Increasing the policy and program relevance of results from randomized trials of home visitation

Abstract

In the present article, we describe the efforts we have made to increase the relevance of findings from our randomized trials of prenatal and early childhood home visitation for the formulation of public policies and programs for pregnant women and parents of young children. We then consider the reasons that findings from well-conducted research often fail to influence policies and programs. Some factors influencing policymaking are especially noteworthy in the context of studies of prenatal and early childhood home visitation. One is that findings from randomized trials are sometimes contradictory, causing confusion among the public and policy communities. A second is that in their understandable zeal to help children and families, advocates for particular health and social welfare programs often overstate the potential benefits of these services. A third is that the economic and social benefits of well-designed and executed home-visitation programs are spread over multiple domains of government spending, making it difficult for any single organization or branch of government to fund the program on the grounds that it will recover those costs in reduced expenditures within then own budgets. Finally, legitimate questions can be raised about the extent to which results from randomized trials can be used to predict results from programs that are scaled up on the basis of such experiments. Replicated or institutionalized programs often fail to resemble adequately the models upon which they were based. Consequently, effectiveness frequently falls short of expectations. This article concludes with a list of activities that we are conducting to further strengthen the applicability of our findings for policy and program planners. © 1998 John Wiley & Sons, Inc.