HomeMy WebLinkAboutPrevent Child Abuse America-Healthy Families America Program_A-24-489.pdf COtj County of Fresno Hall of Records, Room 301
2281 Tulare Street
Fresno,California
601 Board of Supervisors 93721-2198
O� 1$56 0 Telephone: (559)600-3529
FRV,t' Minute Order Toll Free: 1-800-742-1011
www.fresnocountyca.gov
September 10, 2024
Present: 5- Supervisor Steve Brandau, Chairman Nathan Magsig,Vice Chairman Buddy Mendes,
Supervisor Brian Pacheco, and Supervisor Sal Quintero
Agenda No. 45. Public Health File ID: 24-0679
Re: Retroactively authorize the Department of Public Health's previous submittal of an affiliation application
to the evidence-based model developer Prevent Child Abuse America for the Healthy Families
America®Program; Under Administrative Policy No. 34 for competitive bids or requests for proposals
(AP 34), determine that an exception to the competitive bidding requirement under AP 34 is satisfied
and a sole source is warranted due to unusual or extraordinary circumstances, and that the best
interests of the County would be served by entering into an agreement with Prevent Child Abuse
America, as it is the only vendor able to provide affiliation and licensing for its proprietary
evidence-based home visiting model, Healthy Families America®; and Approve and authorize the
Chairman to execute an Affiliation and License Agreement with Prevent Child Abuse America,for the
Healthy Families America®program, effective upon execution,through June 30, 2029, not to exceed
five consecutive years,which includes a three-year base contract and two optional one-year
extensions,total not to exceed ($28,750)
APPROVED AS RECOMMENDED
Ayes: 5- Brandau, Magsig, Mendes, Pacheco, and Quintero
Agreement No. 24-489
County of Fresno Page 48
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Board Agenda Item 45
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DATE: September 10, 2024
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Retroactive Application and Affiliation and License Agreement to Implement the
Healthy Families America Model
RECOMMENDED ACTION(S):
1. Retroactively authorize the Department of Public Health's previous submittal of an affiliation
application to the evidence-based model developer Prevent Child Abuse America for the
Healthy Families America®Program;
2. Under Administrative Policy No. 34 for competitive bids or requests for proposals (AP 34),
determine that an exception to the competitive bidding requirement under AP 34 is satisfied
and a sole source is warranted due to unusual or extraordinary circumstances, and that the
best interests of the County would be served by entering into an agreement with Prevent
Child Abuse America, as it is the only vendor able to provide affiliation and licensing for its
proprietary evidence-based home visiting model, Healthy Families America®; and
3. Approve and authorize the Chairman to execute an Affiliation and License Agreement with
Prevent Child Abuse America, for the Healthy Families America®program, effective upon
execution, through June 30, 2029, not to exceed five consecutive years,which includes a
three-year base contract and two optional one-year extensions, total not to exceed ($28,750).
There is no additional Net County Cost associated with approval of the recommended actions, which will
waive the competitive bidding process and allow the Department of Public Health (Department)to provide a
new evidence-based home visiting service to families. The Healthy Families America®(HFA) program is
funded by the California Department of Public Health (CDPH) California Home Visiting Program (CHVP)
State General Funds (SGF) Expansion. The program will provide strengths-based, intensive, in-home
services that focus on enhancing child welfare, health, and development, both prenatally and after birth. It
should be noted that the affiliation application was submitted to Prevent Child Abuse America (PCA America)
on May 10, 2024, contingent upon the Board's approval, to meet the implementation goal set with CDPH.
The affiliation application was approved by PCA America on May 22, 2024. This item is countywide.
ALTERNATIVE ACTION(S):
If the recommended actions are not approved, the affiliation application will be rescinded, and the
Department will forego the opportunity to offer this valuable new service and would be unable to utilize the
funding currently allocated to this program.
SUSPENSION OF COMPETITION/SOLE SOURCE CONTRACT:
It is requested that the County find under AP 34, that an exception to the competitive bidding requirement is
County of Fresno Page I File Number.24-0679
File Number:24-0679
satisfied, and a sole source is warranted due to unusual or extraordinary circumstances, as PCA America is
the only vendor authorized to provide affiliation and licensing for its proprietary evidence-based home visiting
model. The Internal Services Department- Purchasing, concurs with the Department's assessment that
this satisfies the exception to the competitive bidding process required by AP 34.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The maximum
compensation for FY2024-25 is $7,500 with a total compensation not to exceed $28,750 for the term of the
agreement. If approved, the maximum cost of the recommended agreement will be 100%funded by Health
Realignment. Sufficient appropriations and estimated revenues are included in the Department's Org 5620
FY 2024-25 Recommended Budget and will be included in subsequent budget requests.
DISCUSSION:
The CHVP is a preventative intervention focused on promoting positive parenting and child development,
strengthening family functioning, and cultivating strong communities. CDPH funding has supported the
CHVP in the County since 2012. On June 9, 2020, your Board accepted SGF from CDPH to expand the
CHVP. On November 16, 2021, your Board approved and accepted award funding for CHVP SGF
Expansion for FY 2020-23. On April 25, 2023, your Board accepted additional CHVP SGF Expansion for FY
2022-23. On October 10, 2023, your Board approved and accepted award funding for the Department's
CHVP SGF Evidence-Based Home Visitation (EBHV)through June 30, 2028. Approval of the recommended
actions would allow the Department to utilize SGF to cover the cost of this Affiliation and Licensing
Agreement, allowing the County to provide HFA services through the Department's CHVP.
CHVP funds local health jurisdictions to serve clients using Nurse-Family Partnership (NFP), Parents as
Teachers (PAT), and Healthy Families America (HFA) home visitation models, based on the specific needs
of the region. The CHVP SGF EBHV program provides additional funding with the long-term goal of
increasing the number of families participating in the three models supported by CHVP. The Department has
provided NFP home visitation services since 1997. The Department conducted a needs assessment and
determined there was a gap in services for families who did not meet eligibility requirements for NFP and
therefore determined the CHVP SGF EBHV would be best utilized by funding an alternative program. The
Department completed comprehensive research on both the PAT and HFA models and determined HFA
was the best fit for the Department's CHVP SGF EBHV program. By adding a second model, the
Department will be able to grow the network of local home visiting programs and expand participant
eligibility.
PCA America is the developer of HFA, which is an internationally recognized, voluntary, evidence-based
home visiting model with goals of increasing parent knowledge of early childhood development, providing
early detection of developmental delays and health issues, preventing child abuse and neglect, and
increasing children's school readiness and success. HFA is highly rated by the Title IV-E Prevention
Services Clearinghouse and works to address health equity and the social determinants of health that
impact child and family well-being. As a proprietary model, the Department was required to submit an
affiliation application to PCA America prior to being granted permission to utilize the model. The application
was submitted contingent on your Board's approval. Through the affiliation and licensing agreement, PCA
America will provide the County access to their proprietary property, and guidance in best practices for the
use of the HFA model.
The recommended agreement was drafted by PCA America and deviates from the County's standard
agreement language; however, it contains standard language approved by the Human Resources Risk
Management Department as well as County Counsel. The agreement will be effective upon execution and
will remain in effect for a term not to exceed five years.
REFERENCE MATERIAL:
County of Fresno Page 2 File Number.24-0679
File Number:24-0679
BAI #56, October 10, 2023
BAI #71, June 20, 2023
BAI #38, April 25, 2023
BAI #45, November 16, 2021
BAI #29, June 9, 2020
ATTACHMENTS INCLUDED AND/OR ON FILE:
Sole Source Acquisition Request
On file with Clerk- Healthy Families America Affiliation and Licensing Agreement
CAO ANALYST:
Ronald Alexander
County of Fresno Page 3 File Number:24-0679
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o , Sole Source Acquisition Request
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1. Fully describe the product(s) and/or service(s) being requested.
The Department of Public Health (DPH) seeks an affiliation and licensing agreement with Prevent Child
Abuse America (PCA America), necessary to utilize their proprietary, evidence-based home visiting
model, Healthy Families America ® (HFA). The requested agreement would enable DPH to implement
the HFA model in Fresno County. HFA is a strengths-based, individualized home visiting program
designed to promote family and child well-being, prevent child maltreatment and other adverse childhood
experiences.
2. Identify the selected vendor and contact person; include the address, phone number and e-mail address
for each.
Prevent Child Abuse America
Diana Sanchez
Site Development Specialist
33 N Dearborn Street, Suite 2300
Chicago, IL 60602
(312) 663-3520
dsanchez@preventchildabuse.org
3. What is the total cost of the acquisition? If an agreement, state the total cost of the initial term and the
amounts for potential renewal terms.
The total cost of the acquisition will not exceed $28,750. The cost for the initial three-year term is
$19,750. For the optional one-year extension periods, the cost is $4,500 each. The affiliation and
licensing agreement will be effective upon execution and the base term will end on June 30, 2027, with
two optional one-year extensions through June 30, 2029.
4. Identify the unique qualities and/or capabilities of the service(s) and/or product(s) that qualify this as a
sole source acquisition.
As a proprietary model, PCA America is the sole organization capable of granting HFA affiliation and
providing the necessary license for DPH to implement the model in Fresno County.
5. Explain why the unique qualities and/or capabilities described above are essential to your department.
The California Department of Public Health (CDPH) California Home Visitiation Program (CHVP) funds
three evidence-based home visiting models: Nurse Family Partnership (NFP), Parents as Teachers
(PAT) and Healthy Families America (HFA). DPH receives CHVP State General Funds (SGF) to support
NFP services already provided by the Department. In 2020, CDPH provided SGF expansion funds to
local health jurisdictions to expand home visiting services. DPH conducted a needs assessment and
determined there was a gap in services for families who did not meet eligibility requirements for NFP and
therefore determined the SGF expansion would be best utilized by funding an alternative program. DPH
conducted extensive research on both the PAT and HFA models and determined HFA was the best fit,
based on the needs of the community and alignment with department goals. In comparison to the PAT
model, HFA shows higher effectiveness ratings and is slightly more cost-effective to implement. For this
model to be implemented by the Department, an affiliation and licensing agreement is required.
6. Provide a comprehensive explanation of the research done to verify that there is only a sole vendor that is
capable of providing the required service(s) and/or product(s). Include a list of all other vendors contacted
with regard to providing the requested product(s) and/or service(s) and indicate their response.
E-PD-047 (07/2021)
PCA America has trademarked their HFA model and is therefore the only vendor with authority to
grant the Department affiliation and provide licensing to utilize the model.
bivend 7/17/2024 1:37:12 PM Senior Staff Analyst [a Sign] Double click!
Requested By: Title
I approve this request to sole source for the service(s) and/or product(s) identified herein.
dluchini 7/22/2024 1:16:17 PM [a Sign] Double click!
Department Head Signature
mvilanova 7/24/2024 1:33:29 PM [a Sign] Double click!
Purchasing Manager Signature
E-PD-047 (07/2021)
Agreement No. 24-489
HEALTHY FAMILIES AMERICA@
AFFILIATION AND LICENSE AGREEMENT
I. INTRODUCTION
This document and all Exhibits hereto establish the Affiliation and License Agreement
(hereinafter "Agreement") made this lOth day of September, 2024 (the "Effective
Date")between Prevent Child Abuse America®, an Illinois not-for-profit corporation
and the developer of the Healthy Families America Model, ("PCA America"), and
[the County of Fresno, a political subdivision of the State of California] ("Affiliate")
(collectively the "Parties" and each individually a"Party").
The Affiliate under this Agreement may be either a Provisional Affiliate or an Accredited
Affiliate, each as defined below.
II. RECITALS
WHEREAS, the Healthy Families America® ("HFA") Model is an internationally
recognized, evidence-based home visiting model,based on the Critical Elements, set forth
in Exhibit 1, and operationalized through the Best Practice Standards, set forth in Exhibit
2, designed to promote family and child well-being, prevent child maltreatment and other
adverse childhood experiences;
WHEREAS,PCA America owns certain Proprietary Property,as defined herein in Section
III and set forth in Exhibit 3;
WHEREAS, Affiliate has been granted affiliation by PCA America and such affiliation
remains in Good Standing;
WHEREAS, Affiliate wishes to implement the HFA Model to serve expectant and new
parents in its Territory, set forth in Exhibit 4, and to be known to the public as:
Healthy Families Fresno County
(ex:Healthy Families<County Name> or Site Name, a Healthy Families America Affiliate)
WHEREAS, PCA America has the power and authority to grant to Affiliate the licenses
to use the Proprietary Property for the purposes described herein;
WHEREAS, Affiliate desires to obtain from PCA America affiliation and license to
implement the HFA Model and use the Proprietary Property in the Territory; and
WHEREAS, Fidelity to the Model has been demonstrated by Affiliate;
NOW, THEREFORE, in consideration of the foregoing premises, covenants and
promises contained herein, PCA America and Affiliate covenant and agree as follows:
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III. DEFINITIONS
"Accreditation Expiration Date" means the date when an Affiliate is required to have
completed the Accreditation Process. For single sites, this occurs initially three (3) years
from the date of the site's Fidelity Assessment, and then every four (4) years thereafter.
For multi-site affiliates this occurs initially three (3) years from multi-site affiliation and
every five (5)years thereafter.
"Accreditation Process" means the steps an Affiliate or multi-site system is required to
follow in order to become accredited. This includes completion of a self-study, a national
peer-reviewed site visit and any subsequent quality improvement efforts in order to meet
the threshold to be accredited (100% of all first order and safety standards and 85% of all
third order and stand-alone second order standards). Completion of this process is required
to confirm Fidelity to the Model, as set forth in Exhibit 11.
"Accredited Affiliate" means Affiliates that have demonstrated Fidelity to the Model
through successful completion of the Accreditation Process or through the completion of a
Fidelity Assessment.
"Adaptation" means an actual adjustment or modification to the specific best practices
that relate to the critical elements. In rare situations, an Affiliate or system may be
compelled to seek an adaptation to the model. All Adaptations must be approved by PCA
America.
"Affiliate"identifies the approved Local Implementing Agency delivering the HFA Model
in the specified Territory set forth in Exhibit 4. Sometimes referred to as "site."
"Affiliation Fee" the fee Affiliates pay annually for the right to use the HFA Model, and
to utilize all support services available for successful implementation and to illustrate
Fidelity to the Model.
"Association Management System (AMS)"refers to the web-based system used by HFA
headquarters to collect site and staff demographic data, and link local HFA staff to HFA's
online portal for access to training,network resources and making online payment of fees.
"Best Practice Standards" describe expectations for Fidelity to the Model and are a tool
used to identify the policies, procedures and practices necessary for HFA Affiliates to
implement. It is also the tool used for accreditation to measure Affiliate performance
relative to each standard.
"Enhancement" means any service that augments or supplements the HFA Model
without altering the critical elements or fidelity expectations of the model. For example,
utilization of doulas in addition to Family Support Specialists while a mother is pregnant,
the use of fatherhood specialists, mental health specialists, the use of depression-focused
curriculum materials and modules or the use of parent group services are all considered
enhancements. Enhancements are encouraged and do not require permission from HFA
Headquarters in order to be implemented.
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"Family Support Specialist" means an individual who has received HFA Model training
to work as a home visitor. Sometimes referred to as "FSS."
"Fidelity Assessment Expiration Date" means the date approximately three (3) years
from Affiliation date when a new single site affiliate is required to complete a Fidelity
Assessment from HFA Headquarters.
Fidelity Assessment Process" means the steps a new single site affiliate follows within
three (3) years of its initial affiliation with HFA. This includes completion of a self-study
by the affiliate, a review of select documentation including all Safety and Essential
Standards, and virtual interviews with all staff by HFA Headquarters, with the purpose of
confirming sites understand how to implement the model and have implemented key
components to fidelity.
"Fidelity to the Model"means implementing the HFA Model in a manner consistent with
the Critical Elements and the Best Practice Standards through successful completion of the
Fidelity Assessment or the Accreditation Process; therefore, maximizing the likelihood of
achieving results comparable to those measured in Research.
"Good Standing" means an affiliate that is current with payment of all fees, information
in the HFA Site Tracker and Association Management System (AMS) and the
Accreditation Process.
"HFA Headquarters" refers to HFA staff employed by PCA America to provide
oversight and support to the HFA network. Sometimes referred to as the "HFA National
Office".
"HFA Model" means the services offered to families based on the Proprietary Property.
Sometimes referred to as the "Program".
"Healthy Families America Site Tracker (HFAST)" refers to the web-based
administrative data system for the HFA National Office. HFAST includes a Site Profile
Report (SPR) module to collect aggregate program data from Affiliates. Collectively, the
data in HFAST enables national staff to better support quality of local Affiliates, including
state and Affiliate-specific feedback reports. The data collected in HFAST also helps
identify national trends within the HFA network.
"Program Manager" means the person at an affiliate site responsible for the day-to-day,
hands-on management of the HFA Model, and involved in program planning, budgeting,
staffing, training, quality assurance and evaluation. The Program Manager also typically is
responsible for ongoing collaboration with community/state partners, public relations and
for maintaining positive working relationships with early childhood partners and providers.
"Proprietary Property" means the items listed in Exhibit 3 and: (i) the HFA Model,
including facilitators and handouts, (ii) the Critical Elements; (iii) the name "Healthy
Families America"; (iii) the "Healthy Families America" logo; (iv) all HFA website
content and HFA Network Resources content; (v) the copyrighted materials; (vi) trade
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secrets, including but not limited to technical or non-technical data, formulas, patterns,
compilations,programs, devices,methods,techniques, drawings,processes, financial data,
or lists of actual or potential customers or suppliers; and (vii) participant information and
other materials used in the HFA Model as of the Effective Date that would be designated
as protectable intellectual property under applicable law, including, but not limited to, all
modifications, additions,updates and derivative works thereof and all of the rights of HFA
and its licensors associated with this property. Proprietary Property shall also include,
individually and collectively, all ideas, concepts, designs, methods, inventions,
modifications, improvements, new uses and discoveries that are conceived and/or made in
the performance of the responsibilities stated under this Agreement by one or more of
Affiliate, HFA or its licensors, whether or not they are incorporated into the HFA Model
or the Proprietary Property.
"Provisional Affiliate" means an Affiliate in the initial start-up phase that has not yet
demonstrated Fidelity to the Model through the Fidelity Assessment Process for the first
time.
"Research" means a systematic examination of information to answer a question and
advance knowledge and any activity, including program evaluation and/or quality
improvement activities, (i)that would, according to Federal regulations, require review by
an Institutional Review Board, or (ii) that could be expected to yield generalizable
knowledge that could be shared publicly with the professional, academic and/or lay
communities. Evaluation can be a type of research if the knowledge to be gained is
applicable to and will be applied beyond the immediate participants and context of the
study. Evaluation solely for purposes of quality assurance is not considered Research.
"Territory" means the HFA site service area set forth in Exhibit 4.
IV. REQUIREMENTS OF PCA AMERICA
Pursuant to this Agreement, PCA America commits to comply with the following requirements:
A. PCA America agrees to offer services consistent with Exhibit 5.
B. PCA America shall provide Affiliate with invoices for Annual Affiliation Fees to
Affiliate,based upon the fee schedule provided in Exhibit 6.
V. REQUIREMENTS OF AFFILIATE
Affiliate commits to comply with the following requirements, subject to the terms of this
Agreement:
A. Implement HFA Model with Fidelity to the Model and will undertake the steps
described in Exhibit 7, HFA Model Requirements, in order to do so.
B. Utilize HFA National Office services, as appropriate and available, to ensure
Fidelity to the Model.
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C. Pay all Fees associated with being an affiliate as set forth in Exhibit 6.
D. Maintain information in the Association Management System related to site and
staff demographics,provided there are no legal restrictions to do so.
E. Input aggregate data annually into HFAST per the annual Site Profile Report
Guidance,provided there are no legal restrictions to do so.
F. Implement a data management system to track participant level data as described
in the HFA Best Practice Standards (Exhibit 2) and the Data Elements provided in
Exhibit 8,provided there are no legal restrictions to do so.
G. Take all appropriate steps to maintain participant confidentiality and obtain any
necessary written participant consents, in accordance with applicable federal and
state laws, should there be a need to disclose protected information to HFA
Headquarters.
H. Affiliate agrees to communicate with PCA America prior to participating in any
research study involving 1) the HFA Model or 2) participant families, past or
present, enrolled in HFA services per HFA Best Practice Standards and the HFA
Research Review Policy set forth in Exhibit 2 and Exhibit 13 respectively.
I. Should an Affiliate wish to make any Adaptation to the HFA Model, a formal
request will be submitted to HFA Headquarters, and implementation will begin
only if approval is received.
J. Enhancements that do not alter or impact Fidelity to the Model can be implemented
in the absence of formal approval from HFA Headquarters. However, Affiliates
shall provide updates to the annual Site Profile Report via HFAST of any
enhancement services being delivered.
K. In addition to the requirements set forth in Paragraphs A - J of this Section, if
Affiliate is a Provisional Affiliate as of the Effective Date, Affiliate also must
schedule the Fidelity Assessment at least twenty-four (24) months prior to the
Fidelity Assessment Expiration Date. Provisional Affiliate also must successfully
complete the Fidelity Assessment process in order to receive accredited status and
transition from a Provisional Affiliate to an Accredited Affiliate pursuant to Section
VII of this Agreement.
L. In addition to the requirements set forth in Paragraphs A - J of this Section, if
Affiliate is an Accredited Affiliate as of the Effective Date or becomes an
Accredited Affiliate after the Effective Date, Affiliate also must initiate the
Accreditation Process at least twelve (12) months prior to the Accreditation
Expiration Date to be re-accredited.
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VI. GRANT OF LICENSES TO USE PROPRIETARY PROPERTY
A. Ownership of Proprietary Property. As between PCA America and Affiliate,
PCA America owns and shall retain all right, title and interest to the Proprietary
Property,including the goodwill associated with the Proprietary Property. Affiliate
agrees that it will not challenge PCA America's ownership rights to the Proprietary
Property or the validity or enforceability of such property. Nothing in this
Agreement shall be construed as an assignment or grant of any right,title or interest
to Affiliate in the Proprietary Property. To the extent Affiliate gains any ownership
rights by operation of law in any Proprietary Property,Affiliate hereby assigns PCA
America right, title, and interest, including all copyrights, trademark rights, and
other intellectual property rights, in and to any such Proprietary Property. In such
regard, Affiliate agrees to execute such assignments, documents, and other
instruments, and perform such other actions, as may be required to effectuate and
perfect such assignment. Nothing contained herein shall operate to deprive PCA
America of any said right,title and interest in and to the Proprietary Property, or be
construed as a limitation on the right of PCA America to use or license all or any
part of the Proprietary Property except as provided in Section VI.D herein.
B. License Grant—Sublicenses. Affiliate may not grant any sublicenses to any third
parry without the prior express written consent of the PCA America,which may be
withheld for any reason.
C. Property of Affiliate. For clarity, the Proprietary Property does not include ideas,
concepts, designs, methods, inventions, modifications, improvements, new uses
and discoveries that Affiliate conceives or develops outside the scope of this
Agreement and without the use of or reference to Proprietary Property. The
concepts of the Affiliate, and the implementation of them, shall remain the property
of the Affiliate.
D. License Grant — Trademarks. Subject to the terms and conditions of this
Agreement, PCA America hereby grants Affiliate a limited, non-exclusive, non-
transferable license,without the right to sublicense,to use the trademarks and logos
set forth on Exhibit 3 for the purpose of promoting goods, services and activities
that are consistent with implementation of the HFA Model in the specified
Territory, provided that at all times Affiliate complies with PCA America's then-
current"Graphic Standards and Branding Requirements of HFA." (Exhibit 10 sets
forth the version current as of the Effective Date.) Any goodwill arising from the
exercise of such license will inure to the benefit of PCA America and will become
part of the Proprietary Property. Affiliate will not during or after the Term use,
adopt, or attempt to register, either directly or indirectly, any trademarks included
in the Proprietary Property or any similar trademarks or logos. At PCA America's
request and expense, Affiliate will cooperate and provide PCA America with
assistance for PCA America to register such trademarks in the Territory.
E. License Grant — Works of Authorship. Subject to the terms and conditions of
this Agreement, PCA America hereby grants Affiliate a limited, non-exclusive,
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non-transferable license, without the right to sublicense, to copy, modify, prepare
derivative works of, and distribute, solely in the Territory, any works of authorship
included in Exhibit 3 solely in connection with goods, services and activities that
are consistent with the implementation of the HFA Model.
F. Quality Control. Affiliate shall ensure that the nature and quality of the Affiliate's
goods, services and activities made, used, or promoted by the Affiliate or on the
Affiliate's behalf, and all related advertising,promotional, and other related uses of
the trademarks and logos are consistent with implementation of the HFA Model in
the specified Territory and meet PCA America's standards and specifications,
including any requirements of applicable governmental authorities (including
regulatory agencies) in the Territory. Affiliate agrees that all such activities shall
be under the control of PCA America. Affiliate shall cooperate with PCA America
in facilitating PCA America's control of the nature and quality of Affiliate's goods,
services and activities and other uses of the trademarks and logos. Affiliate shall
not alter the quality of its goods, services and activities except with PCA America's
express written consent and approval. Affiliate shall,periodically and immediately
on demand by PCA America at any time, furnish samples of its goods, services and
activities to PCA America.
G. Inspection of Affiliate's Uses of PCA America's Trademarks and Logos.
Affiliate hereby grants PCA America the right on reasonable notice to inspect
during the Term of the Agreement Affiliate's goods, services, and activities, and
all related advertising, promotional, and other related uses of the trademarks and
logos. In the event that the quality of Affiliate's goods, services, and activities and
related uses fall below PCA America's standards and specifications,Affiliate shall
promptly prepare for Affiliate's review and approval a detailed corrective action
plan and, upon obtaining PCA America's consent and approval, promptly
implement such plan.
H. Ownership, Maintenance, Protection and Promotion of the Proprietary
Property. If Affiliate becomes aware of any infringement or acts of unfair
competition related to the Proprietary Property, Affiliate shall promptly inform
PCA America of any such activity and provide reasonable cooperation when
requested by PCA America in any action against such acts of infringement or unfair
competition.
I. Amendment of Exhibit 3. From time to time,PCA America and its licensors may
amend Exhibit 3 to include other works. Any such amendment will clearly identify
the work or works that will be the subject of the amendment. PCA America will
provide Affiliate with reasonable written notice of any amendments to Exhibit 3.
Upon the entry of such an amendment,the work or works that are the subject of the
amendment shall fall within the scope of the license granted hereunder and will be
subject to all the terms and conditions set forth herein.
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J. Third Party Complaints.Immediately upon receipt of any complaint from a Third
Parry concerning any of Affiliate's goods,services,or activities,Affiliate shall send
PCA America a copy of such complaint.
VII. TRANSITION FROM PROVISIONAL AFFILIATE TO ACCREDITED
AFFILIATE
A. If Affiliate is a Provisional Affiliate as of the Effective Date, and the Affiliate
successfully completes the Fidelity Assessment Process, Affiliate's status shall
change from Provisional Affiliate to Accredited Affiliate under this Agreement,
effective the date it receives notice from PCA America that it has successfully
completed the Fidelity Assessment Process.
B. If Affiliate is a Provisional Affiliate as of the Effective Date, and Affiliate is unable
to successfully complete the Fidelity Assessment and Accreditation Process,
Affiliate shall have ninety (90) days from the date notice is received by Affiliate
from PCA America that it has failed to meet the accreditation requirements to
successfully complete the Fidelity Assessment and Accreditation Process. If
Affiliate is unable to successfully complete the Fidelity Assessment and
Accreditation Process within the ninety (90) day period, this Agreement shall
terminate effective ninety (90) days from the date Affiliate received notice, and in
accordance with the provisions of Section X of this Agreement.
VIII. TRANSFERABILITY AND ASSIGNMENT
A. Affiliate shall not transfer, assign or delegate its rights or obligations under this
Agreement or any portion thereof PCA America shall not transfer, assign or
delegate its rights or obligations under this Agreement or any portion thereof
without providing thirty (30) days' notice thereof to Affiliate.
B. PCA America retains the right to revoke the affiliation and this Agreement at any
time for substantial and/or serious noncompliance with the Requirements of
Affiliate set forth in Section V herein and the procedures set forth in Exhibit 7 to
this Agreement.
IX. DISAFFILIATION
A. Failure to comply with the terms of the Agreement or misuse of the Proprietary
Property can result in disaffiliation from the HFA Model. Grounds for disaffiliation
include,but are not limited to: (i)inability to pay fees in a timely manner; (ii) delay
in scheduling an accreditation site visit or achieving accreditation by the
Accreditation Expiration Date; (iii) misuse of Proprietary Property; and (iv)
disregard for Fidelity to the Model requirements.
B. In the case where grounds for disaffiliation exist, Affiliate shall have ninety (90)
days from the date notice of disaffiliation from PCA America to cure all grounds
for disaffiliation. If Affiliate is unable to cure all grounds for disaffiliation within
8
the ninety (90) day period, disaffiliation shall be effective the day after the
expiration of the ninety(90) day period.
C. If disaffiliated, PCA America reserves the right to advise the Affiliate's funder(s)
of the change in Affiliate status, or to provide notice that the Affiliate is no longer
in Good Standing.
X. TERM AND TERMINATION
A. Term. This Agreement and the provisions hereof, except as otherwise provided,
shall be in full force and effect commencing on August 6, 2024 and terminate on
June 30, 2027. The term of this Agreement may be extended for no more than two,
one-year periods only upon written approval of both parties at least 30 days before
the first day of the next one-year extension period. The Director of the Department
of Public Health or their designee is authorized to sign the written approval on
behalf of the County.
B. Termination by Affiliate.
1. Affiliate may terminate the Agreement: (i) if Affiliate relinquishes its
affiliation; or (ii) if PCA America breaches any of the terms or provisions
of this Agreement. Affiliate must serve PCA America with written notice
of its intent to terminate the Agreement.
2. The terms of this Agreement are contingent on the approval of funds by the
appropriating government agency. If sufficient funds are not allocated,then
Affiliate, upon at least 30 days' advance written notice to PCA America,
may terminate this Agreement.
3. Termination of the Agreement in the event Affiliate relinquishes its
affiliation will be effective the date specified in a formal disaffiliation letter
from HFA Headquarters. In the case of a breach of the Agreement by PCA
America, PCA America shall have ninety(90) days from the date notice of
breach is received from Affiliate to cure such breach. If it is unable to cure
the breach,termination of the Agreement shall be effective the day after the
expiration of the ninety(90) day period.
C. Termination by PCA America.
1. PCA America may terminate the Agreement if Affiliate breaches any of the
terms or provisions of this Agreement. Grounds for termination of the
Agreement include, but are not limited to: (i) Affiliate fails to perform any
of its obligations under this Agreement; (ii) Affiliate's activities are no
longer consistent with the HFA Model,pursuant to Exhibits I and 2 of this
Agreement; (iii) Affiliate voluntarily relinquishes its Affiliation and its
rights under this Agreement; or(iv) Affiliate loses funding and is unable to
provide HFA services.
9
2. In the case of a breach of the Agreement by Affiliate, Affiliate shall have
ninety (90) days from the date notice of breach is received from PCA
America to cure such breach. If it is unable to cure the breach, termination
shall be effective the day after the expiration of the ninety (90) day period.
3. The Agreement shall terminate immediately if Affiliate has a change of
control. In such event, Affiliate will give written notice to PCA America of
said occurrence within five (5)days of Affiliate's execution of any letter of
intent.
4. If the Agreement is terminated, PCA America reserves the right to advise
the Affiliate's funder(s)of the change in Affiliate status,or to provide notice
that the Affiliate is no longer in Good Standing.
D. Remedies at Law or Equity. Each Party recognizes and acknowledges that, in the
event of a breach of this Agreement,the non-breaching Party is entitled to seek any
and all available remedies in equity or at law.
E. Use of Proprietary Property. Upon the termination or expiration of this
Agreement, Affiliate shall discontinue use of the Proprietary Property immediately
upon receipt of the notice of termination of this Agreement. Should Affiliate fail
to discontinue the use of PCA America's Proprietary Property, PCA America shall
seek all remedies available to it, including,without limitation, filing a suit in equity
to enjoin Affiliate from further use of PCA America's Proprietary Property.
F. Payment of Fees. All fees payable by Affiliate to PCA America up through the
date of termination of the Agreement will be due immediately upon the date of
termination, and with respect to termination by Affiliate, any fees previously paid
by Affiliate shall be non-refundable.
G. Miscellaneous.
1. Termination of this Agreement shall have no consequences upon the
obligation of each Party to complete its obligations to the other Party hereto,
customers or other third parties under contracts and other agreements
entered into prior to the effective date of such termination of this
Agreement.
2. The termination of this Agreement shall not terminate the liability of the
breaching or defaulting Party resulting from such breach or default of this
Agreement.
3. The provisions of Sections VII,X,XI, and XII shall remain in full force and
effect following the termination of this Agreement.
10
XI. CONFIDENTIALITY
A. During the Term of this Agreement,each Party may have or may be provided access
to the other Parry's Confidential Information and materials (including, without
limitation, the Proprietary Property). All such Confidential Information shall be
retained in confidence in accordance with the terms of this Agreement and any
applicable separate nondisclosure agreement between PCA America and Affiliate.
B. The HFA Accreditation Process requires mutual commitments from PCA
America's staff, Certified Peer Reviewers and Affiliate to interact with candor,
cooperation, integrity and trust. All individuals working on the Accreditation
Process have the responsibility to maintain confidentiality regarding information of
which they become aware as a result of accreditation activities. Only information
that is procedurally identified as being public or that legally must be released will
be disclosed. The policy is binding on PCA America staff and HFA Certified Peer
Reviewers pursuant to the terms and conditions provided in the Peer Confidentiality
Agreement set forth in Exhibit 12.
C. Neither Parry shall use the Confidential Information of the other Parry for any
purpose other than to perform the receiving Party's obligations under this
Agreement both during the Term of this Agreement or after its termination.
D. Neither Party shall publish or disclose or cause to or permit anyone else to use,
publish or disclose any such Confidential Information, unless: (i) the receiving
Party can show by written evidence that such Confidential Information was
lawfully known to it at the time of receipt thereof from the other Party; (ii) such
Confidential Information becomes publicly available through no fault of the
receiving Party; (iii) the receiving Party can show by written evidence that it has
received such Confidential Information from another source without any
confidentiality obligation owing to the disclosing Party or any other third Party;
(iv) the receiving Party can show by written evidence that its employees or agents
have developed such Confidential Information independently without any
knowledge of the disclosing Parry's Confidential Information; or (v) disclosure is
required by, or pursuant to, laws or other act or order of any court, government or
governmental agency, as to which the receiving Party shall give the Party whose
Confidential Information is being disclosed prompt notice, and with whom the
receiving Party shall consult on the possibility of seeking a protective order or other
means to preserve the confidentiality of the Confidential Information required to be
disclosed.
XII. MISCELLANEOUS
A. Governing Law. The Agreement shall be interpreted and governed by the internal
substantive laws of the State of Illinois without regard to its conflict of law
principles.
11
B. Modification and Waiver. No amendment, modification or waiver of the terms
of this Agreement shall be binding on either Parry unless reduced to writing and
signed by an authorized officer of the Party to be bound and,in the case of a waiver,
shall be effective only in the specific instance and for the specific purpose for which
given, and shall not be construed as a waiver of any subsequent breach. The failure
of either Party to enforce at any time or for any period of time any of the provisions
of this Agreement shall not be construed as a waiver of such provisions or of the
right of such Parry thereafter to enforce each and every provision.
C. Entire Agreement. This Agreement and all Exhibits hereto contain the complete
Agreement between the Affiliate and PCA America relating to the subject matter
hereof. This Agreement supersedes any and all prior and collateral agreements,
representations,warranties,promises, conditions proposals,discussions or writings
relating to the subject matter of this Agreement between the Affiliate and PCA
America. This Agreement may only be amended by a written instrument duly
executed by the Parties hereto.
D. Severability. If any provision in this agreement shall be held invalid, illegal or
unenforceable in any respect, such invalidity,illegality or unenforceability shall not
affect any other provision of this agreement. The remaining provisions of this
agreement shall continue in full force and effect, and such invalid, illegal or
unenforceable provision shall be reformed to be made enforceable so as to provide
the same substantive result intended by such a provision.
E. Notice. All notices provided for or which may be given in connection with this
Agreement shall be in writing, and shall be effective (i) on receipt if delivered
personally to an officer of the Party to receive such notice, (ii) on the next business
day if sent by electronic mail and (iii) on the second business day following the
date of mailing if sent by registered airmail,postage prepaid,addressed or telefaxed
as follows (or such other address or telefax as may be designated by similar notice
from time to time delivered to the other Party):
If to PCA America, to:
Kathleen Strader, Chief Program Officer
Prevent Child Abuse America
33 N. Dearborn St., Suite 2300
Chicago, Illinois 60602
Fax: 312.939.8962
If to Affiliate, to:
Director of the Department of Public Health
County of Fresno
Address: 1221 Fulton Street Fresno, CA, 93721
Attention: HFA Program Manager
Fax: (559) 455-4705/phnfax@fresnocountyca.gov
12
F. Effect of Counterparts. For convenience of the Parties, this Agreement may be
executed in one or more counterparts, each of which shall be deemed an original
for all purposes.
G. No Authority to Bind Other Party or Act as Agent. Other than specifically set
forth herein, neither of the Parties, their agents nor employees shall, under any
circumstances, be considered to be an agent, representative of the other Party or
anything other than an affiliate as specified herein for all purposes of this
Agreement. Neither Party shall be liable for the debts nor obligations of the other
Party, except as may be authorized specifically in writing. Neither Party has the
express or implied authority to bind the other in any manner whatsoever by virtue
of this Agreement, and neither shall hold itself out as having such authority.
[Signature page follows]
13
Docusign Envelope ID: 1EA5EA7B-9108-452B-AD38-FD5B9CA43499
IN WITNESS WHEREOF, the Parties have caused this Agreement to be executed and
delivered by their duly authorized officers or representatives as of the Effective Date.
PREATUALTr' d-uTT n "'RUSE AMERICA COUNTY OF FRESNO
D__o��cu''Si__g__ned(by
---D
III y: �
By: 36837F4360964E0.. By.
Name: Kathleen Strader Name: Nathan Magsig
Title: National Director, HFA Title: Chairman of the Board of
Date:
8/5/2024 Supervisors of the County of Fresno_
Date:
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County of Fresno;State of California
By Deputy
For accounting use only:
Org No.: 56201750
Account No.: 7295
Fund No.: 0001
Subclass No.: 10000
14
EXHIBIT 1
CRITICAL ELEMENTS& SPECIFIC HFA MODEL REQUIREMENTS
HFA's Critical Elements make up the overarching research-based components of the HFA
Model, with the exception of Section XIII which is associated with the governance and
administration of a program. The Critical Elements can be broken into three broad areas: Service
Initiation, Service Content and Administration. Each Critical Element is further defined and with
requirements for HFA model implementation in the HFA Best Practice Standards (Exhibit 2).
Service Initiation
I. INITIATE SERVICES EARLY,IDEALLY DURING PREGNANCY.
II. USE THE VALIDATED FAMILY RESILIENCE AND OPPORTUNITIES FOR
GROWTH (FROG) SCALE TO IDENTIFY FAMILY STRENGTHS AND
CONCERNS AT THE START OF SERVICES.
III. OFFER SERVICES VOLUNTARILY AND USE PERSONALIZED, FAMILY-
CENTERED OUTREACH EFFORTS TO BUILD TRUST WITH FAMILIES.
Service Content
IV. OFFER SERVICES INTENSELY AND OVER THE LONG TERM, WITH WELL-
DEFINED CRITERIA AND A PROCESS FOR INCREASING OR DECREASING
INTENSITY OF SERVICE.
V. 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.
VI. 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.
VII. AT A MINIMUM, ALL FAMILIES ARE LINKED TO A MEDICAL PROVIDER
TO ENSURE OPTIMAL HEALTH AND DEVELOPMENT.DEPENDING ON THE
FAMILY'S NEEDS, THEY MAY ALSO BE LINKED TO ADDITIONAL
SERVICES RELATED TO: FINANCES, FOOD, HOUSING ASSISTANCE,
SCHOOL READINESS, CHILD CARE, JOB TRAINING, FAMILY SUPPORT,
15
SUBSTANCE ABUSE TREATMENT, MENTAL HEALTH TREATMENT, AND
DOMESTIC VIOLENCE RESOURCES.
VIII. SERVICES ARE PROVIDED BY STAFF IN ACCORDANCE WITH PRINCIPLES
OF ETHICAL PRACTICE AND WITH LIMITED CASELOADS TO ENSURE
FAMILY SUPPORT SPECIALISTS HAVE AN ADEQUATE AMOUNT OF TIME
TO SPEND WITH EACH FAMILY TO MEET THEIR UNIQUE AND VARYING
NEEDS AND TO PLAN FOR FUTURE ACTIVITIES.
Administration (Personnel Selection, Staffing, Training, Supervision, Governance &
Administration)
IX. 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.
X. SERVICE PROVIDERS RECEIVE INTENSIVE TRAINING SPECIFIC TO
THEIR ROLE TO UNDERSTAND THE ESSENTIAL COMPONENTS OF
FAMILY ASSESSMENT, HOME VISITING AND SUPERVISION.
XI. SERVICE PROVIDERS HAVE A FRAMEWORK, BASED ON EDUCATION OR
EXPERIENCE, FOR HANDLING THE VARIETY OF EXPERIENCES THEY
MAY ENCOUNTER WHEN WORKING WITH AT-RISK FAMILIES. ALL
SERVICE PROVIDERS RECEIVE TRAINING IN AREAS SUCH AS CULTURAL
COMPETENCY, REPORTING CHILD ABUSE, DETERMINING THE SAFETY
OF THE HOME, MANAGING CRISIS SITUATIONS, RESPONDING TO
MENTAL HEALTH,SUBSTANCE ABUSE,OR DOMESTIC VIOLENCE ISSUES,
DRUG-EXPOSED INFANTS, AND SERVICES IN THEIR COMMUNITY.
XII. SERVICE PROVIDERS RECEIVE ONGOING,REFLECTIVE SUPERVISION SO
THEY ARE ABLE TO DEVELOP REALISTIC AND EFFECTIVE PLANS TO
EMPOWER FAMILIES.
XIII. GOVERNANCE & ADMINISTRATION (NOT A CRITICAL ELEMENT) THE
AFFILIATE IS GOVERNED AND ADMINISTERED IN ACCORDANCE WITH
PRINCIPLES OF EFFECTIVE MANAGEMENT AND OF ETHICAL PRACTICE.
16
EXHIBIT 2
HFA BEST PRACTICE STANDARDS
8'" EDITION
HEALTHY FAMILIES AMERICA
BEST PRACTICE STANDARDS
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17
TABLE OF CONTENTS
GLOSSARY---------------------------------------------------------------------------------------------------- 6
SUMMARY AND GUIDANCE FOR DATA COLLECTION TIMEFRAMES ---------------------------------26
1. Initiate Services Early
1-1.A Program Eligibility Criteria -----------------------------------------------------------------------38
1-1.13 Referring Organizations --------------------------------------------------------------------------39
1-1.0 Tracking Referrals and Site Capacity------------------------------------------------------------40
1-2.A Initial Engagement Process(policy) -------------------------------------------------------------41
1-2.6 Initial Engagement Process(practice) ---------------------------------------------------------42
1-2.0 Initial Engagement Process:Developed Strategies-------------------------------------------42
1-3.A First Home Visit within 3 months(policy) -----------------------------------------------------43
1-3.6 First Home Visit within 3 months(practice) ---------------------------------------------------44
1-4.A Measure Acceptance Rate ----------------------------------------------------------------------45
1-4.121 Acceptance Analysis -----------------------------------------------------------------------------46
Standardized Assessment Tool(FROG)
24A Family Resilience and Opportunities for Growth(FROG)Scale(policy)------------------52
2-1.13 FROG Uniformity(practice)Essential Standard ----------------------------------------------53
24C FROG Timeframes(practice)---------------------------------------------------------------------54
2-1.13 FROG Supervision(practice)---------------------------------------------------------------------54
3. Offer Services Voluntarily
34A Voluntary Services(policy) ----------------------------------------------------------------------57
3-1.13 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
3-4.13 Retention Analysis --------------------------------------------------------------------------------64
Offer Services Intensely
4-1.A Weekly Visits(policy) -----------------------------------------------------------------------------69
4-1.13 Weekly Visits(practice) --------------------------------------------------------------------------70
4-2.A Levels of Service(policy) -------------------------------------------------------------------------71
4-2.8 Home Visit Completion(practice) -------------------------------------------------------------- 73
4-2.0 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
4-3.6 Services for a minimum of 3 years(practice) -------------------------------------------------76
4-4.A Transition Planning(policy) ---------------------------------------------------------------------- 76
4-4.8 Transition Planning(practice) ------------------------------------------------------------------- 77
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Diversity, Equity, Inclusion
5-1.A Staff Interactions (policy) ------------------------------------------------------------------------82
5.1.B Staff Interactions (practice) ---------------------------------------------------------------------- 82
5-2.A Family Partnership(policy)----------------------------------------------------------------------- 83
5-2.13 Family Partnership(practice) -------------------------------------------------------------------- 83
5-3.A Community Level Advocacy(policy) -----------------------------------------------------------84
5-3.13 Community Level Advocacy(practice) --------------------------------------------------------84
5-4.A Family and Staff Input----------------------------------------------------------------------------- 85
5-4.6 Equity Plan Essential Standard -----------------------------------------------------------------86
5-4.0 Equity Plan Review with Community Advisory Board----------------------------------------86
Promote PCI,Childhood Growth& Development
64A Service Plan (policy) -------------------------------------------------------------------------------91
6-1.6 Service Plan in Supervision (practice) ---------------------------------------------------------- 92
6-1.0 Service Plan with Families (practice) Essential Standard ------------------------------------ 93
6-2.A Development of Family Goals (policy) ---------------------------------------------------------94
6-2.13 Family Goal Development(practice) Essential Standard ------------------------------------95
6-2.0 Family Goals in Supervision (practice) ---------------------------------------------------------96
6-3.A PCI CHEERS(policy) ------------------------------------------------------------------------------ 97
6-3.8 CHEERS Used to Assess PCI (practice) Essential Standard ---------------------------------98
6-3.0 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
6-4.8 Child Dev, Parenting(practice) -----------------------------------------------------------------102
6-4.0 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
6-5.13 ASQ(practice) ------------------------------------------------------------------------------------106
6-S.0 ASQ:SE (practice) --------------------------------------------------------------------------------107
6-S.D Tracks, Refers&F/U for developmental delay(practice) -----------------------------------108
Health Care and Community Resources
7-1.A Medical/Health Providers for Focus children(policy) ----------------------------------------113
7-1.13 Medical/Health Providers for Focus children(practice) -------------------------------------114
7-1.0 Well-Child Care Visits(practice) ----------------------------------------------------------------115
7-2.A Timely Receipt of Immunizations(policy) -----------------------------------------------------115
7-2.B Measure Immunization Rates at lyr(practice)-------------------------------------------------116
7-2.0 Measure Immunization Rates at 2yr(practice) ------------------------------------------------117
7-3.A Health Care and Community Information and/or Referrals and Follow-up(policy) -----118
7-3.13 Health Care Referrals(practice) -----------------------------------------------------------------118
7-3.0 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
19
8. Urnked Caseload Sizes
84A Caseload Size(policy) ----------------------------------------------------------------------------131
8-1.8 Monitoring Caseloads(practice) ---------------------------------------------------------------132
8-2.A Managing Caseloads(policy) -------------------------------------------------------------------133
9-2.8 Managing Caseloads(practice) ----------------------------------------------------------------134
Service Providers Selection
94A Screening&Selection of New Staff(policy) --------------------------------------------------137
9-1.13 Screening&Selection of Program Managers-------------------------------------------------138
9-1.0 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
iv. Model Specific Training
10 1. Training Plan/Policy------------------------------------------------------------------------148
10-2.A-H Orientation Training 10-2.13-Safety Standard -------------------------------------149-152
10-3.A Stop-Gap Training(policy) --------------------------------------------------------------153
10-3.13-C Stop-Gap Provided(practice) ------------------------------------------------------------154
10-4.A HFA Core FROG Training Essential Standard-------------------------------------------155
10-4.13 HFA Core Foundations Training Essential Standard ----------------------------------155
10-4.0 HFA Core Supervision Training Essential Standard -----------------------------------156
10-5. HFA Core Implementation Training-------------------------------------------------------157
10-6A CCI Tool Training ---------------------------------------------------------------------------158
10-6.13 ASO Training --------------------------------------------------------------------------------158
10-6.0 ASO-SE Training----------------------------------------------------------------------------158
10-6.13 Depression Tool Training ------------------------------------------------------------------159
11. Training to Fulfill Job Functions
11-1.A-D Three Month Wraparound Training -------------------------------------------------165-166
11-2.A-G Six Month Wraparound Training -----------------------------------------------------167-171
11-3.A-E Twelve Month Wraparound Training-------------------------------------------------171-173
11-4:A-C Ongoing Training -----------------------------------------------------------------------174-175
Ongoing Reflective Supervision
12-1.A Supervision Frequency&Duration(policy) ---------------------------------------------181
12-1.8 Supervision Frequency and Duration(practice)Safety Standard ------------------182
12-1.0 Group Reflective Consultation -----------------------------------------------------------183
12-1.D Ratio of Supervisors to Staff -------------------------------------------------------------184
12-2.A Reflective Supervision and Annual Shadowing(policy) ------------------------------185
12-2.6 Reflective Supervision provided(practice)Essential Standard ---------------------186
12-2.0 Annual Shadowing Provided(practice)-------------------------------------------------187
12-3.A Supervisor Supervision(policy)----------------------------------------------------------188
12-3.B Supervision of Supervisor(practice) ----------------------------------------------------189
12-3.0 Reflective Consultation/Supervision of Supervisor(practice)-----------------------189
12-4.A Program Manager Support,Accountability(policy) ----------------------------------189
12-4.13 Program Manager Support,Accountability(practice) --------------------------------190
20
CA.Governance and Administration
GA-1.A Organization and function of Community Advisory Board---------------------------193
GA-1.B Advisory with Wide Range of Skills&Knowledge ------------------------------------194
GA-1.0 Program Manager Role with Community Advisory Board ---------------------------195
GA-2.A Quality Assurance Plan --------------------------------------------------------------------196
GA-2.B Quality Improvement Plan(practice)----------------------------------------------------197
GA-3.A Family Rights&Confidentiality(policy and forms) Essential Standard ------------198
GA-3.B Family Rights&Confidentiality(practice)Essential Standard-----------------------199
GA-3.0 Informed Consent to Release Information Safety Standard ------------------------200
GA-3.D Complaint procedures followed --------------------------------------------------------- 200
GA-3.E Site ensures privacy and voluntary choice for families'w/research---------------- 200
GA-4.A Child Abuse and Neglect Reporting(policy)Safety Standard-----------------------201
GA-4.B Reports Suspected Child Abuse&Neglect to Proper Authorities(practice)
SafetyStandard ----------------------------------------------------------------------------202
GA-4.0 Supervisor/Manager Notification and Tracking of Suspected CAN(practice)-----202
GA-5.A Participant Death&Grief Counseling(policy) -----------------------------------------203
GA-5.B Implement support when participant death(practice) -------------------------------203
GA-6. Policy&Procedure Manual--------------------------------------------------------------- 204
National Office Requirements
GA-7.A Data Up-to-Date(National Office Requirement)---------------------------------------207
GA-7.B Site Up-to-Date with Fees(National Office Requirement) ---------------------------207
GA-7.0 Site uses HFA name.logo and brand(National Office Requirement)---------------207
GA-7.D Participation in Research(National Office Requirement)-----------------------------208
GA-7.E Critical Incident Reporting(National Office Requirement)---------------------------209
21
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INTRODUCTION
GLOSSARY
HFA BEST PRACTICE STANDARDS:
A best preCtIM 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. 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.
'Bogan.C.E.and English.M.J.(1994).BenchmafiaN for Best Practices.Winning Through Innovative Adaptation.New York.McGraw-Hdf.
22
QUALITY ASSURANCE AND ACCREDITATION:
Sites implementing HFA commit to provide high quality home visiting services and demonstrate model fidelity through ongoing
quality assurance(OA),quality improvement(OI)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 Uf internal revie:v as they pull tuyether We nfurmatiun
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 remaining 3rd order and unsupported 2nd order standards(standards with Rating Indicators)rated as a 2 or a 3.
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THE STRUCTURE OF THE HFA BEST PRACTICE STANDARDS:
N The Standards:
N
O
The HFA Best Practice Standards contain a series of inter-related standards. A standard establishes the expectation for policy or
�a practice that has been determined either through research or consensus from the field,as a demonstration of quality.The Standards
z are broadly organized by the first order standards(the critical elements)and a section on governance and administration.The first
0
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.
p 1-3 and 1-4).While the second order standards provide more detail and specificity than the first order standards,their main purpose
c 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.
1-1.6.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).
S`ERMI lIll 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 12AA 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 2-1.6,2-1.C,and GA-3.D.
list 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 Intert
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.
A_-2ND AND 3RD ORDER INTENTS ARE BLUE
24
—ip,.
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.
FOUNDV TIPS CAN BE BOXES MARKED WITH A GREEN 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(10-2.1)),supervision of direct service staff(12-1.6),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-4.6).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:
• 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.
• 4-2.C:The use of HFA Level Change Forms to review family progress and decrease the frequency of home visits.
• 5-4.6: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.
• 6-3.13,C,and 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.
• 12-2.13: The provision of weekly reflective supervision to all direct service staff.
• 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.
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.
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>_ Use of HFA Tools and Spreadsheets:
a
oFor 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
o own tracking reports they should ensure they include the same fields of information outlined in the HFA tools.
u All tracking forms car be found here-
0
0 When using the HFA spreadsheets be sure to look carefully at all worksheets contained within(tabs at the bottom of each spreadsheet).
Z 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.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. Families who do not
remain at low-risk,i.e.,when additional family concerns and stresses are shared subsequent to administration of the FROG Scale that
would have resulted in the family scoring 10 or higher.
ASSESS,ADDRESS, PROMOTE:
The complete process of identifying and utilizing CHEERS to support nurturing Parent-Child Interactions during visits with families.
AS$=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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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.
-,EAR ryryS:
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.
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CONTEXTUAL DECISION-MAKING:
a 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
Ln
0 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
as to use contextual decision making to rate a standard,which means they must ensure the site is operating from best practice.For example,
Z in the situation above,if the missed prenatal depression screen was because the baby was born shortly after the first home visit,the site
0
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
o 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.--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 fora 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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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 mayor 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 informationthat sites staff share with familiesmust be evidence-informed,meaning thatthe 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.Find information about the role of
direct service staff on Netxvork Resources,
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 families the purpose of the role in a way that families can relate to.FSS are responsible for building and maintaining
an ongoing supportive relationship with families enrolled in home visiting services.Sites are welcome use this title or to continue titling
this role in a way that best fits within their organization.Find information about the role of direct service staff on Network Resources.
FIDELITY ASSESSMENT:
A process to affirm model fidelity and support COI activities at sites. HFA National Office staff conduct Fidelity Assessments with new
provisional (not yet accredited)sites and, in very limited situations, as an alternative to a full reaccreditation site visit, including when
conditions are such that site visits cannot be safely conducted.A Fidelity Assessment includes the review of site documentation related to
all Essential and Safety Standards,the development of a Self-Study by the site,and a 6-month response period for sites to demonstrate
improved practice.Sites successfully completing a Fidelity Assessment will have their accreditation expiration date extended for up to 3
years from the date of the Fidelity Assessment.
FIRST HOME VISIT.
The first visit completed by the assigned Family Support Specialist 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.
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FOCUS CHILD:
a Eligibility is determined early for HFA families,ideally during the prenatal period.Healthy Families services are centered on the focus
o 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.
0
u
FOUNDATIONS TRAINING:
o Foundations training 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
5 practice: communication skills: assessing,addressing,and promoting nurturing and sensitive parent-child relationships; creating a
o 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.
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
FROG 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.
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.Learn more about calculating FTE.
GRADUATE:
A Healthy Families participant who has completed the program in its entirety(3 or 5 years as defined by the site).
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HANDS-ON PRACTICE:
Actual utilization of a tool during training or orientation to a new role, which may include role play, videotaping assessments or
portions of home visits,or scoring a videotaped or shadowed FROG Scale.
HOME VISIT:
A face-to-face interaction that occurs between the family and the Family Support Specialist.The goal of the home visit is to promote
nurturing parent-child interaction, support 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.Circumstances may occur where visits take place
outside the home,are of slightly shorter duration than an hour,or occur with the child not present.These may be counted as a home
visit if the overall goals of a home visit and some of the focus areas(listed below)have been addressed.
Also, when engagement challenges are present or special situations such as severe weather, natural disaster or community safety
advisory impedes the ability to conduct an in-person visit with a family,a virtual home visit(via phone or preferably video platform),can
be counted when documented on a home visit record and the goals of a home visit are met,including some of the focus areas(below).
Sites are permitted to count one group meeting per month as a home visit while families are on Level 1 or 1P;however,to do so requires
that a Family Support Specialist be present during the group meeting and that the group meeting be documented on a home visit
note,including some aspects of CHEERS for that particular family (when the group includes parent-child interaction time).The site
may also count one visit per month conducted by a multi-disciplinary team member(if with documentation to demonstrate the staff
person received HFA Foundations for Family Support training and receives supervision consistent with 12-1 and 12-2 standards.The
focus areas 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.
•PCI screening and assessment
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
•health and development screening
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
•family functioning screening and assessment
•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
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IMMUNIZATION SCHEDULE:
Immunization schedules follow different guidelines,depending upon the schedule adopted by the site/multi-site system.The American
o Academy of Pediatrics.the Centers for Disease Control,and most Departments of Public Health at the state level issue immunization
schedules which spell out what immunizations a child should have and at what age.The CDC has an interactive immunization scheduler
of where child's name and birthdate can be entered.and an individualized schedule created for printing. HFA expects its sites site to
o follow one of these generally accepted immunization schedules but does not recommend one schedule over another. However,if the
i= state's schedule is used and it is without specific age requirements for immunizations between birth and 24 months,then the site will
z) want to use the AAP or CDC schedule in order to calculate up-to-date status at 12 and 24 months in accordance with standards 7-2.13
o and C.Additionally,sites should be aware that,in some states,the ability for families to withdraw from immunizations due to personal
beliefs may only be allowable until the child reaches school age,at which time all immunizations are required.Site staff will want to
make parents aware if this is the case.
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. This training is provided online by HFA National Office Staff.
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 relationships;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"'.
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 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.
MEDICAL/HEALTH CARE PROVIDER.
The primary individual,provider,medical group.public or private health agency,or culturally recognized medical professional where
participants can go to receive a full array of health and medical services.
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 from specific partners with informal information about provider relationships from direct service staff.
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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.`The spirit of Motivational Interviewing is a significant part of HFA Advanced Family Support:Facilitating Change training.
MULTI-DISCIPLINARY TEAM MEMBER(S):
An employed or contracted member of the local HFA site providing supplemental support to HFA staff and/or families(e.g.,doulas,
therapists,child development specialists,etc.).When providing services to families,these staff work in conjunction with the assigned
FSS,and therefore are not considered to carry an HFA caseload.If the site chooses to have a visit from a multi-disciplinary team member
count as an HFA home visit,the multi-disciplinary team member must 1)have received HFA Foundations training,2)document the
visit,including CHEERS observations,on an HFA home visit record and 3)receive supervision consistent with HFA standards for direct
service staff.If the site is not counting visits from multi-disciplinary members as an HFA home visit,items 1-3 above are not required.
ONGOING TRAINING:
Supportive and regularly scheduled training provided to staff based upon the specific needs,job responsibilities,and issues of families
within the community served.
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.
PARENT:
When referenced in the HFA Best Practice Standards.parent is inclusive of biological mother and father,as well as parent figures who
have a significant relationship with the focus child.
PARENT GROUP:
HFA sites are encouraged to hold regular parent groups to build informal support systems and reduce social isolation for participant
families.For those families assigned to a weekly level of service,one HFA site-hosted parent group meeting per month may be counted
as a home visit,if it is documented on a home visit record(by someone who has received HFA Foundations for Family Support Core
and at least one goal of a home visit(see home visit definition)is met.
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.
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.
POLICY:
Written statements of principles,procedures,and processes that guide site operation and services which are typically approved by
the governing body,the host agency,or appropriate administrative body.Policy and Procedure Checklist and Sample Policy and
Procedure Template/Guide.
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PRIMARY CAREGIVER:
a HFA embraces a family-centered approach and allows the family to define who the child's family is. The primary caregiver is the
v,
o 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 Family Support Specialist when conducting home visits and observing PCI. In co-parenting or
m multi-generational parenting families,one person will be identified within the system as the primary caregiver.Depression screens are
o only required to be administered with this person.
U
PROCEDURE:
p The step-by-step methods by which policies are expected to be implemented and site operations are to be carried out.Procedures are
clearly outlined in writing within the site's Policy and Procedure manual.
z_
PROGRAM MANAGER:
Each site has a designated Program Manager(PM)that is responsible for the day-to-day,hands-on management of the site,and is involved
in planning,budgeting,staffing,training, quality assurance,and evaluation. PMs are also responsible for ongoing collaboration with
community/state partners,public relations,and maintaining positive working relationships with early childhood partners and providers.
If a site has a supervisor,the PM typically provides supervision to that individual.The PM receives regular supervision according to the
personnel policies of the employing agency and in accordance with the Standards. Depending on the size and resources of the site,
program managers may also provide supervision to direct service staff in a dual role as Supervisor(see Supervisor definition).Find
information about the role of program manager on Network Resources.
PROTECTIVE FACTORS:
•parental resilience
•social connections
•concrete supports in times of need
•knowledge of parenting and child development
•social and emotional competence
Additional information and training can be found online.Learn more.
QUALITY ASSURANCE PLAN:
A plan to monitor and track quality and implementation to model fidelity that includes all aspects of the service delivery system,i.e.,
initial engagement,home visiting,supervision and management.Quality assurance can be monitored via satisfaction surveys,case file
reviews,shadowing,quality assurance phone calls.supervision rates,etc.A sample Quality Assurance Plan is available.
QUALITY IMPROVEMENT PLAN:
A plan that incorporates specific,measurable.attainable,realistic,and time-oriented improvement goals carried out by the entire team
with an intent to test small changes and their impact on process and/or outcomes.Downloaa sample Quality Improvement Plan.
RECENT PRACTICE:
The period of time required to demonstrate consistent practice across all staff of any new policy or procedural changes.Most often this
period of time is a minimum of the three most recent consecutive months.though there may be certain circumstances when additional
time is necessary to illustrate implementation.
RE-ENROLLMENT:
A family that enrolls in HFA services may later choose to discontinue services prior to program completion.This may be due to any
number of situations,such as the family needing time to"warm"to the idea of home visiting,especially when existing stresses and
past history complicate how the parent views the helping profession.Or it may be related to a move out of the service area but then
the family later returns to the area.A parent who is closed to services may decide weeks or months later that they would like to re-
enroll with the existing focus child.When sites have capacity to do so,they are encouraged to accept re-enrollments,and should do
so at the site's discretion.If a site re-enrolls a family,that family will not be counted in the 1-3.13 measurement standard.A family that
discontinues services but requests to re-enter the program with a subsequent focus child is considered a new enrollment.A family that
is enrolled and making progress toward successful completion of the program should not be re-enrolled with a subsequent birth.This
space should be reserved for new families that have not had any opportunity to participate in services.
REFERRAL:
HFA sites are encouraged to provide linkages for families to community resources on an as-needed basis. HFA staff need to be
knowledgeable of resources within their communities and help families connect to these resources.HFA requires a signed consent to
release information on all referrals to external agencies when the staff member is sharing information about the family.Referrals to
services that are housed within the same agency as the HFA site do not require a signed consent.though this is recommended,as is
documentation of these connections to additional services as referrals.
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REFLECTIVE CAPACITY:
The capacity to exercise introspection and the willingness to learn more about the fundamental nature, purpose, and essence of how
humans experience this world and how our own world-view is impacted by that experience.HFA staff with reflective capacity are able to
consider multiple points of view,have awareness of their own biases and feelings,can tolerate ambiguity and are able to recognize their own
dysregulation.It is important for hiring organizations to think about an applicant's reflective capacity during the recruitment and screening
process.Reflective Capacity questions may be useful at this stage.
REFLECTIVE CONSULTATION GROUPS:
Sessions generally last 1.S-2 or more hours and are conducted by an individual with advanced training or credential in the area of
reflective practice and professional group facilitation.Reflective consultation groups include but are not limited to:
• case presentation
• focus on holding the space that encourages self-reflection and self-regulation,both physically and emotionally
• observation of the staff member's internal responses to the work including parallels between what might be going on for the
worker as well as how that might impact the work
• focus on the parallel process:expanding what might be going on for the staff to what might the family and the baby might
be experiencing
• considering what the supervisor might do differently for the next supervision,developing a plan with direct service staff for
work going forward
• opportunities for participants in the group to reflect on the group session they just observed.
REFLECTIVE STRATEGIES:
The HFA Reflective Strategies are specifically designed intervention tools that create an environment of increased self-awareness and self-
efficacy sustained within healthy helping relationships.The reflective strategies are in alignment with the trauma-informed approach and
utilized by all HFA staff regardless of role.Each strategy has a unique purpose as follows:
• Mindful Self-Regulation encourages self-awareness and promotes self-regulatory,self-care practices.
• Accentuate the Positive builds self-esteem and confidence by promoting specific skills and strengths along with the impacts
and benefits of the identified skills and strengths.
• Strategic Accentuate the Positive increases the frequency of healthy,safe.and nurturing behaviors that also builds self-esteem
and confidence.
• Feel.Name.&Tame supports a persons'capacity to recognize and regulate their feelings.
• Explore&Wonder builds awareness,empathy,and sensitive responses to missed cues and the feelings of others.
• Problem Talk encourages creative thinking and problem solving by clarifying and learning more about a concern,problem,or situation.
• Normalizing addresses concerns related to dangerous or harmful beliefs, behaviors,and practices while offering alternative
healthy and safe options for consideration and further exploration.
The HFA Foundations for Family Support Core and Supervisor Core training include detailed descriptions,discussions,examples,handouts,
and practice opportunities on all the HFA Reflective Strategies.
REFUSED SERVICES:
A family that is determined to be eligible for services, is offered services.and declines participation in services(either verbally or in
writing).Or a family who has been enrolled.and for whatever reason declines further participation.
RESEARCH:
A systematic examination of information to answer a question and advance knowledge and any activity,including program evaluation
and/or quality improvement activities,(i)that would,according to Federal regulations,require review by an Institutional Review Board,
or(ii)that could be expected to yield generalizable knowledge that could be shared publicly with the professional,academic and/or
lay communities. Evaluation can be a type of research if the knowledge to be gained is applicable to and will be applied beyond the
immediate participants and context of the study. Evaluation solely for purposes of quality assurance or quality improvement is not
considered Research.
SAFER SLEEP:
HFA sites share information with families about infant sleep to reduce the risk of sleep related infant death. Sites provide information
about evidence-based safe sleep practices and engage in conversations with families related to things that parents and caregivers
can do to keep babies safe. For families whose choices around infant sleep may include co-sleeping or other culturally specific sleep
practices. HFA staff may choose to take a harm reduction approach and share information with families about how to increase the
safety of these practices.
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SELF-STUDY:
The self-study is the site's opportunity to demonstrate implementation of the HFA Best Practice Standards and is the compilation of
`^ all of the policy requirements and the pre-site evidence requirements outlined in the Tables of Documentation(described below).The
0
0 self-study serves as both a process and a product.Sites are encouraged to initiate improvement strategies(with HFA National Office
-a Technical Assistance support as needed)whenever areas for improvement are identified during the compilation of the self-study.
z
0
SERVICE PLAN:
z) HFA requires sites to develop a Service Plan for each family. The Service Plan is a Supervisor's tool that brings collaboration and
0 intentionality to the forefront of our work.A well-constructed Service Plan is the cornerstone of services that are effectively organized,
ix
coordinated,and based on each family's unique strengths and areas of concerns.A Service Plan operationalizes the family story into
a road map that supports Family Support Specialists in their ongoing and long-term work with the family and is the mechanism by
which Supervisors document their clinical support to staff that is specific to each family.
Sites may adapt or develop their own Service Plan document if it meets the expectation of the 6-1 standard.The HFA National Office
is happy to review and advise on any modified forms.Download HFA Service Plan Materials.
SERVICE POPULATION:
The individuals currently enrolled and receiving services.
SERVICES:
When referenced in the Standards, services include the activities offered to families by Healthy Families direct service staff at
enrollment and during home visits and does not include Healthy Families service enhancements(e.g.,groups,augmented support
from clinicians,or other programs housed at the agency).
S;IT'
The term used to describe an HFA affiliate.Additional information about defining an HFA Site can be found in HFA Site Definition documents.
STAFF DEVELOPMENT PLAN:
All staff bring professional experience and education to the job. Training and self-study are added to broaden the knowledge
base and expertise.Each staff member has strengths to build on 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.When experiential gaps exist at the time of hire,the staff member and supervisor
develop a plan to support staff development and the acquisition of new knowledge and experience.
Download Sample Staff Development Plan for Program Managers,Supervisors,and Direct Service Staff,
SUPERVISION 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,supervision of staff using the FROG Scale,sample tools and forms to
use for continuous quality improvement.etc.The trainer is certified by the HFA National Office.
SUPERVISOR:
Supervisors provide weekly individualized supervision to the direct service staff within a Healthy Families site.The supervisor ensures
quality of service provision.The supervisor protects the integrity of the program and demonstrates respect for the parallel process
by supporting,guiding,and building on the strengths of staff so that they may best support,guide.and build on the strengths of the
families served.Find nformat on about the role of supervisor on Network Resou ces.
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TRANSFER FAMILIES:
When families move from one location to another,HFA encourages sites to ask families if they would be interested in continuing with HFA
home visiting services in their new location. The HFA website has a Site Finder feature that sites can use to locate an HFA site close to
where the family is relocating and to determine if the site can provide services for this transitioning family.In addition,new HFA affiliates
who are transitioning from a previous home visiting model to HFA will transfer families from previous services to HFA when possible.
When families transfer from one HFA site to a new HFA site.we recommend the Family Support Specialist at the original site review
with the family what information would be helpful to share with the new site so that families can make an informed decision about
their consent to share this information.For continuity of service,the new site my find the following information helpful:
•Initial FROG scale
•Current Service Plan(including documentation of any additional concerns identified by the site over the course of services,
including potential developmental delays,parental depression or concerns related to the parent-child relationship)
•Current Family Goal
•Family Transition Plan(if developed by the original site ahead of the close of services)
•Current family Level of Service
•Signed release of information from the family
Sites must follow all HFA policies related to informed consent when transferring families.Families transferred into an HFA site should
be tracked in the same way as other referrals and included in acceptance and retention data tracking.
If the initial FROG scale completed with the family at the original site has not been shared with the new HFA site,the new FSS should
complete the FROG scale early in services with transfer families to begin the process of learning more about their strengths and
opportunities for growth.
Families transferring into an HFA site will be offered weekly visits at the onset of services,until progress criteria is met for moving to
less frequent visits. While families may have been receiving less frequent visits at their previous site,all families benefit from increased
frequency of initial visits after a transfer.allowing for staff and families to learn more about each other and to begin the process of
trust-building. The life transitions and circumstances related to a move to a new community may have created additional stress in the
family and weekly visits ensure families receive adequate support during this time. Sites will assess the progress of transfer families
using HFA Level Change forms and will reduce frequency of visits as progress criteria are met.
Transfer families are included in HFA data collection,though they may be excluded from some calculations.
•Sites do not have to include transfer families in the calculation of families'receipt of the initial home visit before three months
of age.(1-3.13)
•Transfer families are exempt from the requirement to be offered three years of service from the date of enrollment,but sites
should plan to serve transfer families until the focus child reaches three years of age at a minimum. (4-3.13)
• For standards related to completion of screening tools with children and families, (6-3.D,6-5.13,6-5.C,) sites should note
transfer status of families in data reporting in cases where the timing of the transfer to the new HFA site precludes the ability
of the site to complete screenings as described in the standards.This information can be used for contextual decision-making
by peer reviewers or the Panel.
•Sites will follow their policies related to depression screening,administering screens to primary caregivers within 3 months
of enrollment.including transfer families-
TRAUMA-INFORMED:
One component of the HFA Advantage is HFA's trauma-informed approach. Being trauma-informed requires an awareness of the
impact that trauma has had on the lives of families.an awareness of behaviors and responses that might trigger re-traumatization,
and an openness to understanding how current behaviors are often adaptations to past abuses. Trauma-informed support includes
ensuring safety.emphasizing autonomy and a collaborative strength-based approach. The trauma-informed approach applies to all
families,and across the parallel process to include site staff,and does not rely on specific knowledge of anyone's trauma experiences
or require disclosure on the part of any individuals. Because trauma is a common experience, being trauma-informed does not
mean that we treat certain individuals differently based on their trauma history,but instead we provide trauma-informed support to
everyone. HFA sites and systems build successful working relationships with all families and staff that provide safety.predictability,
comfort and joy and result in improved outcomes for all families.
VOLUNTARY:
This term is used to differentiate between activities in which an individual chooses to participate(i.e..voluntary)and activities in which
an individual is required,without choice,to participate(i.e.,mandatory).
37
WAITLIST:
a When a local site is at capacity and unable to offer services to new families,the site may be inclined to put the family on a wait list.
o HFA discourages this practice,given that wait-listing a family gives the family false hope that they may soon access HFA services
when this may not be possible.More concerning is that particularly vulnerable families should be connected to alternative resources
�a in the community before existing risks become further amplified.This may also pose increased liability to the site if something were
Z to happen to the family while on a wait list.
0
COMMON TERMS ASSOCIATED WITH ACCEPTANCE&RETENTION RATES AND STANDARDS REQUIRING AN
o ANALYSIS(1-4.A&B and 3-4.A&B):
HFA ACCEPTANCE RATE:
The methodology for tracking the percentage of families who accept HFA home visiting services during a particular time period.
Many factors may impact the acceptance rate.For example,numerous HFA sites have found that the narrower the window of time
between initial referral to HFA and the offer of services,the higher the acceptance rate.
To ensure uniformity in measurement,HFA requires sites to track the acceptance rate of families based on the receipt of the first
home visit(behavioral acceptance).regardless of how a site may define its enrollment date.
Measuring Acceptance Rates:
HFA methodology for calculating a site's acceptance rate is:
1. Count the total number of potential families who, during a specified time period, were offered services after being
determined eligible at the time of the initial screen/assessment(whichever is used to determine eligibility).This number will
be your denominator.
2. Of the families who were offered services within that specified period of time.count how many completed a first home visit.
This is your numerator.
3. Divide the number of those who had a first home visit by those who were offered services.
The HFA National Office has a spreadsheet available that will calculate acceptance rates using HFA methodology.
HFA RETENTION RATE:
HFA methodology requires that sites measure the percent of families who remain in the site over specified periods of time
(6 months,12 months,24 months,36 months,etc.)after receiving a first home visit.
Measuring Retention Rates:
HFA methodology for calculating a site's retention rate is:
1. Select a specified time period,e.g..January 1,2019,to December 31,2019(can be a calendar year or fiscal year).
2. Count the number of families who received a first home visit during this time period.
3. Count the number of families in this group that remained in services over specified periods of time(six months,12 months,
two years or more,etc.).
4. Divide this number by the total number of families defined in step 2(that received a first home visit during the time period).
5. For accuracy,a time period must be selected that ended at least one year ago for one year retention rate,two years ago for
two-year retention rate,three years ago for three-year retention rate,and so on.This is to ensure that all families beginning
services during the specified time period have had the opportunity to stay for the full retention period being measured. For
example,a family enrolled in December 2019 could not be counted as retained for one year until December 2020.
The HFA National Office has a spreadsheet available that will calculate retention rates using HFA methodology.
NOTE To ensure uniformity in measurement of retention rates,HFA requires that retention calculations use first and last
home visit dates,even if sites define enrollment and termination differently. As described above,the first home visit is
defined as the first visit from a Family Support Specialist that is completed and documented subsequent to the offer of
HFA services.The last home visit applies only to families that have been closed to services.It is defined as the most recent
date that a Family Support Specialist completed and documented a home visit with the family prior to closure(regardless
of level at that time).Families that are still considered"active"or"open"will not have a last home visit reflected until they
have been closed.The retention rate is impacted by the way sites measure from the beginning to the end of services.For
example,if retention is measured from initial screening/assessment date to termination date,retention will calculate lower
than it does for sites that define acceptance later in the recruitment process(e.g.,first home visit). Also,at the end of
services,the termination date is often assigned after a period of creative outreach,which artificially extends the period of
time a family was considered to be receiving home visiting services.
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ANALYSIS:
A detailed study and reporting of site patterns and trends.For the purposes of analyzing HFA Acceptance Rates,sites will compare
the families who accepted services(received first home visit)to those who refused(never received first home visit).HFA Retention
Rates measure families who stayed in services(enrolled)compared to those who dropped out(terminated)of services.An analysis
must include:
1. data(both numbers and percentages)that depicts analysis factors selected.along with reasons why families refuse/
drop-out of service
2. a narrative that reflects anecdotal findings from discussions with staff in team meetings,supervision sessions,advisory
board conversations,etc.
3. a narrative summary of the data that illustrates the patterns and trends,or in some cases the absence of patterns or trends,
among families(patterns and trends are determined by comparing data across opposing groups,e.g.,those who accept
compared to those who do not or families that stay compared to those that leave over the same periods of time)
Below you will find suggestions of factors to use with regard to Acceptance and Retention analyses;however,sites may consider
utilizing certain criteria for other analyses.
Please note:Not all factors listed below are required to be analyzed,however sites should review as many as possible in order to
isolate those that may be impacting acceptance and retention rates most.
Sites are strongly encouraged to choose factors that will allow them to uncover potential equity issues related to acceptance and
retention in the program. In addition, the inclusion of at least one factor related to how the program operates allows the site to
learn more about how adjustments to policies and practices may improve family experiences.
PROGRAMMATIC FACTORS:
General site-related factors that impact service planning and delivery.Below are some suggested factors that sites may consider using
in the analysis.For ease with programmatic factors,they have been separated out with regards to acceptance and retention analyses.
Programmatic Factors to consider for Acceptance Analysis
•relationships with partner agencies or other community providers
•referral sources
•staffing issues(patterns&trends among direct service staff)
•number of days between referral and assessment
•screening or assessment timeframe(e.g.,prenatal,at birth within two weeks,more than two weeks)
•if a re-enrolled or transferred family
•training of staff
Programmatic Factors to consider for Retention Analysis
•enrollment timeframe(e.g.,enrolled prenatally,at birth,or at a later period)
•if a re-enrolled of transfer family
•staffing issues(patterns and trends among direct service staff--depending on site size,staffing trends can be evaluated by
individual,by team.and by satellite
•current service level
•length of time in services
•age of focus child(ren)at enrollment
•how policies impact what happens with families and site outcomes
•relationships with partner agencies or other community providers
•training of staff
39
PARENT AND FAMILY FACTORS:
•gender identity
•age
•raceðnicity
•marital status
•education level(last grade completed)
•primary language
•sexual orientation
•employment Status(not employed,employed part-time,full-time,or seasonally)
•socioeconomic status
•location:urban,suburban,rural
•families experiencing systematic oppression
•city/zip code
•FROG Scale score
• work or school issues (barriers to engaging or retaining due to HS or college schedule,work hours,significant commute,
works night shift,etc.)
•family or friend support
•teen parent(s)living independently or with parents
•grandparents raising focus child
•linkages to other community resources
•religious affiliation
•domestic/family violence
•families with disabled parents or children
•families impacted by substance use
•families impacted by mental health
•families impacted by violence or over-policing
INFORMATION USED IN ANALYSES:
Sites are required to consider formal data and other information related to analysis factors to identify patterns or trends in
family acceptance or retention. Formal data refers to information that can be numerically recorded, often regarded as "hard
data,"or quantitative data.Factors related to program processes and activities,and factors related to family or individual parent
characteristics can all be reported as formal data using both numbers and percentages.Anecdotal information,often regarded as
qualitative data.gathered from site staff,advisory board members and parents related to the analysis factors helps complete the
story of what is impacting family acceptance or retention.Anecdotal information may be collected in staff meetings, individual
supervision,parent focus groups or community advisory board meetings.
REASONS WHY:
Staff will attempt to determine the reasons why a family did not want to accept services or dropped out of services prior to completion.
At times the specific details may not be available(e.g..a family said yes to the initial offer,yet never received a first home visit or a family
was on creative outreach and is eventually closed).In these instances,staff may draw upon anecdotal assumptions about the reasons
why.Sites will summarize reasons why in their narrative and utilize this information when planning to improve acceptance or retention.
COMPREHENSIVE ANALYSIS:
A comprehensive analysis is a thoughtful and intentional selection and examination of key programmatic, and Parent and Family
factors that includes a combination of raw(numeric)and aggregate(percentage)formal data as well as informal(anecdotal)data,
and how various factors may relate to and influence other factors.A comprehensive analysis also includes a narrative that summarizes
the findings,including any patterns or trends.Data and conclusions from the analysis are used to develop and apply strategies aimed
at improving site services in the site's Comprehensive Quality Improvement Plan.
40
Tables of Documentation
Summary Of
LL
• Guidance for • •
W
E
The Tables of Documentation provide a complete list of data requirements in the HFA Best Practice Standards(BPS). Also included is a
Z column with recommended timeframes for ongoing mondonng and adherence to the standards,as it is helpful to have routine monitoring,
0
;__ measurement,and documentation of these activities support your site's Quality Assurance Plan(GA-2.A). These recommended timeframes
,U� may also be helpful as you develop and follow-up on your site's Quality Improvement Plan(Standard GA-2.6). When a site finds that any of
these QA activities are following below expectations stated in the standards the site is also encouraged to include these items on their site
0 Quality Improvement Plan for ongoing monitoring and improvement_
U
a
a Measuring/Monitoring/Reporting Tiniteftannes
0
a -Annual-Site selects the most recent 12 months,most recent calendar year,or most recent fiscal year
0
-Quarterly-Site selects the most recent three months,or most recent full quarter(Jan-Mar,Apr-Jun,Jul-Sept.Oct-Dec)
w
U
Z What to report for
How to Measure Accreditatiori Ongoing OA
< Required Please Note:HFA Spreadsheets
Standard Timeframe (see also Tables of Recommendations
O_
are available
7
l7 Documentation by Standard)
0 Submit report reflecting all families referred to your site
> in the most recent quarter.
1-1.0
f Tracking 1.Number of families referred by each referral source HFA Spreadsheet or local
Referrals and Quarterly 2.Then eligibility status data report and strategies. Update Monthly
`n Site Capacity Include most recent plan with strategies to fill available
slots or reduce gaps in service availability. Indicate
which have been applied.
Submit a narrative about how the site monitors its initial
engagement process and activities reflecting all families
1-2 B referred in the most recent year.A data report may be Update Quarterly
submitted in combination with a narrative regarding or more frequently,
Initial HFA Spreadsheet or local
Annual engagement activities-HFA's spreadsheet includes: depending on
Engagement data report and strategies. number of referrals
Process 1.The length of time from referral to initial contact
2.The length of time from initial contact to offer of services received
3.Whether able to establish initial contact or not
-
4.Whether services were offered or not.
Reasons why if services not offered.
Submit a report reflecting all families who received a first
home visit in the most recent year.
1.Count number with a first home visit
2.Count number with first home visit either prenatally HFA Spreadsheet or local
or within 3 months of birth data report.
3.Calculate:#2(number with first home visit prenatally
or within 3 months)divided by#1(number who had a This is a threshold standard,
1-3.1121 first home visit) meaning to be in adherence
Initial For sites enrolling families through Child Welfare a minimum threshold has
Engagement Annual Protocols(CWP).remove CWP families from the been established(80%in Update Monthly
Process calculation above to calculate CWP families separately, this case).When the site's
1.Count CWP number with a first home visit annual data in the self-study
2.Count CWP number with first home visit within falls below this threshold,
24 months of birth Peer Reviewers or Panel will
3.Calculate:2.(number with first home visit within 24 request more recent data.
months)divided by 1.(number with a first home visit)
Sites will include the signed MOU with CWP partners in
then accreditation self-study.
41
Tables of Documentation
Summary • Guidance for • •
How to Measure What to report for
Standard Required Please Note:HFA Spreadsheets Accreditation Ongoing QA
Timetrarne (see also Tables of Recommendations
are ava4lable Documentation by Standard)
Submit a narrative describing the site's definition of
acceptance rate and method for calculation(unless
using HFA spreadsheet)and the current acceptance rate
for all families offered services in the most recent year. HFA Spreadsheet or
1-4.A Also describe the site's process(how and when) Acceptance Rate and
acceptance rate is reviewed or reference the site's Update Every
Measure Annual current QA Plan if the site has included a review of its description of methodology. Six Months
Acceptance acceptance rate there. if not us HFA
spreadsheets.
1.Count number offered HFA home visiting services
2.Count number with a first home visit
3.Calculate:#2(number with a first home visit)
divided by#1(number offered services).
Analyze the data from all families who were offered
services during at least the most recent year. Analyze
both formally and informally:
1.Families who refused services in comparison to
families who accept services. HFA Spreaasheet or
2.Includes at least one analysis factor Acceptance Analysis for at
3.The reasons why families decline. least one cohort year.
For smaller sites with less than SO families offered
1-4.8 services over a two-year period,the site is required at For sites not required to
Acceptance Every other a minimum to submit a narrative including: complete Acceptance Update Annually
Analysis year 1.The number of families offered services within the Analysis,submit a narrative
two-year period. defining reason for
2.Informal data about families who refuse services or exemption.
accepts services Please see glossary for
3.Reasons why families are not accepting services more information on
If at least ninety percent(90%)of families offered analysis.
services over a two-year timeframe accepted services
by receiving a first home visit,an analysis is not
required.New sites not yet in operation for two full
years with an acceptance rate of 90%during the first
year are also exempt from completing an analysis.
42
Ln
F Tables of Documentation
Summary a
• Guidance for • •
to Measure What to report for
Required How
F
Z Standard Please Note:HFA Spreadsheets Accreditation Ongoing GA
O are avaiLable Documentation by Standard)
r
w Submit the site's definition of farruly retention and
method for calculating(unless using HFA spreadsheet)
O and retention calculation for families enrolled within at
U
< least one cohort year.
O HFA methodology for calculating a site's retention rate is:
p L Select a specified time frame(i.e.,January 1,2020 to
December 31,2020). This can be a 12-month penod.a
U calendar year,or fiscal year.
Z 2.Count the number of families who received a first
a
o home visit during this time frame.
3.Count the number of families in this group who
LL remained in services at specified intervals(i.e.,the
0 number from this group remaining in services 6
cc months or longer,12 months or longer,two years or
a more,etc.):
f 4.Divide#3(totals remaining for 6 months.12 months,
HFA Spreadsheet
3-4.A or Retention Rate and
v, etc.)by the number of families in #2(that Update Every
Measure Annual received a first home visit during the time frame. description of methodology. Six Months
Retention 5.When selecting a time frame,it helps keep in mind if not using HFA
the last day of your time frame will determine which spreadsheets.
Intervals you can measure. A family who might have
enrolled on the last day of that time frame could only
be counted as retained or not for 6 months if at least
6 months have passed since they enrolled.
Example: I have selected 1/1/2020-12/31/2020 and
today is 11112022.so any family that might have
enrolled on the last day of that year has had the
opportunity to be in the program for lyear and 1
day. For all the families who enrolled during that
year.I can measure how many were still enrolled at
the 6-month interval and the 12-month interval. I
can't measure the 2-year interval yet because not
all families who enrolled in that year(specifically,a
family that might have enrolled on the last day)have
had the opportunity to make it to the 2-year mark.
For all families who enrolled within at least one
cohort year.analyze both formally(numbers and
percentages)and informally(anecdotal information
from staff and advisory members)
HFA Spreadsheet or
1.Families who remain in services in comparison to Retention Analysis for at
families who leave. least one cohort year.
2.Includes at least one analysis factor
3.The reason why families leave.
3-4.B For sites with less than 50 enrolled families at any one For sites not required
Every other time over a two-year period,submit a narrative including: to complete Retention
Retention year p Update Annually
Analysis 1.The maximum number of families that were Analysis,submit a narrative
enrolled at any one time. describing the reason for
2.Informal data about families who leave service or are retained exemption.
3.Reasons why families are leaving services
Please see glossary for
If at least ninety percent(90%)of families enrolled more information on
in services over a two-year timeframe remained in analysis.
services,an analysis is not required.New sites not yet
in operation for two full years with a retention rate
of 90%during the first year are also exempt from
completing an analysis.
43
Tables of Documentation
Summary • Guidance for • •
Now to Measure What to report for
Standard Required Please Note:HFA Spreadsheets Accreditation Ongoing GA
Timoftame (see also Tables of Recommendations 11111111
are available Documentation by Standard)
HFA Spreadsheet or local
Home Visit completion
Submit home visit completion report for the most reports by FSS and rolled-
recent quarter which includes: up by site for the most
All active families by FSS including level of service,level recent quarter
changes that quarter,number of expected home visits
that quarter and number of completed home visits that Note:The overall site level
quarter.To calculate home visit completion: HVC is determined by
1.Determine for each family over the course of a quarter taking the total number of
the expected number of home visits(based on level of families who completed at
service alone). least 75%of the expected
home visits based on their
2.Count the number of completed visits(while family level of service.divided by
is on active service level)for each family during the the total number of families
4-2.B Home Visit Quarterly quarter. on active caseloads for the Update
3.For each family calculate:#2(completed visits) site(exclude families who Quarterly
Completion divided by#1(expected visits). were on creative outreach
4.Count the total number of active families. the entire quarter).It is NOT
calculated by averaging the
5.Subtract from#4(total active families)the number HVC for all FSSs.
of families who were on creative outreach for the entire
quarter.
6.Count the number of active families who received at This is a threshold standard.
least 75%of expected home visits. meaning to be in adherence
a minimum threshold has
7.Program HVC rate is calculated by taking#6(number been established(75%in
of active families who received at least 75%of visits) this case).When the site's
divided by#5(active families-minus CO entire annual data in the self-study
quarter). falls below this threshold,
Peer Reviewers or Panel will
request more recent data.
Report indicating current
4-3.B number of families who have
Services been enrolled for 3 or more
minimum Annual Local data. years.If families graduate Update Annually
of three after three years of service,
years provide a report indicating all
families who have graduated
within the last yea,.
Submit a narrative summary
of most recent efforts to
5-4.A obtain meaningful feedback
Staff& from parents/caregivers
Family Every Year Narrative Summary and staff(current and Update Annually
Input former).Include a summary
of findings:summarize
patterns and trends.
strengths and challenges.
Please submit the most
5-4.B
recent site equity plan.
Equity Plan Every Year Submit site's Equity Plan Please note:Sample of Update Annually
Essential organizational self-
Standard assessments available
44
fTables of Documentation
a
lL
Summary • Guidance for • •
W
f
Required How to Measure What to report for Accreditation Ongoing CIA
Z Standard Timirfraine Please Note:HFA Spreadsheets (see also Tables of Recommendations
O
are available Documentation by Standard)
w HFA Spreadsheet or CHEERS
Submit a report of all enrolled focus children Check-In tracking report
O (including multiples)that includes:
This is a threshold standard.
1.Child's date of birth meaning to be in adherence
0 6-3.D 2.CCI administration dates a minimum threshold has
a CHEERS Annual 3.Documentation of declined screening been established(90%in Update Annually
O Check-In by primary caregiver
W this case).When the site's
u Provide a summary of the total focus children annual data in the self-study
z (number and percent)who received the required falls below this threshold,
o screens divided by the total number of focus children. Peer Reviewers or Panel will
Z) request more recent data.
W Submit a report of all enrolled focus children
O that includes:
a 1.Child's date of birth HFA Spreadsheet or ASO-3
2.Enrollment date
Tracking Report including
3.ASO-3 administration dates explanation of any missed
`n 4_Documentation of screens.
a.Indication of delay and if a referral was made This is a threshold standard.
b.Not screened due to involvement of early
Ongoing-All intervention services meaning to be in adherence
6-S.B ASO Active Focus c.Revised screening schedule(prematurity minimum threshold hasty been established(90%in Update Monthly
Children or other reason)
Development this case).When the site's
d.If the timing of re-enrolling,transferring into
Screening services,or Child Welfare Protocol enrollment annual data in the self-study
precludes availability of 2 remaining intervals in
falls below this threshold.
a given year for contextual deosion-making by Peer Reviewers or Panel will
Peer Reviewers or Panel. request more recent data.
Provide a summary of the total focus children(number
and percent)who received the required screens divided
by the total number of focus children.
HFA Spreadsheet or
Submit a report of all enrolled focus children that ASO-SE-2 Tracking Report
includes: including explanation of any
1.Child's date of birth missed screens.
6-S.0 2.Enrollment date
This is a threshold standard.
ASO:SE
Ongoing-All 3.ASO:SE administration dates since 1/1/2018 meaning to be in adherence
Social Active Focus 4.Documentation of a minimum threshold has Update Monthly
Emotional Children a.Indication of delay been established(90%in
Screening b.Not screened when developmentally inappropriate this case).When the site's
Provide a summary of the total focus children annual data in the self-study
(number and percent)who received the required falls below this threshold.
screens divided by the total number of focus children. Peer Reviewers or Panel will
request more recent data.
HFA Spreadst:eet or report
detailing all active focus children
and their current medical/health
care provider.including percent of
Submit a report reflecting: children with a provider.
7-1.B Ongoing-All 1.List and count all active focus children This isa threshold standard,
Medical/ 2.List and count all active focus children w/medical meaning to be in adherence a
Active Focus Update Monthly
Health Care Children provider,include provider minimum threshold has been Provider Calculate:#2(focus children w/medical provider) established(80%in this case).
divided by#1(total number of focus children) When the site's annual data in
the self-study falls below this
threshold,Peer Reviewers or Panel
will request more recent data.
45
Tables of Documentation
Summary • Guidance for • •
What to report for
How to Measure Accreditation ongoing GA
Standard Required Please Note:HFA Spreadsheets
Timetrarne are available (see also Tables of Recs
Documentation by Standard)
Please submit the site's immunization schedule.
Also submit a report reflecting immunization rates for all enrolled
focus children ages 12-23 months(including those on Creative
Outreach). HFA Spreadsheetor
1.Count number of focus children currently between 12-23 months local data report and site's
immun¢atpn schedde,h[hxling
2.Subtract from#1(focus children between 12-23 months)those immunization rate.
who are excused from receiving immunizations according to
7-2.B Ongoing- allowable reasons in BPS This is a threshold standard.
Measure All Active 3.Of these children(determined in step#2),count how many are meaning to be in adherence a Update
Immunization Focus fully up to date with all immunizations expected through 6 months mnimum threshold has been Every
Rates at 1 yr Children 4.Report number and calculate:#3(those up to date)divided by#2 established(80%in this case). 6 Months
(number between 12-23 months minus those excluded from count) When the site's annual data in
the self-study falls below this
Children served through CWP who are enrolled between 6-12 months threshold.Peer Reviewers or
of age may be excluded from the Standard 7-2.13 measurement if not Panel will request more recent
up to date with immunizations at one year of age. data.
Children served through CWP who are enrolled before 6 months of
age will be included in all immunization data cohorts as described
in the standard(see Standard 7-2).
Submit a report reflecting immunization rates for all active focus
children 24 months and older(including those on creative outreach).
1.Count number of focus children currently older than 24 months HFA Spreadsheet or
2.Subtract from#1(focus children 24 months and older)those local data report,including
who are excused from receiving immunizations according to immunization rate.
allowable reasons in BPS
3.Of these children(determined in step#2),count how many are This is a threshold standard,
7-2.0 Ongoing- fully up to date with all immunizations expected through 18 months meaning to be in adherence
Measure All Active 4.Report number and calculate:#3(those up to date)divided by a minimum threshold has Update
Immunization Focus #2(number 24 months and older minus those excluded from count) been established(80%in Every
Rates at 2yr Children this case).When the site's 6 Months
Children served through CWP who are enrolled between 18-24 months annual data in the self-study
of age may be excluded from the Standard 7-C.B measurement if not falls below this threshold,
up to date with immunizations at two years of age. Peer Reviewers or Panel will
request more recent data.
Children served through CWP who are enrolled before 6 months of
age will be included in all immunization data cohorts as described
in the standard(see Standard 7-2).'Sites will include the signed
MOU with CWP partners in their accreditation self-study-
Submit a report of all current primary caregivers enrolled
prenatally in the past 12 months.Include: HFA Spreadsheet or
local data report,including
1.enrollment date
7-4.B 2.date of birth of focus child percent screened prenatally.
Prenatal Ongoing- This is a threshold standard,
9 9- 3.Prenatal screening date(s)
Screening All Active 4.Provide an explanation of any missed screens meaning to be in adherence Update
Primary Care Focus To calculate percent screened prenatally: a minimum threshold has Monthly
Giver for Families been established(80%in
Depression 1.Count number enrolled prenatally this case).When the site's
2.Count number screened prenatally annual data in the self-study
Divide#3(screened prenatally)by 42 falls below this threshold,
(enrolled prenatally). Peer Reviewers or Panel will
request more recent data.
46
Tables of Documentation
Summary a
LL
• Guidance for • •
W
Required Please Note:HFA Spreadsheets (see also Tables of Ongoing GAHow to Measure What to report for Accreditation
Z Standard Tirnotrame Recommendations
Q are available Documentation by Standard)
H
w Submit a report of all current primary caregivers
enrolled in the past 12 months.Include:
0
U 1.Enrollment date
a 2.Date of birth of focus child
0 3.Postnatal screening date(s)
rr 4.Provide an explanation of any missed screens
0
To calculate percent of primary caregivers screened HFA Spreadsheet or local
v within 3 months: data report,including
a 1.Count number enrolled percent of primary
caregivers screened within 3
2.Count number screened
0 7-4.0 a.For prenatal enrollments,count if received within months and within 6 months-
0 Postnatal Ongoing- 3 months of the child's birth This is a threshold standard,
>_ Screening All Active b.For postnatal ervollments.count ifreceived within meaning to be in adherence Update Monthly
Primary Care Families 3 months of enrollment a minimum threshold has
F Giver for c.Add these counts together(a f b) been established(80%in
Z) Depression 3.Divide#2(screened)by#1(enrolled)for percent screened this case).When the site's
`n annual data in the self-study
To calculate percent of primary caregivers screened
within 6 months: falls below this threshold,
Peer Reviewers or Panel will
1.Count number enrolled request more recent data.
2.Count number screened:
a.For prenatal enrollments,count if received within
6 months of the child's birth
b.For postnatal enrollments.count if received within
6 months of enrollment
c.Add these counts together(a«b).
3.Divide#2(screened)by#1(enrolled)for percent screened
Submit a report of all current primary caregivers HFA Spreadsheet or
with a subsequent birth in the most recent 12 local data report,including
months.Include: percent of subsequent births
1.date of birth of subsequent child screened within 3 months.
7-4.D 2.Postnatal screening dates) This is a threshold standard.
Subsequent Ongoing- 3.Provide an explanation of any missed screens meaning to be in adherence
Birth All Active a minimum threshold has
Depression Families To calculate percent of primary caregivers screened:
Screen 1.Count number who had a subsequent birth been established(80%in
2.Count number screened within 3 months of the this case).When the site's
subsequent birth annual data in the self-study
3.Divide#2(screened)by#1(number with a
falls below this threshold.
subsequent birth)for percent screened Peer Reviewers or Panel will
request more recent data.
8-1.13 Ongoing- Report indicating the active caseload for all current FSS
Caseload All Active over the past 12 months.Include each FSS's full time HFA Spreadsheet or Update Monthly
monitoring Families equivalency,the number of families assigned to them, local data report.
and the level/intensity of service each family is receiving.
47
Tables of Documentation
Summary • Guidance for • •
How to Measure fhat to repoct for Accretillitation Ongoing QA
Standard Timetram%W Note:HFA Spreadsht (see also Tables ot Recommendations
are available Documentation by Standard)
Submit:
1.For staff retention Include staff(by position title) Narrative reflecting
who left during the timeframe(12 months for new factors associated with
sites,24 months for all others),their hire date, staff turnover along with
termination date,reason why they left:and any other satisfaction feedback from
9-4. pertinent characteristics. existing HFA staff utilized
Staff 2.For staff satisfaction include a summary of staff to develop staff retention
Satisfaction Every satisfaction input in regard to work conditions that strategies.improve Update Annually
and other year diversity and inclusion.and
contribute both negatively and positively to lob
Retention satisfaction(typically aggregated survey results)for promote equity.Include
those currently employed with the HFA site.Agency- which strategies have been
wide staff satisfaction surveys,if used,must be implemented.
filtered and reported for HFA staff only. Please note:Sample
Include strategies developed for staff retention based on Surveys available
what was learned from retention and satisfaction data.
Training Logs indicate the date of hire and
the date staff person began providing direct
10-2. Ongoing- service or supervision,along with the date each HFA Training Loa or local
Orientation All Current staff person(direct service staff,supervisors, training report. Update Monthly
Training Staff and program managers)completed each of
the orientation topics(10-2.A-H). Also include
the date the program manager's supervisor
completed 10-2.A.
10-3. Ongoing- Training Logs including hire date and date of all
Stop-Gap All Current training topics received for all current HFA staff HFA Training Loa or local Update Monthly
Training Staff (direct service staff,supervisors.and program training report.
managers).
10-4. Training Logs including hire date and date of all
HFA Core Ongoing- training topics received for all current HFA staff HFA Trairirn Loa or local
Training All Current Update Monthly
FS58t111is1 Staff (direct service staff,supervisors.and program training report.
StuWards managers).
10-5. Ongoing- Training Logs including hire date and date of all HFA Training Log or local
Implementation All Current training topics received for program manager. training report.
Training Staff
Training Logs including hire date,date of
10-6. Ongoing-
all trainings received,and date of first tool
Screening administration(or tool supervision)for all current HFA Trainina Loa or local
Tools All Current HFA staff and supervisors who are responsible training report.
Training Staff for the administration of the screening tools or
supervising the use of the screening tools.
48
w Tables of Documentation
f
cc Summary
a
• Guidance for • •
Required How to Measure What to report for Accreditation Ongoing GA
f
Z Standard TIrneframe Please Note:HFA Spreadsheets (see also Tables of Recommendations
O are available Docuritentation by Standard)
w Training Logs including hire date and date of training
topics received for current HFA supervisors&direct
O service staff.
U
All staff at affiliated HFA sites may use the online
0 11-1 trainings developed by HFA(or other training
resources provided by the National Office)to
O through Ongoing- complete the 11-1.11-2.and 11-3 training topics.If
11.3 HFA Training Log or local
w All Current sites use something other than HFA's recommended Update Monthly
Wrap training report.
Z Staff online wraparound training,the training will
a Around
Q comprehensively address each of the overall topics
5 Training with a variety of relevant subtopics critical for
u preparing staff to do this work.
Program Managers will have documentation of
training topics related to diversity and equity
F
11-4. Ongoing- Training Logs including hire date and date of all
training topics received for all current HFA staff HFA Training Log or local
Ongoing All Current Update Monthly
Training Staff (direct service staff,supervisors,and program training report.
managers).
Please submit a report indicating the frequency
and duration of supervision sessions for the most
recent quarter.
1.Determine needed frequency and duration of
supervision per FTE guidelines within BPS for each
direct service staff
2.Determine number of expected supervision
12-1.B sessions for each staff member for one quarter
Frequency 3.Subtract from#2(expected sessions)any
and Quarterly excused sessions per guidelines provided by BPS HFA Spreadsheet or Update Monthly
local data report.
Duration of 4.Count number of supervision sessions that
Supervision occurred within proper timeframes and for
expected duration
S.Divide#4(number of supervision sessions at
required duration)by#3(expected sessions minus
those excused)
6.Create report to communicate findings for each
staff member
49
Tables of Documentation
Summary • Guidance for • •
r
Standord R Please Note:HFA Spreadsheets (see also Tables of Ongoing OA
are available Documentation by Standard) Recommendations
Please submit the site's
Quality Assurance Plan
including QA activities
related to all aspects
of site implementation
(initial engagement,home
GA-2.A visiting,supervision and
Quality management).Indicate how
Assurance Annually Site's Quality Assurance Plan these activities have been Update Quarterly
implemented and follow-up
Plan mechanisms developed and
implemented to address
areas of improvement.
Sample Quality Assurance
Plan Template Available.
Please submit site Quality
Improvement Plan including
G A-2.B improvement goals,
Quality improvement strategies and Update
Improvement Annually Site's Quality Improvement Plan annual progress review. Quarterly
Plan Sample Quality
Improvement P a,)
Template Available
50
0
Q
1 0
Z
Initiate services early,
ideally during pregnancy
i
Standard 1 Intent is to ensure the site has a well-thought out
mechanism for the early identification and engagement of families
who could benefit from services. The earlier families are enrolled
during pregnancy the greater the opportunity to support healthy
practices during pregnancy which can lead to improved birth
outcomes(Lee,E.,et al,2009)and longer term parent and infant health.
When enrolled in the newborn period (0-3 months), parents can
be supported with consistent, responsive, nurturing caregiving
practices early in the infant's development, helping to ensure a
secure attachment relationship. This timing is pivotal and research
demonstrates it can increase resilience and buffer the child from
later adversity (Hambrick, Brawn & Perry, 2017). Children who are
securely attached as infants tend to develop stronger self-esteem
and better self-reliance as they grow older and also tend to be
more independent, perform better in school, have successful social
relationships, and experience less depression and anxiety (Young,
Simpson, Griskevicius, Huelsnitz, & Fleck, 2019).
1-1. The site has a description of its eligibility criteria and the community relationships in place to
identify and initiate services during pregnancy or within three months of birth. Please Note:See
glossary for limited exception and approval process related to HFA's Child Welfare Protocols.
52
0 1-1.A The site has a description of:1)its eligibility criteria 2)how these criteria were selected,3)the defined service area,
oand 4) the number of families the site has capacity to serve. Eligibility criteria are determined based on data
a collected from one or more sources, e.g.. a community needs assessment, kidscount.org, state rankings, vital
records,census anv,etc.,and are reviewed by the site's community advisory board at least once every four years.
Intent: Communities choose to implement the HFA model as a mechanism to improve family and child outcomes and
do so because there is local, state,and/or federal interest in providing supportive home visiting services
in partnership with parents of infants and young children.It is important for the site to focus on creating
equitable access to services for families experiencing barriers to resources and to base its eligibility criteria
on community data,ensuring a systematic process for identifying families is in place.
The site's eligibility criteria are reviewed at least once every four years and updated as changes in funding,site
infrastructure,or community demographics warrant.When the site is approved to implement HFA's Child
Welfare protocols for families referred from child welfare, this must be referenced in the site's eligibility
criteria description.
For example, I work with my community advisory board and we determine teen parents are the eligibility
criteria we will use,because teen parents are an underserved demographic
supportexisting services in our community to Data Center(kidscount.
eligibilityorg),in the most recent year data is available.a total of 1,000 women under the age of 20 gave birth in our
area.We also know 780 women under the age of 20 gave birth in our city's largest birthing hospital last year.
We therefore define our parenting
. .),who reside in Babyville County.We have ten full-time Family Support Specialists able to serve a total
of •• families
1-1.A RATING INDICATORS
M 3 The site has a description of 1)its eligibility criteria 2)community data (include source and year)used in deciding
Z on these criteria.3)the geographic service area.and 4)the total number of families projected annually to be served based
= on site capacity.The description and data utilized have been reviewed by the site's community advisory board within the
last two years,and adjusted as needed based on changing community demographics or program infrastructure.
The site has a description of 1)its eligibility criteria 2)community data(include source and year)used in deciding on
these criteria.3)the geographic service area,and 4)the total number of families projected annually to be served based
on site capacity.Both the description and data utilized have been reviewed by the site's community advisory board wlWn
the Wd four years and adjusted as needed based on changing community demographics or program infrastructure.
i The site does not yet have a description of its eligibility criteria;or any of the following are not yet included:community data
(source and year).service area,or total number of families projected annually to be served:or it has been four years or more
since the community advisory board last reviewed.
TIP: Sites are encouraged to be realistic when identifying eligibility criteria.For example,while it is commendable to
want to reach all families giving birth.fiscal capacity or limited staffing may make this goal unrealistic.
lTIP: Eligibility criteria may include factorsparent age, Medicaid eligibility, geographical
pregnancy, a particular numberof positive
and Opportunities for Growth(FROG)Scale.etc.
53
1-1.B The site establishes organizational relationships with community providers for purposes of identifying families and
receiving referrals(e.g.,local hospitals,prenatal clinics,high schools,centralized intake systems.etc.).Please Note:
for sites approved to use HFA's Child Welfare Protocols,a formal Memorandum of Understanding(MOU)between
the HFA site and local child welfare office is required.HFA has a sample MOU.
Intent: In addition to the sites description of its eligibility criteria and process for determining eligibility,the site
will indicate the community providers who identify and refer families to HFA services. In order for sites
to engage families, it is essential to create relationships with community entities who come into contact
with families. In some cases these community partnerships may require formal Memorandums of
Understanding/Agreement(MOU/MOA),and in other cases these relationships may be verbal agreements
or informal in nature.In either case,it is important these relationships allow site staff to initially engage with
families.The site will decide if a formal agreement would be beneficial with some of its referral sources.Some
sites may have only formal agreements in place,while others will have only informal(verbal)agreements in
place,and others still may have a mix of both formal and Informal.
hospital'sContinuing with the example in H-A for Babyville County,the HFA site there reaches out to the largest birthing
hospital where 780 births to women under the age of 20 occurred last year. We establish a Memorandum of
Agreement with the hospital's social work department to identify and refer teen parents to our HFA site-We
invite the Department director to participate .ensure
ongoing communication,and we coordinate in-service meetings with key hospital unit staff to provide them with
materials and information about our HFA services.including how to describe HFA services to families.Similarly,
we engage our local WIC provider,though in a less formal way(without an MOA)so they too are aware and can
refer teen parents who meet our criteria(pregnant or with a newborn,
montheach .w many referrals are coming in from .from any other sources.
1-1.6 RAi'ING INDICATORS
= 3 No 3 rating indicator for 1.1.B.
2 The site identifies organizations within the community where families can be referred from.and agreements(either
formal or informal)are in place.Sites approved by the National Office to implement HFA's Child Welfare Protocols
M have an MOU established with the local child welfare office.
The site does not yet identify organizations within the community where families can be referred from.or the site
has not yet initiated relationships with identified referral organizations:or if approved to use HFA's Child Welfare
Protocols,does not have an MOU established with the local child welfare office.
54
1-1.0 The site tracks the number of families identified or referred by referral source.and their eligibility status.The site
a implements strategies to help maximize existing program capacity and support family needs in the community.
c
z Please Note:An HFA Spreadsheet is available for this standard.
a
Intent: Tracking the number of families identified or referred allows the site to utilize data effectively to advocate
for families in the community whose needs may go unmet.For example,there may be many more potential
families than can be served owing to the site's current capacity.This data provides the site with valuable
information to maximize existing staff capacity. allowing the site to determine what dynamics might be
getting in the way of engaging families in services.
Monitoring the system of organizational relationships is a key component to understanding how families are
identified or referred.The site will use this data to develop strategies to improve its identification and referral
processes (e.g., form new community provider relationships. strengthen existing provider relationships,
provide in-service training for referral agencies including how to describe services in ways that may be more
appealing to families,create more effective ways to identify families in the service area,etc.).
For example,over the past four quarters,the Babyville HFA site received . total of 350 referrals,with 210
referrals from the birthing hospital.90 from WIC,46 from a local food pantry,and 4 self-referrals:however.
100 of these referrals were duplicates or did not meet eligibility criteria because they either resided outside
the county or were not teens.As a result • referrals received in the past year met eligibility
capacityten full-time Family Support Specialists,we have capacity to serve 200 families at any given time,and have
remained at One • • referrals could
not be d given current capacitypast two years,
SupportBabyville's community advisory board has helped identify potential funding sources to support an additional
1-2 Family processapplying
1-1.0 RATING INDICATORS
3 The site tracks at least quarterly all families identified or referred to Healthy Families services.indicating whether the
family was eligible or not,and the source of each referral.The site.in conjunction with its community advisory board,
= uses this data to monitor program capacity and apply strategies to fill available slots when not yet at full capacity,
and,when at capacity,to reduce gaps in service availability.The site discusses with its community advisory board
= opportunities for improvement at least once annually.
= 2 The site tracks at least quarterly all families identified or referred to Healthy Families services,indicating whether
the family was eligible or not, and the source of each referral. Past instances may have occurred when the site
= did not track data quarterly or use this data to apply strategies to fill available slots or reduce gaps in service
availability,however recent practice indicates this is now occurring.The site discusses with its community advisory
board opportunities for improvement at least once annually.
r 1 Any of the following:the site has not yet tracked at least quarterly all families identified or referred:or does not
yet identify the referral source: or has not yet applied strategies to increase capacity, or in conjunction with its
community advisory board,discussed opportunities for improvement at least once annually.
1TIP: When working in partnership with an external entity providing centralize• intake,it will be important
placeformal agreement in .wing reciprocal sharing of data.
being identified and referred to HFA by centralized intake and how many of these referrals are engaging in
services.When partnering with centralized intake entities,it is important to periodically review criteria prompting
referral to Healthy Families to ensure it is neither too broad nor too restrictive.
55
1-2. The site ensures all referrals into the HFA site are tracked and monitored from receipt of referral to the offer of services.
1-2.A The site has policy and procedures regarding initial engagement processes and mechanisms(from referral to offer
of services)to ensure timely determination of eligibility and offer of service.Policy and procedures include each step
of the process for all referrals, from receipt of referral to offer of service, the site's tracking and monitoring
requirements,and documentation of reasons why when families are not offered services.
1-2.A RATING INDICATORS
= 3 No 3 rating indicator for standard 1-2.A.
= 2 The site's policy and procedures include the following information:
Activities and expected timeframe between receipt of referral and initial contact with family
Activities and expected timeframe between initial contact with family and offer of services
How and when eligibility is determined
Mechanisms to track and monitor each step of the initial engagement process,whether able to establish initial
contact or not,whether services were offered or not,and the timeliness of these activities
Documentation of reasons why if families are not offered services
1 The site does not yet have policy and procedures;or the policy and procedures do not yet include the requirements listed
in the 2 rating.
TIP: Things to consider 1)how do you receive referrals?2)what eligibility criteria do you use?3)what happens if a
family does not meet these criteria?
TI P: Throughout the process, what are the points of contact with families?Which staff are responsible for these
points of contact,and what is the goal for each step in the process?How quickly should this process move?
What is documented along the way(and where)?Is follow-up with the referral sources expected?
Are the policies and . .
readinginitial engagement by policy?
TI P: It is recommended sites utilize the following timeframes, which help demonstrate to the family the site's
responsiveness and the site's genuine care and concern for the family. A shorter window between referral
and contact with the family has been demonstrated to increase the likelihocd of successful engagement in
services(unless site is at full ..
Ideallydays between receipt of referral and initial(actual or attempted)contact with family
Ideally .. . business days between initial contact(actual)and offer of services
56
0 1-2.13 The site monitors its initial engagement process,tracking the timeliness from receipt of referral to offer of service,
owhether able to establish initial contact or not,whether services are offered or not,and reasons why if families were
z not offered services.
a
Intent: Many families miss the opportunity to participate in services because site staff is unable,for a variety of
reasons,to establish or maintain contact with them subsequent to the initial referral.Therefore,sites monitor
closely the initial engagement process.
Please Note:For sites working with a centralized intake system that offers HFA services to families,the site
will consider the offer of services to occur after the site receives the referral and contacts the family themselves
to offer services.
Please Note: During times when HFA caseloads are at capacity, sites are discouraged from maintaining
families on a waitlist.Telling eligible families they are on a waitlist conveys a promise of eventual enrollment,
which may not be possible. It may be several months before an opening occurs and urgent or immediate
needs the family has would go unattended.potentially at dire consequence to the family or child,bringing a
liability risk to the HFA host agency. In such situations,a referral to other community services is preferred
to wait-listing the family(unless a known opening is about to occur). Most often, the reason sites use a
waitlist is to ensure caseload capacity can be maintained should a family leave services early.While this may
be in service to the agency to demonstrate consistent capacity levels,it is not in service to the family.It also
undermines the ability to initiate services as early as possible.
1-2.8 RATING INDICATORS
= 3 The site monitors its initial engagement process. For each family referred,the site tracks the length of time from
referral to offer of services.whether able to establish initial contact or not,whether services were offered or not,and
when services are not offered to the family,reasons why are documented.
2 The site monitors its initial engagement rocess.Past instances may have occurred when the site did not track each
� P Y
family referred,including the length of time from referral to offer of service,whether able to establish initial contact
or not,whether services were offered or not.and when services were not offered to the family,reasons why were
not documented.however reCent practke indicates this is now occurring.
The site does not yet monitor its initial engagement process:or track the timeliness of its initial engagement process
from referral to offer of service;or,when services are not offered,the reasons why are not yet being documented.
1-2.0 The site develops strategies. based on its data from 1-2.13, to strengthen its initial engagement process with
families.aiming to reduce barriers and provide equitable access to HFA services.
Intent: The intention behind all data collection should be the opportunity to monitor quality and to guide continuous
quality improvement efforts. With data the site collects for standard 1-2.13, it will develop strategies for
increasing the capacity of the site to connect with families and improve initial engagement.
1-2.0 RATING INDICATORS
3 The site has applied Strategies to improve the initial engagement process or 90% of families referred received
�
initial contact and were offered services.in which case strategies do not need to be 9 applied-
2
The site has developed strategies to improve the initial engagement process.
1 The site has not yet developed strategies to improve the initial engagement process.
contactTIP: Sites are encouraged to follow-up with referring entities(assuming referring organization has a signed consent
in place for information sharing)to provide information regarding the outcome of their referral(s).including
when the initial •t completed
57
1
1-3. The first home visit occurs within three months after the birth of the baby for at least 80%off amilies:for sites approved
to use HFA's Child Welfare Protocols, the first home visit occurs within twenty-four months for at least 80% of
families referred from child welfare.
See glossary for limited exception and approval process related to HFA's Child Welfare Protocols.
Intent: HFA research,as well as significant anecdotal evidence,demonstrate the models ability to achieve improved
outcomes the earlier services are initiated.This is owing to multiple variables including:
• the particular vulnerability of the infant during the prenatal and newborn period.and an opportunity to help
shape better health,nutrition,and lifestyle practices that can impact the infant during this sensitive period
• the patterns of the parent-infant relationship,including parental responsiveness and interpretation of infant
behavior.begin during this period,and strategies employed by Family Support Specialists can promote
healthier bonding and attachment
• families with limited exposure to healthy,trusting relationships gain the ability to form a trusting relationship
with a Family Support Specialist over time
The earlier the alliance between Family Support Specialist and parent is formed,the greater the likelihood of
increased family engagement and retention,and improved outcomes.
1-3.A The site has policy and procedures describing activities to ensure at least 80%of families receive a first home visit
prenatally or within the first three months after the birth of the baby(i.e..up until the baby turns 3 months of age),or
within 24 months for families referred from child welfare(when approved by the National Office to use HFA's Child
Welfare Protocols).
1-3.A RATING INDICATORS
= 3 No 3 rating indicator for standard 1-3.A.
2 The site's policy and procedures describe the site's activities to ensure: the first home visit occurs prenatally or
= within the first three months after the birth of the baby for at least 80%of families:or for sites approved to use HFA's
Child Welfare Protocols,within twenty-four months for at least 80%of families referred from child welfare.
The site does not yet have policy and procedures,or the policy and procedures do not yet address the requirements listed
in the 2 rating.
58
Q
Z
Q
ti
1-3.B The site's practices ensure,for families who accept services.the first home visit occurs prenatally or within the first
three months of the birth of the baby,or within 24 months of birth for sites approved to use HFA's Child Welfare
Protocols,for at least 80%of families initiating services in a given year.
Please Note:When infants begin life with an extended hospital stay in the NICU, it may not be possible to begin
home visits until after 3 months.These situations must be documented and will be exempted from the requirements
of this standard.
Please Note:Sites approved to implement HFA's Child Welfare Protocols will calculate separately the percentage of
families referred from child welfare with at least 80%or more of first home visits by 24 months of age.
Please Note:Sites are encouraged to accept transfers from other sites whenever appropriate and to re-enroll families
with the same focus child when previously closed from services. Any transfers or re-enrollments when the child
is already 3 months old or older will be exempted from this calculation. Re-enrollment of graduate or soon-to-
graduate families(on Level 3)with a new focus child(based on a subsequent pregnancy)is discouraged.given the
progress the family has already demonstrated,and to ensure space is available to enroll brand new families.
1-3.8 RATING INDICATORS
3 Ninety-five percent(95%)through one hundred percent(100%)of first home visits occur prenatally or within the
first three months after the birth of the baby,and within twenty-four months after the birth of the baby for families
= referred from child welfare(when site has been approved to use HFA's Child Welfare Protocols).
2 EW ty percent(80%)through ninety-four percent(94%)of first home visits occur within the timeframes described
in the 3 raurg
Less than eighty percent(80%)of first home visits occur within the timeframes described in the 3 rating.
TIP: Sites are encouraged to set goals/be nch marks(for Standard GA-2.B)when rates fall below the 80%threshold.
and supervision time is used to focus on exceptions,reasons.and problem-solving strategies to increase rates.
59
s
c , L
�l
14
_do
1-4. The site measures the acceptance rate of families offered services on an annual basis and in a consistent manner
and,at least once every two years,analyzes its data associated with family acceptance to better understand the
underlying issues associated with families choosing to accept services or not.
1-4.A The site measures annually (12 consecutive months of data whether calendar or fiscal year) the acceptance rate
of families offered services, using HFA methodology (based on receipt of first home visit and using both numbers
and percentages).When measuring and analyzing,sites can use the An HFA Spreadsheet is available for this standard.
Intent: Calculating the site's acceptance rate is a critical quality improvement measure.Sites look at the total number
of families offered services over the course of a year and what number and percentage of those families
accepted site services(as demonstrated by completion of a first home visit after the offer was made).To
ensure uniformity in measurement. HFA requires sites to track the acceptance rate of families based on
acceptance of the first home visit,regardless of how a site may define its enrollment date.Please Note:As
stated in the glossary,the first home visit is the first visit completed by the assigned Family Support Specialist
after eligibility has been determined, where rights and confidentiality forms are signed (unless already
signed),CHEERS is observed,and at least one focus area of a home visit(see glossary for home visit definition)
occurs.The visit is documented on a home visit record.
1-4.A RATING INDICATORS
= 3 The site measures its acceptance rate of families(using HFA methodology)into services and acceptance rates are
being measured more than once a year.
M
0 2 The site measures its acceptance rate of families(using HFA methodology)into services and acceptance rates are
being measured annually.
The site is not yet measuring its acceptance rate using HFA methodology at least annually.
60
0 1-4.113 For sites with 50 or more families offered Healthy Families services over a two-year period,the site analyzes its data.
oto identify to identify possible reasons for changes in the site's acceptance rate, comparing data for
z families who accept services to those who decline services(including the reasons why families decline services).
a
Please see glossary for common terms associated with analyses.An HFA Soreadsheet is available for this standard.
For smaller sites with less than 50 families offered services over a two-year period,the site will at a minimum review
anecdotal information from staff about any patterns associated with acceptance and reasons why families are not
accepting services,at least once every two years.The site will do a more thorough analysis when the sample size
over a two-year period is 50 or more.
Intent: Sites conduct a thorough acceptance analysis at least once every two years to determine possible
reasons for changes in the site's acceptance rate. The analysis examines various factors of those who
accept services(demonstrated by completion of a first home visit)compared with those,during the
same time period.who were offered services yet never received a first home visit.The site will determine
which factors it analyzes based on trends or patterns it has observed.The intent is to ensure the analysis
can yield meaningful results that lead to activities to address underlying causes and increase acceptance
as a result(see GA-2.6)Please Note:Sites can analyze data more frequently than every other year if
beneficial to the site.Please Note:Brand new sites will complete a first analysis with one year of data
instead of two.If the site is both new and small(fewer than 25 families offered services over one year;or
less than 50 over two years),they will report on informal information and reasons why for families who
declined services.
1-4.13 RATING INDICATORS
= 3 The site uses formal data(numbers and percentages)and anecdotal information from staff to analyze,at least once
every two years, families who declined services and why. The analysis examines data to identify and
better understand possible reasons for changes in the site's acceptance rates. The analysis Indudes at bast
three(3)factors in its comparison of those who accepted and those who declined during the same time period
at least ninety percent(90%)of families offered services over a two-year timeframe accepted services by receiving a
first home visit,in which case an analysis is not required.New sites not yet in operation for two full years with an
acceptance rate of 90%during the first year are also exempt from completing an analysis.
The site uses formal(numbers and percentages)and anecdotal information from staff to analyze,at least once every
two years, families who declined services and why. The analysis examines data to better understand possible
reasons for changes in the site's acceptance rates.The analysis indudes one or two factors in its comparison of
those who accepted and those who declined during the same time period.
Sites with fewer than 50 families offered services over a two-year period have collected informal data and reasons why
families are not accepting services
Any one of the following:
1)the site does not yet have an analysis of who declined services and why
2)the analysis does not yet include both formal data and anecdotal information
3)the analysis does not yet include a comparison of any factors of those who accepted and those who declined during the
same time period
4)the analysis is not yet conducted at least once every two years
5)if a smaller site,the site has not yet,at a minimum,collected informal data and reasons why families are not accepting
v�-The site did not offer HFA services to any families in the last two years,or there were less than 10 families who declined
service during the two-year period to determine any patterns.
ITIP: While sites choose which factors .include in their acceptance . . .sites consider the role race and
ethnicity may have on acceptance.In addition it is recommended that sites consider the impact of factors related to the
program(such as staffing issues,or policy issues)may have on family acceptance-Sites are encouraged to reflect on any
trends observed from the last acceptance analysis to the present one.and any lessons to be learned.
61
TablesDocumentation
Z
'Note:Submit Self Study Face Sheet with Self Study
1.Initiate services early,ideally during pregnancy.
Stwmiwd Pre-Site Documentation to include in Self Study
Submit a narrative description of:1)Site eligibility criteria 2)how these criteria were selected,3)the
1-1.A I Eligibility defined service area,and 4)the number of families the site has capacity to serve.Eligibility criteria are
Criteria determined based on data collected from one or more sources and reviewed at least once every four years.
Submit a narrative identifying organizations within the community where families can be referred
1-1.6 1 Referring from,and the formal/informal agreements in place.
Organizations Sites approved by the national office to implement HFA's Child Welfare Protocols have an MOU
established with the local child welfare office.5_aMple MOU available.
Submit report reflecting all families referred in the most recent quarter:
1-1.0 I Tracking 1.Number of families referred by each referral source
Referrals and Site 2.Their eligibility status
Capacity 3.Include most recent plan with strategies to fill available slots or reduce gaps in service availability
and indicate which have been applied
Please note:An HFA Spreadsheet is available for data elements of this standard
1-2.A I Policy-Initial Submit Policy
Engagement Process Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available
Submit a narrative about how the site monitors its initial engagement process and activities reflecting
1-2.6 1 Initial all families referred in the most recent year.A data report may be submitted in combination with a
Engagement Process narrative regarding engagement activities.HFA's spreadsheet includes:
1.The length of time from referral to initial contact
2.The length of time from initial contact to offer of services
3.Whether able to establish initial contact or not
4.Whether services were offered or not
5.Reasons why if services not offered
Please note:An HFA Spreadsheet is available for this standard.
1-2.0 I Initial Submit a narrative of developed strategies(based on data from 1-2.13)to improve the initial
Engagement Process engagement process with families reducing barriers to ensure equitable access to HFA services.
Developed Strategies
1-3.A I Policy-First
Home Visit Within 3 Submit Policy
Months or Within 24
Months if Approved Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available
To Use CWP
62
Tables of • • •
Standard Pro-Site Documentation to Include In Self Study
Submit a report reflecting all families who received a first home visit in the most recent year.
1-3.B I First Home 1.Count number with a first home visit
Visit Within 3 Months 2.Count number with first home visit either prenatally or within 3 months of birth
3.Calculate:#2(number with first home visit prenatally or within 3 months)divided by#1
(number who had a first home visit)
For sites enrolling families through Child Welfare Protocols(CWP),remove CWP families from
the calculation above to calculate CWP families separately,
1.Count CWP number with a first home visit
2.Count CWP number with first home visit within 24 months of birth
3.Calculate:2.(number with first home visit within 24 months)divided by 1.(number with a first home visit)
Please note: An HFA Spreadsheet is available for this standard.
This is a threshold standard,meaning to be in adherence a minimum threshold has been established
(80%in this case).When the site's annual data in the self-study falls below this threshold,Peer
Reviewers or Panel will request more recent data.
Submit a narrative describing the site's definition of acceptance rate and method for calculation
1-4.A I Measure (unless using HFA spreadsheet)and the current acceptance rate for all families offered services in
Acceptance Rate the most recent year.
1.Count number offered HFA home visiting services
2.Count number with a first home visit
3.Calculate:42(number with a first home visit)divided by#1(number offered services)
Please note: An HFA Spreadsheet is available for this standard.
1-4.B Analyze the data from all families who were offered services during at least the most recent year.Analyze
Acceptance Analysis both formally and informally:
1.Families who refused services in comparison to families who accept services
2.Includes at least one analysis factor
3.The reasons why families decline
Please note:An HFA Spreadsheet is available for formal analysis.Please see glossary for more
information on analysis.
For smaller sites with less than SO families offered services over a two-year period,the site is
required at a minimum to submit a narrative including:
1.The number of families offered services within the two-year period
2.Informal data about families who refuse services or accepts services
3.Reasons why families are not accepting services
For sites not required to complete Acceptance Analysis,submit a narrative describing the reason
for exemption:
If at least ninety percent(90%)of families offered services over a two-year timeframe accepted
services by receiving a first home visit,an analysis is not required.New sites not yet in operation for two
full years with an acceptance rate of 90%during the first year are also exempt from completing an analysis.
63
N
Q
2
0
Z
Q
•
V
f
Sites use the validated
� Family Resilience and
Opportunities for
Growth (FROGS Scale
to identify family
strengths and concerns � �,,� i
at the start of services.
a
Standard 2 Intent is to ensure the site has an objective process for
learning about each family's strengths and concerns at the start of
services. The FROG Scale is a family-centered tool used to identify
the presence of both protective factors that promote resilience
and factors associated with increased risk for child maltreatment
or other adverse childhood experiences. It is used at the start of
services to guide initial service planning and ongoing support
services for the family throughout the course of services based on
their identified strengths and needs.
2-1. The site is required to use the FROG Scale at the start of services to provide the family an
opportunity to tell their story,to identify the presence of protective factors as well as factors that
could contribute to increased risk for child maltreatment or other adverse childhood experiences,
and to support the development of a service plan to support the unique needs of each family.
Intent: Parents/caregivers represent a broad variety of backgrounds, experiences, values, and
cultural norms, and these are combined in unique ways in each individual family. What
may appear as a risk factor in one family may be mediated by nurturing relationships
and/or significant protective factors in another. By completing the Family Resilience and
Opportunities for Growth (FROG) Scale, staff learn about each family's strengths and
concerns and are better able to plan services and resources that will be of most interest
and benefit to the family.
65
0 2-1.A The site has policy and procedures requiring the FROG Scale be administered to identify risk and protective factors
a that could contribute to or mediate the risk for child maltreatment or other adverse childhood experiences. The
0
z policy and procedures also require documentation of these risk and protective factors be completed in narrative
a
format that fully describes the concerns/needs and strengths expressed by the parent(s)during the FROG Scale
conversation. and all items are scored in accordance with the guidelines of the tool. The policy and procedures
identify who is responsible for administering the tool and the timeframe for completing the narrative, including
supervisor review.
Intent: Site policy and procedures ensure the FROG Scale is administered objectively and reliably,and in a relationship-
building,conversational style.Using a conversational style allows parents to share their story in a way that
makes sense to them and enables staff to follow up for greater understanding of the family's experiences.
When parents are able to tell their story at the onset of service(or as soon as possible thereafter),the parent
feels heard and valued.The intent with the FROG Scale is for staff to explore all areas while understanding
parents are only expected to share as much as they are comfortable sharing.Doing so conveys the respect all
families deserve,and sets the stage for a genuinely attentive and responsive relationship.
Site policy also includes expectations for the documentation of the FROG Scale narrative to ensure it conveys
accurately what each family shared in regard to strengths.risk factors,questions.and concerns.Consistent
documentation in this way ensures accurate scoring of the tool and provides Family Support Specialists with
an understanding of each family and an opportunity to provide individualized service planning based upon
each family's unique strengths and concerns.
The FROG Scale is completed in as timely a way possible,i.e.,no later than the fourth home visit(ideally within
30 days of enrollment though the fourth home visit may extend beyond 30 days if parents are not immediately
receptive to weekly home visits).
Please Note:Some sites choose to use the FROG Scale to determine eligibility, in which case it will be
completed prior to the first home visit.
2-1.A RATING INDICATORS
= 3 The site policy and procedures require:
= 1) The FROG Scale is completed on of before the first or second home visit(ideally within a single visit and no later
than within 15 days from enrollment).
= 2) The FROG Scale is documented in narrative format detailing the presence of tactors that could contribute to
increased risk for child maltreatment or other adverse childhood experiences.Any area not yet documented is
= identified for later conversation and inclusion in the service plan when needs warrant(the same is true for any
updated information a family shares at a later time).
M 3) Responses from parents (or partner/significant other) present at the FROG visit are scored (0-4 or UR) in
m all domains the parent shared information for. When staff do not explore a particular area of the FROG,the
m reason is documented.
4) The timeframe for completing the narrative documentation and scoring is identified.
M 5) The process and timeframe for supervisor review and feedback are identified.
2 The site policy and procedures require
7
1) The FROG Scale is completed by the third or fourth home visit(ideally within a single visit and no later than 30
days from enrollment).
2) The FROG Scale is documented in narrative format detailing the presence of factors that could contribute to
increased risk for child maltreatment or other adverse childhood experiences.Any area not yet documented is
identified for later conversation and inclusion in the service plan when needs warrant(the same is true for any
updated information a family shares at a later time).
3) Responses from parents (or partner/significant other) present at the FROG visit are scored (as 0.4 or UR) in
all domains the parent shared information.When staff do not explore a particular area of the FROG,the reason
is documented.
4) The timeframe for completing the narrative documentation and scoring is identified.
5) The process and timeframe for supervisor review and feedback are identified.
The site does not yet have policy and procedures including the detail listed in the 2 rating.
66
r�
1 �
1
2-1.13 The FROG Scale is administered and documented uniformly and in accordance with site policy and procedures.
2-LB RATING INDICATORS
3 The FROG Scale is administered and documented in accordance with site policy and procedures.
2 Past instances may have occurred when the site did not administer and document the FROG Scale in accordance
M with site policy and procedures:
0 1 The site does not yet administer and document the FROG Scale in accordance with site policy and procedures.
Note:This is an Essential Standard.
TIP: Sites are encouraged to highlight/document specific conversations indicating a parents)motivation for change
67
(e.g.,statements such as."I don't want to parent the same way as my parents,""I really want to finish school,"
"I want to learn everything I can to meet my baby's needs,""I want to stay clean for my baby,"or"I am not going
to use a belt to discipline my baby").Statements like these assist FSSs in identifying potential starting points for
home visit actroities and can facilitate connections with families.
TIP: Information gathered on the FROG Scale is used throughout the time a family is enrolled m HFA for ongoing
service planning and is the basis for standards 6-1.A.6.1.B.and 6-1.C.
2-1.0 The FROG Scale is administered within the timeframe identified in the site's policy and procedures.
a
i 2-1.0 RATING INDICATORS
a
= 3 The FROG Scale is administered within the timeframe identified in the site's policy and procedures (by the 2nd
visit or the 4th visit).
M
2 Past instances may have occurred when the site did not administer the FROG Scale within the timeframe identified
in the site's policy and procedures(by the 2nd visit or the 4th visit);however,recent praCtice indicates this is now occurring.
M 1 The site does not yet administer the FROG Scale within the timeframe identified in its policy and procedures.
2-1.D Supervisors provide support and skill building to staff such that FROG conversations are done in a manner that is
respectful, culturally responsive, and strength-based. Supervisors review and provide feedback to staff who
administer the FROG Scale to ensure consistent quality of scoring and documentation.
2-1.D RATING INDICATORS
= 3 Supervisors review and provide feedback to staff each time the tool is administered to ensure documentation
is complete, scoring is accurate,and staff are supported over time in the way they engage families in the FROG
= Scale conversation.
Past instances may have occurred when the supervisor did not review and provide feedback to staff each time the
tool is administered or support staff over time in the way they engage families in the FROG Scale conversation:
however,recent practice indicates this is now occurring.
Supervisors do not yet review.provide feedback.and support staff each time the FROG Scale is administered.
ITIP: When supervisors attend FROG • •to complete•• feedback
their trainer.Doing so helps to develop a process supervisors can use with their staff for ongoing review and feedback.
I of •• • or signature on ••G Scale,along with notes
Supervision binder can be used to indicate the review and feedback process and demonstrate that staff are
receiving support and skill building overtime in the way they engage families in the FROG conversation.Supervisors
may choose to save the initial draft of the FROG Scale narrative.with comments they provided or suggestions for
alternate scoring,though that is not required.
ITIP: Supervisors are strongly • . to review the FROGbusiness days of administration
(allowing staff 1-3 business days to complete documentation and the supervisor an additional 1-2 business days
to review after receiving it from staff). This helps ensure the family's immediate concerns can be addressed
promptly and service planning can begin in as timely a way as possible.
68
Tables of • •
2. Sites use the validated Family Resilience and Opportunities for Growth(FROG)
Scale to identify family strengths and concerns at the start of services.
DocumentationSfanderd Pre-Site
2-1.A I Policy-
Submit Policy
FROG Scale Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist
are available
2-1.B I FROG Scale
Uniformity No documentation required pre-site.Peers will review documentation and interview staff,advisory
board members,and families on-site.
Essential Standard
2-1.0 I FROG Scale No documentation required pre-site.Peers will review documentation and interview staff,advisory
Timeframes board members.and families on-site.
2-1.D 1 FROG No documentation required pre-site.Peers will review documentation and interview staff,advisory
Scale Supervision board members,and families on-site.
69
M
0
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Offer services voluntarily and use
personalized, family-centered
outreach efforts to build trust
with families
Standard 3 Intent is to ensure the site has an equitable process for
reaching out to and engaging families initially as well as throughout
the time families choose to remain enrolled.HFA's emphasis on trust-
building informs the HFA Advantage-a relationship-focused and
trauma-informed approach to working with families. Staff interact
with families utilizing the components of secure attachment-safety,
predictability, comfort, and pleasure-to develop trust. Providing
outreach in this way reflects our commitment to families and
demonstrates our understanding of the impact that institutional
and generational mistrust and misuse of power have created. The
HFA approach to outreach seeks to address some of the power
imbalances that can be found in helping relationships by putting
parents in control and engaging with them in partnership.
3-1. The site's policy,procedures,and practices ensure services are offered to families on a voluntary basis.
Intent: Offering services voluntarily (allowing families to choose to participate) increases trust
and receptivity. Research suggests an important reason for voluntary services is that
mandatory services shift emphasis from one of social support to one of social control(Daro.
1988). Home visiting services must be voluntary, such that the entire context and tone is
one of respect for families-their desires and their strengths(Gomby,1993).
3-1.A The site has policy and procedures stating services are voluntary and including how this information
is shared with families. Please Note: See Standard GA-3.6 regarding the need to have a written
Family Rights form that includes but is not limited to the voluntary nature of services and a family's
right to decline service.
3-1.A RATING INDICATORS
= 3 No 3 rating indicator for standard 3-1.A.
M 2 The site has policy and procedures regarding the voluntary nature of site services, including how
this information is shared with families.
1 The site does not yet have policy and procedures regarding the voluntary nature of services.
including how this information is shared with families.
71
M
o /I
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0
2
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i'
3-1.13 The site's practices ensure services are offered to families on a voluntary basis.
Intent: HFA is very clear about services to families being offered voluntarily:however,there may be some external
agencies who require HFA as part of mandated treatment(e.g.,child welfare,court systems,substance abuse
treatment facilities,etc.).HFA does not have authority to prevent this type of referral.however,sites should
remind referral entities of such and clarify with families that regardless of the intent of the referral entity,HFA
services are voluntary and families may end services at any time.Doing so helps to reduce stigma and fear,
and establishes for parents a greater sense of personal power and control.
Additionally,when the site enrolls families already open and active with child welfare(CPS),whether referred
directly from CPS or not,and whether the site is approved to implement HFA's Child Welfare Protocols or
not,HFA staff are not to monitor family's progress on behalf of CPS or the court.Sharing of family service
information with child welfare or the court system is bound by HFA's confidentiality requirements and
informed consent process (GA-3) (unless subpoenaed or directed by statute) which is authorized by the
parent and indicates precisely what information is to be shared.Additionally,it may be important to inform
families that sharing such information may not always be helpful to the family's situation.
3-1.121 RATING INDICATORS
= 3 The site practice clearly indicates services are offered to all families solely on a voluntary basis.
2 Past instances may have occurred when services were not provided voluntarily to all families; however, recw t
M prwdce indicates services are now offered to families solely on a voluntary basis.
There are instances in which services are not yet provided voluntarily.
72
101111111 f
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3-2. Staff utilizes positive pre-enrollment outreach methods to build family trust and engage new families.
3-2.A The site has policy and procedures specifying a variety of positive methods to build family trust when engaging new
families in services.
Intent: This standard reflects the need for staff to reach out to families and utilize trust-budding methods and tools,
including supervision support.when establishing relationships with families.When parents have experienced
unresolved early childhood trauma.or been marginalized by society.their sense of whether people are safe,
predictable,and pleasurable may be compromised.As a result,families may be reluctant to accept services
and may struggle to develop healthy,trusting relationships.Therefore,site staff must identify positive ways
to establish a relationship with a family.Utilizing a family-centered approach allows staff to focus on what is
important to the family.Supervision is an excellent place to strategize ways to build trust and engage families.
Please Note:This standard applies to families who have not yet enrolled or received a first home visit(i.e_
subsequent to the site offering services),and is not to be confused with creative outreach expectations,which
occur after the family is enrolled and has received a first home visit(Standard 3-3).
3-2.A RATING INDICATORS
= 3 No 3 rating indicator for 3-2.A.
2 The site has policy and procedures specifying a variety of positive methods to build family trust when engaging new
families to enroll in services.
1 The site does not yet have policy and procedures or the policy and procedures do not yet address the requirements in a 2 rating.
fTIP: Pre-enrollment outreach methodsbest when personalized and may include:
drop-bywarm telephone calls focused on the family's well being texting brief messages to let a parent know you are thinking
creative and upbeat notes which encourage parents to want about them
to participate anchoring conversations based on family's interests
families are not home
the pre-enrollment outreach(outreach services provided prior to the first home visit)concludes within 30-45 days of theTIP: While there is no requirement for the amount of time staff will spend trying to initially engage families.it is recommended
workingfirst attempted contact with the family subsequent to their verbal acceptance.For early prenatal referrals or when sites
are
•build caseloads,
73
3-2.13 Staff utilize positive methods to build family trust when engaging them to enroll in services.
Intent: Staff utilize a variety of strategies to engage and enroll families in services.Research indicates families who
< have experienced generational abuse are at greater risk for difficulty in developing healthy relationships with
others and are often reluctant to accept a partnership with direct service staff (Fraiberg,1975).Staff will
develop unique ways to connect with families.
Please Note:If there are safety concerns based upon the initial screen or assessment,supervisors and direct
service staff use caution when considering unplanned visits.
3-2.13 RATING INDICATORS
3 Site staff use positive methods to build family trust when enrolling families in services.
2 Past instances may have occurred when positive methods were not used;however,recent practice indicates the site
now uses positive methods to build family trust when enrolling families in services.
The site does not yet use positive methods to build family trust when enrolling families in services.
3-3. For families that have had at least one home visit,the site offers post-enrollment outreach(level CO)for a minimum
of three months before discontinuing services(or for a cumulative three-month period over six consecutive months).
Families remain at the case weight of the level they were on prior to moving to CO.
3-3.A The site policy and procedures specify when families are placed on a post-enrollment outreach level and the activities
to be carried out(and documented)while the family is on outreach.The site maintains the case weight at the level
prior to CO and all post-enrollment outreach levels are continued for three months (or for a cumulative three-
month period over six consecutive months).Creative Outreach is only concluded prior to three months when families
have engaged in services,declined services,moved from the area,or closed due to other allowable reasons(bolded
below in the intent).
Families who are assigned a permanent worker from Level TR or returned to the service area from Level TO,but who
are unable to be engaged on an active service level,will be moved to Level CO.In these situations,the cumulative
time on TR or TO plus CO will be for a minimum of 90 days.
Intent: It is the site's responsibility to reach out to families who have received a first home visit,yet for a variety of
reasons may not be comfortable receiving ongoing home visits in a consistent manner.Often families who
have experienced trauma in their own childhood,or have been marginalized or oppressed,will find it difficult
to trust others.Additionally,families currently in crisis may find it difficult to continue participation due to a
variety of factors.
Creative outreach activities are uniquely tailored to the individual family and are focused on demonstrating to
the family that the Family Support Specialist is genuinely interested in them and wanting to continue to offer
services.Creative outreach activities occur consistently and at the frequency associated with their previous
level throughout the three-month time period. Sites are advised to avoid correspondence demanding the
family contact the site or threatening termination from services.While services may end up being terminated
after the three-month timeframe,correspondence indicating such will likely add to the feelings of alienation
and lack of trust families have.Repeated, positive attempts at interaction through personalized notes and
texts may be more effective in establishing a trusting relationship.
Site policy will include criteria for closing prior to three months only if the family re-engages in service,
declines services, moves out of the service area, or other allowable reasons for ending services
(parent no longer has custody,pregnancy terminated or ended In miscarriage,focus child or primary care
provider is deceased,significant staff safety issues,or transferred to another program).
Please Note:Use of outreach level change forms can be helpful to keep track of dates when changes in service
level occurred but are not required if start and end dates of outreach are maintained in a data system.Only
levels that require progress criteria be met for movement to less frequent visits are required to be maintained
in the family record.
74
standard3-3.A RATING INDICATORS
3 No 3 rating indicator for
2 The policy procedures specify:
M -when families will be placed on a post-enrollment outreach level(CO)
.the activities to be carried out and documented during the course of outreach
-outreach is continued for 3 months and the case weight from the family's previous level is maintained during this time
•is only concluded . . . consecutive
6-month period) when families have engaged in services, declined services. moved from the service area, other
allowable reasons (parent no longer has custody, pregnancy is terminated or ends in miscarriage,focus child or
primary care provider is deceased,significant staff safety issues,or transferred to another program).or permanent
staff assignment has been reestablished.
0 The site does not yet have policy and procedures:or the policy and procedures do not yet address all points required in the 2 rating.
TIP: Post-enrollment outreach methods are best when personalized and may include:
75
• warm telephone calls focused on the family's well being textmg beef messages to let a parent know you are
• creative and upbeat notes which encourage parents to thinking about them
want to participate anchoring conversations based on family's interests
• drop•by visits(exerusing safety)and leaving a card when • encouraging self-care practices
families are not home
4 TIP: It is common for families to go on and off creative outreach several times,particularly when the parent has a history
of past relationships that have been unsafe.unstable.or unpredictable. Reluctance to engage may be a form of self-
and family protection to avoid repeating a pattern of being hurt or victimized by others.Reluctance to engage might
be one of few mechanisms a parent feels able to use in order to establish some amount of control over their lives.When
the Family Support Specialist offers positive,attentive creative outreach activities, it demonstrates to the parent our
genuine caring for the family.
TIP: Some of the most poignant and powerful stories of family outcomes are with families who were initially very hard
to engage and were on and off creative outreach.Some sites have reported as many as 40-60%of families engage from
creative outreach, which is tremendous. When considering the high-risk circumstances of families' lives and the
vulnerability of babies,re-engaging dust one family is a huge success.
4 TIP: It is recommended the Family Support Specialist check in with families regularly to obtain new or additional emergency
contacts.Having updated secondary contact information,and consent from the parent to use if unable to locate,can
make a significant difference in maintaining connections with families over the course of service delivery.
0 3-3.13 Families disengaging from services are placed on post-enrollment outreach (level CO)and outreach activities are
a continued for at least three months(or for a cumulative three month period over six consecutive months),only
i concluding outreach prior to three months when families have engaged in services.declined services,moved from
a
the area,or other allowable reasons as stated in the 3-3.A intent.
3-3.13 RATING INDICATORS
3 The site places families disengaging from services on outreach appropriately,conducts activities while on outreach
to engage the family,and continues creative outreach for at least three months. The only instances found when
� Y. Y
outreach was concluded prior to three months occurred when the family engaged in services,declined services,
,� moved from the area for other allowable reasons(parent no longer has custody,y,pregnancy ended in miscarriage,
M focus child or primary care provider is deceased,significant staff safety issues,or transferred to another program),
m
or permanent staff assignment has been established.
M
2 Past instances may have occurred when families were not placed on outreach when disengaging from services:
m however, recent� practice indicates the site places families on outreach, conducts activities while on outreach to
M engage the family, and continues outreach for at least three months. The only instances found when creative
m
outreach was concluded prior to three months occurred when the family engaged in services,declined services,
M moved from the area,for other allowable reasons(parent no longer has custody,pregnancy ended in miscarriage,
I
focus child or primary care provider is deceased,significant staff safety issues,or transferred to another program),
M or permanent staff assignment has been established.
Any of the following:the site does not yet place families on creative outreach when disengaging from services:does not yet
conduct activities while on outreach to engage the family;or does not yet continue outreach services for at least three months.
Note: This is an Essential Standard.
placeTIP* Sites may on creative outreach when a scheduled visit results in a cancelled visit without notice,followed by
a consecutive rescheduled
fbegan-
TIP, When returning a family to their previous service level.toavoid frequent .. placement •
to.
liabilitya one-to-three-month period based on level.i.e.,a family returning to level I receives over half of expected visits.or
at least 3 visits,in one month,a family returning to level 2 receives over half,or at least 4 visits,in two months,and a
family returning to level 3 receives over half,or at least 2 visits,in three months.
TIP: Supervisors use discretion to determine family situations warranting a creative outreach period longer than three
months,generally when engagement is imminent-This should be documented in supervision notes.Due to potential
safety and •ncerns.caution should .
if there has been no visual contact with the family.
76
3-4. The site measures the retention rate of families on an annual basis and in a consistent manner,and analyzes data
associated with family retention at least once every two years to better understand why some families choose to
leave services and others choose to stay.
3-4.A The site measures its retention rate using HFA approved methodology—first and last home visit of all who enrolled
in a particular calendar or fiscal year(please see measuring retention rates in the glossary).Other methodologies
may be used in addition.Sites can use the HFA Spreadsheet available for this standard.
Intent: Calculating the site's retention rate is a critical quality improvement measure.Sites look at the length of time
families remain in services and identify patterns and trends associated with families leaving services at
specified intervals.Comparing retention rates across various years(e.g.,all families enrolled in 2018 with all
families enrolled in 2019)allows sites to determine if improvement strategies employed one year are having
impact the next,or if there have been significant demographic or programmatic shifts that have impacted
retent+on from year to year.Please Mote:New sites without 2 full years since home visiting servkes began will
complete an annual measurement of retention based on 6-month retention data.
3-4.A RATING INDICATORS
3 The site annually measures its retention rate (using HFA methodology) for families enrolled in multiple years
M (e.g.,families enrolled the previous two fiscal or calendar years)at multiple intervals(e.g..families enrolled in both
M of the previous two years have 6-month,12-month,18-month,etc.,retention rates measured).
M2 The site annually measures its retention rate(using HFA methodology)for families enrolled during a single one-year
period at multiple intervals(e.g..measuring 6-month and 12-month retention rates).
� 1 The site is not yet measuring its retention rate using HFA methodology at least annually.
For example,if you want to measure retention for families that enrolled two years ..
.you will first record
each family that . . .. you selected with the date of each family's first
home visit.And then.for any of these families that have left services,you will also record the date of their
last home visit.Families that remain open(including those still on creative outreach)will only have the first
home visit date recorded.
To calculate a valid six-month retention rate,you day of the
enrollment year you d and then look
.. day of the enrollment period,
looking12-month retention rate
And twenty-four months after the last day of the enrollment period you will be able to calculate a valid
2-year retention rate.
Calculating retention at multiple intervals for one enrollment year will result in a 2 rating for this standard.
Calculating retention at multiple intervals for different enrollment years will result in 3 rating.
77
0 3-4.13 For sites with SO or more active families at any one time over the last two years,the site analyzes its data,to better
a understand why some families are choosing to leave and others are choosing to stay in services,comparing data for
i families no longer receiving services to data of families remaining in services (including reasons why families leave
a
services).Please see glossary for common terms associated with analyses.Sites can use the HFA Spreadsheet available
for this standard.
Intent: Sites conduct a thorough retention analysis at least once every two years to better understand
why some families are choosing to leave and others are choosing to stay in services.The analysis examines
various factors of those who remain enrolled with those,during the same time period.who are no longer
enrolled.The site will determine which factors it analyzes based on trends or patterns it has observed.The
intent is to ensure the analysis can yield meaningful results that lead to activities to address underlying
causes and increase retention as a result(see GA-2.13).
For smaller sites with less than 50 active families in services at any one time over a two-year period,the
site will at a minimum review anecdotal information from staff about any patterns associated with retention
and reasons why families are leaving services,and to do a more comprehensive analysis when active families
at any one time exceeds 50 or more over a two-year period.
P19MNOW When a site completes this analysis every other year,sites may include two years of families(e.g..
instead of choosing to analyze families that enroll over a one-year period, sites could choose to analyze
families that enroll over two years combined).In this case,the annual measurement(3-4.A)and the analysis
(3.4.B)will reflect different data sets and this is perfectly acceptable.
Please Note:Sites or multi-site systems with capacity and desire to conduct a more rigorous or more frequent
retention analysis are welcome to do so.
Please Note:New sites with less than two full years of home visiting services will complete a first analysis with
one year of data instead of two.If the site is both new and small(less than 2S active families at any time in
one year,or less than 50 over two years),they will also use one year of data and only analyze informal data
and reasons why for families who have left services.
3-4.13 RATING INDICATORS
3 The site uses data (numbers and percentages) and anecdotal information from staff to analyze, at least once
M ever two ears,families who leave services and reasons why-The analysis examines data to identify and better
� Y Y Y- Y Y
understand why some families are choosing to leave and other choosing to stay.The analysis Includes at least three(3)
factors in its comparison of those who remained in services and those who left during the same time period.
at least ninety percent(90%)of families enrolled in services over a two-year timeframe remained in services.in
which case an analysis is not required.New sites not yet in operation for two full years with a retention rate of 90%
during the first year are also exempt from completing an analysis.
The site uses data(numbers and percentages)and anecdotal information from staff to analyze.at least once every
two years.families who leave services and reasons why.The analysis examines data to better identify and understand
why some families are choosing to leave and others choosing to stay in services.The analysis includes One or two
factors in its comparison of those who remained and those who left during the same time period.
Sites with fewer than 50 families active in services at any one time over a two-year period(or for new sites without
two years of data. fewer than 25 active families over one year), have collected informal data and reasons why
families left services.
Any of the following:
1)the site does not yet have an analysis of families who left services and reasons why
2)the analysis does not yet include data and anecdotal information from staff
3)the analysis does not yet include a comparison of any factors of those who remained in service with those who left during the
same time period
4)the analysis is not yet conducted at least once every two years
5)if a smaller site.the site has not yet,at a minimum,collected informal data and reasons why families have left services
N There were less than 10 families who left service during the two-year period to determine any patterns.
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Q TIP- Sites whose 12-month retention rate has remained 90%or more over a two-year period(3 rating)are encouraged to
x collect informal data,along with reasons why,for families leaving services.
4 TIP- While sites choose which factors to include in their retention analysis it is recommended sites consider the role race
and ethnicity may have on retention.In addition it is recommended that sites consider the impact of factors related to
the program(such as staffing issues,or policy issues)may have on family retention.Sites are encouraged to reflect on
any trends observed from the last retention analysis to the present one,and any lessons to be learned.
M
Q
Tables ofDocumentation
0
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3.Offer services voluntarily and use personalized, family-centered outreach efforts to build trust with families.
Standard Pre-Site Documentation to include in Self Study
3-1.A I Policy- Submit Policy
Voluntary Services Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available.
3-1.6 1 Services No documentation required pre-site.Peers will review documentation and interview staff,advisory
are Voluntary board members,and families on-site.
3-2.A I Policy- Submit Policy
Trust Building
(Pre-Enrollment) Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available
3-2.B 1 Trust Building No documentation required pre-site.Peers will review documentation and interview staff,advisory
(Pre-Enrollment) board members.and families on-site.
3-3.A I Policy- Submit Policy
Creative Outreach
(Post-Enrollment) Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available
3-3.B 1
Creative Outreach No documentation required pre-site.Peers will review documentation and interview staff,advisory
(Post-Enrollment) board members,and families on-site.
Essential Standard
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Tablesof • •
DocumentationStandard Pre-Site
Submit the site's definition of family retention and method for calculating(unless using HFA
spreadsheet)and retention calculation for families enrolled within at least one cohort year.
HFA methodology for calculating a site's retention rate is:
1.Select a specified time frame(i.e.,January 1.2020 to December 31,2020). This can be a 12-month
period.a calendar year.or fiscal year.
2.Count the number of families who received a first home visit during this time frame.
3.Count the number of families in this group who remained in services at specified intervals(i.e.,the
number from this group remaining in services 6 months or longer,12 months or longer,two years
or more,etc.):
4.Divide#3(totals remaining for 6 months.12 months,etc.)by the number of families in step#2
3-4.A I (that received a first home visit during the time frame):
Measure Retention
S.When selecting a time frame,it helps keep in mind the last day of your time frame will determine
which intervals you can measure. A family who might have enrolled on the last day of that time
frame could only be counted as retained or not for 6 months if at least 6 months have passed
since they enrolled.
Example: I have selected 1/l/2020-12/31/2020 and today is 1/l/2022,so any family that might have
enrolled on the last day of that year has had the opportunity to be in the program for lyear and 1 day.
For all the families who enrolled during that year,I can measure how many were still enrolled at the
6-month interval and the 12-month interval. I can't measure the 2-year interval yet because not all
families who enrolled in that year(specifically,a family that might have enrolled on the last day)have
had the opportunity to make it to the 2-year mark.
Please note:An HFA Spreadsheet is available for this standard.
For all families who enrolled within at least one cohort year,analyze both formally(numbers and
percentages)and informally(anecdotal information from staff and advisory members)
1.Families who remain in services in comparison to families who leave.
2.Includes at least one analysis factor
3.The reason why families leave.
Please note: An HFA Spreadsheet is available for formal analysis
Please see glossary for more information on analysis.
For sites with less than 50 enrolled families at any one time over a two-year period,submit a
3-4 B I narrative including:
Retention Analysis 1.The maximum number of families that were enrolled at any one time.
2.Informal data about families who leave service or are retained
3.Reasons why families are leaving services
For sites with less than 50 enrolled families at any one time over a two-year period,submit a
narrative of informal data and reasons why families are leaving services. Include the maximum
number of families that have been enrolled at any one time.
For sites not required to complete Retention Analysis,submit a narrative describing the reason for exemption_
If at least ninety percent(90%)of families enrolled in services over a two-year timeframe remained in
services,an analysis is not required.New sites not yet in operation for two full years with a retention
rate of 90%during the first year are also exempt from completing an analysis.
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Offer services intensely and over the
long term, with well-defined progress
criteria and a process for increasing or
decreasing intensity of service.
Standard 4 Intent is to ensure sites offer services intensely at the
onset of services to support relationship building between the FSS
and the parent(s), and attachment and bonding between parents
and child, through repeated positive experiences. This reflects the
parallel process. HFA services are offered for a minimum of three
years and up to five years, subsequent to the birth of the focus
child or date of enrollment, whichever is later. Additionally, sites
utilize HFA's Level Change process for determining the frequency
of home visits consistent with the progress of each family.
4-1. The site offers weekly home visiting services at the onset of services.
4-1.A The site's policy and procedures state families are offered weekly home visits at the start of
services until the family meets progress criteria to support moving to every- other-week visits.
Please Note. Families experiencing significant challenge(s), i.e., with elevated FROG Scale score.
will likely continue with weekly visits for at least six months and often much longer before progress
criteria are met and the family moves to every-other-week visits.Occasionally,families will remain
at the most intense level for the full three-five year service length owing to the severity of the
issues being faced.
Intent:The first several months of involvement with a family are critical for many reasons,i.e.,building
a trusting partnership with the parent(s),helping develop a strong parent-infant relationship,
supporting infant care and safety,assisting with the adjustment to parenthood,and addressing
immediate concerns.
If a family requests less frequent home visits prior to meeting progress criteria, sites will
respect the family's wishes and adjust visit frequency to family request (documenting the
parent's request on the home visit record when this occurs),while maintaining the family on
Level 1 and continuing to offer and encourage the family's receptivity to weekly visits. This
does not mean the Family Support Specialist must continually try to schedule or engage the
family in weekly visits,but the family should be fully aware of the availability of weekly visits.
This ensures the FSS's caseload weight is safeguarded to allow for weekly home visits to
occur until the family meets progress criteria to move to Level 2. This also ensures that
movement to Level 2 is based on family progress vs family availability.
Please Note:Families whose infant is hospitalized in the NICU after birth will not be placed on
Level 1 until the baby comes home from the hospital, unless the parents want weekly visits
during that time.Otherwise.the family will be on level CO or TO while in the NICU and weekly
visits will be offered once the baby comes home(as specified in the standard).
4-1.A RATING INDICATORS
= 3 No 3 rating indicator for standard 4-1.A.
2 The site's policy and procedures state families are offered weekly home visits at the start of
services and continue to be offered weekly visits until the family meets progress criteria to support
moving to every other week visits.
1 The site's policy and procedures do not yet state the expectation for the offer of weekly home visits as
specified in the 2 rating.
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4-1.13 The site ensures families(with the exception of families who enroll on level 2P)are offered weekly home visits at
the onset of services (including with transfer and re-enrolling families)and until progress criteria are met for moving
to less frequent visits.
Intent: When families initiate services,whether new,transferred from another HFA site and re-enrolling at the same
site,it is important to begin with the weekly offer of services. People have a natural tendency to like what is
familiar to us(things we interact with or see repeatedly). More frequent contacts in the beginning increases
familiarity and trust.When a family's immediate work/school schedule precludes the receipt of weekly home
visits,home visits will continue to be offered weekly in the event the family's schedule later permits weekly
visits,and until the family has met progress criteria to move to Level 2.If a family moves to creative outreach
while on Level 1, their service level returns to weekly when the family engages again in services. It is not
intended for families in these situations to automatically move to Level 2 since progression to less frequent home
visits is based on indicators of increased family stability and parent-child well-being,as identified in level change
criteria,and not based on scheduling conflicts.
Please Note:Any family that re-enrolls with the same focus child after previously being closed to services or that
transfers into HFA services from another site(when the transfer or re-enrollment occurs postnatally)will be
placed on Level 1 until progress criteria for movement to Level 2 have been met.
Please Note: Families enrolled as HFA Accelerated—when parent(s) score low risk on the FROG Scale—will
remain on Level 1 until progress criteria for movement to Level 2 have been met.
4-1.B RATING INDICATORS
3 All families(with the exception of 2P families)are offered weekly home visits at the onset of services(including
transfer and re-enrolling families).
M 2 Past instances may have occurred where families were not offered weekly visits at the onset of services,however
Z recerit practice indicates this is now occurring with all families (including transfer and re-enrolling families and
= excluding 2P families).
Families are not offered weekly visits at the onset of services.
TIP: Families who enroll early in pregnancy on level 2P may benefit from an initial offer of weekly visits for a brief period
of time to support FSS-parent relationship development and family retention, rather than an immediate start of
offering every other week visits.
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4-2. The site utilizes a well-thought-out system for managing the intensity/frequency of home visiting services,which
includes use of HFA Level Change forms for all levels requiring progress criteria to be met when moving to less
frequent visits.
4-2.A The site has policy and procedures clearly defining the levels of service(i.e.,visit frequency for weekly,bi-weekly,
monthly.etc.and corresponding case weight at the various levels).The site's policy and procedures also include the
process for reviewing progress and achievements made by families, and the involvement of parent. FSS, and
supervisor in the level change decision.
Please download HFA Level Change Forms and Documents.
Intent: Sites are required to use HFA's"level system"for managing the intensity of services.This well-thought-out system
is sensitive to the needs of each family, changes in family stability and competencies over time, and the
responsibilities of the FSS.Clearly defined levels reflect in measurable ways the capacity of the family.Families
with higher needs are able to receive more intensive services,and less frequent services are provided as stability
and progress increase.Not only does an effective"level system"allow for individualized service delivery,but
it also provides sites a mechanism to monitor caseload capacity more effectively,thus promoting higher quality
services.It is important for the FSS to know where to locate information regarding levels of service and to be
familiar with the process of how families progress from one level to another.Changes to visit frequency are
based on progress,therefore the age of the child or the length of time on a particular level are not the basis for
level change decisions.
HFA has the following levels and associated case weights are provided below.Supervisors may use discretion
to assign higher case weight points (adding .S-1 point) on a permanent basis for families with ongoing
circumstances that need extra time from the FSS to plan for and/or conduct regular visits.This includes but is
not limited to:twins,triplets or other multiple birth,extensive travel to reach the family, ongoing translation
needs,parents with cognitive impairment).Supervisors and FSS can also add weight on a temporary(3 month)
basis by assigning the family a Special Services(SS)level-see below.
Please Note: At the time of enrollment,families are assigned to either Level 2P.Level 1P or Level 1.
Level 2P= 2 points-every other week visits when enrolled during first or second trimester of pregnancy(0-27
weeks gestation).Case weight of 2 pts ensures caseload space is retained to allow move to Level 1
at birth
Level 1P= 2 points-weekly visits when enrolled in third trimester of pregnancy(28 weeks gestation and later),
or prior to 28 weeks when family needs warrant
Level 1= 2 points-weekly visits
Level 2= 1 point-every other week visits
Level 3= 0.5 point-monthly visits
Level 4= 0.25 point-quarterly visits
Level SS= additional 1 point added to Level 1,2,or 3 weight during temporary periods of intense crisis
Level CO= 0.5 point-2 points-creative outreach activities are carried out for 3 months when families are not
engaged in regular visits. Sites maintain a family's case weight while on Level CO equal to the
family's level prior to being placed on CO to ensure space is retained to move family back to that
level if re-engaged.
Level TO= 0.5 point-2 points-family plans to be temporarily out of area and unavailable for visits for up to 3
months. Sites maintain a family's case weight while on Level TO equal to the family's level prior to
being placed on TO to ensure space is retained to move family back to that level if re-engaged.
Level TR= .5 point-temporary re-assignment to another staff person during extended staff leave or turnover
up to 3 months.For families who are receptive and interested in receiving visits consistent with their
previous level,sites should make every effort to do so,rather than using TR.
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4-2.A Intent: Please Note: Level change decisions based on family progress are specifically tied to when families move
(cont.) from one active service level to another(i.e.,Level 1 to Level 2,Level 2 to Level 3,and Level 3 to Level 4)and these
Level Change forms are required. It does not apply to moving families to Level CO,TO,or TR or from Level
2P to Level 1P or from Level 1P to Level 1.These levels are not based on progress and therefore these Level
Change forms are optional.However.sites are required to keep track of the dates when families move from any
of these levels to another,as well as documentation of activities that occur while on these levels.
Please Note: When fully completed, the Level Change form can suffice for all documentation required to
demonstrate supervisor and FSS involvement in the level change decision.If sites use HFA Celebration forms
(giving copy to the family and keeping a copy in the file with the date shared with the family), this will be
sufficient for all documentation required to show the FSS and family discussed level change and no additional
documentation in the home visit record is needed.
4-2.A RATING INDICATORS
= 3 No 3 rating indicator for standard 4.2.A.
2 The site's policy and procedures:
0 •define levels of service
•require use of HFA Level Change forms
M •describe the process for FSS,family.and supervisor to review family progress when level change decisions are made
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1 The site does not yet have policy and procedures:or the policy and procedures do not yet address the requirements listed in the 2 rating.
decisions about
receivedhas demonstrated higher rates of positive birth outcome when visits are initiated as early in the pregnancy as possible.
and no later than 31 weeks gestation,with a minimum of 7 visits prior to• 009
.Reducing
low birth weight through • . randomized
TIP: When families exit services • later express • discretion about
to do so,based on their knowledge of the family and whether space is available to re-enroll.When a family has been
discharged for longer than 6 months,a site should consider whether a brand new service record should be established,
including obtaining updates on the FROG Scale and other intake information.
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4-2.13 Sites measure whether families at the various levels of service (e.g., weekly visits, bi-weekly visits, monthly visits,
etc.)receive the expected number of home visits,based upon the level of service to which they are assigned.An HFA
Spreadsheet is available for this standara.
Intent: Home visits provide the opportunity to experience the family's living environment and gain first-hand knowledge
of the strengths and stresses of the home environment,to implement home safety checks with the family,and to
engage the family on "their turf." It is acknowledged not all visits will occur in the home.Visits may happen
outside the home for a variety of important,necessary,and beneficial reasons.For example when transporting
to medical appointments,as an activity to reduce social isolation,when privacy and confidentiality concerns
warrant a location outside the home,etc.Virtual visiting(via video preferably or phone)is also allowable when
direct service staff safety is at risk,when the family is not initially comfortable with a new person coming into
their home,when continuity of service can only be maintained virtually,etc.These visits can count as a home visit
but only when the content of the visit matches the goal of a home visit and can be documented as such,
including documentation of CHEERS.The goal of a home visit is to promote nurturing parent-child interaction,
healthy childhood growth and development,and enhanced family functioning.Typically,an in-person home visit
lasts about an hour and the child is present.Virtual visits may function similarly though often have a different
cadence,i.e.,shorter and multiple segments in the same week make up a visit,with less observation of the child.
For families assigned to a weekly level of service(Level 1 and 1P),one parent group meeting per month may be
counted as a home visit if documented individually on a home visit record in the family file. The home visit
documentation of the group meeting must be documented by an HFA-trained staff(does not have to be the
assigned Family Support Specialist)and includes CHEERS observations when the group includes parent-child
interaction time.
Some sites work in collaboration with other multi-disciplinary team members, such as doulas. lactation
consultants, child development specialists, mental health therapists, etc. The site may choose to count one
home visit per month conducted by these team members if the provider has received HFA Foundations core
training,documents the visit on the site's home visit record,includes documentation of CHEERS,and receives
supervision in accordance with standards 12-1 and 12-2.This can occur for any family regardless of level.
Please Note_When conducting virtual home visits,text messaging does not count as a home visit.
Please Note:The HFA Spreadsheet(or an equivalent database report)measures home visit completion rates
(per family for each FSS caseload)over a period of three consecutive months(one quarter),If the staff supporting
the family changes during the quarter,home visit completion is measured only for the period covered by the
currently assigned staff person.Families who are on CO,TO,or TR during the entire quarter being measured are
not included in the home visit completion calculation.Families on any of these levels for a portion of the quarter
are only counted in home visit completion rates for the portion while on Level P,1,2 3.or 4.
The home visit completion percentages detailed in the rating indicators are designed to account for situations
when staff or family may not be available due to illness,vacation,training,etc.
4-2.13 RATING INDICATORS
= 3 Ninety percent(90%)of families receive at least seventy-five(75%) percent of the appropriate number of home
visits based upon the indiv dual le,-,el of service to which they are assigned.
2 Seventy-five percent(75%)of families receive at least seventy-five(75%) percent of the appropriate number of
home visits based upon the individual level of service to which they are assigned.
Less than seventy-five percent(75%)of families receive at least seventy-five(75%)percent of the appropriate number
of home visits based upon the individual level of service to which they are assigned.
TIP: Sites are encouraged to set goals/benchmarks(for Standard GA-2.13)when home visit completion rates fall below
a the 75% threshold, and supervision time should be used to focus on exceptions, reasons, and problem-solving
strategies to increase completion
1TIP: When the FSS is away from the office fora period . . one . provided with contact
information of who to contact in their absence, if needed. When extended absences occur, i.e., due to family or
medical leave,a more formal coverage plan should be in place.so families receive necessary support and services.
1 and trends associated with home • • duration are supported
recommends quarterly review.which accounts for variations associated with family and staff schedules on a weekly
or . basis.
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0 4-2.0 Each family's progress(as identified on completed HFA Level Change forms)to a new level of service is reviewed
a and agreed upon by the Family Support Specialist and Supervisor prior to moving a family from one level of service
i to another. Please Note:completed HFA Level Change forms meet all documentation needs for 4-2.C.Any edit of
these forms must be approved in advance by the national office.
Intent: Family progress is reviewed in an ongoing fashion as often as needed (whether semi-annually,quarterly or
more frequently)based on the needs of the family and the current home visit frequency.The decision to change
to a new level of service is based on family progress and is outlined on level change forms. Level change
decisions are not made based on site needs,personnel issues,family availability,or the age of the child.
4-2.0 RATING INDICATORS
Each family's progress(as identified on completed HFA Level Change forms)serves as the basis to move to a new
M level of service and is reviewed and agreed upon b the Family Support Specialist and supervisor prior to moving
� 9 Y Y 9
= families from one level of service to another.
Past instances may have occurred when families moved from one level of service to another in absence of completed
HFA Level Change forms or review and agreement of family progress by FSS and supervisor. however, recent
practice indicates staff and supervisor base level change decisions on family progress and complete the appropriate
Level Change form prior to moving families to a new service level.
Families are moved from one level of service to another in absence of completed HFA Level Change forms:or a review and
agreement on family progress by the supervisor and staff did not occur prior to level change.
Note:This is an Essential Standard.
4-2.13 Once the supervisor and FSS agree a family's progress indicates readiness for movement to a less intensive service
level, the FSS discusses with the family the change to visit frequency based on progress and celebrates family
progress and achievements.
Intent: The decision to change to less frequent home visits is based on family progress,as outlined on level change
forms.The conversation with families when moving to less frequent visits is used to prepare families for an
adjusted visit schedule and as a time to celebrate with the family their progress and achievements.HFA has
sample celebration forms that can be used with families for this purpose.
4-2.D RATING INDICATORS
3 The Family Support Specialist celebrates the progress and achievements with the family and discusses the change
in visit frequency based on progress when families move from one level of service to another.
2 Past instances may have occurred when families moved from one level of service to another in absence of a
celebration of family progress between the Family Support Specialist and family;however.recent practice indicates the
Family Support Specialist and family celebrate progress and discuss the change in visit frequency based on progress.
Families are moved from one level of service to another in absence of a celebration of family progress,or the Family
Support Specialist did not discuss the change in visit frequency based on progress.
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4-3. The site offers HFA services to families for a minimum of three years(or five years when sites are funded to do so),
after enrollment or after the birth of the baby(with exception of families identified as eligible for HFA Accelerated
based on a low risk score on the FROG in which case may successfully complete and graduate from services sooner).
Please Note:Because HFA is voluntary,families may choose to end services at any time.FSS are encouraged to use
HFA's Successful Completion of Program criteria,and to acknowledge the family as such when meeting these criteria,
even when choosing to leave services early.
4-3.A The site has policy and procedures specifying HFA services are offered for a minimum of three years after enrollment or
after the birth of the focus child(whichever is later), with the exception of families who transfer from another program.
Please Note: Sites who enroll families in HFA Accelerated when parent(s) score low risk on the FROG Scale, and
remain at low risk,may successfully complete progress criteria and conclude services prior to three years.
Families who transfer from another program will be offered services until age three(or age five when funded to do so).
4-3.A RATING INDICATORS
= 3 No 3 rating indicator for standard 4-3.A.
= 2 The site policy and procedures specify HFA services are offered for a minimum of three years after enrollment or after the
birth of the focus child(whichever is later).
M 1 The site does not yet have policy and procedures,or the policy and procedures do not yet address the requirements
listed in the 2 rating.
addingTIP* Service length may also be extended beyond the norm on occasions where Level 3 or 4 families nearing service
completion experience a crisis warranting a temporary return to more intensive services,such as a subsequent birth
. to the functioning of the family.
I demonstrated progre • moved to less frequent visits,a normative situation,like a healthy
subsequent
progress and achievements reflect their ability to provide a nurturing, safe,and stable environment for the focus
child and subsequent children,and space in the program can be opened for new families.
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0 4-3.e Services are offered to families for a minimum of three years after enrollment or after the birth of the focus child
a (whichever is later).
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3 Services are offered for a minimum of three years after enrollment or after the birth of the baby(whichever is later).
Past instances may have occurred when the site did not offer services to families for a minimum of three years;
however,recent practice indicates the site is offering services for a minimum of three years;or the site has not yet
been in operation for 3 years.
Site is not yet offering services for a minimum of three years.
4-4. The site ensures families planning to discontinue or close from services have a well-thought-out transition plan.
Intent: When a family plans to leave HFA services(due to HFA service completion,graduation,transition to a different
service provider in the community, planned move out of the service area, etc.), transition-planning efforts
involving the family,Family Support Specialist,and Supervisor will be made to ensure a successful transition.
Please Note:All parties do not have to be present at the same time to develop the plan.While the decision
to develop a transition plan is based on the wishes of the family(the family may decline),the site is expected
to be strongly proactive with respect to transition planning.To increase the likelihood that needed supports and
services will be accessed after service closure,the site takes the initiative to explore suitable resources,contact
service providers.and follow-up on the transition plan,as appropriate,when possible.and with the permission
of the family,ensuring appropriate informed consents are signed. Whenever possible, sites are to allow for
sufficient time to ensure needed services will be planned for and accessed after HFA services end.Typically,this
process may take 3-6 months prior to the transition.
4-4.A The site has policy and procedures specifying the activities related to service closure and transition planning for
families who have a planned closure and provide notice of such to the Family Support Specialist at least three
months prior to closure(circumstances leading to an unplanned or unexpected closure,or a planned closure with
less than three months'notice would not be held to the standard,though the site is encouraged to provide as much
support as possible in these situations).The activities include the following:
•documentation of a transition plan that includes reason for planned closure and date the discussion was
initiated with the family(including if family declined need for a transition plan)
• the family, Family Support Specialist and Supervisor are involved,though not required to be present
at the same time
•sufficient time is allotted to conduct the plan(typically 3.6 months prior to transition)
•resources or services needed or desired by the family are identified
•steps are outlined to obtain any identified resources or services
• prior to closure the site or family (based on family preference)follows up with identified resources to
determine availability and assist with successful case closing transition
4-4.A RATING INDICATORS
= 3 No 3 rating indicator for 4-4.A.
2 The site has policy and procedures specifying the process for service closure and transition planning,including all
components identified in the standard.
The site does not yet have policy and procedures;or the policy and procedures do not yet include the components outlined
in the standard.
ITIP- Site should begin transitionplanning with families when the child months of age(when length of service is 3
is 30
. . . Following discussion. .• of transitionplanning
resources/servicesshould be included in most discussions with the family at subsequent home visits,including identification of available
needed or desired. 90
4-4.8 The site utilizes transition planning,to support families with a planned closure from services.Download HFA Sample
Transition Plan in English and Soanis
4-4.8 RATING INDICATORS
3 The site conducts transition planning with families when there is a planned closure,and activities include all items
included in the standard.
2 Past instances may have occurred when transition planning activities as outlined in the standard were not conducted:
however,reco t prectice indicates the site conducts transition planning according to the standard: or there have
been no planned closures yet,or families with planned closure declined a transition plan.
t A transition plan for families with a planned closure is not yet offered or does not yet include all components identified in
the standard.
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v 4.Offer services intensely and over the long term,with well-defined progress criteria
and a process for increasing or decreasing intensity of service.
DocumentationStmKMrd Pre-Site
4-1.A I Policy- Submit Policy
Weekly Visits Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available.
4-1.8 1 Weekly Visits No documentation required pre-site.Peers will review documentation and interview staff,advisory
board members,and families on-site.
4-2.A I Policy- Submit Policy
Levels of Service Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available
Submit home visit completion report for the most recent quarter which includes:
All active families by FSS including level of service,level changes that quarter,number of expected
home visits that quarter and number of completed home visits that quarter(completed visits while
on Level 1 or 1P may include one parent group per month or one multi-disciplinary team member visit
per month when all requirements as stated in the intent are met).To calculate home visit completion:
1.Determine for each family over the course of a quarter the expected number of home visits(based
on level of service alone).
2.Count the number of completed visits(while family is on active service level)for each family
during the quarter.
4-2.113 1 Home Visit 3.For each family calculate:#2(completed visits)divided by 41(expected visits).
Completion Rate 4.Count the total number of active families.
5.Subtract from#4(total active families)the number of families who were on creative outreach for
the entire quarter.
6.Count the number of active families who received at least 75%of expected home visits.
7.Program HVC rate is calculated by taking#6(number of active families who received at least 75%
of visits)divided by#S(active families-minus CO entire quarter).
Please Note:An HFA Spreadsheet is available for this standard.
This is a threshold standard,meaning to be in adherence a minimum threshold has been established
(75%in this case).When the site's annual data in the self-study falls below this threshold.Peer
Reviewers or Panel will request more recent data.
4-2.0 I Level No documentation required pre-site.Peers will review documentation and interview staff,advisory
Changes in Supervision
Essential Standard board members,and families on site.
4-2.113 1 Level Changes No documentation required pre-site.Peers will review documentation and interview staff,advisory
with Families board members.and families on-site.
4-3.A I Policy- Submit Policy
Services for Minimum
of Three Years Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available
Submit a report indicating the current number of families who have been enrolled for 3 or more
4-3.6 1 Services years.If families graduate after three years of service.provide a report indicating all families who
Provided For 3-5 Years have graduated within the last year,excluding any who meet criteria for HFA Accelerated and
successful completion earlier than 3 years.
4-4.A I Policy- Submit Policy
Transition Planning Please note:HFA Sample Policies and Procedures and Policy and Procedure Checks st are available
4-4.B I Transition No documentation required pre-site.Peers will review documentation and interview staff,advisory
Planning board members,and families on-site.
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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,
increase access to services and achieve
greater equity in service delivery, especially
for underrepresented groups in the
community, confronting disparities caused
by systemic oppression, institu i a raci
and discriminat'
�a
Standard 5 ensures each site is intentional in its efforts to promote
equity in all facets of operations with families,staff,and community.
Doing so compels an honest look at existing flaws, individually
and systemically, exposing and resolving blind spots previously
unrecognized.
This level of intentionality allows us to listen and learn from the lived
expertise of others, and to recognize how implicit bias and power
imbalance impair authentic relationships. By examining and gaining
greater clarity related to the causes of these and other challenges
associated with long-standing health and social disparities, we are
more likely to effect change through our advocacy, allyship, and
meaningful dialogue with one another.
This work is hard, complicated, and at times uncomfortable. There
is no quick fix and no one is exempt. It requires sustained, long-
term, individual and organizational commitment. It is a unique and
continuous journey we all must engage in. It involves an ongoing
commitment to increasing one's self-awareness.
i policies,
g policies,personnel policies, guidance.
94
0 5-1. Through policy(or other written guidance)and practice.the site supports staff's ability to continually strengthen the skills
a required for authentic relationships,including self-awareness,self-regulation,self-reflection,skilled listening,and empathy.
0
a Intent: Taking an honest and reflective look inward increases awareness and understanding of our biases,offering us
an opportunity to be intentional in our efforts to counteract these.Being afforded safe space in supervision,team
meetings,and peer-to-peer interactions enables greater likelihood for honest,respectful,and brave conversations.
Recognizing the distinction between intent and impact,as well as the importance of repair,facilitates stronger
relationships.These are the building blocks upon which growth and change become possible.
Samole Team Commitments/Ground Rules are available.
5-1.A The site has policy or other written guidance expressing the site's commitment to respectful staff interactions and
supporting staff to continually strengthen their relational skills focused on diversity,equity.and inclusion.
5-1.A RATING INDICATORS
= 3 No 3 rating indicator for standard 5-1.A.
2 The site has policy and procedures.or other written guidance,including team commitments or round rules regarding:
� P Y P 9 9 9 9 9
1)expectations for staff interactions.and 2)professional development and supervision expectations,to ensure staff have
the resources needed to continually strengthen their relational skills as mentioned in standard 5-1.
The site does not yet have policies and procedures,or other written guidance,as stated above.
5-1.13 The site's practices support a respectful team environment and staff ability to continually strengthen their relational skills.
5-1.6 RATING INDICATORS
0 All Staff are aware of the site's policies,or written guidance,an.i are able to describe-fforts they have undertaken to
strengthen their relational skills,and multiple mechanbms have been acted on to sippurt a respectful team environment.
All staff are aware of the site's policies.or written guidance,and the majority of staff are able to deserlbe efforts they
have undertaken to strengthen their relational skills,and at least one mechanism has been acted on to support a respectful
team environment,
All staff are not yet aware of the site's policies or written guidance; or a majority of staff are not yet able to describe
efforts they have undertaken to strengthen their relational skills;or there have not yet been any mechanisms acted on to
support a respectful team environment.
supportTIP: There are many mechanisms to
0 supervisors play an instrumental role in creating a team culture supportive of self-learning and group exploration
within a safe environment.This can happen through individual supervision, shadowing, team meetings, creating
shared agreements,etc.Additionally. staff surveys.staff goal setting, and performance reviews are more formal
ways to obtain staff input and support staff development.
95
5-2. Through policy(or other written guidance)and practice,the site supports development of a partnership with families
that honors diverse family structures and the sources of strength derived from family cultures,values,beliefs,and
parenting practices. Practice also recognizes the historic and current relevance of discrimination based on race,
ethnicity.gender identity,sexual orientation,age,religion,and abilities and seeks inclusivity in all aspects of its work
with families.
Intent: Cultural humility is not what one knows of another person's culture, though a certain level of foundational
knowledge can be helpful.It is instead how we are in allowing another person to share their own story which
reflects their identity,experiences,background,values,and beliefs.Allowing parents to teach us of their culture,
and being observant and accepting of behaviors,attitudes,and beliefs that may be different from our own,
reduces the risk of making faulty assumptions, and helps us evolve as individuals with appreciation for our
common humanity.
Direct service staff observe cultural differences and use them as a springboard for inquiry and understanding,
asking families about particular behaviors and practices. Family background and ethnicity influence value
systems, how people seek and receive assistance,and communication style among other things. When staff
express curiosity with open-ended questions,are non-judgmental,refrain from imparting their own belief and
value systems,and seek to repair relationships when missteps occur,families and staff have an opportunity to
grow and develop.
5-2.A The site has policy or other written guidance expressing the site's commitment to interact with families in a
partnership that honors diversity and inclusivity and elevates family voice.
5-2.A RATING INDICATORS
3 No 3 rating indicator for standard 5-2.A.
2 The site has policy and procedures,or other written guidance,describing the site's intention and expectations for engaging
� P Y P 9 9 P
with families in a partnership that honors diverse family structures and seeks inclusivity in all aspects of its work,and
elevates family voice.
1 The site does not yet have policy and procedures.or other written guidance,as stated above.
5-2.13 The site's practices engage families in partnership,elevating family voice and honoring family diversity.
5-2.13 RATING INDICATORS
3 All staff are aware of the site's policy,or written guidance,and are able to describe efforts they have undertaken to work
together in partnership with families,elevating family voice and honoring diverse family structures,values,beliefs,and
M parenting practices-
2 All staff are aware of the site's policy,or written guidance,and the majority of staff are able to describe efforts they have
undertaken to work together in partnership with families.elevating family voice and honoring diverse family structures,
values,beliefs,and parenting practices.
■
All staff are not yet aware of the site's policy or written guidance:or a majority of staff are not yet able to describe efforts
= they have undertaken to work together in partnership with families,elevating family voice and honoring diverse family
structures,values,beliefs,and parenting practices.
96
0 5-3. The site works at the community level,through policy and practice,and with guidance from its community advisory
a board,as a champion for families and children,advocating forjust and equitable opportunities within the community,
i and increasing access to services and supports for those it serves and employs.
a
^ Intent: Racial and ethnic minorities, and other underrepresented groups, face barriers in accessing services within their
communities.Organizations within communities have a responsibility to utilize their influence and decision-making
in ways that identify and address structural inequities brought about by privilege and discrimination.This includes
actions taken both internally(in support of the organization)and externally(in support of the community).
Additionally, it is the site's responsibility to identify major cultural groups within the community, determine
groups currently underserved,and prioritize hiring staff who represent these groups and can provide support
in the family's preferred language.Sites will also make sure that.in addition to staff,graphics and materials are
representative of the community.
5-3.A The site,and/or organization,has policy or other written guidance expressing its commitment to advocating at the
community level to address barriers and promote equity for those it serves and employs.
5-3.A RATING INDICATORS
= 3 No 3 rating indicator for standard 5-3.A.
2 The site,and/or organization,has policy and procedures,or other written guidance,reflecting how it advocates at the
community level and with its community advisory board to identify and address existing barriers, increasing equitable
access to services,ensuring diverse representation in staff and materials.and meeting the cultural and language needs of
those it serves and employs.
The site does not yet have policy and procedures,or other written guidance,as stated above.
5-3.13 The site's practices demonstrate its commitment to working at the community level to address barriers and promote
equity for those it serves and employs.
5-3.13 RATING INDICATORS
3 Site leadership and community advisory members are aware of the site's policy,or written guidance,and can describe
multiple efforts undertaken at the community level to identify and address existing barriers,increase equitable access to
M services.ensure diverse representation in staff and materials,and/or meet the cultural and language needs of those it
serves and employs.
Site leadership and community advisory members are aware of the site's policy,or written guidance,and can describe at
least one effort they have undertaken to identify and address existing barriers,increase equitable access to services,ensure
diverse representation in staff and materials,and/or meet the cultural and language needs of those it serves and employs.
Site leadership and/or advisory members are not yet aware of the site's policy or written guidance:or a majority of staff
are not yet able to describe at least one effort undertaken to identify and address existing barriers,increase equitable
access to services,ensure diverse representation in staff and materials,and/or meet the cultural and language needs of
those it serves and employs.
TIP: Sites are encouraged to include questions on employee satisfaction surveys related to equitable personnel oractices,
including hiring.promotions or other advancement,and performance evaluations.
97
5-4. The site gathers information to reflect on and better understand issues impacting staff and families served and to
examine the effectiveness of its equity strategies. These strategies will vary from year to year and are based
on family and staff input received and what the site has learned from implementing standards 5-1, 5-2, and 5.3.
Family engagement and retention data,and staff engagement and retention data may also be used.
5-4.A The site starts by gathering information,ensuring parent/caregiver voice and staff input is obtained and used to improve its ability
to provide culturally respectful and responsive services as referenced in standards 5-1,5-2 and 5-3.
Intent: It is critical for sites, in their efforts toward continuous quality improvement, to receive and utilize feedback from
families and staff.When families and staff provide their observations and experiences,it can help point out areas
which would benefit from additional training or support,as well as highlight particular areas of strength or staff skill,
and help identify ways in which the site can advance its work to achieve greater equity in service delivery and systems
change.Families and staff may provide input in a variety of ways,e.g.,through the use of a satisfaction and cultural
humility survey for currently enrolled families,post-service questionnaires or interviews,service on the community
advisory board,family advisory committee,focus groups,etc.
5-4.A RATING INDICATORS
3 The site obtains input from currant and former families and staff that helps the site understand how it is doing with
implementation of standards 5-1,5-2 and 5-3.Input is sought at least once annually.
= 2 The site obtains input from Current families and staff that helps the site understand how it is doing with implementation
of standards S-1.5-2 and 5-3 Input is sought at least once annually.
1 The site does not yet obtain input from current families and staff to help the site understand how it is doing with
implementation of standards 5-1,5-2 and 5-3, or the site has not yet sought input at least once annually.
candidTIP: Staff surveys should be offered to all site staff,and ideally responses should be obtained by all,protecting worker
anonymity to encourage feedbackbe
ensured.cross-department or organization-wide surveys may be a better option.
98
a 5-4.B The site makes meaning of the information it collects and develops an equity plan based on what the site learns about itself,
from an equity perspective,in the way it supports its staff.the families it serves,and the community it works within.
L The equity plan sets a course for continuous improvement to achieve greater equity in all facets of its work.
a
^ Intent: Taking time to thoughtfully review the information gathered from staff and families demonstrates respect and value
for what has been shared.assists the site in focusing on particular areas where there is opportunity for growth,and
provides the site an opportunity to reflect on the progress it is making to promote equity.The meaningful identification
of growth opportunities is the basis of the site's equity plan.which also summarizes strengths and challenges,along
with any patterns or trends noted over time.The equity plan provides an opportunity to identify strategies to combat
implicit bias.address barriers to equitable service delivery,and work to dismantle the causes of disparity and inequity.
5-4.B RATING INDICATORS
3 The site has an equity plan that incorporate<_ _ summary of family and staff input obtained in 5-4.A,along with ,,hat it
learns by
aorrfplatkg a formal 598Ssmiard tool related to diversity,equity,inclusion,and belonging(DEIB). Strategies
M are based on what it learns from this information
2 The site has an equity plan that incorporates a summary of family and staff input obtained in 5-4.A,-,i id strategies are
� based on what it learns from this information.
Any of the following:there is no equity plan:the equity plan aces not yet incorporate a sjmmary of family and staff input
obtained in 5-4.A,or strategies are not based on family and staff input.
Note: This is an Essential Standard.
I obtain information in ways that yield more meaningful lessons
learned can also. .. part of an equity plan.
I DEIB focused . .
choose the one that will work best for them.HFA provides links to a few different options to consider.
5-4.0 The site's equity plan is reviewed and updated at least once annually to reflect progress associated with the
strategies identified in it. Revisions and new strategies are included when appropriate based on lessons learned
and new input received annually from staff and families. Regular focus on the equity plan is intended to foster
growth and increased capacity to promote equity.
Intent: A site continually reviews and improves its service delivery system by integrating information learned. It can be
difficult to self-identify gaps and determine strategies. This is why it is important to seek the perspective and
assistance from staff and families on an ongoing basis.
5-4.0 RATING INDICATORS
= 3 The equity plan is reviewed and updated at least once annually by site staff and the Coff#YNX ty advisory board.Equity
strategies are updated and revised based on feedback received annually from staff and families(5-4.A)and lessons learned.
III 2 The equity plan is reviewed and updated at least once annually by site staff.Equity strategies are updated and revised
based on feedback received annually from staff and families(5-4.A)and lessons learned-
1 Any of the following:there is no equity plan:or the equity plan has not yet been reviewed or updated at least once annually:
or equity strategies are not yet updated and revised based on feedback received annually from staff and families(5-4.A)and
lessonslearned.
99
Tables of • •
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.
Standard Pro-Site Documentation to Include In Self Study
5-1.A I Policy-
Submit Policy
Staff Interactions Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available.
Sample Team Commitments/Ground Rules are available
5-1.13 I Staff Interactions No documentation required pre-site.Peers will review documentation and interview staff,advisory
board members,and families on-site.
5-2.A I Policy- Submit Policy
Family Partnership Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available
5-2.B I Family No documentation required pre-site.Peers will review documentation and interview staff,advisory
Partnership board members,and families on-site.
5-3.A I Policy- Submit Policy
Community Level
Advocacy Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available
5-3.B I Community No documentation required pre-site.Peers will review documentation and interview staff,advisory
Level Advocacy board members,and families on-site.
5-4.A I Family& Submit a narrative summary of most recent efforts to obtain meaningful feedback from parents/
Staff Input caregivers and staff.Include a summary of findings:summarize patterns and trends,strengths
and challenges.
5-4.13 I Equity Plan Submit the most recent organizational self-assessment and equity plan.
Essential Standard Please note:Sample of organizational self-assessments available
5-4.0 I Advisory Input Submit notes to illustrate review of the Equity Plan.Please highlight updated strengths and strategies
Regarding Equity Plan based on feedback received from staff and lessons learned.If identified strengths and strategies are
documented elsewhere,submit relevant supplemental documentation.
100
0
Q
Z
a
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.
t� r
t
1
Standard 6 Intent is to reduce risk factors and build protective
factors,ensuring site staff provide services that are family-centered
and growth oriented; supporting parents in nurturing their children;
setting meaningful goals; and enhancing health, development, and
family functioning.
HFA employs an infant mental health approach in which services
are relationship-focused, strength-based (building on parental
competencies), and culturally respectful and responsive, and are
anchored to the parallel process.
Healthy Families sites serve many families who are struggling
with issues including substance abuse, intimate partner violence,
developmental delay in parents, depression, and other mental
health challenges,some of which may be an effect of early childhood
trauma, multiple other life stressors, and institutionalized racism
and systems of oppression that have limited equitable access to
financial stability, housing stability, quality education, employment
opportunity, health care, transportation, and nutrition. In order to
address these challenges, site staff: 1) form healthy relationships
with parents, 2) apply a strength-based approach that includes
being honest when parents are responding to their environment
in ways that may cause harm to themselves and their children,
3) accept families where they are, without judgment or bias, 4)
build on parental competencies, and 5) focus on learning about
the individual's lived experience and means of coping versus
judging behavior as "right or wrong." These principles are core
HFA components.
102
0 6-1. Risk factors and stressors identified in the FROG Scale.as well as risk factors that emerge later in the course of services
a (when not disclosed or present initially),are addressed during the course of services utilizing a Service Plan.The Service
z Plan is developed by the supervisor and Family Support Specialist and includes a focus on budding protective factors.
v Practice demonstrates the Service Plan is being implemented.
Download HFA Service Plan Materials.Please Note:HFA's Service Plan template can be modified by the site without
approval and an alternate Service Plan format can be created if desired.It is the responsibility of the site to ensure
a uniquely developed Service Plan meets the documentation requirements.
Intent: A well-constructed Service Plan is the cornerstone of home visiting services that are effectively organized and
coordinated and is based on each family's unique strengths and areas of concern.The purpose of a Service Plan is
to operationalize the family"story"into a"road map"that supports Family Support Specialists in their ongoing and
long-term work with the family and is the mechanism by which supervisors document their clinical support to staff
that is specific to each family.
A Service Plan is fluid and dynamic in order to remain relevant to the family as changes to family systems.circumstances,
and dynamics occur over time.As such,service priorities also are likely change over time and a Service Plan helps to
manage and"visualize"the complexity of change and the re-prioritization of activities that result.A Service Plan
ensures issues identified by the family can be systematically addressed and supported in partnership with parents,
without interfering or compromising the family's choice in regard to goals they are motivated to achieve.Family goal
setting is a distinct and separate activity and is discussed in Standards 6-2.
103
6-1.A The site has policy and procedures describing the review of each family's strengths and stressors as identified in the FROG
Scale, as well as parent-child interaction/attachment concerns and challenging issues identified subsequent to
administration of the FROG Scale(i.e.,substance abuse,intimate partner violence,parent's cognitive impairment,and
mental health concerns).
Policy and procedures include the Supervisor and Family Support Specialist working together to develop an HFA Service
Plan with activities to address these issues over time and to build protective factors. Procedures also include the
prioritization of these activities to support them being carried out successfully without overwhelming staff or the family.
Download HFA Service Plan Materials.
Intent: Research clearly demonstrates that past trauma and untreated disorders can have serious consequences for
early learning,social competence,and lifelong health.Family Support Specialists are not counselors or therapists:
however, the incredibly therapeutic nature of the partnership formed with parents cannot be overstated. The
most important role as it relates to supporting the challenges parents face is to listen,acknowledge,and support
the parent(s).Additionally,Family Support Specialists play an important role in:
•providing an atmosphere of safety and acceptance
•keeping the baby and the parent-child relationship at the center when helping parents recognize the impact of
various challenges
•providing honest feedback with parents'permission
•pointing out discrepancies between stated values and actual behavior
•encouraging forward thinking(i.e.,assist parent in developing a vision of what they want)
• providing information and referrals in a way that helps parents bridge the fear or uncertainty of accessing
additional services
•using motivational interviewing(when trained on this technique)
When supporting families with challenging and complex issues,a Service Plan helps staff work with intention
and can help staff focus on incremental progress being made despite at times feeling"stuck."
6-1.A RATING INDICATORS
= 3 No 3 rating for 6-1.A.
2 The site has policy and procedures regarding the review of each family's risk factors and stressors as identified in the
FROG Scale,as well as parent(s)challenging issues(i.e.,substance abuse,intimate partner violence,cognitive impairment,
and mental health issues) identified subsequent to the administration of the FROG Scale. Procedures include 1) the
Supervisor and Family Support Specialist working together to develop a Service Plan which includes activities to
address identified issues and build protective factors, 2) the prioritization/pacing of such activities, and 3) the Family
Support Specialist and family working together on the implementation of these the activities during home visits initially
and during the course of services-
1 The site does not yet have policy and procedures:or the policy and procedures do not yet address all the requirements
listed in the 2 rating.
104
6-1.13 At the start of services,the Supervisor and Family Support Specialist review each family's stressors and strengths as
< identified in the FROG Scale.as well as parent-child interaction/attachment concerns(i.e..any item rated a 4 or less
z on the CCI is documented on the Service Plan to be addressed),and challenging issues(i.e.,substance abuse.intimate
a
y partner violence,cognitive impairment,or mental health issues)identified subsequent to the administration of the FROG
Scale.Together the Supervisor and Family Support Specialist develop a Service Plan and update it over time prioritizing/
pacing activities to address risk and build protective factors.
Intent: Supervisors and Family Support Specialists develop a Service Plan at the start of services based on the strengths
and concerns identified by families during the FROG Scale conversation, plus identifying activities to support
the family and build protective factors.To support the family and Family Support Specialist,there will also be
planning for the appropriate prioritization and pacing of these activities.
Activities reflect a thoughtful,purposeful discussion that assists the Family Support Specialist in understanding
how early childhood trauma and the stressors experienced by the family impact parenting. Discussions
acknowledge and build on family strengths(protective factors)and guide the Family Support Specialist's work
with the family.
6-1.113 RATING INDICATORS
= 3 The Supervisor and Family Support Specialist review and document in a Service Plan all the risk factors and stressors
identified in the FROG Scale. Challenging issues(i.e.,substance abuse.intimate partner violence,cognitive impairment,
M or mental health issues)identified subsequent to the administration of the FROG Scale are also documented,in addition
M to the pacing and prioritization of activities to address these issues and build protective factors with families initially and
M
during the course of services.
Past instances occurred when the Supervisor and Family Support Specialist did not review and document in a
Service Plan all the risk factors and stressors identified in the FROG Scale,or challenging issues(i.e.,substance abuse,
intimate partner violence,cognitive impairment,or mental health issues)identified subsequent to the administration of
the FROG Scale, or the pacing and prioritization of activities to address these issues and build protective factors with
families initially and during the course of services;however Pewit pre ke indicates this is now occurring.
The Supervisor and Family Support Specialist do not yet review and document in a Service Plan all the risk factors and
stressors identified in the FROG Scale;or documentation does not yet include challenging issues(i.e.,substance abuse,
intimate partner violence,cognitive impairment,or mental health issues)identified subsequent to the administration of
the FROG Scale;or documentation does not yet include the pacing and prioritization of activities to address risk factors
and build protective factors with families initially and during the course of services.
TIP: Activities to address
protective
ITIP: Many sites utilize components of • •nal interviewing.anchor to •. and dreams
build on parental strengths,offer decision matrices(pros and cons regarding making decisions),and other strategies
to support families in making healthy decisions about lifestyle.
ITIP: The FROG Scale is expected to be • • • by • •. • 2-I.A).It is recommended the initial
Service Plan be developed within 2 weeks of that visit (or sooner when the FROG is completed sooner)followed
by • update of each family's Service Plan once monthly for families on Level 1.IP,or SS,every other month
for families on Level 2,and quarterly for families on Levels 3 or 4.
105
6-1.0 The Family Support Specialist implements with the family over the course of services.the activities identified on the HFA
Service Plan in an effort to build protective factors and to address the stressors identified in the FROG Scale, as well
as parent(s)challenging issues(i.e.,substance abuse,intimate partner violence,cognitive impairment,or mental health
issues)identified subsequent to the administration of the FROG Scale.
Intent: The Family Support Specialist addresses with families the stressors identified in the FROG Scale over the course
of a family's enrollment in home visiting services, ensuring families are offered ongoing opportunities and
support to make positive healthy changes in their life.Utilizing a Service Plan ensures services are family driven
and tailored to each family's unique strengths,concerns,stresses,and priorities articulated by the family.It is
not expected a Family Support Specialist will discuss with the family all of the risk factors and stressors at one
time, or that the Family Support Specialist "enforce" behavior-change or issue-resolution prior to a family's
readiness to do so.
Implementation of the Service Plan is collaborative in nature,meaning family input and changing family dynamics
are incorporated.Supervisors and Family Support Specialists will update the Service Plan and clarify how the
issues that place families at-risk for poor childhood outcomes are addressed over time.The frequency of the
update to the Service Plan depends on the complexity of each family's situation, including risk factors and
challenging issues (i.e., substance abuse, intimate partner violence, cognitive impairment, and mental health
issues) that may emerge subsequent to the initial administration of the FROG Scale, all of which will be
incorporated into the Service Plan.Family Support Specialists will need access to or their own copy of the most
updated Service Plan.
Please Note.When the Family Support Specialist implements activities outlined on the Service Plan,the date
this occurred is documented on the Service Plan to ensure it is easy to reference the home visit record for the
detail on what the FSS did.
Please Noce:HFA has developed a document,"Procedures:Working with Families in Acute Crisis"which may be
helpful in clarifying staff roles and responsibilities for supporting families experiencing challenging issues.
6-1.0 RATING INDICATORS
M 3 The Family Support Specialist implements with families activities documented in a Service Plan.
2 Past instances may have occurred when the Family Support Specialist did not implement with families activities
documented in a Service Plan:however,resent prectke indicates this is now occurring.
= 1 The Family Support Specialist does not yet implement with families activities documented in a Service Plan.
Note: This is an Essential Standard.
106
0 6-2. Setting and achieving family goals builds a family's resiliency and promotes protective factors.The process of setting
< and accomplishing goals is family driven,and the process is more important than the product.
0
z
< Intent: Parents whose needs were not met in infant or who were raised with earl childhood trauma may be more
Y Y Y
focused on survival and may have a distorted perception of what they can accomplish in their lives.This can limit
their ability to think about the future and impact their feelings of self-worth. Therefore a family's ability to
develop and achieve goals can be life changing.The process is more important than the product,which means
the support of the Family Support Specialist and the Supervisor in the goal setting process is critical to family success.
Goal setting is a powerful activity for parents.When the activity is repeated often enough,it builds motivation
and increases self-confidence and self-determination.For many,it becomes an internalized and lifelong process.
That said, it is initially a new process for many families, making the encouragement from the Family Support
Specialist very important.
The purpose of the Family Goal process is to amplify parents' problem-solving skills, support their ability
to develop and implement options to improve their situation,and celebrate with them their successes in achieving
goals and objectives.The Family Goal process allows Family Support Specialists 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 Family Support
Specialist can assist
•develop opportunities for the family to experience success
•assist the family to identify and acknowledge their strengths
•celebrate success with the family
6-2.A The site has policy and procedures regarding the process of helping parents develop family goals throughout the course
of services.with new goals set as previous goals are accomplished or retired.
6-2.A RATING INDICATORS
= 3 No 3 rating for 6-2.A.
2 The site has policy and procedures regarding the development and review of meaningful family
� y p g g p g y goals,including:
•goal setting as an activity throughout the course of services with new goals set as previous goals are accomplished or retired
•projected dates for accomplishing the goal
•identifying family strengths to support goal achievement
•celebration of goal achievement
•FSS and supervisor support of the family goal process
The site does not yet have policy and procedures:or policy and procedures do not yet address the requirements listed in the 2 rating.
r
.l
107
6-2.13 The Family Support Specialist supports the family insetting and achieving goals that are meaningful to the parent.
Please Note: It may take up to 3 months after the initiation of home visiting services for a family to be ready to
set a goal:however, once an initial goal has been set and achieved.families will repeat the process of setting new
goals throughout the course of services.
Intent: The Family Support Specialist invites the family to develop meaningful, manageable goals. There is a clear
conversation to support parents in feeling competent, capable, and hopeful in being able to make positive
changes in their own lives. Breaking larger goals into small goals assists parents in developing problem-
solving skills,increases their sense of power over their situations,and supports adult brain development.Steps
are incremental, measurable, and functional for the family. The focus is not on how many goals families
accomplish; rather,it is entirely related to the skills parents build in the process of developing and working on
goals,and especially in the celebration when there is success in making progress and achieving goals.
The goal setting process is 100%family-driven based on what the parent wants, needs,or dreams about.The
process supports parental self-efficacy, enhances family functioning,and builds protective factors.The more
success a family has, the more they change their world view. Helping families identify the strengths and
competencies they have to address the goals they set develops critical thinking and problem-solving skills and
promotes protective factors.
6-2.13 RATING INDICATORS
3 The Family Support Specialist supports the family to have a goal with a projected date for accomplishing the goal,
and helps the family identify strengths and resources specifically related to accomplishing the goal. Family Support
= Specialists support families in achieving their goals,celebrate successes,and help parent(s)develop new goals when the
previous goal is accomplished or when a goal may no longer be relevant to the family.
2 Past instances were found when the Family Support Specialist did not support the family to have a goal with a projected
date for accomplishing the goal:or did not identify family strengths and resources;or did not support families in achieving
their goals,celebrate successes,and help parent(s)develop new goals when the previous goal is accomplished or when
= a goal may no longer be relevant to the family:however,reowt practice indicates the site is now consistently applying
these practices.
1 Any of the following:the Family Support Specialist does not yet support the family to have a goal;or does not include a projected
date for accomplishing the goal:or does not yet identify family strengths and resources specifically related to supporting parents
in accomplishing the goals;or does not yet support the family in achieving their goals,celebrate successes,and help parent(s)
M develop new goals when previous goals are accomplished or when goals may no longer be relevant to the family.
Note: This is an Essential Standard.
I goal setting process takes time. Sites may use moreone •• or • develop goals
goals.achieve the
TIP: Identification of strengths and needs may be ongoing.Documentation of these conversations may be found in home
visit notes.or in the tools each site uses to talk about strengths and needs with families(including tools provided in
HFA Core training such as the Values Clarification activity or What I'd Like for My Child), or in actual family goal
sheets.Sites are encouraged to articulate in their policy and procedures which tools are used to identify strengths.
Exploring the .. parents
supportfor change. Additionally. sites offer families an opportunity to explore their strengths and consider how these
strengths can parent goals.
I For planned • •. •4-4),the required transition plan may be accomplished on the same
happenform used to document a family's goal.In this case the goal would be related to what the parent would like to see
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6-2.0 The Family Support Specialist and Supervisor review family goal progress on an ongoing basis.
Intent: In order to support growth in families.supervisors and Family Support Specialists review the progress families
are making towards the achievement of their goals.The supervisor and Family Support Specialist collaborate to
ensure the goals for families are current,challenges to achieving goals are addressed,and accomplishment of
each step/objective is celebrated.Additionally,the supervisor brainstorms with the Family Support Specialist
any barriers being faced regarding development of family goals with families and supports the Family Support
Specialist in increasing the quality of the family goal process.
6-2.0 RATING INDICATORS
= 3 The Family Support Specialist and supervisor review family goal progress on an ongoing basis,ensuring families have a
current goal.Family Support Specialists are supported to help problem-solve any challenges,and successes are celebrated.
2 Past instances were found when the Family Support Specialist and supervisor did not review family goal progress on an
ongoing basis; however,r9cwt practice indicates the site now ensures this occurs,families have current goals, Family
Support Specialists receive support to help problem-solve any challenges,and successes are celebrated.
The Family Support Specialist and supervisor do not yet review family goal progress as indicated in the 2 rating.
TI P: Intervals for reviewing the family goal progress during supervision will vary based on a variety of factors.including
family needs pertaining to a particular goal.the projected date for goal completion,and/or visit frequency,
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6-3. The site assesses, addresses.and promotes nurturing parent-child interaction,attachment and bonding, and the
development of sensitive.responsive parent-child relationships.
Intent: The promotion of parent-child relationships is a primary HFA goal. Many parents in HFA have experienced
significant early childhood trauma that can impact their ability to be emotionally present for their children.
Parents who themselves have experienced early childhood trauma often struggle in being responsive and
available to their children, distort emotional content in their relationships with others and have a restricted
ability to utilize cognitive reasoning until their own basic needs for safety and trust are met.HFA Family Support
Specialists are trained to use an infant mental health approach which supports the formation of a dyadic alliance
between the parent(s) and the Family Support Specialist and provides an effective strategy to mediate
successful parenting.This parent-worker alliance provides the parent with an experience of a strong and healthy
relationship and facilitates the strengthening of the parent-child relationship through the parallel process.
Utilizing an infant mental health approach reinforces that child development occurs within the context of the
parent-child relationship.
6-3.A The site has policy and procedures requiring the use of CHEERS and indicating how the staff will partner with
parents to assess, address. and promote nurturing parent-child interaction (PCI). attachment. and bonding. Site
policy also includes the role of supervisors to support Family Support Specialists in the use of CHEERS, and that
the validated CHEERS Check-In(CCI)tool will be administered at least twice annually.
Intent: Sites develop clear policy and procedures for how Family Support Specialists will assess parent-child
relationships using CHEERS. Site policy also indicates how Family Support Specialists will partner with
supervisors to develop plans for increasing nurturing parent-child interactions, beginning prenatally (when
services are initiated prior to birth). Policy and procedures include the use of the strength-based reflective
strategies introduced in HFA's Foundedons Core bVil p. Policy also includes expectations related to 1)
documenting CHEERS on each home visit.2)the reflective strategies used,curriculum material shared,or visit
activities completed to address concerns and promote positive PCI,and 3) use of the CCI tool at least twice
annually.It is expected the parent-child relationship is observed and discussed each visit.
6-3.A RATING INDICATORS
= 3 No 3 rating indicator for standard 6-3.A.
2 The site has policy and procedures regarding the use of CHEERS including when and how Family Support Specialists
= will partner with parents to assess, address concerning parent-child interaction, and promote nurturing parent-child
interaction(through use of reflective strategies,visit activities,and curriculum material).Site policy also includes the use
of HFA's Cheers Check-in (CCI) tool at least twice annually, and the role of the supervisor to support Family Support
= Specialists with CHEERS assessments and interventions.
0 1 Any of the following:the site does not yet have policy and procedures.or the policy and procedures do not yet require the use of
= CHEERS,including when and how Family Support Specialists partner with parents to assess,address concerning parent-child
interaction,and promote nurturing parent-child interaction(through use of reflective strategies and curriculum material):or the
policy does not yet include the use of HFA's Cheers Check-In(CCI)tool at least twice annually:or the role of the supervisor to
r
support Family Support Specialists with CHEERS assessments and interventions.
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0 6-3.13 The site assesses parent-child interaction.attachment,and bonding with families,utilizing CHEERS on all home visits.
a
z Intent: HFA requires CHEERS be used as a parent-child observation strategy during each home visit,with the exception
N of when the FROG Scale is being administered,or when the CHEERS Check-In tool is administered.A minimum
of two domains of CHEERS is documented for all home visits(including virtual visits)based on observation or
parent report(the focus is on quality over quantity of domains documented).It is also expected that any group
session being counted as a home visit(1 per month allowed while a family is on Level 1 or 1P)will include some
documentation of CHEERS.
HFA supports the concept of the strength-based approach with families; however, because of the strong
relationships staff develop with families,the intent of"strength-based"may be distorted.This can lead to only
positive interactions being recorded in documentation. In addition to seeing the strengths, capacities, and
resources of parents related to attachment.observations and documentation must also be honest,and reflect
the experience of the full home visit. Therefore, observations and documentation through CHEERS provide
factual description of parent-child interactions.Only documenting positive PCI limits the FSS's capacity to have
impact on creating nurturing attachment relationships.
Supporting the use of CHEERS is analogous to supporting use of the Ages and Stages Questionnaire(ASO-3).
Staff would not record a child being able to accomplish a developmental task just because he is really trying
hard or when a skill is emerging.Instead,the staff would support the parent by offering more practice,sharing
child development information/curriculum,or referring for early intervention services.The same is true about
parent-child interaction.When a parent is not able to respond to their child in a consistently safe,predictable,
comfortable,or pleasurable manner,supporting parent-child connections by using a reflective strategy is critical.
When reflective strategies are used well,parents feel supported,capable,and competent.
6-3.6 RATING INDICATORS
= 3 Family Support Specialists partner with parents to assess parent-child interaction, attachment, and bonding with all
families,utilizing CHEERS on all home visits,with the exception of when the FROG Scale or CCI tool is used on a particular
M visit.At least one domain of CHEERS is documented in the second trimester of pregnancy beginning at 24 weeks gestation,
and at least two domains of CHEERS are documented in the third trimester and for all families throughout the time they
are enrolled(with the exception of home visits where the FROG Scale or CCI tool is administered).
Past instances were found when the Family Support Specialist did not partner with parents to assess parent-child
interaction, attachment,and bonding with all families utilizing CHEERS; however, reoent praCtim indicates this is now
occurring(including at least one domain of CHEERS for prenatal families in the second trimester,and at least two domains
of CHEERS for prenatal families in the third trimester and for all families throughout the time they are enrolled(with the
exception of home visits where the FROG Scale or CCI tool is administered).
Family Support Specialists do not yet partner with families to assess parent-child interaction,attachment,and bonding with all families
utilizing CHEERS as specified in the 2 rating.
Note:This is an Essential Standard.
domainsTIP: When less than all six
domains on subsequentdomains
I prenatal and postnatal • sheet for • prompts an• space to document
requirements of 6-3-B and 6-3-C-
ITI P: Promotion of •. • relationship begins
before Birth prenatal training and parenting materials is encouraged.
III
6-3.0 The site addresses concerning parent-child interaction and promotes nurturing parent-child interaction.attachment,
and bonding with all families based on observations made using CHEERS.
Intent: Sites document observations of parent-child interaction and how these observations are used to develop and
implement home visit activities and strength-based interventions to promote nurturing parent-child interaction.
It is helpful for staff to document how they build on parental competences and promote healthy relationships in
a thoughtful way(e.g.,if parents struggle to understand what their baby is communicating to them,the Family
Support Specialist might use Strategic Accentuate the Positive(SATP) when they observe the parent being
empathic,thereby building the parents' skills).Other sites may capture video to promote parental sensitivity,
understanding, and secure attachment. As above, it is important to document parental competencies and
struggles and what the Family Support Specialist is doing (e.g.. through use of reflective strategies, use of
curriculum activities,etc.)to promote and support the parent-child relationship.Accentuate the Positive(ATP)
is used for promotion of parent-child interaction.the other reflective strategies are used to address concerns in
regard to parent-child interactions.
6-3.0 RATING INDICATORS
3 Family Support Specialists address PCI concerns and promote nurturing parent-child interaction,attachment,and bonding
with all families based on CHEERS observations.
2 Past instances were found when the Family Support Specialist did not address PCI concerns and promote nurturing
parent-child interaction,attachment,and bonding with all families utilizing CHEERS:however,recant practice indicates
this is now occurring.
Family Support Specialists do not yet address PCI concerns and promote nurturing parent-child interaction,attachment,and bonding
with all families utilizing CHEERS.
Note: This is an Essential Standard.
6-3.113 The site utilizes the CHEERS Check-In(CCI)tool at least twice annually during each year of the child's life from birth
through thirty-six(36)months.
Please Note:Any item rated a 4 or less on the CCI will be documented on the Service Plan to be addressed. Items
rated as 5 are to be strengthened and items rated 6 or 7 are to be promoted.All currently enrolled families,including
those on levels CO,TO,and TR are included in the calculation.If the primary caregiver declines tool administration,
in which case they are exempted from the calculation; however,the refusal must be documented on the tracking
form.An HFA Spreadsheet is available for th,s standard.
Training on the CHEERS Check-In(CCI)is required for Standard 10-6.A.
6-3.13 RATING INDICATORS
= 3 The site uses the CHEERS Check-fn tool during home visits and at least 90%of all focus children(including each child
when multiples)are screened a minimum of twice per year of the child's life from birth-36 months.
2 Past instances were found when the site did not use the CHEERS Check-In tool with at least 90%of focus children a
minimum of twice per year of the child's life from birth-36 months:however this is now occurring during home visits and
at least 90%of focus children have one CCI screen completed In the last six months.
' Any of the following:the site does not yet use the CHEERS Check-In tool:or less tnan 90%of focus children up to age 36 months have
had the CCI tool completed at least once in the last six months.
VTIP: ThL CCI tool can be used beyond age 3.It is validated for children ages 2 months to 49 months and can also be
used between 49 and .0 months if desired.
TI P: Tip:Suggested CCI intervals in the first year of life are 1)between 4-6 months and 2)between 8-10 months.
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6-3.E Supervisors support Family Support Specialists to assess parent-child interaction (through use of CHEERS), address
concerns,and promote secure attachment and the development of nurturing parent-child relationships.
Intent: Supervisors are critical in developing and maintaining a clear focus on parent-child interaction and attachment.
It is the supervisor's role to partner with staff to ensure CHEERS is used to develop reflective strategies to
increase secure attachment experiences during weekly supervision. The supervisor's documentation will
reflect how they support staff's use of CHEERS.Supervisors do not need to restate the PCI observed on the visit,
as this will be documented in the home visit record.
6-3.E RATING INDICATORS
3 Supervisors support staff to assess parent-child interaction, address concerns, and promote strengths of parent-child
interactions with all families utilizing CHEERS.
2 Past instances were found when the supervisor did not support staff to assess parent-child interaction,address concerns,
and promote the strengths of parent-child interaction with all families utilizing CHEERS:however,raant pracdo indicates
this is now occurring.
1 Supervisors do not yet support staff to assess parent-child interaction,address concerns,and promote the strengths of parent-
child interaction with all families utilizing CHEERS.
Note: This is an Essential Standard.
I domains of CHEERS are assessed on •me visit.the supervisorsupport
assessing different domains on subsequent visits so that over the course of a few visits.all domains are assessed.
I be supportive to Family Support •• supervisors to write up CHEERS with staff immediately
following a shadowed home visit,providing feedback on observations and what to include in each domain(helping
to focus on the facts of observation
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6-4. The site shares information(e.g. credible source parenting materials, evidence-informed curriculum)with parents
to promote healthy child development,nurturing parent-child relationships,parenting skills.and health and safety
practices with families.
Intent: Materials shared with parents are used with intentionality and a strength-based approach that builds on parental
capacity and in response to parent-child interests and observations made by the FSS.Fact-based materials help
Family Support Specialists provide anticipatory guidance, and supports parents in thinking about what their
baby's next phase of development will be and how they can support this development.
When a parent has endured early childhood trauma,it is important for the Family Support Specialist to spend
time with the parent to listen to what the parent is thinking,feeling,and experiencing before presenting reading
materials or activities.It is only when the parent feels safe and supported that they can begin to absorb this type
of information. Including parents in the discovery of their child's development by asking parents what they
have noticed about their baby as related to the specific child development topics, before sharing specific
information, is highly recommended.
The key to successful use of handouts and activities is tied most closely to how the materials are used with
families versus what materials are used.Sites use materials that are culturally respectful.supported by research,
and in response to parent and child needs versus the primary focus of each home visit as they represent just
one piece of a comprehensive approach to working with families. The primary focus of each visit is on the
relationship between parents and child.Over-reliance on parenting materials distracts from this primary focus
and from the ability to be fully observant,attuned.and responsive to these relationship dynamics.
Parenting materials and evidence-informed curriculum contain a variety of components which include:
• information on how to promote nurturing parent-child relationships(e.g., makes parents unique to this baby,
supports the development of empathy,focuses on experience versus what is"right or wrong,"anchors baby's
current behavior to future development,builds parental self-esteem,encourages parents to have fun playing
with their baby.etc.)
• child development information and how to share this in a strength-based manner (e.g., build on parental
competencies, engage parents' critical thinking skills, identify emerging skills, address language use and
literacy,include all developmental domains,incorporate the use of developmental screens,etc.)
•content that is developmental in nature
•strategies that strengthen families and their relationships
• health and safety information such as safer sleep, breastfeeding, pre- and postnatal health care, well-child
care.dental and oral health,and lead exposure
6-4.A The site has policy and procedures regarding the promotion of child development, nurturing parent-child
relationships, parenting skills, and health and safety practices. and the policy specifies which evidence-informed
parenting materials are used with families.
Intent: Sites develop policy and procedures regarding the Family Support Specialist's role in using evidence-informed
parenting materials to promote child development, nurturing parent-child relationships, parenting skills, and
health and safety.
6-4.A RATING INDICATORS
= 3 No 3 rating indicator for standard 6-4.A.
2 The site has policy and procedures regarding the Family Support Specialist's role in promoting child development,
nurturing parent-child relationships, parenting skills,and health and safety practices with families. The policy specifies
how evidence-informed parenting materials are shared with families using a strength-based approach that builds on
parental capacity and in response to parent-child interests and observations made by the FSS versus as the primary focus
= of the visit.
1 An of the following:the site does not et have policy and rocedures:or the policy and procedures do not et cover promotion
� Y 9� Y p Y p Y Y
of child development,nurturing parent-child relationships, parenting skills,and health and safety related issues:or the policy
does not yet specify how evidence-informed parenting materials are shared with families using a strength-based approach that
builds on parental capacity and in response to parent-child interests and observations made by the FSS versus as the primary
focus of the visit.
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6-4.13 Family Support Specialists build skills and share information with families on appropriate activities designed to
promote healthy child development.nurturing parent-child relationships,and parenting skills.
Intent: Family Support Specialists observe, build skills, and share information regarding healthy child development,
nurturing parent-child relationships,and parenting skills with families based upon naturally occurring experiences
as well as through parenting materials,curriculum and other resources.Parenting skills,such as guidance and
discipline, toilet training, weaning from the breast, etc., are included as child development activities and
occur within the context of parent-child interaction. A parent who has the ability to understand what their
child is able to do developmentally and the intent of the baby's behavior will be much more likely to have
empathy within the relationship.Child development activities are designed to promote nurturing parent-child
interaction,thereby impacting the relationship established over time between the parent and child.Whenever
possible,Family Support Specialists are encouraged to organize child development information into activities in
which the parent isencouraged to play with the child while the Family Support Specialist shares the developmental
stimulation the baby is receiving. Family Support Specialists are encouraged share information with families
when it is most meaningful(in response to parent-child interests and observations made by the FSS). Please
Note:Documentation in the home visit note includes what material/information is shared on a particular visit.
6-4.B RATING INDICATORS
M 3 The Family Support Specialist shares information with all families on appropriate activities designed to promote healthy
child development,nurturing
g parent child relationships and parenting skills.
M 2 Past instances were found when the Family Support Specialist did not share information with all families on appropriate
Mactivities designed to promote healthy child development, nurturing parent-child relationships and parenting skills:
however,recent practice indicates this is now occurring.
1 The Family Support Specialist does not yet share information with all families on appropriate activities designed to promote
healthy child development,nurturing parent-child relationships and parenting skills.
encouragedTIP: Sites are . document observations of child development.
to do.but also how the parent responds.It is helpful for staff to document how they build on parental competencies
and promote child development and parenting skills in a thoughtful way(e.g.,if parents struggle to understand
what their baby is communicating to them,the Family Support Specialist might ask parents what they think the
baby might be communicating,explore what parents already know about their child,and anchor the conversation
to what children are able to do within a particular developmental age).
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6-4.0 The Family Support Specialist shares evidence-informed parenting materials designed to promote health and safety
practices based on family needs.
Intent: Health and safety practices include sharing prevention strategies,as well as addressing any health and safety
issues observed in the home. Content shared with families may include smoking cessation, SIDS, "shaken
baby" strategies, baby-proofing, feeding and nutrition, dental and oral health, and selection of childcare
providers or alternative caretakers,in addition to any culturally based safety issues.It is expected Family Support
Specialists will address any health or safety concerns that could be detrimental to parents and their children.
Additionally,Family Support Specialists support the development of a healthy and stimulating home environment.
6-4.0 RATING INDICATORS
= 3 The Family Support Specialist shares information with all families designed to promote evidence-informed health and
safety practices-
2 Past instances were found when the Family Support Specialist did not share information with all families designed to
promote evidence-informed health and safety practices:however r606flt pnKtke indicates this is now occurring.
1 The Family Support Specialist does not yet share information with all families designed to promote evidence-informed health and
safety practices.
ITIP: Sites will have mechanisms for insuring how ..• Specialists use safety checklists or share information
with families.Staff is encouraged to document the content of health and safety discussions in home visit notes.
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c 6-4.D The Family Support Specialist promotes safer sleep practices with pregnant parents and families with an infant
a birth to twelve months of age.
c
z
Intent: Sites begin sharing safer sleep information with parents in the prenatal period. when enrolled prenatally, to
support these practices occurring as soon as the baby comes home from the hospital.When enrolled postnatally,
safer sleep information is shared early and as infant develops and sleep habits change over the course of the first year.
6-4.D RATING INDICATORS
= 3 The Family Support Specialist shares safer sleep information with all pregnant parents and families with an infant birth to
twelve months of age.
M 2 Past instances were found when the Family Support Specialist did not share safer sleep information with all pregnant
parents and families with an infant birth to twelve months of age;however recent practice indicates this is now occurring.
The Family Support Specialist does not yet share safer sleep information with all pregnant parents and families with an infant birth
to twelve months of age.
6-5. The site monitors the development of participating infants and children with the ASO(Ages and Stages Questionnaire)
and ASQ:SE(Social Emotional),using current versions of both.
6-5.A The site has policy and procedures for administration of the ASQ and ASQ:SE,including the frequency these tools
are to be administered with all focus children, unless developmentally inappropriate, and requires tracking of all
children suspected of developmental delay,with appropriate referrals and follow-up,as needed.
Intent: The policy and procedures indicate the ASQ and ASQ:SE are used with all focus children during home visits
unless developmentally inappropriate (e.g., when enrolled in Early Intervention or with permanent health
condition impacting development),and in accordance with established tool guidelines,revising the screening
schedule based on prematurity,and specifying which intervals the site requires staff to administer.At a minimum,
sites are to screen all focus children using the ASQ a minimum of twice per year for children under the age of
three and annually for children ages three through five years.The ASQ:SE is to be administered with all focus
children a minimum of once per year.
Additionally,the policy must specify instances when the site would not be administering the ASQ or ASQ:SE(i.e.,
developmentally inappropriate.receiving early intervention services).Sites are expected to maintain Level CO,TO,
and TR families on their ASO and ASQ:SE data reports(and to note time period they were on Level CO,TO or TR).
Site staff know who to refer a family to when the ASQ or ASQ:SE screen indicates the child may have a
developmental delay.This determination is developed with the supervisor and may include referring the family
to their primary care physician or medical provider. In most instances, sites refer to the early intervention
experts within the community. Many early intervention systems are complicated with numerous requirements
and a variety of agencies that provide different services to families.Families frequently have difficulty keeping
track of various appointments and schedules or may be reluctant to access these services. The site's policy
and procedures will require Family Support Specialists to track children suspected of having a developmental
delay and require staff to follow up with all referrals made. Follow-up supports the family's access to and
utilization of developmental resources,services,and intervention.
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6-S.A RATING INDICATORS
= 3 No 3 rating indicator for standard 6-S.A.
2 The site has policy and procedures for administration of the ASQ and ASQ:SE that require at a minimum:
1)the ASQ and ASQ:SE are used with all focus children,unless developmentally inappropriate
2) the ASQ is administered at least twice per year each year of the child's life for children under the age of three,
and annually for children ages three through five years(for sites serving ages three through five)
3)the ASQ:SE is administered at least once annually each year of the child's life
4)how it tracks focus children who are suspected of having a developmental delay and provides� g y p appropriate referrals and
follow-up as needed
1 Any of the following.
1)the site does not yet have policy and procedures to administer the ASQ and ASQ:SE
= 2)the policy and procedures do not yet specify when the tools are to be used with all focus children,unless developmentally
inappropriate
= 3)the policy and procedures do not yet require use of the ASQ for children under the age of three at least twice per year,
and at least once annually for children ages three through five years(for sites serving children ages three through five)
4)the policy and procedures do not yet require use of annual administration of the ASQ:SE
S)the policy and procedures do not yet indicate how it tracks focus children who are suspected of having a developmental
delay and how it provides appropriate referrals and follow-up as needed
T1 P: Sites are encouraged to screen more frequently than the minimum required in the standard.
T1 P: Supervisors are encouraged to note any concerns identified from the developmental screens on the HFA Service
Plan.with planned interventions/activities to address and track progress.
I policy andprocedures regarding when and how
to, how to determine the outcome of the referral, and how to participate in the process so staff can support
families and greatly facilitate the tracking process to ensure families receive appropriate services in a timely manner.
T1 P: Sites are .•. to contact early intervention services in their community to assist in the development
of policy and procedures regar
is recommended collaboration occur(with parent permission and informed consent) in the development of an
IFSP with both early intervention and HFA sites.Staff is encouraged to continue collaboration with early intervention
services when the child is dually enrolled.
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6-5.B The site ensures the ASQ(Ages and Stages Questionnaire)is used during home visits to monitor child development
a at specified intervals, unless developmentally inappropriate, and is administered according to the developers'
z instructions to ensure valid results(i.e..administered during the specified window of time).An HFA Spreadsheet is
available for this standard.
Intent: All focus children are screened for potential developmental delays.Staff are not required to screen children who
are enrolled in early intervention services(special needs)and are receiving in-depth developmental assessments.
Please Note(was a Tip):Sites are to indicate in the family files when a child has a revised screening schedule due
to premature birth or other reasons,when screens are missed due to families being on creative outreach,or
when families decline the opportunity to screen the child.
6-5.13 RATING INDICATORS
3 The site uses the ASQ during home visits and at least 90%of focus children (excluding those when developmentally
inappropriate)are screened a minimum of twice per year of the child's life for children under the age of three and annually
M for children ages three through five years.
M Past instances were found when the site did not use the ASQ with at least 90%of focus children(excluding those when
developmentally inappropriate)a minimum of twice per year of the child's life for children under the age of three and
annually for children ages three through five years:however,this is now occurring during home visits and 90%of focus
children have one completed screen In the last six months.
Any of the following:the site does not yet use the ASQ during home visits:or the site does not yet use the ASQ at the specified
intervals to ensure all focus children in the site(excluding those when developmentally inappropriate)were screened a minimum
of twice per year for children under the age of three and annually for children ages three through five years:or less than 90%of
focus children have completed ASQ screens due in the last six months.
TI P: The site is encouraged to make the ASO tool available to parents for subsequent births.With subsequent births,
the ASO can be provided to the parent for self-admini st ration,or it may be administered by Healthy Families staff.
If administered by staff,the dates and results should be recorded in the family file.
0) TI P: When a child is receiving early intervention services.it is recommended sites request a copy of the developmental
9 assessment from the family or from the early intervention service provider with permission from the family so the
home visiting site can support the developmental activities of the early intervention team.
TI P: Sites are encouraged to set goa Is/bench marks(for Standard GA-2-B)when rates fall below the 90%threshold,and
supervision time should be used to focus on exceptions,reasons,and problem-solving strategies to increase rates.
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6-S.0 The site ensures the ASQ:SE(Ages and Stages Questionnaire:Social Emotional)is used during home visits,unless
developmentally inappropriate.and is administered according to the developers'instructions to ensure valid results.
An HFA Spreadsheet is available for this stanaard.
6-S.0 RATING INDICATORS
= 3 The site uses the ASQ:SE during home visits at specified intervals and ensures at least 90%of focus children(excluding
those when developmentally inappropriate)are screened a minimum of once per year of the child's life,for children birth
M to age five.
Past instances were found when the site did not use the ASQ:SE with at least 90%of focus children(excluding those when
developmentally inappropriate)a minimum of once per year of the child's life,for children birth through age five:however.this
is now occurring during home visits and at least 90%of focus children have one completed screen In the last twelve months.
Any of the following:the site does not yet use the ASQ:SE during home visits:or the site does not yet use the ASQ:SE a minimum
of once per year for focus children birth to age five:or less than 90%of focus children have completed ASQ:SE screens due in the
last twelve months.
lTI P: The site is encouraged to make the ASQ:SE tool available to parents for • ••
staff.the dates and results should be recorded in the family file.
TIP: Sites are encouraged to set goals/benc h marks(for Standard GA-2.13)when rates fall below the 90%threshold.and
supervision time should be used to focus on exceptions,reasons,and problem-solving strategies to increase rates.
120
0
n
Z
6-S.D The site tracks focus children suspected of having a developmental delay and provides appropriate referrals and
follow-up as needed.
Intent: Sites are encouraged to collaborate with early intervention services for children who are dually enrolled in HFA
and early intervention to avoid duplication of services and to encourage consistency.Early intervention services
can be difficult for parents to understand.The Family Support Specialist can be a great liaison for the family into
various services offered through early intervention. If a family declines early intervention services,be sure to
document this,as well as the Family Support Specialist's continuous efforts to advocate for early intervention
services,in the family's file.Be sure to document any contacts with El for updates,or joint meetings attended,
and any referrals Family Support Specialists made to support parents.
It is critical to support parents by tracking referrals and supporting the parent in following through with in-depth
evaluations and therapy. It is recommended screens and developmental assessments administered by early
intervention services be kept in the family files(however,this is not a requirement).At the site level the program
manager/supervisor is aware of any challenges with referral sources for early intervention services and assists
by advocating with referral entities/partners to reduce these barriers.
6-S.D RATING INDICATORS
3 Site tracks focus children suspected of having a delay and follows through with appropriate referrals and follow-up as needed.
2 Past instances were found when the site did not track focus children suspected of having a delay and follow through with
= appropriate referrals and follow-up as needed:however,r9C90 preCM9 indicates this is now occurring.
Site does not yet track focus children suspected of having a developmental delay or ensure appropriate referrals and follow-up as needed.
NA No children identified with a developmental delay.
TIP: The site is encouraged to record concerns about possible developmental delay for the focus child, along with
associated referrals and.
TIP: The site is also encouraged to track any referrals made regarding developmental delay for non-focus children residing
in the home and obtain signed consent when making the referral on behalf of the family-
121
Tables of • •
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.
DocumentationStandard Pre-Site
6-1.A I Policy- Submit Policy
HFA Service Plan Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklis;are available.
6-1.113 1 HFA Service No documentation required pre-site.Peers will review documentation and interview staff,advisory
Plan in Supervision board members,and families on-site.
6-1.0 I HFA Service No documentation required pre-site.Peers will review documentation and interview staff.advisory
Plan with Families
Essential Standard board members,and families on site.
6-2.A I Policy- Submit Policy
Development of
Family Goals Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available
6-2.113 1 Family Goal No documentation required pre-site.Peers will review documentation and interview staff,advisory
Development board members,and families on-site.
EnenN ShMdMd
6-2.0 I Family Goals No documentation required pre-site.Peers will review documentation and interview staff,advisory
in Supervision board members,and families on-site.
6-3.A I Policy-CHEERS Submit Policy
Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklis`are available
6-3.B I PCI Assessed No documentation required pre-site.Peers will review documentation and interview staff,advisory
using CHEERS
Essential Standard board members.and families on site.
6-3.0 I PCI Addressed
8 Promoted No documentation required pre-site.Peers will review documentation and interview staff,advisory
Essential Standard board members,and families on-site.
Submit a report of all enrolled focus children(including multiples)that includes:
1.Child's date of birth
2.CCI administration dates
3.Documentation of declined screening by primary caregiver
6-3.113 1 CHEERS Provide a summary of the total focus children(number and percent)who received the required
Check-In screens divided by the total number of focus children.
Please Note:An HFA Spreadsheet is available for this standard.
This is a threshold standard,meaning to be in adherence a minimum threshold has been established
(90%in this case).When the site's annual data in the self-study falls below this threshold,Peer
Reviewers or Panel will request more recent data.
6-3.E I Supervision
Support in Assessing.
Addressing and
Promoting PCI(Through No documentation required pre-site.Peers will review documentation and interview staff,advisory
Use of CHEERS and board members,and families on site.
Validated PCI Tool)
EsserM Standard
122
0
Tables • . •
a
Standard Pre-Site
0
z
Documentation to Include In Self Study
6-4.A I Policy-Child Submit Policy
Development,Parenting
Skills,Health&Safety Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available.
6-4.B I Promote Healthy No documentation required pre-site.Peers will review documentation and interview staff,advisory
Child Development and
Parenting Skills board members.and families on site.
6-4.0 I Promote Health No documentation required pre-site.Peers will review documentation and interview staff,advisory
and Safety Practices board members,and families on-site.
6-4.D I Promote Safer No documentation required pre-site.Peers will review documentation and interview staff,advisory
Sleep Practices board members,and families on-site.
6-5.A I Policy-ASQ-3 Submit Policy
and ASQ-SE-2 Screens Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available.
Submit a report of all enrolled focus children that includes:
1.Child's date of birth
2.Enrollment date
3.ASQ-3 administration dates
4.Documentation of
a.Indication of delay and if a referral was made
b.Not screened due to involvement of early intervention services
6-5.B I ASQ-3 c.Revised screening schedule(prematurity or other reason)
Developmental d.If the timing of re-enrolling,transferring into services,or Child Welfare Protocol enrollment
Screening precludes availability of 2 remaining intervals in a given year for contextual decision-making by
Peer Reviewers or Panel.
Provide a summary of the total focus children(number and percent)who received the required
screens divided by the total number of focus children.
Please Note:An HFA Spreadsheet is available for this standard.
This is a threshold standard,meaning to be in adherence a minimum threshold has been established
(90%in this case).When the site's annual data in the self-study falls below this threshold,Peer
Reviewers or Panel will request more recent data.
Submit a report of all enrolled focus children that includes:
1.Child's date of birth
2.Enrollment date
3.ASQ-3 administration dates since 1/1/2018
4.Documentation of
a.Indication of delay
6-5.0 I ASQ:SE-2 Social b.Not screened when developmentally inappropriate
Emotional Screening Provide a summary of the total focus children(number and percent)who received the required
screens divided by the total number of focus children.
Please Note:An HFA Spreadsheet is available for this standard.
This is a threshold standard,meaning to be in adherence a minimum threshold has been established
(90%in this case).When the site's annual data in the self-study falls below this threshold,Peer
Reviewers or Panel will request more recent data.
6-5.D I Developmental Submit a report the site uses to track currently enrolled focus children identified with suspected
Delay Tracking and developmental delay,including referrals made and follow-up on referrals.
Follow-Up
123
n
Q
0
Z 7
Q
H
At a minimum, all families have a
medical provider to ensure optimal
health and development. Depending
on the family's needs, they may also
be linked to additional services related
to: finances, food, housing assistance,
school readiness, child care, job training,
family support, substance abuse
treatment, mental health treatment,
and domestic violence resources.
Standard 7 Intent is to ensure site staff link families to providers
for preventative health care and timely receipt of immunizations,
and appropriately refer families to additional community services
based on each family's unique needs.
HFA alone may not be able to provide all the resources a family
might need to become strong, so encouraging parents to access a
variety of community resources is an essential part of our work. It is
important to consider many parents may not have been protected
by their parents when they were children. This may result in parents
not knowing how to protect their own children. Supporting families
to take action and advocate on behalf of themselves and their
children in incremental steps based on parental capacity is critically
important. Staff must strike a delicate balance between doing too
little and doing too much for families, lest they prevent families
from learning how to successfully advocate for themselves (hence,
the longstanding philosophy of HFA, "Do For, Do With, Cheer On"
as it relates to connecting to community resources). Additionally,
staff is expected to both refer and follow up to ensure families are
able to access needed services.
7-1. Participating focus children have a medical/health care provider to ensure optimal health and development.
7-1.A The site has policy and procedures for linking all focus children to medical/health care provider(s).
Intent: It is important for each focus child to have a medical home(a partnership between the family
and the child's primary health care professional) and to utilize preventative health care
practices for children. The site is to have a process for informing and connecting focus
children to medical/health care provider(s) available within the community. Through this
partnership,the primary health care professional can help the parent access and coordinate
routine well-child care,sick-child care,and specialty care when needed.
7-1.A RATING INDICATORS
3 No 3 rating indicator for standard 7-1.
2 The site has policy and procedures for linking all focus children to medical/health care providers and
M supporting parents in utilizing health care appropriately,including the receipt of well-child care for their child(ren).
1 The site does not yet have policy and procedures to link all focus children to medical/health care
providers:or policy does not yet include how parents will be supported in utilizing health care,including
well-child care,for their child(ren).
TIP: Supervisors are encouraged to note any concerns related to linkages to a medical home on a family's HFA Service
Plan,with planned interventions/activities to address and track progress.
125
0
a
z
z
a
7-1.13 Focus children have a medical/health care provider.
Intent: A medical home is crucial to the health and optimal development of the child.In addition to being a vital resource
for ongoing preventive health and wellness guidance, and medical interventions as needed, a medical home
plays a crucial role in child abuse prevention,as it allows another professional consistent access to the family to
provide support and monitoring for the well-being of the child.An HFA Spreadsheet is available for this standard.
7-1.121 RATING INDICATORS
M 3 Ninety-five percent(95%)through one hundred percent(100%)of focus children have a medical/health care provider.
2 Eighty percent(80%)through ninety-four percent(94%)of focus children have a medical/health care provider-
1 Less than eighty percent(80%)of focus children have a medical/health care provider.
ITI P: For focus childrenwho currently ••not have a medical/healthprovider. • sure to indicate the reasons why
-
• clearly document
I also encouraged to document the current medical/healthprovider forparticipating
members(children other than focus children and adults)-see standard 7-3.
ITIP: Sites are encouraged to set .•. •'nch marks(for Standard .• • :0'. threshold.and
supervision time should be used to focus on exceptions.reasons,and problem-solving strategies to increase rates.
126
7-1.0 The site monitors the utilization of well-child care for focus children, and works to address barriers impacting
access and receipt of well-child care.
Intent: Well-child visits are essential for preventive health care,to monitor growth and development,and to establish a
regular connection with a medical provider. Sites track the receipt of well-child visits subsequent to enrollment
in HFA and based on age of the child at the intervals recommended by the American Academy of Pediatrics
(AAP)schedule (3 to 7 days,2 to 4 weeks.2 to 3 months,4 to 5 months,6 to 7 months.9 to 10 months,12 to 13
months.15 to 16 months,18 to 19 months,2 to 2.5 years,3 to 3.5 years,and 4 to 4.5 years).An HFA Spreadsheet
is available to track the receipt of well-child visits.If the site uses a well-child visit schedule other than the AAP,
a reference to it will be provided.
It is important for sites to understand what factors are impacting well-child care utilization rates. In some
communities there is a documented shortage of primary care providers(HRSA.2012).These shortages are most
pervasive in urban and rural areas, in contrast to suburban areas, which generally have a larger supply of
providers. In addition, accessing treatment may be difficult for some because of financial, transportation,
language,or other barriers.
7-1.0 RATING INDICATORS
M 3 The site monitors the receipt of well-child care visits for all focus children, and has Imp{emetlbed strategies to address
identified barriers.
2 The site monitors the receipt of well-child care visits for all focus children; and the site has developed but not yet
implemented strategies to address identified barriers.
S1 The site does not yet monitor the receipt of well child care visits:or has not yet developed strategies to address identified barriers.
7-2. The Family Support Specialist promotes and educates families regarding the importance of immunizing their
children. tracks the receipt of immunizations, and follows up with parents when immunization appointments are
missed.Participating focus children are up-to-date on immunizations.
7-2.A The site has policy and procedures to ensure the Family Support Specialist shares information with families
designed to promote and educate families on the importance of immunizations.tracks the receipt of immunizations,
and follows up with parents when immunization appointments are missed.
Intent: Immunizations are very important in keeping children healthy.The regular schedule recommends shots starting
at birth through 24 months of age,with boosters and catch-up vaccines continuing through the teenage years
and adulthood.By immunizing,children are safeguarded against the potentially devastating effects of 11 vaccine-
preventable diseases plus Hepatitis A and the flu. The catastrophic effects of childhood diseases can lead to
life-long illness or death.
Vaccines help prevent infectious diseases and save lives.Childhood immunizations are responsible for the control
of many infectious diseases that were once common in this country,including polio.measles,diphtheria,pertussis
(whooping cough),rubella(German measles),mumps,tetanus.and Haemophilus influenzae type b(Hib).While
the U.S. currently has near record low cases of vaccine-preventable diseases, the viruses and bacteria which
cause them still exist.Vaccines prevent disease in the people who receive them and protect those who come into
contact with unvaccinated individuals(aap.org).
7-2.A RATING INDICATORS
M 3 No 3 rating indicator for 7-2.A.
2 The site has policy and procedures including all of the following.
•how Family Support Specialists will share information with all families designed to promote and educate families on the
importance of immunizations
= •how Family Support Specialists will obtain and track information regarding the receipt of immunizations
•how Family Support Specialists will follow up when immunization appointments are missed
1 The site does not yet have policy and procedures;or policy and procedures do not yet include all items listed in the 2 rating.
127
0 7-2.13 The site ensures immunizations are up-to-date for focus children at one year of age.Please Note:the percentage does
a not include children whose permanent health conditions or family beliefs preclude immunizations;however,explanation
i of these exceptions must be documented in the family file.An HFA Spreadsheet is available for this standard.
a
Intent: All children are immunized at regular health care visits, beginning at birth.Some children may be ill or have
other reasons preventing them from receiving immunizations according to the identified immunization schedule
(if a site does not have access to a local or state identified immunization schedule that specifies recommended
immunizations for infants from birth through eighteen months,the CDC guidelines are recommended for this
purpose).Therefore,children may not necessarily receive their immunizations on time:however,it is essential to
keep them up-to-date.
Sites track immunization information differently. Some choose to collect the information from the parent/
caregiver and document it on the site's tracking sheets,and others obtain(with consent)periodic updates from
the medical provider or from a statewide electronic immunization system that indicates whether or not the child
is up-to-date or current. Therefore, sites are encouraged to clearly indicate how they obtain information on
which immunizations have been administered to determine if focus children are up-to-date.
Please Note.When calculating up-to-date immunization rates at one year of age,the site will look at all enrolled
focus children ages 12-23 months(including those on creative outreach),and the number of those children who
received all immunizations recommended for infants birth through six months.
For example.if at the end of one fiscal year there are 25 enrolled focus children who are ages 12-23 months,
and 20 of them received all immunizations expected through 6 months of age,the rate for this age group is
• •• = :•'.
7-2.13 RATING INDICATORS
3 Ninety percent(90%)through one hundred percent(100%)of focus children who are currently 12-23 months of age are
up-to-date with all immunizations expected by six months of age.
= 2 Eighty percent(M)through eighty-nire peroeM(M)of focus children who are currently 12-23 months of age are
up-to-date with all immunizations expected by six months of age.
1 Less than eighty percent(80%)of focus children who are currently 12-23 months of age are up-to-date with all immunizations
expected by six months of age.
stepsTI P: For focus children who are not currently up-to-date,be sure to indicate the reasons why and clearly document
• obtain
I Control .Prevention(CDC)have an interactive immunization scheduler available online.
TIP: Sites are encouraged to set goals/benchmarks(for Standard GA-2.13) when rates fall below the 80%threshold,and
supervision time should be used to focus on exceptions,reasons,and problem-solving strategies to increase rates.
128
7-2.0 The site ensures immunizations are up-to-date for focus children at two years of age.Please Note:the percentage does
not include children whose permanent health conditions or family beliefs preclude immunizations;however,explanation
of these exceptions must be documented in the family file.An HFA Spreadsheet is available for this standard.
Intent: See intent for 7-2.13. Please Note: When calculating up-to-date immunization rates at two years of age. the
site will look at all enrolled focus children 24 months and older(including those on creative outreach).and the
number of those children who received all immunizations expected through 18 months.
For example,if at the end of one fiscal year there are 10 enrolled focus children who are 24 months old and
older and 9 of those children received all the immunizations expected for children through 18 months of age,
7-2.0 RATING INDICATORS
3 Ninety percent(9O%)through one hundred percent(100%)of focus children who are currently 24 months or older are
up-to-date with all immunizations expected by eighteen months of age.
2 Eighty percent (M)through elgW-nine percent(M)of focus children who are currently 24 months or older are
up-to-date with all immunizations expected by eighteen months of age.
1 Less than eighty percent (80%)of focus children who are currently 24 months or older are up-to-date with all immunization
expected by eighteen months of age.
ITI P: For focuso are not currently up-to-date, • . document
steps taken o obtain immunizations for these children,
availableTIP: The Centers for Disease Control and Prevention(CDC)have an interactive immunization scheduler online.
TIP: Sites are encouraged to set goals/benchmarks(for Standard GA-2.13) when rates fall below the 80%threshold,and
supervision time should be used to focus on exceptions.reasons,and problem-solving strategies to increase rates.
129
0 7-3. Families are connected to services in the community on an as needed basis.
a
a7-3.A The site has policy and procedures describing how direct service staff will provide information and/or referrals to available
N health care and othercommurnty services for all participating family members.The policy includes follow-up mechanisms
to determine whether parents receive the services they were referred to.
7-3.A RATING INDICATORS
= 3 No 3 rating for standard 7-3.A.
M 2 The site has policy and procedures describing the process for direct service staff to provide information and/or referrals
= to available health care and other community services for all participating family members.The policy and procedures
includes follow-up mechanisms to determine whether parents receive the services they were referred to.
t The site does not yet have policy and procedures:or the policy and procedures do not yet address the requirements listed in
the 2 rating.
7-3.B Direct service staff provide information and referrals to health care and health care resources for all participating
family members.
Intent: Sites are encouraged to provide information,referrals,and linkages for all participating family members.including
the focus child. Information could include a variety of topics which may benefit all participating members
(e.g.,smoking cessation support groups,free health clinics for adults,immunization clinics,flu shots,nutritional
classes,birth spacing,etc.).Health care information includes the importance of dental care as well as referrals
linking families to preventive services for dental care.as appropriate.Site staff are knowledgeable about health
care resources within the community and able to appropriately provide referrals and linkages to families. It
is recommended sites only provide information,referrals.and linkages when necessary(e.g.,when a pregnant
mother needs assistance connecting to prenatal care.or when parents or siblings have health concerns and are
without a medical care provider).Therefore if a family is currently receiving necessary services/care,there may
be no need for further provision of the above-mentioned services.
7-3.B RATING INDICATORS
Direct service staff provide information and/or referrals to all participating family members on available health care and
health care resources,when necessary.
0 2 Past instances were found when direct service staff did not provide information and/or referrals to all participating family
members on available health care and health care resources,when necessary:however,recent practice indicates this is
M now occurring.
Direct service staff are not yet providing information and/or referrals to all participating family members on available health care
and health care resources,when necessary.
T1 P: Sites may want to consider documenting health care resource referrals associated with this standard in the same way
other communitydocumented for standards
130
7-3.0 The site connects families to appropriate community providers for additional services when needed.
Intent: Families benefit by accessing community agencies and services to support the family in accomplishing goals
or overcoming challenges they may be experiencing. Families may be reluctant to access additional services,
and direct service staff are one way to bridge the gap. Site staff are familiar with the community agencies
and the services they provide to ensure families are referred appropriately. Sites are encouraged to provide
referrals as often as needed.Additionally,while there may be services to refer the family to within the community,
it does not mean they are necessarily appropriate or needed by the family. Sites stay up-to-date on existing
resources in the community so referrals can be provided appropriately when needed.
7-3.0 RATING INDICATORS
= 3 Families are linked to additional services in the community when needed.
LM 2 Past instances were found when families needing additional services were not connected to appropriate services
(when resources exist in the community):however,remnt pracUce indicates this is now occurring.
1 Families are not yet linked to additional services in the community on an as needed basis.
7-3.D The site tracks and follows up with the family or service provider(if appropriate)to determine if the family received
needed services.Follow-up with these referral sources will require signed informed consent(see GA-S.Q.
7-3.D RATING INDICATORS
3 The site has a method for tracking and following up on referrals of families to other community services as needed and
the site is tracking and following up on referrals.
2 Past instances were found when tracking and follow-up did not occur:however,recent practice ndicates this is now occurring.
1 Either the site does not yet have a method or the site has a method but is not yet tracking and following up.
I •referrals related toaddressing issues and. on beclocumented•
alongService Plan . . on these referrals if it is helpful to keep this information in one location.
lTI P: Periodical ly,sites may want to review any trendspertai ni ng to famil ies'abi lit y to. particular
Doing so can assist with the ongoing assessment of community needs and identification of gaps in service availability.
131
0 7-4. The site conducts depression screening with all families using a standardized instrument.
a
z Intent: Many of the items on the FROG Scale are precursors for depression.Add to that the extreme stress families experience
N and the likelihood for depression is extremely high.When parents are depressed.there are significant impacts for the
parent-child relationship,such as the inability for the parent to be emotionally available to their infant,assist with physical
and emotional regulation(read cues and respond in a timely and sensitive manner),and provide intellectual stimulation.
Screening for depression during the prenatal and postnatal periods allows Family Support Specialists to assist
parents in becoming aware of the depression and determining if there are depressive issues needing to be addressed
by a clinician.Administering a depression screen requires both knowledge of how to administer the screen and what
to do if the screen has positive results.Staff training includes the following:
•administration guidelines
•ways to talk with parents about depression
•community resource information
•activities Family Support Specialists can do with families to reduce stress and increase serotonin
•ways to support parents in meeting their child's physical and emotional development
Additional training opportunities include:
•11-2.D wraparound training on mental health
•access to the free online course through the National Child Traumatic Stress Network(Psychological First Aid
Field Operations Guide)
Although staff are not therapists,it is critical for Family Support Specialists to support parents in alleviating their
depression while a parent is awaiting treatment or while considering treatment options.A sample of health and
wellness activities Family Support Specialists may suggest include:
•providing linkages and referrals to appropriate resources
•providing referrals for mental health consultation(when available)
•using motivational interviewing(when trained)to assist parents in accepting resources or treatment
•utilizing supervision to assist staff in discussing depression with parents
•getting parents out in the sunshine(which increases serotonin)
•encouraging parents to walk,exercise,or engage in other forms of physical movement
•encouraging parents to smile(even a"practice"smile increases serotonin)
•encouraging parents to keep hydrated(hydration increases brain functioning)
•encouraging self-care
•practicing gratitude
•using healthy strategies that have worked for the parent in the past
•utilizing Procedures for Working with Families in Acute Crisis
•encouraging parents to meet their baby's physical and emotional needs
•using other strategies/activities identified locally
Severe depression is life threatening and must be addressed by a licensed clinician.
132
7-4.A The site has policy and procedures for administration of a standardized depression screening tool specifying when(at
least once prenatally and at least once within three months after birth. or within 3 months of enrollment if enrolled
postnatally,and at least once within 3 months of all subsequent births)the tool is to be used with the primary caregiver of
all enrolled families and ensures all staff who administer the tool are fully trained.and staff understand what constitutes a
positive screen and steps to take when the screen is positive.As indicated in the glossary.the primary caregiver is the
individual the baby lives with and receives primary care from.This individual is generally,though not always,a parent,and
is the primary point of contact for the Family Support Specialist 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 with this person.
7-4.A RATING INDICATORS
= 3 No 3 rating for standard 7-4.A.
2 The site has policy and procedures for administration of the depression screening tool and specifies the following:
= •is to be used with the primary caregiver of all enrolled families
•what tool is used for depression screening
•the frequency of screening:at least once prenatally and at least once within three months of birth OR within 3 months
= of enrollment when enrolled after birth,AND at least once within 3 months of all subsequent births(born 1/1/18 or later)
•what score constitutes a positive screen
= •referral and follow-up expectations with elevated screens
•activities appropriate for Family Support Specialists to do with families
•the requirement that all staff receive training on how to administer the tool prior to first use(unless already included in
the site's training plan/policy-standard 10-1).
The site does not yet have policy and procedures;or policy and procedures do not yet include all components in the 2 rating.
TIP: Sites may choose to administer the depression screen during the assessment process.
TIP: Sites may consider conducting the depression screen with other caregivers,in addition to the primary caregiver.
TIP: Research has shown pre-and postnatal depression is not exclusive to mothers.Paternal depression is of concern as well
with first births and subsequent
133
7-4.13 The site conducts depression screening with the primary caregiver of all enrolled families. If enrolled prenatally,the
a screening will be completed at least once during the prenatal period.Please Note the following limited exception criteria:
z If the primary caregiver declines the screen,they are not counted within the cohort.and the refusal must be noted on
a
N the tracking form.
Intent: Depression screening is conducted prenatally and postnatally. Depression screens are completed even when
families are in treatment to ensure treatment is meeting the needs of the family.Sites are expected to include
Level CO families on their depression screening data reports(and to note time period the family was on Level
CO),and to track receipt of depression screening during times the family is not on Level CO.
Please Note:Sites can use the HFA Spreadsheet to track depression screens.
7-4.113 RATING INDICATORS
3 At lost 95%of active primary caregivers enrolled in the past twelve months are screened using a standardized and
validated depression screening tool at least once prenatally(when enrolled prenatally).
2 80%-94%of active primary caregivers enrolled in the past twelve months are screened using a standardized and validated
depression screening tool at least once prenatally(when enrolled prenatally).
Any of the following:the site does not yet use a standardized depression screening tool:or less than 80%of active primary
caregivers enrolled in the past twelve months are screened prenatally.
NA The site does not enroll families prenatally.
IT1 P: If another service provider is inv• -• and has completed depression ••• Specialists may
done,choose to coordinate to reduce duplicate screening.When doing so,a written consent to release information must be
on file in the participant record and the site must be in receipt of a copy of the depression screen to show the screening
was . to track any necessary follow-up
T1 P: According to several Perinatal Care Position Statements.depression screening is recommended to occur twice during
a the prenatal period(when families are enrolled in services early in their pregnancy).
IT1 P: Si tes are encouraged to set.•. ••nchma rks(for Stan•. • bel ow the:•'.
and supervision time should be used to focus on exceptions,reasons,and problem-solving strategies to increase rates.
134
7-4.0 The site conducts postnatal depression screening with the primary caregiver of all enrolled families at a minimum of at
least once postnatally before the baby is 3 months of age(when enrolled prenatally)and within 3 months of enrollment
(when enrolled postnatally). Please Note the following limited exception criteria: If the pnmary caregiver declines the
screen,they are not counted within the cohort,and the refusal must be noted on the tracking form.
Intent: Depression screens are completed even when families are in treatment to ensure treatment is meeting the needs
of the family.Sites are expected to include Level CO families on their depression screening data reports(and to
note time period the family was on Level CO),and to track receipt of depression screening during times the
family is not on Level CO.
Please Note:Sites can use the HFA Spreadsheet to track depression screens.
7-4.0 RATING INDICATORS
0 s At least 95%of active primary caregivers enrolled in the past twelve months are screened using a standardized and
validated depression screening tool at least once postnatally within 3 months of the baby's birth (for those enrolled
prenatally),or within 3 months of enrollment(for those enrolled postnatally).
= Families not screened within 3 months are screened at least once within 6 months postnatally or post-enrollment(unless
caregiver declined the screen).
90%-94%of active primary caregivers enrolled in the past twelve months are screened using a standardized and validated
depression screening tool at least once postnatally within 3 months of the baby's birth(for those enrolled prenatally),or
within 3 months of enrollment(for those enrolled postnatally).
Families not screened within 3 months are screened at least once within 6 months postnatally or post-enrollment(unless
_ the Caregiver declined the screen).
1 Any of the following:the site does not yet use a standardized depression screening tool:or less than 80%of active primary
caregivers enrolled in the past twelve months are screened within 3 months as described in the 2 rating:or less than 100%
have a depression screen within 6 months of enrollment.
IAccording •several Perinatal Care Positiondepression screening is rec. . postnatally at 6 weeks,
3 months.and I year following the birth of the baby.
ITIP: If another service provider • • and has completeddepression Support
done,choose to coordinate to reduce duplicate screening.When doing so,a written consent to release information must be
on file in the participant record and the site must be in receipt of a copy of the depression screen to show the screening
was . to track any necessary follow-up
I obtains copiesof done at birth by another provider. re-screening is strongly recommended.
Best practice would be to re-screen at 6 weeks and 3 months postpartum.
ITIP: Sites are encouraged to set.•. •enchmarks(for Standard below the 80%"on-time"threshold
or the 100%within 6 months threshold,and supervision time should be used to focus on exceptions, reasons.and
problem-solving •• • • increase rates.
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0 7-4.D The site conducts postnatal depression screening with the primary caregiver of all enrolled families with a subsequent
a birth at a minimum of at least once postnatally within 3 months of the subsequent birth.Please Note the following limited
i exception criteria:If the primary caregiver declines the screen,they are not counted within the cohort,and the refusal
a
must be noted on the tracking form.
Intent: Postpartum depression is estimated to affect more than S percent of all women following childbirth,making it
the most common postnatal complication of childbearing.The risk of recurrence is also known to be high and,
given the impact of depression on parent and child health,HFA sites are required to screen all subsequent births
to ensure appropriate supports are provided when indicated.
In a study,researchers analyzed data on 457.317 women who had a first child(and subsequent births)between
1996 and 2013 and had no prior psychiatric hospital contacts or use of antidepressants.Postpartum affective
disorder(which included postpartum depression)was defined as an antidepressant prescription fill or hospital
contact for depression within six months after birth.
In the cohort,0.6%of all births among women with no history of psychiatric disease led to postpartum affective
disorder.A year after their first treatment,27.9%of these women were still in treatment:after four years.that
number was 5.4%. For women with a hospital contact for depression after a first birth,the risk of postpartum
affective disorder recurrence was 21%:the recurrence was 15% for women who took antidepressants after a
first birth.These rates mean that,compared to women without history of affective disorder, the likelihood of
depression with a subsequent birth is much higher for women with postpartum affective disorder after their first birth.
Rasmussen M-LH.Strom M,Wohlfahrt J,Videbech P,Melbye M(2017).Risk,treatment duration,and recurrence
risk of postpartum affective disorder in women with no prior psychiatric history. A population-based cohort
study.PLoS Med 14(9):e1002392.Please Note:Sites can use the HFA Spreadsheet to track depression screens.
7-4.D RATING INDICATORS
= 3 In the last completed reporting year,at least 95%of active primary caregivers with a subsequent birth were screened
using a standardized and validated depression screening tool at least once postnatally within 3 months of the birth.
2 In the last completed reporting year.80%-94%of active primary caregivers with a subsequent birth were screened using
0 a standardized and validated depression screening tool at least once postnatally within 3 months of the birth:or there
have been no subsequent births.
Any of the following:the site does not yet use a standardized depression screening tool:or in the last completed reporting
year less than 80%of active primary caregivers with a subsequent birth were screened within 3 months of the birth.
I obtains copiesof done at birth by • provider, • is strongly • •-•
. Best
practice would be to re-screen at 6 weeks and 3 months postpartum.
I ..••to set... .• .. • below :0threshold,
and supervision time should be used to focus on exceptions.reasons.and problem-solving strategies to increase rates.
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7-4.E Family Support Specialists provide activities to support primary caregivers whose depression screening scores
are elevated and considered to be at-risk of depression. including items listed in the intent for standard 7-4, in
addition to referral and follow-up on referrals,unless already involved in treatment,or treatment resources do not
exist in the community.
Please Note:When caregivers are already involved in treatment or treatment resources do not exist in the community,
these situations are noted in the tracking report.
7-4.E RATING INDICATORS
= 3 Primary caregivers with an elevated depression screening score are supported with appropriate activities by the Family
Support Specialist and are referred(with consent when needed)for further evaluation/treatment and follow-up unless
= already involved in treatment,or treatment resources do not exist in the community.
2 Past instances were found when the site did not ensure all primary caregivers with an elevated depression screening score
were supported with appropriate activities by the Family Support Specialist and referred (with consent when needed)
for further evaluation/treatment and follow-up unless already involved in treatment or treatment resources do not exist in
the community: however, rACOM prKUC9 indicates this is now occurring. Or there have been no elevated depression
= screens for currently enrolled families.
1 Any of the following:primary caregivers with an elevated depression screening score are not yet supported with appropriate
activities by the Family Support Specialists:or are not yet referred for further evaluation/treatment:or there is no follow-up
on those who are referred.
IT1 Ill Supervisors . .. . to note any concernsidentified from the depression
Plan.with planned interventions/activities to address and track progress.
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0
Q
Tables of Documentation
0
2
G
7.At a minimum,all families are linked to a medical provider to ensure optimal health and development.
Depending on the family's needs,they may also be linked to additional services related to:finances.food,housing
assistance,school readiness,child care,job training,family support,substance abuse treatment,mental health
treatment,and domestic violence resources.
DocumentationStandard Pre-Site
7-1.A I Policy- Submit Policy
Medical Providers
for Focus Children Please note:HFA Sample Policies aed Procedures and Policy and Procedure Checklist are available.
Submit a report reflecting:
1.List and count all active focus children
2.List and count all active focus children w/medical provider,include provider
3.Calculate:#2(focus children w/medical provider)divided by#1(total number of focus children)
7-1.8 1 Focus Please Note:An HFA Spreadsheet is available for this standard.
Children with Health
Care Provider Submit HFA Spreadsheet or report detailing all active focus children and their current medical/health
care provider.including percent of children with a provider.
This is a threshold standard,meaning to be in adherence a minimum threshold has been established
(80%in this case).When the site's annual data in the self-study falls below this threshold.Peer
Reviewers or Panel will request more recent data.
7-1.0 I Focus Children Submit a narrative of how the site monitors well-child care along with any strategies developed to
with Well-Child Care address identified barriers. Indicate what strategies have been implemented.
7-2.A I Policy- Submit Policy
Timely Receipt of
Immunizations Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available
Submit the site's immunization schedule.
Also submit a report reflecting immunization rates for all enrolled focus children ages 12-23 months
(including those on Creative Outreach).
1.Count number of focus children currently between 12-23 months
7-2.B 1 Measure 2.Subtract from#1(focus children between 12-23 months)those who are excused from receiving
Immunization Rates immunizations according to allowable reasons in BPS
at lyr 3.Of these children(determined in step#2),count how many are fully up to date with all
immunizations expected through 6 months
4.Report number and calculate:#3(those up to date)divided by#2(number between 12-23 months
minus those excluded from count)
Please Note:An HFA Spreadsheet is available for this standard.
Submit a report reflecting immunization rates for all active focus children 24 months and older
(including those on creative outreach).
1.Count number of focus children currently older than 24 months
7-2.0 I Measure 2.Subtract from#1(focus children 24 months and older)those who are excused from receiving
Immunization Rates immunizations according to allowable reasons in BPS
at 2yr 3.Of these children(determined in step 42),count how many are fully up to date with all
immunizations expected through 18 months
4.Report number and calculate:#3(those up to date)divided by#2(number 24 months and older
minus those excluded from count)
Please Note:An HFA Spreadsheet is available for this standard.
7-3.A I Policy-Health
Care and Community Submit Policy
Information and/or Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available
Referrals and Follow-up
138
Tablesof • • •
DocumentationStandard Pre-Site SOVANEW
7-3.6 1 Health No documentation required pre-site.Peers will review documentation and interview staff,advisory
Care Referrals board members,and families on-site.
7-3.0 I Community No documentation required pre-site.Peers will review documentation and interview staff,advisory
Resource Referrals board members.and families on-site.
7-3.11)1 Referral No documentation required pre-site.Peers will review documentation and interview staff,advisory
Follow-up board members,and families on-site.
7-4.A I Policy- Submit Policy
Depression Screening Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available
Submit a report of all current primary caregivers enrolled prenatally in the past 12 months.Include:
1.Enrollment date
2.Date of birth of focus child
3.Prenatal screening date(s)
7-4.111 1 Prenatal 4.Provide an explanation of any missed screens
Depression Screening To calculate percent screened prenatally:
1.Count number enrolled prenatally
2.Count number screened prenatally
3.Divide#3(screened prenatally)by#2(enrolled prenatally)
Please Note:An HFA Spreadsheet is available for this standard.
This is a threshold standard,meaning to be in adherence a minimum threshold has been established
(80%in this case).When the site's annual data in the self-study falls below this threshold,Peer
Reviewers or Panel will request more recent data.
Submit a report of all current primary caregivers enrolled in the past 12 months.Include:
1.Enrollment date
2.Date of birth of focus child
3.Postnatal screening date(s)
4.Provide an explanation of any missed screens
To calculate percent of primary caregivers screened within 3 months:
1.Count number enrolled
2.Count number screened
a.For prenatal enrollments,count if received within 3 months of the child's birth
7-4.0 Postnatal b.For postnatal enrollments,count if received within 3 months of enrollment
Depression Screening c.Add these counts together(a+b)
3.Divide#2(screened)by#1(enrolled)for percent screened
To calculate percent of primary caregivers screened within 6 months:
1.Count number enrolled
2.Count number screened:
a.For prenatal enrollments,count if received within 6 months of the child's birth
b.For postnatal enrollments,count if received within 6 months of enrollment
c.Add these counts together(a+b).
3.Divide#2(screened)by#1(enrolled)for percent screened
Please Note:An HFA Spreadsheet is available for this standard.
This is a threshold standard,meaning to be in adherence a minimum threshold has been established
(80%in this case).When the site's annual data in the self-study falls below this threshold,Peer
Reviewers or Panel will request more recent data.
139
0
aTables of Documentation (cont.)
0
Z
4
r Documentation to include in Self Study
tA
Submit a report of all current primary caregivers with a subsequent birth in the most recent 12
months.Include:
1.Date of birth of subsequent child
2.Postnatal screening date(s)
3.Provide an explanation of any missed screens
7-4.11D I Screening To calculate percent of primary caregivers screened:
for Depression w/ 1.Count number who had a subsequent birth
Subsequent Births 2.Count number screened within 3 months of the subsequent birth
3.Divide#2(screened)by#1(number with a subsequent birth)for percent screened
Please Note:An HFA Spreadsheet is available for this standard.
This is a threshold standard,meaning to be in adherence a minimum threshold has been established
(80%in this case).When the site's annual data in the self-study falls below this threshold,Peer
Reviewers or Panel will request more recent data.
7-4.E I Referral and
Follow up for Primary No documentation required pre-site.Peers will review documentation and interview staff,advisory
Caregiver with Elevated board members.and families on-site.
Screens
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Services are provided by staff in
accordance with principles of ethical
practice and with limited caseloads to
ensure Family Support Specialists have
an adequate amount of time to spend
with each family to meet their unique
and varying needs and to plan for
future activities.
Standard 8 Intent is to ensure site staff have limited caseloads
to allow them the necessary time with families to build trusting,
nurturing relationships.
8-1. Services are provided by staff with limited caseloads to ensure Family Support Specialists have an
adequate amount of time to spend with each family to meet their needs and plan for future activities.
Intent: The importance of a limited and manageable caseload for each Family Support Specialist
cannot be emphasized enough.It ensures staff are able to work most successfully and families
will be afforded the time,energy,and resources necessary to help build protective factors.
reduce risk,and impact positive change.
When setting caseload size, it is important to consider staff tenure and experience, along
with family complexity and service intensity.HFA's level change system assures each family
is individually considered both in terms of need and in terms of progress being made.
Maximum case weight of thirty points expresses the absolute ceiling,not the expected size of
an FSS caseload.
In addition to guidance about assigning case weight based on level of service (standard
4-2.A), HFA allows sites to increase case weight for families when warranted(referenced in
the Glossary and HFA's Level Change forms). Supervisors and FSSs will determine whether
service intensity should be temporarily increased or if a more permanent increase in service
intensity should be applied owing to case complexity, extensive travel, births of multiples,
translation needs.etc.
8-1.A The site's policy and procedures regarding caseload size indicate full-time (40 hours/week)
Family Support Specialists in their first and second year working in this role to typically carry a
caseload of approximately 10.12 families,and full-time Family Support Specialists in the role for
three years or more typically carry a caseload of approximately 15-20 families.with supervisors
using discretion about the pace which staff build a caseload and size of each staff person's
caseload,not exceeding thirty(30)case weight points.
8-1.A RATING INDICATORS
= 3 No 3 rating indicator for 8-1.A
M 2 The site's policy and procedures regarding caseload size are based on staff tenure,with full-time Family
Support Specialists in their role for one-two years typically with a caseload of 10-12 families and
full-time Family Support Specialists employed for three years or more typically with caseload of
= 15-20 families.Supervisors use discretion regarding the pace each staff person builds a caseload and,
. ensures regardless of time in role or number of families,caseload will not exceed thirty case weight
points(prorated for staff working less and a 40 hour work week).
1 The site does not yet have policy and procedures regarding caseload size:or the site's policy states
case weight exceeds the maximum allowable for full time Family Support Specialist(40 hrs/wk).
In P: Supervisors are encouraged to monitor caseload size closely,beginning with gradual increases to an FSS caseload
when staff are newly hired and trained.and setting an expectation for all staff of an average caseload size vs an
expectation that all staff carry the maximum number • •.
caseloadT1 P: For sites serving families experiencing complex stressors,a tenured full-time staff person generally is maxed out with
of 12-16 families.
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0 8-1.B Full-time Family Support Specialists do not exceed a case weight of thirty points.
o Intent: HFA's case weight system helps to ensure the caseload of Family Support Specialists is manageable and
a family needs can be effectively supported.There are select circumstances when FSSs may exceed the maximum
case weight of thirty points,e.g.,a Family Support Specialist leaves and the caseload is temporarily dispersed
among existing Family Support Specialists temporarily (3 consecutive months or less). Sites are to clearly
document the reasons why the caseload has exceeded the limit,as well as the duration of this deviation.
Also,the maximum is based on a full-time schedule of 40 hours worked per week.When an organization employs
full-time staff at less than 40 hours per week, and/or part-time staff,the maximum case weight will need to be
prorated accordingly,and the proration calculation grid(below)can be used to determine maximum case weight.
An HFA Spreadsheet is available for this standard.
8-1.121 RATING INDICATORS
= 3 Within the fast twelve(12)months,no Family Support Specialist exceeds the maximum case weight-r thirty points(or the
prorated case weight for staff working less than 40 hour,,
M 2 Instances were found when Family Support Speelelist(s)exceeded the maximum case weight of thirty points(or the
0 prorated case weight for staff working less than 40 hour/week):however, any deviation in the past twelve(12)months
was temporary(3 consecutive months or less).
In the past twelve(12)months.Family Support Specialists have had case weights in excess of thirty points(or in excess
of the prorated case weight for staff working less than 40 hour/week)for periods longer than 3 consecutive months:or
data regarding case weight has not been maintained for the past 12 months.
MAXIMUM CASE WEIGHT
Formula:0.75 x#of hours per week
• HOUR • • • HOUR
30 pts 28 pts 26 pts 15 pts J
f
,I rt
r
143
8-2. The site's caseload system ensures Supervisors have procedures to apply when assigning families and when
managing caseloads,including principles of ethical practice.
Intent: The primary intent of HFA's Level Change System(including case weights for each level)is focused on ensuring
staff have sufficient time to support the needs of families during home visits,as well as planning time prior to
home visits and documentation and follow-up time after the visit. Other circumstances also impact caseload
size,such as staff who are new to HFA and who need time to integrate the essential components of HFA's approach.
Consideration when assigning families will need to factor in any potential boundary issues or conflicts to ensure
staff avoid these situations.Other considerations include the length of time to travel to and from family homes,
especially for rural or remote areas where travel time may exceed the norm.Considerations are also made when
there are multiple births(see guidelines in HFA's Level System).
8-2.A The site has policy and procedures for assigning and managing its caseloads.
8-2.A RATING INDICATORS
3 No 3 rating indicator for standard 8-2.A.
2 The site's policy and procedures include all of the following criteria:
= •experience,length of time in role,and skill level of the Family Support Specialist
•nature and difficulty of family dynamics
•work and time required to serve each family
•avoiding potential worker conflict or boundary challenge owing to an existing personal relationship
•current staff capacity
•travel and other non-direct service time required to fulfill responsibilities
•extent of other resources available in the community to meet family needs
•other assigned duties
The site does not yet have policy and procedures: or the policy and procedures do not yet include all the criteria listed
above in the 2 rating.
I ..•. to utilize a Code of Ethics,whether one established through professional organizations
workers,early childhood professionals.or a multi-di scipli nary Code of Ethics for Human Service Professionals.
IAdditionally,developirvg relationshipswho have lostprevious Family Support • additional
supportcreative .maintain engagement in services since there may be an additional
144
°D 8-2.B The site uses the criteria identified in 8-2.A.to assign and manage
0
a
its caseloads.
0
8-2.B RATING INDICATORS
3 The site assigns and manages its caseload sizes utilizing criteria
identified in 8-2.A and outlined in the policy and procedures.
M 2 Past instances were found when caseloads were not assigned
or managed according to the criteria identified in 8-2.A; however,
ww pMCft indicates this is now occurring.
1 The site does not yet assign or manage its caseloads utilizing
criteria identified in 8-2.A.
Tables of • •
8.Services are provided by staff in accordance with principles of ethical practice and with limited caseloads to
ensure Family Support Specialists(FSS)have an adequate amount of time to spend with each family to meet
their unique and varying needs and to plan for future activities
DocumentationStandard Pre-Site
8-1.A I Policy- Submit Policy
Caseload Size Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available.
Submit a report indicating the monthly caseload for all current FSSs over the past 12 months.Include
each FSS's full time equivalency(FTE and work hours expected per week),the number of families
8-1.8 1 Monitoring assigned to him or her,the level/intensity of service each family is receiving,and the case weight for
Caseloads each family.
Please Note:An HFA Spreadsheet is available for this standard
8-2.A I Policy- Submit Policy
Managing Caseloads Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available.
8-2.13 1 Caseload No documentation required pre-site.Peers will review documentation and interview staff,advisory
Management board members,and families on-site.
145
Q
0 9
Z
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Art,
A'' .W
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.
4f
Standard 9 Intent is to ensure staff are selected because they
possess characteristics necessary to build trusting, nurturing
relationships, and work effectively with families with different
cultural values and beliefs than their own. Focusing on these
characteristics also increases opportunities for diverse
representation and equitable access to positions for historically
and currently underrepresented individuals and groups.
Download Sample Staff Development Plan for Program Managers,Supervisors,and Direct Service Staff.
9-1. Direct service providers,managers,and supervisors are selected because of a combination of personal
characteristics,experiences.and educational qualifications.The site's hiring system includes processes
to ensure this can happen.
9-1.A The site's system for hiring new staff includes the following:
•job descriptions which include at least the minimum criteria indicated in standard 9-1.6-11)for
the positions of Program Manager.Supervisor,and direct service staff
•standardized interview questions appropriate to each role,including questions to screen for an
applicant's reflective capacity
• policy requiring at least two reference checks and a criminal background check prior to hire
9-1.A RATING INDICATORS
= 3 No 3 rating for standard 9-1.A.
Or 2 The site's system for screening and selection of new staff includes:1)job descriptions with at least the
R minimum criteria listed for program managers, supervisors, and direct service staff(see standards
9-1.13-1)),2)standardized interview questions appropriate to each role with questions to assess each
applicant's reflective capacity,and 3)policy regarding two reference checks and a criminal background
check being complete prior to hire.
1 The site's system for screening and selection of new staff does not yet include all components listed
in the 2 rating.
glossaryTIP: Please see the definition of reflective capacity
applicant's Reflective Capacit These and other hiring tools in the HFA Supervisors Manual can be used by program
and HIR staff.
147
9-1.13 Screening and selection of program managers includes consideration of characteristics including.but not limited to:
•a solid understanding of and experience in managing diverse staff with humility
a •administrative experience in human service or related field including experience in quality assurance and continuous
quality improvement
•master's degree in public health or human services administration or fields related to working with children and families,
or bachelor's degree in these fields with 3 years of relevant experience, or less than a bachelor's degree but with
commensurate HFA experience
•willingness to engage in building reflective practice(e.g.,capacity for introspection.communicating awareness of self
in relation to others,recognizing value of supervision,etc.)
•infant mental health endorsement preferred(if available in the state;if unsure,you can find out on the IMH website)
9-1.6 RATING INDICATORS
= ? The program manager,if hired after the last accreditation site visit,or if this is a first-time accreditation.meets all of tM
required criteria i the standard.
■ The program manager, if hired after the last accreditation, or if this is a first-time accreditation.does not meet all of
the criteria; however,the site documented its justiflcatlon for the hiring decision and a staff development plan for the
manager has been developed and implemented.
1 The program manager, if hired after the last accreditation, or if this is a first-time accreditation, did not meet all of
the criteria stated in the standard and reason for hire not documented: or a staff development plan has not yet been
= developed or implemented.
NA The Program Manager has worked as the Program Manager at the site prior to last accreditation site visit.
9-1.0 Screening and selection of supervisors includes all of the following,but is not limited to:
•master's degree in human services or fields related to working with children and families.or bachelor's degree in these
fields with 3 years of relevant experience.or less than a bachelor's degree but with commensurate HFA experience
•a solid understanding of or experience in supervising diverse staff with humility,as well as providing support to staff in
stressful work environments
•knowledge of infant and child development and parent-child attachment
•experience with family services that embraces the concepts of family-centered and strength-based service provision
•knowledge of parent-infant health and dynamics of child abuse and neglect
•experience supporting culturally diverse communities/families
•experience in home visiting with a strong background in early childhood prevention services
•willingness to engage in building reflective practice(e.g.,capacity for introspection.communicating awareness of self
in relation to others,recognizing value of supervision,etc.)
•infant mental health endorsement preferred(if available in the state;if unsure,you can find out on the IY-1 website)
•experience with reflective practice preferred(see standard 12-2.B for more detail)
9-1.0 RATING INDICATORS
= 3 The site supervisors, if hired after the last accreditation site visit,or if this is a first-time accreditation, meet all of the
squired criteria in the standard.
Thy site si�t�er;��5rrs, if hirer.rj diter the 3si -3rr,rrd1'A_'Inr,. nr If this is a first-time accredltatlr, do not meet all of the
criteria; however, the site documented its justification for the hiring decision and a staff development plan for the
supervisor has been developed and implemented.
= The site supervisors, if hired after the last accreditation, or if this is a first-time accreditation, do not meet all of the
criteria stated in the standard and reason for hire not documented;or a staff development plan has not yet been developed
or implemented.
NA The site supervisors have worked as supervisors at the site prior to last accreditation site visit.
148
9-1.D Screening and selection of direct service staff, volunteers, and interns (performing the same function) include
consideration of personal characteristics.including but not limited to:
•minimum of a high school diploma or equivalent
•experience in working with or providing services to children and families
• an ability to establish trusting relationships
•acceptance of individual differences
•experience and humility to work with the culturally diverse families
•knowledge of infant and child development
•willing to engage in budding reflective capacity(e.g.,capacity for introspection,communicating awareness of self in
relation to others,recognizing value of supervision,etc.)
•infant mental health endorsement preferred(if available in the state:9 unsure,you can find out on the IMH website)
9-1.D RATING INDICATORS
= 3 The site's direct service staff,if hired after the last accreditation site visit.or if this is a first-time accreditation,meets all
of the required criteria listed in the standard.
M 2 The site's direct service staff.if hired after the last accreditation.or if this is a first-time accreditation meets the educational
criteria but at the time of hire did not meet all the experiential criteria:however,a staff development plan for direct service
staff is In place and has been acted upon.
S
= 1 Any of the following.direct service staff,if hired after the last accreditation,or if this is a fast-time accreditation.do not yet
meet the educational criteria stated in the standard,or do not yet meet all the experiential criteria and there is no development
plan to compensate for experiential gaps:or the development plan has not yet been acted upon.
NA All direct service staff have worked as direct service staff at the site prior to last accreditation site visit.
Note: This is an Essential Standard.
9-2. The site actively recruits,employs.and promotes qualified personnel and administers its personnel practices without
discrimination based upon age,sex,gender identity.sexual orientation,race,creed,color,ethnicity.religion,nationality,
political affiliation,citizenship status,marital status,veteran status,disability or handicap,genetic information,pregnancy,
family medical history,or any other characteristic protected by applicable federal,state,or local laws of the individual
under consideration.EEOC Discrimination Tvoes.
9-2.RATING INDICATORS
= 3 The site:
•� is in compliance with the Equal p q Opportunity Act in the United States and communicates its equal opportunity practices
in recruitment,employment,transfer,and promotion of employees
•informs staff of the equal opportunity practices
•uses recruitment materials which specify the non-discriminatory nature of the site's employment practices
•has no administrative findkW or pout rulings against the site In this respect
•has tic known violations of equal employment opper_
2 Status is under review and pending final determination;no major difficulties have been identified in the process of a review
conducted by a regulatory authority;EEO practices do not incluue all areas of personnel administration and there are
r - n violatio - _r equal employment opportunity:dW site uses limited means of communicating Information on Its
non-discriminatory hiring practices.
= 1 Any of the following:the site is not yet in compliance with the applicable law and has not yet begun corrective action:or
the site has violated its equal opportunity policy:or the site does not yet disseminate information internally on its position
M on equal opportunity.
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9-3. The site's recruitment and selection practices ensure its human resource needs are met.
9-3.A The site's recruitment and selection practices are in compliance with applicable law or regulation and include:
•utilization of standardized interview questions that comply with employment and labor laws,and interview responses
or summaries maintained for currently employed staff
• verification of two references or letters of recommendation: if hired from within the organization, performance
appraisals can suffice
Please Note: If Human Resources policy does not permit interview responses/summary or reference checks to be
maintained in personnel files,the program manager or supervisor is expected to maintain copies in their own staff files.
Please Note:Each round of recruits for a particular role will be asked the same set of questions.
9-3.A RATING INDICATORS
= 3 The site's recruitment and selection practices contain all practices identified in the standard for both staff and volunteers.
2 Past instances were found where the site's recruitment and selection practices did not contain all practices identified in
the standard for both staff and volunteers:however,r♦pnt practice(through new hires)indicates this is now occurring.
The site's recruitment and selection practices consistently do not yet include all practices identified in the standard for both
staff and volunteers.
TIP: It is recommended practice that all available positions are posted internally before posting externall-�
TI P: HFA has sample interview questions in English and Spanish if needed.
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9-3.13 The agency conducts appropriate,legally permissible.and mandated inquiries(as allowed within the state or province)
of state or provincial criminal history records on all employees, subcontractors, and volunteers who will have direct
contact with children or access to data involving children.
Intent: Sites must ensure the safety of the families and children it serves by conducting criminal background checks on all
employees who will come in contact with them,e.g., Direct service staff,supervisors,and program managers.
Even in cases when the State does not mandate criminal background checks for HFA staff,sites are expected to
check legally permissible criminal history records. At a minimum, sites are to conduct legally permissible
background checks(at any point during employment)in order to be in adherence to the standard.While inquiries
made to civil child abuse and neglect registries are highly recommended,they are not always legally permissible
or readily available to sites.
Criminal history records should not be used to deny employment of qualified individuals unless the nature of
the conviction is related to the specific job duties.Legal counsel should be sought with regard to appropriate
use of background checks.
The site is not required to conduct background checks for licensed staff if the site has verified that background
checks or FBI fingerprinting are part of the licensing process,and staff reporting to be licensed have a valid and
current license on file in the personnel record.
Please Note: If Human Resources policy does not permit criminal background checks to be maintained in
personnel files,the head of Human Resources will need to provide a signed letter on agency letterhead indicating
each employee's first and last name,the date of hire,and the date the criminal background check was completed.
9-3.6 RATING INDICATORS
= 3 All currently employed site staff have had legally permissible criminal background checks completed at the time of
enWloynwit.State child abuse and neglect registries may also have been checked.
All currently employed staff have had criminal background checks completed at wW point during employment.State child
abuse registries may also have been checked.
The site has conducted legally permissible background checks on some but not all currently employed staff;or does not yet
conduct criminal background checks.
Note: This is a Safety Standard.
TIP: Sites are encouraged to re-screen employees at various time intervals and conduct background checks not only at the
time of hire but also during the course of employment(e.g.,once every five years)or if transferring within the agency.
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9-4. The site evaluates and reports on staff satisfaction and retention at least once every two years and addresses how it may
increase staff retention,improve staff diversity,inclusion,belonging and promote equity.
Intent: A stable,qualified workforce is known to contribute to improved participant outcomes,with families more likely
to be retained in services when staff are retained. Therefore, site management evaluates factors associated
with staff turnover.By understanding the circumstances and characteristics of staff who leave,along with input
from those who stay,strategies to increase retention can be developed(based on the data)and implemented
with a greater likelihood of success.Please Note:While the site will want to include in their report all the reasons
contributing to staff turnover,strategies for improvement do not need to be developed when reasons pertain to
personal growth opportunities that could not be fulfilled on the job(e.g.,returning to school,job promotion,
etc.).Please Note:New sites without two full years since home visiting services began will monitor staff retention
and satisfaction with one year of data.Please Note:If there has been no turnover in the last two years,the site
will still monitor staff satisfaction among employed staff.
Download Sample Staff Satisfaction and Retention Template.
9-4.RATING INDICATORS
The site evaluates and reports on staff retention and satisfaction at least once every two years and has Implemented
M strategies to address any issues identified from compiled satisfaction surveys or that impacted staff who left employment,
M including any issues associated with diversity,equity and inclusion.
M 2 The site evaluates and reports on staff retention and satisfaction at least once every two years and has developed
strategies to address any issues identified from compiled satisfaction surveys or that impacted staff who left employment,
including any issues associated with diversity,equity and inclusion,though strategies have not yet been Implemented.
1 The site has not yet evaluated staff retention or satisfaction at least once every two years;or has not yet developed strategies
to address issues.
obtainTIP: When sites •..
a encouraged to consider factors such as:job category,staff demographics,role clarity,acknowledgment of work
performed, satisfaction with salary and benefits, reasonable workload. autonomy. and opportunities for
advancement • career development.
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Tables of Documentation
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9.Service providers are selected because of their personal characteristics,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
DocumentationStandard Pre-Site
Staff are selected because of a combination of personal characteristics,experiential,and educational
qualifications,and the site's hiring system includes processes to ensure this can happen.
9-1.A I Site's System 1.Job descriptions with at least the minimum criteria listed for program managers,supervisors and
for Hiring New Staff direct service staff(see standards 9-1.6-13).
2.Standardized interview questions appropriate to each role with questions to assess each
applicant's reflective capacity,
3.Policy regarding at least two reference checks and a criminal background check prior to hire
9-1.121 1 Screening&
Selection of Program
Managers If this is a first accreditation visit,submit resumes for all current staff.If this is a reaccreditation visit,
9-1.0 I Screening& submit resumes for all staff hired since the last accreditation visit.Please also provide narrative for
Selection of Supervisors staff who do not meet all the criteria as outlined in the standard,including justification for the hiring
decision and staff development plans that have been developed and implemented.
9-1.13 1 Screening&
Selection of Direct
Service Staff.Volunteers. Sample Staff Development Plan for Program Managers.Supervisors.and Direct Service Staff.
and Interns
Essential Standard
Please provide a narrative description of the organization's current status with regard to EOE,
9-2. 1 Equal Opportunity whether with no violations,under current review,in remediation,or with a history of previous
Employment(EOE) findings.Please also provide any HR policy or protocols or other descriptive documentation specific
to how the organization applies EOE laws.
Personnel files will be reviewed onsite.If peers are not permitted access to personnel files,a letter
on agency letterhead signed by HR director can be provided verifying internal review of personnel
records.If providing a letter,it must include the first and last names of all current HFA staff,date of
9-3.A I Recruitment hire.and confirmation that each of the following exist in the personnel record:
and Selection Practices utilization of standardized interview questions that comply with employment and labor laws and
interview responses or summaries maintained for currently employed staff
verification of two reference checks or letters of recommendation.If hired from within the
9-3.B I Legally organization,performance appraisals can suffice.
Permissible date criminal background check was completed.
Background Checks if utilized,date of state child abuse registry check.
Safety Standard Any items not maintained by HR in the personnel file,such as interview responses/summary or
reference checks,and thus unable to be verified via a letter from HR,must be provided by the
program manager to be reviewed onsite.
Submit narrative indicating factors associated with staff who have left along with satisfaction feedback from
existing HFA staff.Also indicate how this data has been used to develop staff retention strategies,improve
staff diversity and inclusion,and promote equity.Include which strategies have been implemented.
1.For staff retention,include data of staff who have left.Include staff(by position title)who left during
the timeframe(12 months for new sites.24 months for all others),their hire date.termination date,
reason why they left;and any other pertinent characteristics.
9-4.1 Staff Retention 2.For staff satisfaction include a summary of staff satisfaction input in regard to work conditions that
and Satisfaction contribute both negatively and positively to job satisfaction(typically aggregated survey results)for
those currently employed with the HFA site.Agency-wide staff satisfaction surveys,if used,must be
filtered and reported for HFA staff only.
3.Include strategies developed for staff retention based on what was learned from retention and
satisfaction data.
Please note:Sample Surveys available.
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AD
Service providers receive intensive
training specific to their role to
understand the key components of
family assessment, home visiting,
and supervision.
Standard 10 Intent is to ensure staff receive training specific to
their role. HFA Core training is required for all direct service staff,
supervisors, and program managers within six months of hire.
This training must be provided by a nationally certified HFA Core
trainer. Stop-gap training is provided when staff begin providing
direct services prior to receiving Foundations or Supervision
training. In addition, there are seven orientation training topics
required to be received by staff prior to work with families.
Please Note: For training standards (10 & 11) where "recent
practice" is indicated for a 2 rating, at the time of the accreditation
site visit, the site's most recent hire (whose hire date has allowed
sufficient time to receive training) plus any staff hired three
months prior to the most recent hire, will demonstrate training
was received in accordance with the standard, specific to content
and timeframe requirements, unless extenuating circumstances
warrant contextual decision-making.
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Q 10-1. The site has a comprehensive training policy detailing all required trainings listed below for staff(direct service staff.
asupervisors,and program managers),including:1)topics.2)the method for obtaining training,and 3)the timeframe for each.
c
a •orientation(10-2.A-G)and 10-2.H for sites in multi-site systems
•stopgap training(10-3.A-C)when HFA Core is received after first direct service
•intensive model specific(HFA Core)training(10-4.A-C)
•implementation training(10-5)(program managers or designee only)
•CCI.ASO and ASO:SE,and depression screen(10-6.A-D)for staff who administer the tool and their supervisors
•wrap-around training topics within 3 months of hire(11-1.A-D)
•wrap-around training topics within 6 months of hire(11-2.A-G)
•wrap-around training topics within 12 months of hire(11-3.A-E)
•annual ongoing training(11-4.A)
•annual training on child abuse and neglect update(11.4.13)
•annual training on diversity,equity,inclusion and belonging(11-4.C)
Please Note:All interns and volunteers who perform the same duties as direct service staff and supervisors receive the
same type of training as paid staff.
Intent: The policy guides the site toward achieving all required training in a timely manner and clearly identifies:
•topics covered in each training module or session
•how the training is provided and by whom(e.g..program manager/supervisor,community agency.HFA online
training modules,video,reading materials,etc.)
•the required timeframe for each training
•mechanism for tracking and supervisor verification
If the site's policy references its training log for description of all topics and the method they will be received,
then a link to the log must also be provided in the policy.Training logs include date of hire to HFA,date of 1st
direct service(home visit,FROG.supervision),and date of training(even when dates fall outside the required
timeframe).If sites use something other than HFA's recommended online wraparound training,the training will
comprehensively address each of the overall topics with a variety of relevant subtopics critical for preparing
staff to do this work.
Please Note:HFA provides online training options for receipt of wrap-around training.For sites that do not use
these options,the site will create a crosswalk showing each of the required topic areas,with the corresponding
training title,training provider,training agenda or list of training content,and method used to cover each topic.
Sites can track training using the HFA Spreadsheet available for this standard.
10-1. RATING INDICATORS
= 3 No 3 rating for standard 10-1.
2 The site has a comprehensive training policy,including all required trainings and the method and timeframe for receipt
of all trainings.
1 Any of the following:there is no training policy:or the training plan/policy is not yet comprehensive(does not list all required
topics and method for receipt of training,e.g.,e-learning,LMS,onsite,etc.):or does not yet include timeframe for receipt
of all training.
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10-2. Staff(direct service staff,supervisors.and program managers):receive orientation training after HFA hire date and prior
to direct work with families or supervision of staff to familiarize them with site responsibilities.Program managers hired
prior to July 1.2014,are not required to document receipt of orientation topics.
Intent: When staff are hired.they often begin their work with families prior to receiving HFA Core training.Therefore.it
is essential staff have been oriented to topics which will directly impact their immediate work with families or
with direct service staff(for supervisors).Typically,these orientation trainings are designed and provided by the
site and will reflect the resources,laws,and requirements specific to the host organization,local community,or
state.The HFA National Office makes available online orientation that sites may choose to use in addition to any
organization-required orientation training.Site administrators ensure these orientation topics are comprehensive
and support the staff to succeed in their roles during this early part of employment.All of these training topics
must be covered prior to direct contact with participants and prior to direct supervision of staff.Please Note:In
the event staff did not receive these trainings within the required timeframes, for accreditation purposes it
is expected all staff will receive the training regardless of the timeframe.Please Note.When a site is brand new,
the program manager or supervisor may be involved in the writing of policy and procedure and the development
of orientation procedures for staff.These activities,with documented dates relative to each orientation topic,
can be referenced as completion of orientation for program managers or supervisors.Please Note:For any staff
who are a re-hire to the HFA site,the expectation is to receive orientation again, if longer than three months
since previously employed.
10-2.A Staff(direct service staff,supervisors,program managers,and the manager's supervisor)hired January 1,2022 or later receive
HFA Quick Start orientation training.
Orientation training pnor to January 1,2022 included:1)the HFA goals and services.2)the philosophy of home visiting/
family support, and 3) the principles of ethical practice, subsequent to HFA hire date and prior to direct work with
families or supervision of staff.
10-2.A RATING INDICATORS
3 Staff hired 01/01/22 or later receive HFA Quick Start training after HFA hire date and prior to direct work with
families or supervision of staff.For sites in their first accreditation cycle,staff hired more than five years ago have received
M the training but it may have occurred after first direct service. For sites in a reaccreditation cycle,training data for staff
hired longer than five years is not required.
Past instances were found when staff hired 01/01/22 or later did not receive HFA Quick Start training after HFA
hire date and prior to direct work with families or supervision of staff. however, recent prattloe indicates this is now
occurring and all staff (if site is in its first accreditation cycle) have received the orientation training regardless of the
timeframe.For sites in a reaccreditation cycle,training data for staff hired longer than five years is not required,and rated
"2"if no new hires in the last five years.
1 Staff hired 01/01/22 or later do not yet receive HFA Quick Start after HFA hire date and prior to direct work with families:or
supervision of staff.
TIP: Sites are encouraged to invite all Community Advisory Board(CAB)members to view HFA Quick Start orientation
5 training at the start of their term with the CAB.
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Q 10-2.13 Staff(direct service staff,supervisors,and program managers)are oriented to their roles as they relate to:1)the site's
aparenting materials,curriculum.and other handouts shared with parents 2)policy and operating procedures.and 3)data
i collection forms and processes,after HFA hire date and prior to direct work with families or supervision of staff.
a
10-2.6 RATING INDICATORS
3 All staff are oriented to their roles as they relate to the site's curriculum materials,policy and operating procedures,and
data collection forms and processes, after HFA hire date and prior to direct work with families or supervision
M of staff.For sites in their first accreditation cycle,staff hired more than five years ago have received the training but it may
have occurred after first direct service.For sites in a reaccreditation cycle,training data for staff hired longer than five
years is not required.
2 Past instances were found when staff were not oriented to their roles as they relate to the site's curriculum materials,policy
and operating procedures,and data collection forms and processes,after HFA hire date and prior to direct work with
= families or supervision of staff;however,recant p►aclim indicates this is now occurring and all staff(if site is in its first
accreditation cycle)have received the orientation training regardless of the timeframe.For sites in a reaccreditation cycle,
training data for staff hired longer than five years is not required.
Staff are not yet oriented to their roles as they relate to the site's curriculum materials,policy and operating procedures,and
data collection forms and processes,after HFA hire date and prior to direct work with families or supervision of staff.
10-2.0 Staff(direct service staff,supervisors,and program managers)are oriented to the site's relationship with other community
resources after HFA hire date and prior to direct work with families or supervision of staff.
10-2.0 RATING INDICATORS
3 All staff are oriented to the site's relationship with other community resources(e.g.,organizations in the community with
which the site has working relationships) after HFA hire date and prior to direct work with families or supervision
of staff.For sites in their first accreditation cycle,staff hired more than five years ago have received the training but it may
have occurred after first direct service.For sites in a reaccreditation cycle,training data for staff hired longer than five
years is not required.
2 Past instances were found when staff were not oriented to the site's relationship with other community resources
after HFA hire date and prior to direct work with families or supervision of staff; however, recent praCtICe indicates
this is now occurring and all staff(if site is in its first accreditation cycle)have received the orientation training regardless
of the timeframe.For sites in a reaccreditation cycle,training data for staff hired longer than five years is not required.
Staff are not yet oriented to the site's relationship with other community resources after HFA hire date and prior to
direct work with families or supervision of staff.
10-2.D Staff(direct service staff,supervisors,and program managers)are oriented to:1)child abuse and neglect indicators,and
2)reporting requirements after HFA hire date and prior to direct work with families or supervision of staff.
10-2.1) RATING INDICATORS
3 All staff are oriented to child abuse and neglect indicators and reporting requirements after HFA hire date and
prior to direct work with families or supervision of staff.For sites in their first accreditation cycle,staff hired more than
five years ago have received the training but it may have occurred after first direct service.For sites in a reaccreditation
cycle,training data for staff hired longer than five years is not required.
M 2 Past instances were found when staff were not oriented to child abuse and neglect indicators and reporting ortin 9 P 9 requirements
after HFA hire date and prior to direct work with families or supervision of staff; however, resent praMCS indicates
this is now occurring and all staff(if site is in its first accreditation cycle)have received the orientation training regardless
of the timeframe.For sites in a reaccreditation cycle,training data for staff hired longer than five years is not required.
1 Staff are not yet oriented to child abuse and neglect indicators and reporting requirements after HFA hire date and
prior to direct work with families or supervision of staff.
Note: This is a Safety Standard
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10-2.E Staff (direct service staff, supervisors. and program managers) are oriented to issues of confidentiality and issues of
ethical practice prior to direct work with families or supervision of staff.
10-2.E RATING INDICATORS
= 3 All staff are oriented to issues of confidentiality and principles of ethical practice after HFA hire date and prior
to direct work with families or supervision of staff. For sites in their first accreditation cycle, staff hired more than five
M years ago have received the training but it may have occurred after first direct service.For sites in a reaccreditation cycle,
training data for staff hired longer than five years is not required.
2 Past instances were found when staff were not oriented to confidentiality and principles of ethical practice after
= HFA hire date and prior to direct work with families or supervision of staff:however,reCeM praCtJCe indicates this is now
occurring and all staff (if site is in its first accreditation cycle) have received the orientation training regardless of the
timeframe.For sites in a reaccreditation cycle.training data for staff hired longer than five years is not required-
1 Staff are not yet oriented to issues of confidentiality and principles of ethical practice after HFA hire date and prior
to direct work with families or supervision of staff.
TI P- Sites are encouraged to utilize a Code of Ethics, whether one established through professional organizations
for nurses, social workers, or early childhood professionals, or a multi-disciplinary Code of Ethics for Human
Service Professionals.
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Q 10-2.F Staff(direct service staff,supervisors,and program managers)are oriented to issues related to boundaries after HFA
ahire date and prior to direct work with families or supervision of staff.
0
a 10-2.F RATING INDICATORS
N
3 All staff are oriented to issues related to boundaries after HFA hire date and prior to direct work with families or supervision
of staff.For sites in their first accreditation cycle,staff hired more than five years ago have received thetraining but it may
M have occurred after first direct service.For sites in a reaccreditation cycle,training data for staff hired longer than five
years is not required.
2 Past instances were found when staff were not oriented to issues related to boundaries after HFA hire date and
prior to direct work with families or supervision of staff:however,recent practke indicates this is now occurring and all
staff (if site is in its first accreditation cycle) have received the training regardless of the timeframe. For sites in a
reaccreditation cycle,training data for staff hired longer than five years is not required.
1 Staff are not yet oriented to issues related to boundaries after HFA hire date and prior to direct work with families
or supervision of staff.
10-2.G Staff(direct service staff.supervisors,and program managers)are oriented to issues related to staff safety after HFA hire
date and prior to direct work with families or supervision of staff.
10-2.G RATING INDICATORS
3 All staff are oriented to issues related to staff safety after HFA hire date and prior to direct work with families or
supervision of staff. For sites in their first accreditation cycle, staff hired more than five years ago have received the
training but it may have occurred after first direct service.For sites in a reaccreditation cycle,training data for staff hired
longer than five years is not required.
2 Past instances were found when staff were not oriented to issues related to staff safety after HFA hire date and
= prior to direct work with families or supervision of staff:however,recent practke indicates this is now occurring and all
staff (if site is in its first accreditation cycle) have received the training regardless of the timeframe. For sites in a
reaccreditation cycle,training data for staff hired longer than five years is not required.
1 Staff are not yet oriented to issues related to staff safety after HFA hire date and prior to direct work with families
or supervision of staff.
10-2.1-11 Staff(direct service staff.supervisors,and program managers)who work at a site that is part of an HFA Multi-Site System
are oriented to the Multi-Site System,including the goals,objectives,policies,and functions of the Multi-Site System and
Central Administration.
10-2.1-11 RATING INDICATORS
= 3 All staff are oriented to the Multi-Site System, including the goals, objectives, policies, and functions of the Multi-Site
System and Central Administration,within three months of hire.For Multi-Site Systems in their first accreditation cycle,
staff hired more than five years ago have received the training regardless of timeframe.For systems in a reaccreditation
cycle,training data for staff hired longer than five years is not required.
2 Past instances were found when staff were not oriented to the Multi-Site System,including the goals,objectives,policies,
= and functions of the Multi-Site System and Central Administration,within three months of hire:however,recent pfeetlae
indicates this is now occurring and all staff(if system is in its first accreditation cycle)have received the training regardless
= of the timeframe.For systems in a reaccreditation cycle,training data for staff hired longer than five years is not required.
1 Staff are not yet oriented to the Multi-Site System,including the goals,objectives,policies,and functions of the Multi-Site
System and Central Administration,within three months of hire.
NA The site is not part of an HFA Multi-Site System.
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10-3. Supervisors and Family Support Specialists who begin home visiting or supervision work prior to receipt of HFA Core
training. must receive "stop-gap" training. Stop-gap training does not need to be conducted by a certified trainer,
however,it must be conducted by someone who has been intensively trained in the role they are providing stop-gap
training for.Stop-gap training does not replace the requirement to attend HFA Core training.
Intent: When staff begin home visiting or supervision work prior to the receipt of role-specific HFA Cote training,the
site must have a policy for the provision of stop-gap training. Stop-gap training is defined as: customized
training provided as-needed to meet an individual's urgent need for training in the skills necessary
to perform their work prior to the receipt of HFA Core training.HFA has developed a series of stop-gap training
webinars to be used in conjunction with on-site activities designed to set staff on a positive trajectory for their
work with families. Stop-gap on-site activities do not need to be conducted by a certified trainer: however,it
must be conducted by someone who has been intensively trained in the role.Stop-gap training does not replace
the requirement to attend HFA Core training.
For established sites,all new staff will complete stop-gap training in order to begin their work with families when
waiting to attend HFA Core Foundations or Supervision training,unless the site's policy requires HFA Core
Training is received prior to direct service.Stop-gap training,including on-site activities,have been developed
by HFA and may be conducted by the site supervisor or program manager.HFA stop-gap training includes:
•a clear description of the"HFA Advantage"(what makes HFA unique,including trauma-informed practice,the
power of relationships/attachment,and reflective capacity)
•shadowing of other staff in a similar role
•hands-on practice(with observation and feedback)
•training on forms used by individuals in that role and expectations for documentation
•use of a strengths-based approach when working with others
Please Note: For brand new sites where there is currently no one on staff who has received HFA Core Training
or there is not a neighboring site with which to connect,the HFA National Office can provide support allowing
families to begin receiving services.Please contact your HFA Training and TA Specialist for more details.
10-3.A The site has policy and procedures for providing stop-gap training to direct service staff and supervisors of direct
service staff when they begin their work prior to the receipt of HFA Core Foundations or Supervision training,to ensure
staff has adequate understanding and knowledge of their role. The training must include the bulleted components
described in the intent.
10-3.A RATING INDICATORS
= 3 No 3 rating for 10-3.A.
2 The site has policy and procedures for providing stop-gap
� y g training to direct service staff and their supervisors who will
= begin their work prior to the receipt of HFA Core Foundations or Supervision training.Stop-gap training includes all
bulleted components described in the intent.
1 The site does not yet have policy and procedures for providing stop-gap training to direct service staff and their supervisors
who will begin their work prior to the receipt of HFA Core Foundations or Supervision training:or the policy and procedures
do not yet specify the training include all bulleted components described in the intent.
� Y 9 P
NA The site's policy requires that HFA Core training be received prior to providing direct service.
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0 10-3.13 Direct service staff who begin their work with families prior to completion of Intensive HFA Core Foundations training,and
a
their supervisor, have received stop-gap training to ensure direct service staff and their supervisor have adequate
i understanding and knowledge of their role.
a
10-3.B RATING INDICATORS
3 Staff receive stop-gap training prior to their work with families and/or supervising direct service staff which includes all
required components.For sites in their first accreditation cycle,staff hired more than five years ago have received training
= though it may have occurred after first direct service.For sites in a reaccreditation cycle.training data for staff hired more
than five years ago is not required-
2 Past instances may have occurred when stop-gap training was not received prior to beginning work with families and/or
supervising direct service staff,or some of the required components were not included;however,rNGartt practice indicates this
is now occurring and all staff(if site is in its first accreditation cycle)have received the training regardless of the timeframe.For
sites in a reaccreditation cycle.training data for staff hired in current position longer than five years is not required.
Site staff do not yet receive stop-gap training prior to beginning work with families and/or supervising direct service staff;
or the training does not yet include the required components.
on
N:; All staff have received HFA Core training prior to providing direct service.
10-3.0 Supervisors who begin providing supervision prior to completion of intensive HFA Core Supervision training have
received supervisor stop-gap training to ensure the supervisor has adequate understanding and knowledge of their role.
10-3.0 RATING INDICATORS
= 3 Supervisors receive supervisor stop-gap training including all required components within four weeks of hire to HFA
supervisor role. For sites in their first accreditation cycle, staff hired more than five years ago have received training
= though it may have occurred after first direct service.For sites in a reaccreditation cycle,training data for staff hired more
than five years ago is not required.
2 Past instances may have occurred when training was not received within four weeks of hire to HFA supervisor role or
= some of the required components were not included: however, recent practJoe indicates this is now occurring and
all supervisors(if site is in its first accreditation cycle)have received the training regardless of the timeframe.For sites in
= a reaccreditation cycle,training data for staff hired in current position longer than five years is not required.
i Supervisors do not yet receive training within four weeks of hire to HFA supervisor role:or the training does not yet include
all of the required components.
NA All supervisors have received HFA Core Supervisor training prior to supervising staff.
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10-4. Staff(direct service staff,supervisors,and program managers)receive intensive HFA Core trainings within the following
timeframes.For those administering the FROG Scale.training is received prior to first use:for Foundations and Supervision
training. and FROG training for Supervisors. within six months of hire. HFA Core trainings are provided by an HFA
certified trainer.
Intent: Intensive training develops the knowledge and skills necessary to achieve site goals.It prepares staff to assess
family needs,assist with parent-child interaction,strengthen family functioning,provide appropriate information,
connect families with appropriate resources,and meet the expected standards of service delivery.Furthermore,
intensive training allows staff to link theory to practice by developing and implementing practical approaches to
real-life situations,to share information and experiences,and to learn from one another.
Please Note:In the event staff did not receive HFA Core training within the required timeframes,it is required all
staff will receive the training regardless of the timeframe.
Please Note:When a staff member who has received Core training is re-hired for the same position,whether at
the same site or at a different site,re-taking of HFA Core training is required if the staff person has not worked
for HFA in three or more years.
10-4.A All staff administering the FROG Scale receive intensive HFA Core FROG Scale training by an HFA certified trainer prior
to first use of the tool and all supervisors receive this training within six months of hire.
10-4.A RATING INDICATORS
3 All staff using the FROG Scale and all supervisors receive intensive HFA Core FROG Scale training by an HFA certified
trainer within the timeframes indicated in the standard.For sites in their first accreditation cycle,staff hired more than five
years ago have received the training,though it may have been received later.
2 Past instances were found when staff using the FROG Scale or supervisors did not receive intensive HFA Core FROG Scale
training by an HFA certified trainer within the timeframes indicated in the standard:however,recent practke indicates this
= is now occurring and all staff(if site is in its first accreditation cycle)have received the training regardless of the timeframe.
1 Staff using the FROG Scale or supervisors do not yet receive intensive HFA Core FROG Scale training within the timeframes
indicated:or training was not conducted by an HFA certified trainer.
Note: This is an Essential Standard.
TI P: FROG Scale training is optional for program managers who do not supervise staff administering the FROG.
10-4.13 All staff(including program managers hired January 1,2022, or later) have received intensive HFA Core Foundations
training by an HFA certified trainer,within six months of date of hire,to understand key components of the HFA model.
Program managers hired prior to January 1.2022,receive the training within eighteen months of hire.
10-4.13 RATING INDICATORS
3 All staff receive intensive HFA Core Foundations training by an HFA certified trainer,within six months of the date of hire.
For sites in their first accreditation cycle,staff hired more than five years ago have received the training,though it may
= have been received later than within six months of hire. For sites in a reaccreditation cycle,training data for staff hired
more than five years ago is not required.
M 2 Past instances were found when staff did not receive intensive HFA Core Foundations training by an HFA certified trainer
within six months after hire: however, recent practice indicates this is now occurring, and all staff(if site is in its first
accreditation cycle)have received the training regardless of the timeframe. For sites in a reaccreditation cycle,training
= data for staff hired in current position longer than five years is not required.
1 Staff do not yet receive intensive HFA Core Foundations training within six months of hire:or the training was not conducted
by an HFA certified trainer.
Note: This is an Essential Standard.
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10-4.0 Supervisors and program managers have received Intensive HFA Core Supervision training by an HFA certified trainer
within six months of date of hire,to understand the key components of supervision. This includes FROG Supervision
training for those who supervise staff administering the FROG Scale.Program managers hired prior to January 1,2022,
receive the training within eighteen months of hire.
10-4.0 RATING INDICATORS
3 All supervisors and program managers receive intensive HFA Core Supervision training by an HFA certified trainer,on the
M
f• key components of supervision.within six months of the date of hire or position change-For sites in their first accreditation
M cycle,staff hired more than five years ago have received the training,though it may have been received later than within
six months of hire.For sites in a reaccreditation cycle.training data for staff hired more than five years ago not required.
f♦
2 Past instances were found when supervisors and program managers did not receive intensive HFA Core Supervision
training by an HFA certified trainer,within six months after hire or position change: however.recent practice indicates
this is now occurring and all supervisors and program managers(if site is in its first accreditation cycle)have now received
the training regardless of the timeframe-For sites in a reaccreditation cycle,training data for staff hired in current position
IN longer than five years is not required.
Supervisors and program managers do not yet receive intensive HFA Core Supervision training within the specified time
frames:or training was not conducted by an HFA certified trainer.
Note: This is an Essential Standard.
1TIP: After receiving HFA CoreSupervision training.all supervisors are strongly encouraged to also.. .
1TIP: FROG Supervisionoptional forprogram managerswho••not supervise • FROG.
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10-5. All Program Managers(or those in a role and fulfilling expectation of program manager as defined in the glossary)hired
to HFA on or after January 1,2018,receive intensive HFA Core Implementation training from the HFA National Office
within eighteen months of date of hire, to understand the key components of implementing the HFA model. HFA
Implementation training is strongly encouraged and optional for program managers hired prior to January 1.2018.
10-5. RATING INDICATORS
= 3 All program managers hired to HFA on or after January 1,2018, receive intensive HFA Core Implementation training.by
National Office staff,on the key components of implementing the HFA model,within twelve ffxm tffi of the date of hire or
position change;or program managers hired prior to January 1,2018,completed HFA Implementation Training.
2 All program managers hired on or after January 1.2018.receive intensive HFA Core Implementation training by National
Office staff within eighteen months of hire or position change;or have a plan to attend if less than eighteen months since hire.
1 Program managers hired un or after January 1.2018,have not yet received intensive HFA Core Implementation training from
National Office staff within eighteen months of hire or position change.
NA The site's program manager was hired prior to January 1,2018,and is exempt from completing HFA Core Implementation Training.
I possible, • •.ram manager's supervisor also attend
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Q 10-6. Staff who are responsible for the administration of required screening tools receive trainings on these tools prior to first
ause.and supervisors receive these trainings within six(6)months of hire.
c
a 10-6.A Those who administer the CHEERS Check-In(CCI)tool have been trained in the use of the tool before administering it,
and supervisors also receive this training.
Intent: Staff must be trained before administering the CCI.Training can be accessed on HFA's Network Resources.CCI
training received prior to HFA hire date is acceptable if the staff has been using the tool consistently(without
lapse)since receipt of training.
10-6.A RATING INDICATORS
= 3 All staff hired in the past five years,who use the CCI,are trained in its use prior to administering the tool.Supervisors hired
in the past five years receive training within six months of hire.For sites in their first accreditation cycle,staff hired more
= than five years ago have received the training but it may have occurred later than above. For sites in a reaccreditation
cycle,training data for staff hired in current position longer than five years is not required.
2 Past instances were found when staff hired in the past five years did not receive training on the CCI prior to administering
the tool.or for supervisors within six months of hire:however.recent practice indicates this is now occurring and all staff
(if site is in its first accreditation cycle)have received the training regardless of the timeframe.For sites in a reaccreditation
M cycle,training data for staff hired in current position longer than five years is not required.
M
1 Staff administer the CCI tool prior to being trained:or supervisors have not yet received the training.
10-6.13 Those who administer the ASQ have been trained in the use of the current version of the tool before administering it,and
supervisors also receive this training.
Intent: Staff must be trained before administering the ASQ. Ideally, this training is conducted by an individual who
understands the use of the tool in a home visit setting.When possible.this training includes information detailing
the critical function behind each of the developmental questions.ASQ training received prior to HFA hire date
is acceptable if the staff person has been using the tool consistently(without lapse)since receipt of training.
10-6.B RATING INDICATORS
3 All staff hired in the past five years,who use the ASQ,are trained in its use prior to administering the tool.Supervisors
hired in the past five years receive training within six months of hire.For sites in their first accreditation cycle,staff hired
more than five years ago have received the training but it may have occurred later than above.For sites in a reaccreditation
cycle,training data for staff hired in current position longer than five years is not required.
2 Past instances were found when staff hired in the past five years did not receive training on the ASQ prior to administering
= the tool,or for supervisors within six months of hire:however,r9e@11t practice indicates this is now occurring and all staff
(if site is in its first accreditation cycle)have received the training regardless of the timeframe.For sites in a reaccreditation
cycle,training data for staff hired in current position longer than five years is not required.
Staff administer the ASQ prior to being trained;or supervisors have not yet received the training.
10-6.0 Those who administer the ASQ:SE have been trained in the use of the current version of the tool before administering it,
and supervisors also receive this training.
Intent: Staff must be trained before administering the ASQ:SE. Ideally,this training is conducted by an individual who
understands the use of the tool in a home visit setting.When possible.this training includes information detailing
the critical function behind each of the questions.ASQ:SE training received prior to HFA hire date is acceptable
if there has been no gap in use of the tool.
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10-6.0 RATING INDICATORS
3 All staff hired in the past five years,who use the ASQ:SE,are trained in its use prior to administering the tool.Supervisors
hired in the past five years receive training within six months of hire.For sites in their first accreditation cycle,staff hired
= more than five years ago have received the training but it may have occurred later than above.For sites in a reaccreditation
cycle,training data for staff hired in current position longer than five years is not required.
r
2 Past instances were found when staff hired in the past five years did not receive training on the ASQ:SE prior to
M administering the tool, or for supervisors within six months of hire: however, recent practice indicates this is now
occurring and all staff(if site is in its first accreditation cycle)have received the training regardless of the timeframe.For
sites in a reaccreditation cycle,training data for staff hired in current position longer than five years is not required.
1 Staff administer the ASQ:SE prior to being trained:or supervisors have not yet received this training.
10-6.13 Those who administer the depression screen/tool have been trained in the use of the tool before administering it
including ways to talk with parents about depression,and Supervisors also receive this training.
Intent: All staff who administer the depression screening tool, and their supervisors, receive training on the use of
the tool prior to first use.Please Note:When a collaborative partnership results in another provider completing
the depression screen and providing a copy to the Healthy Families provider, the HFA site does not need to
monitor training of non-HFA staff in administering the screen.However,HFA sites are required in these situations
to ensure HFA staff receive depression screen training to ensure understanding of administration guidelines and
referral procedures,regardless of whether or not they administer the screen,as they need to be able to interpret
and act on the results.
10-6.13 RATING INDICATORS
3 All staff hired in the past five years,who use the depression screening tool,are trained in its use prior to administering
the tool.Supervisors hired in the past five years receive training within six months of hire.For sites in their first accreditation
cycle,staff hired more than five years ago have received the training but it may have occurred later than above.For sites
in a reaccreditation cycle,training data for staff hired in current position longer than five years is not required
2 Past instances were found when staff hired in the past five years did not receive training on the depression screening
tool prior to administering the tool,or for supervisors within six months of hire:however,raMt practice indicates this is
now occurring and all staff(if site is in its first accreditation cycle)have received the training regardless of the timeframe.
= For sites in a reaccreditation cycle,training data for staff hired in current position longer than five years is not required.
1 Staff administer the tool prior to being trained:or supervisors have not yet received the training.
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G 10.Service providers receive intensive training specific to their role to understand the
essential components of family assessment,home visiting and supervision
DocumentationStandard Pre-Site
Submit training plan/policy for all staff(direct service staff,supervisors,and program managers)
10-1.1 Training including:all required topics,method for receipt of training(i.e,e-learning,onsite,etc.):and
Plan/Policy timeframe for receipt.
Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available.
10-2A-H Submit documentation indicating the date each staff person(direct service staff,supervisors,and
Orientation Training program managers)completed each of the orientation topics(10-2.A-H),including the date of hire
and the date staff person began providing direct service or supervision. Also include the date the
10-2.11) program manager's supervisor completed 10-2A.
Safety Standard Please Note:HFA Training Log availab e.
Submit Policy
10-3.A I Policy for Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are
Stop-Gap Training available.
Submit documentation indicating receipt of Stop-Gap training(if used)including the date each training
provided
when needed Stop-Gap topic completed,as well as the date of hire for each staff(direct service staff,supervisors,and program
provid managers).
Please Note:HFA Training Loa available.
10-4.A I HFA FROG
Scale Training
Essential Standard Submit documentation indicating the date each staff person completed Core training(direct service staff,
10-4.6 1 HFA CORE supervisors,and program managers)and include the staff date of hire.Documentation can be recorded in a
Foundations Training training log with supervisor signature,or training certificates may be submitted.
Ell Standard Please Note:HFA Trainirg Lcq available.
10-4.0 I HFA
Supervisor Training
Essential Standard
10-5. I HFA Submit documentation indicating the date of hire for the Program Manager(or designee)and the date HFA
Implementation training Implementation training was completed.
for Program Managers Please Note:HFA Training Log available.
For staff who are responsible for the administration of required screening tools,and their supervisors,
10-G.A-D I submit documentation indicating the date each person completed training on each of the screening tools
Tools Training (CCI.ASO-3.ASO:SE,and depression screening)and the date they first administered(or supervised use of)
each tool.
Please Note:HFA Training Loa available.
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All direct service staff and their P,pe
supervisors receive training in areas
such as prenatal and infant care, child
safety and development, family health,
parent-child relationships, family goal ', w
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.
Standard 11 Intent is to ensure staff receive training support
and have the skill set necessary to fulfill their job functions
and achieve improved outcomes with families. Training can be
received through a variety of methods including, but not limited
to, the following: HFA wraparound training modules, in-person
or virtual attendance at lectures, interactive presentations,
workshops, and college coursework.
Intent 11-1 (training within 3 months), 11-2 (training within 6 months),
and 11-3 (training within 12 months): Training that is specific and
relevant to the field of home visiting and can translate to the
work of HFA staff is critical in the first year of employment. It is
intended for staff to receive training in all of the topics outlined in
the rating indicators, incorporating suggested subtopics based
on relevant community dynamics and the individual learning
needs of staff. It is a site's responsibility to ensure competency of
staff and determine their need for additional training beyond the
required topics outlined in these standards. The intent of training
is to provide staff with the knowledge and skills necessary to
support family well-being.
Several formats are acceptable to accomplish training in each of
the specified areas below and can include:attendance at trainings/
workshops/in-services, online trainings developed by HFA, other
online training, formal education, certification, licensure, and
competency-based testing (individual's knowledge of a topic
measured by written test or through observation of skills and
abilities). Previous professional experience or formal education
specific to the topics identified in the standards can be used to
meet the standard when received no more than three years prior
to HFA hire and when coupled with competency-based testing
or supervision follow-up. Follow-up with the supervisor is to
ensure successful knowledge acquisition and understanding of
the concepts or materials within the context of home visiting
and the individual's role, and whether additional training in this
topic might be beneficial.
170
Please Note:
1. All staff at affiliated HFA sites may use the online trainings
developed by HFA (or other training resources provided by
the National Office) to complete the 11-1, 11-2, and 11-3 training
topics. If sites use something other than HFA's recommended
online wraparound training, the training will comprehensively
address each of the overall topics with a variety of relevant
subtopics critical for preparing staff to do this work.
2. HFA Core training (standards 10-4.I3-D) cannot be used to
satisfy the 3-, 6-, and 12-month training requirements.
3. The purpose for specifying in the rating indicators a five-
year timeframe is to allow sites that have been in existence
more than five years to demonstrate their current capacity to
achieve a 3 rating, rather than being hindered by practice that
may have occurred prior to its last accreditation site visit.
4. For training standards (10 & 11) where "recent practice" is
indicated for a 2 rating,at the time of the accreditation site visit,
the site's most recent hire (whose hire date has allowed
sufficient time to receive training) plus any staff hired three
months prior to the most recent hire,will demonstrate training
was received in accordance with the standard, specific
to content and timeframe requirements, unless extenuating
circumstances warrant contextual decision-making.
Sites should have mechanisms for ensuring staff training needs are being met and the trainings are of high
.. supervision sessions or team meetings).
When circumstances prevent staff from . . required training in a timely way, it is recommended sites
document
wrap-aroundconsideration when assigning a rating.
When staff complete
topicspoint once they begin
appliedassist with the transfer of knowledge to practice,as training done very early or too quickly may not be readily
171
11-1. Staff(direct service staff and supervisors)receive training on a variety of topics necessary for effectively working with
families and children within three months of hire.
11-1.A Staff(direct service staff and supervisors)receive training on Infant Care within three months of the date of hire.
HFA's online training includes these subtopics:
•infant sleep and safer sleep practices
•feeding/Breastfeeding
•failure to thrive
•physical care of the baby
•infant crying and responses to crying
11-1.A RATING INDICATORS
3 Staff hired within the past five years received training on Infant Care within three months of hire.For sites in their first
accreditation cycle,staff hired more than five years ago have received the training but it may have been later than three
M months after hire.For sites in a reaccreditation cycle,training data for staff hired in current position longer than five years
is not required.
Past instances were found when staff hired within the past five years did not receive training related to Infant Care within
three months of hire;however,with the most recent hire(s),practice indicates this is now occurring:and all other staff(if
in a first accreditation cycle)have received training on this topic regardless of the timeframe.For sites in a reaccreditation
cycle,training data for staff hired in current position longer than five years is not required and rated as"2"if no new hires
in the last five years.
1 The site's most recent hire(s)have not yet received training on Infant Care within three months of hire;or staff hired within
the past five years have not received training on this topic.
11-1.8 Staff(direct service staff and supervisors)receive training on Child Health and Safety within three months of the date of hire.
HFA's online training includes these subtopics:
•home safety(e.g..fire,child supervision,water temperature,pools.falls,etc.)
•abusive head trauma prevention
•sudden unexpected infant death
•seeking medical care
•well-child visits,immunizations,and oral health
•parenting children with special health needs
•community resources for child health
11-1.13 RATING INDICATORS
3 Staff hired within the past five years received training on Child Health and Safety within three months of hire.For sites in
their first accreditation cycle,staff hired more than five years ago have received the training but it may have been later
M than three months after hire.For sites in a reaccreditation cycle, training data for staff hired in current position longer
than five years is not required.
2 Past instances were found when staff hired within the past five years did not receive training related to Child Health and
Safety within three months of hire:however,with the most recent tft(s).practice indicates this is now occurring;and all
other staff (if in a first accreditation cycle) have received the training regardless of the timeframe. For sites in a
reaccreditation cycle,training data for staff hired in current position longer than five years is not required and rated as
_ "2"if no new hires in the last five years.
1 The site's most recent hire(s)have not yet received training on Child Health and Safety within three months of hire:or staff
hired within the past five years have not received training on this topic.
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0 11-1.0 Staff(direct service staff and supervisors)receive training on Family Health within three months of the date of hire.
a HFA's online training includes these subtopics:
c
a •adult primary care
•family planning and reproductive justice
•disability and chronic health issues
•smoking cessation
•health equity and access to care
•community resources for adult medical care and nutrition
11-1.0 RATING INDICATORS
3 Staff hired within the past five years received training on Family Health within three months of hire.For sites in their first
accreditation cycle,staff hired more than five years ago have received the training but it may have been later than three
= months after hire.For sites in a reaccreditation cycle,training data for staff hired in current position longer than five years
is not required.
2 Past instances were found when staff hired within the past five years did not receive training related to Family Health
within three months of hire:however,with the most recent hlreW.practice indicates this is now occurring:and all other
staff(if in a first accreditation cycle)have received the training regardless of the timeframe.For sites in a reaccreditation
= cycle.training data for staff hired in current position longer than five years is not required and rated as"2"if no new hires
in the last five years.
1 The site's most recent hire(s)have not yet received training on Family Health within three months of hire:or staff hired within
the past five years have not received training on this topic.
11-1.D Staff(direct service staff,program managers and supervisors)receive training on Cultural Self-Awareness within three
months of the date of hire.
HFA's online training includes these subtopics:
•seeking clarity on personal identity,values,and beliefs
•understanding privilege and its role in systems of oppression and racism
•how our own experiences play out in home visiting work
•implicit bias
•demonstrating compassion for self and others
11-1.D RATING INDICATORS
3 Staff hired January 2022 or later received training on Cultural Self-Awareness within three months of hire.Staff hired prior
to January 2022 have received the training but it may have been later than three months after hire.
= 2 Past instances were found when staff hired January 2022 or later did not receive training related to Cultural Self-Awareness
within three months of hire;however,with the most recent hlre(s),practice indicates this is now occurring:and all other
staff have received the training regardless of timeframe.
1 The site's most recent hire(s)from January 2022 or later have not yet received training on Cultural Self-Awareness within
three months of hire:or staff hired prior to January 2022 have not yet received training on this topic.
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11-2. Staff(direct service staff and supervisors)receive training on a variety of topics necessary for effectively working with
families and children within six months of hire.
11-2.A Staff(direct service staff,and supervisors)receive training on Infant and Child Development within six months of the date of hire.
HFA's online training includes these subtopics:
•brain development
•social and emotional development
•language development and early literacy
•physical development
•infant behavior(cues.states.reflexes)
•responding to developmental delays
•community resources to support children with delays
11-2.A RATING INDICATORS
= 3 Staff hired within the past five years received training on Infant and Child Development within six months of hire.For sites
in their first accreditation cycle,staff hired more than five years ago have received the training but it may have been later
0 than six months after hire. For sites in a reaccreditation cycle,training data for staff hired in current position longer than
five years is not required.
2 Past instances were found when staff hired within the past five years did not receive training related to Infant and Child
= Development within six months of hire:however,for the most reoeftt hlre(s),practice indicates this is now occurring:and
all other staff(if in a first accreditation cycle) have received the training regardless of the timeframe. For sites in a re-
accreditation cycle,training data for staff hired in current position longer than five years is not required and rated as"2"
if no new hires in the last five years.
1 The site's most recent hire(s)have not yet received training on Infant and Child Development within six months of hire:or
staff hired within the past five years have not received training on this topic.
11-2.13 Staff (direct service staff and supervisors) receive training on Supporting the Parent-Child Relationship within six
months of the date of hire.
HFA's online training includes these subtopics:
•observing parent-child interactions
•supporting attachment
•nurturing parenting strategies
•discipline
11-2.6 RATING INDICATORS
= 3 Staff hired within the past five years received training on Supporting the Parent-Child Relationship within six months of
hire.For sites in their first accreditation cycle,staff hired more than five years ago have received the training but it may
M have been later than six months after hire. For sites in a reaccreditation cycle, training data for staff hired in current
position longer than five years is not required.
2 Past instances were found when staff hired within the past five years did not receive training related to Supporting the
= Parent-Child Relationship within six months of hire:however,with the Most r800f1t hire(s).practice indicates this is now
occurring:and all other staff(if in a first accreditation cycle)have received the training regardless of the timeframe.For
sites in a reaccreditation cycle.training data for staff hired in current position longer than five years is not required and
rated as"2"if no new hires in the last five years.
1 The site's most recent hire(s) have not yet received training on Supporting the Parent-Child Relationship topics within six
months of hire:or staff hired within the past five years have not received training on this topic.
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11-2.0 Staff(direct service staff and supervisors)receive training on Professional Practice within six months of the date of hire.
HFA's online training includes these subtopics:
•time management
•coping with stress
•recognizing and preventing burnout
•power imbalances in professional relationships
•reflective practice
11-2.0 RATING INDICATORS
= 3 Staff hired within the past five years received training on Professional Practice within six months of hire.For sites in their
first accreditation cycle,staff hired more than five years ago have received the training but it may have been later than six
months after hire.For sites in a reaccreditation cycle,training data for staff hired in current position longer than five years
is not required.
2 Past instances were found when staff hired within the past five years did not receive training related to Professional
Practice within six months of hire:however with the most remnt hWs),practice indicates this is now occurring:and all
other staff (if in a first accreditation cycle) have received the training regardless of the timeframe. For sites in a re-
0 accreditation cycle,training data for staff hired in current position longer than five years is not required and rated as"2"
if no new hires in the last five years.
1 The site's most recent hire(s)have not yet received training on Professional Practice within six months of hire:or staff hired
within the past five years have not received training on this topic.
fTI P: Drogram managers dre encouraged but riot required to complete training.
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11-2.D Staff(direct service staff and supervisors)receive training on Mental Health within six months of the date of hire.
HFA's online training includes these subtopics:
•promotion of positive mental health
•behavioral signs of mental health issues
•depression
•perinatal mood disorders
•coping with loss
•strategies for working with families with mental health issues
•mental health emergencies
•referral resources for mental health
11-2.D RATING INDICATORS
3 Staff hired within the past five years received training on Mental Health within six months of hire. For sites in their first
accreditation cycle,staff hired more than five years ago have received the training but it may have been later than six
= months after hire.For sites in a reaccreditation cycle,training data for staff hired in current position longer than five years
is not required.
2 Past instances were found when staff hired within the past five years did not receive training related to Mental Health
= within six months of hire: however, with the most recent hireW, practice indicates this is now occurring: and all other
staff(if in a first accreditation cycle)have received the training regardless of the timeframe.For sites in a reaccreditation
= cycle,training data for staff hired in current position longer than five years is not required and rated as"2"if no new hires
in the last five years.
1 The site's most recent hire(s)have not yet received training on Mental Health within six months of hire:or staff hired within
the past five years have not received training on this topic.
11-2.E Staff(direct service staff and supervisors)receive Prenatal training within six months of hire.
HFA's online training includes these subtopics:
•fetal growth&development during each trimester
•warning signs:when to call the doctor
•activities to promote the parenting role,and the parent-child relationship during pregnancy
•preparing for the baby
•promoting parental awareness of what the baby is experiencing with a connection to what the parent is doing(reflection)
11-2.E RATING INDICATORS
= 3 Staff have received Prenatal Training within six months of hire.For sites in their first accreditation cycle,staff hired more
than five years ago have received the training but it may have been later than six months after hire. For sites in a re-
M accreditation cycle,training data for staff hired in current position longer than five years is not required.
2 Past instances were found when staff received Prenatal Training later than six months after hire:however,with the most
recent hire(s) practice indicates this is now occurring:and all other staff(if in a first accreditation cycle)have received the
= traminy regardless of the timeframe.For sites in a reaccreditation cycle,training data for staff hired in current position
longer than five years is not required and rated as"2"if no new hires in the last five years.
= 1 The site's most recent hire(s)have not yet received Prenatal training within six months of hire:or staff hired within the past
five years have not received training on this topic.
ITI P: HFA's Great Beginnings Start Before Birth training meets the expectationsof this standard . d provides. .-.p.
dive into work with prenatal families utilizing the HFA approach.This training is strongly encouraged.
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11-2.F Staff(direct service staff and supervisors)receive training on the Family Goal process within six months of hire.
HFA's online training includes these subtopics:
•purpose and importance of the family goal process in HFA services
•working with families to identify strengths and needs
•supporting the family's role in setting and achieving meaningful goals to assist families in taking charge of their lives
•development of family goals based upon the Family Support Specialist's knowledge about the family.as well as tools
completed with the family
•practice writing family goals in ways that help families create measurable goals
11-2.F RATING INDICATORS
3 Staff receive training on the Family Goal process within six months of hire.For sites in their first accreditation cycle.staff
hired more than five years ago have received the training but it may have been later than six months after hire.For sites
= in a reaccreditation cycle.training data for staff hired in current position longer than five years is not required.
2 Past instances were found when staff received training on the Family Goal process later than six months after hire:
V however,with the most rent hire(s)practice indicates this is now occurring and all staff(if in a first accreditation cycle)
have received the training regardless of the timeframe.For sites in a reaccreditation cycle.training data for staff hired in
S current position longer than five years is not required and rated as"2"if no new hires in the last five years.
1 The site's most recent hire(s)have not yet received training on the Family Goal process within six months of hire:or staff hired
within the past five years have not received training on this topic.
ITIP: HFAI s Family Goal webinaron informationprovided during HFA CoreFoundations
date,and therefore it is recommended the webinar be viewed after staff receive Core,unless Core is received so close
to the 6-month due . past 6 months for receipt of 11-2.F
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11-2.G Staff(direct service staff.program managers and supervisors)receive Cultural Humility in Home Visiting training within
six months of hire.
HFA's online training includes these subtopics:
•HFA's approach to culture
•honoring diverse family structures
•LGBTQIA+parenting
•family culture as a source of family strength
•acknowledging,respecting,and celebrating cultural differences
11-2.G RATING INDICATORS
M 3 Staff hired January 2022 or later have received Cultural Humility in Home Visiting training within six months of hire.Staff
hired prior to January 2022 have received the training but it may have been later than six months after hire.
= 2 Past instances were found when staff hired January 2022 or later did not receive training related to Cultural Humility in
Home Visiting training within six months of hire: however, with the most recent hlre(s), practice indicates this is now
occurring and all other staff have received the training regardless of timeframe.
M
1 The site's most recent hire(s)from January 2022 or later have not yet received training on Cultural Humility in Home Visiting
within six months of hire:or staff hired prior to January 2022 have not yet received training on this topic.
11-3. Staff(direct service staff,and supervisors)received training on a variety of topics necessary for effectively working with
families and children within twelve months of hire.
11-3.A Staff(direct service staff and supervisors)receive training on Child Abuse and Neglect within twelve months of the date of hire.
HFA's online training includes these subtopics:
•parent and child risks for abuse and neglect
•prevention and education with families
•racial disparities in the child welfare system
•role of HFA with child welfare-involved families
11-3.A RATING INDICATORS
3 Staff hired within the past five years received training on Child Abuse and Neglect within twelve months of hire.For sites
in their first accreditation cycle,staff hired more than five years ago have received the training but it may have been later
than twelve months after hire.For sites in a reaccreditation cycle,training data for staff hired in current position longer
than five years is not required.
2 Past instances were found when staff hired within the past five years did not receive training related to Child Abuse and
= Neglect within twelve months of hire:however,with the most recent hlre(s),practice indicates this is now occurring and all
other staff (if in a first accreditation cycle) have received the training regardless of the timeframe. For sites in a re-
M accreditation cycle,training data for staff hired in current position longer than five years is not required.and rated as"2"
if no new hires in the last five years.
The site's most recent hire(s)have not yet received training on Child Abuse and Neglect within twelve months of hire:or staff
hired within the past five years have not received training on this topic.
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0 11-3.113 Staff(direct service staff.and supervisors)receive training on Intimate Partner Violence within twelve months of the date of hire.
a HFA's online training includes these subtopics:
z
•indicators of Intimate Partner Violence
•dynamics of Intimate Partner Violence
•strategies for working with families with Intimate Partner Violence issues
•effects on children
•universal education approach to discussing healthy and unhealthy relationships with families
•the impact of racially disproportionate policing on family responses to IPV
•referral resources for family violence
11-3.13 RATING INDICATORS
3 Staff hired within the past five years received training on Intimate Partner Violence within twelve months of hire. For
sites in their first accreditation cycle,staff hired more than five years ago have received the training but it may have been
= later than twelve months after hire. For sites in a reaccreditation cycle, training data for staff hired in current position
longer than five years is not required.
2 Past instances were found when staff hired within the past fi-de years.did not receive training related to Intimate Partner
Violence within twelve months of hire:however,with the most recent hire(s),practice indicates this is now occurring:and
all other staff(if in a first accreditation cycle) have received the training regardless of the timeframe. For sites in a re-
accreditation cycle,training data for staff hired in current position longer than five years is not required and rated as"2"
if no new hires in the last five years.
The site's most recent hire(s)have not yet received training on Intimate Partner Violence within twelve months of hire.or
staff hired within the past five years have not received training on this topic.
11-3.0 Staff(direct service staff,and supervisors)received training on Substance Use within twelve months of the date of hire.
HFA's online training includes these subtopics:
•causes of and risks for substance use disorders
•alcohol use and dependence
•substances prevalent in the community
•talking with families about substance and alcohol use
•strategies for working with families with substance use challenges and families in recovery
•substance use and racial disparities in the judicial system
•referral resources for substance use disorders
11-3.0 RATING INDICATORS
3 Staff hired within the past five years received training on Substance Use within twelve months of hire. For sites in their
first accreditation cycle,staff hired more than five years ago have received the training but it may have been later than
= twelve months after hire.For sites in a reaccreditation cycle,training data for staff hired in current position longer than
five years is not required.
M
2 Past instances were found when staff hired within the past five years did not receive training related to Substance Use
within twelve months of hire:however,with the most remnt hireft practice indicates this is now occurring:and all other
staff(if in a first accreditation cycle)have received the training regardless of the timeframe.For sites in a reaccreditation
cycle,training data for staff hired in current position longer than five years is not required and rated as"2"if no new hires
in the last five years.
The site's most recent hire(s)have not yet received training on Substance Use topics within twelve months of hire:or staff
hired within the past five years have not received training on this topic.
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11-3.D Staff(direct service staff,and supervisors)receive training on Engaging Families within twelve months of the date of hire.
HFA's online training includes these subtopics:
•engaging fathers and co-parents
•multi-generational families
•working with adolescent parents
•engaging non-binary parents
•strategies for working with families impacted by personal,historical,or generational trauma
11-3.D RATING INDICATORS
= 3 Staff hired within the past five years received training on Engaging Families within twelve months of hire.For sites in their
first accreditation cycle,staff hired more than five years ago have received the training but it may have been later than
M twelve months after hire.For sites in a reaccreditation cycle,training data for staff hired in current position longer than
five years is not required.
M
2 Past instances were found when staff hired within the past five years did not receive training related to Engaging Families
within twelve months of hire;however, with the most reeerd hires, practice indicates this is now occurring;and all other
staff(if in a first accreditation cycle)have received the training regardless of the timeframe.For sites in a reaccreditation
cycle,training data for staff hired in current position longer than five years is not required and rated as"2"if no new hires
in the last five years.
The site's most recent hire(s)have not yet received training on Engaging within 12 months of hire;or staff hired within the
past five years have not received training on this topic.
11-3.E Staff(direct service staff,program managers and supervisors)receive training on Inequity and Family Context within twelve
months of the date of hire.
HFA's online training includes these subtopics:
•historically and currently marginalized communities
•racial wealth gap
•systemic barriers to access and accessibility
•systemic racism and social inequities
•intersectionality
•impacts of inequity on parenting and the home visiting relationship
11-3.E RATING INDICATORS
3 Staff hired January 2022 or later have received training on Inequity and Family Context within twelve months of hire.Staff
hired prior to January 2022 have received the training but it may have been later than six months after hire.
2 Past instances were found when staff hired January 2022 or later did not receive training on Inequity and Family Context
within twelve months of hire;however with the mostrecw thlreW,practice indicates this is now occurring:and all other staff
have received the training regardless of timeframe.
m
1 The site's most recent hire(s)from January 2022 or later have not yet received training on Inequity and Family Context within
twelve months of hire;or staff hired prior to January 2022 have not yet received training on this topic.
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11-4. The site ensures direct service staff,supervisors.and program managers hired longer than twelve months receive annual
training (i.e. at some time during each calendar year) that takes into account the individual's knowledge. Staff also
receive annual child abuse and neglect training and annual training related to diversity,equity,inclusion.and belonging.
11-4.A The site ensures direct service staff,supervisors,and program managers hired more than twelve months ago receive
ongoing training on an annual basis that takes into account the individual's knowledge and skill base,and supports
ongoing professional development.Please Note:All staff do not have to attend the same training.
Intent: The worker and supervisor identify individual training needs and determine what additional training topics
would be most beneficial in enhancing job performance. This determination would be based upon worker
knowledge,skill base,and interest.
11-4.A RATING INDICATORS
3 The site ensures staff hired to Healthy Families for more than twelve months receive ongoing training on an annual basis,
beyond the trainings identified in the 10-2, 10-3,10-4. 11-1, 11-2.and 11-3 standards.Staff are offered and participate in
ongoing training,
2 Past instances were found when staff hired more than twelve months did not receive ongoing training on an annual basis,
M beyond the trainings identified in the 10-2,10-3,10-4,11-1.11-2,and 11-3 standards:however,fe0mt prKtIce indicates this
= is now occurring.
1 The site does not yet ensure staff hired more than twelve months receive ongoing training on an annual basis:or staff does
not yet participate in ongoing training opportunities.
TIP: It is recommended supervisors assist staff in identifying relevant training opportunities to meet each staff person's
unique needs and all staff receive a minimum of fifteen(15)hours of ongoing training each year after the first year
of hire to remain energized.enthused.and up-to-date on recent advances in the field.
TI P: Direct service staff and supervisors are encouraged to attend HFA's Facilitating Change training to meet ongoing
training requirements for one year.
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11-4.8 All staff hired more than twelve months receive training annually related to child abuse and neglect.All staff do not have
to attend the same training.Please Note:During the first year of hire,standard 11-3.A.(Child Abuse and Neglect),may
be used to satisfy this standard.
Intent: Self-study training applies for this standard with appropriate documentation (e.g.. reading manuals or literature,
watching videos.etc.).Remote training,e.g..webinars produced by the state and updated regularly,can also be used
to satisfy requirements of this standard,or professional experience when face-to-face training is not available.
11-4.8 RATING INDICATORS
0 3 All staff hired more than twelve months receive annual training related to child abuse and neglect.
q 2 Past instances were found when staff hired more than twelve months did not receive annual training related to child
abuse and neglect,however,recent practice indicates this is now occurring and all staff received the training regardless
of the timeframe.
1 All staff hired more than twelve months have not yet received annual training on child abuse and neglect.
11-4.0 The site ensures all staff hired more than twelve months receive annual training designed to increase awareness and
understanding of concepts associated with diversity. equity, inclusion and belonging and how families, communities,
home visiting services,and staff are impacted.All staff do not have to attend the same training. Please Note:During the
first year of hire,standards 11-1.D(Cultural Self Awareness),11-2.G(Cultural Humility in Home Visiting),and 11-3.E(Inequity
and Family Context)may be used to satisfy this standard.
Intent: Staff are better prepared to serve and interact with families when they have increased awareness and
understanding of diversity,equity, inclusion and belonging and how families,communities, staff,and services
are impacted by social injustice,institutionalized racism,power imbalance,and implicit bias.Expanding learning
opportunities in these areas on at least an annual basis clearly conveys the priority HFA places on supporting each
individual's journey,and our collective effort to end racism and discriminatory practices and nurture inclusion
and compassion for our common humanity.
11-4.0 RATING INDICATORS
3 All staff receives,at least annually,training related to concepts associated with diversity.equity,inclusion and belonging,
and how families.communities.home visiting services,and staff are impacted.
2 Past instances may have occurred when an annual training related to concepts associated with diversity,equity,inclusion,
and belonging,and how families,communities,home visiting services,and staff are impacted was not received:however,
recent practice indicates the site is now ensuring all staff receives training annually.
1 Staff do not yet complete training on an annual basis related to concepts associated with diversity,equity, inclusion and
belonging,and how families,communities,home visiting services,and staff are impacted.
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Tables of Documentation
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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,diversity,equity,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.
DocumentationStandard Pre-Site
Submit Training Logs including hire date and date of training topics received for current HFA
supervisors&direct service staff.
11-1.A-D I Three-month
wraparound training All staff at affiliated HFA sites may use the online trainings developed by HFA(or other training
resources provided by the National Office)to complete the 11-1.11-2,and 11-3 training topics.If
sites use something other than HFA's recommended online wraparound training,the training will
11-2.A-G I Six-month comprehensively address each of the overall topics with a variety of relevant subtopics critical for
wraparound training preparing staff to do this work.
For staff utilizing formal education,previous training,and/or previous professional experience to satisfy
the 3,6&12 month training requirements,please include a narrative indicating any competency based
11-3.A-E I Twelve- testing and/or supervision follow-up to assure successful knowledge acquisition and understanding of
month wraparound concepts and/or materials provided to assure knowledge of the topics was satisfied.
training PMs will have documentation of training topics related to diversity and equity.(11-1.D,11-2.G,11-3.E)
Please Note:HFA Training Lora available.
11-4.A Submit a list of all staff and the ongoing training(s)completed(this can be in the form of a training
Ongoing Training log or database printout).
Please Note:HFA Training Log available.
11-4.iB 1 Annual Child Submit a list of all staff and the annual child abuse and neglect training completed(this can be in the form
Abuse and Neglect of a training log or database printout).
Training Please Note:HFA Training Log available.
11-4.0 I Annual Submit a list of all staff and the annual diversity,equity,inclusion,and belonging training completed(this
Diversity,Equity,and can be in the form of a training log or database printout).
Inclusion Training Please Note:HFA Trainina Loa available.
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12
Q
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Service providers receive ongoing,
reflective supervision so they are able
to develop realistic and effective plans
to support families.
A,
•
Standard 12 Intent: The field of infant mental health has identified
reflective supervision as a best practice approach, and recognizes
and embraces the supervisory relationship as being central to
the work with families. "Over 30 years of clinical experience
and empirical evidence indicates that Reflective Supervision/
Consultation (RS/C) increases the quality of infant mental health
services by reducing vicarious trauma, staff turnover, and bias,
while increasing practitioner knowledge and improving practice,
job satisfaction, efficacy, and responsiveness. This has led to a
general consensus in the multidisciplinary field of infant mental
health that RS/C is inextricably both a best practice and an essential
component for those providing relationship-focused prevention,
intervention, and treatment" (MI-AIMH, 2017). Therefore, reflective
supervision is central to the effectiveness of the Healthy Families
America model. The intent of reflective supervision is to promote
self-awareness, increase clarity about the work being done with
a family, build confidence in staff skills, encourage intentionality,
and ultimately increase the quality of services provided to families.
This approach to supervision recognizes the work with families is
very personal work that requires continual introspection about who
we are, what we bring to the work, and how the work is impacting
us. Reflective supervision is a collaborative process in which all
involved (supervisor, supervisee, parent, and child) play a role,
whether intentional or not.
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Reflective supervision consciously connects the experiences individuals
have in the context of their relationships of others. Reflective
supervision is not just about understanding how these relationships
affect one other. It is also about intentionally impacting relationships.
In other words, if we want parents to see, hold, respond to, and nurture
their infants, they must have experienced being cared for themselves.
For parents who have not been provided such caregiving through a
secure, nurturing relationship, staff may provide an environment for
those parents to begin to experience secure relationships. And, in order
for staff to be able to provide parents with such safety and security,
staff must have someone to provide a safe place for them as well. This is
what we refer to as the parallel process. This work often challenges our
values and worldviews in ways that result in heightened emotions that
can cloud our ability to interpret family circumstances both objectively
and empathetically. In work with families, direct service staff's most
powerful strategy is the intentional use of self. Reflective supervisors
become someone with whom staff can feel seen, held, and supported.
The hope is that, as staff experience the support, compassion, respect,
and feeling of being seen and heard by their supervisor, this will spill
over into their work with families.
During supervision, staff are recognized for the gifts they bring to the
work, such as their compassion, wisdom, patience, and ability to see
all the strengths each family has to offer their children. They have
an opportunity to step back from the day-to-day tasks of their work
(writing notes, completing home visits, tracking data, etc.) and are
invited to look at what is working well and what is not working so well
in their work with families. Supervisors partner with staff in this process
of reflection by allowing space and time for honest conversations about
the work. They use reflective strategies and conversations as a means
of increasing staff's reflective capacity (including self-awareness of the
impact of their own culture, values, and beliefs on others), their ability
to identify and build on parental competencies, and, ultimately, their
effectiveness in their interactions with families. Supervisory sessions
encourage professional and personal development by providing a safe
yet challenging environment where taking initiative is nurtured and
supported. Reflection is a key component of all supervisory discussions,
regardless of whether those discussions are administrative or clinical
(related to the family) in nature.
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12-1. The site ensures direct service staff receive weekly and ongoing supervision.
Intent: Providing weekly scheduled supervision helps direct service staff maintain perspective, evaluate their own
performance.increase personal and professional development,learn and practice new strategies to effectively
work with families, and develop reflective capacity, and ultimately enhances the quality of services families
receive. Additionally, supervision promotes both staff and site accountability and reduces staff burnout and
turnover by providing much needed support. Supervisors must ensure they have adequate time to spend with
each staff person: therefore, the frequency and duration of supervision is monitored closely. Additionally,
supervisors must have a limited number of staff to supervise,ensuring expectations of the supervisor role can
be fulfilled,and each staff person being supervised receives the support they deserve.
Policy and procedures clearly define the frequency (weekly for anyone .25 FTE and above) and duration
(minimum of 1.5 hours weekly)requirements for individual supervision of each direct service staff.When needs
warrant,a single weekly supervision session can be split into no more than two sessions per week.
With regard to duration:For all full-time and part-time staff who are.75 FTE to 1.0 FTE,the requirement is 1.5 to
2 hours weekly. For part-time staff who are.25 FTE to .74 FTE, the requirement is 1 hour weekly. For staff or
contractors working less than.25 FTE,supervision may be provided according to occurrence of services.
For full-time staff who serve in more than one role(e.g.,a position is split with Supervisor time at 30%and Family
Support Specialist time at 70%,or a position that is 100%FSS also responsible for conducting the FROG Scale
with their families)1.5 hours per week is the expectation to meet the supervision requirements of both roles and
functions,and documentation clearly indicates both are being addressed.
12-1.A The site's policy states individual supervision is provided to all direct service staff(e.g.,Family Resource Specialists and
Family Support Specialists)and volunteers and interns(performing the same function)at the frequency and duration
required within the standards.
Intent: All full-time direct service staff receive weekly individual supervision for 1.5 to 2 hours and part-time staff receive
at least 1 to 1.5 hours as described above in the 12-1 intent. Supervision sessions must be received individually
each week, unless excused due to the FSS or FRS being out the entire week. Please Note. For sites using
reflective consultation groups, one session per month may apply towards the weekly supervision rates, when
done in accordance with the expectations outlined in standard 12-1.C.
12-1.A RATING INDICATORS
M 3 The site policy and procedures specify all .75-1.0 FTE direct service staff receive a minimum of 2 hours per week of
m scheduled individual supervision and part-time staff employed.25-.74 FTE receive a prorated amount of supervision as
M defined in the intent,and staff less than.25 receive supervision based on occurrence of service.
The site's policy also indicates:
•supervision can be divided into no more than two sessions per week
= •reflective supervision groups(if used)count for 1 session per month when conducted by a qualified individual(for direct
service staff who have been in their role for at least 12 months and who have demonstrated proficiency in their role as
IM determined by the site and based on supervisor judgment)
•the ratio of supervisors to direct service staff is 1:5.
2 The site policy and procedures specifies all .75-1.0 FTE direct service staff receive a minimum c 1.5 hours per week of
= scheduled individual supervision and part-time staff employed.25-.74 FTE receive a prorated amuunt of super�,isiun as
defined in the intent,and staff less than.25 receive supervision based on occurrence of service.
= The site's policy also indicates:
•supervision can be divided into no more than two sessions per week
•reflective supervision groups(if used)count for 1 session per month when conducted by a qualified individual(for direct
= service staff who have been in their role for at least 12 months and who have demonstrated proficiency in their role as
determined by the site and based on supervisor judgment)
the ratio of supervisors to direct service staff is 1:6.
The site does not yet have policy and procedures:or the policy and procedures does not yet meet the requirements of the 2 rating.
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12-1.8 The site ensures weekly individual supervision is received by all direct service staff(Family Resource Specialists and
aFamily Support Specialists)and any volunteers and interns who provide direct services to families independently in the
i role of a Family Support Specialist or Family Resource Specialist. Please Note: Volunteers or interns who perform
Nsupportive functions to assist direct service staff(e.g.. assist with parent groups,data entry,accompanying a Family
Support Specialist on home visits,etc.)are exempt from the supervision and training requirements of the standards.
An HFA Spreadsheet is available for this standard.
Intent: It is understood that staff bring various experiences and educational backgrounds to their work:however,all
staff have in common the need for regular supervision to obtain guidance and support in regard to the complex
challenges many families present and the impact the work has on the worker.It is therefore required sites track
and monitor in an ongoing way the receipt of weekly supervision for each staff.Please Note:When circumstances
warrant. (i.e. sites exist in rural or frontier areas, the Family Support Specialists work in remote or off-site
locations from the"main office"where the supervisor is located,or natural disaster,severe weather or community
health advisory) the use of virtual sessions via video or telephone will count for weekly supervision. Please
Note: Direct service staff who are new to their role or are without full caseloads are still expected to receive
the required amount of weekly supervision. In these situations, supervision may be more focused on skill
development than family discussion.Please Note:When supervisors are on leave,direct service staff will have a
back-up supervisor they can obtain support from.If the supervisor's leave is for two weeks or less,the back-
up supervisor does not have to have received HFA Core training,though it would be preferred.However,if the
Supervisor's leave is for longer than two consecutive weeks,the back-up supervisor must have received HFA
Core training,as required of all supervisors.Sites may want to consider establishing a "team lead" role,as a
career ladder opportunity for a direct service staff person with capacity to perform as back-up supervisor,and
to have that person obtain supervision training as well.
12-1.8 RATING INDICATORS
3 All direct service staff receive 90%of required weekly individual supervision for a minimum of 1.5-2 hours (excluding
weeks when direct service staff is out all week).Supervision sessions are not split into more than two scheduled meetings
= and less than.75 FTE staff receive a prorated amount of supervision as defined in the intent above.
All direct service staff receive 7S%of required weekly individual supervision for a minimum of 1.5-2 hours (excluding
weeks when direct service staff is out all week).Supervision sessions are not split into more than two scheduled meetings
and less than.75 FTE staff receive a prorated amount of supervision as defined in the intent above.
The site is not yet following the guidelines as outlined in 2 rating above.
Note: This is a Safety Standard.
Frequency • duration of ••
to account for times when staff are in training, on vacation. or for seasonal fluctuations in service delivery.
Semi-annual and annual supervision rate reviews are recommended in addition to quarterly monitoring.
providing su• • • by phone
session per month as an in-person meeting.if possible.
T1 P: Sites are encouraged to set goals/benchmarks(for Standard GA-2.13)when rates fall below the 75%threshold,and
supervision time should be used to focus on exceptions,reasons.and problem-solving strategies to increase rates.
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12-1.0 A site may choose to provide once monthly reflective consultation groups in place of one weekly individual supervision
session per month(for direct service staff in their role for a minimum of twelve(12)months.Documentation must include
who attended and content topics covered,and must be facilitated by a qualified individual.
Intent: Typically,these sessions last approximately 1.5-2 hours.Reflective consultation groups include but are not limited to:
•family presentation
•focus on holding the space that encourages self-reflection and self-regulation for staff,both physically and emotionally
•observation of the staff member's internal responses to the work,including parallels between what might be
going on for the worker as well as how that might impact the work
•focus on the parallel process by expanding to what might be going on for the staff in conjunction with what
the family and the baby might be experiencing
•considering what the supervisor might do differently for the next supervision
•developing a plan with staff for work going forward
•opportunities for participants in the group to reflect on the group session they just observed
Supervision sessions must be received individually each week for a minimum of 12 months after initial hire to
HFA role for all staff.Subsequent to that time,and with demonstrated staff proficiency,one reflective consultation
group per month may substitute for one individual weekly supervision session for .25-1.0 FTE direct service
staff(.24 FTE or less may attend reflective groups:however,it cannot be used to offset individual supervision).
Please Note:Staff not yet in their HFA role for at least 12 months are encouraged to attend and benefit from
group supervision (if held): however, attendance cannot be counted toward the required weekly individual
sessions expected of staff during that time period.
Please Note:If group reflective consultation is done,there are specific documented qualifications the reflective
practice consultant must have:
1 IMH Endorsement or Master's degree or higher in human services related field: Master of Arts(MA), Master
of Science (MS). Master of Education (MEd), Doctorate in Education (EdD), Master of Social Work (MSW),
Master of Nursing (MSN), Doctor of Psychology (PsyD), Doctor of Philosophy (PhD), Medical Doctor (MD),
Doctor of Osteopathy(DO)or other degree specific to one's professional focus in infant mental health;university
certificate program,and/or course work in areas such as infant/very young child development,family-centered
practice,cultural sensitivity,family relationships and dynamics,assessment,and intervention.
2 Two years of work experience providing culturally sensitive, relationship-focused infant mental health
services with infants and toddlers and their families.This specialized work experience must be with both the
infant/toddler and his/her biological,foster,or adoptive parent on behalf of the parent-infant relationship.
Infant mental health services will include early relationship assessment,and parent-infant/very young child
relationship-based therapies and practices.Infant mental health services include parent-infant psychotherapy,
interaction guidance,and child-parent psychotherapy.These therapies and practices are intended to explicitly
address issues related to attachment, separation, trauma, and unresolved losses as they affect the
development,behavior,and care of the infant/very young child.
3 Previous recipient of reflective supervision. The facilitator will need to have received relationship focused,
reflective supervision/consultation,individually or in a group,post-Masters,while providing services to infants,
very young children,and families from a qualified professional.
4 Training or experience facilitating groups and managing group dynamics.
This person may be sub-contracted by the agency.If reflective consultation is conducted by a contractor,a site
supervisor attends as a group member in order to support staff with any recommended action steps pertaining
to the family discussed during group.
fTIP: It is recommended reflective consultationgroups . • . to protect confidentiality and promote
an environment of safety between and among members.See sample aroup rules,
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12-1.0 RATING INDICATORS
0
a 3 The site provides reflective consultation groups conducted according to the guidelines listed in the intent.Group reflective
o �
a consultation is counted for no more than one session per month only for staff who have demonstrated proficiency in their
W role and have been with the site for at least 12 months.Group reflective consultation is provided by a qualified individual
m and documentation at minimum includes individuals in attendance and content areas discussed.
2 Past instances occurred when the site provided group reflective consultation not conducted according to the guidelines
listed in the intent and with documentation at minimum including individuals in attendance and content areas discussed;
howeve, recent practice indicates this is now occurring.
Any of the following:the site does not yet provide group reflective consultation according to the guidelines listed in the
intent.or it is not yet conducted by a qualified individual:or documentation of reflective consultation group meetings has
not yet occurred:or group reflective consultation is counted for more than one weekly individual supervision rate per month.
NA Site does not use reflective consultation groups to offset one weekly individual supervision session per month for any of
its direct service staff.
12-1.13 The ratio of supervisors to direct service staff and volunteers and interns(performing the same function)is sufficient to
allow regular,ongoing,and effective supervision to occur.
Intent: It is critical supervisors have the time to prepare for supervision as well as complete all of the requirements
of the site and host organization. It is estimated each direct service staff member requires approximately 8
hours per week of supervision time,including the actual supervision session as well as the supervision activities
outside of the session including internal quality management activities,administrative work,arranging training,
staff meetings.etc.Please Note:full-time equates to a 40-hour work week.Therefore,sites that employ staff
considered full-time but working less than 40 hours per week must prorate staffing ratios accordingly.See the
proration calculation tool for guidance.Please Note:In the event the Supervisor is not full time in their role(e.g.,
is hired 75%,or is hired full-time,but a portion of that time is as a part-time Family Resource Specialist,or is a
Program Manager also providing supervision to direct service staff,or is full-time to the agency but only part-
time to Healthy Families,etc.),they are to indicate the amount of time spent in their Healthy Families supervision
role and calculate the ratio of direct service staff based on the percentage of time spent in the supervision role.
For example.a supervisor who is 75%supervisor and 25%Family Support Specialist would have a ratio of.75
FTE supervisor:4.5 FTE direct service staff.This is calculated by taking.75(%FTE)X 6(as allowed in a 2 rating)
equals 4.5 FTE.This formula can be used to determine the ratio of supervisors to direct service staff regardless
of the percentage of time.
12-1.D RATING INDICATORS
= 3 The ratio of supervisors to direct service staff is one(1)full time supervisor to five(5)full time direct service staff.The site
is consistently following this standard.
M 2 The ratio of supervisors to direct service staff is one(1)full time supervisor to six(6)full time direct service staff(or 8
part-time staff).The site is consistently following this standard.Any overage within the past twelve(12)months due to
1111111 turnover or unexpected staff shortage does not exceed more than three months.
The site ratio of supervisors to direct service staff has more than six (6) full time direct service staff(or more than 8
part-time staff)to one(1)full time supervisor:or the site is not yet following the standard as outlined in 2 rating above.
ITIP: It is recommended that sites whose •.• .-ly comprised of ••
elevated risk on •• supervisor
TIP: It is recommended supervisors responsible for other agency program staff maintain a similar staff to supervisor
ratio in order to balance workload of the supervisor.
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12-2. Direct service staff(and volunteers and interns performing the same function)receive reflective supervision pertaining
to their work and are provided opportunities for skill development and professional support.
Intent: HFA Supervisors support their staff in both a mentoring and monitoring role.As a monitor,supervisors oversee
the completion of activities that meet the Best Practice Standards as well as other site or agency requirements
and provide strength-based feedback to nurture the staff's professional development.As the mentor,supervisors
support the integration of training into the work,add to the knowledge of direct service staff,discuss how to
work with families,and generally enhance their abilities.Working with families who are experiencing complex
life challenges is a high stress job,and as a result,supervisors have a critical role of offering guidance,emotional
support,and insight into the impact of the work on the worker.
12-2.A The site has supervision policy and procedures to ensure all direct service staff(and volunteers and interns performing
the same function)are provided with reflective supervision pertaining to their work and opportunities for skill development
and professional support,including twice annual shadowed visits and debrief with their supervisors.
12-2.A RATING INDICATORS
3 No 3 rating indicator for standard 12-2.A.
2 The site has supervision policy and procedures which indicate supervisors are responsible for providing all direct service
staff with reflective supervision and twice annual shadow visits (including debrief of shadow visits) to ensure all staff
receive professional support and skill development to continuously improve the quality of their performance-
1 The site does not yet have policy and procedures: or the policy and procedures do not yet include the expectations
described in the 2 rating.
IT1 P: In an effort to streamline supervisordocumentation, • • •-
documented on the HFA Service Plan for each family.
I not possible to engage in ••-• reflective conversationpertaining to each •-
are encouraged to have in-depth reflective conversation for each Level 1, P, or SS family on a Family Support
Specialist's caseload a minimum of one time per month.and a minimum of once every other month for Level 2 families.
I to their role, • • demonstrate supportshadowing
twice annually during the onboarding process.
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12-2.8 The site ensures all direct service staff (and volunteers and interns when performing the same function) receive
reflective supervision pertaining to their work,and are provided opportunities for skill development and professional
support to continuously improve the quality of their performance.
12-2.8 RATING INDICATORS
3 The site ensures all direct service staff receive reflective supervision pertaining to all aspects of the work and are
provided opportunities for skill development and professional support to continuously improve the quality of their performance.
= 2 Past instances were found when staff did not receive reflective supervision or opportunities for skill development
and professional support to continuously improve the quality of their performance;however,r8C8f1t prKtICS indicates this
is now occurring for all direct service staff.
1 Staff do not yet receive weekly reflective supervision as described in Standard 12-2.6.
Note: This is an Essential Standard.
supportTI P: Utilizing the Reflective Strategies as a supervisor during supervision will
effectively with families.
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12-2.0 The site ensures all direct service staff(and volunteers and interns performing the same function) are provided with
twice annual shadow visits and debrief with their supervisor to continuously improve the quality of their performance.
Please Note:A shadow visit combined with debrief conversation between the supervisor and direct service staff counts
as a weekly supervision session.
12-2.0 RATING INDICATORS
3 All direct service staff (and volunteers and interns performing the same function)are provided with a minimum of twice annual
shadowed visits and debrief with their supervisor.
11111 2 Past instances were found when the direct service staff did not receive twice annual shadow visits and debrief with their
supervisor:however recent practice within the past year indicates this is now occurring consistently for all direct service staff.
1 Staff do not yet receive twice annual shadow visits and debrief with their supervisor.
TIP: For Family Support Specialists who administer the FROG it is recommended one of the two shadow visits per year
is done on ••
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12-3. Supervisors receive regular.ongoing supervision which holds them accountable for the quality of their work and provides
athem with skill development and professional support.
0
z Intent: According to the Best Practice Guidelines for Reflective Supervision/Consultation of the Alliance for the
a
Advancement of Infant Mental Health,in order to maintain a reflective lens through the challenges and complexity
involved in the supervisory role,it is essential that supervisors also engage in their own reflective supervision/
consultation. Supervisors' experience of developing and advancing their supervisory reflective skills should
include parallel dynamics to that of direct service staff's supervisory experience. The goal of supervisors'
supervision should be to facilitate their ability to integrate a reflective lens into their work with direct staff and
ultimately the work with families.
Sites are to have clear policy and procedures regarding the frequency of supervision for supervisors,including
the professional support, skill development, and accountability measures in place to support supervisors. It
is recommended supervisors receive individual supervision every other week;however,the minimum requirement
is monthly.Supervision of the supervisors can occur face-to face or virtually(via video conferencing or phone).
Supervision sessions are regularly scheduled to ensure the supervisor has the support they need to ensure
quality at the staff and direct service level.
12-3.A The site has policy and procedures to ensure supervisors are held accountable for the quality of their work,receive skill
development and professional support through regular and ongoing supervision, and are able to receive reflective
supervision,individually or as part of a reflective group for supervisors(reflective consultation groups for supervisors are
encouraged to utilize facilitators with the same qualifications as indicated in standard 12-1.C).
Intent: Please Note: For supervisors carrying small caseloads(one visit or less per week)on a permanent basis, or
carrying a larger caseload,but on a temporary basis(i.e.when families are temporarily re-assigned due to staff
leave or turnover),or occasionally administer the FROG Scale(as a back-up):
•The person providing supervision does not have to be trained as an HFA supervisor.It is preferred but not required.
•The supervision session can occur based on the frequency of contact and does not have to occur weekly.
• If the person providing the supervision is not trained as a supervisor in HFA,the supervisor can maintain the
supervision notes based on the discussions being conducted.
Please Note: For supervisors carrying larger caseloads (2 or more visits each week)on an ongoing basis), or
routine administration of the FROG Scale:
• The ratio of supervisor to staff (12-1.C) is to be taken into account based on the percentage of time the
supervisor is providing direct services.
•Supervisors must receive supervision in accordance with the 12-1 and 12-2 standards.
•The individual providing supervision to the supervisor must have received all HFA required training as outlined
in Standards 10 and 11.
12-3.A RATING INDICATORS
= 3 Policy and procedures include a requirement that,in addition to all components of monthly administrative supervision
did described in the 2 rating,supervisors will receive 11101 ft reflective supervision.
2 The site has policy and procedures which specify supervisors receive a minimum ut once every other month reflective
supervision (individually or as part of a reflective consultation group for supervisors) and at least monthly individual
administrative supervision focused on areas such as:
•addressing personnel issues
•team development and agency issues
•review of site documentation including monthly or quarterly reports
•site statistics(screening and initial engagement,home visit rates,content of home visits,quality assurance mechanisms,etc.)
•review of progress towards meeting site goals and objectives
E •strategies to promote professional development/growth
� •quality oversight that could include shadowing of the supervisor
1 The site does not yet have policy and procedures:or the policy does not yet meet the requirements specified in the 2 rating.
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12-3.8 The site's practice ensures supervisors receive individual administrative supervision and are held accountable for the
quality of their work.Please Note:sites may use HFA's shadowing of supervision form.
12-3.B RATING INDICATORS
3 Site ensures supervisors receive at least monthly individual administrative supervision and at least once annual shadowing
with debrief of a supervision session,and are held accountable for the quality of their worK.
2 Past instances were found when the site did not ensure supervisors received at least monthly individual administrative
� supervision or were not held accountable for their work;however,rKlfit proCtioe indicates this is now occurring.
1 Individual administrative supervision of supervisors is not yet occurring at least monthly;or supervisors are not yet held
accountable for the quality of their work.
12-3.0 The site's practice ensures supervisors receive regularly scheduled reflective supervision.
12-3.0 RATING INDICATORS
= 3 Site ensures supervisors receive at least monthly reflective supervision.
2 Past instances were found when the site did not ensure supervisors received at least every other month reflective
= supervision;however,r!C90 praCUCe indicates this is now occurring.
1 Reflective supervision for supervisors is not yet occurring at least once every other month.
f consultation groups for . .to utilize facilitators with the sarne qualificdtions as
indicated in standard
12-4. Program managers are held accountable for the quality of their work and are provided with skill development and
professional support.
12-4.A The site has policy and procedures to ensure program managers are held accountable for the quality of their work and
receive skill development and professional support.
Intent: The program manager role is distinct from that of program supervisor and,while both roles can be assumed by
the same person.the FTE status of both roles must be delineated and protected to ensure sustainable program
leadership and adequate support to staff being supervised.
Program Managers are provided with skill development and professional support and are held accountable for
the quality of their work. This can happen through accountability with quarterly reports.annual performance
reviews,regularly scheduled meetings(in-person or virtually)with the program manager's Supervisor or chair
of the advisory/governing board, peer supervision with HFA Program Manager from a neighboring site, and
attendance at conferences or other training
12-4.A RATING INDICATORS
= 3 No 3 rating indicator for standard 12-4.A.
2 The site has policy and procedures ensuring program managers are held accountable for the quality of their work and
= receive skill development and professional support.
1 The site does not yet have policy and procedures;or the policy does not yet meet the requirements specified in the 2 rating.
TIP: While very small sites may be able to function with a part-time program manager,HFA recommends a full-time
program .•
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12-4.B The site ensures Program Managers are held accountable for the quality of their work and receive skill development and
0
a professional support.
0
a 12-4.8 RATING INDICATORS
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= 3 Site ensures program managers are held accountable for the quality of their work and receive skill development and
professional support.
2 Past instances were found when programs managers were not held accountable,receiving skill development or professional
support:however,r9mnt prWUC9 indicates this is now occurring.
1 Program managers are not yet held accountable for the quality of their work: or do not receive skill development or
professional support.
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Tables of • •
12.Service providers receive ongoing,effective supervision so they are able to develop realistic
and effective plans to support families
DocumentationStandard Pre-Site
12-1.A I Policy for Submit Policy
Frequency&Duration Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available.
Submit a report indicating the frequency and duration of supervision sessions for the most recent quarter.
1.Determine needed frequency and duration of supervision per FTE guidelines within BPS for each
direct service staff
2_Determine number of expected supervision sessions for each staff member for one quarter
3.Subtract from#2(expected sessions)any excused sessions per guidelines provided by BPS
12-1.6 I Measure 4.Count number of supervision sessions that occurred within proper timeframes and for expected duration
supervision frequency 5.Divide#4(number of supervision sessions at required duration)by 43(expected sessions minus
and duration those excused)
Sallft StwWard 6.Create report to communicate findings for each staff member
Please Note:HFA Spreadsheet ava-abble.
This is a threshold standard,meaning to be in adherence a minimum threshold has been established
(75%in this case).When the site's data in the self-study falls below this threshold,Peer Reviewers or
Panel will request more recent data.
12-1.0 I Reflective Submit a report indicating the date,time and attendees of group reflective consultation groups(if utilized)
Consultation Group for the most recent quarter,along with content areas discussed.Also,please submit the qualifications of the
individual facilitating groups.
12-1.13 I Ratio of Submit the HFA Face Shea(indicating each supervisor,their full time equivalency(FTE),percentage of
Supervisors to staff time spent in a supervisor role,and the staff they supervise(with FTE for each position).For any staff with
multiple roles,be sure to capture FTE for each role each staff person has.
12-2.A I Policy
-Administrative, Submit Policy
Clinical and Reflective Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available.
Supervision and
Professional Support
12-2.8 I Reflective,
Supervision,Skill No documentation required pre-site.Peers will review documentation and interview staff,advisory
Development and
Professional Support board members,and families on site.
Essential Standard
12-2.0 I Shadow Visits
No documentation required pre-site.Peers will review documentation and interview staff,advisory
board members,and families on-site.
12-3.A I Policy- Submit Policy
Supervision of Supervisor Please note.HFA Sample Policies and Procedures and Policy and Procedure Checklist are available.
12-3.6 I Supervision of No documentation required pre-site.Peers will review documentation and interview staff,advisory
the Supervisor Received board members,and families on-site.
12-3.0 I Supervisors No documentation required pre-site.Peers will review documentation and interview staff,advisory
Receive Reflective
Supervision board members,and families on site.
12-4.A I Policy-Program Submit Policy
Manager Accountability Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available.
12-4.8 I Program Manager No documentation required pre-site.Peers will review documentation and interview staff,advisory
Supervision Received board members,and families on-site.
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GOVERNANCE AND
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z accordance with principles of effective
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management and of ethical practice.
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Governance and Administration Standards Intent is to ensure the
site has feedback and oversight mechanisms to ensure high quality
services to families. These practices include effective community
advisory board operation, review of site quality, handling of family
complaints, utilization of informed consent, protection for families
related to research conducted, and appropriate reporting of child
abuse and neglect.
GA-1. The site has a community advisory board that serves in an advisory or governing capacity in the
planning,implementation,and continuous quality improvement of site-related activities.
Intent: Community advisory boards serve an important function in community-based agencies.They
can be advocates for the site in the community, representing the site and agency in other
venues and settings, which can bring more recognition and visibility. Community advisory
members bring to the site different skills and perspectives than might be present within site
staff. Members share strategies, brainstorming ideas and facilitating growth for the site.
Additionally,members often have access to resources to strengthen the site or agency. It is
important the group has the community connections to understand the needs of the families
receiving HFA services.
Some HFA sites fulfill the need for the functions outlined in the Standards below by having
two different groups.This happens most often when HFA sites function as part of a larger
agency that has its own governing board. The agency board typically has many other
functions outside of Healthy Families and usually does not have the capacity to serve in all
the ways the Standards require,but it may be involved in making key decisions about the site
and its financial status.
Regardless of whether or not HFA sites have this larger agency board, sites will need to
create and maintain a community advisory board with the primary function of advising in
the planning, implementation,and continuous quality improvement of site-related activities.
Many times the host agency governing board will have final say,but the community advisory
board can provide input to the Program Managers (or other representative from the local
site) who can provide the information to the agency board. Please Note: Frequency of
meetings may vary depending on the duties assigned to the advisory group and activities
carried out by any subcommittees.A minimum of quarterly meetings is required.
GA-1.A The site's community advisory board meets at least quarterly and is an effectively organized.
active body advising the functions specified in GA-1.
GA-1.A RATING INDICATORS
3 The site's community advisory board is an organized, active body that meets at least quarterly and
advises the activities of planning,implementation,and continuous quality improvement of site services.
Past instances occurred when the community advisory board did not meet quarterly:however,recut
practice indicates this is now occurring. The site's community advisory board advises the specified
functions,but could be more active in one area of functioning.
1 Any of the following: the site's community advisory board meets less than quarterly: or is not yet
active:or is not advising on planning,implementation.and continuous quality improvement.
ITIP: Community advisoryboard
Community leadership is critical to the launch of the site, and well-established sites benefit tremendously from
community advisory board involvement as well. Over time, a well-formed advisory board with strong member
relationships is a huge asset to the continuation of a shared vision and the realization of intended impacts.
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GA-LB The community advisory board has a wide range of needed skills and abilities and includes representatives with a
heterogeneous mix in terms of skills,strengths,community knowledge,professions,and cultural diversity,allowing it to
effectively serve the interests of the community and advocate on behalf of the diverse needs of site participants.
GA-1.8 RATING INDICATORS
3 The community advisory board has a range of skills, strengths, community knowledge, and cultural characteristics
(as determined by the site to represent the diverse needs of site participants).The site does not have any Identified yaps
= In Its membership.
2 The community advisory board's membership has a range of skills, strengths, community knowledge. and cultural
characteristics(as determined by the site to represent the diverse needs of site participants).The site h_-identffied gaps
In its membership which It is vrorkbV to address.
The community advisory board's membership does not yet represent the skills, strengths, community knowledge, and
cultural characteristics(as determined by the site to represent the diverse needs of site participants).
1 ..rent/caregiver representatives participate of the community advisoryboard.
expertiseencouraged to provide support,and education to ensure parents are well-received,their voice heard and regarded
equally,and their effectively.
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GA-LC The program manager(or other representative from the local site)and the community advisory board work together
effectively.The program manager provides site information for each meeting.Advisory members participate in discussion
and guidance in regard to this information-
GA-LC RATING INDICATORS
3 The program manager (or other representative from the local site) partners with the community advisory board by
� providing members site information needed for each meeting and engages them in advising site operations.
2 Past instances occurred when the program manager (or other representative from the local site) did not provide site
information needed for each meeting to engage members to participate in advising site operations: however, recill
practIm indicates this is now occurring.
1 The program manager does not yet provide site information or engage advisory members to advise on site operations.
GA-2. The site monitors and improves the quality of its services.
Intent: The site uses a variety of methods to monitor and improve the quality of all services offered to families.Both quality
assurance activities(GA-2.A)and quality improvement activities(GA-2.6)are necessary and distinguished as follows:
IMPROVEMENTQUALITY ASSURANCE QUALITY
Defines quality Raises quality
Relies on inspection Emphasizes prevention
Uses a reactive approach Uses a proactive approach
Looks at compliance with standards Improves the process to meet standards
Requires a specific fix Requires continuous efforts
Relies on individuals Relies on teamwork
Examines criteria or requirements Examines processes and outcomes
Asks, "Do we provide good services?" Asks,"How can we provide better services?"
Scamarcia Tews.Debra,et al.Embracing 0ua 6ty in Public Health.2nd ea.,ww .m phiaccreAandgi.org.2012.
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GA-2.A The site develops a quality assurance plan for reviewing and documenting the quality of site implementation,to
increase fidelity to the model within the four components of the service delivery system(initial engagement,home
visiting,supervision,and management).
Intent: Sites will develop a Quality Assurance plan that includes activities such as satisfaction surveys,annual file review,
reports related to site activities,etc.These activities help ensure accountability and commitment to implementing the
HFA model with fidelity. Additionally, sites will document the completion of these activities Download Sample
Quality Assurance Plan.
GA-2.A RATING INDICATORS
3 The site has a current quality assurance plan including all components of the service delivery system(initial engagement,
home visiting. supervision, and management) and has implewarRed quality aasuram activities related to all these
components to increase fidelity to the model.
2 The site has a current quality assurance plan including all components of the service delivery system(initial engagement,
home visiting,supervision,and management);and quality assurance activities to increase fidelity to the model have been
= implemenbud for at least two but not yet all of these components.
Any of the following:the site either does not yet have a quality assurance plan:or the quality assurance plan does not yet
include all components of the service delivery system(initial engagement,home visiting,supervision,and management):
or the site has not yet initiated quality assurance activities to increase fidelity to the model.
ITIP: Sites are encouraged to•• of improvement and demonstrate • • been
ITIP: Sites are encouraged to discuss GA findings • • • b•. •to obtain support
increase fidelity.
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GA-2.113 The site establishes a comprehensive quality improvement plan, utilizing site level data related to acceptance,
retention, home visit completion,etc.,to develop and apply strategies aimed at strengthening site services. The
plan is reviewed and updated annually.
Intent: Each year the site identifies one or more areas it wants to focus on(such as increasing home visit completion rates,
or increasing participant acceptance).The site usually identifies its goals based on areas it is striving to improve,
though continuous quality improvement(COI)expectations may also be established by an oversight entity or(under.
However decided,once the site has articulated its goals, it should indicate what the baseline is (e.g., home visit
completion is 62%at start of the year),what the goal is(home visit completion rate will increase to 75%by year end),
and a process for monitoring and evaluating progress toward meeting its goals and addressing any identified issues.
Sites use this information for continuous quality improvement.Sites may use PDSA(Plan-Do-Study-Act)cycles to
illustrate their efforts to achieve identified goals.
Download Quality Improvement Plan.
GA-2.6 RATING INDICATORS
3 Each year the site establishes one or more quality improvement goals, applies improvement strategies, and monitim
prop m toward reaching its goals at leWquafEefly.and implements follow-up mechanisms to address areas of improvement.
Each year the site establishes one o,more quality improvement goals,applies improvement strategies,moriftimpmgmw
toward reaching its goals at least annually.and implements follow-up mechanisms to address areas of improvement.
1 Any of the following:the site does not yet establish goals;or it is not yet conducted on an annual basis;or progress is not
yet monitored at least quarterly;or follow-up mechanisms have not yet been implemented.
encouraged0 TIP: Sites are to discuss QA findings • advisory••. •to obtain support
11111 increase fidelity.
GA-3. The site informs families of their rights at the start of services and ensures confidentiality throughout the course of services.
Intent: HrA values a family-centered approach to service delivery, which requires site practices that reflect a profound
respect for personal dignity,confidentiality.and privacy.This approach is in all services provided,and the standards
in this section are devoted to preserving the rights and dignity of all service recipients.In addition to addressing
legally protected family rights,the standards in this section also center on the professional ethics of service delivery
and promote privacy,honesty,and mutual respect.
Research Note(Client Rights: COA 8th Edition 2006): Ethics documents published by the National Association
of Social Workers and the American Psychological Association.Both statean individual's right to privacy,confidentiality,
and self-determination.Practitioners,while not always required by law,are ethically obligated to protect these rights
for all individuals.
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c GA-3.A The site has policy and procedures and appropriate forms for timely communication with families about 1) their
It rights and confidentiality.2) consent procedures when family information will be shared with another entity. and
3)the process for making a complaint.The policy and procedures also indicate when forms are to be completed,and
z the process for addressing any complaints,if received.
Rights and confidentiality forms are written in family-friendly language and include the following:
Z Family Rights
W • the r.ght to be treated fairly,with courtesy and respect
Z •the right to decline service(voluntary nature)
Z •the right to be referred,as appropriate,to other service providers
o •the right to participate in the planning of services to be provided
L •the right to file a complaint,who to contact should the need arise(including phone number or contact information),
and the process and timeframes associated with response and resolution
Cortfidendallty
• the manner in which information is shared. with whom. and the process for release of information forms to be
signed when exchanging information
• the circumstances when information is shared with consent(e.g.,for purposes of referral, or if participating in a
research or evaluation study where identifying information is shared.or when data required by funders or model
developer includes identifying information)
•the circumstances when information is shared without consent(e.g.,need to report child abuse and neglect)
Download Sample Rights and Confidentiality form in E—1g; =,n and 5D3 ISh.
The release of information form includes the following:
•a signature from the person whose information will be released or parent/legal guardian of a person who is unable
to provide authorization
•the specific information to be released
•the purpose for which the information is to be used
•the specific date the release takes effect
•the timeframe or date the release expires(not to exceed 12 months)
•the name of person/agency to whom the information is to be released
•the name of the HFA site providing the confidential information
•a statement that the person/family may withdraw their authorization at any time
Download Sample Release of Information Form in English and 5 anuh.
GA-3.A RATING INDICATORS
= 3 No 3 rating for standard GA-3.A.
JIM
2 The policy and procedures address rights and confidentiality and the procedures for addressing any complaints, and
= states the family is informed about their rights and confidentiality before or on the first home visit,including the right to
file a complaint. The policy and procedures also state the family is informed and signs written consent every time
information is to be shared with a new external agency.Site forms currently in use include all required elements identified
= in the intent.
The site does not et have policy and procedures addressing rights and confidentiality,on or before the first home visit,the
� Y Y P 9 9 Y.
procedures for addressing complaints,and the process for obtaining informed consent to release information,or the site's
forms currently in use do not yet include all the required elements identified in the intent.
Note: This is an Essential Standard.
204
GA-3.13 The site implements its policy and procedures ensuring all parents are notified and receive copy of family rights
and confidentiality at the onset of services, both verbally and in writing. Documentation that the rights and
confidentiality assurances were reviewed with families is placed in the participant file,and a copy is provided for the
family to keep.
GA-3.B RATING INDICATORS
3 Families are informed and receive copy of their family rights and confidentiality,on or before the first home visit,both
verbally and in writing.
2 Past instances were found when families were not being informed verbally and in writing,or provided copy of their rights
and confidentiality on or before the first home visit:however,reCeftt prKtIM indicates this is now occurring.
1 Any of the following:families are not yet being informed about their family rights and confidentiality on or before the first
home visit:or the site does not protect family confidentiality and privacy.
Note: This is an Essential Standard.
ITI P: While the rights and confidentiality form is requiredbe • only once at the initiation of services,sites
encouragedare to considerbest practice.
components bulleted above pertaining to family rights and confidentiality can be addressed via more than one
form,sitesare strongly encouraged to utilize only one form so as not to overwhelm families with excessive paperwork.
205
GA-3.0 Parents are informed and sign a new release of information form every time information is to be shared with a new
external source or with the same source but for a subsequent time period.
C,
T Intent: When a site receives a request for confidential information about a family,or when a release of confidential
f
information is necessary for the provision of services,the site must obtain the family's informed,written
d
consent prior to releasing the information.All information on the form must be filled in before parents sign the
o form.It is not permissible to have parents sign incomplete forms.This consent may also apply to verbal
a sharing of information,and sufficient details about what staff may speak about must be clearly listed.
W
z
z
d GA-3.0 RATING INDICATORS
z
o3 Families provide written consent every time information is to be shared with a new external source or with the same
Q source but for a subsequent time period.
= - Past instances were found when families did not provide written consent for sharing of information however, recent
prattke indicates this is now occurring.
Information is shared without the family's written consent.
Note: This is a Safety Standard.
GA-3.D The site ensures complaints are responded to in accordance with its policy and procedures.
GA-3.13 RATING INDICATORS
M 3 The site ensures participant complaints have been responded to in accordance with its policy and procedures.
M
M 2 Past instances may have occurred when participant complaints were not responded to in accordance with site policy and
procedures;however,recent pnKtke indicates this is now occurring.
1 Complaints have not been responded to in accordance with site policy.
P,NA No participant complaints have been received by the site in the past five years.
GA-3.E The site ensures participant privacy and voluntary choice with regard to research conducted by or in cooperation with the site.
Intent: A site that participates in or permits research conducted by an outside source involving service recipients
establishes the right of individuals to decline to participate without penalty and guarantees participants'
confidentiality.All research involving service recipients must be conducted in accordance with applicable legal
requirements.Research includes all forms of internal or external research involving service recipients.
GA-3.E RATING INDICATORS
M 3 The site ensures participant privacy and voluntary choice for all families with regard to research.
2 Past instances may have occurred where participant privacy and voluntary choice with regard to research was not ensured;
however,recent pnKtke indicates this is now occurring.
= 1 Any of the following:individual researchers follow their own plans and potential for disclosure of identity or violation of
privacy is high;or families are not yet provided an opportunity to decline disclosure.
r
N A No research is currently being conducted by or in collaboration with the site.
206
GA-4. The site reports all suspected cases of child abuse and neglect to the appropriate authorities.
Intent: Staff clearly understand how to identify child abuse and neglect indicators and the State's definitions of child
abuse and neglect. This will assist them with knowing how and when to report. Additionally, it is important
for staff to know who to contact for support when abuse or neglect is suspected.It is the intent that site leadership
be notified in advance of a CPS report being made; however, imminent child safety concerns are of higher
priority. Therefore,staff also clearly understand that contacting Child Protective Services prior to immediate
notification of the site manager or supervisor is appropriate ONLY IF waiting to contact site leadership may
cause greater risk to the child(ren). Exceptions must be fully documented. These criteria and reporting
procedures are clearly outlined in the orientation training staff receive prior to their work with families(10-2.1))
and reviewed annually throughout employment(11-4.13).
All direct service staff(including Supervisors)should be viewed as mandated reporters and adapt a mandated
reporter philosophy, even if the state does not identify them as mandated reporters. Therefore. it is also
important to familiarize staff with mandated reporting laws,which place ultimate responsibility on direct service
staff to report a suspicion of child abuse or neglect to Child Protective Services,without risk or jeopardy,even in
situations where site leadership may not agree with the need to report.
GA-4.A The site has policy and procedures to report all suspected cases of child abuse and neglect to the proper authorities.
Intent: The site must have policy and procedures to effectively guide staff in situations where abuse or neglect is
suspected so appropriate and timely action can be taken. Sites may choose to reiterate information from the
State's Children's Code,agency-wide policy,or training materials indicating the child abuse and neglect criteria
and reporting requirements.At a minimum,these materials must be referenced in policy with a link so staff know
where to locate them.
GA-4.A RATING INDICATORS
M 3 No 3 rating indicator for standard GA-4.A.
M
M 2 The site has policy and procedures that are in accordance with all applicable laws and specify the following:
M
criteria used to identify and determine when to report suspected child abuse and neglect(or,at a minimum,policy must
indicate where these criteria can be found)
• expectation of all staff(managers,supervisors and direct service staff)as mandated reporters
• immediate notification of the program manager or supervisor when abuse or neglect is suspected
• the site's mechanism to track and follow-up on all children with suspected abuse and neglect
The site does not yet have policy and procedures specifying the items listed in the 2 rating.
Note: This is a Safety Standard.
TIP: The site's policy can reference child abuse and neglect reporting criteria from a mandated reporter document
written by the agency or by a local or state child welfare office. In such cases,the site must be sure to include
access to this document so staff have easy access to the reference document when needed.
207
GA-4.B The staff reports all suspected cases of child abuse and neglect to the proper authorities, including situations
where it is believed a report has already been made by another individual or organization.
z GA-4.B RATING INDICATORS
f
a 3 Staff report all suspected cases of child abuse and neglect to the proper authorities.
o �
W2 Past instances were found when staff did not report suspected cases of child abuse and neglect to the proper authorities:
i = however, recent practice indicates all suspected child abuse and neglect situations are reported or, If there have been
iM no situations of suspected abuse and neglect to report,all currently employed staff have awareness of site's policy on how
they would respond to this type of situation.
0 There are situations within the past twelve months when staff did not report suspected abuse and neglect to the proper
authorities;or staff are unfamiliar with site policy.
Note: This is a Safety Standard.
GA-4.0 The staff notifies the supervisor or program manager immediately in situations where staff suspect abuse or neglect.
The supervisor or program manager tracks these situations to ensure safety concerns are addressed and appropriate
follow-through occurs.
GA-4.0 RATING INDICATORS
3 Staff immediately notify the program manager or supervisor when abuse or neglect are suspected. and a tracking
mechanism is in place to ensure safety concerns are addressed and follow-through occurs.
fi
fi 2 Past instances were found when staff did not immediately notify the supervisor or program manager of suspected abuse
or neglect; or the site did not use a tracking mechanism; however retell practice indicates this is now occurring;or
IN currently employed staff have had no suspected abuse and neglect situations In the past year to tlustrate Implementation.
fi
1 The site's staff do not yet immediately notify the supervisor or program mdr;dger of suspected abuse and neglect:or the
site is not using a mechanism to track all suspected abuse and neglect situations:or staff is unfamiliar with site policy.
ITI P: The site is encouraged to document on been •• •• abuse or -
208
GA-S. The site responds to support families and staff in situations involving participant death.
GA-S.A The site has policy and procedures specifying immediate notification of the program manager or supervisor in cases of
participant death(other appropriate staff/supervisors within the site are notified as needed)and specify staff are offered
grief counseling when a participant death occurs.and families are offered extended support as needed.
GA-5.A RATING INDICATORS
= 3 No 3 rating for GA-5.A.
2 The site's policy and procedures specify immediate notification of the program manager or supervisor,staff are offered
� Y Y 9
M grief counseling when a death occurs,and extended support is offered to the family.
M
M 1 Any of the following:the site does not yet have policy and procedures:or the site's policy and procedures do not yet specify
immediate notification of program manager or supervisor:or policy and procedures do not yet indicate staff are offered
counseling when a death occurs:or do not yet indicate the family is offered extended support as needed.
GA-5.13 The site responds in situations involving participant death to support family members and staff as needed.Program
manager or supervisor is notified immediately.
Intent: This standard ensures both staff and family members are supported through the grief process. This could
include additional reflective supervision, short-term transitional home visits with the family,the offer of grief
counseling when these resources are available,etc.A death creates a deep sense of loss for families as well as
staff, including direct service staff and supervisors with whom the family member had a relationship. At a
minimum,reporting would occur if there were a death of a focus child or participating parent.
GA-5.13 RATING INDICATORS
= 3 In situations involving participant death of a parent or focus child, immediate notification of the program manager or
supervisor occurs.Support is provided to families and staff when a death occurs.
Past instances were found when notification of prcwam manager or supervisor did not occur immediately or staff er
families were not offered support: however recent practice indicates this is now occurring: or if there have been no
partkipant deaths,all currently employed staff are aware of site pollcy on how they would respond to this type of situation.
Program manager or supervisor have not yet been notified irnrnediately,or staff or families dre not yet offered support when
a death occurs:or staff are unfamiliar with site policy.
monthsTI P: Offering services to families after the loss of a child is crucial to supporting the grief process and services
should not be closed too quickly. Sites may want to create an informal transition plan in partnership with the
family to beintentional aboutservices thatwill beprovided aftera loss.Servicesoften continue for approximately
three desired b
209
o GA-6. Updates to the site-s Policy and Procedures Manual are communicated to all staff in a timely basis and staff have
a access to a copy of the Policy and Procedure Manual.
D Intent: It is critical for all staff to know and understand the policies and procedures which guide their work. It is not
f necessary for staff to have the Policy and Procedures manual memorized, but they will,at a minimum, know
a
where to look when they have a policy or procedure question and are able to use it as a support to practice when
o needed. Please Note: Orientation to policy and procedures is required before contact with families as per
a standard 10-2.A.For additional guidance see Policy and Procedure Checklist and Sample Policy and Procedure
u Template/Guide.
z
a
z
W GA-6. RATING INDICATORS
0
= 3 The site has a Policy and Procedures Manual,all staff have access to it,and updates have been communicated to staff when they occur.
2 The site has a Policy and Procedures Manual.Past instances were found when the site staff did not have access to it or
= receive communication when updates occurred:however,all staff now have access to the Policy and Procedures Manual
and recent policy changes ,.ere communicated to staff when they occurred.
Any of the following:the site does not yet have a Policy and Procedures Manual;or all staff do not yet have access to it;or
staff have not yet received communication when updates to policy occur.
TJ P. Staff receive orientation training to the site's policy and procedures (10-2.13). Communication with staff about
policy updates can occur during supervision or team meetings with support provided to help staff understand and
integrate policy changes into •
210
z
O
a
PRIOR TO AN ACCREDITATION
a
OR CERTIFICATION DECISION,
0
z
a the HFA National Office will confirm
W
z the following GA-7 requirements are in
a
W adherence. A site is required to remedy
o any that are out of adherence before
the accreditation or fidelity assessment
certification award can be conferred.
Ab
i
1
GA-7. In accordance with HFA's Affiliation and Licensing Agreement,which grants sites the ability to implement the model
and access its intellectual property, affiliates are required to adhere to the responsibilities outlined therein,
particularly those pertaining to data,fees,brand identity.and research.
GA-7.A The site ensures that all HFA required data pertaining to site staff and participants is provided as specified in the
Overview of HFA Data Reporting Requirements.
Intent: HFA requires select data on sites,staff,and participants in order to accurately and effectively represent the entire
HFA network and support continuous quality improvement.It is imperative that sites provide current information
as defined in the Overview of HFA Data Reporting Requirements.When all site data is recorded accurately and
is up-to-date, we are best able to understand,reflect on,and articulate to the field and key stakeholders and
decision-makers the collective impact the HFA model has.
GA-7.A RATING INDICATORS
= 3 No 3 rating for GA-7.A.
2 All HFA required data,as defined in the Overview of HFA Data Regorting Requirements,is accurate and up-to-date and
= is consistent with expectations for all affiliated sites.
1 Data required of all HFA affiliates is not yet currently up-to-date as required of all HFA affiliates.
GA-7.B The site is up-to-date with all fees owed to the HFA National Office.
Intent: Sites must have any outstanding fees paid in full prior to accreditation or fidelity assessment certification.
GA-7.13 RATING INDICATORS
3 No 3 rating for GA-7.13.
2 The site has no outstanding fees owed to the National Office or has now paid any fees previously owed.
M
1 The site currently has overdue or unpaid fees.
Note: This is a National Office Requirement.
GA-7.0 ;he site utilizes the trademarked HFA name.logo.and brand according to HFA graphic standards.
Intent: The image and integrity of the HFA model is maintained through appropriate use of HFA graphics on all
promotional materials and other documents and images shared publicly(electronically or in hard copy).Visual
representation that is uniform across the HFA network conveys a stronger brand identity.
GA-7.0 RATING INDICATORS
= 3 No 3 rating for GA-7.C.
2 The site utilizes HFA graphics(name,logo.etc.)in accordance with HFA graphic standards for site materials made available publicly.
1 The site is not yet utilizing HFA graphics (name,logo,etc.) in accordance with HFA graphic standards for site materials
made available publicly.
Note: This is a National Office Requirement.
212
o GA-7.D The site ensures that the National Office 1)is notified in advance of a site's participation in a research study involving
a a)the HFA model,or b)participant families,past or present,enrolled in HFA services:and 2)is provided information
on the study,as described in the HFA Site Research Policy,
Intent: HFA encourages participation in research when feasible and appropriate. Notifying a 9 Y 9 the National Office prior
a to participation and sharing information about the project 1)establishes ongoing communication between the
Z National Office,participating site(s),and study investigators:and 2)provides the opportunity to ensure alignment
d with the HFA Site Research Policy,maximizing the value of study findings and their integration with existing HFA
ievidence and practice.Please Note:
d
a •Another entity(state system or research partner)may submit the study notification and information on the
site's behalf.The site ensures this information is received by HFA,as described in the HFA Site Research Policy.
0
•For sites not involved in any research studies,the site will indicate in writing they are not involved and indicate
their understanding of HFA requirements should a request for participation in research occur at a later time.
GA-7.D RATING INDICATORS
= 3 No 3 rating for GA-7.D.
2 The site notifies the National Office prior to the site's participation in any research study involving 1)the HFA model, or
2) participant families, past or present,enrolled in HFA services:and receives study updates consistent with HFA's Site
Research Policy.If the site is not involved in any research study,the site will provide a written statement indicating such,as
� described in the intent.
The site has not followed through with National Office requirements as listed in the 2 rating.
Note: This is a National Office Requirement.
I Department at the NationalOffice is able to provide guidance and support
investigators- Sites(or the central administration when part of a Multi-Site System)are strongly encouraged to
reach out to the Research Department through their Training and TA Specialist as early in the process as possible.
213
GA-TE When critical incidents occur at the local site level,communication procedures are followed to ensure the national
office is notified if the matter escalates to state or national level attention.This includes situations 1)involving child
or caregiver death, or serious abuse incidents, which prompt local investigation or media involvement, and
2)litigation pertaining to Healthy Families work/services.
To inform the National Office,please submit this form as instructed.
Intent: Though not common, situations may arise when public relations for damage control is needed to minimize
the negative effect caused by an event or series of events. Public relations is about building, improving and
maintaining the public image and perception of an individual, company or organization. To ensure the most
appropriate response and public communication about such events,sites are to promptly communicate critical
incidents to the National Office,when the situation garners heightened media attention.Should the National
Office be contacted by the media,national staff must employ its own public relations response. In each case,
National Office can do effective public relations work when information of the incident has been communicated
in a timely way.The National Office has a critical incident form to be used for communication purposes.Please
Note: Sites that are part of an HFA Multi-Site System will communicate critical incidents to their Central
Administration who will then report them to the National Office.Sites outside of a Multi-Site System will report
directly to the National Office.
GA-7.E RATING INDICATORS
3 No 3 rating for GA-7.E_
2 Prompt communication to the National Office has occurred in the event of any critical incidents(as defined in the standard).
1 Communication to the National Office did not occur associated with a critical incident(as defined in the standard).
NA No critical incidents have occurred at the site in the last 24 months.
214
Z
O
Q
Tables of Documentation
N
Z
o GA.The site is governed and administered in accordance with principles of effective management and of ethical practice
o Please Note.GA Is not a Critical Element
< Standard Pre-Site w
Documentation
Z GA-1.A I Organization
Z and Function of Submit a narrative,policy or bylaw describing the community advisory board's role in advising with
w Community Advisory regards to planning,implementation,and evaluation of site activities.
'o Board
GA-1.6 I Advisory with Submit a community advisory board roster which includes organization affiliation(s)and a summary of
Wide Range of Skills& skills,knowledge and abilities to effectively serve the interest of the community.
Knowledge
GA-1.0 I Program Submit a narrative describing how the program manager(or other representative from the local site)
Manager&Community
Advisory Board Work Partners with the community advisory board by providing members site information for each meeting and
Effectively engages them in advising site operations.
GA-2.A I Quality Submit the site's Quality Assurance Plan.
Assurance Plan Please Note:Sample Quality Assurance Plan Template Available.
GA-2.6 I Quality Submit the site's Quality Improvement Plan.
Improvement Plan Please Note:Sample Quality Improvement Plan Template Available.
GA-3.A I Policy Submit Policy and samples of relevant form(s)related to confidentiality,informing families of their
-Family Rights& rights and informing families of how to file complaints.
Confidentiality Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available.
GA-3.6 I Family Rights No documentation required pre-site.Peers will review documentation and interview staff,advisory
&Confidentiality board members,and families on-site.
Esmftl Standard
GA-3.0 I Informed No documentation required pre-site.Peers will review documentation and interview staff,advisory
Consent board members.and families on-site.
Safety Standard
GA-3.D I Complaints No documentation required pre-site.Peers will review documentation and interview staff,advisory
Procedure Followed board members,and families on-site.
GA-3.E I Participant
Privacy&Voluntary Indicate whether or not site is currently or previously involved in a research project in the past five
Choice in Research years.Peers will review documentation and interview staff,advisory members and families onsite.
GA-4.A I Policy-
Criteria to Identify Child Submit Policy
Abuse&Neglect Please note.HFA Sample Policies and Procedures and Policy and Procedure Checklist are available.
Sd*Standard
GA-4.B I Child Abuse No documentation required pre-site.Peers will review documentation and interview staff,advisory
Reporting
SafltyStandard board members.and families on site.
GA-4.0 I Suspected Submit report of currently enrolled families where child abuse and neglect was suspected and
Child Abuse&Neglect reported to the proper authorities,documenting how safety concerns are addressed and appropriate
Immediate Notification follow-through occurs.
to Supervisors and
Program Managers Peers will review documentation and interview staff,advisory board members,and families on-site.
215
Tablesof • •
DocumentationStandard Pre-Site
GA-5.A I Policy- Submit Policy
Participant Death&Grief
Counseling Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available.
GA-5.B I Participant Submit narrative indicating any incidents of participant death that have occurred within the past year.
Death&Grief Counseling
GA-6.I Policy& Submit Policy
Procedure Manual Please note:HFA Sample Policies and Procedures and Policy and Procedure Checklist are available.
GA-7. I National Office
No documentation required pre-site.
Requirements
216
EXHIBIT 3
PREVENT CHILD ABUSE AMERICA PROPRIETARY PROPERTY
• Trademarks, service marks or logos owned by Prevent Child Abuse America, including:
Proprietary Mark Applicationor Registration i
HEALTHY FAMILIES AMERICA U.S. Reg. No. 4,986,976
PREVENT CHILD ABUSE AMERICA U.S. Reg. No. 3,571,637
PINWHEELS FOR PREVENTION U.S. Reg. No. 2,800,287
PINWHEEL CITY USA U.S. Reg. No. 4,400,426
U.S. Reg. No. 5,443,912
Adow U.S. App.Nos. 86,528,257, 86,983,716
♦�1i�
DESIGN ONLY
• HFA Critical Elements
• HFA Best Practice Standards
• HFA Website, including all login protected resources
• CHEERS Check-In Tool
• Family Resilience and Opportunities for Growth Scale
• All copyrighted HFA Training Materials
217
EXHIBIT 4
TERRITORY
Fresno County
i.
I-Ap'l-ced
Notional
Forest
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c,s B 111 C'5
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DUNILAR
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Park
!3 0 Visa I ia
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Fr,re st
D
218
EXHIBIT 5
PCA AMERICA RESPONSIBILITIES
To ensure Affiliate staff have support for Fidelity to the Model,The HFA National Office provides
access to the following support regarding model implementation:
1. Technical Assistance and Support
a. Offered by experienced staff,via telephone, email or webinar, to support planning,
development, implementation and accreditation of the HFA Model based on the
Best Practice Standards.
b. HFA Implementation training
c. Data system selection guidance
d. On-site Technical Assistance as deemed necessary and appropriate (for an
additional fee)
2. Training &Professional Development
a. Access to comprehensive training from certified HFA trainers for direct service
staff, Supervisors and Program Managers (training fees are associated with these
services)
b. Access to HFA Model enhancement training such as Great Beginnings Start Before
Birth (prenatal training), and Facilitating Change (motivational interviewing
techniques for home visitors)
c. HFA materials and webinars free of charge or at a reduced cost, including low cost
training manuals and free access to HFA developed wrap-around trainings.
d. CHEERS Check-In Tool
3. Research, Evaluation and Data Collection
a. HFA Site Tracker(HFAST) for collection of Site Profile Reports;
b. HFA Association Management System for staff and training data, along with HFA
fee payment information;
c. Data Security protocols to protect site data that has been shared with HFA;
d. Current and emerging research translation for the home visiting field;
e. Consultation and/or recommendations regarding practical methodological issues;
219
f. Opportunities to develop an understanding of evidence-based evaluation, to
collaborate on research projects and participate in development of research
methodologies when applicable;
g. Nationally-recognized researchers through our Prevent Child Abuse America
National Board, and other research colleagues.
4. Capacity Building
a. National replication and state systems development expertise;
b. Federal and State Advocacy and Government Affairs;
c. Dedicated staff for analysis of federal public policy proposals that impact home
visiting and prevention of child maltreatment;
d. Electronic advocacy updates and alerts on federal policies related to child abuse
prevention;
e. Guidance in seeking legislative and public support for prevention;
f. National collaborations with national organizations to provide both national and
local benefit;
5. National Conferences
a. Subject matter experts and peer-to-peer idea exchange on leading-edge topics
related to healthy child development and child abuse prevention at PCA America's
conferences;
6. Marketing and Communications
a. Print ready logos in various colors and versions (JPG, EPS and JNP) specific to
Healthy Families Location/Agency;
b. Research-based messaging on the most effective manner to communicate HFA,
home visiting and child abuse and neglect prevention;
c. Opportunities to participate in and receive support for PCA America's national
signature campaign through the 50 State Chapter Network: Pinwheels for
Prevention®;
7. National Advisory Groups
a. To ensure HFA Headquarters is responsive to the changing needs and challenges
of the network and that any policy and procedures from HFA Headquarters are
implemented effectively, advisory committees (made up of individuals from the
HFA network) are utilized to create a two way dialogue with the best interest of the
network a priority.
220
EXHIBIT 6
AFFILIATION FEE SCHEDULE
Affiliation Fee Schedule for Provisional Sites January 2024 through June 2025
Fee Schedule
Size of Site Total Fees for Provisional Sites
(paid in two installments in January and Jul
1-2 direct service staff $4000
3-5 direct service staff $5000
6-10 direct service staff $6000
11-16 direct service staff $7000
17-25 direct service staff $8000
26-34 direct service staff $9000
35+direct service staff $9000 plus$250 for each direct service staff beyond 34
Affiliation Fees July 2025 — June 2026 will reflect a 50% increase between 2024 rates and
July 2026 rates. To be calculated for each site individually, based on most recent data.
Affiliation Fee Schedule starting July 2026 through June 2027.
Sites move from "Provisional" status to "Single Site" status after successful completion of a
Fidelity Assessment.
July 2026 Affiliation Fees"
Min(#direct Max(#direct
service staff) service staff) Single Site MultiSite Provisional
1 2 $ 2,500.00 $ 2,375.00 $ 4,500.00
3 4 $ 3,500.00 $ 3,325.00 $ 5,500.00
5 7 $ 4,500.00 $ 4,275.00 $ 6,500.00
8 10 $ 5,500.00 $ 5,225.00 $ 7,500.00
11 13 $ 6,500.00 $ 6,175.00 $ 8,500.00
14 16 $ 7,500.00 $ 7,125.00 $ 9,500.00
17 24 $ 8.500.00 $ 8,075.00 $ 10,500.00
25 200 $ 10,000.00* $ 9,500.00* $ 12,000.00
221
EXHIBIT 7
HFA ACCREDITATION PROCESS
Accreditation Preparation Guide
ACCREDITATION
PREPARATION GUIDE
8th Edition Best Practice Standards
.!
:`Healthy Families
America
Instructions and resources to help sites prepare for HFA Accreditation.
www.HealthyFamiliesAmenca.org
,c 9022.Prevent Child Ahura America.Healthv Families Amerina
222
!`Healthy Families
America
Accreditation Preparation Guide
Accreditation Process 3
Roles and Responsibilities 4
Accreditation Site Visit Checklists 5
After the Site Visit 12
The Best Practice Standards 1b
Ai)oendix contains helpful examples and links 18
Sample Self Study Structure 18
Tables of Documentation 19
Self Study Work Plan 20
Sample Site Visit Agenda 20
Family and Supervision File Checklist 22
Pre Site On Site SVR 23
223
Alccreditsititon
Congratulations(
R6Sp0f� Accreditation is the
1 cornerstone by which
Sete Ytsit K the site meets model IidelRy rs folbwedJt
the threshold for is a"seal of approval'to
���� Peer Reviewers accredtaton for families,communtties,and
� rewew the stte's F'ideftty Certification) funders of a site's
Self-Study,conduct a they skip the response commitment to provide
Implerne�ntation The indial step rs period.Sites not yet Quality home vislLng
the development of Site Visit,and complete services.Celebrate tAls
the Site Wstt Report meeting the threshold to
A newry affiliated site the site's Self-Study detailing the site's be awarded axredtted success and continue down
implements HFA home which can begin nine status(or fidelity the road of continuous
vistting utilizing HFA's months to a year prior ratings for each of the ual Improvement and
Best Practice certification)work to Q tty
Best Practice Standards to the Srte Visit or Standards,along with address standards rated Implementation of the HFA
Immediatery and begins Fdelity Assessment. out of adherence on the Best Practice Standards.
the fidelity assessment detailed strengths. Srte Vlsrt Report
The Setl-Study process Is recommendations,and ReaCcredlUtUon occurs every
process one year after one of continuous uall rationales. four ors far si sties
enrolling families.For Q � TAe Srte submits Ye ng�
accredited HFA affiliates, Improvement reflecting detailed narratives and and every five years fw
wth and National Office staff
Smp�e Sites Implement for � posttrve documentation to the Mufti-Srte Systems.Re-
two years(three change throughan conduct Fldeltty HFA National Office and accredttaUon begins 18-24
years for intense review of the Assessments with months ar to expiration so
Mufti-Srte Systems),then the HFA Accreditation Pr
site's policies, new affiliates aRer panel.Accredttatron e, sites can complete the
the reaccreditation two ors of service
process beginsi procedures.&Oractioes ye awarded once the site Process prior to expiration.
as outlined in the Best (for sites affiAating m meets the threshold for
Practice Standards. 2021 and Deyond). accreditation.
Healthy Families America Steps • Accreditation
Roles and Responsibilities
Site Staff
Complete self-study
Schedule interviews
Be available and responsive
Advise Peer Team on local travel and accommodations
Orient Peer Teams to the organization of files
Respond to pre-site questions from Peers
Follow up as needed after the site visit
Peer Reviewer
Represent HFA
Review self-study prior to visit
Review family and supervision files and other documentation as needed
Conduct interviews
Develop consensus ratings
Support on-site activities and Site Visit Report (SVR) development
Communication and meetings with site leadership
Writing and finalizing the SVR in HFAST
HFA National Staff
Coordinate site visit date and assign Peers
Send surveys to HFA site staff and site advisory board
Available to provide TA and answer questions
Finalize SVR with Peer Team
Support site through entire accreditation process
HFA Accreditation Panel
Review SVRs and Site Responses
Upgrade Standards brought into adherence
Make Accreditation Decisions
225
Accreditation Site Visit Checklists
Pre-Site Visit Checklist
Submit Accreditation Application and Application Fee via HFAST. Visit HFA website.
Network Resources, filter by Topic, select Accreditation, download HFAST Accreditation
Application Guide. While you will fill out the application in HFAST, you will need to mail in
the signature page and fee to the National Office.
Payment of Accreditation Application fees ($250) must be received prior to being
placed on the site visit schedule. Once received.your Training&Technical
Assistance Specialist will contact you to schedule a Pre-Site Visit Consult and
select the dates for your visit.
Typically, site visits begin on a Sunday for file review. If a Monday start date is
preferred/needed, please indicate this to your Training&TA Specialist at the time
of scheduling. In addition, please indicate your language needs for Peer
Reviewers.
Site visit fees reflect a flat rate charged to the site for peer reviewer travel costs.
These rates are adjusted over time to reflect changes in travel costs. Your
Training and TA Specialist will confirm the fee for your visit. HFA invoices sites for
peer expenses within 30 days following the site visit.
Prepare. The resources included in this guide can be used at your site to help determine
your site's adherence to the standards.
Self-Study. This can be submitted electronically, on a flash drive, or hard copy in a
binder. The Best Practice Standards(BPS) is the guidance document utilized for
completing your Self-Study. Please be sure to ask your Training&TA Specialist for the
most recent version of the BPS.
Include HFA Face Sheet as the cover page. ,,.a.:
Organize your Self Study by creating separate
folders or tabs for each Critical Element 1-12
and Governance& Administration. Sample
images of the self-study structure can be ;
found on a e 17 iftmaw.: """"""
Utilize the Tables of Documentation, (the
column labeled Pre-Site Documentation to =�• ��
include in Self-Study)to determine what — --
information should be included in your Self.
Study. These are found at the end of each — — — —
Critical Element in the Best Practice _ ---------•----
Standards. A sample of this document can be
found in the Appendix. ---
226
Provide sufficient detail in the narratives to paint a clear picture for outside
reviewers. Describe it in a way that others could replicate the process.
If a policy is asked for, provide the individual policy in the self-study - do not
reference the entire Policy and Procedure Manual. HFA encourages sites to utilize
the sample P&P template. Policies and Procedures.
Provide documentation (i.e.,forms, guidelines, policies, spreadsheets etc.)
directly behind the narrative (whether electronic or paper). If the documentation
is requested in another standard under the same Critical Element, you do not
have to submit it again. Instead, reference the standard it was provided in
originally. However,you may want to highlight a specific detail from that piece of
documentation. In that case. it may make sense to resubmit it with highlights.
You may wish to utilize HFA spreadsheets for standards -, unless you have a data
system to collect and report data using HFA methodology. See definitions.
methodologies, and links to all resources in the Glossary section of the Best
Practice Standards.
The self-study should be a standalone document with enough information to
address standards required to have pre-site documentation in your self-study.
Staff and Advisory Group Surveys
HFA staff will email a survey link to your staff and advisory group members about 8-12
weeks prior to your site visit. Please be sure to send a list of staff and advisory group's
email addresses to HFA staff. The survey topics can be found in the 4th column of the
Tables of Documentation. Below are examples of questions found in the surveys.
Sample Staff Survey Question
Each family's unique strengths and needs are explored with the family and
factored into all areas of service delivery(initial engagement, home visiting, and
supervision).
Always Most of the Sometimes Seldom Never
Time
Sample Advisory Group Survey Question
The site puts a focus on quality by continuously evaluating the effectiveness of
its services and taking action to continuously improve quality.
Strongly Strongly Don't
Agree Agree Neutral Disagree Disagree Know
Confirmation of Site Visit Date & Peer Review Team (approximately 1-2 weeks prior to
the due date of your self-study)
227
You will receive a confirmation letter identifying the following:
• The dates of the site visit.
• The Peer Reviewer Team contact information including addresses.
• Information about how to submit your Self-Study
Submission of Self-Study(6 weeks prior to site visit)
Send a copy of the completed self-study to each Peer Reviewer.
Send a copy to your Training&TA Specialist.
Keep a copy of the completed self-study for your site.
First Contact with Peer Reviewers
The Peer Team will contact your program soon after receiving your self-study to
discuss travel logistics.
The Peer Team will need recommendations from you regarding the airport to fly
into, as well as hotels in the area that you recommend.
The Peer Team will reserve a rental car for the visit, unless the site plans to
provide transportation for the peer team to and from the airport, and to and from
the office each day.
If you have not received communication from the Peer Team within 4 weeks of
the visit, please feel free to call or email the Peer Team. If you are still unable to
contact the Peer Team, please call your Training&TA Specialist for assistance.
❑ Setting the Site Visit Agenda
o The Peer Team will coordinate with you in setting up the agenda for the site visit.
o The file/documentation review will always occur first with interviews following.
o The Peer Team will email a draft of the agenda to you 4 weeks prior to the visit so
that you can schedule the individuals who will be interviewed. Please note there
is some flexibility with the agenda. The Peer Team will work with you to make
adjustments when needed.
Request for Additional Materials
The Peer Team will conduct a review of your self-study over the course of the time
leading up to the site visit.
It is during this time that the team will identify additional documentation they
would like to see pre-site or on-site.
228
Be sure to include any updates or any new information since you put together the
self-study. Particularly updates you have made to any policies or analyses, as
updates to these cannot be accepted once the peers arrive on site.
The Peer Team will email both a copy of the final agenda and any additional items
the team would like to see on-site during the review period prior to the visit.
Selection of Family Files. The Peer Team
will ask for an active caseload list
approximately one week before the visit so Active Famines by Moms Visitor
the peer team can select which files will be men rye.a.c.itiaa«rc.uen,xx .un.ti umtm
Pl
reviewed. The list of all active families by we �= -
home visitor should include: IT
Participant/family ID
Enrollment date
Date of the focus child's birth
Current level of service
all
Length in program
Suspected developmental delay
indicated (this may be a separate
report)
inr«m:.e n:.rrt eraearn«...en
i...aed can..un
cc..a mIn pa.n.!
Elevated Depression Screens
CPS Report made by staff
Additional Family Files will also be selected:
3 most recent closed files on Creative Outreach (Standard 3-3.6)
3 most recent files with a planned transition (Standard 4-4.13)
Files in which either a participant or child death occurred (Standard GA-5.6)
Electronic Records?Advise the Peer Team if your records are maintained electronically
and whether peers will be able to access them electronically while onsite. If they are not
permitted to do so, it is your responsibility to print a hard copy of all file material for the
files selected.
229
On-Site Visit Checklist
❑ File/Documentation Review On-site
The Peer Team will review records when they
get on site(typically on Sunday).
Before beginningthe record review portion, ✓ Documentation
the team will most likely want to sit down review
with you to go over the organization of your ./ Daily leadership
records.
briefings
The Peer Team will need time and a private
space in which to review the files and other
documentation.
The Peer Team will communicate which family files to pull a few days prior to the
visit (typically Thursday)so the files are ready for review upon arrival. If the site
has advised the electronic files cannot be accessed by the peers and need to be
printed, peers will send the list of selected family files 5-7 days ahead of the visit
(typically Monday). The peer team will select files based on the number of home
visitors:
• 1 - 5 home visitors: 3 files per home visitor
■ 6 - 11 home visitors: 2 files per home visitor
• 12 or more home visitors: 1 file per home visitor
Additional family files, as noted above,for Creative Outreach. Planned
Transitions. CPS Reports or Participant/Child deaths, will be reviewed. The Peer
Team may also ask for additional records, when needed,to support recent
practice of a particular standard(s).
The Peer Team will also review the corresponding supervision notes per FSS and
family file selected.
a Please have Staff Meeting Minutes and Advisory Group Meeting Minutes
available.
o Please have personnel files available for all HFA staff for review.
You will need to be available throughout the review in case there are questions.
J Welcome Meeting
On the morning of day two (typically Monday), the site visit will start with an
Welcome Meeting where the Peer Review Team will introduce themselves.
provide an overview of what to expect during the next couple of days and provide
an overview of the Accreditation Process. The team will also clarify their role as
impartial, objective observers that do not provide technical assistance.
230
All site staff should attend. You may invite
others if you would like. We recommend
advisory/governing board members,the
executive director of the host agency. etc.
Typically, all individuals who will be
interviewed (excluding families)are ✓ Welcome Meeting
recommended to attend. ✓ Interviews &
provide more info
Interviewing On-site ✓ Daily leadership
The Peer Team will interview staff(program briefings
managers, supervisors, and direct service
staff).
In addition to staff, the team will interview the supervisor of the program
manager. and one to two advisory board members and some families
participating in the program.
Staff may bring a file with them into the interview. This file should be selected by
staff and can be used to illustrate practice.
To help put staff at ease, you may consider mock interviews prior to the site visit.
Family interviews are often conducted individually as well.
Sample Home Visitor Interview Questions:
• What strategies do you use to build trust with families,engage them,and retain
them?
• When do you put a family on Creative Outreach? What do you do during that
time? Do you discuss these families during supervision?
• What does a typical supervision session look like?
• How is child maltreatment handled at your site?
Sample Family Interview Questions:
• How did your home visitor build trust with you so you felt good about allowing
them into your home?
• Was there a time you were not available for visits for a period of time? If yes, what
did communication during that time look like?
• Has your home visitor been able to help connect you with other resources in your
community? If yes.did they follow-up to be sure you were connected?
Compiling the Site Visit Report (SVR)
After reviewing files/documentation and conducting interviews,the Peer Team
will compile a preliminary SVR.
231
A sample of this preliminary site visit report is included as a resource on [)aye 22.
The Exit Meeting
First,the Peer Team will meet with the site
leadership to seek any additional
documentation of adherence. There should
be no surprises at the formal exit meeting.
While they are not able to give actual ✓ Interviews &
ratings, they will provide an overview of their provide more info
preliminary findings. ✓ pre-exit with
Once site leadership has been briefed, the leadership
Peer Team will present an overview of their
preliminary findings to the entire staff Exit Meeting
including the strengths and areas that need
strengthening.
Again, no ratings will be provided.
As with the Entrance Meeting, all staff should attend. You may invite others if you
would like, such as advisory/governing board members,the executive director of
the host agency, etc.
Site visits will end mid-late afternoon on the last day of your visit.
Next Steps
The HFA Training&TA Specialist will finalize and send the SVR 4-6 weeks after
the site visit.
The HFA Training&TA Specialist will schedule a Post Site Visit Consultation with
you to go over the SVR in detail and discuss next steps to complete the
accreditation process including verifying adherence with GA-7 standards.
232
After the Site Visit
Here is what you can expect after you receive your written Site Visit Report (SVR)
EXPEDITED
85%of all 3,1 order and stand-alone
2,1d order standards are in adherence
c All 1S'order standards are in
adherence
c. All Safety standards are in adherence
All Essential standards are in
adherence
ESSENTIAL RESPONSE
Meets threshold to be expedited
EXCEPT all Essential standards are not
yet in adherence
FRESPONSE TO PANEL
s than 85"/,, of all 3rd order anddalone 21,d order standards are
in adherence, or
One or more 15'order standards is
not yet in adherence, or
All safety standards are not yet in
adherence
There are 15 Essential standards
2-1.13: The administration of the FROG scale to learn about family strengths and
challenges.
3.3.13:The use of Creative Outreach as a trauma-informed strategyto build trust and
re-engage families who have missed visits.
4-2.C: The use of HFA Level Change Forms to review family progress and
decrease the frequency of home visits.
233
c 5-4.13: 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.
6-2.6: The supports that FSSs provide around setting and achieving goals with
families.
6-3.6, C and 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 and C: The Core trainings required of staff within certain timeframes
c 12-2.13: The provision of weekly reflective supervision to all direct service staff.
GA-3.13: The practice of informing families of their rights and about the
processes around confidentiality at the start of HFA services.
There are 6 Safety standards
9-3.13: Staff criminal background check
10-2.D: Child abuse and neglect Orientation prior to work with families
12-1.13: Frequency and duration of supervision
GA-3.C: Site practices related to informed consent when sharingfamily information
GA 4-A& B: Policy and practice around child abuse and neglect reporting.
National Office Standards
GA-7 standards are evaluated as the last activity and all GA-7 standards must be in
adherence prior to receiving an award of accreditation. Sites are encouraged to begin
working on these at the start of the accreditation process because it often involves
collaboration with other departments within your organization. Follow the links below to find
resources to assist you:
GA-7.A: HFA required data is kept up to date through HFAST
c GA-7.13: The site is up to date with all fees
c GA-7.C: The site utilizes the HFA name. logo. and brand according to HFA graphic
standards
GA-7.D: The site notifies HFA national office in advance of participation in a research
study involving the HFA model or participant families, past or present enrolled in HFA
services: and provides information on the study as described in the HFA site research
policy.
GA-7.E: The site notifies HFA national office of critical incidents at the local site level
234
Accreditation!
Once accredited, sites will receive
an Accreditation Certificate and
letter of acknowledgement from
Prevent Child Abuse America as Tlu.cmIrhdur
well as a sample press release. your Site
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l lr-allin Fames Amerk-ax,mock!
.'M't.li"I N:uyxr SUjMIjj'h'
71nv ar+�virtaoon n t4franr du.xgh
235
The HFA Best Practice Standards
The HFA Best Practice Standards establish the expectation for the policies and practices of
HFA sites around the world. These standards have been constructed through research and
consensus from the field and are updated every four years.
The HFA Accreditation process originally evolved during a time when the HFA network was
experiencing rapid growth. During this expansion, HFA affiliate sites expressed a desire for it
to `truly mean something" when sites called themselves "Healthy Families". The
accreditation process was initially developed out of this desire and need. Still today, HFA
accreditation ensures sites are providing high-quality home visiting services in fidelity with
the HFA model.
Accreditation is quite an achievement.
But the process is just as important. Through the completion of a self-study, a site visit, and
additionally, potential responses to the HFA National Office. HFA sites have a unique
opportunity to reflect on everything from their policies to their practices and receive
feedback from objective reviewers.And while HFA sites always have Training&Technical
Assistance Specialists available to them,the accreditation process is a time when these
National-level staff become even more involved with the happenings at the local level. as
they provide support to help sites achieve accreditation.
While the accreditation process is required every few years, sites are encouraged to
embrace a philosophy of continuous quality improvement by making the HFA Best Practice
Standards a part of everyday practices and ongoing activities.
What does the research tell us?
StandardsHFA Best
L Practice
CM I
What is happening in the field?
The Organization of the Best Practice Standards
The HFA Best Practice Standards serve as the site's guide to model implementation. In
preparing for accreditation. it is very important to understand not just the content written
within the standards, but how they are organized.
The Standards are broken down into 13 overall sections. which we call "First Order
Standards".They are labeled 1-12, and the 131, is called Governance and Administration.
236
fob
002
First order standard
(Always bolded on a photo)
ISites use the validated
Family Resilience and
Within Opportunities for
.. • of Growth R•
G) Scale
standards • • • • to identify family
standards-.Standards • • str4mgths and concerns
order standard.
2.1. The s.te Is required to use the FROG Scale at the start of services to provide the family an
opportunity to tell their story,to Identify the presence of protective factors as well as factors that
Could contribute to Increased risk for child maltreatment or other adverse childhood experiences,
and to support the development of a service plan to support the unique needs of each family
Int*nt: vatents/caregsvers represent a troad variety of backgrounds,expertertces,values,anti
cultural norms.and these ate combined to unique ways in each pldltndual family What
may appear as a nsk factor in one faintly Mary be mediated by nurtwng relatlonshtos
Second
arbor significant protective factors in another By completing the family Resilience and
order Opportunities for Growth(FROG)Scale,staff loam about each famiy's strengths and
concerns and we better able to plan services and resowces that will be of most interest
standard and benefit to the family,
a-tw The roe lyt•oky aM ttrpce "IOW+q the FROG Scare or adti—Mero0 to 4~1 rim aM Or0lKttse factor
VW could coriltrOub to w rnadoe the tak r01 chM tnadnehTent a WMr adwn it dill e en rperces The
an poky d pr'OCaA/et aM mgttee docvnwah eta m or th ink aM Vat""tactat a CovVW"n rtrrrtw
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cornww w rid a Run sn scored n accor"".tin the qudtMttt a M led To*PDbCV nil•roce lik—
dentFy who is moonsbM IW ad kwt,4 IM toil aM die tanelrame tW[c/r,a Wq the Meta".wkrdaq
trdrMgf r1'tew
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Third order wh•'` Third-order standardsmost
tar.,..
detailed.and contain a few different components,
standard which we will explore . )a
(Includes rating indicators) ; „
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1) TM FT"kW is tltKstmrRad a wrattw tortrrt Oeta.Mtd try gretarrt It rxtas trtat Could cmhalte to
eV104Wd MA To CMd WWI"~Of Pair a(Awse thAMOod HgatNt ABM Mo rot Vitt ftC..rMld n
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E if~n chum to
Rl M ttrtMlrama ra carpMLrq•ti w.st:t.doati•'trtatton rid xanq K dMrNd
237
Now that you understand the difference between the first,second, and third order
standards. let's dig deeper into the third order standards. Here's a walkthrough for
Standard
This is the"third order standard This is the intent! Whenever you
7-1.8 Focus children have a medical/health care provider
language". You can think of it as see blue text,you know you are
the elevator pitch for the looking at the intent of the
standard overall - a concise way standards. This helps to clarify
to encapsulate what this the language above, going into
standard is all about! more detail about the "why"of
this standard.
developmentIntont: A medical home is crucial to the health and optimal
for ongoing preventive health and wellness guidance.and medical interventions as needed.a T&all
plays a crucial role in child abuse prevention.as It allows another professional consistent access I
provide support and monito"for the well-being of the chrld,An HFA Spreadsheet is avartable for s
7-11.121 RATING .•
M3 Ninety-five percent(95%)through one hundred percent .. . children
Z Eighty percent(80%)through n1nety-four percent(94%)of focus children have a medical/heanh care provider.
I Less than eighty percent :. . provider.
4 TIP: For focus children who currently do not have a medical/health care provider,be sure to mdlca[e the reasons why
and clearly document steps taken to Ilnk these children.
4 TIP: Sites are also encouraged to document the current medical/health care provider for all participating lamily
members(children other Iharr focus children and aduMs)-see standard 1-3.
TIP: Sites are encouraged to set goals/benchmarks(ta Standard GA-2.H)when rates tall below the Bo%Ifxeshold,and
supervision time should be used to focus on exceptions,reasons,and problem-solving strategies to increase rate~
Last,we have the Tips,which are always
These are the rating indicators. in a navy blue box following the
They always appear with a green standard. These tips are for the site.
scale. Peer Reviewers will not be holding the
Notice the bolded text? This is to site to anything found in the tips. For
clearly demarcate the difference instance, here is a tip about
between a 2 and 3 rating! documenting the health provider for ALL
participating family members. While
238
having this as part of your practice
would be great, it is not a requirement.
Appendix
Sample Self-Study Structure. Sample images below are for formatting purposes only.
Information on the Self-Study is found on page 4.
� 1
LanKALZUROM s
GUMICALSUNIULS
•
US8 Drrve(E:) 9
��fiitl�3II ,o
Date modrFied Type 11
ovemance and Ad V l'20,'0 4.10 PM Fie folder CSr1 lU i1 UjBj , 11
Standard 1 5/21/20201 32 PM FAe folder
Standard S/212020101 PM Fie fold"
Standard 511t/20,204:45PM Fiefelde,
Standard 5 6r11/20204:4.'oM fie feldn
Standard 6 6/11/2020 536 PM Fie f oldc,
Standard' 6//2/20204,06PM Fiefolorr
Standard 8 6r12R020 3:27 PM Fie folder
Standard 9 61IW20202.02 PM Fie folder
Standard 10 S/21/20202.41 PM Fie folde,
Standard 11 N12R0203:L'PM Fie foldr,
Standard 12 W12/2020437 PM Fie folds FF,
inside1 1 1
tabs) 1 1 organize
files 7 q_ q
by their 2nd and
order 1 1
Local Disk(C:) 0(D:) > Self Sttxly + ndard 6
STORE N 60(D.)
Self Study ❑ Name Date modified Type Size
Go-rernance ano Adrr nstrabon 0 6.tA Policy-HFA Service Plan Addres_ 5012019 12:18 PM Microsoft Nord D.. 36 KB
Standard 1 0 6.2A Policy-Deveiopment of Famiiy_ 5292019 1219 PM Microsoft Nord D_. 36 KB
0 6.3A Policy-CHEERS 5/29/20191220 PM Microsoft Word D_. 36 KB
Standard 2
0 6.4A Policy-Child Development Pare_ 529/20191222 PM Microsoft Word D_. 36 KB
Standard 3
0 6.SA Policy-ASQ-3 and ASQ-SE-2 Scr._ 5129/201912.23 PM Microsoft Word D.. 36 KB
Standard 4 0 6.6.A Policy-Tracking and Follow Thro_ 529/2019 1215 PM Microsoft Word D. 36 KB
Standard 5 0 6-3.D.PCI Tracker Feb 202012FSS 314(MD 308 PM Microsoft Excel W_ 178 KB
Standard 6 0,6-5.8 ASOs.12FSS 2-2020 3/4/2020 309 PM Microsoft Excel M_ 1A00 KB
Standard 1 0_,6.5.0 ASQSE's-12FSS.2-2020;2) 3/4/2020 309 PM Microsoft Excel M_ 332 KB
239
Tables of Documentation. At the front of the HFA Best Practice Standards,just after the
Glossary, you will find the Summary and Guidance for Data Collection Timeframes that lists
the data collection required in the HFA Best Practice Standards.
Tables of Documentation
Summary d
• Guidance for • •
LL Time frames
f
The lab-es_N Documentation provide a cuniplele,,st of Gala rE•uire nertts in the HFA best Prdclxe Slarr]ards lbE'sl- Alsu inciuded Is a
OZ column with recommended timetrames for ongoing monitoring and adherence to the standards,as itrs helpful to have routine nxmtonng
- measurement,and documentation of these activities support your site's Oualily Assurance Plan(GA-2.A). these recommended timerrames
W may also be helpful as you develop and follow-up on your site's Oualrty Improvement Plan(Standard GA-2.8). When a site finds that any of
these GA activities are following below expectations stated in the standards the site Is also encouraged to include these Items on their site
O Quality Improvement Plan for ong(Nnq monitoring and Improvement
v
a
0
Cr -Annual-Site selects the most recent 12 moriths most recent calendar year,or most recent nscal year
0
w
Quarterly-Site selects the most recent three months,or most recent full quarter(Jan-Mar.Apr-Jun,Jul-Sept,Oct-Dec)
v
p Submit report rellec"all families referred to your site
& in the most recent quarter
t•l.c
dc Tracking 1.Number of families referred by each referral source FA or local
X Referrals and Quarterly 2.their eligibit"status data report and strategies Update Monthly
Site Capac ty tfictude most recent plan with strategies to fill available
slots or reduce gaps in service availabduty. Militate
which have been apoled.
Also in the BPS are the Tables of Documentation, found at the end of each Critical Element.
Tables of Documentation
'Note.Submit Self Study Face Sheet with Self Study
1.Initiate services early.ideally during pregnancy.
Documentation
1-1.A I Eligibility Submit a narrative description of 1)Site eligibility criteria 2)how these criteria were selected.3)the
Criteria defined service area,and 4)the number of families the site has capacity to serve.Eligibility criteria are
determined based on data collected from one or more sources and reviewed at least once every four years
Submit a narrative identifying organizations within the community where families can be referred
1.1.6 i Referring from,and the formal/informal agreements in place
Organizations Sites approved by the national office to implement NFA's Child Welfare Protocols have an MOU
established with the local child wr+fare office Sam>le.M�xr ry rla-e
Submit report reflecting all families referred in the most recent quarter
1.1.0 I Tracking 1.Number of families referred by each referral source
Referrals and Site 2.Their eligibility status
Capacity 3.Include most recent plan with strategies to fill available slots or reduce gaps in service availability
240
Self-Study Work Plan. Download this customizable work plan to help you stay on track!
It rs highly recommended that you jrye yourself a year to prepare for your self study an
Today's Date: site Out,
[mt.,today',date,as W*A a,your sn.-vt data and self study due date to plan well
Site Visit Date. (this spreadsheet WIII not work unless you enter all 1 dates)
Y'ea:.`n tc.An,dares:ria:arc h gf.;;onted hart a,rsv v Passed.use 1r„s fearwe ru keep[rack
Self-Study Due Date: of p,ogmss OR Jul drrtcd wh~/a mead to[Arch up.
j Start planning on:
N.n llwfr Standsd o«r.r,r,u. .n.:hlr is et Dale Upddle ard[irsal[w Oly
All policy Standards Ixe.,vi,p B p All reWxd polu,es to 1,r
Is"Virrh,.rklrs[; �mptwmrntsd t,
-cost s data a 6bb1lty accotdirg to the me Manlaev and
Summary rd GL-danre for Data Collectson Supemwrs
Innet"es
9 Reyaety repent data for
1-2 C(Identrhed prs.nalally or Within tort) smpl.nrrm drat""'t,for
v Waeks) past.lAW supervnpr,sAWs . prays rt bf.
1 r. 1-1.a(1'home—.1 W IMrn 1 months)
1 A-1.8(Iay91 l ta6",OMnq SuOsry
Sample Site Visit Agenda for a typical 3-day site visit
Sunday, -Lune 15
9:00 A.M. - 5:00 P.M. Check in with Program Manager(PM)about any:
• updates to practice since the self-study was completed
• additional information requested by peers prior to the site visit
• changes to the agenda
PM/Supervisor to provide an overview of the family files, how organized
and key home visit and assessment activities linked to file review.
Peers to review family files, supervision records, training records,
advisory group meeting notes, team meeting minutes and any other
relevant documentation.
Working Lunch
Debrief with Program Manager(request any additional evidence needed)
Monday, -tune 16
8:30 A.M. -9:00 A.M. Peers arrive
9:00 A.M. -9:30 A.M. Welcome Meeting with all staff and whomever else you would like to
invite
9:30 A.M. - 10:00 A.M. Interview 2 Advisory Board Members(15 minutes each) Names
10:00 A.M. - 10:15 A.M. Regroup/Break
241
10:15 A.M. — 11:45 A.M. FSS/FRS Interviews (individually, 30 minutes each)
10:15 A.M. — 10:45 A.M. FSS/FRS 1 Name
10:45 A.M. — 11:15 A.M. FSS/FRS 2 Name
11:15 A.M. — 11:45 A.M. FSS/FRS 3 Name
11:45 A.M. — 12:45 P.M. Working Lunch
12:45 P.M. — 2:15 P.M. FSS/FRS Interviews (individually, 30 minutes each)
12:45 P.M. — 1:15 P.M. FSS/FRS 4 Name
1:15 P.M. — 1:45 P.M. FSS/FRS 5 Name
1:45 P.M. — 2:15 P.M. FSS/FRS 6 Name
2:15 P.M. — 2:30 P.M. Break/Regroup
2:30 P.M. — 3:30 P.M. FSS/FRS Interviews (individually, 30 minutes each)
2:30 P.M. — 3:00 P.M. FSS/FRS 7 Name
3:00 P.M. — 3:30 P.M. FSS/FRS 8 Name
3:30 P.M. —4:15 P.M. Supervisor Interviews (individually, 45 minutes each)
Peer 1 with Sup 1 Name
Peer 2 with Sup 2 Name
4:15 P.M. —4:45 P.M. Peers Regroup/Review Documentation/Debrief
4:45 P.M. — 5:00 P.M. Debrief with Program Manager (request any additional documentation
needed)
Tuesday, .Lune 17
8:30 A.M. — 9:30 A.M. Personnel File Review &Any Other Documentation Still to Review
9:30 A.M. — 10:00 A.M. Interview Program Manager- Name
10:00 A.M. — 10:20 A.M. Interview Program Manager's Supervisor - Name—Title
10:20 A.M. — 11:00 A.M. Break/Regroup/Rate Standards
11:00 A.M. — 12:00 P.M. Family Interviews (individually, 15 minutes each)
Identify language/interrupter needs for peers/families
Site to in vite families from a varlety of FSS
11:00 A.M. — 11:15 A.M. Peer 1 with family 1 Name
Peer 2 with family 2 Name
11:15 A.M. — 11:30 A.M. Peer 1 with family 3 Name
Peer 2 with family 4 Name
242
11:30 A.M. - 11:45 A.M. Peer 1 with family 5 Name
Peer 2 with family 6 Name
11:45 A.M. - 12:00 P.M. Peer 1 &2 with family 7 Name
12:00 P.M. - 1:00 P.M. Peers to work on report- Working Lunch
1:00 P.M. - 2:00 P.M. Finalize Site Visit Report (SVR)
2:00 P.M. - 2:30 P.M. Pre-Exit Meeting with PM and whomever PM would like to attend -add
names
2:30 P.M. - 3:30 P.M. Exit Meeting
Family and Supervision File Checklist. The Peer Team utilizes this checklist when
reviewingfamily files and supervision notes.
"Healthy Families Family and supervision File Checklist
I.'l loll
Peer Reviewer Name
Pkwse k—p record prW=e ar mad arid ask for more fdeA iviarn rwwbd.When prachw clm qr m li a bear nude,reNerY n Wiix d iecroril Bien to ensure corrselnd
mpM.nrmtahnn auores all staff fQ at feast three mordle prior b sM vet
tamAy File Review(one family per column) 1 2 3 4 5 6 T a 9
FSS&Supervisor Initials/
Family If3 [ZZZZZZ ZZ
low er 8WADW L-1 F-Prr Lr el 1-1%eekb
LWV 2-SPA"61) Lever 3-Vm"M Lerer d-Qbb
f mOu nUII,of am
died 1.110M vat
6R$9 Families informed of roils&eonfrdentiaigy
oneor before 1st HV:DATF: Yes,Nol
IFW"1.r P-1k`IN"rth.rDi.casnnrr(t wrrebri pia!
f 6 v;vfe 1 It➢f on-ft to
Nnses etia4tnrs 4p orooez.rar-rs.rr.�snaaa
t:!er xvnerr, rp rants
G 3Z f livid S informred and sign consent every time
nformatron is shared-swotu a spKeo nro reared
L iq:i m am or ene[t 1rMrarra ro m:ra err L'm:atMr
q-7 r4a➢aG]_'.er MFA si4-,w,dt
FROG Scale,Please now This may require review of 2 3 recent FROG Scales across staff to reftect recent practice_if older files selecterl no
not yet►effect implementation of these standards Additional files reviewed can be fmorded on last page,if iwwded
211i kfr(Ni xaie s daunt nte0 undo mp arq m
accordance%ith sae pok),
1BUIM 2 6 3 er Pd0tir 2 JA Wnatna a1 done
2-S.0 FROG Scale a admirwdered in timreframe
243
HFA Pre-Site/On-Site SVR. The Peer Team utilizes a paper or digital version to record notes
and preliminary ratings.
v�� FIFA PRE-SITE/ON-SITE
'11. Healthy Families ACCREDITATION SITE VISIT REPORT(SVR)
America` HFA Best Practice Standards 81"Edition
PLEASE NOTE: THIS FORMAI IS FOR PRELIMINARY SCORING AND
INDIVIDUAL NOTE-TAKING PURPOSES ONLY THE FORMAL SVR
ENTERED INTO HFAST BY PEER TEAM
Site Name:
Bolded and Italllefhed standards=safety or essential standards NOTES:
Standards with(11 in front=interview paradigirns • Reasons for 1 rating lot on the'List of Is'document)
Standards with(P)in front=could be rated pre-site iWsed un sun-study) • Planned Interview topics based on initial review
Standards with(F)in front-based on file or other documentation review • RemiMers/Recommendations for Formal SVR
1. Initiate Services Early
Standard Rating
1 Description&Notes
1-1 Description of eligibility criteria and community relationships
❑Description of eligibility criteria
8 Community data(include source and year)used in deciding these criteria
Geographic service area
°1-1 A ❑Number of families projected annually based on site capacity
Reviewed by the site's community advisory board(CAB)in last 4 years
Reviewed by the site's community advisory board(CAB)in last 2 years(3 rating)
- P Adjusted as needed based on changing demographics or infrastructure
°F i-1.B Identifies referral partners Formal/Informal agreements
(max 2) If implementing Child Welfare Protocols(CWP).signed MOU with local child welfare office
Quartery tracks all families identified/referred rl Eligibility status 0 Source of referral
P'F 1-1.0 ❑Uses data to monitor capacity and apply strategies to fill slots or reduce gaps in service
244
EXHIBIT 8
OVERVIEW OF REQUIRED DATA ELEMENTS
�A
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HFA Overview of Required Data Collection
HFA requires sites to collect data for multiple purposes. Sites collect data for their own use to
monitor.analyze.and create strategies for their work in continuous quality improvement(CQI). Sites
also collect data that is reported to the national office about their site.staff,and the families they
serve. The data required by the Best Practice Standards(BPS)are listed below.
Data to meet BPS standards related to site CQI
This section outlines the data points that are necessary to complete the monitoring and analysis
requirements found within the Best Practice Standards. These standards include mechanisms
intended to help sites understand the cultural makeup of their community and ensure services are
provided in a manner that is culturally humble. They also include mechanisms that ensure your site
is delivering services that are in alignment with the standards,such as timely depression screening
for new parents or ensuring staff receive the appropriate supervision time. HFA has developed
spreadsheet resources to assist sites in collecting much of the information in this section for sites
that do not have a database to support this data collection.
• Date of referral and the referral source
• Date eligibility was determined,the eligibility result(eligible or not eligible),and whether the
family was offered services or not
• Date FROG Scale completed
• Focus Child's DOB
• Date of first home visit
• Collect data that helps you to understand your service population(Examples can be
education level,language spoken, race/ethnicity.age of child at enrollment.)
• Date of last home visit and reason family left services
• Dates CCI tool administered
• Dates ASQ administered
• Dates ASQ-SE administered
• Focus Child's medical provider
• Up to date on immunizations due by 6mo
• Up to date on immunizations due by 12mo
• Dates of depression screening and reason for any missed screens
• Subsequent Child DOB
• Direct Service FTE
• For each family track over time
o Direct Service Staff
o Family service level and dates of service level changes
o Case weight
o Number of home visits received
• For each staff person,track:
o Date of hire
o Date staff person began providing direct service or supervision
o Training date and topic
o Termination date
o Reason why they left and any other characteristics regarding termination
• Frequency and duration of supervision sessions for all staff
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g�"Healthy Families
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• Date,time.attendees,and topics of group reflective consultation groups
Data for Annual Reporting
HFA's national office requires sites to provide key information, including:
• Site contact information: Such as site name,address,etc
• Staff profiles: Basic characteristics for each program staff
• Site Profile Report: Site characteristics. family data.financial.and program policy data.
The information provided to the national office helps us better understand who we are serving,
where they are,and the staff who provide services. We learn about innovations sites are
implementing and the changing needs of the network.
Guide to data collected in HFA Community: Site Information
It is important that site information is updated in the HFA Community whenever there is a change to
ensure uninterrupted communication between the site and the National Office. This information is also
provided to families and providers in the HFA Site Finder to help locate services.
Field Name Instructions &Response Choices
Username Site username is the SitelD
Email Address Email address for the site's primary contact(program manager)
Full Name Primary Contact's(program manager)first and last name
Organization Site name and(SitelD). This is used on the HFA Sitefinder to help families
and professionals find services.
Address Site street address. This is used on the HFA Sitefinder to help families and
professionals find services.
City/Town Site city
State Site State
Postal Code Site zip code
Phone Site phone number. This is used on the HFA Sitefinder to help families and
professionals find services.
Host Agency Host Agency Name
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em
�� "Healthy Families
Host Agency Type Select from dropdown:
Community Action Agency
Child Abuse Prevention Agency
Child Welfare
Family Support/Family Resource Center
Federally Qualified Health Center
Health Department
Hospital/Medical Provider
Mental Health Provider
Prevent Child Abuse America Chapter
Public Health Department
School or Educational Organization
Tribal Organization
No Host Agency
Other Private Non-Profit
Other
Host Agency Accredited Select from dropdown.
by COA
CARF
JCAHO
N/A
Other
Secondary Contact Please list a secondary, or alternate, contact in the event the primary. or
Name program manager, contact cannot be reached.
Secondary Contact Email address for the site's secondary contact
Email
Total Direct Service FTE Direct Service Staff engage and enroll families using the Parent Survey(or
FROG Scale)and/or carry a caseload of enrolled families& provide HFA
home visits. Enter the total FTE of all Direct Service Staff positions, includin
current active staff and vacant positions.
Guide to data collected in HFA Community: Staff Information
To ensure system security,sites are requested to update your list of active staff whenever staffing changes
occur and encourage staff to keep their profiles updated. A site meets the GA-7.A requirements for Staff
Information by completing 90%of the required item per staff person per role(there can be no more than
two of the required fields left blank).
Field Name Instructions&Response Choices
Username User's email address is also the Username
Email Address
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First Name User's first name
Last Name User's last name
Race/Ethnicity Select all that apply. Staff may select I Prefer to not Answer.
I prefer to not answer
American Indian/Alaskan Native
Asian
Black/African American
Latino/Hispanic
Middle Eastern/North African
Native Hawaiian/Pacific Islander
White
Other race/ethnicity
Gender Select from dropdown. Woman includes cisgender and transgender women and
man includes cisgender and transgender men. Staff may select I Prefer to not
Answer.
I prefer to not answer
Woman
Man
Non-Binary/Gender Expansive
Primary Language Select primary language from list. Primary language can be the language you prefer
to speak at home.
see text box to the right for full list of responses)
Secondary Select all that apply.
Language(s)
Education Level Select highest attained from dropdown
Less than high school
High school
Some college
2 year degree
4 year degree
Graduate degree
248
Healthy Families
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Study Area Select from dropdown
General Education: high school or undergraduate
Child Development
Education
Human Relationships
Liberal Arts
Nursing
Psychology
Public Health
Social Work
Sociology
Not Applicable
Other
Are you currently in Select yes/no from dropdown
school?
Do you have Select yes. no.or I Prefer to not Answer from dropdown menu
experience with
—raising children?
Mobile Phone Staff person's cell phone-may be used as a backup means of contact during web-
number based trainings.
HFA Hire Date Date hired to HFA role
Years of Experience Years of experience in home visiting prior to hire in HFA role
in Home Visiting
Prior to Hire
Are you a direct Direct Service Staff engage and enroll families using the Parent Survey(or FROG
service staff member Scale)and/or carry a caseload of enrolled families&provide HFA home visits. Enter
the total FTE of all Direct Service Staff positions, including current active staff and
vacant positions.
Yes/No
Direct Service FTE Enter FTE for direct service role or select N/A.
Are you a Supervisor Supervisors provide supervision to direct service staff
Yes/No
Supervisor FTE Enter FTE for supervisor role or select N/A.
Are you a Program Program managers manage the HFA program and provide supervision to
Manager? supervisors.
Yes/No
Program Manager Enter FTE for program manager role or select N/A.
FTE
List role, if not in a If you are not a program manager,supervisor,or direct service staff member.what
role already listed is your role? Common answers include Supervisor of Program Manager. Director,
Fiscal Contact, etc.
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Guide to data collected in HFAST: Site Profile Report 2023
The Site Profile Report informs HFA's quality assurance and national efforts. helps national and
regional HFA staff understand and respond to the needs of the network,and promotes HFA with a
national voice. This information is collected annually during the month of February.
The data is organized into 4 tabs in HFAST:Site Characteristics, Family Data. Financial,and
Program Policy. Data entry from the previous year is frequently carried forward for site
characteristics,financial.and program policy.
Items on this sheet that appear in gray are not required.
Site Characteristic Tab
Item in HFAST Instructions & Response Choices
Use Centralized Yes or no
Intake
When is the Select one option that best fits most families:
assessment Before enrollment
(FROG) After enrollment
conducted?
For the FROG Sites might use a FROG cutoff score for multiple reasons, like
Scale, are you determining eligibility for services or HFA Accelerated, or for
using HFA's other types of reporting. Select one option:
recommended Yes
cut-off of 10 or No, lower score(specify below)
higher? No, higher score (specify below)
Not applicable(my site does not use a cutoff score)
Eligibility criteria - For each of the eligibility categories below,pick one of the
Select one two options that best fits your site.
response per
question that best
fits your site
Parent Age Only young parents(such as teens or early 20's)
Parents of any age
Number of Only first-time parents
children Any number of children
Income Only low income, or eligible for WIC, Medicaid,
TANF
Any income level
250
160
'Healthy Families
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Other FROG Cut- (Optional) List other eligibility criteria, exceptions, or other
off or Eligibility details;or include FROG cut-off score if your site uses a score
Criteria Specify other than 10
Family Data Select one option:
Collection System Apricot
CMEDS
En Lite
ETO
FamilyWise
HFMIS (SUNY)
Nightingale Notes
OCHIDS(Ohio)
Penelope
PhDoc
PIMS
Visit Tracker
other(specify in next item)
Other Data Specify other data management system only if'other"was
Management selected above, otherwise leave this field blank.
System Specify:
What do you use Select one option:
for HFA Family Data Collection System only
accreditation HFA Spreadsheets only
reporting? both
Site involved in Has your site participated in any research or formal external
any formal evaluation in the post 2 years? Please note that this does not
research or include accreditation activities.
evaluation now or Select Yes or No
in the past 2
years?
If YES, provide Enter the email address for your main contact person on the
email for evaluation team only if you selected Yes above, otherwise
evaluator leave this field blank.
Service Area
Service Area Select one that best fits your site:
Single County
Multi-County
Single City
Multi-City
Neighborhood
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� 'Healthy Families
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other(select item only if your site serves on area
not described above and provide more information in the next
item)
Describe other If you selected 'other"in the item above, please describe
type of Service other service area, otherwise leave this field blank.
Area
In the past 12 Select one option:
months, has your Yes, added new zip codes or counties
service area Yes, we serve fewer zip codes or counties than last
expanded or year
changed? (If so, Not yet, but we plan to expand in the next 12
please update months
your Service Zip No, same zip codes or counties as last year
Code list.
Remember to
notify your TA
Specialist before
expanding)
Additional If needed,please provide additional comments on service
comments on area changes, otherwise leave this field blank.
service area
changes
Add Service Area In the table, list all of the counties you serve within your state.
Counties Click 'Add State and County", select your state from the first
drop down, click on all counties served to select them in the
second dropdown, then click "Update"to save. If your service
area extends to another state, click "Add State and County"
again to report those counties.
Comments? If needed,provide any additional information about counties
served.
Add Service Area Any zip codes that may appear in this list ore carried over
Zip Codes from previous Site Profiles:please review and add or delete
any zip codes to reflect changes in your service area.
Click 'Add Service Zip code"and enter a 5-digit zip code, then
click "Update". Repeat for additional zip codes. Please note
the newly entered zip code will appear at the end of the list,
possibly on another page.
"Please update zip codes throughout the year if your site
experiences changes to service area.
Community Select the categories that best fit your families and estimate
Served the percentage of families served from each type. Enter this
as a whole number. Percentages should total 100%.
Urban
Suburban
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Rural
Tribal
Other Community List other community type(s)and percent of families served
Type who live in that community type.
Caregiver Depression Screen
Caregiver Check all the maternal depression screens your program uses
Depression with families.
Screen BDI: Beck Depression Inventory
CESD: Center for Epidemiological Studies -
Depression Scale
EPDS: Edinburgh Postnatal Depression Scale
LSP: Life Skills Progression
PHQ(any version): Patient Health Questionnaire
(any version)
Other Caregiver Depression screen: Fill in name of
other depression screen or describe if not listed above,
otherwise leave this field blank.
Domestic Violence Screens
Domestic Check all the domestic violence screening tools your program
Violence Screens uses with families.
None: we don't screen for DV. Select this choice if
you do not screen for domestic violence
Abuse Within Intimate Relationships
Abusive Behavior Inventory
DOVE Abuse Assessment Screen
HARK/HARK C: Humiliation,Afraid, Rape, Kick
HITS: Hurt, Insult, Threaten, Scream
Partner Violence Screen
RAT/WEB: Relationship Assessment Tool(RAT)or
the Women's'Experience of Battering(WEB)developed by
Futures Without Violence
Universal Education (e.g., CUES)
Other Domestic Violence screen: Fill in name of
domestic violence screen if not listed above, otherwise leave
this field blank.
Other Assessment Tools (HFA
Optional Tools)
Other Assessment Check all other assessment tools your site utilizes that are not
Tools required by HFA's Best Practice Standards.
None: we don't use any other tools. Select this
choice if you do not use any other ongoing assessment tools.
AAPI: Adult Adolescent Parenting Inventory
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'Healthy Families
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ACEs: Adverse Childhood Experiences Questionnaire
AUDIT: Alcohol Use Disorders Identification Test
CLS: Casey Life Skills
CPS Case: Select if you track substantiated child
maltreatment
CPS Report: Select if you track Reported child
maltreatment
DAST: Drug&Alcohol Screening Test
HFPI: Healthy Families Parenting Inventory
HOME: Home Observation for Measurement of
Environment
ISEL: Interpersonal Support Evaluation List
Kotelchuck Index: Kotelchuck's Adequacy of
Prenatal Care Utilization
LSP: Life Skills Progression
PFS: Protective Factors Scale
UNCOPE: Substance abuse screening
Other Ongoing Assessment Tool: List other ongoing
assessment tool(s)your program uses if not listed above,
otherwise leave this field blank.
Tamily Data Tab
Item in HFAST Instructions & Response Choices
All information Please take note of the example time frames:
below is for: calendar year(January 1, 2022 to December 31, 2022)
federal fiscal year(October 1, 2021 to September 30, 2022)
state fiscal year(mid-2021 to mid-2022, dates vary by state)
other fiscal year
For 2022 (fiscal or calendar) ALL items in Family Data refer to families served in 1011
Number of home Count the total number of home visits completed in 2022 for
visits completed all families served during that year.
in 2022
Of the home visits Total number of virtual completed.
above, how many
were conducted
virtually?
How many families in 2022:
Received at least Enter number of families who received 1 or more home visits
1 home visit(in- in 202Z regardless of when they first enrolled or if the visit
person or virtual) was in-person or virtual.
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7'4Healthy Families
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Received at least Enter number of families who received 1 or more home v;s;is
1 virtual home by phone or video call in 2022, regardless of when they first
visit enrolled.
Reported as Enter number of families reported to HRSA as served by
served by MIECHV MIECHV funds.
funds
Received first Enter number of newly enrolled families who received their
home visit in 2022 1st home visit in 2022. How many of the families who
received at least 1 HV received their first home visit in 2022?
Received 1st Enter number of newly enrolled families (families who
home visit received their first HV in 2022) who received their 1st home
prenatally visit prenatally.
Received 1st Enter number of newly enrolled families (families who
home visit received their first HV in 2022) who received their 1st home
prenatally before visit prior to 31 weeks gestation.
31 weeks
gestation
How many Enter the number of families who received a FROG visit in
received a FROG 2022.
visit?
Enrolled in the Enter number of newly enrolled families who received their
past year as HFA 1st home visit in 2022 under HFA Accelerated.
Accelerated
Enrolled in the Enter number of newly enrolled families who received their
past year and 1st home visit in 2022 and were referred from Child Welfare
referred from Agency.
Child Welfare
Agency
With a father or Enter number of families with o father or partner who has
partner involved attended more than 1 home visit in 2022.
in home visiting
Number of Enter number of focus children. Sites may use their own
children served in definition of'focus child". For example, a site may or may not
2022 as the Focus count a prenatal child as a focus child.
Child
Number of Enter number of children (such as older or younger siblings)if
additional served in any way(does not need to be formally defined
children served services)who were not counted as a Focus child above.
How many 2022 primary ALL items in this section count only the enrolled primary
participants were: participant for any family who received at least 1 home visit
in 2022
Women ' It is preferred that sites report on only one PRIMARY
(cisgender or coregiver/participant per family, even if more than one is
transgender) participating.
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Men (cisgender or
transgender)
Non-
binary/gender
expansive
Preferred not to
report/unknown
gender
First time parent Enter number of primary participants who are 1st time
parents.
Grandparent of Enter number of primary participants who are the
focus child grandparent of focus child.
Bachelor's Degree Enter number of primary participants who achieved a
or Higher bachelor's degree or higher before enrolling in HFA.
Associate's Enter number of primary participants who achieved on
Degree associate's degree before enrolling in HFA.
Technical Training Enter number of primary participants who achieved technical
or Certification training or certification before enrolling in HFA.
Some Enter number of primary participants who attended some
College/Training college/training before enrolling in HFA.
HS graduate/GED Enter number of primary participants who graduated high
at enrollment school or completed GED before enrolling in HFA.
Less than HS Enter number of primary participants who had not graduated
Graduate/GED at high school or completed GED before enrolling in HFA.
enrollment
Education Enter number of primary participants whose highest
Unknown education level is unknown.
Developmentally Enter number of primary participants who are
delayed developmentally delayed. Please consider developmental
delay as any parent whose learning needs are permanently
challenged and therefore warrant extra time from service
providers, special consideration of materials, and resources
used. This may be based on diagnosis or observation.
Medicaid Eligible Enter number of primary participants who are eligible for
Medicaid.
Low-income Enter number of families in low-income households. HFA's
households preferred definition of"low-income households"is on annual
household income at or below 200% of Federal Poverty
Guidelines (FPG). Alternatively, sites can use their own
definition of"low-income households"for this item.
Military personnel Enter number of families with a member who is or has served
or spouse in the Armed Forces.
256
Healthy Familie-
America
History of Enter number of primary participants with history of
substance use substance use disorder(whether currently using or not;
disorder estimate is acceptable). This may be based on diagnosis,
screening/assessment, parent report, or observation.
In need of Enter number of primary participants who were in need of
treatment for treatment for substance use disorder in 2022 (estimate is
substance use acceptable). This may be based on diagnosis,
disorder screening/assessment, parent report, or observation.
Abused or Enter number of primary participants who experienced abuse
neglected as a or neglect as a child(whether reported to CPS or not).
child
Involved in Child Enter number of primary participants with history or current
Welfare System involvement in Child Welfare(like Child Protective Services)as
(as caregiver) a caregiver.
Single Parent Enter number of primary participants whose marital status is
single, divorced, or widowed at time of enrollment.
Over cutoff on Enter the number of primary participants with on elevated
depression screen depression score. If multiple screens were given in 2022, the
(any assessment preferred definition is to count participants with elevated
in 2022) screen at any point in 2022. If this is not feasible, report
number with elevated screen at a single screening point. The
intent is to document how many HFA participants experience
elevated symptoms of depression in a given year.
Insurance Status(when last assessed in 2022)
Of those served in Number of Primary Participants with:
2022, enter no insurance
number in each Medicaid or CHIP
group: Tri-Care
Private or other insurance
insurance unknown
Of those served in Number of Target Children with:
2022, enter no insurance
number in each Medicaid or CHIP
group: Tri-Care
Private or other insurance
insurance unknown
Housing Status (when last assessed in 2022)
Housing Status Own/share ownership of their home
(when last Rent/share rent of their home
assessed in 2022) Live in public housing
Live with parent or family member
Other arrangement (not homeless)
257
Healthy Families
America
Homeless- sharing housing
Homeless-emergency or transitional shelter
Homeless - other arrangement
Unknown/Did not report
Caregiver employment status (when last assessed in 2022)
Of primary employed full time
participants in employed part time
2022, how many not employed (whether seeking work or not)
were: unknown employment situation
Focus children: How many in each age group (as of last home visit received in 2022)
Focus children: If ages can't be calculated to last HV, please use other
How many in each available data on child's age during 2022.
age group (as of Prenatal
last home visit 0-5 months
received in 2022) 6-11 months
12-23 months
24-35 months
36-47 months
48-59 months
60-71 months
72-83 months
Age Unknown
Focus Child Issues: Number of children who were:
Child Issues: Born at low birth weight, less than 2500 grams or
Number of 5lbs 8oz
children who Born premature,born before 37 weeks completed
were: Developmentally delayed or disabled (known or
suspected)
Medicaid eligible
Primary Participant Age at Enrollment:
Primary Site should enter 0 if there are none in a category
Participant Age at Less than 18
Enrollment: 18-19 years
20-21 years
22-24 years
25-29 years
30-34 years
35-44 years
45-54 years
55-64 years
258
'Healthy Families
America•
65 or more
Age Unknown
Race/Ethnicity: Number of Primary Participants who are:
Race/Ethnicity: Site should enter 0 if there are none in a category and leave
Number of the category blank if that category is not yet tracked.
Primary American Indian/Alaskan Native
Participants who Asian
identify as: Black/African American
Latino/Hispanic
Middle Eastern/North African
Multi-race/ethnicity
Native Hawaiian/Pacific Islander
White (non-Hispanic)
Other race/ethnicity
Unknown race/ethnicity
Other race/ethnicity specify: list other
race/ethnicity if you reported participants in the Other
race/ethnicity category, otherwise leave this item blank
Primary Participant Language
Primary Enter the number of primary participants in each category
Participant Primary Language English
Language Primary Language Spanish
Primary Language not English nor Spanish
Site Language Select all primary(or fluent) languages(s) for families and/or
Capacity staff at your site in the last 12 months:
Click Add Language then select a language from the language
drop-down menu that either staff or families speak. Check
the boxes to indicate who speaks that language and choose
the appropriate materials options from the drop down. Click
update. Your entry will be saved to the end of the list, so you
may have to navigate to the last page of the table to see it!
Families Speak: select yes or no to indicate if any
families you serve speak this as a primary language
Staff Speak: select yes or no to indicate if any staff
can speak this language.
Interpreter used: select yes or no to indicate if on
interpreter is used with families who speak this language
Materials in this language: Select one to indicate
what materials you have available for families who speak this
language
Yes, all
259
'Healthy Familie-
/ America
Some (consents, handouts)
Consents only
No
Comment on If needed, please provide any further information on
languages for our language, otherwise leave this field blank.
site/families:
Direct Service Staff Numbers
How many Note:Direct service staff are those who engage and enroll
PEOPLE in direct families using the FROG Scale(or Parent Survey), and/or carry
service roles at a caseload of enrolled families&provide HFA home visits.(For
end of last year? supervisors who carry a caseload, count only those that
provide at least 2 home visits per week).
What was your Add the direct service FTEs for all staff listed above.
total FTEs in direct
service roles at
the end of last
year?
How many direct Add the FTE for un-filled positions for direct service staff
service FTEs were
open (not staffed)
at the end of last
year?
Race/Ethnicity: Enter the number of Direct Service Staff in each category.
Number of Direct Sites should enter 0 if there are none in a category and lean:
Service Staff who the category blank if that category is not yet tracked. The
identify as: sum of these rac%thnicity categories should equal the
number of people who provided direct service.
American Indian/Alaskan Native
Asian
Black/African American
Latino/Hispanic
Middle Eastern/North African
Multi-race/ethnicity
Native Hawaiian/Pacific Islander
White (non-Hispanic)
Other race/ethnicity
Preferred not to report/Unknown race/ethnicity
Other race/ethnicity specify: list other
rac%thnicity if you reported staff in the Other rac%thnicity
Category, otherwise leave this item blank.
260
SON
7-,,
: Healthy Families
America
Gender: Number Enter the number of Direct Service Staff in each category.
of Direct Service Sites should enter 0 if there are none in a category. The sum
Staff who identify of these gender categories should equal the number of people
as: who provided direct service.
Women (cisgender or transgender)
Men (cisgender or transgender)
Non-binary/gender expansive
Preferred not to report/Unknown
HFA comments This field will only be used to indicate if the National Office
makes any changes to your Site Profile Report data.
Comments This field is to allow you to provide any further information or
commentary regarding your site's data. Please note:any
questions needing immediate response should be directed to
Jennifer Baxter(see contact information in General
Instructions above).
Financial Tab
Item in HFAST Instructions & Response Choices
Fiscal Year Type Please take note of the example dates:
calendar year (January 1, 2023 to December 31,
2023)
federal fiscal year(October 1, 2022 to September
30, 2023)
state fiscal year (mid-2022 to mid-2023, dates vary
by state)
Other
Fiscal Year Other Fill in dates used only if"other"is selected above.
Type
Previous Year Enter total site budget in whole dollars(no decimals)for 2022
Program Budget "ONLY INCLUDE HFA SERVICES, not host agency
(2022)
Current Year Some as above for 2023
Program Budget
(2023)
What proportion of your overall current budget comes from the following:
Enter percent for Only include funding from State System that is not included in
each type of other categories below,for example, if you receive MIECHV
funding received; funds from your state system, including these funds only
the total for all under the MIECHV category.
entries should not Local Government
exceed 100%. State Children's Trust Fund
State Dept of Child/Family Services
261
�o
i `Healthy Families
America
State Dept. of Education
State Dept of Human Services
State Dept. of Public Health
State General Revenue
State System
State Other: Include state funding sources not
listed above
Federal TANF
Federal Other: Include federal funding sources not
listed above
TANF Maintenance
CAPTA
CBCAP
CCDBG
State/Fed Other Specify: indicate funding if State
Other or Federal Other was selected above.
Corporations
Earned Income
Family First Prevention Services Act
Foundations
IDEA
Medicaid
MIECHV
Private Donations
Title IV-B
Title IV-E
Title V
Title XX
United Way
Unknown: For use if site does not know specific
source of funding
Other Funding: Include other funding sources not
listed above
Other Funding(specify source) : Specify other
funding sources
Have MIECHV Select Yes or No
Funding? If yes,
complete next 2
items
262
P.
�'j� 'Healthy Families
/ nierica
Current Year Enter amount of funding received from MIECHV in 2023.
MIECHV Funding Required unless "no"is selected above.
(2023)
Previous Year Enter amount of funding received from MIECHV in 2022.
MIECHV Funding Required unless "no"is selected above.
(2022)
Program Policies Tab
Item in HFAST Instructions & Response Choices
What is your major source of parenting materials and child development activities?
Primary Parenting BabyTalk
Materials(Select Growing Great Kids/Growing Great Families
one) Just In Time
Near @ Home
Nurturing Program
Parents as Teachers
Partners for Healthy Baby
PIPE
None
Other (specify below)
Specify Other Enter ONLY if you chose "Other"in above question
Primary Parenting
Materials
Additional None
Parenting 24/7 Dad
Materials(check BabyTalk
all that apply): GGK/GGF: Growing Great Kids/Growing Great
Families
Just In Time
Near @ Home
MOM Project
Nurturing Program
Partners for Healthy Baby(FSU)
PIPE
PAT: Parents as Teachers
Additional Specify additional parenting materials you use that is not on
Parenting the list above
Materials 1
Additional Specify additional parenting materials you use that is not on
Parenting the list above
Materials 2
263
'Healthy Families
/ .Amer►ca
Additional Specify additional parenting materials you use that is not on
Parenting the list above
Materials 3
Additional Services and Enhancements
Additional Pregnoncy/Health:
services/ Doula
Enhancements Lactation consultant/CLC
offered by your Nurse consultation
site (Check all that
Infant massage classes
apply) Nutrition/fitness strategy for parents or children
Car seat installation or checks
Other pregnancy/health services (specify):
Groups
Family social
Parent group
Alumni group
Other group (specify):
Father group
Father engagement specialist
Other father engagement strategies(specify):
Economic Well-Being Supports
Basic needs(diapers, formula, food, clothing
closets, etc.)
Cash assistance(financial support for housing,
utilities, groceries, one-time cash transfers,etc)
Employment readiness
Financial education (EX: budgeting, finances)
Legal assistance/education
Gifts (EX: children's books, Brain Boxes, Bedtime
Boxes, Safe Sleep Boxes, etc)
Incentives(gift cards, etc. for participation)
Other economic supports (specify)
Depression and Mental Health
IPV universal education (e.g., CUES)
Mental Health Specialist/Therapist
Moving Beyond Depression
Tandon Mothers& Babies Program
Other Depression Services (specify)
Data Usage Policy
264
"Healthy Families
Item in HFAST Instructions & Response Choices
HFA Affiliate Data Click the link to open the HFA Affiliate Data Usage Policy. You
Usage Policy won't be able to sign the acknowledgement in HFAST until
you hove clicked on the link!
I am authorized to Check this box. if you are not authorized to complete the
acknowledge this Data Usage Policy Acknowledgement, have the authorized
policy for my site person log in to complete it.
I have reviewed Check this box.
and understand
HFA's Data Usage
Policy on behalf of
my site
Type your name Type in your name. If you cannot type in the box, be sure to
here to sign click the HFA Affiliate Data Usage Policy link first.
265
EXHIBIT 9
HFAST DATA USAGE POLICY
s
sHealthy Families Rev.9242021
Auicrica-
HFA Affiliate Data Usage Policy
HFA requires data from affiliate sites and individuals associated with HFA for administrative purposes
such as communication, billing for fees and services,and monitoring of affiliate requirements(e.g.,
training,accreditation). Data are also used to examine network characteristics and quality indicators,
to inform advocacy efforts and network support All data sharing is conducted responsibly and
mindfully for the benefit of HFA affiliates and the children,families,and communities they serve. This
policy describes how,HFA uses and shares required data from affiliates.
• Aggregate(summary)data representing multiple sites,including but not limited to a region,state,
or territory may be shared publicly without explicit permission from affiliates,such as on the HFA
website_
• Site-level data may be shared with certain entities,without explicit site permission,if we determine
there is a benefit to the HFA Network and the recipient of the data has established a non-
Sharing of sde-level data is allowed for a variety of purposes that benefit individual or multiple
sites,including access to resources,advocacy,fund raising,performance monitoring quality
assurance,quality improvement,and research_
Site name and contact information are shared on the publicly accessible HFA website to
help point potential families,funders,and government representatives to the site nearest
them.
• Individual(person-level)data are not stared without advance written permission from an
authorized representative,with the exception of email addresses and other contact information.
Email addresses may also be shared in order to connect staff on targeted issues with potential for
mutual benefit General communications to the HFA Network are directed to contacts designated
by affiliates and other staff who have elected to receive them.HFA will never sell or share staff
contact information for marketing purposes.
Note:All provisions in this policy may be superseded by later agreements between PGA America and
an affiliate.
Questions about this policy are welcome and should be submitted to researchv@preventchildabuse_org.
266
EXHIBIT 10
HFA BRAND GUIDELINES
t�r
Healthy Families
Amerlcw
Graphics Standard Manual
February
267
TABLE OF CONTENTS
Tableof Contents......................................................................................................1
Introduction...............................................................................................................2
National Office Graphic Standards..........................................................................3
Logo Placement and Usage- National office and Sites........................................9
BrandMessaging....................................................................................................16
IntellectualProperty................................................................................................18
February 2017
The purpose of the Healthy Families America' (HFA) graphic standards manual is to enable
every HFA employee and partner to deliver a single. strong and recognizable brand throughout
communications materials. This manual was developed to provide detailed guidelines regarding
us of the logo. wordmark, colors and visual brand style for HFA.
HFA is the signature program for Prevent Child Abuse America" and one of the leading family
support and home-visiting programs in the country. Recently, the HFA logo was updated
to modernize the brand and further align it with Prevent Child Abuse America. This new
logo allows HFA to achieve consistency with the national organization brand by utilizing the
pinwheel, color scheme and structure.
269
NATIONALOFFICE GRAPHIC STANDARDS
Office.The graphic standards in this section apply to the National
National Office Graphic Standards
Organizational Logo
The pines heel reprc;cnts the happy,healthy and t//
care-tree childhood we want for ALL children inV,•"W
the context of family and community.It provides Healthy Families
us all with the opportunity to engage multiple
audiences in a new and consistent way,and enjoy America
unique brand recognition in a crowded non-profit
landscape.
The organizational logo is the combination of the
pinwheel symbol and the organizational name.
The organization name typeface is Franklin
Gothic Heavy(m gray).When using the Healthy
Families America logo at the site level,each site
is to replace"America"in the National Office
logo,with its own site name in the Times New
Roman typeface(in gray).
Site Logo
'//
When using the Healthy Families America logo ._•ate
at the site level,each site is to replace"America' I'inH Healthy Families
the National Office logo,with its own site
name in the Times New Roman typeface(in Allegheny
gray).
Logo Alignment
The typography is always lefl aligned and
positioned to the right of the pimvheel symbol. t0'
The spacing between the pinwheel and the 1
typography is always the same distance. tip of blade aligns Healthy Families
at baseline
The stick of the pinwheel is at an angle to create aligns at baseline --America
a more dynamic symbol.The angle follows
the same angle as the"A"of"America".The
baseline of the pinwheel stick always aligns with
the baseline of the"America"or state name type.
The leading is set as the same pt.as the type size.
270
National Office Graphic Standards
Fonts ABC DEFGHIIKLMNOPQRSTUVWXYZ
abcdefghi jklmnopgrstuvwxyz
Organization name is hpcset in Franklin Gothic 1234567890
Heavy."America"and secondary typography,
such as addresses,titles or board lists.are tvp-set ABCDEFGHIJKLMNOPQRSTUVWXYZ
in Times New Roman.Board list headers are set in abedefghijklmnopgrstuvwxyz
Franklin Gothic Derm
1234567890
ABCDLI-GHIJKLNINOPQRSTUVWXYZ
abLdefghi jklmnopgrstu vwxyz
1234567890
ABCDEFGHIJKLMNOPQRST U V WX YZ
abcdefghijkhrrnopqrstrn•►t,.x vz
1234567890
Logo Spacing
To maximize impact and recognition,an area I
equal to the height of"X..(shown at right)is to .........
remain clear around the logo.
The exception to this rule is when there is a ',.Healthy Fa m i I i es
i ;
horizontal line under the logo,such as the j •n i
anniversary logo example shown below.The I '..x A meri�ca� '�. .... t.........
horizontal line must be!�of the height of`A"
below the baseline of the pinwheel suck
Use of Pinwheel as a
Stand-Along Image ,owLalthy Families
.W. WTo enhance design or accommodate tight spaces. �0,it is allowable to show the pinwheel as a standHMP,�V remres
alone image on a print(e.g.brochure)or electronicpiece(e.g.Faccbook page)as long as the full
organizational logo is also shown on that piece.
See examples at right.lase of the pinwheel as a �^stand-alone image image without the use of the full logo "" �•-•
on the same piece is not allowed ® ,,�, _����•�+�
271
National Office Graphic Standards
Logo Placement -
Co-Branded Sites
I or those I Icalthv I ambles Amenca sites that
utilize the Healthy Families Amenca logo along
with another organizational logo,there are
specific instances to consider:
• When retcrcncmg Healthy Families Amenca
as a program of a larger organization,the
Healthy Families Amenca logo should be
included near the program description.
Placement and usage of the logo should follow
all graphic standards noted.
• When displaying two logos together,each
logo should have similar prominence within
the collateral Placement and usage of the logo
should follow all graphic standards noted.
Things to Avoid
Elements of the logo may not be rearranged into 46:1 r
other configurations.The logo in its entirety maN W. , li=ai�ies :°.;Health Families
be scaled up or down in size to accommodate
various needs Individual elements may not be �merice
scaled,such as making the organizational name
smaller or the pimvhccl bigger
When scaling the logo up or down.be sure not to
distort the logo. /
The text may not be stacked under the pinwheel
symbol. America- America
The angle of the pinwheel pinwheel suck may
not be changed.
t,1
Fonts other than those indicated—Franklinhas VA M
��•�
Gothic Heavy and Times New Roman—may
not be used.Treatments,such as italicizing or America•
capitalizing the entire organizational name,may
not be used with the logo.
The logo may not be shown in any color
combination other than the options shown on
page 7-For example,the logo may not be shown FAMILIFSs
in red.white and blue for Independence Day or `l rrt e1 rre! Ainericx
all green for St Patrick's Day_
To prevent brand degradation.the pinwheel
image may not be used as an"I'-within another
word
272
National Office Graphic Standards
Logo Colors R=0 G=93 B=170 R=92 G=111 B=124
C=100 M=66 Y=0 K=2 C=23 M=2 Y=0 K=63
The organizational logo colors are blue PMS 286
and gray PMS 7545(Pantonc Matching System)
Printing the logo in the two Pantonc colors Iblue
and gray)is preferred. 25•.
To account for multiple graphic needs,the
1•ollowtng altemames are acceptable:
Two-color PMS 286 blue and PMS 7545 gray;
solid and various tints—PMS 286: 1005 and Wa .................................................................................
and PMS 7545: 1OWo,7Wo and 2590 Primary w*
(hie-color PMS 286 blue;solid and vanous tints—
PMS 286- 10000,7500,64"o and 25%. it,r'
One-color black;solid 35°o black(also referred to Healthy Families
/
as Black&White) America
Re%tined out against blue PMS 286 background:
solid white and 3(1°°blue(also referred to as
Knocked Out or KO).
Rcvrncd out against black background: ��' Healthy Families solid •
white and 35%black(also referred to as Knocked America
Out or KO)
Pleasenote,reversed out images should only be t
used for specific projexts that requireFA Families
e it.
When designing materials,it is important to work
America
within the brand primary and secondary colors:
i
Primary Colors Healthy Families
The pnmary colors are an integral part of our America
brand Primary colors should be used on all
materials to build brand recognition.
PMS 286&PMS 7545 INS
America
R=84 G=149 11=66 R=255 G=216 B=129
Secondary Colors C=72 M=20 Y=100 K=5 C=O M=15 Y=58 K=0
I he secondary colors broaden the color palette to 75•;
provide variety and visual interest,without leaving
the recognizable color palette-Secondary colors w•..
should be used in less than 50 percent of the whole PMS 2005
palette for one piece- 35
PMS 2277&2005
25
273
National Office Graphic Standards
Organizational Name Usage
When rctcrcncmg the organization,our lull name.Health Families Amcnca"should be used as the first rctcrcncc.Any
rctcrcncc thereafter,can exclude the registered mark.It;in subscyuent content,the HFA acronym is used,then the initial
rctcrcncc must be,Healthy Families America` (HFA).
Tag Line
The tag line for Healthy Families America is-Great childhoods begin at home".
Questions on Logo Usage
II your chapter is unsure about any particular possible logo usage,please contact the Prevent Child Abuse America
Director of Marketing at 312.663.3520 x861.
LOGO PLACEMENT AND USAGE
NATIONALOFFICE AND SITES
The following sub-sections demonstrate the national office's approach to stationery,website and
social media, incorporating the organizational pinwheel logo. For consistency,sites are encouraged,
but not required,to follow these models for your print and electronic elements.
274
Logo Placement and Usage- NatronaI Office and Sites
Business Card
The size of the business card is 3'• 'x 2".
"Healthy Families"is 17 point Franklin Gothic Healthy Families
Heavy m gray."America"is 17 point Times New America
Roman in gray.Address is 8 point on 9 point 118 South Wabash Avenue Kathleen Strader.M"imm.v in
leading Times New Roman in gray Name is 8 Irhh Floor Nj:�"owl Duc,hu
point on 9 point leading in Franklin Gothic Demi Chicago.IL MKdN Implememaimn and
t 24M 9MM M990 kwaderirpnn A& �i,l..,
in blue.The loco is 2-59"Wide in 2-color.
Hcalthv Families Amenca cards are punted on heaitiWamiliesamenea.org
White stock-
No. 10 Envelope
Healthy Families"is 20 point Franklin Gothic
HcaNv in gray ':Amenca"is 20 point Times No-%%
Roman in gray Address is 9 point on I point �4'Healthy Families
leading Times New Roman in gray.The logo is y� y�
3.05"Widc in 2-color America
Baseline of address aligns at 2.125"from the top 228 South Wabash Avenue
10th Floor
of the envelope and 4"in from the left side of the Chicago.IL 60fiO4
cnyclope.
Healthy Families America envelopes are printed Name of A(
on white stock. Title of Ad(
Company�
Street Addr
City,State
Letterhead
Healthy Famihcti'is 20 point Franklin Gothic Heavy in gray "America"is 20 point Times New Roman in gray.Address is 9
point Times New Roman in gray The logo is 3 05"wide in 2-color-
Second sheet letterhead should only include the logo in the same positron as on the letterhead These same rules apply for
electronic letterhead
275
&i
Healthy Families
America
Date
Name of Addressee
Title of Addressee
Company Name
Street Address
City,State Zip Code
Name of Addressee:
The purpose of this sample letter is to provide a guide for the typing format within Ilealthy Families America`
and its sites.
A common visual presentation of the organization will reinforce the objective of creating a unified purpose.
The date for the standard letter begins 7 picas,3 points from the top edge of the paper and aligns flush
left vertically with the I lealthy Families America name.
One double space should precede and follow the salutation line_The letter margins should be set to allow for
33 picas of typing-Typing should be flush left,rag right,without indentations.One double space should be left
between paragraphs,and four double spaces allowed for the signature_
Sites are welcome to print their 501c3 designation and/or include a tag line of their choosing on letterhead
and/or all other stationery_The only stipulation is that tag lines be consistent with re-framing.
Sincerely,
276
Press Release
"Healthy Families"is 20 point Franklin Gothic Heavy in gray."America"is 20 point Times New Roman In gray Address is 9
point Times New Roman in gray The logo is 3.05"wide in 2-color.
`Healthy Families
America
PRESS RELEASE Contact Name:I irst last Name
Phone Number:123.456.7890
F., e-.-.
IMMEDIATELY(OR DATE)
Headline
Subhead(if appropriate)
CITY,STATE—The body of the release begins four lines below the
deepest line under"Release"or"Contact-.The deadline is flush left,
as are all the paragraphs.There is one line of space between each
paragraph.The city where the release originated is typed in all capitals.
The state name is abbreviated.
It is not necessary to provide a date preceding the city if one has been given in the
"Release"above.
If additional pages are required,the bottom ofthe first page is to
have the word—MORE—in all capital letters,centered with body
of the release.The additional page is to be identified with the title of the
release and a page number.The concluding page is to have three
pound signs—###—centered under the copy.There is one letter
space between each sign.
229 5uu111 wabuu Av we,Ift flour Chwagu.IL 606b4:T 311663.3320 F 312 939_irY62 I YeallOyr�oraioamrrica_urK
277
Logo Placement and usage • National Office and Sites
Memoranda & Fax Cover Sheet
�N
Health Fainilics"is 20 point Franklin Gothic .'Heakhy Famines
MEMO
Heavy in gray "Amcnca"is 20 point Times
\cw Roman in gray Address is 9 point Times
New Roman in gray The logo is 3.05"wide in
2-color
wx. r,el.�.or wine
um.�....,>mn]+-Imm,mum•rr oa np.a„ome,.a
�r.
-'Healthy Famines FAX
Q: caret wf la R` fin,W,k.n.
A(tita I lµ l� .u.t lT nr,km mu rwM1,.tla�!W yp
278
Logo Placement and Usage National Office and Sites
Print, Electronic Newsletters,
Signage,Collateral,Ads or Video 0 0 00
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organizational logo is placed in a prominent , Healthy Families
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Electronic Signature Director of Operations
All national office employees should use the Healthy Families America'
same electronic signature,as shown to the nght 228 S. Wabash Avenue, 10th Floor
Chicago. IL 60604
Phone: (312)663-3520 ext. XXX
Fax: (312)939-8962
`Healthy Families
America
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Logo Placement and Usage National Office and Sites
Website �..�., .w... .,_. ,. ,.... ...... ..,.,... M _
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Display the organizational primary logo at the
top of the home page and cam'through the
webstte.Follow all graphic standard guidelines.
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the functionality of various social media sues.such as Facelx)ok or Twitter.Follow all graphic
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Brand Messaging
Mission,Vision,Promise
Mission:To promote child well-bring and prevent the abuse and neglect of our nation's children through intensive home visiting.
Iiston:All children receive nurturing care from their family essential to leading a healthy and productive life.
Promise:Healthy Families America is supporting relationships between parents and children within communities.to strengthen
American families.
Core Messages
• Healthy Families Amenca is an evidence-based(or research-based)home visiting program that focuses on enhancing child
welfare,health and development.
• It is a national,voluntary program that support%families to provide intensive in-home services.equipping parents with the tools
and resources needed to create strong,lifelong relationships with their children.
• Healthy Families Amenca uses a relationship focused approach,while promoting positive parenting skills and parent-child
interaction and attachment,optimal prenatal care,child health and development and enhanced family self-sufficiency to
ultimately create safe,stable and nurturing relationships and environments.
• Healthy Families Amenca equips parents with the tools and resources needed to create strong,lifelong relationships with their
children.
• Healthy Families Amenca works with parents prenatally and after birth.
• );sing the proven practice of home visits,Healthy Families America's slafFconnects with and supports parents and children in
any given community.
• Healthy Families Amenca uses an infant mental health(or relationship fixused)approach to enhance child health and
development through strengths baud intensive in-home services.
• Healthy Families Amenca is theoretically rooted in the belief that stimulating,early learning environments and nurturing,and
our earliest relationships lay the tbundation lbr life-long healthy development_
• Healthy Families Amenca is unique from other home visiting models in that it offers flexibility to meet the needs of all kinds of
communities and families.
• In 2011,HFA was named one of seven proven home visiting models by the United States Department of Health and Human
Services.
• HFA actively reaches out to engage with families who could benefit from a unique community partnership approach to access
services.
• The core of HFA includes care that understands and recognizes the impact of trauma,relationship building and a focus on the
parent-child interaction.
• HFA is the only home visiting program that has developed an accreditation process that ensures the quality of each HFA affiliate
through adherence to best practice standards.
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Intellectual Property
Logo Protection
To ensure that the Healthy Families America logo and wordmark continue to be used in a manner that advances our brand and
allows the trademarks to be recognized as our trademark,it is imperative that we properly use the trademark consistently and
correctly.
What is a trademark?
A trademark is a word,phrase,slogan,svmtxrl,or design,or combination thereof that identifies the source of goods and services
ofone owner and distinguishes them from the goods and services of another owner. A trademark les consumers know that the
goods or services come only from a single source,and not someone else.
Using a trademark in commerce with specific goods and services establishes common law rights in the mark.which may be
limited to a specific geographic area. Federal registration ofa trademark provides the trademark owner with a legal presumption
that he or she is the owner of the mark and has the exclusive right to use the mark nationwide on or in conjunction with the goods
or services identified in the registration_
id hich srmhol t f?i TM or'")should I use?
To use the k symbol,the trademark must be a federally registered mark with the I IS Patent and Trademark Office. The R symbol
may be used with the mark only in connection with the goods or services listed in the federal trademark registration. Also,the R
symbol only can be used if a federal registration has been granted,and not while an application is pending. The Healthy Families
America wordmark is federally registered and thus should include the R sN-mbol placed to the right of the mark:Healthy Families
America'or Hcalthy Families America' (HFA).
If a word,phrase,slogan,symbol,or design,or combination thereof is being used as a trademark but is not federally registered
(either an application for federal registration has not been filed or an application for federal registration is pending but has not yet
been granted),the T"symbol(for an unregistered trademark)or"'symbol(for an unregistered service mark)should be used to
alert the public of trademark use. Once a federal registration is granted,the T"or"symbol can be replaced with the R symbol.
Cop right rise
A copyright protects an onginal artistic or literary work fixed in a tangible medium of expression. Copynght covers both
published and unpublished works. An original work of authorship automatically is protected under copyright the moment it
is created and fixed in a tangible form. Although federal copyright registration is not mandatory to protect original works of
authorship,federal registration nonetheless allows a copyright owner to make the tact of their copyright public record and collect
statutory damages in the event of infringement.
A copyright notice is an identifier placed on copies of the work to inform the world of copyright ownership.The copyright notice
generally consist%of the symbol 0 or word`Copyright"or the abbreviation'Copr."the year of first publication.and the name of
the copyright owner(e.g., C2008 John Doc).
Using this notice reduces the likelihood that our intellectual property(e.g.,training documents,wcbsite content)will be
reproduced,dlstnbutod,perlbimed,publicly displayed,or made into a denvatrvc work without the permission of Healthy Families
America.
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EXHIBIT 11
FIDELITY TO THE MODEL REQUIREMENTS
Affiliation Application - see page 5
t "
Healthy Families
America
2022-2024 AFFILIATION APPLICATION
This application begins the process by which sites are able to affiliate with Healthy Families
America"(HFA). Following review of this application and communication with the applicant site,
the HFA National Office will notify the site in writing of its decision.The HFA National Office at
Prevent Child America is the sole entity with designation as HFA Model Developer.Only the HFA
National Office is able to grant site affiliation status which occurs upon determination that the site
is committed to the HFA critical elements and adherence to model fidelity through the
accreditation process.
Should you have any questions about the applicatior or need to submit your completed HFA Affiliat on
Application and Implementation Plan,please email Diana Sanchez at dsanchez(ftreventchildabuse ora
'I'l- GENERAL.SITE INFORMATION DATE 5/10/2024
Program Manager(Primary Contact Person) Ah Vang
Host Agency/Address 1221 Fulton Street
Physical Site Address 1221 Fulton Street
City Fresno State California Zip 9372':
Telephone(559)600-6358 Fax (559)455-4705 E-mail ahvangafresnocountyca aov
Is your host organization accredited by COA? ❑Yes LI No
Are you starting up a new site or transitioning existing home visiting services to the HFA model?
O New C Existing
Is your site receiving MIECHV funds? 0 Yes ] No
Is your funder requiring you to serve families using the Healthy Families model by a specific date?
Yes A No If yes,what is the date:
Have you hired staff(program manager,supervisor,direct service staff)?
C Yes,we have all our staff.
R Yes,we have some staff,we do not yet have. 1 Health Education Assistant(FSS)
We have not yet hired staff but plan to by:
What evidence informed parenting materialslcurriculum will you be using'?
Partners for a Healthy Daoy will be the primary curriculum for families in the prenatal to 3-year group and
Partners in Parenhnc Eau-cation(PIPE)will be the primary curriculum for any families served with children
apes 3-5. Staff will be trained in both curriculums and may substitute if a certain curriculum seems better
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suited to a family's needs Just in Time Parentinq newsletters may be usea as supplemental materials for
all families.as needed,and wren appropriate
_� We are undecided about which parenting materials we will be purchasing and would like to discuss
this with HFA.
What will you be using to collect data?
J We will be using our existing data system(specify)_Avatar will be used for intake and referral
distribution and Efforts To Outcomes(ETO)will be used for ongoing data collection and reporting.
We are considering the following option
❑ We would like to discuss data system options for maintaining records and generating program reports
Have you decided on a local Healthy Families site name?If you have decided on a name which meets
our guidelines(see HFA Logo Creation Process).please provide it here.
E We have not decided on a name and would like to discuss the naming and branding of our site with
HFA.
`. SITE CEMOGRAPEIC ROFILE
Select the site's geographic service area from the drop-down menu below
Single county(specify below)
County Fresno
Other
Estimate the percentage of families served from each community type:
80 % Urban community
20 % Suburban community
% Rural community
Tribal community
% Other(specify)___
Estimate the percentage of the following ethnic groups that will be served by the site:
1 % American Indian/Alaskan Native
4 % Asian
10 % Black/African American
61 % Latino/Hispanic
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2 % Middle Eastern/North African
1 % Native Hawaiian/Pacific Islander
12 % White(non-Hispanic)
<1 % Multi-race/ethnicity
1 % Other race/ethnicity(specify) _
8 % Unknown race/ethnicity
PLEASE NOTE: HEALTHY FAMILIES AMERICA HAS SIANDARDIZE•D DEFINITIONS OF WHAT CONSTITUTES A
SIT[. IF YOU EXPAND OR CONTRACT YOUR GEOGRAPHIC SERVICE AREA, THIS MUST RE APPROVED BY
HEALTHY FANIKIEs AMERICA.
NUMBER OF FAMILIES
Please indicate the number of families you are projecting to serve annually. 75-100
STAFF INFORMATION
As described in the Implementation Plan.,please remember Supervisor to Direct Service Staff ratios are 1 6
max, and preferably 1 5 Also,there must be FTE dedicated to the Program Manager role, even if it is not
full time, in order to ensure sustainable program leadership and adequate support to staff, At an absolute
minimum,we recommended.17 FTE for sites with less than 2.0 FTE Direct Service Staff.
Please indicate the Full-Time Equivalent(FTE)status for all budgeted staff(employed or contracted)to
serve in the following Healthy Families roles'
25 Program Manager/Site Coordinator
75 Supervisor
Direct Service Staff
3.0 Family Support Specialist
1.0 Family Resource Specialist
PLEASE NOTE: SITES WILL BE REQUIRED TO UPDATE HFA ON STAFFING CHAFIGES SUCH AS ADDING
ADDITIONAL FTE'S OR REDUCING FTE'S OR IF You EXPAND SERVICES. AS THESE COMPONENTS IMPACT
FILLING.
FINANCIAL DATA
Anticipated Total Budget for HFA for current year: $ 600 OOO annual maximum
List major funding sources and their percentage of the Total Income
Source of Funding % of Total Income
California Home Visiting Program(CHVP)State General Fund(SGF) 75% _
Health Reali nmen: 25%
How many years is this funding confirmed for?
4 Vears
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What is your long-term funding sustainability strategy?
Should State General Fund be reduced or no longer available,the Department will seek grant
opportunities and/or braid/leverage health realignment funds with other funding sources to sustain this
program.
COLLABORATING AGENCIES
List agencies with which you have active collaborative relationships and type of collaboration:
Name Of Agency Type of Collaboration"
Women,Infants,Children Program WIC Community resourcepotential referral source
Fresno Unified School District(FUSD)Early Learning Community resource,potential referral source
Fresno County Superintendent of Schools Community resource,potential referral source
Economic Opportunities Commission EOC Community resource,potential referral source
Focus Forward Community resource,potential referral source
UCSF Fresno Community resource,potential referral source
Central CA Food Bank Community resource,potential referral source
Workforce Connection Community resource,potential referral source
Shine Together Community resource,potential referral source
First 5 Community resource.potential referral source
Valley Health Team Community resource,potential referral source
Rape Counseling Services Fresno Community resource,potential referral source
Fatherhood Program EOC Community resource,potential referral source
Central Valley Urban Institute Community resource,potential referral source
Community Health Teams Community resource,potential referral source
California Health Collaborative I Community resource,potential referral source
*TYPE OF COLLABORATION: CONSIDER AGENCIES YOU CURRENTLY HAVE PARTNERSHIPS WITH;AGENCIES
WHO CAN PROVIDE RESOURCES TO YOUR FAMILIES. AGENCIES WHO WILL BE REFERRING FAMILIES TO YOUR
PROGRAM. AGENCIES OR INDIVIDUALS WHO WILL SERVE AS ADVOCATES FOR YOUR PROGRAM; POTENTIAL
COMMUNITY ADVISORY BOARD MEMBERS.
List agencies which currently provide home visitation services in your proposed service area and how you
plan to collaborate with each:
County of Fresno Department of Public Health(DPH)in-house home visitation programs:
• Nurse Family Partnership(NFP)-This program serves first-time mothers who are able to
participate in a home visit before the end of their 280,week of Pregnancy. Referrals that are
received by DPH will be categorized into those eligible for NFP,who have high-acuity/medical
needs that would benefit from nursing services and those that are beyond their 281"week or have
low-acuity and no need for specialized medical/nursing services.Families in the latter category will
be referred to the HFA program.
• Black Infant Health(BIH)—This program provides group and individual case management including
home visitation services The BIH program also contracts with Black Wellness and Prosperity
Center for home visiting and group services.
• Public Health Nursing Program—This program includes Nurse Liaison,High-Risk Infant and MCAH
Programs.Collectively the Public Healtn Nursing program provides short-term home visitation
services to children 0-17 years.including children ages 0-5 in childcare,with developmental and/or
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behavioral concerns.and pregnant women of anv gestational age. Incluamg teen parents served
through Cal Learn. Clients receive one on one Support by a Public Health Nurse, including
assessments and screenings growth monitoring education on various health topics.as well as
referrals to community resources.
Countv of Fresno DPH contracted service providers:
Community health beams(CHT) Tl,e CHT program consists of community-based organizations
who receive referrals for families seeking short-term interventions including home visitation.This
program is not currently implementinq an evidence-based model
BUILDING RELATIONSHIPS IS AT THE HEART OG THE HFA MODEL. ESTABLISHING PARTNERSHIPS AND
COLLAUORATIONS WITH OTHER HOME VISITATION SERVICES IN YOUR AREA PROVIDES INCREASED ACCESS
FOP FAMILIES AND THE COMMUNITY,
C. SITE LEGAL STATUS AND :dFA RITICAL < LEN'IEi!iS
Describe the legal status of the site or host agency,i.e.,501(c)3,public agency,etc.
The County of Fresno is a public agency and a charter law county.
CRITICAL ELEMENTS
The Critical Elements serve as the twelve research-based standards defining the Healthy Families
America Model. Submission of a completed HFA Affiliation packet indicates a commitment to the
policies, procedures,and practices within each Critical Element.
Critical Element#1:
Initiate services early, ideally during pregnancy.
Critical Element#2:
Sites use the validated Family Resilience and Ooportunities for Growth (FROG) Scale to identify family
strengths and concerns at the start of services
Critical Element#3:
Offer services voluntarily and use personalized,family-centered outreach efforts to build trust with families.
Critical Element#4:
Offer services intensely and over the long-term with well-defined progress criteria and a process for
increasing or decreasing intensity of service.
Critical Element#5:
Staff celebrate diversity and honor the dignity of families and colleagues by education 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.
Critical Element#6:
Services focus on supporting the parent(s), as well as the child by cultivating the growth of nurturing,
respons ve parent-child relationships and promoting healthy childhood growth and development within a
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caring community
Critical Element#7:
At a minimum. all families are linked to a medical provider to assure optimal health and development
Depending on the family's reeds,they may also be linked to additional services related to finances,food,
housing assistance school readiness,child care,job training,family support,substance abuse treatment,
mental health treatment,and domestic violence resources.
Critical Element#8
Services are provided by staff in accordance with principles of ethical practice and with limited caseloads
to ensure that Family Support Specialists have an adequate amount of time to spend with each family to
meet their unique and varying needs and to plan for future activities.
Critical Element#9:
Service providers should be 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 skills to
do the job.
Critical Elements#10&11:
Service providers receive intensive training specific to their role to understand the key components of family
assessment, home visiting, and supervision 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, responding to mental
health, substance use,or intimate partner violence issues,All staff including prograrn managers, receive
training on topics related to diversity and equity
Critical Element#12:
Service providers receive ongoing.reflective supervision so they are able to develop realistic and
effective plans to empower families.
Before submitting this application to Prevent Child Abuse America please make sure Vou have:
Completed Parts A,B,C and D of the HFA Affiliation application
Please note Section D is the final page of this document and is a signature page.
Obtained appropriate signatures on the statement of commitment to the HFA critical elements—Part D
Prepared a written implementation plan using the HFA Implementation Plan template
Contact staff at the PCA National Office for payment of the non-refundable$500 application fee
Completed Affiliation Application and Implementation Plan:
Must be submitted electronically to Diana Sanchez at dsanchez(d)preventchildabuse.org
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D. PLEASE READ AND SIGN THE FOLLOWING STATEMENT OF COMMITMENT TO
HFA AFFILI %TION
The County of Fresno Department of Public Health hereby signifies that it is committed to
providing home visiting services to pa.ents and their young children using the H FA model and applying the
HFA critical elements(identified on pages 4 and 5)as the site's foundation for both policy and practice. If
granted affiliation by the HFA National Office (including use of the "Healthy Families" name, logo and
training), the site agrees to the following terms and terms detailed in the HFA Licensing Agreement:
1. Pay annual affiliation fees to the HFA National Office,
2 Provide site level data annually via HFAST(HFA Site Tracker data system),
3 Implement a data management system to track participant data and share aggregate infonmation
to the National Office,and
4. Begin the HFA Fidelity Assessment process by the one year anniversary of site operation(based
upon the official date of affiliation) In addition, it is understood that completion of HFA Fidelity
Assessment is necessary by the third anniversary(based on the official date of affiliation)in order
to maintain affiliation with the HFA National Office.
zzq
Sigrure. Executive ire or/President of Host Agency Date
David Luchii
Please print or type name
2-d
Sgnature, ProaFam-MaQagsrTiff hired at time of application) Date
Ah Vanq
Please print or type name
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Healthy Families
America Implementation Plan
Submit this completed Affiliation Implementation Plan with your HFA Affiliation Application.We
understand that you may not yet have all areas in place or even fully conceptualized.
A thorough response to all items detailing your current plans/status in regard each HFA expectation
will assist the HFA National Office in understanding how things are taking shape as you begin your
HFA site and will allow us to tailor information and support specifically to your needs.
Service Initiation
HFA has no limitations on the types of families you can serve,however,sometimes funders request you to
serve specific families such as:teenage parents,parents who are foster youth themselves,families who live
below the poverty line,etc.Is your funder asking for you to serve any specific groups?If so,who?Based on
your community knowledge,you might have some other criteria you're thinking about as you narrow down the
list of all the families you could possibly serve.Ultimately,who you will serve is up to the you and your site,and
can include service area,age,and any other factors.
Who will you serve?
The California Department of Public Health(CDPH)is not requiring the County of Fresno
Department of Public Health(FCDPH)to serve any specific groups;however,in an effort to avoid
duplication with other home visitation services,align with CDPH program guidelines,and
prioritize under-served groups,FCDPH intends to serve families from the prenatal stage up until
the child reaches 3 years of age,potentially up to age 5,when circumstances warrant and funding
permits.See below for additional proposed eligibility and prioritization criteria.
Community partnerships are critical in serving as referral sources for your site.have you wentified who your
referral sources will be?
Are you already connected to these entities,or will you need to build those relationships?
FCDPH has established relationships with many community partners and has an existing referral
system in place for receiving referrals from community partners and the public.As part of a local
Home Visitation Network,the FCDPH is connected with other family serving agencies and
involved in discussions about the available network of services,which both allows the
department to receive appropriate referrals from and make referrals to,a wide variety of
community resources.
After recemng referrals from the community,how will you deterrnine eligibility?
Eligibility Criteria:
Prenatal families,less than 28 weeks gestation—eligible for HFA if the family is ineligible for
another home visitation program(for example:multi-parous,low/no medical need,waitlisted
for another program and will not be able to begin services within the enrollment limitations
of that program)
Prenatal families,greater than 28 weeks gestation
Postnatal families up to the child reaching 3 months of age
Postnatal families with children older than 3 months of age who are experiencing crisis or
extenuating circumstances which cannot be addressed with other available resources.
A minimum of 80%of enrolled families will fall under the first three criteria.Families in the final
category will not exceed 20%at any given time.
Revised 2022
290
Prioritization Criteria:
Families who are not eligible for any other home visitation program but would benefit from
long-term home visitation services,will be prioritized.Examples include but are not limited
to,multi-parous families(having more than one child),families who have recently delivered
but are not considered high-risklsignificant medical need.
Families who are transitioning from a short-term program but have a need for ongoing
support/long-term services(for example,parents referred from First 5 prenatal care groups).
Teen parents 112-19 years of age)who are not already served by another program or are in
need of a long-term programisupport.
HFA has requirements about the timeframe of the first home visit with the family.The first home visit must be
completed either prenatally or within the first 3 months after birth.The goal will be for this to happen with all
your families,but we recognize the need for sane flexibility.
What will your process be to ensure families are enrolled prenatally or within the first 3 months after birth?
Incoming referrals will be triaged by the FCDPH Public Health Nursing Division Referral
Coordinator. Referrals for families in the prenatal stage up until 3 months postpartum,will be
prioritized.If program capacity remains after all eligible families have been enrolled,the program
may consider enrolling additional families who are beyond 3 months postpartum who have
extenuating circumstances.
As referrals are sent to the HFA Program Supervisor/Manager,they will cross-reference reports
regarding the percentage of families enrolled prenatally or within the first 3 months after birth to
determine whether the program can accept any referrals beyond 3 months after birth and if the
family's circumstances are appropriate for the program.When a family cannot be served,the HFA
Family Resource Specialist will follow up to try to connect them with other available community
resources to meet their needs.
Building Reiationsh_ips with Families
HFA services are voluntary.It is important that families,community partners and especially with entities like
child welfare or the covets who may be inclined to mandate service involvement,understand the voluntary
nature of services.
How do you plan to ensure that families and community partners are informed of the voluntary nature of
services?
All FCDPH Public Health Nursing Division home visitation services are voluntary.The voluntary
nature of this program will be consistent with other services offered.Program materials and
messaging to families will include statements regarding the voluntary nature of services.
Many families can be reluctant to engage;n services and may have difficulty building trusting relationships.
You will need to provide guidance to staff around positive ways to engage families,how to build healthy and
positive relationships,and keep families interested and connected.
How do you intend to guide staff in establishing trusting relationships with families?
FCDPH staff who will be reassigned to the HFA program have been providing home visitation
services for several years and have experience building trusting relationships with families.They
understand the importance of building rapport with the families they serve.
291
Ongoing professional development and support will be provided to ensure staff continue to
practice and build upon these skills.New staff will receive training,including but not limited to,
shadowing experienced staff.
Sites must have policy,procedures.and practice for informing families of their rights and ensunrg
confidentiality of information both dwing the intake process as well as during the course of services,HFA has
specific language which will need to be included on the forms used at the onset of services,which you will be
able to access after affiliation when you receive the Best Practice Standards.
Do you foresee any challenges with adopting specific HFA language into your policy and procedures?
Without knowing what specific language HFA requires to be included, it is difficult to assess the
potential challenges.As a county government,there are often many levels of review that need to
be completed prior to implementation of any new forms,which can take significant time.As CDPH
provides funding to support HFA programs in several other jurisdictions, FCDPH will consult with
them as needed if we experience any unexpected challenges with local implementation of HFA
specific language.
Levels o�Service and Familv Progress
The Signature HFA Model requires sites to offer sewices fora minimum of three years and up to fivc years
(wnen funding permits).
Please indicate the length of time your site will be offering home visits.
FCDPH understands services are to be offered for a minimum of three years and will make every
effort to keep families engaged for the duration and may serve families up to five years when
funding permits and when the family is receptive to such long-term service.
HFA has established criteria for how families progress through the program.There are multiple levels of
service.and as families meet the progress criteria for each level they are moved up to the next Each move up
to another level correlates with a decreased frequency of home visits.
At the onset of services,families start with weekly home visits.Families experiencing significant challenges will
likely continue with weekly visits for at least six months or longer before progress criteria are met and they
move to every other week visits.
Will starting with weekly visits be a significant change for your site or staff?
Starting with weekly visits will be a significant change for staff; however, we understand this is a
requirement and are prepared to implement accordingly.The HFA program supervisorlmanager is
aware of the service levels and will monitor caseloads closely to ensure staff have capacity to
meet this requirement.
Please note:HFA Acceierated is an option for sites serving low-risk families.Accelerated families move through
the various levels of service at a more rapid pace and may complete services in less than three years when
progress criteria for successful completion of program have been met. Offering HFA Accelerated alongside
HFA Signature Model must be discussed with the Training and Technical Assistance Specialist after
implementation of services. Your Training and Technical Assistance Specialist will also be able to explain the
HFA criteria for low-risk.
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Family Centered Home Visits
HFA sites will use a psychosocial assessment tool called the Family Resilience and Opportunities for Growth
Scale(FROG)Scale with all enrolled families at the onset of services to develop an initial service plan.Staff will
implement this service plan to ensure services are family driven and tailored to each family's unique needs.
What experience does your site have with service planning and psychosocial assessment tools?
Although staff being reassigned to the HFA program do not have experience with formal service
planning activities,their experience in delivering family goal-driven home visitation services
makes them well-positioned to begin implementing this work with families.FCDPH home visiting
staff in the Nurse Family Partnership program have experience with service planning and can
serve as a resource for HFA staff.Current staff who are being reassigned to the HFA program
have experience administering abuse assessments and developmental screenings and have
worked closely with families to discuss family goals and needs to determine what services would
benefit each individual family.
Staff will need training on the FROG scale and any other HFA required psychosocial assessment
tools prior to utilizing with families.
Building positive Parent-Child Interaction(PCI)is at the heart of the Healthy Families America model.During
home visits,staff will not just observe Parent-Child Interaction,but will address any concerning interactions,
and continually promote positive interactions.Staff will be trained on strategies,tools(including HFA's
validated PCI tool,the CHEERS Check-In),and how to docurnent interactions utilizing strength-based
approaches throughout the course of services.
What experience does your site have in building positive Parent-Child Interaction or using Parent-Child
Interaction tools?
HFA staff are trained and have experience with the Partners for a Healthy Baby curriculum and are
trained to administer the ASQ and ASQ-SE with families.Other FCDPH home visiting teams(NFP)
can also serve as a resource on the Partners in Parenting Education(PIPE)curriculum,until the
HFA team receives formal training.
While curriculum is not the focus of HFA home visas.HFA does require sites to share parenting materials from
credible sources and/or evidence informed currrculurn with families.(See a list of commonly used curricula
within the HFA network here)We recommend you choose materials with the specific needs of your families and
community in mind.Consider how families will feel represented in the materials they see and if they will easily
connect to the materials(ex:Are materials in their language?Written in easy-to-understand language?What
medium is the resource in-Are you texting them a link,or bringing a piece of paper?What are the
demographics of the families you serve-and are those the kinds of families depicted in the materials?)
What specific parenting materials you are currently using or have used previously? Have you decided which
parenting raterials/curriculum you will use with your HFA families?
Partners for a Healthy Baby curriculum has been used in the past and will be the primary
curriculum for families in the prenatal to 3-year group.Partners in Parenting Education is utilized
by another FCDPH home visiting program and that curriculum will be used primarily with the 3-5
year old group.Staff will receive training in both curriculums and may substitute one for the other,
depending on the needs of the family.Just in Time Parenting Newsletters will also be used as
supplemental material for all families,as needed and when appropriate.
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Families will often need more resources than HFA can provide alone,such as:food,housing,mental health
services,medical services,etc.
Please list and describe the nature of your relationship with the services and/or resources you have in your
community that you may be able to refer and connect families to.
FCDPH Public Health Nursing Division has established relationships with other county-level
resources(social services,behavioral health)as well as many community resource providers
including the Women, Infants, Children (WIC)program,First 5,Central California Food Bank,
California Health Collaborative and many community-based organizations.
Regarding the resources mentioned above,Staff may need to reach out to community partners on behalf of
the family.Families must always consent to the sharing of information and indicate their consent through
releases of information.HFA will provide your site with specific language which will need to be included in the
release,which you will be able to access after affiliation when you receive the Best Practice Standards.
What current policy and procedures does your site have in place when sharing family specific information?
FCDPH currently utilizes a county-wide release of information form and a department-specific
HIPAA privacy practice form for case managed families.The FCDPH HFA site will develop an HFA
program specific release of information and policy, in consultation with HFA, CDPH,county
management and counsel,as needed,to ensure appropriate language is used.
All staff are considered mandated reporters and sites must have policies and procedures for staff to follow for
reporting any suspected cases of child abuse and neglect to the appropriate authorities.
Do you understand and agree to have staff report any suspected cases of child abuse and neglect to the
appropriate authorities?
Yes,all FCDPH Public Health Nursing Division staff understand they are mandated reporters and
receive mandated reporter training on a regular basis.
Development. Health, and Depression Screening
Sites will work with families to monitor child development milestones by using the ASQ-3 and the ASQ:SE•2.If a
developmental screen were to indicate a potential delay,families must be referred to additional services.To
best support families.the outcome of these referrals must be tracked by the site.
Have you previously used the ASQ-3 and ASQ:SE-2 at your Site?How will you track referrals for made by your
staff?
FCDPH Public Health Nursing Division home visitation programs regularly utilize the ASQ-3 and
ASQ:SE-2.As required by CDPH,the FCDPH HFA program will track administration of ASQ-3 and
ASQ:SE-2 in the Efforts To Outcomes(ETO)data system. Referrals resulting from these
screenings will be tracked in the Referral Tracking section of ETO.
While fanrhes may face barners in accessi•ig health care services,staff will work to ensure 0 a*.participating
families have the primary HFA child linked to a medical/health care provider and are up to date with
immunizations. Please note,different sites use different immunization schedules to track the extent to which
children are up to date.If you do not yet have one,the CDC one is commonly used Link.
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Flow will your si e track and monitor immunizations received?
FCDPH currently utilizes and will continue to utilize the CDC Immunization Schedule to monitor
immunization status.The information will be tracked in the ETO data system via the Child
Immunization Log,as required by CDPH.
The primary caregiver of each family will need to be screened for depression prenatally(if enrolled prenatally)
and postnatally,using a standardized depression screen(Edinburgh/EDPS and PHQ-9 are the ones most used
throughout HFA).If a depression screen were to be elevated,the primary caregiver must be referred to
additional services and the outcome of these referrals must be tracked.
Are you already familiar with or using a standardized depression screen at your site that you intend to continue
using with HFA?How will you track referrals for elevated screens?
FCDPH Public Health Nursing Division regularly utilizes the PHQ-9 screening with families.The
PHQ-9 screening tool will be utilized with HFA families.Referrals for elevated screens will be
tracked in the Referral Tracking section of the ETO data system.
Are there any other health and development screening tools you intend to use with families?
FCDPH will utilize the ASQ-3,ASQ:SE-2,and PHQ-9 with families.Once affiliated and trained,if
additional screening tools are required or there appears to be a need for additional tools,FCDPH
will research,train and implement use of the tools accordingly.
When Families Disenga_qe or Transition out oz Services
While staff work diligently to build trust with families and provide excellent services,sometimes families
disengage and may miss scheduled home visits.When this happens,staff will work to re-engage families back
into services for a rninimum of three months.There are a variety of activities and strategies they can employ,
and more guidance will be given after affiliation.
What strategies does your site currently use to re-engage families when they disengage?
Current practice is for staff to attempt a home visit with families and if unable to connect,staff
follow up with a phone callitext message.This is sometimes followed by a second home visit
attempt,prior to sending the family a final letter to attempt to re-engage.Staff communicate the
value of the program and work with families to ensure home visits work with their schedule and
are meeting their needs.
Please note:While working to re-engage families over the course of three months,families will be kept open
and enrolled,and remain on the caseload list for staff.This will ensure adequate space is reserved on the staff
caseload for the family to resume their regularly scheduled home visits when they re-engage.
When families are preparing to close from services due to graduation,moving out of the service area,or for any
other reasons,staff will work with families to develop transition plans.Transition plans prepare families for
their next steps without HFA staff support.
What is your current process for families who transition out of your programs?How are families celebrated
when they transition out of services?
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Staff refer transitioning families to age-appropriate community resources for any ongoing
resource needs.Graduating families may receive a certificate of service completion.
Hirinq Stair"
Having the right staff in place can make all the difference for families and for the success of your Healthy
Families America site.Please review the HFA Sample Jou Descriptions,which include the educational and
experiential requirements for each staff member. You may notice criteria in staff selection includes reflective
capacity.Here is a resource you can use to learn more.
If staff have not yet been hired,ensure your hiring plan includes the following:
Equal Cippo-tunity Employment Protocols
Job descriptions which include the minimum criteria required for each position
Use of standard zed interview questions including questions to screen for applicant's reflective
capacity
Verification of two references or letters of recommendatior
Legally perrniss`ble criminal background checks
If possible,CAN registry checks
Sorne sites will begin the process of hiring staff after afiiliatior.Some sites already have staff within their
agency they are intending to transfer into proved ng HFA home visiting services.
When do you plan to have staff hired or are staff already hired(internal transfer)?
FCDPH is planning to transition staff into the HFA program.Three of the four positions are
currently filled.Due to a recent vacancy,one new staff member will be hired.At this time we are
not sure if that vacancy will be filled with a transfer from within the department or an external
candidate.
Some of the above points are already included in our county-wide hiring plan(Equal Employment
Opportunity protocols and job descriptions with minimum qualifications).Others,such as
interview questions to screen for an applicant's reflective capacity,will be included in our hiring
plan as we move forward. References, letters of recommendation, background and CAN registry
checks are not part of our current standard hiring practices and will require consultation with
county legal and union representatives to implement;however,our Personnel team is already
working on a protocol and implementation plan to operationalize these pieces.
Training and Onboardincl Staff
Ideally,you should submit your Implementation plan three months prior to beginning services with families.It
Will take roughly one month to finalize the affiliation process and staff cannot access training until the site is
affiliated.
When do you plan to start serving families?
Our plan is to start serving families in summer 2024.
The fol,owing training plan is a recommendation and should be customized to fit your specific needs and
deadlines set by your funder.The table is intended to provide you a wort<ing guide of the first six months of
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training and onboarding of your HFA staff.HFA certified trainers facilitate Foundations CORE,Family Resilience
and Opportunities for Growth(FROG)Scale.and Supervisor Trarnings.
You will receive more information regarding training once you affiliate and receive the Best Practice Standards.
What questions arise regarding training for star?
What is the mechanism for payment of HFA trainings?Is a licensing/technical assistance
agreement required before training can begin?
Write In Target Dates Direct Seriice Staff Supervisors Program Managers
Month•3 Turn in Affiliation Application
May 2024
Month-2 Affiliation!Site Should be completing hiring soon.Prepare orientation materials.
June 2024 Supervisor completes depression screening training,ASQ-3,ASQ-SE training
Month-1 Foundations Stop Gap Foundations CORE Foundations CORE
July 2024 Orientation Trairing Training
Start 3 mo.Wraparound Start Wraparound Start Wraparound
Modules Modules Modules
Depression screening Supervisor Training Supervisor Training
Month C Start Serving Families Start HFA Supervision
August 2024 FROG Training
FROG Supervisor
Training
CCI Training
Mond 1, ASQ-3,ASQ-SE
September 2024
Month 2 Foundations CORE
October 2024 Training
FROG Training
Month 3 Start 6 mo.Wraparound
November 2024 Modules
Month Q CCI Training Implementation Training
December 2024
Month 5 Start 12 mo.
January2025 wiaparound modules
Please note:Direct service staff can begin their role ahead of completion of Core Foundations if they complete
Stop Gap training that meets all the required elements as listed in the HFA Best Practice Standards.Stop Gap
training does not replace the need for HFA CORE training.
Staff"Supervision and Support
Full time supervisors can supervise up to six full time direct service staff.Full time direct service Staff must
receive a minimum of 1.5 hours weekly,individualized supery sion.
Hrnv many hill-time Supery sors:will you emploP
One Supervisor at.75FTE,who will supervise 4 direct service staff at 3.5FTE(3 Family Support
Specialists at 1.0 FTE, 1 Family Resource Specialist at 0.5FTE).
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Supervisors will monitor caseload sizes and utilize specific criteria when assigning and managing staff
caseloads to ensure direct service staff have adequate time to spend with each family.In Year 1,one full-time
direct service staff person can serve between 10-12 families at a time.In Years 3+.one full-time direct service
staff person can serve between 15-20 families at a time.
How many full-time direct service staff members will you have?
The HFA program will have three full-time Family Support Specialists.
Will you have any part-Lime direct service staff members(caseloads will need to be prorated accordingly)?If so,
how many?
One Family Resource Specialist will be.50FTE.They will be responsible for outreach,
groups/events,community resource referrals,caseload coverage,and other duties as necessary.
After affiliation,HFA provides a great deal of guidance aed support to help supervisors and understand their
role and how to provide effective supervision.Reflective supervision provides all staff the space to reflect on
their individual experiences and how those experiences impact others.
Does your organization currently provide reflective supe vision,if so,what does that look like?
The FCDPH NFP program currently provides reflective supervision on a weekly basis; however,
staff that will be implementing HFA are not currently part of any reflective supervision.The HFA
Program Manager/Supervisor will need to be trained in reflective supervision and may utilize the
NFP supervisors as a resource for sharing challenges and best practices.
Supervisors and Program Managers are not required to have the same level of reflective supervision as direct
service staff but must be provided supervision for individual skill development and professional support.
Who will provide supervision to the supervisor and program manager,and how of on?
The FCDPH Public Health Nursing Division Manager will provide supervision to the
Supervisor/Program Manager.It is expected that the Division Manager and HFA
Supervisor/Program Manager will continue to meet at their regularly scheduled monthly meetings.
Program Managers have overall responsibility for program accountability.This includes but not limited to
supervision of the supervisor,financial oversite,quality assurance.Accreditation,and engaging the Community
Advisory Board.At an absolute minimum,we recommend.17 FTE for sites with less than 2.0 FTE direct service
staff.
Will your site have a full-time program manager?If not,how many hours/week of program management will
your HFA site have?
The FCDPH HFA site will have a Program Manager at.25FTE.This person will function as the HFA
Supervisor for the remaining.75FTE.This person is 100%dedicated to the HFA program;
however,will split time between the role of Supervisor and Program Manager.
Staff retention ano satisfaction is monitored at least once every two years.Strategies to add:ess issues are
developed based on findings.
Please indicate your understanding of this requirement,or any questions you might have.
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FCDPH understands this requirement.FCDPH currently utilizes exit surveys when staff leave.That
data can be utilized to help the program form strategies to improve retention and employee
satisfaction.We are eager to learn any additional strategies to improve employee satisfaction and
retention.
Administration and Evaluation
Sites are required to use HFA methodology to measure the acceptance and retention rates of families on an
annual basis and,at least once every two years,analyze its data associated to better understand the
underlying issues associated with families choosing to accept services or not and choosing to stay in services
versus leave services.
Please indicate your agreement to these requirements,and any questions you might have.
FCDPH understands and agrees to comply with these requirements.
Sites are required to monitor home visit completion rates for all staff on an ongoing basis.The expectation is
that 75%of families will receive 75%of the appropriate number of home visits.
Please indicate your understanding of this requirement,and any questions you might have.
FCDPH understands this requirement.
At least once every other year,sites complete an Equity Plan.The Equity Plan utilizes data to better understand
the root causes of issues impacting families served,and to examine the effectiveness of its equity strategies
implemented in all aspects of its service delivery system.HFA will provide additional details about the
requirements of this evaluation after affiliation.
Please Indicate your understanding of this requirement,and any questions you might have.
FCDPH understands this requirement.
Sites must have a Community Advisory Group to focus on program planning,implementation,and assessment
of site related activities.Your site may currently have an active community advisory group or may have key
members who would be willing to participate in your HFA Community Advisory Group.
Please describe status of your community advisory board or intended members,and any questions you may
have.
FCDPH is currently assessing options for a Community Advisory Group that will meet the needs
of the HFA program.Key members have already been identified.
Families must have a mechanism for providing feedback that at minimum relates to service satisfaction and if
services offered are culturally responsive.Additional opportunities for parent involvement are encouraged
including parent advisory committee,focus groups,etc.Sites must also have a process for families to follow
Should there be a grievance.
Please describe your plans to involve parents,obtain their feedback,and assure that any grievances will be
handled.
The HFA team has experience with program-specific client satisfaction surveys and may consider
implementing a similar survey for this program.Grievances are handled through a department
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process specific to the type of grievance alleged(privacy,discrimination,etc.)Complaints may
also be addressed at Community Advisory Board meetings.
The site must have a comprehensive policy and procedure manual outlining all the necessary policy and
procedures which guide the HFA practice.The HFA national office can provide a policy and procedure manual
template to support you with this.
Have you begun to write program policies and procedures?
FCDPH has not begun drafting any HFA specific policies or procedures.We look forward to
seeing the HFA resource material to help guide our policy work.
Through completing this Implementation Plan,you have learned about the core requirements for HFA sites.
As you reflect on everything you have teamed,are there any sections or requirements that feel particularly
challenging to Implement?Please explain:
Implementation of a new evidence-based program is likely to present challenges,as well as many
opportunities for organizational growth.FCDPH has access to state and local resources,in
addition to those provided by HFA,to help us achieve success.We are eager to begin this journey
and provide the community with this impactful new service.
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EXHIBIT 12
PEER CONFIDENTIALITY AGREEMENT
00,
"Healthy Families
America
Confidentiality Agreement & Principles of Behavior
It is the policy of Prevent Child Abuse America®(PCA America)to hold in confidence all
proprietary or nonpublic information regarding the operations of organizations,the
persons served by organizations and the Board and staff of organizations,which may be
learned during the accreditation process. PCA America requires that each of its trustees,
staff,HFA Accreditation Panel members,independent contractors,and peer reviewers
specifically agree to adhere fully and unreservedly to this policy as a condition of serving
in that capacity.
You therefore specifically agree that you will not release or divulge outside the
accreditation process any information gathered during the accreditation process,(a)
without the written permission of the organization,or(b)as PCA America may specifically
direct in its Policies and Procedures as follows:
• for the purpose of making known the accreditation status and performance of on
organization;
• for the purpose of informing appropriate public authorities when you have
documented information that clients have been seriously injured and/or that
conditions believed to have contributed to previous injuries exist;or as required by
law.
Information gathered during the accreditation or re-accreditation process includes,but is
not limited to,data,documents,reports,narratives,evaluations and proprietary material
or products submitted with the application,an organization's self-study,questionnaires,
observations,reports,work notes of the on-site review,verbal disclosures of agency
personnel,and the deliberations of the HFA Accreditation Panel.
In addition,as a Peer Reviewer,and Prevent Child Abuse America representative,you
specifically agree to the following principles of behavior
• Apply the Healthy Families America®Best Practice Standards in a consistent and
bias-free manner. Take into account the big picture as to whether the site's
performance meets the standard as written_Avoid comparisons with your
program and ratings based on your personal belief system.
• Avoid all actual,potential,and appearances of conflicts of interest. Declare to
HFA any relationships with programs or individuals.Avoid pursuing employment
or business opportunities or accepting goods or services before,during,or after
the survey process_
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�1.
Healthy Families
Amerim
• Do not conduct personal business during the review,except in the case of an
emergency,and limit the use of cell phones. If you plan a vacation around a
review,do not let it compete with the task at hand.
• Treat each person in a caring and respectful fashion,mindful of individual
differences and cultural and ethnic diversity.Put aside personal beliefs that may
affect your ability to be unbiased,and do not discriminate based on an
individual's race,national origin,or any other status protected by law.
• Work to establish and maintain a safe environment and exercise good judgment.
Practice safe and courteous driving to and from the review and avoid the
excessive use of alcohol.
• Safeguard HFA's reputation and its assets. Submit to HFA for reimbursement
only actual site visit expenses.Restrict the use of manuals,checklists and tools
to official HFA business.
I have read the above policy regarding confidentiality,understand PCA America's
expectations,and agree to adhere to its intent. I understand that PCA America would
have no fully adequate remedy at law for a breach of this agreement and consent to entry
of injunctive relief,including preliminary injunctive relief,for any breach of the policy set
forth in this Agreement. This agreement will be governed and interpreted by Illinois law
without giving effect to choice of law rules.
Signature Date
Please print name
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EXHIBIT 13
RESEARCH REVIEW POLICY
�1�
Vow
Rev.2021.11.17
Healthy Families
America
HFA Policy on Research with Affiliates
Healthy Families America 1HFA) acuvely encourages research' to strengthen effectiveness,
and promotes the involvement of program leadership and staff in the research process
(i.e., participatory research) to maximize the utility of results and to help ensure diversity,
equity, and inclusion Recognizing that research with HFA affiliates may have broad
implications, our policy seeks to ensure regular communication on study progress, and
maximize the utility of research to strengthen the HFA network and model per HFA's Best
Practice Standards (GA-7.13.).
• Prior to participation in research that involves a) the HFA model, or b) participants,
past or present, enrolled in services, the HFA affiliate (or a research partner on
their behalf) notifies the National Office.
• The HFA affiliate facilitates communication between the research partner and
National Office, including a contact who can provide information on the study on
the form linked here.
• The HFA National Office will indicate receipt of study notification and information
to the affiliate through the affiliate's account on the HFA Community.
• Annual updates on study progress. reports, and any plans to disseminate results
will be requested of research partners and HFA affiliate.
HFA Research Guidelines: It is HFA's expectation that the guidelines below will be
followed in all research with sites. Note that HFA specifically requires that participation
in research is voluntary for all families and not a requirement for receiving services.
1. Study methodology and questions are compatible with model requirements. (Note:
HFA encourages innovation. However. model adaptations must be approved by
PCA America in advance of their implementation. as required in the HFA Best
Practice Standards).
2. Study design and conduct is informed by and consistent with the Diversity-
Informed Infant Mental Health Tenets and principles of community-based
participatory research (for example, see description in the Community Tool Box) to
ensure equitable and inclusive study practices.
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Healthy Families Rev.2021.11.17
Ameri
ca
ca
3. Sites participating in research are accredited and in good standing; exceptions will
be considered if warranted by the study.
4. Research methodology supports service delivery as the top priority for site staff,
and does not add significantly to existing staff data collection burden.
S. Research is conducted with quality.
6. Research questions build on existing evidence to address questions of value to the
prevention field.
7. Research participation conveys benefits to site and/or the field (e.g.,valuable
training for staff, resources for families,fair compensation to site/families for extra
time, and/or knowledge gained).
Click to go to the Notification of Research with HFA Affiliates Form
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