Early Childhood Home Research Articles

아동의 표현어휘 지연 예측 요인 연구: 3세 말늦은 아동과 정상 언어발달 아동의 가정환경의 질 차이를 중심으로

The purpose of this study is to examine the influence of home environment quality on children’s expressive vocabulary development by comparing the home environments of 3-year-old late talkers and typically developing children. The study used the data of 1,723 3-year-old children from the Korean Children’s Panel Study 4th wave data (2011) of the Korea Institute of Child Care and Education (KICCE). Frequency analysis, t-test, and logistic regression were performed to analyze the data. The Early Childhood HOME(ECHOME) was used to measure the quality of home environment and a new variable ‘overall home environment’ was created to represent the average of the six sub-domains of home environment quality. T-test results indicated significant differences in the overall home environment quality and every sub-domain between 3-year-old late talking children and typically developing children. Logistic regression analysis revealed that the overall home environment quality at the age of 3 was a significant predictor distinguishing the two groups. When all six sub-domains were included as an independent variable, learning materials and diversity demonstrated significant influences. This study emphasizes the significance of home environment quality as a predictor of expressive vocabulary delay and identifies specific sub-domains that influence children's language development.

“I feel like it's just really become second nature, almost like the screen’s not there”: a qualitative case study of the transition to telehealth for home visitation program to support fragile infants due to the COVID-19 pandemic

A subset of early childhood home visitation programs support fragile infants and prevent hospital readmission as infants transition out of the neonatal intensive care unit (NICU) into their home. However, the COVID-19 pandemic initiated an unexpected change in the delivery of home visitation care to adhere to social distancing guidelines, resulting in a rapid transition into telehealth services. In this study, individual semi-structured interviews were conducted with staff from a NICU-transition home visitation program in Arizona. The Modified Technology Acceptance Model (MTAM) was used to evaluate the experiences of in-person to telehealth home visitations during the COVID-19 pandemic. Rapid Qualitative Analysis Method was utilized to generate a thematic analysis. Three major themes were identified: staff-centric, family-centric, and the experience of collective adjustment to the stressors of the pandemic. Participants faced challenges transitioning to telehealth visits, including not being able to physically demonstrate development skills on the infant. However, the telehealth model allowed staff to serve a larger geographic area, as well as allowing them to build a larger caseload as they had more control over their schedule. Staff also noted that families appreciated telehealth home visits as an added layer of health protection for their fragile infants. Because the transition to telehealth was abruptly necessitated by the COVID-19 pandemic, the study participants did not have the option to not use telehealth; thus, in the future, the MTAM framework could benefit from adaptions that address the rapid adoption of technology due to large disruptors such as COVID-19.

Injury prevention in the US Maternal, Infant and Early Childhood Home Visiting programme

BackgroundMany home-based interventions have been demonstrated to reduce unintentional and intentional injuries in young children aged 0–4 years, but an understanding of their inclusion in federally-funded home visiting programmes in...

Educating Families on Urgent Maternal Warning Signs: Learning From a Pilot to Improve Training and Tools for Maternal and Child Home Visiting Programs.

Early recognition of the warning signs of pregnancy-related complications and provision of timely, quality care could prevent many maternal deaths. We piloted a maternal warning signs education intervention with five Maryland-based maternal, infant, and early childhood home visiting programs serving populations disproportionately affected by adverse maternal outcomes. The intervention included a 1.5-hr online training for home visitors, monthly collaborative calls with program managers, and a client education toolkit with a 3-min video, illustrated handout of 15 urgent maternal warning signs, magnet with the same, and discussion guide for home visitor-client interactions. A mixed-methods formative evaluation assessed the acceptability, feasibility, and utilization of different components of the intervention. Home visiting program staff reported that the materials were highly acceptable and easily understood by diverse client populations. They valued the illustrations, simple language, and translation of materials in multiple languages. Program managers found implementation a relatively simple process, feasible for in-person and remote visits. Despite positive reception, not all components of the toolkit were used consistently. Program managers and staff also identified the need for more guidance and tools to help clients communicate with health care providers and advocate for their health care needs. Feedback from pilot sites was used to adapt the training and tools, including adding content on patient self-advocacy. Home visiting programs have a unique ability to engage families during pregnancy and the postpartum period. This pilot offers lessons learned on strategies and tools that home visiting programs can use to improve early recognition and care-seeking for urgent maternal warning signs.

Identifying barriers and interagency solutions to meeting the needs of families experiencing intimate partner violence (IPV): Home visiting and IPV agency perspectives

BackgroundAddressing intimate partner violence (IPV) among expectant families and caregivers with young children requires that multi-professional systems work collaboratively towards a common goal. IPV services and maternal and infant home visiting programs are two important perspectives to consider in designing interagency strategies. The purpose of this study was to identify shared priorities among home visiting and IPV professionals on IPV-related challenges and interagency solutions to support families with young children. MethodsHome visiting and IPV service providers (n=22) separately completed a structured brainstorming activity during four virtual focus groups using nominal group technique (NGT) to generate, rank, and reach consensus on prioritized barriers and solutions for the service population. The multi-professional study team (including home visiting and IPV partners) grouped and organized the top three prioritized barriers and solutions identified across groups using a pile sort activity. As a reliance measure, NGT discussion transcripts were coded to the final pile sort categories to ensure our presentation of the data was contextualized and supported by original participant responses. ResultsTwenty-four items were sorted into seven piles (three barriers and four solutions). The need to address families’ concrete needs was consistently prioritized across groups and matched with solutions that provide families with immediate financial support. Participants prioritized barriers resulting from client involvement in multiple, complex systems and named interagency process solutions (e.g., cross-systems training, enhanced referral processes) as the corresponding solution. The impact of individual and collective trauma was discussed as a barrier and matched with community-facing development (e.g., healthy relationship education). Policy, advocacy, and funding-oriented solutions were discussed as cross-cutting across all barriers. ConclusionEffective cross-system efforts are warranted to meet the interrelated needs of families impacted by IPV. The study highlights a shared view on prioritized challenges and actionable solutions to inform interagency collaboration among IPV agencies and early childhood home visiting programs. Our findings shed light on the importance of an organized public health approach to target IPV prevention and response.

Implementation of training and coaching to improve goal planning and family engagement in early childhood home visiting

Early childhood home visiting services aim to support child and family health and development, yet challenges engaging and retaining families persist. One promising strategy to improve family engagement involves enhancing the capacity of the home visiting workforce to partner with families to set and implement service goals that align with families’ needs and preferences. This study examined implementation of ‘Goal Plan Strategies’ (GPS), a training and coaching innovation designed to improve family-centered goal planning. Aims were to evaluate (1) the extent to which training and eight sessions of audio-based coaching were implemented with fidelity, (2) whether coaching fidelity was associated with home visitors’ perceptions of coaching and confidence using goal planning strategies, and (3) whether GPS was perceived as feasible, acceptable, and useful by coaches and home visitors. Home visitors (N = 22) and coaches (N = 10) took part in GPS and completed surveys, session logs, and interviews. Training and coaching sessions were observed and coded for fidelity (e.g., dose, adherence, quality). GPS was implemented with high levels of fidelity. Findings support feasibility, acceptability, and usefulness of GPS, overall, and suggest the need to examine coaching dosage and overlap with other implementation supports more closely. Findings highlight the benefits of audio-based coaching, mentoring of coaches, and observational measures of implementation fidelity.

Maintaining Family Engagement During Home Visitor Turnover: a Mixed Methods Study of Best Practices

Evidence-based home visiting services (EBHV) are available in states and localities nationwide through the federally-funded Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. Nevertheless, the anticipated benefits of EBHV, such as improved child developmental outcomes and increased positive parenting practices, may be undermined by the fact that most families withdraw from services earlier than the model developers planned. Prior studies have linked family attrition with staff turnover. The current study used a mixed methods design to investigate the conditions under which families remained active in the home visiting program after their assigned home visitor resigned. Coincidence Analysis revealed that giving families advance notice (at least 1 month) prior to the home visitors’ upcoming resignation or developing a strong positive working alliance with the inheriting home visitor appears to independently make a difference for ongoing family engagement at 3 and 6 months following a staff transition. These findings suggest that emphasizing how staff turnover is managed may mitigate the risk of family withdrawal during these transitions.

Perceptions of facilitators, barriers and solutions when preparing to implement a home visiting program in Sweden: a mixed-methods study.

Although there is growing awareness that early childhood development programs are important for a sustainable society, there is a knowledge gap about how to implement such programs. Successful implementation requires attention to implementation drivers (competency, organization, and leadership) during all phases of the implementation. The purpose of this study was to describe cross-sectoral operational workgroups' perceptions of facilitators, barriers and solutions related to implementation drivers in the preparationphase of implementing an evidence-based early childhood home visiting program. Quantitative and qualitative data were collected from twenty-four participants, divided into 5 groups, during implementation planning workshops. The workshops were guided by a structured method informed by the principles of Motivational Interviewing and within a framework of implementation drivers. Groups sorted cards with statements representing implementation drivers according to perceptions of facilitators and barriers, and percentages were calculated for each type of implementation determinant, for each type of driver. The groups discussed their card sorting and wrote action plans to address barriers, yielding documentation that was analyzed using deductive qualitative content analysis. A mixed-methods analysis resulted identification of facilitators, barriers, unknowns and solutions in two to three subcategories under each main category of implementation driver. A competent and confident workforce, and enthusiasm and commitment were key facilitators. Key barriers were unclear roles and responsibilities, and insufficient articulation of local vision and goals. Many factors were described as yet unknown. Specific solutions were generated to support the implementation. Our study furthers the scientific understanding of how to take evidence-based early childhood programs from research to practice within an implementation drivers framework. Facilitators, barriers and solutions in key areas during the preparation phase were identified with the help of a novel tool. The results provide useful knowledge for decision makers and organizations preparing similar initiatives in communities striving to attain sustainable development goals.

A Social Network Analysis of a Multi-sector Service System for Intimate Partner Violence in a Large US City

About one in four women in the US report having experienced some form of intimate partner violence (IPV) during their lifetime and an estimated 15.5 million children live in families in which IPV occurred in the past year. Families of young children with IPV experiences often face complex needs and require well-coordinated efforts among service providers across social and health sectors. One promising partnership aims to support pregnant and parenting IPV survivors through coordination between IPV agencies and community-based maternal and early childhood home visiting programs. This study used social network analysis (SNA) to understand the interconnectedness of the system of IPV prevention and intervention for families with young children in a large US city. The SNA included 43 agencies serving this population across various service domains spanning IPV, legal, maternal and child health, and public benefit programs. An SNA survey collected data on four forms of collaboration between agencies, including formal administrative relationship, referral reciprocity, case consultation, and shared activities in community committees/organizing bodies. Density and centrality were the primary outcomes of interest. A community detection analysis was performed as a secondary analysis. The overall level of interconnectedness between the 43 responding agencies was low. Making referrals to each other was the most common form of collaboration, with a network density of 30%. IPV agencies had the highest average number of connections in the networks. There was a high level of variation in external collaborations among home visiting agencies, with several home visiting agencies having very few connections in the community but one home visiting program endorsing collaborative relationships with upwards of 38 partner agencies in the network. In serving families at risk for IPV, home visiting agencies were most likely to have referral relationships with mental health provider agencies and substance use disorder service agencies. A community detection analysis identified distinct communities within the network and demonstrated that certain agency types were more connected to one another while others were typically siloed within the network. Notably, the IPV and home visiting communities infrequently overlapped. Sensitivity analyses showed that survey participants’ knowledge of their agencies’ external collaborations varied by their work roles and agencies overall had low levels of consensus about their connectedness to one another. We identified a heterogeneous service system available to families of young children at-risk for or experiencing IPV. Overall inter-agency connectedness was low, with many siloed agencies and a lack of shared knowledge of community resources. Understanding current collaborations, silos, and centrality of agencies is an effective public health tool for allocating scarce resources across diverse service sectors to efficiently improve the system serving families experiencing IPV.

Importance of school gardens. As a strategy for the consumption of healthy food in an early childhood home in Bogota-Colombia

Importance of school gardens. As a strategy for the consumption of healthy food in an early childhood home in Bogota-Colombia

Feasibility, Acceptability, and Usefulness of a Screening Tool for Caregiver Learning Differences in Early Childhood Home Visiting: Staff and Caregiver Perspectives.

Early childhood home visiting programs are well positioned to improve equity and reduce health disparities for families headed by caregivers with intellectual disabilities and other learning differences. Early identification of learning differences through screening may help home visiting staff tailor services and thus improve family engagement and outcomes. Using a mixed methods design, this study assessed potential determinants and outcomes related to implementation of a screening tool for learning differences adapted for the home visiting context. Participants were six home visiting staff and nine caregivers from multiple home visiting programs in one state. Staff completed surveys at enrollment and each time they conducted a screen with a caregiver. Staff also completed semi-structured interviews after conducting screens with at least two caregivers. Caregivers completed semi-structured interviews after taking part in a screen. At study enrollment, staff felt it was important to know if caregivers had learning differences, yet some believed caregivers would not like being asked about them. Survey and interview data aligned with theoretical determinants of implementation success, including staff competencies related to screening (e.g., knowledge, skills), perceived fit of screening with staff role and organizational context, and beliefs that the screening would improve engagement of caregivers and service delivery. Staff perceived the tool to be acceptable, feasible, and useful, although some acknowledged that caregivers might feel uncomfortable if the tool was not used carefully. Overall, caregivers found the tool to be acceptable and most believed it was helpful for the home visitor to have information about their learning experiences and needs. Findings lend initial support for the use of an adapted screening tool to identify potential learning differences.

Home visitor preparation in higher education

ABSTRACT Although home visiting is growing as a service for families with young children, the field does not adequately prepare the home visiting workforce, and higher education courses on home visiting are rare. Many home visitors are prepared through higher education as teachers, social workers, or nurses, which provides knowledge but few of the skills needed to collaborate with families to support their children’s development, revealing a need for focused pre-service preparation for home visiting. We conducted a qualitative study to (1) describe the present state of preparation in higher education and (2) propose recommendations for strengthening home visitor preparation via higher education. Focus groups (N = 43) were conducted at conferences that included some focus on early childhood home visiting. Individual interviews (N = 11) were conducted parallel to focus groups. Participants were faculty and administrators in higher education or home visiting related professionals. Using thematic analysis, three major themes surfaced: (1) learning, training, and awareness in higher education; (2) blending of a myriad of skills in home visiting; and (3) unification and support needs. Our findings emphasize the need for higher education to provide professional preparation for careers in home visiting. We offer recommendations to meet this need.

Promoting Coordination and Collaboration in Tribal Home Visiting Programs in the United States.

A joint statement from two federal agencies in the United States calls for coordination and collaboration between programs serving families of infants and toddlers who are at risk or developmentally delayed or disabled U.S. Department of Education and U.S. Department of Health and Human Services. Policy guidance: Joint statement on collaboration and coordination of the MIECHV and IDEA Part C programs. (2017). Individuals with Disabilities Education Act. ED/HHS Joint Guidance Document: Collaboration and Coordination of the Maternal, Infant, and Early Childhood Home Visiting Program and the Individuals with Disabilities Education Act Part C Programs. Young Native American children living on tribal lands in this country are currently eligible for two federal programs associated with these agencies which overlap in mission and implementation. This paper outlines potential strategies for creating a more seamless system of services for tribal families involving more centralized intake processes and procedures, cross training of staff to work across programs, and adopting more unifying approaches to program implementation. A streamlined system of services will result in interventions that better support family and child outcomes while reducing duplication of services, consolidating the limited number of qualified professionals available to provide services, and increasing convenience and cultural attunement of services to Native American families currently participating in both programs.

Promotion of school readiness in home visiting: creating a key driver diagram for continuous quality improvement

ABSTRACT School readiness is a topic of great interest to early childhood and maternal child health initiatives, such as the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) programme. However, there is a lack of information about best practices or strategies in home visiting and their relative effectiveness in improving school readiness, making this topic appropriate for improvement through Continuous Quality Improvement (CQI) methods. In 2022, Alabama developed a Key Driver Diagram (KDD) for improving school readiness efforts within the home visiting programme using synchronous online focus groups as a method of qualitative data collection with early childhood and home visiting experts. Findings from this study include development of a KDD that includes aims, key drivers, and secondary drivers. The KDD represents the first of many steps toward a unified theory of change. Future efforts will include development of a CQI change package and testing change ideas in the field.

Early childhood home visiting’s initial transition to virtual visits in response to the COVID-19 pandemic

BackgroundA reliance on in-home service delivery rendered early childhood home visiting vulnerable to the disruptions caused by the COVID-19 pandemic. Local programs transitioned rapidly from in-home visits to virtual contact with families. ObjectivesTo assess how local programs adapted to changes in staffing, supervision, and connecting with families and the prevalence and strength of associations of program, home visitor, and family-level factors influencing local programs’ transition to virtual visits using interactive video conferencing (IVC). The study also assessed whether adaptations and factors for IVC varied by use of an evidence-based model of home visiting and federal funding. MethodsThis national, cross-sectional study used a short, web-based survey to elicit local programs’ operational adaptations to social distancing policies, and challenges they encountered in transitioning to virtual contact with families. A total of 1154 program managers completed the survey, reporting on 1310 unduplicated, model-specific, local programs. Responding programs were located throughout the United States and represented over 30 different home visiting models. ResultsLocal programs swiftly transitioned to alternatives to in-home visits to maintain contact with families. While programs quickly transitioned to remote visits, they reported challenges in connecting with families via IVC. Major challenges in local program resources, visitor and family receptivity and technology were associated with significantly fewer families reached by IVC. Implementing an evidence-based model and federal funding support were associated with adapting to changes in staffing, supervision, and connecting with families by IVC. While programs reported more technology challenges for families than for visitors, major challenges in visitor technology also impacted the percent of families reached by IVC. ConclusionsWith its reach into communities experiencing disparities, home visiting is well-positioned to serve the families most adversely impacted by COVID-19. This survey demonstrated that programs swiftly transitioned to alternatives to in-home visits to maintain contact with families. This study highlighted major challenges in access to technology for families and the significant impacts of visitor and family technology challenges on reaching families by IVC. Strategies for ensuring access to technology are necessary to decrease disparities in access to home visiting. As home visiting programs adopt IVC as a more permanent option for service delivery, additional research is needed to determine the implications for reaching families, achieving model fidelity, addressing staff and family concerns, preparing the workforce to deliver IVC services effectively, and addressing enduring challenges to the use of IVC.

Co-designing a conceptual framework of home visiting implementation quality

Early childhood home visiting is a two-generation approach to promote positive health and well-being outcomes among people who are pregnant and families with infants and young children. A popular family support strategy for the past several decades, home visiting expanded exponentially in the United States when the federal Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) was authorized in 2010 through a provision within the Affordable Care Act. MIECHV currently funds evidence-based home visiting services in underserved and historically marginalized communities in all 50 states, 22 tribes, the District of Columbia, and five U.S. territories. It is widely accepted that achieving intended child and family outcomes through home visiting services requires “high-quality” program implementation, but the field lacks a standard definition or empirical evidence for what “quality” means in the context of home visiting. With the rapid expansion of home visiting that has accompanied MIECHV, there is increased interest from the field in having a shared understanding of home visiting implementation quality that is applicable across models and accounts for dimensions of quality across the entirety of the home visiting implementation system. This paper describes the process used to develop a conceptual framework to understand home visiting quality. We engaged MIECHV awardees and other experts from the fields of home visiting, early childhood, implementation science, and health equity in a co-design process that involved initial brainstorming, a series of iterative framework drafts, and finalization of the model. The resulting framework captures the multiple levels (i.e., the contexts, agencies, entities, and individuals) that are part of the home visiting system and the theorized key aspects of quality that are applicable across the levels of the systems. We discuss potential uses of the conceptual framework, as well as lessons learned from the co-design process.

Precarity and work-family balance: fathers’ workplace demands and perinatal home visiting participation

ABSTRACT Father engagement in home visiting programs is beneficial to the family and increases program retention. This qualitative evaluation explored occupational barriers to fathers’ involvement in their child’s life and engagement in Florida Maternal, Infant and Early Childhood Home Visiting (MIECHV) programs through 29 focus groups conducted with 114 Florida MIECHV staff across eight counties and 15 interviews conducted with fathers of enrolled children/infants in seven counties. Conversations were recorded, transcribed, and coded using inductive thematic analysis. Results showed that father’s work was the most referenced of logistical factors (fathers’ work, living situation, program scheduling, and transportation) impacting father engagement in the program. Specific work factors included type of occupation, work precarity, work schedule, and the family’s reliance on father’s income. The results suggest that for the majority of fathers, not engaging in the MIECHV program is due to work demands rather than a lack of interest.

Research Development on Management of Child-Friendly Schools (CFS) in Elementary School: A Bibliometric Analysis Using VOSviewer

The purpose of this study was to analyze the research trends development of management on child-friendly schools (CFS) management at the elementary school. The research method used is bibliometric analysis. Data was obtained from the Google Scholar database in the form of papers published in international journals from 2017-2022. Data processing was carried out in three stages, 1) data collection, 2) data selection and 3) data analysis using VOSviewer. The results showed that the trend of research development on management of child-friendly school was highest in 2013 with 162 publications. The results of the overlay analysis shown in yellow circles indicate research topics that are often used in recent research, namely young child, early childhood education, children, appropriate education, need, school closure, learning, pandemic, covid, parent and home. While topics that are rarely used are clinician, school climate, school closure, disability, anxiety, autism spectrum disorder, women. The results of this study illustrate that the research topic for management of child-friendly school can be developed towards the term model of friendly schools for women and disabilities, development of a child-friendly school climate, and friendly schools for children with special needs.

Virtual home visits during COVID-19 pandemic: mothers’ and home visitors’ perspectives

BackgroundThe experiences of mothers enrolled in Maternal, Infant and Early Childhood Home Visiting (MIECHV) program with virtual home visiting (VHV) during the pandemic remain mostly unknown. This study aimed to describe in detail the experience of home visitors and mothers with VHV during COVID-19 pandemic. This is a prerequisite for guiding future efforts to optimize MIECHV services that are provided through virtual operation.MethodsFocus groups discussion were conducted with home visitors (n = 13) and mothers (n = 30) who were enrolled in BabyCare program in Virginia from January 2019 to June 2022. This included mothers who received in-person home visiting (IPHV), VHV, or both (hybrid IPHV and VHV). Inductive analysis was used to identify emergent themes from the transcripts, then coding was conducted following a codebook that was developed by the research team.ResultsBoth mothers and home visitors considered IPHV necessary for a proper assessment of developmental milestones of children, for the assessment of the growth of the child through measuring the weight and height/length of the child, for the mothers to open up and discuss sensitive issues like domestic violence, for building a relationship between home-visitor and the parents, and for other potential benefits (comprehensive assessment of the environment around the child inside and outside the house from home visitors’ perspective and detecting abnormal health conditions in children from mothers’ perspective). Both mothers and home visitors see that VHV has some role to play but not to be a replacement for IPHV. If VHV is to be used, video conference is preferred by both mothers and home visitors, as it allows for some assessment.ConclusionMothers and nurses considered IPHV critical for proper and comprehensive assessment of the child and the family and also essential to build the nurse-client relationship. Both mothers and home visitors considered VHV supplementary to IPHV that can be used from time to time particularly with busy mothers. VHV may have little room with parents with intellectual disabilities and the difficulty in dealing with technology seems to be no longer a major issue.

Service Coordination in Early Childhood Home Visiting: a Multiple-Case Study

Early childhood home visiting is a preventive service delivery strategy that aims to promote child and parent health, positive parenting, child development and school readiness, and family economic self-sufficiency. To meet families’ needs, programs provide a combination of direct services, and referrals and linkages to community-based services. Service coordination is therefore a critical component of home visiting’s role within the early childhood system of care. This multiple-case study describes facilitators and barriers to service coordination, as identified by home visiting program staff and families. We interviewed program managers, supervisors, home visitors, and families from four local home visiting programs in the eastern USA with diverse contextual characteristics that showed evidence of having strong coordination. Using multiple-case study methodology, we analyzed the data to understand key facilitators and barriers to service coordination for each case and identify and describe common themes across cases. Facilitators included interagency relationships and collaboration; a culture of teamwork; dedicated, well-connected staff; supervision; trusting relationships with families; and warm handoffs. Barriers to service coordination were limited availability and accessibility of local resources, perceived stigma among other service providers, and families’ ambivalence toward some services. Home visiting staff and families emphasized that relationships at multiple levels are fundamental to service coordination, barriers are complex, and coordination is time- and labor-intensive. Coalitions that bring together diverse stakeholder groups at the state and local levels can provide meaningful coordination support to the early childhood services.