Home Visiting – a 2-Generation Strategy
to Improve Family Health
PFRH Noon Seminar
September 2, 2015
Our Group’s Reason for Being

Early family life matters.

Decision-makers need research to
guide the scale up of interventions to
improve early family life.

Our team plays a major role in this; we
have many opportunities for students.
Give me a child for the first
seven years,
and I’ll give you the man.

Various Attributions
 St. Ignatius Loyola?
Adverse Childhood Experiences
EXAMPLES
 Harsh and neglectful
parenting, household
substance use, mental
illness, violence
PREVALENCE
 Any ACE: 50%
 Multiple ACEs: 25%
As ACEs increase, so does the
likelihood of behavioral risks for the
leading causes of death in adults.
52%
40%
34%
24%
15%
0
1
2
3
Number of ACEs
Filetti et al., Am J Prev Med (1998)
>3
Two Waves of Home Visiting
Organized Charity
Movement
Early
Childhood
System of
Care
1900
1970
2000
A Decade Launching Model-Specific Scale Up
1988
1985
1994
1992
1996
What Research Now?
Dissemination and Implementation
Best strategies for adoption, adaptation,
high quality implementation?
Effectiveness - Impact in usual circumstances?
Efficacy - Impact under ideal conditions?
Pre-Intervention - What causes X?
Relevance for PFRH Students?

Opportunities
Internships
Doctoral dissertations
PT student employment
Special Studies

Positions post graduation









Activities
Instrument design
Primary data collection
Data analysis
Dissemination
Grant applications
Team journal clubs
US Scale Up – Four Lines of Research
2
HARC
3
4
Maternal and
Infant Home
Visiting Program
Evaluation
State Evaluations of Competitive Projects
1
 36 local sites nationally
 4 foci
 Breastfeeding
 Developmental screening
 Maternal depression
 Family engagement
 How best to build CQI capacity???
2
 Set agenda  top 10 priorities
 workforce development
 family engagement
 research infrastructure
 Promote innovative methods
 Conduct and translate agenda-
driven research
 3 studies done, 4 underway
 National “year book”
www.hvresearch.org
•
•
•
•
•
•
3
MIHOPE
RCT + Implementation Study
Four models: EHS, HFA, NFP, PAT
88 local sites in 12 states
Nearly 4500 families
Standardized measures
Questions
• Impacts on outcomes?
• Actual service delivery?
• Multi-level moderators of service delivery and impacts?
4
State Evaluative Research
Focus on state priorities
Tied to QI
Family recruitment and engagement
Social interactions in visits
Major issues
Coordination with health care
Administrative data matching
Questions, Questions, Questions …
1.
Reaching Families Most Likely to Benefit

2.
Making the Most of Visits

3.
How well do we do? How can we do better?
What happens during visits? How is time spent? How is
decision-making shared? How adept are visitors at motivating
and reinforcing behavior change?
Coordinating in a System of Care

How do stakeholders view coordination? How can we
measure achievement of coordination? How to support it?
Relevance for PFRH Students?

Opportunities
Internships
Doctoral dissertations
PT student employment
Special Studies

Positions post graduation









Activities
Instrument design
Primary data collection
Data analysis
Dissemination
Grant applications
Team journal clubs