Friday, February 4, 2011

New Discovery: Home Visits

Home-visiting or "home visitation" programs have been discovered by the early childhood community and they're the new hot thing. Obama has called for support of such programs and they are proliferating and generally gaining a lot of national attention.

On February 16 and 17, the National Summit on Quality in Home Visiting Programs: Connecting Research to Policy and Practice will be held in Washington, DC (http://www.homevisitingsummit2011.org/). Where is Part C? Nowhere to be found among the confirmed speakers.

This has been true over the past 2 years, as these programs have been created and debated. Despite the fact that over 70% of the Part C children are receiving their most important service in the home, we are by and large not at the table with these Johnny Come Latelies.

To give credit where it's due, David Olds and his nurse home visiting model have been around for a long time, but they do not operate at nearly the scale of Part C home visits. Should we be at the table with these other programs or are we so fundamentally different that we're relieved to be excluded?

This is an important question the early intervention field needs to contend with. Amazingly, when the evidence base about home visiting programs is discussed, the conclusion is that it is ineffective. These findings primarily came out of the old Abecedarian Project and the Infant Health and Development Program, where these disadvantaged-family home visits were largely discredited, compared to intensive classroom-based programing.

But think of the different nature of those home visits from Part C home visits. Whereas disadvantaged-family homes visits often involve quite didactic interactions between trainers and parents, early intervention home visits, when done well, are designed to provide emotional, material, and informational support to families. The support is aimed in part at addressing specific, measurable family-chosen goals. I'm not trying to make Part C home visits sound better. Both types are designed to help with parenting.

So do we want early intervention to be associated with these increasingly popular home visitation initiatives? It seems peculiar for these programs not to learn from the history of over 25 years of early intervention home visits. But we also don't want the association to be so strong that we shy away from our special obligation to work on IFSP outcomes/goals.

It just seems peculiar to have a national summit on home visiting with no representation of Part C in it.

10 comments:

Davye said...

As of yet, do you have any research published on your specific method (RBI)? I would assume you do after reading your bio from the Siskin Institute. ("...One of the nation's leading researchers in early intervention/early childhood special education (EI/ECSE)..." who has a "...proven method...") Please direct me to YOUR research for YOUR method. (Any responsible "interventionist" should not adopt a method without question.

beckylake06 said...

http://www.siskin.org/www/docs/112.190/

Kris said...

Hello,
It seems as though home visiting programs are largely funded through the Maternal and Child Health Bureau and the US Department of Health and Human Services, Human Resources and Services Administration (HRSA) and not the the Department of Education. My interpretation of the problem is that there are 2 silos that exist at the federal level and these agencies are not communicating very well. Better collaboration between the Maternal and Child Health Bureau and Part C in the Department of Education at the federal level may trickle down to the families we serve in EI. I'm not sure how to facilitate the collaboration between the two agencies, but it should happen. A publication about the issue may help.

Robin McWilliam said...

Davye: If you were on the Siskin Children's Institute website, you could see my research: www.siskinresearch.org.

Robin McWilliam said...

Kris: You're absolutely right that there are two silos at the federal level. On the one hand, it would be great for early intervention home visiting to get a slice of the big pie going to home visitation. On the other hand, I would not want our methods changed to follow the "evidence-based programs" that are not designed for children with disabilities and their families. Do we want the money or the autonomy?

Erin said...

I think the post is right on. I think one issue is that as money has gotten tigher, Part C has "tightened the belt". Restricting eligibiity and serving (hypothetically) less children. The more restrictive we have become as providers and as a system, the less our federal partners see us a home visiting program relevant to a larger population. While I feel that Part C practices and foundations could be built upon to serve a wider population base (even universally)others see us as a "speciality hv program". Again I think this a limited view of the skills of providers in Early Intervention but worth mentioning, nonetheless. Oh and I would hate to limit our EI services to the myopic "evidence based program" mentality.

Robin McWilliam said...

Erin, I think you're right about the path from belt tightening to the perception that we're a boutique program, irrelevant to others.

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Admin said...

I've encountered a lot of good sites supporting the practice of home visits. This is the first site where I read about the ineffectiveness of the effort. Quite intriguing.


Erm @ Beard Trimmer Central

Robin McWilliam said...

Bear in mind that the limited-effectiveness (better than no-effectiveness) studies were usually in comparison with a high-dosage, high-quality child care. The research by David Olds on nurse practitioner visits tells a more positive story.