Impact and Outcome Research

In  2011, HIPPY was recognized by the independent research firm Mathematica as one of the first seven evidenced-based home visiting models with quality research showing significant outcomes – particularly in the areas of school readiness and positive parenting skills. As a result, HIPPY was included on the list of models that met the rigorous eligibility criteria for funding under the federal Maternal, Infant and Early Childhood Home Visiting Program.

Twenty years of research have shown HIPPY to be effective in improving school readiness, parent involvement, school attendance, classroom behavior and standardized test scores and academic performance.

Parents - more engaged in reading, talking and working with their children.

  • Home literacy environments improve and parent involvement in children’s academic learning increase. (Necoechea, 2007; Garcia, 2006; O’Brien, 2007)

  • Parents participating in the HIPPY program report spending more time reading to their children; teaching them letters, words and numbers; visiting the library and monitoring their child’s TV use. (Black, 2010; McEnturff, 2014; Palladino, 2015)

HIPPY improves children's school readiness.

  • On school readiness assessments, children in the HIPPY program show statistically significant gains while participating in the HIPPY program. (McEnturff, 2014; Palladino, 2015)

Higher achievement in school

  • Children participating in HIPPY have demonstrated statistically significant higher achievement scores in reading, math and social studies in third, fifth and sixth grades based on multiple measures used in Arkansas, Texas, Florida and Colorado. (Bradley& Gilkey, 2002; Brown & Lee, 2014; Center for  Human Investment Policy , 2003; Garcia, 2006; Neivar & Jacobson, 2011)
  • Children who participated in HIPPY adapt to the classroom better than children from comparable backgrounds and are less likely to be retained a grade. (Baker, Piotrkowski & Brooks-Gunn, 1999)

Increased parental involvement

  • Nine out of ten HIPPY parents credit the program with motivating them to check that their school-age children have completed their homework. (Cuenca, 2003)
  • Teachers report higher levels of participation in parent-teacher conferences and other school events among HIPPY parents compared to their non-HIPPY counterparts. (Black, 2010)

Summary of research 

Colorado Research

HIPPY programs have been thoroughly studied in recent years, thanks to generous support from the Temple Hoyne Buell Foundation. Three years of intensive standardized testing showed statistically significant gains in all areas measured for both children and parents.

External evaluators studied program impacts through 5 separate rigorous research studies that examined:

    • Progression of child learning.
    • Parent knowledge
    • Kindergarten readiness
    • Reading engagement

Data from the child outcome studies (one of which was an experimental, multiple baseline study) showed significant gains in child learning that were the direct result of HIPPY programming and not due to other factors.

Data on the parent knowledge study showed that as a direct result of HIPPY, not only were HIPPY parents more knowledgeable of school readiness strategies than non-HIPPY parents, but they also were able to articulate specific activities they employ with their children.

Data from the kindergarten teacher study showed that HIPPY children are better prepared for learning and better behaved than non-HIPPY children, and that their parents are more engaged in their child’s learning.

Data on the reading engagement study showed that HIPPY children were more engaged in reading interaction than non-HIPPY children, and they were read to more on a daily basis than non-HIPPY children.

More than a dozen outcome studies have been conducted on the effects of the Parents as Teachers model. Evaluations have been supported by various states, school districts, private foundations, universities and research organizations. With each new evaluation, we continue to learn about the children and families served by Parents as Teachers and the long-term impacts on communities.

Results show:

  • Children’s developmental delays and health problems are detected early
  • Children enter kindergarten ready to learn and the achievement gap is narrowed
  • Children achieve school success into the elementary grades
  • Parents improve their parenting knowledge and skills
  • Parents are more involved in their children’s schooling
  • Families are more likely to promote children’s language and literacy
  • Child abuse and neglect is prevented

Parents as Teachers: An Evidence-Based Home Visiting Model

Parents promote children’s language and literacy:

  • PAT families with very low income were more likely to read aloud to their children and to tell stories, and sing with their children.
  • Over 75% of parents in PAT reported taking their child to the library regularly and modeling enjoyment of reading and writing.
  • Parents were more likely to promote reading and PAT families have more books at home.

Parents improve their parenting knowledge and skills:

    • PAT parents showed significant improvements in parent knowledge, parenting behavior and parenting attitudes
    • Teen mothers showed greater improvement in knowledge about discipline

Parents are involved in their children’s school:

  • Sixty-three percent of PAT parents (vs 37 percent of non-PATparents) requested parent-teacher conferences.
  • PAT parents were more likely to enroll their children in preschool, attend school events, volunteer in the classroom, talk with their children’s teacher and assist with homework.

Further Evidence Based Research

Colorado Research

Since the program was first authorized in 1994, Early Head Start research has examined the program’s implementation, its impacts on children and families, and a variety of special topics such as infant and toddler mental health, fatherhood and child welfare. With a particular focus on partnerships between the research community and local programs and the Office of Head Start, the results of this body of research help to identify and build on program strengths, continuously refine and improve practices, and promote healthy growth and development of low-income children.

Early Head Start Children in Grade 5: Long-Term Followup of the Early Head Start Research and Evaluation Project Study Sample, Final Report

The study found long term impacts:

  • African Americans. African American children who had participated in Early Head Start, compared to those in the control group, had fewer attention problems and were less likely to report being bullied by peers (trend level); families were more involved in school, provided more support for education in the home, reported fewer family moves, fewer depressive symptoms (trend level), and less use of alcohol.
  • Whites.  For white children, there were favorable effects at the trend level of Early Head Start on improving children’s problem solving, reducing externalizing behavior problems as well as reducing parenting distress, family conflict and welfare participation.
  • Hispanics. For Hispanic families, Early Head Start had long-term benefits at the trend level in the area of family self-sufficiency.Hispanic mothers who had participated in Early Head Start had higher educational attainment.

Benefits of Early Care and Education for Children in the Child Welfare System

A longitudinal follow-up study of several sites that were part of the Early Head Start Research and Evaluation Project (EHSREP), a randomized controlled trial of EHS, examined child welfare encounters from ages 0 to 13.

The study found that children enrolled in EHS:

  • had significantly fewer child welfare encounters (i.e., a substantiated report of child maltreatment or an out-of-home placement due to child maltreatment) between ages 5 and 9 years than children who were not enrolled in EHS (Green et al., 2014).
  • In addition, children enrolled in EHS were less likely to have multiple child welfare encounters, and EHS slowed the rate of subsequent encounters (Green et al., 2014).

HealthySteps has demonstrated positive outcomes for children, their families, and the physicians and practices that serve them.

By age three, HealthySteps children showed more secure attachment to their parents and less aggressive behavior in general.

HealthySteps parents were:

  • nine times more likely than those in the control group to have discussed age-appropriate, preventive topics with clinic professionals,
  • less likely to have used severe discipline such as a slap in the face or spanking with an object,
  • given 25 percent more community resource information, and
  • twice as satisfied with their pediatric care and more likely to remain at that practice.

The evaluations also found that HealthySteps families were more likely to:

  • discuss important concerns, including nutrition, discipline, language development, child temperament, and maternal depression and anxiety, and
  • read to and interact sensitively with their infants, and
  • ensure they slept on their backs to prevent Sudden Infant Death Syndrome.

Overall, HealthySteps significantly reduced income disparities in access to preventive services.


New research Early Childhood Behavioral Health Integration Activities andHealthySteps: Sustaining Practice, Averting Costs found that HealthySteps reduced the cost of future maternal and child health interventions. These savings were greater than the cost of the program.

HealthySteps Outcomes

Colorado Results

Since its founding in 2006, ABCD has helped Colorado become a national leader in the early identification and intervention movement. For example:

  • The number of primary care practices that are screening and referring children increased by 1,200 percent since 2006 (740 to 9,514 practices). 
  • In 2016, Colorado reported a rate of 41.8 percent for developmental screenings in the first three years of life for children enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). Colorado’s rate is now above the median among those states reporting. 
  • Primary care practices that partnered with ABCD also improved by 20 percent the rate of referred children who followed through to evaluations for developmental needs. This compares to a 9 percent improvement in non-partner agencies in the same community over the same one-year period.

SafeCare® is a research-based parenting program for families with children 0 to 5. It addresses three key risk factors for child abuse and neglect: the parent-child relationship, home safety, and child health.

SafeCare has over 30 years of scientific research supporting its effectiveness at improving positive parenting skills and at reducing and preventing abuse and neglect.

There have been over 60 studies conducted to develop and validate SafeCare or extensions of the model.

The three primary modules of SafeCare have each been validated with single-case studies:

  • Parent-child interaction and use of planned activities (Lutzker, Megson, Webb, & Dachman, 1985; Dachman, Halasz, Bickett, & Lutzker, 1984; Cordon, Lutzker, Bigelow, & Doctor, 1998);
  • Home safety to reduce home hazards (Tertinger, Greene, & Luztker, 1984; Barone, Greene, & Lutzker, 1986; Metchikian, Mink, Bigelow, Lutzker, & Doctor, 1999);
  • Health-care skills (Delgado & Lutzker, 1988; Bigelow & Lutzker, 2000).

Additionally, an uncontrolled group trial of SafeCare found that: parents showed significant change in the behaviors targeted by the SafeCare model, that is, improved safety, health, and parenting skills (Gershater-Molko, Lutzker, & Wesch, 2003).

  • In this study, the number of home hazards was reduced by 78% for maltreating families
  • There was an 84% increase in the use of the parenting skills taught.

In terms of child maltreatment outcomes, Lutzker and colleagues (Gershater-Molko, Lutzker, & Wesch, 2002; Wesch & Lutzker, 1991) compared families receiving SafeCare services to families receiving standard family preservation services in California, and found that:

  • SafeCare families were significantly less likely to have a recurrence of child maltreatment (15% over three years) compared to services-as-usual families (44% over three years).

Four randomized trials of SafeCare have recently been completed, and each has found benefit of SafeCare relative to other services or to a no treatment control.  The largest study was a statewide comparative effectiveness trial of SafeCare in the Oklahoma child welfare system. In that trial, the six service regions of Oklahoma were matched and randomized to continue with services as usual (SAU), a six-month intensive family preservation program with a case management focus or to deliver SafeCare as part of family preservation services. Over 2100 families were enrolled in the study, and were followed for up to seven years post-enrollment.

  • SafeCare reduced child maltreatment recidivism by about 26% relative to services as usual (Chaffin, Hecht, Bard, Silovsky, & Beasley, 2012) among parents of children ages 0-5 (the primary target of SafeCare).

Cost Benefit Analysis

SafeCare Evaluation Report

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