CHALLENGES FACED BY HOME VISITING PROGRAMS · Family Involvement · Staffing · Cultural and Linguistic Diversity · Domestic Violence, Maternal Depression, and. Workshop participants identified several critical challenges faced by virtually all home visiting programs. They include family involvement, staffing, cultural and linguistic diversity, and conditions, such as maternal depression, that many of the participating families suffer from. Regardless of visitors' backgrounds, they always face extremely complex issues when working with families and require adequate preparation, ongoing information, and constant feedback to do their job well.
Many participants in the workshop commented on the need for more extensive and higher-level staff training, both before the home visitor begins working with families and during their employment. Two aspects of training were frequently mentioned in the workshop. The first concerned ensuring that home visitors were well informed and accepted the desired objectives and the philosophy of the particular home visiting program that they were responsible for implementing. The second had to do with the relatively poor ability of some home visitors to recognize conditions such as maternal depression, substance abuse and domestic violence, which interfere with program implementation, family participation and effectiveness.
At the same time, it can be difficult to get young pregnant women and mothers receiving care to participate in home visiting services. Often, home visitors and doulas needed more time to establish a good relationship and trust with the participants. Factors such as unstable living conditions and mental health crises made providing home visiting services to participants particularly difficult. Faced with these challenges, home visitors and doulas sometimes deviated from their usual way of delivering services to adapt to the needs and circumstances of the participants.
For high-risk families with multiple challenges and levels of adversity, home visiting programs can serve to encourage families to take advantage of preschool programs available to them and their children and increase their participation in other family support programs from preschool to third grade59 to further support school readiness outcomes. The main findings were that the strong supplier network in the St. Louis does not regularly or systematically coordinate the provision of services. Funders and policymakers influence the services families receive and the geographic areas where services are provided, but home visiting services don't always target zip codes where the need for services is greatest.
This means that there are gaps where the communities most in need are not getting the support they need. Home visiting programs also compete for funding, making it difficult to collaborate, share data, or work together to improve the lives of families. Home visits are an intervention strategy with extensive support for parents of young children who need to improve their parenting skills. However, parental involvement limits the potential public health impact of home visits, as these programs tend to have low enrollment rates, as well as high dropout rates and low completion rates for those who enroll in these programs programs.
The Coalition for Research on Participation and Wellness (CREW) supported three pilot projects that represent different home visiting models and aspects of commitment. The results of these pilot projects are presented in this special section. The purpose of this comment is to introduce CREW and highlight the importance of a multimodel project to improve the participation of home visiting programs. Many families who participate in home visiting programs find them beneficial and useful during some of the most difficult and stressful times of parenting children.
Home visiting programs help create protective factors that reduce the risk of abuse and neglect, strengthen family relationships, and promote the healthy development of children through the hard work of experienced and dedicated professionals. Every visitor works with families to meet their unique needs because every child and every family is different. Home visits are often a lifesaver for many parents to get answers that allow them to find out how they can help their baby or talk about something else they might be struggling with after giving birth, such as mental or physical health or financial difficulties. As Baca pointed out, for example, a home visitor from a culture other than that of the family is likely to find it more difficult to distinguish between practices and beliefs that are culturally different and those that are dysfunctional since the cultural point of view.
Two studies that collected data on this aspect of the implementation revealed that between a tenth and a quarter of families declined invitations to participate in the home visiting program. The nurse home visiting program is based on the premise that nurses are more effective home visitors than paraprofessionals. This comprehensive approach to home visiting as part of a comprehensive early childhood system has been identified as an effective strategy to help close the gap in school readiness and child well-being associated with poverty and adversity in early childhood. However, “fewer cases of child abuse and neglect were reported in the group that received both home visits and comprehensive case management services” (Gomby et al.
The most recent studies continue to show a persistent problem with families who leave the program and do not visit as intended by the program's developers. One of the main objectives of this pilot project was to promote collaboration between home visiting and child welfare systems. The NHVP uses a structured curriculum in which visits focus on health, relationships and the creation of community resources. More recently, due to the pandemic, programs have been based on virtual methods or on conducting remote home visits through digital devices.
Home visits are often structured to provide coherence between participants, providers and visitors and to link program practices to expected outcomes. Home visits are a type of service delivery model that can be used to offer many different types of interventions to specific participants. However, traditional home visiting programs cannot always be used with adolescent populations in the same way that they are used with adult parents.
