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Active Ingredients in Precision Home Visiting

 

The home visiting landscape consists of many programs, each with different strategies, goals, and target populations. All home visiting programs, however, include a set of characteristics that must be present for the program to achieve its intended results. In precision home visiting, these are called active ingredients.

Precision home visiting research seeks to determine the elements of home visiting that work best for particular families in particular contexts. In turn, home visiting programs can be personalized to achieve the best outcomes for a family.

How Active Ingredients Work

Active ingredients are the elements of an intervention empirically proven to be responsible for changes in specific outcomes. If active ingredients are not present, the intervention will not produce the desired outcomes.

Active ingredients look different from study to study and from home visiting intervention to home visiting intervention. Some active ingredients are universal; without these elements, a home visiting intervention likely will not work effectively for most participants. Other active ingredients may only be “active” for certain families. Finally, in some cases, multiple active ingredients may be needed to produce certain changes in outcomes.

Active Ingredients and Meaningful Subgroups of Participants

To improve outcomes for diverse home visiting participants, precision home visiting research focuses not only on active ingredients but also on identifying meaningful subgroups of children and families who receive services. Research with a precision lens differs from traditional home visiting research in two key ways:

  • Traditional studies test an intervention across an entire population, then run a secondary analysis to determine if subgroups differ in their response. Precision home visiting research sets out to test an intervention’s effect on different subgroups and incorporates participant factors into the initial research design.
  • Researchers who include subgroups in their analysis traditionally focus on common demographic factors such as race, gender, and socioeconomic status. Precision home visiting research looks beyond commonly used characteristics to consider strengths, needs, and other factors that might affect how an intervention impacts participants.[i]

Examples of Active Ingredients in Practice

Limited research has been done on the active ingredients of home visiting interventions, but current models provide theory-based examples of this concept. The Attachment and Biobehavioral Catch-Up (ABC) model aims to help caregivers have nurturing interactions with their children, follow their children’s lead, and avoid behaviors that are frightening or overwhelming to the child. Coaches visit families in the home for weekly, one-hour sessions over 10 weeks to observe caregiving behaviors and provide specific, “in-the-moment” feedback.[ii] This method of feedback is one theorized active ingredient for improving caregiving behaviors using the ABC model. If an ABC practitioner worked with a caregiver using all the approaches of ABC but did not give that feedback, we would not expect the program to have the intended outcomes. If the home visitor provided feedback about something unrelated to the caregiver’s behavior, such as the safety of a caregiver’s living room, we would not expect to see changes in the caregiver’s interactions with their child.


[i] Segal, L., Opie, R.S., & Dalzeil, K. (2012). Theory! The missing link in understanding the performance of neonate/infant home visiting programs to prevent child maltreatment: A systematic review. The Milbank Quarterly, 90(1), 47-106.
[ii] U.S. Department of Health and Human Services. (2018). Reductions in juvenile delinquency, family violence, and crime. Home Visiting Evidence of Effectiveness. Retrieved from https://homvee.acf.hhs.gov/Model/1/Attachment-and-Biobehavioral-Catch-Up–ABC–Intervention-In-Brief/5