Expert-Generated Standard Practice Elements for Evidence-Based Home Visiting Programs Using a Delphi Process

Background. States, territories, non-profits, and tribes are eligible to obtain federal funding to implement federally-endorsed evidence-based home visiting programs. This represents a massive success in translational science, with $400 million a year allocated to these implementation efforts. This legislation also requires that 3% of this annual funding be allocated to tribal entities implementing home visiting in their communities. However, implementing stakeholders face challenges with selecting which program is best for their desired outcomes and context. Moreover, recent reviews have indicated that when implemented in practice and delivered at scale, many evidence-based home visiting programs fail to replicate the retention rates and effects achieved during clinical trials. To inform program implementers and better identify the active ingredients in home visiting programs that drive significant impacts, we aimed to develop an expert derived consensus taxonomy on the elements used in home visiting practice that are essential to priority outcome domains. Methods. We convened a panel of 16 experts representing researchers, model representatives, and program implementers using a Delphi approach. We first elicited standard practice elements (SPEs) using open-ended inquiry, then compared these elements to behavior change techniques (BCTs) given their general importance in the field of home visiting; and finally rated their importance to 10 outcome domains. Results. Our process identified 48 SPEs derived from the panel, with 83 additional BCTs added based on the literature. Six SPEs, mostly related to home visitor characteristics and skills, were rated essential across all outcome domains. Fifty-three of the 83 BCTs were rated unnecessary across all outcome domains. Conclusions. This work represents the first step in a consensus-grounded taxonomy of techniques and strategies necessary for home visiting programs and provides a framework for future hypothesis testing and replication studies.

A Novel Application of Photovoice in a Statewide Home Visiting Evaluation

Photovoice is an empowering, qualitative, community-based participatory research method that engages participants to take photographs and reflect on their meanings. We employed a novel application of a Photovoice-inspired methodology to evaluate perinatal home visiting services. This article describes the feasibility and utility of remote implementation of a Photovoice-inspired project in one state’s federally funded Maternal, Infant, and Early Childhood Home Visiting Initiative. The initial project aimed to identify aspects of parenting roles/identities, goals, and home visitor–client relationship that can be leveraged to improve program engagement and retention. Training materials were sent to home visitors who acted as liaisons with parents. Reflective interviews about this photo-elicitation method conducted with parents, home visitors, and the evaluators following the project revealed that informational materials were beneficial to understanding the process. Home visitors were noted as gatekeepers and key motivators. Trainings, flexibility, timely communication, and logistics should be considered when remotely implementing Photovoice.

‘A Way to Know’ Your Stress: Acceptability and Meaning of Hair Sample Collection for Cortisol Analysis From African-American and Latina Women in a Digital Storytelling Study

Obtaining biological samples for research purposes from members of marginalized communities demands careful social and ethical consideration. This paper aims to discuss how feasibility and acceptability translate into methodological and ethical considerations for collecting hair samples in a study comprised of young, pregnant Latinx and African-American women participating in a digital storytelling intervention (DST). Transcripts from two focus groups with Healthy Families home visitor staff (N =10) and follow-up interviews with DST participants (N = 8) were analyzed through qualitative content analysis for hair sampling acceptability. Responses regarding the feasibility of obtaining a hair sample were generally positive amongst Healthy Families home visitor staff participating in the two focus groups, though responses overall were more favorable with the pregnant women participants who were interviewed post-DST intervention. Home visitors emphasized clear communication to participants around the reasoning for obtaining biological samples. Social and ethical considerations for communication of biomarker data to participants, as well as the intersection of lay knowledge of stress and participants' perspectives on providing a hair sample for cortisol analysis, is discussed.

Precision Family Spirit: a pilot randomized implementation trial of a precision home visiting approach with families in Michigan—trial rationale and study protocol

Background Home visiting is a well-supported strategy for addressing maternal and child health disparities. However, evidence-based models generally share implementation challenges at scale, including engagement and retention of families. Precision home visiting may address this issue. This paper describes the first known pilot randomized implementation trial of a precision home visiting approach vs. standard implementation. Primary aims are to: 1) explore the acceptability and feasibility of a precision approach to home visiting and 2) examine the difference between Standard Family Spirit and Precision Family Spirit on participants’ program satisfaction, client-home visitor relationship, goal alliance, and the impact of these factors on participant engagement and retention. Secondary aims are to explore potential differences on maternal behavioral and mental health outcomes and child development outcomes to inform sample size estimations for a fully powered study. Methods This is a pilot Hybrid Type 3 implementation trial. Four Michigan communities primarily serving the Native American families and already using Family Spirit were randomized by site to receive Standard Family Spirit or Precision Family Spirit. Participants include N = 60 mothers at least 14 years of age (pregnant or with a newborn < 2 months of age) currently enrolled in Family Spirit. Precision Family Spirit participants receive core lessons plus additional lessons based on needs identified at baseline and that emerge during the trial. Control mothers receive the standard sequence of Family Spirit lessons. Data is collected at baseline (< 2 months postpartum), and 2, 6, and 12 months postpartum. All Precision Family Spirit participants are invited to complete qualitative interviews at study midpoint and endpoint. All home visitors are invited to participate in focus groups between study midpoint and endpoint. Exploratory data analysis will assess feasibility, acceptability, client-home visitor relationship, retention, adherence, and potential differences in intervention outcomes. Discussion This trial will provide new information about the acceptability and feasibility of precision home visiting and pilot data on program satisfaction, client-home visitor relationship, goal alliance, retention, and targeted maternal-child intervention outcomes. Findings will inform the design of a fully powered randomized implementation trial of precision vs. standard home visiting. Trial registration ClinicalTrials.gov #NCT03975530; Registered on June 5, 2019

An Integrative Review of Home Visiting Programs for Mothers and Infants from Birth to 12 Months in Developed and Underdeveloped Countries

Objectives. To investigate home visiting for mothers and young infants, age birth-to-12 months, program goals, interventions used, home visitor characteristics and qualifications, and the program content and outcomes. Methods. Electronic databases PubMed, CINAHL, ScienceDirect, and Sagepub were used. Eleven studies investigating home visiting from 2011-to-2016 were included. Studies were included if they: 1) were a primary study; 2)commenced during the antepartum or early postpartum period for mothers and finished before or when the infant was12 months old; 3) and provided a description of home visiting program in terms of goal, type of home visitor, content,length, and outcomes. Data extraction included goals, activities, home visitor characteristics and qualifications,and outcomes. A descriptive approach was used to synthesize data. Results. Home visiting impacted birth preparedness, newborn care practices, breastfeeding practices, and home environment necessary for maternal wellness and child health and development. Conclusion. Home visits in developed and underdeveloped countries create positive outcomes for mothers and infants. It is important to understand the process in order to make it more effective.

The ripple effect: Examining the impact on parents of an Abecedarian early child care intervention in an urban social housing development

The Abecedarian Approach is an internationally recognised early childhood intervention program that has shown long-term positive outcomes for children living in low SES communities. However, there are few studies examining the broader influence of such interventions for young children on the lives of their parents. This article describes the findings of a qualitative study exploring the perceptions and experiences of parents whose children attend an Abecedarian early intervention program located in an urban social housing complex. Eighteen parents whose children had attended the program for a minimum of one year were interviewed. The main themes that emerged were: strengthened relationships between parents and program staff, as well as between parents themselves, particularly supported through the home visitor; increased awareness among parents about early development and of their role in supporting child development; and opportunities for parents’ personal growth. The findings suggest that high quality early child intervention programs, such as the Abecedarian Approach, can positively impact the lives of parents.