Section 2: Developing/Assessing Logic Models

Provider Characteristics

The characteristics of the people who deliver services can influence how effective a program is. The training, skill, professional credentials, and empathic qualities of the providers are all relevant. In addition, age, ethnicity, gender, socioeconomic status, and the provider's experience (or lack of experience) as a parent or spouse may create a bond with families or barriers that limit the provider's positive impact. Providers need to be sensitive to cultural, ethnic, and social class differences in all interactions with program families.

• Volume and Timing of Service Delivery

Service duration and intensity have also been identified as important factors influencing positive outcomes in families. Some questions to help the evaluator identify a few of these factors are listed below.

• When do services take place?
• How much time does each activity take?
• What are the established standards for program activities?
• Can the extent and frequency of services reasonably be expected to effect program outcomes?
  

A rationale for the type and timing of intervention can be based on successful past programs. Healthy Families America is an example of a successful program using home visitation as the primary means of service delivery to prevent child abuse. Below are Healthy Families America's (1996) 12 critical elements in a home visitation program. Several of the critical elements specifically address the issue of volume and intensity of services:

1. Initiate services prenatally or at birth.
2. Use a standardized risk assessment tool (including areas of social support substance abuse, family of origin abuse).
3. Offer services voluntarily and use positive, persistent outreach efforts to build family trust.
4. Offer services intensely (at least once a week) with well-defined criteria for increasing or decreasing intensity of service and over the long term (three to five years).
5. Services should be culturally competent such that staff understands, acknowledges, and respects cultural differences among staff; staff and materials should reflect the cultural, linguistic, geographical, racial and ethnic diversity of the population served.
6. Services should focus on supporting the parent as well as supporting parent-child interaction and child development.
7. At minimum all families should be linked to a medical provider to assure optimal health and development (e.g., timely immunizations, well-child care). Depending on the family's needs, they may also be linked to services such as financial, food, and housing assistance programs, child care, job training programs, family support centers, substance abuse treatment centers, and domestic violence shelters.
8. Services should be provided by staff with limited caseloads to assure that home visitors have an adequate amount of time to spend with each family to meet the family's needs and to plan for future activities (i.e., for many communities the upper limit should be no more than 15 families per home visitor, and for some communities, the number may need to be significantly lower (e.g., less than 10).
9. Service providers should be selected because of their personal characteristics (i.e., non-judgmental, compassionate, ability to establish a trusting relationship), their willingness to work in or their experience working with culturally diverse communities and their skills to do the job.
10. Service providers should have a framework, based on education or experience, for handling the variety of experiences they may encounter when working with at-risk families. All service providers should receive training in areas such as: cultural competency, substance abuse, reporting child abuse, domestic violence, drug exposed infants, and services in their community.
11. Service providers should receive intensive training specific to their role to understand the essential components of family assessment and home visitation (i.e., identifying at-risk families, completing a standardized risk assessment, offering services and making referrals, promoting use of preventive health care, securing medical homes, emphasizing the importance of immunizations, utilizing creative outreach, establishing and maintaining trust, building on family strengths, developing an individual family support plan, observing parent-child interactions, determining the safety of the home, teaching parent-child interaction, managing crisis situations).
12. Service providers should receive ongoing, effective supervision so that they are able to develop realistic and effective plans to empower families to meet their objectives; to understand why a family may not be making progress and how to work with the family more effectively; and to express their concerns and frustrations so that they can see that they are making a difference and in order to avoid stress-related burnout.

Decisions about the volume of services also need to be based on the estimated number of families that are eligible for services (both primary and secondary), and whether there is adequate staff coverage and other resources. If there is not sufficient staff, either more need to be hired or the protocol for the delivery of services needs to be trimmed and modified. A program staff that is spread too thinly will not be effective in delivering services, and may even provide a sense of false security (in that families at-risk may be seen as receiving effective services when they are not). The following questions can help articulate some of the specifics of program activities (see also Worksheet 2.3 at the end of this section).

• Who provides each listed service?
• When is this service provided (timing)?
• How often is this service provided (intensity)?

The contents of Worksheets 2.2 and 2.3 at the end of this section provide information to help complete column B on Figure 2.3 above (program activities).