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Findings vary but are generally positive

• There was great variability in the degree to which the sites achieved fidelity to the Welcome Baby model.
• For each of the 11 fidelity domains, there were large differences in the proportion of sites that met the fidelity threshold.
• The completeness of referral directories varied widely across sites.
• Both qualitative and quantitative data indicated that Welcome Baby participants generally had a positive perception of the program.
• Adherence to Welcome Baby fidelity standards, such as covering the curriculum, was related to lower rates of participants leaving the program early
• Where regional or national benchmarks were available, Welcome Baby participants exhibited better outcomes in more than half of the outcome areas measured. Welcome Baby participants exhibited lower levels of family planning and exclusive breastfeeding compared to benchmarks.
• There was little evidence of relationships between program fidelity and participant outcomes.

In 2015, First 5 LA contracted with the RAND Corporation to perform an implementation and outcomes evaluation of its Welcome Baby universal home visitation program. RAND designed and executed a mixed-methods implementation and outcomes evaluation program that examined program fidelity across 12 sites in Los Angeles County, each site's community referral and resource process, staff and participant experiences with the program, factors that may influence program attrition, short-term outcomes, and the relationship between program fidelity and outcomes. Data from multiple sources were used, including interviews with staff and focus groups with participants, quantitative data from staff and participant surveys, data collected by staff and entered into an administrative database, and document review. There was significant variation across the sites in meeting fidelity thresholds. Staff qualifications and training, reflective supervision, enrolling clients in the maternity ward, and service dosage elements were most challenging. Sites performed well in participant perceptions of their home visitor, supervisory requirements, and home visit content. Considerable variation in sites' community referral and resource process was also found. Welcome Baby participants achieved better outcomes compared to local and national benchmarks in more than half of the areas measured, including more positive parenting practices, higher levels of any breastfeeding, and safer sleep environments. Few clear patterns were evident in terms of relationships between meeting fidelity thresholds and outcomes. It is important to note challenges in evaluation, such as the lack of data to assess some of the fidelity and outcome domains.

• Chapter One

  Introduction

• Chapter Two

  Overview of the Welcome Baby Program

• Chapter Three

  Data Sources

• Chapter Four

  Methods and Findings by Evaluation Question

• Chapter Five

  Summary, Recommendations, and Limitations