Att F - HFA Best Practice Standards_version-8.4 Jul 2025.pdf

8TH EDITION

Digital version 8.4 released July 1, 2025. To make sure you have the right version, please login to healthyfamiliesamerica.org

HEALTHY FAMILIES AMERICA

BEST PRACTICE STANDARDS

TABLE OF CONTENTS

GLOSSARY -------------------------------------------------------------------------------------------------------- 6 SUMMARY AND GUIDANCE FOR DATA COLLECTION TIMEFRAMES ---------------------------------- 26

1. Initiate Services Early 1-1.A Program Eligibility Criteria ----------------------------------------------------------------------- 38 1-1.B Referring Organizations -------------------------------------------------------------------------- 39 1-1.C Tracking Referrals and Site Capacity ------------------------------------------------------------ 40 1-2.A Initial Engagement Process (policy) -------------------------------------------------------------41 1-2.B Initial Engagement Process (practice) --------------------------------------------------------- 42 1-2.C Initial Engagement Process: Developed Strategies ------------------------------------------- 42 1-3.A First Home Visit within 3 months (policy) ----------------------------------------------------- 43 1-3.B First Home Visit within 3 months (practice) --------------------------------------------------- 44 1-4.A Measure Acceptance Rate ----------------------------------------------------------------------- 45 1-4.B Acceptance Analysis ------------------------------------------------------------------------------ 46

2. Standardized Assessment Tool (FROG) 2-1.A Family Resilience and Opportunities for Growth (FROG) Scale (policy) ------------------ 52 2-1.B FROG Uniformity (practice) Essential Standard ---------------------------------------------- 53 2-1.C FROG Timeframes (practice) --------------------------------------------------------------------- 54 2-1.D FROG Supervision (practice) --------------------------------------------------------------------- 54

3. Offer Services Voluntarily 3-1.A Voluntary Services (policy) ---------------------------------------------------------------------- 57 3-1.B Voluntary Services (practice) -------------------------------------------------------------------- 58 3-2.A Pre-Enrollment Outreach (policy) --------------------------------------------------------------- 59 3-2.B Pre-Enrollment Outreach (practice) ------------------------------------------------------------ 60 3-3.A Post-Enrollment Creative Outreach (policy) -------------------------------------------------- 60 3-3.B Post-Enrollment Creative Outreach (practice) Essential Standard ------------------------- 62 3-4.A Measure Retention -------------------------------------------------------------------------------- 63 3-4.B Retention Analysis -------------------------------------------------------------------------------- 64

4. Offer Services Intensely 4-1.A Weekly Visits (policy) ----------------------------------------------------------------------------- 69 4-1.B Weekly Visits (practice) -------------------------------------------------------------------------- 70 4-2.A Levels of Service (policy) ------------------------------------------------------------------------- 71 4-2.B Home Visit Completion (practice) -------------------------------------------------------------- 73 4-2.C Level Changes in Supervision (practice) Essential Standard -------------------------------- 74 4-2.D Level Changes with Families (practice) -------------------------------------------------------- 74 4-3.A Services for a minimum of 3 years (policy) ---------------------------------------------------- 75 4-3.B Services for a minimum of 3 years (practice) ------------------------------------------------- 76 4-4.A Transition Planning (policy) ---------------------------------------------------------------------- 76 4-4.B Transition Planning (practice) ------------------------------------------------------------------- 77

5. Diversity, Equity, Inclusion 5-1.A Staff Interactions (policy) ------------------------------------------------------------------------ 82 5-1.B Staff Interactions (practice) ---------------------------------------------------------------------- 82 5-2.A Family Partnership (policy) ----------------------------------------------------------------------- 83 5-2.B Family Partnership (practice) -------------------------------------------------------------------- 83 5-3.A Community Level Advocacy (policy) ----------------------------------------------------------- 84 5-3.B Community Level Advocacy (practice) -------------------------------------------------------- 84 5-4.A Family and Staff Input ----------------------------------------------------------------------------- 85 5-4.B Equity Plan Essential Standard ----------------------------------------------------------------- 86 5-4.C Equity Plan Review with Community Advisory Board ---------------------------------------- 86

6. Promote PCI, Childhood Growth & Development 6-1.A Service Plan (policy) -------------------------------------------------------------------------------91 6-1.B Service Plan in Supervision (practice) ---------------------------------------------------------- 92 6-1.C Service Plan with Families (practice) Essential Standard ------------------------------------ 93 6-2.A Development of Family Goals (policy) --------------------------------------------------------- 94 6-2.B Family Goal Development (practice) Essential Standard ------------------------------------ 95 6-2.C Family Goals in Supervision (practice) --------------------------------------------------------- 96 6-3.A PCI CHEERS (policy) ------------------------------------------------------------------------------ 97 6-3.B CHEERS Used to Assess PCI (practice) Essential Standard --------------------------------- 98 6-3.C PCI Addressed and Promoted (practice) Essential Standard ------------------------------- 99 6-3.D Validated CCI Tool (practice) -------------------------------------------------------------------- 99 6-3.E SUP support staff in assessing, addressing, promoting PCI (practice) Essential Standard -- 100 6-4.A Child Dev, Parenting, Health & Safety (policy) ------------------------------------------------ 101 6-4.B Child Dev, Parenting (practice) ----------------------------------------------------------------- 102 6-4.C Health & Safety (practice) ----------------------------------------------------------------------- 103 6-4.D Safer Sleep (practice) ---------------------------------------------------------------------------- 104 6-5.A Developmental Screening ASQ and ASQ:SE and Tracking Delays (policy) --------------- 104 6-5.B ASQ (practice) ------------------------------------------------------------------------------------ 106 6-5.C ASQ:SE (practice) -------------------------------------------------------------------------------- 107 6-5.D Tracks, Refers & F/U for developmental delay (practice) ----------------------------------- 108

7. Health Care and Community Resources 7-1.A Medical/Health Providers for Focus children (policy) ---------------------------------------- 113 7-1.B Medical/Health Providers for Focus children (practice) ------------------------------------- 114 7-1.C Well-Child Care Visits (practice) ---------------------------------------------------------------- 115 7-2.A Timely Receipt of Immunizations (policy) ----------------------------------------------------- 115 7-2.B Measure Immunization Rates at 1yr (practice) ------------------------------------------------- 116 7-2.C Measure Immunization Rates at 2yr (practice) ------------------------------------------------ 117 7-3.A Health Care and Community Information and/or Referrals and Follow-up (policy) ----- 118 7-3.B Health Care Referrals (practice) ----------------------------------------------------------------- 118 7-3.C Community Resource Referrals (practice) ----------------------------------------------------- 119 7-3.D Referral Follow-up (practice) -------------------------------------------------------------------- 119 7-4.A Depression Screening (policy) ------------------------------------------------------------------- 121 7-4.B Prenatal Depression Screening (practice) -----------------------------------------------------122 7-4.C Postnatal Depression Screening (practice) -------------------------------------------------- 123 7-4.D Screening for Depression w/ Subsequent Births -------------------------------------------- 124 7-4.E Referral and Follow up for Primary Care Giver with Elevated Screens (practice) ------- 125

8. Limited Caseload Sizes 8-1.A Caseload Size (policy) ---------------------------------------------------------------------------- 131 8-1.B Monitoring Caseloads (practice) --------------------------------------------------------------- 132 8-2.A Managing Caseloads (policy) ------------------------------------------------------------------- 133 8-2.B Managing Caseloads (practice) ---------------------------------------------------------------- 134

9. Service Providers Selection 9-1.A Screening & Selection of New Staff (policy) --------------------------------------------------137 9-1.B Screening & Selection of Program Managers ------------------------------------------------- 138 9-1.C Screening & Selection of Supervisors --------------------------------------------------------- 138 9-1.D Screening & Selection of Direct Service Staff Essential Standard ------------------------ 139 9-2. Equal Opportunity Employment --------------------------------------------------------------- 139 9-3.A Recruitment and Selection Practices ---------------------------------------------------------- 140 9.3.B Legally Permissible Background Checks Safety Standard ---------------------------------- 141 9-4. Report on staff retention and satisfaction ---------------------------------------------------- 142

10. Model Specific Training Training Plan/Policy ------------------------------------------------------------------------ 148 10-2.A-H Orientation Training 10-2.D - Safety Standard -------------------------------------149-152 10-3.A Stop-Gap Training (policy) --------------------------------------------------------------- 153 10-3.B-C Stop-Gap Provided (practice) ------------------------------------------------------------ 154 10-4.A 10-4.B 10-4.C 10-5.

10-6.A 10-6.B 10-6.C 10-6.D

HFA Core FROG Training Essential Standard ------------------------------------------- 155 HFA Core Foundations Training Essential Standard ---------------------------------- 155 HFA Core Supervision Training Essential Standard ----------------------------------- 156 HFA Core Implementation Training -------------------------------------------------------157 CCI Tool Training --------------------------------------------------------------------------- 158 ASQ Training -------------------------------------------------------------------------------- 158 ASQ-SE Training ---------------------------------------------------------------------------- 158 Depression Tool Training ------------------------------------------------------------------ 159

11. Training to Fulfill Job Functions

11-2.A-G 11-3.A-E 11-4:A-C

Three Month Wraparound Training ------------------------------------------------- 165-166 Six Month Wraparound Training ----------------------------------------------------- 167-171 Twelve Month Wraparound Training ------------------------------------------------- 171-173 Ongoing Training ----------------------------------------------------------------------- 174-175

12. Ongoing Reflective Supervision

12-2.A 12-2.B 12-2.C 12-3.A 12-3.B 12-3.C 12-4.A 12-4.B

Supervision Frequency & Duration (policy) --------------------------------------------- 181 Supervision Frequency and Duration (practice) Safety Standard ------------------ 182 Group Reflective Consultation ----------------------------------------------------------- 183 Ratio of Supervisors to Staff ------------------------------------------------------------- 184 Reflective Supervision and Annual Shadowing (policy) ------------------------------ 185 Reflective Supervision provided (practice) Essential Standard --------------------- 186 Annual Shadowing Provided (practice) ------------------------------------------------- 187 Supervisor Supervision (policy) ---------------------------------------------------------- 188 Supervision of Supervisor (practice) ---------------------------------------------------- 189 Reflective Consultation/Supervision of Supervisor (practice) ----------------------- 189 Program Manager Support, Accountability (policy) ---------------------------------- 189 Program Manager Support, Accountability (practice) -------------------------------- 190

GA. Governance and Administration

Organization and function of Community Advisory Board --------------------------- 193 Advisory with Wide Range of Skills & Knowledge ------------------------------------ 194 Program Manager Role with Community Advisory Board --------------------------- 195 Quality Assurance Plan -------------------------------------------------------------------- 196 Quality Improvement Plan (practice) ---------------------------------------------------- 197 Family Rights & Confidentiality (policy and forms) Essential Standard ------------ 198 Family Rights & Confidentiality (practice) Essential Standard ----------------------- 199 Informed Consent to Release Information Safety Standard ------------------------ 200 Complaint procedures followed --------------------------------------------------------- 200 Site ensures privacy and voluntary choice for families’ w/research ---------------- 200 Child Abuse and Neglect Reporting (policy) Safety Standard ----------------------- 201 Reports Suspected Child Abuse & Neglect to Proper Authorities (practice) Safety Standard ----------------------------------------------------------------------------202 Supervisor/Manager Notification and Tracking of Suspected CAN (practice) -----202 Participant Death & Grief Counseling (policy) -----------------------------------------203 Implement support when participant death (practice) -------------------------------203 Policy & Procedure Manual --------------------------------------------------------------- 204

National Office Requirements

Data Up-to-Date (National Office Requirement) ---------------------------------------207 Site Up-to-Date with Fees (National Office Requirement) ---------------------------207 Site uses HFA name, logo and brand (National Office Requirement) ---------------207 Participation in Research (National Office Requirement) -----------------------------208 Critical Incident Reporting (National Office Requirement) ---------------------------209

HFA Best Practice Standards | © Prevent Child Abuse America

HFA BEST PRACTICE STANDARDS:

A best practice is a method or technique that sets the standard by consistently resulting in outcomes superior to those achieved by other means. Serving as an alternative to mandatory legislated standards, best practices are used to formulate self-assessments and benchmarks as a mechanism to maintain quality. 1 Best practices define a standard way of operating across multiple organizations.

Not intended to be stagnant and immovable, best practices can and do evolve to become better as improvements are discovered.

The HFA Best Practice Standards (BPS) describe expectations for fidelity to the Healthy Families America model. Herein referred to as the Standards, they are structured around the twelve research-based critical elements upon which the Healthy Families America (HFA) model was designed. The critical elements serve as the overarching ‘big ideas’ defining the Healthy Families America model.

The Standards also include a section on Governance and Administration which articulates expectations for effective site management.

The policies, procedures and practices within each critical element are defined specifically so that HFA sites have clear direction on how to implement the HFA model. Sites utilize the Standards to engage in a process of continuous quality improvement while striving to meet model fidelity expectations. In order to ensure that all families being served through the HFA model receive high quality services, all HFA sites regularly participate in HFA’s Accreditation process, which evaluates the site’s current degree of model implementation and fidelity.

1 Bogan, C.E. and English, M.J. (1994). Benchmarking for Best Practices: Winning Through Innovative Adaptation. New York: McGraw-Hill.

INTRODUCTION &

GLOSSARY

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7HFA Best Practice Standards | © Prevent Child Abuse America

QUALITY ASSURANCE AND ACCREDITATION:

Sites implementing HFA commit to provide high quality home visiting services and demonstrate model fidelity through ongoing quality assurance (QA), quality improvement (QI) and Accreditation site visits. The Standards serve as the site’s guide to model implementation and are used to evaluate the site’s status toward achieving model fidelity. Coupled with each standard are rating indicators used to determine the site’s current degree of implementation. The rating indicators are used to determine if the site is exceeding, meeting, or not yet meeting the expectation of the standard. Each rating indicator is represented by a numerical system (3-exceeds, 2-meets, 1-does not yet meet).

Read more about the Structure of the HFA Best Practice Standards (next section) in order to understand how they are rated.

The Accreditation process is divided into three steps. Each of these steps allows the site to modify or tailor its current policies, procedures, or practices. While the Accreditation process is required every four years (five years for HFA multi-site systems), sites are encouraged to embrace a philosophy of continuous quality improvement by making the Standards a part of every day practices and ongoing quality assurance (e.g., referencing standards and intents in team meetings, supervision, training, etc.).

Step 1 - The Self-Study

The initial step in the Accreditation process is the development of the site’s self-study. The self-study is the site’s first opportunity to demonstrate implementation of the Standards and serves as both a process and ultimately a prepared document compiled by the site to reflect its policies, procedures and practices. The first page of each site’s self-study is a completed face sheet, which is required to serve as the cover page of the self-study. Site staff engage in a process of internal review as they pull together the information necessary to illustrate implementation of the Standards. This self-study process is one of continuous quality improvement whereby growth and positive change is achieved through an intense examination of each site’s policies, procedures and practices. The process also acknowledges and reinforces the standards that a site is already implementing to fidelity.

Step 2 - The Site Visit

The second step in the Accreditation process is the peer review site visit. The self-study document is used in conjunction with the peer review site visit to determine the site’s current rating for all the Standards. Peer Review teams review the site’s self-study to familiarize themselves with the site’s processes during the weeks leading up to the site visit and identify areas requiring further clarification. Onsite, the peer team completes a review of family files and other documentation (e.g., personnel records, meeting minutes, supervision documentation, training logs, etc.) and conducts detailed interviews with site staff, families and advisory board members. Once compiled, the peer team utilizes its findings to determine the rating of each standard. As described above, a rating of 1, 2 or 3 is assigned to each standard and when a 1 rating is assigned to a standard, peer teams are required to provide detailed information to indicate the basis for the rating and to guide the site on what areas need to be strengthened. The peer team’s rating for each of the standards is provided in the Accreditation Site Visit Report (SVR). In some limited circumstances, sites may undergo a Fidelity Assessment instead of an Accreditation Site Visit.

Step 3 - Response Period

The final step in the Accreditation process requires sites to address the standards rated out of adherence (1 rating) as outlined in the SVR when the site does not yet meet the threshold to be awarded accredited status. Sites submit detailed narratives along with documentation of implementation to the HFA National Office and to the HFA Accreditation Panel (the Panel). Upon review of the materials, it is determined whether the site has shown sufficient improvement and now meets the threshold for accreditation. The minimum threshold requires 100% of 1st order standards rated as a 2 or a 3, 100% of safety standards rated as a 2 or a 3, plus at least 85% of all 3rd order and standalone 2nd order standards (standards with Rating Indicators) rated as a 2 or a 3.

https://www.healthyfamiliesamerica.org/network-resources/face-sheet-for-site-self-study/

THE STRUCTURE OF THE HFA BEST PRACTICE STANDARDS:

The Standards:

The HFA Best Practice Standards contain a series of inter-related standards. A standard establishes the expectation for policy or practice that has been determined either through research or consensus from the field, as a demonstration of quality. The Standards are broadly organized by the first order standards (the critical elements) and a section on governance and administration. The first order standard (e.g., Standard 1, Standard 2, Standard 3, etc.) states the overall purpose or aim of the practice within each section.

Each first order standard is supported by a series of second order standards (e.g., within Standard 1 are second order standards 1-1, 1-2, 1-3 and 1-4). While the second order standards provide more detail and specificity than the first order standards, their main purpose is to provide further context to guide implementation. Some second order standards are unsupported or stand-alone, meaning they are not broken down any further into third order standards. These include 9-2, 9-4, 10-1, 10-5 and GA-6. However, most second order standards are further broken down into a series of third order standards (e.g., within second order 1-1, are third order standards 1-1.A, 1-1.B, and 1-1.C). The third order standards and the stand-alone second order standards allow for the formation of strong programmatic practice and are the most specific standards with which the site needs to show documentation of implementation.

Found with each third order standard and stand-alone second order standard are rating indicators used to determine the site’s current degree of implementation. The rating indicators are used to determine if the site is exceeding, meeting, or not yet meeting the expectation of the standard. Each rating indicator is represented by a numerical system (3-exceeds, 2-meets, 1-does not yet meet).

Read more about rating indicators below.

Rating Indicators:

Rating indicators are provided for every third order and stand-alone second order standard in the Standards. They were developed to help sites measure their own level of quality and model fidelity, and to ensure consistency of ratings from peer team to peer team. These rating indicators provide further interpretation of the standard. They also provide assurance to a site that standards are measured objectively, and help to identify areas in need of further improvement. The rating indicators are used, in combination with the standard and intent, as part of the criteria with which to evaluate site performance. The rating indicators have been designed using a three point system. Each rating indicator is represented by a numerical system (3-exceeds, 2-meets, 1-does not yet meet).

ALL RATING INDICATORS ARE IN TEAL WITH A TEAL GRADIENT SCALE.

Standards that are specific to policy expectations are rated as a 2 or 1 rating only, owing to the fact that policy is either in adherence or not. However, there are a few exceptions to this rule. For standard 2-1.A regarding a site’s policy on the administration of the FROG scale sites will be acknowledged with a 3 rating if their policy states that the tool will be completed on or before the second home visit, or a 2 rating if the policy states that the tool will be completed on or before the fourth home visit with a family. This also applies to supervision policy standards 12-1.A and 12-3.A, where sites can receive a 3 rating if they have established policy that meets the added expectation about supervision duration for direct service staff (12-1.A) and frequency of reflective supervision for supervisors (12-3.A).

It is also important to note that while most practice related standards will hold the site accountable to the standard, there are some standards that will hold the site to their policy, even if the site’s policy expectation is more rigorous than the standard. It is useful for sites to keep this in mind when establishing policy for standards 2-1.B, 2-1.C, and GA-3.D.

1st Order Intent:

The 12 Critical Elements and Governance and Administration (GA) are represented in the first order standards 1-12 and GA and are found at the beginning of each section. Immediately following each of the 1st order standards is the overall intent of the critical element. The intent provides the context or foundation for the critical element. The HFA Literature Review can also be utilized to provide greater understanding of the critical elements.

ALL 1ST ORDER INTENT STATEMENTS ARE BOLD IN BLUE.

2nd Order and 3rd Order Standards Intent

Intent has also been added to many of the 2nd and 3rd order standards to further clarify what is expected, or the purpose of the standards, as it relates to best practices. The intent focuses on providing more detail on the “why” behind the standards.

ALL 2ND AND 3RD ORDER INTENTS ARE BLUE

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9HFA Best Practice Standards | © Prevent Child Abuse America

Tips:

The tips were designed to help sites with implementation of standards. The tips are not required, but typically focus on ideas related to how a site might choose to document or implement the standard.

TIPS CAN BE FOUND IN BLUE BOXES MARKED WITH A PINK ICON

Safety Standards:

These are standards that must be met in order to be accredited as they impact the safety of the children and families being served and the staff serving them. Safety standards include personnel background checks (9-3.B), orienting staff on child abuse and neglect indicators, role as a mandated reporter, and reporting requirements (10-2.D), supervision of direct service staff (12-1.B), site practices related to informed consent when sharing family information (GA-3.C) and child abuse and neglect policy and procedures that include reporting criteria, definitions and practice (GA-4.A, GA-4.B). Each of these standards is identified as a safety standard in its respective rating indicator box.

Essential Standards:

Essential Standards are standards determined to be especially significant to the HFA model, as they embody the essence of what it means to implement HFA. The existence of Essential Standards within the BPS is not to suggest that the other standards are non-essential, but to bring additional emphasis to this set of standards as a representation of what it means to embrace the HFA Advantage. HFA’s Essential Standards set HFA sites and systems apart from other family support or case management approaches and they stand out as essential in helping direct service staff meet the goals of Healthy Families America.

The Essential Standards are:

relationships, and the supervisor support to staff around this important aspect of their work.

While adherence to each of these standards is not required in order to receive HFA accreditation, a site with any of these standards rated out of adherence will be required to prepare and submit an improvement plan that clearly indicates the site’s efforts to bring the standard into compliance, coupled with documentation of implementation.

Note: Safety and Essential Standards will be indicated in BOLD font at the bottom of the rating indicator box.

National Office Requirements:

In order to be accredited, sites must also demonstrate that they are in good standing and upholding responsibilities as an HFA affiliate pursuant to the HFA Affiliation and Licensing agreement. These are described in GA-7 and include providing HFA required data, having HFA fees paid and up-to-date, using the HFA logo, name and graphics appropriately, following the HFA Site Research Policy, and reporting any critical incidents to the National Office.

Tables of Documentation:

At the end of each Critical Element and the Governance and Administration section is a Table of Documentation. This table is intended for sites preparing for accreditation as it indicates the policy, procedures, and other documentation needed to demonstrate adherence to each standard. Details are provided about how a site should prepare this information, whether it needs to be included in the self-study (which is sent to the peer reviewers 6 weeks prior to the site visit) or if it is part of what peers will review in files and/or during interviews on site. Sites should utilize the Tables of Documentation as a checklist when preparing their self-study, and when preparing materials that will be made available to the peer team when they arrive for the site visit.

TIPS CAN BE FOUND IN BLUE BOXES MARKED WITH A GREEN ICON

https://www.healthyfamiliesamerica.org/network-resources/critical-incident-report/

Use of HFA Tools and Spreadsheets:

For certain standards, forms and spreadsheets have been created to support sites in measuring data consistent with HFA expectations and presenting documentation in a concise and manageable format. These forms should be used if the site does not have a current data system to present the information, or if the data system does not provide reports on any of these standards. If sites provide their own tracking reports they should ensure they include the same fields of information outlined in the HFA tools.

All tracking forms can be found here.

When using the HFA spreadsheets be sure to look carefully at all worksheets contained within (tabs at the bottom of each spreadsheet).

This includes reading the tabbed worksheet that gives instructions on the correct use of the spreadsheet. Sites should ensure that in addition to entering data that data is also analyzed and interpreted with narrative in the space provided, along with a plan for improvement. Additionally, be sure that all data is compiled for the entire time period and use all tabs on the analyses spreadsheets.

If the site works across multiple counties or with multiple partner agencies in the delivery of HFA services, the data from all counties or all partner agencies must be combined and reported collectively as one site.

ADAPTATIONS AND ENHANCEMENTS TO THE HFA MODEL:

The HFA National Office views an adaptation as an actual adjustment or modification to the specific best practices related to the critical elements. In rare situations, a site or system may be compelled to seek an adaptation to the model. In these situations, the site/ system must complete and submit to the HFA National Office an Adaptation Request Form. Permission to implement any proposed adaptation is at the sole discretion of the HFA National Office. The HFA National Office will approve or deny the adaptation request and will provide its decision in writing. Whether the adaptation will be considered in adherence to HFA standards is also at the sole discretion of the HFA National Office. Sites should be aware that requests pertaining to any 1st order standard, Safety standard or Essential standard will not be approved.

Adaptations, which seek to change some aspect of the model, are not to be confused with Enhancements, which supplement the model. For example, sites that use Doulas in addition to Family Support Specialists during the prenatal and newborn period, or sites that augment services with clinical staff to provide therapy for mental health or substance use issues. Enhancements are encouraged and do not require permission from the model to implement.

GLOSSARY OF COMMON TERMS USED THROUGHOUT THE HFA BEST PRACTICE STANDARDS:

ACCELERATED:

An option for HFA service delivery available to sites that serve families identified at low risk (less than 10) on the FROG Scale at enrollment. Families remaining at low-risk generally move through the various levels of service at a more rapid pace and may complete services in less than three years when criteria for successful completion of program (see HFA Level Change forms) have been met. As with all families, HFA Level Change criteria guide the pace that accelerated families move through levels of service.

ASSESS, ADDRESS, PROMOTE:

The complete process of identifying and utilizing CHEERS to support nurturing Parent-Child Interactions during visits with families.

Assess refers to the factual parent-child interactions that are seen or heard during visits and documented on the visit record by the Family Support Specialist (FSS). Once the FSS has an opportunity to assess the parent-child interactions for CHEERS, this information is used to identify what to address and what to promote during the current visit or during future visits. Address refers to any CHEERS domains identified as opportunities for improvement or concerns that are addressed with the parent by the FSS through the use of HFA Reflective Strategies, visit activities, and/or parenting materials. Promote refers to any CHEERS domains identified as strengths, skills, or emerging strengths and skills that are promoted with the parent by the FSS using Accentuate the Positive, Strategic Accentuate the Positive, other affirmations, and celebratory visit activities.

CASELOAD:

The total number of families assigned to a direct service staff person, and not to exceed the maximum case weight of 30 points.

CENTRALIZED or COORDINATED INTAKE SYSTEMS:

Sites can choose to use a centralized intake system for referrals into their program. This system needs to have a solid understanding of the site’s eligibility criteria so the site receives referrals from the intake system that reflect the families the site intends to serve.

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11HFA Best Practice Standards | © Prevent Child Abuse America

CHALLENGING ISSUES:

Standard 6-1 uses terminology of challenging issues, which in this case refers to parent behaviors or life circumstances which can place children at especially high risk. These include parental substance use, mental illness, cognitive disability, and intimate partner violence.

Support from a supervisor, use of reflective consultation groups (where available), and additional training are critical, as are procedures for worker safety and addressing family safety concerns. The procedures outlined in this HFA Procedures for Working with Families in Acute Crisis can be a useful resource. The focus of this manual is to provide general guidelines to enhance understanding and awareness of supporting families who may be experiencing challenging issues and identifying safety practices for direct service staff.

Safety considerations may vary from location to location as well as from situation to situation. For example, safety issues in rural areas may differ somewhat from safety issues in urban areas. Because each community is unique, the safety issues encountered in that community may also be unique. With regard to safety issues, there are other factors, in addition to context, that may need to be considered. Those factors include agency policies and procedures as well as current state laws.

Safety guidelines often need to be adapted or expanded to address the specific concerns of each location or situation. Supervision sessions provide an appropriate venue for discussion of specific safety concerns and fine-tuning of safety procedures. The supervisor should be available and immediately informed if the direct service staff fears for their safety. The safety of staff is of utmost importance.

CHEERS:

An acronym to support Family Support Specialists and parents in understanding and observing the different dimensions of parent-child interaction that ultimately result in attachment over time. The elements of the acronym include Cues, Holding, Expression, Empathy, Rhythmicity/Reciprocity, and Smiles. These observations are expected to be made during each home visit as specified in the standard and intent. Training on CHEERS is also a significant part of HFA Core (Foundations for Family Support) training.

CHEERS CHECK-IN:

The CHEERS Check-In is a validated measurement tool developed by HFA and used to assess parent-child interaction at least twice annually and up to quarterly. Web-based training (required) and support on the use of this tool is provided by HFA.

CHILD WELFARE PROTOCOLS:

An option for HFA service delivery available to support sites with maintaining model fidelity while working with child welfare referred families. Affiliated sites seeking to implement CWP will submit a written implementation plan. Sites will establish relationships with their local child welfare office before seeking approval for implementation. Families enrolled through CWP must be referred by an agency within the child welfare system and the first home visit must be completed within 24 months of birth (see Standard 1-3). Sites implementing CWP are expected to establish a formal Memorandum of Agreement with the local child welfare office (see Standard 1-1.B) and code family data in a way that allows it to be analyzed and reported separately from families enrolled through traditional HFA protocols. Families are offered voluntary services for three years from the date of enrollment regardless of age at intake.

COMMENSURATE HFA EXPERIENCE:

During the new hire recruitment process, applicants for HFA site level positions are screened based on a variety of factors. Individuals who themselves participated in HFA services and/or worked in other HFA roles (e.g. an FSS, FRS or team lead now applying for a supervisor position) bring highly valuable attributes from their HFA experience and lived expertise. When considering whether the level of HFA experience is commensurate with an educational degree, this will be decided on a case-by-case basis by the hiring team, factoring the length of their previous experience (though there is not an automatic 1:1 ratio where for example a 4-year degree is met by having 4 years HFA experience), and more importantly how the individual themselves describes the impact of HFA involvement on their readiness to take on a new role.

COMMUNITY ADVISORY BOARD:

An organized voluntary group with responsibilities to advise on the planning, implementation, and evaluation of the HFA site operations.

The functions and responsibilities of this group may include making recommendations to the HFA site and the organization’s governing group regarding site policy, operations, fiscal needs, community needs, etc. Community Advisory Board members are a diverse group of individuals who represent the interests of the community as guided by the critical elements.

COMPLAINT:

HFA requires that all families be informed about how to file a grievance or a complaint. The site also needs to have a policy that describes how the family will be notified and what to do when they have a complaint. The site needs to have steps to follow if they receive a complaint, and the follow-up mechanisms to address the areas identified in the complaint. The family files need to have documentation that the complaint policy was reviewed with the family and a copy should be provided to the family.

https://www.healthyfamiliesamerica.org/network-resources/protocols-working-with-families-experiencing-acute-crisis/ https://www.healthyfamiliesamerica.org/network-resources/protocols-working-with-families-experiencing-acute-crisis/

CONTEXTUAL DECISION-MAKING:

On a site visit, the peer reviewers may see mixed information pertaining to a standard (e.g., an FSS has a first home visit with a prenatal family, and the Focus Child is born before the second visit. Because of this, the family is no longer prenatal, and the FSS was unable to complete a prenatal depression screen). In situations like this, where there may be extenuating circumstances, peer reviewers are trained to use contextual decision making to rate a standard, which means they must ensure the site is operating from best practice. For example, in the situation above, if the missed prenatal depression screen was because the baby was born shortly after the first home visit, the site could be rated in adherence even though not all prenatal families received a prenatal depression screen. Or, in another example, if the site had a new staff signed up for Core training, however she missed it because she was out unexpectedly for 3 months on FMLA, but as soon as she returned from FMLA she went to Core, the site was operating from best practice so therefore this would be taken into account to rate the standard in adherence vs out of adherence. This means sites should document the reasons for variances when they arise, which allows peers to have the information they need to use contextual decision making.

CORE TRAINING:

Intensive model-specific training that addresses some or all of the core components of the model, including FROG Scale, Foundations, Supervision and Implementation training.

CULTURAL CHARACTERISTICS:

Distinguishing features and attributes such as ethnic heritage, race, age, customs, values, language, gender, religion, sexual orientation, social class, and geographic origin, disability, among others, that combine to create a unique cultural identity for families, based on both experience and history.

CULTURAL HUMILITY:

Originating in the health care field, the concept of “cultural humility” was developed as an alternative to the idea that we can become “competent” in the cultures of others. Cultural humility is a lifelong commitment to self-awareness, to addressing power imbalances and to developing partnerships with people and groups who advocate for others.2 In HFA, we embrace cultural humility in our approach to working with families from a place of self-awareness, understanding that each family has a unique culture and that our own culture and values can impact our interactions with families. It is our responsibility to continuously evaluate our interactions, interpretations and assumptions and to be committed to lifelong learning about ourselves and others. We reflect on our interactions with others and seek to understand how real or perceived power imbalances can influence our effectiveness. We align ourselves with other people or groups that advocate for others as we build authentic relationships with the families we serve. A culturally humble approach to our work ensures that we are successful in creating healthy relationships across the parallel process in alignment with the HFA Advantage.

CRITERIA:

Rules upon which judgment or decisions are based.

DEPRESSION SCREENING TOOL:

HFA requires that sites select a standardized screening tool to screen the primary caregiver in each family for depression at least once prenatally and once within three months of birth or 3 months of enrollment (when enrolled after birth), and at least once within 3 months of all subsequent births. While HFA does not specify a particular tool, the tools most commonly used by sites are the Edinburgh (EPDS) and the PHQ-9. The PHQ-2 may be used as a pre-screening followed by the PHQ-9 when indicated. The CES-D and Beck are also used by some sites, though much less frequently. Tools like the EPDS have been used with both parents.

DIRECT SERVICE STAFF:

Staff at an HFA site who carry a caseload of enrolled families to whom they provide HFA home visits and/or staff who administer the FROG scale with families.

EARLY COMPLETION:

A family enrolled and remaining as HFA Accelerated is eligible for early completion when able to sustain Level 3 accomplishments to move to Level 4 for a minimum of 6 months (or 180 days). Families enrolled in traditional HFA services, who choose to discontinue service early may potentially be regarded as early completers when they also meet and sustain for a minimum of six months accomplishments associated with moving from Level 3 to Level 4. In both cases, the Level 3-4 Completion form must be completed and signed.

ELIGIBILITY FOR SERVICES:

The process utilized to determine potential families who may be most in need of or could benefit from intensive home visiting services.

Sites will determine the best way to identify eligible families, based on funder guidance, community need, and their own description of the families they intend to serve. HFA recognizes that in most situations, a well-developed screen will meet site needs for eligibility determination. Some sites may choose to use the FROG Scale to determine eligibility for service.

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2 Tervalon & Murray-Garcia (1998)

13HFA Best Practice Standards | © Prevent Child Abuse America

ELIGIBILITY SCREENING:

A process for early identification of potential families that often occurs via medical record review, community or self-referral, questionnaire that gathers needs/risk data, or similar information. In most cases, sites determine eligibility for services using a screening tool. In some cases, sites may use the FROG Scale to determine eligibility.

ENGAGED FAMILIES:

Families, including caregivers (e.g., mother, father, significant other, grandparents, etc.) actively participate and are consistently available for the majority of home visiting services offered. Some engaged families may become disengaged from time to time during the course of services, at which time sites will extend creative outreach activities in an effort to re-engage the family.

ENROLLED FAMILIES:

Families who have accepted services and are considered to be participants in services. Enrolled families may or may not be engaged in services.

EQUITY PLAN:

An Equity Plan results from the site’s intentional, honest, critical and reflective look inward (site self-assessment) that also integrates feedback received from families and staff. This level of exploration allows sites to assess their capacity to 1) provide families with equitable access to culturally respectful and responsive services, 2) create a diverse, inclusive and supportive work culture for staff, and 3) operate within the context of the community and in partnership with parents and other providers to strengthen services. Based on what the site learns, activities are applied to promote equity and advance the current level of cultural humility at the family, staff and/or community level. The Equity Plan also includes recommendations/suggestions from its community advisory board.

EVIDENCE-INFORMED PARENTING MATERIALS:

The information that sites staff share with families must be evidence-informed, meaning that the information is based on scientific knowledge or research. Strategies employed may also be grounded in scientific research (e.g., strive to strengthen the parent-child relationship, which research has shown to be a key factor in healthy development). The reason there is a focus on the use of evidence-informed materials is to ensure that families are receiving well-founded, factual, relevant, and credible information versus materials that are opinion-based or outdated and no longer accurate. Sites may choose to use a formal parenting curriculum that is designed for home visiting or parent support, or sites may identify other evidence-based sources of parenting materials.

FAMILY-CENTERED:

Services that are designed to be flexible, accessible, developmentally appropriate, strength-based, and responsive to family-identified needs.

FAMILY RESOURCE SPECIALIST (FRS):

Typically, HFA sites use the title Family Resource Specialist to represent a direct service staff member with responsibilities related to the engagement and enrollment of new families. This role may include activities such as managing referrals, outreach to families referred, determining eligibility for services, offering HFA services, connecting families to additional resources in the community, and maintaining relationships with referral sources. Because of the variability in how this role is defined across sites, and because some sites divide these responsibilities across all direct service staff, HFA does not provide a role-specific training for the FRS.

FAMILY SUPPORT SPECIALIST (FSS):

HFA home visitors are referred to in HFA training materials, the BPS, and other HFA produced documents as Family Support Specialists.

This title conveys to…