Research That Matters (January 17 - 20, 2008)

Home visitation programs to improve the health and development of children, and to prevent child abuse and neglect comprise one of the largest and fastest growing prevention efforts in the United States. While many policy makers and researchers have been focused on outcome evaluations of home visitation, it is recognized that a more complete understanding of service delivery and implementation has been lacking (Paris & Dubus, 2005). Specifically, studies are needed that explore the home visitor and new mother relationship from the participant's perspective (Hebbeler & Gerlach-Downie, 2002). The context for this study is centered on one particular model of home visitation, Healthy Families America. This particular program model was adopted by the National Committee to Prevent Child Abuse, since renamed Prevent Child Abuse America in 1992. The three overarching goals of Healthy Families America are: (a) to promote positive parenting, (b) to enhance child health and development, and (c) to prevent child abuse and neglect. This paper reports the results of a qualitative study of the Healthy Families program. The study took place in Arizona, one of the first states to begin implementing the Healthy Families America home visitation program. A total of 46 mothers who were participating in the program were recruited from three program sites, a large urban site, a medium-sized urban site, and a rural site. Trained research assistants conducted face-to-face interviews with each woman with interviews ranging from 30 to 90 minutes in length. The interviews focused on understanding the participant's experience of program procedures and services, and how the participant perceived any benefits of participating in the program compared to what they understood as the intent of the program. All 46 interviews were audio taped, transcribed, coded and analyzed. Analysis of narrative was used to summarize the themes that emerged in the data. Guidelines were followed for conducting reliability checks and tests of internal and external validity. Three researchers coded the data and worked together to produce a systematic analysis process for the study. The findings reveal that the relationship between the mother and home visitor was considered a central feature of the program. Not only did the women relate their personal achievements to the quality of their relationship with their home visitor, but through positive relationships the home visitors were able to address parenting behaviors that are considered harmful to children. These findings are important in that prior research has questioned the ability of strength-based home visitation programs such as Healthy Families to address major risk factors associated with child maltreatment (e.g., Duggan et al., 2004). In addition to reporting the findings, recommendations are made for improving the intake process so that fewer women will experience initially negative reactions to home visitation.