Re-Defining Success in Home Visiting Using Concept Mapping

Background and Purpose:

Long-term, evidence-based home visiting (HV) programs conventionally use service dosage and duration as metrics of program success. Consequently, programs may consider an early service exit as a negative outcome regardless of whether a family felt their needs were successfully fulfilled. This state-wide, cross-model study employed concept mapping to learn about dimensions of success as defined by families and home visiting professionals.

Concept mapping is a methodology designed to facilitate inclusive engagement. The method preserves the nuances of qualitative insights while generating quantitative results that measure the underlying associations and relative importance of different dimensions of successful HV service completion.

Methods:

The study included 61 family members and 139 professionals who generated 660 responses to the following prompt, “When we think about successful completion of HV services, we should consider...”. These responses were condensed into 53 distinct statements. Subsequently, participants classified these statements into categories and rated them based on their importance and feasibility. Data from the sorting exercise was entered into CS Global Max^TM software (Concept Systems Inc., Ithica NY) which generated a concept map using multidimensional scaling and hierarchical cluster analyses. Scaling fit was assessed using the stress value, where values lower than 0.33 was considered acceptable. Ratings of importance and feasibility were averaged by cluster. Go-Zone and ladder graphs were also used to visualize importance and feasibility ratings. Additionally, a secondary thematic analysis examined the original 660 statements to assess if responses varied by participant role.

Results:

A team of evaluators and stakeholders reviewed resulting cluster maps ranging from four to ten clusters. The eight-cluster solution was selected as most meaningful and yielded a stress value of 0.25. The clusters included self-sufficiency, safety and stability, parenting competencies, trust between families and home visitors, parental professional development, program and model fidelity, parental engagement in services, and child developmental/school readiness. The clusters receiving the highest mean importance rating were: parenting competencies, safety and stability, and trust between families and home visitors. The clusters considered most feasible were trust between families and home visitors, parental professional development, program and model fidelity, and child developmental/school readiness. Thematic analysis of the original responses indicated key differences in responses by role. Family participants prioritized economic stability and parenting skills. Home visitors emphasized promoting protective factors beyond parenting behaviors. Compared to participants in other roles, program administrators more frequently mentioned dimensions of success related to service duration and model requirements.

Conclusion and Implications:

Study findings suggest that both families and professionals prioritized family-centered outcomes (i.e., parenting competency) over program-centric metrics (i.e. duration of service) when defining successful program completion. Long-term participation in HV services is a promising pathway to achieving desired family outcomes. Nevertheless, the development of operational definitions and metrics of successful service exit that are focused on family-centered outcomes at exit, irrespective of exit timing, could promote family autonomy and support the adoption of flexible, precision home-visiting practices. Additionally, insights gained from implementing concept mapping should be explored.