| 1: Staffing differences need clarification |
| Interpretation of these results would benefit from greater precision in defining staffing patterns. It appears that the "paraprofessionals" performing home visits in "some" sites may actually be Community Health Workers, a DOL standard occupational classification taking effect in 2010. The term "paraprofessionals" is imprecise. It may be that limited size of this study precludes analyzing differences in outcomes among sites based on staffing, but this can have major implications for cost-effectiveness since nurses and social workers are more expensive than CHWs. It has been shown that CHWs can apply methods such as Motivational Interviewing with success comparable to that of other professionals. Further clarification would be appreciated.
Carl H. Rush, MRP
Community Resources LLC
San Antonio, Texas |
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Carl H. Rush, MRP, Wednesday, November 11, 2009 12:33 pm |
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| 2: Paraprofessional home visitors in FHL study |
| The home visitation field is not homogenous in either staffing types, frequency of visits or service models. The term paraprofessionals is used in the article because that is the term generally used by the home visitation programs to describe visitors who are not licensed professionals (Ex.RNs or SWs). The parent education models like Parents as Teachers have staff with a range of educations from Early Childhood Ed (AA) to Masters in Ed. The Healthy Families America (HFAs) and most of the other national models have moved away from using staff with only HS/GED educations...and an AA in anything is fairly common. CHW is a term that I have not heard used by any of the programs I have trained to describe their staff. It is more common in clinical, home health or public health situations. For this study the participating sites used AA level paraprofessionals or parent educators; one site used nurses but was not a Nurse Family Partnership model. |
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Linda Wollesen, Wednesday, November 11, 2009 4:36 pm |
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| 3: Community Health Workers, size of study |
| I followed development of the job classification for community health workers. Home visitors in this study may fit that classification, but as explained in the previous comment, the term is not used in the maternal child health field. This study has an N of 2432 parent child dyads, sufficient to compare results by staffing model. We are seeking funding for additional analysis, including staffing models. ss |
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Sandra Smith, PhD, Thursday, November 19, 2009 4:41 pm |
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| 4: Reply to expert commentary |
Dr Lee wrote: The measures should be interpreted with caution, however, since they differ from the Healthy People 2010 definition of health literacy, which refers to the “degree to which individuals have the capacity to obtain, process and understand basic information and services needed to make appropriate health decisions.”
This study responded to calls for new measures to increase understanding of health literacy beyond the current focus on reading in a medical setting, which has largely limited intervention to reducing the cognitive demand of information. This intervention focuses on developing advanced health literacy skills (interaction & reflection)(Nutbeam 2008) as a personal and community asset that enables people to use information and services in ways that promote health (WHO 2000). |
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Sandra Smith, PhD, Thursday, November 19, 2009 4:55 pm |
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