Richard N. Roberts

Family support in the home: Programs, policy, and social change.

The need for a coordinated national policy on family support in the home is discussed. First, the history of home visiting programs is reviewed. Then, recommendations for practice, training, and research in family support programs are presented. A discussion of the impact of new federal initiatives on family support programs and research demonstration efforts follows.

Emerging Issues from State Level Evaluations of Early Intervention Programs.

This article synthesizes discussions that occurred among a consortium of professionals who were responsible for the evaluations of Part H (now Part C) programs in various states. The consortium was part of the Federal Interagency Coordinating Councils Subcommittee on Service Integration and Continuity of Services. This paper highlights issues emerging from state level evaluations in the context of 6 different areas: measures, outcomes, service integration, eligibility, funding models, and cost effectiveness. Part C originally was conceived to provide additional services to children and families who qualified under state definitions and to assist in system reform efforts through service integration strategies. The consortium addressed these purposes within the context of evaluation plans and data collected by states conducting state level evaluations. This paper synthesizes the consortium deliberations and suggests issues that need to be addressed in the evaluation planning process.

Psychologists' Role in a Family-Centered Approach to Practice, Training, and Research with Young Children.

Family-centered, community-based, coordinated care for children with special needs is presented as the best practice model for providing services to children and families. Psychologists must learn to play an active role in this frame-work that both integrates psychology with other health and education disciplines and uses the broad spectrum of psychological knowledge about families, development, community organization, and intervention strategies. Key principles of family-centered child psychology affect practice research and training. The psychologist becomes part of a team created to support families as the primary care-givers of their children. Training programs must reorganize the types of experiences both in the classroom and the field to train new psychologists within this model. As mandates for family-centered care affect policies at the state and federal levels, research will remain a critical factor in understanding the effects of these policy shifts on child and family functioning and the delivery of services.

Home Visiting Programs for Families with Children Birth to Three: Results of a National Survey.

This article presents the data from a national swvey of 643 home uisiting programs exclusively serving families with children ages birth to 3. Private and public programs affiliated with health, education, and social service domains are represented in the survey results. Information is presented on family characteristics, purpose of home visits, services provided, organizational structure, the conduct of home visits, home visitor employment and training, and program evaluation efforts.

Survey of home visiting programs for abused and neglected children and their families.

This study reports on home visitation programs that provide services for abused and neglected children and their families. Data were collected as part of a national survey of home visiting programs. Of the 1,904 programs participating in the survey, 224 had as their primary focus services for children who were abused or neglected. For this group, data are presented on program characteristics, characteristics of home visits, credentials of home visitors, and program documentation procedures. The survey data showed that over 70% of the 224 programs identified social service as their organization affiliation which, in contrast to other providers, offered a broad range of services for the abused or neglected children and their families. The most frequently identified purpose for providing services was the social and emotional development of the child. Parenting skills and parent coping were considered the most important services. Stress management was considered more important by respondents of programs for maltreating families than by those providing services to nonmaltreating families. Approximately half the respondents reported that they required a bachelors or masters degree for employment. Results are discussed in relation to research and practice implications.

Home Visitor Characteristics, Training, and Supervision: Results of a National Survey.

The provision of home-based services for individuals or families in the United States dates from colonial times and remains prevalent in education, social service, and health agencies. These services are offered by a professional or paraprofessional who enters the home of a client to provide information, health care, psychological counseling, or other support services over a sustained period of time Wasik, Bryant, & Lyons, 1990). As long ago as the 1860s, issues were raised about the qualifications, training, and supervision of those who would provide home visiting services. Florence Nightingale, one of the pioneers of home visiting, devoted considerable attention to the importance of training (Monteiro, 1985). The hiring and training of home visitors was also addressed in the classic book, Friendly Visiting Among the Poor, by Richmond (1899). From the late 1800s into the early 1900s, home visiting services were developed to address conditions associated with urbanization and immigration, including poverty, contagious diseases, high infant mortality, and poor school attendance. These efforts, part of the general social reform movement of the time, received less attention in the 1920s (Levine & Levine, 1970). By mid-century, several events converged to generate renewed attention to home visiting as a service delivery procedure (Wasik, 1993). These events included a recognition that the home was often a more desirable setting for the care of children with disabilities than was an institution, that parents of children with special needs have an important role in their childrens social and cognitive development, and that at times parents need help in caring for their children with special needs. Since the 1970s, a rapid expansion has occurred in the provision of home visiting services. Both Hawaii and Missouri have statewide home visiting programs (Gomby, Larson, Lewitt, & Behrman, 1993). The U.S. General Accounting Office (1990), based on its analysis of home visiting programs, has recommended home visiting as a service delivery program, especially for infants and mothers. The National Commission to Prevent Infant Mortality (1989) is promoting home visiting through its Resource Mothers program, which employs mothers as lay home visitors. The U.S. Advisory Board on Child Abuse and Neglect 1991) has strongly recommended a universal voluntary neonatal home visiting system for the prevention of child abuse and neglect. In 1992 and 1993, the Bureau of Maternal and Child Health funded a total of 41 community integrated service system projects to help reduce infant mortality and improve maternal health. In 1992, over 80% of the funded programs included home visiting services. In 1933, legislation was passed authorizing the expenditure of

“Let momma show you how”: Maternal-child interactions and their effects on children's cognitive performance☆

1 billion over 5 years for family preservation and family support (Gomby et al., 1993). A number of home visiting programs has been described in the literature, including those designed to prevent child abuse and neglect (see Dubowitz, 1990, and Fink & McCloskey, 1990, for reviews), to enhance childrens cognitive development (Wasik, Ramey, Bryant, & Sparling, 1990), to improve prenatal and postnatal outcomes (Olds, Henderson, & Kitzman, 1994), or to reduce out-of-home placements for adolescents (Henggeler, Melton, & Smith, 192; Kinney, Haapala, & Booth, 1991). This wide diversity in populations served and in program goals among home visiting programs has led to debate about the appropriate characteristics of home visitors. Discussion has focused on issues of employment criteria, especially the employment of professional home visitors versus paraprofessional home visitors, preemployment training and experience, professional skills essential for home visitors, and the importance of training and supervision following hiring (Fenichel, 1992; Halpern, 1992; Larner & Halpern, 1987; Wasik, Bryant, & Lyons, 1990). Possibly the most intense debate regarding home visiting focuses on whether to employ professional or paraprofessional home visitors. …

Home visiting options within head start: Current practice and future directions

Abstract Qualitative and quantitative components of maternal speech and involvement were examined as they related to cognitive skills of entering preschool children. Hawaiian mothers and 4-year-old children were videotaped in a free-play and task-oriented session. Maternal involvement and maternal speech were then coded. The quality of maternal speech as measured by levels of distancing was more predictive of childrens cognitive abilities than SES, maternal physical involvement, or quantity of speech.

Developing a University-Workforce Partnership to Address Rural and Frontier MCH Training Needs: The Rocky Mountain Public Health Education Consortium (RMPHEC)

The results of a national survey of home-visiting programs compared Head Start home visiting programs (n = 295) to other home-visiting programs serving families with children in the 3- to 6-year-old age range (n = 117). Because both sets of programs serve children within the same age range, comparisons have been made to illustrate common points of contact for possible integration of services at the client level and coordination at the systems level. Consonant with the recent Advisory Committee on Head Start Quality and Expansion (ACHSQE) report (1994), strategies for providing more coordination of Head Start home visiting services at the systems and client levels are discussed.

Delivering on the Promise of Early Intervention: Accountability as the Keystone

The objective of the article is to provide the socio-cultural, political, economic, and geographic conditions that justified a regional effort for training maternal and child health (MCH) professionals in the Rocky Mountain region, describe a historical account of factors that led to the development of the Rocky Mountain Public Health Education Consortium (RMPHEC), and present RMPHEC as a replicable model developed to enhance practice/academic partnerships among state, tribal, and public health agencies and universities to enhance public health capacity and MCH outcomes. This article provides a description of the development of the RMPHEC, the impetus that drove the Consortium’s development, the process used to create it, and its management and programs. Beginning in 1997, local, regional, and federal efforts encouraged stronger MCH training and continuing education in the Rocky Mountain Region. By 1998, the RMPHEC was established to respond to the growing needs of MCH professionals in the region by enhancing workforce development through various programs, including the MCH Certificate Program, MCH Institutes, and distance learning products as well as establishing a place for professionals and MCH agencies to discuss new ideas and opportunities for the region. Finally over the last decade local, state, regional, and federal efforts have encouraged a synergy of MCH resources, opportunities, and training within the region because of the health disparities among MCH populations in the region. The RMPHEC was founded to provide training and continuing education to MCH professionals in the region and as a venue to bring regional MCH organizations together to discuss current opportunities and challenges. RMPHEC is a consortium model that can be replicated in other underserved regions, looking to strengthen MCH training and continuing education.