Skip to main content

A Qualitative Exploration of Co-location as an Intervention to Strengthen Home Visiting Implementation in Addressing Maternal Child Health


Objectives The aim of this paper is to explore the process and impact of co-locating evidence-based maternal and child service models to inform future implementation efforts. Methods As part of a state-wide evaluation of maternal and child home visiting programs, we conducted semi-structured interviews with administrators and home visitors from home visiting agencies across Pennsylvania. We collected 33 interviews from 4 co-located agencies. We used the Consolidated Framework for Implementation Research (CFIR) to describe the key elements mitigating implementation of multiple home visiting models. Results A primary advantage of co-location described by participants was the ability to increase the agency’s base of eligible clients through the implementation of a model with different program eligibility (e.g. income, child age) than the existing agency offering. Model differences related to curriculum (e.g. content or intensity/meeting frequency) enabled programs to more selectively match clients to models. To recruit eligible clients, new models were able to build upon the existing service networks of the initial program. Co-location provided organizational opportunities for shared trainings, enabling administrative efficiencies and collaborative staff learning. Programs implemented strategies to build synergies with complementary model features, for instance using the additional program option to serve waitlisted clients and to transition services after one model is completed. Conclusions for Practice Considerable benefits are experienced when home visiting models co-locate. This research builds on literature encouraging collaboration among community agencies and provides insight on a specific facilitative approach. This implementation strategy informs policy across the social services spectrum and competitive funding contexts.

This is a preview of subscription content, access via your institution.


  • Anyon, Y., Nicotera, N., & Veeh, C. A. (2016). Contextual Influences on the Implementation of a Schoolwide Intervention to Promote Students’ Social, Emotional, and Academic Learning. [Article]. Children and Schools, 38(2), 81–82.

    Article  Google Scholar 

  • Bleser, W. K., Miller-Day, M., Naughton, D., Bricker, P. L., Cronholm, P. F., & Gabbay, R. A. (2014). Strategies for achieving whole-practice engagement and buy-in to the patient-centered medical home. [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t]. Annals of Family Medicine, 12(1), 37–45.

    Article  PubMed  PubMed Central  Google Scholar 

  • Carrilio, T. E. (2007). Home-visiting strategies: A case-management guide for caregivers. Columbia: University of South Carolina Press.

    Google Scholar 

  • Charmaz, K., & Smith, J. (2003). Grounded theory. In Qualitative psychology: A practical guide to research methods, (pp. 81–110). London: Sage

    Google Scholar 

  • Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(1), 50.

    Article  PubMed  PubMed Central  Google Scholar 

  • Damschroder, L. J., & Lowery, J. C. (2013). Evaluation of a large-scale weight management program using the consolidated framework for implementation research (CFIR). Implementation Science, 8(1), 51.

    Article  PubMed  PubMed Central  Google Scholar 

  • Daro, D., & Dodge, K. A. (2010). Strengthening home-visiting intervention policy: Expanding reach, building knowledge. In New directions for America’s preschool policies, (pp. 79–86). Washington D.C.: NIERR and Brookings.

    Google Scholar 

  • Ditty, M. S., Landes, S. J., Doyle, A., & Beidas, R. S. (2015). It takes a village: A mixed method analysis of inner setting variables and dialectical behavior therapy implementation. Administration and Policy in Mental Health and Mental Health Services Research, 42(6), 672–681.

    Article  PubMed  PubMed Central  Google Scholar 

  • Glaser, B. G., & Strauss, A. L. (2009). The discovery of grounded theory: Strategies for qualitative research. Transaction Publishers.

  • Heckman, J. J. (2010). Invest in early childhood development: Reduce deficits, strengthen the economy. The Heckman Equation.

  • Kitzman, H., Olds, D. L., Henderson, C. R., Hanks, C., Cole, R., Tatelbaum, R., … Shaver, D. (1997). Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing: A randomized controlled trial. JAMA, 278(8), 644–652.

    Article  CAS  PubMed  Google Scholar 

  • Lau, R., Stevenson, F., Ong, B. N., Dziedzic, K., Treweek, S., Eldridge, S., … Murray, E. (2016). Achieving change in primary care-causes of the evidence to practice gap: Systematic reviews of reviews. [Review]. Implementation Science, 11(1).

  • Matone, M., O’Reilly, A. L., Luan, X., Localio, R., & Rubin, D. M. (2012). Home visitation program effectiveness and the influence of community behavioral norms: A propensity score matched analysis of prenatal smoking cessation. [Comparative Study Research Support, Non-U.S. Gov’t]. BMC Public Health, 12, 1016.

    Article  PubMed  PubMed Central  Google Scholar 

  • McDonald, L. (2011). Overview of Home Visitation Programs, from

  • Miller, T. R. (2015). Projected outcomes of nurse-family partnership home visitation during 1996–2013, USA. [Research Support, N.I.H., Extramural]. Prevention Science: The Official Journal of the Society for Prevention Research, 16(6), 765–777.

    Article  Google Scholar 

  • Olds, D. L. (2002). Prenatal and infancy home visiting by nurses: From randomized trials to community replication. Prevention Science, 3(3), 153–172.

    Article  PubMed  Google Scholar 

  • Olds, D. L., Henderson, C. R., Tatelbaum, R., & Chamberlin, R. (1986). Improving the delivery of prenatal care and outcomes of pregnancy: A randomized trial of nurse home visitation. Pediatrics, 77(1), 16–28.

    CAS  PubMed  Google Scholar 

  • Olds, D. L., Kitzman, H. J., Cole, R. E., Hanks, C. A., Arcoleo, K. J., Anson, E. A., … Bondy, J. (2010). Enduring effects of prenatal and infancy home visiting by nurses on maternal life course and government spending: Follow-up of a randomized trial among children at age 12 years. Archives of Pediatrics & Adolescent Medicine, 164(5), 419–424.

    Article  Google Scholar 

  • Sides, K. (2015). Coordinating comprehensive healthcare with home visits for new families: A case study of home visitation integration with the family-centered medical home at Carolina Health Centers. In First Focus (Ed.), Big ideas 2015 - pioneering change: Innovative ideas for children and families (pp. 73–88). Retrieved from

  • U.S. Department of Health & Human Services. Program Model Profiles. Retrieved from

  • U.S. Department of Health & Human Services. Model Implementation Reports. Retrieved from

Download references


We would like to acknowledge the administrators and home visitors who generously shared their time and valuable input with us to make this research possible. We would also like to acknowledge the contributions of research staff at the Mixed Methods Research Lab who helped manage and code the qualitative dataset.


This research was funded by the Commonwealth of Pennsylvania Department of Human Services.

Author information

Authors and Affiliations



The initial research proposal was developed by DR and MM with input from PC and FB. Data collection and analysis were performed by KK, AA, and PC. All authors contributed to the development and writing of the manuscript and have approved the final version for publication.

Corresponding author

Correspondence to Peter F. Cronholm.

Ethics declarations

Conflict of interests

The authors declare that they have no conflict of interests.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kellom, K.S., Matone, M., Adejare, A. et al. A Qualitative Exploration of Co-location as an Intervention to Strengthen Home Visiting Implementation in Addressing Maternal Child Health. Matern Child Health J 22, 883–892 (2018).

Download citation

  • Published:

  • Issue Date:

  • DOI:


  • Home visiting
  • Qualitative methods
  • CFIR
  • Implementation strategies
  • Early childhood system