Carla peterson

QUALITY AS A RIGHT: HOME VISITS Carla Peterson Iowa State University VI Simposio Internacional Recife, Brazil – November, 2016

Healthy Families – Healthy Children 1. Identify assumptions a. What is this child learning? b. How is this child learning? c. What does this tell us about how to intervene with young children and their families?

2. Turn to your neighbor a. Discuss your assumptions

Home Visiting – A Service Delivery System ◦ One way to deliver comprehensive early intervention services ◦ Widely used -- historically and currently ◦ MIECHV-funded programs in U.S. ◦ Part C services ◦ State funded and locally directed services

◦ Home visits represent a “place” ◦ Home visits are not an intervention

Home Visiting – Assumptions ◦ An indirect service delivery method ◦ Services ◦ Target diverse goals ◦ Provided to diverse populations

◦ Allow opportunity to understand needs and provide services in natural environment ◦ Two general approaches common ◦ Parent education ◦ Family support

Home Visiting – It’s a Big Job ◦ Promoting child development ◦ Assessment & curriculum ◦ Home visit activities ◦ Group/community socialization activities

◦ Indirect intervention model ◦ Family engagement is key ◦ Embedded intervention ◦ Triadic intervention strategies ◦ Routines-based interviewing

◦ Professional development is key ◦ Training ◦ Reflective supervision ◦ Multiple team members

Do You Wonder Where to Start?

Session Overview ◦ Assumptions underlying home visiting programs ◦ Theory of change (ToC) for home visiting programs ◦ Enhancing the quality and effectiveness of home visits ◦ Family engagement ◦ Triadic interactions

◦ What does quality look like? ◦ What do home visitors need to know and do?

Development in Context: Bioecological Model ◦ Children must be understood within their environments ◦ Direct interactions with environment drive development ◦ 4 Systems influencing a child’s development ◦ Microsystem ◦ E.g. child and family

◦ Mesosystem ◦ E.g. school, church, neighborhood

◦ Exosystem ◦ E.g. parents’ work place

◦ Macrosystem ◦ E.g. government policies

Macrosystem Exosystem Mesosytem Microsystem

Child as an Active Agent ◌ Environment matters, but children are not passive recipients of inputs from the world

Theory of Change (ToC) Theories of Change = Outcomes + Program Model + Specific Mechanisms

◦ Outcomes(goals)- programs intend to influence (e.g. school readiness goals, child assessments, child health exams, full-term births) ◦ Program Model-(e.g. home visiting, center-based care, family child care) ◦ Specific Mechanisms-(methods; family education/engagement, securing resources) for achieving them

Theory of Change (ToC) ◦ How and with whom do you work primarily to achieve child goals in center-based programs? ◦ How and with whom do you work to achieve child goals in home-based programs? ◦ A ToC asks ◦ What are the intended outcomes for a home-based program? ◦ What should happen during home visits and other program activities to promote the intended outcomes?

Theories of Change Outcomes (e.g. school readiness, parental wellbeing) Caregiver- child relationship

Key agents of change in child‘s life

Home Visiting Theory of Change

Child care environment

Childcare Theory of Change

Theory of Change Home Visiting Theory of Change

Courtesy EHS NRC

Childcare Theory of Change

Home Visiting – Intervention – Outcomes

Unpacking Home Visits Family- Home Visitor Collaborations Triadic Interactions

• Embedding Intervention Activities -Learning Opportunities

Home Visitor Training

Tell me, and I'll forget Show me, and I may not remember Involve me, and I'll understand ~Native American Proverb

Families, Home Visitors & Positive Outcomes ◦ Positive outcomes are about

◦ Commitment ◦ Among home visitors and family members to ensure ◦ Better child outcomes ◦ Stronger families ◦ Higher quality programs ◦ More vibrant communities

◦ Partnering is essential ◦ True partnership -- what we do together, not individually ◦ Family members and home visitors contribute to positive outcomes

Family Engagement Home visitors can facilitate family engagement when they ◦ Solicit input ◦ Share planning ◦ Report progress ◦ Invite parents to engage in planning for their children

Family Engagement Outcomes What do they mean to you?

Family Wellbeing

Positive ParentChild Relationships

Families as Lifelong Educators

Families as Learners

Family Engagement in Transitions

Family Connections to Peers and Community

Families as Advocates and Leaders

What is Triadic Interaction? ◦ A home visitor working with the parent and the child ◦ Interacts with both parent and child ◦ Works to strengthen the parent-child relationship

Parent

Child

In-Home Worker

How Do I Create a Triadic Environment? ◦ Encourage parent-child interaction the during the visit • Encourage the parent to use skills they know • Help parent recognize his or her skills • Provide information about a technique and why it is useful • Observe the parent-child interaction • Coach the parent as opportunities arise ◦ When necessary – Demonstrate a new technique with the child and then have the parent try the technique

Why Should We Use Triadic Intervention?

• While home visitors facilitate a family’s development, home visitors are only in the home for a short amount of time

• Building on skills the parents already have makes it more likely they will continue using those skills ◦ Helps identify skills the parent values ◦ Builds parent’s confidence

• Parents need to feel able to embed skills, facilitated by the home visitor, into daily routines ◦ Remember the home visitor is not always present

Triadic Interactions – Tips ◦ Talk to the parent ◦ Directly ◦ Through the child

◦ Hand materials to the child ◦ Draw parent into activity through the child

How Do I Create a Triadic Environment?

• Create a relationship with the parent • The parent and the home visitor work together as a team • Build on • A parent’s current skills • Resources provided in the home • Resources of the family’s community

◦ Pretend there is a glass wall between you and the parent

Home Visit Observation Form-Revised (McBride & Peterson, 1996) ◦ Describes home visiting activities ◦ 5 categories of interactions ◦ Who is Present ◦ Primary Interactors ◦ Content of Interaction ◦ Nature of HV Activity ◦ Parent Engagement during Home Visit

◦ Interval observation ◦ Triadic interactions related to + parent engagement

Home Visiting Rating Scales (HOVRS A+ v2.0) (Roggman, et al., 2014) ◦ Rating of overall home visit quality ◦ Measures 7 domains of quality ◦ 4 scales of Home Visit Process Quality ◦ Home visitor’s responsiveness and interactions with parent and child

◦ 3 scales of Home Visit Effectiveness ◦ Parent’s and child’s engagement with each other and home visit activities

◦ Quality ratings related to + parenting and child outcomes

HOVRS-A+ Scales ◦ Home Visit Process Quality ◦ Home Visitor Responsiveness to Family ◦ Home Visitor-Family Relationship ◦ Home Visitor Facilitation of Parent-Child Interaction ◦ Home Visitor Non-Intrusiveness & Collaboration

◦ Home Visit Effectiveness ◦ Parent-Child Interaction During Home Visit ◦ Parent Engagement During Home Visit ◦ Child Engagement During Home Visit

Results: Overall HOVRS and HVOF 90

80

70

Percentage

60

50

Triadic Child Content

40

30

20

10

0

1

2

3

4

5

<6

HV Facilitation of Parent-Child Interaction 100

90

80

70

Percentage

60 Parent HV

50

Triadic Child Content

40

30

20

10

0

1

2

3

4

5

6

7

Results: Parent Engagement 100

90

80

Percentage

70

PercentTriadic

60

PercentChildContent

50

PercentParentInteracti on

40

30

20

10

0 Rating 1

Rating 2

Rating 3

Rating 4

Rating 5

Rating 6

Rating 7

Competencies for I-T Workforce & HV Additions ◦ Additional Competency for HV 1. Health & Safety

2. Reflectivity & Reflective Practice 3. Understanding & Supporting Relationships 4. Understanding & Supporting Learning 5. Child Guidance 6. Partnering with & Supporting Families 7. Assessing Development, Learning & Environments 8. Diversity and Inclusion 9. Professionalism

◦ Guiding Parents in Competencies 1-8

◦ Plus ◦ Expanded knowledge ◦ Specific skills ◦ Attitudes conducive to partnering with families

◦ Example – Competency 3 ◦ Expanded knowledge of importance of secure attachment ◦ Skills to support sustained relationships ◦ Attitudes of respect for primacy of family in child’s life

HV Need Knowledge ◦ Child development and strategies to support it ◦ Theoretical background – complexity of family contexts and systems ◦ Prenatal development, changes in mother’s physical and emotional needs, use of substances ◦ Poverty-related family stressors ◦ Respect for and awareness of cultural variations in parenting beliefs and practices ◦ Importance of strong, positive racial and cultural identify to healthy social-emotional development ◦ Challenges related to mental health, domestic violence and child maltreatment

HV Need Skills ◦ Engage parents in trusting relationships focused on children’s development ◦ Relate to parents different than themselves – culture, age, education, mental health ◦ Support adult/adolescent development ◦ Communicate openly about family routines and child’s experiences and needs

◦ Teach adults ◦ Active learning opportunities – allow for practice of new skills ◦ Make information relevant ◦ Plan collaboratively with parents

◦ Facilitate parent-child interactions ◦ Involve parent and child in activities together ◦ Help parents identify skills and build on these

HV Need Collaborative Attitudes ◦ View parents as partners ◦ Expert on their child ◦ Parents as primary decision makers and change agents for children

◦ HV supports and guides parent who supports the child ◦ Respect for family strengths and cultural diversity ◦ Commitment to flexibility ◦ Individualizing on the basis of family goals, strengths, and preferences

◦ Self-reflective attitude ◦ Willingness to examine own biases ◦ Interest in examining families’ reflections on services

Of History and Hope Who dreamed for every child an even chance Cannot let luck alone turn doorknobs or not â&#x2014;Śâ&#x20AC;Ż Miller Williams