Quality matters.
Little work has examined how parents view home visiting program quality specifically or how programs aim to collect this feedback. However, prior assessment work on home visiting program quality has suggested that relying on simple satisfaction surveys or parent ratings of their home visitor tends to produce results with restricted ranges that don't lend themselves to quality improvement feedback. This project aimed to: (1) describe how program directors currently seek feedback on program quality from parents, (2) describe how parents define quality and experience methods of feedback, (3) use these results to design a measure of parent-defined quality to incorporate into the Home Visiting Program Quality Rating Tool (HVPQRT). The overall aim of this project is to find ways to gather information that provides a greater range of parent experiences and attitudes towards home visiting program operations and services in order to improve home visiting program quality.
We used a mixed-methods approach to explore how family voice was integrated into home visiting services, examining perspectives of both program directors and the families they serve. The data collection process included surveys and semi-structured interviews with program directors, alongside surveys and semi-structured interviews with families.
Though analysis is ongoing, in general we find that:
Home visiting programs typically collect feedback from families in multiple ways
Home visiting program leaders reported that the collected feedback is overwhelmingly positive and parents independently reported nearly complete satisfaction with programming
Because the feedback is rarely negative, it is limited in its ability to improve quality
Parents reported that their main method of giving feedback – informal conversations – are largely self-initiated. This does not seem to yield any changes in practice or programming
What parents and program directors had to say about incorporating family voice in home visiting program quality :
Program leaders reported using surveys most often to collect feedback from parents; but it was unclear how exactly those surveys informed program quality. Echoing many, one program leader stated,
“I'd like to... I really like to see suggestions, like, "What would you like to see in the home visit?" or "What are some things that you would like to learn more about?" I really... and like, I tell them we want them to say, "I love home visits." But what are some ideas that you will have to make it better? You know what I'm saying? So that we know where we need to go. Cause someone we get back, everything is rosy and great. "Oh, I love home visits. I love the lesson. I love this. I love that." And it's nothing negative. It's nothing I can do with this survey, you know. But if you say, "Oh, I would really like to know more about creating a safer home for my children," or "How to go out in public more with my children," or "Some things that I can do to get along with friends and family more." Those things are things to help you in planning.”
Parents expressed frustration that completing the parent surveys is mysterious and opaque:
“I've never actually like thought about it, because I think I do the surveys, thinking that you know each one is looked at very carefully and considered, but I guess I don't know. […] I mean, I don't know if they're anonymous. So that's one aspect. But I was gonna say, I've never necessarily been like followed up with like, ‘Hey, we saw you made this?’ No about ‘blah blah blah like, can we ask you more about that?’ Like I've never, you know, been asked… that to me would probably tell me, like, okay, you're listening, and you're trying to do something.”
I spoke with only one director who reported following up with families who had discontinued services. She stated,
“I think in those cases it is kind of challenge, maybe not the best fit with their home visitor, or there has been a misunderstanding or a conflict with their home visitor. And sometimes […] they are interested in staying in services, and it makes sense to maybe switch their home visitor, and […] we can kind of work something out, you know, where they're able to resolve the issue with the with the staff member with some support.”
This outlier suggests that following up with families that leave the program may be a key way in which programs adjust intimate elements in the home visitor-parent relationship.