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Touchpoints for Addressing Substance Use Issues in Home Visiting: Phase 1 Final Report OPRE Report 2020-27 March 2020

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Touchpoints for Addressing Substance Use Issues in Home Visiting: Phase 1 Final Report OPRE Report 2020-27 March 2020 Anchor Touchpoints for Addressing Substance Use Issues in Home Visiting: Phase 1 Final Report OPRE Report 2020-27 March 2020 This page has been left blank for double-sided copying. Touchpoints for Addressing Substance Use Issues in Home Visiting: Phase 1 Final Report OPRE Report 2020-27 March 2020 Mynti Hossain, Lauren Akers, Patricia Del Grosso, Marisa Shenk, Michael Cavanaugh, and Melissa Azur Submitted to: Nicole Denmark, Project Officer Office of Planning, Research, and Evaluation Administration for Children and Families U.S. Department of Health and Human Services Contract Number: HHSP233201500035I Submitted by: Mathematica P.O. Box 2393 Princeton, NJ 08543-2393 Telephone: (609) 799-3535 Project Director: Patricia Del Grosso This report is in the public domain. Permission to reproduce is not necessary. Suggested citation: Hossain, Mynti, Akers, Lauren, Del Grosso, Patricia, Shenk, Marisa, Cavanaugh, Michael, and Azur, Melissa (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. Disclaimer: The views expressed in this publication do not necessarily reflect the views or policies of the Office of Planning, Research, and Evaluation, the Administration for Children and Families, or the U.S. Department of Health and Human Services. This report and other reports sponsored by the Office of Planning, Research, and Evaluation are available at http://www.acf.hhs.gov/opre. This page has been left blank for double-sided copying. ACKNOWLEDGMENTS We would like to express our appreciation to our Project Officer Nicole Denmark (Office of Planning, Research, and Evaluation [OPRE]). In addition, we would like to thank Kathleen Dwyer (OPRE) and Rachel Herzfeldt-Kamprath (Health Resources and Services Administration [HRSA]). We would also like to thank OPRE and HRSA leadership for their contributions to this work. We thank the Mathematica team, including Elizabeth Cavadel, Emily Sama-Miller, Brigitte Tran, Colleen Fitts, and Cindy Castro, as well as our team of editors. We also thank our project partners Dr. Ron Prinz of the University of South Carolina, Dr. Darius Tandon of Northwestern University, and Dr. Norma Finkelstein of the Institute for Health and Recovery. Most of all, we offer our gratitude to the home visiting model developers and Maternal, Infant, and Early Childhood Home Visiting (MIECHV) awardee leaders, and Tribal MIECHV grantee leaders, who shared information with us. We would also like to thank the following members of the project’s expert work group. The views expressed in this publication do not necessarily reflect the views of these members. Robert T. Ammerman Every Child Succeeds Cincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine Allison Barlow Johns Hopkins Center for American Indian Health Ken DeCerchio Children and Family Futures Ruth Paris School of Social Work Boston University Meghan Shanahan Department of Maternal and Child Health University of North Carolina at Chapel Hill (UNC) UNC Injury Prevention Research Center v This page has been left blank for double-sided copying . vi OVERVIEW Introduction 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 funded by the Office of Planning, Research, and Evaluation (OPRE) in the Administration for Children and Families (ACF), U.S. Department of Health and Human Services, in collaboration with the Health Resources and Services Administration (HRSA) and was conducted by Mathematica and its partners, Dr. Ron Prinz of the University of South Carolina, Dr. Darius Tandon of Northwestern University, and Dr. Norma Finkelstein of the Institute for Health and Recovery. Home visiting aims to support expectant parents and families with young children by offering them What is home visiting? “resources and skills to raise children who are Home visiting is a voluntary service in which physically, socially, and emotionally healthy and “trained professionals meet regularly with expectant parents or families with young ready to learn” (HRSA, 2019). Although the children in their homes, building strong, characteristics of the families served, the outcomes positive relationships with families who want targeted, and the service components delivered vary and need support” (HRSA, 2018a). by evidence-based home visiting model What are the major components of home implemented, engaging and supporting families to visiting services? prevent, identify, and address substance use issues is Home visiting services include three major types of activities: (1) assessment of family commonly one of the many outcome areas addressed needs; (2) parent education and support; and by home visitors in their engagement with families. (3) referral to, and coordination with, needed Despite this goal, minimal research has focused on services (Michalopoulos et al., 2015). the ways home visiting programs can effectively What is a home visiting program? engage and support families affected by substance For this project, the term “program” use issues. This report describes what is known and encompasses the implementation of home what needs to be learned about this topic. The visiting services at the local level. 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. Primary research questions This project addressed four primary research questions: 1. 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 and staff to deliver the touchpoints? vii OVERVIEW MATHEMATICA 2. What practices are used by home visiting programs to prevent, identify, and address substance use issues among families, based on information from select model developers, MIECHV awardee leaders, and Tribal MIECHV grantee leaders? 3. What is the state of evidence on practices for working with families with young children Key terms around substance use prevention and supporting Touchpoints refer to activities involving direct families with substance use issues through interaction between home visiting staff and treatment and recovery that can be applied to families through which home visiting programs can help prevent, identify, and address home visiting? substance use issues among families. 4. What research opportunities are available to help Implementation system inputs are stakeholders (researchers, federal staff, model organizational- and home visitor-level resources, infrastructure, and constraints that developers, and program administrators) can support the delivery of home visiting understand how home visiting programs can services. engage and support families to prevent, identify, Practices are procedures, processes, and and address substance use issues? techniques to prevent, identify, and address substance use issues among families. Purpose Active ingredients are the set of characteristics of home visiting programs that Home visiting is generally a prevention strategy are needed to produce specific outcomes, to support parenting and child development. Given whether for most participants or for certain that programs target expectant parents and families families (Home Visiting Applied Research with young children and that they can be tailored to Collaborative, n.d.). 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
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