Can a place-based investment improve child health and development? Early implementation lessons from the Best Start LA Evaluation

Best Start LA's goal is to increase the number of children who achieve optimal health and development through home visiting for mothers of infants, community mobilization, and development of family-friendly community services. Our five-year evaluation of this “place-based initiative” employs qualitative and quantitative methods, including case studies of implementation, focus groups, a longitudinal household survey, and analysis of secondary community data, to assess whether the initiative improves child/family functioning, and expands community capacity to support families. Results will inform the development of Best Start LA initiatives in 13 other Los Angeles communities.

During year one, we interviewed 30 key informants during a multi-day site visit, and conducted focus groups with parents receiving home visiting, home visitors, and community members. Findings suggest that home visiting to high-risk mothers is benefiting the health and developmental potential of children. More than 700 parents of newborns received multiple home visits from nurses and college-educated “parent coaches,” and parents received education in breastfeeding, child health and development, parenting, home and environmental safety, and community resources. Focus groups indicated that mothers highly valued the service, formed strong bonds with coaches, and perceived improved breast feeding and parenting skills.

Community-level components of the initiative have been slower to take hold. Engaging community members, resolving tensions between community providers, and coordinating multiple out-of-sync contract schedules have all challenged the launch of place-based strategies designed to develop family-friendly communities and systems.

Household survey results in future years of the evaluation will provide definitive quantitative evidence of the intervention's impacts.