Facilitating caregiver-child interactions in home visiting: A qualitative observational study.

Facilitating parent-child interactions is a key component of evidence-based early childhood home visiting programs. Several observational measures have been created to effectively capture home visiting activities from an operationalized perspective. While the field has a reasonable understanding of what home visitors can do to facilitate developmentally supportive interactions, and why, the how remains elusive for many home visitors. This qualitative study used a modified grounded theory approach to examine the facilitation of caregiver-child interactions during home visits. Home visit video recordings previously coded using the Home Visit Rating Scale (HOVRS) A+ were selected based on facilitation quality. Sixteen home visits (8 lower- and 8 higher-quality facilitation scores) were examined for differences in home visitor behaviors that support parent-child interactions during visits. We identified contextual and specific behaviors that home visitors used to actively engage caregivers and children together in developmentally supportive interactions. Results revealed 11 home visitor behaviors that discriminated higher quality facilitation. These behaviors were categorized into four domains: environmental conditions, executing the activity, strengths-based focus, and caregiver responses. This qualitative study highlights specific behaviors and professional development areas to support more effective home visiting services for a diverse population of families with young children.

Facilitar las interacciones progenitor-niño es un componente clave de los programas de visita a casa en la temprana niñez con base en la evidencia. Varias medidas de observación se han creado para captar eficazmente las actividades de visita a casa desde una perspectiva operacional. A pesar de que el campo tiene una comprensión razonable de lo que los visitantes a casa pueden hacer para facilitar las interacciones de apoyo al desarrollo, y el por qué, el cómo permanece aún esquivo para muchos visitantes a casa. Este estudio cualitativo usó un bien fundado acercamiento teórico modificado para examinar la manera de facilitar las interacciones cuidador-niño durante las visitas a casa. Con base en la calidad del proceso facilitador, se seleccionaron grabaciones en video de visitas a casa previamente codificadas usando la Escala de Puntuación de Visitas a Casa (HOVRS) A+. Dieciséis visitas a casa (8 con puntajes del proceso facilitador de más baja calidad y 8 de más alta calidad) se examinaron en cuanto a las diferencias en el comportamiento del visitador a casa que apoya las interacciones progenitor-niño durante las visitas. Identificamos comportamientos contextuales y específicos que los visitadores a casa usaron para hacer que los cuidadores y los niños participaran juntos activamente en las interacciones de apoyo al desarrollo. Los resultados revelaron 11 comportamientos del visitador a casa en que se comprometía la más alta calidad del proceso facilitador. Se categorizaron estos comportamientos en cuatro dominios: condiciones ambientales, ejecución de la actividad, enfoque con base en los puntos fuertes, así como las respuestas del cuidador. Este estudio cualitativo resalta comportamientos específicos y áreas de desarrollo profesional para apoyar servicios de visita a casa más eficaces para un diverso grupo de población de familias con niños pequeños.

La facilitation des interactions parent-enfant est une composante clé des programmes de visite à domicile de le petite enfance, fondés sur des données probantes. Plusieurs mesures d'observation ont été créées afin de capturer efficacement les activités de visite à domicile du point de vue de l'opération. Le domaine a une compréhension raisonnable de ce que les visiteurs à domicile peuvent faire pour facilité des interactions qui soutiennent le développement mais le pourquoi et le comment demeurent insaisissables pour bien des visiteurs à domicile. Cette étude qualitative a utilisé une approche théorique fondée modifiée pour faciliter les interactions personne prenant soin de l'enfant - enfant durant les visites à domicile. Des enregistrements vidéo de visite à domicile, préalablement codés en utilisant l'Echelle d'Evaluation de Visite à Domicile (HOVRS en anglais), A+ ont été sélectionnées basé sur la qualité de la facilitation. Seize visites à domicile (8 de scores de plus faible qualité et 8 de scores de la meilleure qualité de facilitation) ont été examinées pour leurs différences dans les comportements du visiteur à domicile qui soutiennent les interactions parent-enfant durant ces visites. Nous avons identifié des comportements contextuels et spécifiques que les visiteurs à domicile ont utilisés afin d'engager activement les personnes prenant soin des enfants et les enfants ensemble dans des interactions soutenant le développement. Les résultats ont révélé 11 comportements de visiteur à domicile qui dans la facilitation distinguant la facilitation de haute qualité. Ces comportements ont été catégorisés en quatre domaines: conditions environnementales, exécuter l'activité, attention mise sur les forces, et réponses de la personne prenant soin de l'enfant. Cette étude qualitative met en lumière des comportements spécifiques et des domaines de développement professionnel pour soutenir des services efficaces de visite à domicile pour une population diverse de familles avec de jeunes enfants.

Exploring Changes in Home Visitors' Perspectives in the Context of a Professional Development Activity.

Research-based professional development opportunities for early childhood home visitors are valuable to the Early Head Start-Home-Based Option (EHS-HBO) and to the home visiting field broadly to strengthen effective practice. We explored EHS-HBO home visitors' (N = 5) perspectives on effective practice through a professional development activity that included viewing videos of their own practice, analyzing the video and assessment data of their practice and parent-child interactions, and reflection. A convergent mixed methods multiple-case study was used. A variety of skills were noted within each case as indicators of effective practice, suggesting that a plethora of complex skills are needed to work with families. Across-case analytic strategies were used to compare subthemes, codes, and substantial statements across cases to generate themes. Two major themes emerged from our data analysis across cases: practicing self-reflective consciousness and building foundations for parent-child interactions. The findings have implications for professional development activities. Supplementary Information: The online version contains supplementary material available at 10.1007/s10643-021-01249-3.

The Early Intervention Referral Process for Rural Infants and Toddlers with Delays or Disabilities: A Family Perspective.

INTRODUCTION: Early intervention (EI) services provide essential support to families of children with delays or disabilities. Children can enter EI via a variety of routes, though all begin with a referral, and for children who require additional services, subsequent referrals are generally warranted. The referral process may be complicated by rurality, but little is known about families' experiences with EI referrals in rural areas. This study focuses on better understanding rural families' perspectives of the EI referral process. METHODS: Families with children in Part C services throughout Montana (N = 30) were interviewed regarding their referral experiences. A layered analysis was used to analyze initial and subsequent referrals, and investigate families' experiences regarding the referral process. RESULTS: Families' reports regarding which professionals provided referrals and who they provided referrals to were diverse. As part of qualitative content analysis three themes emerged: 1) the referral process is both challenging and complex; 2) professionals facilitate connections; and, 3) some professionals may have misconceptions or misunderstandings. Some families discussed how aspects of rurality may have exacerbated the complexities and challenges of the EI referral process. DISCUSSION: Based on families' experiences, professional development related to when, how, and who to refer to EI services, and subsequent support of families during the referral process, may be of utmost importance. Furthermore, families discussed rurality in relationship to turnover rates, limited access to services or specialized knowledge, and travel distance required to receive services, demonstrating the importance of training and retaining rural EI professionals.

The Home Visit Rating Scales: Revised, restructured, and revalidated.

The Home Visit Rating Scales (HOVRS) were initially developed from field-based descriptions of successful home visits and are supported by home-visiting research in multiple disciplines. Four home-visiting practices scales include indicators of relationship building with families, responsiveness to family strengths, facilitation of parent-child interaction, and collaboration with parents. Three family engagement scales include indicators of parent-child interaction, parent engagement, and child engagement in the visit. The original version, the HOVRS-1, was validated using video and data from two Early Head Start home-visiting programs. Conceptual and structural changes for the HOVRS-3 were designed to improve readability, usability, and clarity. Newly trained observers used the HOVRS-3 to observe archived videos from the original measurement sample. The HOVRS-3 showed good interrater reliability, scale internal consistency, convergent validity, predictive validity, practical significance, and version stability. When the HOVRS-3 home-visit quality scores were higher, it was twice as likely for parenting scores to be average or better and for child language to be at age level or better at age 3 years, over and above parenting and child language at age 1 year. The HOVRS can guide observations of home-visit quality in infant-toddler and early childhood programs to improve home-visiting practices and family engagement.

Las Escalas de Evaluación de Visitas a Casa inicialmente se desarrollaron a partir de las descripciones sobre el campo de exitosas visitas a casa y las mismas están apoyadas por la investigación sobre la visita a casa en múltiples disciplinas. Las escalas de prácticas de cuatro visitas a casa incluyen indicadores de relaciones establecidas con familias, sensibilidad hacia los puntos fuertes de la familia, el facilitar la interacción entre progenitor y niño, y la colaboración con los progenitores. Las escalas de participación de tres familias incluyen indicadores sobre la interacción entre progenitor y niño, la participación del progenitor, y la participación del niño en la visita. Se validó la versión original, HOVRS-1, usando un video e información de dos programas de visitas a casa de Un Comienzo Temprano (Early Head Start). Se diseñaron cambios conceptuales y estructurales para HOVRS-3 para mejorar la legibilidad, la disponibilidad para el uso y la claridad. Nuevos observadores entrenados usaron HOVRS-3 para observar videos archivados acerca de las medidas de la muestra original - HOVRS-3 mostró buena confiabilidad entre los evaluadores, consistencia interna de la escala, validez convergente, validez de predicción, importancia práctica y estabilidad de la versión. Cuando los puntajes de calidad de HOVRS-3 sobre la visita a casa fueron más altos, la inclinación de los puntajes de crianza de ser promedio o mejores fue dos veces mayor, así como también fue el lenguaje del niño de estar al nivel de la edad o mejor a los 3 años, muy por encima del lenguaje de crianza y del niño a la edad de un año. Las Escalas de Evaluación de Visitas a Casa pueden guiar las observaciones de la calidad de la visita a casa en programas para infantes y niños pequeñitos y en la temprana niñez para mejorar las prácticas de visitas a casa y la participación de la familia.

Les Echelles d'Evaluation de la Visite à Domicile ont été initialement développées à partir de descriptions sur le terrain de visites à domicile réussies et sont soutenues par les recherches sur les visites à domicile dans de multiples disciplines. Quatre échelles de pratique de visites à domicile incluent des indicateurs de développement de la relation avec les familles, la réaction aux forces familiales, la facilitation de l'interaction parent-enfant, et la collaboration avec les parents. Trois échelles d'engagement de la famille incluent des indicateurs d'interaction parent-enfant, d'engagement parental, et d'engagement de l'enfant durant la visite. La version originale, abrégée en anglais HOVRS-1, a été validée en utilisant des vidéos et des données de deux programmes de visites à domiciles américains dans le cadre du programme d'aide aux enfants défavorisés de Early Head Start. Les changements conceptuels et structurels du HOVRS-3 ont été faits afin d'améliorer sa lisibilité, sa facilité d'utilisation et sa clarté. De nouveaux observateurs fraîchement formés ont utilisé les afin d'observer des vidéos mises en archive de l'échantillon original de mesure. Les HOVRS-3 ont fait preuve d'une bonne fiabilité d'inter-évaluateur, d'une bonne cohérence interne à l'échelle, de validité convergente et de stabilité de version. Lorsque les scores de qualité de la visite à domicile HOVRS-3 étaient plus élevés il était deux fois plus probable que les scores de parentage soient moyens ou mieux et pour le langage de l'enfant qu'il soit au niveau de l'âge ou mieux à l'âge de 3 ans, bien au dessus du parentage et du langage de l'enfant à l'âge de 1 ans. Les Echelles d'Evaluation de la Visite à Domicile peuvent guider des observations de la qualité de la visite à domicile chez les nourrissons-petits-enfants et de programmes de la petite enfance afin d'améliorer les pratiques de visites à domicile et d'engagement de la famille.

HOME VISIT QUALITY VARIATIONS IN TWO EARLY HEAD START PROGRAMS IN RELATION TO PARENTING AND CHILD VOCABULARY OUTCOMES.

Home-visiting programs aiming to improve early child development have demonstrated positive outcomes, but processes within home visits to individual families are rarely documented. We examined family-level variations in the home-visiting process (N = 71) from extant video recordings of home visits in two Early Head Start programs, using an observational measure of research-based quality indicators of home-visiting practices and family engagement, the Home Visit Rating Scales (HOVRS). HOVRS scores, showing good interrater agreement and internal consistency, were significantly associated with parent- and staff-reported positive characteristics of home visiting as well as with parenting and child language outcomes tested at program exit. When home-visiting processes were higher quality during the program, home visit content was more focused on child development, families were more involved in the overall program, and most important, scores on measures of the parenting environment and children's vocabulary were higher at the end of the program. Results showed that home visit quality was indirectly associated with child language outcomes through parenting outcomes. Observation ratings of home visit quality could be useful for guiding program improvement, supporting professional development, and increasing our understanding of the links between home-visiting processes and outcomes.

Academic outcomes of very low birth weight infants: the influence of mother-child relationships.

It is commonly accepted that parent-child interactions are bidirectional and complex and are influenced by many different factors. The current study examined the academic and behavioral skills in the early elementary years of preterm infants and the influence of their early mother-child interactions on these skills. Using a sample of 21 premature infants and their mothers, this study found that positive early interactions during feeding were related to later mutual enjoyment during a teaching task at school age, but early maternal depression was not. Early risk factors of premature infants, specifically the number of days spent on a ventilator, were positively related to maternal perceptions of hassle associated with feeding and negatively related to maternal sensitivity during feeding. Finally, mutual enjoyment was strongly associated with language, cognitive, and behavioral skills at school age. These results suggest that it is not only the infant risk factors following a premature birth that influence later development but also the parent-child relationship and emphasize the importance of understanding and promoting these early positive parent-child interactions for premature infants.

4-(Phenylsulfonyl)piperidines: novel, selective, and bioavailable 5-HT(2A) receptor antagonists.

On the basis of a spirocyclic ether screening lead, a series of acyclic sulfones have been identified as high-affinity, selective 5-HT(2A) receptor antagonists. Bioavailability lacking in the parent, 1-(2-(2,4-difluorophenyl)ethyl)-4-(phenylsulfonyl)piperidine (12), was introduced by using stability toward rat liver microsomes as a predictor of bioavailability. By this means, the 4-cyano- and 4-carboxamidophenylsulfonyl derivatives 26 and 31 were identified as orally bioavailable, brain-penetrant analogues suitable for evaluation in animal models. Bioavailability was also attainable by N substitution leading to the N-phenacyl derivative 35. IKr activity detected through counterscreening was reduced to insignificant levels in vivo with the latter compound.