Massachusetts Department of Public Health F.O.R Families Program: A Qualitative EvaluationZobeida Bonilla-Vega, MPH, Ph D, Melissa Marlowe, RN, MS, and Karin Downs, RN, MPH.

Division of Perinatal, Early Childhood and Special Health Needs, Massachusetts Department of Public Health

The program has been a central player in:

identifying needs of families

delineating strategies to address identified needs

assembling/aligning resources

advocating for families

providing caring and respectful support to the families in their journey towards self-sufficiency at different moments of their lives

We wish to thank staff from the Mass Department of Public Health and the Housing and Homeless Unit of the Department of Transitional Assistance who asssited with this project.  We especially thank the families, F.O.R. Families home visitors, and key informants who shared with us their time and experiences with the program.

Rational and Methodology

The F.O.R. (Follow-up, Outreach, and Referral) Families program is a home visiting program of the Massachusetts Department of Public Health and the Department of Transitional Assistance to provide services to homeless families.

The program aims to assist families by identifying and addressing barriers that prevent them from attaining and maintaining self-sufficiency and well-being

The program goal is to improve families’ access to appropriate resources.

Background Conclusion

Contact Information

Karin Downs, RN MPH Assistant Director for Clinical Affairs(617) 624-5967Karin.downs@state.ma.us

Melissa Marlowe, RN MS F.O.R Families Project Director(617) 624-5913Melissa.marlowe@state.ma.us

Overall Program

Develop specific program measures related to child and maternal health to monitor and evaluate program outcomes.

Using standard Maternal and Child Health measures could facilitate collection of data, continuous evaluation, and sharing information with other programs and agencies.

Services Provided to the Families

Develop clear goals with clients at the outset and monitor progress of client vis-à-vis realistic self-sufficiency goals.

Develop a client self-assessment mechanism where families report what was helpful and how they see themselves moving towards stability and self-sufficiency.

Explore collaborations with the Massachusetts Homeless Management Information System.

An evaluation was initiated to document how the program had benefited clients served. A qualitative research model was chosen for this evaluation to learn from the experiences of program beneficiaries and providers about promising practices for working with homeless families.

Evaluation Objectives

1. identify the strengths of the F.O.R. Families program and promising practices for working with homeless families

2. assess the role of the F.O.R. Families program in facilitating the transition of the clients from homelessness into a more stable situation

3. inform the development of a homeless screening tool, a F.O.R. Families home visitors protocol, and a program logic model

4. make recommendations for program improvement.

Clients interviewed reported positive experiences with the F.O.R. Families program and indicated that the program was instrumental in their progress toward a more stable situation.

Help with housing and with finding health care services were the most useful services that they received from program staff.

Clients also described counseling, parenting skills education, help with self-esteem and self-confidence, advocacy, help navigating the system and interacting with government and community agencies, phone calls to make appointments for health services, and provision of tangible items such as books, school supplies, toys, clothing, and food as significant benefits received from the program

Home visitors have encouraged positive, change-oriented actions that have helped families move closer to attaining self-sufficiency or to move out of homelessness.

The relationship built between home visitors and clients appears to be central to the clients’ positive experiences with the program.

Clients’ Experiences with F.O.R. Families: Perceptions of Program BenefitsInstrumental Emotional Structural InformationalFinding money for expenses such as rent, bills, and moving expensesSchool suppliesFood and groceriesRefrigerator and furniture for apartment

Parenting skillsCounselingFast response to their needs

Help getting SSIHelp to go to court Phone calls to housing authoritiesArrange appointments for services such as dental care, mental health, prenatal care, and child care

Lists of services in the communityHealth education materials on depressionInformation about schools

Recommendations

Defining SuccessHow do you define success for the families that you work with?

Of the families that were successful, what factors do you think contributed to their success?

What specifically about the F.O.R. Families program do you think contributed to the success of the families that were successful?

Success is related to acknowledging and changing behavior which is mutually agreed uponAcknowledging that there is a problem and beginning to think about how to resolve this problemHaving services in place: health care, substance abuse, mental health, domestic violenceSelf-advocacy

Clients personality: self-motivation and determination, positive attitude, goal oriented, wanting more for their children and for themselves, being someone who will ask for help, hopeLack of substance abuse, mental health issues, and domestic violence or presence of services in these areasHistory that allowed them to have examples of success (i.e., parents, friends, mentors)Client’s engagement

F.O.R. Families provide a safe place for families to identify and begin to work on problem areasStaff usually act as positive role models and offer positive action-oriented interventionsOn-going supportHome visiting and personal connections

Key Findings

Suggestions for the Development of Relevant and Appropriate Measures of Success to Evaluate F.O.R. Families Program

Is the family connected to programs and services?

Knowledge and awareness of resources

Number of family members among all families served by program that are able to hold jobs over a 3, 6, 12 month period

Number of families who obtained permanent housing

Number of times child misses school

Ask clients how they think they are doing and conduct self-evaluation of their own progress toward stability and self-sufficiency

Creation of an individualized plan and goals with the client and re-examining them on a regular basis to monitor progress.

Changes in behaviors and habits

Screen

Screen positive

Screen negative

ID sources of well-being

Referrals

DTA

F.O.R. Families

Other agencies

End process

Sample Screening Process

Factors to Consider in Developing a Screening Tool for Homeless Families

Risk Factors Possible Screening SettingsFamily not paying billsIncome levelsSubstance abuse presentDomestic violence presentMental health issues presentEviction and reasons for evictionCORI issuesImmigration statusFamily left shelterDSS involvementEducation historyWhen they had first jobLongest sustaining job Out of work for 6 monthsMoney management historyWeak or non-existing social support system

DTA officesEmergency roomsCommunity Health Centers across the stateCommunity action programsImmigration servicesWIC officesPsychiatric hospitalsSchools

Sample screening/assessment questionsDo you have safe and permanent housing?Where are you staying?How long have you been there?Have there been changes in your housing situation since your last visit?Do you have any concerns about your housing?How many times have you moved in the last year?What keeps you strong? What keeps you going every day?