Many states are working to implement evidence-based home visiting programs to improve birth outcomes and to support women and families by connecting them to necessary services. One of the challenges to implementing home visiting programs is deciding which home visiting models to use and what is the level of evidence necessary. To get a state’s perspective, we asked a state currently grappling with these issues the following questions:
· How do you use evidence to inform program planning, particularly if federal law is restricting what you currently do?
· How do you proceed with your programmatic work in the absence of strong evidence of its impact?
Jackie Newson, Interim Director
West Virginia Home Visitation Program
Office of Maternal, Child and Family Health
Bureau for Public Health
Department of Health and Human Resources
The Maternal, Infant and Early Childhood Home Visitation Supplemental Information Request (SIR) identified seven evidence-based models to be used by states to shape their home visitation programs. West Virginia is uniquely positioned, with three of the seven models currently established in some of our highest at-risk counties. Additionally, the Office of Maternal, Child and Family Health (OMCFH) houses a comprehensive statewide home visitation and targeted case management initiative, Right From The Start (RFTS), for government sponsored pregnant women and at-risk infants to one year of age to reduce the risk of adverse pregnancy outcomes and improve infant outcomes. Strengthening the referral network between existing models and resource agencies maximizes resources and provides a continuum of care for prenatals through age five.
A West Virginia Home Visitation Program Stakeholder Workgroup was formed with representation from the WV Early Childhood Advisory Council, Department of Education, Division of Alcoholism and Substance Abuse, WV Coalition Against Domestic Violence, Bureau for Children and Families, Head Start, Right From The Start, current evidenced-based home visitation models and other interested partners. Utilizing OMCFH epidemiological support and the Stakeholder Workgroup to collectively review the Needs Assessment results and current home visitation capacity, the counties (our definition of communities) to initially target were determined. Inclusion has been the emphasis in the design of West Virginia’s infrastructure to expand existing efforts. From the beginning we have encouraged open discussions and assurances of no surprises or hidden agendas. This collective process, with the state program and MCH staff in the lead, has enabled active participation between stakeholders in establishing processes and decision making.
Using this same successful philosophy, we are now reaching out to county leaders to identify both the highest risk population and factors to target for home visitation services. To ensure effective program planning at each required level, we are utilizing key county participants’ expertise and community Needs Assessment data to advance the decision making process. The first objective of the county level meetings is to present common goals between multiple state and community agencies on utilizing home visitation services to improve prenatal/infant health outcomes, school readiness, economic self sufficiency and aid in reducing substance abuse and domestic violence rates. The evidence-based information for each model will be presented to county leaders to aid in the decision making process and ensure the model/s best suited for individual communities are identified.
The most time-sensitive and challenging area of work is obtaining the required documentation and establishing evaluation processes for the “Promising Approaches” section. Based upon the historical success and strong outcomes of one of our state’s current home visitation models, Maternal Infant Health Outreach Worker (MIHOW), we have chosen to proceed with required activities for selection as a “Promising Approach” model. MIHOW, OMCFH and Vanderbilt University staff will complete the fact gathering and design process, including reaching out to other states for possible collaborative efforts. The mission, priority areas, target populations, evaluation plan and current capacity assignments have been distributed between involved parties with strict timelines being followed to ensure completion.
Open lines of communication with our stakeholders on relevant home visitation activities and sharing information obtained through the federal conference calls and webinars is ensuring everyone stays abreast of events. This ensures timely decision making on SIR activities and development of the state plan. Through this process, we are working to ensure that approved, evidence-based models receive service delivery funds from this grant, while a combination or continuum of available service models will enable additional West Virginia families to receive home visitation services.