"Risky" Neighborhoods and "Local" Communities: Investigating How Managers Understand Neighborhoods and Communities in Home Visitation

Background and Purpose                                                                                   

Neighborhood and community factors that influence families to continue or end participation in home visiting programs are the least studied area of home visiting retention research (Rockhill, Nygren, & Green, 2017). Innovative community engagement enhancement strategies that partner with churches and healthcare providers (Folger et al., 2016) and mental health providers (Price et al., 2015) have shown promising results for participant retention, but little is known about how home visiting program managers broadly conceptualize and understand neighborhood and community factors in relation to their programs. This paper uses interviews with administrators of home visiting programs to investigate their perspectives on what neighborhoods and communities mean in and for home visitation.

 

Methods                                                                                   

In-depth, semi-structured, qualitative interviews approximately 90-120 minutes in length were conducted with 34 program administrators in a Midwestern, statewide network of home visiting programs.  Interviews were transcribed, coded thematically, and subjected to content analysis. A total of 13 references to neighborhood and 297 references to community were found across interviews. References to community were sorted and dropped from analysis if they were part of an interviewer’s question (49), part of a proper name (14), or part of a term of art (such as “community college”) (12).

 

Results

From the remaining 222 community references and the 13 neighborhood references, three primary themes emerged: 1) Neighborhoods were framed as sites of risk for crime, with respondents primarily describing neighborhoods by risk level and providing examples that supported their assessment, such as the presence of gang activity or drug dealing. A few scattered references noted positively that neighborhoods sometimes contained extended family of program participants and that participants often knew their neighborhoods well. 2) One set of community references suggested a market definition of community, in which community was framed as a marketplace of recruitment, referrals, and resources. Home visiting programs marketed themselves to other nonprofits to recruit participants, served as navigators to other services for participants, and monitored for service duplication and participant access. 3) Another set of community references suggested a public health approach to defining community, in which community was framed as a tool to sort demographic categories and set conceptual boundaries. This approach foregrounded prevention and defined communities by jurisdiction as well by epidemiological categories such as disease rates.

 

 

 

 

Conclusions and Implications

The infrequent use of neighborhood primarily as a shorthand danger assessment forecloses the potential for neighborhoods to inform and conceptualize home visiting in more meaningful ways. Regarding community, respondents evinced strong market (self) awareness, associating the term community with how their home visiting programs participated in various markets to attract participants, staff, and grants. This finding echoes Stout’s (2009) analysis of how community development since the settlement movement in the Progressive Era coopted elements of the marketplace to achieve social goals. Additionally, public health approaches to understanding community offer promise for translational efforts that use fluid definitions of community membership, organized around specific places and health conditions, to enact systems approaches in home visiting that improve community health and prevent and reduce disparities.