Assessing Needs and Resources for the Home Visiting System in Alabama: A Mixed Methods Approach

Abstract

The purpose of this article is to describe the initial assessment for the development of a home visiting (HV) system in a state with no existing system. We outline a mixed methods process where the quantitative component was used to identify the communities that possess "at-risk" profiles, and the qualitative component explored the resources and gaps in existing HV services. We employed a mixed methods approach, using six categories of indicators from quantitative secondary data sources to identify "at-risk" profiles for Alabama's 67 counties. A weighted score for each indicator was calculated and counties were ranked. Surveys and focus groups were conducted to further define resources and gaps of existing HV programs. The composite indicator scores identified 13 counties as having the highest level of risk. Five of these 13 communities had no HV home visitation services. Areas of focus for future HV system development include trust, communication, availability, cost, and timeliness. In this assessment related to the Alabama HV system, we used quantitative data to apply criteria to the indicators being measured and qualitative data to supplement the quantitative findings. We examined resources, gaps, program quality, and capacity of the existing HV programs in order to assist in the future development of the HV system and early childhood system. The methods presented in this paper have potential applications beyond HV programs and systems, including broader examinations of complex systems for service provision to the maternal and child health populations.

Advancing Quality Improvement in Public Health by Exploring CQI in Alabama's Home Visiting Program

“…In 2010, on the basis of a statewide home visiting needs assessment, First Teacher started with 13 counties in the state deemed "most at risk" for poor health, developmental, psychosocial, and economic outcomes for children and families. 8 As of 2019, First Teacher serves all 67 counties in the state. In Alabama, the Department of Early Childhood Education (ADECE) is the state awardee; members of the University of Alabama at Birmingham School of Public Health (UAB-SOPH) provide support services, including CQI.…”

“…First Teacher is Alabama's MIECHV-funded program. In 2010, on the basis of a statewide home visiting needs assessment, First Teacher started with 13 counties in the state deemed “most at risk” for poor health, developmental, psychosocial, and economic outcomes for children and families 8. As of 2019, First Teacher serves all 67 counties in the state.…”

Retention and attrition in a home visiting programme: looking back and moving forward

“…Previous researchers have identified differential reasons for attrition in HV programmes, including (a) lack of interest (Lutzker, Tymchuk, & Bigelow, 2001;Stevens, Ammerman, Putnam, Gannon, & Van Ginkel, 2005); (b) lack of perceived benefits (Garvey, Julion, Fogg, Kratovil, & Gross, 2006;Holland, Christensen, Shone, Kearney, & Kitzman, 2014;Stevens et al, 2005); (c) lack of adherence to visit schedules (Ammerman et al, 2006;Wagner, Spiker, Gerlach-Downie, & Hernandez, 2000); (d) external distractions and unstable housing (Holland et al, 2014;Wagner et al, 2000); (e) confusion regarding programme expectations (Green, McAllister, & Tarte, 2004;Stevens et al, 2005;Wagner et al, 2000); (f) perceived intrusiveness of programme staff (Korfmacher & Marchi, 2002;Wingate et al, 2014); and (g) home visitor/parent match (Brooks-Gunn, Berlin, & Fuligni, 2000;Brookes, Summers, Thornburg, Ispa, & Lane, 2006).…”

“…Each state was given the flexibility to define communities and develop suitable measures for identifying areas of greatest risk in order to most effectively target HV services. In Alabama, at-risk communities were considered those with high concentrations of risk factors related to preterm birth, low birth weight infants, infant mortality, poor maternal health, poverty, crime, domestic violence, high school drop-out rates, substance abuse, unemployment, and child maltreatment (Wingate et al, 2014).…”