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Research Brief

Home visiting has achieved prominence on the national policy agenda because of the long-lasting positive outcomes—including improved child development, school readiness, and health for children and their mothers, as well as reductions in child maltreatment—achieved by many home visiting models.

Home visiting programs match parents and other caregivers with trained professionals who deliver an established curriculum of information, skill-building, social support, and other assistance. But a community that wishes to introduce a home visiting program may find it difficult to select from the many programs available, to adapt the chosen program for the community's specific needs, to implement the program, and to then evaluate the program's effectiveness and make adjustments as needed.

The RAND Corporation developed the Getting To Outcomes® for Home Visiting (GTO-HV) online toolkit and printable GTO-HV manual to help communities plan, implement, and evaluate home visiting programs to help produce the best possible outcomes for young children, parents, and families.

The Manual Is a Detailed How-to Guide and Toolkit

The GTO-HV manual begins with background information and instructions for completing readiness activities and then outlines the ten GTO steps in ten chapters. Each chapter provides detailed instructions for completing that step, along with helpful worksheets, checklists, and resources.

The GTO-HV Manual's Helpful Extras

Clipboard Checklists: things to think about before beginning the program and as each step is completed
Houses Townville examples: the work completed by one imaginary town as its leaders used the GTO approach to plan, implement, and evaluate a home visiting program
Light Bulb Tips, resources, and other helpful extras: advanced tips, lists of resources, examples, and more
Swiss Army Knife Tools: worksheets to help in planning, implementing, and evaluating the program

The Ten GTO Steps Can Be Thought of as a Painter's Palette

It is recommended that communities developing a program for the first time follow the ten steps in order, but for developers who are further along or who want to refine various elements of their existing programs, the steps can be thought of as a painter's palette of tools to choose from.

Overview of the Ten Steps

Step 1 guides planners in gaining a data-informed understanding of the community's needs and resources.

In Step 2, communities consider the needs and resources they identified in Step 1 and determine goals and objectives for their program, which will help them select (in Step 3) the most appropriate programs for their community.

In Step 3, the GTO-HV manual provides detailed information about a variety of home visiting programs to help the community understand the evidence related to the effectiveness of specific programs, narrow their choices, and select a few programs that seem to fit their needs, resources, goals, and objectives.

In Step 4, planners make a final program selection by assessing how well the program "finalists" selected in Step 3 fit with their community's other programs and system of care and with the organization that will take the lead in implementing the program. The manual describes "green light," "yellow light," and "red light" adaptations to help planners understand what changes can and cannot be made without jeopardizing the core elements that make a program effective.

Step 5 helps community planners consider the staff, skills, facilities, and other resources that they need to implement and sustain their selected program. They may find that they need to train and hire staff or bring on additional partners to fill in gaps in funding or expertise.

Step 6 outlines a process for making an implementation plan—a detailed list of program components and key activities, a schedule, responsible individuals and groups, the location of activities, and the infrastructure and other resources needed.

In Steps 7 and 8, the GTO manual and online guide provide support to monitor and document how well program plans are put into action and instructions on how to conduct both a process and outcome evaluation based on the goals and objectives set forth in Step 2.

Continuous quality improvement (Step 9) means systematically reviewing previous work to see how it could be improved in the future. The continuous quality improvement worksheet in the manual organizes the review into questions (for example, "Have the needs or resources of the community changed?"), responses, and action plans for using the answers to improve the program.

Finally, Step 10 discusses how to build a program sustainability plan to deal with threats to the program's continuation and to take advantage of unanticipated opportunities.

Emphasized throughout the manual are the value of careful planning, use of data and best practices, collaboration, and an iterative approach to evaluation and quality improvement.

This report is part of the RAND research brief series. RAND research briefs present policy-oriented summaries of individual published, peer-reviewed documents or of a body of published work.

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