All Fall Down: A Lack of Support for Evidence-Based Social Policy

Photo Illustration by C. J. Burton

When Shanice Beckles met Brenda Tuggle, it seemed as if her life was closing in on her. Beckles was pregnant and 16, overwhelmed and out of options. Her dream of becoming a nurse was slipping out of reach.

Today, three years later, Beckles displays her newly obtained high school diploma on the living room table in her Jamaica Plain apartment. She’s enrolled at Northeastern University, she tells me confidently, and plans to become an occupational therapist. And her two-year-old special-needs son is thriving.

She says none of this would have been possible without Tuggle, her home visitor from a local Healthy Families America program. Wherever Beckles was—her father’s place in Roxbury; a shelter in Waltham after her father threw her out; or this apartment where I’m talking with her now—Tuggles visited with her, mentoring her in child-rearing and helping her navigate the thickets of government assistance.

“Brenda has been there, and Healthy Families has been there, to support me, making sure everything’s okay with my son and with me,” Beckles says. “I don’t know where I’d be without this program and Brenda.”

The program that brought the two women together has been successful all across the state, for Beckles and hundreds of other struggling first-time parents. It owes its existence in large part to a little-known provision in the Affordable Care Act—a.k.a. Obamacare. Known as the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, it has brought $21 million into Massachusetts to fund Healthy Families and similar programs.

What’s important to note, though, is that MIECHV doesn’t choose the programs it funds based on heartwarming anecdotes or “common sense” policies. Instead, it’s a rare instance of governmental support for what’s known as “evidence-based” policy—these programs must demonstrate results by participating in scientifically rigorous testing using randomized control studies. The idea is that by testing the success of social programs in a science-based and systematic way, the government can, over time, discover the best public policy—in fields such as education, public safety, and child health.

Normally, the political process chokes off all attempts at evidence-based policymaking. This is the story of how one good evidence-based policy slipped in through a side entrance, when nobody was looking—and why it will probably be eliminated next year.

I first learned about the home-visit program in 2007, through a conversation with Bill Woodward, of the University of Colorado’s Center for the Study and Prevention of Violence. It was just after the Virginia Tech massacre. After dismissing one policy proposal after another as either unproven or ineffective, Woodward told me that there is only one thing that’s been proven, through actual evidence, to reduce violent crime: a program called the Nurse-Family Partnership.

That program, one of several accredited for MIECHV grants, has decades of data demonstrating its positive effect on school readiness, child and maternal health, economic self-sufficiency, child maltreatment, juvenile delinquency, family violence, and crime. Not only that, the Nurse-Family Partnership is a deficit reducer: For every dollar spent on it, taxpayers save about $5 on such things as food stamps, Medicaid, and incarceration.

It’s a no-brainer, but Woodward was pessimistic about implementing it on a large scale. Politicians, he told me, don’t tend to spend their efforts on expensive programs that show benefits many years down the road.