I’m using my first blog to clarify a frequently misunderstood point:  ‘‘Evidence-based’’ does not have to mean experimental-based.  To improve outcomes we must apply evidence not only from program evaluations, but also from many other kinds of research, as well as practice.   

An example of how to improve outcomes by applying the lessons from research and practice to proven programs comes from the Nurse Family Partnership (NFP), widely considered the most rigorously proven early childhood intervention.[1] NFP fields nurses to make home visits to low-income teenagers pregnant with their first child, and continues periodic visits until the baby is two. NFP tested its model in three randomized clinical trials (RCTs) beginning 34 years ago in Elmira, New York, with consistent, if modest, results, especially in prolonging the interval between first and second births.  (This turned out to be an important result, because it is easily monetized.)

The NFP model has been basically frozen in time for three decades.  To maintain its “proven” status, it has not been adapted to take account of the explosion of knowledge in the last two decades. If communities could build on what we now know from research and experience, they would  

• Expand eligibility to include the 62% of mothers who are not first-time teen mothers, and mothers who received no prenatal care.[2]
• Enlist partners that have worked successfully with parents suffering from what the Harvard Center on the Developing Child has identified the two most common precipitants of toxic stress in children, parental substance abuse and postpartum depression.
• Add capacity to deal with crises arising from domestic violence or homelessness.
• Extend home visiting services and efforts to upgrade care beyond formal settings to family, friend, and neighbor caregivers, who care for 41 percent of low-income children under age 5 with employed mothers.

          It is worrisome that several communities that have enhanced their home visiting programs in one or more of these ways have told us about their concerns that they will be at a disadvantage in competing for new federal home visiting funding, because they would no longer be seen as implementing proven models.  This despite the reasons to believe that adding missing evidence-based components to proven programs, linking them to each other and to supportive systems and a strong infrastructure vastly increases the chances of achieving transformative outcomes at greater scale, even when every element of the enhanced intervention has not previously been experimentally proven to be effective.