Kansas Healthy Start Home Visitor Training

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Kansas Healthy Start Home Visitor Training

• Who are We and What do We Do?

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Introduction

• Welcome to your new role as a Kansas Healthy
  Start Home Visitor (HSHV).
• Member of the public health team.
• You can change the future of the families you
  serve.
• You reach out to families in your community.

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Purpose of Training

• To provide information and education to local
  health department staff, including HSHVs and
  their nurse supervisors, for the development and
  enhancement of the Kansas Healthy Start Home
  Visitation program by

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• Providing a basis for understanding the home
  visitation model as a strategy for working with
  families.
• Providing a framework for a home visitor.
• Providing rationale for the home visitor.
• Providing elements of the home visitor role that
  is most likely to bring about positive changes
  for children and families.
• Providing principles that guide the home visitors
  role and application to the Kansas Healthy Start
  Home Visitor Program.

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Whats on the Agenda?

• History of home visitation, both nationally, and
  in Kansas.
• Philosophy of Kansas Healthy Start Home Visitor
  program.
• Strategy of service delivery.
• Home visitation services.

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Philosophy

• Interventions that educate and support pregnant
  women, children and families can reduce the
  incidence of child abuse and neglect and increase
  the use of preventive health services.

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Kansas Healthy Start Home Visitor Program

• Is successful in preventing many crises,
  promoting healthy families, identifying those
  families at greatest risk, and providing linkages
  within the community systems for necessary
  services.

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Primary Focus of Kansas HSHV

• Supporting parents in developing positive
  attachment relationships with their infants and
  children along with enhancing family
  self-sufficiency.

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Basic Assumptions

• Preservation of the family as the foundation of
  our social structure is essential.
• The rights and integrity of the family must be
  recognized and respected.
• The family will ultimately make important
  decisions about its interactions with community
  resources/services.
• Healthy focused programs will improve the health
  status and increase usage of preventive health
  care for pregnant women, children and families.

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History of Home Visitation

• Latter part of the 19th century saw increasing
  industrialization, massive European immigration
  to the new world, and rapid urbanization.
• Settlement houses emerged.
• Public health nurses and social workers began
  providing in-home education and health care to
  women and children, primarily in poor urban
  environments.

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• Florence Nightengale
• 1858 Friendly Visitors
• Lillian Walds Henry Street Visiting Nurse
  Service
• 20th Century Progressive Era and social reform

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• 1909 First White House Conference on Children
• G. Stanley Hall Parent Teacher Associations
• Field of family support work expanded
• Poor viewed as victims

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• 1920s decade when nursery schools, embraced
  parent education for middle class children.
• 1960s President Lyndon B. Johnsons Great
  Society program
• 1970s New York City Health Department
  implemented a home visitor program
• Late 20th century home visitation focused on
  prematurity or low-birth weight, developmental
  delays, teen parents, and families identified as
  high risk for child abuse and neglect

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Todays Ideation

• The parent is the expert about their own child.
• Effective home visiting is a partnership between
  professional and parent, not the expert
  teaching the parent!

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Research Best Practice

• Lower incidence of child abuse and neglect
• Reduction of welfare dependence and subsequent
  pregnancies
• Decreased involvement in the criminal justice
  system by parents
• Reducing serious anti-social behaviors in
  children involved in structured home visitation
  services
• ( Kumpfer, Strengthening Americas Families, US
  Dept of Justice, 1999)

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• Home visitation programs may differ in dimension,
  (ie. populations they serve, to whom and how they
  deliver their services, and the outcomes that are
  measured), but they are all rooted in common
  belief. Parents play a critical role in shaping
  outcomes of their children and early childhood is
  the crucial time to provide support.

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HSHVs

• Believe that resources should be brought to the
  families through home visits to the home, and
  these are more beneficial than this expectation
  being left in the community for families to seek
  out individually.

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HSHV Additional Value

• The visitor not only educates the mother,
  provides feedback concerning her effectiveness in
  parenting, but serves as a positive role model as
  well. Through this model the mother receives
  approval and reassurance.

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Kansas HSHV Program

• 1977 A 2-year grant from the National Center
  for Child Abuse and Neglect was awarded to Kansas
  Dept of Social and Rehabilitation Services for a
  rural multi-county home visiting project.
  Administration of this grant was transferred to
  KDHE, in which a project was funded with 11
  counties in north central Kansas.

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• 1978 Discretionary funds, awarded a grant to
  Kansas City-Wyandotte County Health Department to
  provide home visits for the purpose of reducing
  child abuse and neglect.
• 1979 Ks. Legislature provided state general
  funds to continue these projects and more funding
  came from the Childrens Trust Fund.

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• Also in 1979 funding from the Maternal and
  Child Health Block Grant, and the Preventive
  Health Block Grant expanded home visiting
  services within the state.
• 1988 Governors Commission on Children and
  Families enhanced HSHV projects through statewide
  expansion.

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• 1999 funding increased to expand the program
  from 80-100 counties to 104 counties.
• Childrens advocacy groups in Kansas have become
  strong supporters of the program, including
  Kansas Action for Children (KAC), Childrens
  Cabinet, and Kansas Child Abuse Prevention
  Council (KCAPC).

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Kansas Healthy Start Home Visitor Program

• Directly linked to Maternal Infant programs,
  physicians and communities to offer outreach and
  support for pregnant women, their infants,
  children and families.

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Kansas HSHV Program

• Uses a paraprofessional model for home service
  provision.
• Paraprofessional an individual who has no
  academic credentials in a relevant field, such as
  nursing, education, or social work.
• Kansas HSHVs are hired based on their personal
  qualities of warmth, self-assurance, cultural
  sensitivity and competence with parenting.

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• Knowledge of and involvement in community
  networks is vital in recruiting families into the
  program.
• These professionals are non-stigmatizing,
  family-friendly, culturally competent members of
  the community.

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Kansas HSHVs

• Work under direct supervision of the registered
  professional public health nurse.
• Supervision entails developing a relationship
  with another person that will foster professional
  growth, promoting a high-quality program,
  encouraging accountability and facilitates
  personal and professional growth for themselves
  and the home visitor.

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• Are community focused matching specific community
  needs, being culturally sensitive to the make-up
  of families served, and avoiding duplication of
  services.
• Reduction of local barriers to care, and matching
  goals to the needs of the community.

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• Serve families through promotion of effective
  parenting, improving pregnancy outcomes, reducing
  the number of children in poverty, reducing the
  number of abused or injured children, providing
  health education and disease prevention
  information, case management to ensure access to
  medical home and other necessary community
  resources and advancement of social, emotional
  and intellectual development of children and
  families.

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Target Population

• Kansas Healthy Start Home Visitor Services are
  available to all pregnant women and families with
  priority to high-risk families. Adoptive
  families and families who have lost a newborn are
  also eligible.

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• Focus of program should be on individual familys
  needs and stressors, rather than just on intended
  curriculum.
• Services and educational endeavors should be
  geared toward teaching parents the skills
  necessary to function in the social environment
  in the future as well as making use of community
  services.

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• Focus should be on parenting confidence and
  comfort within existing social networks.
• Assessment of linkages between social network
  factors and child maltreatment risk.
• Enabling families to build on their own strengths
  and capacities promotes the healthy development
  of children.

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Persons Served

• Pregnant women, parents, infants and children.
• Overall Goal To prevent or lessen the potential
  isolation of families by assisting them to assess
  and engage the existing informal support systems
  available in their community.

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• Goals
• Prevention of negative birth outcomes (low
  birth weight, substance abuse, criminal activity,
  early prenatal care, and prematurity)
• Prevention of infant mortality
• Increase proper nutrition and physical
  activity for families

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• Prevention of child abuse and neglect
• Prevention of unintentional injuries
• Improvement of family coping skills
• Promotion of positive family parenting skills
• Promotion of child development/school
  readiness
• Outreach and support for families to improve
  use of community resources, including access to
  provision of a medical home

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Objectives

• Identification of families at risk (targeting
  population of low-income, first-time mothers and
  their babies)
• Reduce the incidence of child abuse and
  neglect by improving parents nurturing skills
• Improve and enhance parenting and problem -
  solving skills

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• Enhance quality of care giving for infants
  and toddlers to prevent child maltreatment,
  childhood injuries, developmental delays, and
  behavioral problems
• Promotion of early prenatal care to reduce
  the incidence of premature and low birth weight
  babies

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• Improvement of womens health behaviors
  related to alcohol and substance abuse, smoking
  and nutrition, risk factors for pre-term
  delivery, low birth weight and infant
  neuro-developmental impairment
• Reduce health care costs by promotion of
  preventive health care and through enhancement of
  informal support by linking families with needed
  health and human services

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• Kansas Healthy Start Home Visitor works under
  direct supervision of the registered public
  health nurse supervisor.

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Qualifications of the Nurse Supervisor

• A graduate of an approved school of professional
  nursing (preferably have completed a
  baccalaureate degree program approved by the
  National League for Nursing)
• Be a licensed registered professional nurse in
  the state of Kansas
• Have a minimum of one (1) year experience as a
  professional RN

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Supervision

• Meet individually with the visitor at least two
  times per month to review client records and home
  visitor recommended follow-ups
• Assist home visitor in prioritizing workload
• Determine which families require Public Health
  Nurse visits after consultation with home visitor

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• Review and sign off documentation of the home
  visitor, including supervision of documentation
  of Client Visitor Records of encounters that are
  sent to Kansas Department of Health Environment
  for data collection, including mid-year and year
  end reports

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Responsibilities of Nurse Supervisor

• Consult with KDHE Kansas Healthy Start Home
  Visitor program manager to assist in filling a
  home visitor vacancy if needed
• Supervise the activities of the home visitor
• Consult with the home visitor on a regular basis
  and as needed

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• Complete an annual written personnel evaluation
• Ensure that a PHN will make follow-up visits to
  families when the home visitor observes current
  or potential problems
• Promote effective interagency cooperation with
  other community resources and programs
• Consult with other professionals who have
  provided referrals to the Kansas Healthy Start
  Home Visitor program

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• Ensure that all reports are completed in a
  correct and timely manner
• Include home visitors in appropriate local staff
  meetings
• Periodically accompany home visitor on home
  visits to evaluate content of visit and
  effectiveness of the visitor
• Assist home visitor in prioritizing workload
• Review and sign documentation of home visitor

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Qualifications of HSHV

• Have a minimum of a high school diploma or GED
• Be an experienced parent who has successfully
  nurtured a family
• Demonstrate the ability to respect the
  confidentiality of a client relationship
• Demonstrate effective communication skills

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• Present a warm, caring, concerned attitude toward
  families
• Be knowledgeable of available community resources
  and how to utilize them
• Be able to differentiate between home visitor and
  nursing supervisor responsibilities
• Take direction and carry out decisions made by
  nurse supervisor

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• Work independently in a dependable manner
• Speak bilingually, if population needs indicate
  this specialty
• Be in good health and free from communicable
  disease
• Model a healthy lifestyle
• Complete reports in a correct and timely manner

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Responsibilities of HSHV

• Visit families with or expecting newborns to
  provide non-threatening, friendly support
• Visit all families within seven (7) days of
  referral or sooner if indicated.
• Observe families for any current or potential
  problems
• Provide a resource list to families for local
  service options such as transportation,
  babysitting, child care, SRS, physicians,
  pharmacies, etc.

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• Make referrals to local resources
• Alert PHN supervisors of existing or potential
  problems
• Make return visits to give continued support to
  families as determined by the PHN supervisor
• Alert PHN supervisor of existing or potential
  problems

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• Serves as a facilitator for crisis intervention
• Seek client referrals from local health
  department programs, hospitals, physicians, SRS,
  and all available local resources to initiate
  visits to a client prior to delivery or during
  the hospitalization period

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• Ensure that all members within the family have
  access to a primary care provider or medical
  home
• Participate in training workshops provided by
  KDHE
• Complete reports in a correct and timely manner
  and distribute client survey postcards to
  families visited
• Promote the HSHV program through all media
  resources in cooperation with PHN supervisors.
• Collaborate and communicate with local, county,
  regional and state-wide visitors to increase
  coordination of services to all clients and
  families

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CONFIDENTIALITY

• Dont leave client records out in the open.
• Write only what is necessary and, when you do, be
  objective and factual.
• Subjective information, assumptions, and opinions
  should not be included in your documentation.
• Parents have the right to read any and all
  portions of their files so be thoughtful about
  what you write.

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• Families are empowered when they have access to
  information other resources take action to
  improve the well-being of children, families, and
  communities.

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Referrals to Other Services

• Immunizations
• WIC
• Family Planning
• Prenatal/Postnatal
• Parental/Parenting
• Other Medical

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• Early Childhood
• Support Groups
• Development
• Child Care Services
• Self-Help Groups

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Resources and Services

• Local Health Department (MI, WIC, Family
  Planning, Immunizations, Child Adolescent
  Health Services, including Well-Child/Kan Be
  Healthy)
• Office of Social Rehabilitation Services (SRS)
• Hospitals

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• Physicians that serve prenatal women, infants,
  children families
• Mental Health Services
• Extension homemaker units
• Business and health coalitions
• Professional associations

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• School Nurses and Administrators
• Licensed and registered child care facilities
• Ministerial alliances
• Parents as Teachers
• Head Start Programs

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Role of the HSHV

• Advocate Bridging cultural and other barriers
  to early and effective prenatal care/services
  to advise or accompany pregnant women to prenatal
  appointments and other community services and to
  assist children and families as needed.

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• Collaborator Working with numerous support and
  resource services available to secure appropriate
  services for women, children and families.

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• Consultant Finds answers to families questions
  about their pregnancy, relationships, and
  parenting.

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• Mobilizer Observation and early identification
  of unhealthy behaviors, disease processes, injury
  potential, and other lifestyle occurrences with
  prompt referral to supervising registered nurse.

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• Mediator Seeks solutions and assists families
  to work through problems that may arise.

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• Model Demonstrates positive lifestyle and
  parenting behaviors.

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• Coach Actively and attentively listens to what
  families need or want without being judgmental,
  and supports families efforts to obtain these.

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• Motivator Motivates families to make lifestyle
  changes and engage in healthy behaviors with the
  ultimate goal of a healthy pregnancy, and healthy
  children.

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• Record Keeper Documents and maintains accurate
  visitor records reviewed and co-signed by
  registered nurse supervisor, with appropriate
  completion of Client Visitor Encounter Records
  sent to KDHE.

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• Partner Supporting families through local
  community, surrounding county, and state-wide
  collaborative efforts.

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• Home visiting is not an easy job. It requires
  the patience of a saint, the diplomacy of a
  statesman, a sense of humor like Whoopi Goldberg,
  and the belief, like Dorothys, that dreams can
  come true. (Weiss, 1993).

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Kansas HSHV Qualities, Skills Knowledge

• Knowledge of program philosophy, goals and
  objectives.
• Interpersonal skills such as empathy,
  flexibility, accessibility, patience,
  resourcefulness, enthusiasm, and non-judgmental
  demeanor.

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• Effective interpersonal and communication skills
  both verbally and in writing.
• Effective listening and cultural sensitivity.
• Support and respect of family competence, values
  and privacy.
• Promotion of empowerment and self-sufficiency.

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• Problem solving and solution-seeking skills.
• Teaching skills and motivating change.
• Knowledge of and access to community resources.
• Identification and response to warning signs.

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• To help ensure a quality, positive home visit
  environment, you must communicate acceptance and
  respect. You must foster interpersonal skills
  including sensitivity, empathy, flexibility,
  accessibility, resourcefulness, enthusiasm, and
  the ability to be non-judgmental.

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Cultural Information/Competency

• Respecting and accepting a familys culture makes
  home visitation much more effective through
  competency and sensitivity.
• Requires balancing awareness of the familys
  cultural patterns with awareness of ones own and
  using that awareness to track what is happening
  within home visits.

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Knowing Oneself

• Knowledge of Self
• Awareness and understanding of ones own cultural
  values, beliefs, norms, and expectations.

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Social Class Differences

• Poverty increases the likelihood of the presence
  of risk factors such as unemployment, substandard
  housing, violence within neighborhoods, and
  social and emotional problems.
• These families are not inherently weak,
  disorganized, or unhealthy.
• These families need to be treated with respect
  and dignity.

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What is a Home Visit?

• Face-to-face interaction between the home visitor
  and a parent or family.
• Scheduled in advance.
• Planned for a specific period of time usually
  60-90 minutes.
• Usually takes place in the home setting, but may
  take place at a mutually convenient location
  (such as a work place, library, etc.)

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• Offers social support and discussion of topics
  that are important to the families.
• Involves planned activities and topics based both
  on the familys needs and the goals of the HSHV
  program.
• Requires planning before the visit and follow-up
  after the visit as needed.

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Where do I begin? How do I conduct a home visit?

• Every visit requires you to plan beforehand,
  discuss planned topics during the visit, and
  complete follow-up activities afterwards.
• First impressions are very important and lay the
  groundwork for future visits!

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• Consider cultural tradition/practices
• State clearly expectations of the visitor
• Stress issue of privacy and confidentiality
• Use clear statements
• Gain confidence of your families

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Before the Home Visit

• Call to schedule a time for your visit.
• Review the information about the client or family
  and gather any other information you need.
• Plan what you will discuss at the visit, and
  identify appropriate educational information to
  present.

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• Collect all the items you will need such as
  written materials, safety devices, toys, bags,
  packets, etc.
• Kansas Healthy Start Home Visitors should provide
  parenting curriculum with clear objectives and
  structured information that directly address the
  needs of families within their cultural and
  individual contexts.

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Topics and educational information

• Prenatal/Postpartum changes
• Feeding, nutrition, and weaning
• Attachment behaviors and nurturance, such as
  reading and responding to infant cues (ie
  crying), by soothing, making eye contact,
  providing tactile response and communicating
  verbally and nonverbally

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• Safety of the home environment and infant first
  aid
• Babies biological cycles of sleep, feeding,
  elimination
• Normative development and milestones
• Developmentally appropriate play
• Managing challenges such as sleep deprivation,
  physical recuperation after birth, and
  fussy/colicky babies

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• Early discipline and limit setting
• Immunizations and Communicable Diseases
• Medical home, food assistance, employment and
  other targeted assistance programs

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During The Visit

• Be on time!
• Greetings and Introductions
• Discuss information and topics planned for the
  visit
• Observe and make mental notes of any concerns,
  threats, or dangers that may require further
  discussion, action or referral

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• Ask about any immediate concerns or expectations
  from the parent
• Model desired parenting skills and parent-child
  interaction
• Summarize purpose and information presented at
  the visit

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• Request topics that might be planned for the next
  visit
• Confirm the date and time of next scheduled visit
• Good-byes should be made to each person present

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After the Home Visit

• Complete CVR
• Record and document accomplishments and
  discussions from the visit.
• Note any referrals or follow-ups determined from
  the visit.
• Take a moment for reflection Did I cover the
  important topics and education during the visit?
  Did I scan the environment and see any signs of
  problems?

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• Did I feel confident that the mother and
  children are in a safe place? Did I empower
  this family?
• Follow-up with nurse supervisor to discuss any
  concerns
• Document visit with any recommendations or
  actions taken

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• Maintaining and promoting safety are basic to
  effective home visitation.

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Basic Safety Information for the Kansas HSHV

• Use common sense and trust your own judgment. If
  you find yourself in a place that feels unsafe,
  it probably is GET OUT!!
• Make sure your supervisor or other staff know
  your home visiting schedule, the name and address
  of the person you are visiting, and when you plan
  to return to your home or office.

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• Know the neighborhoods and areas in which your
  home visits will take place.
• Do not go into dangerous neighborhoods after
  dusk.
• Learn the safest route to and from your clients
  home.
• Make sure the locks on your car doors work and
  that you have enough gas in your tank.

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• Dont carry more money with you than you will
  need to get through the day.
• Dont wear expensive jewelry or clothing.
• Protect yourself from contagious disease. If you
  find that someone in the clients home has a
  serious contagious illness, like measles, flu, or
  tuberculosis, reschedule your visit, or perhaps
  conduct the visit over the phone.

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Preparation for the Visit

• Car should be in good condition.
• May require making visits in pairs.
• Take a two-way radio or cell phone.
• Let someone know where you are going and your
  estimated time of arrival back.

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Assessing the Environment

• Note any homes and/or businesses that could be
  utilized as a resource if needed.
• Note any individuals or animals outside the home
  that could present danger.
• Once inside, note the tone of voice and nonverbal
  behaviors of your client and family.

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Uncooperative Clients

• You will have some clients that just dont
  cooperate with scheduled visits.
• Look at reasons why the client is not
  cooperative.
• Remember some of your clients may have had bad
  experiences in the past with health professionals.

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• Development of a working, trusting relationship
  may be enhanced through the following skills

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• Positive Attitude
• Respect, politeness and kindness
• Role clarification
• Praising and Encouraging
• Being a Good Listener

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• Foster easy to understand methods for
  communication.
• Nonverbal behavior
• Do not be judgmental
• Maintain Confidentiality
• Reliability

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Coping with Stress

• Stress refers to mental or emotional strain or
  tension.
• What causes stress?

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HSHV Role in Assisting Families with Stress

• Assist families in coping with stress caused by
  the demands of pregnancy and the birth of a baby.
• Facilitate in the problem-solving process,
  through encouragement, assistance and goal
  setting for problems defined and outcomes desired.

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• Flexibility and non-judgmental attitude assists
  clients to share problems and implement
  solutions.
• Give and take discussion and listening.
• Clients need to define, think about, and take
  action to solve problems ultimately to assist in
  gaining control over lifes problems

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• Kansas Healthy Start Home Visitors should address
  specific barriers to ongoing service
  participation as well as ways to enhance
  motivation for ongoing service participation.

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Barriers

• Parents perceived needs and the degree to which
  home visits are viewed as meaningful to their
  needs.
• Perceived stigma of home visitation services and
  the degree of positive/negative responses.
• Obstacles such as time conflicts from employment,
  job training, family activities or even infants
  nap-time schedule.

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• Presence of other significant stressors that
  distract parents or impair self-help seeking
  skills.
• Previous experiences of other service provision
  such as with nurses, social workers, SRS, child
  enforcement officials, immigration, etc.
• Family privacy may inhibit their willingness to
  let an outsider in.

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• Family cultural and personal values may not be
  perceived as compatible with home visitors.
• Influence of other family members (such as
  father, grandmother) encouraging or discouraging
  parents involvement in services.

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• Working with families to identify and enact
  strategies to overcome such barriers holds the
  potential to improve ongoing service
  participation and ultimately programs intended
  benefits.

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Orientation/Training of Kansas HSHVs

• The key to proficiency and success for home
  visitors is orientation to practice followed by
  continuous training.
• Continuous in-service education is crucial to
  this program, with ongoing feedback allowing the
  program to be flexible to the changing needs of
  both the visitors and the families they serve.

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Basic Knowledge for Kansas HSHVs

• Prenatal Health Preparation
• Postnatal/Postpartum Issues
• Breastfeeding/Nutrition
• Caring for Infant and Children
• Growth Child Development
• Child Health Care
• Child Safety
• Childhood Diseases and Immunizations
• Guidance and Discipline
• Parenting Skills
• Abuse and Neglect

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Methods for Learning

• Education
• Reflection on action
• Learning by doing-practicing over time

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Education

• Involves gaining new knowledge and understanding
  of how that knowledge can be applied to ones
  practice.

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Reflection on action

• Reflection on action means that home visitors
  stop and think about how they understand their
  work.

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Practice

• With practice, learning to think about what you
  are doing while you are doing it.
• Being aware of the uniqueness of each person
  along with common themes among families is
  important through this process, as with the
  evolving relationship with the family, the home
  visitor should develop a series of expectations
  of the parents, child, and their own actions and
  reactions.

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• The Public Health Nurse must provide a clear
  program philosophy and principles to guide the
  home visitor. To ensure active, reflective
  learning, the PHN should structure regularly
  scheduled educational workshops or meetings where
  the home visitor can learn new content and then
  directly apply that content to their everyday
  work with families.
• KDHE provides two trainings a year for the HSHVs
  and mandate they attend five trainings a year,
  which they report in the year-end narrative
  report that is completed and sent to KDHE at the
  end of each fiscal year.

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Program Evaluation and Self-Assessment

• Program evaluation can provide information
  important to consider in hiring of staff as well
  as identification of training needs. Evaluation
  is also a method to determine if program goals
  and objectives are being met and if community
  needs are being addressed.

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• The Kansas Healthy Start Home Visitor program is
  evaluated through the Kansas Department of Health
  Environment (KDHE), Bureau for Children, Youth
  Families (BCYF) staff. Through funding
  provided through the Maternal Child Health Block
  Grant to local health departments and other
  agencies, a written MCH Monitoring Tool is used
  to document evaluation of this program, in
  collaboration with the Maternal Infant,
  Child/Adolescent Health and Children with Special
  Health Care Needs programs to provide quality
  assurance of client services for pregnant women,
  infants, children and families. These visits are
  conducted every other year for baseline data, and
  after review will be placed onto a one, three and
  five year visit cycle to be determined by
  KDHE/BCYF staff.

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• Most home visitors have an impression or a
  feeling about the effectiveness of their services
  to, or support for, a family or client. They see
  parents making progress towards self-sufficiency,
  and they see children growing, learning and
  playing appropriately. They can tell when a
  client needs extra encouragement to continue
  making progress toward a goal.

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Determining Client Satisfaction

• Is important because clients are more likely to
  follow through with the goals or procedures of
  programs that they like. The Kansas HSHV program
  uses a post-card evaluation system. These
  postcards are postage-paid by the local Healthy
  Start Home Visitor Program site and are addressed
  to KDHE. These postcards are an assessment tool
  on which clients can comment about the usefulness
  of the Kansas HSHV program services.

127

• Upon receiving these cards KDHE, BCYF program
  staff review this information and document into a
  database. The postcards are then mailed on a
  monthly basis, to the administrator and or the
  PHN supervisor to follow up with the visitor to
  address successes and/or problems.

128

• A yearly evaluation of the HSHV should be
  conducted by the PHN supervisor and/or local
  public health administrator. This evaluation
  should contain information including job
  performance, program philosophy goals and
  objectives being met, professional development,
  client satisfaction card review, with ongoing
  progress of individual clients and families being
  documented on a regular basis. This process
  should provide information about the overall
  effectiveness of the program for the clients and
  families served.

129
Referrals and Resources

• Families are empowered when they have access to
  information other resources take action to
  improve the well-being of children, families, and
  communities.

130
Outreach and Support

• You must become familiar with whatever resources
  and services are available in your community.
  These resources may include health care, mental
  health counseling, assistance for battered women,
  immunization clinics, assistance with purchasing
  or preparing foods, homeless shelters, health
  care professionals (physicians, dentists,
  pharmacists).

131
Tips for Successful Referrals

• Tell your client what the service can do for
  them. Assist with questions that may be asked at
  the service provider to which they are referred.
• If you refer a client to a service that is going
  to have a financial responsibility, make sure
  that they understand there will be a charge and
  that the client has the funds to do so.

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• Make sure the client knows what paperwork, if
  any, she needs to bring with her. Ask her if she
  needs help getting copies of any of the papers
  she will need, such as babys birth certificate,
  proof of income, etc.
• Provide her with information about the days and
  hours of operation for the referral agency.

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• Make sure the client has accurate, up-to-date
  information about making an appointment. Perhaps
  you can make the appointment personally.
• Let the client know the location of the referral
  agency, and provide her with written directions.

134

• Provide the client with the name of a contact
  person at the agency.
• Provide the client with information on methods of
  transportation to use to get to the service.

135

• Networking means talking to other people and
  finding out what is going on in other agencies
  that might be useful to your clients. The more
  contacts you have in the community, the more help
  you can be to your clients.

136
Health Care

• The HSHV should become familiar with their
  regional Social and Rehabilitation Services
  Medicaid contact person.
• Clients should be instructed to contact their
  insurance company to find out what services are
  covered under their health insurance benefits.

137

• Pregnant clients will need to receive early and
  regular prenatal exams. The Kansas Healthy Start
  Home Visitor must identify agencies and
  facilities where pregnant women, both normal and
  high-risk, should be referred. HSHVs must also
  know which hospitals in their county area provide
  maternity services and which take Medicaid
  patients or provide low-cost delivery services
  for women.

138

• HSHVs must also know where to send clients for
  their check-ups, post-partum.
• Well baby care and check ups are usually done by
  private providers or in local public health
  departments. The visitor must know who the
  providers for infant and child care are within
  their counties. They must also know which of
  these providers accept Medicaid and/or see
  indigent clients.

139

• For sick babies and children, usually the health
  care provider who sees the children for their
  well-baby check-ups also sees them if they are
  ill.
• The HSHV should reinforce the concept of a
  medical home.

140
Medical Home

• It is not a building, house, or hospital, but
  rather an approach to providing health care
  services in a high quality and cost-effective
  manner. Children and their families who have a
  medical home receive the care that they need from
  a pediatrician, physician, or health care
  provider, who they know and trust. Health care
  professionals partner with parents to identify
  and access all the medical and non-medical
  services needed to help children and their
  families achieve their maximum potential.

141
Social and Rehabilitation Services

• Local and regional access point offices.
• Areas for referrals and access.
• Child abuse and neglect.
• Foster-parents.
• Day care.
• Food and shelter.

142
KAN Be Healthy/EPSDT

• The Early and Periodic Screening, Diagnosis and
  Treatment (EPSDT) program provides eligible
  children under the age of 21 years with
  well-child screening, diagnostic, and medically
  necessary treatment services through their
  Medicaid program.

143

• The EPSDT program in Kansas is known as KAN Be
  Healthy (KBH).
• Promotes regular check-ups where medical
  conditions can be prevented, detected, or
  corrected before further advancement.
• KAN Be Healthy Program provides services to
  children, teenagers, and young adults who have a
  medical card.
• For more info visit https//kmap-state-ks.us

144
Infant Toddler Program

• Kansas Part C Infant Toddler Services is a
  statewide system of community-based,
  family-centered services that is designed to
  assist families in meeting the needs of their
  infants and toddlers, birth to three years of
  age, who have developmental delays or
  disabilities. Eligibility is determined by
  evaluation and assessment.
• For more information visit http//www.kdhe.state
  .ks.us/its/index.html

145
Women, Infants and Children (WIC) Program

• Special supplemental nutrition program.
• USDA federally-funded program that provides
  nutrition education, medical assessment, food
  prescriptions and referrals to pregnant,
  breastfeeding and postpartum women, infants, and
  children up to five years of age.
• For more information visit http//www.kdhe.state
  .ks.us/nws-wic/index.html

146
Parents as Teachers

• Parents as Teachers is an award-winning nonprofit
  parent education organization providing parents
  of children prenatal-age 5 with support and
  information on their developing child through a
  network of local programs.
• http//www.kpata.org/

147
Head Start

• Head Start is a national child development
  program for children from birth to age 5, which
  provides services to promote academic, social and
  emotional development, as well as providing
  social, health and nutrition services for
  income-eligible families.

148

• Goals
• To enhance children's physical, social, emotional
  and cognitive development
• To enable parents to be better caregivers and
  teachers to their children
• To help parents meet their own goals including
  economic independence

149

• History
• Head Start was established in 1965 to help
  low-income families provide their children with
  developmentally appropriate education, health and
  social services to better prepare them to achieve
  in school and society.
• Initially, Head Start served preschool children
  3-5.
• Early Head Start (EHS) was created in 1994 to
  target the needs of pregnant women, infants and
  toddlers, thereby fostering positive development
  at even earlier stages

150

• For more information visit the Kansas Head Start
  website at
• http//www.ksheadstart.org/home.html

151
Schools

• Kansas Department of Education
• http//www.ksde.org
• Coordinated School Health Program is a
  multifaceted approach to helping youth establish
  healthful behaviors and attitudes. Eight
  components Health Education, Physical
  Education, Health Services, Nutrition Services,
  Counseling, Healthy School Environment, Health
  Promotion for Staff and Family/Community
  Involvement. Visit http//www.kshealthykids.org
  

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153
Fatherhood

• Given the multifaceted influence of strong-tie
  relationships, such as those with fathers or
  other male partners, strategies that promote
  positive partnerships and minimize ties that
  complicate parents efforts to succeed with their
  children, should be implemented.

154

• Fathers traditional role was financial provider
  and guardian of the family values.
• In the 1970s, the role of many fathers changed
  dramatically.
• Fathers as well as mothers bond to their baby
  shortly after birth and contribute significantly
  to the childs emotional, social, and
  intellectual development.
• National Fatherhood Initiative
  800-790-DADS(3237.
• or http//www.fatherhood.org

155
Children with Special Health Care Needs

• CSHCN is a state and federally funded program.
• Provides early identification of children at risk
  for, or with, disabilities or chronic illness.
• To ensure availability of diagnostic and
  treatment services.
• To promote the functional skills of young persons
  in Kansas who have a disability or chronic
  disease by providing or supporting a system of
  specialty health care.

156

• CSHCN can assist families, regardless of income,
  obtain a one time diagnostic evaluation at one of
  their specialty clinics, assist families with
  identification of local service providers and
  provision of case management for eligible
  children.
• Make A Difference Hotline [phone]
• http//www.kdhe.state.ks.us/shs/index.html

157
Kansas Lead Screening Prevention Program

• The Kansas Department of Health and Environment
  (KDHE) established the Kansas Childhood Lead
  Poisoning Prevention Program (KCLPPP) to respond
  to concerns about lead and its effect on the
  health of Kansans, most notably our children. 
  Lead is common in our environment and many
  individuals, especially children, show no outward
  signs of lead poisoning.  The Centers for Disease
  Control and Prevention (CDC) states lead
  poisoning is one of today's major preventable
  environmental health problems.  Blood lead levels
  (BLLs) as low as 10 micrograms per deciliter
  (ug/dL) are associated with harmful effects on
  children's learning and behavior.  BLLs as high
  as 70 ug/dL can cause seizures, coma, and death.

158

• The mission of the Childhood Lead Poisoning
  Prevention Program is to establish an
  infrastructure of trained personnel to screen,
  identify and recommend proper medical and
  environmental management of lead-poisoned
  children.  The most common cause of childhood
  lead poisoning today is the deterioration or
  disruption of a lead paint surface of a home.

159

• For more information visit the Kansas Lead
  Prevention Program at
• http//www.unleadedks.com
• Also to view the Kansas Childhood Blood Lead
  Testing and Case Management Guidelines visit
• http//www.unleadedks.com/download/revised_ks_bloo
  d_lead_testing_and_case_management_guidelines.pdf

160
Normal Child

• The health needs of children are susceptible to
  ever-changing social, behavioral, economic, and
  psychosocial influences. The issues affecting
  the health of children and families are
  consequently broad in scope and continue to
  challenge intellect and imagination. Families
  are particularly receptive to health promotion
  messages after the birth of a child and during
  the first year. Home visitors address many
  issues related to child health during this time.

161
Physical Health

• The physical health of the mother, the infant and
  children is very important. Activities and
  education must be aimed at promoting the physical
  and emotional health of families served.

162
Health Related Programs should target

• Diet and exercise for mother, infant children.
• Pregnancy and birth related complications.
• Smoking and intake of alcohol and other drugs
  that affect pregnancy and parenting.
• Common illnesses, and communicable diseases.

163

• Family planning and contraception.
• Screening and education for environmental toxins,
  such as lead and mold.
• Accident and poisoning prevention in the home,
  including first aid and CPR for infant and child.

164

• Screening for maternal/infant/child depression
  and other mental illness.
• Well-baby care and immunizations.
• Child Physical Sexual Abuse Prevention and
  Intervention.
• Intimate Partner Violence Prevention and
  Intervention.

165

• To address these issues, the Kansas Healthy Start
  Home Visitor must strive to coordinate outreach
  and support with medical provider or other
  resources in local and surrounding communities.

166
Mental Health

• Approximately one in five over 14 million
  children and adolescents in the U.S. have mental
  health problems. (US Dept of Health Human
  Services, 1999)

167

• There is a complex two-way interplay between
  mental and physical disorders.
• Untreated mental disorders result in poor
  outcomes for co-morbid physical illness.
• Persons with mental disorders have a heightened
  risk of suffering from physical illness because
  of diminished immune function, poor health
  behavior, non-compliance with prescribed medical
  regimens and barriers to obtaining treatment for
  physical disorders.
• Persons with chronic physical illness are
  significantly more likely than other people to
  suffer from mental disorders.

168
Kansas Healthy Start Home Visitor Role in Mental
Health

• Assess
• Refer if needed
• Follow up to assure link to access of provider as
  for medical home

169
Nutrition

• Good nutrition is important for everyone. A
  pregnant woman should eat healthy to make sure
  that her baby is born healthy. Nutrients are the
  building blocks needed to grow a healthy baby.

170

• Provide written information to your families to
  demonstrate the types of nutrients obtained in
  the foods that they eat.
• Stress the importance of a well-balanced diet.
• Encourage your families to visit with their
  health care provider, as well as their WIC
  nutritionist, if they are participating in WIC.

171

• Encourage and support exclusive breast-feeding
  through six months of age.
• Refer to medical providers or other resources for
  nutrition counseling as needed.
• Ensure access to referral sites.

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Nutrition Resources

• Kansas Nutrition and WIC Services
• http//www.kdhe.state.ks.us/nws-wic/
• Bright Futures Nutrition Curriculum
• http//www.brightfutures.org/nutrition/index.html
• Bright Futures Physical Activity Curriculum
• http//www.brightfutures.org/physicalactivity/abou
  t.htm

173
Child Abuse and Neglect

• Although the wounds that maltreatment and abused
  children suffer differ in variety and severity,
  all abused and neglected children confront the
  reality that those who take care of them are also
  those who harm them (Gutterman, 2001).

174
Can we stop child abuse before it starts?

• Preventing child abuse and neglect before it
  occurs is a goal of the Kansas Healthy Start Home
  Visitor Program. Prevention of physical abuse
  and neglect through development of positive
  parent-child interaction may be achieved by
  providing in-home support to families with very
  young children, promoting child and family
  functioning during a vulnerable and opportune
  time.

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HSHV should discuss and provide education to
parents on topics such as

• The need to develop an ongoing repertoire of
  skills and knowledge in parenting a new child.
• The task of responding appropriately to the
  infants immediate and quickly evolving needs.
• Dealing with possible sleep deprivation.
• Biological changes accompanying pregnancy, birth
  and healing, as well as lactation.

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• Reduction in autonomy.
• Increased financial stressors.
• Decreased time and energy for relationships.
• New social influences and messages in parenting
  alteration in significant relationship as a
  result of new parenting role.

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Risk factors of child abuse and neglect
indicating an immediate referral

• Physical injuries such as bruising, burn marks,
  subdural hemorrhage, retinal hemorrhages or bone
  fractures.
• Delayed physical growth.
• Neurological damage.
• Problems with social relationships, trust,
  attachment and bonding.

178

• Problems with self-regulation of emotions.
• Aggression, externalizing behavior problems,
  and/or criminal activity.
• Depression, low self-esteem, suicidal ideation
  and behavior, post-traumatic stress disorder, and
  substance and/or alcohol abuse.
• Cognitive or language deficit.

179

• Child abuse and neglect is a major social and
  health problem in the United States and in
  Kansas. To report child abuse and neglect call
  the Kansas Protection Report Center at
  800-922-5330, or your local law enforcement
  agency by dialing 911. For more information
  visit http//www.srskansas.org/services/child_pr
  otective_services.htm

180
Immunizations

• A primary objective for HSHV is to educate Kansas
  families about the importance of immunizations.
  HSHVs must become familiar with current
  immunization schedules which can be downloaded
  at
• http//www.cdc.gov/nip/recs/child-schedule.PDF

181

• A second objective for the HSHV is to learn who
  the immunization providers are in their county
  and how to access these services. You must be
  able to refer a client for updates and completion
  of the immunization schedule.

182

• A third objective is for the HSHV to ensure
  linkages to the immunization provider for the
  client to receive their immunizations. You must
  ensure the client has a method of transportation,
  has health insurance or other funding to cover
  the immunization fee, and understand the
  importance of reducing communicable disease
  through immunization.

183
Vaccine for Children Program (VFC)

• Intended to help raise childhood immunization
  levels in the United States by supplying, at no
  cost to private and public health care providers
  who participate, federally purchased vaccine to
  administer to eligible children. For more
  information visit
• http//www.kdhe.state.ks.us/immunize/

184
Child Safety

• Preventable injuries are the leading cause of
  childhood morbidity and mortality in Kansas.
  Studies have found serious gaps in injury
  prevention knowledge among parents. Home
  visitors are in a position to provide home and
  auto safety guidance, as well as attend and
  training and become certified car safety seat
  technicians.

185

• Kansas Safety Seat Belt Office Jeff Halloran
• Jhalloran_at_dccca.org or 800-416-2522
• Kansas SAFE Kids Coalitions
• http//www.kdhe.state.ks.us/safekids/
• Poison Control Mid-America Poison Control
• http//www.kumc.edu/poison/

186
Teen Pregnancy

• Comprehensive pregnancy services with support and
  follow-up of adolescent mothers and infants offer
  the best chances for healthy outcomes, including
  reducing the risk of early repeated pregnancies.
  Major changes in education, child day care,
  medical access, health education and social
  support for mothers and children are needed to
  help our children become productive adults in
  todays technological society. Kansas Healthy
  Start Home Visitors provide necessary support and
  referral services to this population.

187
Substance Abuse

• Kansas Healthy Start Home Visitors should
  routinely and sensitively assess the home
  environment and parent for the presence of
  substance and/or alcohol use and abuse patterns.

188

• Substance abusing behavior is often accompanied
  by intense personal shame and cognitive processes
  such as denial and minimization, which require
  the visitor to employ sensitive and strategic
  probing with non-judgmental attitude. The
  visitor should convey an accepting tone and
  establish trust and alliance with their families.

189

• Instances where substance and/or alcohol abuse
  have been identified as concerns should be
  reported and referred to the registered nurse
  supervisor. Work with the family should remain
  ongoing to directly reduce the risks and harm the
  substance abuse may have on the children and the
  family.

190

• The Kansas Healthy Start Home Visitor must work
  with families to enrich a supportive informal
  network and to minimize the negative influences
  in existing support networks to reduce substance
  abuse.

191
Summing It All UP!

• Pregnant women and families live in a network of
  family and culture and often need support form
  husbands, extended family, and friends. Each
  womans pregnancy experience is affected by past
  pregnancies, spousal and family support, and
  stressors in the womans life.

192

• Kansas Healthy Start Home Visitors first tasks
  with pregnant women is to provide support,
  encouragement, and shared delight. They are also
  a source of information and referral to
  appropriate services.

193

• They provide information about the importance of
  avoiding alcohol, tobacco and other drugs
  proper nutrition and physical activity and the
  importance of seeking early prenatal care.

194

• They provide outreach and support for family
  parenting skills and successful bonding.
• Finally, they can ask open-ended questions to
  motivate the pregnant woman and families to share
  any stressors or changes they may be experiencing.

195
MCH 2010 Kansas Maternal and Child Health 5-Year
Needs Assessment

• As a recipient of Title V funds, Kansas is
  legislatively required to complete a statewide
  needs assessment every five years to identify the
  need for
• Preventive and primary care services for pregnant
  women and infants,
• Preventive and primary care services for
  children, and
• Services for children with special health care
  needs.

196
Pregnant Women and Infants

• Increase early and comprehensive health care
  before, during, and after pregnancy
• Reduce premature births and low birthweight
• Increase breastfeeding

197
Children and Adolescents

• Improve behavioral/mental health
• Reduce overweight
• Reduce injury and death

198
Children with Special Health Care Needs

• Increase care within a medical home
• Improve transitional service systems for CSHCN
• Decrease financial impact on CSHCN and their
  families

199
Three additional focus issues were chosen

• Reduce teen pregnancy and sexually transmitted
  diseases
• Improve oral health
• Improve asthma diagnosis

200
Kansas Healthy Start Home Visitors

• Strengthening Kan