ACF OPRE: Early Head Start Research and Evaluation Project (EHSRE)

INSIDE HOME VISITS: A COLLABORATIVE LOOK AT PROCESS AND QUALITY

L. Roggman, L.K. Boyce, G.A. Cook, and V.K. Jump
Utah State University
(Supported by grant 90-YF-0004 from the Head Start Bureau and a contract with Bear River Early Head Start)

For Bear River Early Head Start, serving northern Utah and southern Idaho, the target and setting of intervention are the mother and child in their home. Like many other home-based Early Head Start programs, Bear River Early Head Start is committed to this strategy for service delivery as a practical way to emphasize parent-child relationships and parent education in a mostly rural area. Some research has questioned the benefits of home visits, so new research is especially needed to examine variations in the quality and process of home visits. Individual home visitors may implement visit strategies in different ways that may or may not match the program's intended model. Therefore, an informative evaluation of home visits includes an examination of what happens during home visits and how families respond.
Bear River Early Head Start is funded to serve 75 families at any given time. Staff provided ratings on 61 families (no ratings in cases of recent staff turnover), and home visits were videotaped and observed for 49 families. The families this program served during the evaluation period were predominantly white (82 percent), married (73 percent), and first-time parents (52 percent).

Home visit quality was assessed at Bear River Early Head Start using measures developed in collaboration with program staff. Like many previous studies of home visits, we used parent satisfaction ratings and home visitors' ratings to get different perspectives. In addition, we added direct observations of home visits to provide a more complete inside view. Parent ratings were obtained during interviews by research staff 6 and 15 months after enrollment. Scales were developed, based on program objectives, to ask parents 14 questions about their home visits and 15 questions about their home visitor (alpha = .99 for both scales). Home visitor ratings of the quality of visits and level of functioning for each family were analogous to assessments by other professionals such as classroom teachers who evaluate outcomes of the services they provide. For each family, home visitors rated the quality of the home visits, the quality of their relationships with the parents, and each family's current level of functioning and extent of improvement (alphas = .95 for both current functioning and improvement ratings). Researchers independently coded 49 videotaped home visits. Parent engagement (McBride and Peterson 1997) and home visitor facilitation (a new coding scheme developed in collaboration with the program) were rated for each home visit. Interrater agreement based on 22 percent of the videotapes was 88 percent, kappa = .75 for both codes.

Parent ratings of their home visits and home visitors were high and consistent, indicating that parents consistently agreed with positive statements about their home visits and home visitors. Home visitors rated their relationships with parents as "better than most" with a "feeling of partnership." Home visits were rated somewhere between "typical" and "better than most." Researchers' independent observations of home visitor facilitation indicated that home visitors were "trying to facilitate" parent-child interaction, although not all their attempts were effective, and that parents were available and appeared interested in activities of the home visit by asking questions and participating, although not initiating activities or focusing on child development topics. (See descriptive data in Table 1.)

Although not directly comparable, these measures of home visit quality were interrelated in interesting ways, as shown in bivariate correlations (see Table 2). Home visitor ratings of relationships with parents were positively correlated with parent ratings of home visit quality. In addition, home visitor ratings of relationships with parents and quality of home visits were higher for parents whom researchers rated as highly engaged during home visits. How staff perceived family functioning and improvement was related to staff ratings of relationships and home visits, a possible "halo effect," so it was important to examine the relation of staff perceptions with researchers' independently coded observations. Indeed, staff ratings of family improvement were correlated with research observers' ratings of parent engagement and home visitor facilitation of parent-child interaction during home visits.

Multiple viewpoints of home visits are valuable, because each perspective represents a different view of the quality of home visits. These perspectives together indicated that the quality of home visits in this program was high. They also indicated that how well home visitors and parents worked together was related to how much program staff reported that parents benefited from the program. When researchers independently coded home visitors as more facilitative and parents as more engaged, program staff rated families as having better home visits and making more progress. Therefore, development of this Early Head Start program was enhanced by its collaboration with researchers. The results of this evaluation were used to strengthen the quality of home visits. In response to feedback about variations in the quality of home visits, the program reexamined its home visit strategies and provided more extensive training and supervision for home visitors.

References

McBride, S.L., and C.A. Peterson "Homebased Interventions with Families of Children with Disabilities: Who Is Doing What?" Topics in Early Childhood Special Education, vol. 17, 1997, pp. 209-233.

TABLE 1
DESCRIPTIVES OF PARENT RATINGS, STAFF RATINGS, AND RESEARCHER OBSERVATIONS
Measure		N	M	SD	Range
Parent Ratings
	Home visitor (HV)	92	4.78	.40	1.80 - 5.00
	Home visits (V)	91	4.67	.43	2.79 - 5.00
Staff Ratings
	Relationship with parent	61	3.60	1.23	1.00 - 5.00
	Home visits with family	61	3.48	1.32	1.00 - 5.00
Researcher Observation Ratings
	Parent engagement	49	3.17	1.06	1.00 - 5.00
	Home visitor facilitation	49	2.89	.92	1.00 - 4.50
Researcher Observed Percentages of Interactions
	Parent-child (P-C)	49	4.95%	6.71%	0 - 34%
	Parent-home visitor (P-HV)	49	37.20%	17.14%	8 - 83%
	Home visitor - child (HV-C)	49	6.51%	6.72%	0 - 28%
	HV-C-P (joint)	49	41.14%	18.85%	8 - 79%
Family Functioning Ratings
	Current Functioning	61	3.21	.85	1.50 - 4.94
	Improvement	61	3.35	.81	1.38 - 5.00

TABLE 2
CORRELATIONS AMONG HOME VISIT QUALITY AND FAMILY FUNCTIONING MEASURES
Measure		1	2	3	4	5	6	7
		Correlations
Parent Ratings
	1. Home visitor
	2. Home visits	.70**
Staff Ratings
	3. Relationship w/parent	0.2	.27*
	4. Home visits w/family	0.19	0.15	.80**
Researcher Observation Ratings
	5. Parent engagement	0.16	0.04	0.31	.39*
	6. Home visitor facilitation	0.07	0.01	0.2	0.27	.54**
Family Functioning Ratings
	7. Current functioning	0.13	0.05	.72**	.79**	.48**	0.27
	8. Improvement	0.21	0.19	.64**	.78**	.49**	.34*	.86**
p < .05 *p < .01

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