Effects of A Collaborative Home-Visiting Program for Children with Motor Delays
Date Issued
2009
Date
2009
Author(s)
Hsieh, Yu-Hsin
Abstract
Background and Purpose: Infants and toddlers with motor delays (MD) not only had limitations in motor activities but also showed deficits in other developmental areas and daily participation. Home environment is considered as an important influencing factor for these limitations and deficits. It is an international trend to apply collaborative team into home visiting service with parental participation for infants and toddlers with MD. However, the effectiveness was not proved yet. This study investigated the effects of a collaborative home visiting program, which was the cooperation between a university pediatric physical therapy program and a local institute on (1) daily participation；(2) motor function；(3) quality of home environment；(4) parental knowledge；(5) parental stress for infants and toddlers with motor delays in rural area. In addition, we would analyze the cost effectiveness of the collaborative home visiting program. Methods: This study was conducted as a double-blind randomized control trial. 24 infants and toddlers aged 6 to 33 months and with MD were enrolled from Early Intervention Referral and Management Center in Taitung County. They were stratified according to age and motor severity and then were assigned to either a collaborative home visiting group (collaborative group) or a routine home visiting group (routine group) randomly. Both groups received five-time home-visiting services in three months. A tester who was masked with the group assignment performed the pre- and post-intervention assessments. The outcome measures included Pediatric Evaluation of Disability Inventory (PEDI), Peabody Developmental Motor Scales 2nd Edition (PDMS Ⅱ), Disability-Adapted Infant/Toddler version of Home Observation for Measurement of the Environment (DA-IT-HOME), Knowledge of Infant Development Inventory (KIDI), and Parenting Stress Index-Short Form (PSI-SF). The collaborative group received a collaborative home-visiting program. The collaborative team members comprised a program designer, a social worker and a main facilitator. The program designer analyzed the relationship among functioning, disability and contextual factors of each child and family based on ICF model and to set primary functional goals for child and family. In addition, 2 to 3 functional programs which were frequent occurrence in the family’s daily routine were designed according to Carolina curriculum. Parental programs that referred to family goals included parenting knowledge of child’s development and skills for the main caregivers. After team discussion, the main facilitator provided with direct intervention and instruction during each home visiting. For routine group, they received regular home visiting program which were social resource provision and emotional support for family. After three months, the changes of the daily participation, motor function, quality of home environment, parental knowledge, and parental stress were analyzed by using two-way mixed ANOVA. The significant level α was set as 0.05 with one tailed test. In cost analysis, the incremental cost-effectiveness ratio (ICER) was used to calculate the incremental cost in order to increase one point of score in collaborative home visiting compared with routine home visiting. Results: The mean corrected age of the collaborative group and routine group was 20 months and the mean motor age was 12 months. Education level of main caregivers was mostly senior high school or lower in the collaborative group or routine group (100% and 75% respectively) and most families were low socioeconomic status (100% and 83% respectively). After three months, infants and toddlers in collaborative group showed significantly improvement in Mobility scaled scores of PEDI (p=.01), total scores of DA-IT-HOME (p<.0001) and total scores of PSI-SF (p=.028) than those in routine group. In other outcomes as other scales of PEDI, percentage scores of PDMS-2, and accuracy percentages of KIDI, the whole group showed improvement without significant group and time interaction. In cost analysis, the collaborative home visiting program could increase one scaled score in Mobility domain of PEDI with the incremental cost of 2,880 NTD within 3 months. For DA-IT-HOME and PSI-SF, the collaborative home visiting program definitely demonstrated better cost effectiveness than routine home visiting program. Discussion and Conclusion: The findings in this study supported the effectiveness of collaborative home visiting on improvement of mobility participation, quality of home environment and parental stress alleviation for infants and toddlers with motor delays in rural area. The collaborative home visiting program, which provided with functional programs in daily routine, encouraged the engagement of main caregivers and suggested the arrangement of home environment could lead to increase participation of daily mobility for young children, positive responsivity and adequate stimulation in home environment for main caregivers and reduced the parenting stress furthermore. From the ICER analysis, the collaborative home visiting needed to increase the cost of an amount equal to the expenditure of 5-time physical therapy in the National Health Insurance to increase one scaled score in mobility participation for a child. The long term effects of collaborative home visiting for infants and toddlers with motor delays needs further studies.
Subjects
Randomized control trial
Motor delays
Infants and toddlers
Collaborative team
Home-visiting
ICF model
Carolina curriculum
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