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Critical Components of 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 critical components.

Precision home visiting aims to identify critical components of home visiting interventions and to empirically test how these components impact diverse home visiting participants. In turn, interventions can be personalized to achieve the best outcomes for a family.

The two types of critical components

Essential implementation components are the elements of a home visiting program that ensure the program is delivered in a manner that allows for changes in outcome. For example, essential implementation components could be staff members’ foundational knowledge for implementing program elements, supports provided to staff, or program delivery mechanisms.

Essential operational components are the factors responsible for driving changes in outcomes for home visiting participants. For example, essential operational components could be specific lessons that the home visitor delivers to parents or the parents’ receptivity to these lessons.

If either the essential implementation components or the essential operational components are absent, the outcomes will not be achieved. This process can be thought of like a multiplication problem. If either value being multiplied equals zero, the outcome of the equation will be zero.

Adapted from the National Implementation Research Network. (2013). Implementation Drivers: The Infrastructure to Promote Success. University of North Carolina at Chapel Hill: Karen A. Blase. Retrieved from http://slideplayer.com/slide/10719910/

More about essential implementation components

Essential implementation components include the training necessary to ensure home visitors have the knowledge, skills, and motivation to deliver a home visiting intervention. Additionally, implementation components include things like structural supports, home visits, supervision, coaching, policies and procedures, and all necessary actions for the delivery of the home visiting intervention. This is the actual process of using the training and support that the home visitor received to go into a family’s home and work with that family. implementation components facilitate the delivery of services that change outcomes for families.

More about essential operational components

There are two categories of essential operational components: active ingredients and the relationship between the family and home visitor.

Active ingredients are the program elements responsible for driving changes in parents’ knowledge, attitudes, and behaviors. Active ingredients could include, for example, a specific lesson teaching parents about the importance of reading to their children, a home safety action plan the home visitor completes with the parent, a 15-minute video shown to parents on promoting secure attachment, or any other core intervention component that has been empirically tested to show that if it is not present, the intervention does not produce the outcomes desired. Active ingredients are delivered to the family through the home visiting intervention.

The relationship between the family/home visitor is how the family and home visitor engage with the content and interact with each other. The relationship could include, for example, a family or home visitor’s interpretation of the curriculum or program content, a family’s personal compatibility with and positive regard for the home visitor and vice versa, or any other aspect of how the family and home visitor relate to one another or the content.

Examples of critical components

The bread example

One example of the critical components concept can be seen in the process of baking a loaf of bread. Most loaves of bread need yeast, flour, and water (the essential operational components), but you also need heat to cook the bread (essential implementation components). You can bake bread at different temperatures and you can add different flavors, but without yeast, flour, and water, the ingredients will not become a loaf of bread.

A home visiting example

The Attachment and Biobehavioral Catch-up (ABC) intervention is a home-based, parent skills-training program. An active ingredient of ABC is having home visitors provide in-the-moment feedback on a caregiver’s interaction with their child. 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.