Paving the Way for a Coordinated System of Home Visiting Services
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Paving the Way for a Coordinated System of Home Visiting Services in Alameda County: An Evaluation of County Population Needs, Existing Programs, and Opportunities for Enhancement of Services San Francisco CityMatCH Conference, September 19, 2011.

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Paving the way for a coordinated system of home visiting services

Paving the Way for a Coordinated System of Home Visiting Services

in Alameda County: An Evaluation of County Population Needs, Existing Programs, and Opportunities for Enhancement of Services

San Francisco CityMatCH Conference,

September 19, 2011

Janet Brown1, Kristi Kelly2, Chris Hwang3 and Anita Siegel1

1Alameda County Public Health Department , 2Applied Survey Research, 3First 5 Alameda County


Paving the way for a coordinated system of home visiting services

  • Objective of Presentation

  • Describe efforts to coordinate a system of home visiting services in Alameda County.

  • Outline

  • Project background

  • Overview of local evaluation and key findings

  • - population served

  • - outcome data

  • Getting to the next level

  • - recommendations from evaluation

  • - lessons learned

  • - perinatal system design process


Paving the way for a coordinated system of home visiting services

  • Project Background

  • Infrastructure

    • - Life Course System Design Committee in Alameda County

  • Timing

    • - State home visiting funding opportunities

  • One-Time Pot of Money

  • - $25,000 RFP awarded to Applied Survey Research


Paving the way for a coordinated system of home visiting services

Common

Standards

Strengthening

Families

Approach

Shared

Outcomes

Community-

Wide

Home Visiting

Program

Blended

Funding

Triage

Families Based

On Needs

Smooth

Transitions

Between

Systems

Integrated Family Support System of Care

Vision


Paving the way for a coordinated system of home visiting services

Full Report and Executive Summary available for downloadhttp://www.acphd.org/data-reports/reports-by-topic/home-visiting.aspx or http://bit.ly/oda1Kk This report collectively and individually describes ten perinatal/early childhood home visiting programs, including whom each one serves, what services and interventions each provides, and the intended and demonstrated outcomes associated with participation in each program. The report also includes a set of five recommendations with possible action steps for enhancing home visiting services. Produced in conjunction with First 5 Alameda County

Overview of Local Evaluation


Paving the way for a coordinated system of home visiting services

Project Overview: What we did

Fall 2010 – Winter 2011

Review of 10 perinatal/early childhood home visiting programs:

  • Improving Pregnancy Outcomes Program (IPOP)

  • Black Infant Health (BIH)

  • Maternal Access and Linkages for Desired Reproductive Health (MADRE)

  • Perinatal Hepatitis B Program (Perinatal Hep B)

  • Public Health Nursing

  • Pregnant & Parenting Teen Program

  • Your Family Counts

  • Special Start

  • Another Road to Safety

  • Homeless Families Program


Paving the way for a coordinated system of home visiting services

Project Overview: What we did

Final report

  • Brief review of home visiting literature.

  • A look at key population needs among county residents.

  • Cross-program summaries (populations served, services provided, and outcomes of participation).

  • Recommendations for next steps.

    How do we move toward a

    deliberate system of services

    that effectively address the needs of the county?


Paving the way for a coordinated system of home visiting services

… And, What we did NOT do

Not intended to be a comprehensive review of any single program.

Not intended to be used to compare one program to another.


Paving the way for a coordinated system of home visiting services

A BRIEF REVIEW OF KEY FINDINGS

Populations served

Key services provided

Outcomes expected and demonstrated


Paving the way for a coordinated system of home visiting services

Populations: The Perinatal Timeline

Teen/woman becomes pregnant

Teen/woman loses child during pregnancy or at birth

Teen/woman has a live birth

Teen/woman is parenting/ interconceptional


Paving the way for a coordinated system of home visiting services

Populations: Program Entry Points Along the Timeline

Teen/woman becomes pregnant

Teen/woman loses child during pregnancy or at birth

Teen/woman has a live birth

Teen/woman is parenting/ interconceptional


Paving the way for a coordinated system of home visiting services

POPULATIONS : PROGRAM ENTRY POINTS ALONG THE TIMELINE

Teen/woman becomes pregnant

Teen/woman loses child during pregnancy or at birth

Teen/woman has a live birth

Teen/woman is parenting/ interconceptional


Paving the way for a coordinated system of home visiting services

POPULATIONS : PROGRAM ENTRY POINTS ALONG THE TIMELINE

Teen/woman becomes pregnant

Teen/woman loses child during pregnancy or at birth

Teen/woman has a live birth

Teen/woman is parenting/ interconceptional


Paving the way for a coordinated system of home visiting services

POPULATIONS : PROGRAM INTERVENTION PERIODS

MADRE


20 000 births in alameda county 2 921 new home visiting cases mostly brief visits

6,600 Medi-Cal Births

1,500 Born

Low Birth Weight

~ 27% Postpartum

Depression

At-risk African American

Families

1,500 Births to

Teen Mothers

~50% Experience

Breastfeeding

Problems

6,000 Children 0-5

Have Contact with CPS

20,000+ Births in Alameda County2,921 new home visiting cases – mostly brief visits


Paving the way for a coordinated system of home visiting services

CONCLUSIONS: SERVICES PROVIDED

Programs provide same TYPES of services

However, there are likely large differences in HOW these services are provided –

  • What is the quality of these services?

  • How comprehensively are they delivered?

  • What do participants think of them?

    Program intensity varies substantially –

  • Does this program intensity “fit” the program goals?


Paving the way for a coordinated system of home visiting services

PROGRAM OUTCOMES: OVERVIEW OF MAJOR PROGRAM OUTCOMES

… with more specific outcomes within each outcome area.


Paving the way for a coordinated system of home visiting services

A Snapshot of Home Visiting Program Outcomes CHILDREN


Paving the way for a coordinated system of home visiting services

A Snapshot of Home Visiting Program Outcomes Mothers/Parents/Families


Paving the way for a coordinated system of home visiting services

What Did we Learn?

21


Paving the way for a coordinated system of home visiting services

HOW DO WE GET TO THE NEXT LEVEL?


Paving the way for a coordinated system of home visiting services

Recommendations

Recommendation 1

Develop a process for: (1) identifying (and then monitoring) the level of county need over time; and (2) coordinating services and ensuring that those in need are matched to the right home visitation programs.

Readiness

for school

  • Decide on key county-level indicators to describe county needs.

  • Identify and invite other partners to participate in county-wide coordination efforts.

  • Develop guidelines for matching participants to home visiting programs.

  • Develop coordinated outreach efforts.

  • Monitor and continue updating of the portrait of Alameda County needs.

Older children are more ready. 16-23% are < 5 upon entry.


Paving the way for a coordinated system of home visiting services

RECOMMENDATIONS

Recommendation 2

Enhance the quality of this community of home visitation programs, both individually and collectively.

Readiness

for school

  • Develop appropriate and consistent approaches to staffing.

  • Encourage staff retention within programs.

  • Develop consistent approaches to initial and ongoing staff training and development.

  • When possible, create coordinated standards of practice among programs doing similar work.

  • Review each program design as intended versus as delivered.

Older children are more ready. 16-23% are < 5 upon entry.


Paving the way for a coordinated system of home visiting services

RECOMMENDATIONS

Recommendation 3

Finalize and implement a measurement system that gathers clear and relevant data that will help to determine whether the community of home visitation programs is successful.

Readiness

for school

  • Develop common, cross-program data elements to collect about participants,services, and outcomes.

  • Gather feedback from program participants to better understand their perspective.

  • Consider ways to facilitate merging of data across programs.

  • Foster a culture that sees the value of collecting data.

  • Develop a high-level summary communication to simply display efforts and outcomes.

Older children are more ready. 16-23% are < 5 upon entry.


Paving the way for a coordinated system of home visiting services

RECOMMENDATIONS

Recommendation 4

Ensure commitment to the ongoing work of this community of programs by developing and implementing processes to help sustain it.

  • Continue meeting regularly.

  • Establish subcommittees for interim work.

  • As a group, prioritize these recommendations and actions.

  • Use your data dashboard to guide your work together.

Older children are more ready. 16-23% are < 5 upon entry.


Paving the way for a coordinated system of home visiting services

RECOMMENDATIONS

Recommendation 5

Each program should enhance its routine data collection practices … and also consider conducting a one-time, rigorous program evaluation to become more competitive for funding that has an “evidence-based” standard.

Readiness

for school

  • Be informed about the research basics: participants, design, dropout issues, what and when to measure.

  • Start with any changes/refinements to program delivery – test your “best” program, not a diluted version of it.

  • Once resolved, consider a high-quality research study and commit to enhanced ongoing data collection.

Older children are more ready. 16-23% are < 5 upon entry.


Paving the way for a coordinated system of home visiting services

  • Lessons Learned

  • Leadership

  • Membership

  • Job functions

  • Project scope

  • Outside help

  • Innovation


Paving the way for a coordinated system of home visiting services

  • The Perinatal System Design Team:

  • A participatory design process

  • PRE-LAUNCH

  • Compile information (shapes questions, discussion for launch; use brief surveys, HV evaluation report, case studies)

  • Identify panel

  • Preliminary list of tenets from leadership team

  • Consultation, technical assistance, training with IDEO

  • Pre-meeting with families to participate

  • Outreach to programs for initial buy-in, set context

  • ASR follow up meeting

  • 2. LAUNCH

  • Invite leadership, staff, and selected clients

  • Present context/situation – broad

  • Discuss and brainstorm challenges through information-gathering on what’s working, concerns, and pitfalls

  • Next steps and Q&A

  • Compile list of those interested in being part of Design Team

  • 20-30 on design team, including facilitators

  • Identify Design Leads

  • 3. TRAINING

    • Train Design Leaders in one or two trainings/workshops

  • Topics

    • Design thinking

    • Facilitation/discussion

    • Leadership

    • Team-building

    • Design process & tools

  • Keep focus on big picture, broad lens


  • Paving the way for a coordinated system of home visiting services

    • 7. SCALE, SPREAD, SUSTAIN

      • Evaluate, six-month or periodic checkins

    • Dissemination plan

    • Communications strategy

    • Follow up, troubleshoot

    • Identify new challenges  back to “understand”

    • 4. UNDERSTAND

    • “Research”: conducted by Design Team

    • Shadowing, interviews, surveys, case studies

    • “Extreme users” identify five challenges

    • Five groups of six make up the Design Team

    • 6. BUILD TO LEARN

    • Resource Bank contains resources that design teams can use.

    • Each small group  Design Team

      • Prototype, test, prototype, test, etc. until can put each solution into Big Plan

    • Take Big Plan as Prototype 1 to real world programs/clients

    • Test Prototype 1 on small scale: evaluate, troubleshoot, revise

    • Test, evaluate, etc. until ready to roll out to all of home visiting

    • 5. ENVISION

    • Design team creates idealized process vision:

    • - Brainstorming solutions

    • - Identify conceptual blocks, potential solutions

    • -Split each mini-team of six in half to brainstorm solutions to the challenge, come back together to discuss, then present to entire team

    • Keep as creative as possible – don’t got into the nitty gritty


    Paving the way for a coordinated system of home visiting services

    THANK YOU

    For more information contact Janet Brown

    by email at [email protected] or by phone at (510) 267-8098


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