Iowa State researchers aim to improve the quality of home visiting programs through a statewide evaluation. Photo by Ryan Riley.

Statewide evaluation aims to improve quality of home visiting programs

Iowa State University faculty and graduate students in human development and family studies are improving support for at-risk families by evaluating statewide home visiting programs for families with young children.

From preliminary data, the Health Resources and Services Administration has already decreased the amount of paperwork burden on home visitors.

“The dynamic nature of home visiting means the home visitor must be a careful observer to pick up on the subtle cues presented by the parents and the children,” said Janet Horras, the director of the home visitation programs in Iowa. “Burdening home visitors with too much data collection can take away from their ability to focus on the key ingredients to a successful home visit.”

Groundbreaking research

The evaluation of programs funded through Maternal, Infant, and Early Childhood Home Visiting (MIECHV) for the Iowa Department of Public Health is similar to research in other states aimed at helping improve the quality of home visits for parents and children.

However, the Health Resources and Services Administration and the Pew Charitable Trust, Center on the States, consider Iowa State’s evaluation of the state’s home visiting programs one of the top evaluation projects in the nation.

“This type of in-depth analysis is producing groundbreaking research that will improve the quality of home visits and produce better results for parents and children,” Horras said. “The research will not only impact Iowa home visiting services, but the entire nation.”

Supporting home visitors

Through the evaluation, Iowa State researchers attempt to improve the readiness of home visitors such as nurses, childhood educators, social workers, and family support personnel.

“The goal is to have healthy outcomes for children,” said Leslie Dooley, a graduate student who started with the project in August. “Part of that is getting awareness to not just families but other service providers. There is a great infrastructure to support and help families that need them. But if you don’t know it’s there, you don’t know to ask for it.”

The evaluation helps service providers be more effective home visitors.

“Supporting the efforts of the home visitors is both a direct and indirect help to the families in need,” said Liuran Fan, a graduate student on the project.

“We have to figure out what kinds of support and resources they need to be able to provide the best possible services that they can to families,” said Melissa Clucas, a graduate student involved in the project. “Sometimes education is not enough and they need to have other supports and resources to achieve their goals.”

Engaging families in need

Home visiting programs using funding from the Maternal, Infant, and Early Childhood Home Visiting program serve about 700 families in Iowa. These programs target vulnerable families to promote child development and family health. Families may receive support for a variety of reasons including poverty, low education, or health issues in children.

Home visiting programs have supported families in need for more than 100 years in the United States. The Affordable Care Act strengthened existing home visiting programs in Iowa and expanded them as part of the Maternal, Infant, and Early Childhood Home Visiting program.

The program brings national attention to how important home visiting is, said Linda Cavazos, an early childhood program supervisor with Lutheran Services in Iowa. It has helped to identify needs for families and connect them with available resources, such as therapy.

“First and foremost the assessment has helped us know how to meet the needs of the most burdened families,” Cavazos said.

What happens in a home visit varies based on the family’s needs. However, each visit is designed to engage family members in an activity and provide materials and resources related to their parenting and development needs.

“A major portion of the activities are aimed at helping the parents better understand child development, child health, and promoting parent-child interaction,” said Carla Peterson, associate dean of the College of Human Sciences and human development and family studies faculty member on the project.

“My life and my family life can also benefit from this evaluation project,” said Wen Wang, a graduate student who is part of the evaluation team. “For the researchers who have children, this project helps provide information about infant development and parenting.”

Personalizing the data

To improve the quality of home visit programs, researchers evaluate the relationship between the quality of the services, the outcomes of those services, and the characteristics of the participants.

Evaluators visit the families when the child is 4 months and 2 years old. At the visit they interview the primary caregiver, assess the child’s development, and videotape the parent and child interacting together.

Through these assessments, researchers get an up-close view of each family and their data.

“There’s a whole different aspect that comes in when you’re in the home and all of a sudden these numbers are people and you’re actually seeing those interactions,” Dooley said. “It’s such a valuable part of the process.”

Making an impact worldwide

Iowa State researchers are also making an impact across the world.

When China’s Health Ministry was interested in beginning a home visiting program, the ministry contacted Horras for consultation. Iowa State researchers helped her prepare for her visit.

“Carla (Peterson) stepped forward and offered to host an informal get together at her home so I could meet a few ISU students from China and learn more about the family customs and culture of China,” Horras said.

“In addition, an ISU postdoctoral fellow was in China visiting family during my visit,” she added. “Yuzhu Zheng flew from her home to Beijing and was my personal tour guide and interpreter for the trip. She was invaluable to the entire delegation.”