Promoting Maternal and Child Health, One Home Visit at A Time T eresa Kelly , LCSW, ACSW Lesley Schwartz, LCSW, ACSW Project Director Manager of Research and Evaluation teresa.m.kelly@illinois.gov lesley .schwartz@illinois.gov Strong Foundations Partnership Governor ’ s Office of Early Childhood Development
What is Home Visiting? Home visiting is a voluntary service that matches parents with trained professionals to provide evidence-based family support and parent coaching during pregnancy and throughout their child ’ s early years of life. Through partnering with home visitors, families learn how to improve their family ’ s health and provide better opportunities for their children. For more information go to igrowillinois.org. 2
The Illinois Home Visiting Systems Goal Illinois has long valued evidence-based home visiting programs as an effective and efficient strategy for improving the life trajectory of expectant and new families who are at risk for poor health, educational, economic and social outcomes by improving maternal and child health, reducing the risk of child abuse and neglect, improving self-sufficiency and increasing children ’ s readiness for school. 3
What a Home Visitor Does on a Home Visit Check in on how the mother and baby are doing; assess if there is anything stressful going on or if there is a celebratory moment Conduct developmental screens and make referrals as necessary; support breast feeding Perform activities with mother and baby to support increased parent child attachment Screen for maternal depression, intimate partner violence, substance and tobacco use Discuss post partum contraception, birth spacing, safe sleep 4
What Makes Home Visiting Unique? We go where the families are We are voluntary We work to build trust and relationships We are intensive – meeting weekly or bi-weekly with the parent and child Visits are 60 – 90 minutes long and usually on the floor with the parent and child We work to retain the family until the child is 5 years old. If possible, we provide doulas to those who are pregnant on our caseloads 5
Who does Home Visiting Serve? Low income Pregnant women under 21 years of age History of child abuse/neglect or interactions with child welfare services History of substance abuse or needs substance abuse treatment Users of tobacco products in the home Have, or have children with, low student achievement Child or children with developmental delays or disabilities Families that are or have served in the US Armed Forces 6
What are the Benefits of Home Visiting? National and Illinois-specific research studies show that high-quality evidence-based home visiting programs result in myriad positive outcomes for children and their families, including the following: Increasing rates of breastfeeding, immunization, well-child visit, and developmental screenings; Promoting language development and school readiness; Improving rates of high school graduation; and Increased rates of talking, reading and positive interactions between parent and child. I 7
Benefits of Home Visiting in Illinois In Illinois, data have consistently indicated that home visiting services are having a significant impact in: Increasing breastfeeding rates, Increasing inter-partum intervals (particularly among teen parents), Helping families establish medical homes Ensuring that children are routinely screened for potential developmental delays. 8
Evidence Based Home Visiting in Illinois In 2009, the U.S. Office of Planning Research, and Evaluation at the Administration for Children and Families at the Department of Health and Human Services (DHHS) contracted with Mathematica to conduct the Home Visiting Evidence of Effectiveness (HomVEE) project, a systematic review of home visiting research that identifies effective program models The most common evidence based models used in Illinois are: Parents as Teacher, Healthy Families America, and Early Head Start-Home Based. 9
Why is home visiting in the spotlight now? The research is in-Home Visiting works! Illinois had early conversations with a freshman senator about the importance of investing in early childhood and he took that to the White house. It was perfect convergence of political interest and research coming together. 10
The Illinois Home Visiting System There are almost 300 home visiting programs throughout Illinois. Virtually all programs use evidence based models, those who are not, are being moved using an evidence based model. The 4 largest funders of home visiting in Illinois: Illinois State Board of Education MIECHV Chicago Public School Illinois Department of Human Services Head Start/Early Head Start- Home Based 11
The “Black Box” of Home Visiting Home Visitor: “ We ’ re not there to tell her what to do or fix her problem, so we ’ ve learned to ask ‘ Well, what you have you tried, what do you think works, what would you like to try?’ They ’ re always in the front seat, and should always feel like they ’ re the expert in their lives .” Parent: “[My home visitor] tries to get me to answer my own question. …She'll keep asking questions, and eventually I'll address my own concerns. I'll say , ‘W hat, how did you do that? ’…[An d] when I have concerns that I can't just get on the phone and call somebody , I can think in my mind, ‘ Okay , let's walk through this. Let's do what we do at our visi ts.’ It's nice to have that idea in the back of my head that I can get through this on my own.” 12
The Affordable Health Care Act Makes Home Visiting Part of Health Originally , in 2010 MIECHV was part of the ACA and the benchmarks the program was charged with collecting was associated with maternal and child health. Initially , MIECHV had to collect 7 benchmark areas with 36 constructs. Illinois had one of the most rigorous evaluations. As of October 1, 2016, HRSA reduced the constructs to 19 and standardized them across the nation. 13
Benchmark Areas (6) Improved maternal and newborn health Prevention of child injuries, child abuse, neglect, or maltreatment, and reduction of emergency department visits Improvement in school readiness and achievement Reduction in crime or domestic violence Improvements in family economic self-sufficiency Improvements in the coordination and referrals for other community resources and supports 14
Constructs (19) Preterm Birth Parent-Child Interaction Breastfeeding (6 mos) Early Language and Literacy Activities Depressions screening and completed referral Developmental Screening and completed referral Well child Visits Behavioral Concerns Postpartum Care IPV Screening and referral T obacco Cessations Referrals Primary Caregiver Education Safe Sleep Continuity of Insurance Child Injury Coverage Child Maltreatment 15
Partnering with Title V Nurses and Public Health Nurses In keeping with the grant requirements Illinois MIECHV partnered with Title V Nurses to help support MIECHV home visiting programs The nurses complete annual sites visits in which they review files, observe home visits and interview program staff and then provide feedback and support to programs in regards how health related goals are integrated into programs. The nurses also provide specialized training in topics such as Breastfeeding, Family Planning, and Immunizations. 16
Eligibility Criteria Is the family pregnant or parenting children 5 years or younger (Required)? Does the family receive Medicare, WIC, T ANF or SNAP Benefits? Does the family have social or medical risk factors (homeless, chronic medical conditions, etc.? If the answer is yes, the family may be eligible for services. 17
How to Refer a Family Southside Cluster; (Englewood/ West Peoria Englewood/ Greater Grand Crossing in Chicago) Stephenson/Jo Davies Counties Cicero Kankakee County; East St. Elgin Louis Rockford Mid-Central Cluster Macon County (McLean, Piatt and Dewitt Counties) Vermilion County 18
How to Refer a Family If you are not located in the Coordinated Intake areas listed previously: Check out our website and do a search http://igrowillinois.org/ Call or email Kathy Staten at OECD at and we will make the connection Katherine.staten@illinois.gov 312-814-6741 19
“ We have so much to do, a long way to go but a lot to build from” ~ Diana Rauner, PhD President, Ounce of Prevention and First Lady of Illinois (Jan 2017) 20
References http://igrowillinois.org/ http://homvee.acf.hhs.gov/ http://www.theounce.org/ https://mchb.hrsa.gov/maternal-child-health- initiatives/home-visiting-overview Diana Rauner ’ s March 2017 T estimony to Congress (https://waysandmeans.house.gov/live/ ) 21
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