Involvement in Home Visiting Services: Concepts, Measures and Outcomes

1. Involvement in Home Visiting Services: Concepts, Measures and Outcomes Beth Green NPC Research, Portland OR green@npcresearch.com Helen Raikes Administration for Children and Families, U. S. DHHS

2. Acknowledgements • Funded by grants from The E. M Kauffman Foundation, the Packard Foundation, Zero-to-Three, and the Administration for Children and Families (ACF), US DHHS • Based on research conducted by the national Early Head Start Research and Evaluation Project, Mathematica Policy Research, Inc, Columbia Teachers College, and the Early Head Start Research Consortium • Findings in press, Early Childhood Research Quarterly. Raikes, H., Green, B.L., Atwater, J., Kisker, E., Constantine, J., & Chazan-Cohen, R., Involvement in Early Head Start Home Visiting Services: Demographic Predictors and Relations to Child and Parent Outcomes.

3. Why study involvement in home visiting programs? • Impact studies of home visiting programs show mixed results • Voluntary home visiting programs show large variability in implementation of planned home visiting • Dosage in home visiting programs a complex construct

4. Parent Involvement: 2 Components • Participation: Quantity of service, eg: • Number of visits • Duration of visits • Length of time in the program • Ratio of expected visits to completed visits • Engagement: Quality of involvement • Interest in activities • Relationship with home visitor

5. Conceptual Model of Parent Involvement in Home Visiting Program Structure & Content Involvement P(1)P(2)P(3) E(1)E(2)E(3) Home Visitor: Background Ability to engage, relate Supervision/Training Parent: Background Needs, Expectations Motivation Critical Events P=Participation E=Engagement 1,2,3=Time

6. Research Questions • Are there multiple, distinct components of parent involvement? • Do parent characteristics predict aspects of parent involvement? • Does parent involvement predict child and parent outcomes?

7. Sample • Study participants: • Mothers • Early Head Start national evaluation • 11 home-based sites • Subsample of 579 mothers with at least two parent involvement measures (n’s for individual analyses range from 579-179) • Low-income • Pregnant or had a child 12 months or younger at enrollment

8. Sample Characteristics • Ethnicity: • 45% white • 25% African American/black • 27% Hispanic • 4% other racial/ethnic backgrounds • 25% spoke language other than English as first language (mostly Spanish) • 32% aged 19 or younger at time of child’s birth • 45% less than a high school diploma • 70% unmarried

9. Parent Involvement: Measures of Participation • Total number of home visits over the interview period, collected at 6, 17, and 28 months following enrollment, aggregated • Total number of home visits reported on home visit logs by home visitors, adjusted to the interview period • Duration of program enrollment: Enrollment date through date of last home visit, staff report. • Intensity: Number of data collection periods family received weekly home visits • Average length of home visits: Home visit logs, average minutes per visit.

10. Parent Involvement: Measures of Engagement • Overall engagement of family in program services and home visit activities, staff rating: • 4=consistently highly involved; • 3= variable involvement, sometimes high and sometimes low • 2=consistently low involvement • 1=not involved • Home-visit specific engagement, staff report of parents’ engagement in each visit (aggregated) • 5=very interested/engaged • 3=available, neither interested nor disinterested • 1=not interested or involved

11. Home Visit Content • Home visitors indicated, for each home visit, how much time was spent: • On child-focused activities (activities that promote child development) • 57% • On family-focused activities • 28% • On rapport-building activities • 14%

12. Outcome Measures • Assessed when children were 14 and 36 months of age by a trained data collector, most data collected at parents’ homes • Child Outcomes (36 months): • Bayley Mental Development Index (MDI) • Peabody Picture Vocabulary Test (PPVT) • Parent Outcomes: • Parenting sensitivity ratings of parent-child play • Home Observation Measure of the Environment (HOME) & Support for language subscale • CES-D Depression scale, short version

13. Descriptives: Parent Involvement Measures

14. Correlations Between PI Measures

15. Do Family Characteristics Predict Parent of Involvement • No significant predictors of duration of participation or average length of visits • Number of home visits and intensity of home visits were lower for: • Single parents • Parents without a HS diploma • African American parents • Mothers higher vocabulary score • Global and home-visit specific engagement were lower for: • Teen parents • Single parents • Parents without a HS diploma • African American parents • Mothers with higher vocabulary score

16. Less child-focused content was provided to parents who were: • Single • Less than a HS education • African American parents • Higher maternal IQ • Parents of children with a disability

17. How Does Participation Relate to Outcomes? • Number of visits, duration of service, intensity of service all (individually) predict more positive 36-month child outcomes: • Child vocabulary • Parent supportiveness • HOME scores • Support for language development

18. How Does Engagement Relate to Outcomes • Global and visit-specific engagement both significantly related to more positive 36-month child outcomes: • Bayley MDI scores • Child Vocabulary • Parent Supportiveness • Support for Language • HOME • Maternal Depression at 36 months • Child focused content also significantly predicts all these outcomes except parent supportiveness

19. Participation & Engagement (Jointly) Predicting Outcomes • Entered all “participation” variables as a block, followed by all “engagement” variables • Child outcomes: • Bayley: Intensity • PPVT: Intensity, global engagement • Parenting outcomes: • Supportiveness: Intensity, global engagement • HOME: Intensity, global engagement (weak) • Support for language:Intensity, global engagement • Maternal depression: Global engagement predicted

20. Controlling for Parent Characteristics, Does Involvement Predict Child Outcomes? • Controlling for parent characteristics & child outcomes at 14 months (thus, looking at change over time on outcome variables): • Child focused content predicted Bayley and PPVT scores • Parent characteristics & 14-month scores were relatively strong predictors of 36-month scores (total variance accounted for by models was 24% for Bayley scores and 31% of PPVT)

21. Controlling for Parent Characteristics, Does Involvement Predict Parenting Outcomes? • Controlling for parent characteristics & parent outcomes at 14 months (thus, looking at change over time on outcome variables): • Parent Supportiveness: none uniquely predicted • HOME—child focused content uniquely predicted • Support for language: child focused content uniquely predicted • Maternal Depression: Global and Visit-specific engagement uniquely predicted (negatively)

22. Summary • Both participation and engagement variables strongly predicted by parent characteristics • When parent characteristics are not in the equation, participation and engagement do make a different for outcomes • Intensity seems most important for child & parent outcomes • Engagement more important for parent outcomes • Child-focused content important for parent and (some) child outcomes • Measurement • Parent report of number of visits = staff report • Global engagement rating = visit specific engagement • Both engagement ratings very positive

23. Implications For Conceptual Model of Parent Involvement in Home Visiting Program Structure & Content Involvement P(1)P(2)P(3) E(1)E(2)E(3) Home Visitor: Background Ability to Engage, Relate Supervision/Training Parent: Background Needs, Expectations Motivation Critical Events P=Participation E=Engagement 1,2,3=Time