Supporting Family Economic Well-Being through Home Visiting (HomeEc)

Instrument 1

Program Recruitment Script and Eligibility Screener

OMB#: 0970-0356

Expiration Date: 02/24/2024

Supporting Family Economic Well-Being through Home Visiting

PROGRAM RECRUITMENT SCRIPT AND ELIGIBILITY SCREENER

In spring 2023, the HomeEc team will use the talking points below to (1) determine if the home visiting program meets the criteria to be in the study, (2) assess the home visiting program’s interest in participating in the study; (3) provide information about planned activities; (4) describe which supporting documents will be most helpful for our review of practices that support family economic well-being; (5) learn about the home visiting program’s research protocols, if any; (6) answer questions the program may have about the study, and (7) establish a point of contact to coordinate activities if the program is selected to participate.

A. Introduce yourself

Hello, my name is (NAME). I am calling on behalf of [Mathematica, JBA, or Start Early], an independent research organization, to talk about your program’s participation in the Supporting Family Economic Well-Being through Home Visiting project, also known as the HomeEc project. Your home visiting program was referred to us by____ because you have used some strategies or practices to support families’ economic well-being. We found your practices to be of interest for possible further study or replication in the wider home visiting field, and we’d like to learn more about them from you, your staff, and families who participate in your home visiting services.

We recently emailed you an introductory letter about this project and our interest in your program’s practices. Did you receive that email?

[If they did not receive the email, send it to them at the time of the call or immediately after, and summarize the email’s contents before continuing the call]

Is now a good time to talk? I would like to answer any questions you have about the HomeEc project and discuss the logistics of it with you.

[If they ask how long the call will take, say about 45 minutes.

If they say now is not a good time, set up another time for the call.

Allow time for questions, and answer or defer answering until later in the call if the topic is going to be covered later.]

B. HomeEc activities

First, I want to tell you that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB # for the described information collection is 0970-0356 and the expiration date is 02/29/2024. Now I’d like to tell you about HomeEc’s activities. We would like to talk to some of your program staff and a few parents your program serves and ask the program for some documentation.

Our team will conduct three interviews with program staff. One will be with you or someone you designate as the program director; another will be with a program manager or supervisor; and the third interview will be with a group of three to six home visitors or other frontline staff from your program. Each participating staff member will receive a $25 gift card for sharing their expertise if they participate in an interview outside of work hours. The program itself will receive the $25 gift card per person if a staff member participates in an interview during work hours, in an effort to offset any burden to the program. We will provide participating programs with a $200 honorarium to be used at their discretion to acknowledge their contribution to the study and their efforts in helping us coordinate the study activities.

[SAY THE FOLLOWING ONLY if the director asks for specifics] We will ask program team members about their professional backgrounds, what they think “family economic well-being” means, practices and strategies the program uses [Parenthetical material that follows to be said only if applicable:] to support families’ economic well-being (especially those you submitted in the call for nominations), the characteristics of the families served by the program, community resources available, challenges and successes of supporting family economic well-being, and their comfort levels in supporting families’ economic well-being.

In addition to talking to your staff, we would like to talk to some parents served by the program in a focus group and in a few individual interviews. We will ask home visitors to help us recruit caregivers for these activities. Each parent participant in the focus group or interviews will receive a $35 gift card as a token of appreciation for participating.

[SAY ONLY if the director asks for specifics:] The focus group would include four to six primary caregivers who have participated in your program and who volunteer to share their experiences. We will ask caregivers how they think about family economic well-being and their experiences receiving home visiting support for family economic well-being.

[SAY ONLY if the director asks for specifics] We also may conduct one-on-one interviews with one to three primary caregivers who have participated in your program and who volunteer to share their experiences. We will ask caregivers about their financial stressors and their family strengths, financial goals they have, and how they talk about and receive support from home visiting to address family economic well-being.

We will obtain informed consent from parents and staff before the interview or focus group. We will also give credit to the program for any publicly shared information about the program’s specific practices, always while protecting staff and family privacy.

All interviews and focus groups will take place virtually on videoconferencing platforms. We will work with you to determine which platform, like Zoom or MS Teams, will work best for your staff and participants, and it will be our responsibility to organize and run the virtual focus groups.

Last, we will also ask for program documentation that describes your program’s practices with regard to family economic well-being. These could include program materials, brochures, flyers, or anything else you think would be relevant and helpful.

The experiences, practices, and wisdom you and your participating staff and families share will help advance the field of home visiting and support better outcomes for families.

Do you have any questions or concerns?

Now that you have a basic understanding of the study, do you think you might be interested in participating? [staff member name] will be helping to take notes.

We would like to record the rest of our conversation today so we do not miss anything you tell us. Only the study team will listen to the recording, and we will destroy the recording at the end of the project.

Do we have your permission to record this call?

C. Site selection criteria

[Say only if interested:]

Before we enroll your program in this study, we need to go over the study criteria to determine if the program is eligible to participate. I would like to ask you a few questions about your home visiting program. If we determine your program is not eligible for the study, the information you give me will be destroyed immediately. Your participation in this call is voluntary, and you do not have to answer these questions. Please feel free to stop me at any time if you have any questions or concerns.

Do I have your permission to ask you questions about your home visiting program?

1. Required criteria

1. Does your program operate at least one home visiting model? If so, which model(s)?

2. Does your home visiting program provide services to families to support their economic well-being (such as financial literacy workshops, budget counseling, or job interview training)? If yes, please describe them.

[ONLY move on to preferred criteria and additional information if they meet all required criteria]

2. Preferred criteria

1. Does your program have specialized staff who provide support or services to families to help them achieve economic well-being?

2. Does your program collaborate with community partners to provide services? To provide supports and services to improve family economic well-being? If yes, who are the community partners?

3. Does your program conduct screenings and assessments that are tailored to different cultural groups and special populations, like immigrant families or people with disabilities?

4. Does your program collect data or assessments on family economic well-being?

5. Does your program use data on family economic well-being to improve the program?

6. Are any of the home visiting models you implement eligible for funds from the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV)?

1. Which MIECHV-eligible model(s) do you use?

2. If so, does (do) the MIECHV-eligible home visiting model(s) include services and supports to address family economic well-being?

3. [If applicable] Is your program funded by MIECHV?

3. Additional information

1. Could you please describe the demographics of the population your program primarily serves, such as race or ethnicity, socioeconomic status, family size and structure, or immigration status?

1. Is this the population your program was designed to serve? If not, please describe the population the program was designed for.

2. What kind of geographic area do you serve? Is it rural or urban; metro or non-metro?

3. Do you use an individual or group format in providing services to support family economic well-being? About how many staff members are employed at your program?

1. How many staff are full-time employees?

2. How many staff are part-time employees?

3. How many families are typically on a home visitor’s caseload?

4. Do program staff receive training on cultural responsiveness, awareness, or sensitivity?

5. How is your home visiting program funded?

6. Is your home visiting program part of a larger system of care in your community?

D. Research protocols

Mathematica and its partners adhere to the research protocols for this project that were approved by the study funder, the Administration for Children and Families. Does your local program or the national program model you use have any other research protocols we need to be aware of? If yes, can you provide us with written information on this?

E. Next steps

Thank you for talking to us. We will email you within the next month to let you know if your program is eligible to participate in this study. If your program is selected, who should be our main point of contact?

Do you have any questions at this time?

If you think of any questions or concerns, please feel free to contact me at (PHONE or EMAIL ADDRESS). Thanks again for your time today.

Instrument 2

Program Director Interview Protocol

OMB#: 0970-0356

Expiration Date: 02/24/2024

Supporting Family Economic Well-Being through Home Visiting

In spring 2023, the HomeEc team will use this guide to conduct 60-minute virtual interviews with program directors of up to six early childhood home visiting programs. We will ask program directors to provide verbal consent to participate and share a consent form beforehand that summarizes key study information. We will seek the program director’s permission to record their interview.

PROGRAM DIRECTOR INTERVIEW PROTOCOL

I. INTRODUCTION AND BACKGROUND ON THE PROJECT

A. Interviewer Introduction

My name is [NAME], and I am from [ORGANIZATION]. I really appreciate your time and look forward to hearing about your experiences.

B. Explanation of Project and Purpose of Interview

I am part of a team conducting a study called Supporting Family Economic Well-Being through Home Visiting. The Administration for Children and Families (ACF) in the U.S. Department of Health and Human Services is overseeing this study. First, before I explain the purpose of the study, I want to tell you that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB # for the described information collection is 0970-0356 and the expiration date is 02/29/2024.

The study aims to better understand, measure, and support family economic well-being through home visiting. First, this study seeks to understand how home visiting programs define family economic well-being, which might include how well a family can meet its needs and the financial goals it sets, such as meeting all its current needs, preparing for future expenses, and having a job that is stable and satisfying. In addition, in this study, we want to learn how programs measure family economic well-being, and what supports home visiting programs could provide to families to help them achieve economic well-being. [INCLUDE HOW WE CHOSE THE PROGRAM/PERSON TO INTERVIEW]. We are here to learn from you about what your program is doing to support family economic well-being.

C. Privacy and Recording

We expect this interview to take 60 minutes. Before we start, I would like to briefly review the informed consent form you received prior to this discussion and answer any questions you might have [REVIEW THE CONSENT FORM WITH RESPONDENT, HIGLIGHTING THE FOLLOWING POINTS ABOUT PRIVACY].

I want to let you know that your participation in this discussion is voluntary, and you can decline to answer any questions. All information you provide will be kept private, except if you say something that suggests you are very likely to harm yourself, that you are planning to hurt another person or child, or that someone is likely to harm you. We will use the information you share to write a summary of what we learned, but your name will not be connected to your answers. We will summarize information from your site for our reports. We would like to record our conversation today to make sure we have an accurate record of what you say. No one will hear the recording except for researchers and the person who transcribes it. If you want to say anything that you do not want recorded, please let me know, and I will be glad to pause the recorder. We will store the recording and any notes from our conversation in a secure location, and our study team will destroy the recording and notes at the end of the project. We have a Certificate of Confidentiality from the National Institutes of Health, and this certificate helps us protect your privacy, except in cases required by Federal, State or local laws, such as for reporting of child or elder abuse.

Do you agree to participate in this interview?

Do we have your permission to record this interview?

Do you have any questions before we start?

II. QUESTIONS

A. Staff Background

I’d like to start our conversation by learning a bit more about your background and experience as the program director of [NAME OF PROGRAM].

1. Please describe your professional background.

Probes: How many years have you been a program director? Have you served as a home visitor or in another frontline service role?

2. Please tell me about your current role and responsibilities as a director.

B. Definition of Family Economic Well-Being

Now I’d like to ask you to describe family economic well-being from your perspective.

3. From your perspective, what does family economic well-being look like?

4. From your perspective, what do you think are the most critical components to a family’s economic well-being to support overall family functioning?

C. Program Characteristics

Next, I’d like to discuss your home visiting program. I have questions about your program’s services, organizational structure, and policies and procedures.

1. Home visiting model and services

1. What are the overall goals of the program?

2. What services does your home visiting program offer to families? For example, screening for depression, substance use, developmental delays; provide knowledge and training focused on safe homes and safe sleep practices, refer families to prenatal care and well-child visits.

Probe: Do you provide other services besides home visiting?

3. I understand that your home visiting agency implements [NAME OF MODEL(S)]. Is that correct?

[IF INCORRECT]: Which home visiting model(s) does your home visiting agency implement?

2. Service area

1. I understand that your home visiting program serves families in [LIST OUT AREA PARAMETERS (for example, Fairfax County, Virginia)]. Is that correct?

[IF INCORRECT]: In what geographic area(s) does your home visiting program serve families?

3. Organizational structure

1. Please describe your home visiting program’s organizational structure. This includes your program’s staffing structure and who oversees which staff.

2. Do you have staff who directly provide family economic well-being services, supports, or activities? Or staff who discuss economic well-being topics with families?

1. If yes, what are their responsibilities?

2. If no, why?

Probe: [FOR AGENCIES HOUSED WITHIN LARGER ORGANIZATIONS] What is the level of support your program receives from [LARGER ORGANIZATION] to determine how the program designs and provides services that promote family economic well-being?

4. Eligibility requirements

1. Please describe the criteria that families must meet to be eligible for your home visiting program.

5. Recruitment and enrollment policies and procedures

1. What strategies does your program use to recruit families into your home visiting program?

2. Please describe your home visiting program’s enrollment policies and procedures. For example, once you recruit a family, what are the next steps they must complete before they start receiving home visiting services from your program?

6. Family economic well-being data

1. Does your program collect information on family economic well-being? If so, how? For example, this could be through observation, documentation, interviews, and so on.

1. Does your program use specific instruments or tools to collect data on family economic well-being?

2. Please give some examples of how your program uses information about family economic well-being.

Probes: Do you use the data to adjust overall program approaches? For example, if transportation is a common barrier to economic well-being goals, does the program change the location of activities or incorporate a voucher program to help families access various transportation options?

D. Characteristics of Families Served in Home Visiting Program

Now let’s talk about the families enrolled in your home visiting program, and the communities in which they live.

1. Family strengths and resources

1. What are economic well-being strengths that you or your staff have observed in the families your program serves?

Probes: Financial security, financial literacy, home ownerships, stable housing, multigenerational homes, or supportive social networks

2. Family economic well-being challenges and the effect of COVID-19

1. What are some of the most common economic challenges or stressors that enrolled families experience?

Probes: Low-paying jobs, lack of health insurance, limited access to reliable transportation, limited education or training, debt, financial uncertainty, limited housing options, or increasing housing and food costs.

2. Have you observed any differences in how certain populations have experienced economic challenges or stressors?

1. If yes, please describe.

3. Have the economic well-being challenges of the families your program serves changed since the COVID-19 pandemic started?

1. If yes, please describe how these challenges have changed.

1. Are these challenges experienced differently by certain populations?

4. What type of community resources do families draw on to address their economic well-being needs?

5. How do families learn about and access resources in the community to address their economic well-being needs?

1. How do families access resources from your program?

Probes: Does your program refer families to resources, provide them with information about available resources, or help them complete application forms?

2. Do families access resources from other organizations? If yes, which ones?

E. Strategies for Supporting Family Economic Well-Being

Now I’d like to discuss the various strategies, practices, and activities your program uses to help support the economic well-being of families, as well as supports needed to implement them.

1. Strategies and practices the program uses to support family economic well-being

1. What strategies or practices does your program use to support the economic well-being of families?

2. Professional support

1. What professional support and resources does the program offer staff to help address family economic well-being needs?

Probe: Training, coaching, written guidance, and mentoring.

3. Collaboration with community partners

1. Does your program collaborate with community partners to support family economic well-being services?

1. If yes, what partners?

2. What type of services or supports do these partners provide?

Probes: Family economic services, mental health services, or referrals.

Probe: Are additional partnerships needed to support family economic well-being?

F. Recommendations

Finally, I would like to discuss your program’s successes, strengths, opportunities for improvement, and lessons learned regarding the implementation of economic well-being services.

1. Lessons learned

1. What are some of the lessons your program has learned from addressing and supporting family economic well-being?

2. What changes has your program made, based on those lessons learned, in its approach to addressing and supporting family economic well-being?

Probe: Changes made because of the COVID-19 pandemic? Changes related to new challenges families face or new ways the program needs to serve families?

2. Opportunities for improvement in supporting economic well-being

1. In what ways could your program better support the economic well-being of enrolled families? For example, are there additional home visiting strategies that you think would be beneficial to implement?

2. What barriers, if any, prevent your program from improving services to support family economic well-being?

3. Accomplishments in supporting family economic well-being

1. Please describe your program’s accomplishments in supporting family economic well-being. These could include family success stories, partnerships in the community to better support families in your program, or other achievements.

G. Additional Information

a. Is there anything else you would like to mention that we have not discussed?

H. Wrap-Up

That covers all the questions I have for you today. Thank you so much for taking the time to speak with me. Before we end, I wanted to see if there is anything else you think I should know about how your program addresses the economic well-being needs of families.

Also, when we review our notes from today’s call, if we have any questions or clarifications, may we contact you again?

Thanks again for speaking with me today. Your input was very valuable.

Instrument 3

Program Supervisor Interview Protocol

OMB#: 0970-0356

Expiration Date: 02/24/2024

Supporting Family Economic Well-Being through Home Visiting

In spring 2023, the HomeEc team will use this guide to conduct 60-minute virtual interviews with program supervisors from up to six early childhood home visiting programs. We will ask program supervisors to provide verbal consent to participate and share a consent form beforehand that summarizes key study information. We will seek the program supervisor’s permission to record their interview.

PROGRAM SUPERVISOR INTERVIEW PROTOCOL

I. INTRODUCTION AND BACKGROUND ON THE PROJECT

A. Introduction

My name is [NAME], and I am from [ORGANIZATION]. I really appreciate your time and look forward to hearing about your experiences.

B. Explanation of Project and Purpose of Interview

I am part of a team conducting a study called Supporting Family Economic Well-Being through Home Visiting. The Administration for Children and Families (ACF) in the U.S. Department of Health and Human Services is overseeing this study. First, before I explain the purpose of the study, I want to tell you that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB # for the described information collection is 0970-0356 and the expiration date is 02/29/2024.

The study aims to better understand, measure, and support family economic well-being through home visiting. First, this study seeks to understand how home visiting programs define family economic well-being, which might include how well a family can meet its needs and the financial goals it sets, such as meeting all its current needs, preparing for future expenses, and having a job that is stable and satisfying. In addition, in this study, we want to learn how programs measure family economic well-being, and what supports home visiting programs could provide to families to help them achieve economic well-being. [INCLUDE HOW WE CHOSE THE PROGRAM/PERSON TO INTERVIEW]. We are here to learn from you about what your program is doing to support family economic well-being.

C. Privacy and Recording

We expect this interview to take 60 minutes. Before we start, I would like to briefly review the informed consent form you received prior to this discussion and answer any questions you might have [REVIEW THE CONSENT FORM WITH RESPONDENT, HIGHLIGHTING THE FOLLOWING POINTS ABOUT PRIVACY].

I want to let you know that your participation in this discussion is voluntary, and you can decline to answer any questions. All information you provide will be kept private, except if you say something that suggests you are very likely to harm yourself, that you are planning to hurt another person or child, or that someone is likely to harm you. We will use the information you share to write a summary of what we learned, but your name will not be connected to your answers. We will summarize information from your site for our reports. We would like to record our conversation today to make sure we have an accurate record of what you say. No one will hear the recording except for researchers and the person who transcribes it. If you want to say anything that you do not want recorded, please let me know, and I will be glad to pause the recorder. We will store the recording and any notes from our conversation in a secure location, and our study team will destroy the recording and notes at the end of the project. We have a Certificate of Confidentiality from the National Institutes of Health, and this certificate helps us protect your privacy, except in cases required by Federal, State or local laws, such as for reporting of child or elder abuse.

Do you agree to participate in this interview?

Do we have your permission to record this interview?

Do you have any questions before we start?

II. QUESTIONS

A. Staff Background

I’d like to begin our conversation by learning a bit more about your background and experience as a home visitor supervisor.

Please describe your professional background.

Please tell me about your current role and responsibilities as a supervisor of home visitors.

Probes: How many years have you been a supervisor? How many staff do you currently supervise?

B. Program Characteristics

Now, I’d like to discuss your home visiting program.

1. Home visiting model and services

1. What services does your home visiting program offer to families? For example, screening for depression, substance use, developmental delays; provide knowledge and training focused on safe homes and safe sleep practices, refer families to prenatal care and well-child visits, provide doula services. [We’d like to learn about your services in general and will discuss specific family economic well-being services later.]

Which services do families use the most?

2. I understand that your home visiting agency implements [NAME OF MODEL(S)]. Is that correct?

[IF INCORRECT]: Which home visiting model(s) does your home visiting agency implement?

2. Family economic well-being

1. From your perspective, what does family economic well-being look like?

2. From your perspective, what do you think are the most critical components of a family’s economic well-being to support overall family functioning?

3. How does your program develop relationships with families to ensure home visitors are comfortable providing economic well-being information and families are comfortable sharing their economic situation?

Probes: Do home visitors encounter challenges when talking about financial issues with families? These could be challenges related to family cultural practices regarding sharing information. For example, in some cultures, only the male head of the family can discuss financial information and might be the only one who knows the full extent of the family’s financial situation.

Are there any other barriers to discussing a family’s economic well-being?

4. Do power dynamics between home visitors and families play a role in creating a comfortable space to discuss financial issues? If so, how do home visitors address power dynamics with families?

3. Influence of family economic well-being

Now, I’d like to get your perspective on whether (and how) family economic well-being influences caregiver and child health, behavior, and relationships, and program engagement.

1. In your experience, does family economic well-being influence the relationship between a caregiver and child? If yes, how?

Probes: Could you provide an example of the influence of economic well-being on the caregiver–child relationship?

On maternal–child interactions?

2. In your experience, does family economic well-being influence maternal and child health? If yes, how?

Probe: Could you provide an example of the influence of economic well-being on caregiver or maternal physical or mental health?

3. In your experience, does family economic well-being influence whether and how much families participate in home visiting? If yes, how?

Probe: Could you provide an example of the influence of economic well-being on how families participate in home visiting?

4. In your experience, does family economic well-being influence whether families leave the program? If yes, how?

Probes: Could you provide an example of the influence of economic well-being on families leaving the program?

Do improvements in family economic well-being often or ever lead to families leaving the program?

Does the program encourage families who experience improvement in economic well-being to remain in the program?

1. If so, how?

2. Do economic stressors affect family participation levels?

4. Family economic well-being data

1. Does your program collect information on family economic well-being? If so, how? For example, this could be through assessments, screenings, observation, documentation, interviews, and so on.

2. Does your program use specific instruments or tools to collect data on family economic well-being?

1. Are the assessments or screening tools culturally relevant for the families in your program? For example, do they reflect the language, and the cultural identities, norms, and values for the communities and families you serve? If yes, how? If no, are you aware of other assessment and screening tools that would be a more relevant cultural fit for the families your program serves?

2. Are there any improvements you would make to your existing tools to make them more culturally relevant?

3. What type of information regarding family economic well-being does your program collect? For example, household income, expenditures, debt, assets, financial satisfaction, etc.

4. How often does your program collect data on family economic well-being?

Does the timing of collection of these measures vary based on a family’s economic well-being needs?

5. Please give some examples of how you or your program uses information about family economic well-being? For example, do home visitors use the information to tailor approaches to supporting families? If yes, please explain.

C. Characteristics of the families and communities served

Now I’d like to talk about the families enrolled in your home visiting program, and the communities in which they live.

1. Family and community characteristics

1. Could you please describe the characteristics of the families you serve?

Probes: Which racial/ethnic groups are represented? What are their cultural backgrounds?? What is the typical size of families? What are their family structures? What kind of education do family members typically have? What languages do families speak?

2. How would you describe the communities where families in your program live?

Probe: This could be characteristics related to their neighborhood, demographics, cultures, history, safety, economic and social characteristics, and networks.

2. Family strengths and resources

1. What are some economic well-being strengths that you or your staff have observed in the families you serve?

Probes: Financial security, financial literacy, home ownerships, stable housing, multigenerational homes, or supportive social networks

2. What type of economic well-being goals do the families you serve typically have?

Probes: Education and employment goals, savings plan, paying off debt, or budgeting

3. Family challenges and effect of COVID-19 on families

1. What are some of the most common economic challenges or stressors faced by the families you serve?

Probes: Low-paying jobs, lack of health insurance, limited access to reliable transportation, limited education or training, debt, financial uncertainty, limited housing options, or increasing housing and food costs

2. Have you observed any differences in how certain populations have experienced economic challenges or stressors?

If yes, please describe.

3. Have the economic well-being challenges of the families changed since the COVID-19 pandemic started?

If yes, please describe how these challenges have changed.

Are these challenges experienced differently by certain populations?

4. Did your home visiting program change its services to address the economic well-being needs of families during the COVID-19 pandemic?

Probes: These adjustments could be related to new challenges families faced or new ways the program needed to serve families because of COVID-19 restrictions.

If yes, please describe these changes and how they helped your program serve families during the COVID-19 pandemic.

D. Strategies for supporting family economic well-being

Now I’d like to discuss the various strategies, practices, or activities your program uses to support family economic well-being. Practices might be a component of or an add-on to your home visiting model—for example, helping a family learn to budget, completing applications for the Supplemental Nutrition Assistance Program (SNAP benefits), or developing job interviewing skills.

1. Strategies/practices the program uses to support family economic well-being

1. What strategies, practices, or activities does your program implement to address economic well-being needs?

[FOR EACH STRATEGY]

[If appropriate] How often does your program use [strategy/practice] (e.g., every home visit, weekly, once per quarter, as needed, etc.)?

What percentage of all families need this service? Your best estimate is fine.

How does your program deliver [strategy/practice]?

Probes: Which staff provide the strategy/practice to families? Does your program deliver the strategy using an individual or group format? Do families interact with other families to receive services?

What organizations, programs, or other entities are involved in implementing the [strategy/practice]?

Is there a written protocol or manual that describes how to implement or administer the strategy?

How are your staff trained to implement this strategy/practice?

How does [strategy/practice] address short-term economic well-being needs?

How does [strategy/practice] address long-term economic well-being needs?

How well do you think [strategy/practice] addresses family economic well-being?

Probe: How is it working overall?

What motivates and helps families fully engage in [strategy/practice]?

What barriers do families experience engaging in [strategy/practice]?

What challenges or drawbacks, if any, are there in using this [strategy/practice]?

2. Tailoring and adapting economic well-being strategies and practices

1. In general, how do you decide which families receive which economic well-being strategy or practice?

Probe: Do you use a particular strategy with all families or with specific families?

2. Does your program change strategies, practices, or activities to support family economic well-being for different cultural groups, or for families with special circumstances, such as immigrants and those with disabilities? If so, how?

3. What are the characteristics of families for whom some economic well-being strategies or practices work better than others (for example, family structures, educational backgrounds, families who face particular challenges, including mental health, substance use)? Do some families experience better outcomes than others?

If yes, please explain.

E. Professional support and resources

Now I’d like to discuss the supports and resources your home visiting program provides to staff and external resources available to help address the economic well-being needs of families.

3. Professional support

1. What professional support and resources does the program offer to staff to address family economic well-being needs?

Probes: Training, coaching, written guidance, and mentoring.

2. What supports and resources would be helpful to staff to help address family economic well-being needs?

3. Does your program have clear expectations that home visitors should address economic well-being with families? If so, how does your program communicate that guidance to home visitors?

4. Resources to support family economic well-being services

4. Does your program collaborate with community partners to support family economic well-being services?

1. If yes, what partners?

2. What type of services or supports do these partners provide?

Probes: Family economic services, mental health services, or referrals.

Are additional partnerships needed to support family economic well-being?

3. Who receives these services? How do you or your partners determine and make referrals?

5. What other community resources are available to support families’ economic well-being?

6. How do families learn about and access resources in the community to address their economic well-being needs?

Probes: Does your program refer families to resources, provide them with information about available resources, or help them complete application forms? Do you follow up with families after you refer them to services or after they receive additional resources?

7. What barriers prevent families from accessing benefits to support economic well-being?

Probes: Complex paperwork, tax status, immigration concerns, language barriers, or difficulty applying (such as multiple phone calls, calls on hold for long periods of time, or families needing to take time off from work to attend an appointment)

8. What has been most helpful in helping families overcome barriers to accessing economic resources?

Probes: Relationship building, warm handoffs, extensive and accurate resource lists, or informal supports (churches, advocacy organizations, or local social service nonprofits)

F. Recommendations

Finally, I would like to discuss your program’s successes, strengths, opportunities for improvement, and lessons learned regarding the implementation of economic well-being services.

1. Lessons learned

1. What are some of the lessons your program has learned in addressing and supporting family economic well-being?

2. What adjustments has your program made, based on those lessons learned, in its approach to addressing and supporting family economic well-being?

2. Opportunities for improvement in supporting economic well-being

1. In what ways could your program better support the economic well-being of enrolled families? For example, are there additional home visiting strategies that you think would be beneficial to implement?

2. What barriers, if any, prevent your program from improving services to support family economic well-being?

3. Accomplishments in supporting family economic well-being

1. Please describe your program’s accomplishments in supporting family economic well-being. These could include family success stories, partnerships in the community to better support families in your program, or other achievements.

G. Additional Information

a. Is there anything else you would like to mention that we have not discussed?

H. Wrap-up

That covers all the questions I have for you today. Thank you so much for taking the time to speak with me. Before we end, I wanted to see if there is anything else you think I should know about how your program addresses the economic well-being needs of families.

Also, when we review our notes from today’s call, if we have any questions or clarifications, may we contact you again?

Thanks again for speaking with me today. Your input was very valuable.

Instrument 4

Parent Participant Interview Protocol

OMB#: 0970-0356

Expiration Date: 02/24/2024

Supporting Family Economic Well-Being through Home Visiting

In spring 2023, the HomeEc team will use this guide to conduct 60-minute virtual interviews with parent participants enrolled in up to six different early childhood home visiting programs. We will ask parent participants to provide verbal consent to participate and share a consent form beforehand that summarizes key study information. We will seek parent participants’ permission to record all interviews.

PARENT PARTICIPANT INTERVIEW PROTOCOL

I. INTRODUCTION AND BACKGROUND ON THE PROJECT

A. Interviewer introduction

Thank you for taking the time to speak with me today. My name is [NAME], and I am from [ORGANIZATION]. I really appreciate your time and look forward to hearing about your experiences.

B. Explanation of Project and Purpose of Interview

I am part of a team conducting a study called Supporting Family Economic Well-Being through Home Visiting, also known as the HomeEc project. The Administration for Children and Families, which is part of the U.S. Department of Health and Human Services, is overseeing the study. First, before I explain the purpose of the study, I want to tell you that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB # for the described information collection is 0970-0356 and the expiration date is 02/29/2024.

We are interested in hearing about your experiences as part of a larger research study that is looking at how programs like [PROGRAM NAME] support families’ financial and economic well-being. We are interviewing staff and participants, like yourself, at this program and others like it. We’ll be asking about your ideas, feelings, and opinions on some topics such as your involvement in this program, the support it provides, suggestions for improvement, and decisions about your current financial well-being. We will use the information you share with us to write a summary of what we have learned, but we will not use your name in our reports, so please feel free to talk openly.

Throughout our discussion, you will hear me ask about the way [PROGRAM NAME] has influenced your family’s financial and economic well-being. When you hear these terms, please think about things like how your family is doing financially now and where you expect to be financially in the future. Also think about how your family supports itself through having a good job or in other ways. Finally, consider how well you think you can meet the needs of your family.

C. Privacy and Recording

We expect this interview to take 60 minutes. I would like to briefly review the informed consent form you received prior to this discussion [REVIEW THE CONSENT FORM WITH RESPONDENT, HIGLIGHTING THE FOLLOWING POINTS ABOUT PRIVACY].

I want to let you know that your participation in this discussion is voluntary, and you can decline to answer any questions. All information you provide will be kept private, except if you say something that suggests you are very likely to harm yourself, that you are planning to hurt another person or child, or that someone is likely to harm you. We have a Certificate of Confidentiality from the National Institutes of Health and this certificate helps us protect your privacy, except in cases required by Federal, State or local laws, such as for reporting of child or elder abuse.

We will use the information you share to write a summary of what we learned, but your name will not be connected to your answers. Even if we use quotes, we won’t use your name with them. We will not share any information you tell us about your experience with [PROGRAM NAME].

We are hoping to record our conversation because we value your information and want to make sure we capture it all. No one will hear the recording except for researchers and the person who transcribes it. If you want to say anything that you do not want recorded, please let me know and I will be glad to pause the recorder. We will store the recording and any notes from our conversation in a secure location, and our study team will destroy the recording and notes at the end of the project.

Do you have any questions about this information?

Do you agree to participate in this interview? Are you okay with us recording the call today?

Before we begin, are you in a place where you feel comfortable answering questions about your family and your financial well-being? If no, do you need some time to find a space where you are comfortable answering questions? Or, do we need to find a different time to talk?

II. QUESTIONS

A. Participant Background

First, I would like to learn a little bit more about you and your family.

1. Would you mind telling me a little bit about yourself and your family?

1. How many children do you have, and how old are they?

2. Who lives in your household?

2. How long have you been participating in [NAME of PROGRAM]?

3. How did you learn about the program?

1. When you decided to enroll, how did you hope the program would help you or your family?

4. Are you of Hispanic, Latino, or Spanish origin?

1. Yes

2. No

3. Prefer not to answer

5. What do you consider your race? I will read some options; you can say yes or no to each.

1. American Indian or Alaska Native

2. Asian

3. Black or African American

4. Native Hawaiian or Other Pacific Islander

5. White

6. Other, please describe

6. Were you born in the United States?

1. Yes

2. No

Probe: If no, where were you born?

Probe: When did you come to live in the United States? How old were you?

B. Perspective on Financial Well-Being and Security

Next, I would like to ask you some questions about your family’s financial goals, as well as challenges and supports related to those goals.

1. How would you describe what it means to be comfortable with your family’s finances?

1. What is most important to you to feel comfortable about your finances or your ability to support yourself and your family?

Probes [Probe on the following items if they are not mentioned during the response]:

Being able to afford your family’s basic needs, such as food, housing and utilities, transportation, child care, and health care

Having a job with adequate pay

Having a job that is stable and provides a reliable source of income

Having a fulfilling job

Not worrying about or feeling stressed out about money

Being able to handle unexpected expenses, such as car repairs or medical bills

Saving money for the future

Feeling more in control of your finances and financial decisions, such as establishing good credit or reducing debt

2. When you enrolled in [NAME of PROGRAM], what goals did you have about finances or supporting yourself and your family?

Probes: Meeting basic needs, enrolling in education or training program, reducing your stress about money, getting rid of some of your credit card debt, getting health care coverage

1. What steps are you trying to take to meet those goals?

Probe: Ask about individual goals if multiple goals provided

3. What are some challenges you face in meeting these goals?

Probes:

Education and training (for example, lack of education or training needed to get the job you want)

Few or no jobs in your community that need your experience and skills

Available jobs do not offer enough pay or enough hours or benefits like health care

Limited or no affordable housing, or the location or quality of the affordable housing is a problem

No reliable transportation or limited public transportation to get you where you need to go

Responsibilities for taking care of other family members or children

Health issues

Issues with internet access

Language barriers

Sources of discrimination or other biases

Concerns over immigration status

4. What resources or sources of support do you have to help you meet your goals?

5. What resources or sources of support do you think you need to help you meet these goals?

6. What would achieving these goals do for you or your family?

Probes: Able to move to a safer community, purchasing a car for independence.

7. (If not already mentioned) Do you have any long-term financial goals, perhaps for a couple of years from now?

Probes: Reliable source of income to meet your family’s needs, completing education or training program, employment stability, building savings, purchasing a home.

1. You talked about some challenges achieving the financial goals you had when you enrolled in [NAME of PROGRAM]. What are some other challenges you might face in achieving these longer-term goals?

Probes:

Money for training or education

Lack of jobs in your community that align with your experience and skills, or that offer adequate wages and hours

Availability or quality of affordable housing in your area

Limited availability of reliable transportation

Finding affordable, stable, high-quality child care

Responsibilities for taking care of other family members or children

Issues with internet access

Sources of discrimination or other biases

Language barriers

Concerns over immigration status

8. What resources or sources of support do you have to help you achieve these goals?

Probes: Strong supportive faith community; friends who help with networking, child care, transportation, or other areas; shared housing, extended family

1. What sources of support do you think you might need to achieve these goals? (Probes: scholarships or grants, reliable transportation, family support, better health care, eligibility for housing support or more affordable housing)

9. What are some positive aspects of your family’s financial situation?

Probes: Have family who help care for your children, have good transportation, barter or trade services with others.

10. How does your current financial situation affect you and your family?

1. Stress level

2. How you feel about yourself or about being a parent

3. The way you talk, play, or interact with your children

4. Your sleep

5. Your relationships with family and friends

6. How you feel physically

7. Anything else?

C. Experience with Home Visiting Program

1. Please describe your experience with [NAME of PROGRAM]. In doing so, we would like to hear details about the support you received in terms of your financial well-being and security.

Probes:

How well do you think your home visitor understands what your family needs in terms of support for your financial well-being and security?

2. In thinking about your experience with your home visitor so far, do you feel like you have a good relationship with your home visitor? Does it feel like your home visitor understands and respects you and your family? Why or why not? How does this relationship impact your participation in [NAME of PROGRAM]?

3. Has your home visitor helped you address your financial well-being? If yes, please describe how your home visitor helped you.

Probes [Ask only if not described in response to question 1]:

Helped you get food for your family

Helped you get formula or diapers for your baby

Helped you get a car seat or other items your children need

Helped you get support or financial assistance to pay bills

Helped you find or pay for transportation

Helped you access education or training

Helped you find or keep a job

Helped you with building credit or managing debt

Helped you locate or apply for affordable housing

Helped you obtain affordable health care

4. Has your home visitor provided you with information about programs or resources that could help you with your immediate financial needs or challenges? For example, a food bank, utility assistance, places to get a car seat, or options for child care? What about information about programs or resources that could help you with your longer-term financial needs or challenges, such as connections to education or employment?

1. If yes, what programs did your home visitor tell you about?

Did you ever reach out to those programs, or did the programs ever reach out to you? Why or why not?

For the programs you connected with, were they helpful? How so?

5. Can you tell me about your experience with [ECONOMIC WELL-BEING PRACTICE OR ACTIVITY offered by program]? [INTERVIEWER NOTE: Tailor this guide before the interview to repeat question 4 for each practice or activity that is related to family economic well-being, such as financial education classes, coaching or case management services, or financial assistance.]

1. How did the home visitor introduce you to [ECONOMIC WELL-BEING PRACTICE OR ACTIVITY]?

6. Did you follow-up or complete the service?

7. Was it helpful? How did it help?

8. Was there anything challenging about it? Did it help meet your financial goals or needs?

9. How does working toward your financial goals affect your participation in [NAME of PROGRAM]? For example, is it ever challenging to schedule a home visit because you are working on these goals and have less time? Do you think you would stay in [NAME of PROGRAM] once you achieve your financial goals? Why or why not?

10. Overall, how comfortable do you feel talking to your home visitor about your family’s financial situation or challenges?

1. For the following scenarios, please share how comfortable you would be if your home visitor asked about them. You can say you are not all comfortable, somewhat comfortable, or very comfortable. [Note for interviewer: If respondent says not at all comfortable or very comfortable, ask them why they rated low or high comfort].

Whether you have looked for a job but have been unable to find one or if your job pays enough to cover your bills and necessities.

Whether your family has enough food or enough money to buy food to get you through to your next paycheck

Whether you have access to reliable transportation or enough money to buy gas or pay for car repairs

Whether your family is able to buy basic things that your children need, such as food, clothing, shoes, diapers, or formula

Whether your family can afford to go to the doctor or dentist for routine or emergency care, or buy medication when needed

Whether your family can afford to have either a cell phone or a landline and internet access at your home

Whether your family is at risk of utilities, such as electricity or water, being shut off because you can’t afford the bill, or whether this has already happened

With respect to housing:

1. Whether your family has a safe and healthy place to live and lives in a safe neighborhood

2. Whether your family has enough space for all family members

3. Whether your family has to move because you can’t afford the rent

4. Whether your family has experienced or is experiencing homelessness or is at risk of losing your housing

D. Recommendations for Additional Supports

1. What other supports, if any, would be helpful for your home visitor or [NAME of PROGRAM] to provide to support families’ financial and economic well-being? How would these supports be helpful?

2. What improvements can the home visiting program make to help families like yours improve their financial and economic well-being? What would you want home visiting programs to know about the experience of families that might be struggling financially?

3. Is there anything else about your experience with [NAME of PROGRAM] that you would like to share?

Instrument 5

Home Visitor Group Interview Protocol

OMB#: 0970-0356

Expiration Date: 02/24/2024

Supporting Family Economic Well-Being through Home Visiting

In spring 2023, the HomeEc team will use this guide to conduct 90-minute virtual interviews with small groups of home visitors from up to six early childhood home visiting programs. We will ask home visitors to provide verbal consent to participate and share a consent form beforehand that summarizes key study information. We will seek their permission to record the group interviews.

HOME VISITOR GROUP INTERVIEW PROTOCOL

I. INTRODUCTION AND BACKGROUND ON THE PROJECT

A. Introduction

My name is [NAME], and I am from [ORGANIZATION]. I really appreciate your time and look forward to hearing about your experiences.

B. Explanation of Project and Purpose of Interview

I am part of a team conducting a study called Supporting Family Economic Well-Being through Home Visiting. The Administration for Children and Families (ACF) in the U.S. Department of Health and Human Services is overseeing this study. First, before I explain the purpose of the study, I want to tell you that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB # for the described information collection is 0970-0356 and the expiration date is 02/29/2024.

The study aims to better understand, measure, and support family economic well-being through home visiting. First, this study seeks to understand how home visiting programs define family economic well-being, which might include how well a family can meet its needs and the financial goals it sets, such as meeting all its current needs, preparing for future expenses, and having a job that is stable and satisfying. In addition, in this study, we want to learn how programs measure family economic well-being, and what supports home visiting programs could provide to families to help them achieve economic well-being. [INCLUDE HOW WE CHOSE THE PROGRAM/PERSON TO INTERVIEW]. We are here to learn from you about what your program is doing to support family economic well-being.

C. Privacy and Recording

We expect this interview to take 90 minutes. Before we start, I would like to briefly review the informed consent form you received prior to this discussion and answer any questions you might have [REVIEW THE CONSENT FORM WITH RESPONDENTS, HIGHLIGHTING THE FOLLOWING POINTS ABOUT PRIVACY:].

I want to let you know that your participation in this discussion is voluntary, and you can decline to answer any questions. All information you provide will be kept private, except if you say something that suggests you are very likely to harm yourself, that you are planning to hurt another person or child, or that someone is likely to harm you.. We will use the information you share to write a summary of what we learned, but your name will not be connected to your answers. We will summarize information from your site for our reports. We would like to record our conversation today to make sure we have an accurate record of what you say. No one will hear the recording except for researchers and the person who transcribes it. If you want to say anything that you do not want recorded, please let me know, and I will be glad to pause the recorder. We will store the recording and any notes from our conversation in a secure location, and our study team will destroy the recording and notes at the end of the project. We have a Certificate of Confidentiality from the National Institutes of Health and this certificate helps us protect your privacy, except in cases required by Federal, State or local laws, such as for reporting of child or elder abuse.

Do you agree to participate in this interview?

Do we have your permission to record this interview?

Do you have any questions before we start?

II. QUESTIONS

A. Staff Background

1. I’d like to begin our conversation by learning a bit more about your background and experience as a home visitor.

1. Please describe your professional background.

Probe: How many years have you been a home visitor? What populations have you worked with?

2. What are your job responsibilities?

Probe: How many families are on your caseload?

B. Program Characteristics

Now I’d like to discuss your home visiting program.

1. Home visiting services

1. What are the overall goals of the program?

2. What services does your home visiting program offer to families? For example, screening for depression, substance use, developmental delays; provide knowledge and training focused on safe homes and safe sleep practices, refer families to prenatal care and well-child visits, provide doula services. [We’d like to learn about your services in general and will discuss specific family economic well-being services later.]

1. Which services do families use the most?

2. Family economic well-being

1. From your perspective, what does family economic well-being look like?

2. From your perspective, what do you think are the most critical components of a family’s economic well-being to support overall family functioning?

3. How do you develop rapport and trusting relationships with families so they are comfortable sharing their economic situation with you, and that you are comfortable providing economic well-being information to them?

Probe: Could you please describe your approach during a home visit?

Probe: Do you encounter challenges when talking about financial issues with families? These could be challenges related to family cultural practices regarding sharing information. For example, in some cultures, only the male head of the family can discuss financial information and might be the only one who knows the full extent of the family’s financial situation.

Probe: Are there any other barriers to discussing a family’s economic well-being? Do power dynamics between you and families play a role in creating a comfortable space to discuss financial issues? If so, how do you address power dynamics between you and families?

3. Influence of family economic well-being

Now, I’d like to get your perspective on whether (and how) family economic well-being influences caregiver and child health, behavior, and relationships, and program engagement.

1. In your experience, does family economic well-being influence the relationship between a caregiver and child? If yes, how?

Probe: Could you provide an example of the influence of economic well-being on the caregiver–child relationship? On maternal–child interactions?

2. In your experience, does family economic well-being influence maternal and child health? If yes, how?

Probe: Could you provide an example of the influence of economic well-being on caregiver or maternal physical or mental health?

3. In your experience, does family economic well-being influence whether and how much families participate in home visiting? If yes, how?

Probe: Could you provide an example of the influence of economic well-being on how families participate in home visiting?

4. In your experience, does family economic well-being influence whether families leave the program? If yes, how?

Probe: Could you provide an example of the influence of economic well-being on families leaving the program? Do improvements in family economic well-being often or ever lead to families leaving the program? Does the program encourage families who experience improvement in economic well-being to remain in the program? If so, how? Do economic stressors affect family participation levels?

4. Family economic well-being data

1. Does your program collect information on family economic well-being? If so, how?

Probes: For example, this could be through assessments, screenings, observation, documentation, interviews, and so on.

2. Does your program use specific instruments or tools to collect data on family economic well-being?

• Are the assessments or screening tools culturally relevant for the families in your program? For example, do they reflect the language, and the cultural identities, norms, and values for the communities and families you serve? If yes, how? If no, are you aware of other assessment and screening tools that would be a more relevant cultural fit for the families your program serves?

• Are there any improvements you would make to your existing tools to make them more culturally relevant?

3. What type of information regarding family economic well-being does your program collect? For example, household income, expenditures, debt, assets, financial satisfaction, etc.

4. How often does your program collect data on family economic well-being?

• Does the timing of collection of these measures vary based on a family’s economic well-being needs?

5. Please give some examples of how you or your program use information about family economic well-being. For example, do you use the information to tailor approaches to supporting families? If yes, please explain.

C. Characteristics of the families and communities served

Now I’d like to talk about the families enrolled in your home visiting program, and the communities in which they live.

1. Family and community characteristics

1. Could you please describe the characteristics of the families you serve?

Probes: Which racial/ethnic groups are represented? What are their cultural backgrounds? What is the typical size of families? What kind of education do family members typically have? What languages do families speak?

2. How would you describe the communities where families in your program live?

Probe: This could be characteristics related to their neighborhood, demographics, cultures, history, safety, economic and social characteristics, and networks.

2. Family strengths and resources

1. What are some economic well-being strengths that you have observed in the families you visit?

Probes: Financial security, financial literacy, home ownership, stable housing, multigenerational homes, or supportive social networks

2. What type of economic well-being goals do the families you serve typically have? Probes: education and employment goals, savings plan, paying off debt, or budgeting

3. Family challenges and effect of COVID-19 on families

1. What are some of the most common economic challenges or stressors faced by the families you serve?

Probes: Low-paying jobs, lack of health insurance, limited access to reliable transportation, limited education or training, debt, financial uncertainty, limited housing options, or increasing housing and food costs

2. Have you observed any differences in the way certain populations experience economic challenges or stressors?

   1. If yes, please describe.

3. Have the economic well-being challenges of families changed since the COVID-19 pandemic started?

   1. If yes, please describe how these challenges have changed.

   2. Are there challenges that are experienced differently by certain populations?

4. Did your home visiting program change its services to address the economic well-being needs of families during the COVID-19 pandemic?

Probes: These adjustments could be related to new challenges families faced or new ways the program needed to serve families because of COVID-19 restrictions.

If yes, please describe these changes and how they helped your program serve families during the COVID-19 pandemic.

D. Strategies for supporting family economic well-being

Now I’d like to discuss the various strategies, practices, or activities you use to support family economic well-being. Practices might be a component of or an add-on to your home visiting model—for example, helping a family learn to budget, completing applications for the Supplemental Nutrition Assistance Program (SNAP benefits), or developing job interviewing skills.

1. Strategies/practices the program uses to support family economic well-being

1. What strategies, practices, or activities do you use (or have you used) to address the economic well-being of the families you visit?

[FOR EACH STRATEGY]

1. [If appropriate] How often do you use [strategy/practice/activity] (e.g., every home visit, weekly, once per quarter, as needed, etc.)?

2. What percentage of all families need this service? Your best estimate is fine.

3. How do you deliver [strategy/practice/activity]?

Probe: Do you deliver the strategy using an individual or group format? Do families interact with other families to receive services?

4. What organizations, programs, or other entities are involved in implementing the [strategy/practice/activity]?

5. Is there a written protocol or manual that describes how to implement or administer the strategy?

6. What training did you receive, if any, on implementing this strategy?

7. How does [strategy/practice/activity] address short-term economic well-being needs?

8. How does [strategy/practice/activity] address long-term economic well-being needs?

9. How well do you think [strategy/practice/activity] addresses family economic well-being?

Probe: How is it working overall?

10. What motivates and helps families fully engage in [strategy/practice/activity]?

11. What barriers do families experience engaging in [strategy/practice/activity]?

12. What challenges or drawbacks, if any, are there in using this [strategy/practice/activity]?

13. Could you give an example of how you used [strategy/practice/activity] with a family?

2. Tailoring and adapting strategies and practices

1. In general, how do you decide which families receive which economic well-being strategy, practice, or activity?

Probe: Do you use a particular strategy with all families or with specific families?

2. Do you change strategies, practices, or activities to support family economic well-being for different cultural groups, or for families with special circumstances, such as immigrants and those with disabilities? If so, how?

3. Are there specific types of families for whom economic well-being strategies, practices, or activities work better than others? For example, do some families experience better outcomes than others?

1. If yes, please explain.

E. Professional support and resources

Now I’d like to discuss the supports you receive to address the economic well-being needs of the families you serve.

1. Readiness to provide economic well-being services to families

1. What role do you think home visitors should play in supporting family economic well-being?

2. Does your program or home visiting model set clear and well-defined expectations for your role and responsibilities for supporting family economic well-being?

3. Did your program prepare you to support family economic well-being? If so, how?

Probe: Training, coaching, written guidance, and mentoring

4. How would you describe your level of comfort in supporting family economic well-being?

5. How prepared and knowledgeable do you feel to provide economic support to families?

6. What challenges have you faced in addressing the economic well-being needs of your families?

2. Home visitor supports for providing family economic well-being services

1. Does your program collaborate with community partners to support family economic well-being services?

1. If yes, what partners?

2. What type of services or supports do these partners provide? Probes: family economic services, mental health services, or referrals.

Probe: Are additional partnerships needed to support family economic well-being?

3. Who receives these services? How do you and your partners determine and make referrals?

2. What other community resources are available to support families’ economic well-being?

3. How do families learn about and access resources in the community to address their economic well-being needs?

Probes: Does your program refer families to resources, provide them with information about available resources, or help them complete application forms? Do you follow up with families after you refer them to services or after they receive additional resources?

4. Have you helped families access state or federal benefits to support economic well-being needs? If so, which benefits?

1. What barriers prevent families from accessing benefits?

Probes: Complex paperwork, tax status, immigration concerns, language barriers, or difficulty applying (such as multiple phone calls, calls on hold for long periods of time, or families needing to take time off from work to attend an appointment)

2. What has been most helpful in helping families overcome barriers to accessing economic resources?

Probe: Relationship building, warm handoffs, extensive and accurate resource lists, or informal supports (churches, advocacy organizations, or local social service nonprofits)

5. What internal or external supports or resources have been the most helpful to you for providing economic well-being services?

6. What additional supports do you need to increase your ability to support family economic well-being?

Probe: What would you need to make this work easier? What type of information? What kind of ongoing support would help? For example, training, coaching, links to resources, or staff with specialized training.

F. Recommendations

Finally, I would like to discuss your program’s successes, strengths, opportunities for improvement, and lessons learned regarding the implementation of economic well-being services.

1. Lessons learned

1. What are some of the lessons you have learned in addressing and supporting family economic well-being?

2. What adjustments have you made, based on those lessons learned, in your approach to addressing and supporting family economic well-being?

2. Opportunities for improvement in supporting economic well-being

1. In what ways could your program better support the economic well-being of enrolled families? For example, are there additional home visiting strategies that you think would be beneficial to implement?

2. What barriers, if any, prevent your program from improving services to support family economic well-being?

3. Accomplishments in supporting family economic well-being

1. What successes have you had in supporting family economic well-being? Probe: These could include family success stories, partnerships in the community to better support families in your program, or other achievements.

G. Additional Information

a. Is there anything else you would like to mention that we have not discussed?

H. Wrap-up

That covers all the questions I have for you today. Thank you so much for taking the time to speak with me. Before we end, I wanted to see if there is anything else you think I should know about how your program addresses the economic well-being needs of families.

Also, when we review our notes from today’s call, if we have any questions or clarifications, may we contact you again?

Thanks again for speaking with me today. Your input was very valuable.

Instrument 6

Parent Participant Focus Group Guide

OMB#: 0970-0356

Expiration Date: 02/24/2024

Supporting Family Economic Well-Being through Home Visiting

In spring 2023, the HomeEc team will use this guide to conduct 60-minute virtual focus groups with parent participants enrolled in up to six different early childhood home visiting programs. Each focus group will include four to six parent participants. We will ask parent participants to provide verbal consent to participate and share a consent form beforehand that summarizes key study information. We will seek parent participants’ permission to record all focus groups.

PARENT PARTICIPANT FOCUS GROUP GUIDE

NOTE: This is a guide, not a script. The guide has been developed for focus groups with participants with young children who are enrolled in an early childhood home visiting program that supports family economic well-being. Moderators will tailor questions to the specific programs and add probes to further explore the experiences recounted by group members.

I. INTRODUCTION AND BACKGROUND ON THE PROJECT

A. Moderator and co-facilitator introductions

Thank you for taking the time to speak with us today. We are from [ORGANIZATION(S)], an independent organization(s), and we are here to learn about your experiences with the home visiting program [PROGRAM NAME]. My name is [NAME], and my colleague is [NAME].

B. Explanation of Project and Purpose of Group Discussion

We are part of a team conducting a study called Supporting Family Economic Well-Being through Home Visiting, also known as the HomeEc project. First, before I explain the purpose of the study, I want to tell you that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB # for the described information collection is 0970-0356 and the expiration date is 02/29/2024.

The Administration for Children and Families, which is part of the U.S. Department of Health and Human Services, is overseeing the study. We are interested in hearing about your experiences as part of a larger research study that is looking at how programs like [PROGRAM NAME] support families’ economic well-being. We are interviewing staff at this program and others like it and holding discussion groups with participants like yourselves to ask about your experiences.

A discussion group, also called a focus group, is a way to find out what people think in a group setting. We are interested in learning about your ideas, feelings, and opinions on some topics such as how the program supported your family’s financial or economic well-being, aspects of the program, suggestions for improvement, your thoughts about financial or economic well-being, about the role that financial or economic well-being plays in other parts of life, and about your comfort discussing these topics with a home visitor. We will use the information you share with us to write a summary of what we have learned, but we will not use any of your names in our reports, so please feel free to talk openly.

Throughout the discussion, you will hear me ask about the way [PROGRAM NAME] has influenced your family’s financial and economic well-being. When you hear these terms, please think about things like how your family is doing financially now and where you expect to be financially in the future. Also think about how your family supports itself through having a good job or in other ways. Finally, consider how well you think you can meet the needs of your family.

C. Privacy and Recording

We expect this discussion to take 60 minutes. I would like to briefly review the informed consent form you received prior to this discussion [REVIEW THE CONSENT FORM WITH THE RESPONDENTS, HIGHLIGHTING THE FOLLOWING POINTS ABOUT PRIVACY].

I want to let you know that your participation in this discussion is voluntary, and you can decline to answer any questions. All information you provide will be kept private, except if you say something that suggests you are very likely to harm yourself, that you are planning to hurt another person or child, or that someone is likely to harm you. We have a Certificate of Confidentiality from the National Institutes of Health and this certificate helps us protect your privacy, except in cases required by Federal, State or local laws, such as for reporting of child or elder abuse.

We will use the information you share to write a summary of what we learned, but your name will not be connected to your answers. Even if we use quotes, we won’t use your name with them. We will not share any information you tell us about your experience with [PROGRAM NAME].

We are hoping to record our conversation because we value your information and want to make sure we capture it all. No one will hear the recording except for researchers and the person who transcribes it. If you want to say anything that you do not want recorded, please let me know, and I will be glad to pause the recorder. We will store the recording and any notes from our conversation in a secure location, and our study team will destroy the recording and notes at the end of the project.

Do you have any questions about this information?

Before we get started, I’d like to go around and have you each confirm that you agree to be part of this discussion and are okay with recording the discussion today. [MODERATOR NOTE: Call on each participant by first name only and ask them to indicate they either consent to participate or drop off the call.]

D. Ground Rules for Discussion

Before we start, we want to summarize how our time together will go:

• This will be an informal discussion.

• The discussion will last about one hour. There will be no formal breaks. If needed, please feel free to stretch or go to the bathroom.

• There are no right or wrong answers to the questions we will ask. We are interested in learning each of your opinions. We very much appreciate your input.

• We would like only one person to talk at a time so the recorder can pick up everyone. But we hope that each of you will speak up and tell us your thoughts and feelings. Feel free to write some thoughts in the chat or click the “raise your hand” button. To help make sure we hear from everyone, we may call on you by name to share your thoughts. Please feel free to say “pass” if you do not wish to answer.

• Everyone’s circumstances are different. Please do not share what you hear today from others outside of this gathering.

• Everyone has a right to their own opinions. You may ask questions or build on what another person says, but always be respectful.

• To keep us on schedule, I may change the subject or move the discussion ahead from time to time.

• Please keep your microphone muted when you are not speaking to minimize background noise.

• If you are comfortable, please turn on your video so we can all see one another.

• Each person here today will receive a $35 gift card to show our appreciation for your feedback.

II. QUESTIONS

A. Participant Background

To get things started, I would like to learn a bit more about you and your family. For some of these questions, we will use [polls or chat, depending on the platform]. Then we will discuss your experiences in [PROGRAM NAME]. We would like everyone to participate in the discussion.

1. Please introduce yourself and share how long you have been participating in [PROGRAM NAME]. Please also tell us how many children you have and what their ages are.

[MODERATOR NOTE: It is helpful to go in order of how the group appears on your screen. This will allow the notetaker to label responses by person.]

2. Are you Hispanic, Latino, or Spanish origin?

1. Yes

2. No

3. Prefer not to answer

3. What do you consider your race? Select all that apply.

1. American Indian or Alaska Native

2. Asian

3. Black or African American

4. Native Hawaiian or Other Pacific Islander

5. White

6. Other

7. Prefer not to answer

4. Were you born in the United States?

1. Yes

2. No

5. What is your sex?

1. Male

2. Female

3. Other

B. Family Financial or Economic Well-Being

First, we’d like to talk about what financial or economic well-being means to you and your families, and about all the different ways financial well-being can affect someone’s life. Again, by family financial or economic well-being we mean things like how a family is doing financially now and where they expect to be financially in the future, how a family supports itself through having a good job or in other ways, and how well a family can meet their needs.

1. When you think about your family’s financial or economic well-being or the financial well-being of families like yours, what kinds of things do you think of?

Probes: Probe on the following items if they are not mentioned during the discussion:

How do you think a family’s ability to afford basic needs, such as housing and utilities, transportation, child care, and health care affects economic well-being?

What about employment? Some people think of a job just as a way to earn money, and some people want a job that both pays them and is personally satisfying to do. When you think about having a good job, what does it mean to you?

What about education or training strengths and needs? Are they part of how you think about family financial well-being?

What about having the resources to meet a family member’s personal goals? Maybe planning for the future or saving money for the future?

Is being stressed or not stressed about money a part of how you think about family financial well-being?

What about building credit or managing debt?

What about the resources available in a family’s community? For example, community services such as affordable child care or services to help you find a job? What about connecting to other families about resources, financial problem solving, or support around an issue that affects financial well-being?

What about larger issues that can affect a family, such as low wages, limited job opportunities, or limited affordable housing?

[MODERATOR NOTE: Take note of visual signs of agreement or disagreement, such as nodding or shaking heads. Briefly summarize the discussion for any common understandings or definitions of family economic well-being. Note whether anyone disagrees with any of the statements, indicating that the item is not important to their sense of family economic well-being. For example, “It seems like everyone agrees that [list] are components of family economic well-being. [Many / Some / A few] people would add …”

2. What do you think are the most important components or elements of a family’s financial well-being? Looking at the components on the screen, which three do you think are the most important for family financial well-being? Please share your answers [verbally or in the chat or in the poll]. [MODERATOR NOTE: Display a slide listing the following components.] Why did you pick these as the most important elements? Does anyone have different reasons about why they chose theirs?

1. Afford basic needs, food, housing and utilities, clothing

2. Child care and health care

3. Stable employment with consistent hours of work

4. Employment that is fulfilling and personally satisfying

5. Education

6. Job training or apprenticeships

7. Resources to meet personal goals

8. Planning for the future

9. Not being stressed about money

10. Having money for “extras” like gifts, dinner out, vacations, etc.

11. Building credit or managing debt

12. Community resources, including availability of transportation to get to work and stores

13. Connections with other families

14. Other issues that can affect a family, such as fair and livable wages or job opportunities

3. Does each of you think about financial or economic well-being differently in the short term, like the next few months, versus the long-term, such as the next few years?

1. What makes each of you feel financially well in the short term?

2. What would make each of you feel financially well in the long term?

[MODERATOR NOTE: It might be helpful to provide a definition or examples of short term (e.g., able to pay for basic needs like food or rent each month) versus long term (e.g., money for college or training program, saving for a better place to live or buying a house) to make this clearer. It might also be helpful to tie responses together. For example, saying “You all mentioned X makes you feel financially well in the short term. When you think about the future—like the next few years—is there anything different from or in addition to X that would make you feel financially well?]

4. When you think about a family that doesn’t feel worried or concerned about finances versus one that does, how do you think this influences each family member and their relationships with one another? For example, how might feeling worried or concerned about finances influence how someone feels about themselves as a parent or how they interact with their children?

Probes: Probe on the following items if they are not mentioned during the discussion]:

How might it influence their mental and physical well-being? Items to think about include feelings of depression, amount of energy or fatigue, eating and sleeping habits, or chronic health problems.

How might it influence each person’s relationship with their partner?

How might it influence their social connections or connections to their community?

How might it influence their levels of stress?

How might it influence their self-image or self-confidence?

How might it influence their feelings about and ability to plan for the future?

How might it influence their child’s ability to succeed in school?

How might it influence their home environment? Would there be more tension, stress, or fighting?

How might it influence their ability or capacity to do things for their children, such as making meals for them or helping them with their homework?

How might it influence their interactions with police and the criminal justice system?

Are there any other ways it might influence their lives?

5. What are some ways financial well-being could influence participation with a home visiting program? Do you think someone’s financial well-being could affect their level of participation with a home visiting program?

1. What are some things home visiting programs could do to help families participate in home visiting?

[MODERATOR NOTE: Take note of visual signs of agreement or disagreement, such as nodding or shaking heads. Note that aspects aren’t limited to those listed in the prompts, and encourage participants to discuss any other aspects they feel are relevant.]

C. Strategies for Supporting Family Financial Well-being

Now, I want to talk about what services or activities related to family financial well-being with [PROGRAM NAME] that you may have participated in, how useful the services you received were, and what helped you complete the activities or made participation challenging, and how comfortable you felt discussing these topics with your home visitor.

[MODERATOR NOTE: Tailor this guide before the focus group to repeat Question 7 for each practice or activity that is related to family economic well-being, such as financial education classes, coaching or case management services, or financial assistance.]

1. Did any of you participate in or receive [ECONOMIC WELL-BEING PRACTICE OR ACTIVITY]?

1. If yes, which aspects of [ECONOMIC WELL-BEING PRACTICE OR ACTIVITY] did you participate in? What was your experience like? What did [ECONOMIC WELL-BEING PRACTICE OR ACTIVITY] include?

2. Tell me about the strategy that was most helpful in improving your families’ economic well-being? Why was it the most helpful? Do others agree or disagree?

3. Was anything about [ECONOMIC WELL-BEING PRACTICE OR ACTIVITY] challenging for you to participate in? If so, how?

4. What supports were hard to obtain? For example, if you were searching for a new apartment, was that particularly hard to find? Why?

5. What activities were easy to do, or what supports were easy to access?

2. Were there any other services in [PROGRAM NAME] that helped support your family’s economic well-being?

[MODERATOR NOTE: Take note of visual signs of agreement or disagreement, such as nodding or shaking heads. Briefly summarize the discussion for any common understanding.]

3. For the following scenarios, please share how comfortable you would be if your home visitor asked about them. You can say you are not all comfortable, somewhat comfortable, or very comfortable. Please share your answers [verbally or in the chat or in the poll].

[MODERATOR NOTE: Take note of agreement or disagreement among the group. If respondent says not at all comfortable or very comfortable, ask them why they rated low or high comfort. Ask if others feel similarly or different.]

1. Whether you have had difficulty finding a job

2. Whether your job pays enough to cover your bills and necessities

3. Whether your family has enough food

4. Whether you have access to reliable transportation

5. Whether your family is able to buy basic things that your children need, such as food, clothing, shoes, diapers, or formula

6. Whether your family can afford to go to the doctor or dentist for routine or emergency care, or buy medication when needed

7. Whether your family can afford to have either a cell phone or a landline and internet access at your home

8. Whether your family is at risk of utilities, such as electricity or water, being shut off because you can’t afford the bill, or whether this has already happened

9. With respect to housing:

1. Whether your family has a safe and healthy place to live and lives in a safe neighborhood

2. Whether your family has enough space for all family members

3. Whether your family has to move because you can’t afford the rent

4. Whether your family has experienced or is experiencing homelessness or is at risk of losing your housing

D. Recommendations

We will wrap up today’s discussion with a few questions about how [PROGRAM NAME] influenced your economic well-being and where there is room for improvement.

1. After participating in [PROGRAM NAME], did you notice any changes in your financial or economic well-being?

1. If yes, what changes did you notice?

2. Were there any changes in anyone’s ability to meet basic needs or in their income or employment, financial security, or stress about money?

3. Were there any changes in anyone’s interactions or relationships with their children and family? With your social connections or community?

2. Overall, what aspects of the program were each of you most satisfied with?

3. Overall, what aspects were each of you dissatisfied with?

4. What can [PROGRAM NAME] do better to support the financial well-being of families like yours?

This concludes our discussion for today. Thank you again for taking time to answer our questions. Does anyone have a question or comment they’d like to share before we end?