Parity, Inequality, and Uncertainty: Advancing Equality through an Intermediary/Purveyor Organization for Home Visitation

Background and Purpose                                          

Intermediary/purveyor organizations (IPOs) work to disseminate and provide ongoing support for implementation of numerous evidence-based, psychosocial interventions. Proctor et al. (2019) found that IPOs in child mental health used five primary strategies: 1) education, such as technical assistance and training on a particular intervention; 2) planning, such as reviewing/adapting implementation plans; 3) quality management, such as developing outcome monitoring procedures; 4) finances, such as funding implementation or tailoring implementation to be fully reimbursable; and 5) restructuring, such as changing intervention staff, agency procedures, or data collection to better support implementation. However, this study also founds high variability and little consensus on IPO functions in children’s services, along with a lack of empirical research on IPOs. This study addresses this lack by interviewing IPO managers and agency managers regarding IPO functions and contributions to reducing inequality in home visitation.

Methods                                          

In-depth, semi-structured, qualitative interviews approximately 90-120 minutes in length were conducted with 34 administrators in a Midwestern, statewide network of home visiting programs. Administrators included IPO employees (n=15) who provided training and technical assistance on two home visiting program models (Healthy Families America/HFA and Parents as Teachers/PAT) as well as supervisors of individual HFA and PAT programs (n=19). Interviews were transcribed, coded thematically, and analyzed for content.

Results

Responses clustered into three primary thematic topics concerning the work of the IPO to reduce inequality: 1) assuring parity, 2) identifying inequality, and 3) recognizing uncertainty. The IPO contributed to parity by making sure that interpersonal technical assistance between an IPO employee and a program supervisor received at least as much time as formal group training sessions, so that supervisors received personalized assistance and built up relationships with IPO personnel. Respondents also noted that while the original, homegrown program model was ultimately replaced by the HFA and PAT program models, the IPO transitioned the original model to a functional program enhancement to formal models that made sure the IPO’s teen parent clientele received the same quality of services as older clients. Second, the IPO helped identify existing inequalities by reviewing parent education curricula and program practices. Examples included discontinuing curricula that lacked cultural competence and/or were too remedial, as well as reviewing and replacing longstanding best practices when new evidence suggested they were less effective than originally thought. Finally, the IPO recognized uncertain conditions, such as growing inequality between sites directly funded by the IPO and those receiving fewer IPO services, as well as tensions regarding ideal home visitor education (e.g. nurses or non-nurses, master’s-level or less education).  

Conclusions and Implications

Assuring parity and identifying inequality are important services IPOs provide in home visitation. However, growing inequality between levels of IPO support and home visitor education require monitoring. Future research investigating IPO functions can advance equality and inform other social work interventions.

Reference

Proctor, E., Hooley, C., Morse, A., McCrary, S., Kim, H., & Kohl, P. L. (2019). Intermediary/purveyor organizations for evidence-based interventions in the US child mental health: Characteristics and implementation strategies. Implementation Science, 14(1), 3. doi:10.1186/s13012-018-0845-3