Growing evidence shows that well-designed and executed home visiting programs — in which trained helpers visit families’ homes to provide information and support during pregnancy and early childhood — yield long-term benefits for children, their families, and society.
Yet, researchers sometimes refer to home visiting programs as a “black box”: outcomes are reported and discussed, but what happens inside a program is often less clear.For the better part of 20 years, Professor Jon Korfmacher has worked to shed light on this. His investigation of home visiting programs has revealed new insights and led to the development of a groundbreaking quality measurement tool.
Having emerged as a leader in home visiting research, Korfmacher is increasingly tapped for his expertise by colleagues, governments, and nonprofit organizations — both in the U.S. and overseas. We spoke with him about his latest endeavors and what’s happening in the field internationally.
One of your recent projects was developing a quality measurement tool with funding from the Pew Center on the States. Talk about that.
Korfmacher: Two colleagues from Wisconsin approached me with an interesting challenge. The home visiting agencies they worked with all claimed to have high-quality programs, but each had a different interpretation of quality. There was no standard tool to measure benchmarks of what makes a good program.
Working closely with these agencies, we created the Home Visiting Program Quality Rating Tool [PDF, 96pg], which is the first to measure program quality across multiple models. This is important for large agencies and states, which have never been able to monitor effectiveness across multiple program models using a single instrument. We hope that the rating tool will serve as an efficient roadmap to improvement for all of their programs.
I also had the opportunity to use the tool to assess birth-to-three home visiting programs in the Illinois State Board of Education’s Prevention Initiative through the Herr Research Center for Children and Social Policy. Following some refinements, the tool is now being piloted in collaboration with the Children’s Trust Fund in Massachusetts. We’ll make further tweaks and distribute it more widely.
Your international work has grown in recent years. What sort of global trends are you seeing?
Korfmacher: There is a big push toward evidence-based practices everywhere in the world. Many countries are looking to the U.S. and United Kingdom for evidence-based models of home visiting, when it is not always clear how well these models can be transferred to other settings or cultures.
A program focused on improving home safety or the home care-giving environment, for example, may have to be radically adapted to fit environments where electrical appliances or printed materials are less readily available. There is also a huge debate about whether to go with what I will simplistically call the “U.S. approach” — home visiting for families most at risk — or the “UK approach” — universal home visiting for all families.
Your first overseas foray was in Brazil. Talk about the work you’re doing there.
Korfmacher: Three years ago, the University of São Paulo’s NEV Center for the Study of Violence was designing a home visiting program to support teen moms in the favelas [slums] of São Paulo, and they invited me down as a consultant and international advisory group member. In an intensive three-day meeting, I helped them work through some basic logic modeling — what they were trying to achieve, what outcomes they wanted to see, and how to measure those outcomes.
On a recent trip, I accompanied a home visitor to the home of an adolescent mother. It was a small, concrete house, with the kitchen doubling as a bedroom. But it was clean, and the family had carved out a special space for the baby. The mother was incredibly excited to show us the mobile she had made from old plastic bottles to provide stimulation for her baby — something she had learned from her home visitor.
I now travel to Brazil about once a year to consult with that group. This led to the opportunity to address a conference of more than 1,000 home visitors in the Brazilian state of Rio Grande do Sul, and most recently to participate in a meeting convened by the Ministry of Health in the country’s capital of Brasilia about establishing a national home visiting program in collaboration with multiple branches of the federal government.
This led to work with Chile. What is developing there?
Korfmacher: In Brasilia I met a Chilean researcher who arranged a meeting with Chile’s Ministry of Health in Santiago. They are trying to decide how to allocate scarce resources to home visiting and had a lot of very direct questions, such as how often visits should happen, what kind of supervision visitors should have, where home visitors should be hired, and how to measure specific personality characteristics.
Countries in South America may have home visiting models that are working well, but they lack established ways to document and share information and discuss common challenges. My colleagues are looking to form a Latin American Home Visiting Network and have invited me to be involved.
What will you embark on next?
Korfmacher: My world tour continues. The regional division of UNICEF that works with Central and Eastern European countries recently contracted with Erikson to create a “toolkit” with recommended screenings, assessments, and curricula that home visitors can use in the region.
While many of these countries have nurse home visitors, their work is narrowly focused — for example, monitoring a baby’s weight rather than health and development more broadly — and the region is struggling with maternal and child health outcomes. One challenge is that these countries are quite diverse, and many of the tools we might recommend have not been adapted in their various languages. The toolkit is currently being reviewed by an international technical advisory group that I am part of. Our future work will focus on developing practice recommendations for this region.
In the U.S., I’m working with the Home Visiting Research Network, newly formed out of Johns Hopkins University and supported by the Health Resources and Services Administration. We did a web survey of thousands of stakeholders and came up with 10 priority areas to set the research agenda over the next few years. I’m heading a committee charged with bringing innovative methods into this research.
I’ll also be leading the development of a “practice-based research network” where individual home visiting programs can participate in applied research focused on improving clinical services.
How has being at Erikson benefited your work?
Korfmacher: Erikson gives me the freedom to pursue this research and values that it is applied work with real-world implications. When I interviewed for a faculty position at other institutions 15 years ago, I had to spend a lot of time explaining why I wanted to do this work. Erikson got it right away.
The Institute sees the relevance and the benefit of this kind of study for children and families — and for our students. I recently started teaching research methods, and the lessons I’ve learned have been good fodder for those classes.