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Implementing Family Check-Up® For Children

Meets DHHS criteria for an evidenced based model

Implementation Experiences

Last Updated

June 2017

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Summary of Sources

Information in this section is based on studies included in the HomVEE review. For Family Check-Up (FCU), we reviewed 17 studies, including 14 randomized controlled trials, two implementation studies, and one case study.* (Please see the study database for a list of the studies.)

In the following sections, we consider all pieces of research about a particular sample to be a single study. For example, 15 publications were based on the same group of participants enrolled in the Early Steps Multisite Study (ESMS). These 15 publications are cited as one study. There are three distinct samples across the 17 publications.

*One publication (Shelleby 2015) included a low-rated effectiveness study and an implementation study. We reviewed the implementation study for this report.

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Characteristics of Program Model Participants

In the case study, the mother and father were 34 and 36 years old, respectively, and their daughter was 2 years old when the initial home visit took place. In another study, the average age of the mothers was 27 years and the average age of the children was 24 months at the time of the initial home visit. In the ESMS sample, children had a mean age of 30 months, and caregivers had a mean age of 28 years as of the initial home visit.

The couple profiled in the case study identified as white.

In the ESMS sample, 50 percent of the participants were white, 28 percent were African American, 13 percent were biracial, and 9 percent were other groups. Of these participants, 13 percent identified their ethnicity as Hispanic. In the third study, 48 percent were African American, 40 percent were white, and 11 percent were biracial.

The families in the ESMS sample had risk factors related to maternal depression, daily parenting challenges, parental substance use problems, teen parent status, limited parental education, child conduct problems, or high-conflict child–adult relationships.

About 66 percent of caregivers had a high school education or less (two studies). Of those studies, the mean level of educational attainment for mothers in one study was about 12 years. In the other study, the ESMS sample, 24 percent of caregivers had less than a high school diploma or certificate of general education development (GED), 41 percent had a high school diploma or GED, and an additional 32 percent had one to two years of post–high school training. All of the participants in the ESMS sample received benefits from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Neither parent in the case study had a high school diploma. The mother did not work and the father was unemployed.

The average household size in the ESMS sample was four and a half family members. Fifty-eight percent of children lived in a two-parent household. In all, 36 percent of participants were married, 32 percent were single, 20 percent were living together, 8 percent were separated, 4 percent were divorced, and 1 percent were widowed.

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Location and Setting

Participants were from three locations: Pittsburgh, Pennsylvania; Eugene, Oregon; and Charlottesville, Virginia.

FCU served rural, suburban, and urban populations.

A local community agency implemented the program in the case study. In the ESMS study, a university implemented the program.

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Staffing and Supervision

All the studies reported that home visits were conducted by therapists, also known as parent consultants.

In the ESMS sample, the therapists had at least a master’s degree, and all had previous experience in delivering family-based interventions, but they had moderate experience using FCU. Another study also reported that the therapists held master’s degrees.

Before working with families, the therapists completed two and a half to three months of training to attain certification (two studies). In the ESMS sample, therapists participated in annual trainings and weekly case reviews. One other study reported that the therapists received weekly supervision.

None of the studies reviewed reported the caseload of therapists.

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Program Model Components

FCU primarily consisted of a minimum of three core home visits, additional visits as needed, and yearly check-ups (two studies). During the first visit, the therapist completed the Home Observation Assessment Protocol, which involved a variety of parent–child activities such as a clean-up task and a meal preparation and lunch task. The therapist rated the parents’ involvement with and supervision of the child. The parents also completed questionnaires about their own, their child’s, and the family’s functioning. The second visit, referred to as the “get to know you” session, sought to build rapport with the parents and involved interviewing them. During the third visit, the “feedback session,” the therapist reviewed the results of the assessment and interview with the parents and discussed various subsequent family-intervention options with the family that might involve additional home visits. The therapist conducted yearly check-ups with the family that involved the three core visits and additional visits as needed.

In the ESMS sample, therapists used the Everyday Parenting curriculum for the subsequent intervention sessions focusing on family management, and they shared videotaped examples of parent–child interactions.

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Program Model Adaptations or Enhancements

None of the studies reviewed discussed program adaptations or enhancements.

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Dosage

In one study in which families participated in FCU for one year, families received an average of three visits in total, with 92 percent of families receiving the three initial visits.

In the ESMS sample, 76 percent of participants completed the three initial visits during the first year of the program when their child was 2 years old. Sixty-nine percent completed the three yearly check-up visits at age 3, 70 percent at age 4, and 66 percent at age 5. Of the participants who completed the three initial visits, 72 percent participated in subsequent sessions at age 2, 70 percent at age 3, 74 percent at age 4, and 74 percent at age 5. The average number of total sessions (initial and subsequent sessions) was about four per year.

The ESMS study described the first home visit, during which an assessment was conducted, as lasting two and a half hours and the feedback session lasted one and a half hours.

In the case study, the family received 12 sessions the first year and three or four sessions per year the following two years. The case study reported that the therapist spent 18 hours with the family in year 1, eight hours in year 2, and two hours in year 3. (The study authors noted that the high number of visits received—more than the typical FCU participant—reflected the family’s extensive needs.)

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Lessons Learned

The ESMS study described three lessons that were learned during program implementation. One publication from the study found that single parents were less engaged in the program. The authors suggest that the program focus on facilitating the participation of this population and addressing their unique needs.

The authors of another publication from the study reported that the program had the potential to decrease maternal depressive symptoms and, as such, the authors suggest that the program provide services designed to specifically address maternal depression.

A third publication from the ESMS study found that higher scores on measures of implementation fidelity were related to higher levels of participant engagement.* The findings suggest that therapists who adhere more to the prescribed content and process for the FCU feedback sessions are better able to engage clients.

* HomVEE did not review the rigor of the design used in this publication because the analysis did not include a comparison group.

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