Objectives This study was conducted to look inside home visits to examine active intervention ingredients used and their relations with ratings of home visit quality. In particular, triadic interactions that engage the home visitor, parent, and child together and provide a context for home visitors to facilitate parent-child interactions by observing, modeling and coaching behaviors that promote optimal child development were examined. Methods Observations were conducted to describe intervention activities (with the HVOF-R) and rate quality of home visit practices and engagement (with the HOVRS A+). Results Analyses revealed the majority of home visit time (71%) was spent in home visitor-parent interactions with only a small proportion of home visit time (17%) spent in triadic interactions and an even smaller proportion of time (2%) during which home visitors actively coached parent-child interactions. Amount of time spent in triadic interactions was related positively to quality ratings of home visit practices and engagement. Moreover, time spent coaching parent-child interactions uniquely predicted home visit quality after accounting for visit length and home visitor time spent observing and modeling. Conclusions for Practice Increasing the percentage of home visitors engage the parent and child in triadic interaction should be a focus for home visiting programs. Home visitors will likely need professional development and supervisory support to enhance their skills in coaching parent-child interactions during triadic interactions.
Examination of and support for specific practices that promote high‐quality home visiting are essential as family support programs continue to expand across the country. The current study used direct observation of 91 home visits across 41 home visitors to examine relations among interaction partners, content of the interactions, the home‐visitors’ activities, and quality of home‐visitors’ practices and family‐members’ engagement within programs funded by the Maternal, Infant, and Early Childhood Home Visiting program. More time spent in triadic interactions focused on child‐related content, as measured by the Home Visit Rating Scale‐Revised, was related to higher quality of family engagement in home visits, as measured with the Home Visit Observation Rating Scales. Time spent in adult‐focused interactions and administrative tasks, however, was related to lower quality of home‐visiting practices and family engagement. Implications for research and practice are discussed.
Face-to-face cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) are time-limited, structured psychotherapies recommended for the management of adult major depressive disorder (MDD) and generalized anxiety disorder (GAD). We conducted a systematic review to evaluate the reporting and methodological quality, and cost-effectiveness of economic evaluations that examined these two thoroughly researched psychotherapies. Economic studies were retrieved through systematic searches of bibliographic databases (e.g., Ovid MEDLINE, Embase, PsycINFO: January 2000 to February 2018) and grey literature. The reporting and methodological quality of the studies was independently evaluated by two reviewers using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist and Quality of Health Economic Studies (QHES) tool. The cost-effectiveness results were qualitatively synthesized. Fifteen out of 161 identified economic evaluations were included: 14 examined CBT and one IPT. None was conducted in Canada. Based on the CHEERS criteria, overall reporting quality of the included studies was good. Eighty-seven percent of the included studies were of high quality based on the QHES criteria. Most of these studies examined the cost-effectiveness of individually delivered CBT (alone or with pharmacotherapy) over a short time horizon. CBT represented good value for money at different country-specific willingness-to-pay thresholds. The cost-effectiveness of IPT was uncertain. In conclusion, the quality of economic analyses examining structured psychotherapies is good. Face-to-face CBT represents good value for money in the management of adult MDD and GAD though no study was done in Canada. The long-term cost-effectiveness of the group versus individual format remains unclear and warrants further research.
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