Semi-structured interview with caregivers - MIHOPE-K

Mother and Infant Home Visiting Program Evaluation

MIHOPE-K

SEMI-STRUCTURED INTERVIEW WITH CAREGIVERS

Original Document April 2018

Revised February 2019

Revised July 2019

This collection of information is voluntary and will be used to learn how home visiting programs benefit families. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB number for this information collection is 0970-0402 and the expiration date is 11/30/2021.

SAY TO CAREGIVER: Before starting this interview, I want to let you know that the purpose of this interview is to evaluate the effects of home visiting programs. The information will be used to learn how home visiting programs benefit families. The time required to complete this interview is estimated to average two hours. This interview is voluntary. The responses will be kept private to the extent permitted by law. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB number for this information collection is 0970-0402 and the expiration date is 11/30/2021.

Program group topics:

• Overall impressions of the home visiting program

• What they remember about the home visiting program

• How home visiting impacted or changed the caregiver and child (with regards to parenting, child development, health, social support, etc.)

• Whether they felt home visiting helped them access needed services and if not, what the barriers were

• The relationship between the caregiver and home visitor

• How and why they got involved in the home visiting program

• Length of participation in the program and why they ended their participation

• Expectations about the program and whether those matched actual experiences

• Suggestions for improving the program

• Other resources of the program that were used and were helpful

• Experiences with parenting, overall family functioning, and their child during the child’s early years

• Experiences with other services in the community

• Access to needed services, including successes and challenges

• Reliance on social support and who they turned to if they needed help

Lead-in topic:

• Tell me what it is like to be a mom.

• PROBE: What’s been hard about your experience? What’s been good? Surprising or unexpected?

Topic 1: How and why families got involved in the home visiting program

1. How did you first come to know about [PROGRAM NAME]?

• PROBE: Can you walk me through how you came to find out about the program?

• PROBE: How come you were interested in participating in the program?

2. Thinking back to that time when you first learned about and were interested in the program, describe what was going on in your life.

• Probe on pregnancy and childbearing history

• Probe on relationship with child’s father and family context, household environment, community context, and perceptions of their social support system

• Probe on age, education, and employment history of the mother at this time

• Probe on perceptions of relative disadvantage or advantage – where do they think they fall or how they think they are doing compared to how well other people are doing in their community (e.g. on a scale of 1 to 10, 10 being the most well off, 1 being the least well off, where do they think they fall?).

3. Probe on the mother’s perceptions of her own upbringing, including what was good about her childhood and what she would want to change as she thinks about raising her own children.

4. What did you think the home visitor was going to do with you and your child?

NOTE: You can skip these probes if respondent reports not having a lot of expectations or knowing a whole lot about home visiting services or what the home visitor was going to do

• Probe on expectations of the outcomes or issues that the mother was hoping the program would address

• Probe on expectations of the content of services (e.g., education about certain topics, referrals or linkages with other services)

• Probe on expectations of frequency or intensity of services

• Probe on expectations of duration of services

Topic 2: Experiences with the home visiting program and alignment with expectations

5. I’d like to learn more about the types of activities that the home visitor did with you and your child over the course of your visits.

1. First, what was a typical home visit was like?

NOTE: If respondent has a hard time walking you through a typical visit, then proceed to part b and ask about different topics, including whether and how the home visitor talked about or worked with the mother on these issues, and how often. This section (section b) might help respondents recall things in more detail.

PROBES:

• For example, how did the visit usually begin?

• What did the home visitor ask about? What did she/he talk about?

• Do you remember asking the home visitor questions? What were your questions typically about?

• How much time was spent on talking about the child?

• How much time was spent talking about issues going on with you?

2. Thinking about all the visits you had with the home visitor, what did she/he work with you or your child on over the time that you saw her/him? What did this look like?

• NOTE: If family saw multiple home visitors, ask about each home visitor.

• PROBE on EACH of the specific outcome areas to capture service delivery across domains. If the family had minimal contact (e.g., one or two visits), review with the respondent what was done or discussed during those early visits.

NOTE: It might be helpful, under each topic, to have the respondent think about what happened during different stages, such as what happened during pregnancy, at birth, the child’s first year and so on.

• Healthy child development (e.g. different stages of language development, motor skills, social-emotional well-being)

• Parenting skills (e.g., how to create a strong bond, types of activities to do with child, how to discipline child, limit setting, responding to child cues)

• Child’s health (e.g., healthy pregnancy and birth, getting or maintaining insurance coverage, taking child to well-child visits, when to use the emergency room, healthy sleeping, eating, and growth, household safety)

• Your own physical health (getting or maintaining insurance coverage, postpartum check-ups, birth spacing or family planning, smoking, substance use)

• Your own mental health (awareness and screening for depression or anxiety, mental health history, dealing with childhood trauma)

• Interpersonal dynamics with your partner or the baby’s father (e.g., relationship quality, co-parenting, use of verbal or physical aggression)

• Your education and employment goals (both short- and long-term)

• The types of material resources you and your child needed, such as food, transportation, income support, child support, child care, or housing.

• Help with getting access to other professional services, like doctors, therapists, child development experts, substance use treatment, or relationship counseling.

6. How would you describe your relationship with your home visitor?

• NOTE: If family saw multiple home visitors, ask about experience with each home visitor.

PROBES:

• What was it like in the beginning or when you first started to work with her?

• How did the relationship change over time?

• How would you have liked the relationship to be different? How come?

7. In what ways did your time and interactions with the home visitor match what you were expecting to happen?

NOTE: You can skip this question and these probes if respondent reports not having a lot of expectations or knowing a whole lot about home visiting services or what the home visitor was going to do.

PROBES:

• Expectations and actual experiences with content of services

• Expectations and actual experiences with dosage (length of home visits, frequency of visit, length of participation)

• Expectations and actual experiences with expertise or knowledge of home visitor

• Expectations and actual experiences with getting access to material resources

• Expectations and actual experiences with getting referrals and services from other community providers

Topic 3: Duration of Participation and Reasons for Ending Services

8. How long did you end up seeing the home visitor(s)?

PROBES:

• Whether participation was steady (e.g., maintained one or two visits a month) or was more irregular (would go for a month or two without any contact).

• How the family came to follow the particular pattern they report

9. Can you describe how come the home visits ended?

PROBES:

• What was going on with you and your family at that time?

• How were you feeling about your child’s health and development?

• How were you feeling about your own health (physical and emotional)?

• What about your education or work?

• Relationship with your partner/spouse, the child’s father, other family members, friends?

• What types of other services were you able to get access to or use? What did you think about the quality of these other services?

Topic 4: Perceptions of the program and navigating parenthood outside the program

FOR RESPONDENTS WHO WERE IN LATER LEAVERS and LONG-TERM PARTICIPATORS GROUP

10. How would you describe the ways in which your involvement with the home visiting program helped you with being a parent? With your overall well-being?

PROBES:

• How do you think it changed the way you parent your child? E.g.,

• The way you interact with your child (e.g., bond with child, talk to child, engage with child in different activities, pay attention to what child is doing)

• The way you set limits with child or discipline child

• Ways (that is, activities or things to do, things to watch out for or take care of) to help make sure your child is or stays healthy

• Ways to make sure that your child is developing normally (e.g., their language development, their brain functioning, their motor skills, their emotional health)

• How do you think it changed your own well-being? For example, your own physical health or mental health? With your education and employment goals?

• How did the home visitor help you with family and social support dynamics (e.g., relationships with baby’s father, partner or relatives, feeling more supported)?

• How often were you able to follow through on the things (activities, referrals) the home visitor had recommended you do? What were some of the barriers to following through?

  • Were there any topics or things where you might not have followed through or agreed with what the home visitor recommended? How come?

• How realistic or practical did you think the advice that the home visitor gave you was? (NOTE: Ask for specific examples of when advice was realistic and when it was perceived as not being realistic)

11. How did the home visiting program help you get access to the other services that you or your family might have needed, like food assistance, cash assistance, education or job training, employment help, health care, therapy or counseling, transportation, or housing?

NOTE: This question may have been covered earlier during the interview under Question 4 with the probe on getting access to services and other resources. If you feel that this question was adequately covered earlier, you can skip this question. Just make sure to ask about areas where the respondent might have needed help but wasn’t able to get that help and how come.

• For issues that the respondent noted needing some help with, PROBE on what the process was for receiving that help, the role the home visitor or the program played, what the barriers were, and what strategies were used. If relevant, also probe on their experiences with the quality of services provided.

• PROBE also on areas where the respondent needed help, but wasn’t able to access help (NOTE: have respondent narrate circumstances)

12. Were there other persons (family, friends, or professionals) or other programs or resources that you relied on for help with being a parent during this time? Please describe how you relied on these individuals or resources and what this looked like.

• NOTE: Clarify whether these individuals or resources were accessed through the home visitor or home visiting program versus independently accessed by parent.

FOR RESPONDENTS WHO WERE IN EARLY LEAVERS GROUP

13. Who or what types of programs or resources did you find yourself relying on to help you with being a parent during the early years of [CHILD]’s life? Maybe this help came from the home visiting program, or you looked for advice from a doctor or health care provider, got involved or received services from someone else in the community, relied on your family and friends? Please describe how you relied on these individuals or resources and what this looked like.

1. PROBE on whether and how they sought out advice, guidance or support on:

• Parent-child interactions and child discipline

• Child health

• Child development

• Mother’s own health and emotional well-being, including past trauma

• Interpersonal and other relationships with partner, spouse, family or friends

• Mother’s education or employment opportunities

• PROBE on how they navigated parenting “on their own,” if they respond that they did not rely on any particular individual or resource.

14. A lot of families with young children need help with different things to make ends meet, like food assistance, cash assistance, education or training, employment help, health care, therapy or counseling, transportation, or housing. Were there particular issues that you felt you needed or could have used some help with in the first few years of [CHILD]’s life?

• For issues that the respondent noted needing some help with, PROBE on what the barriers were and what strategies were used to get access to help. If relevant, also probe on their experiences with the quality of services provided.

• PROBE on areas where the respondent needed help, but wasn’t able to access help (NOTE: have respondent narrate circumstances)

Topic 5: Closing thoughts on family situation and opinions on program improvement

15. If you had a friend that was pregnant or recently gave birth to a baby – someone who reminded you of yourself a few years ago -- what would you tell her about [PROGRAM NAME]?

Based on your experience – both in the program and knowing what you know as a parent – how would you change the program? What do you think could be done to improve the program?

16. What do you think your life will look like one, five, or 10 years from now (let them choose time frame for thinking about the future)? What do you hope for or want for yourself and your children?

17. Ask only if there is time; also okay to skip: How would you sum up your experiences and situation now as a parent? Anything else you want to tell us, whether about being a parent or the home visiting program?

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