4 Family Focus Group Protocol

OMB No: 0906-XXXX

Expiration Date: XX/XX/20XX

Public Burden Statement: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0906-XXXX. This information collection will be used to assess nominated ECHV programs’ interest in and eligibility for participation in the Assessing and Describing Practice Transitions Among Evidence-Based Home Visiting Programs in Response to the COVID-19 Public Health Emergency (ADAPT-HV) study. The time required to complete this information collection is estimated to average less than 1 hour per response, including the time to review instructions, search existing data resources, gather the data needed, to review and complete the information collection. This information collection is voluntary and confidentiality is followed according to law. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: HRSA Information Collection Clearance Officer, 5600 Fishers Lane, Room 14N39, Rockville, MD or [email protected].

Family Focus Group Protocol

Thank you for taking the time to talk with us today. My name is [NAME] and this is [co-facilitator/notetaker NAME(s)]. We work as research analysts with The Policy & Research Group (PRG). On behalf of the Health Resources and Services Administration (HRSA), and in collaboration with the Office of Planning, Research, and Evaluation (OPRE) in the Administration for Children and Families (ACF), we are carrying out a project that aims to identify, develop, study, and share evidence-informed strategies and resources that early childhood home visiting (ECHV) programs like [NAME OF HV PROGRAM] may use to improve home visiting services, and, outcomes for children and families. Today we are going to be talking about your experiences with what we are calling coaching.

When I talk about coaching, I’m talking about when your [HOME VISITOR TITLE] explains or talks you through a new parenting skill or practice rather than doing it to show you how to do it. For example, let’s say [note-taker] is my home visitor and they are helping me learn how to soothe my baby by rocking her – they could either show me themselves by picking up baby and rocking her while I observe, or they could talk me though what I need to do. When they help me learn by doing it themselves, we call that modeling, and when they help me learn by explaining or talking me through it, we call that coaching. Does anyone have any questions about what we mean by coaching?

Both modeling and coaching can be useful practices during home visits, but today we are interested in talking about coaching as a teaching or supportive practice, especially because coaching might be more useful when home visits happen virtually and your [HOME VISITOR TITLE] isn’t in the room with you the way they would be during an in-person visit.

• [Phase 1: Co-Definition]

  • We are particularly interested in hearing about how your [HOME VISITOR TITLE] has tried to use coaching in home visits, especially in virtual settings – or when you are on video.

• [Phase 4: Summary]

  • As we are nearing the end of the study, we want to hear about your recent experiences with coaching and what you felt worked or didn’t work in helping you to understand and learn what they were trying to teach or explain to you.

Your participation in our discussion today is completely voluntary, and you can leave the call at any time. Your decision about whether to participate in this focus group or to answer any specific questions will not affect any services that you receive. I may ask you a question directly, but you don’t have to answer anything you don’t want to. This is just an effort to make sure we hear from everyone today. Please know that the information you share today is confidential and only study staff will have access to the notes, recordings, and transcripts. Study staff may summarize what we discuss today to share with interested parties (e.g., staff in your program, HRSA, or other programs participating in the study), but no identifiable information or individual responses will be shared. We ask you to please respect each other’s privacy by not sharing any personal information or experiences discussed during the focus group.

There are no known risks to your participation in this focus group. Although you may not see direct benefits associated with your participation, the information we gather will be used to improve home visiting services in the future. As a token of our appreciation, we will offer you a $40 gift card after the focus group ends.

[When caregivers agreed to join this focus group, they were asked if they were comfortable being audio-recorded. Everyone who agreed is in this session. If anyone did not agree, they will be on a separate call and when holding that call, this same protocol is used, and this paragraph is skipped.]

When you agreed to participate in this focus group, each of you said you were comfortable being recorded. You may leave this discussion at any time – by remaining you are agreeing to participate and have the discussion recorded. Does anyone have any questions before I start recording? [Answer questions]. I’m going to begin the recording so that we can make sure we accurately capture what is said (that we remember the discussion correctly).

As we are getting things set up to record and get our discussion underway – I’m going to send out a link to a quick survey in the Zoom Chat [via email, if using phone]. The survey asks you to answer a few questions about yourself, so we have an understanding of who participated in our discussions. Like your participation in this discussion, filling out the survey is voluntary. You do not have to respond to all or any of the questions. Your name is not on the survey and will not be connected to your responses. By filling out the survey you are agreeing to allow the study team to see your responses and use your answers to describe (summarize) who was involved in the focus groups we conducted. Is everyone able to click on the link? [troubleshoot as necessary]. Great. If you are willing to fill out the survey, please take a few minutes to do so now and we’ll get started in [5 minutes, at TIME].

Ok. We are set up and I’m going to begin recording now. [Start to record]. Before we get started, I’d like us to set a few ground rules for the conversation.

[If using Zoom by video or calling in]

Since we are using Zoom today, I’ll keep my video on the whole time, but you can choose to have your video on or off. We want to make sure that everyone has the opportunity to have their thoughts and opinions heard. So, to avoid us talking over each other, I’ll be helping to direct the conversation. If you want to speak, you can let me know in the chat, click the “raise hand” button, or just chime in when there is a pause in conversation (this is particularly important if calling in instead of using video). Also, I want to emphasize that there are no right or wrong answers, and we are interested in hearing both positive and negative comments and opinions – or whatever you think is important to share. We only ask that you do not use the names of clients or staff outside of this focus group to help maintain everyone’s privacy. Those are all of the guidelines I have - does anyone have additional guidelines for our conversation that you would like us to consider? Does anyone have any questions about Zoom or the guidelines for our discussion? [Confirm that everyone understands Zoom features and can mute/unmute].

[If using Phone/conference call]

We want to make sure that everyone has the opportunity to have their thoughts and opinions heard. So, to avoid us talking over each other, I’ll be helping to direct the conversation. If you want to speak, you can chime in when there is a pause in conversation, otherwise, before we move on to different topics, I will provide an opportunity for people to voice their opinions. Also, I want to emphasize that there are no right or wrong answers, and we are interested in hearing both positive and negative comments and opinions – or whatever you think is important to share. We only ask that you do not use the names of clients or staff outside of this focus group to help maintain everyone’s privacy. Those are all of the guidelines I have - does anyone have additional guidelines for our conversation that you would like us to consider? Does anyone have any questions about the guidelines for our discussion? [Confirm that everyone understands how to mute/unmute].

In all, this should take between 30 minutes and an hour. Does anyone have any questions before we get started? [Answer questions.]

Part 1: Background

[The questions in this section are asked during Phase 1: Co-Definition only. This section is intended to introduce all members of the focus group to each other and open the conversation before moving in the next section.]

First, I’d like us to go around and introduce ourselves. I know that we’re all just meeting each other, so I can share a little more about myself first. [facilitator can share information about self, then cofacilitator, and can also introduce notetaker]

Great. Now if each of you could introduce yourselves telling us your first name only (to protect privacy), how long you’ve participated in [NAME OF HV PROGRAM] and the age of your child or children who participate. Let’s start with [insert first name, roll call rest of participants].

Thanks everyone. Now that we know a little bit about each other, let’s begin by talking about your experiences with [NAME OF HV PROGRAM].

Part 2: Strategies Implemented

[The questions in this section are asked during Phase 1: Co-Definition and Phase 4: Summary. This section gathers information on how coaching is used.]

Question: Can you begin by telling me about your (recent) experiences with coaching (when a [HOME VISITOR TITLE] instructs you on how to do something rather than showing you), especially during virtual home visits?

• Follow-up: Can you think of a specific example of a time when your [HOME VISITOR TITLE] tried coaching with you and tell me about it?

• Follow-up: In what instances has your [HOME VISITOR TITLE] used coaching?

  • Probe: virtual visits versus home visits

[Phase 4: Summary]

Question: During virtual home visits in the past few months, did your home visitor do [strategy chosen by site for implementation] or [(if applicable), strategy with adaptations identified through rapid learning throughout the study]? Please explain.

[Phase 1: Co-Definition and Phase 4: Summary]

Question: What are some differences in how your child interacts or acts when your [HOME VISITOR TITLE] uses coaching vs modeling (showing you by directly interacting with your child)?

Question: Does it seem to you that your [HOME VISITOR TITLE] uses different coaching approaches during virtual visits versus in-person home visits?

[Before moving on to the next question, make sure everyone has had the opportunity to voice their opinions.]

Part 3: Facilitators of and Challenges to Implementation

[The questions in this section are asked during Phase 1: Co-Definition and Phase 4: Summary. This section gathers information on supports and barriers that families experience in relation to coaching.]

Question: When you think about times when your [HOME VISITOR TITLE] has supported or helped you using coaching, what kinds of things are they usually helping you with?

Question: Did you run into any issues when your [HOME VISITOR TITLE] has been trying to coach you? If so, please explain.

• Probe: difficulties hearing or understanding what the home visitor is telling parent/caregiver to do; distractions that made it difficult to do activity being coached

Question: Has there been anything that has helped improve your coaching experience? If so, please explain.

• Probe: importance of physical location (where caregiver or home visitor is in the room, where/how camera is positioned) on ability to follow instructions/guidance

• Probe: anything that helps minimize distractions

[Before moving on to the next question, make sure everyone has had the opportunity to voice their opinions.]

Part 4: Perception of Strategies

[The questions in this section are asked during Phase 1: Co-Definition and Phase 4: Summary. This section gathers information about caregiver’s experiences of coaching strategies before the program implements practice changes (Phase 1: Co-Definition) to set a baseline understanding, and after the study implementation has been completed (Phase 4: Summary) to get family feedback on their experiences and any challenges.]

[Phase 4: Summary]

Question: Have you noticed any changes with how your [HOME VISITOR TITLE] coaches you, or works with you to teach or explain a specific skill or practice they suggest you try?

Question: How has your child reacted to coaching (recently)?

• Probe: child’s behavior while [HOME VISITOR TITLE] talks to parent/caregiver

• Probe: child’s reaction when parent/caregiver tries to do activity being coached

• Follow-up: Is there a difference in response based on whether your visit is virtual or in person?

[Phase 1: Co-Definition and Phase 4: Summary]

Question: What are your overall thoughts about your (recent) experience with coaching?

• Follow-up: What do you like and not like about how your [HOME VISITOR TITLE] has been coaching you?

• Follow-up: What do you feel you have learned or gained through coaching?

  • Probe: specific parenting skills, knowledge, strategies learned

  • Probe: change in interactions with child

  • Probe: changes in relationship with child

• Follow-up: How do your coaching experiences compare to learning through modeling (when a [HOME VISITOR TITLE] works directly with your child to show you how to do something) – do you prefer one over the other? Please explain.

Question: How has coaching influenced how confident you feel in your parenting?

Question: How does coaching make you feel?

Question: How satisfied are you with your [HOME VISITOR TITLE]’s use of coaching?

• Follow-up: How satisfied are you with how (the way) your [HOME VISITOR TITLE] has been using coaching strategies with you?

• Follow-up: How satisfied are you with what you have learned from these coaching experiences?

• Follow-up: Has/does coaching change anything about your relationship with your [HOME VISITOR TITLE]?

  • Probe: change in comfort with [HOME VISITOR]

• Follow-up: Are there changes or improvements you’d like to see in your [HOME VISITOR TITLE]’s coaching or with the experience of coaching more generally?

[Before moving on to the next question, make sure everyone has had the opportunity to voice their opinions.]

Part 5: Wrap-up/Final Questions

[This section is asked during Phase 1: Co-Definition and Phase 4: Summary. This section is the closing of the focus group and is used to make sure we address any outstanding questions and ensure we ask if anyone has anything additional to share before we end the focus group.]

Question: In closing, is there anything else you’d like to share?

Thank you very much for participating in this focus group! If you have questions about this discussion, or how the transcript will be used, feel free to contact me.

[Phase 1: Co-Definition]

Our next focus group will be [provide timing] and will be Phase 4: Summary of the study process, after the program has implemented practice changes related to coaching. We will then be gathering your feedback on these changes and your general experiences with coaching again on that later date.

If you have any questions about the study, please contact Teresa Smith at The Policy & Research Group ([email protected] or (225) 281-3783).

If you have questions about your rights as a research volunteer, you can call Health Media Lab Institutional Review Board at (202) 549-1982.

The Policy & Research Group 6