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Quantifying What Occurs During
Early Intervention Home Visits
Robyn Ridgley
Middle Tennessee State University
Murfreesboro, Tennessee, USA
Patricia Snyder
University of Florida
Gainesville, Florida, USA
We gathered information from 167 home visitors about home-visiting practices using an investigator-developed, self-report questionnaire based on
recommended early intervention practices. The purposes of the present
study were to conduct preliminary evaluations of the psychometric properties of questionnaire responses, to examine whether responses to questionnaire items identified different clusters of home visitors, and to examine whether select demographic characteristics of the home visitors (i.e.,
years experience as home visitor, highest degree) were related to cluster
membership. Results supported acceptable item level statistics and internal
consistency score reliability. Three distinct clusters of home visitors were
identified based on their responses to questionnaire items. With respect to
score validity, findings from a principal components analyses showed questionnaire items associated with practices reported to occur during home
visits organized under four interpretable components, labeled Discussing
Strategies with Caregivers; Addressing Family Activities, Issues, and Resources; Following the Lead of the Child and Family; and Distal Activities. Implications of study findings in relation to recommended home visiting practices described in the extant literature are discussed.
Early Childhood Services
Volume 4, Number 1, pp. 1–27
Copyright © 2010 Plural Publishing, Inc.
1
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Key Words: early intervention, home visitors, home visiting practices, questionnaire psychometrics
Early intervention services under Part
C of the Individuals with Disabilities Education Act (IDEA) are intended to address the
developmental needs of the child and the
priorities of the family in relation to enhancing their child’s development (34 CFR Proposed 303.13(a)). Over 77% of infants and
toddlers eligible for Part C receive services
in their homes (U.S. Department of Education, 2005). Despite the number of children
and families receiving early intervention
services through home visits, few practice
guidelines or protocols have existed about
what should be occurring during home visits provided to young children who have disabilities and their families. A recent notable
exception is a list of agreed upon practices for providing services in natural environments promulgated by the Workgroup on
Principles and Practices in Natural Environments (2007a).
The list of practices provided by this
workgroup and literature in the field of early
intervention suggest general principles that
should guide home visiting practices. For
example, home visits should focus broadly on the family, acknowledging their concerns, current support systems, and daily
activities (Cripe & Venn, 1997; Dunst, Bruder, Trivette, Raab, & McLean, 2001; Hanft
& Pilkington, 2000; McWilliam & Scott,
2001; Trivette & Dunst, 2000; Workgroup
on Principles and Practices in Natural Environments, 2007a). Home visitors should
use methods to assist families in learning
how to support their child’s development
within the context of their natural supports
and daily activities. In addition, caregivers
should be engaged with the home visitor
and activities occurring during the home visit (Peterson, Luze, Eshbaugh, Jeon, & Kantz,
2007) and provided with information or
strategies to address their concerns (Cripe &
Venn, 1997; Hanft & Pilkington, 2000; Jung,
2003; McWilliam & Scott, 2001; Workgroup
on Principles and Practices in Natural Environments, 2007b). Specific “instructional”
strategies for supporting families in this area can include observing and encouraging
families’ natural use of strategies, modeling
approaches, coaching, or problem-solving
with families (e.g., Campbell, 2004; Campbell & Sawyer, 2007, 2009; Hanft, Rush, &
Sheldon, 2004; Wasik & Bryant, 2001; Workgroup on Principles and Practices in Natural
Environments, 2007b).
Researchers and practitioners in early intervention only recently have begun examining the specific practices that occur during
home visits. When collecting information
about the content of home visits, researchers have primarily used observational methods to document a variety of components of
the home visit. For example, Peterson and
her colleagues used their investigator-developed Home Visit Observation Form to gather and record individuals present during visits, interaction partners, content addressed
during interactions, and the role of the interventionist or strategies used by the interventionist (McBride & Peterson, 1997; Peterson
et al., 2007). The results from the 160 observations completed with 15 home visitors revealed that home visitors spent the majority of time interacting with the child directly
and focusing on the child’s development and
care (McBride & Peterson, 1997; Peterson et
al., 2007); practices that generally are not
consistent with home visiting principles recommended in the extant literature. Furthermore, parent-child interactions were encouraged minimally during home visits (McBride
& Peterson, 1997; Peterson et al., 2007).
Campbell and Sawyer (2007) observed
50 child-focused intervention home visits to
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document the content of these visits and determine whether visits were traditional (i.e.,
activities provided for the child to learn or
practice skills without regard for the family’s activities or routines) or participationbased (i.e., activities designed to increase
the child’s participation in the family’s activities or routines). Observations were documented using the Home Visit Observation
Form-Modified (HVOF-M) and the Natural Environments Rating Scale (NERS). The
HVOF-M included recording the role of caregivers in addition to the categories of information described in the Peterson et al. studies. The NERS was designed to be used with
child-focused activities and included rating
the home visit after the observation to determine the type of activity, engagement of
the child, leader of the activity, materials,
role of the caregiver, and role of the home
visitor. Results showed the observed home
visits primarily were traditional, with the
home visitor directing the activities with the
child while the caregiver observed. However, there were noteworthy differences in
the traditional versus participation-based visits in that participation-based visits included
more triadic interactions between the child,
caregiver, and home visitor. These interactions focused on the child’s participation in
daily activities as learning opportunities.
In a later study, Campbell and Sawyer
(2009) collected data from 96 home visitors who had participated in professional
development that included group sessions
and self-study on completing participationbased home visits. Using the NERS to code
videotapes of participants’ home visits, the
researchers found by the end of the professional development activities that 60% of the
home visitors used participation-based practices when completing home visits. This
study included investigating whether home
visitor (e.g., discipline, years of experience)
or family (e.g., educational level, income)
characteristics influenced adoption of participation-based practices. No statistically
significant differences were found based on
home visitor or family characteristics. Furthermore, personal beliefs about recom-
mended practices were explored. Home visitors that demonstrated participation-based
practices “held beliefs more like those that
represented best practice” (p. 230).
These observational studies have resulted in preliminary information about what
might be occurring during home visits for
Part C eligible children and families. However, cost and time involved in collecting
observational data can be prohibitive, resulting in studies involving limited numbers of home visits and few home visitors
being observed. In addition to observational methods, other methods for documenting home visiting practices might be useful
for research, professional development, and
practice. For example, rating scales completed by home visitors might be useful for
characterizing self-reports of home visiting
practices, for self-monitoring home visiting
practices, for identifying areas for self-improvement, and for examining correspondence between what home visitors report
occurs during home visits and what is observed directly.
Self-reports of what occurs during home
visits might vary based on attributes of the
home visitor, curriculum or philosophy adopted by the home visitor or home visiting
program, and individual child/family characteristics and needs. By gathering information
from home visitors about their individual
characteristics and their home visiting practices, more could be learned about what contributes to the use of specific home visiting
practices. Research in early childhood education specifically related to associations between attributes of early education and care
practitioners and classroom quality have
resulted in mixed findings. Several studies
showed that infant/toddler and preschool
classrooms were higher quality when teachers had earned at least a bachelor’s degree
(Burchinal, Cryer, Clifford, & Howes, 2002;
Burchinal, Roberts, Nabors, & Bryant, 1996;
Goelman et al., 2006; Phillipsen, Burchinal,
Howes, & Cryer, 1997). Furthermore, some
studies have demonstrated years of experience in early childhood education resulted
in higher quality infant/toddler or preschool
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classrooms (Buysse, Wesley, Bryant, & Gardner, 1999; Phillipsen et al., 1997). One study
that involved inclusive and segregated early education programs found no statistically significant relationships between teacher demographic characteristics (e.g., level
of education, years of experience, age) and
classroom quality (LeParo, Sexton, & Snyder, 1998). More recently, Early and her colleagues (2006) found few noteworthy associations between teacher demographics
(i.e., education, training, and credentialing)
and pre-K classroom quality.
With respect to Part C programs, research completed with service coordinators
indicated college major was related to their
knowledge of and interaction with services
in the community (Hallam, Rous, & Grove,
2005) and the quality of their individualized
family service plans (IFSPs; Jung & Baird,
2003). However, only a few studies have explored relationships between demographic
characteristics of home visitors and what occurs during early intervention home visits.
Studies exploring these relationships found
no systematic associations between select
demographic characteristics (i.e., years of
experience, years of experience in the field
of early intervention, and hours per week
spent working in early intervention) and the
type of home visit (i.e., participation-based
or traditional; Campbell & Sawyer, 2007,
2009). Variability in research findings in other types of early childhood programs and the
limited data available in home visiting programs related to the relationship between
home visitor characteristics and quality of
services, professional knowledge, or types
of supports provided highlights the need for
additional research to determine if select attributes of providers are related to adoption
of practices in early childhood and early intervention settings. Specifically, research
is needed to explore whether attributes of
home visitors are related in a systematic way
to their self-reported home visiting practices.
The purposes of the present study were
to gather descriptive information from home
visitors about the extent to which they used
a defined set of home visiting practices, par-
ticularly practices focused on what occurs
during visits. In addition, we conducted preliminary evaluations of the psychometric
properties of questionnaire responses to examine whether responses to questionnaire
items identified different clusters of home
visitors, and to examine whether select demographic characteristics of the home visitors were related to cluster membership. Finally, as the majority of the home visiting
research has focused on what home visitors do during their visits, we used principal
components analysis to evaluate whether
home visitors’ reports of practices that typically occurred during their visits might be
associated with a smaller set of interpretable
components.
Methods
Participants
Participants for this study were employed with a statewide early intervention
program in a southeastern state that provided solely home visiting services. The program served approximately 3,000 children
and employed 35 full-time supervisory home
visitors and 570 part-time home visitors at
the time of the study. The supervisory home
visitors provided technical support, training,
and supervision to the part-time home visitors in addition to providing home visits to
children and families. One-hundred sixty-seven home visitors participated in the study.
The home visitors had an average age of
46 years (range 24 to 73 years) and all were
female. Their years as home visitors ranged
from less than 1 to 26 (M = 5.9; SD = 5.5),
whereas the total number of years they had
worked in the field of early intervention
ranged from less than 1 to 31 (M = 6.9; SD =
6.4). The number of years the home visitors
had worked in their current program ranged
from less than 1 to 25 (M = 5.0; SD = 4.8).
Of the home visitors, 95.8% were white (n
= 160), 3.5% were African American (n = 6),
and 0.6% were Hispanic (n = 1).
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When reporting their major in their
highest degree program, 29.3% (n = 49) indicated special education, 9.6% (n = 16) indicated early childhood education, 17.4% (n
= 29) indicated elementary education, 6.0%
(n = 10) indicated psychology, and 37.1% (n
= 62) indicated they had other majors (e.g.,
social work, child development/family studies, sociology, management).
The home visitors varied in their highest
educational attainment. One participant had
earned an associate’s degree (0.6%). Most
held a bachelor’s (41.9%; n = 70) or master’s degree (46.1%; n = 77). Some home visitors had earned a specialist or a master’s degree plus 30 to 40 hours additional graduate
credit (8.9%; n = 15) or doctorate (1.2%; n =
2), whereas others reported having earned
some other degree (e.g., licensed practical
nurse; 1.2%; n = 2). Educational data for
participants in the study sample are comparable to the population of home visitors
working in this program; 43.5% of the home
visitors employed in the program in 2005
had earned a bachelors’ degree, 40.2% had
earned a master’s degree, 15.0% had earned
a specialist or master’s degree plus at least
30 hours additional graduate credit, whereas 0.8% had earned a doctorate.
Procedures
Recruitment
All home visitors employed at the time of
the study were recruited to participate (n =
605). Following recommendations in survey
research, three recruitment mailings were
sent to potential home visitors (Dillman,
2000). Initial recruitment was through electronic format. The first author sent an electronic letter (i.e., e-mail) that explained the
study and included a link to the online version of the questionnaire to all supervising
home visitors (n = 35) who then forwarded
the letter to the home visitors they supervised. A follow-up e-mail was sent 4 weeks
later. When the response rate was not adequate, individual packets that included a let-
ter describing the study, a consent form, a
questionnaire, and a self-addressed stamped
envelope were mailed to each home visiting
office (n = 9) to be distributed to each home
visitor.
Survey Instrument
The Survey of Home Visiting Practices
was developed by the first author through
a review of literature on home visiting and
early intervention recommended service
provision (e.g., Campbell, 2004; Cripe &
Venn, 1997; Dunst et al., 2001; McWilliam
& Scott, 2001; Sandall, Hemmeter, Smith,
& McLean, 2005) and previous studies that
outlined what commonly occurred during
home visits (e.g., McBride & Peterson, 1997;
Ridgley, 2004). Through the review, activities that could occur during early intervention home visits were identified. Home visit components associated with the content
or focus of the visit (e.g., the child’s development, family needs), interaction partners
(e.g., interacting only with the child, interacting with the child and caregiver), and information sharing strategies (e.g., directly
teaching the child, participating with the
family during routines, using materials in the
home) were identified (Campbell, 2004; McBride & Peterson, 1997; Ridgley, 2004). Each
of these components was addressed in the
questionnaire by providing a range of possible activities that could be the focus or occur
when completing the home visit. The specific tasks that home visitors complete prior to
the home visit had not been explored in previous studies. However, the extant literature
and the researcher’s previous experience
with home visits provided guidance about
the general types of activities that could occur (e.g., Cripe & Venn, 1997; Dunst et al.,
2001; McWilliam & Scott, 2001).
After the questionnaire was developed,
five individuals with expertise in home visiting (i.e., administrator of home visiting program [n = 1], home visitors [n = 2], early
childhood faculty [n = 2]) provided feedback on the questionnaire. These individuals were chosen based on their extensive
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experience within home visiting programs
(n = 3) or their previous research experience in early intervention and home visiting programs (n = 2). Each individual was
directed to complete the questionnaire, record the amount of time used to complete
the questionnaire, provide feedback on clarity and wording of questions, outline additional questions or content that should be
included, and provide any additional feedback. Specific recommendations included
rewording directions to improve clarity and
suggestions for additional questions or components to questions. This feedback was
used to refine the questionnaire. Changes
made to the questionnaire included changing wording to make directions clearer and
adding five additional items (i.e., one home
visitor demographic item and four visit logistic items). After the development and use
of the questionnaire, additional studies and
position papers have supported the items
included in the questionnaire (Campbell &
Sawyer, 2007, 2009; Peterson et al., 2007;
Workgroup on Principles and Practices in
Natural Environments, 2007a, 2007b). Specifically, the items related to planning visits, the focus of visits, and completing visits
were addressed in the Workgroup Principles and Practices in Natural Environments
documents (2007a, 2007b). Campbell’s and
Sawyers’ work (2007, 2009) with home visitors supported the inclusion of a range of
“completing the visit” items that correspond
with their description of traditional and participation-based home visits.
The questionnaire included three sections. Part I, entitled Information About
You, was designed to gather information
about attributes of the home visitor and included 10 items related to the home visitor’s age, gender, race, educational level and
program (i.e., special education, early childhood education, elementary education, psychology, other), and years of experience as
a home visitor, in their current program, and
in the field of early intervention. Part II, entitled Visit Logistics, included 13 items related
to the number and types of families served
by the home visitors at the time of the study
(e.g., income, location, race of families), disabilities of the children served by the home
visitors at the time of the study, on average
how often visits occurred with each family,
and the average length of visits with each
family. Items in Part I and II were either multiple choice or closed-ended questions.
Part III, entitled Completing the Home
Visit, included three subscales. The first subscale, Planning for Visits, which focused on
planning practices used by the home visitor, included 17 questions. When completing this subscale, the home visitors were directed to think about how they plan for the
majority of the home visits they complete
and they were given two prompts: (a) When
planning for my home visits, I consider . . .
” and (b) “When planning for my home visits, I complete the following tasks . . . ” Each
prompt was followed by a list of possible
things to consider or complete, respectively. The second subscale, Focus of Visits, included 10 questions. When completing this
subscale, the home visitors were directed to
think about the content focus of the home
visits they complete, and they were given
the prompt, “During the home visits I complete, the focus is on . . . ” The prompt was
followed by a list of possible foci of visits
(e.g., child’s developmental needs, topics of
interest to the family).
The third subscale, What Occurs During
the Visits, included 28 questions and was a
primary focus in the present study because
this subscale focuses on practices home visitors reported they do during a home visit.
When completing this subscale, the home
visitors were directed to think about what
occurs during the majority of the home visits
they complete, and were given two prompts,
“During home visits I complete, the following occurs . . . ” and “At the conclusion of
each visit, the following occurs . . . ”. Each
prompt was followed by a list of practices
that could occur during the visit or a list of
practices that could occur at the conclusion
of a visit, respectively. Each of the 55 questions associated with Part III of the questionnaire required the home visitors to respond
using a 5-point Likert-type scale ranging from
Never (1) to Most of the time (5).
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Data Entry
Questionnaires returned through the
mail were entered into a statistical software
program by an undergraduate student. One
of the investigators confirmed accuracy of data entry by reviewing the data entered for approximately every third questionnaire (i.e.,
20% of questionnaires). Thirty-five questionnaire entries were reviewed with two errors
found in two questionnaires. Errors in data
entry were corrected by the investigator.
Four questionnaire items reflected practices that would be considered not recommended by the field. One of the items was
in the Planning for Visits subscale (i.e., do
nothing to plan) and three items were included in the What Occurs During the Visit
subscale (i.e., bring materials to the home,
directly teach the child, caregiver leaves).
These items were reverse-scored during the
data analysis process.
in the K-means cluster analyses. Cross-tabulations and chi-square analyses were conducted to examine whether statistically significant or noteworthy associations existed
between select home visitor attribute variables and cluster membership.
To examine whether the 28 items associated with the What Occurs During the
Visits subscale could be represented by a
smaller number of interpretable latent components, principal components analysis was
used. We examined bivariate correlations
between the raw scores on the obtained
principal components using Pearson product-moment correlation coefficients. Furthermore, we repeated the cluster analysis procedures described above to evaluate
whether subgroups of home visitors could
be identified on the basis of their responses
to items associated with each component of
the What Occurs During the Visits subscale.
Results
Data Analyses
Response Rate
SPSS Version 17.0 was used to conduct
all data analyses. We conducted descriptive analyses to examine item-level descriptive statistics, correlations among items,
and correlations among scores on the three
subscales.
To evaluate further the psychometric integrity of responses to Part III of the questionnaire, internal consistency score reliability for the three subscales (i.e., Planning
for Visits, Focus of Visits, What Occurs During the Visits) was evaluated using Cronbach’s alpha. We used K-means cluster analysis as an exploratory technique to evaluate
whether subgroups of home visitors could
be identified on the basis of their responses
to items associated with each subscale. Parallel threshold method was used, initial cluster seed points were identified randomly
from all observations, and the number of iterations was limited to 10. An agglomerative
hierarchical cluster technique using Ward’s
method was conducted to help inform decisions about the number of clusters used
A total of 175 home visitors responded.
Seventy-five home visitors responded electronically, whereas 100 responded by mailing the completed questionnaire to the investigator. The response rate was 28.9%.
Eight of the electronic responses were removed from the data set due to home visitors not responding to any questions (n =
3) or responding only to the demographic
questions (n = 5). Therefore, 167 returned
questionnaires were included in this analysis for a final usable response rate of 27.6%.
Steps taken to ensure the same respondent did not complete the survey both via
e-mail and mail included reminding the
home visitors in the questionnaire cover letter about the possibility of completing the
survey electronically, providing directions
about what to do with the questionnaire if
the home visitor had previously completed
it, and checking demographic information
of respondents for exact matches. No exact
matches were found.
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An independent-samples t-test was conducted to compare attributes of home visitors who responded electronically versus
those who responded by mailing the completed questionnaire. There were no statistically significant differences in age (t(164)
= 1.37, p = .17), years in the field of early
intervention (t(163) = .28, p = .78), or number of families served (t(110) = 1.13, p =
.26). There was a statistically significant difference in years as home visitors (t(123) =
2.01, p = .05).The magnitude for the differences in the means for each characteristic
was small. Table 1 shows the means, standard deviations, standard error, and effect
size for each demographic characteristic.
Chi-square analyses indicated there
were not statistically significant differences
in the home visitors who responded electronically versus those who responded by
mailing the completed questionnaire with
respect to highest degree earned (i.e., master’s degree and higher or other; c2 (1, N =
167) = 1.86, p = .17) or highest degree program (i.e., major in special, early childhood,
or elementary education or other degree; c2
(1, N = 167) = 2.25, p = .13). Of the home
visitors who had earned a master’s degree
or higher, 44.7% responded electronically;
34.2% of the home visitors who had earned
less than a master’s degree responded elec-
tronically. Of the home visitors who had a
degree in special, early childhood or elementary education, 37.7% responded electronically; 46.6% of home visitors with some
other degree responded electronically.
Logistics of Home Visits
Based on participants’ responses to Part
II of the questionnaire, descriptive data for
the logistics of the home visits completed by
the home visitors were generated. The number of families served by the home visitors
at the time of the study ranged from 0–16
(n = 165; M = 4.7; SD = 3.5). The majority of the participants (i.e., 54.5%) reported
that 80% or more of the families they visited
were white, whereas 7.8% reported the families they visit were primarily black, and 34%
reported they visited families of varying races. When reporting where the majority (i.e.,
more than 50%) of their families lived, 44.9%
of participants served families in primarily
rural areas or small towns, 22.2% served families in suburban areas, 12.0% served families in urban areas, and 17.4% served families in a variety of settings. The number of
visits scheduled with each family per month
ranged from 1 to 6 (n = 145; M = 3.9; SD =
0.6) whereas the number of visits completed
Table 1. Mean, Standard Deviation, Standard Error, and Effect Size of Demographic
Characteristics for Participants Who Responded Electronically and Through Traditional Mail
Demographic Characteristic
Response
Type
n
Age
Electronic
67
Mail
Years as home visitor
Years in the field
Number of families served
SD
Standard
Error
Eta
squared
45
11.0
1.3
.01
99
47
11.8
1.2
Electronic
67
7.0
6.0
0.7
Mail
98
5.2
5.0
0.5
Electronic
67
7.1
6.3
0.8
Mail
98
6.8
6.5
0.7
Electronic
67
5.0
4.1
0.5
Mail
98
4.4
2.9
0.3
M
.02
.00
.01
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with each family per month ranged from 0 to
8 (n = 139; M = 3.7; SD = 0.8). The length of
the home visits ranged from 0.8 to 1.6 hours
(n = 165; M = 1.0; SD = 0.1).
Descriptive Analyses of
Questionnaire Items
For each questionnaire item and subscale, the means and standard deviations
were calculated. The range of the mean
scores and standard deviations for items included in the Planning for Visits subscale
were 2.6 to 4.97 (M = 4.1) and 0.2 to 1.6, respectively. The range of the mean scores and
standard deviations for items included in the
Focus of Visits subscale were 2.1 to 4.9 (M
= 3.8) and 0.3 to 1.0, respectively, and the
range of the mean scores and standard deviations for items included in the What Occurs During the Visits subscale were 1.3 to
4.93 (M = 3.7) and 0.3 to 1.4, respectively.
Table 2 shows the mean and standard deviation for each subscale and questionnaire
item included in the Planning for Visits, Focus of Visits, and What Occurs During the
Visits subscales.
Correlations Among Subscales
There was a modest positive relationship between Focus of Visits and What Occurs During the Visits (r = .43, n = 146), and
Planning and What Occurs During the Visits
subscales (r = .60, n = 135). About 18% of
the score variance in What Occurs During
the Visits is explained by participants’ selfreports about the content focus of their visits and approximately 36% of What Occurs
score variance is associated with how participants reported they planned for their visits.
Internal Consistency
Score Reliability
Internal consistency score reliability was
examined for all subscales associated with
Part III of the questionnaire. Cronbach’s alphas for Planning, Focus of Visits, and What
Occurs During the Visits subscales based
on data obtained from the study sample
were .74, .76, and .83, respectively, indicating generally acceptable internal consistency score reliability. Inter-item correlations
and Cronbach’s alpha if item deleted coefficients were examined. Generally, no items
were strongly correlated with other items
and Cronbach’s alphas for each subscale
varied minimally when questionnaire items
were deleted. Scale means were 70.3 (SD =
6.3) for Planning, 37.9 (SD = 4.8) for Focus
of Visits, and 103.4 (SD = 10.2) for What Occurs During the Visits.
Cluster Analyses for Planning,
Focus of Visits, and What
Occurs Subscale Scores
Results of the agglomerative hierarchical cluster technique suggested that three
clusters should be specified using the total
subscale raw scores for the Planning, Focus
of Visits, and What Occurs During the Visits as cluster variables. Using three clusters
in the K-means analysis, convergence was
achieved after four changes in initial cluster centers. Table 2 shows the final cluster
centers (i.e., means) for each cluster for the
three subscales. Cluster 1 is composed of 32
home visitors, whereas clusters 2 and 3 are
composed of 67 and 36 home visitors, respectively. The distances between the cluster centers for clusters 1 and 3 are 12.0 for
Planning, 25.3 for What Occurs During the
Visits, and 8.0 for Focus of Visits. The average distance from the classification cluster
center for the 32 home visitors in cluster 1
was 6.9 (SD = 2.6, range 3.3 to 12.8). For
the 67 home visitors in cluster 2, the average distance from the classification cluster
center was 6.8 (SD = 2.4, range 1.5 to 15.0).
Finally, for the 36 home visitors in cluster 3,
the average distance from the classification
cluster center was 7.4 (SD = 3.8, range 1.7
to 16.0). Table 2 shows the mean and standard deviation for each questionnaire item
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10 70.37
Planning for Visits subscale
3.73
Conversations I’ve had with other professionals on the family’s
team related to the concerns of the family or needs of the child or
family.
At the conclusion of one visit, I talk with the family about what we
would like to accomplish during the next visit.
4.17
4.72
The curriculum used by my home visiting program.
When planning for my home visits, I complete the following tasks:
3.91
3.58
Family needs/concerns not directly related to the child (e.g., financial,
emotional support), which are not included on the IFSP but have been
discussed during previous home visits with the family.
Supports the family needs in order to parent or provide care
to their child with a disability (e.g., child care, material or
equipment needs, sibling issues).
4.21
The child’s developmental issues not included on the IFSP but discussed
during previous home visits with the family.
4.13
4.69
The outcomes included on the IFSP.
The health needs of the child.
4.75
The concerns and priorities of the families included on the IFSP.
When planning for my home visits, I consider . . .
M
Subscale items
.87
.87
.48
.92
.89
.93
.77
.54
.47
6.29
SD
Overall
4.50
4.38
4.87
4.56
4.34
3.87
4.47
4.78
4.84
75.56
M
.80
.75
.34
.67
.79
.91
.72
.42
.37
4.33
SD
Cluster one
4.25
3.69
4.72
4.00
4.21
3.67
4.31
4.72
4.75
71.28
M
.79
.80
.49
.82
.83
.86
.68
.55
.47
4.41
SD
Cluster two
3.58
3.19
4.53
3.11
3.53
3.08
3.86
4.53
4.58
63.61
M
.87
.71
.56
.85
.97
.91
.83
.51
.60
4.92
SD
Cluster three
Table 2. Means and Standard Deviations of Questionnaire Items: Overall and by Cluster Membership of Planning, Focus, and Occurs Subscales
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REGISTERED COPY
4.88
3.57
4.23
3.37
The child’s developmental needs not included on the IFSP.
The child’s health needs and issues included on the IFSP.
The child’s health needs and issues not included on the IFSP.
37.86
The child’s developmental needs (e.g., motor, cognition,
communication, adaptive, or social skills) included on the IFSP.
During the home visits I complete, the focus is on . . .
Focus of Visits subscale
4.97
I do nothing to plan for the visit. (reverse scored)
4.90
Gather materials (e.g., toys, handouts, other resources) needed for the
visit.
3.81
3.24
Develop a plan for what I hope to accomplish during the visit
with the family after arriving at the home.
Review the family’s IFSP.
2.57
Plan with the family prior to the visit by talking with a family member on
the phone.
4.32
4.30
Prior to completing the visit, think through what could possibly occur.
Review previous visit notes.
4.54
M
Write a written plan for what I hope will happen during the visit prior to
arriving at the family’s home.
Subscale items
.96
.92
.91
.34
4.78
.21
.91
.82
.33
1.58
.94
.85
.91
SD
Overall
3.81
4.53
3.78
4.91
41.00
5.00
4.00
4.72
5.00
3.69
3.06
4.69
4.78
M
.93
.72
.83
.30
3.94
.00
.98
.52
.00
1.55
.84
.74
.61
SD
Cluster one
3.37
4.28
3.60
4.93
38.62
4.97
3.78
4.31
4.91
3.34
2.70
4.31
4.64
M
.95
.85
.97
.32
4.07
.17
.83
.78
.29
1.56
1.02
.78
.73
SD
Cluster two
.85
1.12
.92
.45
3.92
.37
.91
.97
.51
1.34
.55
.89
1.19
SD
(continues)
2.89
3.69
3.31
4.72
33.00
4.92
3.47
3.92
4.72
2.42
2.08
3.89
4.19
M
Cluster three
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11
REGISTERED COPY
12 1.34
4.07
4.39
2.15
3.59
I use materials present in the home.
The caregiver leaves the room or house. (reverse scored)
I directly teach the child skills or knowledge. (reverse scored)
I follow the caregiver and child’s lead in the activities we do.
103.40
I bring materials into the home. (reverse scored)
During home visits the I complete, the following occurs:
What Occurs During the Visit subscale
2.09
3.44
Issues related to family needs or concerns not directly related to
the child (e.g., financial, emotional support) expressed on the
day of the visit.
Topics of interest to the family not related to early intervention or my
role (e.g., neighbor issues, what’s on television).
3.47
Issues related to family needs or concerns not directly related to
the child (e.g., financial, emotional support) expressed on the
IFSP.
4.55
4.07
Family concerns related to the child (e.g., child care, information
about services) expressed on the day of the visit.
The content from the program curriculum.
4.25
M
.84
1.06
.67
.86
.66
10.16
.90
.65
.98
.91
.83
.82
SD
Overall
Family concerns related to the child (e.g., child care, information about
services) included on the IFSP.
Subscale items
Table 2. (continued)
4.13
2.03
4.34
4.81
1.34
117.06
2.19
4.69
3.97
3.97
4.34
4.62
M
.79
1.15
.70
.39
.65
4.57
.86
.64
.86
.74
.75
.61
SD
Cluster one
3.55
2.16
4.37
4.04
1.37
103.30
2.18
4.57
3.57
3.57
4.21
4.34
M
.84
.99
.69
.86
.69
4.14
.94
.63
.89
.78
.71
.75
SD
Cluster two
3.36
2.33
4.44
3.64
1.44
91.78
1.86
4.28
2.81
2.75
3.39
3.69
M
.72
1.04
.65
.80
.77
5.57
.80
.70
.89
.84
.84
.86
SD
Cluster three
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REGISTERED COPY
4.64
4.31
3.30
2.59
I help the caregiver plan activities they can do during their day to work
on child or family outcomes.
The caregiver and I plan future visits with the family.
The caregiver and I discuss community services (e.g., WIC, food
stamps, child care assistance) the family is currently accessing or
needs to access.
The caregiver and I discuss family issues not related to the child (e.g.,
relationships with relatives or friends, employment issues, financial
concerns).
3.43
The caregiver and I participate together during the family’s daily
activities (e.g., meals, diapering, play time).
4.59
3.55
I observe and provide support during the family’s daily activities
(e.g., meals, diapering, play time).
I provide information on child development
4.23
I join in the child’s play by imitating or following his/her lead.
2.17
4.53
I encourage the caregiver while he/she interacts with the child by
providing suggestions and/or commenting on the child’s response.
I go with the family while they are completing appointments (e.g.,
physician).
4.70
M
I interact with the child while talking with the caregiver about what I’m
doing and how he/she could do the same or similar things.
Subscale items
.87
.81
.89
.54
.53
.85
1.09
1.08
.75
.65
.50
SD
Overall
2.75
3.81
4.87
4.87
4.87
2.72
4.44
4.56
4.78
4.78
4.94
M
.98
.78
.42
.34
.34
.81
.72
7.16
.42
.49
.25
SD
Cluster one
2.73
3.34
4.34
4.70
4.49
2.09
3.37
3.54
4.28
4.63
4.72
M
.79
.69
.79
.46
.50
.83
1.01
.93
.67
.60
.45
SD
Cluster two
.74
.62
1.01
.67
.65
.77
.82
.91
.75
.73
.56
SD
(continues)
2.28
2.69
3.67
4.19
4.39
1.97
2.72
2.75
3.89
4.08
4.47
M
Cluster three
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13
REGISTERED COPY
14 3.28
3.22
I plan with other team members (e.g., therapists, physicians,
service coordinator) to determine how the team can better
support the family.
The caregiver and I plan with other team members (e.g.,
therapists, physicians, service coordinator) to determine how the
team can better support the family.
4.23
3.27
2.10
4.74
3.98
4.33
I verbally summarize what occurred during the visit.
I verbally summarize and write a note outlining what occurred
during the visit.
I leave a written summary of the visit with the family.
I explain to the caregiver how he/she can carryout activities similar to
the ones completed during the home visit during their daily activities.
I develop and/or revise a plan that outlines how the family can
work on outcomes during daily activities.
I discuss with the caregiver steps/actions to be taken by me or the family
before the next visit.
At the conclusion of each visit, the following occurs . . .
3.44
M
.81
1.05
.49
1.22
1.35
.86
1.00
.93
.79
SD
Overall
The caregiver and I discuss family issues related to the child
within the context of the family (e.g., supporting siblings, the
need for respite).
Subscale items
Table 2. (continued)
4.75
4.56
4.94
3.31
4.34
4.75
4.09
4.03
3.91
M
.44
.67
.25
1.23
.83
.44
.82
.86
.69
SD
Cluster one
4.37
4.06
4.81
1.85
3.24
4.36
3.15
3.22
3.51
M
.78
.92
.40
1.06
1.27
.64
.89
.78
.61
SD
Cluster two
3.81
3.08
4.42
1.56
2.58
3.44
2.75
2.83
2.81
M
1.01
1.20
.69
.81
1.34
1.08
.65
.74
.79
SD
Cluster three
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REGISTERED COPY
3.48
4.93
I discuss with the caregiver other services that will be provided to
the family during the week.
The caregiver and I confirm the next visit time and day.
.25
1.02
.57
SD
5.00
4.34
4.97
M
.00
.70
.18
SD
Cluster one
Note. Subscale items with cluster one and cluster three mean scores varying by 1.0 or greater are shown in boldface.
4.72
M
I give the family an opportunity to ask questions or discuss other matters.
Subscale items
Overall
4.93
3.28
4.78
M
.27
1.00
.42
SD
Cluster two
4.89
2.86
4.42
M
.32
.80
.84
SD
Cluster three
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15
REGISTERED COPY
16 EARLY CHILDHOOD SERVICES, VOL. 4, NO. 1
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based on cluster membership. Each item for
which the mean for cluster 1 and cluster 3
varied by 1.0 or greater is in bold.
Relationships Between
Demographic Characteristics
of Home Visitors and Their
Cluster Membership
Cross-tabulations and chi-square analyses were conducted to examine the relationships between home visitor attribute
variables (i.e., highest degree and years as
a home visitor) and cluster membership.
Chi-square analysis indicated there were
not statistically significant differences in
home visitors based on cluster membership
with respect to highest degree earned (i.e.,
bachelor’s degree or less, master’s degree,
or greater than a master’s degree; c2 (4, N
= 134) = 4.96, p = .29). There were statistically significant differences in home visitors
based on cluster membership with respect
to years as a home visitor (i.e., 0-5 years,
6-10 years, greater than 10 years; c2(4, N =
133, p = .04). The strength of the relationship was evaluated using Cramer’s V, which
indicated there was a minimal association
between the variables (V = .20). However,
of the home visitors who had 0 to 5 years
experience as a home visitor, 16.5% were
members of cluster 1, 51.9% were members
of cluster 2, and 31.6% were members of
cluster 3. Of the home visitors who had 6-10
years experience, 28.1% were members of
cluster 1, 50.0% were members of cluster 2,
and 21.9% were members of cluster 3. Finally, of the home visitors who had more than
10 years experience, 45.5% were members
of cluster 1, 45.5% were members of cluster
2, and 9.1% were members of cluster 3.
Principal Components
Analysis for the What Occurs
During the Visits Subscale
Principal components analysis was completed using data obtained from the home
visitors’ responses to the What Occurs Dur-
ing the Visits subscale to determine if a
smaller number of latent components could
adequately represent questionnaire responses. Suitability of the subscale data for a principal components analysis was determined
by inspecting the bivariate correlation matrices for coefficients of .3 or above, the Kaiser-Meyer-Oklin value exceeding .7, and the
statistical significance of the Bartlett’s test of
sphericity. All three criteria were met.
The What Occurs During the Visits subscale included 28 items. The eigen valuegreater-than-one rule suggested eight components, explaining 61.8% of the variance,
be retained. Inspection of the scree plot revealed a break between the third and fourth
component. Results of a parallel analysis
(Snyder & McWilliam, 2006) showed four
components with eigenvalues exceeding
the corresponding criterion values for a randomly generated data matrix of the same size
(28 variables × 146 respondents). Therefore,
four components were retained, which explained 43.6% of the variance. Post-rotated
eigenvalues for the 4-component solution
were 6.8, 2.5, 1.9, and 1.6, respectively.
To assist with the interpretation of these
four components, varimax rotation was conducted. Twenty-six of the 28 items were
associated with a component at /.40/ or
greater. The two items not associated with
a factor at /.40/ were associated with their
respective components at /.39/ and /.38/,
respectively. Although the absolute magnitude of these structure coefficients was
less than /.40/, they were retained in the interpreted solution because the content of
these items were judged to be substantively
related to their respective components. Table 3 shows the varimax-rotated, four-component solution.
As shown in Table 3, the first component was labeled Discussing Strategies with
Caregivers. This component included 10
items that involved the home visitor discussing strategies, activities, and information designed to assist the family in achieving outcomes. A total raw score for this component
was computed for each participant for which
complete data were available (n = 156). Total scores ranged from 29 to 50. The mean
REGISTERED COPY
.62
.62
.62
.58
.58
Help the caregiver plan activities to address outcomes.
Explain to the caregiver how he/she can carryout similar activities to
those completed during the visit.
Discuss with the caregiver steps/actions to be taken by the visitor or
the family before the next visit.
Verbally summarize what occurred.
Develop and/or revise a plan that outlines how the family can work
on outcomes during daily activities.
Item
Discussing
strategies
with
caregivers
.54
.45
.44
.42
.39
.05
.14
.38
.12
Encourage (e.g., provide suggestions, comment) the caregiver while
he/she interacts with the child.
Interact with the child while talking with the caregiver about what
I’m doing.
Provide information on child development.
Verbally summarize and write a note outlining what occurred.
Observe and provide support during family activities.
Participate during family activities.
Plan with family and other team members.
Discuss with caregiver family issues related to the child within the
context of the family (e.g., supporting siblings).
REGISTERED COPY
17
Plan future visits with caregiver.
.55
.66
.74
.81
.21
.12
.03
.07
.16
.20
.17
.20
.02
.10
Addressing
family activities,
issues, and
resources
.16
–.15
.16
.20
.26
.24
.27
.32
.12
.07
.33
–.19
.13
.10
Following
the lead of
the child
and family
Table 3. Varimax-Rotated, Four Component Solution for the What Occurs During the Visits Subscale (n = 146)
.38
–.07
–.03
.01
–.07
.16
.33
.35
.05
–.04
–.14
–.02
.10
.22
Distal
activities
(continues)
Cumulative
% of
variance
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18 .19
Discuss with the caregiver other services that will be provided to
the family during the week.
REGISTERED COPY
.21
Bring materials into the home.
Post-rotated % of variance explained
Caregiver leaves the room.
Directly teach the child.
14.39
–.29
.37
–.10
.38
Give the family an opportunity to ask questions or discuss other matters.
Discuss with caregiver family issues not related to the child (e.g.,
employment, financial needs).
.21
–.09
Confirm the next visit with the caregiver.
Follow the caregiver and child’s lead in activities.
Join the child’s play by imitating or following his/her lead.
.21
.26
Leave a written summary of the visit with the family.
–.25
Go with the family to appointments.
.27
.11
Use materials present in the home.
Discuss community services the family receives or needs to access.
.45
Discussing
strategies
with
caregivers
Plan with other team members (e.g., therapists, service
coordinator), not including the family.
Item
Table 3. (continued)
14.25
.17
–.15
.26
–.15
.03
–.05
.29
.10
.49
.49
.52
.52
.53
.54
Addressing
family activities,
issues, and
resources
7.52
.15
–.10
.02
–.07
.42
.53
.63
.65
–.06
.11
–.10
.15
.35
–.10
Following
the lead of
the child
and family
7.51
.38
.47
.63
.68
–.01
–.18
.04
.22
.23
–.04
.40
.14
–.24
–.00
Distal
activities
43.52
Cumulative
% of
variance
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QUANTIFYING HOME VISITS 19
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score was 43.3 (SD = 4.6). The second component, Addressing Family Activities, Issues,
and Resources, included 10 items related to
the home visitor participating in the family’s
daily activities or other services provided to
the family and discussing child issues. A total
raw score for this component was computed
for each participant for which complete data
were available (n = 157). Total scores ranged
from 19 to 47. The mean score was 31.9 (SD
= 6.0). The third component, Following the
Lead of the Child and Family, included four
items that focused on the home visitor following the lead of the child or caregiver during interactions and providing opportunities for the caregiver to ask questions. A total
raw score for this component was computed for each participant for which complete
data were available (n = 158). Total scores
ranged from 11 to 20. The mean score was
17.5 (SD = 1.7). The fourth component, Distal Activities, included four items related to
home visit activities that are not connected
with the child’s needs or family activities or
materials. A total raw score for this component was computed for each participant for
which complete data were available (n =
154). Total scores ranged from 7 to 15. The
mean score was 10.5 (SD = 1.6).
Correlations Among
Component Scores
There was a modest positive relationship
between Discussing Strategies with Caregivers and Addressing Family Activities, Issues,
and Resources (r = .49, n = 154), Discussing Strategies with Caregivers and Following
the Lead of the Child and Family (r = .39, n =
154), and Addressing Family Activities, Issues,
and Resources and Following the Lead of the
Child and Family component raw scores (r =
.34, n = 155). Thus, about 23% of the score
variance in Discussing Strategies with Caregivers component was associated with participants’ self-reports about how they addressed
family activities, issues, and resources, and approximately 15% of Discussing Strategies with
Caregivers score variance and about 12% of
the score variance in Addressing Family Activities, Issues, and Resources was associated
with how participants reported they followed
the lead of the child and family. Relationships
between Distal Activities and the other component raw scores were minimal (Discussing
Strategies with Caregivers, r = -.18, n = 149;
Addressing Family Activities, Issues, and Resources, r = .06, n = 151; Following the Lead
of the Child and Family, r = .01, n = 151),
with approximately 3%, .4%, and 0% shared
variance, respectively.
Cluster Analyses for What
Occurs Component Scores
Results of the agglomerative hierarchical
cluster technique suggested that three clusters should be specified using the total scores
for the items associated with each of the four
What Occurs During the Visits components.
Using three clusters in the K-means analysis,
convergence was achieved after four changes in initial cluster centers. Table 4 shows
the final cluster centers (i.e., means) for each
cluster for the four components. Cluster 1 is
composed of 42 home visitors, whereas clusters 2 and 3 are composed of 35 and 69 home
visitors, respectively. The distances between
the cluster centers for cluster 1 and 2 are 10.3
for Discuss, 11.6 for Address, and 1.7 for Follow, and 0.7 for Distal. The average distance
from the classification cluster center for the
42 home visitors in cluster 1 was 4.3 (SD =
1.7, range 1.6 to 8.1). For the 35 home visitors in cluster 2, the average distance from
the classification cluster center was 5.4 (SD
= 2.2, range 1.6 to 10.4). Finally, for the 69
home visitors in cluster 3, the average distance from the classification cluster center
was 4.4 (SD = 1.8, range 0.9 to 10.6). Table
4 shows the mean and standard deviations
for items within each component by cluster
membership. Each item for which the mean
for cluster 1 and 2 varied by 1.0 is in boldface.
Correlations Among
Cluster Membership
Cross tabulations and chi square analyses were completed to determine if there
was a relationship between membership
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Table 4. Means and Standard Deviations of Questionnaire Items for the What Occurs
During Visits Components by Cluster Membership
Cluster 1
Cluster 2
Cluster 3
M
SD
M
SD
M
SD
47.0
2.3
36.7
3.0
44.3
2.6
Help the caregiver plan activities to address
outcomes.
4.9
.3
4.1
.6
4.7
.5
Explain to the caregiver how he/she can
carryout similar activities to those completed
during the visit.
4.9
.3
4.3
.7
4.8
.4
Discuss with the caregiver steps/actions to be taken
by the visitor or the family before the next visit.
4.7
.5
3.6
.9
4.5
.7
Verbally summarize what occurred.
4.6
.5
3.3
1.0
4.5
.6
Develop and/or revise a plan that outlines
how the family can work on outcomes
during daily activities.
4.5
.7
3.0
1.2
4.1
.9
Plan future visits with caregiver.
4.8
.5
3.6
.9
4.3
.8
Encourage (e.g., provide suggestions, comment)
the caregiver while he/she interacts with the
child.
4.7
.6
4.0
.6
4.6
.6
Interact with the child while talking with the
caregiver about what I’m doing.
4.9
.3
4.4
.6
4.7
.5
Provide information on child development.
4.8
.4
4.2
.6
4.6
.5
Verbally summarize and write a note
outlining what occurred.
4.1
1.0
2.2
1.2
3.4
1.3
Addressing family activities, issues, and
resources
39.6
3.5
28.1
4.3
29.6
3.5
Observe and provide support during family
activities.
4.6
.6
3.1
.8
3.1
1.0
Participate during family activities.
4.5
.7
2.9
.8
3.1
1.0
Plan with other team members (e.g.,
therapists, service coordinator), not
including the family.
4.0
.9
2.8
.8
3.1
.8
Use materials present in the home.
4.8
.5
3.7
.8
3.9
.8
Go with the family to appointments.
2.6
.9
2.2
.8
2.0
.8
Discuss community services the family
receives or needs to access.
3.9
.8
2.9
.8
3.2
.6
Component Items
Discussing strategies with caregivers
(continues)
20 REGISTERED COPY
QUANTIFYING HOME VISITS 21
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Table 4. (continued)
Cluster 1
Cluster 2
Cluster 3
Component Items
M
SD
M
SD
M
SD
Leave a written summary of the visit with
the family.
3.2
1.2
1.6
.8
1.7
1.0
Discuss with the caregiver other services
that will be provided to the family during
the week.
4.1
.9
3.1
.8
3.2
1.0
18.5
1.3
16.8
1.9
17.3
1.5
Join the child’s play by imitating or following
his/her lead.
4.6
.6
4.0
.7
4.2
.7
Follow the caregiver and child’s lead in
activities.
4.0
.9
3.5
.8
3.4
.8
Confirm the next visit with the caregiver.
5.0
0.0
4.9
.4
4.9
.3
Give the family an opportunity to ask questions
or discuss other matters.
5.0
.2
4.4
.8
4.8
.5
10.3
1.5
11.0
1.8
10.3
1.4
Bring materials into the home.
1.3
.7
1.6
.8
1.3
.6
Discuss with caregiver family issues not related
to the child (e.g., employment, financial needs).
2.8
1.0
2.5
1.0
2.6
.7
Directly teach the child.
2.0
1.1
2.6
1.1
2.0
1.0
Caregiver leaves the room.
4.3
.7
4.4
.7
4.4
.7
Following the lead of the child and family
Distal activities
Note. Subscale items with cluster 1 and cluster 3 mean scores varying by 1.0 or greater are shown in boldface.
in the What Occurs During the Visits component cluster and membership in the subscales cluster. Chi square analyses indicated
there was a statistically significant difference in participants based on subscale cluster membership and What Occurs component cluster membership (c2(4, 144.6, N =
135, p = .001). The strength of the relationship was evaluated using Cramer’s V, which
indicated there was a strong association between the variables (V = .73). Furthermore,
participants in respective What Occurs
component clusters (i.e., high, mid-range,
and low) were in the corresponding (i.e.,
high, mid-range, low) subscales clusters. Of
the participants in the high score subscales
cluster, 79.5% were in the high score What
Occurs component cluster. Of the participants in mid-range subscales cluster, 82.5%
were in the mid-range What Occurs component cluster. Finally, of the participants in
the low subscales cluster, 78.8% were in the
low score What Occurs component cluster.
Discussion
One purpose of the present study was
to generate preliminary descriptive informa-
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tion about self-reported home visiting practices based on responses to items on a home
visiting practices questionnaire and conduct
initial analyses related to the psychometric
integrity of responses. We wanted to determine if responses to questionnaire items
identified different clusters of home visitors.
Furthermore, we wanted to examine whether select home visitor attribute variables
were related to cluster membership.
Based on data obtained from the home
visitor respondents, our descriptive analyses showed variation in item-level responses across home visitors with respect to their
typical home visiting practices. Results of
psychometric analyses demonstrated acceptable internal consistency score reliability for the three major subscales on the portion of the questionnaire focused on how
home visits were planned, focused, and conducted. Results from the correlation analyses
showed positive, although modest relationships between scores on the What Occurs
During the Visits and the Planning and Focus
of Visits subscales. Cluster analyses for the
Planning, Focus, and What Occurs subscales
resulted in identification of three distinct
clusters of participants. Cluster 1 included
participants with higher scores in each subscale, which generally was indicative of selfreported implementation of recommended home visiting practices described in the
extant literature. Cluster 2 included participants with mid-range scores, and cluster
3 included participants with lower scores,
which reflected these home visitors’ self-report of implementing fewer recommended
home visiting practices.
Questionnaire items were reviewed to
determine which items most distinguished
clusters, in the Planning for Visits subscale.
The items were (a) considering supports the
family needs related to parenting or providing care to their child and conversations the
home visitor has had with other team members related to concerns of the family or
needs of the child, and (b) developing a plan
for what to accomplish during the visit after arrival. Questionnaire items in the Focus
of Visits subscale that distinguished clusters
included those related to focusing on family concerns related to the child expressed
on the day of the visit and focusing on issues related to family needs or concerns expressed either on the IFSP or on the day of
the visit. Questionnaire items in the What
Occurs During the Visits subscale that distinguished clusters were those related to using child/family materials or family activities
during visits, planning with the family and/
or team, gathering and/or providing information about community services or other
services provided to the family, and summarizing the visit verbally and/or in writing
for the family. Generally, the questionnaire
items that distinguished clusters were items
associated with contemporary recommended home visiting practices (Campbell, 2004;
Campbell & Sawyer, 2007, 2009; Cripe &
Venn, 1997; Dunst et al., 2001; Hanft & Pilkington, 2000; McWilliam & Scott, 2001; Peterson et al., 2007; Trivette & Dunst, 2000;
Workgroup on Principles and Practices in
Natural Environments, 2007a).
Contrary to Campbell and Sawyer’s
(2009) research with home visitors, when
the relationship between subscale cluster
membership and select demographic variables was explored, a statistically significant
relationship between years as a home visitor and cluster membership was identified.
As years of experience increased, the likelihood that a participant would be a member of cluster 3 (i.e., low score group) decreased. Almost half of all participants with
more than 10 years experience were included in cluster 1 (i.e., high score group), with
half of all participants with 6 to 10 years
experience included in cluster 2 (i.e., midrange group), and 31.6% of participants with
0 to 5 years of home visiting experience included in cluster 3. Despite these findings,
the magnitude of the relationship between
years as a home visitor and cluster membership was modest.
Subjecting responses to items related to
what occurs during visits to principal components analysis resulted in four interpretable components that distinguished categories of home visiting practices: Discussing
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Strategies with Caregivers, Addressing Family Activities, Issues, and Resources, Following the Lead of the Child and Family, and
Distal Activities. Results of the principal
components analysis provide preliminary
support for factorial validity of the home visitor practices. The first component, Discussing Strategies with Caregivers, focused on
providing families with information or strategies they could use to address outcomes
or child development issues. Key words in
these items included explaining, discussing,
planning, interacting, and encouraging. All
words that imply the home visitor interacts
with the caregiver in some capacity. Peterson et al. (2007) found mothers enrolled in
Early Head Start were more engaged during
home visits when the visitor was addressing
child development content through modeling and coaching parent-child interactions.
“Explaining,” “interacting,” and “encouraging” are words associated with modeling and
coaching. Therefore, this component might
indicate practices that promote engagement
of caregivers during visits. The participants
reported they completed tasks included in
this component often during their home visit, which reflects understanding that they
should interact with the caregiver when addressing outcomes or child development issues. The raw score mean for items associated with this component suggests that home
visitors in this sample generally reported engaging in discussing strategies with caregivers most of the time during home visits.
The second component, Addressing
Family Activities, Issues, and Resources, focused on practices used by the home visitor to support families during daily activities
(e.g., routines, appointments, services provided by other professionals) and address issues related to the child within the context
of the family. This component aligns with
the general perspective of what should be
occurring during home visits; home visitors
address family priorities and activities (Cripe
& Venn, 1997; Dunst et al., 2001; Hanft &
Pilkington, 2000; McWilliam & Scott, 2001;
Trivette & Dunst, 2000). Furthermore, this
component aligns with participation-based
home visits described by Campbell and Sawyer (2007, 2009) in that it includes practices
that help families address child participation
during family activities. The mean raw score
for items associated with this component
was 31.9 (total score possible = 50) which
indicates, as a group, participants reported they complete tasks within this component only some of the time during their visits. Previous research has shown that home
visitors tend to focus on child activities and
play (Campbell & Sawyer, 2007; McBride &
Peterson, 1997) and responses obtained in
the present study suggest participants were
aware of the need to address family activities, issues, and resources during home visits
although they did this only some of the time.
The third component, Following the
Lead of the Child and Family, included practices that place the caregiver or child in
control of the visit. In order for home visits to be meaningful to families, the content of the visit must be a priority or of interest to the family (Cripe & Venn, 1997).
This component included those practices
that allow the family to guide the visit. As
reflected in the mean raw score for items associated with this component, the participants reported they frequently engaged in
activities included in this component. This
finding is contrary to previous research that
has shown home visitors tend to lead activities that occur during home visits (Campbell & Sawyer, 2007; Peterson et al., 2007).
One explanation for this difference could be
that home visitors’ perspectives about what
occurs during visits may vary from their actual practices. Campbell and Sawyer (2007)
found home visitors who used a participation-based approach to home visits were
more likely than those who used a traditional approach to allow the caregiver or child
to lead the activities that occur during visits.
The last component, Distal Activities, included practices not directly related to the
child’s or the family’s activities. The majority of the practices included in this component are not recommended home visiting
practices. Directly teaching the child and
bringing materials into the home have the
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potential to create isolated events in which
children learn or practice skills in ways
that families have difficulty generalizing to
their daily activities (Workgroup on Principles and Practices in Natural Environments,
2007b). These practices fall into the category of “traditional” as described by Campbell
and Sawyer (2007, 2009). An additional item
included in this component was “discussing
family issues not related to the child (e.g.,
employment, financial needs).” Although
this activity may be distal, family issues not
related to the child can have direct implications for children when they affect the family’s ability to provide care to children, make
decisions, or access supports or resources
(Dunst, 2000; Dunst, Johanson, Trivette, &
Hamby, 1991: Dunst, Trivette, & Deal, 1988;
McBride, Brotherson, Joanning, Whiddon,
& Demmitt, 1993). The mean raw score for
items associated with this component suggests the participants engaged in these activities only occasionally. When individual
items associated with the component were
examined, directly teaching the child and
bringing materials into the home were reported as occurring frequently by the participants, while the caregiver leaving the room
and discussing family issues not related to
the child occurred seldom and sometimes,
respectively. This finding suggests the participants’ self-reports of their practices reflected traditional beliefs about how home
visits should be conducted (cf. Campbell &
Sawyer, 2007, 2009).
Results from the correlation analyses between raw scores on the four components
related to What Occurs During Home Visits showed some positive modest relationships between several components. The
components with the strongest relationships were Discussing Strategies with Caregivers and Addressing Family Activities, Issues, and Resources, Discussing Strategies
with Caregivers and Following the Lead of
the Child and Family, and Addressing Family Activities, Issues, and Resources and Following the Lead of the Child and Family.
These components included items related
to interacting with the family in order to ad-
dress child outcomes or family needs and addressing topics of interest to the family or
child. If home visitors reported completing
practices within one of these components
often it is likely they would report completing practices within the other components
frequently. Distal Activities included primarily practices that were not connected with
the child’s needs or family activities or materials. If home visitors reported completing
practices within the Distal Activities often,
it might be less likely that they report complete practices included in the other components as often.
Cluster analyses using the What Occurs During the Visits component scores
resulted in the identification of three distinct clusters. The number of participants
in each cluster was different than the number of participants in the subscale clusters.
However, there was a relationship between
cluster membership in the What Occurs
component cluster and membership in the
subscale clusters. Similar to the subscales
cluster, the What Occurs cluster identified
participants with high, mid-range, and lower component scores, representing recommended to less recommended practices reportedly being implemented by this sample
of home visitors. The Distal Activities component scores for each cluster were converse to the other three component scores.
Those who had higher scores in the other
components had lower scores in the Distal
Activities component; this finding is appropriate due to the majority of the Distal Activities questionnaire items reflecting practices
that were reverse scored and, therefore, not
recommended practice.
The cluster analyses suggest that the Survey of Home Visiting Practices holds promise in terms of identifying home visitors who
are implementing recommended practices at
varying levels. Home visitors could use this
tool to assist them in self-reflection and selfmonitoring by providing a framework for reflecting on what they do during their home
visits. The questionnaire might be useful for
program administrators as they provide targeted professional development support
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(e.g., coaching) to home visitors. Finally, the
questionnaire might be useful for comparing the observed practices of home visitors
to their self-reported home visiting practices.
Several limitations associated with the
work reported are acknowledged. First,
the home visitors were from one state and
one home visiting program. Future research
should focus on gathering information from
home visitors in other states and in multiple
programs to determine if results related to
the home visiting practice components replicate. Second, the response rate was low
and, although minimal, the number of respondents for each questionnaire item varied. Although there is no established standard for response rates, high response rates
generally are desired (Fink, 2006; Fowler,
1993). Nevertheless, response rates were
adequate to conduct preliminary psychometric evaluations given the subject-to-variable ratios. Future investigations using this
questionnaire might use procedures that
permit direct access to participants rather
than relying on supervisors to forward and
distribute questionnaires. In addition, intricacies within the population should be considered when sampling. Home visitors may
be new to a program or have small caseloads. Limited experience completing home
visits might have impacted whether a home
visitor responded to the request for participation. Third, most home visitors were Caucasian women with advanced degrees. The
lack of ethnic diversity and the large number of participants with master’s degrees
within the sample could impact the generality of findings. Fourth, data were gathered
through self-report by home visitors. We do
not know whether practices reported by
these home visitors were actually practices
they were using as we did not conduct direct observations of their practices.
One reason for initiating the study was
to determine if useful information about
home visiting practices could be gathered
using this data collection method. In future
studies, researchers might investigate the
correspondence between what practitioners report they do and what they are observed doing. Due to the limited information
available about the practices that occur during early intervention home visits, a variety
of methods are needed to gather data. The
results from this study indicated that the
questionnaire holds promise for distinguishing home visitors based on their responses
to questionnaire items. Finally, the perspectives of families receiving home visits from
these home visitors were not gathered. Not
only is it important to find out from home
visitors what is occurring during their visits, but families should be provided opportunities to share their perspectives related to
what they perceive to be happening during
their visits and whether these practices are
beneficial to their family.
Gathering information about the content
of early intervention home visits should be a
priority for the field. With a long-standing focus on family-centered early intervention, the
field has articulated how home visitors should
relate to families. Additional efforts are needed to specify “what activities” should occur
during home visits, particularly in relation to
strategies that help families enhance the development of their child and promote family well-being (Turnbull et al., 2007). Findings
from this preliminary study suggest gathering information about home visiting practices through a self-report questionnaire might
hold promise, particularly when combined
with direct observation methods. Four components that logically organized what occurs
during home visits were identified and these
might be useful for future studies focused on
identifying home visiting practices. To help
explicate variations in Part C program impacts
and outcomes, the field must continue to explore efficient and thorough approaches for
gathering information about what is occurring during home visits, how these practices
relate to recommended practices in the field,
and which practices are most strongly associated with desired child and family outcomes.
Address Correspondence to: Robyn
Ridgley, Ed.D., Middle Tennessee State
University, Box 86 Dept. of Human
Sciences, Murfreesboro, TN, 37132; Tel:
615-898-5526; Fax: 615-898-5130; E-mail:
[email protected]
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