Objectives. This study was designed to achieve several specific objectives: (1) to conduct a large-scale randomized study of the impact of the Healthy Families Oregon (HFO) program, a home visitation program using the Healthy Families America model, on child welfare system involvement, access to self-sufficiency resources, and use of preventive and other medical services; (2) to conduct a comprehensive and detailed cost-benefit study of the HFO program; and (3) to develop and disseminate a web-based tool to support home visiting program managers, funders, and others to better understand and develop readiness for conducting program cost analysis and cost-benefit research.

Approach. 2,727 eligible first-time parents were randomly assigned to receive the HFO program or a community services-as-usual control group. The research team obtained 2 years of postenrollment follow-up data on all study participants from Oregon’s child welfare system, selfsufficiency services, and medical assistance programs. Additionally, a 1-year post-enrollment telephone interview was conducted with a random sample of 803 study participants (403 program, 400 control). Analyses were also conducted to examine whether program impacts varied for subgroups of families with different demographic and baseline risk characteristics, and to explore the relationship of program fidelity and dosage to outcomes. Finally, a detailed program cost analysis was conducted and administrative data outcomes were used in a cost-benefit analysis.

Results/Benefits. 1-year follow-up interviews with parents found that HFO families were significantly more likely (compared to controls) to read to their young children frequently, to provide developmentally supportive activities, and to report lower parenting-related stress as measured by the Parent Stress Inventory (PSI). These effects appeared to be strongest for families with four or more risk factors (two factors more than the threshold for “at risk”). Administrative data outcomes at 2 years post enrollment found that families were no more likely to have a founded child abuse report than were controls (6.3% vs. 6.0%), but were significantly more likely to have an unfounded report (9.7% vs. 7.9%). HFO families, compared to controls, were also significantly more likely to have been enrolled in TANF services for the first time, received more days of Supplemental Nutrition Assistance Program (SNAP), and were more likely to be enrolled in substance abuse treatment services. There were no significant differences between groups in terms of use of or access to publicly funded health insurance or health-related services. Consistent with other cost-benefit analyses of home visiting and early childhood programs, results of the cost-benefit analyses did not support short-term cost savings associated with receipt of the HFO program. A web-based tool, The Home Visiting Cost Tool, was posted to the following web address: www.homevisitcosts.com.