This review reveals that program participation, components, and results differ based on a variety of factors, including geographic characteristics, program goals, and implementation strategies. The diversity of program designs and evaluation findings suggests an underlying tension between the need to generate cost-effective program impacts and the desire to increase accessibility so that program benefits are not exclusive to certain segments of the population. For more significant and impactful engagement, program goals may need to shift. State level policy support could help shift program goals toward increasing program accessibility for more people. Future research should explore creative strategies that target existing barriers and allow for more inclusive deployment.