Home visiting and reflective practice: when systems change means practice change

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  • This article was downloaded by: [University of Chicago Library]On: 31 August 2013, At: 13:37Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

    Reflective Practice: International andMultidisciplinary PerspectivesPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/crep20

    Home visiting and reflective practice:when systems change means practicechangeLeslie Forstadt aa Univeristy of Maine Cooperative Extension, Orono, Maine, USAPublished online: 24 Oct 2011.

    To cite this article: Leslie Forstadt (2012) Home visiting and reflective practice: when systemschange means practice change, Reflective Practice: International and MultidisciplinaryPerspectives, 13:1, 97-114, DOI: 10.1080/14623943.2011.626023

    To link to this article: http://dx.doi.org/10.1080/14623943.2011.626023

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  • Home visiting and reective practice: when systems change meanspractice change

    Leslie Forstadt*

    Univeristy of Maine Cooperative Extension, Orono, Maine, USA

    (Received 11 March 2011; nal version received 20 September 2011)

    This paper shares the results of a research study with home visitors on theimplementation of a statewide training in a type of reective practice in thenorth-eastern United States. Home visitors (n = 112) participated in a trainingand follow up study of the Touchpoints Approach. All home visiting programsin Maine participated in this research, which used survey methods at multiplepoints in time. The primary research questions examined the effect of training inand application of the Touchpoints Approach on home visitor job satisfaction,competence, and knowledge change. Data were collected immediately after thetraining and after six months of reective practice with Touchpoints. Increasesin condence levels and knowledge related to Touchpoints and reective prac-tice were found. High levels of job satisfaction were present prior to training,and no signicant changes in job satisfaction were found. Home visitorsincreased their ability to critically evaluate their own practice, and qualitativeresponses revealed increased listening and communication skills. The ndingssupport the continuation of the Touchpoints Approach with home visitors. Thisstudy provides insight into a practice approach with children and families thatprovides a foundation for systems change.

    Keywords: home visiting; Touchpoints; reective practice; job satisfaction

    Introduction

    Home visiting is a long-standing effort in the United States (US) to support expec-tant and new parents. The concept of home visiting was developed in England inthe 19th century. By the 1960s and 1970s, home visiting in the US focused on theschool readiness of children, and the needs of at-risk and hard to reach families(Boller, Strong, & Daro, 2010). These needs include the prevention of child abuseand neglect, the healthy social and emotional development of children, and thesupport of young parents. In 2009, the US government dedicated over $8 billiondollars over 10 years for home visitation programs for low-income families.

    Home visiting has evolved over time. It began with homegrown educationalmaterials that were developed by agency professionals. It evolved to includeevidence-based programs developed by universities and in cooperation with federalagencies. Within these evidence-based curricula, there is still a diversity of applica-tion in the eld. There are multiple models of home visiting, with the commonalityof a one-to-one relationship that is built with a home visitor, and the location of the

    *Email: leslie.forstadt@maine.edu

    Reective PracticeVol. 13, No. 1, February 2012, 97114

    ISSN 1462-3943 print/ISSN 1470-1103 online 2012 Taylor & Francishttp://dx.doi.org/10.1080/14623943.2011.626023http://www.tandfonline.com

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  • visit is generally the familys home at a weekly or monthly interval. Differencesamong programs include the focus of home visiting programs: while most of thehome visiting models focus on at-risk populations, some are offered universally(Johnson, 2009; Olds, Sadler, & Kitzman, 2007). Universal home visiting is basedon the notion that any parent could be at risk at any time, and simultaneously, thatevery parent can benet from support.

    Many home visiting programs are guided by curricula that suggest a structurefor the visits broadly focused on child development, the parent child relationship,developmental milestones, and supporting the parents in child rearing (Boller,Strong, & Daro, 2010). Some of the curricula are prescriptive, and rely upon thehome visitor presenting information to the parent. In addition to the curriculum thatserves as a guide, home visitors receive professional development in topics such asinfant mental health, prevention of child abuse, and counseling/direct methods suchas motivational interviewing or use of child development screenings. The use ofreective supervision, while not employed in all home visiting settings, is anotherconcrete method used by many programs to support the working relationshipbetween supervisors and home visitors, which in turn supports the home visitor andfamily relationship (Barron & Paradis, 2010). Training in reective supervision, anda reective style of conducting home visits is rare, as is training of all practitionersin a single state or locality to practice a common method that is also highlyindividualized.

    Success in home visiting

    As methods have evolved over time, so have research and the creation of anevidence base in home visiting. This growing evidence base includes measures ofsuccess in home visiting, which is ultimately graded by the impact on the healthand well-being of the child. This is accomplished by helping parents meet variousneeds like securing stable housing, nding employment, and increasing their under-standing of child development. As indicators of well-being, many home visitingprograms look at outcomes related to child safety, abuse, neglect, breast feeding,immunizations, and doctors visits. The relationship between home visitor and par-ent is also an important outcome, as it is this relationship that forms the model andfoundation upon which parents will hear information about their children, and willmake a difference in the interaction with their own children and family (Daro,McCurdy, Falconnier, & Stojanovic, 2003).

    The research in home visiting has largely explored perspectives and outcomesof the recipient, most often the parent and most frequently, but not always, themother. The research on home visiting is typically focused on the relationshipbetween parent and home visitor (Krysik, LeCroy, & Ashford, 2008; McCurdy,Gannon, & Daro, 2003); parental involvement (Daro, et al., 2003; Tandon, Parilllo,Mercer, Keefer, & Duggan, 2008); factors impacting the efcacy of home visits(Ammerman et al., 2009; Paulsell, Boller, Hallgren, & Esposito, 2010); dangersrelated to child abuse and neglect; and other health-related behaviors such as smok-ing, well-child visits, breastfeeding, and immunizations (Olds, 2006; Armstrong,Fraser, Dadds, & Morris, 2000).

    The studies focused on parental behaviors and child well being are very impor-tant in understanding what is effective in home visiting that can improve relation-ships between parents and children and for positive parent and child outcomes.

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  • Other research studies broaden the focus beyond the parent-child relationship byexploring the relationship between the home visitor and the parent as correlated toparent participation in a program, satisfaction with and continuation in a program,and behaviors related to their children (Armstrong et al., 2000; Paulsell et al.,2010). The ndings are consistent: better relationships between home visitors andparents correlate to improved health behaviors, and satisfaction with and retentionin the program (Korfmacher et al., 2008). The training of the home visitor is also afocus at times, as the correlations between parent engagement in a program and therelationship with their child is investigated with a home visitors professi