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  • Research to Practice Brief #6: Home Visiting Beliefs and Practices(current)

Figure looking through magnifying glass at a puzzle piece.On a given day, you might have anywhere from 2-6 visits with families. If you step back and reflect, how do these visits typically work? There may be a similar way you begin or end your visits. You may find yourself conducting visits in the same parts of the home across visits or asking similar questions of families. Would you say that there is a “culture” to how you practice EI?

The article below challenged me to look at EI from a cultural point of view. We talk all the time about how individualized EI must be in order to be most effective, but the reality is that the way in which home visits are conducted is often similar across providers. Having a similar framework for visits doesn’t preclude individualizing; it seems to me that this could be fine line, though.  Visits could be conducted in such a similar, even predictable manner that the ability to individualize to child interests, family routines, or changing priorities becomes challenging. Or, having a similar, cultural framework across visits could provide the stability needed to allow the provider to individualize. Read on and see what you think.

Source: Brorson, K. (2007). The culture of a home visit in early intervention. Journal of Early Childhood Research. 3(1), 51-76. (PDF, New Window)

Research: What Do We Know?

Brorson (2007) conducted a qualitative study of one EI program to examine how services were delivered. Four families and seven service providers participated in the study. Families and providers participated in multiple videotaped observations of visits and multiple interviews. A review of program documents was also conducted. Results revealed information about the structure of a typical home visit, values and beliefs of providers, and program philosophy.

Typical Home Visit – Brorson noted that the typical home visit included eight parts: 1) planning,  2) greeting, 3) activities, 4) observation, 5) demonstration, 6) shared knowledge, 7) follow-up, and 8) scheduling.

Beliefs of Providers – Providers espoused a belief in collaborative, family-centered interactions with parents, but this was not seen in observations of visits, interviews, or in the reviewed documents. Instead, providers were observed to educate rather than reciprocally collaborate with parents.

Program Philosophy – Brorson described five assumptions that appeared to guide staff in the delivery of services. These assumptions were:

  • Structured activities provide the frame for the visit and the means through which the family learns what to expect.
  • The culture of a home visit is stable across families, providers, treatment techniques, etc. This stability is established by how the provider conducts visits, which tends to be similar across families though does allow for individualizing.
  • Delivery of EI services “is in a constant state of change requiring therapists to become perpetual learners.” (p. 64)
  • Providers play a leadership role during visits in educating families about the culture of visits.
  • Providers have their own individual definitions of family-centeredness (rather than a shared understanding and implementation).

Because this study only focused on a single program and a small sample of families and providers, generalization is not really possible. However, insights learned from this study can be used by providers and program administrators to reflect on the culture of how EI is provided in their programs.

Practice: How Can You Use What You Know?

Yes, this article is older now, but I think that the insights learned in this small study are fascinating. Let’s think about these insights and how they might apply today:

Typical Home Visit – These 8 parts of a visit look very familiar to me, especially when I think of a more traditional model. When I compare these parts to more recent thinking related to caregiver coaching and collaboration, a few important pieces appear to be missing – the opportunity for the caregiver to be in the lead and practice using strategies with the child, reciprocal reflection and feedback, and joint planning for what happens between visits. Spending a few minutes reflecting on which of these parts and pieces of a visit typically happen on YOUR visit could help you identify your strengths and where you’d like to improve.

Beliefs of Providers – We all are pretty sure we understand family-centered practices, but do our understandings match with the literature? Do we practice what we preach? On your visits tomorrow, pay attention to how much you actually collaborate with the parent. Are you doing most of the talking and the work during the visit, or are you sharing the conversation and collaborating to support parent-child interaction?

Program Philosophy – If we accept that we play a leadership role with teaching families how to interact during visits, then that reminds us that families probably don’t start out knowing what they are supposed to do. Remember to take the time on your first few visits to help them learn how the process works. Educate them in the importance of their active participation and practice during and between visits. You may do this the same way across families, but does that mean that all visits should basically look the same? I don’t think so. Your methods may be similar, and your underlying philosophy maybe similar across families, but the activities of the visit should look different – if you are individualizing to child and family interests, environments, and priorities and joining family routines.

So here are the questions I’d like you to consider in the comments below:

Is it okay for your visits to basically work the same way across families? Why or why not?

If you espouse family-centered intervention beliefs, are you implementing them?

How would you describe the culture of visits in your program? In your individual practice? Does it match with Brorson’s findings? If not, how is it different?

Disclaimer – I’m a big believer in calling visits “intervention visits” rather than “home visits.” This reflects the evolution of practices in our field from focusing on the home as the location for EI to focusing on intervention, which can happen anywhere. I used “home visit” in this post to match the language used in the Brorson (2007) article, but in my happy little world, we’re moving away from that phrase to something more reflective of recommended practices. 🙂

8 comments on “Research to Practice Brief #6: Home Visiting Beliefs and Practices

  • Gabrielle says:

    Before I answer the questions, I thought it was very interesting that the sample size had parents ranging from 27-44 years old. There were literally no “young” parents (I say young, acknowledging that I am calling myself old because I am 26). I have to wonder what this study would have looked like if there were teen parents participating. I know that it takes a special set of skills to work with very young parents.

    Anyway, I believe it is okay for visits to “Work the same” across families with the understanding that the content of the visit can be fluid. I would never expect child A to be able and sit with me the way Child B does but, the same flow of visit still applies. Just like I would expect Mom A to attend to me in the same way Mom B does, everyone is different and being flexible is key. I have no issue with this as long as we recognize we need to be flexible. Forcing a certain flow or order of events on a family, particularly one who hails from a different culture than your own is dangerous. I believe that is where an element of the collaboration comes in. Open, honest communication is the best way to speak to anyone, and that includes parents.

    As a newbie in the field, something I have noticed is the frustration that providers experience when a family isn’t doing something the way they believe they should. Yes, we want families to follow the strategies, but perhaps the learning style that particular parent has isn’t the, “tell me and I can do it,” perhaps they have to learn through doing. I feel we as providers need to make space not only for the children to make mistakes but also space for parents to make mistakes as apart of their learning process.

    Just my two cents.

    • Thanks for adding your two cents, Gabrielle! I really like what you write about flexibility and open communication which are so important for individualizing EI. I think my favorite thing that you wrote was about making space for parents to make mistakes as part of their own learning process. When we’re really doing EI well, we absolutely focus our energy on supporting the parent as a learner (not just the child). I’d love to know more about how you do this – what does it look like on your visits when you make space for the parent’s learning?

      Great point too about the age of the parent sample – I hadn’t thought of that. Yes, the demographics of the parents could certainly make a difference!

  • Gabrielle says:

    Since I am new, I am learning along side of the parents as to what works and what doesn’t. IF you feel a parent is not “doing” something that you feel they should be it is important to take a step back and think about why you think they should be doing something. Is it your own set of morals coming in to play? Is it that you are not meeting them where they are, and expecting them to have the same understanding as you? Is it that there is a safety concern for the child? What is it? (Obviously if there is a safety concern you should be frank about it with the parents, and report to whomever you are mandated to report to :).

    I make space for parents to make mistakes by first building that foundation of, “I am a safe person to talk to about life, which includes your child, you can be comfortable with me.” I also make sure to set the expectation that while I want to listen to you and your concerns, and that your concerns and feelings and thoughts are valid, I will also level with you if the need arises. Being a genuine person with families makes them so much more willing to work with you.

    From there, I ask them to show me (a phrase I have heard a million times from my coworkers,) if they aren’t comfortable because they are afraid to mess up, I will show them and then ask them to try. I try to ALWAYS make sure to praise their effort and give encouraging feed back for every simple thing they did right BEFORE I go into what they might have missed.

    Praising parents for the little things, as they are doing them is so important. We work on building the child’s confidence but can sometimes forget to speak words of encouragement and empowerment in the the parents lives as well. Once again, just my two cents as a newbie 🙂

    • Well said, Gabrielle! I couldn’t have written this any better myself! You may be a newbie but you already have wonderful insights into what it takes to partner with families. Thanks so much for adding to the discussion!

  • Mary says:

    This is a great “back to school” resource! I think our team will use this as a guide to examining how our ideals and actual practice may miss the mark (or, hopefully, are aligned!). I really like activities in which the parallels of our work in reflection and that of the parents both serve us well!

  • Jeff says:

    I feel that intervention visits should certainly have a framework within which we work that can guide and direct how we respond depending on what occurs during the session. As long as we use the parents’ needs and questions to guide our interactions, it both respects the parents and provides needed structure. We are actually working on an Early Intervention Visiting Framework over here at EDIS to help provide that to providers new to the coaching model. As for me, I think my initial approach is pretty uniform across families, but then takes on various forms once I learn about a family’s differing needs.

    • Thanks Jeff! I agree, I think we all bring our own structure – the way we do things – to each visit then adapt to the family’s priorities, interests, abilities, needs, routines and activities. That’s a lot that we have to adapt to, isn’t it? 🙂 I would love to take a look at the framework you guys develop, when it’s available!


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