Randomized Trial of a Training Program to Improve Home Visitor Communication around Sensitive Topics

Abstract

IntroductionStrong communication skills are necessary to engage families, perform accurate assessments, and motivate behavior change around sensitive issues encountered in home visiting.MethodsA two-arm, cluster-randomized trial evaluated the impact of a trans-model communications training course for home visitors. Fourteen home visiting programs in Maryland were assigned to a training intervention (n = 7 programs; 30 visitors) or wait-list control group (n = 7 programs; 34 visitors). Independent observers assessed training fidelity. Visitor’s attitudes, knowledge, and confidence were assessed through surveys. Their skills were assessed through coding of video-recorded visits with standardized mothers. Data were collected at baseline, within 2 weeks post-training, and at 2 months post-training. Regression models accounted for clustering within programs and controlled for characteristics on which study groups differed at baseline.ResultsIndependent observers rated the training highly on fidelity and acceptability. Home visitors rated it as useful, consistent with their model, and worth the effort. Immediately following the training, the training group scored higher than the control group on a range of indicators in all domains—knowledge, attitudes, confidence, and skills in using motivational communication techniques. At 2 months post-training, impacts on knowledge and attitudes persisted; impacts on confidence and observed skill were attenuated.DiscussionThe training course showed favorable immediate impacts on knowledge, attitudes, confidence, and skills, and long-term impacts on home visitor knowledge and attitudes. The findings underscore the need for ongoing reinforcement of skills following training.

The Development and Evaluation of a Statewide Training Center for Home Visitors and Supervisors

“…Over 80% reported using training content more than once per week. Although these data were not compared to a control group, these favorable outcomes are consistent with a recent randomized controlled trial demonstrating that our training program improved home visitor skill in using sensitive and motivational communication techniques when discussing challenging topics such as mental health, substance use, intimate partner violence, and parenting (West et al, 2018).…”

“…We neither have independent verification that they did, however, nor know if their use of these skills led to greater support for home visitors. In the RCT of our program, which involved two of the four cohorts evaluated in this study, home visitors demonstrated more use of motivational communication techniques compared to controls immediately following training but then some decline in their skill use 2 months later (West et al., ). Some decline is to be expected, but it also could be that supervisor support for home visitors’ skills was not as strong as intended.…”

“…This paper aims to inform community-based home visiting workforce development by describing the development and evaluation of a unique and multidimensional university-based training certificate program for home visitors and supervisors in Maryland. A recent randomized controlled trial demonstrated that this training certificate program improves home visitor skills in discussing challenging topics such as mental health, substance use, intimate partner violence, and parenting (West et al, 2018). We organize this paper in the following manner: (a) reviewing literature on home visitor competencies and training needs, (b) describing the Interactive Systems Framework for Dissemination and Implementation (ISF; Wandersman et al, 2008) and how our development and evaluation activities align with it, and (c) discussing ongoing challenges and next steps for the training center in its capacity building activities with home visitors.…”

Competency Alignment and Certification for Preservice Home Visitors

“…As support and enthusiasm for home visiting have grown, so too have the expectations for home visits and home visitors. It is not surprising that workforce development is a top agenda item in evidence‐based home visiting programs (Home Visiting Applied Research Collaborative, ; West et al, ). Promotion of high‐quality preservice training in higher education is one important area of home visitor workforce development.…”

“…Both emphasize family self‐sufficiency and well‐being and share other important overlaps that position families' individual needs at the forefront of programming (Walsh, ; Walsh & Mortensen, ). Evidence‐based home visiting models, such as EHS‐HBO, require preservice and ongoing training (Sama‐Miller et al, ; West et al, ). Model‐specific training (Home Visiting Applied Research Collaborative, ; West et al) and training linked to certifications or endorsements are often supported by agencies administering home visiting programs.…”