Healthy Start Home Visit Program

• The Hong Kong Polytechnic University • Professor Cynthia Leung • The University of Hong Kong • Dr. Sandra Tsang • Tung Wah Group of Hospitals • Ms Kitty Heung

「健康由家庭開始」計劃

合辦

贊助

Characteristics

Early

Intervention

Home Visit

Model

Multi-

discipline

collaboration

Evidence-

based Parent

Education

Parent

Involvement

Home-

school

collaboration

VIDEO

Program Introduction

Academic: 2 Professors •Curriculum development •Research support •Lectures

Community: Tung Wah Group of Hospitals (3 social workers) •Coordinate, implementation and monitoring of project • Link up parents to community

28 Nurseries/kindergartens •Select suitable parents • Assist project implementation

5 Health Professionals: Doctor, dentist, dental therapist, physiotherapist, nutritionist •Review curriculum •Lecture on related health knowledge

Funder: QEF

Funder and Partner: Role and Responsibility

Need for empirically supported treatment

• Evidence-based practice

• Empirically supported treatment

• Ineffective or untested practice is expensive

• Well-meaning interventions may do harm (ethical obligation)

Frances Gardner

Hierarchy of evidence • Systematic reviews of all randomized controlled

trials (RCT) • Large scale multi-centre RCTs • Individual RCTs • Controlled trials without randomization • Pre and post studies • Single case experimental designs • Narrative case studies • Opinions based on clinical practice/ expert

committees/ clinical opinion/ credible theory/ professional colleagues

Adapted from Brocklehurst & McGuire (2005) and Thyer (2011)

Evaluation methodology - Design

• Pilot study – pre and post design

– Outcome evaluation (quantitative) – parent and child measures

– Process evaluation (qualitative) – focus group with participants

• Efficacy study – cluster randomized controlled trial design

– 24 preschools (191 families) randomized into

• Intervention group (12 schools) – Healthy Start Home Visit Program (84 families)

• Control group (12 schools) – a series of parent talks (107 families)

6

Evaluation methodology - Measures

• Validated measures for use with Chinese population – Parent outcomes (parent self-report)

• Parenting Stress Index (Lam, 1999) • Social support (Broadhead, Gehlbach, de Gruy & Kaplan, 1988) • Self-efficacy (Zhang & Schwarzer, 1995)

– Child outcomes (parent report) • Eyberg Child Behaviour Inventory (Eyberg & Ross, 1978) • School readiness (Ho, Leung & Lo, 2013) • Behaviour academic competence (Leung, Lo & Leung, 2012) • Motivation (Leung & Lo, 2013) • Health status – weight-for-height, home injuries, hospital

admission, sedentary activities • Oral health (Department of Health, Hong Kong SAR) • Hong Kong Parent Feeding Questionnaire (Department of

Health, 2012)

7

Evaluation methodology - Measures

• Child outcomes (teacher report)

–School readiness (Ho, Leung & Lo, 2013)

–Behaviour academic competence (Leung, Lo & Leung, 2012)

–Motivation (Leung & Lo, 2013)

• Child outcomes (direct assessment of children)

–Preschool Developmental Assessment Scale (Leung, Mak, Lau, Cheung & Lam, 2010; 2013)

8

9

Study results

• Baseline characteristics of intervention and control group

‒ No significant difference

• Psychometric properties of the scales

– Reliability of most scales >.70

Study results

• Significant decrease in parenting stress Significant increase in parent self-efficacy and social support

• Significant decrease in child behavior problems

• Significant increase in child learning

• Significant increase in frequency of tooth brushing and healthy feeding practice

A. Knowledge on Child Health Development – Written test

– Results

• Average: 41/45 full mark

• Range: 33 to 45

B. Home Visit Skills – Demonstration on site

• Parenting skills (PRIDE )

• Quiet time and time-out zone – Results: 100% passed

Parent ambassadors

C. Child and parenting measures

– Decrease in child

behavior

– Decrease in parenting stress

– Increase in self-efficacy

– Increase in social support

11

Confirm program efficacy

Promote evidence-based practice

Facilitate smooth delivery of the model to schools and NGOs

Enhance respect by schools and NGOs

Raise the concern of policy maker

Enlist more funding support

Advance image building

Use of findings

Manpower: research assistant

Questionnaire : Incentive and individual support

Coordination between partners: venue, manpower, schedule

Control group arrangement

Program fidelity: quality control, professional input, supervision and random checking

Balance between practice and research

Lesson learned from having evidence-based service evaluation