An evaluation of factors associated with safe infant sleep practices among perinatal home visiting participants in Florida, United States

Sleep-related deaths are a leading cause of infant mortality in Florida. The American Academy of Pediatrics recommends placing infants to sleep on their back, alone, and without soft bedding. Compliance with these guidelines varies among parents. This evaluation examined the rates of safe infant sleep practices and associated factors among 1985 participants enrolled in Florida Maternal, Infant, and Early Childhood Home Visiting (FL MIECHV) programs during 2017–2019. Participant- and program-level variables were examined in relation to three sleep practices: infant position, bedding, and bed-sharing at 2–3 months to determine which factors were associated with high rates of safe sleep outcomes. Analyses included univariate descriptive statistics, bivariate statistics, and multivariable logistic regression. Most caregivers (70%) reported always placing their babies to sleep on their back, alone, and without soft bedding. Factors such as primary language, race, education, housing situation, and year the Safe Baby™ curriculum implemented were significantly associated with safe infant sleep practices. Bearing this in mind, FL MIECHV can tailor safe sleep education, messaging, and strategies to support participants at highest risk. Recent adoption of the Safe Baby™ curriculum, and associated staff training, was an important factor influencing parents’ infant sleep practices.

Adding Procedures and Standards to the HomVEE Review Handbook on the Transparency, Openness, and Reproducibility of Research on Home Visiting Models

Questionable research practices threaten the credibility of HomVEE designations for “evidence-based early childhood home visiting service delivery models”. Internationally accepted standards for reporting and interpreting the results of reviews—including the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Grading of Recommendations Assessment, Development and Evaluation (GRADE)—recommend that reviews take steps to mitigate bias associated with selective non-reporting of results and other questionable research practices. Moreover, Department of Health and Human Services (HHS) policies require that contractors and grantees engage in transparent and open sciences practices. We propose that HomVEE adopt standards to mitigate the effects of questionable research practices, which would be consistent with international guidelines and with complementary HHS policies and procedures.

A Novel Application of Photovoice in a Statewide Home Visiting Evaluation

Photovoice is an empowering, qualitative, community-based participatory research method that engages participants to take photographs and reflect on their meanings. We employed a novel application of a Photovoice-inspired methodology to evaluate perinatal home visiting services. This article describes the feasibility and utility of remote implementation of a Photovoice-inspired project in one state’s federally funded Maternal, Infant, and Early Childhood Home Visiting Initiative. The initial project aimed to identify aspects of parenting roles/identities, goals, and home visitor–client relationship that can be leveraged to improve program engagement and retention. Training materials were sent to home visitors who acted as liaisons with parents. Reflective interviews about this photo-elicitation method conducted with parents, home visitors, and the evaluators following the project revealed that informational materials were beneficial to understanding the process. Home visitors were noted as gatekeepers and key motivators. Trainings, flexibility, timely communication, and logistics should be considered when remotely implementing Photovoice.

Contributions of Preventive Social Services in Early Childhood Home Visiting in a Disadvantaged Area of Sweden: The Practice of the Parental Advisor

Early childhood home visiting to improve health and development is commonly delivered by child health care (CHC) whereas home visitors from the social services are rare. We applied a constructivist grounded theory approach to explore the practice and contributions of parental advisors from the preventive social services in a home visiting collaboration with CHC in a socioeconomically disadvantaged area of Sweden. The analysis rendered a conceptual model of a situation-based practice, built on interactive encounters between parents and professionals. It includes strengthening of positive parenting, connecting parents to additional services, early detection of needs and provision of psychosocial support in accordance with each family’s specific situation. Rooted in the training and experience in social work, the practice can be seen as contributory to the delivery of complex support to families through home visiting and could provide input to efforts of improving training of home visitors in different contexts.

Using a Developmental Approach to Evaluation Capacity Building in Home Visiting

The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, administered by the Health Resources and Service Administration in collaboration with the Administration for Children and Families, provides evidence-based home visiting services across 50 states, the District of Columbia, and five U.S. territories. MIECHV invests in comprehensive technical assistance (TA) to support and build the capacity of awardees to conduct rigorous evaluations of their programs. Throughout the course of the evaluation process, awardees received TA from the Design Options for Home Visiting Evaluation project. Between 2011 and 2020, over 173 state-led evaluations have been conducted. Individual technical assistance (TA) modalities included conference calls, emails, interactive and individualized webinars, developing and sharing resources, and involvement of content experts. When issues and challenges were identified across multiple awardees, Design Options for Home Visiting Evaluation (DOHVE) delivered targeted group TA to awardees with common needs that may benefit from peer-to-peer learning. When cross-cutting issues and challenges were identified, DOHVE used universal approaches such as webinars and guidance documents that were made available to all awardees.Through the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, efforts have been taken to promote awardee capacity by targeting all phases of the evaluation process, including planning, implementing, and disseminating findings and providing TA that is responsive and tailored to meet awardee-specific needs. This approach enabled DOHVE to support MIECHV awardees in expanding knowledge of their programs and the evidence base on home visiting. Lessons learned from TA provision highlight the importance of developing feasible plans and providing ongoing support during implementation.

Nurse-Family Partnership

David Olds developed nurse home visiting as an intervention for poor, first-time mothers. As demonstrated by three randomized trials in Elmira, Memphis, and Denver, the Nurse-Family Partnership became the basis for significant federal funding under the Maternal, Infant, and Early Childhood Home Visiting Program. The transition from pilot program to federal legislation included tiered funding, by which programs demonstrated by Randomized Controlled Trials were prioritized over those with less empirical support.