HOME VISITING OVERVIEW

HOME VISITING OVERVIEW
source: www.healthychild.ucla.edu/publications/documents/thompson.home-visiting.pdf
HOME VISITING
Home visitingis animportantservice-delivery strategybecause it potentiallyaffords uniqueopportunities forreaching psychologically- and geographically-isolated populations,for gainingamore realisticandcomplete pictureof the home environment, and engaging familieswith youngchildren in a range of services designed to promote thehealthy development of childrenand thewell-being of parents.
source: www.healthychild.ucla.edu/publications/documents/thompson.home-visiting.pdf
Theoretical Basis for Home Visiting
Two influential theories that have guidedmodel developmentforHV programssuch as the Nurse-Family Partnership program,are:Bandura’ssocial theory: Individual self-efficacy: person’s belief in his or her ability to succeed in a particular situation.Banduradescribed these beliefs as determinants of how people think, behave, and feel (1994).Self efficacy in the context of home visiting sees the primary role of the home visitor as building confidence and capacity in families to achieve attainable goals.ANDBronfenbrenner’secological model of humandevelopment:Theecological approachrecognizes howfamily, friends, and community have an important environmental influence on anindividual’s life, and take these factors into account in constructing a long-term therapeuticplan.
source: www.healthychild.ucla.edu/publications/documents/thompson.home-visiting.pdf
Most commonly employed home visiting programs in California:
AdolescentFamily Life Program, Black InfantHealth, Cal-LEARN, California Safe and Healthy Families, Early Head Start and Head StartHome- BasedOption, Early Start, Family Preservation, Healthy Families America, High-Risk InfantFollow- Up, and the Nurse-Family Partnershipprogram.
source: www.healthychild.ucla.edu/publications/documents/thompson.home-visiting.pdf
Funding Home Visiting Programs
Localagencies receive funding to operate home visiting programs through a combinationof contracts, grants, fees for service, and charitable donations.Fundingsources for homevisiting programscome from:1) local, state, and federal departments of health, mental health, education, socialservices, and probation; 2)Medi-Cal and Healthy Families; 3) voter initiatives suchas Proposition10 and Proposition 99; 4) privatefou/’;ndations; 5) non-profit organizations; 6)state litigationsuch as the Tobacco Settlement; 7) health plans; and 8) individual donors.
source: www.healthychild.ucla.edu/publications/documents/thompson.home-visiting.pdf
Staff Issues
Qualifications–It has been suggested that a home visiting program is only as good as thepeoplewhoadminister and staff it. Staff qualities are what draw participants in and keep them involved.Decisions about the educational, professional, and personal qualifications and standards arecrucial anddependent on each individual program’s target population and goals.
source: www.healthychild.ucla.edu/publications/documents/thompson.home-visiting.pdf
Homevisitors:Qualifications
Although research has not yetdelineated the best qualifications of staff,Gombyet al.recommended that home visitorsbe extremelywell trained and should have at least a high school diploma.[3]Professional versus paraprofessional- A key consideration for designing home visiting programsiswhetherto utilize professional or paraprofessional staff as home visitors.Typically,professional homevisitors are defined as those who have earned credentials in a relevant field, such as education, nursing, or socialwork.Paraprofessional home visitors areusually fromthe same community where a home visiting program is delivered and often share thesame racialor cultural background of the clients.
source: www.healthychild.ucla.edu/publications/documents/thompson.home-visiting.pdf
Training and supervision are critical for achieving and maintaining quality in home visiting services.Resources should be allocated within a program’s budget to assure that thehome visitors canreceive trainingandsupervisiWhat type of training your program has to offer?:Are they helpful?What other trainingswoudyou like to have?
source: www.healthychild.ucla.edu/publications/documents/thompson.home-visiting.pdf
SUPERVISION
Home visitors need regular, formal and reflective supervision to provide them a safe time and placein which they can candidly discuss the familieswith whom they are working from bothobjective and subjectivepoints of view. They alsoneed to receive non-judgmental and supportive feedback about their work.Emphasis on supervisionfor home visitors is particularly important because home visitors work in isolationduring muchof the day. It is therefore critical to provide supervision that helps them deal withthe emotionalstresses of working closely and over long periods of time with high-need families, andit helpsthem maintainobjectivity, prevent drift from program protocols, and provide opportunityfor reflectionand professional growth.
source: www.healthychild.ucla.edu/publications/documents/thompson.home-visiting.pdf
A Four-Quadrant Approach to Performance Measurement
QUANTITY/QUALITYINPUT/EFFORT:I. How Much ServiceDidWeDeliver?II. How Well DidWe DeliverService?OUTPUT/EFFECTIII. How MuchChange/EffectDid We Produce?IV.What Qualityof Change/EffectDidWe Produce?Friedman, M.,Results-Based Accountability. 1999, Fiscal Studies Policy Institute.
source: www.healthychild.ucla.edu/publications/documents/thompson.home-visiting.pdf
One important area that affects a home visiting program’s success is the level of engagementthat familieshave in the program. Many home visiting programs struggleto enroll, involve, and retainFamiliesin home visiting services, and although to some degree family engagementmay bebeyond thecontrol of individual programs, it may also reflect the design of the program intervention.
source: www.healthychild.ucla.edu/publications/documents/thompson.home-visiting.pdf
Theory Assumption/applied to HV
Psychodynamic TraditionAssumesthat the best way to effect change is through the quality of therelationship betweenthehome visitor and the parent. The primary goal of the home visitor is tobeemotionallyavailable and responsive to theparent.ParentEducation TraditionSuggeststhat it is the parent’s access to expert information about child development thatis thekey toimproving the competence ofparents.Empowerment TheoryDefinesthe role of the home visitor as a facilitator or one who assists familiestoaddress problemsin their lives and formulate and achieve realistic goals.\’]
source: www.healthychild.ucla.edu/publications/documents/thompson.home-visiting.pdf
FamilySystems TheoryRecognizes the interdependence of family members and considers theirinterrelationships when designing interventions.Social Exchange TheorySuggests that people will recognize the benefits and costs of certain behaviors through their interactions with others. To motivate parents to accept and engage in home visits, practitioners of thismodel create a set of expectations to be accomplished during the home visits.Parallel ProcessDescribes the ways in which experiences in one relationship carry over into other relationships. By providing the parent with structure, support, and a corrective emotional developmental experience, the family-support staff strengthen the parent’s ability to bond with the child and to provide him/her with structure, security, and age-appropriate nurturing.Which one do you prefer?Why?Whichone does your agency use?
source: www.healthychild.ucla.edu/publications/documents/thompson.home-visiting.pdf