Home Visiting

Home VisitingFoundational Pillars Supporting Quality Home Visiting Practices

Presented by Lynda Cook Pletcher12th National Inclusion Institute

May 15, 2012

”Home visiting is possibly the most personal way of delivering human services in society. It is the process by which a provider enters the home to provide information, health or psychological care or other support services over a sustained time. At the heart of the home visiting process and essential for success is the helping relationship established between the visitor and the family.”

(B. Waski)

Who does home visiting?

Who do you work for?What type of program?Who are your clients?

What is your background or training?What are the goals of your program?

Home visiting programs are not new• 1880’s: “friendly visitors” to the poor and immigrant

families aimed at improving the lives of mothers and children

• 1890’s: Hull house model in Chicago spreads to • Other large cities (one stop shopping)• 1900’s: organized home visits by to new mothers • 1930’s: Maternal Child Health established at federal

level- nurses and home visiting

Home visiting programs are a strategy to:

• Provide information, guidance and practical support directly to families

• Provide emotional support as the home visitor builds a relationship with the family

• Link families to other community supports and services

Frequently mentioned Home Visiting programs

Head Start/ Early Head StartPart C of IDEA- Early Intervention

Parents as Teachers (PAT)Healthy Families AmericaNurse Family Partnership

Healthy StartHome Instruction of Parents (HIPPY)

Many other commercial materials and curriculum

Typical Goals of HV Programs• Help parents help their child• Improve parent and child relationships• Teach positive parenting skills• Improve child health and /or development• Increase school readiness and later academic success• Support early literacy• Enhance parents self-sufficiency to get out of poverty• Increase parents confidence, and competence• Encourage child’s engagement, participation and independence

Renewed emphasis from Congress in 2010Home Visitation Program in the Patient Protections

and Affordable Care Act provided $$$$ for:

• Grants to states to increase HV programs• Provided a choice of EB models/programs states could choose

from• To promote better prenatal care• Promote infant mental health, health and development• Enhance parenting skills• Improve socioeconomic status of families• Reduce child support and neglect

Home visiting programs often have….

Program goals A type of curriculum to

carry out/ prescribe home visiting activities

Designated clients

What is sometimes missing ….

Foundation Pillars: the beliefs and values that support best practices- the why and how providers do certain things with families and children

The most important thing for families

It is not WHAT the program does (i.e. the goals or curriculum).

It is HOW the specific provider works with the family, their specific behaviors and demonstrated values and beliefs.

Test yourself Activity

1. Which of the behaviors or activities listed are things you should NOT do as a general rule with families?

2. Choose 5 of the examples and discuss with the person next to you your reason for the should NOT.

Foundational Pillars

1. Family centered/ relationship based practices

2. Adult learning styles and methods

3. Children’s learning through family routines and daily activities

4. Teaming practice for community linkages

Family Centered/Relationship-Based Practices

1. A set of interconnected beliefs and attitudes that guide the practices

2. Draws from Family System theory3. Draws from positive proactive helping

and4. Empowerment principles

Uri Bronfenbrenner- The “Father” of Family Systems Theory

“The goal of family-system intervention is to identify needs, locate resources and supports for meeting those needs and help link the family with the identified resources”

(Hobbs 1984)

ActivityDescribe in a few words or short sentences Family Centered/Relationship-Based Practices:

If you were doing “it” what would a family see you do…

If you are using Family-Centered practices then you should be able to:

• Treat families with respect• Suspend your judgments• Be flexible and individualized• Work from family identified needs and

concerns• Build on the strengths and abilities of family

members• Provide open and honest information• Assist families to be the key decision makers

(from work of Dunst, Trivette and Deal)

Two major components of Family-Centered Practices

• Relational component -skills you use to build relationships

• Participatory – focuses on strengthen families by actively engaging them

Video

What did you hear the Mother say how the program/provider made a difference to her?

Relationship-Based practices

• Very similar to family centered practices when applied to families

• Child learn in relationship to significant adult

• Adults learn in relationships: provider to provider and families to providers

Major focus of Home Visiting is the adults

• Adults do not learn the same way as children• Adults are more open to learning from

someone they trust and value and feel is knowledgeable

• Adults have different learning styles and need didn't methods of how information is presented to them.

Which perceptual channel is dominant?

VisualAuditory

Kinesthetic

Methods of Teaching Adults1. Coaching2. Modeling3. Mentoring4. Consulting5. Verbal instruction6. Handouts

What training have you had or does your program provide on

Family centered practices?Relationship based learning?

Adult learning?

Children are natural learners!

Some influences on children’s learning: • Their developmental age• Relationships with primary caregivers• Temperament• Health and/ or disabling condition• Likes and interests• Opportunities to “do” and explore

Activity1. What opportunities for learning for a 2 year old can

occur while brushing teeth before going to bed?

2. What opportunities for learning can a 3 year have while grocery shopping with Mom?

3. What opportunities for learning can an 18th month old have while riding in the car?

Children do not learn well• With drilling or over-direction• Watching someone else do something• When you bring “special toys” and then take them

away when you leave• With strangers in strange situations• In your 45 minute home visiting session where

you are trying to get the child or family to do or teach something

There is way more learning that happens all the time between your visits.

The Actual Home VisitThe goals

+The curriculum

+The family and Child

+The foundational pillars=

The quality visit

Setting up the visit Call or confirm (Is this still a good time?) Think about the specific family- their strengths

before their needs, your last visit or contact Reflect on your beliefs and values how they might

effect the visit Be prepared, but also be flexible Use what is available in the home Remember you are professional, not a best friend How can you encourage participation?

During the visit Conduct yourself as a guest Use active, reflective listening Begin visit with open-ended questions Explain clearly what today’s visit is about Decide together what activities to do Change your plan if needed Balance time between listening and doing

Your roles during the visit Listen! Do an activity together. Model a skill, coach the family. Point out the things that are going well without judgment. Encourage! Share and gather information. Solicit input (Ask “Will this work for you?”). Identify new needs or concerns hope and desires. Facilitate referrals to other community resources if family

desires. Increase the families competence, confidence and

enjoyment in raising their child!

Answers to the activity:

Should Not's:

1, 2, 3, 5, 7, 11, 12, 13,14,15, 16, 18

They don’t support the pillars!

“Families who feel they have some control over their lives, who can make informed choices, who can think about the future, who feel they are able to benefit themselves and others, and who know how to connect with their community are better able to raise their children. Children benefit when families are involved in effective, empowering relationships.”

(Pletcher)