Evaluating Fidelity in Home-Visiting Programs a Qualitative Analysis of 1058 Home Visit Case Notes from 105 Families (original) (raw)
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Challenges experienced by home visitors: A qualitative study of program implementation
Journal of Community Psychology, 1997
s While randomized trials that test the effectiveness of different types of homevisitation have increased our understanding of the structural features of programs that promote positive outcomes, we know much less about program processes necessary to achieve success. In spite of increasing emphasis on the importance of adapting programs to suit the needs and characteristics of populations served (Yutrzenka, 1995), little evidence exists about how such adaptations affect the success of program delivery. The purpose of the current work was to examine common challenges faced by home visitors in delivering a program of prenatal and early childhood home visitation while it was studied in a large (N ϭ 1139) randomized trial conducted in Memphis, Tennessee with a primarily African American sample . We employed qualitative analyses to explore common challenges identified by the nurses in their implementation of the program. Many of these challenges grew out of the nurses' efforts to address the unique needs of the families that they served, while simultaneously addressing the broad interrelated goals and objectives of the program.
Early Childhood Research Quarterly, 2002
A longitudinal qualitative investigation of a home visiting program was conducted to explore why the program was not more effective. The sample included 21 case study families and 9 home visitors, plus 60 other mothers who participated in focus groups. Data from interviews with parents and home visitors, videotapes of home visits, and children's assessments were used to construct and examine a theory of change for the program. The study found that home visits had a consistent structure and that the home visitors emphasized their social support role and placed little emphasis on changing parenting behavior. The discussion suggests that the program's flawed theory of change that minimally acknowledged parent-child interaction limited the program's effectiveness. The findings underscore the need to critically examine the theories that underlie home visiting programs and guide the day-today interactions of home visitors.
Parent-provider relationship in home visiting interventions
Home visiting, while a very popular method of early childhood intervention, is not effective for all eligible at-risk families. The relationship between the home visitor and the family is central to the success of this type of intervention. This study aims to investigate, through 1024 home visit case notes from a French home visiting program, the ways in which the home visitor-family relationship develops, and identify the obstacles to and facilitators of a good quality relationship from the provider's point of vue. Results from a qualitative analysis suggest that the factors associated to the quality of relationship are present within the very first moments of the intervention. Poor relationship quality was found to be significantly associated with the family's mistrust towards the home visitor and with poor social conditions that make the supporting relationship difficult to develop. Good relationship quality was found to be facilitated by the parents' high involvement in the intervention and associated with a feeling of isolation and an ability to form social bonds. The necessitation for home visitor training is discussed, together with a reflection on the risk of home visiting programs to increase social inequalities, when they are not flexible enough to meet families' needs.
Child Abuse & Neglect, 2000
Objective: This study aimed to: (1) Assess the community utility of a screening tool to identify families with child abuse or neglect risk factors in the immediate postnatal period (2) Determine the social validity and effectiveness of a home visiting program using community child health nurses and offering social work services for identified families, and (3) Identify factors in the immediate postnatal period associated with the child's environment that predict poor adjustment to the parenting role. Method: A randomized controlled trial using a cohort of 181 families was undertaken to evaluate the impact of a home visiting program. Mothers were recruited in the immediate postnatal period and allocated either into the home visiting program or into a comparison group. The research design required self-identification into the study by providing positive responses to a range of risk factors. A repeated measures design was used to test parenting stress and maternal depression from the immediate postnatal period to 12-month follow-up and physical child abuse potential to 18-month follow-up. To test whether measures taken in the immediate postnatal period were predictive for poor adjustment to the parenting role, a linear regression model was used. Results: The screening procedure was shown to have utility in the context of recruitment to a research trial and mothers were willing to accept the home visiting program examined by this study from the immediate postnatal period. From as early as 6 weeks the program demonstrated ability to impact positively on maternal, infant, family, and home environment variables (testing 90 randomly allocated intervention vs. 91 comparison families). At follow-up, parental adjustment variables were not significantly different between groups (testing the remaining 68 (75.5%) intervention vs. 70 (76.9%) comparison families) and home environment assessment scores had converged. Predictive analysis of factors measured in the immediate postnatal period revealed an absence of any predictive value to demographic characteristics, which secondary prevention efforts typically target. Conclusions: Follow-up evaluation did not demonstrate a positive impact on parenting stress, parenting competence, or quality of the home environment confirming the need to test early program success on longer term outcomes. Further, the 1399 study not only demonstrated that there was a relationship between maternal, family and environmental factors identified in the immediate postnatal period, and adjustment to the parenting role, but also challenged demographic targeting for child abuse and neglect risk. At the same time, the immediate postnatal period presented an exciting window of opportunity to access high-risk families who may otherwise have become marginalized from traditional services.
Effects of Home Visits to Vulnerable Young Families
Journal of Nursing Scholarship, 2000
Nurses' home visits to new parents have been replaced in many high-need communities by nonprofessional visits without clear evidence of effectiveness. Previous reviews of home visiting research have combined nurse and non-nurse interventions and have pooled studies from the US, where home visiting is mainly limited to low-income families, with those from nations where home visiting is a universal service. This integrative review was focused on nurse-delivered interventions in the US and Canada to identify the nursing-specific models with the greatest effect in this cultural context. Evaluation of support for social ecology theory was a secondary aim. The sample consisted of 20 experimental and quasi-experimental studies of home nursing interventions for families of newborn infants who were vulnerable because of poverty, social risks, or prematurity. Each report was examined systematically using specific rules of inference and a scoring system for methodological quality. Intervention effects on five outcome domains were described. Maternal outcomes, maternal-infant interaction, and parenting were more often influenced than was child development, except in preterm infants. Well-child health care did not improve. Effective programs generally began in pregnancy, included frequent visits for more than a year, had well-educated nurses, and were focused on building a trusting relationship and coaching maternal-infant interaction. Social ecology theory was partially supported. Future nurse home-visiting research should test a combination of these effective components. Nurses can use this information to seek funding of nurse-delivered interventions for vulnerable families.
The Home Visit Rating Scales: Revised, restructured, and revalidated
Infant Mental Health Journal, 2019
The Home Visit Rating Scales (HOVRS) were initially developed from field-based descriptions of successful home visits and are supported by home-visiting research in multiple disciplines. Four home-visiting practices scales include indicators of relationship building with families, responsiveness to family strengths, facilitation of parent-child interaction, and collaboration with parents. Three family engagement scales include indicators of parent-child interaction, parent engagement, and child engagement in the visit. The original version, the HOVRS-1, was validated using video and data from two Early Head Start home-visiting programs. Conceptual and structural changes for the HOVRS-3 were designed to improve readability, usability, and clarity. Newly trained observers used the HOVRS-3 to observe archived videos from the original measurement sample. The HOVRS-3 showed good interrater reliability, scale internal consistency, convergent validity, predictive validity, practical significance, and version stability. When the HOVRS-3 home-visit quality scores were higher, it was twice as likely for parenting scores to be average or better and for child language to be at age level or better at age 3 years, over and above parenting and child language at age 1 year. The HOVRS can guide observations of home-visit quality in infant-toddler and early childhood programs to improve home-visiting practices and family engagement. K E Y W O R D S family engagement, home-visiting practices, home-visit quality, Home Visit Rating Scales RESUMEN Las Escalas de Evaluación de Visitas a Casa inicialmente se desarrollaron a partir de las descripciones sobre el campo de exitosas visitas a casa y las mismas están apoyadas por la investigación sobre la visita a casa en múltiples disciplinas. Las escalas de prácticas de cuatro visitas a casa incluyen indicadores de relaciones establecidas con familias, sensibilidad hacia los puntos fuertes de la familia, el facilitar la interacción entre progenitor y niño, y la colaboración con los progenitores. Las escalas de participación de tres familias incluyen indicadores sobre la interacción entre progenitor y niño, la participación del progenitor, y la participación del niño en la visita. Se validó la versión original, HOVRS-1, usando un video e información
Nurse Home Visiting for Families Experiencing Adversity: A Randomized Trial
Pediatrics
Nurse home visiting (NHV) may redress inequities in children's health and development evident by school entry. We tested the effectiveness of an Australian NHV program (right@home), offered to pregnant women experiencing adversity, hypothesizing improvements in (1) parent care, (2) responsivity, and (3) the home learning environment at child age 2 years. METHODS: A randomized controlled trial of NHV delivered via universal child and family health services was conducted. Pregnant women experiencing adversity (≥2 of 10 risk factors) with sufficient English proficiency were recruited from antenatal clinics at 10 hospitals across 2 states. The intervention comprised 25 nurse visits to child age 2 years. Researchers blinded to randomization assessed 13 primary outcomes, including Home Observation of the Environment (HOME) Inventory (6 subscales) and 25 secondary outcomes. RESULTS: Of 1427 eligible women, 722 (50.6%) were randomly assigned; 306 of 363 (84%) women in the intervention and 290 of 359 (81%) women in the control group provided 2-year data. Compared with women in the control group, those in the intervention reported more regular child bedtimes (adjusted odds ratio 1.76; 95% confidence interval [CI] 1.25 to 2.48), increased safety (adjusted mean difference [AMD] 0.22; 95% CI 0.07 to 0.37), increased warm parenting (AMD 0.09; 95% CI 0.02 to 0.16), less hostile parenting (reverse scored; AMD 0.29; 95% CI 0.16 to 0.41), increased HOME parental involvement (AMD 0.26; 95% CI 0.14 to 0.38), and increased HOME variety in experience (AMD 0.20; 95% CI 0.07 to 0.34). CONCLUSIONS: The right@home program improved parenting and home environment determinants of children's health and development. With replicability possible at scale, it could be integrated into Australian child and family health services or trialed in countries with similar child health services.
Content Validation of a Home Visit Program for Mothers and Children *
2018
bjective: To validate a longitudinal care program to assist adolescents in their first pregnancy. Methods: Methodological study for face and content validation of a home visit program. Data were collected using the Delphi technique, by sending the guidelines of Programa Jovens Mães Cuidadoras by e-mail. In data analysis, a content validity index with an established value of 0.75 was used. Results: The sample was 11 professionals, among whom seven were experts in several health areas and four were exclusive nursing professionals. In group 1, the obtained content validity index was compatible with the expected value, but group 2 indicated that the values descriptive of the sample regarding the content of four items resulted in an index and agreement level lower than the established number, that is, 0.75. Conclusion: The home visit program was validated as for its face and content aspects. The suggestions given by the referees were incorporated into a new version of the program and are...
Impact of a statewide home visiting program on parenting and on child health and development
Child Abuse & Neglect, 2007
To assess the impact of a voluntary, paraprofessional home visiting program on promoting child health and development and maternal parenting knowledge, attitudes, and behaviors. Methods: This collaborative, experimental study of 6 Healthy Families Alaska (HFAK) programs enrolled 325 families from 1/00 to 7/01, randomly assigned them to HFAK and control groups, interviewed mothers at baseline, and followed families until children were 2 years old (85% follow-up). Child outcomes included health care use, development and behavior. Parent outcomes included knowledge of infant development, parenting attitudes, quality of the home environment, and parent-child interaction. HFAK records were reviewed to measure home visiting services. Home visitors were surveyed to measure knowledge, perceived effectiveness and perceived training adequacy. Results: There was no overall impact on child health, but HFAK group children had more favorable developmental and behavioral outcomes. HFAK and control mothers had similar parenting outcomes except that HFAK mothers had greater parenting self-efficacy (35.1 vs. 34.6 based on the Teti Self-Efficacy Scale, p < .05). Fewer HFAK families had a poor home environment for learning (20% vs. 31%, p < .001). HFAK families were more likely to use center-based parenting services (48% vs. 39%, p < .05). The impact was greater for families with lower baseline risk (Family Stress Checklist scores < 45). There was little evidence of efficacy for families with a higher dose of service.