Measuring success: program fidelity of Queensland’s child health home visiting services. A document analysis

Abstract

Background The Family CA.R.E. (Community-based Assistance Resourcing and Education) program was introduced in Queensland two decades ago. It aimed to redress health inequalities for infants from families experiencing specific social stressors. The program has been locally adapted over time and has not been evaluated against the original program. This study assessed the extent to which selected hospital and health services in Queensland, Australia have modified the original Family C.A.R.E. program. Methods Altheide’s model was used to facilitate a critical document analysis of policies and guidelines for adapted Family C.A.R.E. home visiting programs in use by hospital and health services (target n = 7). Results Five of seven eligible services provided service model documentation. There was low alignment with the original Family C.A.R.E. program across four of the five participating services. While the program delivered within Service 4 was highly aligned to the structure and intent of the original model, variation to the program was still evident. Importantly, four of the five participating programs were not collecting evaluation measures. Conclusions Health services have adapted the original Family C.A.R.E program format to ‘fit’ the local service environment but have largely failed to collect data to facilitate evaluation. Inability to evaluate the program leads to uncertainty about program success and benefits as well as any unintended consequences for families engaging in unevaluated home visiting programs. This study highlights the importance of monitoring program fidelity and evaluating success given the potential ramifications for this vulnerable cohort and for health service delivery.

Child health nurses’ perceptions of the Family Community-based Assistance Resourcing and Education program in contemporary practice: a qualitative study

“…Participants articulated the importance of establishing a trusting relationship with the family and how this influences engagement with the FCP. Previous research has found that effective home visiting services require relationship-based methods of interaction that involve partnership development between families and the clinician (Adams et al 2019;Latham et al 2023). Effective home visiting programs should ensure that parents can develop meaningful personal goals, be provided with a range of strategies and support to select or develop their parenting style, and build parenting confidence and competence (Moore et al 2012;Adams et al 2019).…”

“…The target population consisted of CHNs currently employed by a single regional health service delivering the FCP within south-east Queensland. This service was identified by Latham et al (2023) as having high fidelity with the original FCP program. Two focus groups were conducted to gather meaningful qualitative data about CHN perspectives of the FCP.…”

“…A qualitative case study was conducted across two phases. The first phase, a document analysis comparing adapted programs in use across the state, has been reported elsewhere (see Latham et al 2023). The results of this comparison have informed the current studyan exploratory descriptive qualitative study of CHN perceptions of how the adapted FCP is used, its strengths and limitations, intentions and anticipated outcomes, and the implications of the model's use in contemporary practice.…”

“…The authors identified generally low levels of alignment with the key program elements of the original FCP (particularly eligibility criteria, evaluation measures, program duration and target group) and little evidence of data collection to support evaluation of the programs against stated objectives. Only one hospital and health service identified high alignment, although program variations were still evident (Latham et al 2023).…”

“…The FCP is still in use, in adapted formats, across many of these sites (as of January 2024). A recent document analysis by Latham et al (2023) compared the original FCP with adapted FCP home visiting programs. The authors identified generally low levels of alignment with the key program elements of the original FCP (particularly eligibility criteria, evaluation measures, program duration and target group) and little evidence of data collection to support evaluation of the programs against stated objectives.…”