Home Visiting in Early
Childhood: Effective
Practices and Strategies
Ariane Gauvreau, Ph D, BCBA-D
Objectives
Discuss components of evidence based
home visiting.
Discuss effective strategies for determining
priorities for intervention at home.
Discuss strategies to support families in
embedding instruction into daily routines.
70% of children in Part C
are served at home.
Why are home based services important?
Which number is
greater?
a) 3
b) 168
c) 9
d) 15
Home Visiting Math
8,736 hours in a year
2,000 hours at work/childcare (40/week, 2
weeks vacation)
6,736 hours a parent is with their child
20,208 hours birth – age 3
We think of early
intervention like this…
But it should look
more like this
SO…HOW DO
WE DO THAT?
Evidence Based Home Visiting
On Going
Supervision for
Home Visitors
Clear
Communication
with Families
In Vivo Practice of
New Skills
Instruction:
• Emotional
Communication
• Positive Interactions
• Disciplinarly
Consistency
Positive
Outcomes
for Families
and Children
Strong Relationship
with the Home
Visitor
Instruction
Disciplinary Consistency
& Supporting
Challenging Behavior
Positive Parent Child
Interactions
Emotional
Communication
In Vivo Practice of New Skills
Home visitor
models strategy
or skill for parent
Parent tries this
new during the
visit
• Better generalization
• Feedback
• Reinforcement
Support for Home Visitors
Regular supervision meetings
Parents remain with programs longer when home visitors
receive supervision (McGuigan et al., 2003)
Visitors find insufficient training, difficulty establishing a
relationship, and challenging family characteristics as a barrier to
service delivery (McBride & Peterson, 1997)
Clear Communication
Parents used to practitioners
directing all activity, engaging with
the child
Roles
Unprepared for this model (Hughes
& Peterson, 2007)
Strong Relationship with Home Visitor
Parents feel the
visitor’s concern and
caring
The visitor is:
• warm, makes the parents
feel comfortable
• actively listens to
whatever parents choose
to discuss
• nonjudgmental and
validating
• praises parents hard work
Parents are the
decision makers
(Klass, 1996)
Family Centered Home Visiting
Parents
Own the
Agenda
Support
Coaching
Parents own the agenda
• Home visitors let families take the lead.
• Their priorities drive the visit, discussion, and
activity.
Social Support
• Not all home visits
with center around
teaching new skills
• Sometimes parents
need someone who
they can talk to about
their concerns,
frustrations, hopes
• A home visitor can
create an
environment where
the parent feels like
they can openly talk
about their child
Practitioners Role in Effective Home
Visits
1. Assessment (RBI)
2. Goal Development
3. Intervention
4. Progress Monitoring
Step 1: Assessment
• Routines Based
Interviews
• Identify parts of a
family’s day that
are challenging,
and priorities for
intervention
Check the
IECC website!
• Goal of assessment = to determine how and
where we can support a family
“Tell me a bit about your morning. What is
getting ready for day care like?”
“How are things in the evening – what happens
at bath time?”
“What sort of things does your family do on the
weekends?”
Step 2: Goal Development
Family
Priorities
•When
•Where
•How
But, what if a
family has too
many priorities?
Focus on 1-2 main
skills during each
home visit.
Family Routines Matrix
Routine
Target Skill
Breakfast
Pointing to request
Getting dressed One-step directions
Play time
Snack
Pointing to request, one-step
directions
Pointing to request
Step 3: Intervention - Parent Coaching
• Supporting caregivers
in teaching specific
skills
– Modeling
– Demonstrating how to
use certain supports
(visuals, timers, etc.)
– Feedback
“
Coaching focuses on supporting family
members…to refine their knowledge and
experience so that they can enhance their
skills and help a child participate in
meaningful situations.
- Hanft, Rush, & Sheldon, 2004
”
Goals of Parent Coaching
Help parents recognize what they
are already doing that promotes
their child’s learning
Assist parents in creating
ongoing learning opportunities
for the child when the home
visitor is not present
(Hanft, Rush, & Shelden, 2004)
• What might be challenging
about this?
Natural Parent Coaching
1. First, rapport
and
relationships.
2. Instill confidence
3. “This is how we
are trained” or
“Lets try this…”
In Vivo Practice
“Lets practice that right now – what’s a direction we could
give Sam today?”
“Let’s have a snack and check in on how pointing is going”
“Would it be helpful to show you how we teach colors at
school?”…. “Why don’t you give it a try?”
“What should we plan to work on today?”
“What should we practice next week?”
Step 4: Progress Monitoring
• Home visit notes = data collection
• Ask guided questions to determine if
intervention is effective
– “We worked on following directions this week.
How did it go? What was a direction that Sam was
able to follow? What was hard for him to follow?”
– “How did bath time go this week? What was it like
giving a warning?”
Topics Covered
Sleeping – this week was a challenge. George was up at 3:30
pretty consistently. Mom and Dad are very tired and interested
in sleep training.
Recommendations
Tara shared information from Sleep Better. Parents are going to
keep a sleep log this week to determine if there are any
patterns in napping and night time sleep.
Sleep hygiene – no screen time before bed, cool, dark room,
bed time story, going to sleep at 7:30 PM – working on
consistently with this routine.
Strategies
Next week, let’s discuss sleep training when George wakes up
during the night.
Update from School
Sam love our new class pet, Marker the fish! He is consistently
following routine directions with the group, and staying with
his friends during transitions.
Update from Home
Family went to the zoo this weekend! Sam did a great job riding
in the stroller. He loved the elephants!
Home Visit Goal
Following one-step directions
Update on Goal
Sam consistently followed the direction “Clean up,” “Come
here” and “Give me” during the week, when asked by mom.
Observational Data
Collection
During the HV, mom gave Sam several directions – he was able
to follow almost all of them. Needed a prompt to follow the
direction “close the door.”
Focus for next week
• Continue working on one step directions – add in “go get
______,” “give [item] to ________” and “high five.”
• Remember to immediately prompt Sam if he doesn’t follow
the direction right away
Sleep Diary Data Sheet
1Sleep
Child: ________________________
Day
Time put
to Bed
Time fell
asleep
Nighttime
waking
(time/how
long)
Diary
Week of: ______________________
Describe nighttime waking
Time
awake
(AM)
Sun
Mon
Tue
Wed
Thu
Fri
Sat
1
Source: Sleep Better: A Guide to Improving Sleep for Children with Special Needs by V. Mark Durand
Describe any naps
Toileting Log
Toileting Log
Use this sheet to record toileting behavior.
Date
Time
Void in
Toilet
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Dry
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Wet
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Soiled
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
Self
Initiated
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Notes
OTHER CONSIDERATIONS
Safety
• Before
– Notify co-workers
– Review in take form for any
possible concerns about
violence
– Cell phone
– Park your car in a place that
enables you to leave quickly
– Wear your badge
Safety
During the home
visit
• Be aware of exit
• Sit near an exit, within
view of hall, bedrooms
• Use non-threatening
body language
• Respect client’s home
• Be aware of pets
Other Safety Tips
• Back your car into a parking spot
• Bring dog biscuits to calm aggressive/excited
dogs
• Ensure car has gas, is in working condition
• Refrain from sharing personal details
• Home visit in pairs
• Trust your intuition
• Debrief with a co-worker
Questions
Common Elements
Challenging behavior
Communication
Sibling Issues
Advocacy
Routines
Environment
Poll:
What are the
priorities of
your families?
Challenging Behavior
Parents learn
to identify the
function of
behavior
Parent/ home
visitor identify
replacement
behaviors
Antecedent
supports
Consequent
strategies
Communication
• Creating opportunities for communication in
daily routines
• Intervention strategies to teach
communication
 Time-delay
 Incidental Teaching
 PECS
• Following Directions
Sibling
Support
•
•
•
•
Sharing
Playing together
Turn Taking
Talking about sib’s
disability
Home Visits: Daily Routines
•
•
•
•
•
Bedtime
Meal Time
Leaving the House
Getting in the Car
Self-Care Routines
Goals of
Parent
Advocacy
• To know the strengths and needs of
your own child
• To be able to participate in your child’s
education
– Goal formation, service delivery
model, etc.
• To build a healthy working relationship
with the school
Advocacy
• Ensure
– family understands what early
intervention services are available
– Rights under IDEA
– active participation in the IFSP, IEP, school
programming, etc.
– Comfort in asking for what they need
Environment
•
•
•
•
•
Schedule
Arranging toys
Mealtimes
Car ride support
Organizing for
independence
• Limiting access to toys
References
Heaman, M., Chalmers, K., Woodgate, R., & Brown, J. (2006). Early childhood
home visiting programme: factors contributing to success. Journal of
Advanced Nursing, 55(3), 291–300. doi:10.1111/j.1365-2648.2006.03914.x
Hughes, K., & Peterson, C. A. (2007). Conducting home visits with an explicit
theory of change. Young Exceptional Children Monograph Series, 10, 47-59.
Klass, C. S. (1996). Home Visiting: Promoting Healthy Parent and Child
Development. Baltimore, MD: Brookes
McCollum, J. A., & Yates, T. J. (1994). Dyad as focus, triad as means: A familycentered approach to supporting parent-child interactions. Infants & Young
Children, 6(4), 54-63.
McGuigan, W. M., Katzev, A. R., & Pratt, C. C. (2003). Multi-level determinants
of retention in a home-visiting child abuse prevention program. Child Abuse &
Neglect, 27(4), 363–380. doi:10.1016/S0145-2134(03)00024-3
Thank You!
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