Illustration of child reading in adult's lap

Little Talks: A Targeted Curriculum for Home Visiting Programs

Patricia Manz develops curriculum to improve home visiting services for children with significant developmental needs.

Story by

Kelly Hochbein

Precision medicine customizes health care to the specific needs of an individual patient. Precision home visiting does the same for the developmental needs of infants and toddlers from socioeconomically disadvantaged backgrounds.

“Home visiting is a broad term of how we might provide child development services to low-income infants and toddlers who are at risk for developmental challenges because of their socioeconomic status,” explains Patricia Manz, professor of school psychology. “Precision home visiting is basically mirroring precision medicine in the sense that it calls for home visiting research that can identify what ingredients of home visiting work best for certain families. … It’s a new way of referring to a previously asserted standard, but it’s a standard that we haven’t met, especially when we talk about interventions for really young children and interventions for children who are culturally diverse or low-income.”

Some home visiting programs prioritize maternal health or parental economic status, while others target child development by working closely with the child’s primary caregiver to deliver services. Manz has focused on the latter. Those services, she says, can be delivered in many different ways, and their effectiveness relies upon high-quality delivery.

“Services need to be evidence-based, and most home visiting programs send home visitors out to the homes who are minimally trained, and so they’re not necessarily using best practices or evidence-based practices,” Manz says.

Illustration of woman and child

The effectiveness of home visiting programs relies upon high-quality delivery, says Manz.

Manz and her team have developed Little Talks, an evidence-based intervention that focuses on multiple approaches to book-sharing interventions to help parents from socioeconomically disadvantaged backgrounds engage their children in dialogue and communication. The program’s modular curriculum is flexible, allowing for adjustments based on parents’ preferences, cultural backgrounds, current skills and how they interact with their children.

The team piloted Little Talks with low-income families, and found that the program was most helpful for parents of infants and toddlers who were Spanish-speaking.

“Among those parents, we saw greater involvement in general learning activities with their child outside of the home visits, [and] we saw greater impact on children’s communication and language skills,” Manz says.

Manz is now analyzing the ways in which home visitors adapted the Little Talks lessons to best meet parents’ and children’s needs.

“While I’m excited about the [improvement among] Spanish-speaking families and I’m excited that we saw impact in a group that’s largely ignored in research … my guess is we’re going to see that for the most part—and we are seeing this very preliminarily—that home visitors stayed at the most basic levels. I wonder if the impact on the specific subgroup of children may be a result of the home visitors’ narrow use of a subset of Little Talks lessons, rather than expanding use to advanced lessons.”

Given the clinical judgment and decision-making skills required of home visitors, high-quality training is essential, says Manz. Moving forward, she hopes to better equip home visitors for success through home-based coaching, with experienced coaches supporting home visitors within the context of actual home visits, demonstrating how to scaffold interventions and assess the family’s needs and eventually turning the work over to the home visitor to work independently.

“I think [home visitors are] going to need that model and demonstration within the home visit,” says Manz. “You have to get that intent with our implementation. Then we’ll see how Little Talks affects low-income families from various cultural and linguistic backgrounds.”

Illustrations by Anna Kövecses

This story originally appeared as "Prescribing Better Child Development" in the 2019 Lehigh Research Review.

Story by

Kelly Hochbein

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