The studies discussed lessons learned about implementation, including lessons related to family engagement, flexibility, community engagement, and use of data.
Engagement in the model was associated with family resources and risk factors (two studies). Authors in one study analyzed hospital birth records to examine associations between engagement and risk factors. Across ethnic groups, families with high-risk births (low birth weight, birth complications, or low gestational age) were less likely than those with low-risk births to schedule and complete a home visit. This study also reported that families with high demographic risks (defined as being uninsured or having public insurance, neighborhood poverty, or young maternal age) were more likely than low-risk families to schedule a home visit, but were relatively less likely to complete the visit. This finding was consistent across ethnic groups. The authors suggested that home visiting staff should not necessarily interpret missed visits as a lack of model interest. Anecdotal information from home visitors suggested that low-resource families faced a greater number of participation barriers, including greater mobility and disconnected telephones than their high-resource counterparts. The second study learned through staff interviews that most of the refusals came from middle- and upper-income mothers who felt they did not need the service or did not like the idea of a visit from a public health nurse.
Another study asked a subset of 830 participating families about their satisfaction with the model. Nearly everyone considered the model to be a helpful resource for materials that the nurses provided, such as diapers, books, or thermometers (99 percent of families); discussing their needs (98 percent); and education (95 percent). Almost all of the families (99 percent) would recommend the visit to a new mother.
Lessons related to service flexibility, community engagement, and use of model data, according to interviews conducted in one study, included the following:
- Staff observed that flexibility to conduct home visits after regular business hours would help accommodate families’ schedules. Such hours, however, would be outside the typical work schedule of public health department nurses;
- The model should fit within the broader array of services already available to residents, and providers in the other service systems (such as medical providers) should be engaged in the model; and
- model developers highlighted as a strength their ability to inform model decisions with model data. For example, their analysis of data from early phases of research led them to implement Family Connects as a universal home visitation model.