1
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
2
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.
3
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.