Transferring training to evidence-based practice in home visitation

This qualitative study explores knowledge transfer in evidence-based home visiting programs, using in-depth, semi-structured interviews with trainers and supervisors of Healthy Families and Parents as Teachers programs in a statewide network. Drawing on theories of knowledge-to-action, two core questions are posed: 1) From the perspectives of home visiting trainers and supervisors, what key factors most need to be transferred through training? and 2) What are main barriers and supports to this transfer happening in home visiting programs? Respondents emphasized the importance of certain aspects of relationship between staff and participants. Relationships need to be motivating, such that participants feel they need the knowledge that the home visitor shares. Relationships need to be secure enough that the participant directly draws content and perspectives from home visits into other areas of life and the participant can keep doing so throughout parenthood. The rapid expansion of home visitation was perceived as adding some barriers to maintaining a relationship focus, especially as technical assistants served more and more programs and task management issues such as employee discipline and heavy documentation and training requirements emerged as challenges to relationship-based practice. Reflective supervision and the relational emphasis of all training in this statewide network were perceived as supporting parallel process relationship. This study contributes to knowledge about how relationship can be fruitfully conceptualized in home visiting beyond simple support and suggests specific ways knowledge transfer in home visiting programs can be improved. Home visitation may need relatively high levels of engagement to activate the intervention's relationship mechanism and to transfer training investments into evidence-based practice. This study suggests avenues for future research on relationship in preventive interventions for families and on home visiting workforce issues.