Triadic Interactions in MIECHV: Relations to Home Visit Quality

Objectives This study was conducted to look inside home visits to examine active intervention ingredients used and their relations with ratings of home visit quality. In particular, triadic interactions that engage the home visitor, parent, and child together and provide a context for home visitors to facilitate parent-child interactions by observing, modeling and coaching behaviors that promote optimal child development were examined. Methods Observations were conducted to describe intervention activities (with the HVOF-R) and rate quality of home visit practices and engagement (with the HOVRS A+). Results Analyses revealed the majority of home visit time (71%) was spent in home visitor-parent interactions with only a small proportion of home visit time (17%) spent in triadic interactions and an even smaller proportion of time (2%) during which home visitors actively coached parent-child interactions. Amount of time spent in triadic interactions was related positively to quality ratings of home visit practices and engagement. Moreover, time spent coaching parent-child interactions uniquely predicted home visit quality after accounting for visit length and home visitor time spent observing and modeling. Conclusions for Practice Increasing the percentage of home visitors engage the parent and child in triadic interaction should be a focus for home visiting programs. Home visitors will likely need professional development and supervisory support to enhance their skills in coaching parent-child interactions during triadic interactions.     

Correction to: Work-Related Stressors Among Maternal,Infant, and Early Childhood Home Visiting (MIECHV) Home Visitors: A Qualitative Study

Maternal and Child Health Journal - The article “Work-Related Stressors Among Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Home Visitors: A Qualitative Study”, written...     

Work-Related Stressors Among Maternal,Infant, and Early Childhood Home Visiting (MIECHV) Home Visitors: A Qualitative Study

Background The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program delivers evidence-based home visiting services to over 1400 families each year. Home visitors are integral in providing resources for families to promote healthy pregnancy, child development, family wellness, and self-sufficiency. Due to the nature of this work, home visitors experience work-related pressures and stressors that can impact staff well-being and retention. Objectives The purpose of this study was to understand primary sources of work-related stress experienced by home visitors, subsequent effects on their engagement with program participants, and to learn of coping mechanisms used to manage stress. Methods In 2015, Florida MIECHV program evaluators conducted ten focus groups with 49 home visitors during which they ranked and discussed their top sources of work-related stress. Qualitative analysis was conducted to identify emergent themes in work-related stressors and coping/supports. Results Across all sites, the burden of paperwork and data entry were the highest ranked work-related stressors perceived as interfering with home visitors’ engagement with participants. The second-highest ranked stressors included caseload management, followed by a lack of resources for families, and dangerous environments. Home visitors reported gratification in their helping relationships families, and relied on coworkers or supervisors as primary sources of workplace support along with self-care (e.g. mini-vacations, recreation, and counseling). Conclusions for practice Florida MIECHV home visitors across all ten focus groups shared similar work-related stressors that they felt diminished engagement with program participants and could impact participant and staff retention. In response, Florida MIECHV increased resources to support home visitor compensation and reduce caseloads, and obtained a competitive award from HRSA to implement a mindfulness-based stress reduction training statewide.     

Interactions Between Medicare and Medicaid Home Care in Connecticut: Responses to the 1997 BBA

ABSTRACT

Although overlaps exist in the provision of home care services financed by Medicare and Medicaid, interactions of the two funding sources at the beneficiary and home care provider levels have not been widely studied. The recent dramatic declines in Medicare home health spending present a rare opportunity to examine how changes in Medicare spending can affect the provision of Medicaid home care services. We conducted a study of Medicare-Medicaid dynamics in the state of Connecticut to shed light on the inter-relationships of the two funding sources.     

Correction to: Getting to the Warm Hand-Off: A Study of Home Visitor Referral Activities

Maternal and Child Health Journal - The article “Getting to the Warm Hand-Off: A Study of Home Visitor Referral Activities”, written by Jessica Goldberg, Jessica Greenstone Winestone,...     

Assessing Pathogen Transmission Opportunities: Variation in Nursing Home Staff-Resident Interactions

ObjectivesThe Centers for Disease Control and Prevention (CDC) recommends implementing Enhanced Barrier Precautions (EBP) for all nursing home (NH) residents known to be colonized with targeted multidrug-resistant organisms (MDROs), wounds, or medical devices. Differences in health care personnel (HCP) and resident interactions between units may affect risk of acquiring and transmitting MDROs, affecting EBP implementation. We studied HCP-resident interactions across a variety of NHs to characterize MDRO transmission opportunities.Design2 cross-sectional visits.Setting and ParticipantsFour CDC Epicenter sites and CDC Emerging Infection Program sites in 7 states recruited NHs with a mix of unit care types (≥30 beds or ≥2 units). HCP were observed providing resident care.MethodsRoom-based observations and HCP interviews assessed HCP-resident interactions, care type provided, and equipment use. Observations and interviews were conducted for 7-8 hours in 3-6-month intervals per unit. Chart reviews collected deidentified resident demographics and MDRO risk factors (eg, indwelling devices, pressure injuries, and antibiotic use).ResultsWe recruited 25 NHs (49 units) with no loss to follow-up, conducted 2540 room-based observations (total duration: 405 hours), and 924 HCP interviews. HCP averaged 2.5 interactions per resident per hour (long-term care units) to 3.4 per resident per hour (ventilator care units). Nurses provided care to more residents (n = 12) than certified nursing assistants (CNAs) and respiratory therapists (RTs) (CNA: 9.8 and RT: 9) but nurses performed significantly fewer task types per interaction compared to CNAs (incidence rate ratio (IRR): 0.61, P < .05). Short-stay (IRR: 0.89) and ventilator-capable (IRR: 0.94) units had less varied care compared with long-term care units (P < .05), although HCP visited residents in these units at similar rates.Conclusions and ImplicationsResident-HCP interaction rates are similar across NH unit types, differing primarily in types of care provided. Current and future interventions such as EBP, care bundling, or targeted infection prevention education should consider unit-specific HCP-resident interaction patterns.     

Agency Approaches to Common Quality Problems in Home Care: A Scenario Study

ABSTRACT

In a study of best practices in home care quality assurance (QA), a sample of 128 respondents from exemplary home care agencies were presented with 7 brief scenarios depicting common problems in home care quality. Agency respondents were asked to describe their likelihood of identifying the problem in each scenario, how they would identify the problem, and how they would correct it. We found that agencies expressed considerable confidence they would identify the problems, but were unlikely to view their QA efforts as contributing to detecting the problems. Identification was more often perceived to come from ordinary care, with considerable burden placed on paraprofessional staff or clients to bring the problem to the attention of the agency. Medically-oriented agencies were significantly more likely than socially-oriented to rely on formal QA to identify deteriorating patient conditions and depression. Across all agencies, a relationship existed between the type of problem in the scenario and the most frequent responses about detection and correction modes. Once the problem was identified, agencies presented an appropriate and fairly wide range of corrective strategies. The implications for making QA more organically related to clinical care are discussed.     

Correction to: Mother and Home Visitor Emotional Well-Being and Alignment on Goals for Home Visiting as Factors for Program Engagement

Maternal and Child Health Journal - The article “Mother and Home Visitor Emotional Well-Being and Alignment on Goals for Home Visiting as Factors for Program Engagement”, written by L....     

Correction to: Randomized Trial of a Training Program to Improve Home Visitor Communication around Sensitive Topics

Introduction

Strong communication skills are necessary to engage families, perform accurate assessments, and motivate behavior change around sensitive issues encountered in home visiting.

Methods

A two-arm, cluster-randomized trial evaluated the impact of a trans-model communications training course for home visitors. Fourteen home visiting programs in Maryland were assigned to a training intervention (n = 7 programs; 30 visitors) or wait-list control group (n = 7 programs; 34 visitors). Independent observers assessed training fidelity. Visitor’s attitudes, knowledge, and confidence were assessed through surveys. Their skills were assessed through coding of video-recorded visits with standardized mothers. Data were collected at baseline, within 2 weeks post-training, and at 2 months post-training. Regression models accounted for clustering within programs and controlled for characteristics on which study groups differed at baseline.

Results

Independent observers rated the training highly on fidelity and acceptability. Home visitors rated it as useful, consistent with their model, and worth the effort. Immediately following the training, the training group scored higher than the control group on a range of indicators in all domains—knowledge, attitudes, confidence, and skills in using motivational communication techniques. At 2 months post-training, impacts on knowledge and attitudes persisted; impacts on confidence and observed skill were attenuated.

Discussion

The training course showed favorable immediate impacts on knowledge, attitudes, confidence, and skills, and long-term impacts on home visitor knowledge and attitudes. The findings underscore the need for ongoing reinforcement of skills following training.

     

Patients' Ratings of the Quality of their Outpatient Visit to Clinical Officers in Kenya

Background

Lack of data on the quality of care offered by Clinical Officers (COs) compromises the current efforts on health reforms in Kenya. The objective of this study was to assess patients'' satisfaction with their outpatient visit to Clinical Officers.

Methods

This was an exit survey of adult outpatients who visited Clinical Officers between September 2009 and May 2010. A total of 326 Clinical Officers were assessed by 2118 randomly selected patients across the country using a modified Visit-Specific Satisfaction Questionnaire (VSQ-9). Responses on patients'' satisfaction were summarized using the average score method. This involved calculation of the mean across all the response categories and transforming them linearly to a 0 to 100 scale. Interpretation involved comparisons to best practice (excellent).

Results

Generally, patients view the quality of their outpatient visit from two dimensions: interaction with Clinical Officers and access to care. The patients were relatively more satisfied with their interaction with Clinical Officers (rated at 67 percent) than with access to care (61 percent). The average age of the patients was 31.31 years (SD = 13.64). Most patients were female (58 percent), married (51 percent) and most had secondary level education (38 percent). Regression results showed that these sociodemographic characteristics had no significant association with patients'' satisfaction.

Conclusion

Overall patients see ample room for improvement in their visits to Clinical Officers. The need to train Clinical Officers on client handling and patient-centeredness is apparent.     

Caregivers in Home Health Care Situations: Measurement and Relations Among Critical Concepts

This article discusses several concepts critical to the investigation of caregivers in home health care contexts. The variables caregiver involvement, social support, caregiver reactions, and mental health outcomes are discussed conceptually, and operationalizations for these concepts are proposed. The psychometric properties of the proposed scales and relations among these scales are tested on data derived from two samples of care providers for patients with Alzheimer's disease. The research confirms internally consistent measures for all scale variables and explores relations among these variables with regression and path analytic techniques. The model developed suggests the importance of communication variables (i.e., the availability of social resources and perceptions of social support) in positively affecting the caregiver's reactions to the caregiving situation and the caregiver's mental health.     

Correction to: Learning Collaboratives: a Strategy for Quality Improvement and Implementation in Behavioral Health

The Journal of Behavioral Health Services & Research -     

Correction to: Introduction to the Special Issue on Taking Home Visiting to Scale: Findings from the Maternal,Infant, and Early Childhood Home Visiting Program State-Led Evaluations

Maternal and Child Health Journal - The article “Introduction to the Special Issue on Taking Home Visiting to Scale: Findings from the Maternal, Infant, and Early Childhood Home Visiting...     

Autonomy Support of Nursing Home Residents With Dementia in Staff-Resident Interactions: Observations of Care

ObjectivesPeople with dementia living in nursing homes benefit from a social environment that fully supports their autonomy. Yet, it is unknown to what extent this is supported in daily practice. This study aimed to explore to which extent autonomy is supported within staff–resident interactions.DesignAn exploratory, cross-sectional study.Setting and ParticipantsIn total, interactions between 57 nursing home residents with dementia and staff from 9 different psychogeriatric wards in the Netherlands were observed.MethodsStructured observations were carried out to assess the support of resident autonomy within staff–resident interactions. Observations were performed during morning care and consisted of 4 main categories: getting up, physical care, physical appearance, and breakfast. For each morning care activity, the observers consecutively scored who initiated the care activity, how staff facilitated autonomy, how residents responded to staff, and how staff reacted to residents’ responses. Each resident was observed during 3 different mornings. In addition, qualitative field notes were taken to include environment and ambience.ResultsIn total, 1770 care interactions were observed. Results show that autonomy seemed to be supported by staff in 60% of the interactions. However, missed opportunities to engage residents in choice were frequently observed. These mainly seem to occur during interactions in which staff members took over tasks and seemed insensitive to residents’ needs and wishes. Differences between staff approach, working procedures, and physical environment were observed across nursing home locations.Conclusions and ImplicationsThe findings of this study indicate that staff members support resident autonomy in more than one-half of the cases during care interactions. Nonetheless, improvements are needed to support resident autonomy. Staff should be encouraged to share and increase knowledge in dementia care to better address residents’ individual needs. Especially for residents with severe dementia, it seems important that staff develop skills to support their autonomy.     

Nursing Home Quality: A Comparative Analysis Using CMS Nursing Home Compare Data to Examine Differences Between Rural and Nonrural Facilities

BackgroundAdvances in medicine and an aging US population suggest that there will be an increasing demand for nursing home services. Although nursing homes are highly regulated and scrutinized, their quality remains a concern and may be a greater issue to those living in rural communities. Despite this, few studies have investigated differences in the quality of nursing home care across the rural-urban continuum. The purpose of this study was to compare the quality of rural and nonrural nursing homes by using aggregated rankings on multiple quality measures calculated by the Centers for Medicare and Medicaid Services and reported on their Nursing Home Compare Web site.MethodsIndependent-sample t tests were performed to compare the mean ratings on the reported quality measures of rural and nonrural nursing homes. A linear mixed binary logistic regression model controlling for state was performed to determine if the covariates of ownership, number of beds, and geographic locale were associated with a higher overall quality rating.ResultsOf the 15,177 nursing homes included in the study sample, 69.2% were located in nonrural areas and 30.8% in rural areas. The t test analysis comparing the overall, health inspection, staffing, and quality measure ratings of rural and nonrural nursing homes yielded statistically significant results for 3 measures, 2 of which (overall ratings and health inspections) favored rural nursing homes. Although a higher percentage of nursing homes (44.8%–42.2%) received a 4-star or higher rating, regression analysis using an overall rating of 4 stars or higher as the dependent variable revealed that when controlling for state and adjusting for size and ownership, rural nursing homes were less likely to have a 4-star or higher rating when compared with nonrural nursing homes (OR = .901, 95% CI 0.824–0.986).ConclusionsMixed model logistic regression analysis suggested that rural nursing home quality was not comparable to that of nonrural nursing homes. When controlling for state and adjusting for nursing home size and ownership, rural nursing homes were not as likely to earn a 4-or higher star quality rating as nonrural nursing homes.