A Research Program in
Home Visiting and the EC System of Care
JHU Team
Lori Burrell, Fallon Cluxton-Keller, Sarah Crowne,
Amanda Latimore, Phil Leaf, Cynthia Minkovitz
Jennica Bouquet, Debbie Chinen, Constance
Mercer, Kristen Ojo, Kay O’Neill, Monique Weisman
Amanda Belknap, Alex Cooper, Kaitlin Donisch
Research Collaborators
Jeanne Brooks-Gunn, Jill Filene, Mark Chaffin, Jon
Korfmacher, John Landsverk, Darius Tandon
Overview
1. Context


Importance of Early Childhood
Past, present, future US investment in HV
2. Approach


Implementation Science
Theory-based multi-level model of behavior
3. Current Work


Partnering with stakeholders
Opportunities for experiential learning
Importance of Early Childhood
Bowlby’s Attachment Theory
 Children need their caregivers to be a secure base for
exploration, a safe haven for protection
 Early experiences give rise to ‘internal working models’
 These models stay with us and color our relationships.
 Adverse Childhood Experiences (Filetti et al., AJPM 1998)
 As ACEs increase, so do behavioral risks for leading causes of death
Number of ACEs
Home Visiting’s Past –
Bottom Line?
 Evolution in 3 sectors: health, early
education, child welfare
 HV can be effective, though we could
do a lot to strengthen its impacts.
 Enough evidence to justify investing in
scale up of evidence-based HV
 Must work together across sectors,
agencies, models to advance the field
The Present –
Creation of MIECHV (McV) Program

$1.9 billion DHHS funding since 2010

HRSA + ACF program



Results  reauthorization
Formula grants  benchmark evaluation
Competitive grants  research to advance field
3%
Research, Training,
and
Technical Assistance
97%
Grants to States,
Territories, Tribal
Organizations
The Present –
MIECHV from a National Perspective

$$ to increased HV availability PLUS
HomVEE
Identify E-B HV models (14 to date)
DOHVE
Training and TA to states
CoIIN
Demonstrate CQI in 4 areas
MIHOPE
National, multi-site randomized trial
HVRN
Set national research agenda 
promote innovative research
Actual Services 
Impacts on Outcomes
“Every system
is perfectly designed
to achieve
exactly the results it gets.”
Donald M Berwick, M.D.
How can we design HV/EC systems so that the
results we get are the results we want?
It is not enough to adopt
an evidence-based model.

Program
impacts vary.

Unintended
variation in
service delivery
contributes to
this.
Duggan et al., Child
Abuse & Neglect (2007)
31:801-827.
Probability of Home Visitor Recognition of
Poor Maternal Mental Health
# of Factors Endorsed by Home Visitor:
Adequate Training, Comfort, Effectiveness,
Discusses Often
It is not enough to adopt
an evidence-based model.

Program
impacts vary.

Unintended
variation in
service delivery
contributes to
this.
Duggan et al., Child
Abuse & Neglect (2007)
31:801-827.
Probability of Home Visitor Recognition of
Poor Maternal Mental Health
# of Factors Endorsed by Home Visitor:
Adequate Training, Comfort, Effectiveness,
Discusses Often
Implementation Science
(NIH/Fogarty Center definition)
…the study of methods to promote the
integration of research findings and evidence
into policy and practice.
Research to:
1. Understand how multi-level factors shape
adoption, adaptation, implementation
2. Design and test innovations to improve
adoption, adaptation, implementation
Forces at multiple levels
shape behavior.
National
 State
 Community
 Implementing Agency
These forces:
• Motivate
• Enable
• Reinforce
 Local HV Program
 Preceptor/Supervisor
 Home Visitor
 Parents/Caregivers
Implementation Science and
Theories of Behavior
OUTPUTS
INPUTS
SERVICE MODEL
Exploration,
Adoption
and
Adaptation
FAMILIES
HV
STAFF
OTHER
PROVIDERS
IMPLEMENTATION
SYSTEM
Professional
ORGANIZATIONAL, Exploration,
Development
Adoption
SYSTEM
AND
Administrative,
and
COMMUNITY
Clinical & SystemAdaptation
INFLUENCES
Level Supports
ACTUAL
SERVICES
and
THEIR
COORDINATION
OUTCOMES
PARENTS
AND
OTHER
CAREGIVERS
CHILDREN
Opportunities for
Experiential Learning

State Evaluative Research




Family recruitment, family engagement,
coordination with health care, social interactions
Administrative data & primary data collection
Opportunities to work with state agencies, sites
MIHOPE RCT + Implementation Study


5000 families in 87 sites in 12 states
Opportunities to work with research firms,
federal agencies, large study teams
Current Work –
HV Research Network (HVRN)
1. Set the agenda
2. Build a PBRN
3. Carry out agenda-
driven research
4. Translate results
HV Research Network

Current Major Study



Developing and applying an observational
measure of social interaction in visits
Four small studies by HV Research Scholars
Opportunities for New Research

D&I research aligned with the national home
visiting research agenda
Interested? Let’s chat…



Brown Bag April 14
HVRN.ORG
[email protected] and [email protected]
Hawaii
DHHS/ACF 90CA1778; O’Neill Foundation Grant #7126
MD
DHHS/HRSA Grant D89MC26357
NJ
DHHS/HRSA Grant D89MC23540
MIHOPE DHHS/ACF ACF99163, 12-233-SOL-00425, ACF96487
HVRN
DHHS/HRSA UD5MC24070;Heising-Simons Foundation #2013-69