Decades of evidence show that voluntary home visiting programs for pregnant women and parents of young children improve maternal and child health, support child development and school readiness, promote families’ economic stability, and help reduce rates of child abuse and neglect. Since 2010, Congress has provided funding for voluntary, evidence-based home visiting programs to states, jurisdictions, and tribal entities through the Maternal Infant and Early Childhood Home Visiting (MIECHV) program.
Connecticut Office of Early Childhood (OEC) manages funding for home visiting programs in the state. In 2021, OEC awarded home visiting grants to Family Centers, Inc. in Stamford and Family & Children’s Agency (FCA) in Norwalk to expand access to supportive home visiting services for families with young children in their communities, in partnership with home visiting programs from Child Guidance Center of Southern Connecticut (CGCSC) and Odyssey Family Executive Center, respectively. Both communities chose to engage the Partnership for Early Education Research (PEER) as a continuous quality improvement (CQI) partner.
PEER worked separately with each organization’s home visiting program from 2021 to 2023 to identify areas for growth and to develop feasible CQI projects to address them. In 2023, PEER and the Stamford and Norwalk programs decided to launch a CQI Collaborative—a network of teams committed to using improvement science within and across their organizations to address a shared problem of practice.
PEER structured the Norwalk–Stamford CQI Collaborative using the Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN) approach developed by Education Development Center, Inc.1 PEER started by meeting separately with each program’s leadership to identify a shared topic, goal, and measurable aim that aligned with all four programs’ needs and priorities. Next, PEER worked with program leaders and other experts to identify the key drivers necessary to achieve the aim, along with shared measures and a data tracker that programs can use to record and visualize their progress. Then PEER hosted monthly cross-team meetings (also known as “learning sessions”) where team members learn about CQI processes,2 use these processes to plan sequential Plan-Do-Study-Act (PDSA) cycles that build on each other toward improvement goals, and learn from one another. Between cross-team meetings, each team was expected to schedule at least one internal meeting to advance their current PDSA cycle. PEER also held a monthly one-on-one call with each team to provide individualized support for their CQI work.
The first phase of the Home Visiting CQI Collaborative focused on increasing enrollment and ongoing engagement of caregivers3 in three priority groups identified by OEC: caregiver who enroll prenatally, identify as Black or African American, or enroll before 20 years of age. From March 2023 to June 2024, teams focused on a range of key drivers and tested a variety of change strategies.
- Prompt and appropriate enrollment of eligible families—tested changes to referral and enrollment processes
- Individualized and intense early engagement of primary caregivers—tested changes in the process for responding when new families cancel visits
- Highly skilled workforce that creates strong relationships with all primary caregivers—tested new opportunities for professional learning
- Parent and community trust and interest in the home visiting program—tested new strategies for reaching parents through trusted community organizations.
The second phase of the Collaborative focused on strengthening caregiver–child interactions that promote secure attachment and on-track child development. From October 2024 to June 2026, team projects focused on three key drivers and a variety of change strategies.
- Skilled and supported workforce with the capacity to accurately and regularly assess the quality of parent/caregiver-child interactions—tested new training for staff on how to administer the program’s observational assessment of parent/caregiver-child interactions4
- Culturally responsive, skilled and supported workforce with the capacity to address and promote positive parent/caregiver–child interactions—tested new training and structures focused on helping staff use assessment data to provide targeted support around parent/caregiver–child interactions
- Equipped and attuned parents/caregivers who understand the importance of positive parent/caregiver-child interactions—tested a new approach for building parent/caregiver knowledge of why parent/caregiver-child interactions matter and how to strengthen them
Throughout this five-year partnership, PEER worked with home visiting programs to continuously improve the services they provide to families. Team members described several ways they benefited from the partnership, including individualized support from PEER, opportunities to learn from other teams, and a more sustained and integrated focus on continuous quality improvement. PEER appreciated the opportunity to learn with these teams and hopes they will carry knowledge and skills from this shared experience into the future.