Date of Defense:
April 1, 2016
Public health and family support programs have implemented home visitation in communities to ensure optimal child development. The goal of the majority of home visiting programs is to decrease child abuse and neglect (Howard & Brooks-Gunn, 2009). Evidence based programs including Healthy Families of America, Early Head Start and Parents as Teachers, have shown positive outcomes in parenting skills, safe home environments and fostering optimal health and child development.
Often home visitation programs recruit participants based on demographic risk factors including socioeconomic status, health status, violence exposure, parity and parental education. This recruitment method may exclude some high risk families based on systematic assessment; while families with minimal demographic risks may be offered services unnecessarily. By evaluating primarily on the demographic risks of the family rather than the ecology of the family can decrease the population-level impact and efficiency of home visiting programs (Dodge, Goodman, Murphy, O’Donnell, & Sato, 2013). Communities supporting positive environments, relationships and behaviors through home visitation programs promote healthy development and learning skills in children and families.
Evidence-based family visitation programs have shown positive outcomes to families served, yet there is limited evidence that these programs lead to system level impacts. There are notable findings that relate to lack of effectiveness of home visitation program at a population-level including: 1) no program has changed the community level outcomes related to optimal child development, health and parenting skills; 2) when programs are disseminated community-wide, the challenges with scaling up may reduce effectiveness; and 3) current funding levels and strategies for disseminating at the federal level are insufficient (Dodge, Goodman, Murphy, O’Donnell, & Sato, 2013).
The Community Partnership for Children (CPC) is an early childhood initiative of the Brown County United Way and community organizations focused on prevention of health and socioeconomic disparities. The vision of the CPC is: “To ensure all Brown County children are safe, healthy and ready for kindergarten.” (Brown County United Way, 2013) The CPC started in November of 2005 by the Brown County United Way in collaboration with community partners to create a system of care to: reduce child abuse and neglect, improve childrens’ health, ensure optimal development and strengthen families (Brown County United Way, 2013). The CPC is implemented by community agencies providing evidence based home visitation programs with Maternal, Infant, Early Childhood Home Visitation (MIECHV) funds.
The Brown County Health Department (BCHD) and City of De Pere Health Department are full service county and municipality health departments, respectively. These health departments provide services based around Title V Maternal and Child Health (MCH) Block grants. The health departments focus on population-based public health services while providing limited direct services to clients to meet community needs.
The goal of my field experience was to identify a plan to incorporate local public health services into the referral process of the CPC gateway programs providing evidence based home visiting programs. Through this collaboration we would develop population level performance outcomes to determine the effect of scaling up of the services on family level outcomes. The specific objectives included:
- Develop an understanding of the gateway agencies’ program requirements, program goals, methods for screening of new parents to determine eligibility for the programs and how clients were identify to be referred to each of the programs.
- Analyze United Way CPC annual reports for areas where public health could offer support to improve the program performance outcomes .From this analysis develop potential options for utilizing public health referrals to improve outcomes and provided educational presentation to the CPC workgroup, the CPC executive committee as well as public health on how this new referral process would work.
- Develop an understanding of the local health departments Title V MCH block grant objectives (family support, child development and safety and injury prevention) and similarities of gateway program objectives. Identify gaps, duplication and replication of services and issues related to the screening that may eliminate clients due to residence transiency, limited English proficiency or other factors.
- Analyze community conversation data with an inductive coding approach for 36 community conversations identifying themes related to MCH topics; child development, family support, and community identified needs to improve the environment for high- risk families. Revise and categorize the themes to guide a community strategic planning summit. Facilitate health professionals’ discussion during the community strategic planning summit to help identify how the community could align to change the environment.
- Align outcome goals, develop and write a plan utilizing a balanced scorecard and strategy map approach to align partners and organization with the vision of the CPC. The written plan will be submitted to the local health departments and presented to the CPC executive committee for approval and adoption as program guiding document.
This experience taught me the importance of community collaborations and system transformation to create long-term improvements in communities. I learned to look at disconnected systems and find areas for collaboration or sharing of services to improve the system and streamline services to reach goals and achieve program identify outcomes measures.
The biggest challenge I identified was the threat that organizations showed related to referring families to other organizations. The gateway agencies realized they could not enroll families due to staff capacity, but maintaining a waiting list ensured participation if families dropped out or were lost to follow up. By helping the gateway agencies recognize the role of public health to focus on population level interventions for health rather than direct service care, provided opportunity for the health departments to identify their role in linking clients to services and support needed rather than long term home visiting. This allowed client that may have previously been ineligible for home visiting program due to transiency, homelessness or non-English speaking to become eligible for enrollment.
An organizational challenge occurred during the field experience as the MCH nurse manager for BCHD transitioned to the Health Officer of neighboring/partner De Pere Health Department. Although at the leadership level there was support for the program, she was instrumental in helping the MCH staff at the BCHD realize their role in population based public health services.
- Arrange regular meetings with open communication of program directors and MCH staff to identify roles and responsibilities
- Develop stages of implementation with continuous evaluation following each phase
- Work public health collaboration into the state model and involve public health from the beginning of CPC development in other communities and triage system.
The Brown County Community Partnership Health Improvement Plan was instrumental in bringing together multiple agencies involved in the CPC to achieve the goals and objectives of the organizations, while incorporating Title V MCH Block grant objectives. The project identified that through community collaborations, the community is better equipped to serve the most families leading to larger, and population based outcome improvements. Through this project the community has seen system changes that are removing the challenges that high-risk families may face, and providing a continuity of support for families to help all children reach their full potential.
Brown County United Way. (2013). The Community Partnership for Children Mid-Year Report. Green Bay.
Dodge, K. A., Goodman, W., Murphy, R., O’Donnell, K., & Sato, J. (2013, January 1). Toward Population Impact from Home Visiting. Zero Three, pp. 17-23.
Howard, K., & Brooks-Gunn, J. (2009). The Role of Home Visiting Programs in preventing Child Abuse and Neglect. 19(2).