Introduction
Research Questions
- What are the conceptual touchpoints for how home visiting programs may prevent, identify, and address substance use issues among families (including pregnant women, children, parents, and other family members)? What implementation system inputs support programs to deliver the touchpoints?
- What practices are used by home visiting programs to engage and support families to prevent, identify, and address substance use, based on information from select model developers, MIECHV awardee leaders, and Tribal MIECHV grantee leaders?
- What is the state of evidence on practices for working with families with young children around substance use prevention and supporting families with substance use issues through treatment and recovery that can be applied to home visiting?
Home visiting aims to support expectant parents and families with young children by offering them “resources and skills to raise children who are physically, socially, and emotionally healthy and ready to learn” (HRSA, 2019). Although the characteristics of the families served, and the service components delivered, vary by evidence-based home visiting model, problematic substance use is commonly one of the many outcome areas addressed by home visitors in the course of their engagement with families. Despite this goal, minimal research has focused on the ways home visiting programs can effectively engage and support families affected by substance use issues. This report describes what is known and what needs to be learned about this topic based on a literature review and review of current practices around six “touchpoints” and four “implementation system inputs.” Touchpoints are activities involving direct interaction between home visiting staff and families through which home visiting programs can help prevent, identify, and address substance use issues among families. Implementation system inputs are organizational- and home visitor-level resources, infrastructure, and constraints that can support the delivery of home visiting. The findings contribute to existing literature on home visiting and point to specific research areas that may warrant further investigation by stakeholders to better understand how to work with families to prevent, identify, and address substance use issues.
The Touchpoints for Addressing Substance Use Issues in Home Visiting (Touchpoints) project generated knowledge about how home visiting programs—including those funded through the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program—can engage and support families to prevent, identify, and address substance use issues. The findings from the project identify areas where more information is needed and inform opportunities for future investigation. The project was conducted by Mathematica and its partners, the University of South Carolina, Northwestern University, and Dr. Norma Finkelstein.
Purpose
Home visiting is generally a prevention strategy aimed to support parenting and child development. Given that programs target expectant parents and families with young children and that they can be tailored to fit each individual family’s needs, they are well positioned to reach families at risk of or experiencing substance use issues, and can play an important role in engaging and supporting families to prevent, identify, and address these issues. However, more information is needed about how to integrate evidence-based practices for working with families on these issues into programs. This project helps to fill this gap by providing stakeholders with a summary of what is generally known and what needs to be learned. This report describes project findings around six touchpoints and four implementation system inputs through which home visiting programs can engage and support families to prevent, identify, and address substance use issues.
Key Findings and Highlights
The project team developed an overarching conceptual model to represent a comprehensive and broad range of relevant inputs, touchpoints, short- and long-term outcomes, and contextual factors representing opportunities for home visiting programs to prevent, identify, and address substance use issues among families. Project findings align with the constructs in the overarching conceptual model. However, limited evidence on which touchpoints and practices (sometimes referred to as active ingredients) relate to which outcomes makes it difficult for the conceptual model to fully reflect the pathways through which home visiting programs can engage and support families to prevent, identify, and address substance use issues. As such, the model serves as a framework for future research by identifying theorized pathways that require testing.
Methods
The project activities included:
- Developing an overarching conceptual model
- Developing three detailed conceptual models to further delineate the pathways in the overarching conceptual model
- Conducting an inventory of practices used in home visiting programs
- Conducting a targeted literature review
- Consulting with key stakeholders
- Assessing opportunities for future research
Recommendations
Based on project findings, the project team identified research areas to guide future study. These areas fall into two broad categories:
- Building the evidence base on practices that can be applied at the touchpoints. Practices to examine further include the use of screening results; the types of training that are most effective in equipping home visitors to offer education on substance use prevention, identification, treatment, and recovery to families; and practices to support families in making progress toward their goals.
- Exploring implementation system inputs. Research areas include home visitor competencies and certifications for addressing substance use issues, the presence of substance use issues as a consideration for program eligibility, and the use of monitoring systems to track family retention in referred treatments.
Citation
Hossain, Mynti, Lauren Akers, Patricia Del Grosso, Marisa Shenk, Michael Cavanaugh, and Melissa Azur (2020). Touchpoints for Addressing Substance Use Issues in Home Visiting: Phase 1 Final Report, OPRE Report 2020-27, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.