Using PICCOLO & HOVRS in Virtual Home Visits—Q&A from Brookes Coffee Chat

Lori Roggman [email protected] & Mark Innocenti [email protected]

Will this webinar be archived?

Here’s a link to the recording that was shared in the follow-up emails. You just have to enter your name and email. Recording Link

Working with families during the pandemic

How can I better engage a family with limited resources in virtual home visits?

All families have some resources, and home visitors can help families identify what they have to support their children’s development. Ask parents what they do have, but remember that young children learn from all their experiences, so you can be helping parents by asking about their regular everyday routines, chores that have to be done regularly, and school requirements for other children in the home—these are great opportunities to think about involving younger children. Be sure to ask open-ended questions about what they have been doing recently to engage their children in something fun and interesting, what they’ve enjoyed doing together in the past that they could try again, how they could adapt what they wish they could do so they can do it, activity ideas they’ve heard from other people they know at home with young children, and maybe even what they would do if they had 10 minutes to themselves without their children needing them. Listen well to identify their ideas and help them pick some things to try before you meet again. If you can meet online, help them pick an activity to try during your meeting so you can coach, inform, and encourage them.

What kind of questions should I be asking my parents?

Due to the pandemic things have changed. How can we keep the visit going longer? What are examples of reflective questions? Ask open-ended questions, follow-up questions, and reflective questions. Google “Motivational Interviewing” OARS. OARS stands for: Open-ended questions, Affirmations, Reflections, and Summaries. Open-ended questions are those that don’t have a right or wrong answer and could have many answers, “How have things changed for your family since this happened?” Affirmations are positive comments about what is going well, even something very simple, “That’s great that you’ve been trying to keep your regular routines going for your kids.” Reflections are comments on the meaning and emotions that you are hearing from parents, “I noticed you sounded concerned when you said you were not going to the playground—what concerns you?” Summarizing, “So you’ve found ways to keep your kids busy and happy, but you haven’t been going to the playground, and you are wondering about other ways your kids can get exercise—is that right?”

Generally about virtual visits:

Should we be concerned about family confidentiality in virtual visits? Is it safe to use Zoom?

Yes, you should be concerned and protect family confidentiality. Each meeting with a family should be scheduled separately rather than using the same link for multiple visits. When you set up a Zoom meeting with a family, be sure to send the password to the family with the Zoom link. Tell parents not to share their link or password. Also, use permission from the family and make sure that the video recording is password protected on a password protected device, used only for the intended purpose, and deleted immediately after use.

How is the family's confidentiality protected when recording with a virtual meeting platform that is not HIPAA compliant?

Programs that require HIPAA compliance may purchase Zoom for Healthcare, Zoom Healthcare.

How do we record parent-child interactions or the whole home visit during a Zoom meeting?

In Zoom, it’s easy because there is a “record” button right on the bottom (or top) of the main screen where you see everyone’s faces. Click on it and it starts recording. Click again later and it stops. Other video meeting platforms can also be recorded. Usually, only the host can record an online meeting.

To see both the family and the home visitor in your recording—for example, for later HOVRS scoring, click on Gallery View. To see only the family in your recording—for example for later PICCOLO scoring, click on Speaker View and mute yourself during the parent-child activity you and the parent planned to do for the observation. For PICCOLO observations, guide the family to identify pictures or a picture book they could talk about, pretend play toys, other sharable toys with parts, or whatever the family has that the child finds fun and interesting.

Virtual visits by phone:

Can you talk more about phone PICCOLO? What would it look like in a virtual home visit by phone? PICCOLO was validated from recordings of parent-child interactions. If your program is using PICCOLO only for reporting, then you must observe parent-child interactions to use PICCOLO. If you are using PICCOLO to increase parent support of their child’s development, however, you can use it effectively by phone. For any PICCOLO observation, begin planning the observation in a previous home visit.

Send the parent, by email or mail, a list of the PICCOLO items in “29 Things Parents Do That Predict School Readiness.”

How can you tell what the child's response is if they are very young and can't talk yet?

Any suggestions for families who don't want to talk on the phone due to too many kids at home? If they simply don't want a virtual home visit by phone, we have to respect that. Some people hate talking on the phone at all. If they find a phone call difficult because they are overwhelmed with having all their kids at home all day every day, we can help. So, try to find another time when they are willing to talk, then focus on ways to make their life with all the kids at home easier, not on program paperwork or telling them what to do. They are telling you that they are overwhelmed, so if you tell them, “just do this great activity from our curriculum to support the development of ___,” they may never answer the phone again when you call. Here are some things to try:

• Set up a time when the kids are busy with something else, before they get up in the morning or after they go to bed at night.
• Talk to the parent about what they’ve tried that keeps their kids busy and happy.
• Ask questions about what they’ve done in the past.
• For each activity they mention, ask what worked and didn’t work and how they might change it to work better.
• Ask them to pick just one to try.

PICCOLO helps practitioners observe a wide range of parenting behaviors that help children develop over time—an approach known as developmental parenting. Parenting strengths—what the parent already believes is important to do and is comfortable doing with his or her child—are a valuable resource for increasing the developmental support available to young children.

Can you complete PICCOLO with the observations seen throughout different activities or visits? Or does it have to be done with only one activity observation?

If you are doing a PICCOLO observation for data collection, PICCOLO was developed to be observed and scored in one 10-minute observation of the parent and child playing together. We recommend having varied materials available for the interaction. However, once you are proficient at using the PICCOLO and can see the behaviors measured by PICCOLO, we recommend using the handout “29 Things Parents Do That Predict School Readiness,” the items from the PICCOLO, on most home visits. The goal is to identify what parents are doing well and let them know what they are doing well, how their child reacts when they do that behavior, and why the behavior is good for child development/school readiness. PICCOLO was validated based on a 10-minute observation. For valid scores, all observations should be the same duration. During 10 minutes, a parent and child may do multiple activities.

My greatest concern is our HV are having trouble seeing the PCI during our ZOOM home visits.

For effective home visits using an online video meeting platform, such as Zoom, it is important to work with the parent to place their device—laptop, tablet, or phone—in a place where the parent, the child, and whatever they are doing together is visible on the screen. On Zoom, select “speaker view” and click on the “record” button to begin recording the observation. After 10 minutes (or sooner if the child does not want to play anymore), you can stop the recording.

Programs use various ways of recording and comparing scores. Excel can calculate differences in scores and can display these changes in graphs. It is widely available, easy to learn, and most questions you will have can be answered by a quick Google search. A parent’s PICCOLO scores are entered in the spreadsheet, and graphs of progress can be produced. If a later score is higher than an earlier score, that is progress. An increase in a PICCOLO domain of 2-3 points is roughly equivalent to an increase of a standard deviation, which is considered meaningful.

Can I use PICCOLO with other outcome measures?

PICCOLO can be used with other measures. For example, we recommend regular use of PICCOLO along with the ASQ to help guide home visit planning. If your other measure is also a parent-child interaction measure, you may want to choose just one measure (PICCOLO has strong psychometric properties).

How is PICCOLO different from Growing Great Kids? Is it a different tool or a supplement tool?

PICCOLO is a measure of developmental parenting. Growing Great Kids is a curriculum to use in home visiting to help parents provide more developmental parenting. The tools seem to work well together. Other observational measures of parent-child interaction can be used similarly to PICCOLO.

What coaching techniques would you suggest using with the parent who communicates with her child by a barrage of questions such as "What color is that?" "What shape is that?"

Always provide positive feedback that describes the parent’s positive behavior in relation to the child’s response and development. For example, you could say, “You ask your child a lot of questions, and when your child can answer your questions, you are helping them practice the language and cognitive skills they are developing.” And you can add more information, “Sometimes when we ask a lot of hard questions, kids get frustrated and stop answering, but when we keep questions easy and fun, they usually try to answer.”

Can you do a PICCOLO with multiple children in the home?

You can do a PICCOLO with each child, one at a time. We would recommend doing these multiple observations on separate home visits to avoid overwhelming the family.

Can we bridge PICCOLO to a developmental parenting curriculum, such as Parents as Teachers?

PICCOLO shows you what a parent’s strengths are for supporting their child’s early development. Knowing those strengths can help you and the parent select activities together that are a good fit for the parent’s strengths, the child’s development, and what the family already does and has. Some home visitors use their curriculum’s table of contents or another list of age-appropriate activities to guide this joint planning with parents, but more experienced home visitors can simply brainstorm ideas with a parent for experiences that will help their child reach the goals the parent has for their child.

Where can we get training on developmental parenting, PICCOLO, HOVRS, or virtual home visiting?

Email me at [email protected] for our training information. We are now scheduling virtual training webinars on developmental parenting, PICCOLO and HOVRS. We offer training for making virtual home visits. Many of you have already become our new experts on virtual home visiting. Some families and programs intend to continue virtual home visits in the future when there is family illness or bad weather.