Program Description

HV CoIIN 1.0 (September 2013-August 2017)

From 2013 to 2017, the Health Resources and Services Administration (HRSA), through a cooperative agreement with Education Development Center, Inc., implemented the first national initiative using the Breakthrough Series (BTS) model to accelerate improvements in select process and outcome measures that reflect positive health and well-being for children and families within the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program. HV CoIIN 1.0 demonstrated that the BTS model can be used in home visiting to improve outcomes and to develop the necessary resources and conditions for subsequent spread and scale efforts.

For more on HV CoIIN 1.0 processes and outcomes, click here.

HV CoIIN 2.0 (September 2017-August 2022)

HV CoIIN 2.0 builds on the work of HV CoIIN 1.0, and aims to achieve improvements with 25 state and territory MIECHV awardees, and 250 local home visiting agencies -- also known as Local Implementing Agencies (LIAs). This was done by dividing the work into three cohorts over the course of a four-year period. Each cohort lasts approximately 12–18 months, depending on the level of support required by the cadre of awardees selected.

Cohort 1 began in September of 2018, with 5 awardees and 55 LIAs who scaled across the topics: (1) maternal depression (MD) and (2) developmental promotion, early detection, and linkage to services. Additionally, 6 awardees and 18 LIAs participated in the first New Topic CoIIN, dedicated to improving processes and outcomes related to intimate partner violence (IPV). 

Cohort 2 began in January of 2020, with 7 awardees and 26 LIAs across two workstreams:

  • Scale: Spread improvements in two topic areas: (1) maternal depression screening, treatment access, and symptom reduction and (2) exclusive breastfeeding
  • New Topic: Develop, test, and subsequently spread improvements using the Breakthrough Series model in one new topic area: Well Child Visits (WCV)

Click here to learn more about WCV. 


Cohort 3 launched in January of 2021 with 14 awardees and over 90 LIAs across the following workstreams:

  • Scale: Spread and scale improvements in: (1) maternal depression screening, treatment access, and symptom reduction, (2) exclusive breastfeeding, and (3) intimate partner violence (IPV).
  • New Topic: Develop, test, and subsequently spread improvements using the Breakthrough Series model in two new topic areas: Staff Recruitment and Retention (SRR) and Health Equity

Our Mission

HV CoIIN 2.0 builds on the success of HV CoIIN 1.0, the first national quality improvement collaborative in home visiting, by (1) spreading improvements in previously tested topic areas (maternal depression screening, access to treatment, and symptom reduction; exclusive breastfeeding; and early detection of and linkage to services for developmental risk), and (2) developing and subsequently spreading improvements in New Topic areas (IPV in Cohort 1; WCV in Cohort 2; SRR & Health Equity in Cohort 3).

Furthermore, HV CoIIN 2.0 continues to build capacity among awardees and home visiting teams for continuous quality improvement (CQI) in order to unleash the potential of home visiting programs, with the goal of realizing large-scale improvements in population health by (1) providing group and individualized teaching and coaching in CQI practices, application of those practices, and scaling methods, (2) building infrastructure and facilitating intentional opportunities for networked learning, and (3) prioritizing and providing guidance, resources, and support on engaging families as partners and leaders in home visiting program improvement. 

Collaborative SMART AIM

We will improve maternal and child health outcomes specific to home visiting, and meet the following aims by 2022:

  • 85% of women who screen positive for depression and access services will report a 25% reduction in symptoms within 12 weeks of the first service contact.
  • 80% of children with a developmental or behavioral concern identified in partnership with the family will receive targeted developmental promotion in a timely manner, including an appropriate combination of home visitor-delivered developmental promotion, community services, and/or Part B or Part C services. 
  • Among infants whose mothers initiate breastfeeding, 30% of infants will be exclusively breastfed at 3 months and 15% of infants will be exclusively breastfed at 6 months. 
  • 90% of caregivers with identified IPV offered supports or services aligned with their self-identified needs and priorities and 85% of caregivers offered supports or services receive follow-up from home visitor.   

We will use the Breakthrough Series model to develop and test measurement systems in three new topic areas aligned with required MIECHV Benchmark Domains by 2022.

Major Activities

  • Scale Up of Tested Topics
  • New Topic Collaborative Improvement and Innovation (CoIIN) Networks Aligned with MIECHV Federal Benchmarks
  • Professional Development and Coaching in Quality Improvement to Awardees and local implementing agencies
  • Training in the Breakthrough Series Approach with partners from the Institute for Healthcare Improvement
  • Building Parent Leadership in Continuous Quality Improvement
  • Implementation Evaluation of Scale and CoIIN Activities