What Makes Home Visits Effective? An Examination of Therapeutic Mechanisms in the Recipe 4 Success Preventive Intervention.

Previous research has documented the importance of early childhood home visiting programs in promoting healthy parent and child functioning among families living in poverty. However, it remains unclear which aspects of home visiting are most critical in driving change. This study helps fill that gap by examining the extent to which five key therapeutic mechanisms accounted for differences between families who participated in the Recipe 4 Success preventive intervention, which was embedded within Early Head Start, compared to families who continued to receive usual practice Early Head Start home visits. The sample included 242 families with 2-year-old toddlers, most of whom were living in poverty (37% white, 25% Black, 19% Latiné, 17% Multiracial, and 2% Asian; median income = $1,555 per month). Three sessions of home visits across both study conditions were audio recorded and coded to assess therapeutic mechanisms. Findings from mediation path analysis models revealed that enhancements to therapeutic mechanisms representing the parent-home visitor working alliance, home visitor facilitation skills, and parent engagement appeared to account for much of the intervention effect on multiple indicators of parents' sensitive scaffolding and responsive food parenting practices. This study highlights the value of a carefully structured and sequenced curriculum in enhancing critical therapeutic mechanisms to improve the overall effectiveness of home visits, so participating families have a greater opportunity to thrive.