Preparing for Life—Home Visiting

Preparing for Life (PFL) is a prevention and early intervention program serving families living in disadvantaged communities in Ireland. The model serves families and children from pregnancy to school entry, and it aims to support the creation of a nurturing home environment, improve parenting outcomes such as parental self-efficacy and well-being, and promote children’s school-readiness. PFL is a multi-component program delivered over four to five years that offers home visiting, prenatal education classes, breastfeeding support, baby massage, and Triple P Positive Parenting Program classes (for families with children between 2 and 3 years old). The HomVEE review focuses on the home visiting component of the model (PFL–Home Visiting), which is available for families with pregnant people and children up to school entry. During monthly visits, home visitors share information about child development and engage families through role-playing, modeling, demonstration, coaching, discussion, and encouragement. Home visitors recommend that families participate in the program’s baby massage and Triple P Positive Parenting Program courses.

Preparing for Life (PFL) is a prevention and early intervention program serving disadvantaged communities in Ireland. The Northside Partnership (a local human services organization), along with 28 local agencies and community groups, developed PFL in 2006 and 2007 in response to community members’ concerns that the cognitive and social emotional skills of children from their neighborhoods were below those of their peers at school entry.

PFL was designed to prepare children for school by equipping parents with the skills needed to encourage child development from pregnancy onwards. PFL’s theoretical approach is consistent with a number of psychological theories, including Bowlby’s theory of human attachment, Bronfenbrenner’s socio-ecological theory of development, and Bandura’s social-learning theory.

The program provides a range of supports from pregnancy until school entry, including home visiting, prenatal education classes, breastfeeding support, baby massage, and Triple P Positive Parenting Program classes for families with children 2 to 3 years old. This report focuses on the home visiting component of PFL, which, for the purposes of the HomVEE review, is referred to as PFL–Home Visiting.

The Board of the Northside Partnership oversees the PFL project. The PFL Development and Implementation Team supports local communities interested in implementing the model by helping communities do the following:

• Explore the model’s suitability for their context
• Develop an implementation plan
• Recruit and train staff
• Adapt the model to local conditions
• Recruit families
• Develop support and supervision structures
• Establish governance and oversight structures
• Assess model fidelity

The team supports ongoing implementation by helping communities address challenges and ensure sustainability.

Please contact the model developer for information on replicating the model in the United States.

PFL–Home Visiting intends to support the growth and development of children and prepare them for school by enhancing parents’ skills and parenting knowledge. The model seeks to foster development in the following areas:

• Cognitive development: (For example, understanding information, thinking logically, becoming familiar with numbers, seeing patterns, and solving puzzles)
• Language development: (For example, understanding what others are saying, talking to others, and starting to read words)
• Approaches to learning: (For example, being excited and interested in learning and able to focus on and complete tasks)
• Social and emotional development: (For example, behaving well, following rules, getting along with others, sharing, and helping)
• Physical wellbeing and motor development: (For example, being healthy, free from illness, able to run, and able to hold objects such as pencils)

PFL–Home Visiting offers home visits between a home visitor and parents, as well as group-based Triple P Positive Parenting Program and baby massage classes. The core activity is the home visit, which consists of three key elements:

1. Tip sheets: Home visitors provide age-appropriate information to families across a number of key domains of child development and coaching to support parents in implementing positive parenting practices.
2. Goals and aspirations: Home visitors seek to establish a positive coaching and mentoring relationship with families and support parents to identify and work toward goals for themselves and their children.
3. Interagency work: Home visitors help parents access additional supports in the community.

During visits, home visitors share information relevant to the developmental stage of the child: prenatal, birth to 6 months, 6 to 12 months, 1 to 2 years, and 2 to 5 years. The home visitors use role-playing, modeling, demonstration, coaching, discussion, and encouragement to engage families during visits. At the end of each visit, home visitors provide parents with feedback and tip sheets to reinforce the information discussed.

The PFL–Home Visiting manual and tip sheets guide service delivery. The tip sheets contain information related to:

• Cognitive development
• Social and emotional development
• Nutrition
• Safety and supervision
• Rest and routines
• Parental support
• Transitioning to school

During the prenatal phase of the intervention, the home visitors discuss making healthy choices, getting support and care during pregnancy, and preparing for labor and delivery. After the child’s birth, the home visits focus on caring for the baby, bonding and attachment, setting positive routines, providing a safe home environment, and self-care. When the child is 6 to 12 months old, the home visitor addresses feeding and weaning, sleep routines, movement and thinking, listening and talking, and common illnesses. When the child is 1 year old, home visitors discuss playing and learning, language development, and healthy eating choices. During the final stage of the intervention, when the child is 2 to 5 years old, the home visitor addresses how to manage tantrums, toilet training, and getting ready for school.

The home visitors recommend families participate in individual and group-based baby massage sessions during the child’s first year. Home visitors also help families access the group-based Triple P Positive Parenting Program when children are between 2 and 3 years old. Social events take place three to four times each year.

PFL-Home Visiting recommends monthly home visits until school (kindergarten) entry at age 5. Home visits last 30 to 60 minutes. Home visitors are flexible about scheduling home visits and will work with parents to determine the appropriate frequency. Parents may request more or less frequent visits and are not required to meet with their home visitor each month.

The model also offers families five sessions of the baby massage program when their infants are at least 4 weeks old and eight 2-hour sessions of a group-based Triple P Positive Parenting Program when their children are between 2 and 3 years old.

PFL is currently partnering with the Center for the Economics of Human Development at the University of Chicago and Casa Central, a social services organization, to bring the PFL–Home Visiting model to Chicago. Community members and families will have the opportunity to give input on the creation and adaptation of the program to help ensure its relevance to clients served. Model materials are being adapted for use in the United States and will be available in Spanish and English.

Community-based organizations implement PFL–Home Visiting. Implementing organizations should be able to provide the necessary infrastructure to support a team of home visitors as well as provide supervision, governance, and financial oversight. Organizations should have close working relationships with local community-based organizations, early childhood care and education programs, and health and social services programs.

PFL has quality and fidelity guidelines for implementing organizations. The PFL Development and Implementation Team supports implementing organizations to maintain fidelity through a combination of coaching, mentoring, and supervision. The team observes a program’s practice and reviews documentation at set time points throughout implementation. Please contact the model developer for additional information about fidelity guidelines.

Home visitors implement the PFL–Home Visiting model. Managers supervise the home visitors. PFL does not require additional staff but recommends that implementing organizations have clear referral pathways and collaborative arrangements with prenatal care, breastfeeding support, and health care providers.

Home visitors can come from a variety of professional backgrounds including education, social services, youth studies, psychology, and early childhood care and education. Home visitors must have a bachelor’s degree and a minimum of three years of experience working with families. Managers must have a thorough grounding in PFL–Home Visiting. Please contact the model developer for additional information about minimum education and experience requirements for managers.

Managers provide home visitors with two hours of supervision per month. Supervision includes individual supervision, local team meetings, and peer support and case review. All supervision is based on the following PFL principles:

• Family capabilities
• Relationship-based family partnership
• Parallel process
• Mutual competence
• Reflective practice

Please contact the model developer for information on whether managers have access to supervision or support.

The model requires home visitors and managers to participate in a two-day pre-service training on PFL-Home Visiting. The training covers the home visiting role, including evidence-based findings on home visiting programs, relationships and activities, policy and practice alignment, and the PFL-Home Visiting logic model. Managers receive three to four days of training on supervision, coaching, and mentoring. The Northside Partnership connects implementing organizations with the local Triple P training provider to arrange training for home visitors on the Triple P Positive Parenting Program. (Implementing agencies are responsible for the cost of the Triple P training.) Please contact the model developer for additional information about the pre-service training requirement.

PFL does not require ongoing professional development but encourages home visitors to seek additional training in areas such as infant mental health, diversity and inclusion, and pediatric first aid. Please contact the model developer for additional information about professional development.

Phone: 353 1 877–1509

Email: pfl.info@nspartnership.ie

Website: https://www.preparingforlife.ie/preparing-for-life-home-visiting-programme/