Four Steps to Help Home Visitors Increase Use of Evidence-Based Practices

Michael H. Little
AIR’s Early Language Home Visiting Study included 59 children, aged 18 to 30 months, and 23 home visitors in Pennsylvania. The randomized controlled pilot study examined parent-implemented early childhood language intervention in the home visiting context.

Learn more about how the Covid-19 pandemic is affecting home visiting programs.

For families of young children who are at risk of developmental delays or have disabilities, evidence shows that interventions such as home visiting can provide needed support and lead to gains in parent-child relationships and cognitive development. Through home visiting, child development specialists, speech therapists, and other professionals work with families and their children in their homes to assess children’s development and health, as well as bolster parenting skills. Home visiting is often funded through federal or state government programs.

Consistent, correct use of evidence-based practices by practitioners such as home visitors can help improve children’s outcomes, even as the Covid-19 pandemic continues to affect nearly all aspects of everyday life. These practices may include frequent assessment of children’s early communication, home-based language interventions, and data-based decision-making. However, a number of factors, such as lack of access to high-quality professional learning opportunities, stand in the way of increasing use of evidence-based practices among home visitors.   

AIR conducted a study of a parent-implemented language-based intervention used in the home visiting context. Based on that research and AIR’s years of experience in providing technical assistance to early childhood development practitioners, we offer four steps for home visitors and leaders of home visiting programs to increase use of evidence-based practices.

Step 1: Choose Interventions and Assessments that Add Value

Image of mother and son playing with blocksBefore implementing any evidence-based practice, home visitors and leaders need to determine whether it offers a clear advantage over “business as usual” home visiting practice.

Answering these four questions can help determine if an evidence-based practice adds value:

  1. Does the practice offer strong evidence of effectiveness with the specific children that home visitors support?
  2. Can it easily fit into the day-to-day interactions that caregivers and families have with children?
  3. Can home visitors easily adapt the practice, using their existing skill sets?
  4. Does it cost less than existing practice, in terms of both actual dollars-and-cents and the time required to learn the new practice?

If the answer is yes to any or all of these questions, practitioners may consider moving on to training home visitors to use evidence-based practices properly and effectively.

Step 2: Involve Evidence-Based Practice Experts in Training

Experts—such as a researcher or external consultant from a major university or a reputable research institute or organization—can enhance home visitors’ implementation and use of evidence-based practices. For instance, when evidence-based practice experts facilitate trainings, home visitors learn not only the basics of the practice, but also the nuances (e.g., why an intervention is designed in a particular way, which elements are ancillary, and which elements are most critical to improve children’s outcomes). Further, experts can help develop implementation plans that result in regular use of the practice, and home visitors can use this guidance to set reasonable implementation goals.

After the initial training concludes, experts can recommend resources and tools, such as tip sheets or a compilation of videos showing practitioners implementing a practice, to further support home visitors.

These resources and tools should aim to help home visitors:

  • Develop an increasingly sophisticated understanding of the practice;
  • Successfully navigate implementation of the practice; and
  • Resolve time-sensitive implementation challenges that otherwise would get in the way of improving children’s outcomes.  

Step 3: Help Home Visitors Learn from Each Other

Home visitors can benefit from high-quality, ongoing professional learning opportunities, such as trainings and face-to-face or virtual one-on-one coaching. For a more powerful experience, in which practitioners learn from each other, home visitors and leaders might consider using a model from the Institute for Healthcare Improvement Breakthrough Series Collaborative. AIR researchers used this model in their study of the language intervention to help home visitors with implementation.

Image of man playing with daughter with Downs syndromeUnder this model, practitioners attend ongoing virtual support sessions, facilitated by experts, to advance their use of a given practice. During the first few sessions, practitioners share their implementation stories, including successes and challenges. As a group, practitioners brainstorm ways to address the challenges and refine the implementation plans they developed at the initial training (e.g., My implementation plan for this month is to try out one new strategy for eliciting two-word utterances from children). The group conversations honor practioners’ professional wisdom by encouraging them to coach each other, resulting in building a network of practioners who are increasingly skilled in implementing evidence-based practices.

Step 4: Improve Data-based Decision-making Skills

Making decisions based on data can be difficult for any practitioner. In particular, home visitors can find it challenging to understand how their use of evidence-based practices affects child outcomes. Yet making such connections is central to successful data-based decision making.

In AIR’s research, home visitors first examined outcomes data for the children they were working with (e.g., gestures or verbal utterances) and then looked at implementation data (e.g., the strategies that the home visitor used when working with children). Next, AIR experts helped home visitors identify which specific language strategies positively affected children’s language skills.

This analysis helped home visitors better understand how to adjust their practice and refine their use of language strategies. As the study concluded, home visitors reported that learning how to review child data in relation to implementation data allowed them to better support children and further improve language skills.

Evidence-based Home Visiting in the Context of COVID-19

The federal government and a number of states have recommended that in-person home visits be suspended when there is a risk of community transmission of COVID-19, in order to protect the health of families and home visitors. Home visitors can use telephone calls or videoconferencing as an alternative to in-person visits, and some evidence suggests that these telehealth approaches can be as effective as in-person services.

When deciding whether to offer virtual services, home visitors should consider the quality of home visitors’ and families’ internet connections, their access to video-enabled devices, the security of video-conferencing platforms, and the process for remote completion of enrollment and consent documents. Despite these potential challenges, it is more important than ever to maintain contact with families who seek home visiting services. The COVID-19 pandemic has contributed to increased unemployment, social isolation, parenting stress, and potential child abuse and neglect, intensifying the need for family supports and interventions.
Aleksandra Holod
Principal Researcher
Jennifer Pierce
Senior TA Consultant