chapter 11 for chw
TRANSCRIPT
Ch. 11 Home Visiting
What You Will LearnDefine home visiting and provide examples of when and why
they are conductedPrepare for home visitsIdentify key safety concerns and plan for ways to address
themDiscuss what to do (and what not to do) when you arrive at a
client’s homeConduct a subtle assessment of the home environment, and
explain why this is importantIdentify and respond to common challenges related to home
visiting
An Overview of Home VisitingHome visiting involves meeting with clients
where they live.Could be an apartment, home, trailer, single-room
occupancy (SRO) hotel, a shelter, jail, homeless encampment, on the streets, in the park etc.
Home visiting is one of the most direct and personal ways to work with clients
Why Make Home Visits To visit clients who are unable to come to your office
To follow up with clients who recently received services from your program
To contact clients who have not kept in touch, to see whether they are all right and interested in participating in services again
To see clients who have recently experienced a decline in health
Because family members or friends of a client contact you out of concern for the client and ask you to visit that person
Why Make Home Visits continued To encourage clients to come to your agency for important services
that cannot be delivered at their homes To support new parents or guardians To enable clients to assess their home environments and possible
health risks, such as exposure to mold, dust, or other allergens that cause asthma
To provide support and guidance to clients regarding how to take medication properly
To notify clients that they may have been exposed to an infectious disease and to encourage them to get screened
To meet with clients who are in the hospital, jail, or other institutionsThe Power of Home Visits
The Challenges of Home Visiting Clients may not want you to visit or may not want to talk with you right then Clients may be embarrassed about their living conditions Clients may be concerned about their privacy Clients may worry that you will judge them if they live in nontraditional
families, or they may have other cultural concerns They may worry that you will learn about or expose their immigration status,
or worry that they could lose certain health, housing, or social benefits Clients may have had bad experiences with home visits from child welfare,
social workers, the police, or other authorities You may witness or learn about drug use, neglect, or abuse You may face risks to your personal safety Your clients may be very ill or facing death
Preparing to Conduct a Home VisitPut yourself in the client’s shoes
How might it feel for a stranger to come into your home?
What would you want from the CHW?What would you not want them to do, see, or ask?
Respect a client’s right to privacy-discreet home visitsSome clients may not want others to know they are
working with you/your agency.How do you protect their privacy during home visits?
Ex. “Hey, Bernadette, good to see you today. Is this a good time for a visit?”
Start Things off RightShadow another CHW
Observe what they do & how they interact with clients & their families
Review and Prepare Clients FilesReview client files and key strengths, risks, needs,
and other health concernsCheck to see if referrals were providedBring copies of blank release forms
Organize and Pack Resources to Bring on the Visit Your ID badge & business card
Written info about your agency
Client files, blank new client files, and other forms
Copies of any test results that you are authorized to review with the client
Any medications of tests that your are authorized to bring and administer
Educational materials to use to explain something more clearly
Risk-reduction or other health materials such as condoms, lubricants, hygiene kits, nutritional supplements, food or transportation vouchers etc
A map, phone or GPS in case you get lost
A folding chair or stool
A flashlight
A cell phone
Plan How You Will Travel to the Client’s Home Client’s address Landmarks nearby Public transportation or parking availability Anything you might need to know for your safetyIf you have an appointment, try to determine: If there is a house, apartment, or room number clearly marked If the client has a dog or other pets If there is a gate or intercom at the home or building Any possible problems you may encounter
Identify Key ObjectsWrite down what you hope to accomplish during
the home visitDon’t set too many goals for a single visitYou need to be flexibleTalk with the client to learn their current health
status, needs, and priorities
Preparing to Conduct a First Visit to a New ClientObtain informed consent before you conduct an
initial assessmentCheck to see if client has already signed a HIPAA
formPrimary goals are to establish a positive
connection with the client, assess client’s resources and needs, and to determine whether the person is interested in the services that you can provide
Conducting Home Visits
Preparing for Follow-Up Visits Reintroduce yourself and the purpose of your visit
Review your program’s services
Answer the client’s questions and concerns
Obtain informed consent, again, to continue with your visit and to provide services
Ask what the client remembers about your previous work together
Review any decisions, agreements, or accomplishments that the client previously made
Assess their current concerns, needs and priorities
Establish new goals that the client wants to work on
Provide health education, client-centered counseling, and referrals
Bring medications and assist clients with medications management
Provide additional supplies as needed
Set a date and time for your next visit
Respect the Client’s TimeShow up on time- let client know if you are
running lateDiscuss how much time you both have for the visitIt is the client’s home, the client’s time, the
client’s lifeIf you don’t accomplish all of your goals during the
visit, schedule a follow-up
Announce and Introduce YourselfWhen you arrive at the client’s home, announce
yourself.Use your name but not your agency to protect
client’s identity
Introduce yourself againBe sure to wear proper identificationIf the situation seems uncomfortable, ask the
client if they would like to reschedule
Dress for the OccasionWear appropriate clothing- wear something
comfortable but also culturally appropriateFind out dress code if you’re visiting someone who
is incarceratedUse your own best judgment or ask other CHWs
what they would wear
Practice Cultural HumilityCultures, values, and traditions of clients and
families will be reflected in their homesMany things in their home may be different than
what you are familiar withView home visits as an opportunity to learn more
about other cultureshttps://www.youtube.com/watch?v=lVZ71undTJ0
Speak ClearlyA calming voice can serve to relax othersSpeak loudly enough for the client to hear you,
but not so loudly that you broadcast private info to others
Listen carefully to clients- if you can’t hear or understand what they say, ask them to tell you again
Maintain Healthy BoundariesBe cautious about disclosing personal informationIf a client asks personal questions that you do not feel
comfortable answering, explain and clarify your role as a CHWEx. “My role is to be here for you, to support you to
improve your health. I don’t talk about my private life when I’m at work, because that will distract us-this is your time.”
If a client continues to push at your boundaries, you may have to leave
https://www.youtube.com/watch?v=gBpDwbTsLlE
Stay On TopicPlan for how you will disengage from
conversations that are taking up too much timeBut, be prepared to do some casual visitingSome clients may want to talk for a very long
time- this may be a sign of their isolation and loneliness etc.Develop your own way to politely interrupt clients
and remind them of the time and main purpose for the visit
Overcoming Distractions Media: ask client if it would be possible to turn these off or down so
that you can focus on their needs and concerns Pets: if there is a pet such as a large dog that makes you
uncomfortable, ask if it would be possible to put it in another room Other people: if other people are a distraction, ask the client if it
would be possible to talk privately Drug and alcohol use: do your best to provide the services you are
authorized to provide & be sensitive to informed consent issues. Do not ask client to make life-changing decisions when high. If client has a history of being abusive or violent while high, do not attempt to work under these circumstances
Cluttering or Hoarding: do not make negative comments about the clutter or attempt to move anything- this could upset the client. It is recommended you bring a portable stool to sit on when you conduct home visits
Safety Guidelines for Home VisitsBe aware of your surroundingsDon’t let your bias guide or distort the way that
you assess safety risksTake time to get to know the community you are
working inListen to your instincts- they may be tipping you
off to a dangerous situation
Be Prepared Find out as much info as possible about the client you will visit Find out what type of housing the client lives in and where Find out detailed info about the locations you will be visiting Consider working with a partner in communities that have a reputation
of being risky Let your supervisor know whom you will be visiting, where you will be
going, and when Dress appropriately Avoid agency logos or signage on your car, clothing or anywhere else Bring a cell phone If you will be visiting a client after dark, bring a flashlight
Pay Attention, and Be DiscreetBe discreet when visiting a new locationCarry yourself with secure body languageThe risks to women are different from those of
men- be aware of these risks, and make good decisions to preserve your safety
Be aware of your surroundingsBe ready to think on your feet
If Conflict or Danger ArisesDe-escalate conflict and work to calm the person
involvedApologize: you may have unintentionally done
something that provoked that person’s angerLeave if you don’t feel safeReport and documentOnly call the police if it is absolutely required
How to Conduct a Home VisitIntroduce yourselfConfirm you are talking to the clientBe friendly and patient if other family members
are presentExplain why you are thereAsk if it is still a good time to visit and discuss
what the client would like to accomplish
Conduct and AssessmentDuring each home visit you will conduct some type of an assessment, such as: A client’s knowledge about and interest in a particular service A client’s strengths, risks, and needs in order to develop a risk-
reduction plan A client’s current health status and needs for additional services Adherence to specific treatments such as taking daily
medications for diabetes or HIV diseases A client’s progress with a risk-reduction or case management plan Exposure to environmental health risks
Conducting an Environmental AssessmentYou may observe: Client’s level of stress at home Basic living conditions, including access to clean sheets, clothing,
and resources for hygiene Availability of food Environmental risks such as mold, dust, insect or rodent issues, or
safety hazards for young children The presence or absence of friends, family, roommates, and the
quality of those relationships Challenges with mobility within or outside of the home Exposure to safety risks such as abuse or neglect
Providing Case Management, Client-Centered Counseling, and Health EducationYou may provide health education about a specific
condition-like hypertension or heart diseaseThis may include assessing their levels of
knowledge, providing info, and supporting them in thinking about relevant behavior changes
You may provide client-centered counseling or coaching- including parenting, domestic violence, or depression
Explain the Next StepsClarify and document what the next steps will be
Plan should address all concerns and priorities that client discussed with you
Confirm date and location of next appointmentWrite down plan and leave it for client- if they
cannot read, ask if there is someone who can review it with them
Goodbye and Thank YouTell the client goodbyeThank them again for their time & hospitality
After the VisitComplete paperwork documenting the visit, any
assessment conducted, info you learned, services provided, and agreements made
Write down future appointments or visits in your planner or calendar
Find out info you needed during your visit but did not have, such as specific resources
Check in with the client by phone, with a follow-up visit, or with an appointment at another location
Talk with your supervisor or another colleague about any remaining questions or concerns you may have
Common ChallengesVisits to People Without Traditional Homes
Be as respectful of this space as you would any other home
If client expresses that they do not want you there, leave
Do you best to keep your communication confidential- keep your voice low
If others are nearby and may be listening, do not discuss confidential matters
When Clients are AngryWhile their anger may sometimes be about you,
generally it is about other issues they are confronting, such as experiences of discrimination, violence, mental health conditions, separation, or conflict with family members
Be patient and stay calmStay respectful, professional, and politeIf client acts in ways that are threatening or
physically aggressive and you cannot de-escalate their anger, leave immediately
Working with Clients Who are IncarceratedContact the jail to gain security clearance and ask
what to wearAssist client in making plans for what to do in the
very first hours and days when they are releasedIf clients want to make changes regarding
substance abuse, assist them to figure out what they can do that will reduce their risks of using
You may ask them to call you when they know that they will be released to schedule a time to meet
Workbook pg. 25Motivational Interviewing: “Directive, client-centered counseling style for eliciting behavior change by assisting clients to explore and resolve ambivalence”Doing Client-Centered WorkListen carefully to what the client is telling youClosely observe the client and his/her surroundingsSpeak less and listen more. Are you dominating the
discussion?This does NOT mean that you should always agree with the
client or support everything WAIT- Why Am I Talking?
Workbook pg. 25Attitudes and Behaviors Used in Motivational InterviewingEnhance motivation for change: Respect Empathy Being nonjudgmental Curiosity Genuine interest Collaborative spirit Emphasis on client’s choice Support of client’s autonomy
Workbook pg. 25Promote resistance to change:Arguing, coercing, imposingBlaming, shaming, criticizingJudging, labeling, warningCommanding, threateningMoralizing, preaching, lecturingAssuming the expert role
Workbook pg. 25OARS
Open-ended questionsAffirmationsReflective listeningSummarizing
Open-Ended QuestionsUsing open ended questions allows the client to
talk moreOpportunity for client to talk about feelings,
desires, and fearsListen to these answers without judgment- this
will build trust