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Implementing Home Instruction for Parents of Preschool Youngsters (HIPPY)®

Meets DHHS criteria for an evidenced based model

Implementation Experiences

Last Updated

June 2011

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Summary of Sources

Information in this section is based on studies included in the HomVEE review. For HIPPY, we reviewed five studies, including two RCTs/QEDs with a moderate or high rating, two implementation studies, and one case study. (Please see the study database for a list of the studies.)

Two of the studies report data from the same sample. Throughout this section, we refer to this as the New York/Arkansas studies.  

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Characteristics of Program Model Participants

In one study, the children’s average age upon enrollment in the program was 45 months. In the New York/Arkansas studies, the children’s average age ranged from 54 to 58 months. The studies did not specify the average age of the caregivers enrolled in the program.

In one study, only mothers participated. The gender of the adult caregivers was not reported in the other studies. In one study, 54 percent of the children were female. In the New York/Arkansas studies, the percentage of female children ranged from 36 to 59 percent across sites and cohorts.

Across the New York/Arkansas studies, the children enrolled in the program were racially and ethnically diverse: the percentage of African American (non-Hispanic) children ranged from 16 to 97 percent, the percentage of white (non-Hispanic) children ranged from 3 to 27 percent, and the percentage of children of other or multiple races ranged from 0 to 19 percent. In one of the sites, the percentage of Hispanic children ranged from 32 to 38 percent. In one study, nearly all of the participants were Hispanic. 

In one study, 89 percent of the sample were married. Across the New York/Arkansas studies, the percentage of single-parent families ranged from 26 to 48 percent, the percentage of single parents living with family ranged from 8 to 22 percent, the percentage of couples among the sample ranged from 25 to 60 percent, and the percentage of couples living with family ranged from 6 to 11 percent.

In one study, the average family income was between $10,000 and $30,000 in 2005. Across the New York/Arkansas studies, the percentage of families for whom public assistance was the primary source of income ranged from 34 to 46 percent. In a fourth study, 61 percent of families were below 50 percent of poverty level.

In one study, the average level of education for both mothers and fathers was some high school. Across the New York/Arkansas studies, the percentage of the sample with less than a high school education ranged from 28 to 37 percent, the percentage with a high school education ranged from 24 to 64 percent, and the percentage with more than a high school education ranged from 3 to 41 percent. In another study, 38 percent of parents had completed high school or earned a GED and 19 percent had less than a high school education.

Participation in the program was voluntary across four of the studies.

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Location and Setting

Study locations included Arkansas, California, Michigan, New York State, and Tennessee. In four studies, the programs were located in urban settings.

Only three studies described the implementing agency. In two of these studies, HIPPY was implemented by school districts. In the third HIPPY was implemented in a local advocacy organization.

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Staffing and Supervision

The New York/Arkansas studies and two additional studies reported that paraprofessionals served as the home visitors. The New York/Arkansas studies reported that program coordinators provided supervision for the paraprofessionals. One site hired a family support specialist to work with high-risk families.

In one study, the family support specialist employed by the site had a two-year nursing degree and the home visitors were paraprofessionals for whom the position was their first job. In another study, the home visitors had at least a high school diploma or GED and were members of the clients’ community. In the New York/Arkansas studies, most of the program coordinators had a bachelor’s degree, a few had a master’s degree, and at a least one had a doctorate. Their degrees typically were in early childhood education, elementary education, community service, social work, or public administration.

One study reported that trainings were held at the national, state, and local levels for the home visitors and program coordinators. Another study reported that program coordinators received a five-day pre-service training and attended a national training workshop. The home visitors received weekly training from the program coordinator.

The New York/Arkansas studies and two additional studies reported that the program coordinators supervised the paraprofessionals. No additional information on supervision was provided in the studies reviewed.

No information was provided in the studies reviewed on the caseloads of the staff.

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Program Model Components

The New York/Arkansas studies and one additional study reported offering home visiting along with parent meetings. Another study reported providing case management to enrolled families.

No information was provided in the studies reviewed about assessments.

The New York/Arkansas studies and an additional study reported that a standardized curriculum was used consisting of children’s books and activity guides designed to enhance children’s cognitive development.

Two of the studies reported providing Spanish-language materials for parents.

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Program Model Adaptations or Enhancements

The studies reviewed did not describe any program adaptations or enhancements used by the programs beyond the “standard” model.

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Dosage

The New York/Arkansas studies and two additional studies reported that families participated in about two home visits and two parent meetings per month.

No information was available in the studies reviewed about the length of the home visits.

Two of the studies reported providing home visiting services for 30 weeks per year. Another study reported that families completed an average of 40 to 47 of the 60 activity packets comprising the curriculum.

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Fidelity Measurement

In one study, a variety of measures were used to assess the fidelity to the model. Treatment intensity was measured, the quality of the home visits was assessed using the home visitor survey, and fidelity was assessed using the Home Visit Checklist, the Parent Participation Questionnaire, the HIPPY Parent-Child Activity Checklist, and home visitor records.

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Costs

According to one study published in 1996, the cost of serving 60 4-year-old children in year one and 120 children (60 4-year-olds and 60 5-year-olds) was approximately $13,324. This figure includes the cost of the children’s books, the shape materials, the activity packets, home visitor guides, and shipping. In addition, the study reported that a coordinator earned about $35,000 and paraprofessionals earned $4 to $7 per hour.

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Lessons Learned

In one study, the program experienced challenges related to low levels of participation. The authors recommended that programs discuss participation barriers with families upon enrollment and develop strategies to try to overcome those barriers. The authors also noted that the families with the greatest needs were more likely to attend the group meetings than to participate in the home visits. The authors speculated that the families attended the meetings in the hopes of obtaining resources and information related to their specific issues. Thus, the authors recommend that programs tailor the meetings around the identified needs of the participants even if unrelated to the HIPPY curriculum.

Another study reported that the parent groups were particularly well-received by staff and parents. The authors provided a number of possible explanations for this finding: (1) families were able to focus solely on the instruction provided and did not also have to supervise their children as during the home visits; (2) the group meetings were a nonthreatening forum in which issues could be raised; and (3) topics discussed were often based on parents’ suggestions.

A third study found that the addition of the family support specialist in the second year of the program was an important factor in parent satisfaction. The family support specialist was able to focus on addressing the basic necessities of the participants, enabling the home visitors to concentrate on delivering the curriculum.

Another study reported the importance of considering how the HIPPY program is responding to the changing needs of the community.

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