1 JULY 2018 MIHOW of Northern Panhandle Head Start, Inc. Home Visiting Service Coordination Case Study MIHOW of Northern Panhandle Head Start, Inc. Wheeling, WV In MIHOW home visiting, trained mothers from the community mentor their peers. Project Overview This brief is one of a series focusing on service coordination in early childhood home visiting. MIHOW of Wheeling, WV is one of four “high performing” home visiting programs that were invited to participate in case studies to examine facilitators and barriers of coordination. 1 Program Overview The Maternal Infant Health Outreach Worker Program (MIHOW) serves the suburban community of Wheeling, West Virginia. MIHOW uses a “parent to parent,” asset building approach to address family-identified needs. The program provides monthly home visits to 40 families with two home visitors and a site leader. Full-time home visitors serve caseloads of 27-32 families at a time. MIHOW receives a majority of referrals from the Early Head Start program with which it is co-located. It also receives many referrals from a local birthing hospital. Consistent with model standards, 80% of mothers enroll during pregnancy. Notably, due to high rates of opioid use in Wheeling and surrounding areas, MIHOW serves many families with substance use problems. Strategies to Support Service Coordination At MIHOW, family assessment, referral and linkage to services, and following up with families are high priorities. In addition, staff and MIHOW participants revealed four key strategies that support quality service coordination. These include: 1) strong state and community partners, 2) specific points of contact, 3) adapting services to meet population needs, and 4) monitoring and quality improvement. State and Community Coalitions West Virginia has an active state-wide home visiting coalition, Partners in Community Outreach (PICO). Through PICO, home visiting programs representing three models organize joint trainings and work together to assess needs and brainstorm ideas for how to overcome barriers. MIHOW also actively participates in a local Family Resource Network (FRN), which brings together different social service providers from across the county to organize resources and events for families. MIHOW staff regularly attend FRN meetings and serve on the Early Childhood Interagency Committee, which organizes community baby showers and workshops to connect families with services. MIHOW staff also use the FRN meetings to raise awareness about their program among other providers, with one home visitor stating, “We go on a regular basis so we are familiar faces with other coordinators of the services, so they know who we are and we know who they are.” JULY 2018
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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.”
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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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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.
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