POLICIES AND PROCEDURES MANUAL

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.

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 8/24/10 3-5 Policy 1.2 Partner Agency Agreements 8/24/10 5-6 Policy 1.3 Coordination with Other Agencies 8/24/10 6-7 Policy 1.4 Initiation of Services 10/8/12 8-9 Policy 1.5 Acceptance Rates 8/24/10 9-10 Critical Element 2 - Use standardized assessment tool Policy 2.1 Kempe Family Stress Inventory 10/8/2012 11-12 Policy 2.2 Identification and Documentation 5/09/12 12-13 Policy 2.3 Training to Use the Kempe 8/24/10 13-14 Critical Element 3 - Offer services voluntarily Policy 3.1 Voluntary basis 8/24/10 15 Policy 3.2 Informed about Rights 8/24/10 15-17 Policy 3.3 Positive Outreach Methods 2/22/11 17-18 Policy 3.4 Creative Outreach 2/22/11 19-20 Policy 3.5 Retention Rate 8/24/10 20-22 Policy 3.6 Termination Plan 8/24/10 22-23 Critical Element 4 - Offer services intensively Policy 4.1 Managing Intensity of Services 5/9/12 24-26 Policy 4.2 Increasing Completion Rate 8/24/10 26-27 Policy 4.3 Criteria for Changing Intensity of Services 5/2/11 27-28 Policy 4.4 Intensive Home Visits after Birth of Baby 5/16/2012 28-29 Critical Element 5 - Services should be culturally competent Policy 5.0 Cultural Competency 8/24/10 30-31 Critical Element 6 - Services should focus on supporting the parent(s) Policy 6.1 Meeting Family s Concerns and Needs 8/24/10 32-33 Policy 6.2 Individual Family Support Plan 8/24/10 33-36 Policy 6.3 Maintaining focuses (parent(s), child, and 8/24/10 36-38 parent-child relationship) Policy 6.4 Monitoring Child s Development - ASQ 8/24/10 38-40 Policy 6.5 Training on Use of ASQ 8/24/10 40 Policy 6.6 Suspected Delays 8/24/10 40-41 Policy 6.7 2 Protective Factors Survey 10/8/2012 41-43 Critical Element 7 - All families should be linked to services Policy 7.1 Medical/Health Care Providers 8/24/10 43-45 Policy 7.2 Immunizations for Target Child 8/24/10 45-46 Policy 7.3 Additional Services 8/24/10 46-47 Critical Element 8 - Limited caseloads Policy 8.1 Limiting Caseloads 11/30/10 48-50 1

Policy / Document Name Effective / Revised Page Critical Element 9 - Service providers selected because of Policy 9.1 Program Management 8/24/10 51-52 Policy 9.2 Program Supervisors 8/24/10 52 Policy 9.3 FAWs, FSWs and FSVs 3/27/13 53-54 Policy 9.4 Interns and Volunteers 8/24/10 54-55 Policy 9.5 Culturally Diverse Staff 8/24/10 55 Policy 9.6 Compliance with Law/Regulation 8/24/10 55-56 Policy 9.6 4 Personnel Turnover 8/24/10 57 Critical Element 10 - All service providers should receive basic training Policy 10.1 Training Policies 3/27/13 58-69 Policy 10.5 Case Load Building 10/26/10 70 Critical Element 11 - Service providers should receive intensive training Policy 11.1 8/24/10 72-74 Additional KCHS Policies specific to our homebased program Policy 12 Healthy Start Groups 9/22/09 75 Policy 13 Healthy Start n180 Transition Policy 5/23/11 75-76 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 12/1/2012 79 Governance and Administration Credentialing Standards GA 1.A Organization of Advisory Group 8/24/10 79 GA 2.A Formalized Input from Families 8/24/10 78-79 GA 2.B Policies and Procedures Grievances 8/24/10 79-80 GA 3 Quality Assurance Plan 8/24/10 80-81 GA 4 Policies and Procedures Research Proposals 8/24/10 81-82 GA 5.A Family Rights and Confidentiality 8/24/10 82-83 GA 5.B Informed and Signed Consent 8/24/10 83-84 GA 6 Criteria to Idenfity Child Abuse and Neglect 8/24/10 84-85 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 8/24/10 86-87 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 8/24/10 1-2 Appendix B Definitions of 12 Critical Elements 8/24/10 3-4 Appendix C Kent County Healthy Start Committees 8/24/10 5 Appendix D Data Collection Forms 8/24/10 6-7 Appendix E Appendix F 2

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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: http://www.nj.gov/dcf/about/commissions/njtfcan/standardsprevention.pdf and www.familysupportamerica.org 17

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

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

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

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

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

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

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

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 0.25 1/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

1. When families agree to participate in program services, they enter HSPC at Level E. Families will be offered services for 12 months after the birth of the baby. 2. The intended phone call intensity is six total phone calls for each participant. The FSV administers one phone call in each of the following intervals: zero to one month of age, one to two months of age, three to four months of age, six months of age, nine months of age, and twelve months of age. 3. Movement from one level to another is determined by the time span between phone calls. Participants will be moved to Level Q when their phone contacts become three months apart, making them quarterly. The change in level status will be documented on the family s file. If a family changes levels, it is noted in PIMS database. 4. Families in HSPC have no weighted values. Call loads will vary by volunteer preference and availability. Family files are checked weekly by the HSPC Manager for caseload and quality assurance. Policy 4.2 (for CE 4.2c) KCHS evaluates how it might increase its home visit and phone call completion rate. Though it is not always possible to visit families as frequently as their needs might warrant, it is pertinent to understand what barriers exist in achieving the number of visits according to the assigned level and to take action on those things that can be changed to increase home visit completion rates. Research by Powell and Grantham-McGregor (1999) found more frequent visits produced the most positive outcomes and that as visiting increased, both the range of outcomes and degree of gains increased. - A. Home Visit Component 1. Supervisors will provide guidance and support to each FSW to help increase their rate of home visit completion. This will involve reflection and informal analysis of the factors that may be contributing in each case where visits are not occurring at the expected frequency. The discussion between Supervisor and FSW may also involve employing new strategies of outreach to increase the number of visits made to families, who, for a variety of reasons, are harder to reach. 26

2. Supervisors will also make periodic use of regularly scheduled staff meetings for discussion and more formal evaluation, including case presentation of challenges and successes of full participant engagement and home visit completion. 3. The Continuous Quality Improvement (CQI) will also review home visit completion rates across the entire program on a monthly basis and monitor trends and factors contributing to home visit completion rates and capacities. 4. KCHS providers are responsible for evaluating performance improvement. If concerns or situations worth noting arise, Family Support Supervisors will bring them to CQI. 5. Annually, performance data will be compiled along with a summary of successful practice strategies and will be shared during the CQI and/or Partners meeting. B. Phone Call Component 1. Supervisors will, on an ongoing basis, provide guidance and support to each FSV to help increase their rate of phone call completion. This will involve reflection and informal analysis of the factors that may be contributing in each case where calls are not occurring at the expected frequency. The discussion between the HSPC Manager and FSV may also involve employing new strategies of outreach to increase the number of calls made to families that are difficult to reach for a variety of reasons. 2. The HSPC Manager will make periodic use of regularly scheduled Quarterly Volunteer Meetings for discussion and more formal professional development, including case presentation of challenges and successes of phone calls. 3. The HSPC Manager is responsible for evaluating performance improvement. If concerns or situations worth noting arise, the HSPC Manager will bring them to CQI. 4. Annually, performance data will be compiled along with a summary of successful practice strategies and will be shared during the CQI. Policy 4.3 (for CE 4.2d) KCHS has criteria for increasing and decreasing the intensity of services, which is clearly linked to the levels of service offered by KCHS and includes review with family, FSW, and Supervisor. 27

Significant research has demonstrated that more effective support to vulnerable families occurs when it is provided early and intensely, with weekly or, in some cases, more frequent contact. Daro, Jones, and McCurdy (1993) state this as being related to a period that is critical to the child s physical, social, and emotional development and is also a time when parenting patterns are established. As parents become more confident and children s needs become less complex, the frequency of visits should naturally decrease. A stronger, more effective working relationship between parent and family support specialist can develop when contact occurs more frequently. Consistently applied criteria for determining home visit frequency will ensure that these decisions are made objectively and afford families the opportunity to participate in the decisionmaking process as well. Home Visit Component Only A. The FSW will initiate a Level Change Form for each program participant on their caseload, which will be used during individual weekly supervision to monitor participant progress and readiness for level change based on the established criteria for change to each level. B. During home visits, the FSW will discuss with the family their achievements, visit schedule, family circumstances and readiness for change in frequency of home visits. C. Based on the Level Change Form criteria and discussion with the family, the FSW and Supervisor will make determination about each family s level change during the case review that occurs as part of weekly supervision. See Policy 4.1. D. The change will be documented on the participant s Level Change Form and the Monthly Caseload Report, and a PIMS Information Change form will be completed for update to the electronic file. Policy 4.4 (for CE 4.3) KCHS offers home visitation services to participant families for a maximum of five years after the birth of the baby. 28

Both service intensity and length of involvement are crucial components for successful interventions. Long-term services are necessary, because new issues arise for families as children develop and family circumstances change. Long-term services allow home visitors to help families face these new challenges and incorporate new knowledge and life skills. Services through age three also provide education and support to families during the child s time of greatest brain development. A. Home Visit Component 1. KCHS program offers services to participant families for a minimum of three years to a maximum of five years. 2. The KCHS brochure that is given to all prospective participants lets families know that services are provided from infancy through three years of age. Families who have additional children born into the home during the three year service period are eligible to continue receiving services until the Target Child (original child to enter the program) reaches age five. 3. The Participant Agreement ensures that families are made aware, at the time of enrollment, that services can be provided for up to three years. The Participant Agreement that is signed by the family and program staff at the time of enrollment states, we will remain involved with you as long as needed, but no longer than three years (five years if another child is born during this time and services are requested). B. Phone Call Component 1. HSPC offers services to participant families for up to 12 months after the birth of the baby. 2. Participants are informed, at the time of their enrollment to HSPC, that services are available up until their child s first birthday. 29

Critical Element 5: Services should be culturally competent such that staff understands, acknowledges, and respects cultural differences among families; staff and materials should reflect the cultural, linguistic, geographic, racial and ethnic diversity of the population served. Policy 5.0 KCHS seeks to be culturally sensitive to each family s unique characteristics. HFA writes, For home visiting services to be effective it is imperative that cultural context is incorporated into program design and delivery. There are two underlying assumptions to this statement: 1) that the diversity of families is of great significance to intervention programs; and 2) services may be provided by persons whose culture differs from that of the participating family. Thus, in developing home visiting programs, it is important to consider that: Family needs, health beliefs, coping mechanisms and child rearing practices vary by population-thus interventions should reflect this variation; Valuing diversity in its many forms (e.g., cultural, linguistic, racial, geographic and ethnic) allows a home visitor to establish quality relationships with families; and A home visitor s ability to establish strong relationships with families, based on mutual respect and understanding, will enhance the opportunity for providers and families to work together. Successful home visiting programs provide culturally sensitive services so that skills and ideas being shared with the family are respectful of each family s values and decision-making systems. Successful home visiting programs must provide culturally competent services so that ideas and skills fit into the context of each family. The National Commission to Prevent Infant Mortality (1995) stated, Successful home visiting programs are sensitive to the culturally different values and decision-making systems of families. To strengthen families coping abilities and independence, visitors must respect differences among families. A. Annually, KCHS will undertake a review of its ability to provide services in a culturally competent way. 30

B. The review will include a clear, aggregate description of the participants receiving services that details cultural, ethnic and linguistic characteristics of the population. C. The review will be multi-faceted and will include opportunities to obtain input directly from participants and input from staff. D. The review will reflect on the diversity of service providers to meet the needs of the service population, as well as addressing areas related to program materials, staff training and the service delivery system. E. The review will be reported annually to the KCHS Partner s meeting, who will provide input for any needed improvement actions. F. Healthy Start staff will receive annual training on cultural sensitivity/cultural competency that is related to the unique characteristics of the service population. G. KCHS will provide materials to families whenever possible in their primary language, at a reading level appropriate for the family, and that uses photos that are reflective of the diversity of the population. Because KCHS serves a large number of Hispanic families, KCHS will pay particular attention to provision of materials in Spanish. H. Supervisors will assist staff in supporting and respecting the family s cultural, racial/ethnic, and linguistic characteristics. Supervisors will particularly support the assessment process in responding to a family s cultural characteristics. 31

Critical Element 6: Services should focus on supporting the parent, as well as supporting parent-child interaction and child development. Policy 6.1 (for CE 6.1a-b) The supervisor and home visitor, as well as the FSW and family review the issues identified by the family in the initial assessment. The FSW and the family also review and discuss the risk factors identified in the Kempe Family Stress Inventory that could result in increased risk for child maltreatment or other poor childhood outcomes over the course of the family s enrollment in KCHS. During the initial assessment, the family has the opportunity to share their concerns and needs. It is important in the beginning states for the FSW to support the family in any of the needs the family identifies needing assistance with and to offer the family opportunities to make positive, healthy changes in their lives. A. Home Visit Component 1. During weekly supervision, the Supervisor and FSW will review all new cases. This process will be documented on a weekly supervision form (form varies between partner agencies see appendix). 2. The FSW will report on early engagement efforts with new families including any contacts since the initial case assignment was made. 3. The FSW will document on the Home Visit Record whenever there is a focus or discussion with the family on issues presented during the initial assessment. This type of discussion may occur at any time while services are being provided to the family, but is certainly most relevant during the beginning phases of work with a family. 4. To protect participant confidentiality, the assessment information will be discussed only with the parent who originally provided the information unless otherwise requested by the parent. 5. The supervisor, upon regular monthly paperwork review, will monitor that initial assessment concerns are being addressed with the family. 32

B. Phone Call Component Based on Healthy Start Phone Call protocol, if an issue arises with a family at intake, a FSV can request, verbally or in writing, for the HSPC supervisor to consider reasssignment of the family file from HSPC services to Home Visiting services. Policy 6.2 (for CE 6.2a-d) The Individual Family Support Plan (IFSP) guides the delivery of services to families/participants. The process of developing the plan is family centered. Development of the IFSP is a goal-setting process that empowers families to make decisions in their own best interest and helps them build on their strengths. Through regular home visiting support, the FSW can help the parents stay focused on the goals they want to accomplish. Parents can work toward goals incrementally taking small steps with encouragement and support from their FSW. Goal setting is an opportunity for the home visitor to discuss with the family issues that impact healthy parenting (e.g., issues identified in the initial assessment, healthy lifestyle issues, and any other issues identified from other tools used by the program) in an open, honest way as well as goals designed around child development and parent-child interaction. Home visitors experience the greatest success when they clearly understand the family s values and work within a culturally sensitive framework to assist families in developing functional goals. At times, a family may need to focus only on one goal. The focus is not so much about how many goals the families complete, but about the skills the family cultivates through the process of developing and working on goals resulting in enhanced family functioning. (HFA-pg. 42 Critical Elements) A. Home Visit Component 1. The IFSP process establishes regular systematic opportunities for the family and the FSW to collaboratively identify the strengths, needs and concerns of the family, to review the child s health and development status, to identify goals the family has and plan the steps and resources needed to achieve those goals, and to formally review the progress made toward previously set goals. 2. The FSW tailors the intervention according to the unique needs and goals of each family. 3. The process of developing an IFSP with a family may occur in one home visit, but for many families it is a process that will require several home visits. It is therefore important to begin the IFSP before the due date to assure completion 33

within one month (30) days from the date of the Kempe assessment meeting with the FSW. 4. There are a number of tools available to make the IFSP development process less intimidating than it may seem to some families. These include: What I d Like for My Child Worksheet, IFSP Form and Family Needs Scale. These materials are included in the HS/HFA Orientation and Training Binder. 5. It is expected that the FSW and the family will complete the IFSP process twice each year, with the first IFSP completed within one month (30 days) from the date of the Kempe assessment meeting with the FSW. Completion of the IFSP process will involve a fully documented IFSP form that is signed by the parent, the FSW and the Supervisor. The plan shall include, but not be limited to the following: Description of the family s strengths, needs and concerns. Review of the child s health and development status. Creation of goals with the family. Clear statement of goals that are the specific, observable, include measurable steps needed to be done to achieve those goals, who will be complete those steps by what date, and what outcome will be achieved. 6. The FSW and the family work together to develop goals and break those goals into meaningful steps to insure success for each family. There is a clear conversation and partnering between the home visitor and parent that supports growth in families. Breaking larger goals into small steps assists parents in developing problem-solving skills, increases their sense of power over their situations, and supports adult brain development. Steps should be incremental, measurable, and functional for the family. 7. The family and the FSW both sign the IFSP. A copy of the IFSP is given to the family. 8. The development and periodic review of the IFSP can be a process to set boundaries with the family, to further develop the relationship between the FSW, and the family and to clearly define the work of the FSW with each family. 9. During individual weekly supervision, the Supervisor and FSW will review cases, including the status of IFSP development and review. The Supervisor will provide guidance when efforts to establish goals and/or objectives with a family are found to be challenging. 10. The FSW will use the IFSP to guide service delivery. Therefore, practice may include: Reviewing goals on a regular basis Celebrating when steps toward goals are achieved and when goals are achieved 34

Keeping goals current Retiring goals when the family no longer wishes to pursue that goal Assisting in establishing new goals when prior goals are achieved or when the environment changes Creating contingency plans that plan for potential barriers as appropriate Addressing barriers the family may be experiencing in reaching their goals Ensuring that steps/goals for children are anchored in the family s general routines 11. The FSW will document on the Home Visit Record, in the appropriate activity section, whenever there is a focus or discussion with the family on progress toward IFSP goals. 12. The supervisor, upon regular monthly paperwork review, will monitor that IFSP goals are being regularly addressed with the family during home visits and that progress is being made toward goal achievement. 13. Documentation on the IFSP form will include: On Page 1 Child Health and Development Include date and summary status of most recent ASQ as appropriate. If ASQ has not yet been completed, write none for date. Indicate any medical concerns that have been reported or questioned. If no concerns, indicate that in the specific area. Child s Strengths- Have the parents express attributes or characteristics of their child that they like or are proud of, or that make the child special. Family Strengths and Resources- Explore with the parents what areas of their family life they feel most positive about and where they draw their greatest support; remember cultural or religious/spiritual strengths and resources as appropriate. Family Needs or Concerns- Explore with the parents what worries them, what resources they lack, what they feel might be missing, etc On Page 2 Review from Previous IFSP- On the top half of page 2, rewrite each goal and objective established in the last IFSP. In the Progress column describe what has taken place in each of the identified areas. Goals/Objectives for Next Period- Assist the family in identifying observable and measurable goals based on the information identified on the lower half of page 1and any worksheets completed. Use dates, Likert scales and how many by when to make the goals and objectives clear. Work with the family in establishing a plan for how to achieve these goals via writing objectives for each goal. Identify potential barriers to goal achievement and what could be done to overcome these barriers. Include the names of the individuals that will help in achieving these goals. 35

Community Services and Programs- List all workers/programs/agencies involved with the family. Signatures- The parent and FSW sign and date the completed form. Parents are given a copy of the form at a subsequent visit. Policy 6.3 (for CE 6.3a-c) KCHS promotes positive parenting skills, parent-child interaction, and knowledge of child health, safety and development with families/participants. It is essential that FSWs maintain three focuses: the parent(s), the child, and the parentchild relationship. To be optimally effective, programs must address simultaneously the psychological needs of the parents (especially their sense of mastery and competence), the parental behaviors that influence maternal, fetal, and infant development, and the situational stresses and social supports that can either interfere with or promote their adaptation to pregnancy, birth, and early care of the child (Olds and Kitzman, 1990). According to Campbell and Ramey (1994), children s cognitive development is enhanced by strengthening the developmental appropriateness and intellectual stimulus value of their early environment. As a result, children will be more prepared to enter school, and this early school success contributes to later school success. A. Home Visit Component 1. The promotion of positive parenting skills, positive parent-child interaction and knowledge of child development is accomplished in a variety of ways, through education, guidance, modeling, support and monitoring of developmental status during regular home visits. 2. When providing child development education, families will receive education information from the Florida State Partners for a Healthy Baby curriculum, activities from the Growing Great Kids curriculum, handouts from University of Wisconsin Extension and Zero to Three, as well as various other developmental activities. Parents will also participate in completion of the Ages and Stages Questionnaire. These instruments provide information for specific age intervals from prenatal through age three on child development, developmental activities, nutrition, health, safety, discipline, and other parenting topics. a. The Partners for a Healthy Baby curriculum includes prompts, and resources for enhancing maternal health and personal development during baby's first years; infant health and development; and parent/child 36

interaction. This curriculum also focuses on father/partner involvement in parenting and includes practical guidance for families dealing with young children. b. The Growing Great Kids curriculum focuses on the parent-child relationship, utilizing adult learning principles through multi-sensory experiences for learning, hands-on practice activities, and repetition to integrate new information with what the parent already knows. 3. Curriculum discussion and/or activities will be used at each home visit with each family per the dosage required on the Family Support Worker Curriculum Checklist (see Appendix). 4. For effective skill building, activities presented to the parent may begin first with the FSW demonstrating a technique, (i.e. an infant calming technique) then having the parent practice the technique, getting feedback from him/her about what worked or did not, and then offering guidance and support to the parent to improve his/her understanding and comfort with the technique. 5. The FSW will document in detail all curriculum used on the Family Support Worker Curriculum Checklist. Mention of activities completed will also be made on the Home Visit Record. 6. The FSW will also document observed interactions between the parent and the child on the Home Visit Record. The FSW will consistently reinforce the parent s positive interactions to promote nurturing relationship skills. 7. The Ages and Stages Questionnaire (ASQ) will monitor child development status and serve as a teaching tool for the parent(s) to build knowledge regarding appropriate developmental expectations. Administration of the ASQ will be elaborated on in Policy 6.4. 8. Health and safety information, in addition to what is included at different age intervals in the curriculum, also serves as a routine part of home visiting services. FSW s also monitor immunizations and well-child visits, which is discussed in Policy 7.1 and 7.2. B. Phone Call Component 1. The promotion of positive parenting skills, positive parent-child interaction and knowledge of child development is accomplished in a variety of ways, through education, guidance, support and monitoring of developmental status during regular phone calls. 2. When providing child development education, all families will receive the standardized Growing Great Kids, GGK, curriculum through packets mailed at 37

designated time intervals. The curriculum provides information for specific age intervals from prenatal through age three, on child development, developmental activities, nutrition, health, safety, discipline, and other parenting topics. 3. The GGK curriculum handouts should be introduced to the family as soon as possible after the first phone call. 4. FSV will document any additional curriculum used in the family s participant file. All additional curriculum or handouts must be approved by the Healthy Start CQI Committee before use with a family. 5. The FSV will consistently reinforce the parent s positive interactions to promote nurturing relationship skills. 6. The Ages and Stages Questionnaire (ASQ) will monitor child development status and serve as a teaching tool for the parent(s) to build knowledge regarding appropriate developmental expectations. Administration of the ASQ will be elaborated on in Policy 6.4. 7. Health and safety information, in addition to what is included at different age intervals in the curriculum, also serves as a routine part of phone call services. The FSV s monitor immunizations and well-child visits, which are discussed further in Policy 7.1 and 7.2. Policy 6.4 (for CE 6.4a-b) KCHS monitors the development of participating infants and children with a standardized developmental screen. Through regular monitoring of infant and child developmental progress, developmental needs can be addressed early with supportive, supplemental interventions. Parents regular involvement in the developmental screening of their child helps to create reasonable expectations for their child, helps parents understand ways to enhance their child s growth and development, and supports parent-child interactions. A. Home Visit Component 1. The ASQ-3 is used at regular intervals, by the FSW along with the parent, for all target children. The only exception will be for children with a known developmental disability, for whom developmental screening is deemed 38

inappropriate. Follow-up support services and tracking of these children will continue to be required, even when the ASQ-3 is not administered. 2. A total of 17 intervals are included with the ASQ-3, with the first measure at 2 months of age and the last measure at 36 months. All ASQ-3 s between 0-36 months are strongly recommended, however, it is only required that 4 ASQ-3s be done each year. 3. The Kent County Healthy Start Family Support Worker Curriculum Checklist describes the required measures. (See Appendix) 4. The ASQ-3 will be administered in the home consistent with the training provided to each staff person who uses the tool. (see policy 6.5) 5. The ASQ-3 form will be completed, including each developmental checklist page and the final summary page. The checklist pages, once they have been tallied for scoring, will be given to the parent(s). The summary page will be maintained in the participant s file. Parents may obtain pages upon request. 6. Data will be gathered and tracked regarding ASQ-3 s administered with feedback provided to individual FSW s and to contract agencies. B. Phone Call Component 1. The ASQ-3 is mailed at regular intervals to all Phone Call Component families through the Council s Connections program. The only exception will be for children with a known developmental disability, for whom developmental screening is deemed inappropriate. Follow-up support services and tracking of these children will continue to be required, even when the ASQ-3 is not administered. 2. A total of 5 ASQ-3 s are mailed to families every 2 months, with the first measure at 4 months of age and the last measure at 12 months. Families have the choice to participate or not participate in administration of ASQ-3 s. 3. The ASQ-3 can be filled out by the parent in the home. The parents mail the ASQ-3 back to Connections and staff/volunteers score and respond to the questionnaires. A parent educator is available through the Connections program for follow up with families whose child has a low score or additional questions and concerns as a result of completing the Ages and Stages questionnaire. 39

Policy 6.5 (for CE 6.5) Those who administer developmental screenings are trained in the use of the tool before administering it. Those who have been trained to understand the process for implementing, scoring and interpreting the ASQ-3 will obtain accurate results of children s developmental status and will be able to use the measurement as a teaching tool with parents. A. Home Visit Component Only 1. A staff person with responsibility for conducting developmental screenings will, prior to using the Ages and Stages Questionnaire or ASQ-3, complete specific training on its use. 2. The ASQ-3 training will be coordinated by a program Supervisor and will involve learning acquired through readings, video, and experiential learning through shadowing another FSW on an ASQ-3 home visit. 3. The training for FSWs will occur prior to their use of the tool with families. Policy 6.6 (for CE 6.6a-b) KCHS tracks target children who are suspected of having a developmental delay and follows through with appropriate interventions (referrals, follow-up, etc.) as needed. Infants and children provided with supportive early developmental interventions stand the best chance for reducing or reversing developmental lags. A. Home Visit Component Only 1. The ASQ-3 Summary Sheet, when completed, includes cut off scores for each development domain to indicate whether a child is developing typically or whether he or she should be referred for a more comprehensive assessment. The cut off scores define three areas: typical development, children whose 40

scores indicate a need for monitoring, and children who indicate need for further assessment. 2. For every child where there is a score that falls in the monitoring or assessment range in one or more developmental areas, the FSW will discuss this with the parent and provide additional developmental interventions through KCHS or through referral to an outside provider (i.e. pediatrician and/or the school). 3. The FSW will need to discuss with the Supervisor each child who scores below the ASQ-3 typical development cut-off. The Supervisor will also assist with identifying further developmental assessment needs and appropriate referrals. 4. In all monitoring and assessment situations, the FSW will assist the parent to focus on activities that build developmental skills in the particular area showing concern. If insufficient progress in that area occurs, parents will be referred to Early On. 5. The FSW will reference pages 73-74 of the ASQ-3 Administration Guidelines on follow-up procedures. (See Appendix) 6. The FSW will provide the parent with activities, demonstrating how the activity is done and its relationship to that developmental area (i.e. language, motor, etc.) 7. In case discussion during supervision, recommendation may be made for a referral to Early On or for use of an optional ASQ-3 interval to shorten the time period between screenings. 8. All interventions and referrals will be documented on the PIMS Child Development Form and tracked in Supervisory Logs. 9. For any child between 0-3 years who has a developmental delay, there will be a referral made to Early On and a goal addressing the delay will be added to IFSP. Policy 6.7 2 KCHS uses the FRIENDS Protective Factors Survey (PFS) to measure protective factors in five key areas: family functioning/resiliency, social support, concrete support, nurturing and attachment, and knowledge of parenting/child development. The results of the survey will provide the Family Support Workers with a greater understanding of the family s strengths and needs. The Family Support Worker will reflect back to the family those areas of strengths and needs as they work together to accomplish the goals of the Individual Family Support Plan. 2 Policy Effective May 1, 2010 41

The primary purpose of the Protective Factors Survey is to provide feedback to agencies for continuous improvement and evaluation purposes. The survey results are designed to help agencies measure changes in protective factors and identify areas where workers can focus on increasing family protective factors. (Citehttp://www.friendsnrc.org/outcome/pfs.htm) A. Home Visit Component Only 1. PFS is administered to Healthy Start Home Visit participants only. 2. The PFS is a self-administered survey that measures protective factors in five areas: family functioning/resiliency, social support, concrete support, nurturing and attachment, and knowledge of parenting/child development. 3. The involvement in the PFS is strictly voluntary and service will not be affected by those who choose not to participate. If a family chooses not to participate, they have the ability to opt out of the survey by marking the appropriate box on the PFS consent form. 4. The tool is initially administered at the onset of services with completion no later than the end of the second month of home visiting services. 5. The tool is administered every 6 months thereafter and at case closure. 6. Before completion of the first survey, a mandatory Consent Form will be signed by each participant. 7. With the completion of each survey, mandatory demographic data will be gathered and updated in the Program Information Management System (PIMS) Database for each participant who completes the tool via the PIMS intake and follow-up forms. 8. PFS assessments will be scored by Family Futures Healthy Start administrative staff and data will be entered into the FRIENDS provided PFS data collection system by Family Futures Healthy Start administrative staff within a month of completion of the tool. 9. PFS scores will be available to FSWs via a hard copy report within a week of entry into the PFS system in order to assist in the planning of the participant s IFSP. 42

10. PFS scores will be tracked during the families length of stay in the program to help gauge the participants improvement over time. 11. Annually, Healthy Start management will analyze participant data for continuous program quality improvement. The percentage of change in a participants scores will allow management staff to see what is working well within the program structure, as well as make clear what changes are needed to run Healthy Start more effectively for our participants. Aggregate areas of strengths and needs over time will also be used to influence curriculum, strengthen resource connections for participants and determine training needs of FSWs. Critical Element 7: Services should link families to medical providers for preventative health care, ensure timely receipt of immunizations, and appropriately refer to additional services based on the needs of the family. Policy 7.1 (for CE 7.1a-b) Participating family members have a medical/health care provider to assure optimal health and development. The benefits of preventive care are well documented. Women who receive complete and comprehensive prenatal care are much more likely to deliver full-term, normal weight, healthy babies than women who do not. Children who receive comprehensive immunizations and well-child care are healthier. Promoting immunizations and wellchild care, and encouraging the use of safety seats and other safety measures are methods home visiting services use to help prevent avoidable childhood diseases and injuries (Carnegie, 1998). Another reason for home visitors to build bridges from families to health care providers is that health status affects other life areas (Shearer, 1998). Health status affects education because health problems such as hunger, poor vision or hearing, high levels of lead in the blood, or dental problems interfere with learning. Mental or physical disabilities may impede successful development. The health of children may affect their parent s employability and their resulting income. A. Home Visit Component 1. Medical/health care provider is defined as a physician (i.e. pediatrician, obstetrician, family practice) or a health or medical clinic. 43

2. Information regarding the medical/health care provider for the target child and primary-care-giving parent will be collected and documented by the FSW on the PIMS Intake Form during the initial work with the family. 3. In situations where a parent does not have a medical provider, the FSW will assist the parent to gain access to a medical care provider. The FSW will help the family to address any barriers to their receiving health care services. When barriers to receiving health care services are not able to be surmounted, the reasons why shall be documented in the case record and also discussed with the supervisor. 4. The FSW will assist the parent in securing preventive health care services by following up with parents about upcoming immunization, well-child or prenatal care visits 5. When necessary, program staff will assist in coordinating health services through direct communication with the medical provider or physician office staff. The FSW will obtain necessary releases of information to facilitate this communication. 6. On occasion, FSWs will also assist families in obtaining health care services by providing or coordinating transportation to medical visits. 7. The FSW will keep the medical provider information updated utilizing the PIMS Information Change Forms. 8. The FSW will also document the receipt of immunizations, as reflected in Policy 7.2, and will document the receipt of well-child care visits using the PIMS Well- Child Tickler that is printed specifically for each target child. The FSW will also document sick-child office visits, emergency or inpatient hospital visits, and any prenatal or parental health visits for the primary caregiver on the PIMS Medical Visit Form. B. Phone Call Component 1. Medical/health care provider is defined as a physician (i.e. pediatrician, obstetrician, family practice) or a health or medical clinic. 2. Information regarding the medical/health care provider for the target child and primary care giving parent will be collected and documented on the PIMS Intake Form during the initial assessment. 3. In situations where a parent does not have a medical provider, the FSV will assist the parent to gain access to a medical care provider. The FSV will help the family to address any barriers to their receiving health care services. When barriers to receiving health care services are not able to be surmounted, the 44

reasons why shall be documented in the case record and also discussed with the supervisor. 4. The FSV will assist the parent in securing preventive health care services by reminding parents of upcoming immunization, well-child or prenatal care visits. 5. On occasion, FSVs will also assist families in obtaining health care services by providing information about transportation to medical visits. 6. The FSV will keep the medical provider information updated utilizing the PIMS Information Change Forms. 7. The FSV will also document the receipt of immunizations, as reflected in Policy 7.2, and will document the receipt of well-child care visits in the Phone Call Log. The FSV will also document sick-child office visits, emergency or inpatient hospital visits, and any prenatal or parental health visits for the primary caregiver on the Phone Call Log. Policy 7.2 (for CE 7.2) KCHS ensures that immunizations are up to date for target children according to the American Academy of Pediatrics required immunizations. All children should be immunized at regular health care visits, beginning at birth. Immunizations are very important in keeping children healthy. The regular schedule recommends shots starting at birth and going through 24 months of age, with boosters and catch-vaccines continuing through the teenage years and into old age. By immunizing, children are safeguarded against the potentially devastating effects of 11 vaccine-preventable diseases plus Hepatitis A and the flu. The catastrophic effects of childhood diseases can lead to life-long illness or death. FSWs help educate parents about the importance of timely immunizations and help link families to community health providers, including transportation assistance, when needed, for immunizations. FSWs will track the child s receipt of immunizations to help ensure that parents keep their children s immunizations up-to-date. A. Home Visit Component 1. FSWs will provide information to parents regarding the importance of immunizations and will encourage timely receipt of immunizations required by the American Academy of Pediatrics (AAP). 45

2. The FSW will use the PIMS Immunization Tickler, created specifically for each child, which indicates the scheduled due dates of all immunizations. The dates that immunizations are received will be recorded on the appropriate form and entered into PIMS electronically, as are well-child care visits. When immunizations are skipped for any reason, the explanation will also be documented in PIMS. It will also be documented in the case file and in PIMS in the note section on child well being if the family beliefs preclude immunizations. B. Phone Call Component 1. FSVs will provide information to parents regarding the importance of immunizations will encourage timely receipt of immunizations required by the American Academy of Pediatrics (AAP). Policy 7.3 (for CE 7.3) 2. The dates that immunizations are received will be recorded on the Phone Call Log and entered into PIMS electronically, as are well-child care visits. When immunizations are skipped for any reason, the explanation will also be documented on the Phone Call Log and in the case file. It will also be documented in PIMS in the note section on child well being if the family beliefs preclude immunizations. Families/participants are linked to additional healthcare services and community services as needed. Family stress resulting from financial, psychological or social needs can interfere with good parent-child relationships. Therefore, as the parent s needs become known, FSWs will identify and connect families to additional services in the community. A. Home Visit Component 1. Part of the FSW s role is supporting families, which involves listening to their needs. Based on the information gathered through the assessment process, the development of the IFSP, home visits, results from the ASQ-3s, and communication with other service providers, families are linked to additional healthcare and community services for assistance in addressing those needs. 46

2. KCHS staff is expected to be well connected to the service community and responsible for maintaining information on programs and services that might be utilized by Healthy Start families. 3. FSWs must be aware of the family s capacities/abilities. Sometimes the FSW will be involved only in terms of providing referral information to the parent. Other times, the FSW may need to facilitate the referral by making the contact with the referral source and perhaps even taking the family to the first appointment. Some families are not able to initiate a call or need considerable handholding before being able to take more initiative. 4. When information is given or referrals are made, the FSW will follow-up with the family and/or the referral source to ensure connections happen and promote family follow-through. 5. Documentation of the referral and follow-up are made on Home Visit Logs and/ or similar data collection document. 6. Kent County Healthy Start s collaboration team includes representatives of many agencies. This collaboration assists with access to many supplementary support services and community resources that may be needed by the family as well. B. Phone Call Component 1. Part of the FSV s role is supporting families, which involves listening to their needs. Based on the information gathered through the assessment process, phone calls, and results from ASQ-3, families are linked to additional healthcare and community services for assistance in addressing those needs. 2. FSV s are expected to be well informed about the service community and responsible for maintaining information on programs and services that might be utilized by Healthy Start families. 4. Documentation of the referral will be made on Phone Call Logs and on the PIMS Referral Form. 47

Critical Element 8: Services are provided by staff with limited caseloads to assure that home visitors have an adequate amount of time to spend with each family/participant in order to meet their needs and plan for future activities. (i.e., for many communities, no more than 15 families per FSW on the most intense service level) Policy 8.1 (for CE 8.1a-c) Services are provided by staff with limited caseloads to assure that home visitors have an adequate amount of time to spend with each family/participant in order to meet their needs and plan for future activities. The number of families that each FSW serves comprises a caseload. Caseloads are limited in size to better facilitate intensive, individualized, and responsive services that correspond to family needs. Time spent with families encourages the development of strong, trusting, nurturing relationships between FSWs and the families they serve. These relationships are essential to the quality of home visiting services. A. Home Visit Component 1. Using the caseload system as described in Policy 4.1, each FSW will carry a maximum of 15 families when those families are being served at Level I. The maximum caseload size is no more than 25 families at any combination of service levels per full-time home visitor. 2. Caseload size is monitored in conjunction with the supervisor during weekly supervision and through completion of the Monthly Caseload Report. 3. In addition to caseload size, Healthy Start manages productivity by face to face home visit units. Per Healthy Start contracts, each full time Family Support Worker is to spend an average of 65 units (1 unit = 1 hour of face to face visit time)/month with families or average 15 units/week (a pro rata calculation will be done for all part time FSWs). This calculation is based on a 52 week year. Because staff do not work 52 weeks straight each year, FSWs must look at the 15 unit/wk. goal as base line, not a ceiling. There will be many weeks each year when FSWs should exceed the unit goal in an effort to account for vacation time, personal time off, etc. FSWs are also given 2.5 units of time devoted to parent groups provided at least one of their families attend the group (see policy 12). 4. Contract sites will be held to meeting 90% of the above productivity goal. For example, an FSW who has 15.26 units/week for 46 weeks will be in the 90% compliance zone. 48

5. Circumstances may arise when staff exceeds the caseload size of 15 at the most intensive level such as when a family moves from a less intensive level of services to a more intensive level of service or when a FSW leaves and it is necessary to distribute their caseload among existing FSWs. This practice should be temporary (3 months or less). Programs are encouraged to clearly document the reasons why the caseload has exceeded the limit and the expected duration of this deviation. Documentation will be made in the FSWs file during supervision explaining why the worker is over in caseload size and what the plan of action is to bring the caseload size back to 25 families or less. 6. Likewise, circumstances may arise when staff exceeds the caseload size of 25 (e.g., an FSW leaves and the caseload is dispersed among existing home visitors, etc). This practice should be temporary (3 months or less). Programs are encouraged to clearly document the reasons why the caseload has exceeded the limit and the duration of the deviation. Documentation will be made in the FSWs file during supervision explaining why the worker is over in caseload sized and what the plan of action is to bring the caseload down to 25 families or less. 7. Supervisors are sensitive to the FSW s caseload size and the FSW s ability to manage that caseload during supervision taking into account the following: Experience and skill level of the assigned FSW, Nature and difficulty of the problems encountered with families, Work and time required to serve each family, Number of families on the caseload that require more intensive intervention Travel and other non-direct service time required to fulfill the FSW s responsibilities Extent of other resources available in the community to meet the family s needs 8. After the initial seven months, each family s level is based on the intensity of services needed related to adequacy of parent-child interaction, the level of risk, family needs, and the use of other community resources 9. Movement from one level to another is determined by discussions between the FSW and supervisor during weekly supervision, and in discussion with the family. The discussion with the family will be documented on the Home Visit Record. When families are moved from one level to another, it will be documented in supervision notes. If a family changes levels it is noted in the Information Change section on the PIMS Home Visit Log and recorded in PIMS (see Policy 4.1 & 4.3). 10. Each Family Support Worker and Supervisor 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 (also 49

known as the Healthy Start Dashboard). This dashboard will be discussed during supervision and a copy turned in to the supervisor at the end of each month. Referrals will be assigned to workers based on their dashboard and the supervisor s assessment that the FSW has the capacity to serve a new case. B. Phone Call Component 1. Healthy Start Phone Call families have weighted values of less than.25 (per the chart in 4.1). Call loads will vary by volunteer preference and availability. 2. Family files are checked weekly by the Phone Call Supervisor for caseload and quality assurance. 50

Critical Element 9: Service providers should be selected because of a combination of personal characteristics (i.e., non-judgmental, compassionate, ability to establish a trusting relationship), their willingness to work with culturally diverse communities, and their skills to do the job. Policy 9.1 (for CE 9.1a) Program Management staff are selected based on a combination of personal characteristics, experience and educational qualifications. Program leaders set the tone and the context for how staff within KCHS will relate to each other and to families. The personal characteristics of leadership staff will, therefore, weigh equally important to the educational and experiential background of these individuals. A. The position of Program Coordinator of KCHS will be filled in compliance with all established Human Resources protocols for recruitment and selection of organization staff. B. The hiring of the Program Coordinator position will be subject to final authorization from the Chief Operating Officer at the Family Futures, to whom the Program Coordinator officially reports. C. Job responsibilities are detailed in an approved job description for the position and will include the following: A solid understanding of and experience in managing staff and the ability to understand and manage partner agencies Administrative experience in human service or related program(s), including experience in quality assurance/improvement and program development, Minimally a bachelor s degree in human services, psychology, child development, social work or a related field with a Master s degree in social work or a related field preferred. 51

D. Proper educational and experiential background is critical to the successful hiring of this position. As critical are the leadership traits and personal characteristics, including communication style and interpersonal skills of the individual selected. Policy 9.2 (for CE 9.1b) Program managers and supervisors are selected based on a combination of personal characteristics, and experiential and educational qualifications. Program supervisors provide guidance, education, emotional support and nurturance to FSWs and FSVs. Therefore, the personal characteristics of program supervisors will weigh as important as the educational and experiential background of these individuals. A. The positions of Program Supervisors will be filled in compliance with all established Human Resource protocols for recruitment and selection of organization staff. B. Based on the hiring process the Supervisor and Manager at the KCHS home visiting programs will be subject to final authorization for hiring, based on the recommendations noted in policy 9.1. C. Job responsibilities are detailed in approved job descriptions for this position and will include the following: A solid understanding of and experience in supervising and motivating staff, as well as providing support to staff in stressful work environments; Knowledge of infant and child development and parent-child attachment; Experience with family services that embrace the concepts of familycentered and strength based service provision; Knowledge of maternal-infant health and dynamics of child abuse and neglect; Experience in providing services to culturally diverse communities/families; Experience in home visitation with a strong background in prevention services to the 0-3 population; and, Minimally a bachelor s degree in human services, psychology, child development, social work or a related field with a Master s degree in social work or a related field preferred. D. Proper educational and experiential background is critical to the successful hiring of these positions. As critical are the leadership traits and personal characteristics, including communication style and interpersonal skills of the individuals selected. 52

Policy 9.3 (for CE 9.1c) Program staff who work directly with families are selected based on a combination of personal characteristics, experience, and educational qualifications. FSWs and FSVs must be able to work with diverse family types to meet their varying needs and must have empathic, non-judgmental, receptive personalities to establish rapport and build relationships of trust and respect with children and families to provide effective services. Family Assessment and Support Workers should have educational and/or experiential background in child health and development, early childhood education and care, parenting or human services. Personal characteristics may be the most important criteria for selecting home visitors (Wasik, 1993). A. Home Visit Component 1. Program staff whose responsibilities involve direct services to participant families will be employed by agencies contracted to provide Healthy Start services. Hiring decisions will be pursuant to established program contracts and consistent with established hiring protocols of the employing organization with final authorization of hiring decisions assumed by the employing organization. 2. Job responsibilities are detailed in approved job descriptions for these positions, and job descriptions for similar positions will be uniform across partner organizations to assure consistent position expectations program-wide. Job descriptions will include the following: Experience in working with or providing services to children and families; An ability to establish trusting relationships; Acceptance of individual differences; Experience and willingness to work with culturally diverse populations that are present among the program s target population; Knowledge of infant and child development; Ability to provide services during non-traditional business hours when necessary to accommodate each family s scheduling needs. 3. Educational and experiential background is important to the successful hiring of these positions. As critical and possibly even more so, are the personal characteristics, including communication style and interpersonal, relationshipbuilding skills of the individuals selected. 53

4. Supervisors at each agency, who are involved in the hiring of direct service positions for KCHS, will receive information to support their understanding of the position requirements B. Phone Call Component 1. FSVs whose responsibilities described in volunteer job descriptions involve direct and indirect service to participant families are recruited by Family Futures and then assigned to HSPC. 2. Educational and experiential backgrounds are important to the successful filling of these positions. Volunteers will be experienced parents or teachers, social workers, and others with related professional experiences or will have had at least one year of early childhood development education. As critical and possibly even more so, are the personal characteristics, including communication style and interpersonal relationship building skills of the individuals selected. Policy 9.4 Expectations/requirements that apply to students/interns or volunteers are the same as those that apply to direct service staff performing the same function. Any individual, including students or volunteers, providing direct services to families, is expected to possess the characteristics necessary for effective work with children and families. A. The KCHS program will accommodate students/interns in an enriched learning environment at both the Bachelor s and Master s levels. B. The KCHS Phone Call component will retain community volunteers for supplemental support services. C. Students/interns and volunteers will not be expected to perform the same function as FSWs. Their work with parents and children requires that they possess similar personal characteristics to be most effective and that they have close, regular supervision. D. Therefore, students/interns and volunteers will be interviewed prior to placement to assure the most appropriate fit. 54

E. Students/interns and volunteers are subject to the Human Relations Policies and Procedures of the agency for whom they work. Policy 9.5 (for CE 9.2) KCHS actively recruits, employs, and promotes qualified personnel. It administers its personnel practices without discrimination based upon age, sex, race, ethnicity, nationality, handicap, or religion of the individual under consideration. A diverse staff will be best equipped to work effectively with a diverse participant population. A. All agencies involved in the hiring of program staff will adhere to the requirements of the Equal Opportunity Employment Act. B. Discrimination of any kind is unacceptable. C. Staff diversity will be actively sought. D. Each partner agency will make available to KCHS a copy of their Equal Opportunity Policy, which will be maintained at Family Futures. Policy 9.6 (for CE 9.3a-b) KCHS s recruitment and selection practices are in compliance with applicable law or regulation, and KCHS conducts appropriate, legally permissible and mandated background inquiries into the background of prospective employees and volunteers who will have responsibilities where clients are children. The employing agency must do its part, to the extent possible, to protect vulnerable families with young children from individuals with known criminal record and/or prior history of child/abuse neglect, or prior history of criminal sexual conduct. A. The program s recruitment and selection process will include: a. Notification of its personnel of available positions before or concurrent with recruitment elsewhere 55

b. Utilization of standard interview questions that comply with employment and labor laws c. Verification of 2-3 references and credentials B. Each contract that is held with an organization for the purpose of employing KCHS direct services staff will stipulate the requirement for conducting legally permissible criminal background checks using the Internet Criminal History Access Tool (ICHAT), checking for history of being a perpetrator of child abuse and neglect using the Michigan Central Registry, and checking the Michigan and national sexual abuse registry. C. The same requirement will exist for volunteers or students who may work with KCHS. D. A copy of the completed background check will be maintained in the personnel file of the employing organization. E. For any new hire, employee, intern or volunteer who has not resided or lived in Michigan for each of the previous ten (10) years, the Contractor shall require the employee, new hire, intern, or volunteer to sign a waiver attesting to the fact that they have never been convicted of a felony or identified as a perpetrator, if they have, they must provide the nature and recency of the felony. F. KCHS shall not assign to duties any employee, new hire, volunteer, or intern based on a determination by the KCHS agency/sub-contractor that the results of a positive ICHAT, CR, NCIC response or reported criminal felony conviction or perpetrator identification make the individual ineligible to provide the services. The KCHS agency/sub-contractor may consider the recency and type of crime when making this determination. Contractors must inform Family Futures of any positive ICHAT, Central Registry and/or NCIC responses or reported criminal convictions or perpetrator identification for any staff or volunteers assigned to the Healthy Start Program. The Contractor must have a written policy describing the criteria on which its determinations shall be made and must document the basis for each determination. Failure to comply with this provision may be cause for immediate cancellation of the sub-contractor agreement. In addition, the Contractor must further have a written policy regarding acceptable screening practices of new staff members and volunteers who have direct access to participants and/or participant s personal information, which serve to protect the organization and its participants that is clearly defined. 56

Policy 9.6 3 (for CE 9.4) The rate of personnel turnover is measured and evaluated regularly, and action is taken to correct identified problems. A stable, qualified workforce is known to contribute to improved participant outcomes, with families more likely to be retained when staff is retained. In an effort to address staff satisfaction, members of the Healthy Start team will be given regular opportunities to provide feedback about their job and program satisfaction. As a result strategies to increase retention can be planned (based on data) and implemented with greater likelihood of success. A. On an ongoing basis, the KCHS site organizations will abide by organization personnel policies and procedures. B. Once every two years, staff will fill out an online survey regarding job and program satisfaction. Factors to be considered in the survey include: Role clarity, Acknowledgement of work performed, Satisfaction with salary and benefits, Reasonable workload, Autonomy, Opportunities for advancement and career development. C. Findings from the analysis will be used to develop a strategy and implement plans for staff retention. 3 57

Critical Element 10.1: The program has a comprehensive training plan that assures access and ongoing tracking and monitoring of required trainings in a timely manner for all staff (home visitors, assessment workers, and supervisors). Policy 10.1 Kent County Healthy Start has a comprehensive training plan that assures access and ongoing tracking and monitoring of required trainings in a timely manner for Family Support Workers (FSW), Family Assessment Workers (FAW), Supervisors and Family Support Volunteers (FSV). A comprehensive program training plan for Family Support Workers, Family Assessment Workers, Supervisors and Family Support Volunteers helps facilitate and grow staff competency for the purpose of consistent program delivery. FSW and FAW Training A. KCHS partner sites are responsible for ensuring each new FSW and FAW hire is appropriately trained according to HFA recommendations for content areas in a timely fashion. B. New FSW and FAW hires will receive site orientation according to their respective site protocol and/or direct supervisor. C. New FSW and FAW hires will utilize a uniform Program Training Log to track preliminary training and specific content areas. The Program Training Log also tracks the date of hire, first independent home visit, and first Ages & Stages Questionnaire use. D. It is the responsibility of the FSW and FAW to complete and maintain the Program Training Log and to capture supervisor sign-off of completed trainings. It is the responsibility of the supervisor to monitor completion of these trainings. Orientation and training should total 86.5 hours for all new staff. E. Once first-year training is completed, the Program Training Log will be archived by the FSW/FAW s supervisor according to each site s protocol. 58

F. Annually, program supervisors will update the Kent County Healthy Start Training Resource Binder to ensure training resources are current and relevant. The HFA Advisory Committee will annually review the Kent County Healthy Start Training Resource Binder and make recommendations as appropriate. G. KCHS staff that perform assessments and carry a home visitation caseload will be cross trained in both areas-hfa assessment and home visiting. FSV Training A. At the time of acceptance, each FSV in the Healthy Start Phone Call Component (HSPCC) will be provided with a written training plan detailing the orientation and training requirements. B. The HSPCC Manager will provide orientation/training materials to each FSV based on the new HSPCC Training Log to ensure timely receipt of all orientation and training requirements. C. It is the responsibility of the FSV to complete and maintain the HSPCC Training Log and to capture the HSPCC Manager s sign-off of completed trainings. It is the responsibility of the HSPCC Manager to monitor completion of the trainings. D. Initial orientation training will be documented in PIMS and in the HSPCC Phone Call Volunteer Training binder. E. Training completed in the community on the aforementioned topics will be counted toward the professional development requirements at the HSPCC manager s discretion. 59

Critical Element 10.2: Staff (assessment workers, home visitors and supervisors), receive orientation prior to direct work with families to familiarize them with the functions of the program. Policy 10.2a Kent County Healthy Start Family Support Workers (FSWs), Family Assessment Workers (FAWs), Supervisors, and Family Support Volunteers (FSVs) will be oriented to their roles as they relate to the program s goals, services, policies and operating procedures (including forms, evaluation tools and data collection), and philosophy of home visiting/family support prior to direct work with families or supervision of staff. To ensure consistent, quality programming and to impact participating families positively, program staff should be competent and confident in their ability to perform their job responsibilities. Ultimately, Healthy Start staff needs to help parents build a positive relationship with their children, be positive role models for their children, and to effectively parent. This includes being able to respond to the unique characteristics of the community of families they are serving, to effectively connect participants to relevant local resources and to appropriately report child abuse and neglect. FSW Training A. New FSWs and supervisors will receive one-on-one program and job-specific orientation with their direct supervisor before working independently with families. They will also receive site-specific orientation and training. B. Orientation will include, but not be limited to, learning the goals, services, policies and procedures of the Kent County Healthy Start program. C. Orientation will include, but not be limited to, training in completion of all programrelated documentation. D. New FSWs and supervisors will receive a copy of the current Kent County Healthy Start Policy and Procedure Manual during orientation and sign that they have received it.. E. New FSWs will shadow experienced colleagues from their respective sites on home visits to observe and participate as appropriate before working independently with families. 60

FSV Training A. New FSVs will receive one-on-one program and job-specific orientation with their manager before working independently with families. They will also receive sitespecific orientation and training. B. Orientation will include, but not be limited to, learning the goals, services, policies and procedures of the Kent County Healthy Start program. C. Orientation will include, but not be limited to, training in completion of all programrelated documentation. D. New FSVs will receive a copy of the current Kent County Healthy Start Policy and Procedure Manual during orientation and sign that they have received it. E. New FSVs will shadow experienced colleagues from their respective site on phone calls to observe and participate as appropriate before working independently with families. Policy 10.2b Kent County Healthy Start Family Support Workers (FSW), Supervisors, and Family Support Volunteers (FSV) will be oriented to the program s relationship with other community resources prior to direct work with families. Being able to effectively link and refer families to relevant, local community resources helps support parents in meeting their concrete needs, their mental needs when necessary, and treatment needs when necessary. A. New FSWs, supervisors, and FSVs will receive a current edition of the Family Resource Guide from their Supervisor. B. New FSWs will make contact with area, community agencies that provide relevant programs and services for families and children in Kent County. New employees are expected to complete independent research on community programs and services as directed by their supervisor. 61

Policy 10.2c Kent County Healthy Start Family Support Workers (FSW), Family Support Volunteers and Supervisors will be oriented to child abuse and neglect indicators and reporting requirements prior to direct work with families. Child abuse and neglect law requirements and orientation: Based on the law in the state of Michigan, individuals are required to report under this act as follows: (a) A physician, dentist, physician s assistant, registered dental hygienist, medical examiner, nurse, person licensed to provide emergency medical care, audiologist, psychologist, marriage and family therapist, licensed professional counselor, social worker, licensed master s social worker, licensed bachelor s social worker, registered social service technician, social service technician, a person employed in a professional capacity in any office of the friend of the court, school administrator, school counselor or teacher, law enforcement officer, member of the clergy, or regulated child care provider who has reasonable cause to suspect child abuse or neglect shall make immediately, by telephone or otherwise, an oral report, or cause an oral report to be made, of the suspected child abuse or neglect to the Department of Human Services (Department). Within 72 hours after making the oral report, the reporting person shall file a written report as required in this act. If the reporting person is a member of the staff of a hospital, agency, or school, the reporting person shall notify the person in charge of the hospital, agency, or school of his or her finding and that the report has been made, and shall make a copy of the written report available to the person in charge. A notification to the person in charge of a hospital, agency, or school does not relieve the member of the staff of the hospital, agency or school of the obligation of reporting to the Department as required by this section. One report from a hospital, agency, or school shall be considered adequate to meet the reporting requirement. A member of the staff of a hospital, agency, or school shall not be dismissed or otherwise penalized for making a report required by this act or for cooperating in an investigation. Home Visit Component and Phone Call Component A. New FSWs, FSVs and Supervisors will be responsible for attending the first available Mandated Reporter Training through either Family Futures or Department of Human Services/Child Protective Services prior to independent work with families. B. Supervisors will discuss child abuse and neglect indicators and reporting procedures according to their site s protocol during supervision as appropriate with FSW/ FSV 62

staff. New hires are encouraged to discuss their observations and ask questions on this topic with their supervisor. C. Sites will ensure that Mandated Reporter Training resources are kept up-to-date and will encourage refresher trainings for FSW/FSVs as appropriate. Policy 10.2d Kent County Healthy Start Family Support Workers (FSW), Supervisors, and Family Support Volunteers (FSV) will be oriented to issues of confidentiality prior to direct work with families. Respecting and maintaining confidentiality regarding program participants helps ensure quality programming and builds trust between program staff and families. A. New FSWs, Supervisors and FSVs will be oriented to KCHS confidentiality protocol by their supervisor and site-specific confidentiality protocol by their site administrator. FSWs, Supervisors and FSVs will read and sign a confidentiality agreement form before working independently with families. B. Supervisors will address confidentiality with FSWs, and FSVs during supervision as appropriate. Policy 10.2e Kent County Healthy Start Family Support Workers (FSW), Supervisors, and Family Support Volunteers (FSV) will be oriented to issues related to boundaries prior to direct work with families. Program staff and volunteers should understand how appropriate boundaries are beneficial and important for both staff and participants to ensure an effective, safe, respectful, and professional working relationship. A. New FSWs, Supervisors, and FSVs will be trained in appropriate boundaries in their work with families via their Supervisor or a community training opportunity prior to working independently with families. 63

B. Supervisors will address appropriate boundaries with FSWs and FSVs during supervision as appropriate. Critical Element 10.3: Staff (assessment workers, home visitors and supervisors) receives intensive role specific training within six months of date of hire specific to their role within the home visitation program to help them understand the essential components of their role within the program. Policy 10.3a Kent County Healthy Start Family Support Workers (FSW) will receive intensive role specific assessment training, by a certified trainer who has been trained to train others to understand the essential components of his/her role as an assessment worker. Kent County Healthy Start Family Support Workers (FSW) will receive intensive role specific, home visitor training by a certified trainer who has been trained to train others to understand the essential components of his/her role as a home visitor. Formal training develops the knowledge and skills necessary to achieve program goals. It prepares staff to assess family needs, assist with parent-child interaction, provide appropriate information, assess needs and connect families with appropriate resources, and meet certain standards of service delivery. Home Visit Component Only A. New FSWs will receive role-specific, assessment training via Healthy Families America as soon as possible from their hire date. B. New FSWs will receive role-specific, home visitation training via Healthy Families America as soon as possible from their hire date. C. FSWs are responsible for appropriately documenting role-specific training completion in the Program Training Log, and Supervisors are responsible for monitoring training completion (Policy 10.1). 64

Policy 10.3b Kent County Healthy Start Supervisors will receive intensive role specific supervisory training, by a certified trainer who has been trained to train others to understand the essential components of his/her role as a supervisor, as well as the role of family assessment and home visitation. Formal training develops the knowledge and skills necessary to achieve program goals. It prepares staff to assess family needs, assist with parent-child interaction, provide appropriate information, assess needs and connect families with appropriate resources, and meet certain standards of service delivery. Home Visit Component Only A. New Supervisors will receive role-specific supervisory training via Healthy Families America as soon as possible from their hire date. B. Supervisors are responsible for appropriately documenting role-specific training completion in the Program Training Log (Policy 10.1). Policy 10.3d Kent County Healthy Start Family Support Volunteers (FSV) will receive role specific phone call component training, by the HSPCC Manager to understand the essential components of his/her role as an FSV, as well as the role of phone call volunteers in supporting participants. Role specific training develops the knowledge and skills necessary to achieve program goals. It prepares staff to assess family needs, assist with parent-child interaction, provide appropriate information, assess needs and connect families with appropriate resources, and meet certain standards of service delivery. A. New FSVs will receive role-specific supervisory training from the HSPCC Manager as soon as possible from their date of acceptance. 65

B. New FSVs will shadow a minimum of two hours of support calls to program participants with an experienced FSV and/or HSPCC Manager before working independently with families. An additional two hours of shadowing may be required for new FSVs at the discretion of the HSPCC Manager. C. New FSVs will complete a minimum of two hours of phone calls under the HSPCC Manager s supervision before working independently with families. D. FSVs are responsible for appropriately documenting role-specific training completion in the Program Training Log, and the HSPCC Manager is responsible for monitoring training completion (Policy 10.1). Policy 10.4a Kent County Healthy Start Family Support Workers (FSW) and Family Support Volunteers (FSV) will receive training on a variety of topics necessary for effectively working with families and children within six months of the date of hire or acceptance. Training on relevant family support topics in a timely manner will provide staff with the knowledge and skills necessary to assess issues and concerns with families and to share appropriate information accordingly. A. New FSWs, supervisors and FSVs will be responsible for completing training on a variety of Infant Care topics within six months of hire. Topics should include, but are not limited to: sleeping, infant feeding, physical care of babies, crying and comforting the baby. B. New FSWs, supervisors and FSVs will be responsible for completing training on a variety of Child Health and Safety topics within six months of hire. Topics should include, but are not limited to: home safety, shaken baby syndrome prevention, SIDS/SUIDS, seeking medical care, well-child visit/immunizations, finding quality childcare, car seat safety, and failure to thrive. C. New FSWs, supervisors and FSVs will be responsible for completing training on a variety of Maternal and Family Health topics within six months of hire. Topics should include, but are not limited to: family planning, nutrition, pre-/post-natal health, prenatal/post-partum depression. D. New FSWs, supervisors and FSVs will be responsible for completing training on a variety of Child Development topics within six months of hire. Topics should include, but are not limited to: language and literacy development, physical and emotional 66

development, developmental delays, and brain development. E. New FSWs, supervisors and FSVs will be responsible for completing training on the Role of Culture in Parenting topics within six months of hire. Topics should include, but are not limited to: working with diverse populations/cultures, culture of poverty, values clarification. F. New FSWs, supervisors and FSVs will be responsible for completing training on a variety of Supporting the Parent-Child Relationship topics within six months of hire. Topics should include, but are not limited to: attachment, positive parenting, discipline, parent-child interactions, working with difficult relationships. G. Training may include, but is not limited to, community education trainings, seminars, workshops, videos, reading materials, and/or self-study. Employees may also refer to the Kent County Healthy Start Training Resource Binder and Healthy Start Curriculum binder as needed. The FSW supervisor and FSW will work with their respective supervisors to determine the most effective method of obtaining training and acquiring content knowledge. H. If an FSW, supervisor or FSV has prior experience or has completed formal education or training on any of the topics in Policy 10.4a within three years of hire into the program, it may satisfy the HFA training requirement for this topic at their supervisor s discretion. I. New FSWs, supervisors and FSVs are responsible for appropriately documenting training completion in the Program Training Log, and Supervisors are responsible for monitoring completion (Policy 10.1). Policy 10.4b Kent County Healthy Start Family Support Workers (FSW) and Family Support Volunteers (FSV) will receive training on a variety of topics necessary for effectively working with families and children within twelve months of the date of hire or acceptance. Training on relevant family support topics in a timely manner will provide staff with the knowledge and skills necessary to assess issues and concerns with families and to share appropriate information accordingly. 67

Home Visit Component A. New FSWs and supervisors will be responsible for completing training on Family Violence topics within twelve months of hire which should include, but are not limited to indicators of family violence, dynamics of domestic violence, intervention protocols, strategies for working with families with domestic violence issues, effects of domestic violence on children, and referral resources for domestic violence. B. New FSWs and supervisors will be responsible for completing training on a variety of Substance Abuse topics within twelve months of hire. Topics should include, but are not limited to: etiology of substance abuse, culture of drug use, working with families with substance abuse issues, smoking cessation, alcohol use/abuse, fetal alcohol spectrum disorder, street drugs, and resources. C. New FSWs and supervisors will be responsible for completing training on a variety of Child Abuse and Neglect topics within twelve months of hire. Topics should include, but are not limited to: etiology of child abuse and neglect, working with survivors of abuse. D. New FSWs and supervisors will be responsible for completing training on a variety of Staff Related topics within twelve months of hire. Topics should include, but are not limited to: stress and time management, preventing burnout, personal safety, ethics, crisis intervention, emergency protocols. E. New FSWs will be responsible for completing training on a variety of Family Issues topics within twelve months of hire. Topics should include, but are not limited to: life skills management, engaging fathers, multi-generational families, teen parents, relationships, and HIV/AIDS. F. New FSWs and supervisors will be responsible for completing training on a variety of Mental Health topics within twelve months of hire. Topics should include, but are not limited to: promotion of positive mental health, behavioral signs of mental health issues, depression, working with families with mental health issues, resources. G. Training may include, but is not limited to, community education trainings, seminars, workshops, videos, reading materials, and/or self-study. Employees may also refer to the Kent County Healthy Start Training Resource Binder and Healthy Start Curriculum binder as needed. The FSW supervisor and FSW will work with their respective supervisors to determine the most effective method of obtaining training and acquiring content knowledge. H. If an FSW, supervisor or FSV has prior experience or has completed formal education or training on any of the topics in Policy 10.4a within three years of hire 68

into the program, it may satisfy the HFA training requirement for this topic at their supervisor s discretion. I. New FSWs, supervisors and FSVs are responsible for appropriately documenting training completion in the Program Training Log and Supervisors are responsible for monitoring completion (Policy 10.1). Phone Call Component A. New FSVs will be responsible for completing training on Family Violence topics within twelve months of acceptance which should include, but are not limited to indicators of family violence, effects of domestic violence on children, and referral resources for domestic violence. B. New FSVs will be responsible for completing training on Substance Abuse within six months of acceptance which should include, but is not limited to referral resources for substance abuse. C. Training may include, but is not limited to, community education trainings, seminars, workshops, videos, reading materials, and/or self-study. Employees may also refer to the Kent County Healthy Start Training Resource Binder as needed. The FSV will work with their supervisor to determine the most effective method of obtaining training or acquiring content knowledge. D. If a FSV has prior experience or has completed formal education or training on Substance Abuse within three years of hire into the program, it may satisfy the training requirement for this topic at their supervisor s discretion. E. New FSVs will be responsible for completing training on Staff Related topics within six months of acceptance which should include, but are not limited to boundaries and emergency protocols. F. New FSVs are responsible for appropriately documenting Substance Abuse training completion in the Program Training Log, and Supervisors are responsible for monitoring completion (Policy 10.1). Policy 10.5 Kent County Healthy Start Family Support Workers (FSWs) will build caseload capacity on a gradual basis during their first four months from date of hire in an effort to aid in role specific training. RATIONAL In the first month after hire, there is agency specific training, but often FSWs are not able to get into Healthy Families America role specific training right away. As a result, a 69

gradual building of caseload (as proposed/approved below) is a valuable teacher for a new Family Support Worker with in Healthy Start. In an effort to gradually build new worker caseload and to train a new worker effectively, the following case capacity guidelines should be followed: Month One: Assign 3-5 cases to the worker s caseload. Month Two: Assign an additional 1.5 cases/week for a maximum total caseload of 10 cases. Month Three: Assign an additional 1.5 cases/week for a maximum total caseload of 15 cases. Month Four: Assign 1.5 new cases each week until worker reaches full case capacity. Exception to above policy: When Healthy Start has a waiting list, supervisors will work to decrease the length of time it takes for a new worker to reach a full caseload. However, case assignment will still be done respecting the experience level and readiness of the new worker to take cases, their specific training needs, and the need to ensure quality service provision. 70

Critical Element 10.6: The program ensures that program staff receives ongoing training which takes into account the worker s knowledge and skill base. Policy 10.6 Kent County Healthy Start ensures that Family Support Workers (FSW), Family Assessment Workers (FAW), Supervisors and Family Support Volunteers (FSV) receive ongoing training which takes into account their knowledge and skill base. Content training and professional development beyond new hire orientation and training enhances program staff s ability to consistently deliver quality services while adapting to the changing needs of the family and community at large. A. Program staff and their Supervisor will identify additional training opportunities or needs to enhance program delivery or provide professional development of the FSW, and supervisor. This determination is based upon worker knowledge, skill base, and interest as well as on the issues facing families within the community served. B. Through annual performance review processes program staff together with their supervisor will determine if and how ongoing training or professional development may help staff reach their long-term goals. Ongoing training hours should total 32 hours each year. 71

Critical Element 11/12: Service providers should receive ongoing, effective supervision so that they are able to develop realistic and effective plans to empower families to meet their objectives; to understand why a family may not be making progress and how to work with the family more effectively; and to express their concerns and frustrations to see that they are making a difference and to avoid stress-related burnout. Policy 11.0 (for CE 11.1a-c) KCHS ensures that direct service staff and supervisors receive regular, ongoing supervision and that direct service staff, supervisors, and program managers are provided with skill development professional support and held accountable for the quality of their work. Supervision indirectly benefits families by enhancing the quality of home visiting services. It helps direct service staff maintain perspective, evaluate their performance and encourage personal and professional development, learn new strategies to effectively work with families, and ultimately enhance the quality of services families receive. A supervisor s primary role is to create an environment that encourages staff to grow and change, provides motivation and support, maintains ideals, standards, quality assurance and safety, and facilitates open, clear communication. Additionally, supervision promotes both staff and program accountability and reduces staff burnout and turnover by providing much needed support. A. Home Visit Component 1. Full-time FSWs will participate in regular, individual supervision that will be scheduled on a weekly basis for a minimum of 1½ hours. Supervisory sessions should not be split into more than two regularly scheduled sessions per week for FSWS. Part-time FSWs will receive a minimum of 1 hour of supervision each week. Supervisors will receive individual supervisory support on a monthly basis from the Program Director. 2. Program staff will also receive support through regular full team meetings. All program supervisors will also meet as a group on a monthly basis. 3. Supervisors will document the dates and duration of supervision sessions on the Supervision Log, in addition to a summary of the content of the supervisory session. 72

4. Case documentation will be reviewed regularly by supervisors following submission by direct services staff. 5. Supervisors will provide orientation and training support to new staff and will accompany a home visitor on a home visit during the first three months of working with families. Additional shadowed home visits will be provided regarding implementation of the Healthy Start curriculum and as needed thereafter, with a minimum of one shadowed visit occurring each year. 6. A full-time program Supervisor will supervise no more than 6 FTE FSWs. 7. Supervisors will ensure that direct service workers receive the necessary skill development to continuously improve the quality of their performance and are held accountable for the quality of their work. Procedures may include a variety of mechanisms such as: Coaching and providing feedback on strength-based approaches and interventions used Shadowing Reviewing IFSP progress and process including level changes Discussing family retention and attrition Providing feedback on documentation Integrating results of tools used such the ASQ-3 and the PFS with working with the family Integrating quality assurance results that include regular and routine review of assessments, home visitor records and all documentation used by the program Discussing assessment/home visit standards of promptness and productivity rates Assisting staff in implementing new training into practice Assessing cultural sensitivity/practices Ensuring use of curriculum and providing guidance on use of curriculum Identifying areas for growth Identifying and reflecting on potential boundary issues Sharing of information related to community resources 8. In addition to individual supervision, professional support is provided to direct service staff to continuously improve the quality of their performance through: Regular staff meetings that include an agenda and minutes Open door policy with supervisors On call availability for supervisory consultation to FSWs Provision of tools for performing job Scheduling flexibility Acknowledgement of performance 73

9. Supervisors will be available to respond to families who express concerns regarding services and will document discussions with the FSW and family in supervisory notes in order to resolve the issue. 10. Supervisors will be aware of each agency s personnel policies and will support staff s adherence to their respective agency s policies. 11. Supervisors are held accountable for the quality of their work, receive skill development and professional support through a variety of mechanisms such as: Addressing personnel issues Feedback and reflection to supervisors regarding team development and agency issues Review of program documentation including productivity, standards of promptness and fidelity to the Healthy Families America Model Review of progress toward meeting program goals and objectives Strategies to promote professional development/growth 12. The KCHS program manager/coordinator is held responsible for the quality of his/her work by the Chief Operating Officer of Family Futures. This occurs through review of program data, strategizing for program improvement, and reviewing skill development and provision of professional support. B. Phone Call Component 1. FSVs will participate in yearly supervisory reviews to assess progress and development of phone calls skills. 2. FSVs will participate in quarterly supervisory and professional development meetings. If the FSV cannot attend the scheduled meeting, an individual training session of no less than ½ hour will be scheduled and provided. Should additional supervision be necessary, supervisors are available to assist FSVs. 3. Supervisors will document the dates and duration of supervision sessions on the Supervision Log, in addition to a summary of the content of the supervisory session. 4. FSVs can utilize the PIMS Intake Reminder Worksheet to assist in maintaining documentation standards. The FSV assumes responsibility for accuracy; however, family files are checked weekly by the Phone Call Supervisor for caseload and quality assurance. 5. Supervisors will provide orientation and training support to new volunteers and will shadow a number of phone calls during the first three months that the volunteer is working with families. 74

Additional Kent County Healthy Start Policy and Procedures (The following policies and procedures have been put in place by Kent County Healthy Start s Continuous Quality Improvement Team and are not a requirement of Healthy Families America Accreditation) Policy 12: Healthy Start Parent Groups As stated in their contract, each Kent County Healthy Start home visit partner agency is expected to provide parent groups for the families being served by their agency. These groups are to be held on a monthly basis and count for the following in regards to productivity: For families in attendance who are on Level 1, Healthy Start Groups can count for one (1) home visit of the four required in the month. There is no limit in the number of Level 1 clients an FSW can bring to a group. They will receive HOME VISIT credit for each level 1 family in attendance. Each Family Support Worker in attendance at Healthy Start Parent Groups will receive unit credit of 2.5 HOURS (or units) no matter the number of families in attendance. Policy 13: Healthy Start n180 Transition Policy From time to time, policies and procedures need to be established based on the needs of a Healthy Start funding source. The following policy and procedure has been put in place at Arbor Circle: All Arbor Circle n180 families (aka Healthy Start Skills families) will sign an initial agreement that states that Healthy Start services through this funding source only lasts 12 months and that at the end of the 12 months, the case will need to move from Healthy Start Skills to traditional Healthy Start. This agreement will be reviewed at the 9 month mark so that families continue to be aware of the possibility of a switch in worker. When a case closes out of Healthy Start Skills (n180), ideally the family would switch funding but stay with the same worker. If this is not an option, the following would occur: o Flip to 0-3 funding but switch workers within Arbor Circle o Flip to another funding source and move to another agency who has an opening 75

If/when the case has to switch workers or agencies then the new worker and the original worker would visit the family together at the 9 month mark. Paperwork would transfer hands at case closing with the original worker writing up a one page summary of the family s background and any additional helpful information. The Healthy Start Coordinator will be emailed on all case worker/agency changes. If there is not an opening at Arbor Circle and the case has to move to another site, then the Healthy Start Coordinator will be emailed to assign the case for transfer. If there is a waiting list, the family will be offered the option to wait on our waiting list for up to 30 days while receiving support of the phone call component. 76

Healthy Start Results Based Accountability (RBA) Standards Policy 14: Healthy Start Process Goals We will track the following on a monthly basis: 1. Number of families served in Kent County Healthy Start. 2. Percentage of families having an assessment home visit within 14 days of referral to home visit partner site. Goal 65% of families will have an assessment visit within 14 days of referral 3. Percentage of families who have their first home visit within 11 days of assessment visit Goal 80% of families will have their first home visit within 11 days of the assessment visit. 4. Percentage of families who terminate from Healthy Start services based on one of the following reasons: Participant graduated (target child is 3 yrs old and family met all program goals) Participant met IFSP goals/mutual decision to close Participant met IFSP goals and had 24 or more home visits Goal 75% of families will terminate the Healthy Start program for one of the above reasons. We will provide feedback in the following areas for study, evaluation, and goal setting: Domestic violence Family income Breastfeeding rates Safe sleep Smoking around the child Use of birth control 77

Policy 15: Healthy Start Outcome Goals Kent County Healthy Start will use results based accountability to monitor the progress of the following goals: The services provided by the Contractor under the current contractual Agreement shall be evaluated by the Agency on the basis of the following outcome and output criteria: a) Ninety-eight percent (98%) of all families will complete the Ages and Stages Questionnaire with their FSW at the required intervals. b) 100% of children with suspected developmental delays as identified by the Ages and Stages Questionnaire will be provided referrals to appropriate services which are documented in the case record. c) 95% of families referred for services due to a suspected developmental delay will follow through on those referrals with the assistance of their FSW. d) 100% of families referred for other services due to suspected developmental delays will have in their case record documentation of how the family followed through on that referral. If the family, connected with services, there will be clear documentation of what services are being received and the effect of those services on the child s development. e) 95% of families enrolled in the program will have a primary health care provider. f) 95% of target children will receive on time age appropriate immunizations as recommended by the American Academy of Pediatrics. g) 95% of women who become pregnant will begin prenatal care in the first trimester and will receive the American College of Obstetricians and Gynecologists recommended number of prenatal visits. h) 95% of families will not have a Category 1 or 2 disposition (Substantiated Report) of child abuse or neglect while enrolled in the program. i) 95% of parents responding to satisfaction surveys will report that their parenting improved as a result of participating in the program. j) 100% of FSW s will average 15 face-to-face client contacts each week. k) During their enrollment in Healthy Start, families will receive the number of home visits appropriate to their Healthy Families America Service level. l) 90% of the families referred to the Healthy Start program after assessment will engage in services for at least 18 months. 78

GOVERNANCE AND ADMINISTRATION Governance and Administration (Credentialing Standard): KCHS is governed and administered in accordance with principles of effective management and ethical practice. Policy GA1: The program has a broadly-based, advisory/governing group which serves in an advisory and/or governing capacity in the planning, implementation, and evaluation of program related activities. Advisory/governing groups serve an important function in community-based agencies in that they can be advocates for the program in the community and represent the program and agency in other venues and settings, resulting in more recognition and visibility. Community advisory/governing group members can bring to the program different skills and perspectives than might be present within program staff. 1. KCHS is a partnership between various agencies, but coordinated by Family Futures. The coordination provided by Family Futures includes: Seeking funding for KCHS Advocating with our partners for KCHS in the community and with government Using results based accountability both within the Partners Meeting of agency management staff and at Continuous Quality Improvement meetings to hold KCHS accountable for quality programming, adherence to the Healthy Families America model and standards, and to serving our target population for home visiting while providing universal parenting support through the phone call component Ensuring that KCHS is both represented well in various community collaboratives supporting early childhood, school readiness, and the prevention of child abuse and neglect and ensuring that KCHS is cognizant about the work of early childhood in the community and coordinating our work with various community initiatives. 2. The KCHS Partner s Meeting is a meeting of the management of the partner agency at the executive and upper management level. This group meets regularly and reviews the total Kent County Healthy Start budget, makes decisions regarding staffing, provides final approval of recommendations coming from the Continuous Quality Improvement Committee, reviews annual participant 79

satisfaction, and is responsible to ensure that KCHS provides quality programming that meets the outcomes set. 3. KCHS as a program is under the Kent County Prevention Initiative (KCPI). Primarily, KCPI evaluates prevention programming in Kent County using an independent evaluator, SRA International. The evaluation is a long-term evaluation that uses a matched cohort for evaluation purposes as well as providing key feedback annually on selected demographics, outcomes, and program processes. 4. The KCHS is involved with numerous community collaboratives that provide feedback about our work in the community, provide new information to inform our work, and ensure that we are working collaboratively in the community with other home visitation programs. These collaboratives, representing a broad diversity of disciplines, community members, and personal experiences, include: Kent County Family and Children's Coordinating Council- The Mission of the Coordinating Council is to provide leadership to enhance the well being of children, youth, and families in Kent County so that they may achieve their greatest potential. It works for service coordination in Kent County. Great Start Collaborative-The Great Start Collaborative is working to develop a system of support services for Kent County children, ages 0-5, and their families. Its vision is that every young child in Kent County will enter kindergarten ready to succeed in school and in life. Infant-I-Team- The role of the Infant Health Implementation Team is to ensure optimal health for all children in Kent County by improving and providing quality care during the prenatal, infant, and childhood periods. It has developed a set of core concepts for prenatal care for our community and provides practical tools to guide the work of intervention prenatally and during early childhood. Sub-committees of this team include-dad s Count, Safe Sleep, Racial Encounters in Health Care, Breastfeeding Task Force, Perinatal Mood Disorders Coalition, Prenatal and Infant Core Concepts, Pregnancy Prevention Committee, and Drug-Exposed Infant Committee. Policy GA-2A: Participant Involvement in Program Planning and Evaluation (for GA 2a) KCHS offers families opportunities to provide feedback to the program through the use of formal mechanisms. The recipients of service are often in the best position to lend guidance to the planning, implementation and evaluation of program services and their input is highly regarded. 80

1. On an annual basis, Family Futures will facilitate the completion of participant satisfaction surveys to all program participants. 2. The results of all completed surveys will be compiled in a summary report. 3. Survey results will be shared with program staff, agency supervisors and Executive Advisory Board members. 4. Recommendations for action based on participant feedback will be discussed and any necessary steps taken to improve quality of program services. 5. KCHS will use focus groups to illicit specific feedback from participants on a variety of topics such as the curriculum, engagement of families by FSWs, the assessment process, etc. There will be at least one topical focus group annually, but more may be utilized to obtain specific feedback as desired by the Partner s Group or the Continuous Quality Improvement Committee (CQI). Feedback from focus groups will be reviewed by CQI, with recommendations than being forwarded to the Partner s group for final approval before implementation. Policy GA-2B: Participant Grievances (for GA 2b) KCHS has a policy for receiving and reviewing participant grievances. It is important that families know how to communicate any complaint or negative experience they may have with program services so that the complaint or negative experience may be resolved whenever possible, so that program improvement may occur when necessary, and appropriate action taken. 1. Families are informed at the time of enrollment, that any questions, complaints or grievances they may have can be directed to their FSW or whoever is determined by the partner agency policy. The phone number for the Healthy Start Coordinator is also given. Families retain a copy of this document after signing. 2. If a family informs their FSW of a complaint or grievance, the FSW will immediately notify his/her respective supervisor. 3. The supervisor will follow their agency s policy to resolve the complaint or grievance. If the complaint or grievance poses risk to the reputation of KCHS within the 81

community, the supervisor immediately will inform the KCHS coordinator. The KCHS Coordinator will consult with the Chief Operating Officer of Family Futures to determine if a Partner meeting needs to be convened to discuss the situation and determine both how to resolve the specific grievance and how to respond to concerns about KCHS services within the community. 4. If the agency is able to successfully resolve the complaint or grievance following their agency s policies, the supervisor will report the complaint or grievance and how it was resolved in an attachment to their monthly report. 5. The KCHS Coordinator will compile the grievances/complaints that are received and retain them without participant identifiers in the file. When as a result of a grievance/complaint, program improvements are needed, a recommendation will be brought to CQI. CQI will review that recommendation for improvement making any needed changes or adjustments. The final recommendation will be brought to the Executive Partners level for final approval. Policy GA-3: Analysis of Program Quality, Goals and Objectives and Participant Satisfaction (for GA 3a-b) KCHS reviews and analyzes the progress towards its goals and objectives through its Continuous Quality Improvement (CQI) committee which meets monthly. CQI analyzes participant satisfaction, performs a quality assurance review of program components, and has a follow-up mechanism to address areas for improvement identified during the review process. KCHS will take action on an ongoing basis to evaluate the effectiveness of all components of program operations to continuously improve the quality of services offered to families. 1. CQI monitors and evaluates the quality of Healthy Start Services. Monthly, the CQI team, which is composed of mid-managers and supervisors from all partner agencies, review the following using a results based accountability format: Worker productivity Fidelity to the HFA level system in the number of visits to families matching their service level Standards of promptness in relationship to date of referral to date of assessment and date of assessment to date of first home visit. Areas that are not meeting the desired outcome are worked on and tracked for improvement. 82

2. CQI also monitors service quality through: Ensuring use of curriculum Discussion of best practice, of any issues or problems that supervisors are experiencing, and any issues the target population is experiencing Sharing and discussion of data on engagement, retention, and quality and quantity of supervision. 3. CQI is responsible for reviewing the results from the annual satisfaction surveys and taking into account areas in need of improvement. Areas of improvement may be formulated into a program improvement plan. 4. Annually, both CQI and the Partner s meeting will review the results from the SRA evaluation and address any concerns that are identified paying particular attention to outcome achievement. If the targeted outcome is not reached, a program improvement plan may be formulated depending on how far the outcome is from the target. 5. Routine analysis of progress toward program goals and objectives will also occur as required on a quarterly basis by program funders. These quarterly reports are distributed to both CQI and Partners and will be discussed in relationship to quality and process. Policy GA-4: Review of Research Proposals (for GA 4.0) KCHS has procedures for reviewing and recommending approval and denial of research proposals, whether internal or external, which involve past or present participants. To provide a definition of when a project is considered research, and to provide principles that ensure any research request or proposal for study of past or present program participants, is subject to formal and thorough review by the Partners Meeting and meets all policy requirements. 1. Research is broadly defined to include any collection of data by questionnaire, chart review, contact with program participants or experimental protocol which is being used to test a hypothesis or for the purpose of program evaluation. 2. Research proposals will be submitted for consideration to KCHS s Partners. The research proposal will detail the focus or hypothesis of the study, the number of subjects to be included, the geographic region from which study participants will be drawn, the length of the study, listing of all measurement tools to be used, the role 83

and responsibilities of all research staff and any intended role of program staff. KCHS will reserve the right to review all publications and presentations based on KCHS research before they are published or presented. 3. Any research involving KCHS participants or KCHS program data must be approved by the KCHS Partners and must be performed in accordance with the rules of research as defined by the Department of Health and Human Services. KCHS participants must be informed that they are part of a research project, given opportunities to provide informed consent, and be given opportunities as is appropriate to not participate. 4. The Partners will review the proposal for compatibility with the program s mission, and consistency with efforts to achieve and define best practices. 5. Information shared by researchers will typically be aggregate in nature and always protect the privacy and confidentiality of program participants. 6. The Partners can request prior to approval an in-person presentation by the Principal Investigator. 7. A research proposal must be unanimously approved by the Partners. Policy GA-5: Protection of Participant Privacy (for GA 5a-b) Policy GA-5A Before or on the first assessment home visit, the family/participant is informed about their rights, including confidentiality, both verbally and in writing. Parents sign a consent form every time information is to be shared with a new external source. Parents are assured of participant privacy and voluntary choice with regard to research conducted by or in cooperation with the program. It is important for a parent to make a fully informed choice about participating in program services, so, at the time of assessment, families will be informed of their rights, both verbally and in writing, through the KCHS Participant Agreement. KCHS values a family-centered approach to service delivery which requires that practices reflect a profound respect for personal dignity, confidentiality and privacy. KCHS promotes privacy, honesty and mutual respect. A. Home Visit Component 1. At the time that a new family is assessed and offered program services, the FSW will go over, verbally and in writing, the Assessment Consent and HIPAA forms 84

indicating participant rights, including confidentiality, program and participant responsibilities, and the right to participate in the planning of services to be provided. 2. 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 a copy of the Consent Form, along with the assessment documentation, to the Supervisor. If assessment is completed by another Family Support Worker who will not be permanently assigned the case, the consent form and the assessment documentation are given to the FSW supervisor 4. The Supervisor will assign the case and ensure that the assigned FSW receives a copy of the Consent Form and the assessment documentation. 5. If, for any reason, the Consent Form was not signed during the initial assessment, obtaining the parent s signature on the form during the first home visit is required. 6. Parents are informed and will sign releases of information before sharing their confidential information with external sources. Releases of information with be specific for each external source and will include the following: The signature of the person whose information will be released or parent or legal guardian of a person who is unable to provide authorization; The specific information to be released; The purpose for which the information is to be used; The date the release takes effect; The date the release expires; The name of the person/agency to whom the information is to be released; A statement that the person/family may withdraw the authorization at any time. 7. Participants are informed of research involving KCHS participants. Participant s identity and privacy are protected during any research project. Participants are given the opportunity to consent or decline involvement in the use of assessment tools such as the AAPI-2 and Protective Factors Survey without pressure to participate. Consent forms normally include a statement such as, While your input is important, you can choose not to fill out the forms and it will not change any of the services you get. You can decide to stop at any time. Policy GA-5B. 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, including confidentiality and program and participant responsibilities and indicates whether the family verbally accepts and consents. 85

2. When a family agrees to the phone call component during a face to face assessment visit, the FSWs goes over, both verbally and in writing, the KCHD Assessment Consent and HIPAA forms indicating participant rights, including 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 provides 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 remain active in the phone call component. If KCHS has obtained written consent, then the written consent is placed in the file. Policy GA-6: Law - Reporting of Child Abuse and Neglect (for GA 6a-b) KCHS reports suspected cases of child abuse and neglect. Consistent with Michigan Law, HS/HFA staff are mandated reporters and therefore required to report suspected child abuse or neglect. 1. If a FSW suspects abuse and neglect of a child in a family, they are to follow the guidelines set in the current Michigan Child Protection Law as well as the written policy for their individual agency. Under the provisions of Act Number 238, Public Acts of 1979, and Act 519, Public Acts of 1982, it is mandatory for all social workers, nurses, school administrators, dentists and other professional persons working with families and children to report cases of actual or suspected child abuse or neglect. The law provides immunity from civil or criminal liability for the person, acting in good faith, making the report or assisting in any other requirements of this act. Child Abuse by law is defined as harm or threatened harm to a child s health or welfare by a person responsible for the child s health or welfare which occurs through non-accidental physical or mental injury, sexual abuse, sexual exploitation, or maltreatment. Child Neglect by law is defined as harm or threatened harm to a child s health or welfare by a person responsible for the child s health and welfare which occurs through either 1) negligent treatment, including the failure to provide food, clothing, shelter or medical care, or 2) placing a child at unreasonable risk to the child s health or welfare by failure of the parent or any other person responsible for the child s health to intervene to eliminate that risk when that person is able to do so and has or should have knowledge of that risk. 86

2. When child abuse and/or neglect are suspected, FSW s are mandated to contact a program Supervisor or Director. If the Supervisor is unavailable to discuss the situation, the FSW should make the report to Children s Protective Services. The agency Supervisor must be notified consistent with each agency s policy regarding the reporting of child abuse and neglect. 3. The FSW should complete the DHS form 3200 for Reporting Child Abuse and Neglect. The Protective Services report is first called into the Protective Services intake office. 4. The 3200 form is faxed to Children s Protective Services Intake. Policy GA-7: Reporting Participant Death (for GA7) KCHS has an internal reporting procedure for reporting participant (especially child) deaths that may occur while the participant is in the program and ensuring staff receive crisis/grief counseling as needed. A child death (or any participant death if by suicide or homicide) is considered a sentinel event, which requires a thorough internal case review and that appropriate support be provided to staff. A. In the event of a death of a participant family member (specifically Mother of target child, Father of target child or target child themselves), the Healthy Start program will take appropriate action. B. The FSW involved with the family will make immediate notification to the Supervisor as directed by their agency s policies and procedures, who will in turn notify the Coordinating Site, (Family Futures). C. Condolences and support will be offered to the family, and assistance in connecting to services for grief counseling or other therapeutic services if desired by the family. D. Supervisors will extend appropriate support to the staff member and staff team offering grief counseling if desired. E. If the death is suspected to be connected to child abuse or neglect, staff will cooperate fully with the investigation, following program and agency procedures consistent with mandatory child abuse reporting laws. 87

Policy GA-8: Policy and Procedures Manual (for GA8) KCHS has a policy and procedure manual based on the Healthy Families America Critical Elements and Governance and Administration Stand KCHS believes that it is critical for all staff to know and understand the policies and principals that guide their work. It is essential for all KCHS staff to base their work on a common understanding of how service should be delivered. 1. KCHS will receive a copy of the policies and procedure upon hire and will receive orientation to policies and procedures before contact with families occurs. 2. Staff will document by their signature that they have received a copy of the KCHS Policy and Procedures Manual. 3. When policies and procedures are updated, all KCHS staff will be informed and receive updated versions of the policy. This may occur electronically. 4. The KCHS Policy and Procedures Manual will be updated as necessary with input from staff and participants. It will be reviewed every five years minimally by the KCHS program coordinator who will make any recommendations for changes or updates to CQI and to the Partners. Policy GA-9: Kent County Healthy Start Budget (for GA9) The budgets of each partner agency combine to form the total Healthy Start Budget. While each individual agency partner monitors their own budget, the Partner Committee serves to review and manage the total Healthy Start budget with recommendations from both CQI and from the Healthy Start Service Coordinator, Family Futures. The budget is reviewed and approved by the Partner Committee before the beginning of the fiscal year. KCHS seeks to provide a consistent level of Healthy Start Services in the community and seeks additional funding to meet the need for home visiting services in the community. 88

1. Family Futures is responsible for collecting budget information from the Partners and presenting the information to the Partner s before the fiscal year begins. 2. Family Futures will monitor the total Healthy Start Budget, make reports to the Partner Committee, and will make recommendations to the Partners when it is clear that the budget is either over or under in expenditures during the fiscal year so that adjustments might be made. Policy GA-10: (for GA10) KCHS makes available to the community an annual report. The annual report serves as a mechanism to inform the community of how the program is performing and meeting its goals. 1. The current report to the community regarding KCHS is done through the SRA evaluation and is posted on the Family Futures website. 2. Additionally, the Kent County Healthy Start Budget is available through the posting of the each individual partner agencies audit on their respective websites. Policy GA-11: The program is audited annually by a certified public accountant. (for GA11) Kent County Healthy Start partner agencies all participate in annual audits in order to comply with best practices and to ensure that the program is being a responsible steward of funds. Each agency will submit a copy of its annual audit to the Family Futures as well as to other funding sources that require the submission of an annual audit. 89

. APPENDIX & Backup Materials 0

APPENDIX A GLOSSARY OF TERMS TERM ASQ-3 ASQ Administration Guidelines Family Needs Scale (FNS) IFSP form Kempe Family Stress Inventory Program Information Management System (PIMS) DEFINITION Ages and Stages Questionnaire: an inexpensive, quick, standardized child-development screening tool. http://www.agesandstages.com/asq/howitworks.html Tool used to identify the areas in a family s support network that need to be strengthened or accessed to better meet the family s needs. The results can also be used to initiate inquiries into issues related to the support network. See: http://www.friendsnrc.org/download/outcomeresources/toolkit/annot/fns.pdf Records information about Individual Family Support Plans (IFSP) that FSWs routinely make with their participants. (see Appendix F to view form) Tool used to assess the psychosocial risk status of potential participants in Healthy Start. See: http://www.friendsnrc.org/download/outcomeresources/toolkit/annot/fsc.pdf The database software in which program and participant data is collected. PIMS enables HFA sites to manage and report on the community programs and participant services they provide. See http://www.healthyfamiliesamerica.org/research/pims.shtml 1

Growing Great Kids (GGK) DESCRIPTIONS OF CURRICULA This Prenatal to Age 3 Parenting Curriculum was developed to address the unique needs of home visitors, parenting group facilitators and their supervisors throughout their work with families and children. GGK reaches across all cultures and is the only Curriculum available that was designed to reinforce the skills and techniques of strength based, solution focused programs. Most curricula used in the early childhood and parenting field today focus primarily on sharing information about basic care and child development. Growing Great Kids Prenatal to Age 3 Parenting Curriculum is the only Curriculum which focuses more broadly on sharing this information within the context of fostering nurturing parent child relationships while also guiding home based and center based staff in their efforts to provide strength based support to families. The Growing Great Kids Curriculum is distinguished from other curricula by its focus on the integration of the relationship between parents and their infant/child, with comprehensive child development while incorporating the family culture, situations and values specific to each parent. Retrieved from, http://www.greatkidsinc.org/ggk-research.htm 2

APPENDIX B DEFINITIONS OF CRITICAL ELEMENTS For Rationale and Supporting Literature, see Healthy Families America website: http://www.healthyfamiliesamerica.org/downloads/critical_elements_rationale.pdf Critical Element 1 Critical Element 2 Critical Element 3 Critical Element 4 Critical Element 5 Critical Element 6 Critical Element 7 Initiate services prenatally or at birth. Use a standardized (i.e., consistent for all families) 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 and parental history of abuse in childhood). Offer services voluntarily and use positive, persistent outreach efforts to build family trust. Offer services intensively (i.e., at least once a week) with welldefined criteria for increasing or decreasing intensity of service and over the long term (i.e., three to five years). Services should be culturally competent such that the staff understands, acknowledges, and respects cultural differences among participants; and materials used should reflect the cultural, linguistic, geographic, racial, and ethnic diversity of the population served. Services should focus on supporting the parent(s) as well as supporting parent-child interaction and child development. At a minimum, all families should be linked to a medical provider to assure optimal health and development (e.g., timely immunizations, well-child care, etc.) Depending on the family s needs, they may also be linked to additional services such as financial, food, and housing assistance programs, school readiness programs, child care, job training programs, family support centers, substance abuse treatment programs, and domestic violence shelters. 3

Critical Element 8 Critical Element 9 Critical Element 10 Critical Element 11 Critical Element 12 Services should be provided by staff with limited caseloads to assure that home visitors have an adequate amount of time to spend with each family to meet their unique and varying needs and to plan for future activities (i.e., for most communities no more than 15 families per home visitor on the most intense service level. For some communities the number may need to be significantly lower e.g., less than 10) Service providers should be selected because of their personal characteristics (i.e., nonjudgmental, compassionate, able to establish a trusting relationship, etc.), their willingness to work in or their experience working with culturally diverse communities, and their skills to do the job. Service providers should have a framework, based on education or experience, for handling the variety of experiences they may encounter when working with at-risk families. All service providers should receive basic training in areas such as cultural competency, substance abuse, reporting child abuse, domestic violence, drug-exposed infants, and services in their community. Service providers should receive intensive training specific to their role to understand the essential components of family assessment and home visitation (i.e., identifying at-risk families, completing a standardized risk assessment, offering services and making referrals, promoting use of preventive health care, securing medical homes, emphasizing the importance of immunization, utilizing creative outreach efforts, establishing and maintaining trust with families, building on family strengths, developing an individual family support plan, observing parentchild interactions, determining safety of the home, teaching parent-child interaction, managing crisis situations, etc.). Service providers should receive ongoing, effective supervision so that they are able to develop realistic and effective plans to empower families to meet their objectives; to understand why a family may not be making progress and how to work with the family more effectively; and to express their concerns and frustrations. 4

APPENDIX C KENT COUNTY HEALTHY START (KCHS) COMMITTEES KCHS Partners KCHS Continuous Quality Improvement Team Community Health Worker Training Collaborative Kent County Early On LICC Healthy Kent 2010/Infant Health Implementation Team and Prenatal Partnership Committee Kent County Great Start Collaborative Nurse Partnership Advisory Committee Prevention Planning Committee Child Death Review Team Kent County Domestic Violence Community Coordinated Response Team Get the Lead Out / Safe Homes Coalition 5

APPENDIX D DATA COLLECTION FORMS Preliminary Forms Screening... F-1 HS P&P Appendix\01HSscreeningFormFinal 062807.pdf Assessment... F-2 HS P&P Appendix\02HSAssessmentFormFinal062807.pdf Home Visitation Forms Containing Data Entered into PIMS Intake... F-3 HS P&P Appendix\03HSintakeFinal 022108.pdf Monthly Contact Log Landscape orientation... F-4 HS P&P Appendix\07HSMonthlyContactLogFinal 072908.pdf Portrait orientation... F-5 HS P&P Appendix\07HSMonthlyContactLogPortrait.pdf Home Visit Log... F-6 HS P&P Appendix\08HSHomeVisitLogCSSFinal 082207.pdf Progress Note 2-Sided... F-7 HS P&P Appendix\08ProgressNote013109.pdf Brief... F-8 HS P&P Appendix\08ProgressNote-Brief013109.pdf Individual Family Support Plan... F-9 HS P&P Appendix\09HS-IndFamSupPlanFormFinal 062807.pdf Family Support Record... F-10 HS P&P Appendix\10HSFamSupRecord 050108.pdf Follow-Up... F-11 HS P&P Appendix\11HSfollow-upFinal022108.pdf Birth Information Form... F-12 HS P&P Appendix\13HSbirthInfoFinal 082207.pdf CPS Form... F-13 HS P&P Appendix\14HSChildProtectiveServicesFinal 062807.pdf Termination... F-14 HS P&P Appendix\15HSterminationFormFinalCCWM022108.pdf AAPI-2 Adult Adolescent Parenting Inventory AAPI-2 Consent Form English... F-15 HS P&P Appendix\04AAPI-2 consent form FINAL_English.pdf Spanish... F-16 6

AAPI-2 Demographic Questionnaire English... F- 17 HS P&P Appendix\05AAPI-2 Demographic Questionnaire 072806.pdf Spanish... F-18 AAPI-2 Form A Parenting Inventory English... F- 19 HS P&P Appendix\06AAPI-2_form_A.pdf Spanish... F-20 AAPI-2 Form B Parenting Inventory English... F- 21 HS P&P Appendix\12AAPI-2_form_B.pdf Spanish... F-22 Phone Call Component Forms Intake... F-23 HS P&P Appendix\HSPCintakeForm2sided030108.pdf Contact Log... F-24 HS P&P Appendix\HSPCMonthlyContact05-08.pdf Phone Call Log... F-25 HS P&P Appendix\HSPCphoneCallLog05-08.pdf Referrals HS P&P Appendix\HSPCreferralForm.pdf Termination For Arbor Circle... F-26 For CCWM... F-27 HS P&P Appendix\HSPCterminationFormFinal 030108.pdf 7