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

Objective of PresentationDescribe efforts to coordinate a system of home visiting services in Alameda County.

Outline1.Project background2.Overview of local evaluation and key findings

- population served- outcome data

3.Getting to the next level- recommendations from evaluation- lessons learned- perinatal system design process

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

Integrated Family Support System of CareIntegrated Family Support System of Care

StrengtheningFamilies

Approach

BlendedFunding

SmoothTransitionsBetweenSystems

TriageFamilies Based

On Needs

SharedOutcomes

Common Standards

Community-Wide

Home Visiting Program

Vision

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

PROJECT OVERVIEW: WHAT WE DIDPROJECT 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

PROJECT OVERVIEW: WHAT WE DIDPROJECT OVERVIEW: WHAT WE DID

• Final report1. Brief review of home visiting literature.2. A look at key population needs among county residents.3. Cross-program summaries (populations served, services

provided, and outcomes of participation).4. Recommendations for next steps.

How do we move toward a deliberate system of services

that effectively address the needs of the county?

… … AND, WHAT WE DID AND, WHAT WE DID NOTNOT DO DO

• Not intended to be a comprehensive review of any single program.

• Not intended to be used to compare one program to another.

A BRIEF REVIEW OF KEY FINDINGSA BRIEF REVIEW OF KEY FINDINGS

• Populations served• Key services provided

• Outcomes expected and demonstrated

POPULATIONS: POPULATIONS: THE PERINATAL TIMELINETHE PERINATAL TIMELINE

Teen/woman is parenting/

interconceptional

Teen/woman loses child

during pregnancy or

at birth

Teen/woman has a live

birth

Teen/woman becomes pregnant

POPULATIONS: POPULATIONS: PROGRAM ENTRY POINTS ALONG THE TIMELINEPROGRAM ENTRY POINTS ALONG THE TIMELINE

Teen/woman is parenting/

interconceptional

Teen/woman

loses child during

pregnancy or at birth

Teen/woman has a live birth

Teen/woman becomes pregnant

POPULATIONS : POPULATIONS : PROGRAM ENTRY POINTS ALONG THE TIMELINEPROGRAM ENTRY POINTS ALONG THE TIMELINE

Teen/woman is parenting/

interconceptional

Teen/woman

loses child during

pregnancy or at birth

Teen/woman has a live birth

Teen/woman becomes pregnant

POPULATIONS : POPULATIONS : PROGRAM ENTRY POINTS ALONG THE TIMELINEPROGRAM ENTRY POINTS ALONG THE TIMELINE

Teen/woman is parenting/

interconceptional

Teen/woman

loses child during

pregnancy or at birth

Teen/woman has a live birth

Teen/woman becomes pregnant

POPULATIONS : POPULATIONS : PROGRAM INTERVENTION PERIODSPROGRAM INTERVENTION PERIODS

MADRE

20,000+ Births in Alameda County2,921 new home visiting cases – mostly brief visits

6,600 Medi-Cal Births

1,500 BornLow Birth Weight

At-risk African American Families

~50% Experience Breastfeeding

Problems

6,000 Children 0-5Have Contact with CPS

1,500 Births to Teen Mothers

~ 27% Postpartum Depression

CONCLUSIONS: SERVICES PROVIDEDCONCLUSIONS: 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?

PROGRAM OUTCOMES: PROGRAM OUTCOMES: OVERVIEW OF MAJOR PROGRAM OUTCOMESOVERVIEW OF MAJOR PROGRAM OUTCOMES

Six Major Outcome Areas

Child health

Child development and school readiness

Child maltreatment / exposure to violence

Maternal health

Parenting skills / parent-child interactions

Economic self-sufficiency

… with more specific outcomes within each outcome area.

A SNAPSHOT OF HOME VISITING PROGRAM OUTCOMES A SNAPSHOT OF HOME VISITING PROGRAM OUTCOMES CHILDRENCHILDREN

A SNAPSHOT OF HOME VISITING PROGRAM OUTCOMES A SNAPSHOT OF HOME VISITING PROGRAM OUTCOMES MOTHERS/PARENTS/FAMILIESMOTHERS/PARENTS/FAMILIES

WHAT DID WE LEARN?WHAT DID WE LEARN?

21

Data show positive trends

Data show need for program improvement

Data does not exist/ revision to data

collection needed

Child health√

Infant mortalityImmunizationsMedical home

√Birth weight

√

Child development/ school readiness

√Child maltreatment/ exposure to violence

√

Maternal health√

Medical home(data not always collected)

Connecting to mental health supports

√

Parenting skills/ parent-child intxns

√

Economic self-sufficiency

√Positive trends for available data

√

HOW DO WE GET TO THE NEXT LEVEL?

RECOMMENDATIONSRECOMMENDATIONS

Older children are more ready. 16-23% are < 5 upon entry.

Readinessfor 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.

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.

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.

RECOMMENDATIONSRECOMMENDATIONS

Older children are more ready. 16-23% are < 5 upon entry.

Readinessfor 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.

Recommendation 2

Enhance the quality of this community of home visitation programs, both individually and collectively.

Recommendation 2

Enhance the quality of this community of home visitation programs, both individually and collectively.

RECOMMENDATIONSRECOMMENDATIONS

Older children are more ready. 16-23% are < 5 upon entry.

Readinessfor 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.

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.

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.

Recommendation 4

Ensure commitment to the ongoing work of this community of programs by developing and implementing processes to help sustain it.

Recommendation 4

Ensure commitment to the ongoing work of this community of programs by developing and implementing processes to help sustain it.

RECOMMENDATIONSRECOMMENDATIONS

Older children are more ready. 16-23% are < 5 upon entry.

• 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.

RECOMMENDATIONSRECOMMENDATIONS

Older children are more ready. 16-23% are < 5 upon entry.

Readinessfor 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.

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.

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.

Lessons Learned

•Leadership•Membership•Job functions•Project scope•Outside help•Innovation

The Perinatal System Design Team:A participatory design process

1. 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

1. 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

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

•TopicsDesign thinkingFacilitation/discussion LeadershipTeam-buildingDesign process & tools

•Keep focus on big picture, broad lens

3. TRAINING

• Train Design Leaders in one or two trainings/workshops

•TopicsDesign thinkingFacilitation/discussion LeadershipTeam-buildingDesign process & tools

•Keep focus on big picture, broad lens

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

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

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

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

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

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

7. SCALE, SPREAD, SUSTAIN

• Evaluate, six-month or periodic checkins

•Dissemination plan•Communications strategy•Follow up, troubleshoot•Identify new challenges back to “understand”

7. SCALE, SPREAD, SUSTAIN

• Evaluate, six-month or periodic checkins

•Dissemination plan•Communications strategy•Follow up, troubleshoot•Identify new challenges back to “understand”

THANK YOU

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