Att G - FINAL.HFO_PPPM_8th_Edition_HFO_PPPM.42723.pdf

Insert local site name here

OREGON DEPARTMENT OF EDUCATION

EARLY LEARNING DIVISION

PROGRAM

POLICIES &

PROCEDURES

MANUAL

8th Edition - 2022

Healthy Families Oregon Site Policies and Procedures Manual 8th Edition i

TABLE OF CONTENTS

............................................................................................................................................................................................... i Healthy Families America Introduction

HFO Mission Statement

Program Goals

Home Visitation Program Description

Governing Legislation

HFO State System

HFA SAFETY AND ESSENTIAL STANDARDS

Safety Standards:

Essential Standards:

GLOSSARY

A

B

C

D

E

F

G

H

I

L

M

N

O

P

Q

R

S

T

V

W

COMMON TERMS ASSOCIATED WITH ACCEPTANCE & RETENTION RATES AND STANDARDS REQUIRING AN ANALYSIS (1- 4.A-C and 3-4.A-C)

8th Edition PP&PM 2022 ii

HFA ACCEPTANCE RATE:

HFA RETENTION RATE:

ANALYSIS:

PROGRAMMATIC FACTORS:

PARENT AND FAMILY FACTORS:

Common Abbreviations:

STANDARD 1: Initiate services early, ideally during pregnancy

1.1

1.2

1.3

1.4

STANDARD 2: Sites use the validated Family Resilience and Opportunities for Growth (FROG) Scale to identify family strengths and concerns at the start of services

2.1

STANDARD 3: Offer services voluntarily and use personalized, family-centered outreach efforts to build trust with families

3-1

3-2

3-3

3-4

STANDARD 4: Offer services intensely and over the long term, with well-defined progress criteria and a process for increasing or decreasing intensity of service

4-1

4-2

4-3

4-4

STANDARD 5: Staff (managers, supervisors, and direct service staff) celebrate diversity and honor the dignity of families and colleagues by educating and encouraging self and others, continuously striving to improve relationships. Sites work with others in their organization and community to identify and address existing barriers and increase access to services, especially for underrepresented groups in the community, confronting disparities caused by institutional racism and discrimination

5-1

5-2

5-3

5-4

Standard 6: Services focus on supporting the parent(s) as well as the child by cultivating the growth of nurturing, responsive parent-child relationships and promoting healthy childhood growth and development within a caring community

6-1 iii

6-2

6-3

6-4

6-5

STANDARD 7: At a minimum, all families are linked to a medical provider to ensure optimal health and development.

Depending upon the family’s needs, they may also be linked to additional services related to: finances, food, and housing assistance, school readiness, child care, job training, family support, substance abuse treatment, mental health treatment and domestic violence resources

7-1

7-2

7-3

7-4

STANDARD 8: Services are provided by staff in accordance with principles of ethical practice and with limited caseloads to assure that Home Visitors have an adequate amount of time to spend with each family to meet their unique and varying needs and to plan for future activities

8-1

8-2

Standard 9: Service providers are selected because of their personal characteristics, their lived expertise and knowledge of the community they serve, their ability to work with culturally diverse individuals, and their knowledge and skills to do the job

9-1

9-2

9-3

9-4

STANDARD 10: Staff receive intensive training specific to their role to understand the essential components of family assessment, home visitation and supervision

10-1

10-2

10-3

10-4

10-5

10-6

STANDARD 11: All direct service staff and their supervisors receive basic training in areas such as prenatal and infant care, child safety and development, family health, parent-child relationships, family goal setting, reporting child abuse, managing crisis situations, and responding to mental health, substance use, or intimate partner violence issues. All staff, including program managers, receive training on topics related to diversity and equity

11-1

11-2

11-3 iv

11-4

STANDARD 12: Service providers receive ongoing, effective supervision so that they are able to develop realistic and effective plans to empower families

12-1

12-2

12-3

12-4

GOVERNANCE AND ADMINISTRATION: The site is governed and administered in accordance with principles of effective management and of ethical practices

GA-1

GA-2

GA-3

GA-4

GA-5

GA-6

GA-7

Appendix A: Healthy Families Oregon Revised Statutes Appendix B: Healthy Families Oregon Administrative Rules Appendix C: Host Agency Equal Employment Opportunity Policy Appendix D: Host Agency Grievance Procedure Appendix E: Host Agency Mandatory Reporting Incident Form and Policy/Procedure AppendiX F Appendix G

Local Advisory Signature (optional):

The local Advisory Group for insert site name has reviewed and approves the local policies and procedures in this Manual:

Advisory Chair Signature Date

Healthy Families Oregon Program Policies and Procedures Manual- 8th Edition Revised 2022

HEALTHY FAMILIES AMERICA

Mission The mission of the Healthy Families America is to promote child well-being and prevent the abuse and neglect of our nation’s children through intensive home visiting

Goals Build and sustain community partnerships to systematically engage overburdened families in home visiting services prenatally or at birth.

Cultivate and strengthen nurturing parent-child relationships

Promote healthy childhood growth and development

Enhance family functioning by reducing risk and building protective factors

INTRODUCTION

This manual describes the statewide program policies and procedures for Healthy Families Oregon (HFO) that all local sites must follow and aligns with the standards and numbering system in the Healthy Families America (HFA) Best Practice Standards.

Local sites insert specific policies and procedures within the document, describing local practices in detail so staff clearly understand the expectations around their work. Local policies must not conflict with or substitute for state policies and are inserted into the PPPM directly below the instructions written in blue.

HFO MISSION STATEMENT

May add local Mission Statement here:

Healthy Families Oregon, following the Healthy Families America model and the HFA Best Practice Standards, promotes and supports nurturing parent-child relationships and healthy growth and development for all Oregon families expecting or parenting newborns that need and accept extra support.

PROGRAM GOALS

HOME VISITATION PROGRAM DESCRIPTION

Healthy Families Oregon, formerly known as Healthy Start, was created by the Oregon Legislature in 1993. It is a statewide program in Oregon’s system of supports and services for families with young children. Healthy Families promotes wellness for Oregon families who need extra support during a pregnancy and at the time of birth by offering accessible and non-stigmatizing services tailored to the family’s unique situation.

Healthy Families Oregon offers consenting families access to screening for and personalized referrals to community services. Families may receive a Welcome Baby gift packet filled with information about parenting and child development.

Families determined to be at higher risk for adverse childhood outcomes (through the use of a standardized research-based screening tool) are offered ongoing home visiting services.

Home visiting services may continue for as long as the family wants to remain engaged, for at least three and up to five years in some situations, depending on local site policy. Visits assist families in achieving goals around parenting and improved family functioning by building on family strengths.

Today Healthy Families Oregon is a vital link in a network of integrated early childhood services.

May add local site description here

GOVERNING LEGISLATION

The Oregon Revised Statues (ORS 417.795) pertaining to Healthy Families Oregon (HFO) can be found in Appendix A.

The Oregon Administrative Rules (Division 414-525-0015) pertaining to HFO can be found in Appendix B.

Healthy Families Oregon promotes positive parent-child relationships, supports healthy childhood growth and development and enhances family functioning by:

• Building trusting, nurturing relationships with parents

• Teaching parents to identify strengths and utilize problem-solving skills

• Improving the family’s support system through linkages and appropriate referrals to community services

HFO STATE SYSTEM

HFA SAFETY AND ESSENTIAL STANDARDS

HFA has identified the following areas critical to accreditation, and has designated them as Safety and Sentinel Standards.

These standards are described below and marked in this manual with an identifying symbol. Note: Safety and Essential Standards will be indicated in BOLD font at the bottom of the rating indicator box.

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.

9-3.B Personnel background checks

10-2.D Staff orientation training on child abuse/neglect indicators and reporting requirements

12-1.B Supervision of direct service staff

GA-3.C Site practices related to informed consent when sharing family information

GA 4.A, GA 4.B Policies and procedures around child abuse/neglect reporting criteria, definitions, and practice

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.

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.

There are 15 essential standards. Each standard is noted in the body of the PPPM as below.

2-1.B The administration of the FROG scale to learn about family strengths and challenges.

3-3.B The use of Creative Outreach as a trauma-informed strategy to build trust and re-engage families who have missed visits.

Safety Standard

Essential Standard

4-2.C The use of HFA Level Change Forms to review family progress and decrease the frequency of home visits.

5-4.B The development of an Equity plan to support the site in achieving greater equity in all facets of its work.

6-1.C The implementation of the Service Plan, the intentional work of the FSS to respond to concerns that families have shared.

6-2.B The supports that FSSs provide around setting and achieving goals with families.

6-3.B, C, E The use of CHEERS to observe, partner with and support families in developing nurturing parent child relationships, and the supervisor support to staff around this important aspect of their work.

9-1.D The processes for hiring HFA direct service staff.

10-4.A, B, C The Core trainings required of staff within certain timeframes

12-2.B Sites ensure all direct service and volunteers and interns (performing the same function) are provided with supervision including administrative, clinical, and reflective components to continuously improve the quality of their performance

GA-3.A Policies and forms related to family rights and confidentiality.

GA-3.B The practice of informing families of their rights and about the processes around confidentiality at the start of HFA services.

GLOSSARY

A

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.

ACCEPTANCE OF SERVICES: Participants, who voluntarily agree to participate in home visiting services after initial identification through eligibility screening that have accepted intensive services and have received a first home visit.

ADMINISTRATION: The personnel/staff with responsibility for leadership and oversight of the site including service delivery, accountability, data management, and managing the site’s resources (fiscal and personnel).

ADVISORY GROUP: An organized voluntary group that advises HFO site operations. The functions and responsibilities of this group may include making recommendations to the HFO site and the organization’s governing group (if different from the advisory group) regarding site policy, operations, finances, community needs, etc. Typically, advisory group members are a diverse group of individuals who represent the interests of the community as guided by the HFA Standards.

ANALYSIS: A detailed study and reporting of site trends and patterns. Typically, this would include demographic, social, systemic, and other factors that impact services to families.

ANNUAL STATUS REPORT: A comprehensive document prepared by the HFO evaluation team that describes and summarizes site activities and services and is available to the community. This document includes an overview of services provided in the past year, demographic profiles of site participants, and a summary of outcomes achieved during the year. These reports are provided if funds are available a mid-year report is also provided.

B

BYLAWS: Guidelines adopted by the site (or its host agency, collaborative, community partners, advisory/governing group, etc.) for the regulation of its operations.

C

CASELOAD: The total number of families and caseload points assigned to a direct service staff person.

CENTRAL ADMINISTRATION: The Early Learning Division staff and contractors that assure local sites are implementing the HFA model with fidelity. This monitoring is done through training, quality assurance, policy, 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 and service delivery priorities so the site receives referrals from the intake system that reflect the families the site intends to serve.

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.

CHARACTERISTICS: Distinguishing features, attributes, and/or qualities.

CHEERS: An acronym to support Home Visitors in understanding and observing the different dimensions of parent-child interaction. 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 training.

CHEERS CHECK-IN TOOL: The CHEERS Check-In Tool 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.

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 given their HFA experience. 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.

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, if in the example above, 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.

CONTINUOUS QUALITY IMPROVEMENT (CQI) SITE VISIT: Annual site visit to each HFO region completed by HFO Central Administration staff to review and support the quality of the site’s work, ensure adherence to the HFA Best Practice Standards, and fidelity to the HFA model.

CRITERIA: Standards and/or expectations on which judgments or decisions are based (i.e., criteria for moving participants from one level to the next).

CONTRACT: A formal written legal agreement between two or more parties that specifies the services, people, space, or products to be provided in exchange for some form of compensation.

CULTURE: Behaviors, habits/patterns, values and beliefs, language, customs/traditions, religious beliefs, arts, institutions, and all other products of human work and thought considered to be the expression of a particular population or group of people.

CULTURAL CHARACTERISTICS: Distinguishing features and attributes such as the ethnic heritage, race, customs, values, language, gender, religion, sexual orientation, income, and geographic origin 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 (Tervalon & Murray-Garcia, 1998). 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.

CULTURALLY REPSONSIVE: Recognizing the diverse cultural characteristics of parents as assets. Culturally responsive teaching/coaching empowers parents intellectually, socially, emotionally and politically by using cultural referents to impart knowledge, skills and attitudes.

CULTURALLY SENSITIVE: A site’s ability to be aware of and respectful to the diversity of each family it serves and its ability to integrate this awareness into practice. It is the degree to which the site continually modifies or tailors its system of service delivery to the cultural characteristics in its service population including personnel/staff selection, training and all components of the service delivery system (assessment, home visiting and supervision). In striving to find the richness of culture, both our own and that of the families we serve, we are able to learn more about ourselves, our families and the context of their life circumstances.

D

DATA MANAGEMENT SYSTEM: A systematic and standardized way of collecting and organizing information that allows for accurate monitoring of site activities and timely reporting of site statistics.

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

DECLINES SERVICES: A family that is determined to be eligible and is offered services but declines (either verbally or in writing). Or a family who has been enrolled, and for whatever reason declines further participation.

E

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 HFO 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. HFO uses New Baby Questionnaire (NBQ) to determine eligibility for intensive home visiting services.

ELIGIBILITY SCREENING: A process of identification of eligibility of potential site participants based on a standardized risk assessment. HFO uses the New Baby Questionnaire (NBQ) to identify risks associated with poor child and family outcomes to qualify families to receive intensive home visiting 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.

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.

EQUAL OPPORTUNITY POLICY: An employer’s written statement that describes how it ensures that all current and prospective employees are afforded equal employment opportunities and how it overcomes any effects of past discrimination.

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 materials that is designed for home visiting or parent support, or sites may identify other evidence-based sources of parenting materials.

F

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

FAMILY FILE: A confidential, written compilation of information that describes and documents services given to participating families.

FAMILY GOAL PROCESS: The Family Goal process sets the framework for Home Visitors to:

• Offer the concept that change can happen and the family can have an impact creating their future

• Help the family identify what they want to accomplish and the mechanism(s) by which the Home Visitor can assist

• Develop opportunities for the family to experience success

• Assist the family to identify and acknowledge their strengths

• Work together with the family to develop goals and break those goals into meaningful steps to ensure success for each family. This includes a clear conversation and partnering between the Home Visitor and parent that supports growth in families

• Celebrate success with the family

FIRST HOME VISIT: The first visit completed by the assigned Home Visitor after eligibility has been determined, where rights and confidentiality forms are signed (unless already signed), where CHEERS is typically observed, and at least one focus area (see glossary for home visit definition) occurs. The visit is documented on a Home Visit Record. .

FOCUS CHILD: Eligibility is determined early for HFA families, ideally during the prenatal period. Healthy Families services are centered on the focus child (or children in the case of multiples), who is the prenatal child at enrollment, or child most recently born to a newly enrolled family.

FROG SCALE: The FROG (Family Resilience and Opportunities for Growth) Scale is the psychosocial assessment tool used by HFA sites at the onset of services to gather information about each family’s unique strengths (protective factors) and challenges (risks for child maltreatment). HFA sites use the FROG Scale as the foundation for the family’s Service Plan which guides ongoing services. Some sites use the FROG Scale to determine eligibility for HFA. The FROG Scale is administered with families in conversational style, respectful of what families feel comfortable sharing. While staff will continue to learn about families throughout the course of services, early completion of the FROG Scale supports relationship building by:

• immediately offering services that are responsive to the concerns and interests of each family

• building on family strengths to address concerns or challenges

• sending a clear message that this is a safe place to share difficult experiences

Each of the protective factors and potential risks identified below are measured on a continuum from strength to risk, with low scores in each area reflecting significant strengths and high scores reflecting significant risk.

• parent’s childhood experiences

• experiences with substances or other potentially addictive behaviors

• mental illness

• experience with child welfare

• coping skills and supports

• stressors (housing, finances, childcare, employment, etc.)

• relationship with partner (including level of support and history or current intimate partner violence)

• knowledge of child development

• plans for discipline methods

• perception of baby/child

• physical and emotional availability of parent

FOUNDATIONS OF FAMILY SUPPORT CORE TRAINING (FFS): In-depth, formalized training which outlines the specific duties of the Home Visitor’s role within Healthy Families and covers topics including, but not limited to: establishing and maintaining trust with families, completing necessary paperwork/documentation, the role of the Home Visitor, communication skills, and crisis intervention, etc. The trainer is certified by the HFA National Office and has been trained to train others.

FULL TIME EQUIVALENCY (FTE): The calculation of full-time equivalent (FTE) is an employee's scheduled hours divided by the employer's hours for a full-time workweek. When an employer has a 40-hour workweek, employees who are scheduled to work 40 hours per week are 1.0 FTEs. Employees scheduled to work 20 hours per week are 0.5 FTEs. Family Support Specialists caseload maximums are determined by their FTE This caseload expectation needs to be adjusted if the Family Support Specialist is less than 1 FTE. For example, sites will prorate a .5 FTE (1/2-time employee) so that their caseload does not exceed 15 points and that staff have an adequate amount of time to work with each family.

G

GOVERNING GROUP: An organized, voluntary group with the legal authority and responsibility to set policy and oversee the operation of an agency. Generally, the governing group is a group such as the Board of Directors.

H

HANDS-ON PRACTICE: Actual utilization of a tool during training or orientation to a new role, which may include role play, videotaping portions of home visits or FROG Scales, practicing documenting CHEERS or the Home Visit Record, or scoring a videotaped or shadowed FROG Scale.

HEALTHY FAMILIES AMERICA (HFA): The site model on which HFO is based and which provides accreditation for sites and Multi-Site systems that adhere to its research-based Standards.

HFA FROG SCALE TRAINING: FROG Scale training is an in-depth, formalized training for all direct service staff who will use the FROG Scale with families and their supervisors. The training includes but is not limited to: understanding the importance of telling one’s story; using the framework of the FROG Scale to identify families’ strengths and concerns; engaging families through conversation; documenting in narrative form; and using the FROG Scale scoring guide. The training is facilitated by a trainer who has completed an extensive training program and is certified by the HFA National Office.

HFA FOUNDATIONS for FAMILY SUPPORT CORE TRAINING: Foundations for Family Support (FFS) is an in-depth, formalized training required for all direct service staff, supervisors, and program managers. The training outlines the duties of the direct service staff in their role within HFA. Topics include but are not limited to: trauma-informed practice; communication skills;

assessing, addressing, and promoting nurturing and sensitive parent-child relationships; creating a trusting partnership with families; goal setting; and strategies to enhance family functioning, address challenging situations, ensure healthy childhood development, and support healthy relationships. The training is facilitated by a trainer who has completed an extensive training program and is certified by the HFA National Office.

HFA CORE SUPERVISOR TRAINING: In-depth, formalized training that outlines the specific duties of the supervisor’s role within Healthy Families and covers topics including, but not limited to: the role of direct service staff, the importance of reflective supervision, supervision session structure and content for all staff, reflective strategies for supervisors, sample tools and forms to use for continuous quality improvement, etc. The trainer is certified by the HFA National Office and has been trained to train others.

HFA IMPLEMENTATION TRAINING: In-depth, formalized training designed to prepare Program Managers and other Healthy Families America leaders for their important work. Implementation Training is an opportunity to become intensely immersed in HFA, the expectations of the model, and the responsibilities of HFA leaders, all while developing relationships with National Office staff and a network of support from other HFA colleagues throughout the country. Learners receive resources aimed at making implementation of the HFA model easier, gain familiarity with the HFA Best Practice Standards and have opportunities to consider the implementation of these standards within local sites or systems.

HFO FORMS: All HFO forms are located on the HFO SharePoint:

• Standardized & Required forms (SR): Sites must use these specific forms. Cosmetic changes (such as adding the name of local site) are allowed, but the content of the existing form may not be modified.

• Required forms (R): Sites are required to have forms that meet this purpose.

• Optional forms (O): HFO has found these forms helpful in meeting best practice standards but they are not required.

These forms may be modified as needed at the local level.

HFO NEW PROGRAM MANAGER ONLINE CORE TRAINING: In-depth training which outlines the duties and responsibilities of the Program Manager and Assistant Program Manager positions in HFO. This training is required to be completed within 3 months of hire.

HFAST: This is the acronym for Healthy Families America Site Tracker (HFAST). HFAST is an online information and data system that allows for real time updates. Sites are required to communicate changes (demographics, personnel, etc.) on HFAST so that it remains updated. All sites will also complete their annual survey on HFAST.

HOME VISIT: A face-to-face interaction that occurs between the family and the Home Visitor. The goal of the home visit is to promote nurturing parent-child interaction, healthy childhood growth and development, and enhance family functioning.

Typically, home visits occur in the home, last a minimum of an hour and the child is present. Sites are permitted to count one group meeting per month as a home visit while families are on Level 1, however to do so requires that the family’s Home Visitor be present during the group meeting and that the group meeting be documented on a Home Visit Record, including some aspects of CHEERS for that particular family. The focus during home visits may include, but are not limited to:

Promotion of nurturing parent-child interaction/attachment:

• Development of healthy relationships with parent(s)

• Support of parental attachment to child(ren)

• Support of parent-child attachment

• Social-emotional relationship

• Support for parent role in promoting and guiding child development

• Parent-child play activities

• Support for parent-child goals, etc.

Promotion of healthy childhood growth & development:

• Child development milestones

• Child health & safety,

• Nutrition

• Parenting skills (discipline, weaning, etc.)

• Access to health care (well-child check-ups, immunizations)

• School readiness

• Linkage to appropriate early intervention services

Enhancement of family functioning:

• Trust-building and relationship development

• Strength-based strategies to support family well-being and improved self-sufficiency

• Identifying parental capacity and building on it

• Family goals

• Building protective factors

• Assessment tools

• Coping & problem-solving skills

• Stress management & self-care

• Home management & life skills

• Linkage to appropriate community resources (e.g., food stamps, employment, education)

• Access to health care

• Reduction of challenging issues (e.g., substance abuse, domestic violence)

• Reduction of social isolation

• Crisis management

• Advocacy

HOME VISITOR/HFA Family Support Specialist: HFO staff providing direct home visiting services to families. Internally, HFO will continue to use the term “Home Visitor.” Locally, each site can choose the title Home Visitor or Family Support Specialist to use with the families they serve. Within HFO, these two terms are interchangeable.

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INFANT MENTAL HEALTH: Developing the capacity of the child from birth to age three to experience, regulate, and express emotions; form close and secure interpersonal relationship; and explore the environment and learn – all in the context of family, community and cultural expectations (Zero to Three IMH Task Force). Additionally, children must master the primary emotional tasks of early childhood without serious disruption caused by harmful life events. Because infants grow in a context of nurturing environments, infant mental health involves the psychological balance of the infant-family system (World Assn.

IMH).

IMMUNIZATION RATE: The percentage of focus children who are up-to-date with immunizations at a certain point in time (i.e., when the focus child is nine months old, 12 months old, two years old, etc.). The percentage does not include children whose family beliefs preclude immunizations. In order to not count these families, the site requests a written statement from the parents to be kept on file.

INDIVIDUAL TRAINING PLAN: All staff bring professional experience and education to the job. Each staff member brings strengths to build on, has areas to strengthen, and will develop goals for professional development with their Supervisor. To understand and document previous learning and experience, Supervisors discuss topics with the staff member to ensure knowledge and how it is used in the work. The staff member and Supervisor then develop a plan to support ongoing staff development. This can occur during regular supervision and often is formalized during an annual review process. HFA recommends at least 15 hours of annual professional development, including annual ongoing training requirements.

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LEVEL CHANGE FORMS: HFA has developed and requires that sites utilize HFA Level Change forms. These forms provide the criteria for making decisions about a family’s readiness to move to less frequent visits. The process allows the Family Support Specialist the opportunity to acknowledge family achievements throughout the course of services and to have a way to determine when a family has successfully completed services. While sites cannot subtract from the criteria outlined on the HFA Level Change forms, they may be permitted to add criteria. A site wishing to do so will submit any proposed modification to the HFA National Office for approval. HFA Level Change Forms and Documents.

LIVED EXPERTISE: HFA staff are often more effective in supporting families and achieving program outcomes if they have experience within the community, apart from the formal educational attainment that is commonly included in hiring standards. Staff with knowledge of the of the culture of the people that the site intends to serve, and self-awareness around their own place within the community will be more successful in building trusting working relationships with the families that come into contact with the HFA site. Focusing on lived expertise also increases opportunities for diverse representation, equitable access to positions, and elevation of family voice within the services the program provides.

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MEDICAL/HEALTH CARE PROVIDER: The primary individual, provider, medical group, public and/or private health agency, or a culturally recognized medical professional where participants can go to receive a full array of health, mental health, and medical services.

MEMORANDUM OF UNDERSTANDING (MOU): A written agreement between two organizations or entities that outlines the scope, nature, and extent of services provided by each. HFO sites may have MOUs with hospitals or other community partners that provide access to families within the focus population. Other MOUs may be helpful as well to formalize relationships between the site and other entities.

MONITOR: To keep track of through the ongoing collection of available information. The extent of the information collected for tracking and monitoring purposes will vary and is a less rigorous process than compiling data for an analysis. Monitoring is not limited to review of data and reporting. Sites may find that they are able to learn more about the processes and outcomes that they are monitoring through the review of notes in family files, individual screening tool results or survey responses. For example, in monitoring well-child visit completion, sites may find that they are able to identify trends by reviewing a report of all families and the dates of their well child visits, but that they may learn more about site performance in this area through conversations in team meetings. For monitoring the systems related to referral relationships, sites may combine data related to the number and success of referrals

MOTIVATIONAL INTERVIEWING (M.I.): A collaborative, goal-oriented method of communication with particular attention to the language of change. It is intended to strengthen personal motivation for and commitment to a change goal by eliciting and exploring an individual’s own arguments for change (William Miller, Steve Rollnick, 2012). When staff have been trained in motivational interviewing techniques, it is important for Supervisors to also be knowledgeable in order to support staff in their practice.

Example M.I. questions:

• What would you like to see different about your current situation?

• What has you thinking you need to change?

• What will happen if you don’t change?

• If you make changes, how would your life be different from what it is today?

• How would you like things to turn out for you in 2 years?

MULTI-SITE SYSTEM: Oregon is a state system with multiple sites providing home visiting services (i.e., assessment, home visitation, supervision, and management). All sites follow the HFO Program Policies and Procedures Manual and the HFA Best Practice Standards. Multi-site systems receive support and guidance from their Central Administration office in the following:

policy, administration, quality assurance, training, technical assistance, and evaluation services.

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NEW BABY QUESTIONNAIRE (NBQ): A research-based eligibility screening tool adapted from the Hawaii Risk Indicators Inventory for use by Healthy Families Oregon. It is designed to be an easily administered screening tool to measure families' level of risk for negative family and child outcomes.

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ONGOING TRAINING: Regularly scheduled training provided to staff based upon the specific needs, job responsibilities and issues of families within the community served. Ongoing training requirements include providing all HFO staff that have been employed for more than a year, annual Child Abuse and Neglect Reporting training, Medicaid Refresher training, and Cultural Sensitivity training that is related to the focus population that you serve. This also includes training focused on the staff’s professional development, with an annual recommendation of 15 hours.

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PARALLEL PROCESS: A key component of reflective practice, the parallel process encompasses all the relationships within the delivery of the HFA Services and focuses each person’s ability to develop and promote a nurturing relationship. This includes an awareness of how focusing on the ways in which we are present and emotionally available for another creates a nurturing environment within all other relationships within the parallel process: Parent and Baby, Direct Service Staff and Parent, Supervisor and Direct Service Staff, and Program Manager and Supervisor. This is summed up in the Platinum Rule: “Do unto others as you would have others do unto others.” Jeree Pawl.

PARTNERING WITH PARENTS AROUND CHEERS: HFA Family Support Specialists support families and promote nurturing parent-child relationships using CHEERS observations. In addition to the documentation of CHEERS to assess, address and promote attachment, FSSs support the parent-child relationship by discussing the domains of CHEERS with families through the use of reflective strategies, visit activities, and parenting materials. The more that parents become familiar with and reflect on concepts related to secure attachment, the more that they are able to make parenting choices that align with their family culture and build healthy relationships with their children. CHEERS is not something that is “done to” families, but an opportunity to come alongside families and create a shared language to talk about attachment and parent-child interaction.

PARTICIPANTS: Individuals/family members who are enrolled in HFO services.

PERFORMANCE INDICATOR: A measure of site success in reaching a desired result. Performance indicators are identified for both service delivery and family outcomes and monitored through the evaluation and delivered to HFO through the NPC Status Report.

PERSONNEL/STAFF: The body of employees, consultants, and/or volunteers that carry out the tasks of the site performing under the site’s administration and/or supervision.

POLICIES: Written statements of principles and positions that guide site operation and services, which are reviewed and approved by the HFO State Advisory Committee, in the case of state policies, and the local Advisory Group and other appropriate administrative group, for local policies.

PLANNING, IMPLEMENTATION, AND CONTINUOUS QUALITY IMPROVEMENT (ADVISORY GROUP ROLE): Planning refers to the planning of events, additional referral sources, and integration of services between agencies serving families, etc.

Implementation applies to supporting any implementation challenges the site faces, such as striving for early enrollment, engaging fathers, etc. Continuous quality improvement relates to feedback from the group related to the analyses and strategies aimed at strengthening site services.

PRIMARY CAREGIVER: HFA embraces a family centered approach and allows the family to define who the child’s family is.

The primary caregiver is the individual with whom the baby lives and receives primary care from. This individual is generally, though not always, a parent, and is the primary point of contact for the Home Visitor when conducting home visits and observing PCI. In co-parenting or multi-generational parenting families, one person will be identified within the system as the primary caregiver. Depression screens are only required to be administered with this person.

PROCEDURES: The step-by-step methods by which broad policies are implemented and site operations are carried out are written in a manual.

PROGRAM GOAL PLAN: Annual plan created by each HFO region detailing goals and strategies in the areas of eligibility screening and initial engagement, assessment, delivering home visiting services, supervision and management in response to the areas of improvement noted on the site’s annual Site Visit Report.

PROGRAM POLICIES AND PROCEDURES MANUAL (PPPM): This manual specifies policies and procedures for Healthy Families Oregon to assure that sites meet HFA accreditation standards as specified in the Best Practice Standards. All local sites follow the HFO Program Policies and Procedures Manual, and their local policies and procedures as written.

PROTECTIVE FACTORS: Conditions or attributes (skills, strengths, resources, supports or coping strategies) in individuals, families, communities or the larger society that help people deal more effectively with stressful…