home visiting program manual

Home Visiting Section of the Help Me Grow Home Visiting

Program Manual

Providing Quality Home Visits...…………………………………………………………..HV-1 Parenting Education and Curriculum…………………………………………………HV-1 Screenings and Assessments…………………………………………………………HV-2 Family Supports………………………………………………………………………...HV-3 Linkages and Referrals to Agencies………………………………………………… HV-4 Immunization Chart Transitioning to a Development-Enhancing Early Childhood Program...………...HV-8 Responsibilities of the Home Visitor Flow Chart

Additional Considerations in Home Visiting…………………………………………..….HV-9

Scheduling………………………………………………………………………………HV-9

Home Visiting Structure………………………………………………………………HV-10

Home Visiting Personal Safety…………………………………………………………..HV-11

Cultural Competence……………………………………………………………………..HV-13

Additional Strategies for Establishing Relationships Across Cultures…………..HV-16

Specific Resources for Program Targeted Groups………………………………..HV-17

Consents for Services & Parent’s Rights in HMG Home Visiting Program…………HV-18

Consent Form

Guidelines for Writing Good Case Notes………………………………………………HV-19

DARP: Description, Assessment, Response, and Plan…………………………..HV-20

Help Me Grow Case Notes Form

Home Visit Schedule & Screening, Assessment & Program Evaluation……………HV-23

Help Me Grow Home Visiting Program Timeline

Home Visiting Tools and Forms………………………………………………………………HV-24

45 Day Data Collection Form Explanation………………………………………….HV-24

45 Day Data Collection Form

Family Plan Form Explanation……………………………………………………....HV-26

Family Plan

Ongoing Home Visit Form Explanation……………………………………………..HV-27

Ongoing Home Visit Form

Works Cited in this Section………………………………………………………….…..HV-28

Memo #10-03

Ohio Help Me Grow Home Visiting Program Manual Created June 2010 HV-1

Providing Quality Home Visits

Ongoing home visiting services are designed to meet the informational and educational needs of families participating in the Help Me Grow (HMG) Home Visiting Program. In order to provide quality home visiting services to Ohio families, home visits must be provided in a systematic and consistent manner that includes all the following components: (1) use of an evidence-based parenting education curriculum approved by the department, (2) administration of required screenings and assessments, (3) appropriate referrals and community linkages based on family need, and (4) parenting education around the transition to a development-enhancing program/early care and education provider at three years of age. Each of these components shall be discussed further in the subsequent pages of this section.

Parenting Education and Curriculum

A major focus of home visiting is parent education through the use of an evidenced-based curriculum for infants and toddlers. The term ―evidence-based‖ means that the curriculum has been empirically researched and there is sufficient evidence that the curriculum has been associated with or produces positive outcomes.

You as the Home Visitor, in cooperation with the child’s parent(s), are responsible for the provision of age-appropriate child development information to the family. Although the approved curricula provide a number of topics for discussion, as well as handouts and structured materials, the information provided should be flexible so that you can respond to inquiries for information that come the family. Parenting education materials should also be offered in a variety of adult learning styles including, but not limited to: discussions, handouts, videos, parent-child activities, screenings and referrals and linkages to other services in the community (when appropriate). The department notifies all county programs of approved curricula through memorandums. The most recent memorandum is included in this section. Other evidenced-based curricula may be considered; but before it can be used with families in the HMG Home Visiting Program, it must be approved by the department.

In order to meet Ohio’s standards for home visiting and receive departmental approval

for use with participating families, an evidence-based curriculum must meet each of the

following requirements:

Teach prenatal health, nutrition and care

Encourage smoking cessation

Teach child development, including prenatal, infant and toddler brain

development


Teach the importance of child health, medical home, well-child visits and

proper nutrition and feeding

Teach and provide activities to promote nurturing parent-child interaction

Teach appropriate discipline

Teach safe and enriching home environment

Teach use of social support networks, both formal and informal

Teach use of community resources and importance of connecting to

resources

Screenings and Assessments

In the HMG Home Visitation Program, you as the Home Visitor are required to complete screenings and assessments. Guidance regarding procedures for assessment will be discussed in this section and additional information regarding screenings can be found in the Screening and Program Evaluation Tools section of this manual. In the Help Me Grow Home Visitation Eligibility Determination policy, assessment is defined as the ―process of program planning resulting from the collection and synthesis of information.‖ In your daily work with families, this means a continual information-gathering process about the child and the parent(s) should occur in order to identify and consider the factors which will impact the growth, development and well-being of the child in his or her everyday environment. This process is a way to gain an understanding of how a family’s strengths, needs and resources affect the child and parents’ well-being. Assessment is an ongoing process that begins upon the child’s entry to the program and continues until the child’s exit at three years of age. The key to this ongoing process is your relationship with the family. Assessment information is gathered in a variety of ways, some formal and others informal. You are responsible for all of the following:

Engaging in conversations with the parent(s) and learning what life is like for them. What supports do they need? What are his or her priorities at the moment? Does the parent have goals he or she needs assistance to meet? You are building a relationship with the parent(s) during this time and it should never feel like an interview.

Observation of the parent(s) and child in their everyday activities and routines. Then, sharing with the parent(s) what you observe and brainstorming together what supports might be helpful.

Administration of the required tools in such a way that they inform both you and the parent(s). As stated in the ―Screenings, Assessments and Program Evaluation Used in the Help Me Grow Home Visiting Program‖ section of this manual, the developmental screenings, assessment tools and program


evaluation tools are used to assist you in gathering information and development of both Family Plans and program goals.

Home Visitors utilizing these practices should have enough information to develop and

revise the Family Plan in a manner which will be meaningful for the participating family.

Family Supports

All families need support and this support can come from a variety of sources. Your role in providing family support consists of helping the family determine which resources would best meet their needs and helping to address their concerns. Families who live in poverty often experience additional challenges. Your task is to provide supportive services which focus on the family unit as a whole, to identify strengths and mobilize resources to help families resolve problems and reach their goals. You must remain flexible and remember that the support and resources should be customized in order to be responsive to the individual needs of the family. If resources needed by the family are unavailable in the community, consider additional strategies like asking your peers, supervisor or searching online for websites that mention social services and your county name. It is also important to remember that available supports may be formal or informal, as evidenced by the following quote:

“The support that seems to make such a difference in family life can come from a

spouse, a grandmother, a friend, a family support group, a day care center or a

mental health professional. It can occur naturally (informal supports) or through

intentional social planning (formal supports)” (Schorr, 1989).

Formal supports include organized aid and assistance, such as that available through children’s hospital counseling services, social service agencies (such as the local Department of Job and Family Services), area mental health agencies, community food banks, child care agencies, and Early Head Start/Head Start programs. Informal supports include individuals or groups such as neighbors, friends, relatives, social clubs, and support groups. If a family cannot meet the requirements of formal support resources, informal supports should be sought out.

In conjunction with the local Family and Children First Council (FCFC), HMG programs can establish or encourage community networks of support that involve not only local government agencies but also community groups such as veterans groups, social clubs, and local charities to fill gaps in service and support to families. Through continuous dialogue, collaboration and cooperation, persons seeking needed resources can receive the aid and assistance needed to overcome obstacles. Networks can be established to enhance or develop local resources in many areas of family needs, including transportation, food, clothing, medical care and housing.


Family-to-family support can also meet the needs or goals of a family participating in the HMG Home Visiting Program. For example, community fairs, picnics, and potlucks are opportunities that enable parent participation on many different levels—meeting new people, participation in planning events, receiving new information about finances, employment, child development and parental skills. Support programs may also be available specifically to help during transitions such as the birth of a child, family losses due to death, incarceration, unemployment, military duty and family member hospitalizations.

It is important not to underestimate the impact you have in providing support to families. As a Home Visitor, however, it is important to maintain an appropriate role with families participating in the program. It is necessary to maintain some distance between yourself and those you work with otherwise you risk becoming over-involved and setting up a situation where the family becomes too dependent on you or asks you to facilitate resources outside of the program’s scope. The goal of the relationship is to provide support by linking families with resources which enable them to create and sustain their own network of support long after their participation in Help Me Grow ends.

Linkages and Referrals to Agencies

One of your responsibilities as a Home Visitor is to help families identify and access local community resources. In order to meet this responsibility, you must have a thorough knowledge about what is available in your community and how to locate services and supports that the family may need. Through consistent dialogue with the family, Home Visitors can assist in (1) clarifying the family’s needs for services and supports, (2) contacting community resources and (3) assisting in follow through with those resources. In many cases, especially at the beginning, you will need to teach the parent how to access resources by showing or doing the call/link/referral for them. Your role is in facilitating referrals, not just handing over phone numbers. The goal is to enable the family to get information about needed services now and eventually, on their own in the future.

Linking families to resources in the community in which they live can be accomplished through needs-based referrals. Referrals can be made to a program or agency, to a person or a group of people, or to public, private or religious entities. Referrals can be made for traditional and non-traditional supports. The number and scope of referrals made is defined by both what your families need and what is available in your area. Referrals can be made by giving the contact information for the community resource for the family to use, by you making contact with the referral agency on the family’s behalf or by accompanying and facilitating the connection in person. Remember that making effective linkages with the family depends on meeting the family where they are. Some will be willing, able, and even prefer to make calls on their own. Others will be less able to follow up on information provided and will need your assistance in a more hands-on way. The more experience families gain, the more independent they will become, but be prepared to take an active role in facilitating referrals when first working with a family.


Many partnerships and collaborations have already been established among local government agencies through the local FCFC, the body responsible for coordinating child-serving local services, resources and systems in Ohio’s counties. In addition, the Early Childhood Coordinating Committee (ECCC) of each county’s FCFC are charged with addressing the coordination of service delivery, identifying and addressing gaps in local services, and the invention of new approaches to achieve better outcomes for families who are expecting their first child or have children from birth to three years of age. The ECCC may develop relationships within a community that could provide services and supports for the family so that referrals and linkages can be made smoothly as well as being responsive to the particular family needs.

Additional opportunities exist for Home Visitors to identify resources at community-sponsored fairs throughout the year. At local fairs, local service agencies can provide families with additional information and offer parents an opportunity to participate in activities which broaden their perspective and knowledge of what is available in the local community. One final resource is the list of service providers, agencies and other resources that have been identified to support families available on the Help Me Grow website at www.ohiohelpmegrow.org. We have also provided a list which includes a sampling of agencies in the Intake & Referral section of this manual.

Two examples of linkages for families to assist Home Visitors in understanding the importance of community referrals are provided in the boxes below.

http://www.ohiohelpmegrow.org/


For Example: Linking Families with a Medical Home or Primary Health Care Provider

One of the four major program goals in HMG Home Visiting Program is that children will have improved health, development and readiness to learn. To achieve the goal of improved health, you must help families access health care either at a medical home or a primary health care provider. So, what is the difference? A primary health care provider is one that functions as the first point of contact for the child within the health care system. The provider offers the child both sick care and well-child visits, as well as consistent responsibility for the child’s health care. A primary health care provider refers the child to specialty physicians (e.g., surgeon) or clinics when needed and then coordinates the care provided by specialists. The medical home is a specific type of primary health care provider and is defined by the American Academy of Pediatrics as ―[a] family centered, accessible, comprehensive, continuous, coordinated, compassionate and culturally competent [practice] in which the primary care physician shares the responsibility in partnership with families [for the care of young children].‖

The American Academy of Pediatrics maintains a site specifically about the medical home. This is located at: www.medicalhomeinfo.org To facilitate a family’s connection with a medical home, understand what kind of relationship with professionals the parent(s) have had in the past. It will be helpful to know to what extent they tried a particular provider and what kind of experience they had with him/her. Resources exist in your county which will lead you in making this linkage. Some counties operate free medical clinics, but you should be familiar with the pediatric physicians and whether they accept Medicaid patients or are not currently accepting new patients. Moreover, public health nurses are an excellent resource for you and families when children have special health care needs. See link here http://www.odh.ohio.gov/odhPrograms/cmh/cwmh/infoprov/cmhphn.aspx for more information.

http://www.medicalhomeinfo.org/

http://www.odh.ohio.gov/odhPrograms/cmh/cwmh/infoprov/cmhphn.aspx


For Example: Linking Families with Access to Childhood Immunizations

As a Home Visitor, you are responsible for encouraging parents in the HMG Home Visiting Program to obtain childhood immunizations for their children. An immunization chart for teaching purposes can be obtained at the Ohio Chapter of American Academy of Pediatrics web site: http://www.ohioaap.org/files/OTIS_2010.pdf The brochure titled Shots for your Child’s Health should be given to parents to provide information about each immunization. See the chart ―Ordering Instructions for Resource Materials‖ in the Resources Section of this manual for ordering information. Besides providing information about immunizations, the Home Visitor is responsible for providing parents with information on community resources where immunizations can be obtained (at a reduced cost or for free). Low-cost immunization services can be identified in each county by viewing the Ohio Department of Health’s website and clicking on the icon for local health districts at: http://www.odh.ohio.gov/localHealthDistricts/localHealthDistricts.aspx Home Visitors are also required to document immunization status for each child in both the child’s record and in Early Track, but they are not required to review immunization records for this task. In order to meet the data entry requirement, the following guidelines are provided to determine immunization status among the four options in Early Track:

1. Not Medically Recommended: The child’s physician has indicated that immunizations are not recommended for this child due to a medical concern.

2. Not-Up-to Date: Ask the parent when the child was last seen by the physician. If the child has not been seen since age 5 months and the child is now 8 months old, then the immunizations are not up-to-date.

The Home Visitor should refer to the attached immunization chart which indicates that several immunizations should have been given to the child since age 5 months of age. The child is then considered not-up-to-date if the child does not have all immunizations for his/her age listed on the chart.

The exception to this situation would be a child visiting an immunization clinic to get immunizations instead of going to the physician. In this situation, ask when the child last received immunizations. If the child is 8 months old and has not been seen at the immunization clinic since age 5 months then the child is ―not-up-to-date.‖ Even if the child is on a schedule to catch up on immunizations, you would consider him/her ―not-up-to-date.‖

3. Parent Choice: The parent has chosen not to immunize the child. Options here include Declined All Immunizations and Declined Some Immunizations.

4. Up-to-Date: Ask whether the child received an immunization at the last medical visit. If the child received an immunization at that visit, then indicate that the child is up-to-date.

If the last visit was a sick visit, then inquire about the last well-child visit and consider the child up-to-date if the child received an immunization at the well-child visit.

As noted above, if the child is receiving immunizations from an immunization clinic on time, then the child is up-to-date.

http://www.ohioaap.org/files/OTIS_2010.pdf

http://www.odh.ohio.gov/localHealthDistricts/localHealthDistricts.aspx


Transitioning to a Development-Enhancing Early Childhood Program

The fourth and final component of the HMG Home Visiting program is to educate and facilitate transitions to development-enhancing programs/early care and education providers at age three. This can be an anxious time for parent(s) who have come to rely on your support. However, if you begin teaching parent(s) about the benefits of these programs/providers early it will help the transition processes. It is your job as the Home Visitor to take opportunities to inform and talk about what the benefits are. As the Home Visitor, you need to be well informed of what is available in your community, what is important to the family, and what the research demonstrates about children keeping the advantage gained from birth to age three. By being prepared with this information early, instead of waiting until the child is three years of age, you will be able to communicate effectively with families on the topic of transition in a way that seems natural and integrated. The Transition section in this manual provides some strategies and information from the research literature to help you start the conversations.


Additional Considerations in Home Visiting

This section will provide an overview of considerations for appropriate planning of home visits, including cultural competence, collecting required data in Early Track and documentation using case notes.

Scheduling In the course of scheduling home visits to participating families, Home Visitors should give special consideration to the family’s concerns in planning and making visits to their home. Some questions you should think about are the following:

What is the purpose of the visit? o Is it a regularly scheduled visit? o Is it an additional visit requested by the family or Home Visitor?

How urgent is the visit? o Is the family experiencing a crisis?

What is the planned content of the visit? o Always have a plan for the visit.

How far is the location of the home? o Are potential delays in travel time (weather, traffic, etc.) figured into your

travel time?

How easy or difficult was it to contact the family? o Do you have all of the contact information available in order to reach the

family?

How long will the visit last? o Is this an initial visit? A planned visit?

How easily will home visits fit into their everyday routines, activities and places?

o What activities are routine for the family and where do they take place? The HMG Home Visiting Program is voluntary and should be offered with the family’s daily life in mind. A specified frequency of home visits is encouraged because this number is based in the research literature on home visiting as being potent at critical points in time. This minimum frequency should always be encouraged, but it always remains the family’s right to decide on a frequency of home visits which would be most beneficial to them. ODH expects that each Home Visitor must, at a minimum, offer the recommended home visit schedule.


Home Visit Structure As you consider how to structure each home visit, remember that the typical visit can be broken down into three areas: introduction, parenting education/activities, and planning. Introduction

Introduce yourself as the HMG Home Visitor

Listen to the family as they share information about their life initially and since the last visit

Work on building your relationship with the family by giving them the first opportunity to talk

Start every home visit with catch-up talk Parenting Education/Activities & Family Support

Provide information that is useful and helpful to parents in order to enable them to understand and support the developmental and emotional needs of their children

Promote bonding, attachment and mutually satisfying parent-child interactions by modeling for the parent activities they can do with their child through descriptions or demonstrations

Support parent(s) to promote early learning and literacy by providing encouragement, examples of things they can do with their child at any age, and stressing the importance of these concepts to their child’s child development

Explore the informal and formal supports available and what that means to the family so that you can facilitate support when and if it is needed

Planning

At the end of your visit, provide resources and referrals for identified needs

Review the progress and achievement of Family Plan goals when appropriate

Summarize the visit and discuss any provided learning materials that reinforce the curriculum, leaving them with the family

Discuss objectives, materials, information and topics for the next home visit with the parent(s) and schedule the date and time for the visit

A critical consideration in visiting families in their homes is gaining an understanding of how culture plays a part in everything they do. The following section will explore what is meant by the term ―culture‖, how it influences people and how Home Visitors can use the concept to broaden their understanding of the parents and families they serve in the HMG Home Visiting Program.


Home Visiting Personal Safety

When visiting homes, you should be aware of your own personal safety. There are steps you can take in the office, before the visit and during the visit which increase the likelihood of feeling and remaining safe. In the office before the visit

Tell other staff your schedule and where you will be

Check with fellow staff regarding possible known risks

If your first time traveling to the location, have clear directions and/or map

Let the parent(s) know you are coming

Before the Visit

Keep your car doors and windows locked

Store valuables out of sight BEFORE you arrive

Park where you can see your car during the visit; Do not park in a driveway

Choose well-lit parking with a safe walking route & park in the direction you

intend to leave

Be cautious of dead-end streets

Walk confidently and purposefully toward your destination

Be alert and observant

Wear shoes that allow for easy movement

Carry minimal cash, your ID and keys on your person

Identify yourself to management and security personnel in the housing complex

Become known to businesses in the neighborhood

Have a way to contact 911 (Even a cell phone with no service contract will still

connect you to 911 for free)

Above all, trust your instincts: leave if you feel uncomfortable!

Drive around the area first looking for unsafe conditions: poor lighting, unsecured

animals, potential sources of help

Incorrect address? Do not search by knocking on strange doors!

Think you are being followed? Enter the nearest public place

People loitering? Walk around or cross the street; remain respectful

Pause at door and listen before knocking. Knock before entering

Find out if the parent is home before entering

Do not enter if you believe an unsafe condition exists


In the Home

Reschedule if you feel uncomfortable

Be aware of ―traffic‖ in and out of home

Be aware of pets

Do not enter dark rooms or basement

Leave immediately if you become aware that a firearm is present

When sitting, choose a hard chair, with your back to solid wall, if possible

Note the exits and sit as closely to them as possible

How to get out

If you are uncomfortable, you don’t have to stay!

Have a cell phone, keep the power on, and keep it with you when you’re in the

home. Then you can always say, ―Oh, my phone is vibrating, I’ve just missed this

call from my supervisor. I need to call her, please excuse me.‖

Or, you can also have a preprogrammed speed dial button to the office. Again,

say, ―My phone is vibrating‖ and press the speed dial.

In either case, you can say on the phone, ―Oh, no, when did that happen?‖ and

then tell the family, ―There’s an emergency. I have to leave right away!‖

Several phrases could be linked to a plan with you office. Depending on what you

say, the office could either call the police, or call you back in a few minutes to

make sure you are okay.

Have a selection of ―excuses‖ for leaving – but they need to be convincing and

not something a family could help you with (e.g. – If you say, ―I have a

headache‖, a family could just offer you some OTC medication)


Cultural Competence

In order to understand the concept of cultural competence, it is necessary to first define culture. Winder (1991) describes culture as:

“a system of collectively held values, beliefs and practices of a group which guides decisions and actions in patterned and recurrent ways. It encompasses the organization of thinking, feeling, believing, valuing and behaving collectively that differentiates one group from another.”

In other words, culture is a system of symbols (customs, rules, mores, beliefs, values) relating to and linking people, things and events. Culture is dynamic and always changing, but it can also be long lasting. Culture is usually thought of in terms of racial, religious, social or political groups. But culture is more than that.

Home Visitors need to have the opportunity to learn about the cultures of the families that they serve. Home Visitors also need to learn about the beliefs and values of the culture of the larger community because understanding the family’s culture provides information about the way in which parents raise their child. In addition, a family’s culture may also affect the degree to which they engage in home visiting.

The book, Embracing Cultural Competency: A Roadmap for Nonprofit Capacity Builders (2009) outlines culture in degrees. The first level includes things that are visible or evident such as dress, sex, age, language, race or ethnicity, and physical characteristics. The next layer of culture includes things like eye behavior, facial expressions, body language, a sense of self and gender identity. At an even deeper level, people of the same culture may have the same beliefs about modesty and cleanliness. In addition, they may have similar emotional response patterns, adhere to certain roles in social interactions and have specific ways to engage in problem-solving. Finally, at the deepest, unobservable level, people may have a shared concept of justice, how individuals and groups are valued, and their perceptions of mental health, health, illness, and disability. Culture may also dictate patterns of superior and subordinate roles related to age, gender and class.

So how do those of us working in the early childhood profession become culturally competent? First, we have to recognize that there are differences and similarities between cultures. There are even subtler differences within cultures. We become culturally competent after becoming aware that every person, in different ways, is like all other persons, like some other persons, and like no other persons (Kluskhohn & Murray, 1948). This means that it is up to the Home Visitor to be open to the influences of culture on parenting beliefs and practices. Home Visitors will need to take time to ask and learn about a families’ culture and to strategize about how knowledge of these influences effect the entire environment of the child and his or her family. Furthermore, it is critical that you never, ever make assumptions about any family based on their


cultural identity. There are various degrees of culture and families often embrace one part of their culture while dismissing others.

Now that culture has been defined, what does it mean to be culturally competent? Essentially, cultural competence is the ability to adapt service delivery to meet the diverse needs of the communities you serve. The first step in successfully adapting services is recognizing that our own values may conflict or be inconsistent with those of other cultural or ethnic groups. Knowing the cultural makeup of a family’s community is important if you are to understand their goals, priorities and environment. In order to provide families with the best program possible, we must understand how beliefs and traditions related to cultural or ethnic identity can affect attitudes about food, gender roles, folk healing methods, appropriate methods of disciplining children and even the definition of family (Spector, 1996). Language assistance is also an important aspect of cultural competence. Language assistance means that someone is available who can communicate directly with families in their language of proficiency (face-to-face or via telephone service). It is important to recognize that limitations in English proficiency are not an indicator of intelligence. One strategy for making sure a parent understands specific information includes following up teaching with one or more of these questions:

How would you explain this to your spouse?

Tell me what you know about…

Show me how you would…

What have I forgotten to explain?

How would you know if…..

It is important to note that these questions can aid you in determining if someone has understood what you have attempted to communicate, but they should not be used in a testing or quizzing manner. Moreover, these questions should never be used to demean or embarrass the parent(s). If these questions are used appropriately, the Home Visitor should be able to discern if an interpreter should be present for the next home visit or if other accommodations are needed. Linguistic competence is another important aspect of the larger concept of cultural competence. Linguistic competence is the capacity to communicate effectively and convey information in a manner that is easily understood by diverse audiences, including those persons with limited English proficiency, those who have low literacy skills and individuals with visual or hearing impairments. Some questions to consider in regards to language assistance and linguistic competence are as follows:

Do you know what languages are spoken in your community?

What does your agency do for language interpreters?


Keep in mind that family and friends can be used if the parent is comfortable with that person serving as an intermediary, but children should not be used as interpreters between you and the parent. Agencies serving families in the HMG Home Visiting Program must make easily understood materials available in the languages of the commonly encountered groups living in the local communities of their area. Any form which the parent must sign, including consent forms, must be made available in his or her language of proficiency. As a Home Visitor or service provider, if you have a need for translation services, please notify the staff at the Bureau of Early Intervention Services (call 614-644-8389) so that accommodations can be explored. Also, remember that meaningful access is not limited to written translations alone and the use of written materials should never be used as a substitute for oral interpreters. Cultural competence can also involve stakeholders in the local community outside of the Help Me Grow system. The local community can become engaged in the design and implementation of a community needs assessment that identifies demographic and cultural patterns and needs in the area. A community needs assessment should address each of the following in the local area being studied:

percentage of cultural minorities in the area

age and gender

languages spoken and read

religions

refugees and immigrants

income distribution

number of unemployed

individuals who are non-English speaking

individuals at or below fourth-grade reading levels

types of community services available

The local Early Childhood Coordinating Committee may have already conducted this type of analysis. If a community needs assessment has not been completed in your area, specific methods for obtaining community input include surveys, public meetings, focus groups, advisory committees, coalition building and parent-to-parent networks. In addition, communication methods such as stand-alone documents (including program brochures and other public awareness and outreach materials), member publications, newsletters targeting the communities served, presentations at conferences, newspaper articles, television, radio and postings on websites can help to inform the community about available services for families.


Additional Strategies for Establishing Relationships Across Cultures

Culture determines the roles for politeness, caring behavior and will also shape the

parent’s concept of a good relationship

Begin by being more formal with those from another culture and address persons as Mr.

or Mrs. until invited to be less formal

In many cultures, it is disrespectful to look directly at another person (especially

someone who is considered to be an authority figure) or to make someone ―lose face‖ by

asking questions. Do not be insulted if the parent fails to look you in the eye or ask

questions about the program

Use questions that will help determine the parent’s central beliefs about parenting (using

the tools required for program evaluation as an aid), but do not make assumptions about

the parent’s values, beliefs, or ideas around raising his or her children

In many cultures, decisions are made by the immediate family or the extended family. If

the family can be involved in the decision making process at each home visit, there is a

greater likelihood of engaging the parent in the home visiting program

The concept of ―need to know‖ is unique to Americans. In many cultures, placing oneself

in the hands of someone like the Home Visitor represents an act of trust and a desire to

transfer responsibility for knowledge provision to the Home Visitor. Watch for and

respect signs that the parent has learned as much as he or she is able to deal with at

that time

Whenever possible, incorporate the parent’s cultural beliefs that are not contradictory to

the program goals into your home visits. This practice will encourage the parent to

develop trust in the program and you as a Home Visitor. It is critically important to learn

and accept education about the family’s unique culture.

For more information on cultural and linguistic competence in general, visit the National center for Cultural Competence at http://www.georgetown.edu/research/gucdc/nccc

http://www.georgetown.edu/research/gucdc/nccc


Specific Resources for Program Targeted Groups

Low-income families

The Bridges Out of Poverty training gives a comprehensive overview of the different socio-economic classes in our society and how the economic circumstances in which an individual was raised influence basic values about authority, work and being on time and child-rearing. Trainings can be coordinated at: http://www.ahaprocess.com/Community_Programs/

Military families

Recently, numerous resources around military cultures have been made available online. To read more about the various cultures that exist in each branch of the U.S. military, explore the following websites:

o http://www.aap.org/sections/uniformedservices/deployment/videos.html

o http://nccp.org/publications/pub_398.html

o http://www.zerotothree.org/about-us/funded-projects/military-families/

o Operation Homefront (a resource network for military families)

http://www.operationhomefront.net/?gclid=CM-

Wgpah2aECFRIhnAodEGMKLQ

Abuse and neglect

For information about how you can support parents of young children in the child welfare system, access the following websites:

o http://www.childwelfare.gov/

o Supporting Parents of Young Children in the Child Welfare System.

Beckmann, Knitzer, & Cooper (2010) -

o http://www.nccp.org/publications/pub_924.html

First-time parents

For information on first time parents, see the following: o Health, safety & pregnancy tips

http://kidshealth.org/parent/pregnancy_newborn/pregnancy/guide_parents.html

o Parenthood website including searchable topics sheets http://www.parenthood.com/index.php

http://www.ahaprocess.com/Community_Programs/

http://www.aap.org/sections/uniformedservices/deployment/videos.html

http://nccp.org/publications/pub_398.html

http://www.zerotothree.org/about-us/funded-projects/military-families/

http://www.operationhomefront.net/?gclid=CM-Wgpah2aECFRIhnAodEGMKLQ

http://www.operationhomefront.net/?gclid=CM-Wgpah2aECFRIhnAodEGMKLQ

http://www.childwelfare.gov/

https://webmail.odh.ohio.gov/owa/redir.aspx?C=0770c1aa27624b38a601c905c422e28f&URL=http%3a%2f%2fwww.childwelfare.gov%2fsurvey%2fdisclaimerAskme.cfm%3ftarget%3dhttp%3a%2f%2fwww.nccp.org%2fpublications%2fpub_924.html%26referrer%3dhttp%3a%2f%2fwww

https://webmail.odh.ohio.gov/owa/redir.aspx?C=0770c1aa27624b38a601c905c422e28f&URL=http%3a%2f%2fwww.nccp.org%2fpublications%2fpub_924.html



http://www.parenthood.com/index.php


Consents for Services and Parent’s Rights in the HMG Home Visiting Program

As the Home Visitor, you are responsible for explaining to the parent what the HMG

Home Visiting program is and what they can expect from the program. With respect to

the targeted population and cultures you will be working with, extra time and effort may

be required before the family is ready to sign the consent form. It is a requirement that

the family be informed of what they are consenting to from HMG, and provide informed

consent. Explaining the Parent’s Rights brochure when giving it to the parent is

required and provides an opportunity for the family to understand the value the program

could provide for them and encourage them to be actively engaged in all aspects of the

program.

Consent must be provided before any activities can occur with the family, such as

conducting any screenings, or developing the Family Plan.

The HMG Consent to Release or Share Information form is included in this section so

that written consent can be obtained from the parent, before services begin. This form is

required for all participants in the HMG Home Visiting Program.

The Consent for Services and Parent’s Rights in the Help Me Grow Home Visiting

Program form is required for all participants in the HMG Home Visiting Program. The

Consent for Help Me Grow services and Receipt of Parent’s Rights form is still to be

used by the HMG Part C Program. Both consent forms are required and must not be

altered. Once signatures are obtained, all consent forms must be kept in the child

records.


Guidelines for Writing Good Case Notes

Case notes provide a record of communication and action that occurs in providing services to a family participating in the HMG Home Visiting Program. In general, case notes should tell the entire story of the family’s time in HMG. ODH expects that each and every contact with the family is documented thoroughly.

This is critically important to ensure that people beside the Home Visitor know how the program is delivered. Any date on which communication occurs with the family should be documented, even if it seems unimportant. An unanswered phone call may seem unimportant when it happens, but if attempts to contact the family need to be cited as documentation to justify an exit from HMG, any unanswered phone call becomes very important. That way, if a complaint arises from a parent, a record exists to show the efforts made by the Home Visitor to provide services. A documented record avoids a situation where opposing accounts of what did or did not occur exists without any supporting evidence. This practice protects both Home Visitors and families being served in the program.

The case note is also important to demonstrate evidence of activities, consents, and informed decision making for program accountability. HMG is a social service program funded with public monies, therefore it is necessary that the employing agency be able to answer any inquiry about how the money is spent. Case notes are also important for the individual Home Visitor in order to have a record of information in preparation for home visits and Family Plan development and reviews. In addition to contact logs, significant incidents in the family’s life during their time in HMG should always be documented. Significant incidents may include: family crises (such as an eviction notice or family has had utilities turned off), options for supports discussed, refusal of supports, and changes in the child’s health, change in residence or change in family membership. Any of these may impose barriers to program engagement, and should be documented as they occur.

Also keep in mind that a person reading case notes is unlikely to be familiar with the individuals in the family’s life. It helps to refer to people by both name AND role in the child’s life. A few strategies are included below to provide guidance regarding appropriate case notes, but understand that proper documentation is a skill that you will develop over time. As you become more experienced, your ability to process the large amounts of information gathered at home visits will become easier.


DARP: Description, Assessment, Response, and Plan

Description of the observed environment

Assessment of what may be going on with the family outside of HMG home

visits which may be affecting their engagement

Response of what you did, suggested; referrals to make/made

Planning for program information delivery (how often parent wants visits, what

information they want at visits, how they prefer information to be shared—

video, handout, hands-on—screenings and evaluation tools) and goal setting.

What will be done between now and the next home visit and what topics will

be covered at the next visit

Some important guidelines for using the DARP process include the following:

When writing descriptions, be objective (value-free, impartial, and unbiased).

Record what you see, not your feelings on what you observed.

When writing assessments, do not make assumptions about what you think is

going on with the family. Instead, record what they told you unless information

can be observed (heat is off in house, no toilet paper available in bathroom).

When writing responses, list what you did at the home visit including what you

said you would prepare for next time and any referrals you will make or made at

the time so that you can follow up.

When writing a plan, some subjectivity is appropriate. This is the time when your

feelings about what is needed can be recorded. Does the parent respond better

to certain materials? What have they shared about information they want? How

do requests for referrals or information align with goals identified on the Family

Plan? What is your plan, strategies, and To Do list before seeing the family next?

Sign and date every entry if using paper case notes


Other important considerations for using case notes effectively include the following:

Be specific

Be thorough, yet concise

Write clear, objective (value-free, impartial, and unbiased) descriptions

Write notes immediately after the visit to maximize recall

Use respectful terminology (non-judgmental, clear that intent is to record)

Avoid acronyms and jargon

People first language (Ex: A mom with; A father who; A child which…)

Always maintain every child’s and parent’s right to confidentiality (and

understand that you cannot provide anonymity, but you can assure confidentiality

of information)

It is generally bad practice to use abbreviations in case notes, particularly ones not commonly used in Help Me Grow throughout the state, as local practices tend to have county abbreviations unfamiliar to others outside the community. It is understandable to use some more common abbreviations and each Home Visitor should use judgment in deciding when and where the use of these types of acronyms is inappropriate.

Acceptable abbreviations recognized statewide may include:

FP – Family Plan

CBDD – County Board of Developmental Disabilities

HMG – Help Me Grow

HV – Home visit

EIS – Early Intervention Specialist

SC – Service Coordinator

PE – Parent Educator

PD – Project Director

PAT – Parents as Teachers

It is also acceptable to use common shorthand to express words or phrases not specific to HMG. They may include:

W/ – With

W/O – Without

& or + – And

Re: – Regarding

F/U – Follow-up

Your County program may have program-specific acronyms that are common within your program. Keep in mind that it is not a good idea to use these on documents the family sees. When documenting when things happened or are scheduled to happen,


always use the date. For someone reading the notes, references to ―tomorrow‖ or ―Wednesday‖ can be very confusing.

Never use white out. If you make a mistake while recording, put a single line through it, initial it, and date it. Write in the correct information near the mistake.

Remember that the record belongs to the family. Use objective language based upon what you have come to know through your senses (hearing, seeing, etc). Subjective statements should be based upon professional opinion and not presented as objective fact.

Regardless of formatting, all case notes must include the following elements:

1. The date on which the case note is recorded

2. The date on which the activity occurred

3. The method of contact (i.e., connected phone call, voice mail messages, home

visits, attempted home visits, etc.)

4. The purpose of the contact or attempted contact

5. A concise, but detailed description of the result of the attempted/successful

contact or visit

In addition to the above elements, when attempting to schedule an appointment with a family, it is also important to document any options you gave the family, in addition to the appointment option selected by the family. When scheduling and rescheduling appointments, ODH looks for two elements in case notes to assure that a good faith effort was made to accommodate all parties. They are:

1. That more than one option was provided to the family. Our preference is that

three dates are given. In the case of the initial scheduling, all three must be

within the related timeline.

2. That the family had options two or more weeks away from the day on which the

appointment was scheduled, particularly if a member of the family needed to take

time off of work.

Case notes must also appear in order of occurrence. All case notes should be dated (reflecting the date the note was written) and initialed. If a particular county program uses an alternate format for specific events that are used for case notes (such as home visit forms), additional forms should be filed with case notes in order of occurrence in the child record. Some counties keep case notes from multiple professionals who have worked with the family (such as Intake Specialists) in the child record. If this is the case, the professional designation of the individual keeping the case notes should be indicated clearly on the form.


Home Visit Schedule & Screening, Assessment & Program Evaluation

The chart on the following page shows the timeline of home visits which must be offered

to families, and the related requirements for screening, assessment and program

evaluation. Each of these specific requirements is detailed in other sections of this

manual, next you will find resources available to you as the Home Visitor that can help

you do the data collection part of your job.


Home Visiting Tools and Forms

In the next several pages, we will provide resource tools which are not required by the

HMG Home Visiting Program (45-Day Data Collection Form, Ongoing Home Visit Form)

and forms which are required for program participants (Family Plan Form).

45 Day Data Collection Form Explanation

This form is not required at this time; however the information it captures is required to be collected and documented in child records. The 45-Day Data Collection form is specific to the HMG Home Visiting Program and it is intended to be a resource for Home Visitors to ensure all required information are collected and documented effectively. There are three different types of items on the 45-Day Data Collection form:

1. Required in Early Track

2. Conditionally Required in Early Track

3. Optional in Early Track

There are two unique conditions related to completing the 45-Day Data Collection form outlined below:

1. ―Child has an older sibling…‖ OR ―Primary caregiver is a first-time parent‖ are

conditionally required

a. If the parent (primary caregiver) related to the infant, toddler, expectant

first-time parent and their family is also the parent designated in Early

Track as the primary caregiver to another child enrolled in the HMG Home

Visiting Program a response to ―Child has an older sibling…‖ is required.

b. If the parent (primary caregiver) related to the infant, toddler, expectant

first-time parent and their family is NOT also the parent designated in

Early Track as the primary caregiver to another child enrolled in the HMG

Home Visiting Program a response to ―Primary caregiver is a first-time

parent‖ is required.

2. Income question(s) are conditionally required

a. If the parent (primary caregiver) related to the infant, toddler, expectant

first-time parent and their family is a Foster Parent no income questions

are required.

b. If the parent (primary caregiver) related to the infant, toddler, expectant

first-time parent and their family is NOT a Foster Parent the following

income questions are required:

i. Yes or No to ―Child currently is eligible for:‖


1. WIC

2. Medicaid

3. OWF (cash assistance)

ii. If the child is NOT eligible for any of the above, then ―Family

income‖ AND ―Family size‖ are required.

Definitions of each of the fields on the 45-Day Data Collection form will be available in the Early Track ―Help‖ screens.


Family Plan Form Explanation

The Family Plan is required for all infants, toddlers, expectant parents and their families enrolled in the Help Me Grow Home Visiting Program. Each child (infant, toddler, or expected child) must have their own Family Plan unless their parent(s) agree to have multiple children enrolled in the Help Me Grow Home Visiting Program on one Family Plan. Home Visitors must work with parent(s) to complete the Family Plan, including the development of Goals relevant to the family’s strengths, priorities and needs as described by the family.

The Family Plan must be kept in the format provided by the department, with the only exception being translations to provide parents with a copy in their native language. Completion of the Family Plan must occur as follows:

1. Initial Family Plan

a. IFP Page 1 must be completed

i. Including ―1st Family Plan Review Scheduled Date‖

b. IFP Page 2 must be completed

i. Signatures are required

c. There must be at least one (1) FAMILY GOAL

2. Family Plan Review

a. FPR Page 1 must be completed

i. The “Actual Date” for the Family Plan Review must be added to IFP Page 1

ii. The next ―Family Plan Review Scheduled Date‖ must be added to IFP Page 1

iii. Signatures are required

b. FAMILY GOAL sheets must be updated with ―achieved/discontinued‖ Dates as

applicable

c. FPR_optional may be completed

i. If completed, there must be a response to ―I would like to change my home visit

schedule to occur:‖

ii. If completed, signatures are required

d. There must be at least one (1) FAMILY GOAL which has not yet been achieved

following each Family Plan Review

i. This may require development of new FAMILY GOALs

The Family Plan is meant to be a living document, or a document which should be continually updated by the Home Visitor and parent. The following is a suggested outline for how to organize Family Plans:

1. IFP Page 1

2. IFP Page 2

3. Goals in the order developed

4. FPR Page 1s in the order completed, including any FPR_optionals

Definitions of Family Plan fields will be available in the Early Track ―Help‖ screens.


Ongoing Home Visit Form Explanation

This form is not required at this time; however the information it captures is required to be collected and documented in the child record(s). The Ongoing Home Visit Data Collection form is specific to the HMG Home Visiting Program and it is intended to be a resource for Home Visitors to ensure all required information are collected and documented effectively. There are two different types of items on the Ongoing Home Visit Data Collection form:

1. Required in Early Track

2. Optional in Early Track

There are two items that are required to be completed only when the child is 6, 12, 24 and 36 months of age:

1. ―Do you smoke?‖

2. ―Immunizations‖

In the event that a referral is made, the referral outcome will be documented at a

later date than the other items. When the referral outcome is known it should be

documented on the Ongoing Home Visit Data Collection form related to the home visit

that identified the need for referral.

Definitions of each of the fields on the Child Ongoing Home Visit Data Collection form will be available in the Early Track ―Help‖ screens.


Works Cited in this Section

Kalyanpur, M. & Harry, B. 1999. A Posture of Reciprocity: A Practical Approach to Collaboration Between Professionals and Parents of Culturally Diverse Backgrounds. Journal of Child and Family Studies, Vol. 6, No. 1, 1997, pp. 487-509. Kluckhohn, C. & Murray, H.A. (Eds.). 1948. Personality in Nature, Society and Culture. New York: Knopf. Puls, Chris. (2004). Protecting Yourself from Violence During Home Visits. Bloomington,

IN: Trafford Publishing.

Spector, R. E. 1996. Cultural Diversity in Health and Illness, 4th edition. Stamford, CT.:

Appleton and Lange.

St. Onge, P. with B. Alpplegate, V. Asakura, M. K. Moss, A. Vergara-Lobo, and B.

Rouson. 2009. Embracing Cultural Competence: A Roadmap for Nonprofit Capacity

Builders. Fieldstone-Alliance.

home visiting program manual

Documents