Understanding How Home Visiting Contributes to Child Level Outcomes: A Qualitative Analysis

Introduction: Home visiting has been conceptualized as an indirect intervention aimed at promoting healthy child development. Past studies proposed that through home visiting interventions, parents learn to implement positive parenting practices to promote healthy child development. We investigated the mechanisms through which home visiting fosters such development. Consistent with previous research, we propose home visiting builds parent capacity, leading to healthy parent-child interactions; these interactions facilitate and support healthy child development.

The current qualitative study draws from a large, mixed-methods evaluation of three evidence-based home visiting models implemented in Washington, DC funded by the DC Department of Health through the Maternal Infant and Early Childhood Home Visiting grant.

Methods: Qualitative data were obtained from semi-structured interviews with 39 parents who have participated in the program and 22 home visitors. Interviews assessed parents’ and home visitors’ perceptions of important child and parent level outcomes resulting from program participation. Parents were either active or withdrawn from the program at the time of interviews; they were English and/or Spanish speakers, and had a mean age of 32. Interviews were audio-recorded, professionally transcribed, and analyzed using ATLAS.ti.

Results:We found that fit between the families’ needs and the home visitors’ ability to meet these needs either promotes or hinders program participation. Active parents, particularly those who remained in the program longer, reported expectations of parent growth. These expectations aligned with home visiting programs’ emphasis on building parent capacity. In contrast, withdrawn parents reported expectations of child growth at enrollment. Parent capacity increased through the development of knowledge, skills, and/or empowerment, resulting in enhanced parent-child interactions. Those who remained longest in the program reported achieving child level outcomes of school readiness and/or socio-emotional development.

Conclusion: We confirmed and elaborated on our theory of change regarding the potential underlying mechanisms through which home visiting programs promote child development. We found that family expectations and goals are as influential as home visitor contributions to parent participation and success in home visiting. The home visitor-parent relationship forms the foundation for effective services that build their parenting capacity. When parents feel supported by their home visitor, they are better equipped to follow through on and engage with services provided. Our results highlight the home visitor-parent relationship as an important mechanism through which parent capacity increases and child outcomes improve.