early Childhood Home Visiting Program (MA MIECHV) and other MIECHV awardee teams, TIER is conducting a 4-year mixed methods study of the home visiting workforce. Using qualitative case studies, focus groups, and a survey, the study explores associations between opportunities for shared decision-making in the home visiting workplace and staff professional well-being and retention, and whether these associations vary by staff role and background characteristics.
The Role of the Parents as Teachers Home Visiting Program (PAT) in Supporting Families Impacted by Substance Use
Project years: 2024–2027
Description: With funding from the Elevance Health Foundation, TIER is collaborating with PATNC on a project focused on enhancing PATNC’s resources and guidance for working with families impacted by substance use. Through a survey, scan of substance use screening tools, qualitative data collection, and a national Affiliate Learning Community, this project explores how PAT affiliates are currently working with families impacted by substance use to the strengths and limitations of the PAT model when working with this special population, and to identify resource gaps and needs. Informed by TIER’s work, PATNC will develop and pilot new resources, and TIER will conduct a process evaluation to understand how these resources are being implemented in the PAT network.
The Role of the Parents as Teachers Home Visiting Program (PAT) in Supporting Families Involved with the Child Welfare System
Project years: 2020–2027
Description: TIER has been collaborating with Parents as Teachers National Center (PATNC) on a series of evaluation activities focused on improving PATNC’s services for families involved with the child welfare system (CWS). Components of this project have included: a national survey of affiliates on their work with families involved with child welfare; multi-state site visits including focus groups with families, home visiting staff, and CWS workers; affiliate-level and state-level Learning Communities focused on informing policy and resource-development; and a mixed methods process evaluation examining state and local program implementation of PAT’s new tailored services package and, more broadly, how states and programs are tailoring services for families navigating CWS.
Publications:
Journey Mapping PAT Participant Experiences Navigating Custody Disruptions