improving home visiting practice with the life skills progression™ (lsp)

Improving Home Visiting Practice with the Life Skills Progression™ (LSP)

Linda Wollesen, M.A., R.N., LMFT Director Life Skills Outcomes, LLC

© 2013 Life Skill Outcomes, LLC

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Purposes of the LSP

Identify individual parent/child strengths, needs, progress & regression over time, across 43 scales

Case summary for family intervention planning

Capture family changes over time Cohort data for funding, research

program improvement


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Utilization focused evaluation Useful to the staff scoring it Reflective practice using the LSP

increases the likelihood of improved client and program outcomes


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LSP measures:

35 parent life skills categories Relationships

Family, Extended family FOB, boyfriend, spouse Children- Parenting skills Home visitor Resources


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LSP measures:

Education & Employment Language High School & other education Employment Immigration


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LSP measures:

Parent & Child Health Prenatal Parent sick care Family Planning

Child well & sick care Immunizations Dental care


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LSP measures:

Mental Health & Substance Use Drugs & Alcohol Tobacco Depression & Mental illness Self-esteem Cognitive development & learning


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LSP measures:

Basic Essentials Housing Food Transportation Health care coverage Income Child care


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LSP measures:

Child Development: Ages 0-5 yrs Communication Fine & gross motor Problem solving Personal-social skills Social-emotional characteristics Regulation Breastfeeding


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Developmental Screening

Child development scales require valid developmental screening tools Ages & Stages Questionnaires®, Third

Edition (ASQ-3™)

LSP summarizes findings & special educational outcomes


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Frequency of use

Intake Every 6 months Closure

Scoring takes 5-10 min. <30 min per year per family


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Validity

The inter-rater reliability 78-90% Content validity confirmed by national

experts and program staff Found useful in practice over 10 years by >75 systems with multiple programs

and individual program sites.


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Training

8 hrs < 40 participants On-site training, provided through

Brookes on Location Training packet Train-the-trainer support For more information, visit

www.brookesonlocation.com


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LSP Training Objectives

Format & terminology Scoring judgment & procedures Practice scoring anonymous families Practice using scored cases for reflective

practice: strengths, needs, progress, regression

Complete & interpret cumulative score sheet on scored family

Design Reflective Questions for key issues © 2013 Life Skill Outcomes, LLC

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Target Range

Each scale has a unique target range

Target Range = parent/child has adequate or optimal skill for each scale.

Target ranges are more useful than means


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Reflective Practice & the LSP Reflective Function is the ability To THINK about behaviors, feelings,

events, relationships and consequences To LINK these to new or needed

information To choose a purposeful RESPONSE

(Smith & Wollesen, Beginning Guides Handbook

2008) © 2013 Life Skill Outcomes, LLC

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Think-Link-Respond

BehaviorsFeelings RelationshipsEventsConsequences

New or KnownInformation

Design,Carry out,Evaluate,Modify a Plan of Action

Think

Link Respond


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Cumulative Score Sheet

Used to see an individual parent’s strengths, needs, progress, regression over time.

Plan a series of Reflective Questions to support parent awareness of a strength, a need or blind-spot

“Teach by Asking” to support Reflective Functions which are the core of parenting, of living.


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Data Management

Databases available Reports

# & % in target range Low Literacy Cumulative score sheets Multiple sites

Easy migration to stats programs $1500-3000/site

orientation & ongoing support


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MIECHV Benchmarks Crosswalk Benchmark 1. Maternal Newborn Health Item 17 Prenatal Care Item 24 Substance Use/Abuse Item 26 Depression/Suicide Item 20 Well Child Care Item 23 Immunizations Item 43 Breastfeeding


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MIECHV Benchmarks Crosswalk 2. Child injuries, Abuse, Neglect, ER

Visits LSP Item 8 Safety LSP Item 21 Child Sick Care LSP Item 6 Discipline Note: Programs must provide official

child abuse reports to document incidence of child abuse


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MIECHV Benchmarks Crosswalk 3. School Readiness & Achievement LSP Item 4 Attitudes to Pregnancy LSP Item 5 Nurturing LSP Item 7 Support of Development LSP Items 26 & 28 Depression, Self

Esteem LSP Items 36-40 Child Development w

ASQ

LSP Items 41-42 Personal Social & Social Emotional w ASQ-SE


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MIECHV Benchmarks Crosswalk 4. Crime or Domestic Violence LSP Item 1 Family Relationships LSP Item 2 Boyfriend, FOB, Spouse

Relationships


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MIECHV Benchmarks Crosswalk 5. Economic Self-sufficiency LSP Item 34 Income LSP Items 13-15 Education and

Employment LSP Item 33 Medical/Health Insurance


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MIECHV Benchmarks Crosswalk 6. Coordination and Referral to other

Community Resources and Supports LSP Item 10 Use of Information LSP Item 11 Use of Resources Note: These items measure parent’s

skills; programs must provide referral log data (program output)


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Research Studies using LSP

AHRQ, NIH: Home Visitation/FHL 2008-9 NLM: Home Visitation/FHL & Depression

2011 NLM: Home Visitation/FHL & Child

Development


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LSP Self-care Literacy Scale

Managing personal & child health at home

LSP Item 4 Attitudes to Pregnancy LSP Item 7 Support of Development LSP Item 8 Safety LSP Item 11 Use of Resources LSP Item 24 Substance Use/Abuse LSP Item 25 Tobacco Use LSP Item 28 Self Esteem


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LSP Healthcare Literacy Scale Use of information and services for

health LSP Item 10 Use of Information LSP Item 17 Prenatal Care LSP Item 18 Parent Sick Care LSP Item 19 Family Planning LSP Item 20 & 21 Child Well & Sick Care LSP Item 22 Child Dental Care LSP Item 23 Child Immunizations LSP Item 33 Medical/Health Insurance


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Research

Does Home Visitation Promote Maternal Health Literacy?

N = 2572 parents Funders: Agency for Healthcare Research & Quality NIH Office of Behavioral & Social Science

Research National Institute for Child Health & Human

Development

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Key Findings

Overall parents achieved significant improvement in health literacy scores after 12-18 months in home visitation (P<.001)

Estimated reading level at baseline predicted entry level health literacy scores, but did not predict who progressed or how much.

Lower functioning parents and those with lower estimated reading level achieved the greatest gains.

The LSP can be used to meaningfully measure maternal health literacy.

Smith, S. A. (2009). Promoting Health Literacy Concept, Measurement & Intervention. Literacy, 170. Dissertation. Union Institute and University.

AHRQ Innovations Exchange: Home Visits Using Reflective Approach Improve Functional Health Literacy Among Low-Income Pregnant Women and New Parents http://www.innovations.ahrq.gov/content.aspx?id=2533

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Health Literacy & Depression N= 750 parents with 4 observations Funder: National Library of Medicine

through contract with University of WA Findings:

Health literacy & depression closely relatedp<.001

Depression does not interferes with home visitors’ ability to promote health literacy

Smith, S. A., & Moore, E. J. (November 26, 2011). Health Literacy and Depression in the Context of Home Visitation. Maternal and Child Health Journal DOI 10.1007/s10995-011-0920- 8http://www.ncbi.nlm.nih.gov/pubmed/22120425

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Health Literacy & Child Development

N= 1301 parents with 2+ ASQ Funder: National Library of Medicine

through a contract with University of WA Health literacy scores predict child

developmental outcomes (p<.001) Healthcare literacy scores predict

participation in Early Intervention (p<.001)

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Lessons Learned

Maternal Health Literacy can be promoted

Reflective skills key Reflective Questioning promising LSP meaningful measure Home based programs effective channel

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For more information

www.HealthLiteracyPromotion.com/Research-Summaries.html

www.BeginningsGuides.com

www.LifeSkillsProgression.com

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Key Findings

Depressed mothers demonstrated lower baseline health literacy scores than not- depressed parents; however, they achieved greater gains (P < .001).

While depression is linked with lower maternal health literacy, after 1 year of enhanced home visitation, vulnerable mothers were better able to manage personal and family health and healthcare.

Enhanced home visitation could be an effective channel to develop health literacy as a life skill, and to improve depression.

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Thanks for joining us!

To order:www.brookespublishing.com1-800-638-3775

To learn more:http://www.brookespublishing.com/resource-center/screening-and-assessment/lsp/

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Questions?
