Sitting at a tiny table, sippy cup in hand, two-year-old Julio giggles as his speech therapist reads The Very Hungry Caterpillar for the third time. Julio’s mother sits with them at the table. Between pages, she proudly shares how her son increasingly points to and names his favorite foods during mealtime — a skill that Julio has worked hard to improve during home visits with his speech therapist. As if on cue, Julio points to the refrigerator and demands, “Juice!” clearly and without hesitation.
This uplifting scene is a familiar one to the thousands of home visit staff who provide essential early intervention (EI) services to families across the United States. Home visits are a critical component of quality support for young children navigating developmental delays or disabilities. Families learn approaches to use to promote their child’s early development through naturally occurring learning opportunities. This practice not only creates positive outcomes for children but also benefits the entire family unit and the broader community — the ultimate goal of any EI service.
Yet many families still face the impacts of the COVID-19 pandemic, including exacerbated racial education and health inequities, longer wait times to receive evaluations and establish eligibility, and a reduction in the quality and frequency of services. This all can make getting the support their children need to thrive more challenging. In turn, EI providers have seen sharp decreases in family enrollments since 2020 (Mersky et al, 2022), meaning families that may benefit from services aren’t getting them. Now more than ever, families and EI providers alike need high-quality, high-impact home visit programs.
However, local agencies and programs cannot achieve this vision alone. To ensure that every family who needs them actually receives these valuable services, these organizations need statewide and regional support. States and regional organizations have immense potential to unlock the power of home visits to meet critical family needs.
Home Visiting Today: Benefits and Challenges
Home visits have been part of EI provider practices for decades, and research repeatedly shows the many benefits of home visiting programs. A 2013 meta-analysis of research on home visitations found that these services resulted in significant improvements to the development and health of young children (Peacock et al, 2013). Some individual family outcomes cited in the analysis included:
- Early prevention of risk factors and child abuse, in some cases
- Improved cognition
- Reduced problem behaviors
- Reduced instances of low birth weights and health problems in older children
Further, according to the Home Visiting Evidence of Effectiveness (HomVEE) project, there are 18 home visitation models that have been vetted as “evidence-based.” Empirical studies revealed that 10 of these 18 models resulted in significantly positive impacts on child development, maternal well-being, and other family outcomes. Though each model differs in its approach to family and child support, the collective outcomes from these models highlight how powerful home visiting can be.
However, programs face a number of challenges as they seek to reap the potential benefits of implementing home visits with their families. In their 2019 health policy brief, Health Affairs summarized three primary challenges that affect EI programs.
Many visitation programs are voluntary, which means that agencies must dedicate resources toward building and maintaining family enrollment on top of managing other program needs. This can be burdensome for local agencies, who may have limited staff time or funding for recruitment efforts.
Relatedly, although federal funding for the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program was reauthorized by Congress in 2022, EI providers still by and large do not have sufficient resources to meet the broader need to support families through home visits. EI funding challenges impact more than the types and variety of services that families can receive. Funding also affects a program’s ability to recruit home visit staff and provide high-quality training to them.
Last, and most critically, there is tremendous variation among home visiting programs both in terms of implementation and efficacy. Even among those 18 models validated by HomVEE, it’s difficult to isolate which factors across these models make them so effective. This ambiguity complicates current and future efforts to expand models in new ways or recreate them in new places.
The result of these challenges is that many families and young children don’t receive the services that may allow them to best thrive. To put the opportunity into perspective, as recently as 2021, only 1.6% of all families that may benefit from home visits actually received them (National Home Visiting Resource Center, 2022).
But here’s the good news: State and regional programs have a huge opportunity to mitigate these challenges, unlock the benefits of home visiting programs, and create opportunities to strengthen learning and coaching.
State & Regional Programs: Game Changers for EI Providers and the Families They Support
A statewide or regional EI program can catalyze a local agency’s impact on their families through home visits in several key ways.
First, with greater reach comes great distribution. State or regional programs are better positioned to distribute available funding strategically across local partners, prioritizing high-need programs or services. With state funding and legislature for home visitation programs on the rise (National Conference of State Legislatures, 2022), there is more opportunity to both increase and allocate resources to support families that need it most.
Second, states can leverage their macro-position to catalyze communication efforts about local EI services, raising awareness among families to drive enrollment. A state or region-wide campaign can also clarify misconceptions about available programs that offer home visiting, many of which are available for free or are covered by some insurance providers.
Last, regional programs enable EI service providers to better support their families by disseminating must-have information, such as emerging trends in research or changes in legislature that may affect programs. This outreach can also arm local programs with best practices beyond home visit services themselves, such as program evaluation, continuous improvement, and data review processes. As an example, in 2018, the Center for Disease Control (CDC) partnered with four states to help spread new, critical information about autism to early childhood providers through their campaign called “Learn the Signs, Act Early.” Over 1,000 providers received statewide training on the Autism Case Training curriculum — far more than in-house or local agencies have the capacity to support on their own.
It’s clear that statewide and regional efforts to support EI funding and services work — so what can these programs do today to impact home visits tomorrow?
3 Ways States Can Catalyze Home Visiting Programs
State and regional programs are key to catalyzing the reach and impact of home visitation programs on families. From their deep experience supporting statewide early intervention and care programs, the TORSH team put together three strategies to help these critical entities unlock the power of home visits.
#1: Expand Outreach to Eligible Families of All Backgrounds
EI services are crucial tools to promote health equity among children and their families. In particular, The Education Trust highlights a critical need for states to engage BIPOC families and families who speak home languages other than English in their efforts to promote EI.
Why? Patterns of inequity in both access to and utilization of EI resources are present among these families. Research shows that Black children with developmental delays are 78% less likely to receive EI services (Feinberg et al, 2011), and similar patterns of inequity emerge among children from other racial or ethnic groups other than White children (Magnusson et al, 2016). The urgency to create equitable access to all families for EI support cannot be understated.
And who knows their community’s cultural diversity and backgrounds better than the local agencies that serve them? Through partnerships with local programs, states can help further spread information about these services to families of diverse backgrounds, especially those that traditionally underutilize statewide or regional intervention supports.
Here’s just one way in which states can create more equitable access to EI services. A key barrier to families accessing early intervention services is how complex and uncoordinated services often are. Minnesota, Oregon, Colorado, and many other states have invested in community-informed family navigation models that are designed to simplify the process of finding services. These models leverage local organizations and agencies to connect families with a person in their community who shares their language and race/ethnicity, acting as guides for the process. These guides work closely with families to determine what services they’re eligible for and then help them take the steps necessary to receive services. Support can include explaining the process, helping to fill out forms, and following up by phone, text, email, and even home visits to ensure families are receiving the services they need.
The results of these statewide efforts are powerful. In Minnesota, the community resource hubs served a greater percentage of people from diverse racial and ethnic backgrounds than their populations in the state. Here’s a snapshot, 15% of the people served were Latino (of any race), 10% were Black, and 10% were Indigenous. For context, the state’s population of Latino people is just 5.8%,the population of Black people is only 7.4%, and Indigenous people account for only 1.4% of the population. This locally-based model is hugely successful in reaching historically underserved communities in the state and is inspirational for other organizations to create more equitable access to EI services for all families.
#2: Invest in Professional Development for Staff
Whether they’re conducting assessments, coaching parents, or providing other services, home-visiting staff are the bridge between what families may need and the services that can help. However, delivering high-quality services during home visits means providing practitioners with more than a one-time workshop or training series. States are well positioned to ensure home visit providers receive ongoing professional learning and coaching — not only about evidence-based practices for EI but also about programmatic processes for continuous improvement.
Several state and regional programs offer inspiration with their comprehensive professional development approach for EI providers. For example, Florida’s Early Steps program utilizes TORSH Talent, a HIPAA secure coaching and professional learning platform, to support comprehensive training for providers and caregivers in the Anita Zucker Center for Excellence in Early Childhood Studies at the University of Florida. Using TORSH Talent’s tools, experts provide evidence-based feedback on using the most current social-emotional practices and EI frameworks through video observations and coaching. These practices offer new benchmarks for creative professional learning and early intervention training that can be adopted by other service providers throughout the state.
Over in Kentucky, the University of Louisville also takes advantage of TORSH Talent to deepen their interventionists’ experience partnering with families during home visits. Ongoing mentorship and feedback are essential to the Coaching in Early Intervention Training and Mentorship Program, and TORSH Talent provides the perfect space to facilitate both. Video recordings of early intervention services, time-stamped feedback, and various rubric tools all support this effective early intervention coaching model.
The nonprofit Zero to Three shares that states can also nurture effective professional development practices by:
- Forming state or region-wide professional learning communities for home visit staff to share resources, questions, and mutual support for one another’s work
- Designing and sharing example processes or tools that support program evaluation and continuous improvement efforts, including guidance on how to leverage early intervention data to guide coaching
- Collecting and reviewing broader data trends across EI programs to inform improvements to professional development models
Professional development for early intervention service providers is a key ingredient in any effort to improve family outcomes. By investing EI funding diligently and comprehensively into professional learning for home visiting programs, states and regional entities set up local providers and families for long-term success.
#3: Leverage Technology to Increase Access to Families
From supporting virtual home visits to bolstering family-provider collaborations between live visits, technology helps broaden and deepen the impact of EI services for families. State and regional entities can provide funding for implementing digital tools like TORSH Talent to ensure all families can more easily access local services.
A beautiful example of the power that technology offers can again be found in Florida. The Autism Institute collaborated with TORSH to implement TORSH Talent as a way to support families in identifying early signs of autism in children. Using TORSH Talent, parents can video their child and securely send the videos to the Institute, whose team then reviews these videos to aid in diagnosing children with autism. If children do have autism, the Institute can provide intervention services remotely. By using TORSH Talent to provide virtual home support the Autism Institute meets their families right where they are.
“Before TORSH Talent, our impact was limited to Florida families or those with the means to travel to our center. With TORSH Talent, we’re able to offer services to any family anywhere. Our diagnosticians are now conducting virtual home observations of children with early signs of autism. Our interventionists remotely coach parents on evidence-based strategies they can use to support their child’s learning in everyday activities. One of the most exciting opportunities TORSH Talent has afforded us is the ability to train interventionists from around the world on our parent-implemented Early Social Interaction model. TORSH Talent removes barriers to our goal of making early detection and early intervention viable for all families regardless of location or socioeconomic status.”
Integrate Evidence-Informed Practices in Home Visiting Programs with TORSH
The Communication and Early Childhood Research and Practice Center (CEC-RAP) is dedicated to advancing the field of early intervention and education for young children with disabilities, communication disorders, and/or multiple risks. Their interdisciplinary approach fosters collaboration with projects nationwide, allowing for groundbreaking research and service delivery expansion.
By partnering with TORSH, CEC-RAP empowers early intervention providers with professional development and coaching from a distance. Regardless of which state they’re located in, early intervention providers can effortlessly share their practice videos with agency team members and external coaches from Florida State University, where CEC-RAP is based. This seamless collaboration, powered by TORSH Talent, ensures optimal support and better outcomes for children and their families.
TORSH Talent also gives practitioners access to a best practices library and comprehensive self-assessment capabilities conveniently located in one platform. Early intervention providers are empowered to be internal coaches, promoting sustainability in their states by embedding Family Guided Routines Based Intervention (FGRBI) into their home visiting practices.
From building a comprehensive training resource library to driving high-impact virtual coaching, statewide and regional programs can take full advantage of the easy-to-use and secure tools built into TORSH Talent, including tools for:
- Video-based observation
- Providing targeted, specific feedback to early interventionists on their interactions with children and families
- Synchronous and asynchronous collaboration
- Individualized coaching and mentoring
- Insights to guide professional learning and training
Discover how state and regional early intervention programs can leverage TORSH Talent to increase family engagement, strengthen home visit programs, and pave the way to a better future for all families and young children. Contact us now to get started supporting deeper learning, greater collaboration, and a stronger practice.