Process Evaluation of the New Mexico Maternal, Infant, and Early Childhood Home Visiting Competitive Development Grant.

This article describes the evaluation of the New Mexico Home Visiting Competitive Development Grant, which sought to pilot test the use of implementation supports to improve the development and implementation of home visiting programs. Each community was to use Getting To Outcomes® (GTO) and ECHO® (Extension for Community Healthcare Outcomes) to support their work. The GTO framework promotes capacity for high-quality programming by specifying ten steps that practitioners should take and by providing support to complete those steps. ECHO involves specialists providing training and technical assistance via distance technology to community practitioners in rural areas to improve the quality of services. The grant was delayed, and the project's scope shifted significantly from the original plan. The evaluation documents significant challenges in meeting grant goals. A local team hired to facilitate GTO did not use it as designed, and no communities were trained in GTO. The coalitions that were developed operated with few resources or accountability, and made little progress on plans to enhance services. Only two of the four communities started home visiting after nearly a year and a half. ECHO was used with fidelity with those two programs. There was no change in the continuum of services to support children and families. Due to delays and lack of implementation of the proposed intervention, the evaluation was not able to assess the project's impact on child or family outcomes, nor did the project serve as a robust pilot test of the use of GTO and ECHO to improve home visiting implementation.