Early childhood home visiting is a two-generation approach to promote positive health and well-being outcomes among people who are pregnant and families with infants and young children. A popular family support strategy for the past several decades, home visiting expanded exponentially in the United States when the federal Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) was authorized in 2010 through a provision within the Affordable Care Act. MIECHV currently funds evidence-based home visiting services in underserved and historically marginalized communities in all 50 states, 22 tribes, the District of Columbia, and five U.S. territories. It is widely accepted that achieving intended child and family outcomes through home visiting services requires “high-quality” program implementation, but the field lacks a standard definition or empirical evidence for what “quality” means in the context of home visiting. With the rapid expansion of home visiting that has accompanied MIECHV, there is increased interest from the field in having a shared understanding of home visiting implementation quality that is applicable across models and accounts for dimensions of quality across the entirety of the home visiting implementation system. This paper describes the process used to develop a conceptual framework to understand home visiting quality. We engaged MIECHV awardees and other experts from the fields of home visiting, early childhood, implementation science, and health equity in a co-design process that involved initial brainstorming, a series of iterative framework drafts, and finalization of the model. The resulting framework captures the multiple levels (i.e., the contexts, agencies, entities, and individuals) that are part of the home visiting system and the theorized key aspects of quality that are applicable across the levels of the systems. We discuss potential uses of the conceptual framework, as well as lessons learned from the co-design process.

the preferred terminology for particular states and/or home visiting model developers. providers care for over seven million children under age 5 in the United States, but many of these providers face barriers to accessing professional development opportunities outside of the home. This brief examines opportunities to support HBCC providers’ professional development through home visiting. As an intervention typically provided to economically disadvantaged families with children under school age, home visiting encompasses a range of supports provided in the family’s home by professionals such as social workers or nurses. Existing home visiting models focus on supporting caregivers—including biological parents, foster and adoptive parents, grandparents, or others who provide primary care for children in a home—in their interactions with their children. The in-home nature of the intervention has the potential to meet the training needs of HBCC providers in a convenient way. Adaptations to home visiting curricula, however, will need to address the unique challenges of working with multiple children across a range of ages and providing developmentally appropriate care and education.

The knowledge, skills, and attitudes that early early care and education (ECE) professionals bring to their settings affect the quality of care that children and families receive. Professional development— that is, opportunities for ECE providers to strengthen and expand their skills—is one of the primary strategies used outside of formal educational systems to strengthen the quality of care in ECE settings. However, the infrastructure to support professional development for ECE providers across the settings and sectors in which they work is often fragmented, siloed, and uncoordinated.

Research Findings: This study examined the development and implementation of six Early Head Start Child Care Partnerships (EHS-CCPs), unique collaborations between EHS grantees and community-based child care partners that expand access to high-quality child care and comprehensive services for low-income infants, toddlers, and their families. Interviews and focus groups with 111 key informants identified similarities across the six EHS-CCPs in initial outreach to community partners for establishing partnerships and approaches to developing partnership agreements but variation in approaches to monitoring quality improvement activities. Benefits and challenges to partnerships for programs and families were noted. Practice or Policy: Findings suggest a need for additional guidance for EHS-CCPs on key components of implementation, including the partnership agreement process, monitoring quality improvement plans, offering support for meeting program requirements, and providing comprehensive services. For example, five of the six partnerships reported the EHS grantee led the development of their partnership agreements. While this approach was attributed to child care partners' lack of prior experience in developing agreements, further guidance on how to engage partners collaboratively in an agreement process that better emulates the principles of authenticity and equality from the conceptual framework for collaborations in early care and education would be useful.

While studies have documented the importance of strong implementation in intervention studies (e.g., see Durlak & Dupre, 2008), more information is needed about how to ensure strong fidelity and quality of program implementation when delivering interventions under "real world conditions'' and on a large scale. In this article, key lessons in implementing a demonstration and evaluation project known as the Foundations of Learning (FOL) demonstration are presented. Our discussion highlights several key components to the success of the project, including the building of effective coalitions before, and during, the delivery of the intervention to support the implementation process, as well as intensive, collaborative, and multilayered technical assistance provided as the intervention was delivered. Key lessons learned over the course of this project represent some that are highly consistent with prior research on this topic, as well as some that are unique, thus representing new areas for exploration in this burgeoning area of study.