Policy Resource

Evaluation and Continuous Quality Improvement in Early Childhood Systems

Nov 4, 2016

Definition: Analyzing the success of activities or processes in order to understand changes needed to achieve optimal outcomes for young children and their families. The purpose of this ongoing effort is to assure and improve the quality of services and the appropriateness and efficiency with which they are delivered.


  • Identify common outcomes and indicators that all early childhood services are aiming to achieve
  • Come to agreement on definitions of home visiting, screening ,and other terms relevant to shared outcomes and indicators
  • Align data collection measures and/or use common data collection tools
  • Engage in cross-sector continuous quality improvement (CQI) to track progress on shared outcomes and make data-informed decisions
  • Use CQI to assess how well home visiting is integrated into the broader early childhood system
  • Support communities to engage in CQI at the local level

Home Visiting Accountability Legislation

Multiple states have passed home visiting accountability legislation requiring home visiting programs and funders to collaborate on system-building activities (such as intake and referral, professional development, and data systems) and annually report on joint outcomes.

  • States that have passed home visiting accountability legislation as of summer 2016 include: Arkansas, Connecticut, Iowa, Kentucky, Maryland, Minnesota, New Mexico, Oklahoma, Rhode Island, Texas, and Vermont.
  • In addition to the coordination and reporting requirements, many states includes requirements that all or a percentage of state funds must go to evidence-based models.

New Mexico

New Mexico developed common standards and outcomes measurement across home visiting programs.

  • The Home Visiting Accountability Act, passed in 2013, created a framework for standards-based home visiting to ensure a level of quality and consistency in home visiting programs.
  • New Mexico developed an outcomes measurement plan to monitor outcomes for children and families receiving home visiting. An annual outcomes report is released.


Michigan identified common data collection measures across home visiting providers and models.

  • Although Michigan doesn’t have a statewide data system, they implemented key practices and processes to collect data consistently.


In Washington, a birth-to-3 implementation proposal outlined recommendations, including home visiting, for improving outcomes for infants and toddlers. The state is working to align data collection to be implemented in state FY2018–19 across eight home visiting models.

New York

New York established five performance standards for MIECHV (Maternal, Infant and Early Childhood Home Visiting)-funded home visiting programs and uses data to engage programs in Continuous Quality Improvement (CQI).

  • The five performance standards are: maintaining program fidelity, recruiting and retaining staff, recruiting and retaining high-risk families, coordinating with other maternal and child health programs, and improving outcomes for families.
  • CQI focused on retention strategies through a MIECHV competitive grant.
  • NOTE about the hyperlink: The measures are not posted independently, only as part of the original Request for Applications to support Nurse Family Partnership and Healthy Families America programs with MIECHV funding.


Through MIECHV, Missouri piloted world cafes in one community to develop local CQI plans to address challenges identified in home visiting benchmark data.

  • Missouri struggled to get buy-in for CQI at the local level so implemented a world café pilot.
  • Missouri found this strategy successful when the topics are relevant for community partners and are drawn from their benchmark data.


Illinois contracts with a CQI facilitator to work with home visiting programs and communities; issues are brought to the state when state-level action is needed.

  • A CQI facilitator works with seven communities and 25 providers currently, but those numbers soon will double.
  • Illinois also hired a quality assurance coordinator to assist with CQI.
  • One example of an issue brought to the state was the safety of home visitors.


Massachusetts is evaluating home visiting system efforts at the service delivery, community, and state levels. This includes community capacity and integration of home visiting into the system of care at the local level and coordination at the state level. • The evaluation is a collaborative partnership between the Massachusetts Department of Public Health and external evaluation partners.

  • The evaluation takes place at multiple levels: individual outcomes, program processes, community capacity and systems of care, and state systems and sustainability.
  • At the state systems level, they are evaluating coordination and collaboration among state agencies, as well as system sustainability in evolving early childhood systems of care.

Intertribal Council of Michigan

Intertribal Council of Michigan spent 2 years collecting data on communities’ needs and readiness through community conversations, then shared the data with each tribe and hosted summits to create plans for addressing the needs.

  • The Honoring Our Children Initiative, with support from the W. K. Kellogg Foundation, collected community/tribal level data beginning in 2012 through a series of focus groups, surveys, and discussions with tribal families, staff, and leaders.
  • They partnered with the Michigan State University Native American Institute to analyze the data by community.
  • Analyzed data were shared with each community/tribe about their own priorities and those of the tribal nation as a whole.
  • Summits were held to develop plans for moving forward.
  • Working together better has resulted in improved communications and referrals across programs.