Fall 2001

R e s e a r c h B r i e f I s s u e # 2

Home Visiting: Developing an Effective Approach inDelaware to Provide Parent Education and Supportwith Young Children

Over the past two decades, advisory reports on infant mortality, teen pregnan-cy, and family services have repeatedly recommended that Delaware develop acoordinated system of parent education and support services for families withyoung children (Unger & Brown, 2001). To date, several important steps havebeen taken to develop home visiting programs as a critical component of such asystem. However, home visiting programs in Delaware will need more training,supervision, education, and increased funding with a long-term commitment tofully address the recent recommendations of the Delaware Home VisitingAdvisory Committee (Unger, Brown, et al, 2001)

In Delaware, home visiting has been the primary model of service deliverychosen by the state government to provide parent education and support. Bybringing services into a family’s home, visitors overcome many obstacles such astransportation, need for childcare, or distrust of social services, which have lim-ited or precluded participation in other programs. Home visiting programs havethe added benefit of being flexible in how services are offered, allowing them totailor the program to a family’s strengths, needs, and desires. Programsthroughout the state employ visitors with varied educational and professionaltraining. Some home visitors are nurses, social workers, and parent educatorswhile others are paraprofessionals who have many practical life experiences andare typically recruited from local communities.

Delaware’s researchers and the Home Visiting Advisory Committee recognizethat home visiting programs must be of high quality to be effective. Significantbenefits have been reported for both parents and their children when well-trained people provide services and education that addresses the multiple factorsthat influence the development of a healthy family. These factors include a focuson: maternal health, competent care of the child, developing and maintainingfamiyl and friend support, personal development and planning for the future,and linkages with needed health and human services (Olds, et al, 1999).

In This Issue:Home Visiting: Developing aneffective approach in Delawareto provide parent educationand support with young children.

Keys to developing qualityHome Visiting Services

........................................................................P. 1Skills of Home Visitors........................................................................P. 2

Supervision and Oversight........................................................................P. 2

How should a Home VisitingProgram be Evaluated........................................................................P. 2

What types of outcomes can bemeasured to determine theeffectiveness of a program?........................................................................P. 4Recommendations forDelaware........................................................................P. 4References........................................................................P. 4

EditorsTheda M. Ellis, Associate Director,Center for Disabilities Studies, Jeromy Curry, & Tara Woolfolk

Lead Researcher & ReporterDonald G. Unger

This issue of delAware: A ResearchBrief is based on original researchby Dr. Donald G. Unger, anAssociate Professor in theDepartment of Individual &Family Studies at the University ofDelaware, and Core FacultyMember of the Center forDisabilities Studies. His researchfocus includes families with chil-dren and/or parents with specialneeds, teen parent families, fami-lies in poverty, and families atrisk for child abuse and/or sub-stance abuse. He is especiallyinterested in preventative andempowering interventions forfamilies, and also serves on theBoard of Directors of theDelaware Children’s Trust Fund toprovide resources to exemplaryprograms to prevent child abuseand neglect.

DesignDepartment of Publications,University of Delaware

Keys to developing quality home visiting services:A positive, respectful relationship between the family and home visitor is essential

to the success or failure of home visiting (Hiatt, Sampson, & Baird, 1997;Kalmanson & Seligman, 1992; Musick & Stott, 1990). Once this relationship has asolid foundation, the home visitor can provide emotional support, model communi-cation and parenting skills, and assist families to reach their goals. In their effortsto achieve this type of visitor/family relationships, home-visiting programs mustaddress many factors, including:

Visits should focus on information related to parenting and family needs.Information should cover, at a minimum, the following topics: maternal health,competent care of the child, maternal life skills and goals, family and friendsupport, and linkages to needed health and human services.

Focus on information relevant to the family

Supervision and oversightFor a home visiting program to be effective,good supervisors are essential. These supervi-sors devote a significant amount of time tosupporting their staff and need a variety ofskills, including:■ Knowledge of reflective supervision.

Reflective supervision promotes motivation,learning, and quality performance aimed atreducing burnout and stress in home visi-tors. This model also gives supervisors anopportunity to better understand the needsand concerns of home visitors (Almonte,1994).

■ Setting standards for performance based onrecommended practices.

■ Providing support to home visitors to main-tain standards.

■ Ensuring an organizational structure thatsupports the work of home visitors.

■ Providing adequate training and education.■ Establishing cooperative relationships with

How should a home visitingprogram be evaluated?For a home visiting program to be successful,an effective method of evaluating its servicesis essential. Evaluations help program super-visors and visitors see what their specificstrengths and weaknesses are, allowing forservices to be improved. An effective evalua-tion has several requirements:

■ Agencies must first establish an ongoing,useful data collection and evaluation systemthat will monitor daily participant and staffactivities, as well as short and long-termprogram goals for both the parents and thechild. These goals should be clearly definedbefore a program is started.

■ Agencies need to establish an outcome eval-uation process. This evaluation will allowan agency to determine if their programsare having the intended effect. Kouneskiand Erikson (1996) suggest some minimumrequirements that must be met for an out-come evaluation to be useful:• Specific services that are provided, as wellas how these services are provided, needto be clearly defined. There must be adirect connection between these servicesand the desired outcomes.

• Programs need to formalize their methodsof recruiting and enrolling participants.This will allow for clear record keeping ofwho is involved in the program and theservices they are receiving.

Home visitor services need to be flexible so they fit with a family’sschedule. Also, a variety of services should be available so that servic-es can be matched with a family’s needs, preferences, and availableresources. Families should be actively included in determining theservices that would be most beneficial to them.

Knowledge of Human Development, Skills andAttitudes

Home visitors have a wide range of responsibilities that require veryspecific knowledge, skills, and attitudes. These include:

Parents need to have age-appropriate expectations about their chil-dren’s development. To provide this, home visitors must understandchild development and how parents’ childhood experiences and cul-ture influence their parenting beliefs. Home visitors also need well-developed observation and inquiry skills to determine if the child isgrowing and developing appropriately.

Home visitors need to understand how the family and quality of the par-enting partnership (e.g. married, divorced, or never married; mother-grandmother) affect the development children. With such knowledge,home visitors can encourage and support the personal development ofparents, particularly teen parents.

Home visitors need to be able to model and teach appropriate parent-ing techniques, including how to read infants’ and children’s’ emo-tional cues in an appropriate and consistent manner and how toensure a child’s health, safety, and nutritional needs.

To establish a trusting relationship, home visitors need training indeveloping a nonjudgmental attitude and using good listening andeffective communication skills. To be effective, home visitors mustdemonstrate warmth and empathy for children, parents, and familieswhile maintaining appropriate professional boundaries.

To conduct a thoroughpsychosocial assessment os a family, home visi-tors must first have good observation and injury skills. They need toknow what to look for, what questions to ask, and the indicators ofchild abuse and neglect. Home visitors also need training in variousassessment methods and how to effectively communicate the resultsto the family. Finally, assessment should be an ongoing processwhereby the visitor constantly reassesses a family’s needs andstrengths and adjusts goals accordingly.

Knowledge of infant, toddler, and child development

Knowledge of life-span and family development

Knowledge of what promotes optimal parent-childinteractions

Development of a trusting relationship

Psychosocial assessments of a family’s needs andstrengths

Flexible services

Home visitors should view record keeping as a chance to documentand reflect on the progress of the families they work with. Soundrecord keeping is necessary for program maintenance, improve-ment, and program evaluation.

Home visitors must adhere to client confidentiality, encouragingparents and families to feel comfortable giving out personal infor-mation. Home visitors must also be constantly aware that theiractions and behaviors are likely to be repeated by the parents withwhom they work. In addition to serving as a role model, home vis-itors must also help parents develop skills that allow them toaccess services that meet their needs and to identify potentialsources of support. These skills will allow families to begin todevelop a support network based on their needs and desires.

Home visitors should actively seek opportunities to continue theireducation, such as regular attendance and participation in professional training sessions. They should also actively seekadvice and guidance from their supervisors. Home visitors shouldview supervision as a resource to foster their professional growthand an opportunity to learn more about the services they are providing. They should develop a list of professional goals, whichare used to guide their career and can be modified to reflectchanges in interest.

While being a home visitor can be fulfilling and rewarding, it canalso be overwhelming to work everyday with families who have avariety of needs. Therefore, it is important that home visitorsmaintain a healthy way to handle demands from both home andwork life. This includes using appropriate stress managementskills to manage personal and professional stress and knowingwhen to seek emotional support from supervisors or other agencypersonnel.

Skills for completing required documentation and acommitment to evaluation and program improvement

Maintain professional relationships with families

A keen interest in one’s own professional growth

Have self-nurturing skills and maintain a healthysupport system

• Programs need to clearly definewhat constitutes a “participant” inthe program. Often, parents partic-ipate in ways that were not designedto be part of the program. By defin-ing participation, programs will beable to clearly document when serv-ices begin and end.

• Programs need to collect informa-tion about the needs and character-istics of the community and partici-pants. This allows for comparisonsto be made between people whoreceive services and those who donot, and assists programs in deter-mining the effectiveness of the serv-ices being offered.

• In order to provide a successfulevaluation, programs need to con-tinually update information abouttheir participants. This requiresestablishing record keeping proce-dures and providing staff withappropriate resources and time tocontinually update information.

What types of outcomes can be measured to determinethe effectiveness of a program?

ReferencesAlmonte, B. (1994). Professionalism as culturechange: Issues for infant / family community work-ers and their supervisors. Zero to Three15, (2), 18-23.

Hiatt, S., Sampson, D., & Baird, D. (1997).Paraprofessional home visitation: Conceptual andpragmatic considerations. Journal of CommunityPsychology, 25, 77-93.

Kalmanson, B. & Seligman, S. (1992). Family-provider relationships: The basis of all intervention.Infant and Young Children, 4, (4), 46-52.

Musick, J. & Stott, F. (1990). Paraprofessionals,parenting, and child development: Understandingthe problems and seeking solutions. In S. Mersels &J. Shonkoff (Eds.). Handbook of Early ChildhoodIntervention. New York: Cambridge.

Olds, D., Henderson, C., Kitzman, H., Eckenrode, J.,Cole, R., & Tatelbaum, R. (1997). Prenatal andinfancy home visitation by nurses: Recent findings.The Future of Children, 9, (1), 44-65.

Unger, D.G., & Brown, M. (2001). ParentEducation and Support in Delaware: 15 Years ofRecommendations Waiting to Be Implemented.Newark, DE: University of Delaware, Center forDisabilities Studies.

Unger, D. G., Brown, M., Tressell, P., Mejia, T.,Antal, P., & Cooksy, L. (2001). Home VisitingEvaluation and Training: Final Report. Newark,DE: University of Delaware, Center for DisabilitiesStudies.

Center for Disability StudiesCollege of Human Services, Education,and Public PolicyUniversity of Delaware166 Graham HallNewark, DE 19716www.udel.edu/chep/cds/Ph: 302-831-6974TDD: 302-831-4689

delAware: A Research Brief is sponsored by the University of Delaware’sCenter for Disabilities Studies, a University Center for Excellence inDevelopmental Disabilities Education, Research, and Service, as part ofour dissemination efforts to educate people in the community about peoplewith disabilities. Comments may be made by calling (302) 831-6964 orTDD at (302) 831-4689, faxing (302) 831-4690, or writing to Ms. ThedaM. Ellis, University of Delaware, Center for Disabilities Studies, 166Graham Hall, Newark, DE 19716-3301.

AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTIONEMPLOYER—The University of Delaware is committed to assur-ing equal opportunity to all persons and does not discriminate onthe basis of race, color, gender, religion, ancestry, national origin,sexual orientation, veteran status, age, or disability in its educa-tional programs, activities, admissions, or employment practicesas required by Title IX of the Education Amendments of 1972,Title VI of the Civil Rights Act of 1964, the Rehabilitation Act of1973, the Americans with Disabilities Act, other applicablestatutes and University policy. Inquiries concerning these statutesand information regarding campus accessibility should bereferred to the Affirmative Action Officer, 305 Hullihen Hall,(302) 831-2835 (voice), (302) 831-4563 (TDD)..21/500/801/L

The Home Visiting Advisory Committee in Delaware has identified severalshort and long term outcomes that would provide a range of meaningfulinformation about the effects of home visiting (Unger, et al, 2001). Thespecific outcomes of a program, however, should be closely matched withthe program’s particular objectives.

Short-term outcomesShort-term outcomes include an evaluation of services provided in oneyear.

■ Increased identification and meeting of daily living needs of children,parents, and families involved in the program, including food, cloth-ing, housing, and developmental needs.

■ Increased Proper medical care■ Increased parent knowledge of child development, parenting skills,

family communication, family problems, and family social support■ Increased awareness of community resources

Standardization of data collection and storage procedures, based on anoverall client-based data management system that includes both participantand community needs and characteristics for recruitment, enrollment, pro-gram operation and evaluation.

Long-term outcomes (two or more years after start of services):■ Long-term outcomes include an evaluation of services provided two

or more years after services were begun.Child Issues:

■ Reduction in child neglect and abuse■ Increased number of children who remain living in their home with

their family■ Increased school readiness■ Increased receipt of routine medical care

Parent Issues:■ Increased amount of time between births■ Decrease in amount of unplanned subsequent pregnancies■ Attainment of high school education / equivalency.■ Increased employment

Family Issues:■ Healthier family lifestyles■ Self-sufficiency■ Families staying together■ Reduction in parenting and family stress

Community Issues:■ Coordinated service delivery in parent education and support services