POLICIES AND PROCEDURES MANUAL

Transcription

1 Kent County Healthy Start POLICIES AND S MANUAL ABOUT THIS MANUAL This manual establishes policies, procedures and guidelines to ensure that standards of effective practice are met by the Kent County Healthy Start Program. It is based on the policies set forth by the Healthy Families America Critical Elements and is aligned with the Healthy Families America Self Assessment Tool.

2 TABLE OF CONTENTS Policy / Document Name Effective / Revised Page About This Manual Critical Element 1 - Initiate services prenatally or at birth. Policy 1.1 Identifying Target Population 8/24/ Policy 1.2 Partner Agency Agreements 8/24/ Policy 1.3 Coordination with Other Agencies 8/24/ Policy 1.4 Initiation of Services 10/8/ Policy 1.5 Acceptance Rates 8/24/ Critical Element 2 - Use standardized assessment tool Policy 2.1 Kempe Family Stress Inventory 10/8/ Policy 2.2 Identification and Documentation 5/09/ Policy 2.3 Training to Use the Kempe 8/24/ Critical Element 3 - Offer services voluntarily Policy 3.1 Voluntary basis 8/24/10 15 Policy 3.2 Informed about Rights 8/24/ Policy 3.3 Positive Outreach Methods 2/22/ Policy 3.4 Creative Outreach 2/22/ Policy 3.5 Retention Rate 8/24/ Policy 3.6 Termination Plan 8/24/ Critical Element 4 - Offer services intensively Policy 4.1 Managing Intensity of Services 5/9/ Policy 4.2 Increasing Completion Rate 8/24/ Policy 4.3 Criteria for Changing Intensity of Services 5/2/ Policy 4.4 Intensive Home Visits after Birth of Baby 5/16/ Critical Element 5 - Services should be culturally competent Policy 5.0 Cultural Competency 8/24/ Critical Element 6 - Services should focus on supporting the parent(s) Policy 6.1 Meeting Family s Concerns and Needs 8/24/ Policy 6.2 Individual Family Support Plan 8/24/ Policy 6.3 Maintaining focuses (parent(s), child, and 8/24/ parent-child relationship) Policy 6.4 Monitoring Child s Development - ASQ 8/24/ Policy 6.5 Training on Use of ASQ 8/24/10 40 Policy 6.6 Suspected Delays 8/24/ Policy Protective Factors Survey 10/8/ Critical Element 7 - All families should be linked to services Policy 7.1 Medical/Health Care Providers 8/24/ Policy 7.2 Immunizations for Target Child 8/24/ Policy 7.3 Additional Services 8/24/ Critical Element 8 - Limited caseloads Policy 8.1 Limiting Caseloads 11/30/

3 Policy / Document Name Effective / Revised Page Critical Element 9 - Service providers selected because of Policy 9.1 Program Management 8/24/ Policy 9.2 Program Supervisors 8/24/10 52 Policy 9.3 FAWs, FSWs and FSVs 3/27/ Policy 9.4 Interns and Volunteers 8/24/ Policy 9.5 Culturally Diverse Staff 8/24/10 55 Policy 9.6 Compliance with Law/Regulation 8/24/ Policy Personnel Turnover 8/24/10 57 Critical Element 10 - All service providers should receive basic training Policy 10.1 Training Policies 3/27/ Policy 10.5 Case Load Building 10/26/10 70 Critical Element 11 - Service providers should receive intensive training Policy /24/ Additional KCHS Policies specific to our homebased program Policy 12 Healthy Start Groups 9/22/09 75 Policy 13 Healthy Start n180 Transition Policy 5/23/ Policy 14 Results Based Accountability Process Policy 15 Goals 9/30/12 77 Results Based Accountability Outcome Goals 9/30/12 78 Policy 16 PIMS Data Entry 12/1/ Governance and Administration Credentialing Standards GA 1.A Organization of Advisory Group 8/24/10 79 GA 2.A Formalized Input from Families 8/24/ GA 2.B Policies and Procedures Grievances 8/24/ GA 3 Quality Assurance Plan 8/24/ GA 4 Policies and Procedures Research Proposals 8/24/ GA 5.A Family Rights and Confidentiality 8/24/ GA 5.B Informed and Signed Consent 8/24/ GA 6 Criteria to Idenfity Child Abuse and Neglect 8/24/ GA 7 Particpant Death and Grief Counseling 8/24/10 85 GA 8 Policy and Procedures Manuel 8/24/10 86 GA 9 Kent County Healthy Start Budget 8/24/ GA 10 Annual Report 8/24/10 87 GA 11 Annual Audits 8/24/10 87 Appendices Appendix A Glossary of Terms and Descriptions of Curricula 8/24/ Appendix B Definitions of 12 Critical Elements 8/24/ Appendix C Kent County Healthy Start Committees 8/24/10 5 Appendix D Data Collection Forms 8/24/ Appendix E Appendix F 2

4 Critical Element 1: Initiate service prenatally or at birth Policy 1.1 (for CE 1.1a) Definition of Kent County Healthy Start s (KCHS s) target population: Phone Call Component - Healthy Start home visit offers the phone call component universally to all parents in Kent County with special emphasis on first time parents and parents who are under age 25. Services are offered specifically to all giving birth at Metro Health, St. Mary s and Spectrum-Butterworth hospitals who desire supportive services and have no identified risk factors at the time of referral. Home Visitation Component - Healthy Start home visit offers the home visiting component universally to all parents in Kent County with special emphasis on first time parents and parents who are under age 25. First time parents of any age and parents under age 25 with any number of children giving birth at Metro Health, St. Mary s and Spectrum-Butterworth hospitals who desire supportive services and have at least one of the following identified risk factors at the time of the referral are specifically identified and given information about Healthy Start Home Visiting. Risk factors include: Family history of child abuse and/or neglect Family who is homeless Parent with negative or ambivalent attitude regarding pregnancy or parenting Parent with a destructive temperament who has unrealistic expectations of the child and/or views harsh punishment as appropriate Parent with substance abuse or addiction Family who is Isolated with inadequate support system Parent with diagnosed mental / physical condition that interferes with parenting ability Family history of delinquency Teen parent Family with incarcerated parent Child with long-term or chronic illness Child with diagnosed handicapped condition Child with a diagnosed mental health condition or documented behavioral issue Family that is clinically positive as determined by the referent, the Family Support Worker, and with supervisor approval of the identification of the factor or factors that qualify the family as clinically positive Families may not have an open Child Protective Services case substantiated at the Category I or II level. 3

5 Description of the Community Information and Referral Process for Early Childhood Services as related to KCHS Kent County hospitals have a process to identify families interested in family support services at birth. All first time parents of any age and parents under age 25 with any number of children are offered a menu of family support services. Families indicating interest in Healthy Start are assessed for risk factors. Those with no risk factors indicating interest in Healthy Start are referred directly to the phone call component. If risk factors are unknown and the family is interested in Healthy Start, a KCHS volunteer or staff calls the family to assess for risk factors. If no risk factors are present and the family is interested in KCHS, the family is eligible for the phone call component. If one risk factor is identified and the family indicates interest in KCHS, the family is eligible for the home visiting component of Healthy Start. The target population to engage in KCHS is those families deemed eligible for KCHS and referred to KCHS for services. Therefore, comparisons may be made between those referred to KCHS by the hospitals and those families who actually engage in service with engagement defined as receiving two phone calls for the phone call component and receiving an assessment visit followed by a first home visit for the home visit component. Kent County, in an effort to best use resources and avoid duplication, collaborates with Welcome Home Baby and all other home visitation programs to inform as many first time parents and parents under age 25 about available family support services. A. Welcome Home Baby provides first time parents and parents under the age of 25 with any number of children, hereafter referred to as the target population, with a menu of available community support services at the hospital when their child is born. In addition, Welcome Home Baby staff explains to the target population the various home visiting services in Kent County including KCHS. Families indicating an interest in KCHS are referred to KCHS. Whenever possible, Welcome Home Baby staff indicates in the referral whether any risk factors are present and what those risk factors are. Hospitals, through Welcome Home Baby, are the largest referral source for KCHS. B. Families also may self-refer or be referred from other agencies including but not limited to the Department of Human Services, First Steps, Kent County Health Department, and the medical community such as obstetricians and pediatricians.. C. KCHS services are offered prenatally up to an infant s seven month birth date. Exceptions to this range are made for families referred by the Department of Human Services (DHS). Then, a child may be served up to their 36 month birth date. DHS provides Strong Families Safe Children funding for the KCHS 4

6 program. Those funds require serving children up to their 36 month birth date (see Policy 1.2) D. KCHS tracks the demographics of those determined to be eligible for KCHS. KCHS compares the demographics of those who accept the program and those who refuse the program. It looks at the reasons given by those who refuse the program. The analysis is comprehensive, addressing programmatic, demographic, social and other factors. It examines any differences in demographics of those who accept and those who refuse the program. When differences are found, KCHS devises strategies for increasing its capacity to connect with and engage participants reflecting that demographic. E. Family Futures, who provides management and oversight to Kent County Healthy Start, maintains an updated community profile, reflecting KCHS s target population. Policy 1.2 (for CE 1.1b) Description of the agreements with community entities allowing KCHS to identify and contact the target population.. The strength of relationships between KCHS and other community organizations that serve the target population governs the ability of KCHS to connect with the target population. Formal partnerships with organizations throughout the community allow families to become aware of and connect with KCHS services and other organizations that provide supportive services and/or treatment. A. KCHS has contracts, re-established annually with First Steps, Arbor Circle (AC) and Catholic Charities West Michigan (CCWM). (See Appendix E for Organizational Charts and overview). Family Futures establishes the contract language for Healthy Start regardless of the funding source in order to ensure fidelity to the Healthy Families America model and to agreed upon outcomes. Family Futures, through the Continuous Quality Improvement meetings, provides feedback about each sites performance and works to establish program improvement plans as needed. B. The system of contracted program service providers is designed to ensure that families can access and receive program services from agencies with different areas of expertise such as health, substance use, child welfare, and early childhood. 5

7 C. Contracts are negotiated between the Executive Director and/or the Chief Operating Officer (a Family Futures employee) and the contracted agency Director/CEO, with authorizing signatures from the authorized agency executives. D. Original copies are maintained at Family Futures and at the contracted agency. Policy 1.3 (For CE 1.1b) KCHS s system of formal and/or informal relationships throughout the community promotes the early identification of families who may be eligible for KCHS and desire KCHS. Efforts are made to promote and encourage referrals during pregnancy or at birth so that screenings and assessments occur either prenatally or within two weeks after the birth of the baby. Early interactions between parents and their Family Support Worker (FSW) serve as the base for all future interactions. Pregnancy is a time of anticipation and preparation, and it brings anxiety that makes new parents eager for information and reassurance that the Family Support Worker can provide. (Fair Start for Children, 2002) Once parenting patterns and a resource network have been established, it is much more difficult to intervene. Thus, offering home visiting services prenatally or at birth facilitates the formation of a long-term, trusting relationship between the FSW and the family. A. The most focused outreach efforts for KCHS occurs at hospitals where the target population is provided with information about KCHS and how to sign up to receive services. B. Employees and/or volunteers at hospitals, clinics, human service organizations and schools are encouraged to offer KCHS information to the target population as well as all first time expectant mothers. C. KCHS management and/or supervisors work to develop and maintain effective referral relationships with other community agencies and to encourage referrals particularly of first time expectant mothers. KCHS also encourages referrals at birth in order to be able to provide support at that critical point. D. Referred families are screened for risk factors. Families with no risk factors are placed in the KCHS phone call component. Families with at least one risk factor receive an in home face-to-face assessment of their strengths and needs using the Kempe Family Stress Checklist. During that assessment, a determination regarding service component, phone call or home visitation component will be 6

8 determined with the input from the family. If the Kempe score is above 25 or if the family has three identified KCHS risk list factors or if the participant is under 18 years of age, the family is offered home visiting. If the Kempe Score is 20 or below and the participant is age 18 or over and the family has no KCHS risk factors, the family is offered the KCHS phone call component. Healthy Start Service Flow Chart Policy 1.4 (for CE 1.1c-f) For those accepting home visiting services, the first home visit will occur within two weeks of receipt of the referral with referrals accepted up to the baby s seven month birth date. For those accepting phone call services, the first phone call will occur within two weeks of receipt of the referral with referrals accepted prenatally up to the baby s four month birth date. 7

9 Research suggests that the attachment relationship between parents and children is generally formed by nine months, and therefore, the earlier family support services are initiated, the greater the likelihood of improved parent-child relationship outcomes and solid attachment. A. Home Visit Component 1. When possible, the screening/assessment will take place prenatally or within two weeks of the baby s birth. 2. Referrals for families with at least one risk factor are sent to the attention of the Family Support Supervisor. The Family Support Supervisor will review the referral and make a case assignment decision as soon as possible, but always within one business day of receipt of the referral. The assigned FSW will then have 14 days to complete the assessment. 3. The FSW will attempt to set up an assessment with the family within 14 calendar days of receiving an eligible screening/referral. During the first 2 business days after assignment, the FSW will conduct three (3) phone calls to attempt to schedule the assessment, (phone calls must take place at different time slots to increase the chance for engagement). If unable to reach the family by phone in 2 business days, the FSW will make two (2) unannounced home visits within 14 calendar days of receipt of the referral in an effort to connect with the family. 4. If face-to-face contact does not occur, the FSW will use available resources to verify contact data and determine alternative means to contact the family. If FSW is still unable to make contact with the family, the FSW will send a letter to the family describing Healthy Start services and inquire about their interest in participation. The letter will indicate this is the final attempt at contact and the family is given 20 business days to respond. 5. If there is no response from the family within 20 business days, the family s case will be closed. 6. When a screening or assessment is completed but the family refuses services offered, the data is collected and the family is offered other community resources that might be of assistance. Engagement in Healthy Start services should be strongly sought for families that are assessed as high risk while still respecting the voluntary nature of the program. 7. When the assessment is provided by a Healthy Start worker who will not be assigned the case, the assessment documentation is given to the appropriate 8

10 Family Support Supervisor, who reviews the information provided and assigns the case within 24 hours of receiving the referral. 8. When the supervisor has assigned a Family Support Worker (FSW), a copy of the assessment, intake and participant agreement forms are provided to the assigned FSW. 9. Upon completion of the assessment home visit, Family Support Workers will be eligible to receive 1.5 units (90 minutes) of additional home visit credit to represent the time spent initially engaging the family in services (phone calls, drive by attempts, etc.) as well as the additional paperwork involved with the start of service. If a family refuses services at the time of the assessment visit no additional home visit credit will be given. A subsequent home visit must be completed before the additional 90 minutes is credited to the FSW. 10. After the assessment visit, the first home visit by the assigned FSW will occur within 11 days. Determinations regarding enrollment for home visitation service provision shall never be longer than 45 days from receipt of the referral. B. Phone Call Component 1. Within one day of receiving an eligible screening/referral, Family Support Volunteers (FSVs) send a welcome packet to the family s home address. A FSV will attempt to phone the family within two weeks of the referral date. 2. If a family cannot be reached within two weeks, three attempts will be made at variable time intervals. If the family still cannot be reached, a letter will be sent within five business days of the last attempted phone call. The family s file is then kept open for 20 business days. After the 20 business days, the Healthy Start Phone Call component (HSPC) will administer the closing process for that family s file. (see Procedure 3.2) Policy 1.5 (for CE 1.2a-c) KCHS defines, measures and monitors the acceptance rate of families into KCHS, analyzes who refuses and why, and addresses how acceptance rates might increase. The ongoing quality assurance efforts analyze acceptance rates to detect a change in trends over time, develop improvement plans based on data, and have a means to evaluate their effectiveness. 9

11 A. KCHS defines its acceptance rate as the number of families who are assessed and agree to participate in program services and who have a first face-to-face home visit (following the assessment visit). B. FSWs collect data regarding referrals received and assessments completed by using the PIMS (Program Information Management System) Screening and Assessment Forms. C. Within five business days of the assessment, the FSW documents information. The case is reviewed and copies are then given to the Family Support Supervisor for review and for case assignment when necessary, based on caseload availability. Copies of the forms will then be provided to KCHS s data entry clerk for entry to the database. D. Review of acceptance rates and standards of promptness occurs annually at the KCHS Continuous Quality Improvement committee (CQI) and regularly at the KCHS Partners committee (See Appendix C). Discussion about how to improve both acceptance rates and the standard of promptness occur. 10

12 Critical Element 2: Use standardized assessment tool to systematically identify families who are most in need of services. This tool should assess the presence of various factors associated with increased risk for child maltreatment or other poor childhood outcomes (i.e., social isolation, substance abuse, parental history of abuse in childhood, etc.) Policy 2.1 (for CE 2.1 a-b) KCHS is available universally to all parents in Kent County with special emphasis on first time expectant mothers of any age, first time parents of any age and parents under age 25 with any number of children who desire supportive services. Screening for risk factors will be done by Healthy Start staff, volunteers and community referral sources. Risk screening information will be accepted from creditable sources. If there are concerns regarding the accuracy of the risk factor information, a second risk screening will be done by KCHS staff normally by phone. Families desiring service with no risk factors are automatically assigned to the phone call component. Families with at least one identified risk factor are provided a further assessment using the Kempe Family Stress Inventory. During the assessment visit in the family s home, the family and Family Support Worker decide on the appropriate Healthy Start service level component for that family. Each file documents the rationale for which KCHS service level component the family was assigned to. Families may change from the phone call component to the home visitation component if their family situation changes or new information indicates home visitation better fits that family s need. In general, families will be assigned to home visitation if the Kempe score is over 25, if either parent is under age 18, or if the family has at least one risk factor from the Healthy Start Risk Factor Checklist. Consistent documentation of known risk factors as well as information from the Kempe Family Stress Inventory will ensure complete information regarding the family s strengths and needs and appropriate case assignment to the phone call component or to home visitation services. S A. Families referred to KCHS are screened for risk using the Healthy Start Risk Factor Checklist either by the referring agency or after referral by KCHS staff. B. Families with no risk factors are automatically placed in the KCHS phone call component with documentation that no risk factors are present. If risk is determined to be present later, the family may be referred to the home visitation 11

13 component and normal procedures for enrollment in the home visitation component ensue. C. Families referred to KCHS with at least two risk factors receive a more in depth assessment. Risk factors will be documented on the Program Information Management System (PIMS) Screening Form and in the case record. D. Families with two risk factors will be contacted to schedule a comprehensive family assessment using the Kempe Family Stress Inventory. Each assessment conducted will be documented on the PIMS Assessment Forms. If a family refuses the assessment, this will be documented on the PIMS Screening Form. Policy 2.2 (for CE 2.1 c) KCHS uses the Kempe Family Stress Inventory uniformly to assess participants in need of intensive home visitor services. Standardized assessment tools identify families most in need of services in an objective manner. Consistent use of standardized assessment tools provide home visitors with an understanding of the unique strengths, risk factors, and needs of a family and afford the opportunity to provide individualized service to build upon their strengths and to reduce risk. A. During the first home visit, the Family Support Worker will use the Kempe Family Stress Inventory in a conversational way with the family to better understand the family s strengths and needs. B. The assessment visit is conducted by the FSW in person at the family s residence unless there is a compelling reason for the visit to occur in an alternate location. It must include the custodial parent. It should include the custodial parent s partner when possible provided the custodial parent does not object. C. The Family Support Worker will, in almost all instances, obtain information from the custodial parent on all ten areas of the Family Stress Inventory. Information about the non-custodial parent of the baby is obtained directly from the noncustodial parent when possible. Otherwise, as much information as possible about the non-custodial parent is obtained from the custodial parent. Normally, one visit should suffice to gather all information needed to properly score the Kempe Family Stress Inventory. If necessary, a second visit may occur to obtain needed information, but an assessment should never take more than two visits. 12

14 D. Each assessment will be fully documented with the information the family provided. Both parents will receive a rating on each item of the Kempe Family Stress Inventory using the Rating Scale. Documentation will occur within five days of the assessment date. E. Information received from a professional source, such as Children s Protective Services or a health care provider, should be included in the assessment documentation and used to determine the rating for any particular item. F. Because assessment visits require extra preparation time (including time trying to engage the family through phone calls, drop by home visits, and letters), as well as a great deal of follow up paperwork, Family Support Workers will be eligible to receive an additional1.5 unit credits (90 minutes) for every assessment visit completed (completed = full assessment visit complete, fully completed, typed KEMPE, signed consent form in file and 1 st home visit scheduled). These units will be documented in both the Healthy Start Dashboard as well as our PIMS database system and will be credited once a subsequent home visit is completed. If a 1 st home visit is not completed but the assessment visit was complete to the definition above, the 90 minutes will be credited to the worker on the Healthy Start dashboard. Policy 2.3 (for CE 2.2a-b) FSWs that use the Kempe Family Stress Inventory will have adequate understanding and knowledge of how to use the tool appropriately. FSWs will receive training on the Kempe Family Stress Inventory through Healthy Families America and hands-on practice in using the tool prior to administering it to program participants. Appropriate training in the Kempe Family Stress Inventory enables FSWs to effectively administer the tool and provide a quality assessment of the program participant s needs and strengths. It also assures proper identification of families needing home visitor services and the appropriate HFA level of service. A. New FSWs will be oriented to the Kempe Family Stress Inventory by their Supervisor. New hires will attend the first available HFA Primary Training for Family Assessment Workers on the Family Stress Inventory following their hire date with the goal that training occur within six months of date of hire. On occasions when staff begin performing assessments prior to the receipt of core training, the stop-gap training will include the components of the theoretical background of the Kempe Family Stress Inventory, observation of the Kempe being administered by a seasoned co-worker, and hands-on practice such as 13

15 role play, video taping assessments, or scoring a video taped assessment. Receipt of core training before administering the Kempe is KCHS preference. A supervisor must receive approval from the Healthy Start Coordinator in writing for the Kempe to be administered by an FSW who has not been trained by HFA. Such approval will only be granted for extenuating circumstances that are documented on the approval form. B. New FSWs are required to shadow the completion of two assessments using the Family Stress Inventory with an experienced FSW or KCHS supervisor prior to administering an assessment independently. C. New workers are required to complete one assessment using the Family Stress Inventory with observation by an FSW trained and experienced in doing assessments and/or Supervisor prior to administering an assessment independently. The observer will provide feedback to the new worker and to the supervisor when the supervisor is not the observer. If the observer believes the new worker is not yet ready to perform an assessment independently, the new worker s supervisor will be notified and the new worker will receive enough additional training and observation to demonstrate competency. D. FSWs are responsible for appropriately documenting Kempe Assessment training completion in the Program Training Log with Supervisors monitoring training completion. (see Policy 10.1) E. Supervisors will review and provide feedback about the Family Stress Inventory with FSWs during supervision as appropriate. 14

16 Critical Element 3: Offer services voluntarily and use positive, persistent outreach efforts to build family trust. Policy 3.1 (for CE 3.1) Services are offered to families on a voluntary basis. According to research by Daro in 1988, an important reason for voluntary programs is that mandatory programs shift emphasis from social support to social control. In 2006, Gomby, in Home Visiting: Analysis and Recommendations, indicated that all home visitation services should be voluntary. The entire context of KCHS should be based on families needs and desires to strengthen their family unit. A. Screenings and assessments will be used by KCHS staff to determine whether to offer the phone call component or the home visitation component to families. Any questions or concerns families express will be addressed so that they are able to make an informed and voluntary choice about participation in KCHS. B. During the Assessment visit, the FSWs will collect information using the Kempe Family Stress Inventory. The FSW also will explain the program s mission, types of services, and the voluntary nature of services. C. The family will be asked to participate in KCHS. The FSW will review the Participant Agreement with the family. D. Once a family elects to participate in KCHS, they will sign and receive a copy of the Family Assessment Consent. Each family will also receive a program brochure and any other appropriate documents. Policy 3.2 (for CE 3.1) At the first home visit, the family/participant is informed about their rights, including confidentiality, both verbally and in writing. For phone call families, the family is informed about their rights verbally when no face to face contact is anticipated. It is important for a parent to make a fully informed choice about participating in program services, so, at the time of enrollment, families will be informed of their rights, always 15

17 verbally and in writing when a face to face contact occurs, using the KCHS Participant Agreement. A. Home Visit Component 1. At the time that a new family is assessed and offered program services, the FSWs goes over, verbally and in writing, the KCHS Assessment Consent and HIPAA forms indicating participant rights, confidentiality, program and participant responsibilities. 2. The participant and the FSW sign and date the Agreement. The participant will be given a copy and the FSW will keep a copy. 3. The FSW provides a copy of the Healthy Start Consent Form, along with the assessment documentation, to the Supervisor. If the assessment is completed by a Family Support Worker who is not assigned the case, the consent form and the documentation will be given to the FSW supervisor for appropriate assignment. 4. The Supervisor will assign the case to an FSW within one business day of receipt of the assessment documentation ensuring that the FSW receives a copy of the Consent Form, a copy of the assessment, and the HIPAA form. 5. If, for any reason, the Consent Form was not signed during the initial assessment home visit, the FSW will obtain the parent s signature on the form during the first home visit. B. Phone Call Component 1. For phone call families, the KCHS volunteer explains the program and offers services. If the family accepts services, the KCHS volunteer verbally explains the Participant Agreement, indicating participant rights, confidentiality and program and participant responsibilities and indicates whether the family verbally accepts and consents. 2. When a family agrees to the phone call component during a face to face assessment visit, the FSW goes over, verbally and in writing, the KCHS Assessment Consent and HIPAA forms indicating participant rights, confidentiality, program and participant responsibilities. The participant and the FSW will sign and date the Agreement. The participant will be given a copy and the FSW will keep a copy. 3. The FSW will provide documentation of consent with the Participant Agreement, along with the assessment documentation, to the Phone Call Component Supervisor. Verbal acceptance and consent is all that is necessary for a family to 16

18 Policy 3.3 (for CE 3.2 a-b) remain active in the phone call component. If KCHS has obtained written consent, then the written consent is placed in the file. KCHS staff uses positive outreach methods to build family trust and engage new families. Outreach efforts allow parents time to recognize that home visiting services may be beneficial to them. Outreach is done by staff with the following characteristics: nonjudgmental, compassionate, able to establish trusting relationships, willingness to work with culturally diverse communities, warm, genuine, empathetic, good communicators, open, willing to share, sensitive to individual family needs, flexible, dedicated to children and families, possessing a sense of humor, credible, knowledgeable about child development, and who are emotionally healthy themselves. Research says that the quality of staff in prevention programs is a key factor in how successful a program is in reaching its intended outcomes 1. A. Home Visit Component 1. In order to engage families and maintain involvement, participants normally enter the home visit component at Level One (Level I) or Prenatal (Level P). However, families entering the program who are in crisis are placed on Level SS. This high level of program participation is keyto engaging families and building trust. 2. After the family has agreed to service, if the family is reluctant to schedule a home visit for assessment or does not appear to be available, the FSW will discuss the details of the case with the Supervisor to develop a positive outreach strategy. 3. Positive outreach strategies will include, but are not limited to the following: Provide 3 phone attempts within 48 hours of receipt of the referral Provide 2 unannounced home visits with in 14 days of receipt of the referral Mail the family a letter asking whether or not they wish to continue services with Healthy Start 4. If at any point during the outreach period, the family moves out of the service area or clearly refuses services, the case is closed even if 20 days has not 1 Retrieved from: and 17

19 passed. Refusing services occurs when a participant, determined to be eligible for services, declines participation in service either verbally or in writing. A participant who has been enrolled in the program may for whatever reason decline further participation. 5. After 20 business days of unsuccessful attempts to engage the family that includes at least the activities outlined above, the case will be closed with documentation of all the engagement attempts. B. Phone Call Component 1. After a phone screen, and possibly an assessment, has been completed, a HSPC volunteer receives the file., A copy of the telephone screening form (completed by KCHS staff) a copy of an in-home assessment (if warranted by risk factors) and a signed participant agreement form will be included in the file. 2. As described in Policy 1.4, within one day of receiving an eligible screen/referral, FSVs send a welcome packet to the family s home address. The FSV has two weeks to make the first phone call to the family. 3. Creative outreach strategies may include leaving telephone messages with the HSPC name and phone number. The use of mailings (e.g. letters, group social event invitations, educational curriculum materials, ASQ*), when phone calls have not been successful is acceptable. 4. If a family appears uninterested or unwilling to participate, attempts should include one or both of the following: asking if there is a more convenient time to talk and/or asking permission to check back with them in a specified period of time (one week to one month). The goal is to reinforce the voluntary nature of KCHS and give families every reasonable chance to get the support they need. If a family still appears uninterested or unwilling, their file will close. 5. When difficulties arise in staying in good contact with a family following a period of successful service, appropriate creative outreach methods should be chosen, with the guidance of the HSPC Manager. When the circumstances arise from a move, a crisis, or some other change, previously described methods will often work. Ultimately, due to the voluntary nature of KCHS, families can choose to remain active or terminate from KCHS at any time. However, community referrals will always be made in closing procedures. 6. Establishing a trusting relationship with a family can take several weeks to several months. FSVs are to adhere to Training Standards in order to establish this trust. 18

20 Policy 3.4 (for CE 3.3a-b) KCHS offers Creative Outreach under specified circumstances for a maximum of three months for each family before discontinuing services. In an evaluation of 14 home visiting programs providing services to high risk families, Daro, Jones and McCurdy (1997) learned that outreach efforts must be made for those families who do not clearly reject services, because outreach efforts can be successful in enrolling families facing substantial risk of maltreatment, not merely those who demonstrate strong service utilization skills. Further, Olds and Kitzman (1993) add, These parents, in our opinion, often are at the greatest risk and therefore, are in the greatest need of service. A. Home Visit Component 1. The use of Creative Outreach (Level X) is appropriate when efforts to maintain engagement with a family are unsuccessful for one or more of these circumstances: a. The family cannot be located and there is hope and a plan for locating them. b. The family has temporarily moved out of the service area and will return within 90 days. c. The family has missed two scheduled home visits, but has not refused services. 2. Creative outreach strategies may include, but are not limited to the following: a. Phone the family and attempt to arrange a visit at the time most convenient to them. b. If the family is consistently missing scheduled home visits, attempt to arrange a home visit to discuss how Healthy Start might better provide support to the family. c. Re-explain the program and invite their participation. d. Attempt an unscheduled visit. e. Provide child development information to the family appropriate for their child and ask them to call to arrange a time to discuss. f. Mail the family invitations to Healthy Start group activities. g. Send a thank you note following a successful home visit. h. Provide a calendar with appointment times noted. i. Send reminder notes or text messages for appointments. 2. The family may remain on Level X for up to a period of three months (90 days) of creative outreach. Anytime during those three months, the family may choose to 19

21 re-engage with services or to refuse services. The case is closed at the end of the three months if the family has not re-engaged or declined services. 3. The FSW will consult with their Supervisor to decide when Level X is appropriate. Level X is assigned when approved by the Supervisor. B. Phone Call Component 1. The use of Creative Outreach, when a family s service level is considered Level C, is appropriate when efforts to engage or maintain engagement with a family are unsuccessful for one or more of these circumstances: The family cannot be reached via telephone The family s phone number is disconnected 3. When a family is considered Level C, they are sent a we cannot reach you letter. 4. After the family receives a we cannot reach you letter, they may remain on Level C until accepting or refusing services or for a minimum of 20 business days of creative outreach. 5. The HSPC Manager will then decide when Level C is assigned and/or the family s file is closed. 6. If 20 business days of creative outreach conclude without success, the family s file will be closed. Policy 3.5 (for CE 3.4 a-c) KCHS defines, measures, and monitors its Retention Rate of families in KCHS by analyzing who dropped out, analyzing why they dropped out, and strategizing how it might increase the Retention Rate. By understanding the circumstances and characteristics of participants who leave KCHS, strategies to increase retention can be planned (based on data) and implemented. A. Home Visit Component 20

22 1. KCHS defines its retention rate by the number of enrolled participants (those that accept program services at the time of assessment and have at least one subsequent home visit) that remain in the program for a specified period of time during which retention is being measured. In measuring retention, KCHS uses the first and last home visit dates. The dropout measurement excludes participants who terminate services for the following reasons: Graduate from the program Mutual decision to close by family and FSW and family has achieved their goals Family has moved out of the geographic service area. 2. KCHS will conduct an analysis of program retention at least annually. 3. The analysis will take into account data compiled in the PIMS Service Termination Summary report, reflecting demographic and programmatic components. 4. The analysis will include programmatic, demographic, social and other factors. The analysis will look at the retention data and seek rationale for the data from KCHS staff of all partner agencies. The KCHS staff will provide the story behind the data. 5. The analysis will address strategies for increasing program retention with a defined implementation plan. B. Phone Call Component 1. KCHS defines its retention rate as the number of enrolled participants (those that accept program services at the time of FSV assignment) that remain in KCHS for a specified period time during which retention is being measured. The dropout measurement excludes participants who graduate/de-enroll from HSPC during the specified time period and those who move out of the geographic service area. 2. HSPC will conduct an analysis of program retention annually. 3. The analysis will take into account data compiled in the PIMS Service Termination Summary report, reflecting demographic and programmatic components. 4. The analysis will look at the retention data and seek rationale for the data from KCHS staff from all partner agencies. The KCHS staff will provide the story behind the data. 21

23 5. The analysis will address strategies for increasing program retention with a defined implementation plan. Policy 3.6 Termination from services for families participating in the Healthy Start program. Termination from services is an important part of Healthy Start. Planned terminations offer the opportunity to recognize and celebrate goals accomplished and to plan for next steps for both parent/s and child. Unplanned terminations offer the opportunity for the FSW to summarize their hopes for the family and to wish the family well in a letter. Both terminations offer the opportunity to wish the family well in their future and for a positive end to services. S A. Home Visit Component 1. Planned termination takes place when the family has progressed through Level IV, target child reaches age 3 (or age 5 if multiple children are involved), and family has met identified goals, or otherwise mutually agreed upon termination of services where at least one goal has been accomplished. a. FSW reminds family well in advance of impending termination from services. b. FSW will develop an after care plan with the family which includes identifying natural and community support systems, providing referrals to other community resources, and reviewing future goals the family would like to accomplish. c. FSW will discuss termination plans with FSW Supervisor. d. FSW will complete termination paperwork. e. For families graduating from KCHS when the child has turned three (or five), a recognition/celebration of achievements accomplished is encouraged. f. For families who have accomplished at least one goal and there is mutual decision to close a recognition/celebration of accomplishments is encouraged. 2. Unplanned termination occurs when a family refuses continued services, a family has moved and is unable to be located, and/or other unexpected change occurs. a. Creative outreach attempts will be made to re-engage family, at the discretion of the FSW and his or her supervisor, for up to three months. b. FSW discusses the termination plan with the FSW Supervisor. c. A final letter of termination is sent to the family that includes a thank you for their participation in services, a summary of what they accomplished, and encouragement to continue learning how to meet their child s needs. 22

24 d. FSW will complete termination paperwork 3. A client may be allowed, after consultation between the FSW and the Supervisor, to re-engage in services if it occurs within one month of the unplanned termination. B. Phone Call Component 1. Planned termination takes place when the family has progressed through Level Q; the target child reaches age one, or otherwise mutually agreed upon termination of services. a. FSV reminds family during fifth phone call of impending termination from services. b. Upon graduation from phone call services, families are referred to and connected with two additional support services in our community: Bright Beginnings and Connections. 2. Unplanned termination occurs when a family refuses continued services, a family has moved, their phone number no longer works, is unable to be located, and/or other unexpected change occurs. a. Creative outreach attempts will be made to re-engage the family, at the discretion of the FSV and the HSPC program manager, for up to two months. b. A final letter of termination will be sent to the family thanking the family for participating in the program. c. FSV will complete termination paperwork. 2. A client may be allowed, after consultation between the FSV and the Supervisor, to re-engage in services if it occurs within one month of the unplanned termination and the child is under age one. 23

25 Critical Element 4: Offer services intensively (i.e., at least once per week) with well defined criteria for increasing or decreasing intensity of service and over the long term (i.e. three years for KCHS). Policy 4.1 (for CE 4.1a-4.2b) KCHS has a well thought out level system for managing the intensity of home visitor services and phone call services with defined levels. The level system used is adopted from Healthy Families America. KCHS is sensitive to the needs of each family and assigns service levels according to family need and family s desired level of contact. KCHS will be responsive both to changing needs and to changing desires on the part of the family for contact. Higher need and/or less stable families require more frequent visits than lower need, stable families. A. Home Visit Component 1. When families agree to participate in program services, they enter KCHS at Level Prenatal if still pregnant, Level I if with a new baby or Level 1-SS if the family is in significant crisis requiring more than weekly home visits. 2. Level Prenatal families will become Level I with the birth of the new baby and Level 1-SS families will become Level I when the crisis or high-need time period resolves. Families will be offered Level I services for a minimum of six months after the birth of the baby or six months after enrollment (whichever is longer) excluding time on creative outreach. 3. After the initial six months, each family s level is based on the intensity of services needed relative to adequacy of parent-child interaction, the level of risk, the family s need, family s desired level of contact, and their involvement with other community resources and programs. 4. The FSW (Family Support Worker) will initiate a level change form for each program participant on their caseload, which will be used during individual supervision to monitor participant progress and readiness for level promotion based on the established criteria for change to each level. 5. During home visits, the FSW will discuss with the family their achievements, visit schedule, family circumstances and readiness for change in frequency of home 24

26 visits. Based on the Level Change Form criteria and discussion with the family, the FSW and Program Supervisor will, during the case review that occurs as part of supervision, make determination about each family s level change. Families must attain all of the listed achievements on the level change form in order to progress to the next service level or have a clinically positive reason for the change as determined by the FSW with supervisor approval. The discussion about the level change will be documented in the Home Visit Log. 6. The change will be documented on the participant s Level Change form, and on the Monthly Caseload Report. 7. The four basic levels of service are reflected as Level I, Level II, Level III, and Level IV. With the exceptions noted above (for Level Prenatal or Level 1-SS), all families enter KCHS at Level I with a home visit provided weekly for at least six months. Level II families receive a home visit twice per month, Level III families receive a monthly visit, and Level IV families receive a home visit once every three months. Level X families are on Creative Outreach and not fully engaged in services. 8. Each level is assigned a weighted numerical value so that program staff and supervisors can closely monitor when their caseload has availability or conversely is at capacity. Consistent with best practice standards, a FSW will carry no more than 25 families at any combination of service levels per full-time home visitor. LEVEL WEIGHTED VALUE #EXPECTED VISITS Level Prenatal 1.0 if < than weekly visits 2/month Level 1-SS (Special Service) 3.0 if twice weekly visits 8/month Level I 2.0 4/month Level II 1.0 2/month Level III 0.5 1/month Level IV /quarter Level X 0.5 Creative Outreach 9. The FSW will maintain a Monthly Caseload Report to document the families on their caseload, their level, the number of home visits and other contacts provided to the family during the month. This report will be discussed during supervision and a copy will be provided to the Supervisor at the beginning of the following month. 10. If necessary, due to need, a client may perform a reverse level change moving from a lower level of service to a higher level based on the decision of the family, the Family Support Worker and the Program Supervisor. When this need arises, a Reverse Level Change form will be completed and the discussion about the level change will be documented in the Home Visit Log and Supervision Notes. B. Phone Call Component 25