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. 2026 Jul 10;47(5):e70107. doi: 10.1002/imhj.70107

Implementation of coaching and peer learning collaboratives to support home visiting practices

Lorraine M McKelvey 1,✉, Angela Rau 2, Tasha L Olson 3, Christine Zimmerman 4, Lauren B Fox 1, Tyra Greenwood 5, Dong Zhang 1, Kanna N Lewis 1
PMCID: PMC13353142  PMID: 42429386

Abstract

Home visiting programs enhance parental capacities in fostering their children's development. Home visitors navigate the dual responsibilities of advancing program objectives and individual family needs, all while cultivating trusting relationships. Effective practice requires distinct competencies, which can be fostered through professional development activities. This study outlines an initiative designed to strengthen home visitors’ self‐awareness, reflective capacity, and practices. The initiative incorporated (1) training in a validated home visiting quality assessment tool; (2) equipment to record and observe oneself delivering home visits; (3) four one‐on‐one reflective, performance‐based coaching sessions with individualized goal setting and feedback; and 4) four coach‐facilitated peer learning sessions. Thirty home visitors in one state in the United States participated in the project. Home visitors implemented one of five home visiting models. The study used a one‐group design. Home visitors were White (54%), Black (21%), Hispanic (18%), and multiracial (7%). Home visitor participants reported high levels satisfaction, citing strong collaborative relationships with their coaches and enhanced reflective practice skills. Analyses comparing participants’ initial and final recorded visits indicated a marginally significant strengthening of the Relationship Building with Families scale. Findings contribute to the growing body of literature examining reflective, performance‐based coaching in home visiting.

Keywords: coaching, home visiting, professional development, peer learning

1. IMPLEMENTATION OF COACHING TO SUPPORT HOME VISITING PRACTICES

Evidence‐based home visiting (EBHV) programs are two‐generation services with a primary goal of strengthening parents' skills to foster their children's development (Cibralic et al., 2025; McKelvey et al., 2024). By delivering services to families in their own homes, EBHV programs provide a better understanding of each family's unique cultures and resources, while also balancing the power dynamic between the family and the practitioner. As home visitors build warm, responsive relationships with families, caregivers become more open to trying new strategies and engaging in meaningful reflection (Weatherston, 2000). These reflective behaviors can enhance the quality of relationships between caregivers and their children, ultimately promoting mental health and well‐being in children (Menashe‐Grinberg et al., 2022).

Key Points

  • This study outlines the implementation of a professional development initiative, which incorporated training in a validated home visiting quality assessment tool, individual coaching with self‐observation, and a peer learning collaborative, intended to strengthen home visitors’ self‐awareness, reflective capacity, and practices.

  • Home visitors reported high levels of satisfaction with the initiative, citing strong collaborative relationships with their coaches and strengthened home visiting practices.

  • Analyses comparing participants’ initial and final recorded visits indicated a marginally significant improvement in relationship building with families.

Statement of Relevance

This study contributes to the growing body of literature describing reflective, performance‐based coaching in home visiting.

While EBHV models’ theories of change and anticipated outcomes can vary, infant and early childhood home visitors primarily conduct activities that directly support child development and parenting outcomes (McKelvey et al., 2024; Walsh et al., 2022b, 2023). Generally, home visitors educate caregivers about child development, conduct developmental screenings, and provide appropriate referrals for additional interventions and services when needs are identified. Many EBHV home visitors also facilitate caregiver–child interactions, supporting families to understand the importance of positive engagement with their child(ren). In addition to focusing on the child's development, home visitors also assess family needs to inform caregiver skill‐building and connect them to resources, including basic support and mental or behavioral healthcare needs. While activities may vary, funding for EBHV programs specifically track performance associated with these home visitor activities (Adirim et al., 2013; Avellar & Supplee, 2013).

During each visit, home visitors must balance their program's goals and curricula with the concrete needs and expectations of participating families all while also nurturing the relationship with the family (Roggman et al., 2008). Given the complex nature of this work and the need to tailor services to families’ lived experiences, it is essential for home visitors to develop competencies that allow them to collaborate effectively with families (Roggman et al., 2016). Home visitors benefit from observation, reflection, and feedback, all of which positively influence their behaviors (Walsh, Steffen et al., 2021). Recommended support often includes reflection on home visiting practice with supervisors (e.g., reflective supervision), practice‐based mentors (e.g., coaching), or with peers (e.g., peer learning groups/communities of practice). Additionally, video recording with self‐ and/or observer‐implemented assessments has been used as tools to support these reflective and skill‐based professional development supports (Casillas et al., 2016; Schultz et al., 2019; Walsh et al., 2022b, 2023).

Coaching involves a collaborative partnership where home visitors, guided by adult learning principles (Haring & Rau, 2025; Haring et al., 2025; Walsh et al., 2022b, 2023), autonomously set goals and priorities. This approach prioritizes self‐direction and goal orientation, empowering home visitors to lead goal setting based on observational data (Powell & Diamond, 2013). Home visiting competency frameworks highlight these practices as vital for preparing home visitors, particularly in adult learning principles and self‐reflection (Division for Early Childhood, 2014; Institute for the Advancement of Family Support Professionals, 2022; Roggman et al., 2016), and recent work further conceptualizes coaching specific for the home visiting context (Haring & Rau, 2025; Peterson et al., 2018; Walsh et al., 2023).

The literature on the conceptualization of reflective, practice‐based coaching in infant and early childhood home visiting is growing (Haring & Rau, 2025; Walsh et al., 2022b). Recent studies highlight positive impacts on home visitor perceptions and satisfaction with coaching as a professional development activity (Walsh, Edwards et al., 2022a; Walsh, Steffen, et al., 2021) as well as the content and fidelity to coaching interventions (West et al., 2024). A recent literature review of research on coaching in home visiting identified seven studies of practice‐based coaching, all in the context of Early Intervention (McLeod et al., 2021). These studies document positive practice‐based changes for providers who received performance‐based feedback (Brown & Woods, 2012; Coogle et al., 2019; Fettig et al., 2016; Hall et al., 2010; Krick Oborn & Johnson, 2015; Meadan et al., 2020; Ryan & Hemmes, 2005). Similarly, there are studies of coaching that document practice‐change specific to individual model fidelity (Whitaker et al., 2025).

2. THE ARKANSAS COACHING INITIATIVE IN HOME VISITING (ARCIHV) PROJECT: DEVELOPMENT AND IMPLEMENTATION

The goal of the ARCIHV project was to develop, implement, and evaluate a workforce development project to support quality home visiting practices. The ARCIHV project (see Figure 1 for project logic model) provided home visitors with training on an extensively validated measure of home visit quality, the Home Visitor Rating Scale 3 (HOVRS‐3) (Roggman et al., 2019). Home visitors were provided the book, Developmental Parenting: A Guide for Early Childhood Practitioners (Roggman et al., 2008), that includes support materials that describe the practices of the HOVRS‐3. Home visitors were also provided equipment and software needed for recording and reviewing home visits with families they serve (i.e., video self‐observation). Home visitors were supported with one‐on‐one reflective, performance‐based coaching using video self‐observation and a cross‐model peer learning collaborative, facilitated by their coach, to further their understanding and self‐assessment of their skills related to the four HOVRS‐3 practice‐based scales. The foundational principles for coaching and peer learning implementation are provided in Table S1.

FIGURE 1.

FIGURE 1

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Project logic model.

ARCIHV was designed to be a collaborative, home visitor‐centered, and strengths‐based learning process. Further, activities were designed to complement, not replace, reflective supervision aligned with each program's model fidelity standards. Reflective supervision requirements for the participating home visiting models vary widely, from no formal supervision to an expectation of weekly supervision. However, regardless of the model requirements, there are no opportunities for reflective supervision to occur outside of a home visiting program's organizational structure (i.e., all reflective supervision within the state is conducted with administrative supervisors). Table S2 includes a summary of the similarities and differences between best practices for reflective supervision (Alliance for the Advancement of Infant Mental Health, 2018) and the individual elements of ARCIHV. Like other forms of reflective practice, coaching in ARCIHV was designed to support optimal parallel process (Walsh et al., 2020, 2022b) as the coaching relationship can function as a model for how home visitors engage with families (Roggman et al., 2008).

ARCHIV was developed to support general (i.e., non‐model specific) home visiting practice‐based reflection and learning. Coaches partnered with home visitors to reflect, set goals, and build skills designed to foster EBHV practices. In ARCHIV's one‐on‐one coaching, coaches’ interactions with home visitors were designed to promote a positive, mutual, and collaborative relationship with strengths‐based reflection. Coaches were selected with foundational training and understanding of a number of core principles (see Table S1), including adult learning theory principles (Cox, 2015; Cox et al., 2014; Knowles, 2014; Walsh et al., 2022b), which have been used in other implementations of coaching in home visiting practice (Haring & Rau, 2025; Haring et al., 2025; Walsh et al., 2022b). The process supports home visitors in cultivating self‐directed learning, where they manage, reflect on, and refine their own practices (Costa & Garmston, 2016; Haring & Rau, 2025; Powell & Diamond, 2013; Rush & Shelden, 2011).

In the ARCIHV implementation, coaching sessions used self‐recorded home visitor interactions with families to foster self‐reflection and self‐assessment with the HOVRS‐3 scale (Roggman et al., 2019). Home visitors recorded home visits, reviewed their practice, and selected the segments of home visits they wished to discuss with coaches. Coaches followed the home visitors’ lead, reinforcing relationship‐building throughout the coaching process (Snyder et al., 2022). The inclusion of recordings to support the coaching process was implemented as self‐observation using video has been shown to have a positive effect on parenting (Innocenti et al., 2023; Vilaseca et al., 2025) and educator performance (Hollingsworth & Clarke, 2017; Major & Watson, 2018).

In addition to coaching, a peer learning approach was selected as it has also been demonstrated an effective resource for the professional development of home visitors (Haring & Rau, 2025). Like all peer learning opportunities, ARCIHV supported peer‐to‐peer sharing and learning and live discussions/reflection on experiences and practice. The ARCIHV peer learning implementation also included assignments that supported knowledge study and reviewing video recording examples, both of which were specific to the HOVRS‐3 and related practice insights provided in Developmental Parenting (Roggman et al., 2008, 2019).

The Collaborative Learning Cycle (CLC) framework (Wellman & Lipton, 2003) was used to structure inquiry, reflection, and action in peer learning sessions. The CLC is a “scaffold for collective investigation, discovery, and action planning” (Wellman & Lipton, 2003, p. 7), emphasizing data‐driven dialogue and shared understanding of practices that support desired outcomes. It includes three interconnected phases: Activating and Engaging, where participants draw on prior experiences through questioning and prediction; Exploring and Discovering, where they analyze and relate data to practice; and Organizing and Integrating, where they evaluate findings and develop theories of action for improvement.

Within peer learning activities, prompts, observations, reflective questioning, tools, and action‐planning were aligned with CLC phases. Facilitators elicited participants’ prior knowledge, guided collaborative analysis of video practice examples using the HOVRS‐3 (Roggman et al., 2019), and supported participants in identifying patterns, determining effective practices, and developing actionable strategies for professional growth. The framework fostered reflective dialogue, collaborative inquiry, and integration of observational data into learning.

In ARCIHV, both coaching and peer learning sessions were conducted virtually, which mitigated challenges posed by geographic distance (Jesionkowska, 2020; Pesare et al., 2017). While virtual professional development has been used in support of home visiting workforce (Shanley et al., 2013; Traube et al., 2020), its implementation remains relatively novel (Walsh et al., 2023). The goal for ARCIHV's combined coaching and peer learning collaborative implementation was that home visitors develop and demonstrate enhanced efficacy, awareness, and self‐assessment of their home visiting practices. These skills enable home visitors to monitor and modify their own professional practice, thereby enhancing the quality of their home visits and their long‐term professional growth.

2.1. The current study

The purpose of the current study was to investigate whether the ARCIHV project, which included training on an assessment of home visiting quality, one‐on‐one coaching using recordings of home visits, and a peer learning collaborative, supported the implementation of quality home visiting services. The current study described home visitor participation, engagement, and satisfaction with the project. Our primary research question was whether ARCIHV would improve home visiting practices as measured with the HOVRS‐3 (Roggman et al., 2019). When coaching home visitors, coaches supported the maintenance or strengthening of home visitors’ skills and evidence‐based practices (Peterson et al., 2018). Although training could build foundational knowledge, meaningful changes in home visitors’ skills and behaviors were more likely when accompanied by relational supports like coaching (Snyder et al., 2022). Based on the existing literature, it was hypothesized that the ARCIHV coaching process would facilitate home visitors’ self‐directed learning (Costa & Garmston, 2016; Haring & Rau, 2025; McLeod et al., 2021; Rush & Shelden, 2011), thereby strengthening home visitor practices.

3. METHODS

3.1. Study design

This study used data collected during the implementation of the ARCIHV coaching project funded through the Maternal, Infant, and Early Childhood Home Visiting (MIECHV). This study used a one‐group pre‐ and posttest design for the primary outcome, examining ratings of home visiting practices. ARCIHV activities included training in February 2024, participation in coaching (plus peer learning collaboratives) from March to June 2024, and data collection in June and July 2024. The Institutional Review Board of the University of Arkansas for Medical Sciences (protocol # 274375) approved the study.

3.2. Participants

The project occurred in MIECHV‐funded programs in Arkansas, which included five funded home visiting models, Healthy Families America (HFA), Home Instruction for Parents of Preschool Youth (HIPPY), Parents as Teachers (PAT), Nurse Family Partnership (NFP), and Following Baby Back Home (FBBH). All MIECHV‐funded home visitors (N = 73) were invited to participate in the project on a first‐come, first‐served basis with a desired sample of 30 participating home visitors.

Participants in the current study included 30 home visitors who voluntarily enrolled in the ARCIHV project. The characteristics of participating home visitors are described in Table 1. All participating home visitors were female and were trained in/delivering HFA (36.7%), HIPPY (26.7%), PAT (23.3%), NFP (3.3%), and FBBH (10.0%). Two of the 30 home visitors resigned from their positions during the project.

TABLE 1.

Characteristics of home visitors participating in the coaching innovation.

Home visitor characteristics Number (%)
Gender a Female a 30 (100%)
Model a Healthy Family America 11 (36.7%)
Home Instruction for Parents of Preschool Youth 8 (26.7%)
Parents as Teachers 7 (23.3%)
Nurse Family Partnership 1 (3.3%)
Following Baby Back Home 3 (10.0%)
Age b <34 years 6 (21.4%)
35–44 years 10 (35.7%)
45–54 years 6 (21.4%)
>55 years 6 (21.4%)
Race/ethnicity b White 15 (53.6%)
Black 6 (21.4%)
Hispanic 5 (17.9%)
Multiracial 2 (7.1%)
Highest level of education b High School/GED 9 (32.1%)
Associate's/Child Development Associate 11 (39.3%)
Bachelor's 8 (28.6%)
Years of experience b <2 years 5 (17.9%)
3–5 years 3 (10.7%)
6–10 years 10 (35.7%)
>10 years 10 (35.7%)
Language b Spanish (Yes) 5 (17.9%)
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aInformation from administrative records (N = 30).

bInformation from survey responses (N = 28). Percentages in parenthesis are column percentage within each category.

The age distribution of participants varied, with a substantial proportion (36%) aged 35–44 years. In terms of racial and ethnic composition, the majority were White (54%), with the remaining participants identifying as Black (21%), Hispanic (18%), and multiracial (7%). Additionally, five participants were Spanish speakers. Regarding educational attainment, 32% of participants had a high school diploma or GED, 39% held an associate's degree or Child Development Associate (CDA) credential, and 29% had a bachelor's degree. Experience levels varied, but most participants (71%) had 6 or more years in the field.

At the end of the project, we collected survey responses from 28 of the 30 participants who participated. REDCap (Harris et al., 2009, 2019) was used to design and administer the survey, which was open for approximately 3 weeks following the completion of all ARCIHV coaching and peer learning sessions. Measures included in the survey are described below. Each participant was compensated $75 for their time to complete the survey. The primary data collection for the project was completed at the end of the project, in July of 2024. Home visit recordings that were used in coaching, the first and last video submitted for the coaching session, were used to score the HOVRS‐3 (Roggman et al., 2019). Ratings were made by a trainer in the administration of the HOVRS‐3 instrument (author 3).

3.3. Measures

3.3.1. ARCIHV implementation

After each completed coaching or peer learning activity, coaches entered information about each participant, their level of engagement, and content covered using a spreadsheet. Coaches rated the proportion of time the home visitor spent engaged in the session on a 0–5 scale (0 ≤ 10%, 1 = 10%–25%, 2 = 26%–50%, 3 = 51%–75%, 4 = 76%–90%, and 5 = 91%–100%). The average engagement rating was calculated across the coaching or peer learning sessions in which home visitors participated. In addition to these metrics, coaches noted whether a video was reviewed with home visitors during coaching sessions.

3.3.2. Program experience and satisfaction

A set of questions was developed for the evaluation to assess participants’ beliefs about the impact of the individual components of the ARCIHV project on their skills as a home visitor. The lead question, “How would you rate the effect of the following on your skills as a home visitor?” was used before a list of the five elements of the intervention, as well as an item rating their program overall (items are presented in Table 2). Responses were rated on a scale of 1 (very negative) to 5 (very positive). Questions from the Relational Health Indices—Mentor (RHI‐M) and Community (RHI‐C) subscales (liang) were adapted to assess participants’ experiences with their coach and peer learning collaboratives. For assessing their relationship with their coach, sample adapted questions included “I could genuinely be myself with my coach.” and “My coach shares their experiences with me in a way that enhanced my work”. For assessing the connection and sense of belonging participants felt in their communities of practice, sample adapted questions include “I felt a sense of belonging with the home visitors in my peer learning group.” and “I feel better about myself after my interactions with the home visitors in my peer learning group.” Responses for both subscales were recorded on a scale from 1 (Never) to 5 (Always). Internal reliability for the Mentor/Coach (α = .81) and Peer Learning (α = .89) scales was high.

TABLE 2.

Home visitor rating of impact of ARCIHV components on skills.

ARCIHV component Mean (SD)
Having HOVRS training 4.79 (.5)
Being able to record and watch your home visits 4.64 (.68)
Having one‐on‐one coaching 4.79 (.5)
Having a peer learning collaborative 4.54 (.69)
The Developmental Parenting Book 4.46 (.69)
Overall impact of this program 4.79 (.5)
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Rating 1 = very negative, 5 = very positive.

3.3.3. Home visit practices

To capture change in observed practice, the first and last recording submitted for coaching sessions were scored using the four home‐visiting practices scales of the Home Visit Rating Scales (HOVRS‐3). The HOVRS‐3 was developed from field‐based descriptions of successful home visits and are supported by home‐visiting research in multiple disciplines (Roggman et al., 2019). HOVRS‐3 ratings were completed by author 3, an expert who trains users to reliability. The four home‐visiting practices scales measure Relationship Building with Families (7 items), Responsiveness to Family Strengths and Cultures (6 items), Facilitation of Parent–Child Interaction (6 items), and Collaboration with Caregivers as Partners (5 items). Home visitor behavior for items on each of these scales is scored on a 7‐point scale, with 1 indicating that the home visitor needs support and 7 indicating excellent practice. In addition to each of the individual scales, a summary score of the 4 practices is computed. Interitem intraclass correlation coefficients (ICCs) were .81, .71, .82, and .83 for the 4 practices scales, respectively, and .76 for the summary score, which reflect strong cohesiveness among the items (Roggman et al., 2019).

3.4. Approach to analysis

Analyses were conducted using SPSS version 29 (IBM Corp., 2022). Descriptive statistics were used to summarize participant demographics and survey response data. For the HOVRS‐3 scores, which are continuous, we conducted paired sample t‐tests to compare home visitors’ first and last video scores, analyzing whether participation in ARCIHV led to measurable enhancements in home visiting practices. In addition to an analysis that included the full sample, we conducted a preliminary analysis to examine whether there were differences in change in HOVRS‐3 practices scales for each of the participating models. Models with fewer participants than statistical tests conducted (i.e., five total comparisons: four HOVRS‐3 scales and one summary practices scale) were excluded from analysis.

4. RESULTS

Three coaches were identified with the competencies outlined in Table S1. Two coaches were master's prepared (authors 2 and 4), and one coach held a doctorate in human development (author 3). All coaches had expertise in home visiting, coaching, and group facilitation and adhered to strengths‐based (Hammond & Zimmerman, 2012) and adult‐learning principles (Cox, 2015; Haring et al., 2025; Knowles, 2014). Table S3 provides more information about the qualifications of each of the coaches.

Each of the three coaches was assigned 10 home visitors, who were respectively assigned to 4 coaching and 4 peer learning sessions. The home visitors assigned to coach 1 were from models HFA (n = 4), PAT (n = 2), HIPPY (n = 3), and FBBH (n = 1). The home visitors assigned to coach 2 were from models HFA (n = 4), PAT (n = 2), HIPPY (n = 2), FBBH (n = 1), and NFP (n = 1). Finally, home visitors with coach 3 were from models HFA (n = 3), PAT (n = 3), HIPPY (n = 3), and FBBH (n = 1). Of the 30 home visitors who volunteered to participate, 2 left the field during project, completing 2 of the 4 months of planned activities (2 coaching and 2 peer learning sessions). An examination of program participation for the remaining 28 home visitors shows 100% participation in all 4 coaching sessions. For peer learning collaborative sessions, 26 (93%) participants attended all four sessions, and 2 (6.7%) attended three sessions.

The coaching sessions were intended to last approximately 1 h. Coach 1 (M = 60.00, SD = 2.20) and coach 3 (M = 60.25, SD = 1.84) had similar average coaching lengths, while coach 2 had a slightly lower average (M = 56.75, SD = 2.51; F (2,27) = 7.84, p = .002). The peer learning collaborative sessions were also designed to last one hour. The overall average length of peer learning sessions was 60.2 min (SD = 2.51), and there were no statistically significant differences between coach facilitators. Among the 28 participants who completed ARCIHV, the majority (n = 22, 79%) viewed and discussed their home visit recording in all 4 video coaching sessions and the remaining home visitors (n = 6, 21%) reviewed recordings in 3 of their coaching sessions. Coaches rated high engagement for coaching sessions (M = 4.98, SD = .10) and for peer learning collaborative sessions (M = 4.95, SD = .15).

As seen in Table 2, participants reported high satisfaction with the ARCIHV program overall. The average score for the scale was 4.79 (SD = .50), which is slightly below the most positive response option (“very positive”). Most participants (88%) had a very or somewhat positive opinion about every aspect of the program.

When asked about their relationship with their coach, participants were positive about the experience (see Table 3). The average score for the scale was 4.75 (SD = .34), which is near the “always agree” option. When asked about their personal feelings of well‐being and the sense of community present (or not) within their peer learning group (see Table 3), participants were also positive about the experience. The average score for the scale was 4.17 (SD = .56), which is above the often‐agree rating.

TABLE 3.

Relational health of home visitors in ARCIHV.

Relational Health Scales Mean (SD)
Coaching Scale a
I could be genuinely myself with my coach. 4.89 (.42)
I believe my coach values me as a whole person (professionally and personally). 4.93 (.26)
My coach shared their experiences with me in a way that enhanced my work. 4.61 (.83)
I know my strengths and weaknesses better because of my coach. 4.68 (.48)
My coach gave me support and encouragement. 4.93 (.26)
I felt uplifted and energized by interactions with my coach. 4.79 (.42)
My coach tried hard to understand my priorities and goals. 4.86 (.36)
My relationship with my coach inspired me to seek other relationships like this. 4.32 (.95)
I felt comfortable expressing concerns to my coach. 4.82 (.39)
Mentor/Coach Relational Health Scale Total 4.76 (.20)
Peer Learning Collaborative Scale a
I felt a sense of belonging with the home visitors in my peer learning group. 4.39 (.99)
I feel better about myself after my interactions with the home visitors in my group. 4.39 (.83)
I felt understood by other home visitors in my peer learning group. 4.71 (.54)
It seems as if the home visitors in this group really like me as a person. 4.43 (.92)
I have a greater sense of self‐worth through my connection with the home visitors in my peer learning group. 4.07 (.98)
My connections with other home visitors in my peer learning group motivate me to pursue relationships with other home visitors outside this community. 3.86 (1.04)
Group Learning Collaborative Relational Health Scale Total 4.31 (.30)
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SD, standard deviation.

aQuestions adapted from: Liang et al. (2002) Relational Health Indices—Mentor and Community Subscales.

Change in practice was measured using the first and last recordings home visitors made for their coaching sessions. A paired samples t‐test was conducted to determine the effect of ARCIHV on HOVRS‐3 scores (see Table 4). The results indicate a marginally significant difference in Relationship Building with Family from the first (M = 4.82; SD = 1.54) to the last recording (M = 5.21; SD = 1.26); [t(29) = 1.38, p = .09]. There were no differences for the other three HOVRS‐3 Home Visiting Practices scales.

TABLE 4.

HOVRS‐3 scale scores for ARCIHV home visitors: first and last recordings.

Construct Time point N Mean SD t
Scale 1: Relationship Building With Family First video 30 4.82 1.54 1.38 *
Last video 30 5.21 1.26
Scale 2: Responsiveness to Family Strengths/Cultures First video 30 3.54 1.143 .16
Last video 30 3.58 1.25
Scale 3: Facilitation of Caregiver–Child Interaction First video 30 3.66 1.51 .00
Last video 30 3.66 1.37
Scale 4: Collaboration With Caregivers as Partners First video 18 3.21 1.76 .14
Last video 18 3.25 1.55
Home Visiting Practices Total (Scales 1–4) First video 30 3.93 1.14 .38
Last video 30 4.01 1.16
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Scores range from 1 (Needs Support) to 7 (Excellent). SD, standard deviation.

* p < .10.

Preliminary analyses to examine whether there were differences in change in HOVRS‐3 practices by model (data not shown) demonstrated changes for home visitors in HFA and PAT. Home visitors in HFA had marginally significantly positive gains in Responsiveness to Family Strengths and Cultures scale from the first (M = 3.76; SD = .96) to the last recording (M = 4.36; SD = 1.28); [t(10) = 1.61, p = .07]. Home visitors in PAT had significant positive gains in Relationship Building with Family from the first (M = 4.61; SD = 1.20) to the last recording (M = 5.54; SD = 1.27); [t(6) = 2.74, p = .02]. No other differences were observed for HFA or PAT. There were no significant changes for the HIPPY model.

5. DISCUSSION

In this reflective, performance‐based coaching and peer learning collaborative intervention, home visitors were highly engaged, with nearly all home visitors completing their individualized coaching and peer learning sessions. The implementation of the ARCIHV project was successful; most coaching sessions included the review of recordings and discussions of home visiting practices, and with high levels of engagement. We also asked about each individual component of the ARCIHV project, and nearly all rated the overall impact of the program on their skills as a home visitor as very positive. Home visitors were highly satisfied with their coaching experience and rated their relationship with their coach very positively. Home visitors also rated their relationships within the peer learning collaborative positively.

Existing evidence from video performance reviews with expert coaching have been found to have positive effects on performance outcomes (Alameddine et al., 2018; Bishop et al., 2021; Hammoud et al., 2012). To assess changes in practice, we scored home visitors’ first and last recorded home visits that were used for coaching using the HOVRS‐3. Results indicated a trend toward higher scores on the Relationship Building with Family scale. Because of the different foci and theories of change used by the home visiting models represented, we preliminarily examined changes for models with the largest numbers of participants. Although samples within each home visiting model were quite small and should be interpreted with caution, there was a trend toward significant increases in the Responsiveness to Family Strengths and Cultures scale for HFA home visitors and a significant increase in Relationship Building with Family for PAT home visitors. As HOVRS‐3 scales were introduced in the same order as they appear within the measure, the scales that were introduced earlier in the project, Relationship Building with Family and Responsiveness to Family Strengths and Cultures, were the scales to show increases. Perhaps with longer follow‐up, there may have been shifts in practices supported during the latter half of the project, Facilitation of Caregiver‐Child Interactions and Collaboration with Caregivers as Partners.

The project was also implemented across multiple program models. This created a unique opportunity to bring the strengths from their models and learn from one another. The different theories of change for programs meant that participants had varying experiences and comfort with home visiting practices that support positive parent‐child relationships. Indeed, home visitors from one model participating in the coaching project were particularly challenged to see the relevance of the parent–child focused content (Facilitation of Parent–Child Interaction and Collaboration with Caregivers as Partners) with their work, specifically because they implement curricular activities directly with parents and often when children are not present. This may also have limited the change observed on these two scales.

5.1. Strengths and limitations

A strength of this implementation was that it was completed across all program models in use in one state. While model diversity reflects a strength in implementation and allowed cross model learning, it may have limited the ability to demonstrate impacts as home visitors’ training and experiences with reflective supervision are quite diverse. Further, the sample of home visitor participants across models was not balanced and representation from some models was quite small, which limits the ability to examine learning across all models. It should also be noted that the findings are weighted more heavily for models with more home visitor participants. Finally, the sample size achieved for this project is sufficient to demonstrate only large effects.

Home visitor participants volunteered and were compensated to conduct the additional work required for the project. Because the participants were not randomly selected, it is not possible to disentangle whether the factors that drove individuals to volunteer resulted in greater motivation to participate in the intervention. To address this limitation, future studies could randomize participants into the coaching project to document change in skills against a control group. Further, the sample of participating home visitors was experienced staff. Future studies could stratify the sample by time in profession, as it may be that home visitors with differing levels of experience would make changes to practice differently than those with more years’ experience.

ARCIHV supports were available to home visitors for a brief period (4 months), which may have weakened study findings. First, the brevity of the intervention did not permit similar lengths of time for home visitors to focus on each one of the four HOVRS practices in coaching. Coaches recorded the focus of coaching sessions and reported that more time was allocated to the Responsiveness to Family Strengths and Cultures and Relationship Building with Family scales, which is where differences in HOVRS scores were observed.

We used video recordings of visits that were done by home visitors for their coaching sessions. The use of recordings that were not intended for research introduces potential limitations to the findings. One primary limitation is that there were no systematic requirements across the recordings. The recordings differed by length and families chosen by the home visitors to record. Home visitors ultimately selected families used for recordings. They were also encouraged to make the coaching project optimally useful to them and to choose families that might represent challenges to their practice (Haring & Rau, 2025; Haring et al., 2025). While the home visitors rated their relationship with their coaches as very positive after the end of the project, the coaching relationship takes time to develop (Johnson et al., 2016). Home visitors’ growing comfort with their coaching relationship as the project evolved may have led to their choice of recording more challenging home visits toward the end of the project rather than at the beginning. As home visitors selected the videos, they may have purposefully selected families in which their practices were more optimal toward the beginning and less optimal toward the end of the coaching support.

There were additional idiosyncrasies across the recordings that may also impact results. Because the project sought to include all models in the intervention, there were issues related to the recordings for participants from the one of the models, which typically delivers curricula to parents without children being present. Further, some families enrolled during pregnancy, which resulted in home visits being recorded where the child was not yet born. Scale scores were computed for the items that could be coded. Finally, while the scoring of submitted videos was completed by an expert in the HOVRS‐3 (author 3) who conducts training in the tool's use and is used as a gold‐standard scorer for certification, scoring was completed by one individual; therefore estimates of interrater reliability are not available.

5.2. Implications

ARCIHV was developed as a collaborative process to support home visitors to understand and apply their strengths to promote professional growth and positive outcomes (McLeod et al., 2017). The project demonstrated promising results for supporting professional growth and reflection across multiple home visiting models. There was a high level of participation, engagement, and satisfaction from home visitors who participated in the project. Through reflective, performance‐based coaching supported by video recordings, and peer learning sessions, home visitors increased their confidence, deepened their self‐awareness, and reported strengthening of relational and cultural responsiveness. Analyses of independent ratings of home visit quality suggest a modest impact on observed practices, with additional subgroup analyses suggesting potential model and practice‐specific changes. Some models may have been challenged to change practice, specifically because of the lack of existing parent‐child interaction support practices within their model. Still, it is encouraging that this cross‐model coaching, and peer learning collaborative project demonstrated positive impacts on the practices where home visitors were given the most time for reflection and implementation changes.

This study contributes to the emerging evidence on performance‐based coaching in home visiting and supports the value of relational, reflective, and strengths‐based professional development. The use of video feedback, when paired with an objective assessment of practices as with the HOVRS‐3, can provide a replicable structure for competency‐focused coaching. Future efforts should consider longer implementation periods, randomization of home visitor participants, and strategies for engaging staff across varying levels of experience.

CONFLICT OF INTEREST STATEMENT

The authors have no conflicts of interest to disclose.

Supporting information

Supporting Information: imhj70107‐supp‐0001‐SuppMat.docx

IMHJ-47-0-s001.docx (41.9KB, docx)

ACKNOWLEDGMENTS

Funding for this study was made possible by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U4GMC45637 of the Affordable Care Act—Maternal, Infant, and Early Childhood Home Visiting Program awarded to the Arkansas Department of Health. The information or content and conclusions expressed in this material or by speakers and moderators are those of the author(s) and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. The authors would also like to thank Lori A. Roggman, PhD, and Mark Innocenti, PhD, for their consultation during the development of the project.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supporting Information: imhj70107‐supp‐0001‐SuppMat.docx

IMHJ-47-0-s001.docx (41.9KB, docx)

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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