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Home Visiting with Partners for a Healthy Baby (PHB) Curriculum

Category

Family Support

Child's Age

Prenatal, 0-1 years, 1-2 years

Participant

Parents/Guardian

Languages

English

Brief Description

Intensive home visiting services provided by a professional trained to support families with children ages birth to 2 years using the Partners for a Healthy Baby (PHB) curriculum.

Expected Impact

  • Increase in positive parenting practices (including: regularly reading with young children, engaging in safe sleep practices, abstaining from smoking cigarettes during third trimester, receiving well child visits) 
  • Decrease in abusive and neglectful parenting practices (including: harsh parenting, physical abuse, physical and psychological aggression against their children) 

Core Components for Model Fidelity

  • Home Visits Utilizing the Partners for a Healthy Baby Curriculum: Home visitors use the Partners for a Healthy Baby curriculum to structure their visits and focus on family-identified goals and needs. Examples of topics discussed during home visits include, but are not limited to:  
    • Framing each priority behavior identified by the family (e.g., breastfeeding protects your child early and has lifelong benefits) 
    • Providing applicable information and resources to the participant (e.g., breastfeeding will hurt in the beginning, but you can prepare your breasts and know that the tenderness will stop in about a week) 
    • Building the skills and routines that help consistently implement a new behavior 
    • Providing social support for new routines 
    • Eliminating environmental barriers to achieve the priority outcome behavior 
  • Community Referrals: Referrals are provided to appropriate and needed community resources with follow-up, warm hand-off, and tracking of referrals to ensure high completion rate. 

Languages Materials are Available in

English

Delivery Mode

Visits are typically provided in person in the client’s home. When needed, services can be provided virtually or in community locations convenient to the family. 

Dosage

During pregnancy, home visits occur at least once a month and last approximately 1 hour. Visits occur on a weekly basis immediately after birth and, based on the family’s needs, decrease over time to a monthly cadence. Based on the evidence, it is recommended that services be provided for the first 2 years of the child’s life. 

Staffing Requirements

Home visitors utilizing the PHB curriculum must have a master's degree in a relevant field such as social work, public health, child and family counseling, or child development or a bachelor's degree with at least 2 years of experience in a similar position. Home visitors must have experience working with families, be representative of the community served, and receive appropriate training.

Training for Model Fidelity

Curriculum training for home visitors and supervisors is provided through Florida State University’s Center for Prevention & Early Intervention Policy.  

Home visitors must complete the 2-day Virtual Partners for a Healthy Baby Training provided by the creators at Florida State, as well as the Partners for a Healthy Baby “Let’s Explore!” Developmental Activities 3-hour workshop.  

Supervisors must complete the full-day Partners for a Healthy Baby Workshop for Supervisors. 

NCPC requires staff to receive training in the Standards of Quality for Family Support and Strengthening for this activity. Contact Positive Childhood Alliance North Carolina (PCANC) or National Family Support Network (NFSN) for more information, training, and certification. 

NCPC recommends that staff receive training in cultural responsiveness, protective factors, motivational interviewing, cultural humility. NCPC recommends the following additional training options:  

Contact Information

https://cpeip.fsu.edu/phb/

Mirine Richey, MPH, IBCLC: Research Faculty; m.richey@fsu.edu, 850-644-2067

Christine Chiricos, PhD: Senior Research Associate; cchiricos@cpeip.fsu.edu

Cost Estimates

The Virtual Partners for a Healthy Baby Training for home visitors is a 2-day training that costs $475 per person and consists of 10.5 contact hours. Home visitors also complete the Partners for a Healthy Baby “Let’s Explore!” Developmental Activities training, which is a 3-hour interactive workshop that costs $175 per person. 

The Partners for a Healthy Baby Workshop for Supervisors is a full-day interactive workshop for supervisors and coaches. This virtual training costs $300 per person. 

Purpose Service Code (PSC)

5525 – Home Visiting

Program Identifier (PID)

Home Visiting with Partners for a Healthy Baby Curriculum 

Minimal Outputs for NCPC Reporting

FY 24-25: 

  • Number of parents/guardians participating† 
  • Average number of Home Visits Per Participant 

Minimal Outcomes for NCPC Reporting

FY 24-25: 

  • Increase in positive parenting practices 

Minimal Measures for NCPC Reporting

FY 24-25: 

  • Standards of Quality Parent Survey 
  • Standards of Quality Program Assessment 
  • Partners for a Healthy Baby- Parent Education Assessment 
  • Protective Factors Survey- Version 2  

NCPC Evidence Categorization

Evidence Informed- Two studies, one of which utilized a randomized experimental design with a control group. 

Research Summary

Two of the most recent and relevant publications on home visiting with the Partners for a Healthy Baby (PHB) curriculum include an evaluation of the Healthy Families New York (HFNY) program during the first 2 years of the child’s life1 and an evaluation of the MomsFirst home visiting program in Cleveland, Ohio during the first 18 months of life.2 Both studies sampled diverse populations, including participants who identified as African-American or Black, White, and Latina; adolescent mothers (age 19 or younger); mothers paying for services with Medicaid; participants with varying levels of education, including those without a high school diploma; mothers who are incarcerated; mothers residing in homeless shelters; participants receiving in-patient treatment for chemical dependencies; mothers who received assistance from welfare services; and mothers who reported experiencing abuse or neglect in their childhood. Dosage varied from at least once a month to weekly, depending on the program and family needs. Measures included the Kempe Family Stress Checklist, Conflict Tactics Scale (CTS-PC), CPS records, Center for Epidemiologic Studies Depression Scale (CES-D), and items from the Revised Conflict Tactics Scale (CTS2) and RAND 36-Item Health Survey 1.0. Results of these studies indicated that home visiting programs utilizing the PHB curriculum improved outcomes related to women's health (percentage of participants with health insurance, a reproductive life plan, abstaining from smoking cigarettes in third trimester, and a usual source of medical care) and family health and wellness (implementation of safe sleep practices, regular reading to young children, well child visits, and father and/or partner involvement during pregnancy). Participants were significantly less likely than their peers in a control group to report engaging in abusive and neglectful parenting practices, such as harsh parenting, physical abuse, and physical and psychological aggression against their children. Together, these results suggest that intensive, comprehensive home visiting programs that utilize the PHB curriculum are effective in improving outcomes for pregnant and parenting people and their children. 

  1. ^ See Dumont et al. (2008). This report evaluates the impacts of the Healthy Families New York (HFNY) home visiting program on parenting behaviors during the first 2 years of the child's life, with a focus on preventing child abuse and neglect. HFNY is staffed by Family Assessment Workers (FAWs), who use the Kempe Family Stress Checklist to assess families for risk of child abuse or neglect, and Family Support Workers (FSWs), who are trained paraprofessionals who reflect the communities they serve through home visits using curricula approved by Healthy Families America (HFA), such as Partners for a Healthy Baby, Parents as Teachers, and Helping Babies Learn. FSWs are not required to have post-secondary education, but approximately a third of HFNY FSWs are college graduates. All staff members complete training on home visits, assessments, parent-child interaction, child development, and strengths-based service delivery. FSWs receive additional support through weekly meetings with supervisors, quarterly observations, intensive "wraparound" training, and shadowing experienced home visitors before being assigned to families. HFNY home visits occur biweekly during pregnancy and weekly after birth. Visits occur less frequently as families progress through different service levels and continue until the child is 5 years old or enrolls in Head Start or Kindergarten. This study utilized a randomized experimental design at three sites in which women completed an assessment and were randomly assigned to an intervention (n = 579) or control group (n = 594) if they met the eligibility criteria for HFNY. Demographic data indicated that participants identified as African-American, non-Latina (45.4%), White, non-Latina (34.4%), and Latina (18.0%). Approximately 20% of participants had prior child abuse or neglect reports, with 9% of these reports being substantiated. About half of mothers reported a history of maltreatment in their childhood (48.7%), were randomly assigned to a treatment group at a gestational age of 30 weeks or less (48.5%), and were first-time mothers (54.2%). Roughly a third of mothers were less than 19 years old (31.0%) and a third of families received assistance from welfare services (29.2%). There were no significant differences between the control and intervention group. The authors also identified an analytic subgroup of 122 mothers who were considered psychologically vulnerable based on the presence of depressive symptoms and mastery of coping resources, and a second analytic "prevention" subgroup of 170 first-time mothers under the age of 19 who were randomly assigned at a gestational age of 30 weeks or less. Mothers in the psychologically vulnerable subgroup were less likely than the other participants to be first-time mothers, were slightly older, and had higher rates of prior substantiated CPS reports, although these differences were not statistically significant. Women in the prevention subgroup were younger than mothers in the overall sample and had no prior substantiated CPS reports. Measures included the Kempe Family Stress Checklist, Conflict Tactics Scale (CTS-PC), CPS records, Center for Epidemiologic Studies Depression Scale (CES-D), and items from the Revised Conflict Tactics Scale (CTS2) and RAND 36-Item Health Survey 1.0. Results of the study found no statistically significant differences between the intervention and control groups for the prevalence or frequency of substantiated CPS reports at year 1 or year 2. At year 1, however, mothers in the HFNY intervention group reported significantly lower frequencies of very serious physical abuse (p = 0.04), minor physical aggression (p = 0.017), and psychological aggression in the past year (p = 0.007), and harsh parenting in the past week (p = 0.04) compared with the control group. At year 2, the intervention group reported a significantly lower frequency of serious physical abuse than the control group (p = 0.03). Mothers in the prevention subgroup were significantly less likely to report engaging in minor physical aggression in the past year (p = 0.02) and harsh parenting in the past week (p = 0.02) than the control group. Mothers in the psychologically vulnerable subgroup were less likely to report engaging in acts of serious abuse or neglect. Altogether, these results indicate that participation in HFNY was associated with reductions in mothers' reports of engaging in abusive and neglectful parenting practices, such as harsh parenting, physical abuse, and physical and psychological aggression against their children. There were no significant impacts on CPS reports, however. Study limitations include the focus on children ages 2 and under, despite HFNY serving children up to age 5. The authors also reported high levels of attrition as half of mothers in the HFNY group dropped out of the program by year 1 and only a third of HFNY participants were still enrolled at the end of the second year.
  2. ^ See Jackson et al. (2020). This evaluation report describes findings from the MomsFirst home visiting program in Cleveland, Ohio. MomsFirst utilizes the Partners for a Healthy Baby curriculum when providing services to families during pregnancy and throughout the first 18 months of their baby's life. The primary audience is pregnant women and teens in Cleveland who are at risk for poor birth outcomes. This includes pregnant women and teens who are incarcerated, residing in homeless shelters, or receiving in-patient treatment for chemical dependencies. MomsFirst is funded by Cleveland's Healthy Family/Healthy Start program which seeks to address and reduce racial disparities in infant mortality. Additionally, MomsFirst services are provided by highly skilled Community Health Workers who are trained on Partners for a Healthy Baby, referral processes, data collection, and use of the MomsFirst data system, and receive additional support through follow-up trainings and quality assurance reviews 2-4 times per year. Community Health Workers connect with families at least once per month. This report includes impacts observed during the COVID-19 pandemic as services transitioned to remote delivery modes in the spring of 2020. Community Health Workers provided services via telephone or video calls and dropped off resources to participants as needed, respecting social distancing protocols. In the fall of 2020, virtual support groups were established to build connections between Community Health Workers and participants who had not had the opportunity to meet in person due to the pandemic. In early 2021, a focus group with Community Health Workers was conducted to understand provider experiences with remote service delivery. Community Health Workers reported that they found using multiple means of communication was most effective to engage and retain MomsFirst participants. This included phone calls, texting, and dropping off materials in person, and the multiple modalities allowed for greater flexibility and continuity during a challenging time. However, families' comfort with and access to technology and various platforms varied. Community Health Workers reported increases in their clients' stress, instability, and family illnesses as a result of the pandemic. The authors report that MomsFirst served 1,061 women and their families in 2020. Of these participants, 41.7% were less than 25 years old, 12.7% were less than 20 years old, 68.0% were not employed, and 92.3% had never been married. MomsFirst participants had a higher percentage of teen births (14.4%), were more likely to pay for their delivery via Medicaid (94.6%), and were more likely to not have received their high school diploma (31.3%) compared with unserved mothers in Cleveland (8.2%, 72.8%, and 20.9%, respectively). MomsFirst participants have a slightly higher rate of low and very low birth weight births (15.4% and 2.7% respectively) compared with the overall rate in the Cleveland (13.6% and 2.5% respectively). Additionally, the infant mortality rate among MomsFirst Participants in 2020 was 18.0 deaths per 1,000 live births, compared with 18.4 for Black babies and 3.3 for White babies born in Cleveland. Healthy Start requires use of the standardized Healthy Start Screening Tools, including the Benchmarks and Performance Measures. In 2020, MomsFirst successfully met or exceeded the following goals related to improving women's health: an increased percentage of women participants with health insurance, a reproductive life plan, and a usual source of medical care; and an increased percentage of women participants who received a well-woman visit. MomsFirst improved family health and wellness by increasing the percentages of child participants who were placed to sleep following safe sleep practices, who received well child visits, and who were read to an average of 3 or more times per week at ages 6-23 months. MomsFirst also decreased the percentage of women participants who conceived within 18 months of their previous live birth and increased the percentage of women participants who abstained from smoking cigarettes in their third trimester, who received intimate partner violence screenings, and who reported father and/or partner involvement during pregnancy. The MomsFirst program also promoted systems change by implementing a Community Action Network (CAN) with quarterly meetings, membership from a variety of community sectors, shared measurement and metrics, open communication across partners, and other components implemented by the CAN. Goals that were not achieved were largely attributed to the limitations and challenges of the pandemic. The authors did not provide information on statistical significance of their findings.

Researched Population

  • African-American or Black, White, and Latina participants  
  • Adolescent mothers (age 19 or younger) 
  • Mothers paying for services with Medicaid and received assistance from welfare services 
  • Participants with varying levels of education, including those without a high school diploma 
  • Mothers who reported experiencing abuse or neglect in their childhood 
  • Mothers who are incarcerated 
  • Mothers residing in homeless shelters 
  • Participants receiving in-patient treatment for chemical dependencies 
  • Perinatal populations, up to the child’s 2nd birthday  

Dumont, K., Mitchell-Herzfeld, S., Greene, R., Lee, E., Lowenfels, A., Rodriguez, M., & Dorabawila, V. (2008). Healthy Families New York (HFNY) randomized trial: Effects on early child abuse and neglect. Child Abuse & Neglect, 32(3), 295-315. https://doi.org/10.1016/j.chiabu.2007.07.007 

Jackson, F. G., Kimball, B., Mills, F., & Matthews, L. M. (2020). MomsFirst Local Evaluation 2020. MomsFirst. https://static1.squarespace.com/static/5669e7885a566831fa755e9b/t/61967fd927edf84430c847b9/1637253084413/momsfirst+2020+local+evaluation+draft+final_11_4.pdf



Local Partnerships Currently Implementing

Local Partnerships in purple have adopted Home Visiting with Partners for a Healthy Baby (PHB) Curriculum. Local Partnership contact information can be found here.