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Utilizing broad-based partnerships to design a precision approach to implementing evidence-based home visiting.

ABSTRACT: The aim of this paper is to describe a participatory process for adapting an implementation strategy, using a precision approach, for an evidence-based home visiting program, Family Spirit. Family Spirit serves Native American and low-income communities nationwide. To redesign Family Spirit's implementation strategy, we used workshops (n = 5) with key stakeholders and conducted an online survey with implementers (n = 81) to identify hypothesized active ingredients and "pivot points" to guide when to tailor the program and for whom. Active ingredients identified included the relationship between the home visitor and clients, lessons ensuring child safety and healthy development, parent-child communication, and goal setting. Pivot points included whether the client is a first-time mother who has substance abuse history, has a baby at risk for childhood obesity, and/or has sexual or reproductive health concerns. These results are informing the adaptation of Family Spirit' implementation strategy making it more responsive to diverse families while balancing fidelity to the previously proven standard model.

SUBMITTER: Haroz EE

PROVIDER: S-EPMC8082059 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Utilizing broad-based partnerships to design a precision approach to implementing evidence-based home visiting.

Haroz Emily E EE Ingalls Allison A Wadlin Joshua J Kee Crystal C Begay Marissa M Neault Nicole N Barlow Allison A

Journal of community psychology 20200123 4

The aim of this paper is to describe a participatory process for adapting an implementation strategy, using a precision approach, for an evidence-based home visiting program, Family Spirit. Family Spirit serves Native American and low-income communities nationwide. To redesign Family Spirit's implementation strategy, we used workshops (n = 5) with key stakeholders and conducted an online survey with implementers (n = 81) to identify hypothesized active ingredients and "pivot points" to guide whe ...[more]

PMID: 31970805

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Project description:BackgroundStates, territories, non-profits, and tribes are eligible to obtain federal funding to implement federally endorsed evidence-based home visiting programs. This represents a massive success in translational science, with $400 million a year allocated to these implementation efforts. This legislation also requires that 3% of this annual funding be allocated to tribal entities implementing home visiting in their communities. However, implementing stakeholders face challenges with selecting which program is best for their desired outcomes and context. Moreover, recent reviews have indicated that when implemented in practice and delivered at scale, many evidence-based home visiting programs fail to replicate the retention rates and effects achieved during clinical trials. To inform program implementers and better identify the active ingredients in home visiting programs that drive significant impacts, we aimed to develop an expert derived consensus taxonomy on the elements used in home visiting practice that are essential to priority outcome domains.MethodsWe convened a panel of 16 experts representing researchers, model representatives, and program implementers using a Delphi approach. We first elicited standard practice elements (SPEs) using open-ended inquiry, then compared these elements to behavior change techniques (BCTs) given their general importance in the field of home visiting; and finally rated their importance to 10 outcome domains.ResultsOur process identified 48 SPEs derived from the panel, with 83 additional BCTs added based on the literature. Six SPEs, mostly related to home visitor characteristics and skills, were rated essential across all outcome domains. Fifty-three of the 83 BCTs were rated unnecessary across all outcome domains.ConclusionsThis work represents the first step in a consensus-grounded taxonomy of techniques and strategies necessary for home visiting programs and provides a framework for future hypothesis testing and replication studies.

Project description:BackgroundHome visiting is a well-supported strategy for addressing maternal and child health disparities. However, evidence-based models generally share implementation challenges at scale, including engagement and retention of families. Precision home visiting may address this issue. This paper describes the first known pilot randomized implementation trial of a precision home visiting approach vs. standard implementation. Primary aims are to: 1) explore the acceptability and feasibility of a precision approach to home visiting and 2) examine the difference between Standard Family Spirit and Precision Family Spirit on participants' program satisfaction, client-home visitor relationship, goal alliance, and the impact of these factors on participant engagement and retention. Secondary aims are to explore potential differences on maternal behavioral and mental health outcomes and child development outcomes to inform sample size estimations for a fully powered study.MethodsThis is a pilot Hybrid Type 3 implementation trial. Four Michigan communities primarily serving the Native American families and already using Family Spirit were randomized by site to receive Standard Family Spirit or Precision Family Spirit. Participants include N = 60 mothers at least 14 years of age (pregnant or with a newborn < 2 months of age) currently enrolled in Family Spirit. Precision Family Spirit participants receive core lessons plus additional lessons based on needs identified at baseline and that emerge during the trial. Control mothers receive the standard sequence of Family Spirit lessons. Data is collected at baseline (< 2 months postpartum), and 2, 6, and 12 months postpartum. All Precision Family Spirit participants are invited to complete qualitative interviews at study midpoint and endpoint. All home visitors are invited to participate in focus groups between study midpoint and endpoint. Exploratory data analysis will assess feasibility, acceptability, client-home visitor relationship, retention, adherence, and potential differences in intervention outcomes.DiscussionThis trial will provide new information about the acceptability and feasibility of precision home visiting and pilot data on program satisfaction, client-home visitor relationship, goal alliance, retention, and targeted maternal-child intervention outcomes. Findings will inform the design of a fully powered randomized implementation trial of precision vs. standard home visiting.Trial registrationClinicalTrials.gov # NCT03975530 ; Registered on June 5, 2019.

Project description:This review maps and summarizes the quantitative studies on the main outcomes associated with home visiting (HV) programs using Brazelton methods aimed at supporting expectant and new parents. One hundred thirty-seven records were identified, and 19 records were selected. The design of our study was based on the methodological framework for conducting scoping reviews. Quality was assessed through the Jadad scale. Studies were coded for participant characteristics (number, mean age, and risk status), methodology (recruitment, home visit frequency, age of the child, Brazelton method, and research design), and intervention outcomes (on infants, parents, and home visitors). The studies mostly focused on the impact of Brazelton HV programs on infant development, the mother's psychological well-being, mother-infant interaction, and home visitor satisfaction. Experimental and quasi-experimental studies consistently have shown that parents receiving the intervention have greater knowledge of their children. Results are less conclusive regarding the intervention's impact on other domains of child development, mothers' psychological well-being, and mothers' sensitivity to the relationship with the child. Overall, the results suggest that the improvements associated with the intervention are mainly influenced by the risk status of families. Further research is needed to better understand the benefits of HV based on the Brazelton approach and the target population that may benefit most from this intervention.Conclusion Although the impact of the Brazelton home visiting intervention is not yet fully understood, there is promising evidence of its positive effects on child development, maternal well-being, and parental knowledge. Further research with consistent methodologies and larger sample sizes is needed to strengthen our understanding. However, existing findings in the literature underscore the importance of preventive interventions such as the Brazelton program in improving family well-being, with potential long-term benefits.What is known• Home visiting programs based on the Brazelton approach aim to increase parents' knowledge and sensitivity to their children. • There is no clear picture in the literature of the effectiveness of these programs.What is new• Existing studies consistently show the effectiveness of these programs to improve parents' knowledge of their children. • Findings on the impact of these programs on child development, mothers' psychological well-being and sensitivity to their child are inconclusive and may be influenced by the risk status.

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Utilizing broad-based partnerships to design a precision approach to implementing evidence-based home visiting.

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Utilizing broad-based partnerships to design a precision approach to implementing evidence-based home visiting.

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