Pride in Parenting: Training Curriculum for Lay Home Visitors
Linda T. Diamond, M.S. and Marion H. Jarrett, Ed.D., editors.

Unit 14
Managing Home Visits

This unit will focus specifically on home visits as our primary intervention. Many skills that will be used for home visits have been taught thus far. This unit will put those skills into the context of home visiting, discuss the general and specific goals of the visits and the ethical considerations involved. Since first visits can set the tone for the future, emphasis will be placed on them.

Objectives

By the end of this session, participants will be able to:

  • Define important aspects of home visiting.
  • Describe ethical considerations important to home visiting.
  • Demonstrate appropriate initiation and termination of a home visit.
  • Demonstrate effective communication techniques to be used with clients.
  • Describe overall goals of working with families.
  • Demonstrate techniques appropriate to crisis situations.

Time

16 hours

Outline

A. Introduction
B. Goals of Working with Families
C. First Home Visit
D. Ethical Considerations
E. Crisis Intervention
F. Summary and Review

Materials

  • Resource Mothers. (1993). Handbook (Ch.2 & 18). Sterling, VA: INMED.
  • PIP Training Manual, Unit 2, "Communication and Relationship Building Skills"
  • Bryant, D., Lyons, C., Wasik, B. (YEAR?). Ethical Issues in Home Visiting. Topics in Early Childhood Special Ed., Vol.10,(:4), 92-107.
  • Wasik, B.H., Bryant, D.M., Lyons, C.M. (1990). Home Visiting: Procedures for Helping Families. N.Y.: Sage Publications.
  • Interpersonal Helping Skills (Handout #1)
  • Open Ended Questions to Elicit Information on Family Needs (Handout #2)
  • Important Aspects of Home Visiting (Training Aid #1)
  • Observation Checklist for Use During Practice Session (Training Aid #2)
  • Active Listening Techniques (Handout #3)
  • Scenarios (Handout #4)
  • Guidelines for Resolving Ethical Issues (Training Aid #3/Handout #5)
  • Crisis Intervention (Handout #6)
  • Case Studies (Training Aid #4)
  • Role Play Feedback (Overhead #1)
  • Post-Unit Test
  • Post-Unit Evaluation
  • Blackboard and chalk, or newsprint, markers, flipchart, or tape
  • Video equipment: video camera, tripod, tape, VCR, TV
Advance Preparation

  • Read "Ethical Issues Involved in Home Visiting"
  • Read Home Visiting: Procedures for Helping Families
  • Read RM Handbook Chapter 18 and review Chapter 2
  • Unit 2 PIP Training Manual as background reading
  • Review scenarios in Handout#3. Change, if needed in order to be relevant to your project
  • Plan to have community home visitors come and talk about the reality of this type of intervention from a personal perspective.
  • Make sufficient copies of handouts.
  • Test video equipment, set up camera to videotape role plays.

A. Introduction (30 minutes)

Rationale:

Since many skills have been learned in the training and training is half over, it is now time to put them to use in the context of home visits. This can be both an exciting and scary time for trainees. Increasing knowledge about home visits and practicing important skills can reassure trainees, increase confidence and allay fears. Beginning this unit with reflections and review can bring a new energy to the trainees.

Procedure:

  1. Begin this session by reviewing with trainees all that has happened so far in this training. For example, knowledge and skills that have been learned and the growth the group has achieved. Have trainees share their thoughts and feelings at this time.
  2. Review objectives for this unit.
  3. Ask volunteers to share how they feel about the next part of the training -- the actual home visit. Are trainees feeling comfortable with the knowledge gained and skills developed? What questions do they have? Is there apprehension as the training moves into the 2nd half? Encourage group members to answer all questions, all concerns, and provide support for each other. List on newsprint any specific questions or concerns that have not been covered or seem to need review for the group or an individual(s).
 
B. Goals for Working with Families (2 hours)

Rationale:

In order to make the home intervention as successful as possible, participants need to have a good working knowledge of what the goals of this type of intervention are.

Procedure:

1. Have Trainees list 5 goals they have for working with families.

On flip chart list the first 2 from each participant's list, these should include:

  • educate
  • support
  • listen
  • empower
  • model
  • form relationships
  • help mom-baby relationship
  • encourage
  • empathize
  • help get services

How do these relate to goals of:

  • being allies and advocates for parent and child vs. allies and advocate for child and adversary of parent
  • teaching family vs. being taught by family
  • setting goals for families to follow or helping families set and achieve their own goals.

2. Discuss how a home visitor can accomplish these goals: Base discussion on Unit 2 Communication (Handout #6) that includes "Respect, Genuiness, Empathy." Ask trainees what they think communicating these feeling would do for clients? How would they communicate these feelings? Have participants give examples.

3. Review information on Handout #1 "Interpersonal Helping Skills" by first having the participants generate a list for each category on the handout. Make the list on a flipchart or a blackboard. Be sure all the points are covered.

 
C. First Home Visit (3 hours)

Rationale:

The first home visit is very important in beginning to establish a relationship with the client but it can be awkward as well. The PSSs need to be comfortable with the goals for this visit and familiar with techniques that can help them proceed smoothly.

Procedure:

1. Discuss the 6 components of the first home visit

a) The PSS and client becoming acquainted.
b) Reviewing the program purpose and goals as it relates to the mother and baby.
c) Defining the PSS's role and that of the client; enlisting client as a partner.
d) Clarifying the client's expectations.
e) Beginning establishment of rapport.
f) Scheduling the next visit.

Overall, the PSSs need to express sincere interest and caring to each family.

2. Distribute Handout #2 "Open Ended Questions to Elicit Information on Family Needs." This information has been introduced in a previous unit (2) of this training program. Review this information and practice asking these questions with one PSS playing the role of the home visitor and one PSS playing the role of the mom.

3. In pairs in front of the group, practice a first home visit scenario starting with the knock on the door. Try different scenarios, for example, a cooperative mother, a withdrawn mother, a hostile mother, an overwhelmed mother, and an eager mother ... Have the group give feedback after each pair has done their role play. As trainer, demonstrate a role play with another trainer if participants are hesitant to begin.

 
D. Ongoing Home Visits (4 hours)

Rationale:

Home visiting evolves as more time is spent between PSS and mother and baby. The relationship will depend on the people involved as well as on the skills of the PSS. PSSs need to be aware of the important aspects involved in home visiting and how they will impact their role and that of their clients.

Procedure:

  1. Home visitors and clients must learn to know and accept one another, work together to achieve mutually acknowledged goals and then terminate the relationship. Discuss this process of learning, joining and parting.
  2. Discuss various aspects of home visiting using Training Aid #1 "Important Aspects of Home Visiting" as a guide. Discuss information and provide specific examples of how these might factor into a home visit.
  3. This is a good tome to review helping skills and techniques including observing, listening, and questioning (from Unit 2 PIP Training Manual and Wasik B et. al Home Visiting). Remind trainees that some of this is a review of information from Unit 2. Use Handout #3 "Active Listening Techniques." Review this information and practice the techniques. As trainer, act as client and have participants act as PSS using one of the active listening techniques. If you have a large group, break into smaller groups of 6 to 8 people and have another trainer lead each group. Have "client" describe how it feels when the person they are interacting with is using active listening techniques or if not successfully using these techniques.
  4. Review Training Aid #2 "Observation Check List." Use this as a guide when giving feedback.
  5. Use Handout #4 "Scenarios" to role play while considering the above techniques. Role play in pairs in front of the group so feedback can be given. If you have a large group of participants, have pairs do role plays and have trainers circulate to give feedback. Have 2 to 3 pairs do role play in front of the group. Give each pair 10 minutes to prepare their role play. (You can expand this activity by giving pairs "what if" questions.)

E. Ethical Considerations (1 hour)

Rationale:

There will be many instances in which PSSs will encounter situations that challenge the general strategies used in home visiting. It is therefore very important that they have guidelines as to ethical issues that may arise and how to assess their role in that situation.

Procedure:

Using Training Aid #3/Handout #5 "Guidelines for Resolving Ethical Issues," discuss each point and have participants as well as you, as trainer, give real life examples. With each example, play out a scenario as to what could happen in each case; what action would be appropriate and how that might impact the situation.


F. Crisis Intervention (2 hours)

Rationale:

Crises are likely to occur and are unpredictable in nature. The PSS must have some general strategies and guidelines to rely on when faced with a client in crisis.

Procedure:

  1. Elicit information on what a crisis is, having trainees share what they consider a crisis.
  2. Discuss with participants what has helped them in times of crisis -- What they have done for themselves and how others have helped them.
  3. Review information on Handout #6 "Crisis Intervention."
  4. Develop several short crisis scenarios with the participants. As a whole group or in pairs identify the crisis and brainstorm about an immediate intervention plan.
  5. For more practice use Training Aid #4. This will incorporate crisis intervention as well as other issues and strategies learned in this unit.
 
G. Summary and Review (30 minutes)

Procedure:

  1. Restate objectives in question form. Encourage all trainees to participate.
  2. Distribute post-unit evaluation.
  3. Distribute post-unit test.


Unit 14 Handout #1
Interpersonal Helping Skills

Helpful Qualities

Why People Do Not Seek Help

Response Option to Convey Helpfulness

Unhelpful Responses


Unit 14 Handout #2
Open-Ended Questions to Elicit Information on Family Needs and Strengths

Questions to Ask:

  • How are things going with (child's name)?
  • If more than one adult at visit, ask each one what they think? How they feel?
  • What kinds of things does (child's name) enjoy doing? What makes him/her happy?
  • What kinds of things do each of you enjoy doing with (child's name)?
  • What have you been told about (child's name) (hearing, vision, motor, etc.--using words of family members)?
  • How does this fit with what you know and believe about (child's name)?
  • What else do you know about (child's identified disability)?
  • In what ways has this information been helpful? or not helpful?
  • What do you think (child's name needs help with, if anything?
  • What kinds of things have you tried that worked? that didn't work?
  • What kinds of advice have you been given?
  • Whose advice has been helpful? not helpful?
  • What happens in a crisis? (If crises have been described as happening in the past.)
  • What is a typical day like? (or if family has identified a particular event that they what to focus on, asking what a typical (mealtime, trip to the park, etc.) is like?)
  • Can you think of a time that (the event-mealtime, trip to the park, etc.) went well or worked the way you wanted it to? What was happening that made it work?
  • Who or what was helpful? Who or what was not helpful?
  • What other things are going on now that are important to you?

Unit 14 Handout #3
Active Listening Techniques

Type of Statement

Purpose

How Achieved

Examples

A. Encouraging

  1. To convey interest
  2. To keep person talking

Don't agree or disagree. Use noncommittal words with positive tone of voice.

  1. "I see ..."
  2. "Uh-huh ..."
  3. "That's interesting ...

B. Restating

  1. To show that you are listening and understanding
  2. To let person know you grasp the facts

Restate the person's basic ideas, emphasizing the facts

  1. "If I understand, your idea is ..."
  2. "in other words, this is your decision ..."

C. Reflecting

  1. To show that you are listening and understanding
  2. To let person know you understand how he/she feels

Reflect the person's basic feelings.

  1. "It sounds like you feet that ..."
  2. "You were pretty disturbed by this ..."

D. Probing

  1. To show that you are listening and understanding
  2. To ask for additional facts or opinions
  3. To lead the person in a desired direction

Ask the person to provide more details. Perhaps ask if a certain idea follows from what has been said.

  1. "How do you think this happened ..."
  2. "Could it be that ..."

E. Summarizing

  1. To pull important ideas, facts, etc. together
  2. To establish a basis for further discussion
  3. To review progress

Restate, reflect and summarize major ideas and feelings.

  1. "These seem to be the key ideas you have expressed ..."
  2. "If I understand you, your overall conclusion about the present situation ..."

Note: This chart represents a summary of the thinking of a number of communication experts regarding "active listening."

Source: Entrepreneurship and Small Business Management. Kenneth R. Van Voorhis, 1980.


Unit 14 Handout #4
Scenarios

Have trainees think about the issues they should consider when deciding how to handle these situations. Work in pairs and come up with a plan.

  1. You are visiting a client, Tanya, who lives with her mother, older brother and her new baby. While you are discussing ways to keep the baby safe, the baby starts to cry, Tanya's mother makes comments about what you are saying and Tanya gets visibly upset, and her older brother turns on the television in the same room.
  2. Your client, Lola, has told you in confidence that she only has enough food for herself and her baby for 2 days. She hopes the food stamps come in time. Lola's boyfriend walks in and goes straight to the refrigerator.
  3. On your first visit to Kim and her baby, Kim tells you about the many things she needs help with.
  4. Keisha's boyfriend comes to visit while you are there. They start to have a loud, angry argument. To calm things down, Keisha tells him something that you know is not true.


Unit 14 Training Aid #1
Important Aspects of Home Visiting

Reprinted with permission from Wasik, B.H., Bryant, D.M., Lyons, C.M. (1990). Home Visiting: Procedures for Helping Families. N.Y.: Sage Publications.

Unit 14 Training Aid #2
Observation Checklist
For practice sessions and on-the-job supervisory sessions of PSS

ROLES (nonverbal communication skills)

Check the appropriate box in the space provided

1
Poor

2

3
Good

4

5
Outstanding

a. Openness to client/nonjudgmental

          

b. Eye contact/appropriate body language

          

c. Varies interaction style to meet needs of client

         

Comments:

CLEAR (verbal communication skills)

Check the appropriate box in the space provided

1
Poor

2

3
Good

4

5
Outstanding

a. Clarifies

          

b. Listens

          

c. Encourages/gives praise

          

d. Acknowledges (what a client says, is feeling, etc.)

         

e. Reflects and repeats back

         

Comments:

Hone Visiting Skills

Check the appropriate box in the space provided

1
Poor

2

3
Good

4

5
Outstanding

a. Establish rapport with client

          

b. Asks open-ended questions and follows when needed with probing questions

          

c. Clearly presents agenda for visit; considers client's needs

          

d. Provides accurate information on the topic being discussed; reviews appropriately

         

e. Is organized with materials for visit

         

f. Uses appropriate support materials:

  • with mothers and other adults
  • with babies
         

g. Clearly models skills/behaviors important to lesson; has mother demonstrate

         

h. Interacts appropriately with baby

         

i. Summarizes and leaves plan

         

j. Schedules next appointment

         

Comments:

Home Environment Observation

Adequate

Inadequate

Temperature

   

Floors

   

Windows

   

Doors

   

Sockets

   

Ceiling

   

Toys

   

Reading material

   

TV (on/off)

   

Radio (on/off)

   

Clock

   

Mirrors

   

Number of people present

   

Comments:


Unit 14 Teaching Aid #3 / Handout #5
Guidelines for Resolving Ethical Issues
(Reamer 1982)

  1. Rules against basic harms to life's necessities (such as life, health, food, shelter, mental health) overrides rules against harms such as lying, revealing confidential information, or threats to such things as recreation, education, wealth.
  2. An individual's right to basic well-being (life's necessities) overrides another individual's right to freedom.
  3. An individual's right to freedom (to make decisions and choices) overrides his or her own right to basic well being.
  4. Obeying laws, rules and regulations overrides an individual's right to act freely if that action conflicts with the laws, rules and regulations.
  5. Individual's rights to well-being may override laws, rules and regulations in cases of conflict.
  6. The obligation to prevent such basic harms as starvation and to promote public good such as housing, education, and public assistance overrides the right to keep property.
Reprinted with permission from Wasik, B.H., Bryant, D.M., Lyons, C.M. (1990). Home Visiting: Procedures for Helping Families. N.Y.: Sage Publications.


Unit 14 Handout #6
Crisis Intervention

Important Reminders:

Principles of Crisis Intervention

NOTE: Time for emotional recovery is needed from crises otherwise the person may overreact the next time. People can only survive in crisis mode for a short period of time before it has more damaging results. Check how family is viewing their situation over time.


Unit 14 Training Aid #4
Case Studies

Note: Please adapt these case studies to be sure your practice session reflects the special cultural and social needs of your community. These case studies will be used for practicing using information about and techniques for home visiting.


Unit 14 Handout for use at end of each Unit
Post-Unit Evaluation

Unit Covered: _____
Date: _____

  1. Do you feel we covered all the information in this unit that we said we were going to?
  2. What did you like best about the unit?
  3. What did you like least about the unit?
  4. Was the information in this unit presented clearly? If not, please explain.
  5. In which skill areas do you feel you need more practice or help?
  6. How can we make this unit better?
  7. Any additional comments?


Unit 14
Post Unit Test

  1. List 3 overall goals of working with families.
  2. How could you begin to work towards these goals? Describe 3 ways.
  3. List 3 goals for the first home visit.
  4. How would you begin your first home visit with a mom?
  5. Name 3 components of home visiting of which you must be aware. Explain why?
  6. Describe an ethical issue that you might confront while home visiting. What would you do?
  7. What is one important technique you could use to help a mom in crisis?


Unit 14 Overhead #1
Role Play Feeback

  1. What do you think you the parenting support specialist did well?
  2. What could the parenting support specialist have changed or done differently?
  3. What other things do you think the parenting support specialist might say or do to help a mother in this situation?

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