Wisconsin Dept of Children and Families and Health Services Home Visitation Plan

Affordable Care Act Maternal, Infant and Early Childhood Home Visiting Program
Updated State Plan for a State Home Visiting Program for Wisconsin
The Wisconsin Department of Children and Families (DCF), in collaboration with the Wisconsin Department of Health Services (DHS) is submitting this updated state plan for a state home visiting program to fulfill the requirements necessary to receive FY2010 Affordable Care Act, Maternal, Infant and Early Childhood Home Visiting Program funding. To ensure that home visiting is part of a continuum of early childhood services within Wisconsin, this application has been developed with representatives from: The state Title V Agency; The state Title II of the Child Abuse Prevention and Treatment Act (CAPTA); The states Single State Agency for Substance Abuse Services; The state child welfare agency; The states Child Care and Development fund; The states Temporary Assistance for Needy Families agency; The states Elementary and Secondary Education Act Title I program; The Migrant and Refuge Services Coordinator; The Tribal Affairs office; The states Head Start Collaboration Office; and The State Advisory Council on Early Childhood Education and Care Wisconsin is submitting an updated state plan for a state home visiting program in order to: 1. Identify the at-risk communities where home visiting services are to be provided; 2. Provide a detailed assessment of the particular needs of the identified communities in terms of risk factors, community strengths, and existing services; 3. Identify the home visiting services to be implemented to meet the identified needs in the communities; 4. Describe the state and local infrastructure available to support the home visiting programs; 5. Identify additional infrastructure support necessary to achieve program success; 6. Describe the plan for collecting benchmark data; and 7. Detail the plan for conducting continuous quality improvement including research and evaluation to strengthen and improve the programs implemented. The information contained in this document details the plan to integrate evidence-based home visiting programs into a comprehensive, high-quality early childhood system in Wisconsin.
Wisconsin Departments of Children and Families and Health Services Updated State Home Visiting Plan ACA Maternal, Infant and Early Childhood Home Visiting Program HHS-2010-HRSA-10-275 (CFDA) No. 93.505 Page 1 of 124
Section 1: Identification of the States Targeted At-Risk Communities

The needs assessment performed in Wisconsin as required by the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program identified eighteen at-risk communities based on the federally required indicators indentified in the guidance provided by the Supplemental Information Request (SIR) with an additional indicator of the percent of minority population. Wisconsin chose to add the indicator of percent of minority population to help address the racial disparities that are of concern in the state. Eliminating racial and ethnic disparities in birth outcomes has been identified as one of the highest priorities in Wisconsin as evidenced by the significant focus of attention to this issue in the Healthiest Wisconsin 2020 plan. During the past 20 years, infants born to Wisconsin African American women have consistently been 3-4 times more likely to die within the first year of life than infants born to Wisconsin Caucasian women, generally due to greater than average numbers of premature births and very low birth weights. Home visiting, initiated early in a pregnancy, is one of the strategies to help improve the birth outcomes in Wisconsin. Wisconsin is a rich blend of urban and rural communities with distinct challenges facing each area. Sixty-one percent of Wisconsins population live in 25 metropolitan counties (those counties with a city of 50,000 or more population plus those nearby counties where commuting to work is a link between the city and suburban counties), while the remaining thirty-nine percent of the population live in Wisconsins 47 non-metropolitan counties. In 2008, there were 72,002 live births to Wisconsin residents. The estimated number of children under age 18 was 1,317,847 or about one-fourth of the states population. Since Wisconsin has a state supervised, county administered system for many services, there are wide variances in the resources available at the community, county, regional and tribal level. Wisconsin communities face distinct challenges such as racial/ethnic disparities in birth outcomes, lack of available resources, births to teen parents, smoking during pregnancy, substance abuse or isolation due to location and language barriers. These unique challenges make it difficult for Wisconsin to prescribe one particular evidence-based home visiting model. Wisconsin currently has five of the evidence-based models identified in the Home Visiting Evidence of Effectiveness (HomVEE) review operating: Early Head Start, Healthy Families America (HFA), Home Instruction for Parents of Preschool Youngsters (HIPPY), Nurse Family Partnership (NFP), and Parents as Teachers (PAT). Wisconsin has provided home visiting dollars to eleven communities through general purpose revenue and Temporary Assistance for Needy Families (TANF) to pilot home visiting programs. These programs were based on the 12 Critical Elements of the Health Families America but were not required to affiliate with a national model. Additional dollars were garnered to provide training and technical assistance to sites for professional development of the staff delivering the services and administering the programs. It was
intended that home visiting would be implemented statewide in subsequent years, but attempts to garner additional funding from the state general purpose revenue were not successful. With the availability of the federal funding to provide evidence-based home visiting programs, Wisconsin decided to blend the funding available through the MIECHV program with the state and federal dollars currently supporting home visiting programs to build on the available resources and create a coordinated system with the requirement to use evidence-based models for all of the home visiting programs supported by the state. To further identify the challenges facing each community, data on maternal and infant birth related statistics for each of the eighteen counties was prepared outlining the total number of births, the number of teen births, the number of Medicaid paid births, the number of women participating in Prenatal Care Coordination (PNCC) services and the racial/ethnic distribution of the births. A tool kit was created to help the at-risk communities begin the planning process to further explore the existing resources, service gaps, priority populations as well as the evidence-based home visiting model that would best address the needs of the families in their community. A technical assistance session was held to assist communities in to: identify the partner agencies key to the planning process for the development or expansion of the home visiting initiative; use the data specific to their county/tribe to prioritize the target population; and identify the process for selecting the evidence-based model(s) best suited to address the needs of the priority population in their communities. This session was recorded and made available for future reference. Communities sent a multi-disciplinary team to assist in the planning of the home visiting initiative with responsibilities for moving the project forward assigned by the end of the session. Outreach was provided to the three counties and tribes that were not in attendance to assist them in coordinating their plans. A Request for Proposals (RFP) was developed based on the requirements of the MIECHV and the state statutes governing the program for prevention of child abuse and neglect. The RFP process is most often used for making awards for services, as it allows for negotiations with proposers. Competitive negotiation, or the request for proposal (RFP) process, is required for soliciting proposals over $25,000 where an award cannot be made strictly on specifications or price and several agencies are qualified to furnish the product or service. Counties, tribes and private agencies within the eighteen identified at-risk counties were eligible to apply for the funds. Detailed instructions on the requirements of the program were provided to assist organizations in making a strong application. Accepted proposals were reviewed and scored by an evaluation committee with expertise in home visiting, county government, social services, maternal child health, and child abuse and neglect prevention to evaluate and weigh the proposals against the requirements in the RFP and MIECHV. Of the 1000 points available, up to
150 points were awarded for demonstrating an understanding of the needs and challenges of the families in the community. Priority is given to families that: have low incomes, are pregnant women age 21 and younger, have a history of child maltreatment or interactions with child welfare, have a history of substance abuse or need treatment, have children at risk for or have low academic achievement, have children with developmental delays, or have members that are serving or have served in the armed forces. To ensure that programs are serving the high-risk families, programs are expected to serve the following distribution: at least 60% of the families would have three or more risk factors; no more than 30% of the families would have two risk factors; and no more than 10% of the families would have only one risk factor. Rationale for selecting the evidence-based home visiting model was awarded up to 150 points. Proposers were to provide a detailed rationale as to how the model selected meets the needs that have been identified for families that will be prioritized for services, and how those home visiting participants will meet the following benchmarks: improved maternal health; improved child health; reduction in: o child abuse and neglect and child maltreatment o childhood injury and use of emergency rooms improvement in service coordination; improvement in family economic self-sufficiency; and reduction in domestic violence. The ability to implement the model with fidelity and the capacity to integrate the home visiting program into the existing early childhood system was also included in the scoring process. To assure the highest need communities among the 18 identified through the needs assessment were prioritized, a formula was developed as part of the scoring process by prorating the proposal from the county with the highest percentage of need. In keeping with the guiding principle of depth over breadth, the State made a commitment to fund a small number of programs through the blended RFP process, but to support organizations with enough funding to fully develop and implement a high quality evidence-based program. All of the five funded sites ranked in the top ten of the identified at-risk communities and the awards will provide services to families in seven of the 18 identified communities at risk. Due to the limited resources available, not all of the eighteen identified at-risk communities were awarded funding. The State will provide technical assistance to the communities that have demonstrated a high need but limited infrastructure to implement the evidence-based home visiting program at this time. Through the RFP process, the communities were selected to receive funds from this procurement process are: City of Milwaukee for Empowering Families, Green County, Lac Courte Oreilles Tribe for Sawyer County, Northwoods Home Visiting Program for
Lincoln, Oneida, and Forest Counties, and Racine County. The following details the specific community characteristics and capacity to implement evidence-based home visiting programs in Wisconsin including risks, strengths, need and local service systems: EMPOWERING FAMILIES OF MILWAUKEE (EFM) Milwaukee County is an urban community in the Southeastern Region of Wisconsin with a population of 594,833 according to the 2010 census data. In 2008 the total number of births in Milwaukee County was 15,353 of which 9,170 or 59.7% were paid for by the Wisconsin Medicaid Program. It is estimated that there are 72,138 children under the age of 5 in Milwaukee County and an estimated 23.1% of these children live in poverty.
Community Strengths City of Milwaukee community organizations and agencies are working to collaborate on addressing the issues facing the largest city in the state of Wisconsin and the 25th largest city in the nation. There are many initiatives working to address the challenges facing families in Milwaukee but the efforts are often not coordinated. Some of the most promising initiatives that are directly related to home visiting include: Project LAUNCH, the Lifecourse for Healthy Families (LIHF) Initiative, and the Home Visiting Community of Practice. Risk Factors Medicaid Births Empowering Families of Milwaukee will provide comprehensive home visiting services to pregnant women and their children in specifically-targeted areas of the city of Milwaukee. The targeted service area is characterized by alarmingly high rates of infant mortality, premature births, and low birth weights, especially among African-Americans in these areas. While the African American population is 5.9% statewide and 36.8% in the city of Milwaukee, two of the eleven targeted zip codes that will be served through the grant have a noticeably concentrated African American population distribution that ranges from 50% to 96%. The vast majority of births to people of color living in the city of Milwaukee were covered by Medicaid, including 87.5% of all births to African Americans and 83.2% of births to all Latinas, compared to just 37.9% of births to whites ( Wisconsin Department of Health Services, 2010). The majority of these Medicaidcovered births occur in EFMs targeted zip codes, since 81% of African American births citywide wide were born in EFMs targeted zip codes (Wisconsin Department of Health Services, 2011). Racial and Socioeconomic Segregation In December 2010, Milwaukee was identified as the most segregated large metropolitan area in the country for blacks and whites, and seventh most segregated between Hispanics and whites (Brookings Institute, 2010). This is to the detriment of healthy birth outcomes as a recent study at Emory University found that racial segregation is associated with very preterm (<32 weeks gestation) and moderately preterm (32-36 weeks gestation)
births in African Americans, but not in whites. The researchers assert that segregation alone accounts for 28% of geographic variation in black-white birth outcomes disparities (Kramer, 2010). Poverty and Unemployment When poverty is experienced during the critical developmental stages of childhood, it can adversely affect well-being across the developmental domains the consequences of which reach into adulthood (Centre for Community Child Health, 2009). According to the U. S. Census Bureaus American Community Survey, the city of Milwaukee is the fourth most impoverished large city in the nation. The poverty rates are greatest for minority populations. Milwaukee African American residents have more than a 38% poverty rate; Milwaukee Hispanics are at 33%. This is a stark contrast to Milwaukees whites who are well below the overall poverty rate at 18.4%. Education attainment also impacts poverty; Bachelors degree-educated individuals and their families have a poverty rate of just 8%, while families of high school dropouts have a poverty rate nearly 5 times higher (37%) (Greater Milwaukee Foundation, 2010). Milwaukees 2010 unemployment rate is very high at 12.4%, edging down in March of 2011 to 10.4%. Wisconsins overall unemployment rate held at 7.4% during the same time period (Department of Workforce Development, 2011). Once more however, a racial gap persists in the city; Milwaukees African American males have an unemployment rate that, at 16.4% in 2008 is nearly tripled that for whites (5.8%) and double that for Hispanics (8.1%). For Milwaukees minority women, there is also a gap, although not as considerable: Hispanic women have the highest unemployment rate at 9.2%, compared to African Americans at 7.0% and whites ate 4.1% (University of Wisconsin-Milwaukee Employment and Training Institute, 2009). Infant Mortality and Prematurity Empowering Families of Milwaukee is focusing on the eleven target zip codes because of the great chasm between the birth outcomes of the citys whites and African Americans. The Infant Mortality (IM) rate is the number of infants who die within on year of birth for a population, per 1,000 births. Milwaukees overall IM rate was 11 per 1,000 births in 2009, the seventh worst city in the country. Even more disturbing is the disparity between white and African American birth outcomes: the black IM rate is nearly 2 times higher than the white IM rate: 15.7 per 1,000 for African Americans vs. 6.4 per 1,000 for whites. In the target zip codes, the IM rate ranges from 13.5 to 20.9 per 1,000 births to African Americans. Infant mortality is caused by a number of factors, many of them preventable, but the main factor is prematurity. In the most recent Fetal Infant Mortality Report, nearly three quarters of the infants who died were born prematurely, before 37 weeks gestation. In Milwaukee, prematurity was a factor in the deaths of African American babies nearly five
times more often than in the deaths of white and Hispanic babies (Michalski, December 2010). A number of factors can contribute to prematurity, such as low socioeconomic status, smoking or using drugs or alcohol during pregnancy, receiving late or no prenatal care, some sexually transmitted infections (STIs), and maternal stress (City of Milwaukee Health Department, 2011). Teen Pregnancy Teen pregnancy impacts the community on many levels. There is a large racial disparity between white, African American and Hispanic teen birth rates. Teen pregnancies are overwhelmingly concentrated in the poorest areas of the city; the 2010 Milwaukee Health Report found that the lower SES zip codes have a teen birth rate 6.4 times higher than the higher SES group, 87.9 vs. 13.7 births per 1,000 15-19 year old females, respectively (Chen, 2010). In addition, nearly 70% of all births to teens ages 19 and under in the city are born within EFMs targeted zip codes. Historically, more than half (55%) of EFM participants are 21 or younger at enrollment into the program. Household makeup The 2010 Milwaukee Health Report found that families in the lower socioeconomic status group are 4.6 times more likely to be single-parent households than those in the higher SES group, 23.9% vs. 5%, respectively (Chen, 2010). Health Status The 2010 Milwaukee Health Report (MHR) examined the health outcomes and disparities across the citys higher, middle, and lower socioeconomic status zip codes. Specific examples of the disparities in Milwaukees health outcomes by SES included the following from the 2010 MHR (lower SES zips vs. higher SES zips): infant Mortality (12.5/1,000 vs. 3.8/1,000); fair or poor self-reported health status (23.9% vs. 10.0%); no health insurance (12.5% vs. 6.5%); no early prenatal care (26.5% vs. 15.6%); smoking during pregnancy (13.1% vs. 7.6%); STD rates (31/1,000 vs. 13/1,000); seat belt non-use (18.0% vs. 8.4%); single-parent households (23.9% vs. 5.2%); and lead poisoning rates (5.2% vs. 1.5%) (Chen, 2010). Research has shown that when low SES, as well as poor physical environment, low access to quality healthcare, and other social factors such as segregation, low social cohesion, and racism persists prenatally and throughout early childhood, poor developmental and physical health outcomes increase across the lifespan and reduce an individuals physical, cognitive, and emotional functioning as adults; the effects accumulate over the life course and are particularly dramatic on birth outcomes, including prematurity and infant mortality (Wilkinson, 2003). Alcohol and Drug Abuse Wisconsin ranks the highest in the nation in adult alcohol consumption (67%), abuse (8%), and binge drinking (23%), and Milwaukee Countys rates are at nearly identical
levels at 66%, 8%, and 22%, respectively (Wisconsin Department of Health Services, Division of Public Health and Division of Mental Health and Substance Abuse, 2010). The rate of drug abuse and dependence in the State of Wisconsin has remained on par with the national average, at 3%. While this may not seem alarming, hospitalizations due to drug abuse and dependence in the state increased by 34% since 2002, with costs to the states health care system reaching $258 million, up 103% from 2002. Milwaukee County ranked in the top 5 counties in the state for drug-related hospitalizations, with a rate more than 25% that of the states overall hospitalization rate (Wisconsin Department of Health Services, Division of Public health and Division of mental Health and Substance Abuse Services, 2010). Sexually Transmitted Infections (STIs) Milwaukees rate of STIs has been consistently one of the highest in the nation, especially among teens. In 2009, Milwaukee was ranked second in the country for Chlamydia rate (Center for Disease Control and Prevention, 2009). In EFMs targeted zip codes, the rates of STI infection are extremely high. In 2010, 76% of all reported Gonorrhea cases and 70% of all Chlamydia cases in Milwaukee County occurred in the eleven targeted zip codes (Department of Health Services, 2010). Academic Achievement for Milwaukee Children The area of Milwaukee targeted by EFM is served by the Milwaukee Public Schools (MPS) school district, a district that faces many financial and other challenges in educating Milwaukees children. MPS educates 25% of Wisconsins poor children, but only 3 % of the states middle income children (University of Wisconsin-Milwaukee Employment and Training Institute, 2009). MPS has a disproportionately high concentration of children living in poverty among its student body as compared with other districts in the region which has a significant impact on its budget as well as its ability to operate optimally. More than 60% of MPS students qualify for free or reducedpriced breakfast and lunches; in bordering Waukesha and Ozaukee Counties, only 17% and 9% qualify, respectively (Wisconsin Council on Children and Families, 2009). At MPS, 92 % of students attend a school in which at least half of its students are below 100% of the Federal Poverty Level; the suburban Greater Milwaukee rate is only 4% (University of Wisconsin-Milwaukee Employment and Training Institute, 2009). Child Welfare Involvement In 2010, nearly half of the families served through in-home services in the child welfare system in Milwaukee County resided in EFMs targeted zip code area. In addition, more than 700 children were removed from their homes in the city of Milwaukee due to safety concerns and placed in out-of-home care. Sixty-five percent of these children resided in EFMs eleven zip codes.
Characteristics and Needs of the Participants African-American and other low income families in the identified 11 zip code target area are disproportionately affected by high infant mortality rates, poor school attainment, and increased exposure to crime and domestic violence, and poor maternal and child health outcomes. Existing Home Visiting Services in the Community The City of Milwaukee Health Department (MHD) currently administers the only NurseFamily Partnership (NFP) program within the State of Wisconsin. The MHD administers NFP and its Empowering Families of Milwaukee (EFM) program as complementary programs targeting the same high-risk zip codes. The NFP program serves only first-time pregnant women who are identified prior to 28 weeks gestation and has a current capacity to serve 125 women and their children annually. Conversely, EFM has the capacity of serving first and subsequent pregnant women and can enroll women who did not obtain early prenatal care. Administering these two complementary programs to the same highrisk target area assures that the MHD utilizes its limited dollars to maximize service provision and expand the safety net to the neediest families. Milwaukee is also fortunate to have Early Head Start programs at the Next Door Foundation and the Guadalupe Head Start programs which services families prenatal to age three. These programs are currently funded by federal stimulus dollars and serve approximately 150-200 families per year. Childrens Outing Association (COA) Youth & Family Centers is the lead agency for the administration of the evidence-based program Home Instruction for Parents of Preschool Youngsters (HIPPY). HIPPY serves approximately 243 families per year. Other agencies active in Milwaukee include Aurora Family Services whose home visiting program serves 1,000 families per year, but does not target its services towards high-risk families and does not focus on enrollment during the prenatal period; the Black Health Coalition which uses federal Healthy Start funding to target up to 400 incarcerated African-American women for home visiting services and several agencies that use the Parents as Teachers curriculum in their home visiting programs, including Rosalie Manor, the Parenting Network, and La Causa. The Medicaid Prenatal Care Coordination (PNCC) benefit available to Medicaid-eligible pregnant women is available through Medicaid HMOs, community clinics, and private agencies. This benefit allows many women to receive individual and tailored case management services during their pregnancy and up to 60 days post-partum. In Milwaukee County, Medicaid-eligible families can also receive the Child Care Coordination (CCC) benefit until the child is five years of age. The City of Milwaukee administers one such PNCC program that serves 150 pregnant women each year.
Existing Mechanisms for Screening, Identifying, and Referring Families in These Communities The City of Milwaukee Health Department (MHD), home to Empowering Families of Milwaukee (EFM), currently houses three prenatal home visiting programs. Each home visiting program has different enrollment criteria based upon zip code, gestational age, Medicaid eligibility, and first-time vs. subsequent pregnancy, among other qualifications. In efforts to minimize confusion within the community during outreach efforts, the MHD developed a Centralized Intake and Referral system. Pregnancy referrals are being received from the following community partners: o Milwaukee area WIC sites o Federally-Qualified Health Centers o Medicaid and SSI HMOs o Area Hospitals and Medical Clinics o Social Service Agencies o Milwaukee Public Schools o Bureau of Milwaukee Child Welfare o Neighboring local health departments o Self-referral and family/friend referral Plan for Coordination Among Existing Community Resources (including gaps) Prior to the development of EFM five years ago, a program did not exist that provided intensive, comprehensive and long-term evidence-based home visiting services beginning in the prenatal period. Since that time the community has seen more providers implementing home visiting for high risk populations. The EFM program works closely with many local social service and health care entities to assure that the needs of families are met on a continual basis. At the systems level, the EFM Program Administration works with local agencies, initiatives, and coalitions to develop cooperative and collaborative services and interactions. Through these partnerships and coalitions, the strengths and resources of each collaborating agency can be pooled to best meet the needs of the community. EFM works with professionals and other service providers in the community to streamline services to families, remove barriers, and build capacity. In order to improve access to the communitys many resources, EFM Program Administration has maintained collaboration with the Milwaukee Child Abuse Prevention Services Committee (MCAPSC), its Teen Parent Task Force subcommittee, and the Milwaukee Public Schools (MPS) system to produce a comprehensive community resource guide for families in Milwaukee. Local Capacity to Integrate the Home Visiting Services into an Early Childhood System The City of Milwaukee Health Department in partnership with the State of Wisconsin Departments of Health and Children and Families implemented Project LAUNCH
(Linking Action to Unmet Needs in Childrens Health). The Project LAUNCH local Child Wellness Council has engaged partners across the Milwaukee child-serving system to integrate and coordinate programs, policies, data and funding. A strategic plan has been developed to guide the implementation of Project LAUNCHs five prevention and promotion strategies mental health consultation, home visiting, use of developmental screening across child-serving settings, integration of behavioral health in primary care, and family strengthening and parenting skill training and increase knowledge about healthy child development through cross-disciplinary workforce development activities and public education. Through the leadership of Project LAUNCH and Empowering Families of Milwaukee, the MHD has partnered with Step Up Milwaukee, an initiative created for the purpose of developing a community consensus around an action plan and strategies that will lead to an accessible, high quality pre-school learning network for all children in Milwaukee County. The aim of this initiative is to gather together individuals, groups, and organizations who work in early childhood care and development as well as those who utilize their services to develop community consensus around uniform goals, outcomes, and quality standards and identify community-wide leadership to prioritize actions and ensure successful implementation efforts. Through Project LAUNCH activities and with leadership provided by Empowering Families of Milwaukee, the MHD has developed a Maternal & Child Health Home Visiting Community of Practice with the intent to engage home visiting practitioners at the direct service and streamlining referral processes, implementing best practice standards, and improving communication between programs. A total of 38 local childserving agencies and 55 supervisors and directors have been engaged in this process since its inception. GREEN COUNTY Green County is a rural area in the Southern Region of Wisconsin comprised of 25 small villages and towns with a total of 36,842 residents according to the 2010 census. In 2008, the total number of births in Green County was 390 of which 156 or 40% were paid for by the Wisconsin Medicaid Program. It is estimated that there are 2,242 children under the age of 5 in the Green County and an estimated 10.1% of these children live in poverty. Community strengths The Green County community is a rural agricultural area with a history of agencies working together to improve the lives of children and families. The Green County Health Department, the Dane County Parent Council (DCPC), and the Green County Human Services Department are committed to being the catalyst in the community for creating the needed comprehensive system of successful early intervention for families with young children.
Risk Factors While Green County has public and private services available to support pregnant women, young children, and their families, such as: Prenatal Care Coordination (PNCC), maternal and child health services, WIC, the Birth-to-Three program, mental health services, educational supports through the local school districts, food pantries, and parish nurse services through churches; families face many barriers in that these services are not well coordinated among providers and are not easily accessible. Many of the services provided by the county are located in the county seat of Monroe, which can be difficult for families in the most rural areas or other towns to easily access. In 2008 only 11 of the 156 mothers eligible for Medicaid births accessed PNCC services. Another critical barrier to positive health outcomes for mothers and their children is the lack of formal services to address not only medical, but also the educational and emotional support needs of pregnant and parenting teens. The greatest impediment for the effective use of resources is the absence of a coordinated system of care providers that focuses on the needs of pregnant mothers, young children, and their families. Characteristics and Needs of the Participants The priority populations that will be targeted under this grant include pregnant and parenting teens, Latino Spanish speaking families, and Medicaid eligible women, especially those who are first time parents or those who have had prior poor birth outcomes. These groups are particularly vulnerable given the very limited availability of prevention services, the isolation caused by large geographic distances and rural settings, and the lack of bilingual and culturally relevant service providers within the Green County community. In addition, these groups are negatively affected by the fact that many of the current service providers within the area have little or no exposure to help them understand the impact of poverty and risk on not only the developing child, but also on the potential for parents to effectively support their childs cognitive, physical, social, and emotional development. Pregnant and parenting teens are one of the priority populations for service. Of the 156 Medicaid eligible births in the Green County community in 2008, 30 were to teens under 20 years of age. There is little to no specific programming at the area schools for pregnant teens despite research indicating that the mothers education level is one of the greatest predictors of her childs future academic success. Of the district school staff contacted, all described teen mothers in their districts as struggling significantly with academics. Teen pregnancy, and the resulting trauma to family relationships and the teen mothers physical and mental health, creates the potential for disproportionately negative impacts on the mother and baby. Pregnant and parenting teens in the Green County community tend to not have specific individualized plans to support their education, have no access to comprehensive home visiting or case management services, and may be isolated due to location and/or transportation issues. In addition, after the teen mother gives birth there is often little financial support to keep the baby in quality child care when the mother returns to finish her education. The lack of financial support means that
some babies are placed in low quality care settings that may negatively affect their development or that the mother may not graduate from high school in a timely manner, if at all. These situations impact the mothers ability to effectively support her family economically and raise the potential for less than optimal child development and readiness for academic success. The lack of coordinated services, the trauma brought to the teens and their families, the potentially devastating impact of the lack of prenatal care, and the increased potential for unidentified and/or unaddressed maternal mental health issues, produces poor outcomes for the teen parent and her child. School and medical professionals in the Green County community who serve teen mothers are in need of resources and assistance in promoting healthy outcomes for the mothers and children. Latina pregnant women and families in the Green County community, especially those who do not speak English as their primary language, have limited access to services and ability to advocate for their needs. During 2008, of the 369 births in the county 19 were to Hispanic women. Latina women and their families in the Green County community can feel very isolated, which negatively impacts access to services and outcomes for health and development. Many Latino families come to this area because of the availability of farm work. When their families live in rural areas, the lack of transportation and unfamiliarity with the area can constrict accessibility to services and basic supports. In addition to geographical isolation, families without proper documentation may not seek necessary services due to fear of deportation and may not get medical care, parenting, child development, and basic needs assistance. Pregnant Latina women and their families in the Green County community need the support that a trusted, familiar, bilingual home visitor can provide to improve outcomes for maternal and child health and development, and their ability to provide basic needs and economic self-sufficiency for their family. Existing Home Visiting Services in the Community The Green County community currently has one Early Head Start home visiting program serving 22 families that began operations in 2010. Existing Mechanisms for Screening, Identifying, and Referring Families in These Communities Partners Roles Dane County Parent Primary partner Council Green County Health Primary partner Department Green County Primary partner Human Services Green County Referral source, community resource Human Services Birth to Three Identify and refer families, resource for families Green County
Human Services Child, Youth and Family Services Green County Human Services Economic Assistance Green County Human Services Mental Health Green County Human Services AODA Monroe School District Early Childhood Green County UW Extension Family Living Agent Multicultural Council of Green County Green Haven Domestic Violence Program Monroe Clinic Reproductive Health Care Center Fowler Memorial Dental Clinic
Identify and refer families, resource for families
Identify and refer families, resource for families
Identify and refer families, resource for families 4K programming for the school district of Monroe; identify and refer pregnant women; Community Advisory Committee Training, family support and parenting, childcare, financial education, referrals, Community Advisory Committee Community Advisory Council
Resource for families, referrals, Primary health care provider for families in Green County, identify and refer high-risk women; Community Advisory Committee Identify newly pregnant, high-risk women; referral source; resource for preconception care, reducing unintended pregnancies; encouraging healthier birth spacing Referral source, Community Advisory Committee
Plan for Coordination Among Existing Community Resources (including gaps) The Early Head Start (EHS) home visiting program will complement existing services in two significant ways: by increasing the number of families accessing family centered coordinated case management and home visiting services, and by building community capacity to establish and maintain a coordinated system of care for pregnant women and their families. The lack of prevention services, specifically to pregnant and parenting teens and Latino families, is one area where the new home visiting program will enhance the capacity to promote healthy child and family development, effective parenting skills, and family self-sufficiency among the Green County communitys most vulnerable population. The home visiting services will help to avoid the isolation and preventable problems such as poor birth outcomes, child neglect and maltreatment, poor nutrition,
lack of school readiness, and limited access to necessary services. The assistance in accessing resources; navigating health, educational and social service agencies; and establishing relationships with providers that the home visitor is able to facilitate will help the family connect to services and develop their own advocacy skills. The Green County Family Foundations Home Visiting Program will form a Community Advisory Committee that will align the system of early childhood education and family support services. The strengthened alliance among these service providers will promote better access and coordination for families. Intentional coordination of services will strengthen the capacity of providers to more effectively and efficiently use the resources available to promote positive outcomes for children and families. The resulting improved comprehensive service system will thus establish a foundation to sustain these partnerships long after the funding has ended. The Community Advisory Committee will consist of members from Green County Human Services, the Green County Health Department, and current EHS programs, partnering agencies, and community members. Their charge is to identify the gaps highlighted in the various needs assessments, review the data on service outcomes, and provide input on suggestions for program changes. Potential service gaps identified will be discussed including possible program adjustments and/or changes in working relationships with other community providers. Once the gaps are identified, the group will suggest solutions among participants and provide guidance to appropriate project leaders on viable options to address problems. Accountability for filling the gaps and communication resource needs to the community at large will be facilitated by staff and the Advisory Council. Local Capacity to Integrate the Home Visiting Services into an Early Childhood System The Community Advisory Council will put into place a systematic way to address the needs of families in the priority population, as well as other families, with coordinated meetings to share information, analyze the data and effectiveness on the families and services provided, ensure that duplication of services does not happen, and find ways to advocate for vulnerable pregnant women and their families in order to support the healthy development of their child(ren). Through sharing information and engaging in regular reflective discussions, individuals across organizations and agencies will help accomplish the goals of an effective system of care for pregnant women, children, and families. LAC COURTE OREILLES TRIBE (LCO) The Lac Courte Oreilles Tribe is located in Sawyer County, a rural area in the Western Region of Wisconsin with a population just over 17,000. In 2008 the total number of births in Sawyer County was 194 of which 142 or 73.2% were paid for by the Wisconsin Medicaid Program. It is estimated that there are 3,861 children under the age of 5 in Sawyer County and an estimated 23.8% of these children live in poverty.
Community Strengths Generally, isolated rural tribes face significant challenges to developing businesses and employment opportunities due to remote locations, lack of reliable transportation, and poor technology infrastructure. Nevertheless, over the past 30 years, the Lac Courte Oreilles (LCO) Tribe has created some of the most successful multi-purpose organizations in the region, the Lac Courte Oreilles Ojibwe Community College, the K12 School System, the WOJB Radio Station, the LCO Federal Credit Union, the Pine View Funeral Home, and the LCO Hydro Electric Facility. The Lac Courte Oreilles Tribal community has many strengths and creativity to provide solutions to existing challenges. Risk Factors Lac Courte Oreilles Reservation is an at-risk community. Tribal families at Lac Courte Oreilles have significant risk factors for child maltreatment including poverty, young motherhood, single parenthood, substance abuse, and dependence upon public assistance programs. The risk factors, combined with environmental factors, result in low educational achievement of youth, truancy, and juvenile delinquency. These issues, individually and in combination, prevent many LCO parents from providing their children with the stability they need to thrive. Poor Birth Outcomes Data is not available for the outcomes for Native American infants in Sawyer County. However, the risk of poor birth outcomes for participants of the Great Lake Inter-Tribal Council Honoring Our Children Program (HOC), whose purpose is to reduce American Indian infant morbidity and mortality rates, while eliminating perinatal health disparities in Wisconsin, is as follows: o The number of pregnant women who smoked during pregnancy: 49% o The number of women who drank alcohol during pregnancy: 15% o The number of women who used drugs before pregnancy: 23% Poverty Within the Tribal Community there are 1,096 children age 16 and under; 66% of children live in households where parents are unemployed and of those employed, 49% live below poverty level (Bureau of Indian Affairs (BIA) Labor Force Report 2005). Program data compiled by all participating tribal agencies reveal that 72% of the client children live in poverty. Income The BIA Labor Force Report of 2009 reports a 67% unemployment rate for the Lac Courte Oreilles community. Recently released data ranks the Sawyer County area with the second highest poverty rate in the State of Wisconsin. (Applied Population Laboratory, 2010). According to the US Census Bureaus SMART data, the reservation tract has noted the Community Disadvantage Index CDI of 8. This indicator is used to
summarize the general socio-economic condition of an area. It is a combination of several measures gathered by the US Census Bureau and is more reliable that any single indicator by itself. This indicates that the Lac Courte Oreilles Reservation tract in Sawyer County is more disadvantaged than 80% of the tracts measured in the United States. The Lac Courte Oreilles School System (K-12) has an enrollment of 270 students and 100% of the students qualify for free or reduced-priced breakfasts and lunches, a primary indicator of the low socioeconomic status of tribal families. Young Mothers Staff of the Honoring Our Children program report that the Lac Courte Oreilles Tribe has approximately 60-90 births per year. Staff believe that teen pregnancies comprise at least 50% of all pregnancies at Lac Courte Oreilles, and reported that two 13 year old girls delivered babies this past year. Child Maltreatment/Child Welfare Historically there has been a large disparity in out-of-home placements experienced by American Indian children compared to non-Indian children. In 2007 there were 55 documented out-of-home placements experienced from a native youth population of 750 compared to 4 documented cases of non-native youth population of 4,500 in Sawyer County in which the LCO reservation resides. In 2008, LCO accounted for 112 Child welfare cases involving 162 children. Due to the federal drug bust that occurred during 2002-2004, 38 parents continue to be incarcerated and are serving long sentences. Social services staff have stated that the largest issue they address are social problems caused primarily by alcohol and other drug addiction. The Indian Child Welfare Director indicated that her department averages 15 initial assessments each month and abuse or neglect is substantiated in an average of six of these cases. Substance Abuse Mike Williams, Behavioral Health Director with the Lac Courte Oreilles Community Health Center, reported that his department provides AODA services to 300 individuals per year. As part of a prevention grant, the Health Department conducted a recent survey on alcohol use in the community. The preliminary results from the survey suggest that virtually every family has been negatively affected by the consequences of alcohol use. This study found that while alcohol remains the drug of choice, the community is experiencing a rapid rise in poly-substance abuse as well. The 2010 Youth Risk Behavioral Survey of Lac Courte Oreilles High School students reveals a high use of alcohol and marijuana and other substances among Native students. Low Academic Achievement The LCO Head Start program reports that 60% of new fall students are not socially ready, thereby causing teachers to focus more on social skills than literacy. As students pass through the grades, statewide Wisconsin Knowledge and Concepts Exams (WKCE)
record a proficiency gap that increases in size and scope. Over the past three years, Native 3rd grade students in Hayward, a small town of about 2,000 in Sawyer County, are three times more likely than white students to be in the minimal proficiency group in reading and only half as likely to be in the advanced proficiency group. The drop out rate for Native American high school students has doubled over the past four years, now four times greater that that of white students 16 times their percentage of the school population. The Hayward Community School District reported that 30 students dropped out of the recent school year; 77% were Native students. Within the Lac Courte Oreilles Ojibwe School District, staggering percentages o f students are truant on a daily basis. In the 2009-2010 school year, there were 251.08 days of unexcused absences among middle-school students and 771.94 days of unexcused absences among high school students. Native students in the Hayward Community Schools are seven times more likely to be habitually truant than white students, comprising over half of all truants (56.9%) again twice the percentage of the school population. While the rates grow for both groups as they progress in grades, the American Indian students nearly triple their truancy between the elementary and middle school grades. Children with Developmental Delays The 2008/2009 screening for entering LCO kindergarteners revealed that 89% of the students were below age level in communication and language skills, 85% below age level in cognitive skills, and 10% below age level in social skills. In the last three years at the Hayward Community School, over half (55) of the preschool referrals for special education screening have been for Native students- twice their percentage- and 22 of 48 students screened (45.8%) have been placed in special education with Speech and language needs, and 7 of 48 (14.5%) with significant developmental delays. Social Isolation and Social Support While low-income families experience significant challenges no cars to get to work, no phones to communicate outside the home or no computers/internet access that allow them to acquire knowledge and skills that will help them in the workplace rural low-income Native American families fare much worse. They are disconnected from economic opportunity, distant from meaningful educational services and separated from other services and institutions that can help families succeed. Violence The LCO police summary report provides data that reflects the violence in the community. Approximately 70% of the police calls in 2010 were related to aggression. The LCO police department reports that there were 42 domestic violence incidents for the
Lac Courte Oreilles Tribe alone. The Sawyer County Sheriffs Department reports 62 for the entire county. Characteristics and Needs of the Participants Priority for home visiting services will be given to families that have the following risk factors: low income, pregnant women age 21 and younger, history of child maltreatment or interactions with Indian Child Welfare (ICW), history of substance abuse or needing treatment, children at risk for or with low academic achievement, children with developmental delays, and members that are serving or have served in the armed forces. Existing Home Visiting Services in the Community Currently there are five early childhood education and family support programs that exist in the LCO community. Four of these programs use home visiting as a service delivery strategy. Over the many years that these programs have existed together, with the recent addition of Early Head Start, program administration and staff have developed strong working relationships and have worked together to better coordinate efforts with young children and families: (1) Honoring Our Children. Funded by the Great Lakes Inter Tribal Council of Wisconsin, the Honoring Our Children program was created to reduce American Indian infant mortality and eliminate disparities in birth outcomes. The Coordinator and her part-time nurse and part-time outreach worker provide education during pregnancy as well as continued education in infant care and parenting to 85 infants/200 families. (2) FACE. The Family and Child Education (FACE) program of the LCO K-12 schools was initially developed by the Office of Indian Education as an Early Childhood/Parental Involvement pilot program in 1990. The program was based upon three distinct and proven early childhood and family education models: Parents as Teachers (PAT), National Center for Family Literacy (NCFL), and the High/Scope preschool curriculum for Early Childhood and the High/Scope Educational Approach for K-3. In 1992, the Early Childhood/Parental Involvement pilot project was renamed and became the Family and Education (FACE) program. FACE has been designed to implement a family literacy program in the home and school settings. At school, services are provided through adult education, early childhood education, PACT (parent and child time), Parent Time, and classroom participation in grades K-3. Home visitation services are also provided by two staff members. One and a half staff provide home visiting services are provided to 30 families. (3) Mino Maajisewin which means A Good Beginning in Ojibwe (Family Foundations). This program provides an intensive home visiting program to first-time parents who are eligible and enrolled in Medicaid and have been determined to be at-risk of physical, mental, or emotional dysfunction. Staff have been trained in the Parents as Teachers model in collaboration with Early Head Start. One home visitor is employed through this program serving 6 families.
(4) Early Head Start. Through resources of the American Recovery and Reinvestment Act, the Tribe was able to secure a 2009 Head Start expansion grant to serve children birth to three and their families. The program is intended to promote healthy lifestyles of family members, improve families access to services, and improve family functioning. Two parent educators are employed to provide home visiting services to 24 families, delivering the Parents as Teachers model. Existing Mechanisms for Screening, Identifying, and Referring Families in These Communities Partners Roles Outreach, engagement, and PNCC services to families with LCO Honoring Our infants and children under 2 years of age Children Program Home-based and center-based services to improve child LCO Early Head Start development and school readiness Program LCO Family and Home-based and center-based services to improve child Children Education development and school readiness (FACE) Nutritional assessments and screenings WIC Referrals of new pregnancies and general preventative LCO Health Center health and medical services Referrals of new pregnancies and reproductive health Sawyer County Public services Health Department Child protective services, parent aide support, and resource LCO Indian Child and referral services Welfare Child protection services, parent aide support, and resource Sawyer County Human and referral services Services Department Safe living space for women and children affected by LCO Oakwood Haven domestic violence and/or sexual assault, safety planning, Domestic Violence and referral services. Shelter LCO Behavioral Health AODA treatment services; mental health counseling; referrals to more intensive services, if needed Department Developmental screenings, physical, occupational, and Sawyer County Birth to speech therapy, parent support, referral assistance, and Three Program family education Resource and referral services for families who have LCO Birth to Three children with developmental disabilities Program LCO Ojibwe K-12 Educational and transitional services School Center-based educational activities for children, parent Northwest Connection Family Resource Center support, and referral assistance Work employment assistance services for individuals with LCO Vocational disabilities Rehabilitation Program Work experience and classroom training for individuals LCO Workforce
Investment Act LCO native Employment Works (NEW) LCO Child Care Program
looking for employment skills Work employment assistance Childcare and respite care assistance and referral and resource services
Plan for Coordination Among Existing Community Resources (including gaps) A comprehensive and aligned system of early childhood education and family support services does not currently exist at Lac Courte Oreille. The Healthy Families LCO will result in a strengthening of the tribes capacity to serve the needs of its most vulnerable families. Instead of analogous stand alone programs that operate individually within the tribes organizational hierarchy, this project will create a formal collaborative structure to pool resources to collectively address maternal, infant, and early childhood needs of high risk families. This will include developing a central point of intake for the existing early childhood education and support services and assessment process to determine level of need for families, and a referral system to match the needs of the family to the most appropriate level of services. With a formal referral system in place, the existing early childhood education and family support programs will eliminate the duplication of services and ultimately have the capacity to serve more families in the community. A more comprehensive assessment process will help assure that the most intensive services are provided to the families with the highest level of need. The integration of a child and family team approach to the proposed evidence-based home visiting program will ensure that services are better coordinated and part of a larger continuum of services and supports for young families. The existing home visiting programs are not serving a sufficient number of eligible, high risk families at Lac Courte Oreilles, nor are the families served with evidence-based programs that address their multitude of risk factors. The Mino-Maajisewin program operates on a $12,000 budget annually and can only serve six families per year. The Honoring Our Children (HOC) program provides case management services for pregnant women through Medicaids prenatal care coordination. In nearly all cases, the HOC IMCH nurse is the case manager. The HOC program served 71 pregnant women in 2010; only 20 received consistent home visiting services. Staffing is not sufficient to provide intensive home visiting services. The LCO Birth-to-Three program was intended to provide case management for children with special health care needs but due to staff limitations, serves primarily as a resource and referral agency. In 2010, there were 71 pregnant women and 85 infants in the Lac Courte Oreilles community based upon medical records of the LCO Community Health Center. Because not all women and infants receive their care at Lac Courte Oreilles, those numbers are likely much higher.
There is currently a very limited and informal system of coordination and referral services among the existing early childhood education and family support programs. In the current service delivery system, it is possible for a LCO family with multiple needs, and who is involved in multiple systems, to have several different care plans as well as several case managers from both tribal and non-tribal agencies. Often times, the service providers involved are not aware of the other services being provided or that any other services are being provided at all. This situation leads to service duplication, inefficient use of limited financial and staff resources, and confusion about who the family goes to for which need. In addition, the current way of providing services is often reactive and responsive primarily to crisis situations, focused on deficits, and does not consider the family as an equal partner. Informal supports that the family has established are rarely utilized in the current way of providing services to LCO families. With the integration of a child and family team approach, modeled after the Coordinated Services Team (CST) initiative, this would ensure that services are better coordinated and part of a larger continuum of services and supports. Local Capacity to Integrate the Home Visiting Services into an Early Childhood System For five years, the Lac Courte Oreilles community has been in the process of implementing the Coordinated Services Team initiative. The vision of the CST is to implement a practice change and system formation in Wisconsin by having a strengthbased, coordinated system of care, driven by a core set of values, that is reflected and measured in the way that we interact with and deliver supports and services for families involved in multiple systems of care, such as: substance abuse, mental health, child welfare, juvenile justice, and special education. The principles of the CST initiative are as follows: o Family-centered approach o Family involvement throughout the process o Building resources on natural and community supports o Strength-based approach o Providing unconditional care o Collaborating across systems o Using a team approach across agencies o Being gender/age/culturally responsive o Promoting self-sufficiency o Focus on education and employment where appropriate o A belief in growth, learning, and recovery o Being oriented to outcomes The home visiting program would facilitate collaboration between the existing CST initiative and the already operating Coordinating Committee. The majority of relevant community agencies are already active partners of the CST Coordinating Committee. The main function of the Coordinating Committee is to prepare Interagency Partnership
Agreements; address gaps in services; establish operational policies and procedures; and ensure quality, including consumer and agency satisfaction; and plan for the sustainability of the system of change. All of the functions of the Coordinating Committee are to assure the system of services is coordinated, family-centered, community based, and culturally appropriate to meet the needs of the families. The LCO and Sawyer County CST initiatives have integrated their two separate Coordinating Committees into one, which has been renamed Teams R Us. The current CST initiative has been mainly focused on families with children 12 and over. The hope is that a system of care for families with children much younger can be developed with the intent of preventing these children from entering into systems as they get older. A subgroup of the larger Teams R US Coordinating Committee will be formed to specifically address issues around early childhood. This subgroup will be comprised of representatives who provide services to young children and their families. This subgroup will include agencies from LCO, such as Early Head Start, Honoring Our Children, Mino Maajisewin, Family and Child Education (FACE), LCO Birth to Three and Community Cares program, and the LCO WIC program. This subgroup will also include organizations from the larger Sawyer County area including Sawyer County Birth-to-Three, Sawyer County Public Health Department, Northwest Connection Family Resource Center, and Hayward Head Start programming. A focus of the early childhood subgroup would be to engage and recruit members from local primary care physicians and HMOs to be an active and collaborating partner, as this is an area that needs to be strengthened. Active efforts will also be made to engage and recruit additional family members who have been recipients of early childhood services to help the group look at what programming and resources have been helpful, what has not been helpful, and how services can be improved for families who participate in them. NORTHWOODS HOME VISITING PROGRAM: LINCOLN, ONEIDA, AND FOREST COUNTIES (LOF) Forest County is a rural area in the Northern Region of Wisconsin comprised of 15 small villages and towns with a total population of 9,605 according to 2010 census data. The Forest County Potawatomi Community and the Sokaogon Chippewa Community have reservations in Forest County. In 2008 the total number of births in Forest County was 98 of which 46 or 46.9% were paid for by the Wisconsin Medicaid Program. It is estimated that there are 562 children under the age of 5 in the Forest County community and an estimated 24.0% of these children live in poverty. Lincoln County is a rural area in the Northern Region of Wisconsin comprised of 20 small villages and towns with a total population of 29,404 according to 2010 census data. In 2008 the total number of births in Lincoln County was 317 of which 146 or 46.1% were paid for by the Wisconsin Medicaid Program. It is estimated that there are 1,661
children under the age of 5 in the Lincoln County community and an estimated 12.7% of these children live in poverty. Oneida County is a rural area in the Northern Region of Wisconsin comprised of 20 towns and the city of Rhinelander with a total population of 35,930 according to 2010 census data. In 2008 the total number of births in Oneida County was 320 of which 185 or 57.8% were paid for by the Wisconsin Medicaid Program. It is an estimated that there are 1,639 children under the age of 5 in the County and an estimated 13.9% of these children live in poverty. Community Strengths The Northwoods Home Visiting Program is a regional response to supporting families in the Northwoods with high quality evidence-based home visiting services, increased prenatal care coordination services, and community coordinated child development and family support services. A collaborative spirit of residents exists in this rural area of the state to make things work. Because communities are small and relationships are close, the level of collaboration needed to bring systems together is often easier to achieve than in large urban areas with more complicated service arrays. By bringing together resources, ideas, and the commitment of people in this three county geographic area, the home visiting project will focus on a comprehensive, collaborative family support network serving north woods families targeting Lincoln, Oneida and Forest Counties. Risk Factors This region of the state is characterized by isolation, increasing poverty of permanent residents, high substantiated child neglect rates compared to the state average, higher rates of births to teen parents than the state average, lower than state average median household incomes, and high rates of child abuse substantiations in Forest and Oneida Counties as compared to the state average. Characteristics and Needs of the Participants The region is largely populated by white, low income families, with the exception of Forest County, which has a Native population belonging to the Potawatomi and Sokaogon Chippewa Tribes representing 12.6% of the countys population. For young children, growing up in poverty puts them at increased risk for having cognitive difficulties/delays and low school achievement. The target populations for this program are all pregnant women under the age of 18 and/or women under the age of 18 who are three months post partum and pregnant women who reside in Lincoln, Oneida or Forest Counties with at least three of the following risk factors: o Eligible for Medical Assistance/Badger Care Plus; o At risk for poor birth outcomes; o Prior interactions with the child welfare agency; o History of substance abuse or need substance abuse treatment;
o Are users of tobacco products in the home; o Have children at risk for or exhibiting low academic achievement; o Have children with developmental delays. Existing Home Visiting Services in the Community Oneida County currently serves 30 families annually with Early Head Start (EHS) home visiting services. The families currently served are not necessarily high risk families as a universal approach with the Parents as Teachers model has been used to deliver services. Through this grant, the Childrens Service Society of Wisconsin (CSSW) will provide eight additional high-risk families with home visiting services through EHS. The home visitor hired for EHS will be trained in the Healthy Families America model and will use the Parent as Teachers (PAT) curriculum. Lincoln County currently serves 38 families through a small home visiting program that is not evidence-based. The Family Resource Center provides very limited services primarily in the form of Play and Learn parent/child interaction groups. The HFA home visiting program will be one of the few parenting support services that employ an evidence-based model in the county. There currently is no home visiting program in Forest County. PNCC services are provided through the Tribal and county health departments. The health departments struggle to provide PNCC services due to lack of resources. There are virtually no parenting support services available to non-Native families in Forest County. Existing Mechanisms for Screening, Identifying, and Referring Families in These Communities This chart below describes the role of the various partner agencies in screening, identifying, and referring families to the program. Partner Agency Roles Provide PNCC services and match, primary partner providing health education to HV families, market the program, co-develop process to increase PNCC service, participate on Tri-County Leadership Council and local steering committees, screen for program eligibility and refer as appropriate, house FF family support worker in Forest County Provide referrals of high risk pregnant women and young families, screen for program eligibility, market the program, participate on Tri-County Leadership Council and local steering committees, house FF family support worker in Lincoln County
Health Department in the Three Counties
DSS Agencies in the Three Counties
Provide fiscal and lead program operations including: hire and support project staff, provide coordination of local CSSW/Family Resource steering committees and Tri-County leadership Council, collect and report outcomes data, market program, provide Centers staff training and weekly supervision, assure model fidelity (HFA and PAT) Co-develop processes for first trimester referrals, market WIC Agencies in the and refer to the program, provide staff training as Three Counties appropriate Screen for eligibility and refer pregnant teens to the School Districts in the program, serve on local steering committees Three Counties Co-develop processes for first trimester referrals, market Family Planning in the and refer to the program, provide staff training as Three Counties appropriate Market and refer to the program, provide staff training as appropriate, co-facilitate group-based programs for UW Extension in the participants, provide evaluation, research and technical Three Counties assistance as needed, serve on local steering committees and/or Tri-County Leadership Council Assist in the screening and referral process, serve on the Ministry Womens local steering committee Health Department Refer expectant and new moms to the program, market the program, work with the high school staff in Lincoln County on early identification and referral of pregnant teens, Head Start in the Three provide PAT home visiting match in Oneida County, serve Counties on local steering committees and/or Tri-County Leadership Council Market and refer to the program, serve on the local steering Birth-to-Three in the committees Three Counties Assist in recruiting and referring, explore options for staff Aspirus Hospital/Clinics screening of Lincoln County families Assist in recruiting and referring, explore options for staff Marshfield Clinic/ St screening of Lincoln County families. Clares Hospital Screen and refer to the program, market the program, Great Lakes Inter-Tribal provide staff training and technical assistance as needed, Council participate on the Tri-County Leadership Council Northern Regional Screen and refer to the program, staff training and Center Children and consultation as needed, participate on the Tri-County Youth With Special Leadership Council Health Care Needs Because of the limited resources, families that have three or more risk factors will be given priority for enrollment in the comprehensive home visiting program. Many more families will be screened, assessed, and referred to services in the community that meet
the needs of the family including home visiting services offered through Head Start and the CSSW FRCs. It is also anticipated that prenatal care coordination services by the health departments will increase. Plan for Coordination Among Existing Community Resources (including gaps) Service delivery and community coordination efforts will be supported by a host of community partners who will serve on the Tri-County Leadership Council or one of three local steering committees to guide implementation of the Northwoods Home Visiting Project and work to improve community support of pregnant women and families with young children. The Tri-County Leadership Council and local steering committees will promote sustainability through engagement of community stakeholders, parent participants and potential funders. The community groups will develop strategies to improve the local project and address the gaps in the system of care based on data collected and analyzed. Participants of this group will include staff from the local organizations who work with pregnant women, infants, young children and their families, and users of the service. Each county either currently has committees (Family Service Network in Forest County and Northwoods Community Partners in Oneida County) that will assume this work; or in the case of Lincoln County, has staff from stakeholder agencies that have agreed to participate in these network meetings. Areas that these groups may address include: recruitment of pregnant women into the project, shared training, centralizing intake and referrals, and developing strategies to improve access to services, etc. The Tri-County Leadership Council will include senior level leaders from each county representing the partners collaborating to implement the project and other community leaders, as appropriate. This group will provide project and resource oversight and represent the projects goals in community and other state level venues. The Tri-County Leadership Council will review evaluation data and suggest improvement projects. This group will also work to develop sustainability plans to sustain and grow the project. Local Capacity to Integrate the Home Visiting Services into an Early Childhood System In the Oneida County community, the Northwoods Community Partners is comprised of community stakeholders that include Head Start, Child Care Resource and Referral, Birth-to-Three, the Food Pantry, the Homeless Shelter, UW-Extension, Tri-Council on Domestic Violence, W-2, the local Chamber of Commerce and the United Way. The members of this group are the community partners who will participate on this projects local steering committee in Oneida County. This group accomplishes some of its work in subcommittees that attend to specific needs in the Oneida County community. Northwoods Community Partners has agreed to include a sub-committee that will act as the local steering committee for this home visiting grant. The Oneida County Health Department, the school district, and staff of Ministry Womens Health have also agreed to participate on the steering committee.
In the Lincoln County community staff will work with members of the existing Parenting Task Force, all of whom work with children and families, to plan and implement the program. Staff will invite members of the Merrill Ministerium, who represent the six largest churches in the community to serve on the local committee. The Family Resource Center is located in the Community Care Center, which houses several human service agencies including St. Vincent DePaul Outreach Center, the United Way, Bridge Community Clinic, Rural Dental Health, NCCAP (the local community action agency), Food Pantry and Comunidad Hispana. All these organizations will receive information about the program and have the opportunity to provide insight into local needs and feedback about how program implementation is proceeding. Lincoln County parents may receive prenatal care within the county; however, all babies in Lincoln County are born in neighboring Marathon or Oneida Counties. The Family Resource Center will expand its work with the local medical providers to identify and reach expectant parents who are eligible to participate in the program. As mentioned previously, very little early childhood prevention programming for pregnant women and families with young children is available in the Forest County community. The Family Foundations home visiting project provides a solid opportunity for the community to build capacity to begin working more collaboratively to have a more fully developed and integrated early childhood care and education and family support system. RACINE COUNTY Racine County is an urban area in the Southeastern Region of Wisconsin with a population of 195,408 according to 2010 census data. In 2008 the total number of births in Racine County was 2,673 of which 1,380 or 51.6% were paid for by the Wisconsin Medicaid Program. It is estimated that there are 13,736 children under the age of 5 in the County and an estimated 14.5% of these children live in poverty. Community Strengths As part of their vision for all students to successfully complete high school, the Racine Unified School District (RUSD) developed an initiative to encourage universal developmental screening of children before they enter school, in collaboration with a number of health care and family servicing agencies in the City, including the agencies involved with the Family Foundations home visiting project. The RUSD aim is to identify children with potential delays so that appropriate interventions can be delivered as early as possible and help positively re-set that childs educational trajectory whenever possible. Risk Factors In Racine County, approximately 14.5% of the children under the age of 5 live in poverty. In 2008 51.6% of the births in Racine County were covered by Medicaid. Racine County also had:
o The third highest number of total births in Wisconsin o The third highest number of births in Wisconsin covered by the Wisconsin Medicaid Program o The fourth highest rate of premature births (<37 weeks) o The second highest rate of low-birth weight births (<2500 grams) in the State. o The highest per capita rate of mothers who were high school drop outs. o The fifth highest number of juvenile arrests o The fourth highest rate of reported crimes o The ninth highest rate of substantiated child victimization The United Way of Racine County Community Indicators Report (2011) reveals that in 2008, there were 290 births to teen mothers under the age of 20 in Racine County, the second highest in the state. Racine County has the twenty-fourth highest unemployment rate among the 72 counties in Wisconsin. The inner city areas of the city of Racine have been particularly hard-hit economically with more than 12 percent of the labor force unemployed, leaving the city with the second highest unemployment rate in the state. More than twelve percent of Racine County individuals are living in poverty, with 18.3 percent of children in poverty. In the city of Racine, nearly a third (32%) of children live in poverty. Characteristics and Needs of the Participants The target population for the proposed project is at-risk young pregnant women (particularly women in their first trimester) and young mothers and their children in Racine County. The majority of mothers to be served face multiple, complex problems that place their own health and the health of their babies at risk. Mothers served will be or have: o African American and/or Hispanic heritage o Under the age of 21 years o Unemployed or underemployed o Uninsured or underinsured o Living at or below the poverty level o Eligible for Medical Assistance/BadgerCare Plus o At-risk for poor birth outcomes o Isolated from family or extended kin supports o At-risk for involvement with the child welfare system o Histories of victimization by intimate partners o At-risk for substance abuse or misuse o Children at home who have developmental delays o Children at home who are at-risk for low academic achievement Existing Home Visiting Services in the Community City of Racine Health Dept (PNCC): 100 families in 2010 City of Racine Health Dept (Healthy Families): 42 families in 2010
Central Racine Co Health Dept (MCH): 14 families in 2010 Teen Parenting Support: 25 Teens in 2010 The types of visits are in-home using the models: PNCC, PAT, Family Smart/Kid Friendly There are three resources in Racine County that provide evidence-based home visiting services: the organizations that make up the Family Smart/Kid Friendly Partnership, the Central Racine County health Department, and the Western Racine County Health Department. Family Smart/Kid Friendly serves up to 100 families a year using the Parents as Teachers (PAT) model. The Central Racine County Health Department visited nearly 40 at-risk newborns. In 2011, the United Way of Racine County partnered with Childrens Service Society of Wisconsin and Next Generation Now to establish the Racine Family Resource Network. Funds received from the Childrens Trust Fund of Wisconsin for that project will enable Family Smart/Kid Friendly to increase the number of families participating in the Parents As Teachers curriculum by another 40 families in the coming year. Even with the addition, the total number of at-risk families who receive evidence-based home visiting services is not close to the total number of at-risk families who could benefit from home visiting support. Despite having a total of 1,380 births covered under the Wisconsin Medicaid program in 2008, only 237 families (17%) participated in home visiting programs in Racine County during the year. In 2010, the number of families served actually declined from 237 families to 217 families, in large part due to a lack of available resources for home visiting services. All of the current providers of evidence-based home visiting services currently maintain waiting lists or refer families out to non-evidence-based home visiting services. Existing Mechanisms for Screening, Identifying, and Referring Families in These Communities One of the primary goals of the proposed project is to establish a coordinated system of care in Racine County for pregnant young women, mothers, infants and children who are at-risk for poor maternal and birth outcomes. With this in mind the project partners will engage a broad array of public and private resource providers who can support the successful implementation of the program by making referrals, receiving referrals and reaching young pregnant women who are in their first trimester. Organizations that will be engaged include: o WIC programs o W-2 providers o Racine Unified School District o Local domestic violence shelters: Safe Haven o Youth serving agencies o Family physicians and OB-GYNs o 4Cs Community Coordinated Child Care
o o o o o o o o o o o o o
Lutheran Social Services The ARC of Racine County Family Literacy Services of Racine Wheaton-Franciscan Health Care System Aurora Health Care Racine Community Health Center (free clinic) Gateway Technical College Family planning providers/PPW HALO Homeless Assistance Leadership Organization Catholic Charities Salvation Moms (Gospel Church) Womens Resource Center Health and Nutrition Services of Racine
Developing strong relationships with these resource providers will not only support project efforts to reach young pregnant women in their first trimester, it will ensure that the families have access to the basic services and supports they need to promote child safety, healthy development, family stability, and well-being. Plan for Coordination Among Existing Community Resources (including gaps) The Racine County Human Services Department will oversee the development of a coordinated community system of care with the project partners in the Racine County Family Visiting network. Participants of the Greater Racine Collaborative for Healthy Birth Outcomes (Racine LIFH) will support increased coordination. The Greater Racine Collaborative for Healthy Birth Outcomes is a collaborative of over 90 member agencies working together to improve birth outcomes and maternal and child well-being in Racine County. Many of the organizations are also involved in the proposed project as members of the collaborative. Most recently the collaboration produced a compendium of family support programs, with detailed descriptions, that serve Racine County pregnant and parenting teens. Local Capacity to Integrate the Home Visiting Services into an Early Childhood System The Racine County Human Service Department will assume responsibility for coordinating a Program Advisory Committee that will meet monthly during the start-up phases, and quarterly thereafter to oversee the implementation and integration of the project into the system of care for families with young children. The Committee will be comprised of 10 12 community stakeholders that include: the project partners, representatives of the target population, representatives from local health care systems, an OB-GYN practitioner, a representative from the Racine Community Health Center (federally qualified health care center), Racine Unified School District, a domestic violence resource provider, and representatives from the United Way of Racine County, and the Greater Racine Collaborative for Healthy Birth Outcomes. The Project Advisory Committee will provide feedback on the project design, share ideas about the program
and outreach materials created for the project, review project outcomes and make recommendations on program improvements and facilitate linkages with other community-based programs. AT-RISK COMMUNITIES NOT FUNDED Eighteen at-risk communities were identified in the needs assessment. Lack of available funding prevents us from providing funding to all of the sites. The following communities did not receive funding: Adams County Ashland County Brown County Burnett County Douglas County Great Lakes Intertribal Council Kenosha County Manitowoc County Menominee County Rock County Rusk County Winnebago County Within the next month, State and regional DCF and DHS staff will outreach to all of the organizations that submitted proposals through the RFP process that were not funded. As additional funds become available through MIECHV or through other federal or private dollars, the State will prioritize awarding funds to the respondents from the 18 at-risk communities that did not get funding in the initial procurement. DCF is committed to update and promote the home visiting website, enhance the on-line Home Visiting Tool Kit, and include non-funded programs in a distribution list for the quarterly Home Visiting Newsletter, so that they may be as well-informed about how the state plan for home visiting is being implemented in Wisconsin. For those non-funded home visiting programs that are currently operational, DCF is committed to keeping as much of the training as low-cost as possible in an effort to sustain and well-position those programs to expand their services with additional resources. Staff will also offer some limited technical assistance that may include an invitation of the non-funded sites to regional TA sessions, so as to prepare them for expansion/enhancement as new funds become available. The organizations that offer home visiting services will be encouraged to participate in the Regional Communities of Practice as a means to remain a part of the statewide peer learning network of home visiting program staff including opportunities for front-line staff, their supervisors and program administrators. Of the 18 at-risk communities, no proposal was received from Rusk or Douglas Counties. The Home Visiting Coordinator will follow up with the initial contacts identified in those
communities during the outreach process to gage interest/familiarity with home visiting as a prevention and early intervention service delivery strategy. Assistance with identifying perceived and actual barriers for completion of a proposal will be offered. Both the Home Visiting Coordinator and MCH Nurse Consultant, as well as the state regional offices of DHS and DCF, will engage the appropriate staff from the county health and social service departments, tribal governments, Head Start programs (if they exist) and family-serving agencies to identify individuals or organizations that may be interested in taking the lead in developing an evidence-based home visiting initiative when future funds are available. State and regional staff are committed to support capacity for development of home visiting services in all at-risk communities. Technical assistance can be provided to address the following areas: What is meant by evidence-based practice? How to match evidence-based home visiting models to the needs of the local community? Information about the goals and expectations for home visiting in Wisconsin, and How to identify potential partners for developing an integrated approach to serving maternal and child health populations at risk?
Section 2: State Home Visiting Program Goals and Objectives

In Wisconsin, we believe that all children should have the opportunity to grow up in safe, healthy and nurturing environments. When families are unable for a myriad of reasons to provide an optimal environment for their children, we want to ensure they have access to a wide range of high quality services wherever they reside in our state. We believe these services should be provided to families in neighborhood locations where they are already utilizing services, including schools, child care centers, and in their homes. We believe its critical to provide a continuum of prevention and intervention services to families that meet their individual needs. Thus, it is our goal to develop a comprehensive early childhood system in Wisconsin with a continuum of service strategies, including a mixture of home visiting models that families can access for supporting their needs. We believe it is imperative that our continuum of services adequately addresses the cultural and ethnic diversity in our state, including programming specific to our Tribes and immigrant and refugee populations. With support from the Affordable Care Act Maternal, Infant and Early Childhood Home Visiting Program, Wisconsin will work towards the development of a comprehensive, high-quality early childhood system that promotes maternal, infant, and early childhood health, safety and development, as well as strong parent-child relationships. Specifically, home visiting services will be intensive, comprehensive and focus on services to children prenatally to age five, and seek to improve the well-being of children and families. Wisconsin has adopted the following guiding principles as we approach the development of a statewide plan for supporting evidence-based home visiting models. 1. 2. Emphasize depth over breadth in order to maximize the likelihood of achieving desired outcomes. Focus on promoting collaboration with existing services, including health care providers and economic support to build a comprehensive coordinated system. Promote sustainability through building community capacity for programs to thrive after the initial grants from the state. Emphasize outcomes with evidence-based models through high levels of model fidelity. Prioritize service delivery to at-risk populations.
3. 4. 5.
Home visiting services in Wisconsin, in coordination with other community programs will prioritize the following three outcome areas: Reductions in child maltreatment Improvements in school readiness and achievement Improvements in maternal and child health
Through our efforts we will build an integrated system that will also address outcomes in these additional areas: Improvements in family stability and economic self sufficiency Improvements in parenting skills related to child development Reductions in family violence Improvements in the coordination and referrals to other community resources, services and supports Reductions of emergency department visits
Wisconsins Home Visiting Initiative will build on existing efforts, including the work of the Governors State Advisory Council on Early Childhood Education and Care (ECAC), co-chaired by the Secretary of the Department of Children and Families and the State Superintendent of Public Instruction. The ECAC was created in December 2008 with the charge to submit a statewide strategic foundation for designing an effective early childhood system in Wisconsin aimed at improving outcomes in school and in life for our children. In an assessment of Wisconsins early childhood programs conducted by the University of Wisconsin on behalf of the ECAC1, key gaps were found in early childhood program sectors: A. Stable, Nurturing, and Economically Secure Families Parenting education is comprised of a diverse set of programs, creating a fragmented system, with limited information on the range and quality of services provided. Home visiting programs in Wisconsin target primarily at-risk families, but serve only a fraction of that population. Economic support benefits are often underused by eligible families. Safe and Healthy Children Health disparities across multiple important health outcomes are evident for children of color. Mental health services are not adequately reaching children in need.
B.
Governors State Advisory Council on Early Childhood Education and Care. (December 2010). Building Blocks for Wisconsins Future: The Foundation for an Early Childhood System. A Report to Governor Jim Doyle. Madison, WI: Department of Children and Families.
C.
Quality Early Learning Data on quality educational experiences of Wisconsins children, especially those served in programs not publicly funded is incomplete. Educational levels of child care workers are relatively low, resulting in low paying jobs in the field.
The Wisconsin Early Childhood Comprehensive Systems (ECCS) grant, the Wisconsin Early Childhood Collaborating Partners (WECCP), and Project LAUNCH will also be critical pieces in helping to embed home visiting services into a statewide comprehensive early childhood system. The overarching intent of Wisconsins ECCS project is to increase coordination and integration of the five components of medical home, mental health, early care and education, family support and parent education to foster collaborative work and evolve into a comprehensive, integrated system of services that supports parents and communities to promote the healthy growth and development of children from birth to school entry. The goal of ECCS is to achieve system change that integrates the components of the early childhood community. WECCP has realigned its work and structure to support all five critical components of the ECCS grant. The goal of Project LAUNCH is for all children to reach physical, social, emotional, behavioral, and cognitive milestones through implementing five evidence-based prevention programs that support young children and families. Linking with the State MCH programs five year early childhood initiative begun in 2010 to strengthen local community use of Bright Futures in programs to support young children will enhance the home visiting system plan. The MCH programs work to integrate key concepts of Life Course will provide framework for local communities to engage partners in their efforts to comprehensively support young families. Though progress has been made in Wisconsin to align the system of the five ECCS component areas into a comprehensive early childhood system, much work is needed over the course of the next five years to embed home visiting strategies and sustain progress. Though Wisconsin has a wide range of family support and home visiting programs, there is no coordinated statewide early childhood system that allows for sharing of data, including the number and types of home visiting programs, populations served or participant outcomes. As a result the quality of services and the degree to which Wisconsin home visiting programs are producing the desired outcomes and reaching at-risk families is not fully known. Wisconsins Home Visiting Program will continue to make investments in a statewide infrastructure which will provide a mechanism to formalize the coordination of services at the local level and allow opportunities for greater efficiencies. In general, we may not know the degree to which home visiting programs in Wisconsin are producing the outcomes for children and families we desire: however, the Wisconsin Early Years Home Visiting Outcomes Project has been leading the way encouraging programs to use data to drive their decision-making. At present, the nine participating
programs have agreed to use some of the same screening and assessment tools in effort to be able to report outcomes that are common across all of the programs, despite employing different home visiting models. Arguably, they have made significant progress toward this goal, and we would like to build upon lessons learned through the Outcomes Project. The primary goals and objectives of Wisconsins Home Visiting Program will build upon the success of our current integrated efforts and address key gaps found in the assessment of early childhood program sectors, specifically in the communities that were identified as high risk through the home visiting needs assessment process. Over the next five years, by identifying relevant strategies to address the gaps in services identified, our intent is to begin the development of a comprehensive, sustainable early childhood system that is accessible for all children in Wisconsin. We will begin by focusing on the high risk communities that were identified in Wisconsins home visiting needs assessment. GOAL 1: Promote a wide range of high-quality, evidence-based home visiting programs that address the multiple, complex needs of children and families across Wisconsin. Objective 1.1 By July 1, 2011, select at-risk communities through a competitive request for proposals process to receive funds to implement evidence-based and promising practices home visiting programs. Ensure a range of home visiting programs are selected based on highest need, organizational capacity and service-delivery experiences, with an emphasis on geographic and cultural/ethnic diversity. Ensure selected models address the key federal benchmark areas. Objective 1.2 By July 1, 2011, create a technical assistance plan that includes assistance on implementing evidence-based home visiting models that meet the target populations needs, and maintains model fidelity, while recognizing and addressing cultural diversity of at-risk families. Identify a regional structure of mentors that can assist key state staff to carry out the technical assistance plan. Objective 1.3 By December 1, 2011 identify training needs for home visiting programs and coordinate the development of a state home visiting training plan aimed at increasing the quality of home visiting programs across the state. Integrate current training efforts being offered across the state including the Wisconsin Model Early Learning Standards, infant mental health, the family support professional core competencies, and the Pyramid Model into the home visiting statewide training plan.
Objective 1.4 By January 1, 2012, create a community of practice to allow for networking, peer support and learning opportunities among selected home visiting sites. Encourage mentoring relationships between more experienced home visiting sites and those just starting up for problem solving and to share best practices. GOAL 2: Develop a comprehensive and sustainable continuum of early childhood services in Wisconsin that includes evidence based, and promising practices home visiting programs. Objective 2.1 By October 1, 2011, conduct a comprehensive professional development scan across systems to determine who is conducting professional development targeted to intensive, comprehensive home visitors and their programs. Objective 2.2 By December 1, 2011, hold an annual meeting with local agency administrators (CEOs, EDs, program supervisors) of selected home visiting programs to ensure successful program implementation at the local level and engagement in the development of a statewide comprehensive early childhood system. Objective 2.3 By January 1, 2012, incorporate outcomes of the statewide child abuse and neglect prevention social marketing campaign funded by the Childrens Trust Fund and Child Abuse Prevention Fund into the early childhood comprehensive system. Objective 2.4 By June 1, 2012, conduct a SWAT analysis of Wisconsins home visiting service system, including the identification of gaps in service delivery. Objective 2.5 By June 1, 2012, create a sustainability plan, including public and private financing to ensure home visiting strategies are a critical component of a statewide comprehensive early childhood system. Objective 2.6 By June 1, 2012, integrate economic support services and activities into the comprehensive system by ensuring all families participating in home visiting programs are aware of their eligibility for public benefits and are enrolled to receive all benefits, as a bridge to achieving self-sufficiency. Objective 2.7 By January 1, 2013, develop a strategic blueprint, based on the results of the SWAT analysis for ensuring all at risk families in Wisconsin have access to quality home visiting
services as a part of a comprehensive early childhood system regardless of where they live in the state. Objective 2.8 By January 1, 2013, revise the core competencies for family support professionals, including home visitors, and use as a foundation for creating a career pathway for professionalizing the field of home visiting. Objective 2.9 By January 1, 2015 ensure evidence-based home visiting services are fully embedded into existing early childhood systems, including Early Childhood Comprehensive System (ECCS), Governors ECAC, Wisconsin Early Childhood Collaborating Partners (WECCP) and family support. Objective 2.10 Ongoing, promote and support promising home visiting models to move towards evidence-based. In addition, support promising practices that are specifically designed to work with diverse populations, including Tribes and refugees. Objective 2.11 Ongoing, assure statewide efforts to integrate a universal screening tool for all newborns in Wisconsin into home visiting programs. Objective 2.12 Ongoing, collaborate with current efforts to create a trauma-informed care system in Wisconsin and ensure that home visiting services are trauma-informed and traumasensitive. Objective 2.13 Ongoing, utilize the ECAC Ad Hoc Committee on Home Visiting to ensure cross systems decision-making on policy direction, evaluation priorities and in monitoring training quality and content. Objective 2.14 Ongoing, develop policy and practice issues that affect full implementation of evidencebased home visiting programs at the local level that can be addressed through the ECAC Ad Hoc Committee on Home Visiting. GOAL 3: Promote continuous quality improvement of home visiting through evaluation strategies to ensure fidelity to the evidence-based models, quality of services, and efficacy in improving the lives of Wisconsin children and families.
Objective 3.1 By October 1, 2011, identify evaluation needs and coordinate the development of a statewide evaluation plan, including the monitoring of programs for fidelity to evidencebased models or promising practices and a cost benefit analysis. Coordinate evaluation efforts of Project LAUNCH with the evaluation plan of the home visiting statewide plan. Objective 3.2 By December 1, 2011, develop and support a statewide data system to ensure common data collected across sites. Allow sites to access their own program data and be able to easily run meaningful reports through the system to assist in monitoring program quality. Objective 3.3 By January 1, 2012, develop a process to complete a regular analysis of home visiting process and outcome data that can be shared with the Governors State Advisory Council on Early Childhood Education and Care to inform statewide policy and program development. Objective 3.4 By June 1, 2012, coordinate required data sources to support an accurate portrayal of services offered through Wisconsins home visiting programs and the outcomes achieved by families participating in those programs. Where there is not county or tribal specific data, recommend the development of indicators to track that information. Objective 3.5 By January 1, 2013, build upon current efforts to create a quality self-assessment tool for home visiting programs. Incorporate a continuous quality improvement process into the comprehensive statewide infrastructure. Objective 3.6 By January 1, 2013, integrate home visiting data and outcomes with Wisconsins efforts to collect data on Adverse Childhood Experiences (ACE) scores. Measure the impact of home visiting services on the reduction of ACE scores in Wisconsin. Objective 3.7 Ongoing, provide technical assistance to home visiting programs awarded grants under the competitive RFP on the importance of collecting data, using the required data collection tools, and analyzing the data to inform local decisions.
Section 3: Selection of Proposed Home Visiting Model(s) and Explanation of How the Model(s) Meet the Needs of Targeted Community(ies)
State Support in the Model Selection Process Through the RFP process, each community selected the home visiting model that it felt best met its needs. To maximize implementation capacity, the State narrowed down the number of approved evidence-based models to the five models currently operating in WI: Early Head Start-Home Based Option (EHS), Healthy Families America (HFA), Home Instruction for Parents of Preschool Youngsters (HIPPY), Nurse-Family Partnership (NFP), and Parents As Teachers (PAT). Based on findings from the Wisconsin Needs Assessment, communities were also particularly encouraged to select home visiting models that had demonstrated positive impacts on child abuse and neglect prevention and healthy birth outcomes. Prior to and during the RFP writing process, the State provided communities with numerous forms of guidance and support in the model selection process, based on resources provided by HRSA and ACF. For example, early State webcasts developed during the Needs Assessment process described the process and indicators to be used in the Needs Assessment and State Plan, and encouraged communities to begin conversations about how evidence-based home visiting programs would fit into their early childhood service systems. After release of the Supplemental Information Request (SIR), State staff began preparing materials describing the HomVEE study and its findings, information about each of the evidence based models, and HRSAs definition of a promising approach to share with potential proposers. At a Technical Assistance Session for potential RFP respondents on March 21st, DCF research analyst Hilary Shager gave a PowerPoint presentation that summarized the HomVEE findings and shared the model selection criteria from the March 17 HRSA webinar, Selecting the Appropriate Model for an At-Risk Community. This presentation was followed by an opportunity for attendees to discuss the use of evidence to guide model choice with DCF and DHS staff and with their local team. These materials were also disseminated via the State Home Visiting Newsletter and Home Visiting Tool Kit2, and were summarized in the History and Background section of the RFP. Model Selection in the RFP Communities were given the choice of proposing implementation of an evidence-based model or promising practice, using the operational definitions given in the SIR. Communities responsibility for choosing an appropriate model was described in the RFP Project Description as follows:
2
These and other community engagement and outreach activities are described in more detail in Section 4 of this Plan.
Home Visiting Model: Successful proposers will provide a detailed rationale that explains how the model selected for implementation best meets the needs that have been identified for families to be prioritized for services, and how those home visiting participants will meet the identified benchmarks (improved maternal health; improved child health; reduction in childhood injury, use of emergency rooms and child maltreatment; improvement in service coordination; improvement in family economic self-sufficiency; and reduction in crime or domestic violence). See Appendix 2, Models that Meet the Criteria for Evidence Base for further information. The successful proposer will provide an implementation plan that is consistent with the selected model requirements to ensure fidelity to the model. The successful proposer will have assessed the models presented to determine which best meets the intended outcomes of this proposal, describe its rationale in coming to that conclusion and, if selecting a model found to be effective for outcomes other than improved birth outcomes and reducing child maltreatment, will provide a detailed description of how it will wrap additional services, approaches, etc. so as to address the desired outcomes. If the proposer has chosen a promising approach, it must describe an approach that ensures it will meet the criteria identified in Appendix 3, Promising Approaches. Priority will be given to proposals that choose to implement a home visiting model that has demonstrated positive impact on child abuse and neglect prevention and healthy birth outcomes. The importance of aligning models with the desired target population and outcomes was reflected in the RFP scoring system, in which 150 of 1,000 total points were awarded for responses to the Rationale for Evidence-Based Model Selected section. In this section, proposers were asked to provide a detailed rationale explaining how the model selected best meets the needs that have been identified for families that will be prioritized for services, and how those home visiting participants will meet each of the following benchmarks: improved maternal health; improved child health; reduction in child abuse, neglect, and maltreatment; reduction in childhood injury and use of emergency rooms; improvement in service coordination, improvement in family economic self-sufficiency; and reduction in domestic violence. Proposers were also asked to describe the following: Describe how your agency will take steps to implement an evidence-based home visiting program that is consistent with the purpose of this RFP. Clearly explain if this will be a new program or the expansion or adaptation of a current program. Describe how your agency will provide intensive, comprehensive home visitation, including frequency of home visits and how the program will meet the needs of the priority populations.
Describe your agencys ability to creatively reach women in the first trimester of pregnancy and new families who may be eligible for this program, but are identified later in the pregnancy. Describe your agencys plans for effectively engaging and providing services to fathers. Describe how your agency will ensure that cultural and linguistic sensitivity will be included in all aspects of program planning and service delivery. Describe your agencys ability to communicate and interact effectively with non-English speaking children and families. Describe your agencys awareness and responsiveness to cultural distinctions families present to successfully engage them in a culturally appropriate and responsive way. Describe how your program will implement strength-based, individual case planning with participants that is consistent with the principles of familycentered, culturally competent services. Describe how families are engaged in developing and monitoring plan goals. Describe the mechanism of establishing the flexible funds for families and how these funds will be uniformly available to all families in the home visiting program. Describe how situations will be handled when families transition out of the home visiting program, whether that happens because the child is turning five or the family is referred to an early childhood or other program.
Based on requirements detailed in the SIR, additional descriptive and evaluation requirements for communities proposing promising approaches were also included in the RFP guidelines; however, no communities proposed to implement a promising approach. Models Selected by At-Risk Communities As a result of this process, Wisconsin has chosen to implement a mix of the models designated in Appendix B of the SIR as evidence based, including Early Head Start (EHS), Healthy Families America (HFA), and Parents as Teachers (PAT). The State will not be implementing any promising approaches in this round of funding. The specific rationales for the model selection of each of the awarded at-risk communities are as follows: EMPOWERING FAMILIES OF MILWAUKEE City of Milwaukee Public Health Department HFA model (with PAT curriculum) The Healthy Families America model is chosen based on its level of evidence addressing seven out of eight benchmarks for positive child and family impacts. Based on the level of need with high-risk families, the Milwaukee community needs to provide services with the highest level of evidence to assure dollars invested will create the highest level of impact.
GREEN COUNTY Green County Health Department/Dane County Parent Council EHS model Green County currently has only one home visiting program for pregnant women and families with very young children, Early Head Start. This existing Early Head Start program was able to serve only 22 of the 156 Medicaid-eligible births reported in 2008 that is less than 15% of the eligible population reached. In addition to being able to serve additional families, the expansion of the program enhances the existing partnership between the GCHD and DCPC and their work to build a comprehensive early childhood system in Green County. LAC COURTE OREILLES TRIBE Lac Courte Oreilles Tribe HFA model (with PAT curriculum) The HFA program was selected because the model demonstrated positive impacts on the needs and risk factors indentified in the Lac Courte Oreilles community: reductions in child maltreatment; positive parenting; child development and school readiness; child health; reduction in crime or domestic violence; service linkages and referrals; and family economic self-sufficiency. The demonstrated positive impact of HFA does not include maternal health. However, this impact area will be addressed by current staff of the Honoring Our Children program through prenatal care coordination and other maternal/child health benchmarks such as reduction in poor birth outcomes. The other model considered that addresses the needs and risk factors of the community was the Nurse Family Partnership model but the tribal community does not have the nurses available to fill the positions. NORTHWOODS (LINCOLN, ONEIDA, FOREST) Childrens Service Society of Wisconsin HFA model (with PAT curriculum) HFA was selected because it is designed to be used with the target population and also because it has demonstrated positive results in: (a) increasing access to prenatal care; (b) increasing the number of participants who have a medical home; (c) increasing the immunization rates; (d) promoting positive parenting practices; (e) improving parentchild interactions; (f) improving healthy child development and school readiness; and (g) promoting family self-sufficiency. The HomVEE review shows that overall the HFA model has demonstrated a positive impact in more areas than the PAT model. HFA demonstrated impact in four areas where PAT has yet to demonstrate impact: child maltreatment, child health, reduction in domestic violence, increased service linkages and referrals and family self-sufficiency. All of these areas are targeted outcomes for the reformed Family Foundation Program. The HFA model has modest outcomes with regard to maternal health, so at the community level in the three counties served, the Northwoods Home Visiting project partners will leverage their relationships with the public health nurses to enhance the ability of the home visitors to address maternal health issues. Public Health has agreed to support the home visitors through consultation, joint visits, providing PNCC and having a key role in project implementation.
RACINE COUNTY Racine County Human Services/Childrens Service Society of Wisconsin HFA model (with PAT curriculum) HFA was selected because it is designed to be used with the target population and also because it has demonstrated positive results in: (a) increasing access to prenatal care; (b) increasing the number of participants who have a medical home; (c) increasing the immunization rates; (d) promoting positive parenting practices; (e) improving parentchild interactions; (f) improving healthy child development and school readiness: and (g) promoting family self-sufficiency. The HomVEE review shows that overall the HFA has demonstrated positive impact in more areas than the PAT model. HFA demonstrated impact in four areas where PAT has yet to demonstrate impact: child maltreatment, child health, reduction in domestic violence, increased service linkages and referrals and family self-sufficiency. Community level factors also influence the selection of the HFA model. Currently there are only three providers in Racine County who are utilizing evidence-based home visiting services. Two of the three Health Departments are using the Parents as Teachers (PAT) model, and the local community is deeply committed to this model. While the PAT model has demonstrated positive impact on maternal and child health outcomes, it is not appropriate for every family. PAT offers both individual and group-level intervention and some families may prefer a model that does not require group experiences. Introducing the HFA model in Racine County will provide partner agencies with another evidence-based home visiting model to utilize for families who require a higher level of care or more intensive home visiting services. The States current and prior experience with implementing the model(s) selected and the current capacity to support the model Wisconsin has experience implementing the Early Head Start and Healthy Family America home visiting models, as well as the PAT curriculum, that were chosen by communities and soon-to-be-awarded home visiting program contracts by the State. This experience, as well as the states current capacity related specifically to each model is detailed below:
Healthy Families America Wisconsin has a long history with the Healthy Families America home visiting model. First, the original Prevention of Child Abuse and Neglect (POCAN) legislation passed in 1998 created a state-funded home visiting pilot project that was built on the Hawaii Healthy Start program, which became the HFA national framework. Additionally, the State has required since its inception that the POCAN/Family Foundations program sites adopt and adhere to the 12 Critical Elements of Successful Home Visiting Programs, developed in consultation with Dr. Deb Daro when she was at Prevent Child Abuse
America. Also, most of the PNCC-certified programs, including many home visiting programs throughout the State, use the HFA Great Beginnings prenatal curriculum. The State currently has four accredited HFA sites - Family Services Northeast Wisconsin (Brown County), Healthy Families Waukesha, an HFA program in Ashland County, and a program in La Crosse. The MIECHV funds provide an opportunity to expand HFA in the State. While the state chapter of Prevent Child Abuse (PCA) America, Prevent Child Abuse Wisconsin (PCAW), has not been actively involved in training or supporting the HFA sites to date, they do bring a history of training around child abuse prevention in other contexts. PCAW is now well-positioned to work closely with both the national office of PCA and HFA to support the delivery of HFA programming in Wisconsin. PCAW provides state-wide training and technical assistance in the area of child abuse prevention through the Stewards of Children Project (sexual abuse prevention) and SCAN-MRT (Suspected Child Abuse and Neglect Mandated Reporter Training). PCAW also sponsors Together for Children, a state-wide conference for professionals, providing information on trends and best practices in the field of child abuse prevention and intervention. Early Head Start Wisconsin has a long and celebrated history with Head Start programs over the years, most recently a significant expansion in 2009 of Early Head Start through American Reinvestment and Recovery Act (ARRA) funds. Each Wisconsin program is unique and designed to best meet the needs of the local community (or communities). Service areas in the state vary from the size of one school district or city to an area that covers multiple counties. Wisconsin Head Start/EHS programs are operated by a variety of organizations including: public/private non-profit organizations, Community Action Agencies, public schools, Cooperative Educational System Agencies (CESAs), a public university, and Tribal governments. Despite these differences, all programs follow the same basic principles and high-quality standards. Currently, the State is home to 42 Head Start and 20 Early Head Start programs operated by 44 unique organizations18 of which provide both Head Start and Early Head Start services. Of the 18 organizations that offer Early Head Start, seven programs offer the home-based option, generally in combination with center-based programs. Five of the 20 Early Head Start programs are American Indian Early Head Start programs. Thought not classified as Early Head Start, the Migrant/Seasonal Head Start program has an infant and toddler aspect that serves children from birth through age five. As of September 2010, operation of the Wisconsin Head Start State Training & Technical Assistance (T/TA) Center was assumed by STG International, Inc. (STGi), which is responsible for the T/TA centers in the six-state Midwest consortium (Region 5). Under this iteration of the T/TA System, the Wisconsin Head Start T/TA Center provides direct support and technical assistance to the Head Start & Early Head Start grantees in the state to improve their capacity to deliver high quality services and improve outcomes for Head Start children. Joanna Parker, principle staff person for the Wisconsin T/TA Center has
been an active member of the ECAC Ad Hoc Committee on Home Visiting Training/TA work group, and remains committed to providing necessary support to EHS programs that will expand as a result of this funding opportunity. Parents as Teachers (PAT) Last year, Parents as Teachers celebrated its 25th anniversary and Wisconsin has been providing PAT services for nineteen of those years. Parents Plus brought the first PAT program to Wisconsin in late 1992, and it was the first organization to be a designated state PAT office. Since the inception of the Parents as Teachers Quality Standards program assessment, only six commendations have been given nationally. Of those, three have come to Wisconsin programs. These programs have demonstrated the highest standards in model fidelity and quality programming. There are currently 55 PAT programs employing over 300 parent educators operating in 39 Wisconsin counties. Twenty-six programs are operating in Wisconsin counties designated to be the most at risk in several indicators affecting families. At this point, three of the selected sites have opted to embed their proposed HFA model programs with the PAT child development curriculum. The State will continue to support the sites use of the PAT curriculum and will work with the PAT national and state offices in the implementation of the Wisconsin Home Visiting Plan. While all the sites are using the funding to build on existing home visiting or family support programs, they have varied degrees of experience with their selected evidencebased home visiting model: EMPOWERING FAMILIES OF MILWAUKEE The development and implementation of the Empowering Families of Milwaukee (EFM) home visiting program in 2006 was founded on the 12 Critical Elements of Home Visitation from the Healthy Families America (HFA) program. The EFM model closely mirrors the requirements of HFA, including the use of a program-chosen curriculumPAT. GREEN COUNTY In 2010, Green County began working with the Dane County Parent Council to implement Early Head Start home visiting services in the county. This was the first prevention service in the county as well as the first regular/on-going home visiting program. Funding will allow for program expansion. LAC COURTE OREILLES TRIBE In 1998, as one of the ten pilot sites for the Prevention of Child Abuse and Neglect (POCAN) state General Purpose Revenue-funded home visiting program, the Lac Courte Oreilles tribe implemented a program based on the 12 Critical Elements of Home Visitation of HFA.
NORTHWOODS (LINCOLN, ONEIDA, FOREST) In the Northwoods area, early home visiting models were developed based on the 12 Critical Elements of Home Visitation and the Hawaii Healthy Start model, but never affiliated with the national HFA model. Two years ago, all staff were trained in the PAT curriculum. RACINE COUNTY Racine County has two years of experience using the PAT curriculum in their home visiting programs, but has not implemented the HFA model. Plan for ensuring implementation, with fidelity to the model Evaluation and quality assurance are cornerstones to the development of a successful system of home visiting in Wisconsin. A critical feature of a solid infrastructure is a secure data system that is comprehensive, non-duplicative and user friendly. Data for the state-funded POCAN and The Early Years Home Visitation Outcomes Project home visiting programs is collected using the publicly accessible Division of Public Healths web-based data system, SPHERE. The SPHERE system is a robust system but enhancements will be required to make it more comprehensive and user-friendly, particularly in terms of local programs generating meaningful reports to use for CQI.
Independent evaluations in Wisconsin home visiting programs have been difficult due to lack of significant resource investment in evaluation. As mentioned in other sections of the state home visiting plan, the Early Years Home Visitation Outcomes Project has laid groundwork for evaluating program effectiveness and using data at the local level to drive decision-making. Additional investment will be needed for monitoring programs and developing clear accountability structures. In an effort to address the need to develop systems for ensuring accountability and quality assurance, Wisconsin proposes to use some of the MIECHV funds to add technical staff dedicated to home visiting. Wisconsins commitment to providing high quality home visiting services will be strengthened by the addition of a Home Visiting Performance Planner, whose primary job will be to provide program monitoring and training/technical assistance related to data collection, performance reporting, maintaining model fidelity and all Continuous Quality Improvement (CQI) activities. Specific duties related to quality assurance and maintaining model fidelity will include: Oversee, direct and complete the design and implementation of performance plans and program evaluations of home visiting programs to assess the fidelity to the selected evidence-based model as well as the effectiveness of the programs, new initiatives/pilots or policy changes and inform continuous quality improvement.
Lead the development and implementation of tools to measure home visiting program performance and communication of performance results. Develop home visiting best practice information. In partnership with other state staff, provide direct oversight to state data reporting by each site and at least quarterly monitor overall implementation of expected program requirements to meet the benchmarks of the grant.
In addition to State support for quality assurance, the evidence-based models have built it into their accreditation and credentialing processes. The Performance Planner will serve as a data systems and CQI liaison to the model-developers so that local programs can be successful in maintaining a high degree of fidelity to the evidence-based models. A new effort funded by the Pew Charitable Trust supports The Early Years Outcomes Home Visitation Project in the development of a quality map that can be used by both policy leaders and program directors to determine how their program elements fit into their plans to provide quality programming. The State will explore how the programs funded through the blended RFP process that are not current Outcomes sites could be integrated into this project, perhaps as part of the field test for the new tool. In addition, in the RFP, each proposer was required to develop a plan to ensure implementation with fidelity to the chosen home visiting model. Quality assurance and fidelity plans for individual programs are detailed below: EMPOWERING FAMILIES OF MILWAUKEE Continuous Quality Improvement (CQI) is a central focus of Empowering Families of Milwaukees service delivery. Benchmark data is used to determine areas of strength and areas of improvement in attaining outcomes for families. The Program Manager reviews Outcomes Attainment Reports quarterly and develops CQI strategies accordingly. EFM works closely with its training partner, the University of Wisconsin Extension, to develop strategic plans to implement these CQI strategies. CQI efforts range from program training, policy and procedure updates, protocol implementation, one-on-one supervision, training specific supervisors, community outreach and collaboration, and strategic planning. The Program Manager also provides a presentation to EFM staff biannually to solicit feedback and involve them in long-term, big-picture program improvement efforts. EFM also obtains feedback yearly on the quality and effectiveness of its services from both its direct service providers and the families the program serves. These confidential surveys help guide program improvement and strategic planning. At each monthly EFM all staff meeting, staff are provided an opportunity to complete a feedback form or Speak up Sheet to submit questions or concerns in a confidential manner. The Program manager provides response, discussion, and directives to these feedback requests at each subsequent monthly staff meeting.
The EFM program has also employed the use of audio-recorded interviews through its Ecocultural Family Interview Project, to provide 1:1 feedback to staff regarding service delivery and helping to identify client strengths and areas for improved care planning. This practice is transitioning into the use of recording a home visit for supervisory feedback on Motivational Interviewing with families to more effectively guide them toward change. GREEN COUNTY Continuous quality improvement will occur at the direct service level through data review and adjustments made between the Program supervisor and individual staff, and also at the program level by the agency directors with input from the Community Advisory Committee. Program data will be reviewed monthly and inconsistencies or gaps will be addressed with each individual home visitor. Program data will be shared at staff meetings with home visitors, the data specialist, and the public health nurse identifying areas for improvement. This strategy for continuous quality improvement builds upon the strengths of the staff team with suggestions coming from their expertise and familiarity with services delivery rather than suggestions only from supervisors or directors. The data will be analyzed and presented to allow a thorough understanding of the impact of programming for specific populations and locations and to help better identify service delivery strengths and gaps to ensure a comprehensive approach to quality improvements. Results of staff and program supervisor data reviews and corresponding suggestions for improvement will be shared with the Community Advisory Committee for input. The department directors will present recommendations for program adjustments to the Dane County Parent Councils Executive Director and Board and the Green County Health Committee for final approval. LAC COURTE OREILLES TRIBE The Project Coordinator, in collaboration with program staff members, will monitor the effectiveness of the home visiting model and fidelity of program implementation. A protocol with specific procedures for conducting the home visiting program will be established during the first six months. The Project coordinator will conduct self-studies every six months and more frequently if needed to determine whether the project is being conducted in a manner consistent with the work plan and consistent with the selected Healthy Families American model. The self-study sessions will include time for a group discussion of how the program is being implemented, staff roles and responsibilities, community resource needs, issues related to implementing the program in Tribal communities, successes, challenges, and lessons learned. The Project Coordinator will provide and/or make arrangements for technical assistance as needed to improve the program. The Healthy Families American Self- Assessment Tool will be used to guide program implementation and to document the continuous quality improvement (CQI) process. Each of the HFA 12 critical elements, along with governance and administration, contains a series of best practice standards for the home visiting model. The on-going
self-study will determine if the program is not meeting, meeting or exceeding the standards. Quality improvement plans will be implemented to address standards that are rated out of adherence. In addition, the Program Coordinator will run monthly SPHERE reports to monitor caseloads, services provided, and outcomes. The CQI process will also include the annual site-specific and aggregate data reports provided by the UW Evaluator that allow each Tribal site to compare their benchmark data with the cross-site averages. Program staff will share their challenges and successful strategies at staff meetings to help improve the efficiency and effectiveness of service delivery. RACINE COUNTY AND NORTHWOODS (LINCOLN, ONEIDA, FOREST) The Childrens Service Society of Wisconsin (CSSW) has developed an agency wide procedure for continuous quality improvement. A dashboard of quality indicators will be created for the home visiting programs that is reviewed quarterly to measure program status in achieving success on process and outcome indicators. The programs will participate in a case record review to ensure that all essential program and agency documentation is recorded and collected. A quarterly Quality Report is issued to measure the programs achievement in meeting agency established goals for quality; that are in turn reported on an agency Balanced Scorecard. To support process improvement across agency functions, CSSW adopted the in-depth Council for Quality review process. The Council reviews quality data across six quality dimensions (Safe Care, Effective Care, Client-centered Care, Timely Care, Efficient Care and Equitable Care). The Council review uses high quality data to identify one or two formal quality improvement projects that will be supported by the system. CSSW has adopted the PDSA (Plan, Do, Study, Act) model for improvement efforts. The PDSA model is easy to understand, action-oriented and can be used for informal improvement projects or rigorously applied for formal improvement projects. A program specific survey collects information on client satisfaction. These surveys are distributed on a quarterly basis to every client that CSSW serves over a two week period during that quarter. Surveys are either hand delivered or mailed, and compiled by the CSSW Performance and Quality Improvement Program. Aggregated results of the client satisfaction surveys are shared with Program Directors and Program managers as an additional tool for continuous quality improvement. Racine County Human Services Department will form a Quality Assurance subcommittee of the Racine County Home Visiting Project. The committee will include representatives from stakeholder organizations in the community and include a representative from stakeholder organizations in the community and include a representative from the Greater Racine Collaborative for Healthy Birth Outcomes (LIHF), the RCHSD QA Coordinator and the United Way of Racine County. All funded projects will present outcomes to the QA committee for review semi-annually. Included in these outcomes will be data on retention, attrition, and demographic trends analysis. Information provided to the QA
subcommittee will be used to inform project modifications and made midcourse corrections to improve the quality and impact of home visiting services in the project. Anticipated challenges and risks of selected program model(s) and technical assistance needs Implementing a mix of home visiting models presents a particular series of challenges for the State. For example, the SIR requires states to report all benchmark data aggregated at the state level; however, models have been developed to impact outcomes in different benchmark areas, and communities were encouraged to choose models based on their demonstrated ability to address specific community needs and populations. Thus, we remain concerned about the potential dilution of individual program success due to this reporting requirement. From a model level, for example, EHS is much more focused on school readiness, parenting, and economic self-sufficiency, but less so on health (particularly maternal health) than HFA. Also, HFA and EHS do not require home visitors to use a specific prenatal or other child development curriculum, so different curricula may be used. There are considerable differences in populations served, community needs, etc. Given the variance in model goals, required tools and processes, as well as differences among the communities selected in terms of target populations to be served and resources available, reporting the aggregate data may not be as useful as site specific reports. Given that many other states have chosen to implement more than one home visiting model, we hope to receive additional technical assistance on how to deal with this issue throughout the reporting process. In addition, although the State has tried to minimize burdens related to data collection, some models may require implementation of particular tools or collection of additional data or measures in different formats than those delineated in the Updated State Plan. Both of the models HFA and EHS that have been chosen by the selected sites have requirements for collecting and reporting data in their national systems. Also, although Wisconsin has experience implementing each of the models selected, we still anticipate implementation challenges, particularly for newly developing programs or existing programs now seeking official accreditation from national models. Two of the sites selected for funding will be implementing a new home visiting program in their service area, and one of the more experienced PAT programs selected is also seeking to become an accredited HFA program as well. Even programs with experience implementing the evidence-based models have not been held to the kind of accountability regarding model fidelity now required. The Home Visiting Coordinator, MCH Nurse Consultant and Home Visiting Performance Planner will work closely with programs and the national model offices to guide new programs through the affiliation or accreditation process and ensure model fidelity.
Section 4: Implementation
Wisconsin has developed and will further develop and monitor the implementation of the Wisconsin Home Visiting Program that will meet the goals and objectives outlined in Section 2. The State will coordinate: Engaging home visiting programs and public and private stakeholders in the implementation and continuous quality improvement of the Wisconsin Home Visiting initiative; Supporting the professional development of home visitors and supervisors; Monitoring the implementation, continuous quality improvement and fidelity to the chosen model; and Enhancing the State administrative structures to support comprehensive evidence-based home visiting services in the at-risk communities.
Process to engage at-risk communities Wisconsin used several methods to engage the 18 at-risk communities as well as other areas of the state. Outreach Activities Website The Department of Children and Families (DCF) added a home visiting page to its website in September 2010 to provide a centralized location for information regarding the statewide home visiting efforts in Wisconsin. The website was modeled after the Washington State Department of Health site. Partner agencies provided links to the home visiting page from their websites. The DCF website will continue to be enhanced with the most up-to-date information about the Wisconsin Home Visiting Program and related early childhood and family support programs and initiatives at the federal, state and local level. Webcasts Two webcasts were developed by the Project Team to provide a forum for questions and answers statewide regarding the application process for the MIECHV program. The target audience was stakeholders across the state with an interest in early childhood and home visiting, including those currently operating home visiting programs. The first webcast, held on August 27, 2010, provided an overview of the federal legislation and the initial plan for gathering the information to complete the needs assessment. The webcast included information about the survey distributed in August 2010 to gather information about existing home visiting programs throughout the state. The second webcast was held on January 6, 2011 and described the process and indicators used in the needs assessment and how that information would be used to shape the state plan. Communities were encouraged to begin conversations on how evidence-based home
visiting programs would fit into their continuum of early childhood services. These webcasts are archived on the DCF website. Future webcasts may be developed to share with home visiting programs and other public and private partners pertinent information regarding the status of the Wisconsin Home Visiting Program implementation, plans for expansion, evaluation results, etc. Webcasts may also be used for training and technical assistance purposes. Home Visiting Newsletter A home visiting newsletter was established in 2011 to provide information on home visiting activities in Wisconsin and nationally. Two issues have been released since the beginning of 2011. Both were e-mailed to stakeholders, who were encouraged to distribute to a variety of early childhood and family support list-serves and posted on the DCF web site. The Home Visiting Newsletter will continue to be published quarterly. In addition to being sent to appropriate e-mail listservs, the Newsletter will be available on the DCF website and linked to the partner agency websites. Home Visiting Tool Kit The Home Visiting Tool Kit was created by DCF and its partners to help communities and organizations create or improve home visiting programs for families with young children. Helpful resources, easy-to-use tools and valuable information were included to help communities embed or improve evidence-based home visiting programs into their early childhood system. Information on the Tool Kit will be updated as needed, including providing links to articles about best practices or the latest research in the home visiting and early childhood fields. The state home visiting staff will also develop a process to obtain feedback regarding the usefulness of the Tool Kit from the communities that have used it. Technical Assistance Session On March 21, 2011, teams from each of the 18 at-risk counties and tribes were invited to participate in a technical assistance session based on the federal guidelines. The interactive session asked the teams to begin to address strategic questions to develop community responses to the Request for Proposals to distribute the funding for home visiting available from state general purpose revenue, TANF and MIECHV. The session was recorded so it could be viewed at a later date. TA sessions will be offered quarterly on a range of topics and will be developed by state home visiting staff and their training and technical assistance contractor(s) in consultation with home visiting program staff and other key partners. Tribal Engagement One of the DHS Tribal Affairs staff was added as a regular member of the Project Team. With his assistance, all of the appropriate tribal leaders were contacted to encourage participation on the ECAC Ad Hoc Committee on Home Visiting, the two work groups related to training/technical assistance and evaluation/program improvement and to encourage them to work with their local county counterparts. Through this effort
representatives from Great Lake Inter-Tribal Council (GLITC) and the Oneida Tribe became engaged in the development of the State Home Visiting Program. In addition, the evaluation/program improvement work group includes the evaluator for the tribal Healthy Start home visiting program, Honoring Our Children, from the UW Population Health Institute. Dave Rynearson will continue to serve on the Project Team so that the special needs and strengths of the tribal communities will be considered as the Home Visiting Program is implemented and plans for expansion are developing. The Evaluation and Program Improvement and Training/Technical Assistance work groups, as well as the ECAC Ad Hoc Committee on Home Visiting will continue to have tribal representatives and work to keep tribes engaged. In 2008, DHS and the sovereign tribes of Wisconsin established a Tribal Equities workgroup dedicated to mitigating health, social and economic disparities experienced by individuals living in tribal communities. The Home Visiting Coordinator met with the workgroup in early April to talk about home visiting and the interest of DCF and its partners to actively engage tribes in development of a State Home Visiting Program. This presented another opportunity to connect with the tribes to encourage participation in home visiting planning committeesboth state and localas well as developing and/or enhancing evidence-based home visiting in tribal communities. Statewide and local meetings/councils The Home Visiting Project Team members took the opportunity to present information at established committee meetings to inform partner agencies of the collaborative process necessary to improve the lives of children and families in the at-risk communities. Fulfilling the Promise Conference This is the annual two-day statewide conference for home visitors, parent educators, early childhood staff and others who work with families with young children. In addition to national speakers, the conference includes workshops that cover a wide variety of topics, including developing programs to support fathers; how to reach teen parents; the effects of labor and birth events on parents; early brain development; building community partnerships for children; motivational interviewing and reflective supervision; and parenting programs for divorced and never-married parents. Home Visiting Project Team staff helped plan, present and provide networking opportunities at this event. WECCP The Wisconsin Early Childhood Collaborating Partners (WECCP) are a network of Wisconsin communities, agencies, associations and public entities working together to build a system of high quality, comprehensive early childhood services for every child and family in the state. Since 2006, WECCP has been the collaborative in Wisconsin that guides implementation of the Early childhood Comprehensive System Grant from MCHB. Cross-sector collaboration to achieve that end is a major priority of WECCP. WECCP seeks to positively impact the lives of Wisconsins young children and their
families by improving early care and education, health, mental health, parent education, and family support services at the state, regional, and community levels. The WECCP network envisions a Wisconsin where all children receive the services and family supports they need to attain their optimal developmental potential during the critical early years of birth through age five. Many of the Home Visiting Project Team members serve on the WECCP State Action Team and the Steering Committee. Outcomes Project The Early Years Home Visitation Outcomes Project of Wisconsin is a collaborative effort of ten (seven until 2010) home visiting providers, public and private funders, and one evaluator to provide an outcome measurement framework for Wisconsins home visitation field. With that framework, the programs collect the same or similar data and use that data for program improvement as well as limited outcome measurement. Each of the participating programs has voluntarily agreed to enter their data into the SPHERE (public health data base) system for monitoring and evaluation. Programs that participate in the Outcomes Project, have to meet requirements related to training of home visitors and supervisors, use of common screening tools (ASQ, ASQ Social Emotional, HOME Inventory, DPH Home Safety Assessment), agree to use the SPHERE data system, and attend quarterly meetings. DCF and DHS staff participate on the executive committee. The project director serves on the ECAC evaluation/program improvement work group. Executive committee members and some of the program staff serve on the evaluation and training/technical assistance work groups. Project LAUNCH Project LAUNCH (Linking Actions for Unmet Needs in Childrens Health), a cooperative agreement funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), was awarded in late 2009 to DHS MCH Program and builds upon existing work and relationships developed under the ECCS grant. The goal of Project LAUNCH is for all children to reach physical, social, emotional, behavioral, and cognitive milestones through implementing five evidence-based prevention programs that support young children and their families. This complements the foundational work of the ECCS partnership collaborative in southeastern Wisconsin. The local partner is the City of Milwaukee Health Department who provides preventive public health services, including home visiting services, for infants and children who reside in high risk neighborhoods; specifically the following zip codes: 53204, 53205, 53206, 53208, 53210, 53212, 53218, and 53233. The Milwaukee Regional WECCP Coach is active in the LAUNCH local advisory committee that assists in linking health and prevention services to family support and early care and education programs. Through LAUNCH funds, Wisconsin expanded the services of two home visitation programs operating out of the City of Milwaukee Health Department. The Empowering Families Milwaukee Program has increased their capacity by 3.75 FTE (2 social workers and 1.75 public health nurses) to serve an additional 65 families per year; the NurseFamily Partnership Program has increased their capacity by 1.5 FTE public health nurses
and 0.5 FTE nursing supervisor to serve an additional 35 families per year. Project LAUNCH has also provided the infrastructure and funding for both home visiting programs to offer infant mental health consultation as an enhancement to their services. Milwaukees Home Visiting Community of Practice Through Project LAUNCH and Empowering Families of Milwaukee a Maternal & Child Home Visitation Community of Practice has been developed with the intention to engage home visiting practitioners at the direct service and supervisor/administrator levels to improve the way they work together, including sharing resources/tools, making referrals, implementing best practice standards, and keeping informed about one anothers programs. More than 55 program directors and supervisors representing 20 agencies attended the kick off meeting on March 24, 2011. Staff from the state home visiting Project Team participated and will be able to build on this effort in Milwaukee and take the model to scale statewide. Statewide Advisory Committee on Eliminating Racial and Ethnic Disparities in Birth Outcomes The Statewide Advisory Committee on Eliminating Racial and Ethnic Disparities in Birth Outcomes was established in 2008 to advise DHS in evidence-based strategies to address birth disparities, especially among African American mothers. The charge to the group was to serve as ambassadors, help raise awareness of the issue, identify resources, and facilitate action at all levels of the community. The Advisory Committee is open to the public with representatives from 40 - 50 diverse organizations regularly attending and contributing time and effort on one or more workgroups. Home visiting has been repeatedly discussed as a viable strategy to improve birth outcomes. The March meeting of the Advisory Committee included a presentation from DCF staff on the State Home Visiting Program and the new opportunity for expanding evidence-based home visiting programs. State Council on Alcohol and Other Drug Abuse (SCAODA) The mission of the State Council on Alcohol and Other Drug Abuse (SCAODA) is to enhance the quality of life for Wisconsin citizens by preventing alcohol and other drug abuse and its consequences through prevention, treatment, recovery, and enforcement and control activities. The SCAODA and associated subcommittees are made up of a wide variety of public and private entities. Presentations on the opportunities to expand home visiting in Wisconsin as well as building relationships among AODA providers and early childhood system providers have been discussed. DHS Area Administration Area Administration (AA), which is part of the Office of Policy Initiatives and Budget, DHS, is the primary link with local county human service agencies in a broad range of program areas. Staff are located in five regional offices and work closely with program
divisions throughout the Department. Several regional staff provided program monitoring and technical assistance to home visiting programs that were previously funded with state GPR dollars. They also coordinate with other state departments, including DCF, the Department of Workforce Development (DWD), and the Department of Corrections (DOC). Project Team staff have been in regular communication with the regional DHS staff to help engage the eligible communities in the home visiting initiative. DCF Regional Offices The Bureau of Regional Operations (BRO) provides support to DCF program divisions by overseeing contracts with local agencies administering department programs, conducting program monitoring and providing technical assistance to local service delivery providers. With teams of staff based in five regional offices, the BRO maintains working relationships between DCF and local agencies to provide support for the major DCF programs, e.g., child welfare, child care subsidy, child support, and W-2 financial assistance. Staff are located in five regional offices Madison, Waukesha, Green Bay, Rhinelander and Eau Claire and are co-housed with DHS regional staff. DCF staff has made presentations at BRO meetings of area administration supervisors and have worked with regional coordinators to engage individuals and organizations in the 18 at-risk communities in the home visiting initiatives. W-2 Contract & Implementation (C & I) Committee Wisconsins TANF Program, Wisconsin Works (W-2), provides employment and training as well as work experience positions through community service jobs, and other work-readiness placements. The W-2 Contract and Implementation (C & I) Committee, composed of advocates and administrators from W-2 agencies across the state, reviews and advises DCF on W-2 program implementation issues related to the W-2 contracts. As fiscal stakeholders in the W-2 program, the W-2 C & I Committee develops recommendations for DCF on the implications of program and procedural issues related to the W-2 contracts. The Home Visiting Coordinator presented information about opportunities for the at-risk communities to develop and/or enhance evidence-based home visiting services through the RFP process at their April 2011 monthly meeting. She also encouraged the local W-2 agency staff both at the administrative and front-line staff levels to become more engaged with home visiting initiatives. She explained that developing effective collaborations with the W-2 agencies is critical for the home visiting providers to ensure that Wisconsin meets the requirement to improve the economic selfsufficiency of families served by home visiting programs.
Approach to development of policy and setting standards for the state Implementation PlanPolicy Development & Standards Policy development for Wisconsins State Home Visiting Program has been and will continue to be guided by the Governors State Advisory Council on Early Childhood Education and Care. The process is highlighted in the following diagram.
Childrens Trust Fund
Department of Health Services
Department of Children & Families
Department of Public Instruction
Early Childhood Advisory Council Policy Recommendations
Ad Hoc Committee on Home Visiting
Evaluation/ Program Improvement Workgroup
Project Team with input from external groups and other stakeholders
Training & Technical Assistance Workgroup
As reflected, recommendations for policy changes can arise from a number of sources, including an array of external groups that are also working on issues that impact young children and their families, especially those living in at-risk communities. Recommendations will initially be vetted by the Home Visiting Project Team then shared with the Ad Hoc Committee on Home Visiting. The Committee will review and forward viable recommendations to the ECAC. From there, recommendations will be shared with the Secretaries of the three key departments and the Childrens Trust Fund Board for final decisions on whether to pursue legislative changes or changes in state administrative rules/procedures.
The Ad Hoc Committee on Home Visiting has established five guiding principles for home visiting programs across the state. 1. Depth over Breathis emphasized to maximize outcomes, i.e., fewer programs will be funded in order to provide more intensive services. 2. Promote Collaborationhome visiting is a fragile service and no program is designed to address families multiple and diverse needs. 3. Promote Sustainabilityhome visiting programs will be primarily anchored in local government agencies to utilize funding from Medicaid via targeted case management and/or Prenatal Care Coordination services; programs will also be embedded in comprehensive systems of early care and education. 4. Outcome DrivenWisconsin has established three key outcomes which will drive program decisions and aid sustainability over the long-term by demonstrating effectiveness. 5. Prioritize services to vulnerable populations in at-risk communitiesthe needs assessment identified 18 Wisconsin communities (counties) with the high risk factors for poor outcomes; these counties were the only sites eligible for funding from the RFP. The RFP required that sites target vulnerable families. In addition to these guiding principles, each evidence-based model has quality standards. DCF, DHS and their partner organizations will work closely with each funded site to ensure model fidelity, including adherence to the guiding principles. DCF, working through the training and technical assistance and evaluation workgroups and the ECAC Ad Hoc Committee on Home Visiting, developed mechanisms to meet the benchmarks in key areas for each funded program. (See Section 5 for a more detailed description of data measurement and the States plan to meet the benchmarks.) Plan for working with Model Developers For the RFP process, proposers were allowed to select from five evidence-based home visiting models that currently operate in Wisconsin. Only two models HFA and Early Head Start are represented in the initial round of sites selected through this process, though three of the five sites selected for the first round of funds have elected to implement the HFA model with the PAT curriculum, as is allowed under the model. Wisconsin has received approval from the national Head Start offices in ACF to partner with them to implement the Early Head Start home based option in the State. Home Visiting staff will continue to work with the national Head Start trainers through STG International (STGi) located in Madison to guide the implementation of the newly funded EHS program in Green County. Joanna Parker, the principle STGi consultant working in Wisconsin, has played and will continue to play an active role on the ECAC Training and Technical Assistance work group. Additionally, the Home Visiting Performance Planner will work with ACF Head Start staff to ensure that data collection and reporting requirements for both the State and the national Head Start Office are met.
Wisconsin has been approved to implement Healthy Families America (HFA) home visiting programs in the State using MIECHV funds. Most of the sites funded through the RFP process in this round are implementing the HFA model. Given the clear interest in HFA in Wisconsin based on the applications received, DCF and DHS will engage with HFA staff and trainers to ensure that existing and new models implement the programs with fidelity and are well-supported to meet the affiliation and eventually, the accreditation standards. At the suggestion of the model developers, DCF plans to develop a train the trainers model for expansion of HFA programs over the next year. Wisconsin is also exploring how to most effectively and efficiently provide on-going training in the Parents As Teachers (PAT) curriculum across the state. Parents Plus, the States PAT office, continues to have strong connections to the development of the Wisconsin Home Visiting Program. DCF and DHS will partner with Parents Plus through training, technical assistance and on-going systems development. Given the number of programs that are interested in using the PAT curriculum embedded in a Healthy Families model, Parents Plus will be instrumental in helping shape how those two models are integrated. Timeline for Obtaining Curriculums EMPOWERING FAMILIES OF MILWAUKEE Empowering Families of Milwaukee will apply for affiliation with HFA within 60 days, with the long-term plan to become accredited in two years. The PAT curriculum will continue to be used. GREEN COUNTY Green County is expanding the Early Head Start program implemented in 2010 so the curriculum is available immediately. LAC COURTE OREILLES TRIBE Lac Courte Oreilles Tribe will apply for affiliation with the HFA program within 60 days, with the long-term plan to become accredited in two years. NORTHWOODS (LINCOLN/ONEIDA/FOREST) The Northwoods Collaborative will apply for affiliation with HFA within 90 days, with the long-term plan to become accredited in two years. The PAT curriculum will continue to be used. RACINE COUNTY Racine County will apply for affiliation with the HFA program within 90 days, with the long-term plan to become accredited within two years. The PAT curriculum will continue to be used.
Initial and On-going Training Existing Training and Technical Assistance for Home Visiting in Wisconsin The capacity to provide quality home visiting training and technical assistance to state funded programs based upon research in the field was developed in Wisconsin through a partnership between the State and the University of Wisconsin-Extension. Historically the home visiting program was administered by the Division of Public Health (DPH) within the Department of Health and Family Services (DHFS), until 2007. During that tenure DHFS/DPH collaborated with the UW Cooperative Extension Family Living Programs (UW-Extension) to develop and provide required training and technical assistance as outlined in the Wisconsin Act 293, now Wisconsin Statute 48.983(8). Through this collaboration multiple workshops were developed and implemented by the UW Cooperative Extension for home visiting staff including the adoption of the 12 Critical Elements of Successful Home Visiting Programs. Beginning in 2005 with funding of the Milwaukee Comprehensive Home Visiting Program enrolling families during the mothers first trimester of pregnancy, additional training content was developed through a contract with Milwaukee County Extension in partnership with Healthy Families America to support families in the prenatal period. Since assuming lead of the state home visiting programs in 2007, DCF has maintained contracts with the UW-Madison Cooperative Extension (UW-Extension) Family Living Programs and Milwaukee County Cooperative Extension offices for training and technical assistance for home visiting programs across Wisconsin. The Milwaukee County Extension contract is focused on the training needs of the Empowering Families Milwaukee program, though the family support professional development staff have also been engaging with public health, social services and family support organizations involved in home visiting in the four-county area in southeast Wisconsin over the last three years. Milwaukee Extension works closely with the staff and administration of Empowering Families to identify training and technical assistance needs of front-line home visitors and their supervisors. Having program staff directly involved in identifying on-going technical assistance needs has allowed the State to use limited training dollars as effectively and efficiently as possible. As part of their duties to support state-funded home visiting programs, UW-Extension has developed some core professional development opportunities specific to comprehensive home visiting services and specific to some of the screening tools administered as well as supplemental skill building. In addition, UW-Extension coordinates an annual conference for home visitors and parent educators that offers skill building workshops and more intensive training institutes on particular topics. With contracts that run through the end of the year, the UW-Extension home visiting training schedule for 2011 is largely set, though locations for the Home Visitation Foundations (basic training for beginning home visitors) and screening tools training for the fall will be identified to be convenient for the program sites are selected.
In addition to the Extension training network, home visitors can take advantage of other professional development opportunities offered across Wisconsin: DHS offers training to help support families during the prenatal period using the Healthy Families America Great Beginnings curriculum to all PNCC-certified programs, including intensive home visiting programs. A significant number of Early Head Start home visitors seek the Family Services Credential, a competency and credit based training experience that corresponds to the Head Start Performance Standards designed to support direct service staff in their work with children and families. More recently the EHS home visitors in Wisconsin are attending the Home Visitation Foundations as well. The Childrens Trust Fund historically has provided training specific to family resource center programming and operations, much of which is applicable to home visiting programs. In 2008, the Childrens Trust Fund started a statewide initiative to provide the Building Protective Factors in Families training for of the nationallyrecognized Strengthening Families Program. Home Visitors can also take advantage of the opportunity to cross-train with other early childhood professionals on the Wisconsin Model Early Learning Standards (WEMLS), a theoretical framework for parents and professionals that work with families with young children to understand appropriate developmental expectations of young children developed through collaboration among DPI, DCF, and DHS. The Early Years Home Visitation Outcomes Project provides training opportunities in the use of SPHERE, the State public health database, specific to data entry and report generation for the programs that are part of the Outcomes Project. Parents Plus, the state organization for Parents as Teachers (PAT), offers specific curriculum training, as well as needed special population and issue-specific training to their sites. Prevent Child Abuse Wisconsin (PCAW) regularly offers Stewards of Children (child sexual abuse prevention) and SCAN-MRT (Suspected Child Abuse and Neglect Mandated Reporter Training) across the State. Finally, the Wisconsin Alliance for Infant Mental Health (WIAIMH) provides training on the conceptual framework for infant mental health and reflective supervision, and staff have provided limited training on using an infant mental health consultant to support social-emotional wellness in children in a select number of home visiting programs.
Home Visitation Foundations and Tools Training As part of the contract with the State, in addition to providing more in-depth training on some of the screening tools commonly used in home visiting programs (i.e., ASQ III, ASQ SE, and the HOME Inventory), the UW-Extension developed the curriculum and provides training for entry-level home visitors 3-4 times annually in locations throughout the state. The Home Visitation Foundations curriculum is based on the Empowerment Skills for Family Workers training developed at Cornell University for the State
Department Family Development Credential and informed the process for the Wisconsin Core Competencies adopted in 2004 for family support workers, though the training was updated as recently as 2010. Initially the training was available to all state-funded sites at no cost. Beginning in 2003, the Home Visiting Foundations Training was offered for a fee to other home visiting programs not supported with those State funds so that they may also have the opportunity to build basic skills in the field. In 2009, home visiting training opened up to non-funded sites for a nominal fee. In 2011, all introductory home visiting training provided through UW-Extension, including some of the tools training, has been available to all programs for a small registration processing fee. Home Visitation Foundations provides the new home visitor with foundational knowledge of theory, skills and strategies to utilize in their work to support and educate parents of infants and young children. The training is provided in group-based, face-toface format, over a period of 2 days. Learning occurs through a variety of methods, including lecture, discussion, interactive activities, reflection, reading assignments of recent research and teach back. The core components of the training include: the 12 Critical Elements of Successful Home Visiting Program, using strength-based practice approaches, child and family development principles and how they relate to practice, the role of home visitors and family systems, an introduction to reflective practice, connecting families to available community resources, goal setting, boundary setting, personal safety, and the importance of documentation. In addition to Home Visitation Foundations and the tools training, DCF, DHS, the Extensions, and their partners have been able to provide specific issue training for home visitors. Unlike the core trainings Home Visitation Foundations and tools training these issue trainings are not provided on a regular schedule. Rather, they are offered once every 2 -3 years, depending on participant interest and available resources. Some of the most recent training topics have included, but are not limited to: engaging fathers, screening families with mental health and AODA issues, identifying domestic violence, working across cultures and using motivational interviewing. Home visitors consistently report that they find these issue-specific trainings useful and that they have measurably enhanced their practice. The last few years has also seen increased use of advanced technology to enhance training and/or provide on-going technical assistance. Depending on the model used in a community, some home visiting programs have been able to access training provided by the model developers. HFA, for example, makes some of their training available on-line, and may allow non-accredited programs access to certain training modules in the web-based system for a small fee. Given the travel burden of many of the home visiting programs in rural Wisconsin, the State and its training contractor(s) will continue to explore ways to use technology effectively. Currently, the Home Visitations Foundations meets the requirements for introductory home visitor training for the Early Head Start (EHS) and Healthy Families America (HFA) models. As mentioned previously, an increasing number of EHS home visitors are attending Foundations trainings as they are hired. Still, many EHS home visitors seek
the Family Services Credential offered through the Portage Project at CESA 5. While this training is not required for home visitors, it is appealing to managers because it helps meet the federal Head Start Standards for center-based and mixed home-based/centerbased programs, and it is appealing to workers because it offers some college credit. The HFA model, on the other hand, requires advanced training requirements for its family assessment workers. Accredited Wisconsin HFA sites have to send their assessment workers outside of the state to receive the required training, which could mean spending considerable amount of money for training those staff. In addition, HFA has requirements for staff to receive particular issue-based training, most of which are modules available on their web-based system and are included as part of the affiliation and accreditation fees. Also, HFA is currently reviewing their affiliation/accreditation process, which may change the introductory home visiting training requirements. Given the number of sites that have committed to seek HFA accreditation and the possible restructuring of the HFA training and accreditation processes, the State is exploring how to most efficiently and effectively meet the training and technical assistance needs of the currently proposed sites as well as an expansion of additional sites with future MIECHV and other funds, which will likely involve the development of significant in-state HFA training capacity. Enhancing the home visiting training/technical assistance system An essential component of a comprehensive state home visiting system that will help ensure that programs meet the federal benchmarks involves the development of a high quality training/technical assistance system. Toward this goal, DCF and DHS established a training and technical assistance workgroup, under the auspices of the ECAC Ad Hoc Committee on Home Visiting, co-chaired by two appointed members of the ECAC, Lilly Irvin-Vitella, Executive Director of Supporting Families Together Association (SFTA) and Suzy Rodriguez, Director of Parents Plus of Wisconsin, the state Parents As Teachers (PAT) office. Workgroup members include representatives from statewide organizations affiliated with the evidence-based home visiting models; state and local program staff; and individuals with expertise in training for public health nursing, early childhood and family support, child abuse prevention, AODA and mental health. The work group was charged with developing recommendations for how the training and technical assistance system can be enhanced to ensure that all home visiting program training needs are met. The State has required that all programs funded through the blended RFP process meet federal requirements for serving priority populations. Serving higher risk families or families with multiple risks may represent a change or narrowing of target populations for certain home visiting programs. Given the challenges of meaningfully engaging difficult-to-engage families and working more intensively and effectively with community-based agency partners, the work group has identified areas for significant training and technical assistance enhancements. There is also an interest in utilizing cross-training opportunities across the early childhood and family support systems at the local and regional levels, not only as a means to be more efficient with limited resources,
but also to build stronger collaboration through development of a continuum of services based on a shared vision for the system. Developing the 2011 Wisconsin Home Visiting Competency Framework DCF, DHS and its agency partners have taken advantage of the state plan development process to review and make recommendations for improvements to the existing system for home visiting in Wisconsin, largely through the ECAC Ad Hoc Committee on Home Visiting work groups. The Training and Technical Assistance work group initially reviewed the framework for home visitor and parent education training based on the Wisconsin Core Competencies in the Field of Family Support adopted in 2004 and reviewed competency maps for the Michigan Infant Mental Health Endorsement (IMHE) process that has recently been implemented in Wisconsin. Currently fourteen states have implemented the Michigan IMH competencies and endorsement process, and several other states and countries in Europe and Asia are also considering adoption. The 2011 Wisconsin Home Visiting Competency Framework, included as Attachment 5, highlights the results of the review process. The work group conducted a crosswalk of Home Visitation Foundations with the IMH-E competencies with the goal of identifying ways in which the curriculum could be more closely aligned with the basic competencies the group agreed are critical for entry level home visitors. The work group also reviewed how training for home visitors is currently phased-in over time. Programs representing each of the models reported the initial training expectations for beginning home visitors, within the first six months and within the first year of beginning work with families. That information is also included in the chart as Attachment 5. The workgroup further discussed existing training and technical assistance opportunities, including training offered by the specific evidence-based home visiting models, to determine how those training supports help home visitors and their supervisors obtain the necessary competencies. In addition to intentionally weaving in cultural competency themes/strategies into all training, the work group identified the following gaps in current training and training priorities for 2011: 1. Updating Home Visitation Foundations curriculum to be more reflective of those newly adopted competencies outlined in the 2011 Home Visiting Competency Framework 2. Development of a Home Visiting 201 with advanced trainings for more experienced home visitors 3. Enhancing training and supports specifically for home visiting program supervisors 4. Enhancing training and technical assistance regarding data collection, program evaluation and CQI efforts
Level 1: Training Recommendations and Updating Home Visitations Foundations Arguably, while there are some well-developed and easily-accessed professional development opportunities for entry level home visitors offered frequently around Wisconsin, there are topic-areas that require further development. Where possible, the training requirements of the evidence-based models need to be woven into the Wisconsin home visiting training system so that local programs can meet quality standards of their models without incurring an extraordinary expense to meet those training requirements. The work group agreed that Home Visitations Foundations provides critical training for home visitors, particularly those that are at the beginning of their family support careers. They recommended that all funded programs prioritize this training within the first two months of hiring new staff, depending on the requirements of model they implement. In the process of optimally aligning training opportunities with the competencies identified in the 2011 Wisconsin Home Visiting Competency Framework, the work group prioritized the following to be added to the Foundations training: Introduction of Family Teaming and Motivational Interviewing concepts and techniques (to be followed by more intensive skill development training as the home visitor gains more experience) More in-depth discussion of setting/maintaining boundaries and working with families in an ethical way Developing transition plans for families graduating and/or transitioning to another early childhood or family support program Deeper discussion about how to effectively use reflective supervision to improve practice In order to accommodate the enhancements and additions to the entry-level training, the work group recommended that the Foundations training be extended from a 2 1/2-day training to 3 full days. Additional foundational training will encompass more in-depth information about infant/toddler brain development and social-emotional development and relationship-based intervention strategies to support the parent-child relationship and attachment that promotes optimal development. Level 2 Training for Experienced Home Visitors: Development of Home Visiting 201 Along with updating Home Visitations Foundations to reflect the changes in expectations for skills/competencies for entry level home visitors, the work group recommended that the State and its training contractor(s) prioritize developing a more intensive training for those home visitors that are more experienced. While it is true that all home visitors need to regularly revisit those critical concepts covered in basic training, there may be particular information and/or strategies that more advanced home visitors could
incorporate into their practices and ultimately be more effective with families. For example, training for experienced home visitors might include such topics as: working with families with drug affected infants, implementing motivational interviewing techniques, developing family goals and case plans with families involved in multiple systems, building effective collaborative relationships, leadership training for mentoring new staff, infant and early childhood mental health, incorporating trauma-informed care principles and becoming a more effective advocate. In addition to an intensive, multi-day training for more advanced home visitors, the work group recommended that the statewide Fulfilling the Promise conference include a system of tracking so that other workshops and half-day and full-day institutes cater to the needs of more experienced home visitors. Similarly, some of the issue-specific trainings should purposely address advanced competencies. Finally, the work group recommended that home visiting programs participate in the Pyramid Model/SEFEL training with their colleagues in early care and education to further enhance their skills to assist parents in the promotion of social-emotional wellness of their infants and toddlers. Support for Supervisors The work group agreed that in order to build a strong home visiting system, supervisors and program administrators need special training and support in their professional development to gain particular skills and implement strategies to help strengthen their relationships with front-line staff and the broader community. Using a process similar to the one they used for home visitors, the work group reviewed the 2004 Wisconsin Core Competencies document and the competencies required for a Level 4 Infant Mental Health Endorsement in Wisconsin. The work group outlined the preferred competencies for supervisors which are included in the 2011 Wisconsin Home Visiting Competencies Framework. The work group also identified gaps in current supervisor training and support. The work group recommended using the statewide conference to provide issuespecific training for supervisors and increasing their knowledge base about how to work with diverse community partners/stakeholders. Enhancing program evaluation supports: training and technical assistance Both ECAC Home Visiting work groups stressed the need for additional support for both front-line home visiting staff and their supervisors in data collection, program evaluation and quality improvement strategies. Again, the tools training developed by UWExtension in partnership with the Outcomes Project for the ASQ, ASQ-SE, and the HOME Inventory have been extremely helpful for those programs that have been able to access it. However, there are additional measurement tools that will be required to enable programs to meet the federal benchmarks and state priorities. Training on these new tools and the processes required to report program results will need to be developed, again as a partnership between the State and its training and technical assistance contractor(s).
As described previously, Wisconsins Early Years Home Visitation Outcomes Project has created a solid foundation on which to build a quality data collection and reporting system for measuring results and using these results to improve programs. One valuable lesson from this effort is the need to engage home visitors and their supervisors early in the process, including clearly explaining why documentation and data collection is important. DCF and DHS leadership staff are in the process of negotiating the potential role of the Outcomes Project in the implementation of the state home visiting plan. The proposed Home Visiting Performance Planner, with the primary responsibility for providing training and on-going technical assistance to local programs on documentation, data collection using SPHERE, monitoring for model fidelity, and developing and implementing local quality improvement plans, would serve as a liaison to the Outcomes Project for purposes of developing CQI plans and data reporting protocols. Project Management for Training/TA As recommended by the training and technical assistance work group, the State is again considering the option to contract with an outside vendor for the management and coordination of home visiting training and technical assistance. The work group recommended that the State consider contracting with an organization or consortia of organizations with the following characteristics: expertise in the field (home visiting, early childhood, ability to identify partners with expertise in identified competency areas); experience in building comprehensive systems and systems change; experience in data driven decision-making; evaluation/CQI experience; experience in building relationships with diverse communities; and experience in working across systems (counties, community-based organizations, tribes, different regions of the state). It would be critical for the training coordinator(s) to ensure that training from different providers is coordinated, using a shared language and builds upon content from other training where appropriate; that evaluation is coordinated; and that it provides oversight for quality assurance in training programs and makes the connection from training and technical assistance. The individual or organization should also have the capacity to oversee the development of new curricula and training, as well as the ability to provide adequate support for implementing existing training and identify opportunities to cross-train with others in the early childhood and family support fields. The primary goal for contracting with an outside vendor is to ensure accountability for limited resources and ensure that training is reflective of the diversity of the families being served. An important improvement to the existing training and technical assistance system calls for development of a mechanism (or multiple mechanisms) for evaluating the effectiveness of home visitor and supervisor training. Using an outcome focus, the State must be able to confidently report that training and technical assistance is effective in enhancing the knowledge of those being trained, changing/improving their practices and, ultimately, improving outcomes for families they serve. In this way, the State
ensures that the effectiveness of training is well-documented so that financial support at the state and federal levels will continue or be expanded as the system grows over time. Plan for Hiring Staff State Level Staff The DCF Home Visiting Coordinator (HVC) is funded through the Wisconsin TANF block grant. The HVC will lead the Project Team meetings, staff the ECAC Ad Hoc Committee on Home Visiting and its workgroups, and oversee the implementation of the home visiting programs throughout the state. The proposed new State positions include: A Home Visiting Performance Planner will be hired to assist in program monitoring related to data collection and reporting and provide leadership in the state and local continuous quality improvement efforts. The hiring process for the Performance Planner has been initiated and it is anticipated the position will be filled by August 2011. An MCH Home Visiting Nurse Consultant to assist the HVC with management of the day to day implementation of the home visitation grant and provide leadership to assure connection to the Title V MCH Program. The hiring process for the Nurse Consultant has been initiated and is anticipated to be filled this summer. Local Agency Staff EMPOWERING FAMILIES OF MILWAUKEE The Empowering Families of Milwaukee program will employ 9 full-time Public Health Home Visitors and 1 full-time Public Health Social Worker Home Visitor. In addition, there are 8 full-time contracted Community Based Home Visitors, 4 full-time Community Based Health Workers, and 3 full-time Community Based Supervisors. There is also 1 full-time Program manager, 1 full-time Health Program Coordinator, 1 full-time Health Information Specialist, and 0.6 Office Assistant. GREEN COUNTY Green County will employ 4 full-time visitors, 1 full-time nurse, 1 full-time data entry/clerical position and 1 full-time home visitor supervisor plus additional time for administrative and clerical support from the partner agencies. LAC COURTE OREILLES TRIBE The LCO tribe will employ 2.8 full-time home visitors, 1 full-time Honoring Our Children Outreach Worker, 1 full-time project coordinator, 1 full-time administrative assistant, 1 full-time nurse, and 0.8 full-time Honoring Our Children Nurse. The LCO Tribe, in accordance with tribal policies, gives hiring preference to tribal members who possesses equal qualifications to non-tribal members. The advantage of this policy is that community members will be hired who are aware of tribal culture and are aware of many of the issues facing high-risk tribal families today. This awareness will also boost
the trust building capabilities and relationships of home visiting staff to the families they serve. NORTHWOODS (LINCOLN, ONEIDA, FOREST) The Northwoods Collaborative will employ 1 full-time Family Assessment Worker, 2.5 full-time Family Support Workers (home visitors) and a .29 full-time Public Health Nurse. RACINE COUNTY Racine County will employ 1 full-time screening and Assessment Worker, 2 full-time home visitors, 0.6 full-time program Supervisor, 0.16 full-time Program Manager, 0.7 full-time data/support staff and contract for 2 full-time home visitor nurse staff and 0.4 Supervision and Administration for the nursing positions. Plan for Clinical Supervision and Reflective Practice All of the sites will use reflective practice that involves attention to all relationships. Reflective practice involves thoughtfully considering ones own experiences in applying knowledge to practice as well as being supported in supervision by attending to the emotional content of the work and how reactions to this content may impact outcomes. The act of reflection is seen as a way of promoting the development of autonomous, qualified and self-directed professionals. Engaging in reflective practice is associated with the improvement of the quality of care, stimulating personal and professional growth and closing the gap between theory and practice (Jasper, 2003). Each site has a plan for one-on-one supervision; group supervision; staff meetings; and home visits with the supervisor observing. One important identified gap in training is the availability of high quality reflective supervision for program supervisors. To address this need, State staff, in partnership with the training and technical assistance contractor(s) and local programs, will develop regional communities of practice, based in part on the Milwaukee experience that is developing under Project LAUNCH. A regional approach will also provide a means for supervisors to engage with their peers to share information, discuss best practices, brainstorm solutions to challenges, identify strategies for reinforcing home visitor training, and provide feedback to the State and its training/TA contractors about how to best support them. To address the limited amount of available reflective supervision for home visiting supervisors in rural areas, the State plans to engage members of the initial cadre of professionals that receive the Infant Mental Health Endorsement, many of whom are also in the first cohort of the Infant, Child and Family Mental Health Certificate Program now offered through the UW-Madison Division of Continuing Studies, as providers of reflective supervision. By providing supervisors meaningful opportunities for receiving reflective supervision, the regional communities of practice help supervisors enhance their abilities to provide effective reflective supervision for their staff and more effectively serve vulnerable families.
Estimated Number of Families to be Served MIECHV Funded Families Empowering Families of Milwaukee Green County Lac Courte Oreilles Tribe Northwoods (Lincoln, Oneida, Forest) Racine County Totals: 34 11 11 11 17 84 Total Funded Families 350 25 24 25 40 464
Plan for Identifying and Recruiting Participants Each site has an outreach plan that includes collaboration with a number of diverse community organizations to refer pregnant women and families to the program. EMPOWERING FAMILIES OF MILWAUKEE When collaborating and connecting with community partners that serve pregnant women, the single most important message that is given is to refer women as early in their pregnancy as possible. EFM has provided deliberate and diligent outreach efforts to educate the community about its programming. An analysis of the agencies that provide referrals helps to determine where additional efforts need to be made. A mass mailing to new and existing partners will be done to highlight the program accomplishments and request continued referrals. One-on-one meetings with program executives will be set up to identify ways in which EFM and their agencies can collaborate and coordinate services for families. GREEN COUNTY Outreach and engagement success will rely on the programs ability to become a visible presence in the community with countywide public awareness, easy accessibility for potential enrolling individuals, and through the establishing and maintaining of effective relationships with service providers and other community partners. Brochures, posters and other community informational resources will be developed to convey the comprehensive nature of the services to be provided, eligibility requirements and referral and information contact sources. Outreach to potential clients will be conducted through public awareness activities in all areas of the county. Written and electronic recruitment materials will include advertisements and articles in local newspapers and program
information on county websites and brochures throughout public locations in the county (schools, doctors offices and clinics, churches, grocery stores, Laundromats, etc.).
LAC COURTE OREILLES TRIBE The home visiting program will utilize techniques for outreach and engagement that have proven to be successful in the LCO Community. Specifically, the Honoring Our Children program has a highly successful strategy for outreach and engagement of pregnant women. Much of the success of Outreach strategies is due to the high levels of involvement and input by community members into the immediate needs of high-risk families. The program has an emphasis on incentives to families that enroll in and participate in the program, such as: Free family photographs/portraits during pregnancy, Mothers Day, and birth announcement photos NEST incentive store, where families purchase items with points such as diapers, safety supplies, and household necessities. Families earn points by participating in activities and programs which are positive for the baby and family (e.g. Prenatal visits, well child checks, receiving home visitation, breastfeeding, attending educational events, etc). Highest incentives are given to families who enroll in the first trimester of pregnancy. Education and distribution of car seats. Families are offered a car seat for the baby/child, by staff certified as child passenger safety technicians. The most successful way of reaching pregnant women has been by former participants of the program and other community members indicating high levels of trust by community members into the integrity and usefulness of the services offered by HOC staff. RACINE COUNTY AND NORTHWOODS (LINCOLN/ONEIDA/FOREST) Creating an effective, broad-based, and aggressive outreach plan for the project will be critical to engaging young pregnant women in their first trimester. Physicians will play a critical role in identifying and referring families to the program. Repeated contacts with private practitioners will be made to share information about the project and develop referral pathways. Thank you notes will be sent to referral sources and other efforts will be made to strengthen relationships with stakeholders. A brochure will be created for the project. Wallet cards with contact information will be distributed to organizations and providers who reach the target population. Information flyers on effective parenting practices and maternal health and child development milestones will also be created. Parent testimonials will be utilized in print materials and at public presentations. Press releases articles and letters in local newspapers as well as radio public service announcements will increase community knowledge about the home visiting services. Opportunities to utilize social media will also be explored. Community presentations
will be made to local organizations and agencies as well as local churches, health fairs and community events. A high priority will be placed on conducting outreach to schools, local hospitals and health systems, OB-GYNs, pediatricians, family practice physicians, public health and child welfare professionals, family planning providers, W-2 providers and basic need programs such as WIC. Providing incentives for pregnant women to participate such as gas cards to make prenatal/doctors appointment, welcome packs of lotions and other beauty supplies, baby books, etc has been a successful strategy in other programs. Plan for Effectively Engaging and Providing Services to Fathers Research shows that father involvement dramatically improves child well-being and success. The programs participating in the grant have developed the following plans to serve fathers: EMPOWERING FAMILIES OF MILWAUKEE Each EFM-contracted community-based organization has fatherhood programming available for EFM families, supporting fathers in ways that are meaningful to them. Home visitors receive training on engaging fathers in service and make every effort to engage them in the family care planning process and parent-child interactive activities of the Parents as Teachers curriculum. The Milwaukee Health Department is also home to the Mens Health Program which provides health access, service, and referrals that are specific to mens needs and can provide dads with male one-on-one service as needed. GREEN COUNTY While Early Head Start home visiting services gives enrollment priority to pregnant women, the program and services are for the whole family, focusing on parent and child relationships and the parents abilities to care for their family and support their childs development. This very clearly must involve the father or other important male figures in the child or pregnant womans life. Outreach and enrollment procedures include information to and for fathers, as well as the mother. All program materials and brochures indicate services are for parents. DCOC also focuses on the role of fathers by offering specific activities and services for male role models through Male Involvement activities and program goals. Specific services addressing the fathers role in early care and family development are present in DCPC and EHS policies and procedures. These include procedures for screening for depression in fathers, parenting and home visit strategies to include fathers in family assessment, goal planning, and case management and procedures for supporting family economic self-sufficiency including employment, housing and education services.
LAC COURTE OREILLES TRIBE Healthy Families Lac Courte Oreilles will utilize the NEST incentives store for the recruitment, engagement, and retention of fathers from the community. NEST incentive points can e earned for participation in activities and redeemed for baby or household items. This has been a very effective and practical way to draw fathers of all ages into participation in both screenings and educational activities, both one-on-one and in a group setting. Father services and outreach will also be addressed with the advisory board/consortium in order to seek input from community leaders, elders, and other community members, including a diverse group of men, as to what methods will be most effective within the tribal community. Healthy Families LCO will coordinate activities with the LCO Early Head Start Father Outreach position. Research will be done to indentify model father programs that have been successful in other tribal communities. NORTHWOODS (LINCOLN, ONEIDA, FOREST) CSSW home visitors will schedule evening and weekend appointments to accommodate the schedule of fathers. The CSSW Family Resource Centers can help engage fathers by offering supportive groups for dads in addition to their participation in the home visiting sessions. Home visitors encourage the participation of custodial and non-custodial fathers in the program. The Family Assessment Worker will pursue outreach to programs that serve fathers as well including the YMCA, job programs and schools. CSSW has a Fatherhood program operation in the southeast region of the state that can mentor the Northwoods sites on outreach and practice knowledge in supporting fathers in the home visiting program. RACINE COUNTY Home visitors will conduct outreach to engage both custodial and non-custodial fathers in the home visiting program. Referrals will be made to community resources and supports that will strengthen their role as parents. One example of a program available in Racine County is the YMCAs Fatherhood Program that was nationally recognized in 2010 with one of only three nationwide Family Strengthening Awards from the Annie E. Casey Foundation. Plan for Minimizing the Attrition Rate of Participants EMPOWERING FAMILIES OF MILWAUKEE First contact with a referral is made within 48 hours of receipt of the referral and outreach is purposeful and intensive. Research shows that father involvement dramatically improves child well-being and success. Programming for fathers is required at each site. EFM has developed a tool, Home Visitation Commitments, to assist home visitors in maintaining the conversation about program expectations and participation on the part of the family and the part of the home visitor. This tool is reviewed at enrollment and periodically revisited when clients become difficult to engage and have inconsistent participation.
GREEN COUNTY Data reports evidencing enrollment, retention and family participation in program services will be monitored monthly by the program supervisor and reviewed with individual staff members as it pertains to their specific caseloads, and with the program team as it relates to program services and planning. One of the most important strategies for analyzing, and making a positive impact on individual staff and program capacity to engage families, is the use for reflective supervision. As program supervisors and the mental health consultant supervise group discussions and mentoring conversations, they too will receive valuable information on the strengths and needs of the program and individuals as they work to engage families. The Head Start model mandates parent involvement at all levels of the program. Monthly Parent Advisory Committee (PAC) meetings will assure parents input on program development and continued improvement on how the program engages them and meets their needs. Parents have a role in the decision making and in assessing the impact and efficacy of the program. NORTHWOODS (LINCOLN, ONEIDA, FOREST) Data will be collected using HFA tools that measure acceptance, retention and attrition from the program. Data will be analyzed and reported to the local steering committees and the Tri-County Leadership Council. Program staff will use the information to improve program implementation using the Plan, Do, Study, Act methodology and will be supported by the program Quality and Evaluation Departments at CSSW and CHHS. RACINE COUNTY Research shows that families are more engaged and committed to remaining engaged in home visiting programs when they are receiving services and supports that they define as important to them. Family-centered care is the ability of the home visitor to treat recipients with dignity and respect, communicate and share information with recipients in ways that are affirming and useful, allow recipients and their families to build on their strengths by participating in experiences that enhance feelings of control, independence and collaborate between providers, recipients, and families in policy and program development, professional education and delivery of care. Timeline to Reach Maximum Caseload EMPOWERING FAMILIES OF MILWAUKEE Empowering Families of Milwaukee will be expanding the current program so it is anticipated that the maximum caseload will be reached by June, 2012. GREEN COUNTY Green County will be expanding the Early Head Start program so maximum caseload will be reached by June, 2012.
LAC COURTE OREILLES TRIBE The Lac Courte Oreilles community is expanding on existing programming and expects to reach maximum caseloads by June, 2012.
NORTHWOODS (LINCOLN, ONEIDA, FOREST) The Northwoods Collaborative will reach maximum caseload by June, 2013. RACINE COUNTY Racine County will reach maximum caseload by June, 2013. Coordination Plan Coordination plans for each agency are found in Section 1. Data Systems for Continuous Quality Improvement The Secure Public Health Electronic Record Environment (SPHERE) SPHERE is an integrated, web-based, state-of-the-art data application used to document public health services. It was developed in 2002 by a collaborative partnership between state and local public health partners and is part of the Wisconsin PHIN (WI-PHIN). WIPHIN was developed in 1999 by the Division of Public Health (DPH), with assistance from the University of Wisconsin, Division of Information Technology (UW-DoIT). The WI-PHIN portal is based on the Centers for Disease Control and Prevention's (CDC) PHIN model and uses a secure modular approach for program area modules (PAMs) that track, monitor, analyze and document public health activities and interventions. SPHERE is transforming agencies day-to-day business because it is secure, confidential, web-based, efficient, and uses standardized data elements. SPHERE documents and evaluates standardized demographic and health information, health status indicators, and outcomes of MCH activities. SPHERE has a unique ability to track selected services and outcomes on individuals, families, groups, and communities that receive public health services specific to maternal, child, and adolescent health, family health, reproductive health, and children and youth with special health care needs. SPHERE utilizes 18 interventions as the framework for the system based on the "Intervention Model" (Minnesota Wheel) to document services provided. These interventions include: Surveillance; Disease and Health Event Investigation; Outreach; Case-Finding; Screening; Referral and Follow-up; Case Management; Delegated Functions; Health Teaching; Counseling; Consultation; Collaboration; Coalition Building; Community Organizing; Advocacy; Social Marketing; Policy Development; and Policy Enforcement.
SPHERE is currently used by 1,484 individual users representing 159 local organizations including all Local Health Departments, the five Regional Children and Youth with Special Health Care Needs (CYSHN) Centers, many private not-for-profit agencies, private agencies including hospitals and clinics, and tribal health centers. Currently there are 238,143 clients in SPHERE and 963,464 activities which allows agencies to: Document needs and services in their community to evaluate outcomes. Show progress over time in improving the health of mothers, infants, and children. Provide information for writing grant proposals and planning future services. Monitor project performance as a quality improvement management tool The initial funding for SPHERE was provided by federal funds from the Title V Maternal and Child Health (MCH) Block Grant. Annually, the MCH program continues to allocate $75,000 per year for SPHERE ongoing maintenance and limited enhancements. These dollars are combined with other limited program funds and outside financial sources for SPHERE enhancements and new functions. As reported in Section 5, although most of the information required for reporting benchmark progress will be available in SPHERE, a few outcomes require the use of State Administrative Data: The Wisconsin Statewide Automated Child Welfare Information System (WiSACWIS) WiSACWIS is the administrative database used by the DCF Division of Safety and Permanence (DSP) to track child welfare services and outcomes. With assistance from DCF staff in the Bureau of Information Technology Services (BITS), information from this database will be matched with home visiting program participation data to track reported suspected and substantiated maltreatment outcomes. WiSACWIS is housed at DCF, and individuals on the Home Visiting Project Group have access to and expertise in using the data. Other Potential Administrative Data Sources Although the current benchmark plan does not call for its use, the State continues to explore the potential use of Medicaid data and data regarding families collection of public benefits and child support to compliment current data collection. In addition, members of the Home Visiting Project Team continue to work with other agencies and stakeholders on the development of an Early Childhood Longitudinal Data System in the State of Wisconsin. This system will connect information about children, families, and programs across service sectors, in order to better answer important policy questions such as which children have access to which services, and which characteristics of intervention programs are associated with positive outcomes for families. While this project is in its nascent stages, the work group is excited about the possibility of contributing to and learning from this important resource.
Some of the sites may develop alternative mechanisms for collection of data as the SPHERE system is enhanced to meet the needs of a variety of home visiting models. In Milwaukee, for example, EFM has developed a program ACCESS database to collect data measures currently not available or not reportable in SPHERE. This database helps to track demographics, case assignments, program referral outcomes, and administration of incentives and supplies.
State Approach to Supporting Implementation The Home Visiting Coordinator, Performance Planner and MCH Nurse Consultant, along with the State Project Team will oversee the implementation of the home visiting models. State home visiting staff in collaboration with other key partner such as representatives of the national home visiting models if necessary will conduct monthly site visits for the first year of program implementation to monitor local program progress. The Project Team will continue to meet weekly for the first six months of the grant to ensure successful implementation of the state home visiting plan. State area administration staff from the DCF regional offices will be kept abreast of the program implementation to assist with the process. Community Collaboration Coaches from the Wisconsin Early Childhood Collaborating Partners (WECCP) provide linkages to a variety of early childhood activities and would also be an important resource within their regions. Finally, with the Regional Communities of Practice, state home visiting staff will develop a peer network and encourage those more experienced programs to mentor new and developing sites. The Training work group will continue to meet to further develop the home visiting competency framework and identify, develop, or re-tool training for home visitors (at all levels) and their supervisors that reflect those competencies. The state team along with the training contractor(s) will provide intensive training and support of the supervisory staff to maintain model fidelity and reflective supervision to support staff. Training and technical assistance from the model developers will also be accessed as needed. Data entry into the SPHERE system and any model required data system will be monitored to ensure the program is accurately entering the necessary information to meet the benchmark areas. Reports will be sent monthly to assure data elements are collected with integrity. Training on the data systems and on-going technical assistance regarding data collection, reporting and CQI activities will be provided to all sites. Monthly reports will be sent by state home visiting staff to the agencies implementing the home visiting programs to assess and guide the program implementation. Agencies will use these reports to monitor program fidelity and effectiveness and correct any variations in implementation.
Self-assessment tools or implementation and quality assurance guides are provided by both Early Head Start and Healthy Families America. State home visiting staff, regional mentors, and training/TA contractor(s) will also be available to assist programs to ensure effective use of the self-assessment tools. In addition, the State is exploring partnership with the Early Years Home Visitations Outcomes Project on the development and field testing of a quality assessment tool. These tools will be used to guide the implementation process. The agency will be able to provide continuous quality improvement through the use of data to: review the ability of staff to engage families, track the attrition and retention rates of families, assess the gaps in services available to families Maintaining Quality and Fidelity As with any program, using best practices and engaging in continuous quality improvement is an ongoing process for home visiting, both at the sate and local level. As mentioned previously in this section, providing high quality training that best meets the needs of home visitors to appropriately serve multiple-risk families in at risk communities is a priority for Wisconsin. A strong training and technical assistance system is the cornerstone to providing quality programs that are consistently delivered. The State is committed to work in partnership with the model developers, the training providers, and the local programs to ensure that training and technical assistance for home visitors and their supervisors is useful and well-supported. Similarly, Wisconsin is committed to creating a system of home visiting that is grounded in quality, with datadriven decision-making and evidence-based programs that have a high degree of model fidelity. For more detailed information about the CQI plans for the state and sites selected for funding, please see Section 7. The Home Visiting Project Team and the local programs are aware that serving high-risk families and following an evidence-based home visiting model with high degree of fidelity is not without challenges. These challenges will likely include engagement and retention of the high risk families, and recruitment of staff that reflects the racial and ethnic diversity of the population served. Maintaining the integrity of the data collected and being able to use reports in a meaningful way provides challenges to programs. Encouraging participation from staff at all levels from the home visiting providers and their partner agencies in identifying training/TA needs and meaningfully engaging them in CQI efforts are critical to overcome those challenges. Collaborative Public and Private Partners See Section 6 for the list and description of the States collaborative public and private partners.
Assurances 1. The home visiting program is designed to be a service delivery strategy in a comprehensive, high quality early childhood system. No one program or system can address all the needs of the families. Wisconsin has five of the identified evidence-based home visiting models in operation in the state, and Early Head Start and Healthy Families America will be supported with the first round of MIECHV funding. Although none of the home visiting evidence-based models address all of the outcomes noted in the legislation, in partnership with the other state and local agencies the programs are designed to address all of the participant outcomes. 2. Individual assessments will be conducted of participant families using Prenatal, Postpartum, and Infant Assessments; HOME Inventory; ASQ-3/ASQ SE child development screens; Edinburgh Postnatal Depression Scale (EPDS); and the Perceived Stress Scale. Services will be provided based on the results of the individual assessments. 3. The services will be provided to families on a voluntary basis. The plan for services is made with the families and families can decide when the services end. 4. The state will comply with the Maintenance of Efforts Requirements for home visiting programs in existence on March 23, 2010. In state fiscal year 2010, this amount is $1,258,200. 5. Priority will be given to serve eligible participants who: have low incomes; are pregnant women who have not attained age 21; have a history of child abuse or neglect or have had interactions with child welfare services; have a history of substance abuse or need substance abuse treatment; are users of tobacco products in the home; have, or have children with, low student achievement; have children with developmental delays or disabilities; are in families that include individuals who are serving or have formerly served in the armed forces, including such families that have members of the armed forces who have had multiple deployments outside of the United States.
Section 5: Plan for Meeting Legislatively-Mandated Benchmarks

States must propose a plan for meeting the benchmark requirements specified in the legislation and described in detail in this SIR. General Data Collection Plan Proposed measures for each benchmark and construct specified in the legislation and described in detail in the SIR, as well as the source, proposed definition of improvement, data collection plan, and justification for each measure, are detailed in the attached Proposed Indicators for Measurement of MIECHV Program Benchmark Table (See Attachment 6). The State will require all MIECHV funded programs to collect data on all benchmarks, for all service recipients as appropriate given the age of the child, time of enrollment, etc. (i.e., we will not use a sampling plan). Per directions in the SIR (p. 38), also as appropriate for each measure, and based on home visiting best practices, we will collect data for each benchmark area and construct when the family is enrolled in the program and one year post-program. Improvement will be measured between year one baseline and the three-year reporting period, as suggested in the May 2011 Design Options for Home Visiting Evaluation (DOHVE) Measurement Brief, Selecting Data Collection Measures for MIECHV Benchmarks. Exceptions to this general plan for specific measures are noted in the last column of the table. Indicators for each benchmark were developed by the Home Visiting Evaluation and Program Quality Work Group3, using the general principles from the SMART (Specific, Measureable, Attainable, Relevant and Timely) goal system recommended in the May 2011 DOHVE Measurement Brief, Selecting Data Collection Measures for MIECHV Benchmarks. Group members attempted to leverage existing data collection practices and data structures, while also taking advantage of opportunities for meaningful system and measurement improvement. In addition, the group considered existing reporting needs under WI State Statute Chapter 48.983, the legislation that authorizes and provides authority to DCF related to the distribution of home visiting grants via a competitive process. Each program will be responsible for collecting its own data and recording information in SPHERE, the states Web-based, comprehensive public health data system.4 In addition to providing a format for collecting required data, SPHERE allows users to access longitudinal client and program-level data for CQI purposes. As part of the RFP process, programs were also asked to develop individual data collection plans, detailed below:
3 4
See Section 6 for a more detailed description of this work group.

See Section 4 for a more detailed description of SPHERE.
EMPOWERING FAMILIES OF MILWAUKEE Empowering Families of Milwaukee (EFM currently utilizes the web-based application, SPHERE, as its primary database to collect information and evaluate changes in health indicators over time with the families we serve. All case management activities including screening tools, assessments, referral/follow-ups, health teaching, delegated functions, and narrative case notes are entered into SPHERE. The EFM program is currently one of the few programs that utilize SPHERE to this degree and intensity. EFM employs a fulltime Health Information Specialist (HIS) who has high-level training in SPHERE and its navigation to assure accurate data reporting for program outcomes. The HIS also provides all SPHERE training, oversight, and quality assurance measures to home visitors data entry and information management. EFM has also developed an EFM Program Access Database to collect data measures currently not available or not reportable in SPHERE. This database helps to track demographics, case assignments, program referral outcomes, and administration of incentives and supplies that are provided above and beyond the required yearly flexible funding allotment. GREEN COUNTY Both Green County Health Department (GCHD) and Dane County Parent Council (DCPC) have demonstrated expertise and infrastructure capacity to collect and manage information systems. GCHD, which will have the responsibility for data reporting to SPHERE in this program, currently uses the SPHERE system to report health data for the county. DCPC has a comprehensive data collection and information management system for Early Head Start program data required in the federal Program Information Report (PIR). The PIR documents much of the data required for the home visiting program as described in the required performance measures. LAC COURTE OREILLES TRIBE The data system and mechanism to track progress and report on most of the benchmarks is currently in place. The primary data source will be SPHERE, the data system currently used by the Honoring Our Children program for monitoring program services at the participant level and for tracking progress on performance indicators. Additional possible data sources for the benchmark areas include Wisconsin Interactive Statistics on Health (WISH), US Census data files, Wisconsin resident birth certificate files, Temporary Assistance for Needy Families (TANF) reports, Department of Children and Families Wisconsin Child Abuse and Neglect report, and Lac du Flambeau Statewide Domestic Abuse Program report. These data sources will be investigated to determine whether existing county-level reports will provide appropriate data for the benchmarks, if state program staff could conduct specific analyses for the tribal service area, or if actual data files need to be obtained and analyzed. The UW evaluator is adept at using webbased query systems and using SPSS-PC for data analysis.
NORTHWOODS (LINCOLN, ONEIDA, FOREST) CSSW has developed several data bases that store needed program data and data staff have the technical skills to develop ad hoc reports. CSSW data and program staff are also trained in the SPHERE data base and have experience pulling reports from this system. CSSW staff are supported by the Information and Technology (IT) department of Childrens Hospital and Health System. The IT Department houses a staff person to support the Northern region of CSSW at the Wausau office. CSSWs prevention core service area has 3 full-time staff assigned to collect, analyze and report program utilization and outcome data. Information is used to improve program operations and attainment of outcomes, inform potential donors of program results, communicate program outcomes to stakeholders and provide accountability to program funders. Program leaders and data staff are further supported by the CHHS Quality Department staff that assist staff to sustain quality programs through quality monitoring processes and data analysis support. RACINE COUNTY Childrens Service Society of Wisconsin (CSSW) has established the capacity and protocols needed to support web-based data collection and reporting. As a child placement agency, the organization has successfully used eWiSACWIS since its inception. CSSW has also used SPHERE to enter client data for families served. The CSSW Performance and Quality Improvement Program has the capacity to collect, analyze, and report required indicators that respond to contract and grant requirements across several programs within the agencys four core program areas. Systems and tools are also in place to collect and report on individual family achievements documented in strength-based individual service plans. In addition to CSSWs capacities, Project Partners from the three public health departments in Racine County have many years experience in collecting and entering data into SPHERE. CSSW will work with the Racine County Home Visiting Network and the Department of Children and Families to implement an evidence-based matrix to measure benchmark service effectiveness and outcomes for home visiting services provided in the county. Data collection and analysis efforts will be supported by the State via training, quality assurance procedures, and technical assistance, managed by the Home Visiting Coordinator and Home Visiting Performance Planner, with additional guidance from DHS SPHERE staff and the Home Visiting Evaluation and Program Improvement Work Group. Other opportunities to support high quality data collection and analysis will also be encouraged, including peer network meetings and dissemination of best practices via the Home Visiting Website, Newsletter, and Toolkit. Annual progress reports to the Federal Government will be compiled by DCF and DHS staff, led by the Visiting Coordinator, MCH Home Visiting Nurse Consultant, and Home Visiting Performance Planner, with input where appropriate from members of the Project Team. More frequent analysis for CQI purposes may also be required. Instruments Required for All Programs
In order to standardize the measurement of certain outcomes across programs, the State has designated several high quality measurement tools to be used by all MIECHV-funded home visiting programs. The majority of home visiting clients in Wisconsin are English speakers; however, for clients who speak other languages, it will be determined on a case-by-case basis whether translation into native language or some other type of assessment is most appropriate. Several of the instruments are available in Spanish, for use with Spanish-speaking clients, as indicated below. Questionnaires that are uploaded to SPHERE SPHERE, the States Web-based, comprehensive public health data system, includes a number of embedded questionnaires to be administered to clients generally with paper and pencil - via interview during home visits. These questionnaires use simply worded, straight-forward questions to collect information about parents, children, households, services, health, and behaviors. Although the questionnaires generally rely on clients self-reports, they provide important and easily accessible information that can also be used for case planning. If there are concerns about accuracy, much of the information can also be triangulated using other sources. Prenatal Assessment-This questionnaire collects basic demographic information, information about the pregnancy and prenatal care, pregnancy history, healthrelated behaviors during pregnancy (e.g., nutrition, smoking, alcohol use), mental health, and social support. This questionnaire is approved by the state to be used as the Prenatal Care Coordination (PNCC) Pregnancy Questionnaire, and implementation is reimbursed by Medicaid. Postpartum Assessment-This questionnaire collects retroactive information about a womans pregnancy, birth outcomes, breastfeeding and other care behaviors, and mental and physical health since pregnancy. Due to concerns about the accuracy of retroactively reported behaviors, we will not use information from this questionnaire for pregnancy measures; however, the questionnaire provides useful information for postpartum measures. Infant Assessment- This questionnaire collects information about a childs birth, infant health, infant health care utilization (including immunization, emergency room visits, and well-baby visits), home safety practices, feeding, and psychosocial risk factors. Early Childhood Assessment- This questionnaire is currently in development and is anticipated to be available in January 2012. this questionnaire will collect information about a toddler and preschoolers health, health care utilization (including immunizations, emergency room visits, and well-child visits), home safety practices, nutrition, and psychosocial risk factors and recommended to assess health, growth and development of children ages 13 months up to 48 months. Other information collected in SPHERE-The State will also require programs to collect additional data to be entered in SPHERE regarding home visiting service provision (e.g., frequency of visits, health teaching topics covered, etc.); referrals
made and results of these referrals; health care utilization; and general household information (e.g., employment and income). As recommended in the May 2011 DOHVE Measurement Brief, Selecting Data Collection Measures for MIECHV Benchmarks, programs are encouraged to develop a protocol to adequately train interviewers to: a) ensure relative consistency in the administration of the protocol and b) avoid potential sources of measurement error, such as deviations from the interview protocol (p. 5). Ages and Stages Questionnaire 3 (ASQ-3) The ASQ-3 (Squires et al., 2009) is a low-cost, reliable way to screen children ages 2 months to 5 years for developmental delays.5 The tool addresses skill areas including: communication, gross motor, fine motor, problem solving, and personal-social skills. Typically, in the home visiting context, parents and their home visitor work through a series of activities with their children and check boxes that best describe what the child can do. Results from the assessment are scored and interpreted by the home visitor. Parents are an integral part of the screening process; thus, the instrument also helps teach parents about child development and their own child's skills. The ASQ-3 was standardized in a national sample of 12,695 children. Rigorous research shows that that it is a reliable and valid tool with high levels of sensitivity and specificity. According to the ASQ-3 Users Guide, both test-retest reliability and inter-rater reliability are excellent (.91 and .92, respectively). In addition, the instrument was found to have excellent validity (.82-.88), as well as a sensitivity of 86% and a specificity of 85%. The instrument also demonstrates good to acceptable internal consistency, with Cronbachs coefficient alphas ranging from .51 to .87, varying by child age and developmental area. In addition to being listed in the DOHVE Compendium of Measures, the ASQ is recommended as a high quality screener by The American Academy of Neurology, the Child Neurology Society, and First Signs, and is also highly rated by the U.S. Department of Health and Human Services, Administration for Children and Families. The ASQ-3 is widely used as a developmental screening tool throughout Wisconsin. Several statewide initiatives and organizations (e.g., LAUNCH, DPI, Early Years Home Visitation Outcomes Project of Wisconsin) encourage its use by child care centers, doctors, and home visiting programs; thus, the state has a strong infrastructure across service sectors, in terms of training and support for instrument implementation. ASQ-3 Questionnaires are available in both English and Spanish. Based on research and work with instrument developers, the State will ask home visiting programs to adopt the following schedule of administration for the ASQ-3, as recommended by the Early Years Home Visitation Outcomes Project of Wisconsin: assessment at 4 months of age or within 4 months of admission into the program, and at the child age of 8 months, 16 months, 24 months, 30 months, 36 months, 48 months, and 60 months. Data will be entered in SPHERE as an ASQ screening; information regarding related referrals or other
5
The administration window ranges from 1 to 66 months.
actions due to ASQ results will be entered under Plan of Action and Plan of Action Results. Ages and Stages Questionnaire: Socio-Emotional (ASQ: SE) The ASQ: SE (Squires et al., 2002) is a companion to the ASQ-3, focusing on childrens social and emotional behavior. Implemented similarly to the ASQ-3, it is also relatively low-cost and easy to use. According to the ASQ: SE technical report, the instrument was standardized on a sample of 3,014 children. Test-retest reliability was 94% and internal consistency measures (Cronbachs coefficient alphas) were in the adequate to excellent range, from .67 to .91, with an overall alpha of .82. Concurrent validity ranged from 81% - 95%. The ASQ:SE was found to have a sensitivity range of 71% - 85% and specificity range of 90% - 98%. As with the ASQ-3, implementation of the ASQ: SE is well-supported in Wisconsin, in terms of utilization across service sectors and opportunities for training. Questionnaires are available in both English and Spanish. Based on research and work with instrument developers, the State will ask home visiting programs to adopt the following schedule of administration for the ASQ: SE, as recommended by the Early Years Home Visitation Outcomes Project of Wisconsin: assessment at 6 months of age or within 6 months of admission into the program, and at the child age of 12 months, 18 months, 24 months, 30 months, 36 months, 48 months, and 60 months. Data will be entered in SPHERE as an ASQSE screening; information regarding related referrals or other actions due to ASQSE results will be entered under Plan of Action and Plan of Action Results. The Home Observation for Measurement of the Environment (HOME) The HOME (Caldwell & Bradley, 2001) tool is designed to measure the quality and quantity of stimulation and support available to a child in the home environment via a combination of interview and direct observation. According to the instrument developers, the focus is on the child in the environment, child as a recipient of inputs from objects, events, and transactions occurring in connection with the family surroundings. The Infant/Toddler (IT) HOME, used to assess households with children birth to age 3, is composed of 45 items clustered into six subscales: 1) Parental Responsivity, 2) Acceptance of Child, 3) Organization of the Environment, 4) Learning Materials, 5) Parental Involvement, and 6) Variety in Experience. The Early Childhood (EC) HOME, used to assess households with children age 3 to 6, is composed of 55 items clustered into 8 subscales: 1) Learning Materials, 2) Language Stimulation, 3) Physical Environment, 4) Parental Responsivity, 5) Learning Stimulation, 6) Modeling of Social Maturity, 7) Variety in Experience, and 8) Acceptance of Child. Items are presented as statements to be scored as yes or no; higher total HOME scores indicate a more enriched home environment. There is an extensive literature documenting research about the psychometric properties of the HOME. Recent studies, focusing on a wide range of children and families (e.g., pre-term infants, poor children, low SES families), similar to those likely to be served by
the States MIECHV-funded programs, report a very good level of inter-rater reliability (at least 90%) and adequate levels of internal consistency (ranging from moderate to high) (Totsika & Sylva, 2004). In terms of concurrent validity, studies suggest small to moderate small to moderate correlations between the HOME and seven socioeconomic status variables: welfare status, maternal education, maternal occupation, presence of father in the house, paternal occupation and crowding in the home. The instrument also demonstrates predictive relationship (mostly .4 or higher) between HOME and cognitive development, HOME and SES, and changes in HOME following intervention programs (Caldwell & Bradley, n.d.). While the choice of a binary scale makes it easier for the interviewer to score, it deprives the home visitor of more subtle information. It is also important to recognize that the information from the HOME, which is obtained by only one informant each time on only one occasion, might not be representative of a childs full life conditions. Despite these limitations, the HOME has a strong capacity to identify strengths and weaknesses in the family environment, and its use is consistent with recommended practice, using assessment that is ecological in nature, allowing for an understanding of the child within the context of family (Totsika & Sylva, 2004). The HOME is relatively low cost, and is a commonly used instrument in home visiting programs throughout Wisconsin. Its implementation is supported by the Early Years Home Visitation Outcomes Project of Wisconsin, and training is widely available. Based on research and work with instrument developers, the State will ask home visiting programs to adopt the following schedule of administration, as recommended by the Early Years Home Visitation Outcomes Project of Wisconsin: assessment when child is 6 months of age, 12 months, 24 months, 36 months, and once between 48 months and 60 months. It is acceptable to administer the HOME within 4 weeks prior or after the targeted age. Data will be entered in SPHERE under HOME Inventory. Pre-existing data structures and reports allow for the calculation of changes in HOME scores over time.
Edinburgh Postnatal Depression Scale (EPDS) Listed in the DOHVE Compendium of Measures, the EPDS is easy to administer and has proven to be an effective screening tool for mothers at risk of postnatal depression. The questionnaire includes 10 short statements; the mother indicates which of the four possible responses is closest to how she has been feeling during the past week. The EPDS is available in the public domain, and users may reproduce the scale without further permission providing they respect copyright by quoting the names of the authors, the title, and the source of the paper in all reproduced copies. Questionnaires are available in both English and Spanish. Concurrent validity for the EDPS was established from a validation study on British mothers, which found that a 12.5 cutoff score identified over 80 percent of the mothers with major depression and about 50 percent of the mothers with minor depression. This same study found that the EPDS had a sensitivity value of 67.7 percent. Another study
found a score of 9.5 or higher to be more appropriate for identifying depression among Chinese mothers (National Center on Child Abuse Prevention Research to Prevent Child Abuse America, 2005). In general, a score of 12 or more on EPDS or an affirmative answer on question 10 (presence of suicidal thoughts) requires more thorough evaluation. 6 Instrument authors caution that the EPDS score should not override clinical judgment; a careful clinical assessment should be carried out to confirm diagnosis. The split-half reliability of the 10-item EPDS was .88 and the standardized alpha coefficient was .87. The EPDS will be a new tool for most Wisconsin home visiting programs; thus, its implementation will be supported by the State in terms of training, quality assurance monitoring, and determining proper follow-up procedures. Screening is recommended between 6 and 8 weeks postpartum. SPHERE already has the capacity to store information about tool administration and scoring, as well as related referrals and followup. Perceived Stress Scale (PSS) The Perceived Stress Scale (PSS) is a 10-item self report questionnaire that measures peoples evaluation of the stressfulness of the situations in the past month of their lives (Cohen & Williamson, 1988). The PSS was designed for use with community samples with at least a junior high school education. The items are easy to understand and the response alternatives are simple to grasp. Moreover, the questions are quite general in nature and hence relatively free of content specific to any sub-population group. Scores can range from 0 to 40, with higher scores indicating greater stress. Cohen and Williamson (1988) report good construct validity (i.e., PSS scores were moderately related to responses on other measures of appraised stress, as well as to measures of potential sources of stress as assessed by event frequency, p. 55) and internal reliability (coefficient alpha= .78) for the measure. The PSS is listed in the DOHVE Compendium of Measures, and is in the public domain, thus free to programs. This will be a new tool for most Wisconsin home visiting programs; thus, its implementation will be supported by the State in terms of training and quality assurance monitoring. Adjustments to SPHERE will eventually allow programs to enter administration dates and scores into the database. Administrative Data Although most of the information required for reporting benchmark progress will be available in SPHERE, a few outcomes require the use of State Administrative Data: The Wisconsin Statewide Automated Child Welfare Information System (WiSACWIS) WiSACWIS is the administrative database used by the DCF Division of Safety and Permanence (DSP) to track child welfare services and outcomes. With assistance from
Original testing suggested a potential cut-off score of 9/10, although when using the EPDS in primary care settings as a component of a screening program, the 9/10 cut-off may be over-inclusive. Thus, a cutoff score of 12/13 is often recommended.
6
DCF staff in the Bureau of Information Technology Services (BITS), information from this database will be matched with home visiting program participation data to track reported suspected and substantiated maltreatment outcomes. WiSACWIS is housed at DCF, and individuals on the Home Visiting Project Group have access to and expertise in using the data. Other Potential Administrative Data Sources Although the current benchmark plan does not call for its use, the State continues to explore the potential use of Medicaid data and data regarding families collection of public benefits and child support to compliment current data collection. If necessary, formal MOUs with the necessary agencies with responsibility or oversight of those data will be established. In addition, members of the Home Visiting Project Group continue to work with other agencies and stakeholders on the development of an Early Childhood Longitudinal Data System in the State of Wisconsin. This system will connect information about children, families, and programs across service sectors, in order to better answer important policy questions such as which children have access to which services, and which characteristics of intervention programs are associated with positive outcomes for families. While this project is in its nascent stages, the work group is excited about the possibility of contributing to and learning from this important resource. Plan for Ensuring the Quality of Data Collection and Analysis At the State level, the Home Visiting Performance Planner will have the primary responsibility for overseeing data collection and analysis. The Planners work will be supported by a research analyst at DCF, the State Systems Development Initiative Coordinator for the DHS/MCH Program, SPHERE staff at DHS, as well as the Evaluation and Program Improvement Work Group (Please see attached resumes for key staff and a position description for a proposed Performance Planner for DCF). The Evaluation and Program Improvement Work Group has also recommended that the State partner with the Early Years Home Visitation Outcomes Project of Wisconsin to support training and quality assurance for the implementation of required standardized tools. Wisconsin is also considering adding hand held technology iPads, Notebooks, PDAs, etc. to enhance the funded programs abilities to collect cleaner data and in a more costeffective fashion. The Outcomes Project sites piloted a Blue Cross Blue Shield funded research project that provided home visitors with hand held computers for recording a variety of screenings and assessments done on typical home visits. The initial results of the study are very promising in terms of having positive impact on the programs involved in the pilot project and improvements in their data management capacities. Use of handheld computers in home visiting programs deserves further investigation and a rigorous cost-benefit analysis, which could fall under the purview of the proposed Home Visiting Performance Planner and the Evaluation and Program Improvement Work Group.
Local programs were also required to develop a plan for ensuring the quality of data collection and analysis via the RFP process. Individual plans approved by the State are detailed below: EMPOWERING FAMILIES OF MILWAUKEE All EFM staff are trained on entering data into the SPHERE system. The EFM Health Information Specialist provides quality assurance and quarterly data clean-up to all data entered into SPHERE. Reports are also generated quarterly to review program outcomes and reports on these measures are provided to the programs current funder biannually. GREEN COUNTY Staffing allocations in the Green County home visiting program include a dedicated fulltime position in Green County Health Department to enter data, portions of the home visiting staff positions at DCPC to collect data, and the program supervisor at DCPC and agency administration in both agencies to supervise the process and analyze and report on individual and program results. The information systems consultant will review hardware, software, systems and training needs in both agencies related to accomplishing data collection, entry, analysis and reporting responsibilities for the home visiting program. Supervison and quality assurance of data entry and reporting processes will be the responsibility of the Program Supervisor with oversight from the department directors. Supervision and monitoring strategies will consist of weekly meetings with the Program Supervisor and monthly oversight by the department directors. The staff member responsible for data entry and reporting will also attend weekly staff meetings to ensure appropriate communication with home visiting staff members regarding data collection. Individual and program data reports will be provided through SPHERE on a monthly basis. LAC COURTE OREILLES TRIBE Assuring the reliability and validity of SPHERE data will be addressed in an initial Home Visiting Program training for staff, with ongoing data collection and reporting updates at staff meetings. The Project Coordinator will run the relevant SPHERE reports on at least a quarterly basis to help assure timely data entry, identifying missing data, and track program outcomes. NORTHWOODS (LINCOLN, ONEIDA, FOREST) All program staff are oriented to the data systems and work processes for documenting and tracking program data. All program staff will be trained in the evaluation process and tools required to collect information from program participants. CSSW prevention staff will rely on data staff to enter and report out collected data. A goal of the CSSW
Prevention Core Service leadership team is to focus direct service staff time on providing quality family support and child development services and provide them the technical support they need to make their data collection role more efficient so they are not in the role of entering data into data systems ore designing reports to get out needed data for reporting purposes or analyzing program data. RACINE COUNTY CSSW prevention core service area has 1.25 full-time staff assigned to collect, analyze and report program utilization and outcome data. Program leaders and data staff are further supported by 2.5 full-time CSSW state level Program Evaluation and Research Department staff who assist staff to sustain quality programs through quality monitoring processes and data analysis support. CSSW data and program staff are trained in the SPHERE data base and have experience entering data and pulling reports from the system. Plan for Analyzing the Data at the Local and at the State Level As noted in the general data collection plan, the Home Visiting Performance Planner will have primary responsibility for analyzing data, with additional guidance from the Home Visiting Evaluation and Program Improvement Work Group. Although staff continue to await specific guidance from the federal government regarding the format for progress reports, DCF and its partners currently expect to report annual progress on benchmark measures, aggregated at the state level, with official improvement generally required between baseline of year 1 and year 3 of the program. In addition, as explained in more detail in Section 7 re: CQI, in conjunction with the Home Visiting Evaluation and Program Improvement Work Group and local programs, the State will choose a select group of benchmark measures to monitor on a more regular basis. These decisions will be driven by individual community needs and assessment of other State priorities and reporting requirements. Via the RFP process, individual programs also developed plans detailing how they would aggregate and disaggregate data to understand the progress made within their communities and for different groups of children and families. Individual plans include: EMPOWERING FAMILIES OF MILWAUKEE EFM collects demographic data on enrolled families through the use of SPHERE and within the EFM Program Access Database, including but not limited to race, age, sex, zip code, length in program and by home visitor. Through these two databases EFM is able to collect other data as well, including the results of prenatal assessments, developmental assessments, and other screenings. Since SPHERE has some limitations in data collection and reporting, the inclusion of the EFM Access Database has been crucial in collecting client data needed for evaluation and program analysis.
While the majority of reports are pulled in an aggregate format to analyze overall program outcomes, disaggregate reports are also pulled to track individual outcomes for families. For example, the program is able to pull a report on a single childs health and developmental outcomes based upon longitudinal ASQ, ASQ-SE, and HOME Inventory scores, including any areas of caution, across the childs time in the program. In addition, through SPHERE EFM is able to track outcomes by caseload, based on an individual worker or teams interventions. EFM also uses the referral and follow up reporting tab within SPHERE to report on the number of referrals and service connections provided to families, as well as to analyze the outcomes of those referrals to families. Through SPHERE and EFMs Program Access Database, the program can analyze data based on numerous aggregate and disaggregate parameters. GREEN COUNTY Green County Home Visiting Program will follow the well established Early Head Start model and DCF requirements for assessment, data collection, reporting, analysis and program involvement in services to children and families. Data in each of the areas of service to pregnant women, families and children will be aggregated across the year and across individual staff providing service to ensure attention to emerging patterns and concerns. Overall program data will also be disaggregated to attend to specific elements such as ability to reach and effectively serve the priority targeted populations of pregnant and parenting teens, Latino families and those eligible for Medicaid PNCC services, especially those who are first time parents and those who have had previous poor birth outcomes. Data regarding medical services for pregnant women will be collected at enrollment and with each public health nurse contact. The data will be broken down into prenatal assessment, postpartum assessment and infant health outcomes, referral and follow-up outcomes, such as immunizations and well-baby check-ups, and individual interventions. Demographic data will be collected upon enrollment, annually and as family changes occur. A separate EHS outcomes data base documenting and reporting on service utilization and participation will be adapted as necessary to accommodate the expanded number of participants and enhanced service elements of the home visiting program. Individual participant service delivery, participation and utilization data will be reported monthly and reviewed by the program supervisor with each individual staff member as pertains to their caseload. The program supervisor and department directors will review whole program data for patterns across individual caseloads, geographic areas across the county, age, gender and ethnicity and make adjustments to program service delivery to address issues that arise. LAC COURTE OREILLES TRIBE Reports of progress toward meeting the benchmarks will become a part of the current Honoring Our Children data reporting process. SPHERE reports, along with additional
analysis of data export files, will be used to describe participant demographics, program services, and participant outcomes. The data for the Home Visiting Program will be reported as a supplement to the existing annual Honoring Our Children data reports. The UW Evaluator currently exports data files from SPHERE and analyzes HOC data from each of the tribal sites to generate site-specific and aggregate reports. The data are summarized in a user-friendly reporting format that presents the results from each year of the HOC project for each of the tribal sites separately and for all sites combined. The UW Evaluator presents these data reports annually at the HOC staff meeting and at the HOC Project Advisory Committee Meeting, to inform everyone of progress toward project objectives. The site-specific data are not revealed to other sites, but staff members are instructed to compare their percentages with the overall averages. Staff members from sites whose data show above average achievement in key areas are encouraged to share their successful strategies. HOC Staff members share the sitespecific data reports with the Tribal Health Director and use the information for presentations to their local consortium and Tribal Council. In addition, program staff members at the Tribal site can select a series of reports in SPHERE for ongoing monitoring of their caseloads and services. These reports include client list, unduplicated clients and total activities, race and ethnicity, health care and dental coverage summary, health needs summary, interventions and sub-interventions summary, health teaching topics and results, referral and follow-up results, prenatal assessments summary, infant assessment summary, postpartum assessment summary and infant outcomes, developmental assessment Ages and Stages Questionnaire, HOME inventory report, injury prevention assessment summary and community/system activity summary. The program will contribute evaluation findings to help build the knowledge base around evidence-based home visiting services to Tribal populations. NORTHWOODS (LINCOLN, ONEIDA, FOREST) Staff will use an intake form to collect demographic data and will track service utilization data using the Client Data System (CDS) and/or SPHERE. Data can be aggregated or disaggregated in any way. The CSSW CDS has ad hoc reporting and CSSW have data staff and program evaluation and research staff who have the expertise to assist program staff in structuring the data flow to retrieve data reports in any way necessary to support the program. RACINE COUNTY CSSW has experience gathering and analyzing demographic and service utilization on clients over more than 20 programs in the agencys four core program areas: prevention, public child welfare, private child welfare, and counseling and case management. Data collection can be reported in aggregated and disaggregated formats. Utilization and program activities are tracked using the FRCS data base for Family Resource Centers and
the Client Database for home visiting and other individual services offered to families at CSSW. In addition, all de-identified demographic and outcome results will be shared on a local level with the Greater Racine Collaborative for Healthy Birth Outcomes initiative (GRC4HBO) for outside review, analysis and dissemination to community stakeholders who are working locally to improve birth outcomes. The local collaborative, part of the Racine Life Course Initiative for Healthy Families (LIHF), is collecting demographic data and outcomes on birth outcomes across the county. Plan for Gathering and Analyzing Demographic and Service-Utilization Data SPHERE has excellent capacity to collect demographic and service-utilization data, and to produce reports to help the State and local programs better understand the progress children and families are making. Programs will be asked to collect and report demographic data including, but not limited to: the childs age in months, the childs race and ethnicity, the childs home language, the childs sex, the parents education or employment, and other relevant information about the child and family. Programs will also be asked to collect and report data on the degree of participation in services, including referrals to other agencies and the results of those referrals (i.e., whether services were rendered). This data will be continuously monitored, to make sure that programs are serving families with the greatest needs, and that communities are improving their capacity to The State also has a particular interest in program retention, and will ask programs to pay particular attention to attrition patterns. Individual program plans to gather and analyze demographic and service-utilization as detailed in the RFP responses were included in the previous section. Plan for Using Benchmark Data for CQI at the Local Program Community and State Level Please see Section 7 for a complete discussion of Wisconsins plan to use benchmark data for CQI purposes. Plan for Data Safety and Monitoring SPHERE is a secure database administered by the DHS, Division of Public Health, and requires a user ID and password. Users are required to sign a security and confidentiality agreement, acknowledging compliance with the SPHERE Security and Confidentiality Policy, as well as their own organizations standard policies and procedures for confidentiality and for release of identifying health information for clients. In addition, all individual home visiting programs are required to be HIPPAA, FERPA, and IRB/human subjects compliant, and must provide training to all staff regarding these policies. Individual compliance practices were reviewed as part of the RFP scoring process and will continue to be monitored by the Home Visiting Performance Planner. Programs
must also provide additional training regarding procedures that do not place individuals at risk of harm (e.g., questions related to domestic violence and child maltreatment reporting). Anticipated Barriers or Challenges in the Benchmark Reporting Process Given the extensive data collection and reporting requirements detailed in the SIR, and the fact that we will be funding several new home visiting programs, we anticipate several continuing challenges: Utilization of and Enhancements to SPHERE While Wisconsin will greatly benefit from the fact that it already has an established database that can be used by home visiting programs, we know that for programs new to SPHERE, training and technical assistance will be needed. The State will work closely with these new programs, and will encourage peer learning exchanges between seasoned SPHERE users and new staff. In addition, although SPHERE has the capacity to collect most of the data we will need for federal reporting purposes, the Evaluation and Quality Improvement Workgroup, along with local SPHERE users, will continue to identify needed enhancements to the system, to support meaningful data analysis and CQI efforts. The State will also work with DPH to financially support these improvements. Duplication of Data Entry/Reporting Burdens As mentioned in Section 3, we remain concerned about burdens related to programs needs to comply with what may amount to different data collection requirements for both the MIECHV grant and the national models. SPHERE has been developing capacity to receive data from other systems and currently receives electronic dad files from the State Vital Records On-Line System and will soon be able to receive client level information from the WIC statewide data system. The long term plan is to have the home visiting models be able to send and receive data in SPHERE as well. The States goal is to work collaboratively with the Early Head Start and HFA model developers to ensure that their requirements for data collection are met while double entry of data or use of multiple tools to measure the required constructs is minimized for the sites where possible. Dilution of Results Due to Differing Community Priorities As mentioned in Section 3, implementing a mix of home visiting models presents a particular series of challenges for the State. While the SIR requires states to report all benchmark data aggregated at the state level, models and programs have been developed to impact outcomes in different benchmark areas, and communities were encouraged to choose models based on their demonstrated ability to address specific community needs and populations. Thus, we remain concerned about the potential dilution of individual program success due to this aggregate reporting requirement. We hope to receive additional technical assistance on how to deal this issue throughout the reporting process.
Child Maltreatment Benchmark Area Issues Although we acknowledge that administrative data seems the best source to truly capture reported and reported substantiated maltreatment, we remain concerned about our ability to accurately match State Administrative Data (WiSACWIS) with home visiting program data. DCF-DSP experts recognize variation in rates of reporting and substantiation among counties. Taken together, these concerns suggest that a different construct, perhaps a measure of reduction in psychosocial risk factors for abuse, would be helpful in this benchmark area. Please see our proposal for piloting this type of measure for the construct first-time victims of maltreatment for children in the program. Identification of MIECHV Funded Families for Reporting Purposes The SIR requires the reporting of data for MIECHV funded families only, yet our State home visiting system development strategy included the braiding of three funding threads (MIECHV, General Purpose Revenue, and TANF) to strengthen the states home visiting infrastructure. In addition, many home visiting programs leverage local matching funds to provide services. Given that all program participants are likely to benefit from the strengthened home visiting infrastructure and guidance following from the MIECHV funding and requirements, we are unsure how to identify MIECHV-only funded clients. We look forward to additional guidance from the Federal Government regarding this issue.
Section 6: Administration
Administrative Structure Description of Lead Agency Development, implementation and management of Wisconsins State Home Visiting Program is shared between the Department of Children and Families (DFC), a cabinetlevel agency responsible for child welfare, child care, Temporary Assistance for Needy Families (TANF), child support, Head Start Collaboration, child abuse/neglect prevention and domestic violence and the Department of Health Services, Bureau of Community Health Programs, Maternal and Child Health Section. The Program is led by a dynamic Project Team composed of mid-level managers from each of the mandatory agencies Title V, Title II of CAPTA, child welfare (Title IV-E and IV-B), Substance Abuse Services, and the Head Start State Collaboration Office. In addition, staff from the Community Learning and Partnerships Early Childhood team from the Department of Public Instruction (DPI) have been active members since the inception. The team is led by Leslie McAlister, the State Home Visiting Coordinator in DCF, though all members of the Project Team have some responsibility to assist with developing meeting agendas and implementing work plans. The work of the Project Team is guided by an Ad Hoc Committee on Home Visiting, established in October 2010 by the Governors Early Childhood Advisory Council to ensure the home visiting is an integrated component of the states comprehensive system of early childhood care and education. The Committee has created two workgroups to assist in developing a robust framework for the states home visiting programs. The organizational chart highlights the diversity of the Project Team and linkages with the Sub-Committee and ECAC. Details about each of the key stakeholders identified here are described below. Department of Children and Families: Leslie McAllister, Home Visiting Coordinator, Division of Safety and Permanence Home Visiting Performance Planner, (to be hired), Division of Safety and Permanence Judith Hermann, Manager of Prevention and Child Welfare Services Integration, Division of Safety and Permanence Kim Eithun-Harshner, Service Integration Specialist, Division of Safety and Permanence Sharon Lewandowski, Domestic Abuse Program Coordinator, Division of Safety and Permanence Hilary Shager, Research Analyst, Office of Performance and Quality Assurance Linda Leonhart, Director, Head Start Collaboration Office
Jean Zawacki, W-2 Program and Policy Analyst, Division of Family and Economic Security Mai Zong Vue, Migrant and Refugee Services Coordinator, Division of Family and Economic Security
Department of Health Services Home Visiting nurse Consultant (to be hired), Bureau of Community Health Promotion/Family Health Section/Maternal and Child Health Unit Linda Hale, Maternal and Child Health Unit Director, Bureau of Community Health Promotion, Division of Public Health Katie Gillespie, Perinatal Nurse Consultant/Prenatal Care Coordination, Bureau of Community Health Promotion/Family Health Section/Maternal and Child Health Unit Ann Altman Stueck, Infant and Toddler nurse Consultant and ECCS Coordinator, Bureau of Community Health Promotion/Family Health Section/Maternal and Child Health Unit Dave Rynearson, Policy Analyst, Tribal Affairs Office Eileen McRae, Medicaid/BadgerCare Plus Policy Analyst Bernestine Jeffers, Womens Substance Abuse Coordinator, Division of Mental health and Substance Abuse, Bureau of Prevention, Treatment, and Recovery Birth-to-Three staff, Division of Long Term Care Wisconsins Childrens Trust Fund (CTF) Mary Anne Snyder, Executive Director, CAPTA Title II Agency Jennifer Jones, Associate Director, CAPTA Title II Agency Department of Public Instruction (DPI) Jane Grinde, Director, Community Learning and Partnerships Team Jill Haglund, Early Childhood Education Specialist, Community learning and Partnerships Team Other Public Collaborative Partners: University of Wisconsin Madison School of Medicine and Public Healthbrings research and evaluation expertise to the table; also funds community-based initiatives to improve maternal and child health Waisman Center University Center for Excellence in Developmental Disabilities manages training programs for providers of Birth to Three services and provides support for parents as leaders Lifecourse Initiative for Healthy Families - an initiative to investigate and address the high incidence of African-American infant mortality in the state using evidence-based programs and best practice public health and self-sustaining community-based interventions
Division of Continuing Studies housed in the Professional Development and Applied Studies Department, the Infant, Early Childhood and Family Mental Health Certificate Program is a one-year professional development program for professionals across multiple disciplines, such as home visitors, childcare providers and pediatricians, to gain an enhanced understanding of infant and early childhood mental health and new skills to support the social and emotional development and well-being of young children in the context of their family/caregiver relationships
University of Wisconsin-Milwaukee brings research and evaluation expertise related to child maltreatment prevention, early childhood development and health/public health Helen Bader School of Social Welfare researchers are serving on the home visiting evaluation work group Center for Urban Population Health dedicated to improving the health outcomes for urban populations, with special focus on maternal and child health, healthy aging and addressing risky health behaviors of urban youth; currently involved in the evaluation of Wisconsins Project LAUNCH grant University of Wisconsin Extension Serviceprovides technical assistance and training for home visitors, community health workers and others across the state Private Collaborative Partners The ECAC includes a number of private stakeholders who are also engaged in the State Home Visiting Program. These include the following key partners: Wisconsin Council for Children and Familiesadvocacy organization focused on improving child and family well-being and an active member of the ECAC Wisconsin Alliance for Infant Mental Healthadvocacy organization for early childhood mental health which also provides training and technical assistance to early childhood providers on incorporating early childhood mental health into existing programs; sponsor and co-developer of Infant Mental Health Endorsement and Infant Mental Health Certificate Program; active member of ECAC. School Readiness Philanthropy Groupprivate funding organization to support school readiness initiatives; also supports prevention of child abuse and neglect; active member of ECAC. Wisconsin Community Action Program Associationadvocacy organization focused on improving child and family well-being; economic support focus as well as early childhood, represented on ECAC. United Waykey funder of home visiting programs and other early childhood programs in many localities across the state; represented on ECAC Wisconsin Chapter of the American Academy of Pediatricsmembership and advocacy organization that works to assure optimal health and safety for all
Wisconsin children and to provide support and on-going education to WI pediatricians to provide the most effective health care services to children Partnership for Wisconsins Economic Successcoalition of private businesses serving as funders and advocates for improved early childhood programs and services; represented on ECAC Childrens Hospital and Health System (CHHS) an independent health care system of 12 separate entities dedicated to the health and well-being of children o includes the CAP Fund, a fundraising initiative of CHHS that provides financial support for child maltreatment prevention activities including home visiting throughout Wisconsin and is the home of the Outcomes Project o includes Prevent Child Abuse Wisconsin (PCAW), a statewide organization that provides materials and education and training on child maltreatment prevention; PCAW is the Wisconsin chapter affiliated with the Healthy Families America (HFA) evidence-based home visiting model Supporting Families Together Association (SFTA) an organization dedicated to directly improving early care and education and family support services by providers in a variety of ways including modeling, supporting, and growing best practices within the early care and education and family support field. Parents Plus of Wisconsin a statewide organization that includes parent education and support programs, as well as support for the professional development of family support professionals; it is the state office for Parents as Teachers (PAT), one of the evidence-based home visiting models adopted in Wisconsin
Other private partners Wisconsin Public Health Association (WPHA) an affiliate of APHA - statewide membership organization dedicated to improving Wisconsins health through effective policy advocacy, increasing public health capacity at the state and local levels and encouraging evidence-based prevention practices Wisconsin Association of Local Health Departments and Boards (WALHDAB) statewide organization of board of health members and health department administrators providing a unified forum for public health leadership development, advocacy, education, and forging of community partnerships for the improvement of public health at the local level. Wisconsin Association of Perinatal Care a statewide membership organization representing consumers as well as the multiple professional disciplines serving women, infants and families; aims to ensure access to quality care through policy advocacy, support and professional development opportunities Wisconsin Task Force on Perinatal Depression - a dedicated collaboration of state and non-profit agencies and individuals committed to promoting the mental health of all women, their infants, and families; promotes awareness and education of consumers and professionals, who are focused on understanding depression as a treatable medical condition from which recovery is possible
Black Health Coalition a Milwaukee community-based organization that aims to decrease the disparity of health status between the majority and minority communities through health advocacy, education, screenings, and promotion; build a cohesive health referral network to ensure greater access to health care; and encourage minority youth to become knowledgeable consumers of health care and to pursue careers in the health care professions
Wisconsin Home Visiting Program Staffing Structure State Home Visiting Coordinator The DCF Home Visiting Coordinator (HVC), Leslie McAllister, leads the Project Team in developing a coordinated statewide system of early childhood home visiting that is sustainable and has the capacity and infrastructure to support high quality, evidencebased practice. To achieve this goal, the HVC oversees existing DCF home visiting programs, provides ongoing consultation and technical assistance to local project staff, and assures coordination with the Title V MCH Program. The Coordinator collaborates with numerous state agency partners and local programs to develop an effective, comprehensive early childhood system that supports the lifelong health and well-being of children, parents and caregivers. As part of the coordination of services, the HVC represents the Department and Division on relevant statewide committees and workgroups related to early childhood care and education and family support. Roles/Responsibilities: Develops and oversees contracts with agencies providing home visiting services, training and technical assistance (TA) providers, and evaluators o Reviews reports submitted by programs, trainers and evaluators o Performs regular site visits with programs o Ensures effective two-way communication between evaluators and program staff Provides staff support to the ECAC Ad Hoc Committee on Home Visiting and its work groups Leads meetings of the inter-agency Project Team Organizes and hosts technical assistance sessions for home visiting programs across the state Authors/submits reports to HRSA/ACF, including any TA requests Convenes meetings of statewide home visiting providers, including specific meetings for grantees Attends all federal and regional meetings/conferences related to home visiting Home Visiting Performance Planner (To be hired through MCIEHV funds) This planning analyst position will develop performance measurement methods for home visiting services, including but not limited to performance measurement plans, methods and processes for a variety of tasks related to the delivery of home visiting services. The Performance Planner will have the responsibility to provide program monitoring and
training/technical assistance related to data collection, performance reporting, maintaining model fidelity and all Continuous Quality Improvement (CQI) activities. The position is also responsible for ensuring the States ability to meet federal Affordable Care Act reporting requirements, analyzing performance data and developing program improvement plans. Finally, this position acts as a liaison between the State and independent researchers and their respective institutions involved with research and/or program evaluations related to home visiting in Wisconsin. Home Visiting Nurse Consultant (To be hired through MCIEHV funds) This position will manage the day to day implementation of the home visitation grant in collaboration with the DCF Home Visiting Coordinator and provide leadership to assure: connection to the Title V MCH Program, supporting system integration, and public/private home visiting partnership programs. The position will provide guidance in the development of a coordinated statewide system of early childhood home visiting that is sustainable and has the capacity and infrastructure to support high quality evidencebased practice that improve key outcomes for families who reside in at risk communities in Wisconsin. The position will promote maternal, infant, and childhood health, safety and development and support local programs in providing services to those identified to be living in at risk communities across the state. Project Team An inter-agency Project Team is responsible for the day-to-day activities of the State Home Visiting Program. The Team is led by DCF and DHS, based on a long-term and on-going partnership to strengthen supports and interventions for young children and their families. Shared management of the Home Visiting Program provides an opportunity to continue the work to improve health and developmental outcomes for atrisk children and their families. The inter-agency Project Team is composed of representatives from the DCF prevention unit, MCH staff, the Head Start Collaborating Office, the Childrens Trust Fund (Title II of CAPTA), and DHSs Division of Mental Health and Substance Abuse Services. Additional staff from both departments will be added to the Project Team as needed to meet the goals of the grant. In addition, members of the Project Team have long-term relationships with other early childhood initiatives thus ensuring that the State Home Visiting Program is closely coordinated with existing efforts across the state. Examples include: Ann Stueck, the MCH Infant and Toddler nurse consultant, is the grant manager for the federally-supported Early Childhood Comprehensive Systems Grant (ECCS) which supports communities in their efforts to build and integrate early childhood service systems that address the critical physical, emotional and social needs of young children. Jennifer Jones, the Associate Director for Wisconsin Childrens Trust Fund, is leading the Strengthening Families Initiative that aims to integrate child
maltreatment prevention planning among state agencies with a family-centered approach that includes early childhood. Another member of the Project Team, Katie Gillespie, provides leadership for the states Prenatal Care Coordination (PNCC) program, funded by Medicaid, as well as the Wisconsin Task Force on Perinatal Depression. Members of the Project Team are also serving on the state and local councils of Project LAUNCH, which focuses on improving the systems that serve young children and address their physical, emotional, social, cognitive and behavioral growth. Several members of the Project Team are also active participants in the Wisconsin Early Childhood Collaborating Partners (WECCP), an organization that brings together local community groups, individuals, agencies, associations, and state government staff to work together as a system of high quality comprehensive early childhood and family support. The Project Team has and will continue to meet weekly to monitor the implementation of evidence-based home visiting programs. Weekly topics for discussion and action include but are not limited to: site specific issues, CQI efforts (both at the program and state level), monitoring data collection and reporting, implementation of the training/technical assistance plan, and maintaining meaningful connection with the ECAC. In December 2011, the Project Team will evaluate the need to continue weekly meetings while ensuring successful implementation of the state home visiting plan. The team will also ensure appropriate and timely communication with local programs and other community stakeholders. Finally, the team will assist the Ad Hoc Committee with identifying needed policy changes; and continue to identify issues for the workgroups. Early Childhood Advisory Council (ECAC) Under Wisconsin Executive Order #269, the Governors State Advisory Council on Early Childhood Education and Care was established in December 2008. The purpose of the Council is to build a comprehensive, sustainable early childhood system for Wisconsin. The Council is comprised of key leaders in early learning and care, health, child welfare, and mental health, as well as state agencies, advocacy organizations, philanthropy, business, higher education and others who serve young children and families. As part of their work to design an effective system of early childhood and family support services across Wisconsin, the members of the Early Childhood Advisory Council (ECAC) identified three critical goals of a comprehensive system: stable, nurturing and economically secure families; quality early learning; and safe and healthy children (free from abuse/neglect and access to quality medical carebroadly defined). Recognizing that home visiting can be an effective strategy for enhancing each of these domains, ECAC members added the Ad Hoc Committee on Home Visiting to their structure in October 2010. (See Attachment 7 for ECAC visual)
ECAC Ad Hoc Home Visiting Committee The charge to the Committee is to facilitate the expansion of evidence-based home visiting programs and incorporate home visiting into the Governors Early Childhood Advisory Councils model of a comprehensive early childhood system. The Committee serves as an advisor to DHS, DCF, DPI and the Childrens Trust Fund. The ad hoc committee meets bi-monthly, and is co-chaired by the Division Administrator for Safety and Permanence in DCF and the Director of Policy and Research, Office of Policy Initiatives and Budget in DHS. The key goals of Ad Hoc Committee on home visiting are to: 1. Review recommendations on mission, goals and objectives for home visiting programs/services in Wisconsin 2. Review and provide advice on recommended target populations and target communities 3. Provide suggestions for maximizing new resources available via ACA and other sources 4. Provide assistance in identifying strategies for expansion of evidencebased programs and those that meet federal criteria for promising practices, e.g., technical assistance approaches 5. Review and provide advice on prioritizing measures for evaluating Wisconsins home visiting programs. 6. Assist in ensuring that home visiting services are an integral component of Wisconsins early care and education system. State agency staff and members of the ECAC Ad Hoc Committee identified the need for two home visiting workgroupstraining/technical assistance and evaluation/program improvementto assist with the development of the state home visiting plan and the integration of evidence-based home visiting into the early childhood system. Guidance for the workgroups comes from the Ad Hoc Committee on Home Visiting and the Project Team. Evaluation and Program Improvement Workgroup The evaluation workgroup is co-chaired by DCF Research Analyst, Hilary Shager, and John Burgess, an Ad Hoc Committee member and local director of a private family-serving agency that includes an accredited Healthy Families America (HFA) program in its menu of services. Membership includes state staff from DHS, DPI and DCF, academic researchers, and local program personnel with expertise in collecting and analyzing data. The workgroup is responsible for making recommendations for the evaluation components of the state home visiting plan, e.g., process and outcome measures for all of the constructs in each of the designated benchmark areas. In addition, the workgroup will review and provide feedback on: local evaluation plans, data collection strategies, preparing
and reviewing evaluation reports, monitoring programs for fidelity to evidencebased models or promising practices, and making recommendations for program improvements. With guidance and support from the Home Visiting Performance Planner, the work group will also help develop and implement CQI processes in partnership with the funded sites. In addition, some members have agreed to provide technical assistance to local programs to assist with implementation of process for quality data collection. Training/Technical Assistance (T/TA) Workgroup The training and technical assistance workgroup is led by two appointed members of the ECAC, Lilly Irvin-Vitella, Executive Director of Supporting Families Together Association (SFTA) and Suzy Rodriguez, Director of Parents Plus of Wisconsin, the state Parents As Teachers (PAT) office. Members include state and local program staff; and individuals with expertise in training for public health nursing, early childhood and family support, child abuse prevention, AODA and mental health. The T/TA workgroup is responsible for developing the training and technical assistance components of the state home visiting plan. Critical elements of technical assistance to local home visiting programs include: designing strategies to assist with implementation of evidence-based programs in partnership with the selected model developers; identifying training needs and coordinating responses; using SPHERE and other databases as needed for data collection; and facilitating relationships/collaboration with other communitybased resources, e.g., family resource centers, work support programs, and child care programs. The training contractor(s) once identified - and representatives from both DCF and DHS will also participate in this workgroup. Members of the workgroup will be available as needed to provide initial assistance to the selected communities.
If the state is supporting more than one home visiting model within a community, a plan for coordination of referrals, assessment, and intake processes across the models. Each of the funded programs has expressed an interest in developing a single entry point for families with young children seeking services to meet their needs and a single referral and brief assessment process to match families with appropriate programs. Preliminary research has been conducted to identify potential models, e.g., Every Child Succeeds in Cincinnati and Help Me Grow in Cleveland. Additional research will be a priority in the near term. As model initiatives are identified, staff in the DHS Office of Policy Initiatives and Budget will do a brief analysis to identify common, critical elements and prepare an option paper for state and local home visiting staff. A two-hour technical assistance sessioneither in person or via teleconferencewill be held to discuss options and determine next steps.
As detailed in Section 4Implementation, the Wisconsin State Home Visiting Program is built on a long-history of collaborative partnerships with numerous stakeholders in a variety of domains, e.g., early childhood, maternal and child health, prenatal care, and system development efforts such as professional development that cuts across programs, common performance measures, and blended funding. These partnerships and collaborative efforts are fully described on pages 41-43. Section 4 also provides detailed descriptions of new partnerships that have been developing at the local level as well. Of particular note for the administration, is the potential partnership with the Early Years Home Visitation Outcomes Project. This evaluation project offers a solid foundation on which to build a more robust accountability process with all MIECHV funded programs and other home visiting programs that volunteer to participate. In addition, the project provides valuable lessons in developing processes for local programs to collect data in systemic ways, how to use the data for program improvement and how to use the data to tell the story and subsequently generate additional funding. Detailed description of how the proposed State Home Visiting Program will ensure: Well-trained, competent staff As part of the RFP process, applications were evaluated and scored based on their responses to the request for information regarding their plans for orienting, training, and supporting home visitors and their supervisors. Under Section 4.1 in the RFP on pages 30-31, the State requested that applicants supply the following detailed information related to staff selection, orientation, supervision and initial and on-going training and support: 1. A description of the agencys experience in employing and supervising both professional and paraprofessional employees. 2. A description of the agencys staffing structure for the proposed evidence-based home visiting program, including how staff meet the Medicaid PNCC, TCM and Child Care Coordination (in Racine and Milwaukee) billing requirements. (See Appendix 4, Wisconsin Medicaid (MA) and BadgerCare Plus (BC+) Case Management Benefits Program.) 3. A description of the agencys ability to recruit and hire qualified professional and paraprofessional staff that will deliver culturally competent home visiting services and are able to establish and maintain trusting relationships with families residing in the service area. 4. A description of the agencys orientation plan for program supervisors and home visiting staff.
5. A description of how the agency will assure that all staff have received basic training from the DCF training contractor(s). 6. A description of how the agency will assess continuing staff training needs and develop individual and agency training plans that address these needs. Many respondents included additional (not required) information by attaching existing or proposed job descriptions that outlined specific duties and minimum qualifications for positions supported by the funding opportunity. In addition to gathering important information from the sites regarding their plans for supporting well-trained staff via the RFP process, the State is committed to enhancing the statewide training and technical assistance infrastructure for home visiting. To that end, the State convened a Training and Technical Assistance work group that reports to the ECAC Ad Hoc Committee on Home Visiting. That work group has developed a plan to more effectively address the training needs of multiple professionals that work in home visiting programs. Building on the successes of the current system, the plan identifies the following for 2011 training priorities: 1. Updating Home Visitation Foundations (introductory course for beginning home visitors) curriculum to be more reflective of those newly adopted competencies outlined in the 2011 Home Visiting Competency Framework. 2. Development of a Home Visiting 201 and advanced trainings for more experienced home visitors 3. Enhancing training and supports specifically for home visiting program supervisors 4. Enhancing training and technical assistance regarding data collection, program evaluation and CQI efforts For more detailed information about the work groups process and intentions, please see the home visiting training plan outlined in Section 4. High quality supervision As part of the RFP process, applications were evaluated and scored based on their responses to the request for information regarding their plans for providing high quality supervision for their home visiting program staff. Under Section 4.1 in the RFP on pages 30-31, the State also requested that applicants supply the following detailed information related to meeting requirements of the models and expectations of the state with regard to high quality supervision: 1. A description of minimum amount of time supervision staff will spend in the field coaching and mentoring staff during home visits.
2. A description of the agencys plan for high quality, intensive supervision of home visiting staff. As part of its work to enhance the training and technical assistance system for home visiting programs in Wisconsin, the ECAC work group had much discussion about how to build a system that most effectively supports supervisors. The work group identified competencies that they felt were essential for supervisors to have, as well as gaps in current supervisor training and support. The work group recommended using the statewide conference to provide issue-specific training for supervisors and increasing their knowledge base about how to work with diverse community partners/stakeholders. In particular, the workgroup recommended taking a regional community of practice approach for supervisors that could both address the need for peer support and information sharing on best practices in the field as well as provide opportunities for supervisors to receive reflective supervision from qualified experts, which is often difficult for them to access locally. See the 2011 State Home Visiting Training Plan for additional information in Section 4 of the state plan. Organizational capacity As part of the RFP process, applications were evaluated and scored based on their responses to the request for information regarding their organizations capacity to implement the proposed evidence-based home visiting program. Under Section 4.1 in the RFP on page 30, the State requested that applicants supply the following detailed information in order to demonstrate organizational capacity to implement new or enhance existing evidence-based home visiting programs: 1. A description of how the proposed evidence-based home visiting program directly relates to the agencys overall mission and commitment to improving the lives of families with young children. 2. A description of the agencys experience in previous successful grant management. 3. A description of how agency collaborates with other organizations in the local community to develop a comprehensive and aligned system of early childhood education and family support services. 4. A description how the agency protects the confidentiality of client information, computer based, written and verbal, within the policies of the Health Information Portability and Accountability Act (HIPAA), the Federal Education Rights and Privacy Act (FERPA), and the IRB/human subject protections. Include descriptions of administration procedures that do not place individuals at risk of harm (e.g., questions related to domestic violence and child maltreatment reporting), and training for all relevant staff on these topics. 5. Appropriate documentation that demonstrates the agency is certified as a PNCC provider. Applicants not yet PNCC certified were required to provide the state an assurance that they would complete certification within 6 months of the grant award.
In addition to providing information to assess organizational readiness, the RFP process also provided insight into the kinds of technical assistance and support applying organizations may need to increase their organizational capacity to implement high quality evidence-based programs. Similar to the results of the provider survey completed for the needs assessment and the CTF Prevention Survey, all applicants whether they will be awarded funds this round or not could significantly benefit from technical assistance and support in the areas of model implementation, program sustainability, developing and maintaining data collection systems and program evaluation/CQI. These identified areas of need for specific technical assistance will be prioritized in the work plans over the coming years for the State home visiting staff as well as reflected in the offerings from the training and technical assistance provider(s). Referral and service networks As part of the RFP process outlined on pages 32-33, applications were evaluated and scored based on their responses to the request for information regarding the readiness of the organization and the community to successfully implement the proposed evidencebased home visiting program. Recognizing that home visiting programs are more effective when they are a part of a system or continuum of services and supports for families and their young children that are well-coordinated and easily accessible, the State required the respondents to the RFP to supply the following: 1. A description of how the agency will involve members of the community and relevant community agencies, including faith-based organizations, in the planning and implementation of the program to assure the system of services are coordinated, family-centered, community-based, and culturally-appropriate to meet the needs of families in the service area. 2. A description of how the agency will work with key local, county, tribal and/or other private non-profit agencies and providers, and explain how these coordination efforts will relate to the proposed goals and operation of the program. 3. A plan for coordination among existing programs and resources in the community (system of care), including how the home visiting program will address existing service gaps. 4. A description of how the program stakeholders will be involved in the program evaluation and quality improvement processes. 5. A description of the primary role of key partners to assist the proposed home visiting program achieve the desired outcomes for women and families with infants and young children
6. A Memorandum of Understanding (MOU) from each key partner identified that outlines the roles and responsibilities of each partner agency or local government department as well as describes the referral process in detail. Integrating evidence-based home visiting into the early childhood system at the state and local levels remains a priority for DCF, DHS and its partners. The Project Team meetings will continue to provide a mechanism to keep home visiting connected to Project LAUNCH, ECCS, WECCP, DPIs Longitudinal Data System Project and other statewide early childhood efforts. Home visiting state staff specifically will continue to support developing programs to build meaningful collaborations with other organizations that serve pregnant women and families with young children. As part of the CQI process, funded programs will be required to regularly assess the quality and functionality of those collaborations. Finally, the ECAC will continue under the current administration to provide leadership and direction for how to ensure systems integration happens at both the state and local levels. Maintaining Model Fidelity As described in more detail in Sections 3, 5 and 7, Wisconsin is committed to developing a strong infrastructure to support programs to maintain a high level of model fidelity as well as systems to improve the programs abilities to collect data, evaluate programs and engage in Continuous Quality Improvement (CQI) efforts at the state and local levels. A critical component of CQI is creating mechanisms to monitor new and enhanced programs with special attention to how well the program is implementing the model requirements. With the addition of the Home Visiting Performance Planner, the State will have added capacity to provide the technical support necessary to help programs implement the evidence-based home visiting models with fidelity. In addition, the State will work with the national model developers to ensure that the selected sites maintain certification or accreditation with the model being implemented. Finally, the State is planning to partner with the Early Years Home Visitation Outcomes Project on their Pew Foundation funded project to develop and test a tool to assess quality across home visiting models.
Section 7: Plan for Continuous Quality Improvement

States must propose a plan describing how continuous quality improvement strategies will be utilized at the local and State levels. Wisconsin recognizes the importance of building a culture of quality and encouraging data driven decision making by its home visiting programs. Therefore, the State plans to develop a strong infrastructure to support Continuous Quality Improvement (CQI) efforts at the state and local levels. Important elements of this infrastructure at the state level will include: 1. Hiring of a Home Visiting Performance Planner at DCF This staff person will serve as the coordinator of state level CQI efforts and supporter of local efforts. Duties will include contract oversight and training/technical assistance related to all CQI activities. (See attached position description for more detail.) 2. Ongoing assistance from the Home Visiting Evaluation and Program Improvement Work Group, in consultation with local program staff and other stakeholders This group will continue to provide guidance around data collection and analysis, including, but not limited to: o Identification of priority outcomes based on community and state needs and goals o Development of benchmark targets for these priority outcomes 3. Development of a home visiting dashboard As recommended in federal calls focused on CQI, the state will develop a 1-page dashboard identifying state and local progress on a handful of priority benchmark areas, to be updated and shared with funded programs on a regular basis. Development of this dashboard will be guided by the principles encouraged in the January 13, 2011 DOHVE webinar, Building a Culture of Quality in Home Visiting: o Reporting metrics are meaningful o Data elements are relevant, accurate and important o Reports are timely and recent o Reports show performance relative to targets o Reports show changes over time o Reports break out small units State home visiting staff will also provide leadership regarding the interpretation and application of information from the dashboard to local practice, focusing on both program strengths and challenges.
4. Ongoing enhancement of the SPHERE data system Developers of the SPHERE data system have a history of working with and responding to the needs of SPHERE users. The State will continue to work with local programs to identify needed improvements to SPHERE and financially support enhancements to the system that: o Improve the ease and quality of data collection required for federal reporting on the MIECHV benchmark areas o Improve the ease and quality of generated reports to be used for local CQI and management efforts 5. Development of peer learning networks The Home Visiting Coordinator will facilitate the development of home visiting program peer learning networks, to share CQI strategies, building on the following successful models already operating in Wisconsin, the State will: o Support the Milwaukee Maternal & Child Home Visitation Community of Practice that has recently developed by EFM and its community partners with the intention to engage all Milwaukee-area home visiting practitioners at the direct service and supervisor/administrator levels to improve the way they work together, including sharing resources/tools, making referrals, implementing best practice standards, and keeping informed about one anothers programs. o Develop Regional Communities of Practice based on the Milwaukee experience with a focus on supervisors for the purposes of information and resource sharing as well as providing a venue for them to receive reflective supervision from a qualified professional and to encourage further development of their own reflective practice. o Partner with The Early Years Home Visitation Outcomes Project of Wisconsin to assist home visiting programs to collect clean data and use that data to inform program improvement efforts. 6. Dissemination of CQI research and best practices The Home Visiting Coordinator and Performance Planner will continue to review the literature and participate in federal technical assistance opportunities regarding CQI. Learning will be shared via the following forums: o Home Visiting Newsletter o State Home Visiting Website o Home Visiting Tool Kit o Regular site visits 7. Include semi-annual review of the funded programs CQI plans as critical element of the contract monitoring process
Wisconsin is also a pilot site for the Pew Center on the States home visiting quality assessment tool project. This tool will measure program quality across various home visiting models and is designed to be useful to home visitation programs and policy makers to determine the extent to which they are providing quality services. The State will closely monitor and widely share results from the ongoing pilot, and provide support to the research project as needed. In addition, via the RFP process, funded programs were asked to develop individualized CQI plans, detailed as follows: EMPOWERING FAMILIES OF MILWAUKEE Continuous Quality Improvement (CQI) is a central focus of Empowering Families of Milwaukees service delivery. Benchmark data is used to determine areas of strength and areas of improvement in attaining outcomes for families. The Program Manager reviews Outcomes Attainment Reports quarterly and develops CQI strategies accordingly. EFM works closely with its training partner, the UW Cooperative Extension - Milwaukee, to develop strategic plans to implement these CQI strategies. CQI efforts range from program training, policy and procedure updates, protocol implementation, one-on-one supervision, training specific supervisors, community outreach and collaboration, and strategic planning. The Program Manager also provides a presentation to EFM staff biannually to solicit feedback and involve them in long-term, big-picture program improvement efforts. EFM also obtains feedback yearly on the quality and effectiveness of its services from both its direct service providers and the families the program serves. These confidential surveys help guide program improvement and strategic planning. At each monthly EFM all staff meeting, staff is provided an opportunity to complete a feedback form or Speak up Sheet to submit questions or concerns in a confidential manner. The Program manager provides response, discussion, and directives to these feedback requests at each subsequent monthly staff meeting. The EFM program has also employed the use of audio-recorded interviews through its Ecocultural Family Interview Project, to provide 1:1 feedback to staff regarding service delivery and helping to identify client strengths and area for improved care planning. This practice is transitioning into the use of recording a home visit for supervisory feedback on Motivational Interviewing with families to more effectively guide them toward change. GREEN COUNTY Continuous quality improvement will occur at the direct service level through data review and adjustments made between the Program supervisor and individual staff, and also at the program level by the Green County Health Department and the Dane County Parent Council agency directors with input from the Community Advisory Committee. Program data will be reviewed monthly and inconsistencies or gaps will be addressed with each
individual home visitor. Program data will be shared at staff meetings with home visitors, the data specialist, and the public health nurse identifying areas for improvement. This strategy for continuous quality improvement builds upon the strengths of the staff team with suggestions based on their expertise and familiarity with services delivery rather than suggestions only coming from supervisors or directors. The data will be aggregated and disaggregated to allow a thorough understanding of the impact of programming for specific populations and locations and to help identify service delivery strengths and gaps to ensure a comprehensive approach to quality improvements. Results of staff and program supervisor data reviews and corresponding suggestions for improvement will be shared with the Community Advisory Committee for input. The Green County Health Department and the Dane County Parent Council directors will present recommendations for program adjustments to the Dane County Parent Councils Executive Director and Board and the Green County Health Committee for final approval. LAC COURTE OREILLES TRIBE The Project Coordinator, in collaboration with program staff members, will monitor the effectiveness for the home visiting model and fidelity of program implementation. A protocol with specific procedures for conducting the home visiting program will be established during the first six months. The Project coordinator will conduct self-studies every six months and more frequently if needed to determine whether the project is being conducted in a manner consistent with the work plan and consistent with the selected Healthy Families America model. The self-study sessions will include time for a group discussion of how the program is being implemented, staff roles and responsibilities, community resource needs, issues related to implementing the program in Tribal communities, successes, challenges, and lessons learned. The Project Coordinator will provide and/or make arrangements for technical assistance as needed to improve the program. The Healthy Families America Self- Assessment Tool will be used to guide program implementation and to document the continuous quality improvement (CQI) process. Each of the HFA 12 critical elements, along with governance and administration, contains a series of best practice standards for the home visiting model. The on-going self-study will determine if the program is not meeting, meeting or exceeding the standards. Quality improvement plans will be implemented to address standards that are rated out of adherence. In addition, the Program Coordinator will run monthly SPHERE reports to monitor caseloads, services provided, and outcomes. The CQI process will also include the annual site-specific and aggregate data reports provided by the UW Evaluator that allow each Tribal site to compare its benchmark data with the cross-site averages. Program staff will share their challenges and successful strategies at staff meetings to help improve the efficiency and effectiveness of service delivery.
Section 8: Technical Assistance Needs

To continue to build our capacity to implement evidence-based home visiting programs with a high degree of model fidelity and integrate them into robust early childhood systems at the local level, Wisconsin intends to take advantage of the technical assistance provided through the MIECHV Program. Possible topics for requested technical assistance: Developing statewide training/technical assistance system: 1. For this first phase of implementation of the MIECHV funds, the three program models represented in the selected sites HFA, Early Head Start and PAT will continue to be engaged in the process to further develop the Wisconsin Home Visiting Training and Technical Assistance system. Currently, the state offices for PAT and HFA are part of the Training/TA work group, and they will continue to provide insight and support to ensure that the training requirements for staff from those models will be met and efficiencies for regional or multi-state training can be realized. Similarly, the federally contracted EHS Training/TA provider is also committed to maintaining connection with the work group. Wherever possible, the State would like to ensure that limited training dollars are used efficiently, across models. 2. Along with the model developers, the organization (or consortia of organizations) that will be contracted with for coordination of training/TA and state agency staff will be researching how to more effectively and efficiently use technology for some of the training and follow-up TA from the training. These ideas include: providing monthly calls (i.e., through the WisLine system) with staff (home visitors, supervisors or both) for extra content training, follow up from more formal training or training on data base/data collection and reporting; developing a series of webinars that can be archived and made available on the DCF and its partners websites that staff can access as needed; and creating an inventory of potential on-line training from model developers or other national early childhood and family support organizations. This may be an area that HHS could offer TA, since many states would be in the same position. 3. As mentioned in previous sections, for some of the programs that are new or implementing a new model with blended funds, targeting families that have multiple risks and may be involved in multiple systems may present added challenges. Some special training may be available through the regional training system for child protective services staff operated by the UW School of Human Ecology/Child Welfare Professional Development System. Given that programs
across the country that are funded through these funds are being asked to serve families that are difficult to engage, HHS may want to consider contracting with national or regional trainers on this topic. 4. The Training/TA workgroup is particularly interested in developing multiple methods for evaluating the effectiveness of the training home visitors and their supervisors receive and the technical assistance programs that are offered. There may be some expertise in the University and Extensions systems, and Wisconsin would take advantage of other opportunities should HHS be able to contract with national trainers on this topic as well. 5. One additional goal for the development of a Training/TA system for home visiting in Wisconsin involves the development of a peer review process. DCF has had some experience with national trainers in the development of our Quality Service Review process used to evaluate initial assessment and other processes in the child welfare system. There is interest in developing a similar QSR-type protocol for prevention services, including home visiting, and any TA available from the models or HHS would be welcome. 6. As described in Section 6, Wisconsin is interested in assisting communities to develop a single entry point for families with young children seeking services to meet their needs and a single referral and brief assessment process to match families with appropriate programs. The DHS Office of Policy Initiatives and Budget has agreed to conduct an analysis to identify common, critical elements and prepare an option paper for state and local home visiting staff, as well as host a TA session for interested sites. Technical assistance from HHS related to a common intake/referral process for multiple home visiting/family support programs would be useful as we put together this session for sites. Creating a long-term vision for home visiting: 1. Through the RFP process, Wisconsin was able to obtain up-to-date information about the capacity of some of the organizations in the identified 18 at-risk communities to provide high quality evidence-based home visiting programs. On-going work will be done to develop the State process for helping those communities build additional capacity so that new sites can be added over time and to ensure that those programs are well-integrated into the early childhood systems at the state and local level. However, DCF, DHS and the other state agency partners would benefit from technical assistance to help existing home visiting and family support programs that are not in the 18 identified communities move to evidence-based programming as well as become more integrated in to the States overall home visiting program.
2. One critical piece for the development of a comprehensive early childhood education and family support system would be to identify additional and on-going sources of funds for home visiting and other programs that support pregnant and parenting families with young children federal grants, local foundations, and public sector philanthropists. Keeping home visiting connected to the Wisconsin ECAC is key, not only because it includes representatives from the business and philanthropic communities, but also so that support for families with children 0-3 is included in any long-term strategy to develop a truly comprehensive system. As always, it is helpful to hear about how other states are developing publicprivate partnerships for early childhood systems. Technical assistance for ongoing integration of family support home visiting specifically into the early childhood system would be useful. Data and Information Systems/Program Evaluation: 1. Wisconsin will need TA from HHS (perhaps through the DOHVE group or the Head Start T/TA Center) to help create a mechanism in the data collection system(s) to be able to identify particular participant as MIECHV funded, similar to the identification of Head Start families by slots paid for with certain funding streams. 2. As described in Section 3, the State is concerned that by aggregating data at the State level, we face the risk of diluting potential program success. As explained in that Section, models vary according to program focus and tools used to achieve a particular goal. At the same time, the local communities have identified their program models based on their perception of the primary needs of their target populations, which vary from community to community. Given that many other states have chosen to implement more than one home visiting model, we hope to receive additional technical assistance on how to deal with this issue throughout the reporting process. 3. As described in Section 7, the state will develop a 1-page dashboard identifying state and local progress on a handful of priority benchmark areas, to be updated and shared with funded programs on a regular basis. Wisconsin will request TA from the DOHVE group to assist in the development of the dashboard, as well as strategies for local programs to use the dashboard for CQI and marketing purposes. 4. It would also be helpful for HHS to help states identify strategies to leverage resources for program evaluation both implementation evaluation and impact studies at the local and state level. As a part of that TA, it would be helpful for local programs to be able to more effectively use data to tell their stories about the success of the programs in helping families be more stable and healthy.
Section 9: Reporting Requirements

The state will provide reports at the required intervals with the following headings: State Home Visiting Program Goals and Objectives Wisconsin will include information about progress made under each goal and objective during the reporting period, including any barriers to progress that have been encountered and strategies/steps taken to overcome them. The Wisconsin report will include information about updates/revisions to goal(s) and objectives identified in the Updated State Plan. To the extent not articulated above, the Wisconsin annual home visiting program report will include a brief summary regarding the States efforts to contribute to a comprehensive high-quality early childhood system, using the logic model provided in the Updated State Plan. We will identify updates or changes to logic model, if necessary. Implementation of Home Visiting Program in Targeted At-risk Communities The annual home visiting progress report will also include updates regarding experience in planning and implementing the home visiting programs identified in the Updated State Plan including a discussion of challenges encountered and steps taken to overcome those challenges - addressing each of the following items: 1. The States progress for engaging the at-risk community(ies) in the proposed State Home Visiting Plan 2. Update on work-to-date with national model developer(s) and a description of the technical assistance and support provided to-date through the national model(s); 3. Based on the timeline provided in Updated State Plan, an update on securing curriculum and other materials needed for the home visiting program 4. Update on training and professional development activities obtained from the national model developer, or provided by the State or the implementing local agencies 5. Update on staff recruitment, hiring, and retention for all positions including subcontracts
6. Update on participant recruitment and retention efforts 7. Status of home visiting program caseload within each at-risk community; 8. Update on the coordination between home visiting program(s) and other existing programs and resources in those communities (e.g., health, mental health, early childhood development, substance abuse, domestic violence prevention, child maltreatment prevention, child welfare, education, and other social and health services); and 9. A discussion of anticipated challenges to maintaining quality and fidelity of each home visiting program, and the proposed response to the issues identified. Progress Toward Meeting Legislatively Mandated Benchmarks The home visiting annual report will also include an update regarding data collection efforts for each of the six benchmark areas, including an update on data collected on all constructs within each benchmark area including definitions of what constitutes improvement, sources of data for each measure utilized, barriers/challenges encountered during data collection efforts, and steps taken to overcome them. Home Visiting Programs CQI Efforts The annual report will also include an update on States efforts regarding planning and implementing CQI for the home visiting program, including copies of CQI reports developed, addressing opportunities, changes implemented, data collected, and results obtained. Administration of State Home Visiting Program The annual report will also include the following updates related to the administration of the State Home Visiting Program: 1. Updated organization chart, if applicable 2. Updates regarding changes to key personnel if any 3. An update on efforts in Wisconsin to meet the following legislative requirements, including a discussion of any barriers/challenges encountered and steps taken to overcome the identified barriers/challenges: Training efforts to ensure well-trained, competent staff; Steps taken to ensure high quality supervision; Steps taken to ensure referral and services networks to support the home visiting program and the families it serves in at-risk communities; and
4. Updates on new policy(ies) created by the State to support home visiting programs. Technical Assistance Needs Finally, the annual progress report will include an update on technical assistance needs anticipated for implementing the home visiting program or for developing a statewide early childhood system.
References Applied Population Laboratory of UW-Extension. (2010). Wisconsin Poverty Projections through 2010. Retrieved April 20, 2011, from Applied Population Laboratory: http://www.apl.wisc.edu/ Brookings Institute. (2010, December 16). New Racial Segregation Measures for States and Large Metropolitan Areas: Analysis of the 2005-2009 American Community Survey. Retrieved April 20, 2011, from Brookings: http://censusscope.org/ACS/Segregation.html Caldwell, B.M., and Bradley, R.H. (2001). Home Inventory Administration Manual, Third Edition, 2001. Little Rock, AR: University of Arkansas at Little Rock. Caldwell, B. M., & Bradley, R. H. (n.d.) Psychometric characteristics. Unpublished manuscript. Centre for Community Child Health. (2009). The Impact of Poverty on Early Childhood Development. Retrieved May 10, 2011, from The Royal Childrens Hospital Melbourne: http://www.rch.org.au/emplibary/ccch/PB14_Impact_Poverty_ECD.pdf Chen, H.-Y. B. (2010). Milwaukee Health Report 2010: Health disparities in Milwaukee by socioeconomic status. Milwaukee, WI: Center for Urban Population Health. City of Milwaukee Health Department. (2011). City of Milwaukee Health Department. Retrieved April 19, 2011, form Infant Mortality: http://city.milwaukee.gov/InfantMortality.htm Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the United States. In S. Spacapan & S. Oskamp (Eds.), The social psychology of health: Claremont Symposium on applied social psychology. Newbury Park, CA: Sage. Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782-786. Greater Milwaukee Foundation. (2010, December 16). Greater Milwaukee Foundation. Retrieved April 13, 2011, from Greater Milwaukee Foundation: http://www.greatermilwaukeefoundation.org/research/poverty.html Jane, M. (2001). Host defense benefits of breastfeeding for the infant effect of breastfeeding: Duration and exclusivity. Pediatric Clinics of North America, 48(1).
Kramer, M. C.-B. (2010). Metropolitan isolation segregation and Black-White disparities in very preterm birth: a test of mediating pathways and variance explained. Social Science and Medicine, 2108-16. McGauhey, P. J., Starfiedl, B., Alexander, C., Ensminger, M. E. (1991). Social environment and vulnerability of low birth weight children: a social-epidemiological perspective. Pediatrics, 88(5), 943-53. National Center on Child Abuse Prevention Research. (2005). Alphabetical listing of annotated measurement tools: Edinburgh Postnatal Depression Scale (EPDS). Retrieved May 29, 2011, from http://www.friendsnrc.org/evaluation-toolkit/compendium-ofannotated-tools/tools-by-alphabetical-listing. Paulsell, D., Avellar, S., Sama Martin, E., & Del Grosso, P. (2010). Home Visiting Evidence of Effectiveness Review: Executive Summary. Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Washington, DC. Squires, J., Bricker, D., Twombly, E., Nickel, R., Clifford, J., Murphy, K. Hoselton, R., Potter, L. Mounts, L, & Farrell, J. (2009). Ages and Stages Questionnaires: A ParentCompleted, Child Monitoring System, Third Edition. Baltimore, MD: Paul Brookes. Squires, J., Bricker, D., Twombly, E., Yockelson, S., Davis, M. S., & Kim, Y. (2002). Ages & Stages Questionnaires: Social-Emotional (ASQ:SE): A Parent-Completed, ChildMonitoring System for Social-Emotional Behaviors. Baltimore, MD: Paul Brookes. Totsika, V., & Sylva, K. (2004). The Home Observation for Measurement of the Environment revisited. Child and Adolescent Mental Health, 9(1), 2535. University of Wisconsin-Milwaukee Employment and Training Institute. (2009, December). Drilldown on African American Male Unemployment and Workforce Needs. Retrieved April 13, 2011, from University of Wisconsin-Milwaukee Employment and Training Institute: http://www4/uwm.edu/eti/2009/AfricanAmericanMaleWorkforce.pdf Voskuil, K. R., Palmersheim, K. A., Glysch, R. L., Jones, N. R. (2010). Burden of Tobacco in Wisconsin: 2010 Edition. University of Wisconsin Carbone Cancer Center: Madison, WI. Wilkinson, R. a. (2003). Social determinants of health: The solid facts. (Second Edition). Retrieved May 10, 2011, from World Health Organization Europe: http://www.euro.who.int/_data/assets/pdf_file/0005/98438/e81384.pdf
Wisconsin Council on Children and Families. (2009). Kids Count Data Center. Retrieved April 19, 2011, from Annie E. Casey Foundation: http://datacenter.kidscount.org/data/bystate/Rankings.aspx?state=WI&ind=3457 Wisconsin Department of Health Services. (2011, March 9). Wisconsin Interactive Statistics on Health (WISH). Retrieved April 28, 2011, form Wisconsin Department of Health Services: http://www.dhs.wisconsin.gov/wish/ Wisconsin Department of Health Services, Division of Public Health and Division of Mental Health and Substance Abuse Services. (2010). Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, 2010. Madison, WI: Population Health Information Section, Division of Public Health.
Attachment 1 Logic Model Name: Wisconsins Home Visiting System Plan Vision: Every Wisconsin Child Beginning at Birth Will Be Healthy, Nurtured, Safe and Successful Primary Goal: By December 31, 2017, a statewide system is established for at-risk Wisconsin communities that supports evidence-based home visiting as part of a robust early childhood education system for expectant and parenting families with children through the childs 6th birthday to promote optimal physical, social-emotional and developmental health, early learning, and safety. Process Components
Inputs At the State Level
STATEWIDE PARTNERS: DCF - State Child Welfare Program - State TANF Program - State Head Start Collaboration Office - State child care program DHS - State MCH/CYSHCN programs - State Medicaid Program - State WIC Program - State Substance Abuse/Mental Health Programs - Birth to 3 Program - Oral Health Program - Family Planning Program DPI - Early Childhood Special Education - 4-K program - Head Start/ Early Head Start Childrens Trust Fund - Child Abuse Prevention Board - State family support & parent education program DOJ -Juvenile Corrections Programs FUNDING: - Federal ACA - Federal TANF (Milwaukee) - State GPR - local match $ - Program generated funds (Medicaid) - Local grant dollars REFERENCE STANDARDS: -Bright Futures 3rd Edition
Outcomes
Strategies - Activities
State Activities: - Select the number of at-risk communities and Tribes via a competitive Request for Proposal using braided federal and state GPR dollars - Develop and phase in a statewide training and technical assistance structure to support implementation and management of evidence-based home visiting programs - Develop evaluation and program improvement strategies within programs and assure accurate data collection - Use the CQI process to identify issues and potential solutions and bring to ECAC, the Ad Hoc Committee on Home Visiting or department leaders for action as needed - Develop regional program of peer mentors to support implementation and on-going operations. - Assist local community collaborative groups throughout Wisconsin to develop a local community plan to ensure that evidence-based home visiting is embedded in early childhood systems.
Inputs At the local level

- Local home visiting and family support programs - All early childhood service providers, including schools - Local Health Departments - County Human Service & Social Service Departments - Primary Care Providers -Local community early childhood collaborative groups - local public and private stakeholders who provide support, training, funds, services, policy for expectant parents and families with young children in home visiting programs - local business and community leaders
SHORT-TERM Outcomes
State: - up to 10 communities are awarded funds to develop new or enhance existing evidence-based home visiting programs - technical assistance plan to address local program needs - communication plan - Trained group of mentors to work individually with programs Local: - Home visiting programs are better prepared to serve highrisk families - Home visitors demonstrate skills and abilities consistent with the training program expectations of the State training plan and the evidence-based model program - County human services and public health departments, family support agencies, child care providers, schools and health care providers are working collaboratively and sharing community resources in the development of a comprehensive early childhood and family support system for expectant parents and families with young children
INTERMEDIATE Outcomes
State: - Home visiting is incorporated into the states early childhood system (through ECCS, Project LAUNCH, ECAC?)
LONG-TERM Outcomes
- Improved child health, development and safety * - Reduction of child abuse and neglect.*
- Use data in policy and financial - Improved school readiness of decision-making all children at time of entry into kindergarten.* - Improve allocation of resources for young children - Increased access to home visiting services for high-risk families living in at-risk communities - Increased use of common messages throughout Wisconsin across all service providers for expectant and parenting families with young children consistent with their evidence-based program model and the AAP Bright Futures standards. Local: - Home visiting programs in at risk communities and Tribes in WI demonstrate capacity to obtain reimbursement for services that meet requirements of the state Medicaid program. - Increased capacity in at risk communities and Tribes in WI for expectant parents and families with young children to access preventive health services - Reduction in preterm birth especially for disparate groups - Reduction in low birth weight especially for disparate groups - Reduction in infant mortality especially for disparate groups - Reduction of incidents of domestic violence. - Reduction in number of childhood injuries - Reduction in number of emergency room visits - Reduction of drug/alcohol use - Improved maternal health and well being - Improved family functioning in areas of positive parenting - Improved stability and family economic self-sufficiency -- Home visiting programs in at
Process Components
- Curricula: Great Beginnings Prenatal, Model program materials - Screening Tools: ASQ, ASQSE, HOME, DPH Home Safety Tool -Injury program materials - Infant Mental Health Endorsement & related materials Pyramid Model for social-emotional wellness - WI Model Early Learning Standards - Evidence-based model programs: Nurse-Family Partnership, Healthy Families, Parents as Teachers, Early Head Start, HIPPY LEAD STATE STAFF Leslie McAllister DCF Hilary Shager-DCF/OPQA Kim Eithun-Harshner DCF Jean Zawacki DCF/W-2 Mai Zong Vue DCF/Refugee Services Ann Altman Stueck DHS Katie Gillespie - DHS Jennifer Jones CTF Linda Leonhart DCF/HSSCO Bernestine Jeffers DHS/SAMHS Linda Hale-WI MCH Program David Rynearson DHS/Tribal Affairs Jill Haglund - DPI Other Key Collaborators - Early Childhood Advisory Council (ECAC) - WI Early Childhood Collaborating Partners/ECCS - State Domestic Violence program -Wisconsin Head Start Association - Federally qualified health centers - Managed Care Organizations
Outcomes
Strategies - Activities
Local Activities: - Communities select evidencebased home visiting model(s) appropriate for their needs - Programs employ effective, culturally relevant outreach and engagement strategies to engage high-risk families in the services - A local collaboration made up of a range of early childhood and family support providers in each at risk community and Tribe guides implementation and on-going operations
SHORT-TERM Outcomes
- Home visitors have increased capacity to identify and prioritize family needs and provide appropriate referrals to services and other resources - Increased capacity to promote maternal health and well-being including depression screening during prenatal, interconception and preconception periods. - Consistent data collection across programs
INTERMEDIATE Outcomes
- Increased access to socialemotional and developmental screenings at recommended frequencies - Parents demonstrate increased expectation for routine developmental screening of their young children and referrals to services if needed.
LONG-TERM Outcomes
risk communities and Tribes that implement evidence-based home visiting models have stable, sustainable funding.
* indicates a high priority for the ECAC Ad Hoc Committee on Home Visiting
Process Components
- WI-Alliance for Infant Mental Health - CAP-Fund - Home Visiting Outcomes Project - UW-Extension - AAP-WI Chapter - Parents Plus - Supporting Families Together Association - Prevent Child Abuse WI - WI Council Children/Families - Business and community leaders throughout Wisconsin
Outcomes
Strategies - Activities SHORT-TERM Outcomes INTERMEDIATE Outcomes LONG-TERM Outcomes
228 S. Wabash, 10 Floor Chicago, IL 60604 312.663.3520 healthyfamiliesamerica.org
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June 6, 2011
Leslie McAllister, MSSW Home Visiting Coordinator Division of Safety and Permanence Department of Children and Families 201 E Washington Room E200 Madison, WI 53708 Re: Documentation of Approval to Utilize the HFA Model Dear Ms. McAllister: This letter is in response to the requirement of the Supplemental Information Request (SIR) from the Affordable Care Act Maternal, Infant and Early Childhood Home Visiting Program (MIECHV Program) to obtain documentation of approval by the model developer to implement the model as proposed. We have had an opportunity to review the information you provided regarding implementation of the Healthy Families America (HFA) model in Wisconsin and any intentions to implement adaptations to the HFA model. This letter outlines the approval from the HFA national office at Prevent Child Abuse America to use the HFA model in Wisconsin (herein referred to as the State). Approval to make adaptation to the model has not been granted as adaptations were not proposed. Currently, HFA is present in 35 states and D.C., including 4 existing HFA program sites in Wisconsin. We understand that given the current funding available in the initial year through the MIECHV program the State has made its decision about the distribution of funds and the selection of home visiting models. Specific to HFA, the funds will be used to implement HFA in 4 locations identified as being at highest risk based on the States Home Visiting Needs Assessment. These locations include: 1. Milwaukee through the City of Milwaukee Health Department (a new HFA affiliate) 2. Lac Courtes Orielles Tribe through the tribal Community Health Center (a new HFA affiliate) 3. Lincoln/Oneida/Forest Counties through Childrens Service Society of Wisconsin (a new HFA affiliate) 4. Racine County through Childrens Service Society of Wisconsin (a new HFA affiliate)
Prevent Child Abuse America
The State agrees to require that all program sites choosing to implement the HFA model will complete the application process to affiliate with HFA. Should any additional HFA sites be established in Wisconsin at a later time, those sites will also be required to affiliate with the HFA National Office. The State has also agreed to pay the required annual fees ($1,350 in 2011) and purchase necessary HFA training for program staff utilizing national certified HFA trainers, with the option of developing in-state training capacity through HFAs trainer-thetrainer process. The State has indicated its intent to work in partnership with the HFA National Office to obtain model specific technical assistance and support related to site planning, development, implementation, and accreditation. Technical assistance will be made available to you from the HFA National Offices Central Region Director at no cost via phone and email, and at a cost of $1,250 per day plus travel for on-site technical assistance. Finally, the above-mentioned programs will continue to utilize the Born to Learn (Parents as Teachers) curriculum. In order to maintain HFA affiliation and the right to use the Healthy Families America name and to insure model fidelity, the State agrees that within the first 3 years of site affiliation, each HFA site will complete the accreditation process and again every 4 years thereafter. The State also agrees to complete, or to require that each site complete, an annual site survey (distributed by PCA America on an annual basis), and to utilize a data management system to better provide information to the National Office. It is PCA Americas intention to affiliate individual program sites and multi-site systems and to authorize use of the name Healthy Families and use of variations of the name (i.e., Healthy Families Place, County, or City), provided they are committed to the best practice standards identified by PCA America through research. Should there be any instance that would impede the programs ability to implement the critical elements (such as a loss of funding, etc.), it is understood that it is the programs responsibility to notify PCA America immediately. It is also understood that PCA America is the sole grantee of the right to use the HFA name and/or affiliation with the HFA initiative. PCA America reserves the right to revoke use of the name, and/or affiliation with the Healthy Families initiative, at any time before, during, or after the community/program enters the HFA Accreditation process. Finally, once entering the HFA Accreditation process, it is understood that the program will be subject to the policies and procedures of that process. We are pleased to grant approval to the State of Wisconsins Department of Children and Families to implement the HFA model. If you would like to discuss this further, I can be reached at kstrader@preventchildabuse.org or 248.988.8990. I applaud your commitment to Wisconsins children and families and look forward to working together in partnership with you. Sincerely,
Kathleen Strader, MSW Director, HFA Central Region Prevent Child Abuse America
Cc:
Cydney M. Wessel, MSW Senior Director of HFA Prevent Child Abuse America
Prevent Child Abuse America 2
Attachment 4 Home Visiting Performance Planner Position Summary Under the general direction of the Manager of the Prevention and Service Integration Unit in the Bureau of Safety and Well-being in the Division of Safety and Permanence, this planning analyst position is responsible for developing and implementing performance measurement methods for home visiting services. The position develops performance measurement plans, methods and processes for a variety of tasks related to the delivery of home visiting services, including home visiting programs and all associated training and technical assistance services. The Performance Planner will have the responsibility to provide contract oversight and training/technical assistance related to data collection, performance reporting, maintaining model fidelity and all Continuous Quality Improvement (CQI) activities. The position is also responsible for ensuring the Departments ability to meet federal Affordable Care Act reporting requirements, analyzing performance data and developing program improvement plans. Finally, this position acts as a liaison between the Department and independent researchers and their respective institutions involved with research and/or program evaluations related to home visiting in Wisconsin. Goals and Activities 40% A. Oversee, direct and complete the design and implementation of performance plans and program evaluations of home visiting programs to assess the fidelity to the selected evidence-based model as well as the effectiveness of the programs, new initiatives/pilots or policy changes and inform continuous quality improvement. A1. Work with DSP management; the DCF Home Visiting Coordinator and other Department staff, Title V/MCH and other appropriate state agency partners to develop home visiting performance plans and program performance objectives. Lead and participate in workgroups to develop performance plans and objectives. A2. Work with DSP management; the DCH Home Visiting Coordinator and other department staff, Title V/MCH and other appropriate state agency partners, and local home visiting program staff to develop tools, processes and methods to assess fidelity to the selected evidence-based home visiting model and/or promising practice. A3. Work with DSP management; the DCF Home Visiting Coordinator and other Department staff, Title V/MCH and other appropriate state agency partners to make recommendations to division management on how to improve program performance. Develop performance methods and procedures and work with bureau directors to develop and implement program improvement plans. A4. Design the evaluation methodology or approach such as impact analysis, process evaluation, customer satisfaction, etc.
Wisconsin Department of Children and Families Updated State Home Visiting Plan June 2011
A5. Provide leadership in providing and coordinating training and technical assistance related to use of SPHERE and other database systems, measurement tools, data collection and reporting to local home visiting programs. A6. Ensure data quality and develop and work with home visiting program staff to improve data reliability. A7. Translate complex analysis into findings or conclusions, and if appropriate, recommendations that are concise and audience-specific. A8. Effectively communicate evaluation findings, results, and if appropriate, recommendations through a variety of methods to internal stakeholders (the Department, program Divisions and contracted providers) and external stakeholders (elected officials, advocates, service recipients, media, and funding agencies). A9. Represent the Department and the Division on statewide and local committees/workgroups and participate in meetings with public and private entities, as needed. A10. Represent the Department and Division in local, state and national in the planning and implementation of home visiting research projects and program evaluations. A11. Respond to data and information requests, as needed. 20% B. Lead the development and implementation of tools to measure home visiting program performance and communication of performance results. B1. Lead the development and maintenance of program performance reports from appropriate data systems to use for program evaluation purposes. Work with program and IT staff from DCF and DHS/MCH to produce reports for performance measurement purposes. B2. Lead the process for working with DCF, Title V/MCH and other appropriate state agency and local home visiting program staff to identify essential information for program performance purposes. Determine priorities for new information and the costs and benefits of obtaining the information. Work with program and IT staff from DCF and DHS/MCH to ensure the information is collected in SPHERE and other data systems where necessary to collect essential information. B3. Determine the availability, quality and limitations of program performance information and make recommendations to division management on how to improve the availability and quality of performance information. Develop and implement plans for improving performance. B4. Coordinate the development and distribution of home visiting performance reports using performance data to show program results for the state home visiting program. Work with program and local agency staff to develop report formats and distribution methods to ensure widespread understanding of program results.
20% C. Development of home visiting best practice information C1. Work closely with the DCF Home Visiting Coordinator to develop an active peer network among programs across Wisconsin for the purposes of sharing information about best practices in the field of home visiting, establishing a peer mentoring system for new/developing programs, and developing a peer review component of the performance monitoring system. C2. Conduct analysis of innovative home visiting service models, model enhancements or model adaptations and assess the potential use of these models, model enhancements or model adaptations in Wisconsin. Work with DCF, Title V/MCH and other appropriate state and local program staff to determine the potential use of these promising practices in home visiting in Wisconsin. Prepare best practice materials for local agencies and provide technical assistance. C2. Write proposals for demonstration projects related to home visiting, secure division and department approval of proposals and submit proposals to appropriate public or private funding organization. C3. Develop and implement methods for evaluating the effectiveness of innovative projects and promising practices in the field of home visiting. Develop and secure approval for evaluation design and evaluation criteria, including client outcomes and cost impacts. Operationalize the evaluation methods, oversee collection of necessary information and prepare evaluation reports. 20% D. Develop program plans, conduct special studies and provide information and problem resolution for department and division management. D1. Work closely with the DCF Home Visiting Coordinator to develop, maintain and update state home visiting plans. Review plans involving home visiting issues prepared by other units in the department and other state agency partners for technical accuracy and conformance with home visiting requirements and program goals. Develop local plan guidelines and work with bureaus to implement planning process for local agencies. Direct and participate in work groups to develop/update program plan materials. D2. Participate in inter-agency workgroups and administrative meetings to address home visiting program policy issues and develop recommendations for changing policy. Keep division management, bureau directors and staff informed about activities in other divisions and state agencies that may affect the home visiting program. D2. Undertake special assignments as requested by the division administrator, office director or other bureaus to research and analyze home visiting issues. Complete special studies related to the state home visiting program, including specific aspects of program management and the practice of home visiting.
Knowledge and Skills Extensive knowledge of program evaluation, CQI processes and research and evaluation design and methodology using quantitative and qualitative data Extensive knowledge of child abuse prevention, health promotion and education and other early childhood education and family support programs High level of skill in effective project management including the coordination and implementation of complex, research and evaluation projects High level of skill in using mainframe or Access, Excel, PowerPoint and other database applications High level of skill in using administrative databases such as SPHERE, eWiSACWIS, CARES, etc. to conduct analysis High level of skill in developing deliverables for executives, program managers and the community Excellent communications and writing skills, including public speaking and effective communications with a wide range of diverse audiences, including executives, contract agencies, advocates, and front-line program staff Ability to work independently and make complex decisions within the scope of his/her responsibility Ability to interpret rules, regulations, etc. affecting early childhood education and family support programs, including but not limited to prenatal care coordination, home visiting and parent education
POSITION DESCRIPTION OSER-DMRS-11 (Rev. 02/00) (07/07 jhm)

State of Wisconsin Office of State Employment Relations
1.
POSITION NO.
2. CERT/RECLASS REQUEST NO.
3. AGENCY NO.
435
5. DEPARTMENT, UNIT, WORK ADDRESS
4.
NAME OF EMPLOYEE
6.
CLASSIFICATION TITLE OF POSITION
PUBLIC HEALTH NURSE 3

7. CLASS TITLE OPTION (to be filled out by Personnel Office) 8.
DEPARTMENT OF HEALTH AND FAMILY SERVICES DPH/ BCHP/ FAMILY HEALTH SECTION/ MCH UNIT ONE WEST WILSON STREET ROOM 351 MADISON, WI 53703
NAME AND CLASS OF FORMER INCUMBENT
MCH HOME VISITING NURSE CONSULTANT

9. AGENCY WORKING TITLE OF POSITION 10. NAME AND CLASS OF EMPLOYEES PERFORMING SIMILAR DUTIES
MCH HOME VISITING NURSE CONSULTANT

11. NAME AND CLASS OF FIRST-LINE SUPERVISOR 12. FROM APPROXIMATELY WHAT DATE HAS THE EMPLOYEE PERFORMED THE WORK DESCRIBED BELOW?
LINDA HALE, FAMILY HEALTH SECTION CHIEF

13. DOES THE POSITION SUPERVISE SUBORDINATE EMPLOYEES IN PERMANENT POSITIONS? IF YES, COMPLETE AND ATTACH A SUPERVISORY POSITION ANALYSIS FORM (DER-PERS-84). 14. POSITION SUMMARY- PLEASE DESCRIBE BELOW THE MAJOR GOALS OF THIS POSITION: Yes No
(See Attached)
15. DESCRIBE THE GOALS AND WORKER ACTIVITIES OF THIS POSITION (Please see sample format and instructions) GOALS: Describe the major achievements, outputs, or results. List them in descending order of importance. WORKER ACTIVITIES: Under each goal, list the work activities performed to meet that goal. TIME %: Include for goals and major work activities. TIME % GOALS AND WORKER ACTIVITIES (Continue on attached sheets)
(See Attached)
16. SUPERVISORY SECTION - TO BE COMPLETED BY THE FIRST LINE SUPERVISOR OF THIS POSITION. (See Instructions) a. The supervision, direction and review given to the work of this position is close limited general. b. The statements and time estimates above and on attachments accurately describe the work assigned to the position. (Please initial and data attachments.) Signature of first-line supervisor Date
17. EMPLOYEE SECTION - TO BE COMPLETED BY THE INCUMBENT OF THIS POSITION. I have read and understand that the statements and time estimates above and on attachments are a description of the functions assigned my position. (Please initial and date attachments.)
Signature of employee
Date
18. Signature of Personnel Manager P-File Department of Employment Relations Employee Department File
Date Cert Request Copy
xxxxxx-Vacant (11/16/2010)
CLASSIFICATION TITLE / SUB-TITLE POSITION SUMMARY
Public Health Nurse 3 / MCH Home Visiting Nurse Consultant
This DHS project position for a Home Visiting Nurse Consultant (PHN3) is critical to the implementation of the Administration of Children and Families (ACF) Maternal, Infant, and Early Childhood Home Visiting Program established in the Affordable Care Act, PL 111-148. as Governor delegated DHS co-lead with the Department of Children and Families. This grant and position provides a unique opportunity to build on and strengthen the existing relationship of the two Departments (DHS and DCF around home visiting both at the state level and in at-risk communities. This project position will manage the day to day implementation of the home visitation grant in collaboration with the DCF Home Visiting Coordinator and provide leadership to assure: connection to the Title V MCH Program, supporting system integration, and public/private home visiting partnership programs. The position will provide guidance in the development of a coordinated statewide system of early childhood home visiting that is sustainable and has the capacity and infrastructure to support high quality evidence-based practice that improve key outcomes for families who reside in at risk communities in Wisconsin. The position will promote maternal, infant, and childhood health, safety and development and support local programs in providing services to those identified to be living in at risk communities across the state. Home visiting is promoted as a foundational strategy connected to and dependent upon an array of early childhood services in Wisconsin working collaboratively with other early childhood initiatives such as the Governors Early Child Advisory Council, Title V MCH Program Early Comprehensive Childhood Systems grant, and the Wisconsin Early Childhood Collaborating Partners.
(Rated PD Only) TR1 TR2
TIME %
GOALS AND WORKER ACTIVITIES
(Consultation, Education, Training, TA) 35% A. Provide statewide consultation and technical assistance to local public health departments (LHDs), agencies, organizations, and individuals for the promotion of optimal health of infants and children, including children and youth with special health care needs (CYSHCN) being served or have potential to be served within the home visiting evidence-based models. A1. Co-coordinate the completion, review, evaluation, and ongoing monitoring of the comprehensive statewide needs assessment identifying at risk communities in WI with concentrations of premature births, low-birth weight infants, and infant mortality, including infant death due to neglect, or other indicators of at risk prenatal, maternal, newborn, or child health; poverty; crime, domestic violence, high rates of high school dropouts, substance abuse, unemployment, or child maltreatment. Collate and work with other state and local partners, both public and private who have completed environmental scans and other related local, regional or statewide needs assessments and or statewide strategic planning, e.g. Head Start, Collaborating Partners, Governors Early Child Advisory Council, CAPTA/Child Trust Fund, MCH, and others as appropriate. A2. Develop a plan in collaboration with DCF and other partners to implement home visiting evidence based programs within identified communities at risk coordinating with state and local agencies to assure delivery of services to eligible families in order to promote improvements in maternal and prenatal health, infant health, child health and development, parenting related to child development outcomes, school readiness, and the socioeconomic status of such families, and reductions in child abuse neglect, and injuries. Provide ongoing monitoring and revisions of the plan as needed.
TIME %
A3. Work to assure the delivery of family support services within a medical home model across the lifecourse and reflecting best practice standards using principles of continuous quality improvement. A4. Create or crosswalk common set of standards to assist local programs that may integrate multiple models. Program standards need to address key program implementation areas such as professional development, technical assistance, supervision, cultural relevance and unique local needs. A5. Identify and assure core competencies for home visiting providers are communicated, monitored and maintained. A6. Support home visiting program and sites through the provision of technical assistance and training and Consult with Bureau, Division, and Department staff, other federal, state, and local public and private health professions and organizations and programs to assure quality of these programs. A7. Identify training systems that meet home visiting model requirements integrated with appropriate training across models. A8. Develop incentives for professional development considering mechanisms along a career path and/or certification and support of home visiting supervision. A9. Develop processes for program expansion. (Data, Outcomes, Evaluation) 35% B. Assist in the development and monitoring of benchmarks, outcome measures, collection and analyses of data. B1. Coordinate development or integration of an already existing centralized data system to collect information on key home visiting indicators and statistics. B2. Evaluate the SPHERE data system for consistency with program services and development of complex analyses to assist in the management of home visiting program activities. B3. Coordinate evaluation of the local and states home visitation programs and develop method to disseminate evaluation results and determine implications for program implementation. B4. Develop quality assurance plan for the home visiting programs. B5. Develop tracking system to assure and monitor fidelity of evidence based and promising early childhood home visiting practices. B6. Establish and monitor quantifiable measureable 3 and 5 year benchmarks for demonstrating that the home visiting program results in improvements for the eligible and participating families in a) improved maternal and newborn health; b) prevention of child injuries, child abuse, neglect, maltreatment, and reduction of emergency department visits; c)improvement in school readiness and achievement; d) reduction in crime or domestic violence; f) improvements in family economic self-sufficiency; g) improvements in coordination and referrals for other community resources and supports. (Assure that after 3 years, the ability to document success in improving at least 4 of the 6 above benchmarks.) (Administration)
TIME %
30%
C. Assure key stakeholders from an array of early childhood and related services are informed on the home visiting system development, implementation, and sustainability efforts. C1. Integrate home visitation planning with other early childhood, behavioral/mental health/substance abuse and maternal and child health planning efforts, e.g. medical home, CYSHCN, ECCS, Project LAUNCH; ECAC; Collaborating Partners; MCH Advisory Council. C2. Assure policies and MOUS are in place between and among early childhood agencies at state and local levels to allow for the creation of seamless continuity of services in at risk communities for families enrolled in multiple early childhood programs. C3. Collaborate with DCF to administer and monitor grant goals and objectives as well as budget; complete required reports and application. C4. Educate the public and state legislators and cultivate champions to support home visitation through use of social media and other marketing strategies. C5. Coordinate marketing and outreach efforts framing common messages to promote home visiting. C6. Act as the resource to the Bureau, Division, Department in the home visiting program area.
KNOWLEDGE / SKILLS / ABILITIES

KR1 KR2
Extensive knowledge of approved principles and practices for the health care of infants and children with at least two years experience in providing leadership to the work of early childhood programs. Extensive knowledge of approved principles, practices, and models for comprehensive communitybased home visiting programs that are culturally appropriate. Extensive knowledge of the role of the consultant in providing consultation and technical assistance related to home visiting programs, infant, child, and maternal health. Extensive knowledge of the organization of public health programs focusing on infants and children, general maternal and child health, and role of home visitation in supporting and promoting optimal health and wellbeing of families. Extensive knowledge of the theory of systems development and evaluation of the collaborative nature of that work. Ability to establish and maintain effective working relationships with a wide variety of agencies and personnel. Ability to communicate effectively and interpret policies and procedures in writing and orally. Ability to guide the work of others and provide constructive program guidance.
Any employee, or applicant for employment, with a disability as defined by the Americans with Disabilities Act, must be able to perform the physical requirements outlined herein. SPECIAL REQUIREMENTS Special Requirements: This position requires a license or eligibility for a license as a Registered Nurse (RN) in the State of WI. This position also requires a WI drivers license or eligibility for a WI drivers license within 3 months of hire.
June2011WisconsinGovernorsEarlyChildhoodAdvisoryCouncilAdHocCommitteeonHomeVisitingTrainingandTechnicalAssistance ProfessionalDevelopmentGapAnalysisandCrosswalkwithMichiganInfantMentalHealthCompetencyGuidelines Attachment 5 2011HomeVisitingCompetencyFramework TheoreticalFoundations

PregnancyandEarlyParenthood ParentsAs HealthyFamiliesof Teachers America First6months Found.Training Breastfeeding Found.Training Prenatal/Postnatal Found.Training healthcare;andPre Found.Training natal/PostPartum Found.Training depression Nutrition Found.Training Found.Training Found.Training Found.Training Found.Training Found.Training
Topics Breastfeeding Basicnutrition Immunizations Transitionto Parenthood Father/Significant otherrole Preventative health Psychiatric medications duringpregnancy andbreastfeeding Maternaltasksof pregnancy Prenatalsupport Doula Domesticviolence duringpregnancy Substanceabuse duringpregnancy (including Suboxoneand Methadonefor opiateaddiction)
TrainingLevel,Hours,andMode CurrentlyofferedtoPNCCfaceto faceasadayand1/2training, The101leveltrainingincludesthe GreatBeginningsHFAprenatal curriculumandHomeVisitation Foundations,whichfocuseson howtodothework;homevisiting asaservicedeliverysystem;and strengthbasedapproaches TheHomeVisitationsFoundations trainingneedstobeextendedto3 daysfrom2daysandinclude introductionsofthetopicsof MotivationalInterviewing,case planningthroughtransitionswith families,andFamilyTeaming. Thetrainingshouldremainface toface. The201versionforintermediate HomeVisitorsshouldinclude: o Homevisitingmethodsw/ familieswithAODAissues o Basicinformationabout
HomeVisitation Foundations Addressedthrough GreatBeginnings training
NurseFamily Partnership OBhealthunder MYHEALTH
EarlyHeadStart HomeBasedOption FamilyPartnerships: 1304.40(c)(1)(i)(ii)(iii) (i)Earlyandcontinuingrisk assessments,whichincludean assessmentofnutritionalstatusas wellasnutritionalcounselingand foodassistance,ifnecessary GUIDANCE educating pregnant/breastfeedingwomen aboutproperhealth&nutrition accesstoagenciessuchasWIC FamilyPartnerships: 1304.40(c)(3) Agenciesmustprovide informationonthebenefitsof breastfeedingtoallpregnant& nursingmothers FamilyPartnerships: Guidancefor1304.40(c)(2) Mothers,fathersandanyother familymembersresponsiblefor infantcareareencouragedtolearn aboutfetaldevelopmentand properpostnatalcare,including: basicknowledgeoffetal
HIPPY
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June2011WisconsinGovernorsEarlyChildhoodAdvisoryCouncilAdHocCommitteeonHomeVisitingTrainingandTechnicalAssistance ProfessionalDevelopmentGapAnalysisandCrosswalkwithMichiganInfantMentalHealthCompetencyGuidelines
Supportingfather role prescriptiondrugmisuse/ abuse o Informationonhighrisk pregnancies 201Trainingtopicscouldbe offeredfacetofaceorvia webinarsoronlinelearning modules. development riskstofetaldevelopment (alcohol,smoking,substance abuse) parentingclassesandsupport groups FamilyPartnerships: Guidancefor1304.40(c)(2) PerformanceStandards Laboranddelivery(whattoexpect, childbirthclasses,train staff/volunteersaslaborand deliverysupportpersons,e.g. doulas) Postpartumrecovery(whatto anticipate,includingthepossibility ofmaternaldepression) ChildMentalHealth 1304.24(a)(1)(iv) Discussinghowto strengthennurturing,supportive environmentsandrelationshipsin thehomeandattheprogram GUIDANCE:through interactionadultssupportthe developmentoftrust,selfesteem, andidentitybyexpressingrespect andaffectiontowardthechildand respondingtothechildsneeds: smilingatthebaby quicklycomfortingan infantindistress FamilyPartnerships: Guidancefor1304.40(c)(2)
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PerformanceStandards Laboranddelivery(whattoexpect, childbirthclasses,train staff/volunteersaslaborand deliverysupportpersons,e.g. doulas) Postpartumrecovery(whatto anticipate,includingthepossibility ofmaternaldepression) FamilyPartnerships: 1304.40(c)(1)(i)(ii)(iii) (iii)MentalHealthinterventions andfollowup,includingsubstance abusepreventionandtreatment,as needed. GUIDANCE identifyfamily&culturalsupport networks supportgroupsfornew& expectantparents listsofsubstanceabuse treatmentprograms
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InfantandYoungChildDevelopmentandBehavior TrainingLevel,Hours,andMode HomeVisitation Parentsas HealthyFamilies NurseFamily Foundations Teachers America Partnership 101TheASQ3andASQSE8hour Found.Training Stagesofgrowth First6months trainingshouldbeofferedfaceto Found.Training anddevelopment Emotional development face Healthdevelopment Braindevelopment Found.Training Staffshouldreceiveadditional Emotionaland trainingregardingsocialemotional behavioral developmentalmilestones Found.Training development Found.Training 101BrainDevelopment Languageand approximately4hoursfacetoface Found.Training cognitive orwebinar development 201PyramidModelofSocial EmotionalDevelopment(Parenting Found.Training andHVModulesapproximately18 Found.Training hours) 201LinkHVtoWIFACETStraining calendarforwebinarsandfaceto faceopportunitiesstatewide (Opportunitiesrangefromlunch hourandearlyeveningwebinarsto fulldayworkshops) 201BestPracticesforworking withSubstanceExposedInfants (webinars23hours) 201FetalAlcoholSpectrum Disorders(webinar23hours)
Topics InfantCues Social emotional development milestones Typicaldev. Milestones Earlybrain development Temperament Determining meaningof behavior Regulation Sensory development Developmental delaysand childrenand familieswith specialneeds
EarlyHeadStarthomebased option
HIPPY Social emotional development milestones Social emotional development milestones Sensory Development
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Topics
Home Visitation Foundations 101Include12Criticalelements; 12Critical Principles familydevelopmentcore Elements offamily principles,protectivefactors; centered Family strengthbasedapproachtofamily practice Developm goalsettingandaddspecialplay Developme entalCore ntal/anticip (partofHVfoundations2.5days) Principles atory Protective 101HVFwouldbeenhancedto guidance Factors intentionallylinksomeofthe Special Strength currenttrainingtopicsusingan Play Based introductionoftheFamily Emotion Approach Teamingconcepts Coaching esto Family Familyled goal goalsetting 201Howtoeffectivelyimplement familyteaming(1/2dayonsiteTA setting Parallel visitandongoingphoneTA) process 201PyramidModelofSocial EmotionalDevelopmentemotion coachingpartof16hourmodules training(facetoface)
TrainingLevel,Hours,andMode
Infant/YoungChildandFamilyCenteredPractice ParentsAs HealthyFamiliesof NurseFamily Teachers America Partnership Found.Training First12months andModel Implementation Training F&MITraining F&MITraining LifeSkillsis recommended Assessmenttobe usedfor Affiliates. Humanecology Paralleland reflectiveprocess
EarlyHeadStarthome basedoption
HIPPY
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RelationshipBased/TherapeuticPractice Parentsas HealthyFamilies Teachers America Found.Training Found.Training Found.Training Found.Training First12months
Topics
Motivational interviewing Strengthbased practice Becomingnon judgmental Buildingtrust Engagement
Home Visitation Foundations 101HVFwouldbeupdatedto includeframethecommunication strategiescurrentlytaughtasthe Strength foundationofmotivational based interviewing practice 101WomenandSubstance Becoming Abuse(webinarorfacetoface34 non hours) judgmental 201MotivationalInterviewing Building IntermediateSkillsandStrategies trust forHomeVisitors(1day/8hours Engagement facetoface) /rapport Supervisors1dayMISupervisors Retreatandmonthly1.5hourmay alsousetheoptionof teleconferenceforsupervisor support
NurseFamily Partnership Motivational Interviewing Selfefficacytheory Therapeutic relationship
EarlyHeadStart homebasedoption
HIPPY
Strengthbased practice
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Topics TrainingLevel,Hours,andMode Home Visitation Foundations FamilyRelationshipsandDynamics Parentsas HealthyFamilies Teachers America Found.Training Found.Training Found.Training Found.Training Found.Training Found.Training Found.Training Found.Training NurseFamily Partnership EarlyHeadstarthomebased option HIPPY
Extending familyimpact Family systems Domestic Violence Substance Abuse Parental Mental Health Supporting parentchild interactions and competencies Engaging extended family Father engagement
101Makesurethatfather engagementisaddedtotheHV foundations2.5daysalsomakesure thattheemphasisonreflective practicetosupportHVineffective servicedeliverythatisnon judgmentalandnonbiased NotethatthePyramidModel trainingsatboththe101and201 levelarelinkedtothiscompetency Providephoneoronsitetechnical assistanceandtheprogramlevel relatedtotheStrengtheningFamilies Organizationalandstaffassessment andtheorganizationalFatherFriendly selfassessment(upto10hoursofTA pertool)
First12months Etiologyofsubstance abuse; Cultureofdruguse Strategiesforworking withfamilieswith substanceabuseissues Smokingcessation Alcoholuse/abuse Streetdrugs Referralresourcesfor substanceabuse IndicatorsofFamily Violence Dynamicsofdomestic violence Interventionprotocols Strategiesforworking withfamilieswithfamily violenceissues Referralresourcefor domesticviolence Effectsonchildren Fatherengagement mentalhealthtopics (similartosubstanceuse topics) multigenerations
Supporting parentchild interactionsand competencies Engaging extendedfamily Father engagement
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Topics TrainingLevel,Hours,andMode Home Visitation Foundations Attachment,Separation,TraumaandLoss Parentsas HealthyFamilies Teachers America Found.Training Found. Training First12 Supportingattachment NurseFamily Partnership Attachmenttheory EarlyHeadstarthomebased option HIPPY
Attachment Trauma informedcare Symptomsof traumain infancy Riskfactorsfor attachment Griefandlossin infancy Adult attachment historyand impacton relationship MilitaryFamilies andtheimpact ofthe deployment cycle Familieswithan incarcerated parent Divorce Deathofa child/parent
101basicscanbecoveredaspartof thePyramidModeltraining RelationshipsandTransitionsneedto becoveredatthe101and201levels: 101Whatarerelationshiptransitions andwhydotheypresentchallenges tofamiliesandpractitioners? 201Howdoyoutransitioninethical andsupportivewaystopreventre traumatizingfamilies 201Topicssuchas:Divorce, Incarceration,MilitaryService,Death canbecoveredinwebinarsand workshops(23hoursorfullday dependingonlearningobjectivesand levelofdepth)
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Topics TrainingLevel,Hours,andMode Home Visitation Foundations DisordersofInfancyandEarlyChildhood Parentsas HealthyFamilies Teachers America First12 Failuretothrive FetalAlcoholSyndrome Shakenbabysyndrome Signsofabuseand neglect NurseFamily Partnership Fetalsyndromes EarlyHeadStarthome basedoption HIPPY
SpecialNeeds children InfantandEarly Childhood MentalHealth Disorders Introductionto DC03Rand disorders commonin infancy Whentorefer Signsofabuse andneglect SignsofMH needs Signsof Substance Misuse/Abuse
Childrenwithspecialneedscovered inInfantandYoungChildren developmentandBehavior(WI FACETSPartnership) Whentoreferandwhentoreport arepartoftheStrengthening Families(3hours)andSCANMRT(3 hours)101bothtrainingsareface tofacetrainings. Othertopicsinthiscompetencyare atthe201levelandcanbedelivered through workshops/conferences/webinars from3hours+dependingonlevelof depthandexperienceofHV
Found. Training
Model Implementati on Foundational Curriculum
Whentorefer Signsofabuse andneglect
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Topics TrainingLevel,Hours,andMode Home Visitation Foundations Talksabout reflection and personal bias Culture withineach familycore values CulturalCompetence Parentsas HealthyFamilies Teachers America Found. Training Found. Training First12months Workingwithdiverse populations(includes culture,ethnicityand specialpopulations) Cultureofpoverty Valuesclarification NurseFamily Partnership Reflectivepractice Respectingculture EarlyHeadStarthome basedoption HIPPY
Selfawareness ofbiasand judgment Familysystems andchildrearing normswithin culturalcontexts Culturewithin eachfamilycore values Classissues Race/Racism andimpacton workand relationships Cultureof feeding, sleeping,healing practices
101Reworkfoundationstoaddress CCinanevidencebasedway Withinfirst3monthsprovideoffsite technicalassistancerelatedtoan organizationalculturalcompetence selfassessmentandCCplanwithin anHVprogram(upto12hoursofoff sitetechnicalassistance) 101Insurethatallstaffunderstand lawsandethicsrelatedtousingan interpreterandhavequalified interpretationservicesinplace 201Completeeffectivetrainings suchas:BeyondDiversity,PACE,and UnlearningRacism,andMosaic Foundationsrangingfrom1/2dayto 2daysdependingonagency's previousPDinthiscategory
Selfawareness ofbiasand judgment Culturewithin eachfamilycore values
Found. Training Initially coversFamily Cultureand Perspectives
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Law,RegulationandAgencyPolicy
EthicalPractice HomeVisitation Parentsas HealthyFamiliesAmerica NurseFamily Foundations Teachers Partnership Beforeseeingfamilies Found. Boundary Training setting Ethics CodeofEthics Found. Confidentiality Training Discretionin Burnoutprevention Found. handling Training sensitive communication Confidentiality
Topics Boundary setting CodeofEthics Discretionin handling sensitive communication Confidentiality
TrainingLevel,Hours,andMode 101addtomodeltrainingswith regularworkshopsonethical dilemmasensurethatethics coverbothHVandFamily boundariesandethicsand supervisorandHVboundaries andethics 201Organizationalboundaries andethics SupervisorT/TArelatedto boundariesandethicsand personnel
EarlyHeadStarthomebased HIPPY option Boundary setting CodeofEthics Discretionin handling sensitive communication Confidentiality
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Topics Home Visitation Foundations 101StateChildAbuseandNeglect Brief MandatoryReporterTraining(3hours discussionof withinfirst3monthsfroman mandated approvedtrainer.) reporting SupervisorTechnicalassistanceto thesupervisororagencytodevelop orreviewmandatoryreporter protocols(Upto10hourswithinfirst 3monthsofimplementation) 201StewardsofChildren/Darkness toLight(3hourswithinfirst1218 months) 201reviewclientrights(23hours) TrainingLevel,Hours,andMode Government,LawandRegulation Parentsas HealthyFamiliesAmerica Teachers NurseFamily Partnership EarlyHeadStarthomebased HIPPY option Mandatory reportinglaws
Mandatory reportinglaws Dutytowarn laws Citizenchildren rightsofnon citizenparents Federaland statelaws Clientrights
Priortofamilyassignment
AgencyPolicy/Orientation Parentsas HealthyFamiliesAmerica Teachers Model Priortoseeingfamilies Implementation Training
Topics
Agencypolicy and procedures
(withinfirst3months) Orientationtoagencyandshadowing ofhomevisitswithamoreexperienced homevisitor Orientationtoagencyvalues,policies, andpractices
Home Visitation Foundations
NurseFamily Partnership
EarlyHeadStarthomebased HIPPY option Agencypolicy andprocedures
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SystemsExpertise
Topics Home Visitation Foundations 101ExpandHVfoundationsto Skillsfor strengthenHVunderstandingofPublic developing Benefitswithafocuson resourcesand understandingeligibilityrequirements referrals, advocacywith 201Understandingpublicbenefits families advocacy Discussionof SupervisorBuildingandsupporting community relationshipswithsocialservicesasa resourcesand sharing foundationforeffectiveclient advocacy TrainingLevel,Hours,andMode Parentsas Teachers HealthyFamiliesAmerica NurseFamily Partnership IntheMyLife domainclients personal development EarlyHeadStarthomebased option HIPPY
Accessingother services Referral processes Early Intervention systems MentalHealth systems Childwelfare systems Mentalhealth systems W2
All:Found.&MI First6months Training (stressed throughroleof supervisor)
Accessingother services Referral processes
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Topics TrainingLevel,Hours,andMode Home Visitation Foundations Service coordination, advocacy Parentsas Teachers CommunityResources HealthyFamiliesAmerica NurseFamily Partnership EarlyHeadStarthomebased option HIPPY
WIC Matchingfamily needswith community resources Collaboration withcommunity partners Concrete assistance Service coordination Helpingparents accessinformal supports
TechnicalAssistancetobuildgood referralnetworksandcommunity resourcedirectories (phoneandemail46hourspersite oraspartoftheRegionalCommunity ofPractice) 201ConflictResolutionSkillsfor HomeVisitors(3,3hourmodules, facetofaceorwebinar) SupervisorConflictresolutionskills forSupervisors(1dayfacetofaceor preconferenceleadershipinstitute)
Found.&MI First6months Training Found.&MI Training
All:Initially coveredin Found.Training with
WIC Matching familyneeds with community resources Collaboration with community partners

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DirectServiceSkills
Observation/Listening Parentsas HealthyFamiliesAmerica Teachers Found. Training First12 Parentchildinteractions
Topics
Observingthe parentchild relationship Listeningfor positive behavioral change
SeecommentsMotivational Interviewing101,201,and SupervisorsandCommunicationSkills SeecommentsPyramidModel101, 201MI?
Home Visitation Foundations
HIPPY
Found.training
Topics
Interviewing skills Screeningtools Identification signsand symptoms Whenandhow toscreen
Enhanceinterviewingandsharing resultsaspartofcommunication withinthe101HVFoundations Seepreviouscommentsrelatedto ASQ3andASQSE 101DepressionScreening(12hour
Home Visitation Foundations Someinfoon interviewingas partof communication
Screening/Assessment Parentsas HealthyFamiliesAmerica Teachers Allcoveredin Foundational andModel Implementatio nTraining coverwith additional recommended Within6months ParentChildinteractions Identifyingdevelopmental delays
HIPPY
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Areasof assessment (socialsupport, basicneeds,dev. Etc.) Informal assessment Parentchild relationship assessment webinar+practicewithroleplayson sitewithcoworkersandshadowing moreexperienced screeners/interviewers) 201CompletingFamilyAssessment andLifeSkills (12hourwebinar+practicewith roleplaysonsitewithcoworkers andshadowingmoreexperienced screeners/interviewers) TechnicalAssistanceQuality Assurancerelatedtousingscreensin areliableandvalidway(sitevisits) trainingof ScreeningTools
RespondingwithEmpathy Parentsas HealthyFamiliesAmerica Teachers Found. Training Withinfirst12months
Topics
Therapeuti clanguage Paying attention tonon verbals Managing our difficult feelings
Technicalassistancerelatedto codingandprovidingreflected supervisiononvideoaudiotapesfor adherencetomotivational interviewingframework,skills,and strategies
Home Visitation Foundations Briefly
HIPPY
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Advocacy HealthyFamiliesAmerica
Topics
Roleof advocating forclients within various systems
PartofHVFoundationsRevisedsee alsoservicedeliverysystemsand collaboration Seerecommendationsfor201 communityresourcesandservice delivery
Home Visitation Foundations Advocacyrole discussion
Parentsas Teachers Found. Training
NurseFamily Partnership Mylifedomain
HIPPY
First6monthsintermsof serviceadvocacyand makingreferralsand referralsources
Topics
Supporting caregivers in developing lifeskills
Home Visitation Foundations 101HVFoundationsenhancedfocus oncasemanagementandcase planning(facetoface2.5daysof training) 201traininginCasePlanningand managementrefresherwith emphasisoncoordinatingservice
Parentsas Teachers
LifeSkills HealthyFamiliesAmerica
NurseFamily Partnership Mylifedomain personal developmentgoals
HIPPY
Lifeskillsmanagement within12months
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Topics TrainingLevel,Hours,andMode Home Visitation Foundations Safetyinthe fieldand personalsafety Parentsas Teachers Found.&MI Training Found. Training Safety HealthyFamiliesAmerica NurseFamily Partnership MyHomeDomain covershomesafety Lead,fire,hazards etc. EarlyHeadStarthomebased option HIPPY
Homesafety andinjury prevention Safetyon Homevisits Deescalation strategies
Seeorientationpoliciesand procedures,boundariesandethics,HV foundationsandmodeltraining(13 months)
First6months personalsafety
Safetyon Homevisits
WorkingwithOthers
BuildingandMaintainingRelationships Parentsas HealthyFamiliesAmerica Teachers First12months Found. Training Strategiesforworkingwith Found. difficultrelationships Training Found. Training Found. Training Found. Training Found. Training
Topics Parentsas experts Followingparents lead Consistencyand followingthrough Regular communication Honest,genuine communication Discussing concernswith parents
TrainingLevel,Hours,andMode MotivationalInterviewing CulturalCompetence StrengtheningFamilies ReflectivePracticeand Supervision (TechnicalAssistancecodingand providingwrittenfeedbackof audio/videotapesfromhome visitsforMIadherence;2hours permonthperHomeVisitor)
HomeVisitation Foundations Parentsas experts Following parentslead Consistencyand following through Regular communication Honest,genuine communication
HIPPY Following parentslead Honest, genuine communication Discussing concernswith parents
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SupportingOthers/Mentoring Parentsas HealthyFamilies Teachers America Found.&MI Training MITraining Found.&MI Training Found.&MI Training First12
Topics
Peer mentoring Empower familiesto develop advocacyskills Providing feedback modeling
ReflectiveSupervision Monthlyconferencecalls Regularstaffmeetings Monthlyconferencecallsto supervisorswithMIand/orreflective practicecoach
Home Visitation Foundations Discussionof empowerment
HIPPY
Empower familiesto develop advocacyskills Providing feedback modeling
Collaborating HealthyFamilies America
Topics
Collaboration withcommunity partners Working effectivelywith teams Teambuilding skills Allies/leverage action
Seeservicedeliverysystems, advocacyandconflictresolution
Home Visitation Foundations Some discussion
Parentsas Teachers
HIPPY
Found.&MI Training MITraining Found.&MI Training Found.&MI Training
Collaboration with community partners Working effectively withteams Teambuilding skills
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Topics TrainingLevel,Hours,andMode Home Visitation Foundations Basiclevel Parentsas Teachers ResolvingConflict HealthyFamilies America NurseFamily Partnership EarlyHeadStarthome basedoption HIPPY
Conflict management withfamilies, colleagues, supervisor Handling difficult conversations
101,201,andTechnicalAssistance (partofleadershipinstitutebefore conference8hours) Includeunderstandingofpower, abilitytoanticipateconflictand identifyrootcausesofconflict;skills andstrategiestoaddressdifferences anddeescalateconflict
First12 Strategiesfordifficult Found.Training relationships Found.Training
Topics TrainingLevel,Hours,andMode Home Visitation Foundations yes EmpathyandCompassion Parentsas HealthyFamilies Teachers America Found.Training First12 NurseFamily Partnership Humanecology theory EarlyHeadStarthome basedoption HIPPY
Providing emotional supportto parents
PyramidModel;Motivational Interviewing;CulturalCompetence; StrengtheningFamilies;andReflective Practice/Supervision
Providing emotional supportto parents
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June2011WisconsinGovernorsEarlyChildhoodAdvisoryCouncilAdHocCommitteeonHomeVisitingTrainingandTechnicalAssistance ProfessionalDevelopmentGapAnalysisandCrosswalkwithMichiganInfantMentalHealthCompetencyGuidelines Communication

Topics TrainingLevel,Hours,andMode Home Visitation Foundations Active listening Reflective listening Nonverbal communication Listening ParentsasTeachers HealthyFamilies America Found.Training Found.Training Found.Training First6 NurseFamily Partnership Motivational interviewing EarlyHeadStarthome basedoption HIPPY
Activelistening Reflective listening Nonverbal communication
ReviseHVFfoundations,infuse culturalcompetence,understanding ofpowerdynamics,anduseof interpreters. MakeconnectionstoMotivational Interviewing
Active listening Reflective listening Nonverbal communicati on
Topics TrainingLevel,Hours,and Mode 101EnhanceHVFoundations (includeinformationonusing aninterpreterlineand ethics/boundariesrelatedto interpretersandtranslation facetoface) Ongoingsupervisionabout qualityofcommunicationwith coworkers,collaborators,and families Home Visitation Foundations Speaking ParentsasTeachers HealthyFamilies America Found.Training Found.Training Found.Training NurseFamily Partnership EarlyHeadStarthomebased HIPPY option Verbal skills
Linguistically appropriate services Verbalskills Presentation andfacilitation skills Useofnon technical language
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Topics TrainingLevel,Hours,andMode Writing Home ParentsasTeachers HealthyFamilies Visitation America Foundations First6months Documentation Found.&MI Training Found&MITraining NurseFamily Partnership EarlyHeadStarthomebased HIPPY option Docum entatio n
Document ation Correspon dence
101Informationoncase managementdocumentationand correspondencewithfamilies (orientation) 201Informationonreporting (technicalassistanceongoing)
Thinking
Topics TrainingLevel,Hours,and Mode Technicalassistancereviewing video/audiotapesforMI adherence Technicalassistanceto supervisorsrelatedtoreflective supervisionandbuildingcritical thinkingandproblemsolving skills Home Visitation Foundations AnalyzingInformation ParentsasTeachers HealthyFamilies America Found.&MI Training MITraining Found.&MI Training Found.&MI Training Found&MI Training NurseFamily Partnership Humanecology theory EarlyHeadStarthomebased HIPPY option
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June2011WisconsinGovernorsEarlyChildhoodAdvisoryCouncilAdHocCommitteeonHomeVisiting TrainingandTechnicalAssistance ProfessionalDevelopmentGapAnalysisandCrosswalkwithMichiganInfantMentalHealthCompetency Guidelines
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Attachment 6
Proposed Indicators for Measurement of Maternal, Infant, & Early Childhood Home Visiting Program Benchmarks Benchmark #1 Improved Maternal & Newborn Health
Construct Prenatal Care Proposed Measure Percentage of pregnant women served by the program receiving any medical prenatal care in the 1st trimester of pregnancy: Source of Measure SPHERE Prenatal Assessment (Question: Section II. 4. Trimester medical prenatal care began) Proposed Definition of Improvement Increase in the percentage of pregnant women who receive any medical prenatal care in 1st trimester, between year 1 baseline and 3-year benchmark reporting period Data Collection Plan (timing, population) This measure will be collected only for women enrolled in the program prenatally.
Parental Use of Alcohol, Tobacco, or Illicit Drugs
Preconception Care
(100 x # of pregnant women who received any 1st trimester medical prenatal care) / total # of women enrolled during pregnancy Justification: Research suggests an important link between early receipt of prenatal care, birth outcomes, and subsequent child development. This measure will only be collected for women enrolled prenatally, as we would not expect a home visiting program to affect outcomes for women enrolled postpartum, nor would we expect community-level impact in the first year of a small, single program. This method of measurement uses existing questionnaires and data structure. Percentage of women served by the program using SPHERE Postpartum Assessment Decrease in the percentage This measure will be tobacco after birth: (Question: Section III.8. Since your pregnancy ended have of women served by the collected for all mothers you smoked cigarettes?) program using tobacco after with a postpartum (100 x # of women using tobacco) /total # of birth, between year 1 assessment served by the women with a postpartum assessment enrolled in baseline and 3-year program. program benchmark reporting period Justification: Although we will also ask programs to collect data on alcohol and drug use, reducing tobacco use among pregnant and mothering women is a top priority for the WI-DHS, as recent State data suggest that despite decreases in smoking overall, there is no decrease in the smoking rate of pregnant women (Wisconsin Department of Health Services, Division of Public Health, Bureau of Health Information and Policy). This postpartum measure will capture rates of tobacco use for a larger set of program participants (all mothers with a postpartum assessment), as well as whether any quitting that occurs during pregnancy is sustained; although, we will also ask programs to collect data specifically on smoking during pregnancy, for CQI and case-planning purposes. This method of measurement uses existing questionnaires and data structure. Percentage of women served by the program taking SPHERE Postpartum Assessment Increase in the percentage of This measure will be a supplement that contains folic acid: (Question: Section II.5. Are you taking a supplement that women served by the collected for all mothers contains folic acid?) program taking a with a postpartum (100 x # of women with a postpartum assessment supplement that contains assessment served by the taking a supplement that contains folic acid)/ total # folic acid, between year 1 program. of women with a postpartum assessment enrolled in baseline and 3-year program benchmark reporting period Wisconsin Department of Children and Families 1
Updated State Home Visiting Plan June 2011
Construct
Proposed Measure
Source of Measure
Proposed Definition of Improvement Increase in the percentage of women served by the program who receive information about birth spacing, between year 1 baseline and 3-year benchmark reporting period
Data Collection Plan (timing, population) This measure will be collected for all mothers served by the program.
Inter-Birth Intervals
Justification: This method of measurement uses existing questionnaires and data structure. Percentage of women served by the program who SPHERE Health Teaching Topics and Result Report: receive information about birth spacing: Birth Spacing (100 x # of women who receive information about birth spacing) / total # of women enrolled in program
Screening for maternal depressive symptoms
Breastfeeding
Justification: The benefits and importance of adequately spacing births is a topic that should be discussed with all home visiting participants, and has implications for effective postpartum case-planning. This method of measurement uses existing questionnaires and data structure. The percentage of postpartum women served by the SPHERE Postpartum Assessment Increase in the percentage of This measure will be program who are screened for depression (Questions: Section III.7e. Depression screening using a women served by the collected for all postpartum using a standardized tool: standardized screening tool in addition to questions asked program who are screened postpartum mothers previously: yes/no for depression postpartum served by the program. (100 x # of women who are screened for depression Section III. 7e. Tool used & Score) using a standardized tool, using a standardized tool) / total # of postpartum between year 1 baseline and women enrolled in program 3-year benchmark reporting period Justification: While informal screening for depressive symptoms has long been the practice in many WI home visiting programs, the State would like to build in standardized, formal screening for all mothers. Specifically, we will be asking all programs to begin using the Edinburgh Postnatal Depression Scale (EPDS) as the State Home Visiting program matures. This measure will capture improvements in our process to develop formal training and quality assurance around this innovation, yet makes use of existing questionnaires and data structure. The percentage of women served by the program SPHERE Infant Assessment Increase in the percentage of This measure will be who breastfeed for 3 months or more: Section VI. 5. Was baby ever breastfed? If yes, how long? women served by the collected only for (We will adjust this question to specifically determine program who breastfeed for women enrolled (100 x # of women who breastfeed for 3 months or whether women breastfed at least 3 months.) 3 months or more, between prenatally. more) / total # of women enrolled in program year 1 baseline and 3-year prenatally benchmark reporting period Justification: Rigorous review of the research suggests that breastfeeding for at least 3 months reduces the risk for illness among infants (Jane, 2001). We will limit this measure to women enrolled prenatally, as we do not want to mix more timely, reliable information with less reliable retroactive self-reports of breastfeeding behavior. We would also expect the biggest impact on breastfeeding behavior to occur for women enrolled in home visiting prenatally.
Construct Maternal and Child Health Insurance Status
Proposed Measure Percentage of women served by the program with any type of health insurance: (100 x # of women with any type of health of insurance) / total # of women enrolled in program Percentage of children served by the program with any type of health insurance:
Source of Measure SPHERE Health Care Coverage Tab (Question: Does the client have health insurance or Medicaid? If yes, coverage type [dropdown menu given])
Proposed Definition of Improvement Increase in the percentage of women and children served by the program with any type of health insurance, between year 1 baseline and 3-year benchmark reporting period
Data Collection Plan (timing, population) This measure will be collected for all mothers and children served by the program.
Well-Child Visits
(100 x # of children with any type of health of insurance) / total # of children enrolled in program Justification: Increasing access to regular health care, facilitated by health insurance coverage is a goal of WIs State Home Visiting Plan. Monitoring this measure will assist programs in connecting clients to appropriate medical care or public insurance programs for which they are eligible. This method of measurement uses existing questionnaires and data structure. Percentage of children served by the program with SPHERE Infant Assessment Increase in the percentage of This measure will be appropriate number of well-visit health exams: III. 15. Completed Baby Health Exams (Well Visits) children served by the collected for all children. III. 16. Baby Health Exams Status program with appropriate (100 x # of children with appropriate number of number of well-visit health well-visit health exams) / total # of children exams based on Medicaid enrolled in program Schedule, between year 1 baseline and 3-year benchmark reporting period Justification: An important goal of the State Home Visiting Plan is to improve the health of children through provision of and coordination with regular, high quality pediatric care. This measure uses the Wisconsin Medicaids Early Periodic Screening, Diagnosing and Treatment (EPSDT) Periodicity Schedule for assessing appropriate number of well-visit health exams. This method of measurement uses existing questionnaires and data structure. Although our official measure for reporting purposes will be percentage of children served by the program with appropriate number of well-visit health exams, per request from State Administration, we will also ask programs to collect information regarding children's immunization status. This information is also available via the SPHERE Infant Assessment.
Benchmark #2 Child Injuries, Child Abuse, Neglect or Maltreatment and Reduction of Emergency Department Visits
Construct Visits for Children to the ER Department from all causes Data Collection Plan (timing, population) Rate of emergency room visits for children served SPHERE Health Care Utilization Screening -This measure will be by the program: (Question: Number of times in the past 12 months collected for all children seen or treated in an emergency room, broken down by served by the program. (# of emergency room visits by children / total # of medical illness, physical injury, dental emergency) -Measure will be children enrolled in program) reported in aggregate and by age category (012 mos., 13-36 mos., 3784 mos., as appropriate given population served by program. Justification: This method of measurement uses existing questionnaires and data structure, and is also consistent with our method for reporting on a similar construct for State Statute Chapter 48: Number of emergency room visits for children. Rate of emergency room visits for mothers served SPHERE Health Care Utilization Screening Decrease in rate of This measure will be by the program: (Question structure similar to above) emergency room visits by collected for all mothers mothers, between year 1 served by the program. (# of emergency room visits by mothers/ total # of baseline and 3-year mothers enrolled in program) benchmark reporting period Proposed Measure Source of Measure Proposed Definition of Improvement Decrease in rate of emergency room visits by children served by the program, between year 1 baseline and 3-year benchmark reporting period
Visits for Mothers to the ER Department from all causes
Justification: This method of measurement uses existing questionnaires and data structure.
Construct Information or training provided to families on prevention of child injuries
Incidence of child injuries requiring medical treatment
Proposed Definition of Data Collection Plan Improvement (timing, population) Percentage of women served by the program who SPHERE Health Teaching Topics and Result Report: Increase in percentage of This measure will be receive information or training on injury Comprehensive Injury Prevention mothers served by the collected for all mothers prevention: program who receive served by the program. information or training on (100 x # of women who receive information or injury prevention, between training on injury prevention) / total # of women year 1 baseline and 3-year enrolled in program benchmark reporting period Justification: Injury prevention professionals identify education along with environmental modifications and enforcement of rules and policies as the primary mechanisms for successfully reducing injury related death and disability during childhood. A standardized definition of what constitutes comprehensive injury prevention will be developed and built into training for home visitors. This method of measurement uses existing questionnaires and data structure. Rate of emergency room visits for physical injuries, SPHERE Health Care Utilization Screening Decrease in rate of -This measure will be by children served by the program: Number of times in the past 12 months emergency room visits for collected for all children seen or treated in an emergency room: physical injuries by children served by the program. (# of emergency room visits for physical injuries by served by the program, -Measure will be children/ total # of children enrolled in program) ONLY: Physical Injury - # times between year 1 baseline and reported in aggregate 3-year benchmark reporting and by age category (0period 12 mos., 13-36 mos., 3784 mos., as appropriate given population served by program. Justification: This method of measurement uses existing questionnaires and data structure, and is consistent with our method for reporting on a similar construct for State Statute Chapter 48: number of emergency room visits for injuries to children.
Proposed Measure
Source of Measure
Construct Reported suspected maltreatment for children in the program (screened in but not substantiated)
Proposed Measure Percentage of children served by the program with a screened in report of suspected maltreatment: (100 x # children having at least 1 screened in report of suspected maltreatment in State Administrative Database/ total # of children enrolled in program)
Source of Measure Access Report available in WiSACWIS
Proposed Definition of Improvement Decrease in percentage of children served by the program with at least 1 reported suspected maltreatment, between year 1 baseline and 3-year benchmark reporting period
Reported substantiated maltreatment for children in the program (substantiated/indi cated/alternative response victim)
As possible, measure will be reported in aggregate, and also for each of the following: neglect, physical abuse, sexual abuse, emotional abuse, other maltreatment Justification: We will use State Administrative Data for this measure, as we know that this is the most valid and reliable source of data for reported suspected maltreatment. We will work with data experts at DCF to determine the best way to match program participants within the WiSACWIS system (however, please see Section 5, Anticipated Barriers or Challenges). Percentage of children served by the program with Initial Assessment Report available in WiSACWIS Decrease in percentage of -This measure will be at least 1 reported, substantiated instance of children served by the collected for all children. maltreatment: program with at least 1 -Measure will be reported, substantiated reported in aggregate (100 x # children having a reported suspected instance of maltreatment, and by age category (0maltreatment in State Administrative Database/ between year 1 baseline and 12 mos., 13-36 mos., 37total # of children enrolled in program) 3-year benchmark reporting 84 mos., as appropriate period given population served As possible, measure will be reported in aggregate, by program. and also for each of the following: neglect, physical abuse, sexual abuse, emotional abuse, other maltreatment Justification: We will use State Administrative Data for this measure, as we know that this is the most valid and reliable source of data for reported substantiated maltreatment. We will work with data experts at DCF to determine the best way to match program participants within the WiSACWIS system (however, please see Section 5, Anticipated Barriers or Challenges).
Data Collection Plan (timing, population) -This measure will be collected for all children served by the program. -Measure will be reported in aggregate and by age category (012 mos., 13-36 mos., 3784 mos., as appropriate given population served by program.
Construct First-time victims of maltreatment for children in the program
Proposed Measure Percentage of children served by the program who are first time victims of maltreatment, to be determined using a standardized questionnaire or tool: (100 x # children demonstrating first-time maltreatment / total # of children enrolled in program)
Source of Measure Our Evaluation and Quality Improvement Work Group is currently researching the best tools and standardized questionnaires to assess this construct. One possible tool under consideration is the Conflict Tactics Scale, ParentChild Version, as listed in the DOHVE Compendium of Measures.
Proposed Definition of Improvement Decrease in percentage of children served by the program who are first time victims of maltreatment, to be determined using a standardized questionnaire or tool, between year 1 baseline and 3-year benchmark reporting period
Data Collection Plan (timing, population) -This measure will be collected for all children -Measure will be reported in aggregate and by age category (012 mos., 13-36 mos., 3784 mos., as appropriate given population served by program.
As possible, measure will be reported in aggregate, and also for each of the following: neglect, physical abuse, sexual abuse, emotional abuse, other maltreatment Justification: Very few home visiting programs have proven their ability to impact rates of substantiated maltreatment, yet some programs have been effective in reducing psychosocial risk factors for abuse, or increasing resilience (Paulsell et al., 2010). Given the less specific language in this construct, we see this as an opportunity to build in piloting of a standardized tool or questionnaire to assess these factors, as well as to improve the validity and reliability of parent reports of maltreatment. In addition, given variation in county substantiation practices, and our concerns regarding our ability to match home visiting data with State Administrative Data, we also see this as an important opportunity to triangulate our findings from administrative data and this type of tool. (Also, see Section 5, Anticipated Barriers or Challenges). Our State Evaluation and Quality Improvement Work Group will make a final recommendation regarding tool, measurement, and definition of improvement prior to the beginning of program implementation, and the state will support the measure roll-out with training opportunities.
Benchmark #3 Improvements in School Readiness and Achievement

Construct Parent support for childrens learning and development (e.g., having appropriate toys available, talking and reading with their child) Proposed Definition of Data Collection Plan Improvement (timing, population) Percentage of enrolled families whose total HOME HOME Inventory, Total Score Increase in percentage of This measure will be score improves between the 6- and 12-month (Recorded in SPHERE: HOME Trends Over Time Report) newly enrolled families reported for enrolled assessment: whose total HOME score families in the program improves between the 6- and with 6- and 12-month (100 x # of families whose total HOME score 12-month assessment, HOME scores improves between 6- and 12-month assessment) / between year 1 baseline and total # of newly enrolled families with 6-12 month 3-year benchmark reporting HOME assessments period Justification: This method of measurement uses a standardized tool required of all programs, and existing data structure. Although we will continue to administer the HOME beyond 12 months (see description in Instruments Required for All Programs), we will limit our federal reporting to improvement between 6- and 12-month assessments, as our stated goal is to enroll at least 75% of women prenatally. Thus, we anticipate that throughout the program, most of our new enrollees will have young infants, and these would be the first two HOME assessments performed for most families. Upon further analysis, we may also consider using subscales from the HOME to specifically address particular domains of parent support. Percentage of mothers served by the program who SPHERE Health Teaching Topics and Result Report: Increase in the percentage of This measure will be receive information or training on child growth and Child Growth and Development mothers served by the collected for all mothers development: program who receive served by the program. information or training on (100 x # of women who receive information or child growth and training on child development) / total # of women development, between year enrolled in program 1 baseline and 3-year benchmark reporting period Justification: This method of measurement uses existing questionnaires and data structure, and supports the following outcome identified in State Statute Chapter 48: Parents receiving home visitation services acquiring knowledge of early learning and child development and interaction with their children in ways that enhance the childrens development and early learning. The technical definition of what constitutes training on child growth and development will be built into professional development, so it is the same across home visitors. Proposed Measure Source of Measure
Parent knowledge of child development and their childs developmental progress
Construct Parenting behaviors and parent-child relationship (e.g., discipline strategies, play interactions)
Parental emotional well-being or parenting stress (some of the data may also be captured for maternal health under that benchmark area)
Proposed Definition of Data Collection Plan Improvement (timing, population) Percentage of newly enrolled families whose total HOME Inventory, Total Score Increase in percentage of This measure will be HOME score improves between the 6- and 12(Recorded in SPHERE: HOME Trends Over Time Report) newly enrolled families reported for newly month assessment: whose total HOME score enrolled families in the improves between the 6- and program with 6- and 12(100 x # of families whose total HOME score 12-month assessment, month HOME scores improves between 6- and 12-month assessment) / between year 1 baseline and total # of newly enrolled families with 6-12 month 3-year benchmark reporting HOME assessments period Justification: This method of measurement uses a standardized tool required of all programs, and existing data structure. Although we will continue to administer the HOME beyond 12 months (see description in Instruments Required for All Programs), we will limit our federal reporting to improvement between 6- and 12-month assessments, as our stated goal is to enroll at least 75% of women prenatally. Thus, we anticipate that throughout the program, most of our new enrollees will have young infants, and these would be the first two HOME assessments performed for most families. Upon further analysis, we may also consider using subscales from the HOME to specifically address particular domains of parenting behaviors. Percentage of newly enrolled mothers administered Date of administration of Perceived Stress Scale, as well Increase in the percentage of This measure will be the Perceived Stress Scale within the first month of as score, will be added to the Client Resources Tab in newly enrolled mothers collected only for newly enrollment: SPHERE administered the Perceived enrolled women. Stress Scale within the first (100 x # of newly enrolled women administered the month of enrollment, Perceived Stress Scale within the first month of between year 1 baseline and enrollment) / total # of newly enrolled women 3-year benchmark reporting period Justification: While informal screening for parental stress has long been the practice in many WI home visiting programs, the State would like to build in a timely, standardized, formal stress assessment for all mothers, which will be helpful for early case-planning. Specifically, we will be asking all programs to begin using the Perceived Stress Scale as the State Home Visiting program matures. This measure will capture improvements in our process to develop formal training and quality assurance around this innovation.
Proposed Measure
Source of Measure
Construct Childs communication, language and emergent literacy
Childs general cognitive skills
Proposed Definition of Data Collection Plan Improvement (timing, population) Percentage of children who received services SPHERE Increase in the percentage of While all children will within 2 months, whose most recent ASQ-3 score Developmental Assessment: ASQ-3 + Plan of Action children who received be screened using the (communication domain) indicates a potential Results services within 2 months, ASQ-3, this measure concern: whose most recent ASQ-3 will capture outcomes score (communication for children whose most (100 x # children who received services within 2 domain) indicates a potential recent ASQ-3 score months) / total # of children whose most recent concern, between year 1 (communication domain) ASQ-3 score (communication domain) indicates a baseline and 3-year indicates a potential potential concern benchmark reporting period concern Justification: The ASQ-3 is widely used throughout Wisconsin, and we will be requiring all home visiting programs to administer it using the recommended schedule (see description in Instruments Required for All Programs). The ASQ-3 is a screening tool; therefore proper use of this tool is to identify children with potential developmental delays, in need of further services. We feel it is most important, then, for programs to document follow-up and receipt of needed services. Services may include, but are not limited to, re-testing, providing additional program services, referrals to other providers such as Birth to 3 Services, or medical care. The measure also uses existing data structure. Additional services may be recommended based on score cutoffs or parental concerns. Percentage of children who received services SPHERE Increase in the percentage of While all children will within 2 months, whose most recent ASQ-3 score Developmental Assessment: ASQ-3 + Plan of Action children who received be screened using the indicates a potential concern: Results services within 2 months, ASQ-3, this measure whose most recent ASQ-3 will capture outcomes (100 x # children who received services within 2 score indicates a potential for children whose most months) / total # of children whose most recent concern, between year 1 recent ASQ-3 score ASQ-3 score indicates a potential concern baseline and 3-year indicates a potential benchmark reporting period concern Justification: The ASQ-3 is widely used throughout Wisconsin, and we will be requiring all home visiting programs to administer it using the recommended schedule (see description in Instruments Required for All Programs). The ASQ-3 is a screening tool; therefore proper use of this tool is to identify children with potential developmental delays, in need of further services. We feel it is most important, then, for programs to document follow-up and receipt of needed services. Services may include, but are not limited to, re-testing, providing additional program services, referrals to other providers such as Birth to 3 Services, or medical care. The measure also uses existing data structure. Additional services may be recommended based on score cutoffs or parental concerns.
Proposed Measure
Source of Measure
10
Construct Childs positive approaches to learning including attention
Childs social behavior, emotion regulation, and emotional wellbeing
Proposed Definition of Data Collection Plan Improvement (timing, population) Percentage of children who received services SPHERE Increase in the percentage of While all children will within 2 months, whose most recent ASQ-3 score Developmental Assessment: ASQ-3 + Plan of Action children who received be screened using the (problem solving domain) indicates a potential Results services within 2 months, ASQ-3, this measure concern: whose most recent ASQ-3 will capture outcomes score (problem solving for children whose most (100 x # children who received services within 2 domain) indicates a potential recent ASQ-3 score months) / total # of children whose most recent concern, between year 1 (problem solving ASQ-3 score (problem solving domain) indicates a baseline and 3-year domain) indicates a potential concern benchmark reporting period potential concern Justification: The ASQ-3 is widely used throughout Wisconsin, and we will be requiring all home visiting programs to administer it using the recommended schedule (see description in Instruments Required for All Programs). The ASQ-3 is a screening tool; therefore proper use of this tool is to identify children with potential developmental delays, in need of further services. We feel it is most important, then, for programs to document follow-up and receipt of needed services. Services may include, but are not limited to, re-testing, providing additional program services, referrals to other providers such as Birth to 3 Services, or medical care. The measure also uses existing data structure. Additional services may be recommended based on score cutoffs or parental concerns. Percentage of children who received services SPHERE Increase in the percentage of While all children will within 2 months, whose most recent ASQ-SE score Developmental Assessment: ASQ-SE + Plan of Action children who received be screened using the indicates a potential concern: Results services within 2 months, ASQ-SE, this measure whose most recent ASQ-SE will capture outcomes (100 x # children who received services within 2 score indicates a potential for children whose most months) / total # of children whose most recent concern, between year 1 recent ASQ-SE score ASQ-SE score indicates a potential concern baseline and 3-year indicates a potential benchmark reporting period concern Justification: The ASQ-SE is widely used throughout Wisconsin, and we will be requiring all home visiting programs to administer it using the recommended schedule (see description in Instruments Required for All Programs). The ASQ-SE is a screening tool; therefore proper use of this tool is to identify children with potential developmental delays, in need of further services. We feel it is most important, then, for programs to document follow-up and receipt of needed services. Services may include, but are not limited to, re-testing, providing additional program services, referrals to other providers such as Birth to 3 Services, or medical care. The measure also uses existing data structure. Additional services may be recommended based on score cutoffs or parental concerns.
Proposed Measure
Source of Measure
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Construct Childs physical health and development
Proposed Definition of Data Collection Plan Improvement (timing, population) Percentage of infants served by the program born SPHERE Infant Assessment Decrease in the percentage This measure will be weighing less than 2,500 grams: 11. Birth weight: of infants served by the collected only for infants program born weighing less born to mothers enrolled (100 x # of infants born weighing less than 2,500 than 2,500 grams, between prenatally. grams / total # of infants born while mother year 1 baseline and 3-year enrolled in the program benchmark reporting period Justification: Low birth weight (defined as <2500 grams) is associated with poor infant health and developmental delays, and may also be indicative of poor prenatal health, stress, detrimental behaviors (e.g., smoking, alcohol use, etc.), and lack of prenatal care (McGauhey et al., 1991). Reducing poor birth outcomes, and in particular, racial disparities in birth outcomes, is a key goal of Wisconsins home visiting program, as identified in the States original Needs Assessment and as an outcome in State Statute Chapter 48. This measure captures an early and important indicator of childs physical health and development, and also uses existing questionnaires and data structure.
Proposed Measure
Source of Measure
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Benchmark #4 Crime or Domestic Violence *Note: WI has chosen to focus on domestic violence for this benchmark area
Construct Screening for Domestic Violence Proposed Measure Percentage of families served by the program who are screened for domestic violence using a standardized tool or questionnaire: (100 x # of families who were screened for domestic violence using a standardized tool or questionnaire) / total # of families enrolled in the program Source of Measure Our Evaluation and Quality Improvement Work Group is currently working with domestic violence experts to identify the best tools and standardized questionnaires to assess this construct. One possible tool under consideration is the Conflict Tactics Scale-Revised, as listed in the DOHVE Compendium of Measures, or we are also considering a series of questions available in the Domestic Violence Handbook for Wisconsin Child Protective Service Workers currently used by the DCF Division of Safety and Permanence. Proposed Definition of Improvement Increase in the percentage of families served by the program who are screened for domestic violence using a standardized tool or questionnaire, between year 1 baseline and 3-year benchmark reporting period Data Collection Plan (timing, population) This measure will be collected for all families served by the program.
Of families identified for presence of domestic violence, number of referrals made to relevant services
The format to report information from the standardized measure will be added to SPHERE Justification: Wisconsin recognizes the need to strengthen home visitings role in recognizing the presence of domestic violence and connecting victims with support services. We also recognize the need to improve the validity and reliability of current, typical measures of domestic violence, which tend to be self-reports collected during unstructured interviews with clients. Therefore, we plan to use this opportunity to strengthen training to home visitors and build in piloting of a standardized tool or questionnaire to screen for domestic violence, as well as to improve the validity and reliability of parent reports of such violence. This measure will capture improvements in our process to develop formal training and quality assurance around this innovation. Our State Evaluation and Quality Improvement Work Group will make a final recommendation regarding tool choice prior to the beginning of program implementation, and the state will support the measure roll-out with training opportunities. Percentage of families who received a referral for SPHERE Referral and Follow-Up Results Increase in the percentage of While all families will services after being identified for presence of families who received a be screened for domestic domestic violence referral for services after violence, this measure being identified for presence will capture outcomes (100 x # of families who received a referral for of domestic violence, for families identified for services after being identified for presence of between year 1 baseline and presence of domestic domestic violence) / total # of families identified 3-year benchmark reporting violence. for presence of domestic violence period Justification: This measure uses existing questionnaires and data structure. 13
Construct Of families identified for presence of domestic violence, number of families for which a safety plan was completed
Proposed Definition of Data Collection Plan Improvement (timing, population) Percentage of families who received services after SPHERE Referral and Follow-Up Results Increase in the percentage of While all families will being identified for presence of domestic violence families who received be screened for domestic services after being violence, this measure (100 x # of families who received services after identified for presence of will capture outcomes being identified for presence of domestic violence) domestic violence, between for families identified for / total # of families identified for presence of year 1 baseline and 3-year presence of domestic domestic violence benchmark reporting period violence. Justification: State domestic violence experts have a very specific definition of a safety plan, which we are concerned may not be accurately captured without very careful questioning or extensive follow-up on the part of home visitors. In other words, we are concerned about construct validity, and therefore are choosing to focus our efforts on making sure women are connected with needed services. This measure also uses existing questionnaires and data structure.
Proposed Measure
Source of Measure
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Benchmark #5 Family Economic Self-Sufficiency

Construct Household Income and Benefits Proposed Definition of Data Collection Plan Improvement (timing, population) Percentage of families served by the program who SPHERE Household Information tab Increase in the percentage of -This measure will be report an increase in total household income and families served by the collected for all families benefits: program who report an served by the program. increase in total household -Changes will be (100 x # of families served by the program who income and benefits, measured over a period report an increase in total household income and between year 1 baseline and of approximately 12 benefits/ total # of families enrolled) 3-year benchmark reporting months. period Justification: Unfortunately, our state administrative data systems for child support and public benefits are separate without an easy client matching system, and unemployment insurance data often lags several quarters behind real time. We do have the capacity in SPHERE to collect total household income (self-reported), but will not be able to break out specific amounts from separate benefit sources. Because of these limitations, we sought technical assistance from Lauren Supplee (ACF) regarding our proposed measure, who shared our question with FESS experts. These experts approved our proposed measure (personal email correspondence, 5/26/11). Percentage of households served by the program SPHERE General/Mortality tab Increase in the percentage of This measure will be with at least 1 employed adult within the last households served by the collected for all quarter program with at least 1 households served by the employed adult within the program. (100 x # of households served by the program with last quarter, between year 1 at least 1 employed adult within the last quarter/ baseline and 3-year total # of households) benchmark reporting period Justification: Unfortunately, there is no easy way to match home visiting data and state administrative data regarding public benefits, and unemployment insurance data often lags several quarters behind real time. We do have the capacity in SPHERE to collect basic information about household employment (self-reported), but felt it would be very difficult to collect data at the hourly level as recommended in the SIR. Because of these limitations, we sought technical assistance from Lauren Supplee (ACF) regarding our proposed measure, who shared our question with FESS experts. These experts approved our proposed measure (personal email correspondence, 5/26/11). Percentage of mothers served by the program who SPHERE General/Mortality tab Increase in the percentage of -This measure will be report an increase in educational attainment: mothers served by the collected for all families program who report an served by the program. (100 x # of mothers served by the program who increase in educational -Changes will be report an increase in educational attainment/ total # attainment, between year 1 measured over a period of mothers enrolled) baseline and 3-year of approximately 12 benchmark reporting period months. 15
Proposed Measure
Source of Measure
Employment* or Education of adult members of the household *Measure both but must show improvement in only one
Employment or Education* of adult members of the household *Measure both but must show
improvement in only one: Construct Health Insurance Status
Justification: Increases in maternal education in particular are linked to improvements in childrens educational outcomes (Magnuson, 2003). Given this knowledge and existing data structures within SPHERE, we propose to focus on increases in maternal education over time. We sought technical assistance from Lauren Supplee (ACF) regarding our proposed measure, who shared our question with FESS experts. These experts approved our proposed measure (personal email correspondence, 5/26/11). Proposed Measure Source of Measure Proposed Definition of Data Collection Plan Improvement (timing, population) Percentage of mothers and fathers with public or SPHERE Health Care Coverage Demographic Data Increase in the percentage of This measure will be private health insurance: Does the client have health insurance or Medicaid? mothers and fathers with collected for all families public or private health served by the program. Percentage of mothers served by the program with insurance, between year 1 any type of health insurance: baseline and 3-year benchmark reporting period (100 x # of mothers with any type of health of insurance) / total # of mothers enrolled in program Percentage of fathers served by the program with any type of health insurance: (100 x # of fathers with any type of health of insurance) / total # of fathers enrolled in program Justification: This measure uses existing questionnaires and data structure.
16
Benchmark #6 Coordination and Referrals for Other Community Resources and Reports
Construct Number of families identified for necessary services Proposed Definition of Data Collection Plan Improvement (timing, population) The percentage of postpartum women served by the SPHERE Postpartum Assessment Increase in the percentage of This measure will be program who are screened for depression (Questions: Section III.7e. Depression screening using a women served by the collected for all postpartum using a standardized tool: standardized screening tool in addition to questions asked program who are screened postpartum mothers previously: yes/no for depression postpartum served by the program. (100 x # of women who are screened for depression Section III. 7e. Tool used & Score) using a standardized tool, using a standardized tool) / total # of postpartum between year 1 baseline and women enrolled in program 3-year benchmark reporting period Justification: Research suggests that maternal depression is a significant risk factor that negatively affects the development and well-being of children (Knitzer et al., 2008). Given the states goal of introducing a new postpartum depression screening tool (the EPDS) and the lack of access to mental health services identified in the State Needs Assessment, we have chosen to focus on depression screening and referral in this benchmark area. Our ultimate goal is to increase the capacity of home visiting programs to screen mothers for depression and make relevant referrals, and to increase the capacity of communities to provide needed mental health services. Percentage of mothers who received a referral for SPHERE Referral and Follow-Up Results Increase in the percentage of While depression services after being identified for potential presence mothers who received a screening will be of postpartum depression referral for services after conducted for all being identified for potential postpartum mothers (100 x # of mothers who received a referral for presence of postpartum served by the program, services after being identified for potential presence depression, between year 1 this measure will capture of postpartum depression) / total # of mothers baseline and 3-year outcomes for mothers identified for potential presence of postpartum benchmark reporting period identified for potential depression presence of postpartum depression Justification: Research suggests that maternal depression is a significant risk factor that negatively affects the development and well-being of children (Knitzer et al., 2008). Given the states goal of introducing a new postpartum depression screening tool (the EPDS) and the lack of access to mental health services identified in the State Needs Assessment, we have chosen to focus on depression screening and referral in this benchmark area. Our ultimate goal is to increase the capacity of home visiting programs to screen mothers for depression and make relevant referrals, and to increase the capacity of communities to provide needed mental health services. Proposed Measure Source of Measure
Number of families that required services and received a referral to available community resources
17
Construct Number of Memoranda of Understanding or other formal agreements with other social service agencies in the community
Number of agencies with which the home visiting provider has a clear point of contact in the collaborating community agency that includes regular sharing of information between agencies Number of completed referrals
Proposed Definition of Data Collection Plan Improvement (timing, population) Total number of Memoranda of Understanding or Measure will be collected by programs, as suggested in the Increase in the total number This measure will be other formal agreements with other social service DOHVE Optional Tool for the Measurement of of Memoranda of collected for all agencies in the community Coordination and Referral Benchmark Constructs (p. 6) Understanding or other programs. formal agreements with other social service agencies in the community, between year 1 baseline and 3-year benchmark reporting period Justification: While data will be reported at the State aggregate level for federal reporting purposes, we will also pay attention to this measure at the individual program level for CQI purposes. Particular communities may have goals for increasing availability of and connections to particular types of services. Total number of agencies with which the home Measure will be collected by programs, as suggested in the Increase in the total number This measure will be visiting provider has a clear point of contact in the DOHVE Optional Tool for the Measurement of of agencies with which the collected for all collaborating community agency that includes Coordination and Referral Benchmark Constructs (p. 6) home visiting provider has a programs. regular sharing of information between agencies clear point of contact in the collaborating community agency that includes regular sharing of information between agencies Justification: While data will be reported at the State aggregate level for federal reporting purposes, we will also pay attention to this measure at the individual program level for CQI purposes. Particular communities may have goals for increasing availability of and connections to particular types of services. Percentage of mothers who received services after being referred, due to identification for potential presence of postpartum depression (100 x # of mothers who received services) / total # of mothers referred for services due to identification of potential presence of postpartum depression SPHERE Referral and Follow-Up Results Increase in the percentage of mothers who received services after being referred, due to identification for potential presence of postpartum depression, between year 1 baseline and 3-year benchmark reporting period While depression screening will be conducted for all postpartum mothers served by the program, this measure will capture outcomes for mothers identified for potential presence of postpartum depression
Proposed Measure
Source of Measure
18
Justification: Research suggests that maternal depression is a significant risk factor that negatively affects the development and well-being of children (Knitzer et al., 2008). Given the states goal of introducing a new postpartum depression screening tool (the EPDS) and the lack of access to mental health services identified in the State Needs Assessment, we have chosen to focus on depression screening and referral in this benchmark area. Our ultimate goal is to increase the capacity of home visiting programs to screen mothers for depression and make relevant referrals, and to increase the capacity of communities to provide needed mental health services.
19
ATTACHMENT 7
Working Draft of Structure

Wisconsin State Early Childhood Advisory Council (ECAC)
Governor appointed Co-Chairs: DCF Secretary and DPI State Superintendent Members appointed by the Governor as per federal requirements and executive order
11/11/10
Wisconsin Early Childhood Collaborating Partners (WECCP) Action Team

Current initiatives as well as assignments from ECAC May also participate in ECAC ad-hoc committees as appropriate Workgroup for select Phase I priorities: WMELS Initiative, Networks, Higher Ed Initiative, and Professional development
Council Ad Hoc Committees

Initial committees are determined based on Phase I and Phase II priorities. As priorities are determined in Phase II and III, new committees may be formed. ECAC co chairs appoint committee chairs (Each committee chair may recommend a co chair) Committee members (or their Designees) are chosen based on their interest
Key state councils, boards, etc. with members on Council

Birth to 3 Interagency Coordinating Council (DHS) Childrens Trust Fund /Celebrate Children Foundation Board
Input Groups
Funding Application
Initial and ongoing input to development of:
ECAC Application for federal funding

including Phase I priorities-completed Other grants as applicable
(Created July meeting)
Maternal Child Health Advisory Committee (DHS) Partnership for Wisconsins Economic Success (PWES) PreK 16 Leadership Council State Superintendents Advisory Council on 4K and community approaches (DPI) WI Head Start Collaboration Office Advisory Committee
Early Learning Committee
System Assessment
Initial and ongoing input to development of system assessment including:
Safe and Healthy Children
Phase II: Review existing assessments

and priorities - completed
Phase III: Define additional areas to

Strengthening Families
assess, complete assessment, recommend priorities

(Created 9/3/09)
System Design
Professional Development/ Higher Education
Phase II recommendations for system components and structure Align Birth to 5 policy initiatives (Created 1/10)
Related Groups
Other State Councils, Boards, etc.
Regional Action Teams Council members with Regional structures may add new members to Regional Teams to assure representation on the regional level. Teams provide regional coordination, as well as input and focus at the regional and local levels
Data Alignment/Annual Report

Work group for Council application data project
(To be formed in early 2010)
Home Visiting
Initial and ongoing input to federal home visiting initiatives
(Created 10/10)
Other State-level Initiatives

Building Bridges to Family Economic Success Quality Rating Improvement System
Public Input
Liaison: Wisconsin Head Start Collaboration Office Director whose role is facilitating the alignment of federal requirements, Council, Staff team, and WECCP Action Team Steering Committee ECAC Staff and Committee chairs are to coordinate and advance the work of committees and ECAC
WI Department of Children and Families Updated State Home Visiting Plan June 2011
Attachment 8
Jennifer Hammel Group
Governors Office
PEW Grant Group
Secretary Anderson
Secretary Smith
Early Childhood Advisory Council
Outcomes Project Management ECAC HV Ad Hoc Committee Project Team Leslie McAllister, DCF Ann Stueck, DHS Katie Gillespie, DHS Hilary Shager, DCF Loraine Lucinski, DHS Linda Hale, DHS Judie Hermann, DCF Jennifer Jones, CTF Linda Leonhart, DCF Jill Haglund, DPI Bernestine Jeffers, DHS Jean Zawacki, DCF Mia Zong Vue, DCF Dave Rynearson, DHS Kim Eithun, DCF Fredi Bove Mark Campbell Susan Uttech Joyce Allen Linda McCart Judie Hermann Leslie McAllister Andrea Alpert-Buss Jay Maes John Burgess Jennifer Jones Ken Taylor Kia LaBracke MaryAnn Lippert Lisa Furseth Lorraine Lathem Mary Anne Snyder Suzy Rodriguez Jennifer Thayer
Evaluation Ad Hoc Committee Chairs: John Burgess Hilary Shager
Training and Technical Assistance Ad Hoc Committee Chairs: Suzy Rodriguez Lilly Irvin-Vitela
Attachment 9
LESLIE A. MCALLISTER, MSSW

100 Lakewood Gardens Lane Madison, WI 53704 (608) 245-9642
EDUCATION
Masters of Science in Social Work, 1998, University of Wisconsin, Madison, WI Concentration Area: Children, Youth and Families with an emphasis on Social Policy Bachelor of Arts in Latin American Studies, 1992, Carleton College, Northfield, MN Senior Thesis: The Effects of Ecological Tourism on Costa Ricas Rainforests
PROFESSIONAL EXPERIENCE
Wisconsin Department of Children and Families, Madison, WI Home Visiting Coordinator, February 2010- present Prepares federal grant applications on behalf of the State of Wisconsin Develops Requests for Proposals to distribute funds for programs and training and technical assistance services related child abuse and neglect prevention Administers federal and state home visiting grants to county health and human service departments and community-based organizations Oversees the contracts for training and technical assistance to home visiting programs across the state Covering Kids and Families/UW-Madison School of Human Ecology, Madison, WI Outreach Specialist, May 2009 February 2010 Staffed the organizations social policy committee Prepared position papers on state and federal health care policies Developed outreach strategies for child care centers and family serving organizations to help eligible families they serve access health insurance benefits Conducted workshops on state and federal health care policy issues for statewide conferences UW-Madison/School of Social Work, Madison, WI Lecturer, Spring Semester 2008-2009 Prepared weekly lectures for Introduction to Social Policy course Prepared and administered exams and class assignments Acted as faculty advisor to social policy students that were interns with Wisconsin Public Interest Research Group (WSPIRG) Tenant Resource Center, Madison, WI Housing Counselor, May 2009 September 2009 Informed tenants and landlords about their legal rights and responsibilities Provided appropriate referrals and information regarding health and social services for low-income tenants City of Madison/Office of Community Services, Madison, WI Weed & Seed Coordinator, May 2004 December 2008
Increased resident access to and participation in City and other government decision-making processes in three low-income communities Worked to improve communication and relationships between police and neighborhood residents Identified gaps in social services and worked with neighborhood-based providers to fill them Provided extensive leadership development training to low-income residents in the areas of understanding legislative processes, advocacy, engaging others in neighborhood activities, facilitating meetings, and project management
Interfaith Hospitality Network, Madison, WI Shelter Case Manager, April 2002 April 2004 Developed and implemented case plans with homeless and families transitioning into permanent housing Provided appropriate referrals and information regarding health and social services for families in shelter Advocated for homeless families in the social services and low-income housing services in Dane County Conducted workshops for social service providers and early childhood educators on public benefits and advocacy as a leader of the Dane County Benefits Advocacy Team (BAT) Coalition of Wisconsin Aging Groups, Madison, WI Intergenerational Advocacy Coordinator, June 2000 September 2001 Coordinated private foundation grant to develop partnerships with advocates for children and families, persons with disabilities, and the elderly Developed grant proposals for local and national foundations and federal and state agencies Conducted training for older adults and social service providers on how to influence the legislative process Prevent Child Abuse Wisconsin, Madison, WI Program Director, December 1998 - May 2000 Coordinated federal grant to expand a statewide network of parent-led support groups Conducted workshops at state conferences and regional meetings Supervised student interns and volunteers Participated in statewide coalitions which advocate for programs and policies that support Wisconsin families Planned agency fundraisers
NON-PROFIT BOARD MEMBERSHIP

Madison Apprenticeship Program, Madison, WI Member at large, January 2009-December 2009 Secretary, February 2010-present Allied Wellness Center, Madison, WI Vice President, October 2010-present
PROFESSIONAL AFFILIATION
National Association of Social Workers, Wisconsin Chapter, Madison, WI
South Central Branch Representative to the Board of Directors, July 2001-June 2004 Legislative and Social Policy Co-Chair, September 1999 January 2007 Legislative and Social Policy and PACE Committees, October 1996 December 2007
Biographical Sketch
Give the following information for all professional personnel contributing to the project beginning with the Project Director. (DO NOT EXCEED 2 PAGES ON ANY INDIVIDUAL)
NAME (Last, first, middle initial) TITLE BIRTH DATE
Stueck, Ann C. Altman
Public Health Nurse 3 Infant/Child Health
01-31
EDUCATION (begin with baccalaureate or other initial professional education and include postdoctoral training) Year Institution and Location Degree Field of Study Completed
University of Wisconsin, Eau Claire WI University of Wisconsin, Madison WI

HONORS
BSN MSN
1973 1980
Nursing Family & Community ursing
BSN cum laude, 1973 MSN summa cum laude, 1980 University of WI-Extension Community Partnership award, 2004, Governors Child Abuse and Neglect Summit Facilitator Recognition, 2005 James R Ryan Memorial Award for support of Infant Mental Health, 2010 Programs and systems of care for children with special health care needs Programs and systems of care for families with children at risk for abuse and neglect Health, development and safety of children, family support, parent education, home visiting to prevent child maltreatment and promote healthy child growth & development Program evaluation and quality improvement
MAJOR PROFESSIONAL INTEREST(S)
RESEARCH AND PROFESSIONAL EXPERIENCE List in reverse chronological order previous employment and experience. List in reverse chronological order most representative publications.
09/2007 present Public Health Nurse 3, Division of Public Health, Bureau of Community Health Promotion, State of Wisconsin (Madison, WI), Infant and Child Health Consultant 08/1999 09/2007 Public Health Nurse 3, Division of Public Health, Bureau of Community Health Promotion, State of Wisconsin (Madison, WI), Maternal and child health systems of services to support families and children at risk. 1991 1999 Public Health Nurse 2, Division of Public Health, Bureau of Family & Community Health, State of Wisconsin (Madison, WI), Systems development activities promoting quality services and care for children with special health care needs and their families in local communities. 1990 1991 Nurse Clinician 4, University of WI Hospital & Clinics (Madison, WI) Discharge planning for complex pediatric and psychiatric inpatient clients and their families to transition to community care. 1979 1990 Handicapped Childrens Specialist I, Department of Public Instruction, State of Wisconsin (Madison, WI), Provide statewide nursing consultation and services to families of children with special health care needs and local school and community service providers. 1978 Registered Nurse 2 University of WI Childrens Hospital, State of Wisconsin (Madison, WI), Inpatient acute, nursing care for youth and adolescents. 1974 1978 Registered Nurse 2 University of WI Health Services, State of Wisconsin (Madison), Outpatient nursing care and treatment for University students and employees, infectious disease follow up, program development activities, and individual and group health education programs. 1973 1974 Registered Nurse 1 & 2 University of WI Childrens Hospital, State of Wisconsin (Madison, WI), Inpatient infant unit acute health care and pediatric intensive care unit.
Publications
A Historical Analysis of the Concept of Continuity of Care December, 1980 (Unpublished Masters Thesis) Prevention of Child Abuse and Neglect (POCAN) Interim Report, Victoria Agnew, Dept of Health & Family Services, Office of Strategic Finance, May 2001 (Contributing author) Prevention of Child Abuse and Neglect (POCAN) Final Evaluation Report, Nina Troia, Dept of Health & Family Services, Office of Strategic Finance, May 2004 (Contributing author)
Biographical Sketch
NAME (Last, first, middle initial) TITLE BIRTH DATE (mm/dd/ccyy)
Gillespie, Kate H.
Maternal/Perinatal Nurse Consultant
10/05/xxxx
EDUCATION (begin with baccalaureate or other initial professional education and include postdoctoral training) Year Institution and Location Degree(s) Field of Study Completed
Northern Illinois University
BA
1985
Nursing
HONORS
January 2008-Present Wisconsin Department of Health Services, Division of Public Health Maternal/Perinatal Nurse Consultant: Provides consultation on a statewide basis to agencies, organizations, and individuals for the promotion of optimal health of pregnant women and newborns in the state. Promotes maternal and perinatal health service program linkages with other human service programs at the state and local level. Serves as a resource for the administration of maternal and child health programs and develops and promotes standards of maternal and perinatal health care. Regularly communicates with multiple levels of local, state, regional and national agencies and organizations. Responsibilities include monitoring the MCH block grant award to the Wisconsin Association for Perinatal Care and the Infant Death Center of Wisconsin; technical consultation to the Medicaid Prenatal Care Coordination program and to maternal and infant mortality review programs. 1996-2007 Meriter Hospital Lactation Educator: Day to day consultation to both in-patient and out-patient women on breastfeeding initiation, maintenance and problem solving. Providing expertise to NICU staff and families on breast pumping and feeding issues specific to the preterm population. Staff education on competencies required for Baby Friendly Hospital status. Group education and support to expectant parents and new moms. 1991-1996 Group Health Cooperative of Southcentral Wisconsin Acute Care RN: Responsible for telephone and face-to-face triage of patients accessing the acute care clinic. Provided lactation education and support to expectant and new parents. 1989-1991 Rush- Presbyterian- St. Lukes Medical Center Nurse Manager of a family practice clinic of the Rush-Anchor HMO. Responsible for 30 staff members and day to day clinic operations for out-patient health care. Served on policy and procedure committee of the nursing department; developed new RN orientation; and organization restructuring under new leadership. 1987-1989 Michael Reese Health Plan Staff RN providing telephone triage for adult patients of an internal medicine practice. Additional Certifications International Board of Lactation Consultant Examiners- board certified lactation consultant 1995present.
HILARY M. SHAGER
201 E. Washington Ave. Madison WI 53703 OBJECTIVE
Seeking research position within government, to advance the use of evidence-based policy making and improve the lives of children and families
(608) 267-9647 Hilary.Shager@wisconsin.gov
WORK EXPERIENCE
Wisconsin Department of Children and Families (DCF), Madison, WI (December 2010-present) Advanced Research Analyst Conduct and coordinate research and evaluation of department programs, and advise policy makers and program staff o Oversee, direct and complete the design and implementation of evaluations of DCF programs (early child care and education, child welfare, child support, W-2) o Provide technical expertise to the executive team and department managers on matters related to program and policy evaluation, research, and performance o Develop and promote the departments research and evaluation agenda o Contribute to the implantation of KidStat, DCFs performance management strategy o Conduct literature reviews and best practice scans as requested University of Wisconsin-Institute for Research on Poverty, Madison, WI (June 2005 December 2010) Research Assistant (under advisement of Dr. Carolyn Heinrich) Conduct evaluation of Families Forward Child Support Debt Reduction Pilot Program in Racine County, WI and subsequent statewide scale up of related child support debt reduction program o Code and analyze KIDS and UI data, using SAS and STATA o Develop protocol for, conduct, and present results from program participant focus groups o Develop, conduct, analyze, and present results of survey for program participants o Write literature review of child support debt reduction programs in the U.S. o Co-author 4 professional reports to WI Bureau of Child Support (BCS) o Co-author peer-reviewed journal article detailing evaluation findings o Develop Power Point presentations of evaluation findings for state child support workers, BCS staff, UW seminar participants, and national policy research conferences Research Assistant (under advisement of Dr. Katherine Magnuson) Conduct meta-analytic research for National Forum on Early Childhood Policy and Programs o Develop meta-analytic codebook used to build meta-analytic database o Code studies for inclusion in meta-analytic database, using Excel and Access o Train graduate assistants regarding meta-analytic methods o Analyze meta-analytic data using STATA and SAS o Co-author studies of the relationship between research design factors and Head Start evaluation results, as well as differential impacts of early education programs by gender
WIDepartmentofChildrenandFamilies UpdatedStateHomeVisitingPlan June2011
o Present findings via Power Point to audiences at UW seminars and national conferences Conduct study of relationship between changes in maternal education and child outcomes using nationally representative sample of early elementary school children (ECLS-K, collected by the U.S. Department of Education, National Center for Education Statistics) o Conceptualize theoretical framework and statistical models for study (value-added, multilevel regression and propensity score matching) o Recode data, multiply impute missing data, and conduct data analysis using STATA o Co-author peer-reviewed journal article o Present findings via Power Point to audiences at UW seminars and national conferences Conduct literature reviews on early childhood policies and programs o Co-author memo for U. S. Department of Health and Human Services on the role of subsequent schooling and the persistence of Head Start effects o Co-author article on early education and child care policies for Children and Youth Services Review o Conduct reviews of child abuse prevention programs and the effects of maternal depression for National Forum on Early Childhood Policy and Programs
University of Wisconsin-La Follette School of Public Affairs, Madison, WI (2003-2005) Project Assistant (under advisement of Dr. Dennis Dresang) Conducted policy research and analysis for Lieutenant Governor Barbara Lawtons WI Women=Prosperity initiative o Instructed and managed eight graduate student groups reviewing current research and identifying best practices for women in the policy areas of academic achievement, health and well-being, leadership and political participation, and economic sufficiency o Co-authored report on continuing gaps for girls in WI, in K-12 science, math, computer science, and vocational-technical education EAGLE School of Madison, Madison, WI (1997-2003) Language Arts and Social Studies Teacher Designed curriculum for and taught 7th and 8th grade language arts and social studies classes for academically gifted and talented students Advised school newspaper Fort Atkinson High School, Fort Atkinson, WI (1995-1997) English Teacher Designed curriculum for and taught English, Yearbook Journalism, Drama & Speech Directed study program for academically at-risk students
EDUCATIONAL EXPERIENCE
Ph.D. Public Policy; Minor in Education Sciences, University of Wisconsin-Madison, expected August 2011 Awarded American Educational Research Association (AERA) Dissertation Grant ($20,000) Awarded 6-year Interdisciplinary Training Program in the Education Sciences Fellowship (sponsored by Department of Education, Institute for Education Sciences) Institute for Research on Poverty Graduate Research Fellow (2005-2010)
M.P.A. Robert M. LaFollette School of Public Affairs, University of Wisconsin-Madison, 2005 Awarded La Follette Associate Directors Award and La Follette Research Award for outstanding achievement in coursework B.S. University of Wisconsin-Madison, 1995; Majors: Secondary Education, English; Psychology Awarded Hilldale Research Scholarship, School of Education Senior Honors Research Award Awarded Phi Beta Kappa, Governors Academic Excellence Scholarship
Biographical Sketch
NAME (Last, first, middle initial) TITLE BIRTH DATE
Lucinski, Loraine A.
MCH Data, Monitoring & Evaluation Consultant
12/19/69
EDUCATION (begin with baccalaureate or other initial professional education and include postdoctoral training) Year Institution and Location Degree Field of Study Completed
Emory University - Rollins School of Public Health, Atlanta, GA Emory University - Rollins School of Public Health, Atlanta, GA University of Illinois - Chicago
HONORS
MPH MPH BA
2006 2005 1991
MCH Epidemiology PostGraduate Certificate Public Health Developmental Psychology
Recipient of Outstanding Achievement Award, Emory Womans Club, 2005 Awarded credential of Child Development Specialist by the Illinois State Board of Education Credentialing Subcommittee of the Early Intervention Personnel Development Committee, 1993
Newborn & Child Surveillance, Developmental Screening, MCH Performance Indicators, Evaluation, Data Linkages and Usage to Inform Policy and Programming
2008 - Present: State of Wisconsin Division of Public Health MCH Data, Monitoring & Evaluation Consultant/State Systems Development Initiative Coordinator: Responsible for the planning, implementation and evaluation of federal SSDI grant; provide leadership to data integration and linking within DPH; lead statewide needs assessment process; participate on team for MCH data collection and reporting; responsible for the development and implementation of maternal and child health surveillance systems; lead staff for quality improvement for local partners; assist with performance monitoring for Title V Block Grant. 2007 - 2008: State of Wisconsin Division of Long Term Care, Birth to 3 Program Early Intervention Consultant: Provided technical assistance and monitoring to the state supervised and county administered program of early intervention for infants and toddlers with disabilities and delays. Assured a family centered, culturally competent approach is taken within Birth to 3 Program services. 1999 - 2007: State of Wisconsin Division of Public Health Family Centered Care Consultant: Assure a family centered, culturally competent approach taken within the Bureau of Family and Community Healths policies and procedures. Develop a Statewide Network of Parent Support for parents of children who have a special health care need. 1997 - 1999: CESA 5 The Portage Project Training Specialist: Provided training and technical assistance to a variety of audiences including Early Head Start; Part C funded programs; School Personnel including teachers, psychologists and administrators; and Parents. Involved with Portage Project Demonstration Grant supporting six Wisconsin Birth to Three programs to implement reflective practices with both supervisors and direct staff. Early Head Start Subcontract Monitor assisting in the start up of three EHS programs in Wisconsin. 1996 - 1997: Renewal Unlimited, Head Start of Central Wisconsin Coordinator of Early Head Start Services: Coordinator of an EHS program serving 75 families in five rural counties
in central Wisconsin. Provided supervision to 14 staff utilizing a reflective supervision model. Provided community assessments, planning and coordinating with many of the health and social service agencies in each county. 1995 - 1996: Helping Hand Rehabilitation Center Early Childhood Education Specialist: Educator of children and their families in a multi-disciplinary program which provided individual education and therapy services to approximately 60 children annually from birth to age five with medical diagnosis and developmental delays. 1993 - 1995: PARC Early Intervention Program Parent-Infant Educator/Preschool Coordinator: Provided family based therapy in a transdiciplinary program to children from birth to age three with developmental disabilities or at risk for delays due to environmental risk factors. Planned and conducted both structured group activities and individual therapy sessions with children. 1991 - 1993: St. Colettas of Illinois Developmental Therapist: Provided technical assistance and developmental programming ideas to staff members of residentially placed infants and toddlers awaiting foster placement by Department of Children Services due to neglect or abuse (majority of whom were prenatally exposed to substances).
PUBLICATIONS
Pizur-Barnekow, K., Erickson, S., Johnston, M., Bass, T., Lucinski, L., & Bleuel, D. (2010) Early Identification of Developmental Delays through Surveillance, Screening and Diagnostic Evaluation. Infants & Young Children, 23, (4), 323-330. Copa, A., Lucinski, L., Olsen E., & Wollenburg, K. (1999). Promoting Professional and Organizational Development: A Reflective Practice Model. Zero to Three, 20, (1), 3-9. http://www.portageproject.org/newslett/rp_model.htm Parents Educated About Research (PEAR) A Project of Parent to Parent of Wisconsin, 2005 http://www.p2pwi.org/PEAR%20Project.pdf
MEDIA AND MATERIALS DEVELOPMENT
Growing: Birth To Three, 1999 Revision The Portage Guide To Early Education: An Overview (Video) Editor Of The Portage People Newsletter, 1998-1999 Family Service Credential Infant/Toddler Modules
Page 1 of 2
Biographical Sketch
NAME (Last, first, middle initial) TITLE BIRTH DATE (mm/dd/ccyy)
Kratz, Susan K.
SPHERE State Coordinator, Public Health Nurse 3
06-06-1958
EDUCATION (begin with baccalaureate or other initial professional education and include postdoctoral training) Year Institution and Location Degree(s) Field of Study Completed
Marian College of Fond du Lac Fond du Lac, WI University of Wisconsin LaCrosse LaCrosse, WI
HONORS
B.S.N.
1980 2002
Nursing 3 credit graduate course in Biostatistics and Epidemiology
Exceptional Performance Award WI Department of Health and Social Services June 1996 Special Achievement in Public Heath Award Wisconsin Public Health Association June 2000
Public Health, Public Health Nursing, Epidemiology, Maternal and Child Health, Home Visiting, Data systems/data skills/system building and linking of data
06/04 - current Public Health Nurse 3, Family Health Section, Bureau of Community Health Promotion, Division of Public Health, State of Wisconsin (Madison, WI). SPHERE (Secure Public Health Electronic Record Environment) State Admin. Responsible for the coordination and management of all aspects of the SPHERE data system which is the main data system for the Maternal and Child Health Programs, Womens Health Program, and Home Visiting.. Functions include providing technical expertise and consultation to implement and evaluate the statewide SPHERE Data System. 11/03 06/04 Public Health Educator - Advanced, Family Health Section, Bureau of Family and Community Health, Division of Public Health, State of Wisconsin (Madison, Wisconsin). Project Director for the Statewide Systems Development Initiative (SSDI) Grant. Responsible for the coordination and management of all activities identified in the SSDI Grant. Functions are related to grant activities that focus on the support of the Title V Maternal and Child Health needs assessment and improvement of the MCH national and state performance measure data sets. Strong working knowledge of the Secure Public Health Electronic Record Environment (SPHERE) data system, which is the main data system for the Maternal and Child Health Programs. 6/91 - 11/03 Public Health Nurse Consultant, Northeastern/Green Bay Region, Division of Public Health, State of Wisconsin. Responsible for assisting local health departments develop public health programs and services; providing technical assistance and consultation on various nursing and public health issues; promoting effective linkages among local and state health programs; and serving as Contract Administrator for various performance based contracts and grants. Temporary job reassignment started in December 2002 to work on the development of the Secure Public Health Electronic Record Environment (SPHERE) which is the MCH Data Replacement System. One of the State Organization Administrators for the SPHERE System. 6/85 - 6/91 Health Officer/ Public Health Director, Kewaunee County Health Department, Kewaunee, WI. Responsible for directing, supervising, and consulting with public health staff regarding office procedures, policies, programs, and assignments; assessing community needs for public health programs and initiating, developing, and implementing programs; preparing and administering budgets and grants; initiating appropriate epidemiologic investigation for communicable diseases; and representing public health and nursing on various boards and organizations. 6/84 6/85 Health Officer/ Public Health Director, DePere City Health Department, DePere, WI. Responsible for the assessment and management of clients requiring home visits and interventions; coordinating and supervising community screening programs and immunization clinics; supervising the school health programs; conducting communicable disease investigation and follow-up; and developing and managing the budget and grants. 2/81 6/84 Staff Nurse, St. Vincent Hospital, Green Bay, WI. Responsible for the acute care management of clients with neurological/surgical problems; served as Charge Nurse of the night shift, which included assessment, management, and intervention of clients and supervising of staff RNs, LPNs, and Nurse Aides.
Page 2 of 2
Continuation Page for Biographical Sketch

NAME (Last, first, middle initial) SOCIAL SECURITY NUMBER
Kratz, Susan K.
PUBLICATIONS
N/A
Crouch-Smolarek, Judy and Susan K. Kratz. Chapter 29 Improving Quality in Public Health. Improving Quality A Guide to Effective Programs. 2nd Edition. Claire Gavin Meisenheimer. 1997; 623-643. Landis M, Kratz S,Spaans-Esten L, Hanrahan L. SPHERE: Tracking Public Health Improvement with Electronic Records Wisconsin Medical Journal. 2007; Volume 106, No.3; 116-119.
BUDGET JUSTIFICATION A. Personnel Costs $112,772 The Maternal Child Health Home Visiting Nurse Consultant will be a full-time position to provide guidance in the development of a coordinated statewide system of early childhood home visiting and assure connection to the Title V MCH Program. The Home Visiting Performance Planner will be a full-time position with responsibilities to develop performance measurement methods for home visiting services, including but not limited to performance plans, Continuous Quality Improvement (CQI) activities, and other tasks related to the delivery of home visiting services. B. C. Indirect Costs $0
Fringe Benefits $50,982 These include health insurance, taxes, unemployment insurance, life insurance, and retirement plan. Travel $7,300 This includes $1,300 for in-state travel and $6,000 for out-of-state travel. Out-of-state travel is budgeted for two trips annually for the DCF HV Coordinator and the DHS MCH HV Nurse Consultant for two days/nights annually to the Washington D.C. area to consult with HRSA/ACF officials and to participate in technical assistance for purposes of meeting grant requirements. Equipment $3,000 Purchase a personal computer for use in accomplishing the position expectations of the MCH HV Nurse Consultant and Home Visiting Performance Planner meeting reporting requirements. Supplies/Services $10,356 Supplies and Services includes professional development and training in evidence-based programs for the HV Coordinator and the MCH HV Nurse Consultant ($6,300), telephone ($475), postage ($25), office rent ($2,956) office supplies ($400), photocopy costs ($200). Subcontracts $965,489 DCF intends to pursue a competitive contracting process to identify key partners to carry out the activities described. Via interagency agreements, DCF will contract with DHS ($25,000) to update the SPHERE data system to include reports needed for the benchmark outcome measures; $100,000 for training on assessment tools and skill-building sessions. A Request for Proposal process will distribute the remaining $840,489 to the evidence-based home visiting programs for implementation. Other $10,101 Administrative costs are direct costs not part of the indirect pool to support the MCH HV Nurse Consultant.
D.
E.
F.
G.
H.
Wisconsin Departments of Children and Families and Health Services ACA Maternal, Infant and Early Childhood Home Visiting Program HHS-2010-HRSA-10-275 (CFDA) No. 93.505

Wisconsin Dept of Children and Families and Health Services Home Visitation Plan

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Wisconsin Dept of Children and Families and Health Services Home Visitation Plan

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Affordable Care Act Maternal, Infant and Early Childhood Home Visiting Program

Section 1: Identification of the States Targeted At-Risk Communities

Identify and refer families, resource for families

Identify and refer families, resource for families

Health Department in the Three Counties

DSS Agencies in the Three Counties

Section 2: State Home Visiting Program Goals and Objectives

Department of Health Services

Department of Children & Families

Department of Public Instruction

Early Childhood Advisory Council Policy Recommendations

Ad Hoc Committee on Home Visiting

Evaluation/ Program Improvement Workgroup

Training & Technical Assistance Workgroup

Section 5: Plan for Meeting Legislatively-Mandated Benchmarks

See Section 6 for a more detailed description of this work group.

The administration window ranges from 1 to 66 months.

Section 7: Plan for Continuous Quality Improvement

Section 8: Technical Assistance Needs

Section 9: Reporting Requirements

Inputs At the local level

Inputs At the local level

Inputs At the local level

228 S. Wabash, 10 Floor Chicago, IL 60604 312.663.3520 healthyfamiliesamerica.org

Prevent Child Abuse America

Prevent Child Abuse America 2

POSITION DESCRIPTION OSER-DMRS-11 (Rev. 02/00) (07/07 jhm)

2. CERT/RECLASS REQUEST NO.

CLASSIFICATION TITLE OF POSITION

PUBLIC HEALTH NURSE 3

MCH HOME VISITING NURSE CONSULTANT

MCH HOME VISITING NURSE CONSULTANT

LINDA HALE, FAMILY HEALTH SECTION CHIEF

Date Cert Request Copy

CLASSIFICATION TITLE / SUB-TITLE POSITION SUMMARY

Public Health Nurse 3 / MCH Home Visiting Nurse Consultant

GOALS AND WORKER ACTIVITIES

(Rated PD Only) TR1 TR2

GOALS AND WORKER ACTIVITIES

(Rated PD Only) TR1 TR2

GOALS AND WORKER ACTIVITIES

KNOWLEDGE / SKILLS / ABILITIES

June2011WisconsinGovernorsEarlyChildhoodAdvisoryCouncilAdHocCommitteeonHomeVisitingTrainingandTechnicalAssistance ProfessionalDevelopmentGapAnalysisandCrosswalkwithMichiganInfantMentalHealthCompetencyGuidelines Attachment 5 2011HomeVisitingCompetencyFramework TheoreticalFoundations

HomeVisitation Foundations Addressedthrough GreatBeginnings training

NurseFamily Partnership OBhealthunder MYHEALTH

Motivational interviewing Strengthbased practice Becomingnon judgmental Buildingtrust Engagement

NurseFamily Partnership Motivational Interviewing Selfefficacytheory Therapeutic relationship

Supporting parentchild interactionsand competencies Engaging extendedfamily Father engagement

Model Implementati on Foundational Curriculum

Whentorefer Signsofabuse andneglect

Selfawareness ofbiasand judgment Culturewithin eachfamilycore values

Found. Training Initially coversFamily Cultureand Perspectives

Topics Boundary setting CodeofEthics Discretionin handling sensitive communication Confidentiality

AgencyPolicy/Orientation Parentsas HealthyFamiliesAmerica Teachers Model Priortoseeingfamilies Implementation Training

Agencypolicy and procedures

(withinfirst3months) Orientationtoagencyandshadowing ofhomevisitswithamoreexperienced homevisitor Orientationtoagencyvalues,policies, andpractices

Home Visitation Foundations

EarlyHeadStarthomebased HIPPY option Agencypolicy andprocedures

All:Found.&MI First6months Training (stressed throughroleof supervisor)

Accessingother services Referral processes

Found.&MI First6months Training Found.&MI Training

All:Initially coveredin Found.Training with

Observingthe parentchild relationship Listeningfor positive behavioral change

SeecommentsMotivational Interviewing101,201,and SupervisorsandCommunicationSkills SeecommentsPyramidModel101, 201MI?