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Paving the Way for a Coordinated System of Home Visiting Services

Paving the Way for a Coordinated System of Home Visiting Services in Alameda County: An Evaluation of County Population Needs, Existing Programs, and Opportunities for Enhancement of Services San Francisco CityMatCH Conference, September 19, 2011.

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Paving the Way for a Coordinated System of Home Visiting Services

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  1. Paving the Way for a Coordinated System of Home Visiting Services in Alameda County: An Evaluation of County Population Needs, Existing Programs, and Opportunities for Enhancement of Services San Francisco CityMatCH Conference, September 19, 2011 Janet Brown1, Kristi Kelly2, Chris Hwang3 and Anita Siegel1 1Alameda County Public Health Department , 2Applied Survey Research, 3First 5 Alameda County

  2. Objective of Presentation • Describe efforts to coordinate a system of home visiting services in Alameda County. • Outline • Project background • Overview of local evaluation and key findings • - population served • - outcome data • Getting to the next level • - recommendations from evaluation • - lessons learned • - perinatal system design process

  3. Project Background • Infrastructure • - Life Course System Design Committee in Alameda County • Timing • - State home visiting funding opportunities • One-Time Pot of Money • - $25,000 RFP awarded to Applied Survey Research

  4. Common Standards Strengthening Families Approach Shared Outcomes Community- Wide Home Visiting Program Blended Funding Triage Families Based On Needs Smooth Transitions Between Systems Integrated Family Support System of Care Vision

  5. Full Report and Executive Summary available for downloadhttp://www.acphd.org/data-reports/reports-by-topic/home-visiting.aspx or http://bit.ly/oda1Kk This report collectively and individually describes ten perinatal/early childhood home visiting programs, including whom each one serves, what services and interventions each provides, and the intended and demonstrated outcomes associated with participation in each program. The report also includes a set of five recommendations with possible action steps for enhancing home visiting services. Produced in conjunction with First 5 Alameda County Overview of Local Evaluation

  6. Project Overview: What we did Fall 2010 – Winter 2011 Review of 10 perinatal/early childhood home visiting programs: • Improving Pregnancy Outcomes Program (IPOP) • Black Infant Health (BIH) • Maternal Access and Linkages for Desired Reproductive Health (MADRE) • Perinatal Hepatitis B Program (Perinatal Hep B) • Public Health Nursing • Pregnant & Parenting Teen Program • Your Family Counts • Special Start • Another Road to Safety • Homeless Families Program

  7. Project Overview: What we did Final report • Brief review of home visiting literature. • A look at key population needs among county residents. • Cross-program summaries (populations served, services provided, and outcomes of participation). • Recommendations for next steps. How do we move toward a deliberate system of services that effectively address the needs of the county?

  8. … And, What we did NOT do Not intended to be a comprehensive review of any single program. Not intended to be used to compare one program to another.

  9. A BRIEF REVIEW OF KEY FINDINGS Populations served Key services provided Outcomes expected and demonstrated

  10. Populations: The Perinatal Timeline Teen/woman becomes pregnant Teen/woman loses child during pregnancy or at birth Teen/woman has a live birth Teen/woman is parenting/ interconceptional

  11. Populations: Program Entry Points Along the Timeline Teen/woman becomes pregnant Teen/woman loses child during pregnancy or at birth Teen/woman has a live birth Teen/woman is parenting/ interconceptional

  12. POPULATIONS : PROGRAM ENTRY POINTS ALONG THE TIMELINE Teen/woman becomes pregnant Teen/woman loses child during pregnancy or at birth Teen/woman has a live birth Teen/woman is parenting/ interconceptional

  13. POPULATIONS : PROGRAM ENTRY POINTS ALONG THE TIMELINE Teen/woman becomes pregnant Teen/woman loses child during pregnancy or at birth Teen/woman has a live birth Teen/woman is parenting/ interconceptional

  14. POPULATIONS : PROGRAM INTERVENTION PERIODS MADRE

  15. 6,600 Medi-Cal Births 1,500 Born Low Birth Weight ~ 27% Postpartum Depression At-risk African American Families 1,500 Births to Teen Mothers ~50% Experience Breastfeeding Problems 6,000 Children 0-5 Have Contact with CPS 20,000+ Births in Alameda County2,921 new home visiting cases – mostly brief visits

  16. CONCLUSIONS: SERVICES PROVIDED Programs provide same TYPES of services However, there are likely large differences in HOW these services are provided – • What is the quality of these services? • How comprehensively are they delivered? • What do participants think of them? Program intensity varies substantially – • Does this program intensity “fit” the program goals?

  17. PROGRAM OUTCOMES: OVERVIEW OF MAJOR PROGRAM OUTCOMES … with more specific outcomes within each outcome area.

  18. A Snapshot of Home Visiting Program Outcomes CHILDREN

  19. A Snapshot of Home Visiting Program Outcomes Mothers/Parents/Families

  20. What Did we Learn? 21

  21. HOW DO WE GET TO THE NEXT LEVEL?

  22. Recommendations Recommendation 1 Develop a process for: (1) identifying (and then monitoring) the level of county need over time; and (2) coordinating services and ensuring that those in need are matched to the right home visitation programs. Readiness for school • Decide on key county-level indicators to describe county needs. • Identify and invite other partners to participate in county-wide coordination efforts. • Develop guidelines for matching participants to home visiting programs. • Develop coordinated outreach efforts. • Monitor and continue updating of the portrait of Alameda County needs. Older children are more ready. 16-23% are < 5 upon entry.

  23. RECOMMENDATIONS Recommendation 2 Enhance the quality of this community of home visitation programs, both individually and collectively. Readiness for school • Develop appropriate and consistent approaches to staffing. • Encourage staff retention within programs. • Develop consistent approaches to initial and ongoing staff training and development. • When possible, create coordinated standards of practice among programs doing similar work. • Review each program design as intended versus as delivered. Older children are more ready. 16-23% are < 5 upon entry.

  24. RECOMMENDATIONS Recommendation 3 Finalize and implement a measurement system that gathers clear and relevant data that will help to determine whether the community of home visitation programs is successful. Readiness for school • Develop common, cross-program data elements to collect about participants,services, and outcomes. • Gather feedback from program participants to better understand their perspective. • Consider ways to facilitate merging of data across programs. • Foster a culture that sees the value of collecting data. • Develop a high-level summary communication to simply display efforts and outcomes. Older children are more ready. 16-23% are < 5 upon entry.

  25. RECOMMENDATIONS Recommendation 4 Ensure commitment to the ongoing work of this community of programs by developing and implementing processes to help sustain it. • Continue meeting regularly. • Establish subcommittees for interim work. • As a group, prioritize these recommendations and actions. • Use your data dashboard to guide your work together. Older children are more ready. 16-23% are < 5 upon entry.

  26. RECOMMENDATIONS Recommendation 5 Each program should enhance its routine data collection practices … and also consider conducting a one-time, rigorous program evaluation to become more competitive for funding that has an “evidence-based” standard. Readiness for school • Be informed about the research basics: participants, design, dropout issues, what and when to measure. • Start with any changes/refinements to program delivery – test your “best” program, not a diluted version of it. • Once resolved, consider a high-quality research study and commit to enhanced ongoing data collection. Older children are more ready. 16-23% are < 5 upon entry.

  27. Lessons Learned • Leadership • Membership • Job functions • Project scope • Outside help • Innovation

  28. The Perinatal System Design Team: • A participatory design process • PRE-LAUNCH • Compile information (shapes questions, discussion for launch; use brief surveys, HV evaluation report, case studies) • Identify panel • Preliminary list of tenets from leadership team • Consultation, technical assistance, training with IDEO • Pre-meeting with families to participate • Outreach to programs for initial buy-in, set context • ASR follow up meeting • 2. LAUNCH • Invite leadership, staff, and selected clients • Present context/situation – broad • Discuss and brainstorm challenges through information-gathering on what’s working, concerns, and pitfalls • Next steps and Q&A • Compile list of those interested in being part of Design Team • 20-30 on design team, including facilitators • Identify Design Leads • 3. TRAINING • Train Design Leaders in one or two trainings/workshops • Topics • Design thinking • Facilitation/discussion • Leadership • Team-building • Design process & tools • Keep focus on big picture, broad lens

  29. 7. SCALE, SPREAD, SUSTAIN • Evaluate, six-month or periodic checkins • Dissemination plan • Communications strategy • Follow up, troubleshoot • Identify new challenges  back to “understand” • 4. UNDERSTAND • “Research”: conducted by Design Team • Shadowing, interviews, surveys, case studies • “Extreme users” identify five challenges • Five groups of six make up the Design Team • 6. BUILD TO LEARN • Resource Bank contains resources that design teams can use. • Each small group  Design Team • Prototype, test, prototype, test, etc. until can put each solution into Big Plan • Take Big Plan as Prototype 1 to real world programs/clients • Test Prototype 1 on small scale: evaluate, troubleshoot, revise • Test, evaluate, etc. until ready to roll out to all of home visiting • 5. ENVISION • Design team creates idealized process vision: • - Brainstorming solutions • - Identify conceptual blocks, potential solutions • -Split each mini-team of six in half to brainstorm solutions to the challenge, come back together to discuss, then present to entire team • Keep as creative as possible – don’t got into the nitty gritty

  30. THANK YOU For more information contact Janet Brown by email at janet.brown@acgov.org or by phone at (510) 267-8098

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