Home Visits

Don Johnson, Washoe Native TANF Training Facilitator

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The Importance of Home Visits

1. What are some primary purposes of Home Visitations?

2. What are 3 reasons for conducting Home Visits?

3. What are 3 goals of Home Visitation?

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What is our motivation?

Why is it so important to know and understand effective Home Visitation?

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Pew Interview Video

Training Expectations1. Participants will be able to define

some of the primary purposes of Home Visits.

2. Participants will be able to identify and explain at least 3 reasons for conducting Home Visits.

3. Participants will be able to list at least 3 goals of Home Visitation.

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Purpose of Home Visits• Foster healthy beginnings of family development

• Improve pregnancy outcomes

• Promote school readiness

• Prevent child abuse and neglect

• Reduce juvenile delinquency

• Promote positive parenting and resiliency in children

• Promote family health and economic self-sufficiency for children and families.

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Purpose of Home Visits

• Make our clients feel empowered

• Not abuse the power we have over them (strong influence on whether they become self-reliant or not)

• Visit their home any time without warning

• Seeing each family member reported to live in the home– verify that documentation is accurate – rule out possible fraud.

• Understand “no cooperation, no benefits”

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How to Implement the Policy

• Review history of your client prior to your visit

• Consult with supervisor regarding keeping appointment or not

• Home visits are not required!

• Fact verification home visits always unannounced

• “Vehicle Authorization Form”

• “Home Visit Form”

• Signed approval of site manager (cc: Deputy Director)

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Pre-visit Preparation & Precautions

• Familiarity with client case file and location

• Alternate or back-up plan

• Decisiveness - what criteria will cause home visit to be aborted

• Someone else knows address (Vehicle Authorization Form)

• Use the buddy system

• Drive by before your first visit

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Pre-visit Preparation & Precautions

• Be aware of potential entrances and exits

• Ask client identity of those who enter

• Safe to sit down? (observe front door / other

entrances)

• Restrain pets

• Fully charged cell phone

• Strong cell signal?

• Be prepared to remove yourself

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Pre-visit Preparation & Precautions • Law enforcement contact

– recent dangerous activity in area?– fore warn them of your intent

• Always prepared to cancel for what seems like “no good reason”

• Morning visits preferred– Never schedule in questionable

neighborhoods during dark hours

• Focus on “family development reasoning”

• Plan to develop mutual respect and trust

• Consider how you will keep your confidentiality

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Success StoriesVideos

Organization and Time Management

• Arrange visits with clients who live near each other for efficiency

• Schedule around school release times and client schedules

• Prepare binder organized with needed forms

• List of other agencies / community resources

• Confirm appointment (for pre-arranged visits)

• Take anecdotal notes / record items later

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In-Home Considerations• Prepare diligently

• Verify who is living in the home

• Map out location if unfamiliar

• Do not sit down until comfortable with your own safety

• Keep an eye on the door

• Stay close to the door

• Use “Home Visit Protocol”

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Advantages of Home Visits• Attention to our clients’ home environment

• How it affects their functioning and well-being for assessment and case planning:

– Conditions of the home

– Safety concerns

– Status of neighborhood and community

• Reduce the power differential (inherent in working with mandated clients)

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Advantages of Home Visits

• Interventions delivered in the home since the home is where problems often occur

• Service barriers avoided

• Limited transportation

• Scheduling conflicts

• Warranted if a client has disappeared

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Layla was born 2 years ago, 6 weeks early. She was addicted to methadone and had marijuana in her system. She was moody, had the jerks and would lose her breath. It was very scary. My childhood wasn’t that great but I knew I wanted better for Layla.But taking care of a baby alone is hard. I didn’t know how to do all those things a baby needs. When I got the call from Catawba Valley Healthy Families asking me if I wanted to join their program, I couldn’t believe it. Here was someone wanting to teach me how to take care of my daughter. And if I was going to have a chance to give Layla a better life, I needed help.Morgan with Barium Springs has been coming to see us for a while now. She answers my questions about baby stuff. She brings books for me to read to Layla. She helps me remember all the doctor’s appointments. We work together to make sure Layla is doing things a baby should do at her age.Today, I have a 2 year old daughter who is healthy and happy. We go to church, go to the park and read stories at night. She’s 2 and doesn’t listen sometimes, but Morgan has showed me how not to get angry. She’s coached me on disciplining Layla the right way. I don’t want Layla to be afraid or get hurt when she gets in trouble like I did.O

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Fath

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Sto

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Family Development Approach

• Build mutually respectful relationship

• Maintain confidentiality

• Help the family assess their situation

• FSP completed prior (review)

• Communicate effectively

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Enhanced Home VisitsVideo

Family Development Approach

• Increase your cultural competence

• Guide a family to self-sufficiency

• Persuade them to think in terms of you and them being a team toward becoming successful

• Only be there as their guide

• They must buy-in

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Family Development Approach

• Instill that sense of pride

• You must help your client-family envision themselves as a thriving self-sufficient family at any level

• Instill cultural values

• Their family pride of accomplishment is their number one priority in life

• No matter how difficult that is you are there to guide them to that goal

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Seeing with Other Eyes

• See the world through the client’s eyes

• See how the client sees self in it

• Understand family relationships, interactions & values

• Promote case management partnership

• Assess strengths & risk factors

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Seeing with Other EyesNote:

• Parenting skills

• Health & safety issues in the home

• Additional resources (neighbors, home computer…)

• Evidence that basic needs are not being met

• Evidence of “red flags”

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Seeing with Other Eyes

Observe:

• Neatness, orderliness

• Sparse? Cluttered?

• Furnishings

• Organization: “a place for everything & everything in its place”

• Quantities: “lots of this, a little of that”

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Benefits of Home Visits• Increased rates of child

immunizations, health care & prenatal care

• Reduced rates of abusive & neglectful parenting behaviors

• Improved employment & academic goal attainment

• Reductions in use of harsh discipline

• Decreased delinquency among children

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Benefits of Home Visits Video

Benefits of Home Visits

• Improvements in parenting skills development, knowledge of appropriate development & knowledge of factors associated with abuse & neglect

• Improvements in home environment related to stressors & parental distress

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Benefits of Home Visits

• Permanent improvements in mother’s life circumstances that result in better stability & wellbeing for children.

• Increased visiting may cause increase in reported cases of child neglect & maltreatment as a result of increased access to the home

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Respect, First Time and Future Visits• If an announced visit

– Get clear directions / leave yourself extra time

• If unannounced - TANF brochure / name badge

– Reassure client

– Ask if they would prefer another time

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Respect, First Time and Future Visits

• Within earshot of neighbors? use your name but not the name of the program

• Make sure they understand why you are there

• Be politely persistent

• Family must be ready to take initiative

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Ethical Considerations:

• Blurred boundaries - stay focused on issues, professional rather than social

• Accepting gifts - use professional discretion

• Confidentiality - Be prepared (Tribal ID)

• Extended family members, neighbors, and friends

• Community setting, park, fast-food restaurant

• Take the client’s lead

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Safety IssuesGeneral

Noise levels, temperature, numbers of people & activity levels

Confined or blind spaces like garage areas, stairwells, elevators, narrow corridors & small rooms without exits

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Safety Issues

Know the neighborhood

Unsafe & unsanitary homes & yards

Lice

Drug manufacturing & paraphernalia

- items such as pipes, foil, razor blades, straws, mirrors, scales & smells such as burning & chemicals

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Safety Issues

Weapons

Intimate partner violence

-the presence of domestic violence in the home increases the risk of abuse to the children and your own safety

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Safety Issues

Dogs & other dangerous pets

Disease exposure

Sexual threats & violence

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Safety Tips

• Speed dial options

• “Phone vibrated” excuse

• Carry only what you’ll need

• Single car key on a key chain-quick exit

• Ready vehicle

• Use restroom before arriving

• Lock car

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Ronna smiles when asked how Every Child Succeeds has made a difference in her life. "I would have been completely lost without it!" she says, as her two-year-old son, Jayden, chases a bouncing rubber ball across the room. "When I got pregnant, I wanted to take responsibility for Jayden, and I wanted to be a good mother. But I had no idea how to go about it."

Every Child Succeeds matched Ronna with Jenny Berndsen, a home visitor. Jenny has been meeting with Ronna weekly since Ronna was eight months pregnant, sharing information with her about baby care, helping her create a positive home environment for learning and emotional growth, and encouraging her to finish high school.

"No one in my family was there for me, so I really felt alone at first," explains Ronna, who now lives with Jayden in an apartment. "Jenny has taught me about the importance of reading to Jayden and about which games are good for his development and even how to get Jayden evaluated for his speech delays. She has helped me become a good mother and be more confident in myself."

In June, Ronna will graduate from her High School, where she recently made honor roll. She plans to attend Cincinnati State and eventually become a social worker to help children who have experienced abuse and neglect.

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Ro

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a’sSu

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A home visit is appropriate when…

• The client is first applying for benefits

• Conflicting information is received

• The client has difficulty attending appointments

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A home visit is appropriate when…

• There is a new family member in the home.

• The client is not meeting TANF requirements

• Time limits are due to expire

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Predictors of Violence (Danger)

History of violence

Sense of powerlessness

Physical factors

Domestic violence

Access to weapons & gang associations

Child welfare involvement

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One Friday afternoon, as Jana was on her way to pickup her grandson from school, she received a very disturbing call. The police had come to her daughter’s apartment the night before, arrested her for drug involvement and taken her grandson, David, into the custody of Marin County’s Child Protective Services. After meeting with CPS, she was able to obtain temporary custody of David and take him home with her. She was not prepared to instantly become a mother again. David’s father was in jail and there was no one else she could turn to.After continuing to drive David to Kindergarten for the remainder of the school year, Jana enrolled David in first grade. Soon afterward, David began to have some very difficult issues. He became angry at home and at school. He began crying all the time, kicking Jana and even talking about killing himself. David clearly was traumatized by what had happened to him. To make matters worse, Jana’s job cut her hours from 40 a week to 10. She was at risk of being evicted.

Grandma learning to be mom again

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Jana called Cope Family Center right away. Cope Family Center was able to help her design a plan that would address both her and David’s needs. Jana was assigned to one of Cope’s Home Visitors. Julie immediately sat down with Jana to assess her family’s needs, set goals and access the resources Jana desperately needed.With help, Jana obtained emergency aid (rental assistance, food bank), counseling services, got David into the Boys & Girls Club, and got him a big brother from Big Brothers-Big Sisters. Cope’s home visiting services acted as Jana’s mentor and guided her through the crisis. Two years later David is in 3rd grade and loves school. He is involved in sports and enjoys the stability and attention he receives from his Big Brother.Jana’s ultimate goal was to reunite David with his mother, Linda. Linda, too, is now a Cope home visitation client. With her Home Visitor, Linda has worked hard to start her life over for her son’s sake. She moved to Napa and enrolled in Napa Valley Community College. She began going to counseling and learned to make better choices about drugs. Child Protective Services allowed David to be reunited with his mother.

Grandma learning to be mom again

Terminating the Visit

• Be sure to summarize

• Identify any “to do” items

• Final opportunity to discuss

• Next steps?

• Contact information for follow-up

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Post-visit Procedures/Recordkeeping

• Alert office staff that the staff member has safely exited the visit.

• If neighborhood is deemed to be unsafe make an exit call

• Document all details as soon as possible

• Condition of the home and its occupants

• As well as any activities that might be considered unusual

• During arrival, visit, departure

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Resources for Researching Home Visiting ProgramsWeb Resources

Child Welfare information Gateway:www.childwelfare.gov

Harvard Family Research Project Home Visiting Forum:www.hfrp.orgChapin Hall:www.chapinhall.org

Pew Center on the States:www.pewcenteronthestates.org

The California Evidence-Based Clearinghouse for Child Welfare:www.cebc4cw.org

Print ResourcesHome Visitation for Families with Young Children -A report from the Congressional Research Service

The Role of Home-Visiting Programs in Preventing Child Abuse and Neglect - An article in the journal The Future of Children special issue on Preventing Child Maltreatment from Fall 2009

Social Science Rising: A Tale of Evidence Shaping Public Policy - A Policy Brief from Future of Children, Fall 2009

State-based Home Visiting: Strengthening Programs Through State Leadership - A report from the National Center for Children in Poverty, March 2009 and a webinar from December 2008

Home Visitation in 2005: Outcomes for Children and Parents - A Working Paper from the Invest in Kids Working Group by Deanna Gomby, July 2005

The Effectiveness of Early Childhood Home Visitation in Preventing Violence: A Systematic Review - An article from the American Journal of Preventive Medicine, Vol. 28, 2SI, 2005

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Obama’s Home Visiting Program

For At-Risk Families