Abstract
Early childhood home visiting programs are well positioned to improve equity and reduce health disparities for families headed by caregivers with intellectual disabilities and other learning differences. Early identification of learning differences through screening may help home visiting staff tailor services and thus improve family engagement and outcomes. Using a mixed methods design, this study assessed potential determinants and outcomes related to implementation of a screening tool for learning differences adapted for the home visiting context. Participants were six home visiting staff and nine caregivers from multiple home visiting programs in one state. Staff completed surveys at enrollment and each time they conducted a screen with a caregiver. Staff also completed semi-structured interviews after conducting screens with at least two caregivers. Caregivers completed semi-structured interviews after taking part in a screen. At study enrollment, staff felt it was important to know if caregivers had learning differences, yet some believed caregivers would not like being asked about them. Survey and interview data aligned with theoretical determinants of implementation success, including staff competencies related to screening (e.g., knowledge, skills), perceived fit of screening with staff role and organizational context, and beliefs that the screening would improve engagement of caregivers and service delivery. Staff perceived the tool to be acceptable, feasible, and useful, although some acknowledged that caregivers might feel uncomfortable if the tool was not used carefully. Overall, caregivers found the tool to be acceptable and most believed it was helpful for the home visitor to have information about their learning experiences and needs. Findings lend initial support for the use of an adapted screening tool to identify potential learning differences.
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Acknowledgements
We thank all the members of our Stakeholder Advisory Group for their contributions to study conceptualization and methodology.
Funding
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number X10MC3114601, Maternal and Infant Early Childhood Home Visiting (MIECHV) program.
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AW: conceptualization, methodology, writing—original draft, funding acquisition, supervision; KW: formal analysis, writing—original draft; JD: investigation, writing—review and editing; LC: formal analysis, writing—review and editing.
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Study procedures were approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.
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West, A., Williams, K., Daniels, J. et al. Feasibility, Acceptability, and Usefulness of a Screening Tool for Caregiver Learning Differences in Early Childhood Home Visiting: Staff and Caregiver Perspectives. Prev Sci 25, 448–458 (2024). https://doi.org/10.1007/s11121-024-01642-5
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DOI: https://doi.org/10.1007/s11121-024-01642-5