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Implementing Oklahoma’s Community-Based Family Resource and Support (CBFRS) Program

Meets DHHS criteria for an evidenced based model

Implementation support is not currently available for the model as reviewed.

Implementation Experiences

Last Updated

June 2012

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Summary of Sources

Information in this section is based on studies included in the HomVEE review. For Oklahoma’s Community-Based Family Resource and Support (CBFRS) Program, we reviewed two quasi-experimental designs (QEDs) with a moderate rating. (Please see the study database for a list of the studies.)

Both studies we reviewed examined the same group of participants being served by the same set of program sites. As a result of this overlap, we refer to only one study throughout the remainder of this section.

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Characteristics of Program Model Participants

According to the study, 205 first-time pregnant women enrolled in Oklahoma's CBFRS program. The study reported characteristics of the 156 women who remained enrolled in the program through completion.

Mothers were, on average, 17.4 weeks pregnant at enrollment and 20 years old at the birth of their child.

Most mothers participating in CBFRS were white (69 percent). Other participants were African American, Native American, Hispanic, or another race/ethnicity. On average, mothers had between 11 and 12 years of education and most were low-income. Most mothers were single (68 percent), 30 percent were married, and 2 percent were divorced or separated. Fifty-nine percent of mothers participated in Medicaid.

The study reported that participation in Oklahoma's CBFRS program was voluntary.

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Location and Setting

The CBFRS program was implemented in five rural counties in Oklahoma.

County health departments implemented the program. Local health department staff hired and supervised home visitors and recruited participants who used local health department services.

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Staffing and Supervision

According to the study, program staff consisted of home visitors and supervisors.

Home visitors were professionals in the field of child development. Most (80 percent) possessed either a bachelor’s or master's degree in child development and 20 percent had a high school degree plus five years of experience working with children and families. Overall, home visitors had, on average, two years of experience working with families. The race and ethnicity of home visitors mirrored the demographics of the counties in which they worked: 65 percent were white, 18 percent were African American, and 12 percent were Native American. Supervisors had master's or doctoral degrees in child development and at least two years of supervisory experience.

The study reviewed reported that home visitors received more than 40 hours of pre-service training and received ongoing training. The study did not describe the duration or frequency of the ongoing training.

Supervisors met with home visitors on a weekly basis. Supervisors monitored home visitors based on the information home visitors recorded, including the length of each home visit and the time they spent on each curriculum topic, as well as their telephone calls with participants and home visit attempts.

The study reviewed did not provide any information about recommendations on the caseloads for home visitors.

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Program Model Components

According to the study reviewed, Oklahoma's CBFRS program consisted of prenatal home visits until the child’s first birthday. Home visits focused on teaching mothers about maternal and child health, child development, home safety, and parenting skills. The content and intensity of the program varied depending upon the stage of the intervention and the age of the child. During pregnancy, the program was designed for weekly home visits in the first month of the program, followed by biweekly visits until the child’s birth for a total of eight prenatal visits. After the child's birth, home visits were intended to occur weekly during the first three months of the child’s life and biweekly for the remaining nine months, for a total of 30 postnatal visits. Each visit was intended to last about one hour.

The study did not describe any assessments used during program implementation.

Oklahoma's CBFRS program followed a standardized curriculum that covered (1) maternal and child health, (2) child growth and development, and (3) parenting skills. Curriculum topics included characteristics of newborns and growing infants; bonding and attachment; play activities that emphasize touching and talking with the infant; healthy and safe living environments; and guidance and discipline. The content of the curriculum varied depending on the stage of the intervention and the interest of families. Home visitors could tailor the curriculum by selecting subtopics within the three overarching categories that addressed families’ specific concerns or interests. During the prenatal phase, home visitors spent most of their time presenting topics focused on maternal health, parenting roles, and education and employment goals. During postnatal visits they mostly focused on child development, parenting roles, and child health. In both pre- and post-natal visits, home visitors spent the smallest proportion of their time discussing other topics, including crisis management, environmental health, and friends and family.

The study did not report whether CBFRS materials were available in a language other than English.

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Program Model Adaptations or Enhancements

The study did not identify any program model adaptations or enhancements.

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Dosage

The study reported that in practice, participants received, on average, more prenatal home visits and fewer postnatal visits than intended. Mothers received 11 prenatal home visits, rather than 8, and about 21 postnatal visits, instead of 30. As intended, visits lasted about 60 minutes.

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Fidelity Measurement

Home visitors completed a Home Visit Encounter form following each contact with participants, including telephone calls, home visits, or attempts at a home visit. They recorded the date, time, and length and location of the visit, and marked the percentage of time they spent covering specific curriculum topics on a checklist. Supervisors reviewed the forms to monitor program fidelity.

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Costs

The study did not provide any information about costs associated with implementing Oklahoma's CBFRS program.

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Lessons Learned

The study did not report lessons learned about implementing Oklahoma's CBFRS program.

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