Home Visitation Program Research Articles

Treatment Effects and the Measurement of Skills in a Prototypical Home Visiting Program

This paper evaluates the causal impacts of an early childhood home visiting program for which treatment is randomly assigned. We estimate multivariate latent skill profiles for individual children and compare treatments and controls. We identify average treatment effects of skills on performance in a variety of tasks. The program substantially improves child language and cognitive, fine motor, and social-emotional skills development. Impacts are especially strong in the most disadvantaged communities. We go beyond reporting treatment effects as unweighted sums of item scores. Instead, we examine how the program affects the latent skills generating item scores and how the program affects the mapping between skills and item scores. We find that enhancements in latent skills explain at least 90% of conventional unweighted treatment effects on language and cognitive tasks. The program enhances some components of the function mapping latent skills into item scores. This can be interpreted as a measure of enhanced productivity in using given bundles of skills to perform tasks. This source explains at most 10% of the average estimated treatment effects.

Parent And Caregiver Active Participation Toolkit (PACT): Adaptation for a Home Visitation Program.

Parent engagement poses a persistent challenge to home visitation (HV) programs. Previous work on parent engagement in HV has focused primarily on enrollment, attendance, and retention, with less attention on participation. The purpose of this study was to adapt an engagement toolkit originally developed for child mental health treatment settings, the Parent And Caregiver Active Participation Toolkit (PACT), and test the adapted toolkit in a HV program, SafeCare® (SC), with a focus on parent participation. Toolkit adaptation was informed by interviews/focus groups with parents and home visitors. Next, home visitors (n = 6) were trained to use adapted PACT for SC as part of SC delivery to 18 parents. A comparison group included 24 parents who received SC one year prior to this study. Analyses compared PACT for SC participants to the comparison group on parent participation and home visitor fidelity to assignment of homework. Qualitative and quantitative data from parents, home visitors, and supervisors (n = 4) assessed the acceptability, utility, appropriateness, and feasibility of PACT for SC. Parents receiving PACT for SC had higher participation and reported greater home visitor fidelity to homework assignment than comparison parents. Parents found PACT for SC acceptable and useful as part of SC. Home visitors and supervisors identified some limitations in PACT for SC's utility but generally found it to be a positive, feasible addition to HV services. Results suggest that enhancing HV programs with an engagement toolkit may improve parents' participation in services and providers' assignment of homework between sessions.

Relationships within MOMS Orange County care coordinated home visitation perinatal program.

The study aimed to examine how registered nurses (RNs) and paraprofessional home visitors (PHVs) work together as a team to care for underserved perinatal women in a coordinated home visitation program. Qualitative methods were used to understand the perspectives of three RNs and twenty PHVs who worked at MOMS Orange County, a community-based perinatal health program. Individual one-on-one interviews were administered with the RNs and focus groups with the PHVs. Qualitative content analysis was conducted to synthesize themes. RNs perceived themselves as educators, mentors, and supervisors. PHVs thought of themselves as supporters, coaches, and advocates. Interdependence and proactive communication were favorable characteristics of the relationship in which RNs trained PHVs to provide health education. The positive interactions between RNs and PHVs appeared to enhance the client-healthcare provider connection. Our study is one of the first to describe relationships and communication patterns among the healthcare team in a coordinated home visitation program in the United States. Future studies should examine how additional members of the team, including clients and healthcare providers, view their experiences with a home visitation program.

Redefining the Science and Policy of Early Childhood Intervention Programs.

* Abbreviation: NFP — : Nurse-Family Partnership David Olds and his team are to be applauded for creating the Nurse-Family Partnership (NFP) home-visiting program and for steadfastly following up with the participants in the Memphis randomized controlled trial. In 2 new “child”1 and “mother”2 articles, they report the impacts of NFP on children and mothers, respectively, when the children reach age 18. All too often in the field of home-visiting, observers want to decide that a program either “works” or does not work. If 1 trial, 1 outcome variable, or 1 subgroup shows a null or adverse effect, there may be a rush to declare that the program failed and should be defunded. If 1 evaluation shows a positive impact for a targeted subgroup, there may be support for at least modest funding, but it is not clear that the population benefits or public health is served. This field is not like drug trials or the Food and Drug Administration,3 for which the stark goal is to “separate the relative handful of discoveries which prove to be true advances from a legion of false leads and unverifiable clinical impressions”; instead, home-visiting programs have multiple goals for the mother and child, are implemented with different subgroups in different contexts at different times, assess outcomes in diverse domains across different ages in child development, and use diverse methods of data analysis (eg, covariance, moderation, and mediation) to understand mechanisms. To have a population impact, they must be embedded in a broader system of care for families. To contextualize my comments with full disclosure, I note that I lead and study a public health approach to home-visiting that connects families with community resources, including targeted home-visiting programs similar to NFP. The scientific question in these articles is not whether the NFP program works but how it … Address correspondence to Kenneth A. Dodge, PhD, Center for Child and Family Policy, Duke University, 302 Towerview Dr, Durham, NC 27708. E-mail: dodge{at}duke.edu

Implementing Pharmacist-Led Patient Home Visits

Introduction Patients with chronic diseases such as hypertension and diabetes often experience difficulties managing complex medication regimens. A promising method for identifying and addressing medication-related problems is pharmacist provision of patient home visits. Pharmacist home visits could alleviate the burden on both patients and providers for the purposes of maintenance medication and goal-achievement assessment. Methods A pharmacist home visit program was developed utilizing social workers to identify patients who would most benefit from a pharmacist home visit. The two pharmacists met with these patients in their homes to evaluate their current medication regimens, adherence, medical condition status, and potential drug-related problems (DRPs). Upon conclusion of the home visit, the pharmacists provided a summary of findings and proposed solutions for identified drug related problems to the patient's primary care provider. Results Fourteen patients participated in pharmacist-provided home visits. During these home visits, 98 unique DRPs were identified. Drug-related problems were grouped into four categories: adherence (n=26, 27%), effectiveness (n=25, 26%), indication (n=24, 24%), and safety (n=23, 23%). Between the initial visit and the final visit, there was a resolution of 25 (26%) drug related problems. Conclusion This project demonstrated a novel referral pathway for identifying patients to participate in pharmacist-led home visits. By providing patient home visits, pharmacists were able to identify and resolve some drug-related problems, but many problems remain unresolved due, in large part, to lack of provider engagement.

A home visit program versus a non-home visit program in total knee replacement patients: a randomized controlled trial

BackgroundThe goals in total knee replacement (TKR) are pain relief, restore functions, and improve quality of life. Surgical outcomes were not related to patients’ satisfaction. Low 1-year WOMAC especially in the first 6 weeks and painful TKR related to patient dissatisfied. To improve satisfaction, we created the home visit program (TKR-H) after hospital discharge. INHOMESSS was the rationale for home visit activities.MethodsWe recruited 52 TKRs. Four TKRs were excluded. We used simple randomization for 24 patients as a home visit (TKR-H) and 24 patients as a non-home visit (TKR). Patients were evaluated by general demographics, pain intensity scores (VAS), range of motion (ROM), WOMAC, knee scores, and functional scores as a primary objective. A duration for gait aid independent and patient’s satisfaction score as secondary objective. The study was 6 weeks after surgery.ResultsTKR-H and TKR had significant differences in the mean of WOMAC score (88.29 ± 10.66 vs. 68.00 ± 12.47, respectively, P < 0.001), pain score (VAS) (6.25 ± 10.13 vs. 35.67 ± 22.05, respectively, P < 0.001), knee score (81.67 ± 10.08 vs. 68.38 ± 6.45, respectively, P < 0.001), functional score (77.83 ± 4.22 vs. 73.70 ± 7.48, respectively, P = 0.037), and range of motion (107.71 ± 8.47 vs. 98.17 ± 9.57, respectively, P = 0.001). The patient’s satisfaction score in TKR-H group (4.71 ± 0.46) was significantly higher than the TKR group (4.13 ± 0.45) (P < 0.001) and time to gait aid independent (2.75 ± 0.99 vs. 3.71 ± 1.23, respectively, P = 0.005).ConclusionOur TKR-H showed better clinical outcomes and satisfaction than non-home visit. The rationale in TKR-H improves satisfaction after total knee replacement.Trial registrationTCTR20190514001.

Effectiveness of the Volunteer Family Connect Program in Reducing Isolation of Vulnerable Families and Supporting Their Parenting: Randomized Controlled Trial With Intention-To-Treat Analysis of Primary Outcome Variables.

BackgroundVolunteer home visiting is a widely adopted community-based approach to support families by linking isolated or vulnerable families with community volunteers who visit their homes weekly over approximately 12 months. This study seeks to robustly evaluate the effectiveness of this model of support for families with young children.ObjectiveThis paper reports the intention-to-treat analysis of primary and secondary outcomes for a pragmatic randomized controlled trial (RCT) of the Volunteer Family Connect intervention, a volunteer home-visiting program designed to support families with young children who experience social isolation or a lack of parenting confidence and skills.MethodsThe RCT was conducted across seven sites in Australia. Overall, 341 families were recruited: 169 intervention (services as usual+volunteer home visits) and 172 control (services as usual) families. Intervention families received the program for 3-12 months. Participants were invited to complete six data collection points over a 15-month period. Primary outcomes were community connectedness and parenting competence. Secondary outcomes included parent physical and mental health, general parent wellbeing, parent empowerment, the sustainability of family routines, and the parent-child relationship. According to the protocol, the program would be judged to be effective if at least one of the primary outcomes was significantly positive and the other was neutral (ie, intervention families did not demonstrate positive or negative outcomes compared to the control group).ResultsThe intervention group demonstrated significant improvement in the primary outcome variable parenting sense of competence as compared to the control group. Overall, there was no significant difference between the intervention and control groups with regard to the primary outcome variable community connectedness, other than on the “Guidance” subscale of the Social Provisions Scale. Because there were statistically significant findings for the total score of one primary outcome variable “parenting sense of competence” and largely neutral findings for the primary outcome variable “community connectedness,” the program met the previously defined criteria for program effectiveness. In relation to secondary outcomes, intervention families reported significantly higher wellbeing and were significantly more likely to feel that life was improving.ConclusionsThe Volunteer Family Connect intervention was considered an effective intervention, with a role to play on the landscape of services available to support vulnerable families with young children.Trial RegistrationAustralian New Zealand Clinical Trial Registry ACTRN12616000396426; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370304

Developing a Model to Address Mental Health, Substance Use, and Intimate Partner Violence Among Home Visiting Clients.

Perinatal women enrolled in home visiting (HV) programs exhibit high rates of depression, substance use, and intimate partner violence (IPV). While HV programs have increasingly screened for these psychosocial risks, initiation and uptake of community-based services to address these risks remain challenging. This project used a community-engaged research approach to engage key HV stakeholders in developing the screening, referral, and individualized prevention and treatment (SCRIPT) model. We highlight how a group of key HV stakeholders-the SCRIPT Advisory Panel-collaborated with academic researchers to develop the SCRIPT model by reviewing literature on HV programs' response to psychosocial risk factors and qualitative data obtained from mental health, substance use, and IPV service providers to whom HV programs referred clients. SCRIPT focuses on (a) screening for psychosocial risks, (b) developing partnerships with outside agencies to address these risk factors, and (c) establishing concrete and systematic processes for client referral and monitoring with outside agencies. SCRIPT provides a structured model for HV programs to systematically identify clients for key psychosocial risks and structure their referral and monitoring process when working with social service agencies. Future work should examine the impact of SCRIPT on mental health, substance use, and IPV service access and use by a vulnerable population.

A HOME-VISIT PILOT INTERVENTION TO PROMOTE COMMUNICATION SKILLS AND WELL-BEING FOR DEMENTIA FAMILY CAREGIVERS

Dementia takes a significant toll on caregivers resulting in their suffering from chronic stress and depression due to responsibility for care for persons with dementia (PWD). Behaviors of PWD could be aggravated by inappropriate responses by family caregivers such as correcting PWD’s memories. The study purpose is to examine the feasibility of a home-visit-based intervention designed to promote communication skills with PWD and well-being in family caregivers. This pilot study used a single-arm experimental pre-post design to test the feasibility of 4 weekly home visits for 13 female family caregivers in Southern California (spouse, n=7; adult children, n=6; mean age=64.3, ranging 46-82). Trained home visitors used video scenarios for behavioral education for caregivers. All caregivers completed the entire home visit program. Significantly caregiver burden was decreased from baseline (M(SD)=51.38(4.58)) to follow-up at 5 weeks (M=43.31(5.67), Wilcoxon signed rank test: p=.04). Additionally, caregiver-reported PWD’s negative behaviors were reduced from baseline to follow-up (Mbase=22.31(3.52), Mfolllowup=19.31(4.4), p=.13). There were other improvements (non-significant) in greater caregiver self-efficacy and less depressive symptoms from baseline to follow-up. Caregiver satisfaction with the intervention was high (M=4.6(0.65) of 5). Qualitatively, participants appreciated the home visits for educational sessions and welcomed the empathy provided. Caregivers expressed better communications and responsiveness to the PWDs. The results showed the home-visit-based caregiver intervention was feasible and had a potential effectiveness on reduction of caregiver burden and possibly on self-efficacy and well-being. A larger-scale study will be needed to demonstrate long term positive effects on caregiver interactive skills and their well-being.

INTERPROFESSIONAL SOCIALIZATION AND VALUING SCALE FOR HEALTH PROFESSIONAL STUDENTS WORKING WITH OLDER ADULTS

Interprofessional education allows students from two or more professions the opportunity to collaboratively practice patient centered care. Given the importance of interprofessional education in helping individuals become effective team members and understanding their value to a healthcare team, there is a need to evaluate the experiences. The Interprofessional Socialization and Valuing Scale (ISVS), aims to measure self-perceived experiences with interprofessional collaborative teamwork, including the ability, value, and comfort in working with others. The Wayne State University Interprofessional Team Visit (IPTV) program is an older adult home visit program that places pharmacy, social work, occupational therapy, nursing, and medical students in teams. Students form teams of 3 different disciplines and interview the older adult to assess various aspects of health and wellbeing. In order to evaluate the interprofessional educational experiences of the students, they are given a pre- and post- survey utilizing the ISVS tool. 18 questions pertaining to perceptions of what students have learned about working with professionals from other disciplines. Students respond to each statement using a 7-point scale with 1 = “Not at All” and 7 = “To a Very Great Extent.” Statistical analysis is conducted in order to compare pre- to post-surveys and also assess differences between groups. It is found that ISVS scores increase from pre- to post-survey, second year medical students and third year pharmacy students feel more comfortable working in teams, and teams consisting of these two have higher average scores.

Using Continuous Quality Improvement Tools to Promote Tobacco Cessation Among Primary Caregivers in a Home Visiting Program in Alabama.

Alabama's Maternal, Infant, and Early Childhood Home Visiting-funded program was one of 10 state teams accepted to participate in the first wave of the Federal Home Visiting Program State and Territory Continuous Quality Improvement Practicum. This article reports methods and results of Alabama's continuous quality improvement (CQI) project and lessons learned in developing CQI capabilities among state and local public health practitioners. The Alabama team tracked CQI data weekly for the duration of the practicum using an annotated run chart. Participants included 20 identified tobacco users in 2 participating LIAs. This article highlights specific CQI tools to achieve the project aim. On the basis of CQI interventions, Alabama reached its goal; 12 of 20 primary caregivers in 2 home visiting programs made quit attempts. Alabama utilized multiple CQI tools to reach an ambitious, behavior-based aim; these same concepts could be broadly applied to quality improvement initiatives in any federal or state public health program to guide process- and outcomes-based improvement efforts.

Postpartum women’s experience of abuse in childhood, postnatal depression, and thoughts of self-harm

Abstract Background Postnatal depression threatens the health of both mothers and babies. To improve maternal and child health in Seoul, South Korea, a nurse home visitation program for pregnant women and new mothers and babies has been implemented since 2013. Methods Cross-sectional data collected from 9,124 mothers while they were visiting a public health center for prenatal services or a nurse was visiting their home within 6 weeks after birth between 2014 and 2018 were analyzed. Mothers were asked whether they had experienced physical, emotional, or sexual abuse in their childhood. Postnatal depression and thoughts of self-harm were measured using the Edinburgh Postnatal Depression Scale (EPDS). Postnatal depression was defined as a total EPDS score of 13 or higher; thoughts of self-harm were defined as a response of “yes, quite often,” “sometimes,” or “hardly ever” to the corresponding item, excluding the response of “never". Results Overall, 3.2% of mothers had experienced child abuse; 8.1% experienced postnatal depression and 5.4% reported thoughts of self-harm. Postnatal depression was more common in mothers who had experienced child abuse than among those who had not (24.2% vs. 7.6%). A similar pattern was found for thoughts of self-harm (21.1% vs. 4.9%, respectively). When controlling for mothers’ age, economic status, history of receiving treatment for mental health problems, and other factors, having experienced child abuse was associated with a 2.73-fold increase in the odds of postnatal depression (odds ratio, 2.02-3.70) and a 3.58-fold increase in the odds of thoughts of self-harm (odds ratio, 2.58-4.96). Conclusions Mothers should be screened for having experienced child abuse when providing public health perinatal care to improve mothers’ mental health and parenting practices and to promote their children’s growth and development. Key messages Child abuse may have a lifelong negative effect on victims, and the effect extends to the next generation’s health and development. Public health policy and interventions to prevent child abuse are needed to tackle health inequality beginning in early childhood.

Effect of a Community Agency–Administered Nurse Home Visitation Program on Program Use and Maternal and Infant Health Outcomes

Postnatal home visitation to support parenting and infant healthy development is becoming increasingly common based on university efficacy studies, but effectiveness when disseminated by communities is not clear. To test implementation and impact of the Family Connects (FC) program when administered by a community agency. In this randomized clinical trial, births were randomly assigned to receive FC or treatment as usual. Independent evaluation was conducted through parent interviews and review of health and child protective services records. Interviewers were blind to the experimental condition of participants, and participants were blind about the purpose of the interview as an intervention evaluation. A total of 936 consecutive residential births at Duke University Hospital from January 1, 2014, through June 30, 2014, were included. Data were analyzed preliminarily for reporting to funders in early 2015 before all birth-record covariates were scored and were analyzed more comprehensively in mid-2019 after administrative birth and child protective service records became available. The goals of the FC brief universal program were to assess family-specific needs, complete brief interventions, and connect families with community resources. Community agencies and families were aligned through an electronic data system. Case records documented program penetration and quality. The primary outcome was child protective services investigations for maltreatment. Secondary outcomes were the number of sustained community connections, maternal mental health, parenting behavior, infant well-child care visits and maternal postpartum care compliance, and emergency health care utilization. Of 936 births, 451 infants (48.2%) were female and 433 (46.3%) were from racial/ethnic minority groups. In all, 456 births (46.5%) were randomized to the intervention and 480 (53.5%) were randomized to the control. All analyses were based on intention to treat. The impact analysis included 158 intervention families and 158 control families. Intervention penetration was 76%, adherence to the protocol was 90%, and independent agreement in scoring (κ) was 0.75. Nurses identified and addressed minor problems for 52% of families and connected an additional 42% to community resources. Analysis of the primary outcome of child abuse investigations revealed a mean (SD) of 0.10 (0.30) investigations for the intervention group vs 0.18 (0.56) investigations for the control group (b = -0.09; 90% CI, -0.01 to -0.12; 95% CI, -0.18 to 0.01; P = .07). The intervention group's rate of possible maternal anxiety or depression was 18.2% vs 25.9% for the control group (b = -7.70; 90% CI, -15.2 to -0.1; 95% CI, -16.6 to 1.3; P = .09). This study indicates that a nurse home visitation program for families of newborns can be implemented by a community agency with high penetration and quality. Other communities could benefit from wider dissemination of the program provided that quality remains strong and evaluation continues. ClinicalTrials.gov identifier: NCT01843036.

The experiences of early childhood development home visitors in the Eastern Cape province of South Africa

Background: This article examines the development of early childhood development (ECD) home-visiting services in South Africa.Aim: To examine the factors that could support the success of home-visiting programmes as well as to explore the experiences of bachelor’s-level home visitors rendering such services.Setting: This study was conducted in the Eastern Cape, a highly impoverished area of South Africa.Methods: It begins with a discussion of the emergence of home-visiting as a strategy for the delivery of ECD services in South Africa and a review of the literature on ECD home-visiting, particularly with highly vulnerable, impoverished families. Next a focus group conducted with a small sample of home visitors as part of a multi-faceted community assessment is described. The results are examined within the context of challenges facing this particular part of South Africa and the nation as a whole.Results: Four themes emerged as most prominent: (1) encountering the effects of extreme family poverty, (2) identifying high rates and multiple aspects of child maltreatment, (3) encountering scarce resources in high-need areas and (4) finding rewards and maintaining a desire to continue serving challenging populations.Conclusion: This study provides a unique window on the challenges that ECD home visitors are likely to encounter when working with families living in extreme poverty, the resourcefulness that home visitors often demonstrate and the rewards to be found in this work.

3.30 THE EFFECTS ON CHILD DEVELOPMENT OF A NURSE HOME VISITATION PROGRAM FOR PREGNANT YOUTH LIVING IN ADVERSE CONDITIONS: A RANDOMIZED CONTROLLED TRIAL

Children of adolescent mothers are at risk for a wide range of adverse outcomes, such as impaired development. Home-visiting programs (HVP) are a well-known set of interventions able to modify environmental risk factors related to child adverse outcomes. We tested the efficacy of a nurse HVP named Primeiros Laços on child development in the first 24 months of life.

Examining consensus for a standardised patient assessment in community paramedicine home visits: a RAND/UCLA-modified Delphi Study

ObjectiveCommunity paramedicine programme are often designed to address repeated and non-urgent use of paramedic services by providing patients with alternatives to the traditional ‘treat and transport’ ambulance model of care....

Home Visiting Program for NICU Graduates: Feasibility and Potential for Impact

Neonatal intensive care unit (NICU) admissions have been increasing. Home visiting services are an integral part of caring for high-risk children with limited resources. The effectiveness of physician-led home visiting programs on post-NICU health outcomes is not well studied. The Pediatric Visiting Doctors (PVD) program provides home-based primary care for high-risk children including NICU graduates, for 6 months after discharge. The team consisted of a pediatrician, and care coordinator or social worker. The study compares the characteristics and care utilization of PVD program participants with a hospital-based pediatric clinic population. A retrospective cohort study of PVD infants born from 2013–2016, who were enrolled after referral during their NICU admission, was conducted. Data were also obtained on infants who were hospital clinic patients born during the same time frame, with parents residing in the PVD catchment area, and had a minimum 72-hour NICU stay. Between group differences were assessed; and logistic regression and generalized linear models were used to adjust for uneven group characteristics. Forty-six PVD participants completed the program, and 91 comparison infants had at least 6 months of post-NICU clinic visits. PVD program completers received a median of 5 home visits. There were no differences in emergency care use or hospitalization. PVD program participants were more likely to attend development clinic compared to the non-PVD group (59% vs 12%, p = 0.002). Physician-led home visiting services is a feasible way of providing clinical care to this population. Additional research is needed to assess patient-centered outcomes of these programs.

Using community health workers to deliver a scalable integrated parenting program in rural China: A cluster-randomized controlled trial

Inadequate care during early childhood can lead to long-term deficits in skill development. Parenting programs are promising tools for improving parenting practices and opportunities for healthy development. We implemented a non-masked cluster-randomized controlled trial in rural China in order to assess the effectiveness of an integrated home-visitation program that includes both psychosocial stimulation and health promotion at fostering development and health outcomes of infants and toddlers in rural China. All 6-18 month-old children of two rural townships and their main caregiver were enrolled. Villages were stratified by township and randomly assigned to intervention or control. Specifically, in September 2015 we assigned 43 clusters to treatment (21 villages, 222 caregiver-child dyads) or control (22 villages, 227 caregiver-child dyads). In the intervention group, community health workers delivered education and training on how to provide young children with psychosocial stimulation and health care (henceforth psychosocial stimulation and health promotion) during bi-weekly home visits over the period of one year. The control group received no home visits. Primary outcomes include measures of child development (i.e. the Bayley Scales of Infant and Toddler Development, third edition—or Bayley-III) and health (i.e. measures of morbidity, nutrition, and growth). Secondary outcomes are measures of parenting practices. Intention-to-treat (ITT) effects show that the intervention led to an improvement of 0·24 standard deviations (SD) [95% CI 0·04 SD-0·44 SD] in cognitive development and to a reduction of 8·1 [95% CI 3·8–12·4] percentage points in the risk of diarrheal illness. In addition, we find positive effects on parenting practices mirroring these results. We conclude that an integrated psychosocial stimulation and health promotion program improves development and health outcomes of infants and toddlers (6–30 month-old children) in rural China. Because of low incremental costs of adding program components (that is, adding health promotion to psychosocial stimulation programs), integrated programs may be cost-effective.

Guests, hosts, and teaching the ethics of service learning in medicine

Within medical education, there is an increasing need to provide ethics education for learners embarking on service learning. The concept of hospitality, as illustrated in Homer’s classic epic the Odyssey, has the potential to underpin such ethics education. This paper describes the implementation and evaluation of an ethics education session for medical students, built on the concept of hospitality, before they embark on a three-year longitudinal service-learning home visit program. In preparation for their household visits, second-year students at a medical school in Miami, Florida, participate in weekly didactic sessions. One of these classes consisted of a two-hour ethics session, involving a brief introductory large-group lecture, followed by self-administered small-group discussions of a series of case scenarios. An innovative web-based platform called Rise allowed the students to run their own small group activities. To assess the impact on the students’ ability to identify, and on their confidence in handling, ethical dilemmas, we administered pre- and post-session surveys. Students indicated statistically significant improvement in median responses to all questions, for two consecutive years. Students also listed three adjectives, both before and after the session, that they associated with good and bad hosts and guests. The consistency of the terms listed suggests that hospitality is a robust concept for the learners. In our experience, the concept of hospitality provides a robust framework for the students, and the mixed large-group and self-facilitated small-group format offers a valuable tool for ethics education related to service learning in medicine. Our study supports the utility of the concept as a teaching tool, and the format facilitates a session using minimal faculty. The notion of hospitality seems particularly fruitful for various ethical considerations in medicine, even beyond those that involve home visits.

Development of an Interprofessional Home Healthcare Management Service: Within an Urban Housing Development.

In response to the need for increased access to primary care services for a low-income, at-risk community, two local universities partnered with a nonprofit Housing and Urban Development affiliated provider of affordable housing to launch a primary care clinic within an urban public housing community. Although the establishment of this clinic represented progress in meeting many healthcare needs of the target population, an interprofessional team also identified a need for the initiation of a new home-based service line. The goal of this project was to establish an innovative, sustainable, and cost-effective healthcare delivery method that would improve the health of this population. The project focused on a literature review, needs-assessment, and development of a comprehensive medical home visit program to serve the homebound, frail elderly, and other at-risk adults with complex medical conditions who reside in this community. The medical needs of potential recipients were assessed by conducting interviews with key support staff including a health service coordinator, health advocates, and housing provider service coordinators. Residents were also interviewed using a newly developed health perception and information survey. The data derived from the needs-assessment and pertinent literature were used to draft an initial program guideline. Because the needs-assessment indicated this population would not derive maximum benefit from a traditional house calls program, the project team developed a Home Healthcare Management service with an expanded scope to provide enhanced care coordination, house visits (medical and nonmedical), and community outreach.