Quality Of Home Visits Research Articles

Little Talks: Building Home Visiting’s Capacity to Promote Communication and Language Skills for Children under Three Years of Age

Poverty continues be most prevalent among young children under three years of age, when development, particularly in communication and language skills, is rapid and vulnerable to socioeconomic impacts. Home visiting was intentionally formulated to support parents in promoting children’s development and health, offsetting poverty’s threats. Little Talks, a parent-mediated intervention to promote children’s communication and language growth, was designed for implementation in home visiting programs. Developed through community-partnership research methods, Little Talks is a modular intervention that is tailored to parents’ styles and preferences for interacting with their children. A randomized control trial of Little Talks’ effectiveness in attaining outcomes aligned with the two-generational processes inherent in home visiting was undertaken. Situated in an Early Head Start program, home visitors and the families they served were randomly assigned to receive EHS with Little Talks and typical EHS services. Assessed across four time points during a 10-month period, Little Talks was demonstrated to significantly enhance the quality of home visits and parents’ involvement in their children’s early learning experiences. In addition, parents’ depressive symptoms did not increase as noted for the comparison condition. Communication and language growth improved for EHS Little Talks children, although statistical significance was not attained. Moreover, parenting outcomes were greatest for families who were less acculturated to US either by immigration status and/or language preferences. Implications advancing Little Talks as a feasible and effective addition to home visiting programs are offered.

Capacity building among frontline health workers (FHWs) in screening for cardiovascular diseases (CVDs): Findings of an implementation study from Bihar, India.

Community-based screening is one of the key preventive strategies to tackle the ever-rising burden of non-communicable diseases (NCDs) under the National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). The current study was aimed to build capacity among frontline health workers (FHWs) in screening for cardiovascular diseases (CVDs) under NPCDCS in the selected districts of Bihar state. This was an implementation study with follow-up components, conducted among 75 FHWs [14 auxiliary nurse midwives (ANMs) and 61 accredited social health activists (ASHAs)] from 15 primary healthcare facilities across four districts of Bihar state from October 2019 to September 2021. The selected FHWs were initially trained on NPCDCS for a day, including pre- and post-training knowledge assessment. Then, supportive supervision (SS) visits using a predesigned questionnaire were done. The pre- and post-training mean knowledge scores of the FHWs were 12.9 and 22.1, respectively, with an overall effect size of 2.5. During SS visits, only 20.0% of the visited primary healthcare facilities had all the required logistics to conduct weekly NCD screening clinics for CVDs. Considering different measurements and operative skill proficiencies of FHWs, waist circumference skills (41.7% for ANMs and 50.8% for ASHAs), followed by blood pressure (BP) (41.7%) and random blood sugar (RBS) measurement (25.0%), were found to be the most deficient skills (among ANMs). Moreover, the quality of initial and follow-up home visits was found to be satisfactory for only 54.1% of the ASHAs. The reported barriers of NCD screening were reported to be non-cooperation, unawareness among community dwellers, lack of knowledge and skill of FHWs, logistic constraints and delayed honorarium credit. One-day training on NCDs for FHWs was quite effective. However, for translating all the desired skills for CVD screening into action, periodic training needs assessment, and SS of FHWs might be fruitful.

Impact of COVID-19 Pandemic on Older Adults Using Hearing aid/s: Indian Scenario.

The online version contains supplementary material available at 10.1007/s12070-022-03209-8.

Strengthening Home Visitor Practice Through an Embedded Model of Infant and Early Childhood Mental Health Consultation.

Home visitors face the difficult task of engaging and supporting families who experience economic, social, and mental health challenges. Infant and Early Childhood Mental Health Consultation (IECMHC) is one strategy to improve early childhood professionals' abilities to promote maternal and children's mental health through relationship building and collaboration. To date, most of the evidence showing positive effects of IECMHC comes from evaluations conducted in center-based early childhood programs. Only a few have examined the implementation and outcomes of IECMHC in home visiting programs. Using a longitudinal, matched-comparison group design, a three-year pilot study of a cross-system, embedded model of IECMHC assessed implementation and outcomes for teachers and home visitors. Here, we focus on intervention effects on home visitor-family relationships based on an analysis of 42 recordings of home visits. We used the Home Visit Rating Scales Adapted & Extended to Excellence (HOVRS-A+ v.2.1; Roggman et al., in2010) and created another scale, the IECMHC scale, of items aligned with the expected outcomes of the model. Home visitors in the intervention group scored significantly higher on the HOVRS-A+ home visitor responsiveness to family scale over time than those in the comparison group. Additionally, scores of home visitors in the intervention group increased at a greater rate, on average, on the newly developed IECMHC scale than scores of home visitors in the comparison group. We conclude that the Illinois model of IECMHC successfully improved home visitors' responsiveness to families and improved the quality of home visits. Due to the small sample, we recommend further study of the model in home visiting and further development of the IECMHC scale as part of the HOVRS-A+ .

Relations among home visit quality, parent-child interactions, and children’s outcomes

Home visiting programs are designed to improve young children’s developmental outcomes and overall health and well-being. The purpose of many early childhood home visiting programs is to support high quality parent–child interactions as the central mechanism for supporting children’s healthy development. For this study, data from home visits with 275 families (across 66 home visitors during a five year period) were coded to rate the quality of home visitors’ practices and family engagement using the Home Visit Observation Rating Scales-Adapted and Extended (HOVRS-A+; Roggman et al., 2010). Parent and child interactions and child developmental outcomes were measured when children were under one year of age and again at age 2. Parental practices and engagement ratings, along with child and family characteristics, were examined as predictors of the quality of the parent–child interactions and the children’s developmental outcomes. Although home visitor practices did not predict parent–child interaction quality or the children’s developmental outcomes, results did show that parent engagement during home visits, quality of parent–child interactions, and changes in interaction quality did predict a variety of child developmental outcomes. The important influence of parents’ engagement, both with their children across time and during home visit activities, is discussed, as well as the need to strengthen professional development for home visitors to facilitate parent–child interactions and collaborate with families.

Strengthening Palliative and Home Care Service During COVID-19 Pandemic in Developing Country: A Single Institution Report

Palliative care is an essential part of integrated care to reduce the suffering condition (physical, psychological, social and occupational, or even spiritual conditions) caused by the patient’s health condition and to improve quality of life. The service of palliative care is significantly increased, commonly at the end-of-life care. The most prevalent diagnosis in our Palliative Care unit is benign tumor and malignancy (35.7%), followed by stroke (14.2%) and the post-surgery patient who needed wound care (12.9%). The number of home visits for palliative care increased from 1537 in 2020 to 2110 in 2021. Because of the low number of nurses in our unit, the compensation adds some nurses to reduce the workload. In conclusion, the need for home visit palliative care during the COVID-19 pandemic is still increasing, but this condition should be followed by increasing the quantity and quality of home visits.

Community-based postnatal care services for women and newborns in Kenya: an opportunity to improve quality and access?

BackgroundIn resource-constrained settings, Community Health Workers (CHWs) are the first point of contact between communities and the health system, as providers of maternal and newborn health services. However, little is known of the quality of community-based postnatal care (PNC). We assessed the content of PNC provided by CHWs and women’s experiences of care in two Kenyan counties.MethodsWe used a cross-sectional, mixed methods design to examine the quality of PNC services provided by CHWs. Trained observers attended PNC home visits to assess technical quality using a 25-item checklist covering four PNC domains: infant health warning signs, maternal health warning signs, essential newborn care, and breastfeeding. The observers completed an 8-item communication quality checklist. We conducted follow-up surveys with observed PNC clients to assess their experiences of care. Finally, we used in-depth interviews with CHWs and focus group discussions with observed PNC clients to understand the experiential quality of care.ResultsObservations suggest shortcomings in the technical quality of PNC home visits. CHWs completed an average of 6.4 (standard deviation SD = 4.1) of the 25 PNC technical quality items. CHWs often lacked essential supplies, and only six percent carried all four of the CHW job aids and tools specified in the national guidelines for maternal health at community level. However, CHWs completed an average of 7.3 (SD = 1.1) of the 8 communication quality items, and most PNC clients (88%) reported being satisfied during follow-up interviews. Higher technical quality scores were associated with older mothers, better communication, longer visit duration, and CHWs who carried at least three job tools. CHWs expressed a strong sense of responsibility for care of their clients, while clients underscored how CHWs were trusted to maintain their clients’ confidentiality and were a valuable community resource.ConclusionThis study identified gaps in the technical quality of CHW PNC practices, while also recognizing positive elements of experiential quality of care, including communication quality, and trusting relationships. This study also demonstrated the strength of the CHWs’ role in establishing linkages between the community and facilities, as long as the CHW are perceived as, and enabled to be, an integral part of the PHC network in Kenya.

Utilization of Postnatal Healthcare Services Delivered through Home Visitation and Health Facilities for Mothers and Newborns: An Integrative Review from Developing Countries.

Despite evidence about the value of high quality postnatal services for the survival, health and wellbeing of the mother and neonate, sub-optimal use of the available services delivered through public sector remains a persistent challenge in India and most low-middle income countries. An extensive search till Dec 31,2017 in databases including PubMed, Scopus and Science Direct was conducted and selected studies were organized, categorized and summarized for integrated review. Of the 3463 studies screened, 47 relevant studies were identified through integrated systematic process. The 'nexus' framework consisting of four domains namely: social-cultural, educational, organizational and economic-physical were used to determine the promoters and inhibitors of postnatal care-utilization. The important inhibitory factors at household and community context were myths-cultural practices, gaps in the awareness of mother and families regarding danger signs and postnatal complications and hesitancy to contact health workers due to trust deficit. There were lack of clarity about job responsibilities, poor quality of training, skills building and supervision of front line workers. Quality of home visits, and irregular incentives to health workers were other factors. The facilitating factors were mother's autonomy, young mothers, access to media and repeated and timely contact with the health worker, antenatal care (ANC) attendance and institutional deliveries, conditional cash transfer and availability of health insurance. Several factors like social mobilization, skill building and training cut across the domains of the nexus framework. The review suggested a multi-dimensional focus on implementing integrated continuum of care models covering prenatal-postnatal and infancy period.

Observing home-visiting quality across time: A longitudinal reliability study of the Home Visit Rating Scales.

Empirical examination of home-visiting quality over time is lacking in the research literature. To this end, this study examined the most recent edition of a widely used observational measure of home-visiting quality, the Home Visit Rating Scales (HOVRS), over four repeated assessments spanning an average of 6 months. Psychometric quality for the HOVRS Total and Home Visitor Practice Scales, including item ratings and calculated scores, across time was demonstrated. Stability indicators for the Family Engagement Scales varied, with superior reliability often indicated for individual ratings over the calculated score. The exploration of interrelationships among family demographics and change in HOVRS scores over time were largely insignificant. Interestingly, a decline in the Home Visitor Practice Scale significantly related to increased symptoms of maternal depression, possibly suggesting that home-visitors' focus shifted from children's needs to those of parents when mental health concerns were observed. Although this study is an examination of one program model and poses limited generalizability, it sets the stage for advancing the HOVRS and longitudinal measurement of home-visiting quality.

The Home Visit Rating Scales: Revised, restructured, and revalidated

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.

Observing home-visit quality with the home visit rating scales: Introduction to the special section.

Evidence-based home-visiting programs aim to address one of the most important challenges facing our species-setting the next generation on a healthy path of development that prepares them for a future that is simultaneously uncertain and promising. Diverse research literatures have pointed to practices to effectively meet this challenge and better achieve the unfulfilled promise of home visiting by more effectively engaging parents in supporting their children's early development and well-being. Measures of home-visit quality practices drawn from social work, pediatric nursing, early childhood, and early intervention research literatures have identified building relationships with families and focusing on their strengths as effective, practices that are particularly important for vulnerable families. The articles in this special section used the Home Visit Rating Scales to examine stability in home-visit quality over time, study specific home-visiting processes linked with quality, validate a supervisor checklist of home-visiting implementation, and consider the home visit in relation to an array of indicators reflecting overall home-visiting program strength and stability. These articles exemplify progress in home-visiting research over recent decades, including advances in direct observational methods and measurement as well as examinations of home visiting as an observable process across various home-visiting program models and populations.

Triadic Interactions in MIECHV: Relations to Home Visit Quality

Objectives This study was conducted to look inside home visits to examine active intervention ingredients used and their relations with ratings of home visit quality. In particular, triadic interactions that engage the home visitor, parent, and child together and provide a context for home visitors to facilitate parent-child interactions by observing, modeling and coaching behaviors that promote optimal child development were examined. Methods Observations were conducted to describe intervention activities (with the HVOF-R) and rate quality of home visit practices and engagement (with the HOVRS A+). Results Analyses revealed the majority of home visit time (71%) was spent in home visitor-parent interactions with only a small proportion of home visit time (17%) spent in triadic interactions and an even smaller proportion of time (2%) during which home visitors actively coached parent-child interactions. Amount of time spent in triadic interactions was related positively to quality ratings of home visit practices and engagement. Moreover, time spent coaching parent-child interactions uniquely predicted home visit quality after accounting for visit length and home visitor time spent observing and modeling. Conclusions for Practice Increasing the percentage of home visitors engage the parent and child in triadic interaction should be a focus for home visiting programs. Home visitors will likely need professional development and supervisory support to enhance their skills in coaching parent-child interactions during triadic interactions.

Monitoring Quality Across Home Visiting Models: A Field Test of Michigan\u2019s Home Visiting Quality Assurance System

Introduction In order to achieve the positive outcomes with parents and children demonstrated by many home visiting models, home visiting services must be well implemented. The Michigan Home Visiting Initiative developed a tool and procedure for monitoring implementation quality across models referred to as Michigan’s Home Visiting Quality Assurance System (MHVQAS). This study field tested the MHVQAS. This article focuses on one of the study’s evaluation questions: Can the MHVQAS be applied across models? Methods Eight local implementing agencies (LIAs) from four home visiting models (Healthy Families America, Early Head Start-Home Based, Parents as Teachers, Maternal Infant Health Program) and five reviewers participated in the study by completing site visits, tracking their time and costs, and completing surveys about the process. LIAs also submitted their most recent review by their model developer. The researchers conducted participant observation of the review process. Results Ratings on the MHVQAS were not significantly different between models. There were some differences in interrater reliability and perceived reliability between models. There were no significant differences between models in perceived validity, satisfaction with the review process, or cost to participate. Observational data suggested that cross-model applicability could be improved by assisting sites in relating the requirements of the tool to the specifics of their model. Discussion The MHVQAS shows promise as a tool and process to monitor implementation quality of home visiting services across models. The results of the study will be used to make improvements before the MHVQAS is used in practice.

Piloting a Statewide Home Visiting Quality Improvement Learning Collaborative.

Objective To pilot test a statewide quality improvement (QI) collaborative learning network of home visiting agencies. Methods Project timeline was June 2014-May 2015. Overall objectives of this 8-month initiative were to assess the use of collaborative QI to engage local home visiting agencies and to test the use of statewide home visiting data for QI. Outcome measures were mean time from referral to first home visit, percentage of families with at least three home visits per month, mean duration of participation, and exit rate among infants <6 months. Of 110 agencies, eight sites were selected based on volume, geography, and agency leadership. Our adapted Breakthrough Series model included monthly calls with performance feedback and cross-agency learning. A statewide data system was used to generate monthly run charts. Results Mean time from referral to first home visit was 16.7 days, and 9.4% of families received ≥3 visits per month. Mean participation was 11.7 months, and the exit rate among infants <6 months old was 6.1%. Agencies tested several strategies, including parent commitment agreements, expedited contact after referral, and Facebook forums. No shift in outcome measures was observed, but agencies tracked intermediate process changes using internal site-specific data. Agencies reported positive experiences from participation including more frequent and structured staff meetings. Conclusions for Practice Within a pilot QI learning network, agencies tested and measured changes using statewide and internal data. Potential next steps are to develop and test new metrics with current pilot sites and a larger collaborative.

HOME VISIT QUALITY VARIATIONS IN TWO EARLY HEAD START PROGRAMS IN RELATION TO PARENTING AND CHILD VOCABULARY OUTCOMES.

Home-visiting programs aiming to improve early child development have demonstrated positive outcomes, but processes within home visits to individual families are rarely documented. We examined family-level variations in the home-visiting process (N = 71) from extant video recordings of home visits in two Early Head Start programs, using an observational measure of research-based quality indicators of home-visiting practices and family engagement, the Home Visit Rating Scales (HOVRS). HOVRS scores, showing good interrater agreement and internal consistency, were significantly associated with parent- and staff-reported positive characteristics of home visiting as well as with parenting and child language outcomes tested at program exit. When home-visiting processes were higher quality during the program, home visit content was more focused on child development, families were more involved in the overall program, and most important, scores on measures of the parenting environment and children's vocabulary were higher at the end of the program. Results showed that home visit quality was indirectly associated with child language outcomes through parenting outcomes. Observation ratings of home visit quality could be useful for guiding program improvement, supporting professional development, and increasing our understanding of the links between home-visiting processes and outcomes.

A Snapshot on the Quality of Seven Home Visit Parenting Programs in Latin America and the Caribbean

Although there is ample support for the causal link between home visit parenting programs and child development outcomes, few studies have explored what it is that drives this relationship – to what extent home visit programs are implemented as designed in terms of the content and strategies used by home visitors. To our knowledge, comparable data on the quality and fidelity of implementation in home visit programs in Latin America and the Caribbean (LAC) does not exist. In light of this gap, this note presents a snapshot of home visit quality in seven countries in which home visits reach a considerable number of children. Using an observational checklist tool, we find strong rapport between visitors and families, and consistent involvement of caregivers and children in practicing activities during the visit. However, visitors rarely explain the importance of these activities in relation to child development, often times do not bring the necessary materials, and do little to encourage meaningful dialogue and feedback from caregivers nor demonstrate the desired activity or behavior. Only one third of the observed visitors emphasized language development throughout the visit. It is important to emphasize that these results are not generalizable due to the small and non-random nature of the sample of home visits observed. Nonetheless, this study serves as a pilot of the instrument and type of domains that can and should be measured in a home visit program in order to ensure implementation quality.

Academic-Practice Partnership in Public Health Nursing: Working with Families in a Village-Based Collaboration.

The purpose of this program development and evaluation project was to promote healthy families and communities by creating academic-practice partnerships, educating BSN students and building family-nursing student partnerships that were supported by a "village" of interconnected resources. A mixed-methods design was used for the project. Data were collected from a convenience sample of vulnerable families, BSN students engaged in PHN practica, and partner members. Nine tools were developed to capture data over two semesters including a GIS mapping strategy. One hundred and seventy-five home visits were completed with 20 families, 14 of whom needed interpreter assistance. Families reported satisfaction with the quality of home visits, education, and assistance toward health goals. Fifty-three students provided 202 educational interventions, 39 community resource connections, and 46 care transitions. Students reported linking theory with practice and valued the PHN practicum experience. Academic-practice partners identified opportunities for program development and sustainability. GIS mapping illustrated complex family linkages to community resources. Results suggest that young, vulnerable families benefit from public health nursing (PHN) home visits, but sustaining home visit programs is challenging. Academic-practice partnerships can guide students and families partnered in a reciprocal relationship with "village" resources.

Measuring Costs and Outcomes of Tele-Intervention When Serving Families of Children who are Deaf/Hard-of-Hearing.

Background:Optimal outcomes for children who are deaf/hard-of-hearing (DHH) depend on access to high quality, specialized early intervention services. Tele-intervention (TI), the delivery of early intervention services via telehealth technology, has the potential to meet this need in a cost-effective manner.Method:Twenty-seven families of infants and toddlers with varying degrees of hearing loss participated in a randomized study, receiving their services primarily through TI or via traditional in-person home visits. Pre- and post-test measures of child outcomes, family and provider satisfaction, and costs were collected.Results:The TI group scored statistically significantly higher on the expressive language measure than the in-person group (p =.03). A measure of home visit quality revealed that the TI group scored statistically significantly better on the Parent Engagement subscale of the Home Visit Rating Scales-Adapted & Extended (HOVRS-A+; Roggman et al., 2012). Cost savings associated with providing services via TI increased as the intensity of service delivery increased. Although most providers and families were positive about TI, there was great variability in their perceptions.Conclusions:Tele-intervention is a promising cost-effective method for delivering high quality early intervention services to families of children who are DHH.

Paternal Work Characteristics and Father-Infant Interactions in Low-Income, Rural Families.

To examine the implications of paternal occupational conditions for the quality of father-infant interactions, home visits, including interviews and videotaped observations of father-infant interactions, were conducted with 446 fathers living in six low-income, nonmetropolitan counties in North Carolina and Pennsylvania. When a variety of individual and demographic characteristics were controlled for, a less supportive work environment was associated with lower levels of fathers' engaged and sensitive parenting. Significant interactions pointed to the importance of understanding combinations of risk factors. Experiencing high levels of workplace stressors, including low levels of self-direction and high levels of care work, in the presence of other individual or demographic risk factors was associated with lower levels of father parenting quality.

Inside home visits: a collaborative look at process and quality

Home visit quality was assessed in an Early Head Start program ( N = 92 families) using measures developed in collaboration with program staff. Parent ratings were high, indicating “customer satisfaction” with home visiting. Home visitors rated their relationships with parents as having a feeling of partnership and their home visits as typically going well. Researcher observations of home visits were consistent with the program’s theory of change: Home visitors attempted to facilitate parent-child interaction, parents were engaged in home visit activities, home visitors interacted mostly with both parent and child together. Families perceived by staff as improving the most had home visitors observed by researchers as most effective at engaging parents and involving parent and child together. Families seen as “success” cases showed consistently high engagement in home visits; while “nonsuccess” cases showed consistently low home visitor facilitation of parent-child interaction. Through a collaborative partnership, assessments of home visits were used to guide both program improvement and research.