The Active Ingredients in Home Visiting: Using The Home Visit Rating Scales (HOVRS) To

Engage Families and Improve OutcomesMark S. Innocenti, PhD

AUCD EI-SIGJanuary 21, 2020

Center for Persons with DisabilitiesLogan, UT, USA

What are the active ingredients when providing services through home visits?

• Answer in the comments section• Send to all

• Observational measure of home visiting practices and engagement

• Research based/practitioner supported indicators• Consistent with DEC Recommended Family Practices• Good psychometric properties

• inter-rater and scale reliability • predictive validity in relation to program outcomes.

• 7 scales, 41 total items

Home Visit Rating ScalesHOVRS

Roggman, Cook, Innocenti, Norman, Boyce, Olson , Christianson & Peterson (2019). Home Visit Rating Scales3 (HOVRS3)

Why HOVRS?Important advances in early intervention

• Child’s natural caregivers are the best intervention agents• Focus on natural environments/daily routines• Moving from practitioners working directly with the child to

consulting with the child’s caregivers (coaching)• Focus on responsive parenting and on the practitioner being

responsive to parents• Importance of parent engagement• Focus on triadic interactions

(Dunst, Trivette & Hamby, 2008; Haders-Algra et al., 2016; Hoffman, 2016; Landa, 2018; McWilliam, 2015; Peterson et al., 2007; Rush & Sheldon, 2011) and many others

Division of Early Childhood (DEC) of the Council for Exceptional Children (CEC) Recommended Family Practices• Family-centered practices:

• individualize to family• involve parent to support child functioning

• Family capacity-building practices:• everyday routines• existing and new parenting skills• support triadic interactions

• Family and professional collaboration: • build relationship with family to achieve shared goals • promote family skills to support child development

Division of Early Childhood (DEC) of the Council for Exceptional Children (CEC) Recommended Family Practices• Family-centered practices:

• individualize to family• involve parent to support child functioning

• Family capacity-building practices: (HOVRS facilitation scale)• everyday routines• existing and new parenting skills• support triadic interactions

• Family and professional collaboration (HOVRS collaboration scale): • build relationship with family to achieve shared goals • promote family skills to support child development

(HOVRS relationship and responsiveness scales)

So, what’s up with EI practice?• Primary focus on child, limited parent engagement

• Observation (Peterson et al., 2007)• 51% teaching the child directly• 33% engaging in adult interactions

• Observation (Hughes-Belding & Peterson, 2016)• 18% of visit on triadic intervention; only 2% coaching• 65% parent-home visitor

• Qualitative information • U.S. – expert model for families in poverty (Coor et al., 2018)• Spain – expert model still primary (Vilaseca et al., 2019)

• Survey (Bruder, Dunst, Maude ….. Gethmann, 2019)• Discrepancies between practitioner desire to use DEC’s recommended family practices

and actual implementation• Anecdotal information

HOVRS is a tool to help improve home visiting practices

How can you better engage parents and improve the quality of home visiting?

ChildDevelopment

Developmental Parenting

1. Plan 2. Implement 3. Measure4. Improve

HOVRS Through the parent, to the child!

Continuous Quality Improvement (CQI)

What are research-based practices for home visiting?

Strategies that engage parents in supporting their children’s development

1. relationship-based2. strengths-based3. facilitative4. collaborative5. engaging!

(Axford et al., 2012; Barak et al., 2014; Fisher et al., 2016; Heinicke et al., 1999, 2000; Kelly et al., 2008; Korfmacher et al., 2008; Moss et al., 2011; Peterson et al., 2013; Peterson et al., 2018; Schaeffer, 2016; Van Doesum et al., 2008; Wagner et al., 2003; Woods et al., 2004; Zajicek-Farber, 2010; Zigler et al., 2008)

(Roggman, Boyce, Innocenti, 2008)

The Home Visit Rating Scales—a research-based measure of home visiting quality reflecting:

ACYF, 2002; Bernstein et al., 2001; Brorson, 2005; Daro & Harding, 1999; Dunst, Trivette, & Hamby, 2006; Emde et al. 2000; Gomby et al., 1999; Guralnick, 1989, 1998; Hebbler & Gerlach-Downie, 2002; Heinicke et al. 2000; Korfmacher et al.1998; Lanzi et al., 1999; Lieberman et al. 1991; Mahoney et al., 1998; Raikes et al. 2006, 2014; Roggman et al., 2001, 2004, 2013; Woods et al., 2004)

Engaging parents and children together during home visit activities

2. Responding to family strengths, culture, values, and goals

1. Building relationships focused on development—child and parent

3. Facilitating parent engagement in supporting child development

4. Collaborating with parents to plan home visit topics and activities

What does HOVRS-3 look like?

1. To [do high quality practice], the home visitor1 = does behaviors that indicate training need3 = does behaviors that indicate adequate practice5 = does behaviors that indicate good practice7 = does behaviors that indicate excellent practice

__(1) Needs support __(3) Adequate __(5) Good __(7) Excellent

------------------------------------------------------Scale 1. SCALE TITLE: Scale definition

Scale: __1 __2 __3 __4 __5 __6 __7Needs support Adequate Good Excellent

Scale ratinganchors

item

indicators

Item ratingusing anchors

How do you use HOVRS-3?

• Based on at least a 30 min observation of the home visit• Live or on video

• Scored by trained supervisor/coach• Performance improvement measure (not high stakes)• Full measure can be used multiple times per year• Measure can be used in varied ways to work on specific skills or

specific domains

Reliability for HOVRS3 Measurement Sample

Scales and Scores n of items

inter-Item ICC a

Inter-Rater ICC b

Scale 1. Relationship 7 .81 .88Scale 2. Responsiveness 6 .71 .91Scale 3. Facilitation 6 .82 .87Scale 4. Collaboration 5 .83 .74Scale 5. Parent-Child Interaction 7 .94 .93Scale 6. Parent Engagement 6 .86 .95Scale 7. Child Engagement 4 .88 .97Practices (scales 1-4) 4 .76Engagement (scales 5-7) 3 .86Total HOVRS-3 Score (scales 1-7) 7 .87

.36* .65*

.11 ns (.35*)

R = .77, R2 = .60***, Indirect effect = .14; Sobel = 1.85+

HOVRS-A+ v2 predicts home visiting outcomes

HOVRS(during program)

Parenting(36 m)

ChildVocabulary

(36 m)

.36* .39*

.19 ns (.35*)R = .57, R2 = .32*, Indirect effect = .23; Sobel = 2.60**

Covariates:14m Parenting14m Child Vocabulary

HOVRS(during program)

Parenting(36 m)

ChildAttention

(36 m)

Roggman, L.A., Cook, G.A., Innocenti, M.S., Jump Norman, V., Christiansen, K., Boyce, L.K., & Peterson, C.A. (2016).

Replicated with HOVRS3

Practical significance –Parents are over 2 times as likely to have high HOME scores if HOVRS is high

Predictors of above average

HOME—36mo B S.E.

Wal

d df p Odds ratio

Site -.15 .87 .03 1 .86 .86

HOME—14mo .53 .22 5.70 1 .02 1.70

HOVRS-3 total .81 .40 4.08 1 .04 2.25

Logistic binary regression

Practical significance –Children are almost 3 times as likely to have high child language scores if HOVRS is high

Predictors of above average

PPVT-III—36mo B S.E. Wald df p

Odds

ratio

Site 1.91 1.21 2.49 1 .11 6.77

Child language—14mo .04 .03 2.92 1 .09 1.05

HOVRS-3 total 1.06 .49 4.58 1 .03 2.88

Logistic binary regression

HOVRS3

N = 65

N = 1210

Mean Scale Ratings on HOVRS3

1234567

HOVRS3 multi-sample

Excellent

Good

Adequate

NeedsTraining

Research support for HOVRS• Tele-intervention compared to traditional home visiting for children

who are deaf/hard of hearing (Behl et al., 2017)• HOVRS scores and expressive language scores higher for tele-intervention

• Home visit observation form (HVOF-R) related to higher HOVRS engagement scores (Hughes-Belding et al., 2019)

• Relation between HOVRS and Prevention Initiative Quality Rating Instrument (PIQRI) (Korfmacher et al., 2019)

• HOVRS found reliable over 4 time points with same program (Manz & Ventresco, 2019)

• HOVRS used in Peru home visiting study was found to be reliable and valid with cultural and program adaptations (Rubio-Cordina et al., 2019)

Infant Mental Health Journal, 2019, 40(3) – Special section on HOVRS

Good tools can improve implementation

HOVRS3 is a promising measure and a useful tool:

• Reliable, valid measure of home visiting quality• Reflects strengths in practices and engagement• Predicts better outcomes for parents and children • Improves home visiting practices & outcomes

Need more use and research with EI programs!

Use HOVRS3 ratings of home visit quality

Better Parenting

Better Child Development

Continuous Quality Improvement

Coaching

HOVRS

HOVRS

Community of practice

Parent & child engagement

Effective Home

Visiting Practices

CoP HOVRS Results

1

2

3

4

5

6

7

Relationship Responsiveness Facilitation Collaboration Engagement

2015 2018

Excellent

Good

Adequate

Needs Support

Learning Collaborative HOVRS Results

1

2

3

4

5

6

7

Relationship Responsiveness Facilitation Collaboration2015 2019

Excellent

Good

Adequate

Needs Support

If you want to . . . Use this HOVRS Strategy• Promote trust • Engage the whole family

Build relationships focused on development

• Increase positive parenting• Build on family strengths

Respond to strengths Adapt to cultures

• Promote developmental parenting • Improve support of child development

Facilitate interactionUse coaching to encourage

• Build parent capacity• Support parent in parenting role

Collaborate with caregiverUse caregiver ideas

•See if strategies are working•See of a family needs more support •See if a particular visit was effective

Parent-Child InteractionParent EngagementChild Engagement

What are the active ingredients when providing services through home visits?

• What the parents/caregivers do between home visits!

If the family receives two visits a month (two hours) and spends half of that time in triadic interaction, less than .5% of the child’s awake time for the month.

SPRING WORKSHOP

Developmental Parenting, PICCOLO, & HOVRSIdeas, Skills, and Tools to Engage Caregivers in

Supporting Children’s Early Development

Lori Roggman, Mark Innocenti, & Gina Cook

May 19-21, 2020

University Inn, Utah State University, Logan, Utah

Register now at http://developmentalparentinghomevisiting.org/

Gina Cook Vonda Jump Norman Lisa BoyceKatie Christiansen

Special thanks to my HOVRS colleagues

Other HOVRS contributors: Carla Peterson, Nikki Aikens, Kim Boller, Diane Paulsell, & Kristin Hallgren

Tasha Olson

Especially to my colleague and wife,Lori Roggman

Mark.Innocenti@USU.EDU