VisitBoost: A Home Visiting Enhancement to Reduce Harm for Families Affected by Substance Misuse - PROJECT SUMMARY Substance misuse during the peripartum period contributes to significant challenges for parents and children including barriers to accessing needed health and social services. More than 20,000 home visitors across the United States are positioned to provide frontline support during this critical window, stigma, lack of knowledge, however, organizational limitations often prevent them from effectively engaging parents with substance misuse. Home visitors themselves report a strong desire for additional training, particularly around emerging practices such as overdose prevention and non-punitive approaches to care. Without sustained supports, however, traditional one-time trainings have little lasting impact on workforce attitudes, practices, or organizational culture. VisitBoost is an innovative training and implementation support program designed to reduce stigmatizing beliefs, strengthen home visitor knowledge and confidence, and promote organizational change. VisitBoost focuses on improving evidence-based practices for building and maintaining relationships, connecting families to effective treatment and recovery services, and supporting safe caregiving and child development. Phase I (R43DA057785) demonstrated feasibility and proof of concept, with evidence of reduced stigma, increased knowledge and confidence, and high ratings of acceptability, appropriateness, and feasibility. The proposed Phase II project has four aims: Aim 1 will complete VisitBoost content and implementation enhancements, adding organizational strategies such as policy auditing, centralized technical assistance, communities of practice, and client involvement and feedback. Aim 2 will assess effectiveness compared to standard training in a cluster- randomized trial of 44 regions (440 home visitors). Aim 3 will evaluate parent outcomes (treatment utilization and recovery capital) in a subset of 240 parents with substance misuse (during pregnancy and the first year postpartum). Aim 4 will assess implementation outcomes, including cost, cost-effectiveness, penetration, and fidelity. By combining training, organizational strategies, and rigorous evaluation, VisitBoost has the potential to strengthen the home visiting workforce, increase family engagement in treatment and recovery supports, and improve outcomes for parents and infants during the peripartum period.
