Purpose
Success factors for a home visiting programme Evidence brief:
The purpose of this evidence brief is to review the international, and any national, home visiting programme literature to help Oranga Tamariki ensure that the current Family Start model supports all partner organisations in their practice, and that whānau receive quality and effective support from the programme. As such, Oranga Tamariki is looking to better understand key indicators of success that are essential for a home visiting service, as well as any factors that are likely to enhance rather than erode programme effectiveness for these whānau, without compromising effectiveness for other users and the programme as a whole.
The following three research questions were developed for the evidence brief.
- What critical factors make a home visiting programme, as applicable to the Family Start context, successful?
- To what extent do such critical factors align with: Family Start as currently designed and delivered? the needs of tamariki and their whānau as identified in the most recent Family Start evaluation reports?
- Which, if any, Family Start programme components could be adapted slightly and/or delivered with a little more flexibility in order to better suit some whānau?
Success factors for a home visiting programme Case studies on programmes supporting Indigenous people:
As a companion report to the evidence brief on success factors for a home visiting programme, this document provides case studies on three different ways of developing and delivering home visiting programmes to Indigenous children and families, comprising the following:
- Family Spirit: A US home visiting programme developed by Indigenous people for Indigenous people
- The Nurse-Family Partnership Australia: A mainstream US home visiting programme with major adaptations designed specifically for Aboriginal and Torres Strait Islander people in Australia
- Parents as Teachers Tribal Maternal Home Visiting: A mainstream US home visiting programme applied (and in particular their curriculum) in a range of different ways by and with Indigenous people.
Methodology
Success factors for a home visiting programme Evidence brief:
The primary information sources for this evidence brief were systematic reviews4 and meta-analyses5. However, given the unusually large volume of published home visiting systematic reviews and meta-analyses, several overviews of (systematic) reviews have also been included. Academic and professional journal articles, books, and book chapters were identified, selected and reviewed using EBSCO (information services journal database) and Google Scholar. Searches of the Campbell Collaboration and Cochrane Library online systematic reviews databases
were also undertaken.
Other data sources included the following:
- EBSCO and Google Scholar were also used to search for individual research and literature reviews (i.e. not systematic reviews) of home visiting programmes or programme components, as well as some research studies on individual select programmes.
- US Home Visiting Evidence of Effectiveness (HomVEE) reviews website (Department of Health and Human Services).
- Select evidence-based websites: California Evidence Based Clearing House for Child Welfare, Blueprints, and Investing in Children.
- Grey literature, i.e. online government reports and select home visiting programme websites.
- A limited amount of unpublished New Zealand material.
All research studies have their limitations, and this evidence brief is no exception:
- This is an evidence brief rather than a full literature review. As such it represents a good, but not necessarily a comprehensive, summary of existing literature.
- By definition the evidence brief is limited to findings from the large (evidenced-based) home visiting programme (research) literature, i.e. no interviews were undertaken with researchers or providers, no programme manuals were accessed for more detailed information beyond the Family Start one, little unpublished material was included, and randomised controlled trial groups aside, no comparisons were made between evidence-based home visiting programmes and other forms of parenting support services.
- For inclusion in systematic reviews and meta-analyses, article inclusion criteria usually require the use of an experimental research design, e.g. randomised-controlled trial. As such there is the potential that the characteristics and success factors of some other effective or theoretically more effective programmes are not included. Furthermore, systematic reviews and meta-analyses may ‘mask’ important differences across different programmes and have the effect of ‘averaging out’ the results from high and low scoring programmes.
- While a very limited number of book chapters available through EBSCO and Google Scholar and the grey literature have been included, most academic and professional books are not available through EBSCO or other academic journal databases.
While not methodological limitations per se, it is also worth noting that:
- Only two studies (McDonald, 2021; Paulsell et al., 2014) comparing the use of different home visiting programmes were identified and neither of these were empirical research.
- Beyond a synthesis of evidence on parenting programmes more generally that includes but is not limited to home visiting (Social Policy Evaluation and Research Unit, 2015), no Aotearoa New Zealand home visiting programme systematic reviews or meta-analyses were identified.
Success factors for a home visiting programme Case studies on programmes supporting Indigenous people:
For each of the three case studies, the following are addressed:
— Programme type
— How developed
— Who for
— Goals
— Key features
— Where
— Who delivers
— Evidence to support the programme.
Key Results
Success factors for a home visiting programme Evidence brief:
From the findings, there is a growing recognition of the importance of greater programme flexibility and adaptability to suit diverse communities. However, building increased flexibility needs to be carefully monitored and evaluated to ensure programme quality is not compromised and that positive outcomes continue to be achieved.
Successful home-visiting programmes have the following components:
- Antenatal participant recruitment
- High frequency of visits
- Programme choices aligned with whānau needs and circumstances
- Focus on the quality of helping relationships.
However, home visiting programmes are extremely diverse in the context under which they are developed, how they are delivered and core programme components. Accordingly, success factors are varied and specific to the context of operation.
Success factors for a home visiting programme Case studies on programmes supporting Indigenous people:
- Programmes do not necessarily need to be developed or managed by government. None of these programmes were originally developed by government and only the Australian Nurse-Family Partnership Program is managed by a government department. Family Spirit was specifically developed by and for Indigenous People.
- Indigenous academics and researchers have a critical role to play in relation to both Family Spirit and the Australian Nurse-Family Partnership Program, through the John Hopkins University Center for American Indian Health and the Charles Darwin University Molly Wardaguaga Research Centre respectively. Also mindful of the recent announcement about the establishment of the Centre for the Child within Te Whare Wānanga o Awanuiarangi and the appointment of an inaugural endowed chair (Davis, 2021) is an opportunity here in Aotearoa New Zealand to involve Indigenous academics and researchers to hone home visiting programmes to better suit Indigenous communities.
- Beyond indigeneity, neither Family Spirit nor the Australian Nurse-Family Partnership Model specifically target families at risk. In an Aotearoa New Zealand context that would place these programmes as much under the auspices of Whānau Ora as Oranga Tamariki.
- Family Spirit, the Australian Nurse-Family Partnership and Parents as Teachers Tribal Maternal Home Visiting all incorporate Indigenous teachings.