Find Programs That Help Achieve Your Goals

Find Programs That Help Achieve Your Goals

step 3 graphic

Your needs and resource assessments have helped you to form your initial goals and desired outcomes. You have a better idea of what you want to accomplish, so now we will begin to explore how you
will achieve the goals that you set in Step 2.

Why look for programs that work to help you achieve your goals?

This step will introduce you to home visiting programs that have been successful at improving outcomes for children and their families. Familiarity with those programs that have demonstrated success elsewhere will help you select a program that is most likely to help your community reach your chosen goals given your local circumstances.

In this section, you might discover that there is a home visiting program out there that has been shown to do a good job of achieving goals similar to yours. You might also find that your goals do not match well with any home visiting programs. If this alter scenario is the case, you can still follow the steps in this manual, but will have to do the additional work of identifying different types of evidence-based programs that meet your needs.

Learning about evidence-based programs

Evidence-based programs have been shown through rigorous research to improve outcomes for children and families. Evidence-based programs are identified by a process in which experts, using commonly agreed upon criteria for rating the programs, agree that evaluation research findings are credible. Several examples of the criteria used for deciding if a program is evidence-based include:

  • The quality of outcome measures used
  • The quality and appropriateness of data collection and data analyses procedures
  • Whether there is strong evidence of a cause and effect relationship (i.e., a high likelihood that the program caused or strongly contributed to the desired outcomes) (Mattox & Kilburn, 2012).

Why is implementing an evidence-based home visiting program important?

Increasingly, funders want to invest their limited dollars in programs that are more likely to make a difference. Since evidence-based home visiting programs have been reasonably well evaluated, choosing one of them will ensure that your program has a greater chance of success.

Tip 3-1 shows a list of evidence-based home visiting programs. These are programs that have been reviewed by the federal government's Home Visiting Evidence of Effectiveness (HomVEE) project. The table has check marks showing the outcomes that these home visiting programs were shown to improve in well-designed research studies. A check mark indicates that the program was successful in changing that outcome.

You may notice that certain programs have been shown to impact nearly all of the outcomes specified. So why won't everyone just pick those? The next table, Tip 3-2, shows the same list of programs and indicates the age that the child must be at enrollment, as well as the program's target population.

As you'll see, not all of these programs target the same populations. Also, as we will learn in Step 4, certain programs may may not fit with the targeted community or may require resources that exceed the community's capacity.

Each of the programs listed in the Tip 3-1 table is described in more detail in the links provided for each program. The model descriptions will give more information, including key activities and intermediate outcomes (i.e., factors that are not the final outcomes but affect them) impacted. The information about capacity requirements will describe the capacities required to implement each program model (for example, staffing, training, or technology requirements). In Step 5, we will discuss the capacities necessary for implementation in more detail.

Note that there are other projects operated by research organizations with the scientific expertise to judge whether a program is evidence-based that we haven't included in this chapter. If you want to do your own research on other programs, you might consider looking at these other resources as well:

Tip 3-1. Evidence-Based Home Visiting Programs and Outcomes Proven to Be Impacted
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✓ indicates that the program had an impact on this outcome.

Home Visiting Program Name

Child development and school readiness

Child health

Family economic self-sufficiency

Linkages and referrals

Maternal health

Positive parenting practices

Child maltreatment

Juvenile delinquency, family violence,
and crime

Child FIRST

Early Head Start—Home Visiting

Early Intervention Program for Adolescent Mothers

Family Check-Up

Healthy Families America (HFA)

Healthy Steps

Home Instruction for Parents of Preschool Youngsters (HIPPY)

Maternal Early Childhood Sustained Home Visiting Program (MESCH)

Nurse Family Partnership (NFP)

Oklahoma's Community-Based Family Resource and Support (CBFRS) Program

Parents as Teachers (PAT)

Play and Learning Strategies (PALS)—Infant

Project 12 Ways/SafeCare (Augmented)

Source: U.S. Department of Health and Human Services, no date.

Tip 3-2. Evidence-Based Home Visiting Programs and Target Populations

Home visiting program

Target age of child at enrollment

Target population

Child FIRST

  • Children birth to age 6
  • Families with children with emotional, behavioral, or develop-mental concerns
  • Families at high risk for abuse and neglect

Early Head Start—Home Visiting

  • Pregnant women
  • Children from birth through age 3
  • Families below federal poverty level
  • Families eligible for Part C services under the Individuals with Disabilities Education Act

Early Intervention Program for Adolescent Mothers

  • Pregnant women
  • Adolescent mothers

Family Check-Up

  • Children ages 2 to 7
  • Families with multiple risk factors

Healthy Families America (HFA)

  • Pregnant women (children can also be enrolled at birth)
  • Target population determined by sites

Healthy Steps

  • Children from birth through age 3
  • Any family

Home Instruction for Parents of Preschool Youngsters (HIPPY)

  • Children ages 3 to 5
  • Families whose parents lack confidence in their ability to instruct their children

Maternal Early Childhood Sustained Home Visiting Program (MESCH)

  • Children from birth through age 1
  • Disadvantaged expectant mothers at risk of adverse maternal and/or child health and development outcomes

Nurse Family Partnership (NFP)

  • Pregnant women
  • First-time, low-income parents

Oklahoma's Community-Based Family Resource and Support (CBFRS) Program

  • Pregnant women
  • First-time mothers living in rural counties

Parents as Teachers (PAT)

  • Pregnant women
  • Children from birth through age 5
  • Target population determined by sites

Play and Learning Strategies (PALS) - Infant

  • Children 5 months to 1 year and their families
  • Target population determined by sites

Project 12 Ways/SafeCare (Augmented)

  • Parents with children ages birth to 5
  • Families with a history of child maltreatment or risk factors for child maltreatment

Source: U.S. Department of Health and Human Services. Models. Retrieved October 24, 2012, from Home Visiting Evidence of Effectiveness: http://homvee.acf.hhs.gov/programs.aspx

Identifying evidence-based programs that meet your community's needs

In this section, we present instructions for completing the Evidence-Based Program Identification Tool, which will help you through the process of identifying which evidence-based programs will meet your needs. After the instructions you will find Townville's example tool, which you can use to help guide you in filling the tool out yourself.

Tool 3-1. Evidence-Based Program Identification

Instructions for using the Evidence-Based Program Identification Tool:

  1. In boxes A, B, and C of the tool, fill in the top-priority goals that you identified in Step 2. (You can add additional columns if you have more than three outcomes, but it is best to stick to just a few at this point if you can.)
  2. In columns 1 and 2 of the tool, fill in the target population you identified for your community, for each of the goals. You might look back to the "for whom" column in the Goals and Desired Outcomes Tool.
  3. Once you have filled out the lettered boxes on the tool, review the program models listed in Tip 3-1 and Tip 3-2 again. Each of those programs is listed in the left-most column of the Evidence-Based Program Identification Tool. You may choose to keep in the table only those program models that address your target population of interest.
  4. Now, fill in the matrix by placing check marks under those goals that you identified that are met by each program. If your goals match up with the outcomes identified in Tip 3-1, then this will be easy to do. If you have desired outcomes that are not on Tip 3-1, you will need to do some more homework. You might start by reading the program descriptions available through the link to the program's website (provided in the table in Tip 3-1). There you will find a more detailed list of targeted outcomes.

If you cannot tell, place a question mark in that box. Some more research may be necessary to further investigate the boxes with question marks, and a good place to start is with the program model's website.

5. Finally, fill in the last two columns of the matrix by placing check marks under the target population(s) you identified that are served by each program.

After you have finished filling out the tool and clearing up any question marks, you will have a good idea about whether each of the program models aligns with your specific needs.

Evidence-Based Program Identification
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Townville Example 3-1. Townville's Evidence-Based Program Identification Tool

As discussed in Step 1, Townville's community coalition set a goal of reducing child abuse and neglect, and reducing hospitalizations for unintentional injuries. They also identified desired outcomes related to each of these goals. Given these priorities, Townville leaders considered the list of programs available to them.

While child maltreatment is included in Tip 3-1 in this chapter, Townville's community coalition had to look more deeply into the program models to identify whether any of the programs addressed hospitalizations or in-home safety precautions.

They found two programs, the ABC program and the XYZ program, that met at least one of the outcomes that they specified in Step 2. Both of the programs also worked for their target population, families with children under the age of five.

Check out how the Townville community coalition filled out the Evidence-Based Program Identification Tool in the sample below.

Program Name Top 3 Outcomes for Townville Target Population in Townville

A. Reduced child abuse and neglect

B. Reduced unintentional injuries

C.

1. Parents of children under age 5

2.

ABC Program

XYZ Program

Narrowing down your options to one or more programs to consider further

After you have completed your review of the programs on your worksheet, it is time to narrow down the list to one, two, or three programs that meet all or most of your stated outcomes. Unless you are really confident you've found just the right program, do not select just one yet.

What if none of the programs match our goals and target population?

If you weren't able to find a home visiting program that fits the needs of your community and/or your target population, you have several options. First, you could take a look at other evidence-based programs (beyond home visiting) that might best serve the needs of your community. Evidence-based practice resources can be a great help here. The Promising Practices Network (http://www.promisingpractices.net), for example, lists dozens of evidence-based programs that address a range of outcomes using many different service models. If you end up selecting a program that does not have a home visiting component, you can still use the GTO-HV model as outlined in this manual to help you plan and implement your program.

If there are no existing evidence-based programs that meet the exact needs of your community, you may consider developing your own, in-house program. We next discuss the challenges and opportunities of this approach.

Should you develop your own program?

If you are unsure about selecting a program, do not automatically assume you should develop one of your own instead. Developing a program from the ground up is hard work. Running a program that hasn't yet been proven effective increases your risk of investing time and resources in a program that may not work. It also might be difficult to secure funding for a program that does not have a track record and solid research evidence.

If you do decide that developing your own program is the best way to go, it is very important to document the program development process and evaluate the program's outcomes, so that your innovations can enhance the whole field. By demonstrating the value of the program, you may also increase your chances of sustaining it. Steps 7–10 of this manual can help guide you through this process, although it may be advisable to collaborate with a university or research organization and/or hire an expert to help you.

Remember that home visiting is not a panacea, and many home visiting programs have been tested and failed. In general, successful home visiting programs (Council on Community Pediatrics, 2009):

  • Serve at-risk mothers, particularly socially isolated mothers.
  • Serve children with multiple risk factors.
  • Provide higher-intensity services for longer periods of time than less-successful home visiting programs.
  • Hire nurses or other professionals. Paraprofessionals and lay home visitors might be appropriate in certain circumstances, but the research is limited.

Checklist 3-1. Completion of Step 3

When you finish working on this step, you should have done the following:

  • Developed an understanding of evidence-based programs in home visiting.
  • Conducted a review to find the programs with the best evidence for success to use to achieve your goals and desired outcomes.
  • Selected one or more candidate programs to consider further.

Before moving on to Step 4

You've figured out which home visiting programs are in line with your community's most urgent needs. Now you are ready to move on to the next step in the GTO-HV process—making sure your program "fits" (Step 4) well with your community and that your community has the capacity (Step 5) to carry it out well. Steps 4 and 5 can help you fine-tune your work in a way that helps maximize your resources and increase your chances of success.