JULY 2018JULY Home Visiting Service Coordination Case ......In addition, staff and MIHOW participants revealed four key strategies that support quality service coordination. These

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JULY 2018

MIHOW of Northern Panhandle Head Start, Inc.

HomeVisitingServiceCoordinationCaseStudyMIHOWofNorthernPanhandleHeadStart,Inc.Wheeling,WV

In MIHOW home visiting, trained

mothers from the community mentor

their peers.

Project Overview Thisbriefisoneofaseriesfocusingonservicecoordinationinearlychildhoodhomevisiting.MIHOWofWheeling,WVisoneoffour“highperforming”homevisitingprogramsthatwereinvitedtoparticipateincasestudiestoexaminefacilitatorsandbarriersofcoordination.1

Program Overview TheMaternalInfantHealthOutreachWorkerProgram(MIHOW)servesthesuburbancommunityofWheeling,WestVirginia.MIHOWusesa“parenttoparent,”assetbuildingapproachtoaddressfamily-identifiedneeds.Theprogramprovidesmonthlyhomevisitsto40familieswithtwohomevisitorsandasiteleader.Full-timehomevisitorsservecaseloadsof27-32familiesatatime.MIHOWreceivesamajorityofreferralsfromtheEarlyHeadStartprogramwithwhichitisco-located.Italsoreceivesmanyreferralsfromalocalbirthinghospital.Consistentwithmodelstandards,80%ofmothersenrollduringpregnancy.Notably,duetohighratesofopioiduseinWheelingandsurroundingareas,MIHOWservesmanyfamilieswithsubstanceuseproblems.

Strategies to Support Service Coordination AtMIHOW,familyassessment,referralandlinkagetoservices,andfollowingupwithfamiliesarehighpriorities.Inaddition,staffandMIHOWparticipantsrevealedfourkeystrategiesthatsupportqualityservicecoordination.Theseinclude:1)strongstateandcommunitypartners,2)specificpointsofcontact,3)adaptingservicestomeetpopulationneeds,and4)monitoringandqualityimprovement.

State and Community Coalitions

WestVirginiahasanactivestate-widehomevisitingcoalition,PartnersinCommunityOutreach(PICO).ThroughPICO,homevisitingprogramsrepresentingthreemodelsorganizejointtrainingsandworktogethertoassessneedsandbrainstormideasforhowtoovercomebarriers.MIHOWalsoactivelyparticipatesinalocalFamilyResourceNetwork(FRN),whichbringstogetherdifferentsocialserviceprovidersfromacrossthecountytoorganizeresourcesandeventsforfamilies.MIHOWstaffregularlyattendFRNmeetingsandserveontheEarlyChildhoodInteragencyCommittee,whichorganizescommunitybabyshowersandworkshopstoconnectfamilieswithservices.MIHOWstaffalsousetheFRNmeetingstoraiseawarenessabouttheirprogramamongotherproviders,withonehomevisitorstating,“Wegoonaregularbasissowearefamiliarfaceswithothercoordinatorsoftheservices,sotheyknowwhoweareandweknowwhotheyare.”

JULY 2018

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JULY 2018

MIHOW of Northern Panhandle Head Start, Inc.

Really, 90% of service coordination has nothing to

do with our families. It is making those connections between our agency and wherever it is that we're

referring families to…. [It] starts out with knowing who

you are referring to and making that personal

connection.

- MIHOW Staff Member

Supervisor, home visitor, community engagement person, and a family are the required members of the [quality improvement] team, so there is always family input and collaborative service network input.

- MIHOW Staff Member

“Personal Connections”

MIHOWstaffhaveworkedhardtodeveloppersonalconnectionswithstaffatlocalagenciesthatprovideservicestoaddressmentalhealth,substanceuse,andpartnerviolence.Thesepersonalrelationshipsallowthemtoreferfamiliesquickly,efficiently,andwithconfidencesothatfamilieswillbetreatedwell.Onehomevisitordescribedhowshepreferstoconnectfamiliestoaspecificperson,becausedoingsomakesthefamilymorecomfortableandalso“addsalevelofaccountabilitytotheagencyandtheprovider.”Familieswhoneedextrasupportreceivea“warmhand-off”–adirectlinkagebyphoneorinpersonwithaserviceprovider.

Adapting Services to Meet Population Needs

MIHOWhasadapteditsservicestomeetthechangingneedsofthecommunity.Forexample,whencommunityleadersnoticedaspikeinsubstanceuse,MIHOWaddedScreening,BriefIntervention,andReferraltoTreatment(SBIRT),anevidence-basedpracticeusedtoidentifyandreferfamiliesforproblemdruguse.TheyuseSBIRTatenrollmentandperiodicallythereafter.Theyalsoledanefforttohireasocialworkerwhoworksinthelocalhospitalandreferssubstanceusingfamiliestohomevisiting.Becausetheyhavecometoknowtheneedsofthecommunitywell,MIHOWiscarefulthatprogrammessagingdoesn’tinvokeshameorguiltamongsubstanceusingmothers,butratherencouragesandwelcomestheirparticipationintheprogram.

Monitoring and Quality Improvement

MIHOWpoliciesandproceduressupportmonitoringandprogram-widequalityimprovementtoensurethatfamiliesreceiveneededservices.Homevisitorsdocumentallreferralsandrelatedfollow-upactivitiesonlogsaftereachvisit.Logsarereviewedregularlyaspartofsupervision.Thelogsalsoremindvisitorstocheckinwithfamiliesduringthenextvisittomakecertainserviceswerereceived.MIHOWalsoparticipatesincontinuousqualityimprovement(CQI)consultationprovidedbytheWestVirginiaHomeVisitationProgram.TheconsultantrecentlyhelpedthemcompleteaCQIprojectthatfocusedonconnectingwomenwithsubstanceuseproblemswithservices.Stakeholdersatalllevels,includingfamilies,participateintheCQIprocess.

Barriers to Service Coordination Whenaskedtodescribethebiggestbarrierstosuccessfulservicecoordination,staffindicated:

• A!tudesandbehaviorofstaffinotheragencies• Lackofservices

• Transporta)on• Childcare

Twothemesemergedasparticularlychallengingforthisprogram:1)communitycontextand2)limitedavailabilityandaccesstoservices.

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JULY 2018

MIHOW of Northern Panhandle Head Start, Inc.

About HARC. TheHomeVisitingAppliedResearchCollaborative(HARC)wasestablishedin2012withcorefundingfromtheMaternalandChildHealthBureauoftheU.S.HealthResourcesandServicesAdministration(MCBHHRSA).Formoreinformation,visitwww.hvresearch.org.

They’re always reaching out. Whether it’s a text or a phone call,

they’re there.

-MIHOW Participant

Say a mom has four children. The appointment might be for the 2- year old. She's a single

mom. [Transportation] will only take the mom and the 2-year

old. It's just layers and layers of resources that they need.

-MIHOW Staff Member

1Formoredetailedinformationonthestudypleaseseehttps://www.hvresearch.org/service-coordination-toolkit/state-of-the-field.

Community Context

MIHOWstaffdescribedseveralcommunity-levelchallengesthathindercoordination.Staffsharedtheperceptionthatmanyprovidersdon’tappreciatethebenefitsofpartneringwithhomevisiting.Relatedtothis,staffspokeofattitudesandculturalmoresthatmayinfluencefamilies’andproviders’interestsinhomevisiting.Theydescribedacultureoffearandmistrustofsocialserviceagenciesamongfamiliesintheircommunity.Culturealsoinfluencesproviders,asnotedbyonestaffmemberwhosaid,“We'restillcombatingsomeoftheculture,especiallyaroundsubstanceuse.Doctorsdon'tfeelit'stheirplacetotalktoyouaboutwhat'sgoingoninyourpersonallife,andsohomevisiting,Iguess,iskindofviewedaswhatwouldbeinyourpersonallife.”Staffalsonotedthathighturnoverinlocalagenciesalsomakesitdifficulttoestablishandmaintainrelationshipswithproviders.

Availability and Access to Services

ThelackofservicesintheareaposesachallengetoMIHOWstaff.Servicesformentalhealthandsubstanceusetreatmentareespeciallylimited,andtheavailableservicesareofvariablequalityandmaynottakeinsurance.Ittakesabouttwomonthstogetanappointmentfornon-emergencymentalhealthservices,forexample.Thisproblemisexacerbatedbyalackofpublictransportation.Staffwerethrilledwhenanewmentalhealthprofessionalwhotakespublicinsurancerecentlymovedtothearea;theynowreferfamiliestoherregularly.

What matters most to families? “Always Reaching Out”

FamiliesdescribedMIHOWstaffasbeinghighlyavailableandaccessible,andtheyfeltsupportedandconnectedtotheprogramthroughfrequentcommunication.BecauseMIHOWhomevisitsoccuronceamonth,homevisitorsoftenfollowupwithphonecallsandtextsbetweenvisits.Thesephonecallsarecriticalforfollow-up.MIHOWwas

describedasparticularlycriticalinhelpingfamiliesmeetbasicneeds,suchasforfood,clothing,diapers,andtransportation.Familiesappreciatedthathomevisitorswouldoftenarriveatthehomewithsmall“gifts.”

Suggestedcitation:CorrellL,WestA,GrussK,DugganAK,MinkovitzC.2018.HomeVisitingServiceCoordinationCaseStudy:MIHOWofNorthernPanhandleHeadStart,Inc.HomeVisitingAppliedResearchCollaborative.