Videobased Instruction + Coaching (VI+C): Putting Motivation Theory into Practice in Home Visiting Intervention

Videobased instruction combined with coaching (VI+C) has been shown to be effective in teaching adults skills across many professions, including surgical skills among medical students, instruction among teachers, and behavioral management among parents. Different VI+C approaches have recently been extended to delivery of manualized early parenting curricula for home visiting programs. Yet few studies consider the challenges and opportunities of VI+C for those frontline home visiting service providers – a key concern if programs are to be successfully implemented at scale. This paper considers motivational mechanisms, skills, and clinical supervision strategies for home visitors’ use of VI+C as well as fidelity of implementation within an RCT home visiting project delivered to low-income Latino families.  

Twenty-four home visitors from seven Early Head Start sites in urban NYC neighborhoods participated in three-day trainings in the evidence-based PALS curriculum as well as weekly supervision from September through July. Home visitors were trained in 3 cohorts, of Latina/Hispanic ethnic origin, in their mid-20’s to late 50’s, and with high levels of experience in informal child care yet relatively low levels of formal education. Notably, a large proportion of home visitors were themselves former Head Start parents.

Initial qualitative checks on the fidelity of implementation in the 1^st pilot year suggested that while VI+C was a promising means of service delivery, it required a substantial shift in home visitors’ styles of working with families, requiring greater intrinsic motivation to learn new skills. Content analysis of the delivery of PALS suggests that use of VI+C capitalizes on key foundations of human motivation, including autonomy (e.g. choice), relatedness (e.g. support from the clinical supervisor), planning (e.g. outlining and meeting specific goals) and competence (e.g. concrete evidence of successful mastery of skill) (see Jones et al., 2013; Gollwitzer & Oettingen, 2013). Based on self-reports, few home visitors had prior educational or work experience using digital technologies, manualized treatments, or directive styles of coaching and found the acquisition of those skills to be challenging. Clinical supervision logs across all meetings with all treatment-assigned home visitors will be analyzed for the extent to which clinical supervision focused on 1) logistical challenges of VI+C , 2) motivational components of VI+C and 3) mastery of curriculum content. Despite those challenges, preliminary analysis of implementation suggest high levels of fidelity to the PALS model. Implications of VI+C models of service delivery with frontline home visiting staff will be discussed.