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History and Development of Home Visiting in the United States

Social justice movements before 1950, the war on poverty and prevention of child maltreatment, expansion of home visiting in recent decades, home visiting outside the united states, poverty, child health, and home visiting, national evaluation and evidence of effectiveness, home visiting and the medical home, recommendations and position statement, community pediatricians, large health systems, managed care organizations, and accountable care organizations, researchers, the aap endorses and promotes the following general policy positions and advocacy strategies:, conclusions.

• Lead Authors
• Council on community Pediatrics Executive Committee, 2016–2017
• Council on Early Childhood Executive Committee, 2016–2017
• Committee on Child abuse and Neglect, 2016–2017

Early Childhood Home Visiting

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

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James H. Duffee , Alan L. Mendelsohn , Alice A. Kuo , Lori A. Legano , Marian F. Earls , COUNCIL ON COMMUNITY PEDIATRICS , COUNCIL ON EARLY CHILDHOOD , COMMITTEE ON CHILD ABUSE AND NEGLECT , Lance A. Chilton , Patricia J. Flanagan , Kimberley J. Dilley , Andrea E. Green , J. Raul Gutierrez , Virginia A. Keane , Scott D. Krugman , Julie M. Linton , Carla D. McKelvey , Jacqueline L. Nelson , Emalee G. Flaherty , Amy R. Gavril , Sheila M. Idzerda , Antoinette “Toni” Laskey , John M. Leventhal , Jill M. Sells , Elaine Donoghue , Andrew Hashikawa , Terri McFadden , Georgina Peacock , Seth Scholer , Jennifer Takagishi , Douglas Vanderbilt , Patricia G. Williams; Early Childhood Home Visiting. Pediatrics September 2017; 140 (3): e20172150. 10.1542/peds.2017-2150

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High-quality home-visiting services for infants and young children can improve family relationships, advance school readiness, reduce child maltreatment, improve maternal-infant health outcomes, and increase family economic self-sufficiency. The American Academy of Pediatrics supports unwavering federal funding of state home-visiting initiatives, the expansion of evidence-based programs, and a robust, coordinated national evaluation designed to confirm best practices and cost-efficiency. Community home visiting is most effective as a component of a comprehensive early childhood system that actively includes and enhances a family-centered medical home.

Recent advances in program design, evaluation, and funding have stimulated widespread implementation of public health programs that use home visiting as a central service. This policy statement is an update of “The Role of Preschool Home-Visiting Programs in Improving Children’s Developmental and Health Outcomes” (2009) and summarizes salient changes, emphasizes practical recommendations for community pediatricians, and outlines important national priorities intended to improve the health and safety of children, families, and communities. 1 By promoting child development, early literacy, school readiness, informed parenting, and family self-sufficiency, home visiting presents a valuable strategy to buffer the effects of poverty and adverse early childhood experiences that influence lifelong health.

The term “home visiting” refers to an evidence-based strategy in which a professional or paraprofessional renders a service in a community or private home setting. Home visiting also refers to the variety of programs that employ home visitors as a central component of a comprehensive service plan. 2 Early childhood home-visiting programs may be focused on young children, children with special health care needs, parents of young children, or the relationship between children and parents, and they can use a 2-generational strategy to simultaneously address parental and family social and economic challenges. 3  

Home-visiting programs vary widely with regard to target populations and goals. Many successful home-visiting models are directed toward mothers and infants in high-risk groups, such as adolescent mothers and single-parent families. Other models concentrate on specific populations, such as recently incarcerated adolescents, children with special needs, or immigrants. Some programs are designed to identify risk factors, such as environmental hazards and maternal mental health, but others include mentoring, coaching, and other therapeutic interventions. Many employ independently licensed health professionals, but others depend on trained paraprofessionals (including community health workers) drawn from the communities they serve. Community-based care coordination (including housing, transportation, and nutritional support) often are service components. Integration with the family-centered medical home (FCMH) has been a recent focus for program improvement and medical education. 4  

Home visiting began in the United States in the 1880s as an activity of each of 3 social justice movements. Derived from the British models developed a few decades earlier, home visitors were deployed to promote universal kindergarten, improve maternal-infant health through public health nursing, and support impoverished immigrant communities as part of the philanthropic settlement house movement. From the late 19th through the early 20th century, teachers and public health nurses visited communities and families to provide in-home education and health care to urban women and children. These efforts were based on the assumptions still held that education is the most powerful strategy to lift children out of poverty and that the lifelong health of families in immigrant and poor neighborhoods is improved by addressing the social and economic aspects of health and disease. 5  

From the Great Depression through World War II, funding for social initiatives decreased and philanthropic support for home visitors declined. After the relatively prosperous postwar period, renewed interest developed in antipoverty activities, including home visiting, especially in the context of the Civil Rights Movement. In the 1960s, home visiting became an important component of the government’s so-called War on Poverty. Home visiting was and remains integral to programs such as Head Start, although it is applied on a limited basis compared with Early Head Start, for which home visiting is a central service component. A decade later, many home-visiting programs shifted to include case management, intending to help families achieve self-sufficiency and link them to other broad community support services. 6 Improving school readiness, moderating poverty-related social risk determinants, reducing environmental safety hazards, and promoting population-based health remain core goals of contemporary home visiting.

In the last quarter of the 20th century, home visiting gained renewed attention as a strategy for the prevention of child abuse and neglect, promotion of child development, and improvement of parental effectiveness. C. Henry Kempe, MD, called for a home visitor for every pregnant mother and preschool-aged child in his 1978 Abraham Jacobi Memorial Award address. 7 He suggested that integral to every child’s right to comprehensive care is the assignment of a home health visitor to work with the family until each child began school. The visionary pediatrician who developed the concept of the medical home, Cal Sia, MD, reiterated Kempe’s call to action in his 1992 Jacobi Award address 8 based on his experience with Hawaii’s Healthy Start Program, which is an innovative, statewide home-visiting initiative to prevent child abuse and neglect. Another pioneer in modern home visiting, David Olds, PhD, initiated the Nurse-Family Partnership (NFP) with families at risk in Elmira, New York, in 1978. 1  

Before 2009, at least 22 states recognized the critical role of home visitors within statewide systems for at-risk pregnant mothers, infants, and toddlers from birth to 5 years old. States legislated funding for home-visiting programs while insisting on proof of effectiveness, fiscal accountability, and continuous quality improvement. Even during the Great Recession that followed the US financial crisis of 2007 to 2008, some state governments enacted home-visiting legislation to ensure long-term sustainability through innovative financing mechanisms and the strategic allocation of limited public resources.

In 2009, the American Recovery and Reinvestment Act (Public Law Number 111-5) included $2.1 billion for the expansion of Head Start and Early Head Start (including the home-visiting components of Early Head Start) to benefit young children in low-resource communities. The next year, the Patient Protection and Affordable Care Act of 2010 (ACA) (Public Law Number 111-148) designated $1.5 billion, allocated over 5 years, for the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV). The Health Resources and Services Administration currently administers the MIECHV in collaboration with the Administration for Children and Families. The allocations to states, territories, and tribal entities are designed to support the implementation and evaluation of evidence-based home-visiting programs regarding specified goals and objectives. All 50 states, the District of Columbia, and 5 US territories have home-visiting programs. 9 In addition, ACA funding provides support for home-visiting initiatives to serve American Indian and Alaskan native children through the Tribal MIECHV program. 10  

Nineteen home-visiting models have met the criteria of the US Department of Health and Human Services (HHS) for evidence of effectiveness through the Home Visiting Evidence of Effectiveness (HomVEE) review. Supported by federal grants through the MIECHV, states receive funding to implement 1 or more evidence-based models designated eligible by the MIECHV that best meet the needs of particular at-risk communities. The program objectives must improve outcomes that are statutorily defined and must include increased family economic self-sufficiency, improved health indicators (eg, a reduction in health disparities) in target populations, and improved school readiness. After 2013, potential program outcomes were expanded to include reductions in family violence, juvenile delinquency, and child maltreatment. 11 A review of 4 common programs illustrates the range of measurable outcomes. Healthy Families America identifies family self-sufficiency as a principal objective measured by a reduction of dependence on public assistance. 12 Early Head Start and other home-visiting programs focus on the promotion of child development and positive family relationships. NFP is designed to improve prenatal health, maternal life course development, and positive parenting. 13 Parents as Teachers promotes child development and school readiness. 14  

Home visiting for families with young children is an early intervention strategy in many industrialized nations outside of the United States. In several European countries, home health visiting is provided at no cost to the family, participation is voluntary, and the service is embedded in a comprehensive maternal and child health system. 3 While visiting young mothers at home, public health nurses in other countries provide many child health-promotion services that are provided by pediatricians in the United States. For instance, Denmark established home visiting in 1937 after a pilot program showed lower infant mortality rates linked with the services of home visitors. France provides universal prenatal care and home visits by midwives and nurses, who educate families about smoking, nutrition, drug use, housing, and other health-related issues.

The Early Start program in New Zealand targets families with 2 or more risk factors on an 11-point screening measure that includes parent and family functioning. Randomized controlled trials showed improvement in access to health care, lower hospitalization rates for injuries and poisonings, longer enrollment in early childhood education, and more positive and nonpunitive parenting. 15 , 16 The Dutch NFP program, VoorZorg, was found to reduce victimization and perpetration of self-reported intimate partner violence during pregnancy and 2 years after birth among low-educated, pregnant young women, 17 and there were fewer reports of child abuse. At 24 months, measurable improvements were evident in the home environments of participating families, and the children exhibited a significant reduction in internalizing symptoms. 18  

Paraprofessionals (ie, trained but unlicensed lay people) are often employed as home visitors in low-resource areas of the world. In Haiti, for example, community health workers trained by Partners in Health improve the care of those with HIV, multidrug-resistant tuberculosis, and such waterborne illnesses as cholera. In southern Mexico and other areas in Central America, “promotoras de salud,” or community health workers, coordinate with lay midwives to care for expectant mothers in rural, isolated, and other low-resource regions. Promotoras are deployed in many regions in the United States and have been recognized by HHS for their ability to reduce barriers and improve access to culturally informed and linguistically appropriate health care. 19  

More than 1 in 5 young children in the United States live in families with incomes below the federal poverty level, and more than 2 in 5 live at less than twice that level. 20 Living at or below 200% of the federal poverty level places children, 21 especially infants and toddlers, at high risk for adverse early childhood experiences that lead to lifelong detrimental effects on health, education, and vocational success. 22 Home visitors can help families attain economic self-sufficiency by linking them to community support services (such as quality preschool) while encouraging parents to enroll in training opportunities that lead to employment. Although they differ in structure, targeted populations, and intended outcomes, high-quality home-visiting programs deliver family support and child development services that provide a foundation for physical health, academic success, and economic stability in vulnerable families that are at risk for the adverse effects of poverty and other negative social determinants of health.

By applying multigenerational interventions, home visiting may improve child health and family wellbeing in many domains. Individual neuroendocrine-immune function, behavioral allostasis, and relational health are all established in the first 3 years of life, 23 when home visiting is most often applied. 24 The emerging science of toxic stress indicates that poverty and its accompanying problems, such as food insecurity, may disrupt the architecture and function of the developing brain. 25 , 26 Home visitors have the opportunity to assess risk and protective factors in families, identify potential adversity, and intervene at the earliest opportunity. By promoting supportive relationships, reducing parental stress, and increasing the likelihood of positive experiences, home visiting may help avoid the deleterious behavioral and medical health outcomes associated with child poverty. 27 , – 31  

Young mothers in poverty disproportionately suffer moderate to severe symptoms of maternal depression, elevating the risk of poor developmental and educational outcomes for their children. 32 Almost 1 in 4 mothers who are near or below the federal poverty level experience significant depression, but few obtain appropriate treatment. In-home cognitive behavioral therapy is a novel treatment modality for maternal depression that has proved to be effective in early trials. 33 Combining in-home cognitive behavioral therapy with other home-visiting programs, such as Early Head Start, that promote positive parenting and infant development provides a model of 2-generational care that has the potential to mitigate the effects of poverty and improve both family financial stability and school readiness. 34  

Home-visiting programs are most effective when they are components of a community-level, comprehensive early childhood system that reaches families as early as possible with needed services, accommodates children with special needs, respects the cultures of the families in the communities, and ensures continuity of care in a continuum from prenatal life to school entry. 35 , 36 An early childhood system may include safety-net resources (such as supplemental food and subsidies for housing, heating, and child care), adult education, job training, cash assistance, quality child care, early childhood education, and preventive health services. 37 Communicating the strengths and risk factors of individual families to the FCMH may further increase the coordination of care and efficient use of services. 38  

When the MIECHV program was established by the ACA, HHS established the HomVEE review of the research literature on home visiting. 11 Results of that review are used to identify home-visiting service delivery models that meet HHS criteria for evidence of effectiveness because, by statute, at least 75% of the funds available from the ACA are to be used for programs that use service delivery models that are evidence based. The HomVEE conducts a yearly literature search to identify promising studies of home-visiting models. It includes only studies that are considered to meet quality standards on the basis of overall design (only randomized controlled trials or quasiexperimental studies are included) and design-specific criteria. Studies that meet criteria for entry are then assessed for outcomes in the following 8 domains, as defined by HHS:

Child health;

Maternal health;

Child development and school readiness;

Reductions in child maltreatment;

Reductions in juvenile delinquency, family violence, and crime;

Positive parenting practices;

Family economic self-sufficiency; and

Linkages and referrals.

To meet HHS criteria for evidence of effectiveness, home-visiting models must demonstrate favorable outcomes in either 1 study with results in 2 or more domains or 2 studies with significant benefits in the same domain. To be included, study designs must meet evaluation quality standards, and outcomes need to show statistically significant benefits using nonoverlapping analytic samples. As of April 2017, the 18 models that meet these standards (along with 2 programs that do not meet criteria for implementation) with target populations, ages of participants, and outcomes for which there is evidence are listed in Table 1 . 11  

Home-Visiting Programs Meeting HHS Criteria for Evidence of Effectiveness (as of April 2017)

Reference: https://www.mathematica-mpr.com/our-publications-and-findings/publications/home-visiting-evidence-of-effectiveness-review-executive-summary-april-2017 . Descriptions of specific home-visiting programs by state can be accessed at: https://homvee.acf.hhs.gov/models.aspx .

Outcomes: (1) child health; (2) maternal health; (3) child development and school readiness; (4) reductions in child maltreatment; (5) reductions in juvenile delinquency, family violence, and crime; (6) positive parenting practices; (7) family economic self-sufficiency; and (8) linkages and referrals.

A rapidly expanding evidence base documents the benefits of high-quality home-visiting programs, especially when they are integrated in a comprehensive early childhood system of care. 39 Home visiting has been shown to increase children’s readiness for school, promote child health (such as vaccine rates), and enhance parents’ abilities to promote their children’s overall development. There is evidence that home visiting reduces the risk of both child abuse and unintended injury. 16 , 40 Maternal health is improved by more frequent prenatal care, better birth outcomes, and early detection and treatment of depression. 41 Outcome studies have established the effectiveness of home visiting by nurses or community health workers in reducing child maltreatment, 42 improving birth outcomes, 43 and increasing school readiness. 44  

A close examination of the evidence of effectiveness published in 2015 by the HomVEE review provides additional insights about the potential benefits and limitations of current models of home visiting. 11 Of the 44 models assessed in 2015, 19 showed improvements in at least 1 primary outcome measure, and 15 had favorable effects on secondary measures. These results are consistent with both the broad scope of many of the models as well as the likelihood that improvements in 1 domain sometimes lead to benefits in another (eg, positive parenting improving child development). All 19 models that showed positive results had evidence of sustained benefits for at least 1 year after enrollment.

In addition to the 19 models approved in 2015, 8 of the 25 that were not approved had evidence of benefit, perhaps because of stringent criteria for study quality and number. Even among programs showing positive outcomes, there was not a high level of consistency across domains. For example, only 7 of 19 models demonstrated benefits in the same domain across 2 or more studies. Many effect sizes were fairly small (approximately 0.2 SDs) but comparable to those seen in many studies of programs located in other settings (eg, early child education). 45 However, modest effect sizes in studies concerning developmental delay can result in important population-level effects given the high proportion of children in low-income families (nearly 20%) meeting criteria for early intervention services. 46 , 47  

Longitudinal studies within the HomVEE review of the NFP have shown improvements in adolescent mental health, in middle school achievement, over substance use and/or criminality immediately after high school, as well as in overall maternal and child mortality. 48 , – 50 Other studies document the persistence of beneficial outcomes after population-level scaling. A study of Durham Connects (also known as Family Connects) showed more than 80% participation and 84% adherence among all mothers delivering in Durham, North Carolina, during an 18-month period. 51 Researchers in this study, using rigorous methodology, documented important and beneficial effects on child health, including a 59% reduction in emergency medical care, an increase in positive parenting, successful linkages to community services, and improved maternal mental health. In addition, a large-scale study of SafeCare home-based services showed reductions in reports to child protective services after a scale-up of the program in Oklahoma. 52 These beneficial outcomes of rigorous program evaluation counterbalance other studies that found little or no benefit after a scale-up, such as the finding of reduced implementation fidelity and limited benefit after scaling up Hawaii’s Healthy Start Program. 53  

Other studies document the capacity of home visiting to successfully target specific high-risk populations and implement interventions of varying intensity specific to the intended outcome. For example, Computer-Assisted Motivational Intervention, when applied in combination with home visiting, successfully reduced subsequent pregnancies among pregnant teenagers. 54 Other 2-generational interventions, including Family Spirit (which targets American Indian teen-aged mothers) and Family Check-Up (which targets young mothers with depression), improved behavioral problems in infants and young children as well as the mental health of the young mothers. 55 , – 57  

Finally, the outcomes documented by the HomVEE need to be considered in the context of a number of meta-analyses and systematic reviews that have been conducted other than the HomVEE. One of the most cited is a meta-analysis that documented significant benefits across 4 broad domains, including child development, child abuse prevention, childrearing, and maternal life course. 58 Benefits were maximized when specific rather than general populations were targeted, when interventions used professionals versus paraprofessionals, and when interventions were more specifically focused on parental rather than child wellbeing. 59 , – 61  

Integration of home visiting with the medical home expands the multidisciplinary team into the community, enhancing the goals of communication, coordination of care, and comprehensive care. With effective leadership, the pediatric or FCMH may become a community hub that connects early education and child development activities with health promotion to support maximum outcomes for children and families. The Institute for Healthcare Improvement has described the triple aim as improvement of the health of populations, improvement of the quality of care and experience of each patient, and the reduction of per capita cost. The history of home visiting also reveals another triple aim of improving health, preparing children for education, and reducing poverty. An advanced medical home that reaches out to the community by collaborating with or integrating a high-quality home-visiting program has the potential of meeting both sets of triple aims. 62 , 63  

Some important factors that are common among home-visiting programs that are also characteristic of an FCMH include an emphasis on relationships, the provision of culturally informed care, coordination with other community support agencies, an emphasis on strength-based assessments, and collaboration with families to support self-identified goals. Of particular importance is the relationship that develops between the visitor and the family engaging in a natural environment and the consequent improvement in the relationships among family members. 64 As more has been learned about toxic stress and its negative effect on the life trajectory, close and nurturing relationships have emerged as a most important protective factor. The home visitor can extend the support of the medical home into the community and provide an important link for the family to the relationship with a compassionate pediatric practitioner while improving family relational health. 65  

The integration or colocation of home visiting with the medical home presents many opportunities for synergy and collaboration. The joint statement from the Academic Pediatric Association and the American Academy of Pediatrics (AAP) regarding integration of the FCMH with home visiting emphasizes the potential for coordinated anticipatory guidance, improved early detection, and enhanced community involvement. 66 Recommendations in the joint statement include integrated, computerized record systems; the creation of a joint registry; coverage of home visiting by payers, including Medicaid and the Children’s Health Insurance Program; and supporting the evaluation of coordination between an FCMH and home visiting. In a collaborative model, referrals between a pediatric practitioner and the home visitor may constitute a warm handoff (face-to-face introduction), increasing the likelihood that family concerns are communicated and addressed. For example, a home visitor has the opportunity to complete developmental screening with the parent in a child’s natural environment. The results of screening may be communicated to the pediatric practitioner for use and comparison with the developmental assessment during health-promotion visits. A shared chronic condition care plan facilitates common therapeutic goals, linkages to community resources, and follow-up on referrals. Particularly helpful have been home-visiting strategies for children with diabetes or asthma. Researchers have associated home visiting with improvements in symptoms, urgent care use, and family quality of life. 67  

Home visiting may be used effectively as an adjunctive strategy in comprehensive community-based programs serving children. Although not approved for MIECHV funding, Healthy Steps for Young Children is a comprehensive primary-care model that may include on the treatment team a home visitor who supports positive parenting, provides in-home developmental assessment, and links the family more strongly to the medical home. 68 The example of Healthy Steps illustrates the significant potential benefits from improved collaboration between the medical home and community home-visiting programs. These include common documentation, centralized intake services, strength-based assessments, colocation of home visitors in the pediatric practice, and multidisciplinary team meetings convened by the practice. Through these coordinated activities, home visitors are in partnership with the medical home to build parental resilience, promote child development, and support healthy family relationships. 66 , 69 Other models that similarly employ home visiting as an adjunctive strategy, such as the Health Resources and Services Administration’s Bridging the Word Gap Research Network 70 , 71 and the New York City Council’s City’s First Readers program, exemplify systematic linkages among the medical home, home-visiting programs, and other community-based services with early childhood education. 63 , 72  

Because home-visiting models and programs cross many health systems and involve many funding sources, this policy divides recommendations into the following 3 levels: community pediatricians, large health systems, and researchers. The section concludes with AAP-supported federal and state advocacy strategies.

Provide community-based leadership to promote home-visiting services to at-risk young mothers, children, and families;

Be familiar with state and local home-visiting programs and develop the capacity to identify and refer eligible children and pregnant mothers;

Consider opportunities to integrate or colocate home visitors in the FCMH;

Recognize home-visiting programs as an evidence-based method to enhance school readiness and reduce child maltreatment;

Recognize home visiting as a promising strategy to buffer the effects of stress related to the social determinants of health, including poverty; and

Serve as a referral source to home-visiting programs as a strategy to engage families in services and strengthen the connection between home visiting and the medical home.

Develop a continuum of early childhood programs that intersects or integrates with the FCMH;

Ensure that home-visiting programs are culturally responsive, linguistically appropriate, and family centered, emphasizing collaboration and shared decision-making;

Ensure that all home-visiting programs incorporate evidence-based strategies and achieve program fidelity to ensure effectiveness;

Support the use of trained community health workers, especially in lower-resourced, tribal, and immigrant communities; and

Develop training and certification programs for community health workers to ensure quality and fidelity to program expectations.

Improve understanding of how to engage difficult-to-reach and high-risk communities and populations, including immigrant families, families with low literacy and/or health literacy and limited English proficiency, families that are socially isolated, and families living in poverty in evidence-based home-visiting programs;

Improve understanding of how to take successful programs to scale while maintaining fidelity;

Improve understanding of how to optimize links between evidence-based home-visiting programs and the medical home;

Determine the degree to which the medical home and strategies using multidisciplinary and integrated interventions can provide added value to and synergy with evidence-based home-visiting programs;

Determine the degree to which home-visiting programs can augment the medical home in the prevention or mitigation of chronic disease, such as asthma and obesity, and associated morbidities;

Improve understanding of how to tailor the implementation of evidence-based home-visiting programs to diverse populations with heterogeneous strengths and challenges; and

Investigate and establish the cost-effectiveness and return on investment of home-visiting programs as well as program components.

The continuation and expansion of federal funding for evidence-based home-visiting programs;

Public support for the dissemination of home-visiting programs that meet the HomVEE criteria for evidence of effectiveness as well as other programs with early and promising evidence of potential effectiveness;

The establishment of state systems that integrate home-visiting infrastructure (such as data collection and evaluation) into a comprehensive early childhood service system;

Coordination across state agencies and health systems that serve young children to build an efficient and effective infrastructure for home-visiting programs;

The simplification and standardization of referral processes in and among states to improve the coordination of care and integration of home-visiting services with the medical home; and

The inclusion of home-visiting experience in community pediatrics education and exposure by residents and medical students to the evidence of effectiveness of home-visiting models.

The objectives of contemporary home-visiting programs have strong roots in public health, early childhood education, and antipoverty efforts. Home visiting has expanded rapidly in the recent past, with the current generation of programs providing strong evidence of effectiveness in many domains of family life. Rigorous national outcome evaluations substantiate that home-visiting programs are effective in the promotion of healthy family relationships, improvement of overall child development, prevention of child maltreatment, advancement of school readiness, and improvement of maternal physical and mental health. By linking families to opportunities such as employment and continuing education, home visiting increases family economic stability and thereby is a successful antipoverty strategy. Home-visiting programs have shown the most effectiveness when they are components of community-wide, early childhood service systems. With pediatrician leadership, the FCMH can serve as the hub for coordinating community-based, family support programs at the intersection of early education with public health promotion designed to help children avoid the lifelong effects of early childhood adversity.

American Academy of Pediatrcs

Patient Protection and Affordable Care Act

family-centered medical home

US Department of Health and Human Services

Home Visiting Evidence of Effectiveness

Maternal, Infant, and Early Childhood Home Visiting Program

Nurse-Family Partnership

Dr Duffee was intimately involved with the concept, organization, and design during the early phases of writing, he reviewed the contributions of the other authors, consolidated the contributions (along with his own) into the final product, took responsibility for responding to comments and direction from staff and the Board of Directors, and reviewed the references in detail to ensure that the evidence supports the recommendations; and Drs Kuo, Legano, Mendelsohn, and Earls assisted with revisions; and all authors approve the final manuscript as submitted.

This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

Policy statements from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. However, policy statements from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent.

The guidance in this statement does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

FUNDING: No external funding.

L ead A uthors

James H. Duffee, MD, MPH, FAAP

Alan L. Mendelsohn, MD, FAAP

Alice A. Kuo, MD, PhD, FAAP

Lori Legano, MD, FAAP

Marian F. Earls, MD, MTS, FAAP

Council on c ommunity Pediatrics Executive Committee , 2016–2017

Lance A. Chilton, MD, FAAP, Chairperson

Patricia J. Flanagan MD, FAAP, Vice Chairperson

Kimberley J. Dilley, MD, MPH, FAAP

Andrea E. Green, MD, FAAP

J. Raul Gutierrez, MD, MPH, FAAP

Virginia A. Keane, MD, FAAP

Scott D. Krugman, MD, MS, FAAP

Julie M. Linton, MD, FAAP

Carla D. McKelvey, MD, MPH, FAAP

Jacqueline L. Nelson, MD, FAAP

Jacqueline R. Dougé, MD, MPH, FAAP – Chairperson, Public Health Special Interest Group

Kathleen Rooney-Otero, MD, MPH – Section on Pediatric Trainees

Camille Watson, MS

Council on Early Childhood Executive Committee , 2016– 20 17

Jill M. Sells, MD, FAAP, Chairperson

Elaine Donoghue, MD, FAAP

Marian Earls, MD, FAAP

Andrew Hashikawa, MD, FAAP

Terri McFadden, MD, FAAP

Alan Mendelsohn, MD, FAAP

Georgina Peacock, MD, FAAP

Seth Scholer, MD, FAAP

Jennifer Takagishi, MD, FAAP

Douglas Vanderbilt, MD, FAAP

Patricia Gail Williams, MD, FAAP

Laurel Murphy Hoffmann, MD – Section on Pediatric Trainees

Barbara Sargent, PNP – National Association of Pediatric Nurse Practitioners

Alecia Stephenson – National Association for the Education of Young Children

Dina Lieser, MD, FAAP – Maternal and Child Health Bureau

David Willis, MD, FAAP – Maternal and Child Health Bureau

Rebecca Parlakian, MA – Zero to Three

Lynette Fraga, PhD – Child Care Aware

Charlotte Zia, MPH, CHES

Committee on Child a buse and Neglect , 2016–2017

Emalee G. Flaherty, MD, FAAP

Amy R Gavril, MD, FAAP

Sheila M. Idzerda, MD, FAAP

Antoinette “Toni” Laskey, MD, MPH, MBA, FAAP

Lori A. Legano, MD, FAAP

John M. Leventhal, MD, FAAP

Harriet MacMillan, MD – American Academy of Child and Adolescent Psychiatry

Elaine Stedt, MSW – Department of Health and Human Services Office on Child Abuse and Neglect

Beverly Fortson, PhD – Centers for Disease Control and Prevention

Tammy Hurley

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Nevada Home Visiting (MIECHV) - Provider Resources

Southern nevada health district: nurse family partnership.

Nurse-Family Partnership is an evidence-based best practice model delivered in the community setting. Low-income women pregnant with their first child are partnered with a Registered Nurse early in the pregnancy. Each mother served by the program receives ongoing nurse home visits that continue through her child’s second birthday. Independent research proves that every dollar invested in Nurse-Family Partnership can yield up to five dollars in return to the community. Program goals include improving pregnancy outcomes, improving child health and development, and improving the economic self-sufficiency of the family.

The Southern Nevada Health District Nurse-Family Partnership Program opened its doors to clients in September 2008. This program is a true partnership between the mother and nurse. They agree to work together from pregnancy to the child’s second birthday. To qualify, low-income, first time mothers must enter the program before the 29th week of pregnancy and be willing to commit to the full program.

Further information on the Nurse-Family Partnership organization may be obtained by visiting www.nursefamilypartnership.org . For information on the Southern Nevada Health District Nurse-Family Partnership program contact Maria Teresa Johnson at (702) 759-0779 or at [email protected] . You can also contact their main office at:

280 South Decatur Boulevard Las Vegas, NV 89107 Phone: (702) 759-1000   

• Southern Nevada Health District: Nurse-Family Partnership

Sunrise Children's Foundation: Early Head Start and HIPPY

Sunrise Children's Foundation is a nonprofit 501(c) (3) corporation whose mission is “Helping children to fulfill their potential of safe, healthy and educated lives.” Their key programs are: EARLY HEAD START (EHS) offers comprehensive child development and family support services to eligible expecting mothers, infants, toddlers and their families. In center-based as well as home-based settings, EHS promotes infant and toddler health and development; fosters positive family relationships and supports parents as the primary decisions makers and nurturers of their children. HIPPY (Home Instruction for Parents of Preschool Youngsters) is a home-visiting, early intervention program for families with children aged 3-5 years. HIPPY helps parents to engage their children in daily learning activities that promote literacy and school readiness. SUNRISE WIC CLINICS - Sunrise Children’s Foundation supports four sites for the Supplemental Nutrition program for Women, Infants and Children (WIC) in Southern Nevada in conjunction with the Nevada Division of Public and Behavioral Health. WIC is a federally funded program designed to improve the health of Nevada's pregnant women, infants and children to the age of 5 years. Sunrise Children’s Foundation was founded in 1993 and proudly partners with family support, health and education agencies throughout Nevada. For more information about Sunrise Children’s Foundation, please email [email protected] . To apply for EHS, HIPPY or WIC services, please call the SCF-Ladd Education Center at (702) 631-7130 for information. 2795 E Desert Inn Road, Suite 100, Las Vegas NV 89121 

• Sunrise Children's Foundation   
• University of Nevada, Reno: Early Head Start

Child and Family Research Center University of Nevada, Reno Sarah Fleischmann Building University of Nevada, Reno | Mail Stop 0141 Reno, NV 89557-0141 Phone: (775) 784-6762 Fax: (775) 784-4533 Early Head Start 785 W. 6th St. Reno, NV 89503 Phone: (775) 327-5100 Fax: (775) 327-5866 

Yerington Paiute Tribe: Parents as Teachers

The Yerington Paiute Tribe is working under a Cooperative Agreement with the Administration for Children and Families to implement Parents as Teachers in the Tribal community. The program is intended to:

• Support the development of healthy, happy, and successful American Indian and Alaska Native (AIAN) children and families through a coordinated, high-quality, evidence-based home visiting strategy which provides services to pregnant women and families with young children aged birth to kindergarten entry.
• Promote cooperation and coordination among various programs that serve pregnant women, expectant fathers, young children, and families in Tribal communities (including AIAN Head Start, Tribal child care, Indian Health Service, and Indian child welfare) to provide the infrastructure which will support high-quality, comprehensive early childhood systems in every community. 

For more information on Parents as Teachers please visit their website . 

For more information on the Yerington Paiute Tribal Maternal, Infant, Early Childhood Home Visitation Program, contact the Yerington Paiute Tribe at:   Renee Rogers Home Visitation Program Coordinator Yerington Paiute Tribe 171 Campbell Lane Yerington, Nevada 89447 Phone: (775) 463-3755 Ext 370 Cell: (775) 400-0447 FAX: (775) 463-7892 Email: [email protected]

Lyon County Human Services

Lyon County Human Services Offering Parents as Teachers home visiting services in Lyon County to pregnant women and families with children from birth to kindergarten entry.

  For information, please contact: Anna Coons (775) 577-5009 x3314 Email: [email protected] Lyon County website: http://www.lyon-county.org/ Parents as Teachers website: http://www.parentsasteachers.org/

The Children's Cabinet - Washoe County

777 Sinclair Ave. Reno, NV  89501 Offering Parents as Teachers home visiting services in Washoe County to pregnant women and families with children from birth to kindergarten entry.

  For information, please contact: Kim Young (775) 352-8090 Toll Free: 800-753-5500 Parents as Teachers website:  Parents as Teachers

Community Chest, Inc

991 South C Street Virginia City, NV 89440 Offering Parents as Teachers home visiting services in Lyon and Storey Counties to pregnant women and families with children from birth to kindergarten entry.

  For information, please contact: Michael-Ann Lazzarino (775) 847-9311 Email: [email protected] Community Chest, Inc. website: http://communitychestnevada.net/ Parents as Teachers website: http://www.parentsasteachers.org/

Brief Home Visiting: Improving Outcomes for Children

What is Home Visiting?

Home visiting is a prevention strategy used to support pregnant moms and new parents to promote infant and child health, foster educational development and school readiness, and help prevent child abuse and neglect. Across the country, high-quality home visiting programs offer vital support to parents as they deal with the challenges of raising babies and young children. Participation in these programs is voluntary and families may choose to opt out whenever they want. Home visitors may be trained nurses, social workers or child development specialists. Their visits focus on linking pregnant women with prenatal care, promoting strong parent-child attachment, and coaching parents on learning activities that foster their child’s development and supporting parents’ role as their child’s first and most important teacher. Home visitors also conduct regular screenings to help parents identify possible health and developmental issues.

Legislators can play an important role in establishing effective home visiting policy in their states through legislation that can ensure that the state is investing in evidence-based home visiting models that demonstrate effectiveness, ensure accountability and address quality improvement measures. State legislation can also address home visiting as a critical component in states’ comprehensive early childhood systems.

What Does the Research Say?

Decades of research in neurobiology underscores the importance of children’s early experiences in laying the foundation for their growing brains. The quality of these early experiences shape brain development which impacts future social, cognitive and emotional competence. This research points to the value of parenting during a child’s early years. High-quality home visiting programs can improve outcomes for children and families, particularly those that face added challenges such as teen or single parenthood, maternal depression and lack of social and financial supports.

Rigorous evaluation of high-quality home visiting programs has also shown positive impact on reducing incidences of child abuse and neglect, improvement in birth outcomes such as decreased pre-term births and low-birthweight babies, improved school readiness for children and increased high school graduation rates for mothers participating in the program. Cost-benefit analyses show that high quality home visiting programs offer returns on investment ranging from $1.75 to $5.70 for every dollar spent due to reduced costs of child protection, K-12 special education and grade retention, and criminal justice expenses.

Maternal, Infant and Early Childhood Home Visiting Grant Program

The federal home visiting initiative, the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program, started in 2010 as a provision within the Affordable Care Act, provides states with substantial resources for home visiting. The law appropriated $1.5 billion in funding over the first five years (from FYs 2010-2014) of the program, with continued funding extensions through 2016. In FY 2016, forty-nine states and the District of Columbia, four territories and five non-profit organizations were awarded $344 million. The MIECHV program was reauthorized under the Medicare Access and CHIP Reauthorization Act through September 30, 2017 with appropriations of $400 million for each of the 2016 and 2017 fiscal years. The Bipartisan Budget Act of 2018 ( P.L. 115-123 ) included new MIECHV funding. MIECH was reauthorized for five years at $400 million and includes a new financing model for states. The new model authorizes states to use up to 25% of their grant funds to enter into public-private partnerships called pay-for-success agreements. This financing model requires states to pay only if the private partner delivers improved outcomes. The bill also requires improved state-federal data exchange standards and statewide needs assessments. MIECHV is up for reauthorization, set to expire on Sept. 30, 2022.  

The MIECHV program emphasizes that 75% of the federal funding must go to evidence-based home visiting models, meaning that funding must go to programs that have been verified as having a strong research basis. To date,  19 models  have met this standard. Twenty-five percent of funds can be used to implement and rigorously evaluate models considered to be promising or innovative approaches. These evaluations will add to the research base for effective home visiting programs. In addition, the MIECVH program includes a strong accountability component requiring states to achieve identified benchmarks and outcomes. States must show improvement in the following areas: maternal and newborn health, childhood injury or maltreatment and reduced emergency room visits, school readiness and achievement, crime or domestic violence, and coordination with community resources and support. Programs are being measured and evaluated at the state and federal levels to ensure that the program is being implemented and operated effectively and is achieving desired outcomes.

With the passage of the MIECHV program governors designated state agencies to receive and administer the federal home visiting funds. These designated  state leads provide a useful entry point for legislators who want to engage their state’s home visiting programs.

Advancing State Policy

Evidence-based home visiting can achieve positive outcomes for children and families while creating long-term savings for states.

With the enactment of the MIECHV grant program, state legislatures have played a key role by financing programs and advancing legislation that helps coordinate the variety of state home visiting programs as well as strengthening the quality and accountability of those programs.

During the 2019 and 2021 sessions, Oregon ( SB 526 ) and New Jersey ( SB 690 ), respectively, enacted legislation to implement and maintain a voluntary statewide program to provide universal newborn nurse home visiting services to all families within the state to support healthy child development. strengthen families and provide parenting skills.    

During the 2018 legislative session New Hampshire passed  SB 592  that authorized the use of Temporary Assistance to Needy Families (TANF) funds to expand home visiting and child care services through family resource centers. Requires the development of evidence-based parental assistance programs aimed at reducing child maltreatment and improving parent-child interactions.

In 2016 Rhode Island lawmakers passed the Rhode Island Home Visiting Act ( HB 7034 ) that requires the Department of Health to coordinate the system of early childhood home visiting services; implement a statewide home visiting system that uses evidence-based models proven to improve child and family outcomes; and implement a system to identify and refer families before the child is born or as early after the birth of a child as possible.

In 2013 Texas lawmakers passed the Voluntary Home Visiting Program ( SB 426 ) for pregnant women and families with children under age 6. The bill also established the definitions of and funding for evidence-based and promising programs (75% and 25%, respectively).

Arkansas lawmakers passed  SB 491  (2013) that required the state to implement statewide, voluntary home visiting services to promote prenatal care and healthy births; to use at least 90% of funding toward evidence-based and promising practice models; and to develop protocols for sharing and reporting program data and a uniform contract for providers.

View a list of significant  enacted home visiting legislation from 2008-2021 . You can also visit NCSL’s early care and education database which contains introduced and enacted home visiting legislation for all fifty states and the District of Columbia. State officials face difficult decisions about how to use limited funding to support vulnerable children and families.

Key Questions to Consider

State officials face difficult decisions about how to use limited funding to support vulnerable children and families and how to ensure programs achieve desired results. Evidence-based home visiting programs have the potential to achieve important short- and long-term outcomes.

Several key policy areas are particularly appropriate for legislative consideration:

• Goal-Setting: What are they key outcomes a state seeks to achieve with its home visiting programs? Examples include improving maternal and child health, increasing school readiness and/or reducing child abuse and neglect.
• Evidence-based Home Visiting: Have funded programs demonstrated that they delivered high-quality services and measureable results? Does the state have the capacity to collect data and measure program outcomes? Is the system capable of linking data systems across public health, human services, and education to measure and track short and long-term outcomes?
• Accountability: Do home visiting programs report data on outcomes for families who participate in their programs? Do state and program officials use data to improve the quality and impact of services?
• Effective Governance and Coordination: Do state officials coordinate all their home visiting programs as well as connect them with other early childhood efforts such as preschool, child care, health and mental health?
• Sustainability:  Shifts in federal funding make it likely that states will have to maintain programs with state funding. Does the state have the capacity to maintain the program? Does the state have the information necessary to make difficult funding decisions to make sure limited resources are spent in the most effective way? 

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Roles of a Home Visitor

Your first task is creating and maintaining a relationship with the family. You partner with the family to understand their hopes and expectations for their child. As you observe and interact with the family and child together, you help the parents maintain an accurate understanding of their child's learning and development. Research studies consistently show the most important role of a home visitor is structuring child-focused home visits that promote parents' ability to support the child's cognitive, social, emotional, and physical development.

When a parent is distracted by personal concerns or crises, you balance listening to the parent and honoring their choice to share concerns with you with eventually bringing the focus back to the child. After assisting a parent in exploring relevant resources and supports, you might say, "This sounds like a very hard time for you. I can see how upset you are. In fact, I've been watching the baby and he looks very concerned about your feelings now. What do you think it's like for him to see you so upset?"

You also take every opportunity to notice and remark on positive actions or interactions on the part of the parent. You bring a strength-based perspective, building on the parent's role as their child's first and most important relationship. For example, "It's wonderful you already know how to comfort her."

In addition to your work on child development, you work with other program staff and community partners to coordinate such services as health, mental health, and oral health services for the family. You offer annual health, vision, hearing, and developmental screening. An important aspect of your work with some families is having strategies and resources for managing a crisis.

In an ongoing way, you help the family move forward with their goals for well-being, economic stability, and self-sufficiency.

Resource Type: Article

Last Updated: December 3, 2019

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5 Things to Know About Early Childhood Home Visiting

• Lauren Supplee

Early childhood home visiting is a type of family support targeted to expectant parents and parents of children birth to age 5. Trained home visitors provide services and support for parents and their children in their homes, where they may feel most comfortable. Parents who choose to participate in home visits may receive information on child development, health, and well-being, and on sources of support for parents themselves. Parents also learn about available services such as developmental screenings, and enrollment in any benefits they—or their children—may need.

States use a mix of federal, state, and foundation funding to support home visiting programs, and expenditures nationally may now exceed $1 billion. [1] Maternal, Infant, and Early Childhood Home Visiting ( MIECHV ) is one federal effort that facilitates the implementation of evidence-based home visiting programs. In fiscal year 2015, MIECHV-supported home visiting programs served 165,500 parents and children in every U.S. state, the District of Columbia, five territories, and 25 tribal entities.

There has been a great deal of research , over many decades, examining the use of home visiting to reach vulnerable children and families. Based on this research, here are five things to know:

1 Evidence shows that home visiting programs benefit children and families.

Research on early childhood models has demonstrated impacts for children and families across different outcome areas . There are many different home visiting models, serving children of different ages or targeting different outcomes (e.g., health, education, child abuse, employment, etc.). Some models target only one outcome while others try to improve a wide range of outcomes. Improving many outcomes versus one is not necessarily better or worse, in terms of effectiveness. Most evidence-based home visiting models (i.e., those with evidence of effectiveness) demonstrate favorable impacts on child development, school readiness, and positive, supportive parenting practices. Evidence-based home visiting models have shown positive long-term impacts on children in the long term, via increased school readiness , reduced child maltreatment , and reduced lifetime arrests and convictions . Evidence-based home visiting programs also show positive impacts for families, such as increased parental income and increased percentages of parents who live together .

2 Frequency of home visits vary by program.

Evidence-based home visiting programs use a wide range of recommended numbers of visits over different time span s . Models such as Family Connects and Family Check Up recommend three visits with a family. Other models, such as Healthy Families America and Nurse Family Partnership , begin seeing families in pregnancy or early infancy and may continue for multiple years. The frequency of visits may vary by the age of the child and the needs of the family. However, more research is needed on the optimal number and length of visits, generally.

3 Some models require rigid implementation, while others are more flexible.

Some home visiting models have a specific curriculum or specific measures they want home visitors to use with families. Some models specify staffing requirements, such as level of education or experience. Other models allow for flexibility in all or some of the program elements. Some implementing agencies (which may be nonprofits, hospitals, universities, county health departments, etc.) find it helpful to have everything packaged and ready to begin implementing, while others want more flexibility. However, there is currently little research on the extent to which giving implementing agencies the ability to be flexible and tailor their programs is related to greater impacts for families.

4 Fathers benefit from participation in home visiting programs.

Dads have reported home visiting programs helped them with their parenting skills and ability to co-parent, and with information about services to help them find jobs and participate in job training. However, research has shown that it is not always easy to include dads . Staff who work in home visiting programs may not have training on the best ways to include fathers in home visits. Sometimes dads are seen as less involved because they may not be present at the visits . However, if dads see the benefits of participating to learn about child development and ways to be better parents, this way of serving families may be a great way to reach fathers.

5 Home visiting models should account for community needs and resources.

Research suggests that in the process of choosing a home visiting model , there are benefits to assessing your community’s needs, goals, and available resources, and the fit of the evidence-based model you are considering. If the chosen model is not a good fit for a community, it may not achieve the outcomes desired , even if it has been effective in other settings. There is growing research examining model selection, the fit of a model to a community, and adaptations of models to meet unique program or community needs.

[1] Congressional Research Service estimate in 2009 suggested $750 million to 1 billion, and the MIECHV Program is now up to $400 million annually.

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UNR Early Head Start Program

Early Head Start is a comprehensive child development program serving poverty-level pregnant women and families with children aged 0-3.

Program Options

Home Visiting

The home visiting program consists of one 1-1/2 hour home visit per week by a certified parent-child educator. Home visitors use the Parents As Teachers curriculum and home-based services include referrals, developmental screenings, nutrition assessments, health screenings, parent engagement activities, and much more to highlight the importance of parents as a child's first educator. Additionally, families enrolled in home-based education services are given priority for child care vacancies if work or school requirements are met.

Center-Based Child Care

Early Head Start has a full-day, full year child care program that is free of cost for low income families with children under the age of 3. Early Head Start's four child care centers operate Monday-Friday, from 7:30am to 5:30pm. In addition to quality child care, Early Head Start provides referrals for parents, conducts developmental, nutrition, and health screenings to monitor development of children, holds monthly parent engagement activities, and provides meals and diapers for children while at the center. To qualify for center-based child care, all adults in the home must be working or attending school full-time.

WCSD Combination Program

Early Head Start and Washoe County School District have partnered to provide child care at Wooster High School and Innovations High School for parents attending high school. This program consists of center-based child care, with 3 months of home visiting services provided when school is out of session.

Qualifications and Application Process

Online Application

Aplicaciones en linea

To qualify for the Early Head Start program families must fall below the federal income guidelines and either be pregnant or have a child under the age of 3.

Complete applications should include:

• Proof of age for your child such as: birth certificate, birth confirmation or immunization record.
• Proof of pregnancy if you would like to enroll prenatally- For example, doctor's note, prenatal appointment summary, or ultrasound copy that includes your name, doctor's name, and date/weeks of gestation.
• Award letter for SNAP, SSI or TANF if anyone in the family is receiving benefits (automatic qualification)
• Or Placement letter for foster care (automatic qualification)
• Or Letter of support if considered homeless/transitional housing/doubled up with another family (automatic qualification)
• Or 2023 W2’s or 2023 taxes (tax form 1040 is preferred)

UNR Early Head Start Program contact information: Main #: (775) 432-2090 Fax #: (775) 236-1794 Email: [email protected] Main address: 786 W. 6th St. Reno, NV 89503 Please call ahead regarding donations.

This page has content that may be inconsistent with new CDC Respiratory Virus Guidance . The content of this page will be updated soon.

Direct Service Providers for Children and Families: Information for Home Visitors

How home visitors can protect themselves and their clients from COVID-19 and other diseases that can be spread from person to person.

• Direct Service Providers
• People with Disabilities
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Home-visiting professionals, or home visitors, provide many needed services directly to children and families in their home. These direct service providers can include maternal, infant, early childhood, and early intervention home visitors. They also may be teachers and therapists who provide needed services for infants, children, and teens, including those with disabilities. When in-person services are delivered, they are often done in close and consistent contact with the clients. This means that it is important to use prevention strategies to protect the home visitor and the family from diseases that can be spread from person to person, such as COVID-19, but also flu, colds, and other respiratory or gastrointestinal illnesses. In addition, home visitors are trusted sources of information and support for families, particularly those who experience health inequity . This page provides an overview of how home visitors can protect themselves and their clients during home visits.

Strategies to prevent the spread of COVID-19

With current high uptake of COVID-19 vaccination and high levels of population immunity from both vaccination and infections, the risk of medically significant disease, hospitalization, and death from COVID-19 is greatly reduced for most people. At the same time, we know that some people and communities, such as our oldest citizens, people who are immunocompromised, and people with disabilities, are more likely to get severely ill and face challenging decisions navigating a world with COVID-19.

People who are up to date on COVID-19 vaccines have much lower risk of severe illness and death from COVID-19 than unvaccinated people. However, many home visitors work with children who are not yet eligible for vaccination. When making decisions about preventive behaviors in addition to vaccination, people should consider the COVID-19 Community Level in the county . These levels show the degree of risk (low, medium, high) and describe the prevention strategies that are recommended for each level. Prevention strategies — like staying up to date on vaccines, screening testing, ventilation, and wearing masks — can help limit severe disease and reduce the potential for strain on the healthcare system. For home visitors who work with children, it may not be feasible to use all recommended prevention strategies. Therefore, particularly in communities with medium or high COVID-19 levels, home visitors should use multiple layers of recommended COVID-19 strategies to the extent possible  while also following any applicable guidance from regulatory agencies and state and local public health departments.

The following information is a brief overview of strategies that home visitors can use when working with children and families. Detailed information about ways home visitors can protect themselves is in the COVID-19 Guidance for Direct Service Providers (cdc.gov) and in the COVID-19 Guidance for Operating Early Care and Education/Child Care (ECE) Programs (cdc.gov)

Ways home visitors can protect themselves and the families they serve:

1. vaccination.

Vaccination is the leading public health prevention strategy to end the COVID-19 pandemic. COVID-19 vaccines available in the United States are effective at protecting people from getting seriously ill, being hospitalized, and dying from COVID-19. As with vaccines for other diseases, people who are up to date with their COVID-19 vaccines  are best protected.

Home visitors can protect themselves, their own families, and the families they care for by staying up to date with all vaccinations, including COVID-19 vaccines. As trusted professionals who know their families well, home visitors can play a role in helping families learn about the importance of vaccines and about supporting children’s healthy development by keeping up to date on all well visits and preventive screenings, such as screening for developmental delays and lead poisoning . They can help connect the family to a regular primary healthcare provider who provides consistent and supportive health care and serves as the family’s medical home . They can remind families that children should get all routine vaccinations to help protect themselves and others from vaccine-preventable diseases , and that family members who are up to date on all vaccines protect children who are not yet old enough to get all vaccines.

Families who are not up to date with all vaccinations may have questions and concerns about the vaccines. Home visitors can promote vaccines by:

• Encouraging families to connect with a regular primary healthcare provider and stay up-to-date on COVID-19 vaccines.
• Sharing information with parents and caregivers to answer questions and help with any worries and concerns: COVID-19 Vaccines for Children and Teens, Frequently Asked Questions about COVID-19 Vaccination in Children , and Resources to Promote the COVID-19 Vaccine for Children & Teens .
• Using the strategies that health care providers use to help with worries and concerns: Talking with Patients about COVID-19 Vaccination , Frequently Asked Questions about COVID-19 Vaccination .
• Helping families who have worries and fears about needles for themselves and their children: Needle Fears and Phobia – Find Ways to Manage .
• Finding ways to support COVID-19 vaccination in their ECE programs .

2. Ventilation

Improving ventilation is an important COVID-19 prevention strategy that can reduce the number of virus particles in the air. Along with other preventive strategies , bringing fresh outdoor air into a building helps keep virus particles from concentrating inside. Home visitors can improve ventilation or ask families to improve ventilation during the visit by

• Opening multiple doors and windows, if feasible.
• Using child-safe fans to increase the effectiveness of open windows.
• Using the exhaust fan  in the kitchen or bathroom to increase air flow, particularly if opening windows is not possible.
• Using portable HEPA air cleaners .
• Visiting with the child outdoors when possible.

Learn more about encouraging families to improve the ventilation in their home .

3. Hygiene: Respiratory Etiquette, Handwashing, Cleaning, Sanitizing, and Disinfecting

Home visitors can limit the spread of illnesses by following all guidance on cleaning, sanitizing, and disinfecting. During home visits, many activities may involve touching children, and infants and toddlers often need to be held.  For COVID-19 in general, cleaning once a day is usually enough to sufficiently remove potential virus that may be on surfaces. However, in addition to cleaning for COVID-19, home visitors should practice and encourage families to practice respiratory etiquette and recommended procedures for cleaning, sanitizing, and disinfection , such as after diapering , feeding , and exposure to bodily fluids. See more information about cleaning and sanitizing toys .

Home visitors can use the following strategies:

• Use respiratory etiquette , including covering coughs and sneezes and washing hands immediately after blowing the nose, coughing, or sneezing.
• If handwashing is not possible, use hand sanitizer containing at least 60% alcohol. Hand sanitizers should be stored up, away, and out of sight of young children and should be used only with adult supervision for children under 6 years of age or for children with certain disabilities that make it hard for the child to use hand sanitizer safely on their own.
• Avoid touching the eyes while holding, washing, or feeding a child.
• Wear disposable gloves during activities such as dressing, bathing/showering, toileting, feeding. Safely dispose of gloves after use. Wash hands before and after taking off disposable gloves. If gloves are unavailable, wash hands immediately after.
• Change clothes right away if body fluids get on them, whenever possible, and then rewash hands. Launder work uniforms or clothes after each use with the warmest appropriate water setting for the items and dry items completely.
• Wash anywhere that was in contact with a child’s body fluids and follow recommendations on  cleaning and sanitizing toys, other learning tools , and assistive devices, particularly if they were in contact with body fluids.
• Follow recommendations for cleaning and disinfecting the home  if someone is sick, or tests positive for COVID-19.

When people ages 2 and older wear a well-fitting mask correctly and consistently, they protect others as well as themselves  from infections that are spread through the air or through respiratory droplets. Consistent and correct mask use is recommended in public settings in communities with high COVID-19 Community Levels , and around people at high risk for severe disease in communities with medium COVID-19 Community Levels . At all COVID-19 Community Levels, people can wear a mask based on personal preference, informed by personal level of risk. People with symptoms of COVID-19, people with a positive COVID-19 test results who are around other people, and people who are quarantining because of a close contact, should wear a mask.

Masks should not be worn by children under age 2. Some older children or adults cannot wear a mask, or cannot safely wear a mask , because of a disability as defined by the Americans with Disabilities Act (ADA) (42 U.S.C. 12101 et seq.).

When choosing a mask , home visitors can consider fit, comfort, and the special needs of the people around them. To facilitate learning and social and emotional development, consider wearing a clear mask or cloth mask with a clear panel when interacting with young children, children learning to speak or read, children learning another language, or when interacting with people who rely on reading lips. Generally, vinyl and non-breathable materials are not recommended for masks . However, for ease of lip-reading, this is an exception to that general guidance.

5. Physical Distancing

It is generally recommended that people maintain a distance of at least 6 feet from persons who are sick with COVID-19. However, maintaining physical distance between a home visitor and their clients is often not feasible during home visiting, especially during certain activities such as physical therapy, feeding, holding/comforting, and among younger children in general. When it is not possible to maintain physical distance in home visiting settings, it is especially important to layer multiple prevention strategies, such as masking indoors, improved ventilation, handwashing, covering coughs and sneezes, and regular cleaning to help reduce COVID-19 transmission risk.

6. Isolation and Quarantine

People who are confirmed to have COVID-19 or are showing symptoms of COVID-19 need to stay home (known as isolation) regardless of their vaccination status. This includes

• People who have a positive viral test  for COVID-19, whether or not they have symptoms .
• People with symptoms  of COVID-19, including people who are awaiting test results or have not been tested. People with symptoms should isolate even if they do not know if they have been in close contact with someone with COVID-19.

People who come into close contact  with someone with COVID-19 should quarantine  if they have not had confirmed COVID-19 within the last 90 days and are in one of the following groups:

• Infants and young children who are not eligible for vaccination based on age .
• Staff and older children who are not up to date with COVID-19 vaccines (have not received all recommended COVID-19 vaccines, including any booster dose(s) when eligible ).

Home visitors can encourage families to monitor children at home for fever (a temperature of 100.4 ºF (38.0 ºC)  or other signs of illnesses that could be spread to others [PDF – 1 page] , including COVID-19, and adjust visit schedules if needed. Services may be provided virtually during quarantine or isolation if feasible.

Learn more about CDC guidance on COVID-19 Quarantine and Isolation  and about making decisions about the length of quarantine and isolation for young children:  Isolation and Quarantine in Early Care and Education (ECE) Programs .

7. Mental Health Support

Taking care of children requires a lot of effort and includes many challenges. CDC provides resources to support the mental health of home visitors and the families they serve, for example:

• Stress and Coping
• How Right Now – Finding What Helps with Emotional Well-Being and Resilience
• Tips for Promoting School Employee Wellness
• Taking Care of Your Emotional Health
• Learn About Children’s Mental Health
• Mental Health
• Occupational Health and Safety
• COVID-19 Guidance for Direct Service Providers
• Vaccinating Children with Disabilities Against COVID-19
• Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program | MCHB (hrsa.gov)
• Home Visiting | The Administration for Children and Families (hhs.gov)
• Health Tips for Home Visitors to Prevent the Spread of Illness (hhs.gov) [PDF – 11 pages]
• COVID-19 Information for Health Centers and Partners | Bureau of Primary Health Care (hrsa.gov)
• Learn About Child Development
• “Learn the Signs. Act Early.” 

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Programs for Infants and Toddlers with Disabilities

Nevada early intervention services (neis).

Nevada Early Intervention Services (NEIS) programs are available to families with children under the age of three (3) who meet Nevada's eligibility requirements. Early Intervention services are provided in natural environments, including home, playgroup and community settings. Families join together with NEIS staff to develop an Individualized Family Services Plan with outcomes that draw on the family's priorities and concerns.

If you are concerned about your child's development, the first step is to have your child referred for evaluation and assessment. You can refer your child directly to an Early Intervention program or you can have your child's physician or another professional make the referral for you. You will be assigned a service coordinator who will help you through the process.

To learn more about services for infants and toddlers provided by the Aging and Disability Services Division, please contact an Early Intervention Office near you.

• Achieving a Better Life Experience (ABLE) Accounts
• Assistive Technology Devices/Services
• Audiology (Hearing) Services
• Family Training, Counseling and Home Visits
• Health Services
• Medical services for diagnostic or evaluation purposes
• Nutrition counseling
• Occupational therapy
• Physical therapy
• Psychological services
• Service coordination
• Social work services
• Special instruction
• Speech and language services
• Transportation services
• Vision and orientation and mobility services
• Others as needed

What are my rights and why are they important?

Rights protect your family and child. All families enrolled in early intervention programs in Nevada have the same rights.  Your rights within the early intervention process begin as soon as you are referred to a program and continue as long as you and your child participate in the early intervention program.  The IDEA, Part C law gives families’ rights.  You can find more information about these laws at the Early Childhood Technical Assistance Center .

Referral Information

• Reno: [email protected]
• Carson City:[email protected]
• Elko: [email protected]
• Las Vegas: [email protected]

Referral Form

• Early Intervention Referral Form

Additional Early Intervention Services Information

• Parent Handbook - English

• Parent Rights and Responsibilities

Helpful Links

• NEIS Recruitment
• Lending Library – Nevada Early Intervention Families & Providers
• NEIS and IDEA Part C Publications
• Nevada DHHS IDEA Part C Office
• Nevada Early Intervention Interagency Coordinating Council
• Nevada Governor’s Council on Developmental Disabilities
• Part C of the Individuals with Disabilities Education Act (IDEA)
• Social Security Benefits for Children with Disabilities

Community Partners

• Advanced Pediatric Therapies (APT)
• Capability Health and Human Services (CHHS)
• The Continuum
• MD Developmental Agency (MDDA)
• Positively Kids (PK)
• Therapy Management Group (TMG)

Resource Toolkit for Home Visiting and other Early Childhood Professionals

Below you will find a variety of topics which you can explore. Our goal is provide current research and resources to support you in your role of supporting infants, toddlers, young children and their families and caregivers. Each will link you to resources related to that topic; articles, webinars, websites, books and face to face training opportunities. If you have resources that you would like us to post and share with other home visiting and family support professionals, please send those to [email protected]

One of the things different experts are talking about it how this whole Covid-19 is impacting our emotional health.  Check out this interesting article to understand the role of grief and the stages of grief in this experience and how it provides another lens and way to look at things during this difficult time. https://hbr.org/2020/03/that-discomfort-youre-feeling-is-grief

The Ounce has launched a new knowledge-sharing platform for the early childhood community. Connect with organizations, community leaders, and experts online to help support children, families, and each other: https://ecconnector.org

Website for home visiting professionals related to best practices and information for services during this time

• https://institutefsp.org/covid-19-rapid-response
• Office of Children’s Mental Health resources page and also have attached their newest newsletter https://children.wi.gov/Pages/Mental-Wellness-During-COVID-19.aspx

Well Badger has COVID-19 curated list of resources for families. Specialists are available to handle COVID-19 related questions and referrals.  Services are available to individuals in Wisconsin operating Monday through Friday from 7:00 a.m. to 6:00 p.m. Specialists are available via email, text message, online live chat and online searchable database.

• Tips for Families: Coronavirus
• Talking to Kids about the Coronavirus
• Tips on Doing Virtual Visits
• Tips on Mental Health and Self-Care
• Health and Human Services guidance on Telehealth
• Virtual Visit Readiness – learn the basics of different types of technology to connect with families.
• Have you checked out the new Wisconsin DHS website for information and updates on all things COVID-19?   https://www.dhs.wisconsin.gov/covid-19/prepare.htm   This website is updated regularly with the latest information.
• Self-care during these times is critical for keeping it all together.  Our partner WI-AIMH has collected and posted a bunch of resources on their website in the Covid section. Some are in our toolkit and there are more worth checking out here

 Webinars & Podcasts

Reflective Supervision / Consultation Webinars Available

In partnership, the Alliance for the Advancement of Infant Mental Health® and First3Years are excited to provide Reflective Supervision/Consultation training through on-demand webinars.

Webinar content consists of three 1-hr meaningful modules and best practice guidelines for Reflective Supervision/Consultation.

·    Session 1: Reflective Supervision/Consultation: How Do I Begin?

·    Session 2: Reflective Supervision/Consultation: Best Practices

·    Session 3: Reflective Supervision/Consultation: Parallel Processing

For additional information visit:

https://first3yearstx.org/reflective-supervision-consultation-w ebinars/

COMING SOON:

Six Weeks of FREE Online Professional Development

Starting June 1,

NAEYC will offer over 100 presentations of content shared by NAEYC experts and a diverse group of presenters from all sectors of the industry. Our presenters include policy experts, higher education faculty, school leaders, researchers, and educators.

While typically this type of content is only offered at NAEYC Professional Learning Institute , we are providing access to these presentations during the NAEYC Virtual Institute at no charge as our gift to you for all that you give to young children and their families.

Who can participate?  

The NAEYC Virtual Institute is open to everyone; early childhood professionals, advocates, families and supporters who are interested in early childhood education. You do not need to be a NAEYC member to participate.  

What is included?  

Explore over a hundred presentations, covering diverse topics from presenters who would have presented at the Professional Learning Institute. Attendees will receive a certificate of attendance for each presentation they view.  

How do I participate?  

Each week you’ll have the opportunity to login and select from a variety of new presentations to meet your needs.  

Stay tuned for more information on how to sign up!  

Another resource and opportunity for your well-being during this time is a new partnership to present a series of three webinars on mindful self-compassion (Please see below)

The Maritz Family Foundation is supporting a series of three webinars beginning April 29 , presented by the  Brazelton Touchpoints Center, the University of Washington Center for Child and Family Well-Being, and the Center for Mindful Self-Compassion.  These webinars will feature leaders in the field sharing appropriate and timely information and practices relevant to the current global crisis and beyond.

During these times when individual, family, and system stress is so amplified, we are particularly vulnerable to trauma, burnout, and deep fatigue. The always important emotion regulation and stress management skills, along with compassion practices, are essential for our ability to navigate these stormy seas. Each webinar will offer an opportunity to explore these skills and practices and consider the many ways they can support us.

We would greatly appreciate your sharing this information with your network(s) via email, newsletter, and/or social media, whichever is best and easiest for you. And please let me know if you have any questions or comments.

Here is a direct link for information and registration:

https://www.brazeltontouchpoints.org/mindful/

• Wi-AIMH has also collected some resources to share with and to support families around Covid which can be found here.   These include resources on how to talk with children and strategies for creating routines and other concrete tools.
• In response to the COVID 19 Pandemic, Rogers InHealth staff have translated the strategies from Compassion Resilience into the context of this pandemic. As we share the resources out with people across our nation, we want to be sure you have access to the link for yourself, your co-workers and your loved ones. There are nine unique blogs and six unique videos “Staying Resilient During COVID -19”They can be found at this link – https://compassionresiliencetoolkit.org/staying-resilient-during-covid-19/ The blogs  and videos can also be accessed from a banner link at www.wisewisconsin.org or www.compassionresiliencetoolkit.org
• Link quickly to the National Alliance for Home Visiting Models COVID information through https://www.nationalalliancehvmodels.org/rapid-response
• “Promoting Effective Parenting with Motivational Interviewing.”
• Did you miss the webinar last week with Dr Bruce Perry – or were you not able to get into the meeting?  Here is the recorded session Coping with COVID19: Helping Children and Families Manage Stress and Build Resilience
• Series of Podcasts from Nationally Renown Brene Brown can be found here with many topics that hit the mark with current experiences.  Check out her new series here

Abuse/Neglect and Adverse Childhood Experiences

• What is Considered Child Abuse? Psychology Today article covers the legal meaning of the term child abuse and links to states’ reporting laws and commonly asked questions about mandated reporting.
• InBrief: The Science of Neglect This short video, from the Center on the Developing Child, Harvard University, reveals the four types of unresponsive care and the impact of neglect on a young child’s brain development. Look for other resources related to neglect on this website.
• The CDC website has the original ACE study, resources, the Behavioral  Risk Factor Surveillance System ACE data, journal articles and presentation graphics.
• The Child Abuse and Prevention Board has Information related to the original ACE study and ACEs data specific to Wisconsin, including a Wisconsin ACE brief and other reports related to our state.
• Services for Families of Infants and Toddlers Experiencing Trauma: A Research-to-Practice Brief . Beginning life in the context of trauma places infants and toddlers on a compromised developmental path.  This brief summarizes what is known about the impact of trauma on infants and toddlers, and the intervention strategies that could potentially protect them from the adverse consequences of traumatic experiences. Office of Planning, Research and Evaluation.
• How Childhood Trauma Affects Health Across a Lifetime Nadine Burke Harris Ted Talk.
• Take The ACE Quiz — And Learn What It Does And Doesn’t Mean , NPR

Online Learning

• Childhood Adversity Narratives (CAN) Developed by 5 researchers from around the country, this webinar is meant to help inform policy makers and the public about the costs and consequences of child maltreatment and adversity.  Feel free to use their work, and provide appropriate citations, to educate others.
• Marks that Matter, Sentinel Injuries, and Other Opportunities for Child Abuse Prevention is a 25-minute module that will teach you about marks that matter and sentinel injuries, including why they are significant, who is at risk, and what to do if you suspect abuse. It is intended for childcare workers, child welfare workers, family support staff, and home visitors, but any person working with children will find it a useful tool.  This module can be viewed on your computer or mobile device.
• WI Mandated Reporter Online Training Reporting requirements vary slightly for a few groups.  Learners can select the affiliation that best fits their role in the WI Child Welfare Professional Development System online training.
• Coping with Early Adversity and Mitigating its Effects—Core Story: Resilience From the Center for Advanced Studies in Child Welfare, this 7 min. video addresses effective ways to help children cope and build resilience through adversity.
• NEAR@Home is a training manual with guided processes to help home visitors learn and practice language and strategies to safely and effectively talk about childhood trauma and the ACEs questionnaire in a safe, respectful, and effective way for both home visitor and family.
• Tip Sheet CES
• Childhood Experiences Survey Developed through UW Milwaukee for home visitors, this validated tool expands the framework of the original ACEs survey to include additional questions around poverty, bullying, absence of a parent, and death of a close family member.

Prevention  Advocacy

• Child Welfare League of America with the following text,.  CWLA leads and engages its network of public and private agencies and partners to advance policies, best practices and collaborative strategies that result in better outcomes for children, youth and families that are vulnerable.
• Prevent Child Abuse America PCA’s mission is to prevent the abuse and neglect of our nation’s children.  Their website offers an activity toolkit, stats and figures, tip sheets for parents, research and ways you can make a difference.
• Wisconsin Child Abuse and Neglect Prevention Board ​​​​​​​​​​​​​​​​The Wisconsin Child Abuse and Neglect Prevention Board is committed to mobilizing research and practices that prevent the occurrence of child maltreatment.  Learn about abuse and neglect risk factors and protective factors, as well as frameworks for child maltreatment prevention.
• Safe Haven for Newborns Information Safe Haven, also known as “infant relinquishment”, this law allows a parent to leave their newborn in a safe place in certain circumstances with certain individuals.  Learn more about this WI law, the Maternal and Child Health Hotline and crisis support on this webpage.
• Wisconsin Sex Trafficking and Exploitation Indicator and Response Guide for Mandated Reporters ( English ) ( Spanish )
• Awareness to Action (A2A) A2A is an initiative focused on preventing child sexual abuse by helping adults and communities take action to protect children through awareness, education, prevention, advocacy and action, through the Child Abuse Prevention Board, Children’s Hospital of WI.

Tip Sheets/ Guides

• Tip Sheet: Talking to Children and Teens about Child Abuse Children need accurate, age-appropriate information about child sexual abuse and confidence that adults they know will support them. This tip sheet can help!
• Books to Help Parents Talk About and Respond to Child Sexual Abuse The Committee for Children features a list of books which provide valuable information for parents to keep their kids safe.
• Long-term consequences of Child Abuse and Neglect fact sheets.
• Babies Cry, Be Prepared Free downloadable brochure in English, Spanish and Hmong from Child Abuse and Prevention Board.
• Signs of Child Abuse and Neglect The WI Dept of Children and Families has outlined the signs of neglect and physical, sexual, and emotional child abuse, to help readers be prepared to recognize situations that may need to be reported.

Text Resources

• Services for Families of Infants and Toddlers Experiencing Trauma: A Research-to-Practice Brief , Office of Planning, Research & Evaluation
• CTA Library The CTA is a Community of Practice  working to improve the lives of high-risk children through direct service, research and education.  CTA translates emerging findings about the human brain and child development into practical implications for the way we nurture, protect, enrich, educate and heal children.

Adult Mental Health

Pregnancy and Postpartum Mental Health

• Depression in Mothers: More Than the Blues: A Toolkit for Family Service Providers through SAMHSA (Substance Abuse and Mental Health Services Administration, 2014)
• Useful Links provides reputable weblinks relevant for different readers, including moms, dads, families, friends and professionals.
• Resources and Information about Maternal Depression , from the Center for Infant and Early Childhood Mental Health Consultation, for the U.S. Department of Health and Human Services, Substance Abuse and Health Services Administration.

For Parents: 

• Depression During and After Pregnancy , from the CDC, includes information to help parents better understand depression, post-partum depression and provides links to other depression-related resources for parents.
• Pregnancy and Postpartum Mental Health Overview , provided by Postpartum Support International, offers information on perinatal mood and anxiety disorders for women concerned about their mental health during or after pregnancy.
• Resources for Mothers and Families includes information about several support groups for mothers concerned about perinatal related mental health disorders.
• HelpLine for  Moms, offered through Postpartum Support International , 1-800-944-4773 (English and Spanish), or text 503-894-9453 .  Available 24 hrs. a day, callers will be asked to leave a confidential message and a trained and caring volunteer will return your call or text. They will listen, answer questions, offer encouragement and connect you with local resources, as needed.

Professional Reading

• Home Visiting and Maternal Depression: Seizing the Opportunities to Help Mothers and Young Children
• Supporting Infants, Toddlers, and Families Impacted by Caregiver Mental Health Problems, Substance Abuse, and Trauma: A Community Guide
• Maternal Depression: Why It Matters to an Anti-Poverty Agenda for Parents and Children Websites, CLASP
• National Institute on Mental Health
• National Center on Early Childhood Health and Wellness Mental Health Newsletter highlighting Stress Reduction for families and professionals (2016). Includes resources in English and Spanish, links to tips and articles.
• National Center on Early Childhood Health and Wellness Mental Health Newsletter highlighting Parental Depression (2016) includes links to articles, briefs, and action steps for families and professionals.

Online Training and Educational Modules

• Perinatal Mental Health Modules is a two-part series designed for home visitors to better understand the signs and symptoms of perinatal mental health issues and how they impact mothers and families. Throughout the training, you will view excerpts from a live webinar taught by Jen Perfetti, MA, LPC, a licensed therapist at Luna Perinatal Counseling and the Clinical and Professional Development Coordinator with the UW Department of Psychiatry Parent-Infant Mental Health Programs.
• WI Dept. of Health Services’ Perinatal Mental Health: Screening, Referral and Supportive Interventions for Women and Families webinar series includes videos, references, information for clinicians, and handouts for women and their families. Developed by leaders in the fields of psychiatry and women’s health, this series covers a variety of topics related to perinatal mental health.
• The Periscope Project (Medical College of WI) offers free online modules on common topics related to perinatal psychiatric disorders. While these modules target medical providers, two of the modules, Perinatal Mood Disorders and Screening and Follow-up, are relevant for family support professionals, as well.
• The Periscope Project website contains work from the Wisconsin project which hosts a consultation line and other resources to support professionals working with new parents, that may be struggling with perinatal mental health and depression. This site provides information on screening guidelines and resources beyond the Perinatal Algorithm training. On the site you will find screening tools, educational modules/ videos and tools on a variety of perinatal mental health topics.
• National Institute of Mental Health ( NIMH) offers authoritative information about mental health disorders well as information on a range of mental health topics and the latest mental health research.
• Mental Health America , learn about the signs and symptoms of mental illness, facts, statistics, how to live mentally healthy, finding help, public policy, screening, and the latest news on mental health.
• B4Stage4 is an initiative that encourages all of us to have a new perspective about mental health. Learn about both prevention and intervention strategies, including the B4Stage4 philosophy, and information and resources available through “Get informed, Get screened and Get help”.
• Mental Health, Oklahoma State Department of Health. Oklahome Home Visitor Training
• Brain Basics from the National Institute of Mental Health provides information on how the brain works, how mental illnesses are disorders of the brain, and ongoing research that helps us better understand and treat disorders.
• Health Nexus Santé’s Perinatal Mood Disorders:   An Interdisciplinary Training Video (25:03) offered in four chapters.  Reviews the risk factors and symptoms of perinatal mood disorders.  Testimonials by women diagnosed with a perinatal mood disorder and counseling vignettes are included.
• Imagine There Was No Stigma to Mental Illness | Dr. Jeffrey Lieberman | TEDxCharlottesville (22:07)
• Ending the Stigma of Mental Illness (4:33)
•   Tip Sheet PSS
• Self-Help and Mental Health Screening Tools , from Mental Health America. This webpage contains great resources for individuals exploring their own mental health, including screening tools.
• National Alliance on Mental Illness (NAMI) , Mental Health by the Numbers,
• National Institutes of Health, Prevalence, includes rates for various mental illness diagnoses in the U.S.
• Mental Health America of Wisconsin

Fact Sheets

• Depression During and After Pregnancy , WomensHealth.gov
• National Institute of Mental Health (NIMH) offers fact sheets related to a variety of mental health issues.
• Wisconsin Department of Health Services Mental Health Resources
• Out of the Boardroom: How Nonprofit Board Members Can Be Effective Advocates in Troubled Times , NonProfit Quarterly /

Instructional

• Advocacy 101 for Family Support Professionals

Talking Points

• HV Talking Point – Home visitors can advocate for their roles and their programs as concerned citizens, during their own private time. You can use this document to help policy-makers understand the value of home visiting and your role
• Value of PD Talking Points – Professional development helps family support professionals feel more confident and competent in their roles.
• Be an Advocate for Young Children, Supporting Families Together Association – Learn about different types of advocacy, how you can get involved, who to contact, and current advocacy alerts (eg. News from the WI Children’s Caucus, webinars, etc.)
• Zero to Three Home Visiting:  Supporting Parents and Child Development includes resources and tools to help policymakers and professional understand the importance of investing in home visiting programs and support the implementation of home visiting programs as part of a comprehensive and coordinated system of services for young children and their families.

AODA/Home Visiting Online Modules

• Relationships Matter!   Learn what professionals need to know about the role of relationships in the lives of women with mental health and substance use issues.  Transcripts, slides and audio recordings of the 2017 SAMHSA (Substance Abuse and Mental Health Services Administration) webinars available. Online registration for these tutorials required. Tutorials are free to earn a Certificate of Completion, fee of $7.50 to earn NAADAC or NBCC CE units.
• National Center on Substance Abuse and Child Welfare (NCSACW) – U.S. Dept. of Health and Human Services, Understanding Substance Use Disorders, Treatment, and Family Recovery: A Guide for Child Welfare Professionals .     This free tutorial requires online registration with the NCSACW.
• Supporting Infants, Toddlers, and Families Impacted by Caregiver Mental Health Problems, Substance Abuse, and Trauma: A Community Guide 2012 SAMHSA: Substance Abuse and Mental Health Services Administration
• What are the Effects of Maternal Cocaine Use?
• Principles of Substance Abuse Prevention for Early Childhood: a Research-based Guide highlights seven evidence-based principles of prevention for use in the early years of a child’s life (prenatal through age 8), developed from research funded in full or part by the National Institute on Drug Abuse (NIDA).  This guide also lists evidence-based prevention and intervention programs that work with different populations and age groups.
• Drugs, Brains, and Behavior:  The Science of Addiction. This publication aims to help readers understand why people become addicted to drugs and how drugs change the brain to foster compulsive drug use by providing scientific information about the disease of drug addiction, including the many harmful consequences of drug abuse and the basic approaches that have been developed to prevent and treat substance use disorders.
• Sex and Gender Differences in Substance Use, DrugFacts (2015). Do special issues related to women’s hormones, menstrual cycle, fertility, pregnancy, breastfeeding and menopause impact their struggle with drug use?
• Fetal Alcohol Spectrum Disorders (FASD) Fact Sheet Series.   SAMHSA provides many different downloadable fact sheets related to alcohol abuse, including: The Physical Effects of Fetal Alcohol Spectrum Disorders, Effects of Alcohol on Women, Fetal Alcohol Spectrum Disorders and the Criminal Justice System, Fetal Alcohol Spectrum Disorders by the Numbers, and more.
• DrugFacts .  Information from the National Institute on Drug Abuse describes methamphetamine, how it’s used, how it affects the brain, its short and long-term affects on users and treatment.
• My Baby and Me  https://www.wwhf.org/mybabyandme/   A free program, sponsored by the Wisconsin Women’s Health Foundation, to help Wisconsin women achieve a healthy and alcohol-free pregnancy through screenings, research-based education, phone counseling and text message support.
• Fetal Alcohol Spectrum Disorders. CDC’s webpage that defines Fetal Alcohol Spectrum Disorders and provides facts, causes, signs, diagnosis and treatment information.  Headings on this web page include:  Research and Tracking, Data and Statistics, Free Materials, Alcohol Use During Pregnancy, Education and Training, Articles, Multimedia and Tools, and Information for Specific Groups. https://www.cdc.gov/ncbddd/fasd/index.html
• National Institute on Alcohol Abuse and Alcoholism. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is one of the 27 institutes and centers that comprise the National Institutes of Health (NIH). NIAAA supports and conducts research on the impact of alcohol use on human health and well-being. It is the largest funder of alcohol research in the world. https://www.niaaa.nih.gov/
• Born Addicted
• Working with Pregnant Women with a History of Substance Abuse
• Pregnancy and Drug Use
• The Growing Issue of Women and Substance Abuse
• Sex and Gender Differences of Importance to Addiction Science. (5:29 min.)  National Institute on Drug Abuse.
• The Reward Circuit:  How the Brain Responds to Methamphetamine  (2:40 min)  https://www.drugabuse.gov/videos/reward-circuit-how-brain-responds-to-methamphetamine

Building Collaborations

• Chamber Executive: Where Workforce Development Begins , October 2012, Libby Doggett
• EDUCATION: Home visits promote early learning , The Press-Enterprise
• Wisconsin Statewide Medical Home Initiative provides information on partnering with a child’s health care provider.
• Partnerships: Frameworks for Working Together . This guidebook, developed for the Strengthening Nonprofits: A Capacity Builder’s Resource Library, is helpful to any organization or coalition of organizations that wants to know more about establishing and managing partnerships. (updated 2010)
• A Structured Approach to Effective Partnering: Lessons Learned from the Public and Private Sector Leaders Centers for Diseases Control and Prevention, Office of Public Health Preparedness and Response.
• Nonprofit Collaborations:  Why Teaming Up Can Make Sense , Forbes Magazine, April 9, 2013.
• Business Leaders Team up to Benefit Education, Economy , ReadyNation
• Change the First five Years and You Can Change Everything , Ounce of Prevention
• Intergenerational Mobility Project:  Building Adult Capacities for Success .  This video profiles the Project and its use of a coaching framework to strengthen families’ ability to navigate the complexities of poverty.
• Smart Beginnings and the Workforce Pipeline
• 11 Videos to Inspire Collaboration and Teamwork .

Local Organizations

• Home Visitation Outcomes Project of Wisconsin
• Wisconsin Early Childhood Collaborating Partners
• Child Abuse and Neglect Prevention “The Wisconsin Child Abuse and Neglect Prevention Board is committed to mobilizing research and practices to prevent child maltreatment in the state.”
• Supporting Families Together Association .  SFTA is Wisconsin’s statewide member association for organizations and individuals committed to making every early childhood a great one. The core membership consists of Wisconsin’s Child Care Resource & Referral Agencies (CCR&Rs) and Family Resource Centers (FRCs). Individual membership is made up of other like-minded individuals.

Child Development

Apps and Activities

• ASQ activities
• Head Start Go Smart offers physical activity suggestions and resources, arranged by age of the child, beginning at birth.
• Milestone Tracker Mobile App , Milestones matter! Track your child’s milestones from age 2 months to 5 years with CDC’s easy-to-use illustrated checklists; get tips from CDC for encouraging your child’s development; and find out what to do if you are ever concerned about how your child is developing. Photos and videos in this app illustrate each milestone and make tracking them for your child easy and fun!
• Text4Baby . The National Healthy Mothers, Healthy Babies Coalition supports Text4baby, a free mobile text messaging service that provides  moms-to-be, new moms and family members  with information to help them care for themselves and their baby throughout pregnancy and the baby’s first year.
• Vroom This practical app helps parents to help their babies brains grow during their regular daily routines!  Using the science of early learning, this app acknowledges parents as their child’s #1 brain builder, helping turn ordinary or fussy times into fun shared moments.
• Sesame Street Fun Games for Kids Parents can use these free online educational games, videos and coloring activities for preschoolers.
• Sesame Streets’ Healthy Habits for Life – We Have the Moves ,  This resource contains fun-filled activities to help build physical activity into everyday moments. Parents will find physical activities that require minimal time and equipment; activities for both large and small spaces and groups; fun and easy ways to add more active play into everyday routines; and ways to link movement to different developmental areas.
•   Bright by Text Parents receive free, timely Bright by Three age-appropriate activities, games and resources in English or Spanish.
• Love, Talk, Read, Sing, Play Provides information for parents to support their child’s development in diverse ways.  The app is available in English, Arabic, Bengali, Chinese or Nepali.
• Kinedu Offers 1,600 activity ideas for baby’s development, 0 – 4 years.
• Activities for Babies on Pinterest  
• Preschool Games on Pinterest .
• Parents Magazine Educational Games for elementary school children.
• Breathe, Think, Do mindfulness app from Sesame Street.  This free app helps teach young children, ages 2 – 5, problem-solving, self-control, planning and task persistence. Available for iOS   and Android  
• Calm free meditation app focuses on meditation, relaxation and sleep.  Their “sleep stories” function tells tales to help users fall asleep easier. There’s also a section for “Calm Kids” that parents may enjoy, as well!  Available for iOS and Android
• Developmental screening information and fact sheet.
• Social-emotional development for infants and toddlers.
• Social-emotional development for infants and toddlers related to peer behavior.
• HHS SED Milestones
• HHS SED Research Background
• HHS SED Tips for Early Childhood Teachers and Providers
• HHS SED Tips for Families
•   Kids in the Monitoring Zone: What to Do Next, ASQ
• Screening and Assessment in Early Childhood Settings, There can be some confusion about the difference between screening and assessment in early childhood settings. This infographic helps illustrate key characteristics for each type of tool.
• Screening for Social Emotional Concerns: Considerations in the Selection of Instruments.
• How kids’ screen-time guidelines came about — and how to enforce them, Kendall Powell
• Deb McNelis Promoting Brain Development Through Play and Nurture, Jennifer Rojas
• What Babies Understand about Adult Sadness, NPR
• Strength-based parenting improves children’s resilience and stress levels, Medical Press
• The Science of Resilience – Why some children can thrive despite adversity, Harvard
• Why maternal mental health matters: a case for early childhood development, Maternal Health Task Force Blog
• How Anxiety Leads to Disruptive Behavior – Kids who seem oppositional are often severely anxious, Child Mind Institute
• What Poverty Does to the Young Brain, The New Yorker
• How to Prevent Mental Health Problems? Begin at the Beginning With Infants and Toddlers – Matthew Melmed, The Huffington Post
• The Difference Between Tantrums and Sensory Meltdowns, Understood
• The Neuroscience of Calming a Baby, Psychology Today
• What Your Baby Can’t Tell You, Janet Lansbury – elevating child care
• Infants create new knowledge while sleeping, Science Daily
• Infant temperaments may reflect parents’ cultural values, Washington State University
• Some Early Childhood Experiences Shape Adult Life, But Which Ones?, NPR
• The scientific evidence against spanking, timeouts, and sleep training, Quartz
• Boy toddlers need extra help dealing with negative emotions, experts urge, Science Daily
• Helping Your Child’s Speech and Language, In the Playroom
• How raising kids within routines boosts social and emotional health, Desert News – National
• Understanding the Relation Between Temperament and Behavior, The Urban Child Institute
• Family Engagement and School Readiness Series, National Center on Parent, Family and Community Engagement
• How Supportive Parenting Protects the Brain, The Atlantic
• Benefits of bilingual children , FastCompany
• Early Childhood Mental Health Consultation: Policies and Practices to Foster the Social-Emotional Development of Young Children , provides an overview of early childhood mental health consultation, current issues in the field and possible future directions. The brief also provides a snapshot of current programs across the nation and highlights some of the challenges and innovations that are shaping the field. (Zero to Three)
• Seeing the Importance of Vision Development, research-to-policy article from the Urban Child Institute. 
• “ Baby’s Vision development: What to Expect the First Year ” from the American Academy of Ophthalmology.

Online Training

• The Wisconsin Department of Health Services Women, Infants, and Children Program site provides an online training course on anthropometrics : weighing, measuring, and interpreting measurement results.
• The Association of Maternal Child Health Programs’ Communicating the Value of Developmental Screening for professionals working directly with families and Title V leaders and other stakeholders to articulate the value of developmental screening.

PowerPoints

• A Home Visitor’s guide for developmental and behavioral screening from Birth To 5: Watch Me Thrive

Resource Guides

• Tips and Resources for Families U.S. Dept. of Health & Human Services, Office of the Administration for Children & Families – Early Childhood Development provides web links to resources that support the development (including social emotional) of young children.
•  Zero to Three’s Parent Favorites Free parenting resources include articles (English and Spanish), series infographics and videos related to early development.
•   Resource Guide:  Child Development Resources for Parents and Providers From the U.S. Health & Human Services Child Care State Capacity Building Center, this guide provides links to resources for both parents and providers.

Resources to Share

• Prevent Blindness Wisconsin offers fact sheets about screening for and protecting children’s vision.
• Preventative Pediatric Health Care Chart
• Bright Futures Guidelines is designed to provide a common framework for well child care from birth to age 21. Explore the Bright Futures materials and tools . If you are asked for a username/password, click cancel, and you should still be routed to the page.
• Feelings Poster
• 5 Steps for Brain-Building Serve and Return
• Kids in the monitoring zone: What to do next ASQ

UW Extension’s   Just in Time Parenting  newsletters are free parenting newsletters that are delivered by email and specific to a child’s age and needs. They are designed so that information that’s relevant to a family is automatically delivered to them just in time! Newsletters are specific to prenatal, newborn, the first year, second – third years (bimonthly), and fourth – fifth years (bimonthly). Newsletters can be downloaded from this webpage, too.

Articles for Families on Play The National Assc. for the Education of Young Children (NAEYC) offers a webpage with links to articles for families that answer the question, “Why is Play Important?” and offer Play in Action ideas.

Power of Play:  Building Skills and Having Fun video (5:33 min.) View this video with parents at Zero to Three’s website.

Sensory Activities 0-18 Months Games and activities that support sensory development in very young children.

Preschooler Creative Learning and Development Ideas and Activitie s Raisingchildren.net.au provides information for parents on all aspects of children’s development, from pregnancy – teens and family life.  This website contains articles, ideas, strategies, videos and more!

The Expectation Gap Downloadable from Zero to Three, these resources help parents understand the benchmarks of social emotional development with infographics, articles and more.

Articles for Families on Behavior and Development These articles support parents as they help their child develop social-emotional competence.

An Activity Book for African American Families:  Helping Children Cope with Crisis Download this activity book, developed by the National Black Child Development Institute and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, to support the social-emotional development of children and families dealing with crisis.

• The Well-Visit Planner is based on national recommendations for parents/guardians of children 4 months to 6 years old. This web tool will result in a personalized visit guide of questions and topics for a child’s next well-child visit.  This was developed as a project of The Child and Adolescent Health Measurement Initiative and Oregon Health and Science University.  English and Spanish .
• Delighting in Writing – Center for Early Literacy Learning (CELL). When young children are given opportunities, they can actively construct meaningful pictures and stories using written symbols.
• Serve and Return Interaction Shapes Brain Circuitry – The Center for the Developing Child. Video 2 from the 3 part series “Three Core Concepts in Early Development” . Young Children naturally reach out for interaction through babbling, facial expressions, and gestures.
• 6 Core Strengths for Child Development – Dr Bruck Perry
• Love, a low tech solution – Laura Peterson, TEDx Talks
• Why is it important to Comfort your child?, Hospital for Sick Children
• Developmental Screening, Ages and Stages Questionnaire (ASQ)
• 5 Tips for Brain-Building Serve and Return – Harvard Center on the Developing Child
• Early Recognition of Child Development Problems/Educational Video (4:33 min)  The Center for Disease Control’s Learn the Signs: Act Early campaign to help parents recognize developmental milestones.  Embed link in name of video.
• Early Signs of Autism Video Tutorial (9:02 min)  Video compares/contrasts typical development with those of children showing signs of early Autism Spectrum Disorder.  Kennedy Krieger Institute, Center for Autism and Related Disorders.
• Brain Builders , First Five Years Fund Early Childhood Education
• When Feelings Overwhelm: How to Help a Child 50 resources to help children manage their emotions includes resources useful to professionals and parents.
• The Wisconsin Department of Health Services offers information on Wisconsin’s Newborn Screening program and the Wisconsin Sound Beginnings newborn hearing screening program.
• The Wisconsin Early Childhood Collaborating Partners provides information about the Wisconsin Model Early Learning Standards .
• Learn the Signs, Act Early
• Children’s Health Alliance of Wisconsin (CHAW, in the acronym lingo), implements programs and initiatives, and offers resources on many health topics, including injury prevention and child death review, oral health, asthma, early literacy, and Medical Home.
• Centers for Disease Control and Prevention offers free childhood developmental resources for professionals and parents, including developmental milestone fact sheets, information on children’s mental health, multimedia resources, research, articles, and positive parenting tips.
• Centers for Disease Control and Prevention’s Learn the Signs: Act Early downloadable resources for professionals and parents. Covers developmental milestones for newborns through age five. Downloadable resources available in English and Spanish.
• Public Broadcasting Service’s The ABC’s of Child Development for Early Care Providers includes articles, quick tips and activity ideas
• Center on the Developing Child – Harvard University . Excellent downloadable articles, briefs, and videos related to the science of early childhood, including: brain architecture, serve and return, toxic stress, executive function & self-regulation and resilience.

Children with special needs

• Wisconsin First Step is an information and referral service hotline with phone and online chat forums and a resource directory to assist Wisconsin families and providers working with children and youth with special needs.
• Family Voices of Wisconsin promotes family-centered care for all children and youth with special health care needs and/or disabilities. Family Voices provides tools for families to make informed decisions, advocates for improved public and private policies, forges partnerships with families and professionals, and serves as a health care resource.
• What are the signs of autism? Since early treatment can improve outcomes for children diagnosed with autism, Autism Speaks stresses the importance of learning early signs of autism. The side offers a helpful Video Glossary after a brief registration.
• The  Adapting Activities & Materials for Young Children with Disabilities handout, with reference citations, provides key ideas, general teaching ideas, and activity adaptations for children with special needs.
• Do2Learn This website for individuals with special needs provides thousands of free pages with social skills and behavior regulation activities and guidance.
• Child Neurology Foundation This website offers insights and suggestions from child neurology experts for caregivers to engage with special needs children to nurture their development. Their mission: To serve as a collaborative center of education and support for caregivers and their children with neurologic conditions.
• Helping Your Child with Autism Thrive with the following text.  This Help Guide provides parenting tips, treatments and services to help parents support the development of a child on the Autism Spectrum.

Language Development

• 12 Ways to Support Language Development for Infants and Toddlers from the National Assc. of Education for Young Children (NAEYC).  Simple strategies for parents to use to support language development with very young children.
• Resources for Home-Based Practitioners The Center for Early Literacy Learning model and approach includes both evidence-based intervention and implementation practices for practitioners and parents to promote the use of early literacy learning practices.
• Storyline Online The SAF-AFRA Foundations’ award-winning children’s literacy website streams videos featuring actors reading children’s books alongside creatively produced illustrations.  Great for all kids, including those with special needs. Download the free app, too!

Child Health and Safety

Immunizations

• The DHS Wisconsin Immunization Registry offers a public link so that parents may access their children’s immunizations records. Through the following link, health professionals may also access materials (in several languages), as well as trainings to support their immunization programs and data collection efforts. The WIR can also be accessed in English, Spanish, or Hmong from this site. https://www.dhs.wisconsin.gov/immunization/wir.htm
• Through these Centers for Disease Control and Prevention links, you can download Easy-To-Read Immunization Schedules for Infants and Children , and for Teens in both English and Spanish. There is also a chart for Adults . On the same page, there is a link to a downloadable tracking chart. Families can write in their children’s measurements: Immunizations and Developmental Milestones for Your Child from Birth Through 6 Years Old
• The Immunization Action Coalition offers vaccine information for families , coalitions , and health professionals .

Infant and Early Childhood Safety and Injury Prevention

• Children’s Safety Network offers information on a wide variety of child injury prevention topics, with links to further resources.
• Children’s Hospital of Wisconsin provides Safe Sleep information in English and Spanish.
• Safe Kids Wisconsin has information on child injury prevention programs and events, including statewide car seat check dates and links to resources such as the Safe Sleep Cribs for Kids .
• Car Seats:  Information for Families .
• National Highway Traffic Safety Administration’s Car Seats and Booster Seats helps parents find and provides information on how to select a car seat, based on a child’s age and size.  It includes ease-of-use ratings that lets parents compare seats to find the right one for their child.
• Children’s Hospital of Wisconsin Car Seat Safety webpage, includes information on car seat clinics, laws and best practices and fact sheets in English and Spanish.
• Pediatric Dentistry: Common Treatment Options The most common pediatric dental services include dental exams and cavity fillings. These dentists also specialize in tooth extractions, preventive treatments, and restorative treatments. From NewMouth .

Hearing and Vision

• “ The Importance of Stimulating a Child’s Vision ” research-to-policy article from the Urban Child Institute.
•   “ Vision Development in Preschool and School-aged Children” from the American Academy of Ophthalmology”.
•   “ Prevent Blindness Wisconsin” offers fact sheets about screening for, and protecting, children’s vision”

Lead Prevention

• The Wisconsin Department of Health Services offers information childhood lead poisoning and lead-free housing: https://www.dhs.wisconsin.gov/lead/create-lead-safe-housing.htm
• On this Environmental Protection Agency (EPA) website, you can Learn about Lead , learn how to Protect Your Family , and find resources to work with children and families . The EPA also offers lead (plomo) information in Spanish .
• Safe Sleep for Babies Updates to the American Academy of Pediatrics’ safe sleep recommendations to protect against SIDS and sleep-related deaths are provided in this 10/24/16 video and accompanying article.
• American Academy of Pediatrics’ Task Force on SIDS:  What’s New in 2016 , Dr. Rachel Moon, MD, internationally recognized expert in SIDS and post-neonatal infant mortality.  52:33 minutes.
• Study:  Parents not following safe sleep advice for infants in AAP News, Aug. 15, 2016.
• American Academy of Pediatrics section on Child Death Review and Prevention – Safe Sleep includes policy and publications, information for families, safe sleep campaigns and frequently asked questions related to safe sleep practices for infants.
• Safe to Sleep public education campaign led by the National Institute of Child Health and Human Development contains science-based information about SIDS/Safe Sleep, campaign materials, outreach materials, videos and more.
• March of Dimes Safe Sleep for your Baby , offers information on how much sleep a baby needs, the safest place for baby to sleep, how to put baby to sleep safely and bedtime routines.
• How to Keep Your Sleeping Baby Safe:  AAP Policy Explained .  This article for parents addresses the dangers of unsafe sleep environments for babies and the pre- and postnatal recommendations from the AAP, through babies’ first year of life.
• Your New Baby Safe at Home .
• Cribs for Kids   A national safe sleep initiative since 1998, their mission is to prevent deaths caused in unsafe sleeping environments by educating parents and caregivers on the importance of practicing safe sleep for their babies and by providing portable cribs to families who, otherwise, cannot afford a safe place for their babies to sleep.
• Children’s Health Alliance of Wisconsin , with the WI Dept. of Health Services Maternal and Child Health Title V program, provides tools that support tribal and local health departments in addressing infant safe sleep. The website includes a safe sleep video, Sleep Baby Safe training modules, training materials, newborn nest and safe sleep local campaign examples. Educational materials available in several languages.

Diversity, Equity and Inclusion

• Principles of Inclusion, Diversity, Access and Equity by Tina Q Tan (September 2019) https://academic.oup.com/jid/article/220/Supplement_2/S30/5552351?login=true
• Reflections on Research: Toward an Open Data Toolkit Centered on Diversity, Equity, Inclusion, and Accessibility Principles (12/9/2020) by Rachel Woodbrook https://deepblue.lib.umich.edu/bitstream/handle/2027.42/166087/Woodbrook_DEIADataToolkit_LYRASIS_Whitepaper.pdf?sequence=1
• Anti – Racism Daily https://antiracismdaily.com/ “Each day, we offer an overview on current events and apply an anti-racism lens. Learn how practices embedded in our politics, criminal justice system, and workplaces enforce systemic oppression – and what you can do about it.”
• Privilege 101: A Quick and Dirty Guide by Sian Ferguson (September 29, 2014) https://everydayfeminism.com/2014/09/what-is-privilege/
• How to get Serious about Diversity and Inclusion in the Workplace by Janet Stovall https://www.youtube.com/watch?v=kvdHqS3ryw0 (September 13, 2018) TED Talk “Imagine a workplace where people of all colors and races are able to climb every rung of the corporate ladder — and where the lessons we learn about diversity at work actually transform the things we do, think and say outside the office. How do we get there? In this candid talk, inclusion advocate Janet Stovall shares a three-part action plan for creating workplaces where people feel safe and expected to be their unassimilated, authentic selves.”
• The Essential Power of Belonging by Caroline Clarke https://www.youtube.com/watch?v=RNiGny7OlWg&list=TLPQMTMwODIwMjEJgfS2KPFg2Q&index=6 TEDx  (11:28) “Author and journalist Caroline Clarke explores our fundamental need for belonging and how critical it is not only to every individual’s fulfillment and success but to our collective wellbeing and future.”
• Just Belonging: Finding the Courage to Interrupt Bias by Kori Carew TEDx https://www.youtube.com/watch?v=DIf43L6hNkM&list=TLPQMTMwODIwMjEJgfS2KPFg2Q&index=3 (19:16) “A moment of racial tension presents a choice. Will we be silent about implicit and unconscious bias, or will we interrupt bias for ourselves and others? Justice, belonging, and community are at stake.”
• Colorism https://www.nccj.org/colorism-0 the National Conference for Community and Justice “In this bulletin, we will be discussing the topic of Colorism. You will find history, videos, articles/handouts, statistics and questions to ponder related to this issue.”
• People of Color Discuss the Impact of ‘Colorism’ on GMA https://www.youtube.com/watch?v=AIx131aaY6A July 22, 2020 (6:28) Research shows people with darker skin experience an increased number of problems, including socioeconomic issues. Amira Adawe of The Beautywell Project weighs in on how to fight the bias.

Cultural Humility 101

• How to Outsmart Your Own Unconscious Bias by Valerie Alexander TEDx (October 22, 2018) https://www.youtube.com/watch?v=GP-cqFLS8Q4 (17:23)
• Sometimes You’re A Caterpillar https://www.youtube.com/watch?v=hRiWgx4sHGg&t=1s
• Mental Health Services
• Children’s Bureau Express
• National Center for Cultural Competence , Georgetown University.  The mission of the NCCC is to increase the capacity of health care and mental health care programs to design, implement, and evaluate culturally and linguistically competent service delivery systems to address growing diversity, persistent disparities, and to promote health and mental health equity.
• The Cross Cultural Health Care Program offers a Cultural Competence Resource Guide for health and social service providers.
• University of Kansas Community Health and Development Center’s Community Toolbox, C ultural Competence in a Multicultural World , features 11 topics related to Culture and Diversity.
• African American Lives Today , Robert Wood Johnson Foundation & Harvard School of Public Health.  Find research data from a national survey examining African-Americans’ views on their personal and family lives, community, experiences of discrimination and financial situations.  There are links to research on health issues faced by African-Americans in our country.
• The Ways : Stories on Culture & Language from Native Communities Around the Central Great Lakes.
• The Danger of a Single Story , 2009, Chimamanda Ngozi Adichie, TED Talks
• My Year of Reading a Book from Every Country in the World , Ted Talk, Ann Morgan,  (12:03 min)
• How Culture Connects to Healing and Recovery , Ted Talk , Fayth Parks (13:40 min)

Online Training Resources

• Allies for Reaching Community Health Equity offers monthly online training events.  For a calendar of online training events, check out the Culture of Health Institute for Leadership Development (CHILD) .
• 5 Diversity Modules include a General Diversity Module, Amish Culture, Hispanic Culture, Hmong Culture and Native American Culture for general audiences and adapted modules for clinical providers from the La Crosse Medical Health Science Consortium, UW Lacrosse.
• Working With the African American Father: The Forgotten Parent Authors: California Social Work Education Center includes objectives, agenda, and trainer and trainee materials to develop professional practice working with African-American father’s and address systemic biases.
• What Works for African American Children and Adolescents: Lessons from Experimental Evaluations of Programs and Interventions Authors: Bandy and Moore Identifies programs that do and do not work and intervention strategies that contribute to program success.
• Culturally Diverse Parent-Child and Family Relationships: Guide for Social Workers and Other Practitioners Author: Webb Reviews the parent-child relationships and caregiving practices of subgroups of various racial and ethnic groups, outlines ethical issues in socialw ork with culturally diverse children, and describes a frameowrk for culturally responsive practice.
• Developing Cross-Cultural Competence: A Guide for Wokring with Children and Thier Families Authors: Lynch and Hanson Information on working with families and children with disabilities from specific cultrual, ethnnic, and language groups.
• Understanding Our New Racial Reality Starts with the Unconscious Source: Greater Good – the Science of Meaningful Life
• McK-V Inquirer: A newsletter of helpful tips & resources for serving children and youth experiencing homelessness found on the Wisconsin Early Childhood Collaborating Partners website. Scroll down to STATE RESOURCES and click on the issue you want to read.
• Standards and Indicators for Cultural Competence in Social Work Practice ,National Association of Social Workers (2015)
• Father Involvement and Child Welfare:  The Voices of Men of Color , Journal of Social Work Values and Ethics, Vol. 11, Number 1 (2014)
• Developing Culturally Responsive Approaches to Serving Diverse Populations: A Resource Guide for Community-Based Organizations This 2017 resource guide identifies easily accessible resources on cultural competency that organizations can use to become more responsive to the needs of their targeted populations, and to help attract funds to support their important work.
• Head Start’s Early Childhood Learning and Knowledge Center (ECLKC) . Administrators, teachers, caregivers, and families can use these resources to help ensure culturally and linguistically appropriate services for all children birth to 5. These resources can also help staff provide high quality services for children who are dual language learners (DLLs). Programs can promote positive experiences for DLLs by holding high expectations. They can also emphasize children’s cultural and linguistic strengths.
• Head Start’s ECLKC Family Engagement webpage, which includes the Parent, Family, and Community Engagement (PFCE) Framework, Boosting School Readiness through Family Engagement (simulation series), Engaging and Goal-Setting with Families, and the Family Engagement Family, Language and Literacy webinar series.  https://eclkc.ohs.acf.hhs.gov/family-engagement

Domestic Violence

• Survivors of Domestic Violence May Enroll in Health Care at ANY TIME Health centers and domestic and sexual violence advocacy organizations can partner to support survivor health and prevent violence. Through cross-trainings and warm referrals, providers and advocates are able to provide comprehensive coordinated care for survivors and their families.
• National Network to End Domestic Violence Take Action NNEDV asks advocates and allies to contact Congress at key times to influence legislation and funding for domestic violence programs.  NNEDV will ask you to make phone calls, send an email or take action on social media sites.  Taking a few minutes to contact your elected officials can mean a world of difference to a survivor of domestic violence.
• Building Domestic Violence Health Care Responses in Indian Country: A Promising Practices Report, The Family Violence Protection Fund
• Stop Asking Already: 6 Reasons Why Intimate Partner Violence Survivors Stay in Their Relationships, Everyday Feminism
• In February 2012, the American College of Obstetrics and Gynecology (now the American Congress of Obstetrics and Gynecology) issued a position paper recommending universal screening for intimate partner violence .

Learning Modules

• Domestic Violence: Understanding the Basics
• DVeducation.ca , sponsored by Women’s College Hospital, Canada, has learning modules targeting health care professionals and others can benefit from the information, as well.  You must register to access the free modules.  Embed link in title. 
• How Much Do you Know About Stalking? Quiz from the Stalking Resource Center of the Nat’l Center for Victims of Crime, from the Office of Violence Against Women, U.S. Dept. of Justice. Embed link in title of quiz.
• Intimate Partner Sexual Abuse:  Adjudicating this Hidden Dimension of Domestic Violence This online course covers the legal, medical and social science aspects of intimate partner sexual abuse. It is focused on judges but is also intended for a multidisciplinary audience including court personnel. You can treat this website as a course and take it straight through or as a resource, accessing the background resources, modules, developing issues, recommendations and case studies on an as-needed basis.  Registration is required for the free modules, developed by the National Judicial Education Program of Legal Momentum.
• See the Signs: Speak Out Free bystander training programs available from a partnership of the Ohio Domestic Violence Network, the New York Society for the Prevention of Cruelty to Children, JWI, No More and Avon Foundation.  Be an Upstander, learn how to Recognize, Respond and Act. Check out these free online modules, available in English and Spanish, with registration.

Resources for Parents

• Children and Domestic Violence Fact Sheet Series – The National Child Trauma Stress Network Domestic Violence Collaborative Group announces a new series of fact sheets created for parents whose children have been affected by domestic violence. The set of 10 fact sheets gets to the heart of the experiences and needs of these children and families, and offers education in support of their resilience and recovery.
• Resources for Families What do kids need?  Find Best Practices for serving children, youth and parents experiencing domestic violence.
• The Childhelp National Abuse Hotline  is available 24 hrs. a day, every day of the year.  All calls are anonymous and toll-free.  Communication is available in 170 languages.  Downloadable resources, related to safety plans, dealing with difficult behavior words of encouragement for children and more, are also available.
• The Domestic Violence Resource Network (DVRN ) is funded by the U.S. Department of Health and Human Services to inform and strengthen domestic violence intervention and prevention efforts at the individual, community, and societal levels. It currently includes two national resource centers, four special issue resource centers, three culturally-specific resource centers, the National Domestic Violence Hotline, and the National LGBTQ DV Capacity Building Learning Center
• The National Domestic Violence Hotline aids victims of domestic violence 24 hours a day. Hotline advocates assist victims, and anyone calling on their behalf, by providing crisis intervention, safety planning and referrals to local service providers. The hotline receives more than 24,000 calls a month.  800-799-SAFE (7233)
• End Domestic Abuse Wisconsin mission is to promote social change that transforms societal attitudes, practices and policies to prevent and eliminate domestic violence, abuse and oppression. Their website includes resources access to services, economic justice, legal issues, public policy, outreach to underserved communities and more.
• Futures Without Violence provides resources and training related to all aspects of violence, including webinars, resources on a continuum of topics related to violence, and downloadable articles/manuals.
• For almost two decades, the National Health Resource Center on Domestic Violence (The Center)  has supported health care professionals, domestic violence experts, survivors, and policy makers at all levels as they improve health care’s response to domestic violence. The U.S. Dept. of Health and Human Services, Family & Youth Service Bureau, funds the Center. Embed link in italicized name.
• The National Center on Domestic Violence, Trauma & Mental Health was established in 2005 with funding from the FVPSP. Its mission is to develop and promote accessible, culturally relevant, and trauma-informed responses to IPV and other lifetime trauma so that survivors and their children can access the resources that are essential to their safety and well-being.
• State and national resources for domestic violence , includes a safety plan, national domestic violence hotline, state-by-state legal information, and more
• Help for Abused and Battered Women provided by HELPGUIDE.org, a trusted guide to mental, emotional and social health through a partnership with Harvard University
• National Indigenous Women’s Resource Center The Mission of NIWRC is to support culturally grounded, grassroots advocacy and to provide national leadership to ending gender-based violence in Indigenous communities through the development of educational materials and programs, direct technical assistance, and the development of local and national policy that builds the capacity of Indigenous communities and strengthens the exercise of tribal sovereignty. Access educational and advocacy resources on this website.
• The National Network to End Domestic Violence (NNEDV ), a social change organization, is dedicated to creating a social, political and economic environment in which violence against women no longer exists.
• Youth.gov Victims of teen dating violence often keep the abuse a secret. They should be encouraged to reach out to trusted adults like parents, teachers, school counselors, youth advisors, or health care providers. They can also seek confidential counsel and advice from professionally trained adults and peers.  Find resources for teens involved in abusive relationships here.
• Transitional Housing Toolkit This toolkit is meant to provide transitional housing providers with easy access to information and resources to enhance services to survivors. The information provided here addresses frequently asked questions, common challenges, best practices, templates for adaptation, and resources for additional information and assistance.
• Domestic Violence Oklahoma State Department of Health. Oklahoma Home Visitor Training. Enter ‘Oklahoma Home Visitor Training, Domestic Violence webinar’ in website’s search bar to gain access to the training.
• Child Abuse and Neglect Reporting Oklahoma State Department of Health. Oklahoma Home Visitor Training. August 2008 – Prevention Webinar presented by the Federal Interagency Work Group on Child Abuse and Neglect’ in website’s search bar to access webinar

Engaging Families

Professional Readings

• “We Were a ‘Hard to Reach’ Family,” Nikia Parker. Harvard Family Research Project, 2012
• “ Engaging Families in Case Planning ,” Child Welfare Information Gateway, 2012
• “Rituals and Routines: Supporting Infants and Toddlers and Their Families,” National Association for the Education of Young Children (NAEYC)
• “Families as Advocates and Leaders” National Center on Parent, Family, and Community Engagement
• Strength-based parenting improves children’s resilience and stress levels Medical Press
• Why Don’t We Prepare Men for Fatherhood? Huffington Post
• Engaging Families in Home Visiting: Why Does Family Engagement Matter? , The Institute for Child and Family Well-Being (UW-Milwaukee and Children’s Hospital of Wisconsin)
• Connecting Strengthening Families with Home Visiting Strategies , Center for the Study of Social Policy’s Strengthening Families.
• Engaging Low-Income Fathers in Home Visiting: Approaches , Challenges and Strategies .  Urban Institute, U.S. Dept. of Health and Human Services, Administration of Children and Families, Nov. 2015.)
• Engaging Families: Field Guide to Making Home Visits Matter.   “This field guide intended for social workers in child welfare, includes strategies for engaging families, steps for working with resistance and developing a working agreement, and tasks that a worker or support person can do to assist families through each stage of the process.”  Maine Dept. of Children and Families Div. of Youth and Family Services, 2012.
• Family Engagement:  Partnering with Families to Improve Child Welfare Outcomes , Bulletin for Professionals, Sept. 2016. Child Welfare Information Gateway. Children’s Bureau/ACYF/ACF/HHS.
•   News You Can Use: A Circle of Support for Infants and Toddlers – Reflective Practices and Strategies in Early Head Start, Explore strategies and issues to consider to overcome a break down in reflective practice, and suggestions for encouraging parents to reflect and build on parenting practices.
• Boosting School Readiness through Effective Family Engagement Series, “What you do and say matters! Explore and practice everyday strategies to develop Positive Goal-Oriented Relationships with a family. Four different simulations provide strategies and opportunities for you to practice skills to build bonds with families, help families develop and set goals, explore strength-based attitudes during challenging times, and have conversations about developmental concerns.  Head Start Early Childhood Learning and Knowledge Center, U.S. Dept. of Health Services

Recognition

• Appreciation Coupon_English
• Appreciation Coupon_Spanish
• Resources including Public Service Announcements, media strategies and talking points are available by clicking the link to the Parents Anonymous NPLM toolkit.

Early Intervention Video Library “This video library is designed to be a central resource for EI videos which can be used for professional development, preservice preparation, public awareness, and individual study. These videos address a variety of topics and represent EI as provided in a variety of states. All videos embedded in this site are available as free resources.”

Ethics and Boundaries Ethics and Boundaries

• ANA – Code of Ethics
• NAEYC – Code of Ethical Conduct and Statement of Commitment
• NOHS – Ethical Standards for Human Service Professionals
• NASW – Code of Ethics of the National Association of Social Workers
• NASW Setting and Maintaining Professional Boundaries
• Home Visitors’ Handbook: Ethical Considerations , The Office of Head Start, in the Administration for Children and Families provides an interactive online handbook for home visitors. This page of the handbook focuses on ethics.
•   Boundaries in Home Visiting.  Heidi Roibl, published by the University of New Mexico, in partnership with NM Children, Youth and Families Department, and Center for Development and Disabilities (2013).
• Maintaining Professional Boundaries and Ethics in the Home Visitation Setting , Michael Provost, LCSW, Parents as Teachers Program Director (Parents Possible).
• Ethical and Boundary Issues for Home Visitors and In-Home Workers , Elizabeth R. Cohen, Director Mental Health and Wellness Division, Power Point presentation, NASW Spring Conference WV, 5/12/13.
• Analysis of an Ethical Dilemma in Child Welfare in The New Social Worker (Fall, 2008).
• Client Relationships and Ethical Boundaries for Social Workers in Child Welfare in The New Social Worker (Winter, 2009).

Financial Capacity Building

• Financial Literacy Resource Directory provides information on financial literacy resources, issues and events that are important to bankers, organizations, and consumers of all ages. The directory includes descriptions and contact information for a sampling of organizations that have undertaken financial literacy initiatives as a primary mission, government programs, fact sheets, newsletters, conference materials, publications, and links to Web sites. Office of the Comptroller of the Currency, U.S. Dept. of the Treasury
• MyMoney.gov contains information, games and fun facts related to money, saving and planning for youth; curricula, tip sheets, lesson plans, guidance and helpful tools for teaching financial capability for teachers/educators; and a clearinghouse of federally-funded research reports, datasets, and articles on financial capability and related topics for researchers/other professionals.
• The Balance : The Balance Money Website is a great tool for people new to budgeting. “Use this budget calculator to plan for your savings goals and manage your expenses. Fill out all fields that apply to you and make adjustments to see how you could save more.”
• Good Budget : Share this budgeting website and app with families, help them to…“Spend, save, and give toward what’s important in life”

Health Insurance and Other Benefits

•   A Minor’s Right to Consent to Treatment and Authorize Disclosure of Protected Health Information .  
• Wisconsin Public Health Information and Referral Services. The State of Wisconsin provides several health hotlines to connect women, children, and children with special needs to services. The hotlines are answered 24 hours/day by professional Information and Referrals Specialists. The Specialists will refer callers statewide to the most appropriate agencies to apply for public benefits, such as, WIC, Birth to Three, Badgercare Plus, FoodShare, Prenatal Care Coordination, Childcare Subsidies, Early Intervention Programs, and the Wisconsin Well Woman Program.
• Prenatal Care Coordination.   Prenatal Care Coordination is a Medicaid and Badger Care Plus benefit that helps pregnant women get the support and services they need to have a healthy baby.
• Covering Kids Wisconsin The Covering Kids & Families initiative seeks to enroll eligible, uninsured children and adults in Medicaid and the State Children’s Health Insurance Program (SCHIP).
• Prenatal Care Coordination is a Medicaid and BadgerCare Plus benefit that helps pregnant women get the support and services they need to have a healthy baby.
• Covering Wisconsin , Their mission is to connect residents with and promote effective use of insurance coverage and other programs that support health. The site includes How to Sheets, Find Local Help, Help Using Health Insurance, tips for applying for Medicare, BadgerCare Plus (Medicaid) and the Health Insurance Marketplace.
• IPV Health . IPV Health cultivates partnerships between health care providers and domestic violence advocates to promote survivor’s health and safety.
• Get Ready for the Health Insurance Marketplace – A 30 minute, interactive training toolkit developed through the Substance Abuse and Mental Health Services Administration (SAMHSA) that describes the health care law, how it works, and why it is important for uninsured individuals with behavioral health conditions.

Home Visitor Safety Professional Reading

• Bed Bugs – Home Visiting
• Oregon’s Home Visitor Safety Guide 2014
• Safety Best Practices for Home Visitors .   Center for Prevention Research and Development, Oct. 2015.
• Meth Watch Program Home Visitor Safety Tips  https://secure.in.gov/meth/files/Employees_Home_Visitors_Safety_Tips.pdf
• Home Visiting Safety , Home Visitation Leadership Advisory Coalition (HVLAC)
• Home Visitor Safety , MIECHV Program Training Module. Adapted from the Idaho Department of Health and Welfare Family and Community Services: Social Worker Academy – Worker Safety
• Personal Safety for Visiting Professionals   Indiana Dept. of Children Health Services

Videos and Training Modules

• Home Visitor Safety:  Staying Safe and Aware on the Job
• Staying Safe as a Home Visitor Webinar : Presented by Police Department of Manchester, NH
• Home Visiting Safety and Other Practical Matters webinar Presented by New York State Community Action Association
• Preventing Lice and Scabies
• Causes, Symptoms and Treatment of Scabies

Knowing about Community Resources

Scavenger Hunt An activity that can be done to help new staff learn about community resources is a “scavenger hunt”. New staff are given a list of community resources – ones that they would frequently come in contact with in the course of their duties – and are required to go there, get information, learn about the resource somehow. The whole day is spent doing this, at the end of the day they report back to ‘home base’ and the supervisor – it can be done with small groups because it is more fun than going by yourself. Great for new staff and interns. You could choose places such as WIC, the county, Salvation Army, housing, a food pantry. And maybe throw in a couple ‘fun things’ too – lunch at a park that would have a great playground for kids or music during the summer over lunch hour. It is a fun way for staff to get experience with resources – before taking a family there.

• Want Happier Kids? Cuddle More , Yahoo Parenting
• Abusive Head Trauma: How to Protect Your Baby , HealthyChildren.Org
• The Neuroscience of Calming a Baby , Psychology Today
• Forbes: Can We Stop A Traumatized Child From Becoming A Traumatized Adult?
• Penn State: Helping parents understand infant sleep patterns
• In the Playroom: Helping Your Child’s Speech and Language
• Desert News – National: How raising kids within routines boosts social and emotional health
• The Atlantic: How Supportive Parenting Protects the Brain

Online Learning Activities

• The Protective Factors Overview learning activity is an introduction for anyone who would like to gain a better understanding of the five Protective Factors. This interactive learning activity provides a synopsis of the five Protective Factors, their relevance and their characteristics, opportunities to practice identifying them and an understanding of how a strengths-based approach is integral to building these Protective Factors.
• Hospital for Sick Children: Why is it important to Comfort your child? (1:08)
• Love, a low tech solution – Laura Peterson, TEDx Talks (16:40)
• Parenting Newsletters and Other Parenting Resources from the University of WI Extensio n, includes audio podcasts and downloadable resources for expecting parents and parents of children in every stage – from infants through teenagers, related to developmental stages, temperament, and useful strategies for parents.
• Head Start: National Center on Parent, Family and Community Engagment
• Zero to Three
• Intimate Partner Violence (IPV) presents complex and difficult issues for families, communities and home visiting programs. Research articles about IPV and its effects can be found at the U.S. Dept of Health and Human Services’ Child Welfare Information Gateway.

Breastfeeding

• The Wisconsin Department of Health Services (DHS) offers breastfeeding information and links to breastfeeding promotion and education resources .
• The Centers for Disease Control and Prevention (CDC) provides breastfeeding information for families, communities, and health providers, including answers to Frequently Asked Questions, approaches to promotion and support, and recommendations for safe handling of human milk, and links to programs such as the Baby-Friendly Hospital Initiative .
•   AllBabiesCryBrochure

Parent Leadership

• Five Similarities Between Leadership and Parenting , Forbes Magazine, Brent Gleeson, 2014.
• Effective Leadership and Parenting for Challenging Times Foster Cline, MD. Happy Heart Families,
• Parenting Styles: the Situational Approach , Penn State Leadership Blog
• Leadership and Parenting:  Parallels , Penn State Leadership Blog
• Leadership Begins at Home , Michael McKinney, Leadership Minute: Building a Community of Leaders
• The   Role of the Parent Co-Presenter  learning activity is designed provide Parent Co-Presenters with an understanding of what is involved in co-facilitating the  Bringing the Protective Factors Framework to Life in Your Work  training for family serving professionals. The learning activity defines the roles of the Parent Co-Presenter and the Certified Trainer. Video montages, by current Parent Co-Presenters, highlight the benefits of serving in this role and sharing one’s story in an impactful way.
• From Leadership to Parenthood:  The Applicability of Leadership Styles to Parenting Styles , Group Dynamics:  Theory, Research, and Practice, 2006, Vol. 10, No. 1, 43-56.
• Building Parent Leadership Manual, Georgia Dept. of Education.  This manual was created to assist organizations and parent leaders in organizing, planning, and implementing events, activities, and outreach programs to promote parent leadership in schools and communities.
• Parents Anonymous
• The Influence of Fathers on Young Children’s Development Zero to Three National Center for Infants, Toddlers, and Families

Poverty and Financial Capacity Building

• Stresses of Poverty May Impair Learning Ability in Young Children .   U.S. Dept. of Health & Human Services, National Institutes of Health
• Children in Poverty:  Key Facts About Child Poverty (Jan. 2019) Child Trends.
• Estimating the Economic Cost of Childhood Poverty in the United States , Social Work Research, Vol. 42, Issue 2, June 2018, found on Oxford Academic Social Work Research website.
• American Psychological Association’s journal, Monitor on Psychology, July/Aug. 2015 cover story, Fighting Poverty .  New research is finding ways to help people overcome poverty and avoid the mental and physical health problems associated with low socioeconomic status.
• How to Reduce Poverty in the United States , University for Poverty Research, UC Davis, 2015.
• Five Ways to End Poverty in the United States (BorgenProject.Org, 2016).  These tips help all of us think about the roles we can take to reduce poverty in our country.
• Poverty and Parenting Young Children: The Role of Parenting in the Intergenerational Transmission of Poverty.  (Focus. Vol. 33, No. 2. Spring/Summer 2017. Found on Institute for Research on Poverty, UW-Madison’s website.)

Reports/Statistics

• United States Census Bureau’s I ncome and Poverty in the United States: 2015 . This report presents data on income, earnings, income inequality, and poverty in the United States based on information collected in the 2016 and earlier Current Population Survey Annual Social and Economic Supplements (CPS ASEC) conducted by the U.S. Census Bureau.
• United States Census Bureau’s Poverty Data , provides poverty data from several household surveys and programs. Here you can find poverty estimates, learn about these surveys and programs, and get guidance on how to choose the right estimate for your needs.
• Wisconsin Poverty Report: Treading Water in 2017: the Eleventh Annual Report of the Wisconsin Poverty Project (2019) is from the Wisconsin Poverty Project, Institute for the Research on Poverty, UW Madison.
• Poverty’s Effect on Infants and Toddlers Infographic (Sept. 2018).  Zero to Three.
• WI ALICE (Asset Limited, Income Constrained, Employed) Report . United Way of Wisconsin 2016. Despite recent reports of overall improvement in employment and gains in median incomes, the economic recovery in Wisconsin has been uneven. This Report updates the cost of basic needs in the Household Survival Budget for each county in Wisconsin, and the number of households earning below the amount needed to afford that budget (the ALICE Threshold). The Report delves deeper into county and municipal data and looks at the demographics of ALICE and poverty-level households by race/ethnicity, age, and household type to reveal variations in hardship that are often masked by state averages.
• U.S. Census Bureau Library for Income and Poverty data contains static, printable materials.
• 2Gen Tools to Help Children and Families Thrive is a resource for programs implementing state, federal and local programs serving children and families, published by the Dept. of Education.
• Pediatricians’ Guide to Poverty Resources – Wisconsin
• Federal Poverty Guidelines determine enrollment in state health care and other programs.
• 99 Great Resources Confronting Poverty and Hunger , from MSWOnlinePorgrams.org, resources for social workers.
• National Center for Homeless Education Wisconsin data and information.
• Wisconsin Community Action Association , whose goal is to help low-income individuals and families escape poverty. WISCAP believes in personal and in community responsibility to ensure economic opportunity.
• Wisconsin Homeless Assistance Agencies , U.S. Housing and Urban Development.
• Benefits.gov – Your Path to Government Benefits in Wisconsin .
• Wisconsin Fathers for Children and Families: Legal Services for Low-Income Parents – Low Income Legal Resources by regions of the state.

Tools for Professionals

• Your Money, Your Goals Toolkit i s a financial empowerment toolkit designed by the Consumer Financial Protection Bureau (CFPB). The toolkit helps organizations understand when and how to introduce to clients’ financial empowerment concepts such as goal- setting, saving for emergencies, managing debts, understanding credit, and choosing safe and affordable financial products. English | Spanish
• National Human Services Directory (NHSA) is comprised of over 55 of the largest national nonprofit human service organizations. In aggregate, members and their affiliates and local service networks collectively touch, or are touched by, nearly every household in America—as consumers, donors, or volunteers.   NHSA staffs four different initiatives through which leaders can work together to improve family stability and well-being.  
•   9 Ways to Reduce Poverty, from PBS’s Raising of America:  Early Childhood and the Future of our Nation.

Pregnancy and Maternal Health

• Breastfeeding Protects against Environmental Pollution.  (2015). Science Daily.  https://www.sciencedaily.com/releases/2015/05/150522083414.htm
• Substance Abuse While Pregnant and Breastfeeding   https://www.drugabuse.gov/publications/research-reports/substance-use-in-women/substance-use-while-pregnant-breastfeeding
• Fetal Alcohol Exposure Fact Sheet.  National Institute on Alcohol Abuse and Alcoholism.  https://pubs.niaaa.nih.gov/publications/FASDFactsheet/FASD.pdf
• Racial and Ethnic Infant Mortality Gaps and Socioeconomic Status (2014) Institute for Research on Poverty research publication. http://www.irp.wisc.edu/publications/focus/pdfs/foc311f.pdf
• Understanding Racial and Ethnic Disparities in U.S. Infant Mortality Rates.  Data Brief, National Center for Health Statistics, U.S. Dept. of Health and Human Services.  (2011). https://www.cdc.gov/nchs/data/databriefs/db74.pdf
• The Periscope Project Website contains work from the Wisconsin project which hosts a consultation line and other resources to support professionals working with new parents, that may be struggling with perinatal mental health and depression.  This site provides information on screening guidelines and resources beyond the Perinatal Algorithm training. On the site you will find screening tools, educational modules/ videos and tools on a variety of perinatal mental health topics.
• Promote, coordinate and develop perinatal care in Wisconsin
• Aid in the development and implementation of programs to improve the health and health care of pregnant women and newborn infants
• Improve public understanding and awareness of perinatal health care
• Prenatal Care Coordination , Wisconsin Department of Health Services
• March of Dimes has information for families, communities, and professionals on a variety of topics designed to promote healthy pregnancies and babies, including prenatal care, and preterm labor and premature birth .
• Text4baby is a free health education text message service (with most cell carriers) for pregnant women and mothers of babies under one year of age. Anyone can sign up!
• National Maternal and Oral Health Resource Center   – Georgetown University https://www.mchoralhealth.org/highlights/pregnancy.php This collection of selected resources offers high-quality information about pregnancy and oral health. Use the website tools for further searching, or contact them for personalized assistance.
• Maternal and Child Health Bureau   https://mchb.hrsa.gov/ Covers MCH domains: maternal/women’s health, perinatal and infant health, child health, adolescent health, and children with special health care needs, data, research & epidemiology and more.
• Breastfeeding Facts and Research. https://www.cdc.gov/breastfeeding/index.htm   The CDC’s webpage includes Guidelines and Recommendation, Diseases and Conditions, Data and Statistics, Research, Promotion and Support, National Policies and Positions, Frequently Asked Questions.
• Breastfeeding vs. Formula Feeding – Medline Plus (U.S. National Library of Medicine) https://medlineplus.gov/ency/patientinstructions/000803.htm
• Tip Sheet Edinburgh Postnatal Depression Scale (EPDS)
• Saving Our Babies “The gap in birth outcomes between Black and white women in Dane County and Wisconsin has persisted for decades, while Black mothers and birthing people across the state face consistently higher rates of maternal deaths each year. We are collaborating across sectors to implement community-driven solutions to end this crisis and produce better birth outcomes for Black families.”
• Nips and Babes “Forging a way for all birthing people to access a new model of comprehensive care: quality doula, lactation, emotional and parenting supports in Dane County.”

Professional Practices and Skills for Working with Families

Competencies and Best Practices

• Challenges and Best Practices for Scaling Home Visiting Programs, New America education policy program, Conor P. Williams, 4/15/14.   
• Infant Mental Health Competency Guidelines for Infant Mental Health Endorsement , Providing services that promote healthy social-emotional development during the first years requires a unique knowledge base and skill set.  Learn more about the competency guidelines that provide a framework for establishing and recognizing expertise of professionals who work with pregnant women and families with children ages birth to 3 years old.
• Competencies and Best Practices, add Home Visiting:  Supporting Parents and Child Development, Zero to Three policy briefs and planning tools.
• The National Family Support Network’s Standards of Quality for Family Strengthening & Support were issued by the California Network of Family Strengthening Networks (CNFSN) in 2012, and adopted by the National Family Support Network in 2013. They are the first and only standards in the country to integrate and operationalize the Principles of Family Support Practice with the Strengthening Families Frameworks and its research-based evidence-informed 5 Protective Factors. The vision is that their implementation will help ensure that families are supported and strengthened through quality practice.
• Best Practices in Early Childhood Home Visiting , MSW research paper is a qualitative research exploration of the best practices surrounding the specific realm of home visiting, focused on ages three to five, specific to school readiness.  Author:  Shannon Melody Karsten
• Want to Work with Children?  5 Skills and Qualities You Should Be Working On , in Social Worker’s Helper, Jan. 30, 2014.
• Tips for Making Home Visits in Child Welfare, The New Social Worker

Professional Tools

• Motivational Interviewing
• FAN tool developed by Erikson’s Fussy Baby Network becomes a national model
• Online Tutorials for Early Childhood Mental Health Consultants, Center for Early Childhood Mental Health Consultation, Georgetown University Center for Child and Human Development free modules.
• James Madison University’s Outreach and Engagement Early Impact Virginia program offers 39 free online courses for home visitors.  Registration is required.

Program Administration Tools

• Critical Elements
• Core Competencies

Federally Recognized Evidenced-Based Home Visiting Models

• Healthy Families of America
• Parents As Teachers
• Nurse Family Partnership
• Early Headstart

Program Evaluation Professional Reading

• The 2017 W. K. Kellogg Foundation Evaluation Handbook is designed for people with little or no experience with formal evaluation, making evaluation practices accessible to grantees, nonprofits and community leaders.
• Designing Evaluations , 2012 Revision Author: U.S. Government Accountability Office Description: “This methodology transfer paper addresses the logic of program evaluation designs. It introduces key issues in planning evaluation studies of federal programs to best meet decision makers’ needs while accounting for the constraints evaluators face. It describes different types of evaluations for answering varied questions about program performance, the process of designing evaluation studies, and key issues to consider toward ensuring overall study quality.”
• How Nonprofits Can Use Data to Solve the World’s Problems , December 2012 Author: Victor Luckerson
• National Conference of State Legislatures, Home Visiting:  Improving Outcomes for Children (4/26/2018) .   
• Using Data to Measure Performance of Home Visiting explores a new framework for assessing effectiveness of home visiting programs. (2015)
• A Framework for Program Evaluation:  A Gateway to Tools provides a synthesis of existing best practices and a set of standards that can be applied in almost any setting.  It provides a stable guide to design and conduct a wide range of evaluation efforts in a variety of specific program areas, made available through the Center for Community Health and Development at the University of Kansas – Community Toolbox.
• An Introduction to Evidence-based Programming is an implementation resource guide for social service programs provided by the Office of Family Assistance, U.S. Dept. of Health and Human Services.
• Center for Disease Control and Prevention; Other Evalaution Resources Purpose Statement: This page is a list of evaluation resources such as: program evaluation guides/manuals, manuals on specific evaluation steps (e.g., logic models, data collection methods), evaluation-related websites, key professional associations and journals.
• MDRC, Design Options for Maternal, Infant, and Early Childhood Home Visiting Evaluation (DOHVE) Project Resources Purpose Statement: This page is a list of resources for Maternal, Infant, and Early Childhood Home Visiting (MIECHV) programs (such as WI’s Family Foundations home visiting sites) on issues related to strengthening their evaluations of promising programs, developing and adapting data systems to facilitate tracking and reporting on federal benchmarks, and implementing quality improvement systems.
• American Evaluation Association Purpose Statement: The American Evaluation Association is an international professional association of evaluators devoted to the application and exploration of program evaluation, personnel evaluation, technology, and many other forms of evaluation. Evaluation involves assessing the strengths and weaknesses of programs, policies, personnel, products, and organizations to improve their effectiveness. AEA has approximately 7300 members representing all 50 states in the U.S. as well as over 60 foreign countries.

Research/Frameworks in Home Visiting Professional Reading

Specific reports/articles:

• Home Visiting Evidence of Effectiveness Review , Office of Planning, Research, and Evaluation, Administration for Children and Families, 2011
• Return on Investment: Evidence-based Options to Improve Statewide Outcomes , Washington State Institute for Public Policy, 2011
• Visiting Nurses, Helping Mothers on the Margins , New York Times
• Opening Up Avenues of Success for New Parents , Huffington Post
• Which families gain most from home visiting? , PeventionAction.Org
• Policy solutions that work for low-income people , CLASP
• Home Visiting Programs: An Early Test for the 114th Congress , Brookings
• Police chiefs call on Congress to fund home visits for at-risk mothers , Milwaukee Journal Sentinel
• H ome Visiting Family Support Programs: Benefits of the Maternal, Infant, and Early Childhood Home Visiting Program .
• Home Visiting:  A Service Strategy to Reduce Poverty and Mitigate Its Consequences , in the Academic Pediatrics Journal.  (2016)
• County Health Rankings & Roadmaps , sponsored by the Robert Wood Johnson Foundation, features the expected beneficial outcomes, other potential beneficial outcomes, evidence of effectiveness, implementation examples and resources.

Journals that often carry Home Visiting research articles:

• Children and Youth Services Review
• Prevention Science
• Tribal Home Visiting Evidence of Effectiveness Review: Process and Results , USDHS, February 28, 2011
• U.S. Department of Health and Human Services, Home Visiting Evidence of Effectiveness
• Pew Charitable Trust, Center on the States, home Visiting Campaign, Research
• Early Head Start Research and Evaluation project
• Nurse Family Partnership – “Proven Results” (includes links to internal and external research)
• Darkness to Light
•   National Home Visiting Resource Center provides comprehensive information about early childhood home visiting. Its goal is to support sound decisions in policy and practice to help children and families thrive.
• Sponsored by the U.S. Dept. of Health and Human Services, Home Visiting Evidence of Effectiveness (HomVEE) offers a thorough and transparent review of the home visiting research literature and assess evidence of effectiveness for home visiting programs that serve families with pregnant women and children from birth to age 5.
• HRSA Maternal & Child Health The Maternal, Infant, and Early Childhood Home Visiting Program gives pregnant women and families, particularly those considered at-risk, necessary resources and skills to raise children who are physically, socially, and emotionally healthy and ready to learn. Learn more about home visiting, evidence-based models, current grantees, research and development platform, outcomes measures and download the 2017 Home Visiting Infographic related to MIECHV funded programs.https://mchb.hrsa.gov/maternal-child-health-initiatives/home-visiting-overview
• Nurse Family Partnership: Helping First-Time Parents Succeed . Learn about this evidence-based nursing model of home visiting on their website.
• Head Start Learning Outcomes Framework resents five broad areas of early learning, referred to as central domains. The framework is designed to show the continuum of learning for infants, toddlers, and preschoolers. It is grounded in comprehensive research around what young children should know and be able to do during their early years. Explore this framework through interactive software .
• Head Start’s Framework for Effective Practice uses the model of a house to represent five integral elements of quality teaching and learning for children ages birth to 5.
• Tribal Evaluation Institute’s mission is to help Tribal Home Visiting Program grantees build capacity in gathering, using and sharing information to improve the health and well-being of children and families.  The website makes the TEI technical assistance resources available to a broader audience of tribal program staff, community members and professionals who partner with tribal communities.
• Family Spirit Home Visiting Program is a unique, evidence-based home-visiting model with a reputation for success: dependability with flexibility. It addresses intergenerational behavioral health problems, applies local cultural assets, and overcomes deficits in the professional healthcare workforce in low-resource communities. It is the only evidence-based home-visiting program ever designed for, by, and with American Indian families.
• Adverse Childhood Experience’s (ACE’s) Study Video Summary
• Example of home visiting/coaching

Self-Care Articles

• The Power of Good Habits – Using High-Performance Habits to Achieve Significant Goals , Mind Tools
• https://www.perimeterhealthcare.com/about/news/the-importance-of-self-care/
• How to Transform Stress into Courage and Connection , Greater Good – the Science of a Meaningful Life
• Stress Diaries – Identifying Causes of Short-Term Stress , Mind Tools
• Doing More Than One Job – How to Juggle Multiple Roles at Work , Mind Tools
• Minimizing Distractions – Managing Your Work Environment , Mind Tools
• Secondary Traumatic Stress: A Fact Sheet for Child-Serving Professionals , The National Child Traumatic Stress Network (NCTSN)
• The Importance of Mindfulness , PsychAlive (2:41)
• What is self-care and why is it important?, Anna Freud NCCF (2:55)

Sound Beginnings Module Resources

• Sound Beginnings Website
• Hearing Milestones Checklist
• Vision Milestones Checklist Strengthening Family Coping Resources

Strengthening Family Coping Resources

• Strengthening Family Coping Resources for Home Visitors (SFCR-HV) is an adaptation of SFCR, a trauma-focused, multi-family, skill-building intervention. The Milwaukee Child Welfare Partnership has two resources for home visitors to use when practicing SFCR:  Strengthening Family Coping Resources: A Guide for Home Visitors  and  Strengthening Family Coping Resources: A Module for Home Visitors.
• The Protective Factors Overview learning activity is an introduction for anyone who would like to gain a better understanding of the five Protective Factors. This interactive learning activity provides a synopsis of the five Protective Factors, their relevance and their characteristics, opportunities to practice identifying them and an understanding of how a strengths-based approach is integral to building these Protective Factors
• Strengthening Family Coping Resources (SFCR) is a manualized, trauma-focused, skill-building intervention. You can learn more about SFCR by visiting their main website .

Substance Abuse Reading Materials

• Understanding Substance Abuse and Facilitating Recovery: A Guide For Child Welfare Workers , PDF
• Parenting Under the Influence: The Effects of Opioids, Alcohol and Cocaine on Mother-Child Interaction , Author(s): Slesnick, Natasha.;Feng, Xin.;Brakenhoff, Brittany.;Brigham, Gregory S. Published: 2014, Journal Name: Addictive Behaviors
• World Health Organization Guidelines on Substance Use and Pregnancy , PDF
• Coalition Against Substance Abuse
• The Likely Cause of Addiction Has Been Discovered, and It Is Not What You Think , Huffington Post
• A parent’s heroin addiction, a newborn’s death sentence , Milwaukee Journal Sentinel
• This guide to Assessment and Intervention in the Home: Women and Infants Affected by Opioids is offered by the Wisconsin Association for Perinatal Care.
•   My Baby and Me is a program through the Wisconsin Women’s Health Foundation that is designed to help women with their alcohol use during pregnancy.
• Bath Salt Intervention (3) Power Point Presentation
• Fetal Alcohol Spectrum Disorder Factsheets The Substance Abuse and Mental Health Services Administration (SAMHSA)Fetal Alcohol Spectrum Disorders (FASD) Center for Excellence recently published two Technical Assistance (TA) Impact fact sheets.
• The Recovery of Hope This video helps women explore the ramifications of their substance abuse during pregnancy, as women share their personal stories.

Supervision/Reflective Supervision

Supervision

• “6 Way to Create a Culture of Creativity”, 2013, Kaplan
• The Power of Good Habits – Using High-Performance Habits to Achieve Significant Goals, Mind Tools
• Avoiding Micromanagement – Helping Team Members Excel – On Their Own, Mind Tools
• Minimizing Distractions – Managing Your Work Environment, Mind Tools
• Dealing with Poor Performance – Lack of Ability, or Low Motivation?, Mind Tools
• Three building blocks of Reflective Supervision Wisconsin Alliance for Infant Mental Health, Best Practices and Guideline for Reflective Supervision , Zero to Three

Trauma/Brain Development

•   Recognizing and Addressing Trauma in Infants, Young Children and their Families.   “This five module tutorial, from the Center for Early Childhood Mental Health Consultation, addresses the effects of trauma on young children and their families, healing and recovery, resources, publications and interventions for childhood mental health consultants and family support professionals.” https://www.ecmhc.org/tutorials/trauma/index.html
• Congressional Briefing: Elizabeth Hudson remarks Elizabeth Hudson addresses the mental health impact of violence and trauma on children. Elizabeth Hudson is a Trauma-Informed Care Consultant; University of Wisconsin-Madison, School of Medicine and Public Health; Consultant to the Wisconsin Department of Health Sevrices.
• Jill Botle Taylor’s Stroke of Insight Neuroanatomist Jill Bolte Taylor had an opportunity few brain scientists would wish for: One morning, she realized she was having a massive stroke. As it happened — as she felt her brain functions slip away one by one, speech, movement, understanding — she studied and remembered every moment. This is a powerful story about how our brains define us and connect us to the world and to one another.
• How Childhood Trauma Affects Health Across a Lifetime (16:03) https://www.youtube.com/watch?v=95ovIJ3dsNk Childhood trauma isn’t something you just get over as you grow up. Pediatrician Nadine Burke Harris explains that the repeated stress of abuse, neglect and parents struggling with mental health or substance abuse issues has real, tangible effects on the development of the brain. This unfolds across a lifetime, to the point where those who’ve experienced high levels of trauma are at triple the risk for heart disease.
• The Paradox of Trauma (12:23) https://www.youtube.com/watch?v=jFdn9479U3s Dr. Vicky Kelly, psychotherapist, administrator, and consultant is also a nationally known trainer in the areas of trauma and attachment. The common thread across her career has been helping victims of trauma heal. She has been an early advocate for human services to adopt “trauma-informed care,” an approach that calls for a focus not just on someone’s behavior, but, more importantly, on what drives behavior.
• How Do We Stop Childhood Adversity from Becoming a Life Sentence? (15:54) https://www.youtube.com/watch?v=qp0kV7JtWiE Adverse childhood experiences are physical, sexual or emotional abuse and neglect as well as witnessing family violence, addiction or mental health episodes in the household. Evidence on the prevalence of adverse childhood experiences is presented-to give a sense of the magnitude of the problem. Research is presented which demonstrates a direct link between the level of adversity in childhood and worse outcomes in adulthood related to health, addiction, imprisonment, education and life success and evidence from the field of neuroscience, which explains this link. Ways to prevent and respond to childhood adversity and support victims are presented
• The Center for the Developing Child Short PDF article regarding Early Childhood Mental Health
• A series of information and online videos and tutorials from the Center for Early Childhood Mental Health Consultation.
• Creating a Culture of Care This toolkit is the result of the STARS project trauma-informed care project, sponsored by the Texas Dept. of State Health Services (2011). The toolkit can be used across human service settings and was developed broadly for this purpose.
• Creating a Trauma Informed HV Program Issue Brief . This issue brief features useful strategies for implementing trauma-informed care in home visiting programs and the section Snapshots of Success From the Field: Trauma-Informed Approaches in Home Visiting , highlights Wisconsin home visiting programs.”

Call or Text the Maternal Mental Health Hotline

Parents: don’t struggle alone

The National Maternal Mental Health Hotline provides free, confidential mental health support. Pregnant people, moms, and new parents can call or text any time, every day.

Start a call: 1-833-TLC-MAMA (1-833-852-6262)

Text now: 1-833-TLC-MAMA (1-833-852-6262)

Use TTY: Use your preferred relay service or dial 711 , then 1-833-852-6262 .

Learn more about the Hotline

• Programs & Impact

MIECHV Program Reauthorization

Congress extended authorization for the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program in December 2022 ( P.L.117-328 ). HRSA encourages MIECHV Program awardees to review this page to learn more about the reauthorization and how HRSA will implement changes to the Program. This page also includes answers to frequently asked questions (FAQs).

Jump to the following sections:

New MIECHV Program grant funding Data collection Reducing administrative burden Virtual home visiting Targeted, intensive home visiting services FAQs

New MIECHV Program grant funding

Starting in fiscal year 2024 (FY24), HRSA will give eligible states and jurisdictions one MIECHV Program grant that includes base funds , matching funds (if applied for), and additional matching funds (starting in FY25, if available and applied for). All MIECHV Program requirements apply to each part of the award. To get a MIECHV Program grant, eligible awardees must meet the Maintenance of Effort requirement.

Maintenance of Effort (MOE)

To meet the MOE requirement, each awardee must obligate state general funds at an amount more than or equal to what they reported spending on evidence-based home visiting and home visiting initiatives in either FY19 or FY21, whichever is less. You can find the amounts for each state and jurisdiction in the notice published in the Federal Register on June 23, 2023. HRSA cannot award base or matching funds to awardees that do not meet the MOE requirement.

Congress increased appropriations for the MIECHV Program to be distributed through base funds and matching funds. HRSA will distribute the funds in one MIECHV Program award according to the formulas outlined in statute.

HRSA calculates base funds according to each state or jurisdiction’s share of children under the age of 5. HRSA will use the most recent U.S. Census data available before FY23 to determine this share. The law requires that the MIECHV Program award for each state or territory include at least $1,000,000 in base funds.

Guardrails require HRSA to award each state or territory no less than 90% of their funding from FY21 and no more than 110% of their funding from FY21.

Matching funds

Matching funds will be available beginning in FY24, with increasing amounts through FY27. The federal government will contribute 75% of the funding and states and jurisdictions will contribute 25% in non-federal funds. This means that the federal government will contribute $3 for every $1 contributed in non-federal funds, up to certain limits determined by law. HRSA calculates the federal contribution based on each state or jurisdiction’s share of children under 5 whose families have incomes below the federal poverty level . HRSA will use the most recent U.S. Census data to determine this share. Each state or jurisdiction will be allocated a matching funds ceiling amount annually. MIECHV awardees have the flexibility to apply for matching funds of any amount up to the full allocation, commensurate with their available qualifying non-federal funds. For more information about state-specific ceiling amounts for state and federal matching funds from FY24 – FY27, please contact your HRSA Project Officer.

Definition of non-federal funds for matching funds

For the purposes of providing MIECHV Program matching funds under 42 U.S.C. 711(c)(4)(B), the amount of the grant payable to the eligible entity for the fiscal year will be increased up to certain specified “matching” amounts determined in reference to amounts of federal and non-federal funding outlined in this section.

Obligations of non-federal funding, for this purpose, are amounts committed by the eligible entity (generally a state or jurisdiction) but do not need to be obligated by the MIECHV recipient entity (generally a specific state/jurisdiction agency), to support home visiting services delivered in compliance with specified MIECHV requirements, reported to the Secretary, and not counted toward meeting the awardee’s MIECHV Program Maintenance of Effort requirement under 42 U.S.C. 711(f). The MIECHV requirements for which such funds are obligated must be related to improvements in outcomes for individual families and core components of the MIECHV Program.

These include all of the following:

• Implementation of service models meeting HHS criteria for evidence of effectiveness (or up to 25% used for implementing and evaluating promising approaches)
• Providing targeted, intensive home visiting services to eligible families
• Prioritizing services to high-risk populations

Non-federal funds must be obligated by the eligible entity (generally a state or jurisdiction) but do not need to be obligated by the MIECHV recipient entity (generally a specific state/jurisdiction agency). Non-federal funds may consist of amounts made available by state appropriations or other state funding sources, local governments, and/or private entities (including funds made available by gifts, donations, or transfers). Non-federal obligated amounts may consist of cash and/or third-party in-kind contributions. The MIECHV recipient entity must report obligated amounts to the Secretary through HRSA in the form and frequency determined by the agency.

• Non-federal funds must be necessary and reasonable for the accomplishment of project or program objectives.
• Non-federal funds used for matching cannot be included as contribution for any other federal award. Costs paid for using non-federal funds may not be included as a cost or used to meet cost sharing or matching requirements for any other federally financed program in either the current or a prior period.
• Funds paid by the federal government for another federal award cannot be applied as a source of non-federal matching funds unless federal statute specifically makes an allowance.
• Matching funds must be verifiable from the non-federal entity’s records and must be adequately documented.

Matching funds reporting requirements

MIECHV performance reporting for X10 grants now comprises base and matching funds, meaning that both will be reported together. Base and matching funds will not be tracked separately for data reporting.

Awardees are required to submit:

• A Quarterly Performance Report ( Form 4 (PDF - 81 KB) ) consolidated across X10 base and matching funds
• An Annual Performance Report (APR) consolidated across X10 base and matching funds
• A Final Report consolidated across X10 base and matching funds

Quarterly Report

There are no changes for X10 quarterly reporting. X10 Quarterly Performance Report will include data for both X10 base and matching funds.

Annual Performance Report

Awardees must provide demographic, service utilization, and select clinical indicators ( Form 1 (PDF - 251 KB) ) and performance indicator and systems outcome measure ( Form 2 (PDF - 329 KB) ) performance data for all participants served through X10 grants. These performance data for participants served using matching funds will be consolidated across X10 (base and matching funds) in corresponding fiscal years, and awardees will submit a single Annual Performance Report.

Final Report

Awardees must submit a final progress report, including a final evaluation report (if applicable), with program specific goals and progress on strategies; impact of the overall project; the degree to which the recipient achieved the mission, goal, and strategies outlined in the program; recipient objectives and accomplishments; barriers encountered; and response to summary questions regarding the recipient’s overall experiences over the entire project period. The report will be consolidated across X10 (base and matching funds) and awardees will submit a single Final Report for each grant project period. Awardees will be required to report on use of matching funds, including impact on service delivery and program capacity; detailed instructions will be available in the final Final Report guidance.

Fiscal Reporting

Awardees will need to provide a description of the non-federal funds they are proposing for the match in their funding application, to include: the amount of non-federal funds, the source of those funds, and an assurance that those funds will be obligated within the period of performance. The awardee must ensure that all non-federal funds they propose support home visiting programs that provide services based on evidence-based models or promising approaches; provide or support targeted, intensive home visiting designed to achieve improvements in outcomes for eligible families; and prioritize services to high-risk populations. Non-federal funds must also align with HRSA’s definition of non-federal funds .

Awardees will be required to report the non-federal funds in their annual SF-425 federal financial report (FFR) so that HRSA can track that the use of non-federal funds aligned with the awardees proposal and non-federal funds were commensurate with the awarded federal match. Awardees will need to develop reporting systems to track the obligation of non-federal funds used for the match to comply with FFR reporting requirements.

For detailed review, such as on future HRSA site visits, documentation requested from awardees for non-federal matching funds will be similar to previous requests for supporting documentation of non-federal funds used to meet maintenance of effort requirements. This may include applicable documents such as state budget appropriations, documentation showing amounts obligated, and agreements between the MIECHV award recipient and agency/ies expending non-federal funds.

Additional matching funds

Starting in FY25, awardees can apply for additional matching funds. These funds include any matching funds that HRSA did not distribute to awardees in the previous fiscal year, as well as any matching funds that were not used by awardees in prior fiscal years and were returned to HRSA. To apply for additional matching funds, awardees may submit a statement of interest in response to the MIECHV Program Notice of Funding Opportunity (NOFO). For more information, please contact your HRSA Project Officer.

HRSA will distribute additional matching funds using the same principles as matching funds. However, the federal share of additional matching funds will be based on the proportion of children under 5 under the poverty line in states that expressed interest in receiving those funds.

Data collection

Reauthorization of the MIECHV Program makes program and performance data more visible by requiring an annual report to Congress and the creation of a new web-based outcomes dashboard. For more information on MIECHV performance data, visit the MIECHV Data & Continuous Quality Improvement page.

Annual report to Congress

Each year, HRSA must share information with Congress about how awardees spend MIECHV grant funds. Most of the information included in the Report will be pulled from existing performance data and other reporting requirements.

Share of the funding expenditure by model

One of the requirements for the Report to Congress is the share of grants spent on each home visiting model. To meet this requirement, HRSA will require awardees to report the dollar amount of base and matching funding spent on each home visiting model in Final Reports, starting with the FY21 Final Report.

To determine the share of the expenditure for each model/promising approach, general guidelines include:

• If LIA implements a single model/promising approach, include the total contractual cost in the share for that model implementation.
• If LIA implements more than one model/promising approach, allocate the direct or approximate share of cost to each model. (See 45 CFR 75.405 for additional information on allocation.)
• If the share of the cost can be determined without undue effort or cost, the cost should be allocated based on the proportional benefit to each model/promising approach. If the share of a cost cannot be determined because of the interrelationship of the work involved, then the costs may be allocated on any reasonable documented basis.

Note that the total percentage expended will generally not add up to 100% of the award due to funding non-model expenditures associated with administration of the award and infrastructure activities.

Annual performance reporting

MIECHV Program awardees must report the number of virtual home visits conducted by each model in their Annual Performance Reports (APRs). This new requirement starts in FY24, and the data must be disaggregated by home visiting model.

Reducing administrative burden

Reauthorization of the MIECHV Program requires HRSA to reduce administrative burden for awardees by at least 15%. HRSA is implementing this requirement by eliminating duplicate reporting requirements and streamlining data collection and reporting processes. HRSA will report recommendations for reducing burden in the FY24 annual report to Congress.

Virtual home visiting

MIECHV statute defines virtual home visits as home visits conducted only through electronic information and telecommunications technologies. Under reauthorization of the MIECHV Program, virtual home visits are allowable; however, guardrails are established to ensure virtual home visits are only used in limited circumstances and do not replace in-person home visits. Reauthorization also requires each home visiting model to have equivalent training standards for virtual and in-person home visits. More information about how awardees must meet these requirements is included in the FY24 NOFO.

Targeted, intensive home visiting services

Federal law requires awardees to use MIECHV funds to provide or support targeted, intensive home visiting services. To meet this requirement, your home visiting services should target populations listed in your most recent statewide needs assessment update and the priority populations listed in the law. You must use evidence-based home visiting models approved by the Home Visiting Evidence of Effectiveness (HomVEE) review. The latest list of approved models is on the HomVEE website .

This requirement also applies to non-federal funds for matching funds . To qualify for federal matching funds, awardees must contribute non-federal funds that are used to provide or support targeted, intensive home visiting services.

Jump to the following subsections:

Maintenance of Effort (MOE) New MIECHV Program grant funding Applying for matching funds Non-federal contributions for matching funds Spending matching funds Additional matching funds Data collection Funding expenditure by model Virtual home visiting Targeted, intensive home visiting services

What is the difference between non-federal funds for the Maintenance of Effort (MOE) requirement and non-federal funds for matching funds?

The non-federal funds the awardee contributes to receive matching funds must be above and beyond those counted toward meeting the MOE requirement. Awardees must meet the MOE requirement to be eligible for base or matching funds and they must also contribute additional non-federal funds to receive federal matching funds. Additionally, different types of funds may be counted to qualify for matching funds. For more information, see the definition of non-federal funds for matching grants .

What happens if the MOE requirement for a state or jurisdiction is $0?

If there is no qualifying non-federal spending from FY19 or FY21, then there is no non-federal spending requirement to meet the MOE. In this case, the first dollar of non-federal funds spent can be applied to the non-federal matching contribution.

Does an awardee's non-federal contribution for matching funds add to their MOE requirement for future years?

For the current authorization of the MIECHV Program from FY23 – FY27, the MOE requirement is the lesser of qualifying non-federal spending from FY19 or FY21. Non-federal spending from other years will not affect the MOE requirement.

How will awardees apply for base and matching funds? What about additional matching funds?

Awardees can apply for a MIECHV Program grant that includes up to three funding sources: base funds, matching funds, and, starting in FY25, additional matching funds. Awardees can apply for any combination of these three funding components in response to the MIECHV Program NOFO or Non-Competing Continuation (NCC) Update. More information on applying for matching funds is included in the FY24 NOFO, and more information on applying for additional matching funds will be included in the FY25 NCC Update.

Will awardees receive two separate grants or one combined grant?

HRSA anticipates issuing MIECHV Program grants using one Notice of Award (NoA) that includes base funds, matching funds, and additional matching funds, if available and requested by the awardee.

What happens if a MIECHV Program awardee does not need matching funds?

Matching funds are optional. If an awardee does not need matching funds, the awardee does not need to apply for them.

Will HRSA recoup unspent MIECHV grant funds?

Yes, HRSA will recoup any unobligated base and matching funds. HRSA will distribute unobligated matching funds in the fiscal year after they are returned to HRSA.

What data does HRSA use to calculate the share of children younger than 5 and children younger than 5 in families with incomes below the poverty line?

Statute requires HRSA use the most recently available data. Specific data source references will be included in the FY24 MIECHV NOFO. However, examples of relevant data may include data from the U.S. Census Bureau based on 2021 American Community survey data showing the population of children younger than 5 in each state and jurisdiction and the population of children in poverty by sex and by age in each state and jurisdiction.

Applying for matching funds

Do states and territories have to apply for the full matching funds amount.

No. States and jurisdictions may choose not to apply for matching funds if they wish. Each state or jurisdiction will be allocated a matching funds ceiling amount, determined annually by the matching funds formula. You may apply for matching funds up to that amount based on your available qualifying non-federal funds.

Will HRSA provide awardees with matching fund ceiling amounts?

HRSA releases matching fund ceiling amounts for each state and jurisdiction around the time the annual NOFO or NCC Update is released. This is similar to the timing and process used to share ceiling amounts for base funds. If you have questions about your specific circumstances, please contact your HRSA Project Officer.

I want to apply for less than the full matching award ceiling amount. How do I calculate the amount of federal matching funds that I can apply for?

If awardees apply for less than the full matching funds ceiling amount, the federal contribution for matching funds will be three times more than the non-federal contribution. For example, if an eligible entity contributes $200,000 in qualifying non-federal funds, they may apply for $600,000 in federal matching funds.

How will sequestration impact matching funds award amounts?

Sequestration will reduce the total amount of money available for matching funds in the years it applies. For example, Congress appropriated $50,000,000 for matching funds in FY24. After accounting for 13% set aside for reservations and mandatory sequestration, which is a 5.7% reduction, the total amount of money available for matching funds in FY24 is about $40,000,000.

Can awardees opt in at any time for matching funds?

Awardees may apply for matching funds through their annual funding application, submitted in response to the NOFO or NCC Update. Not applying for matching funds in one fiscal year does not prevent an awardee from applying for matching funds in a later fiscal year.

Are federal matching funds subject to the same requirements as base funds?

Yes, federal matching funds are subject to all of the same statutory and programmatic requirements for the MIECHV Program as your base funds. Non-federal funds for matching must meet certain requirements., but not all of the requirements that apply to base and federal matching funds. See question: Which statutory requirements apply to matching non-federal funds?

What does the “eligible entity” mean in reference to non-federal funds for matching?

According to the MIECHV statute, “eligible entities” are all 50 states, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, the Commonwealth of the Northern Mariana Islands, and American Samoa. Non-profit organizations may also be considered eligible entities, so long as they received FY23 MIECHV Program – Base Grant Award funding or if the state or jurisdiction does not apply or is not approved to receive award funding for the FY24 MIECHV Program: Base and Matching Grant Awards NOFO. The specific agency of the state that receives MIECHV funds (known as the MIECHV recipient agency) is a subset of the broader eligible entity. Therefore, when identifying non-federal matching funds, awardees can consider any qualifying non-federal funds obligated by the state generally, not just those obligated by the MIECHV recipient agency.

Non-federal contributions for matching funds

How much in non-federal funds will awardees have to contribute to receive the estimated federal match.

Each state or jurisdiction will be allocated a matching funds ceiling amount, determined annually by the matching funds formula. You may apply for matching funds up to that amount based on your available qualifying non-federal funds. Recipients that apply for matching funds but contribute less than required to meet the minimum matching allocation in non-federal funds will see further adjustments to their matching funds award to reflect their reduced contribution.

Awardees can apply for federal matching funds of any amount up to the full matching fund ceiling amount of $725,893 in FY24, as long as they can demonstrate that they meet the requirements outlined in the NOFO with respect to obligations of non-federal and federal funds. See the matching funds section for more information.

Do the non-federal funds have to cover the same two-year period as the NOFO? Can anticipated one-year funds from a non-federal source be considered?

Non-federal funds have to be obligated in the same two-year period of performance as the MIECHV award. However, they do not have to cover the entire period of performance.

Will HRSA issue guidance that identifies what funding sources from the state can be used as a match?

Non-federal funds for MIECHV Program matching funds can come from state appropriations or other state funding sources, local governments, and private entities, including gifts, donations, transfers, and third-party in-kind contributions. For more information, please see the definition of non-federal funds for matching funds . If you have questions about your specific circumstances, please contact your HRSA Project Officer.

Does non-federal, non-state funding, such as investments by localities and philanthropy, “count” towards meeting the state match?

Non-federal funds from localities, philanthropy, and other sources can be used for the non-federal contribution for matching funds, as long as they meet certain statutory requirements and are coordinated with the MIECHV recipient entity.

Can non-federal matching funds come from sources other than the MIECHV lead agency?

Non-federal funds can come from another state agency, local governments, or private organizations, as long as they meet the criteria for non-federal funds .

Can awardees use in-kind contributions from non-federal sources for the state match?

Yes, in-kind contributions can be used to meet the non-federal matching funds requirement. This includes in-kind contributions from state-level entities, local governments, and other local private agencies, such as non-profit and philanthropic organizations. Contact your HRSA Grants Management Specialist or Project Officer to discuss any specific limitations that may apply.

How does a state demonstrate their ability to receive MIECHV matching funds? What if another state agency funds the evidence-based home visiting?

Under the MIECHV statute, eligible entities funded by the MIECHV Program (“state entities”) may demonstrate their eligibility to receive MIECHV matching funds in addition to MIECHV base grant funds, in part, by demonstrating the amount of non-federal dollars that they have obligated for home visiting programs within their state. For purposes of receiving matching funds, the total amount obligated by an eligible entity from non-Federal funds is the total of the amounts that are (1) obligated by the eligible entity from non-federal sources, (2) reported to MCHB, and (3) not counted toward meeting maintenance of effort requirements, for services delivered in compliance with the MIECHV statute. Further, the delivery of evidence-based home visiting services within the state using non-Federal funds must be implemented to achieve improvements in certain outcomes for individual families and using service delivery models that include certain core components.

To demonstrate eligibility to receive matching grant funds, the state entity may identify the amount of non-Federal funds they will obligate during the FY 2024 period of performance. For this purpose, the proposed obligation may include non-Federal funds expended by any state agency that carries out evidence-based home visiting activities, as well as funding recipients of any state agency that provide such services on behalf of the state. In the case of a services provided by a non-state agency funding recipient, the obligation may be demonstrated by an agreement between the state agency and the funding recipient for this purpose. The state’s obligation or commitment of non-Federal funds (including funding from a non-governmental entity) must comply with their state’s applicable laws and policies, and funds must be adequately documented and verifiable from the entity’s records.

What documentation does a MIECHV funding recipient need to provide to count funds invested by a philanthropic or charitable entity in evidence-based home visiting services delivered within the state by a local entity or agency?

Where consistent with state law and policy, eligible entities may demonstrate the obligation or commitment of non-federal funds by the state pursuant to an agreement to this effect with the funder or funding agency obligating non-federal funds. The agreement should be documented in writing, such as a memorandum of understanding (MOU) or other binding or official agreement, that reflects both parties’ expectations and requirements, including financial and performance reporting requirements. As required by statute, commitments must support home visiting programs that provide services based on evidence-based models or promising approaches; provide targeted, intensive home visiting designed to achieve improvements in outcomes for eligible families; and prioritize services to high-risk populations.

What does it mean for non-federal funds to be obligated for services in compliance with certain MIECHV statutory requirements and related to core components of the MIECHV Program?

To qualify as non-federal funds for MIECHV matching grants, non-federal funds must be committed for services that improve outcomes for families and adhere to core components of the MIECHV Program. These services must address all of the following:

• Meet HHS criteria for evidence of effectiveness (or up to 25% may be used for promising approaches that do not yet meet HHS criteria but are being rigorously evaluated)
• Provide or support targeted, intensive home visiting services
• Prioritize serving high-risk populations.

Note: A home visiting service delivery model that qualifies as a promising approach is defined in statute: “the model conforms to a promising and new approach to achieving the benchmark areas specified in paragraph (1)(A) and the participant outcomes described in paragraph (2)(B), has been developed or identified by a national organization or institution of higher education, and will be evaluated through well-designed and rigorous process.” ( 42 U.S.C. 711(d)(3)(A)(i)(II) )

Which statutory requirements apply to matching non-federal funds?

By law, obligations of non-federal funds must support home visiting services that comply with certain MIECHV requirements. Awardees must obligate non-federal funds for services that improve outcomes for individual families and adhere to core components of the MIECHV Program, including all of the following:

• Implementing service models that meet HHS criteria for evidence of effectiveness (or up to 25% used for implementing and evaluating promising approaches)

Can non-federal funds (for example, state or local funds) used for universal intake and referral services be counted as non-federal matching funds?

Yes. Non-federal funding for the match is intended to support the growth of targeted, intensive home visiting programs. Non-federal funding may be used for services that support targeted, intensive home visiting programs, such as intake and referral services, under certain circumstances.

Non-federal funds used for matching must be obligated by the eligible entity to deliver services in compliance with subsections 511(d)(2) and 511(d)(3) of the Social Security Act, which, in part, requires that such funds be used to “provide or support targeted, intensive home visiting services.” (See 42 U.S.C. 711(c)(4)(B)(i)(II).) In accordance with statute, non-federal funding for the match must be used to provide or support targeted, intensive home visiting programs which use models that meet the MIECHV evidence standards; align with federal MIECHV requirements for program design, quality, and service delivery; align with the improvements in individual outcomes described in the MIECHV statute; and target MIECHV priority populations. To meet these criteria, universal intake and referral services must demonstrate active and successful referral relationships to targeted, intensive home visiting programs.

Spending matching funds

Will miechv program awardees have the same period to spend matching funds as for base funds.

Yes, there is a two-year period to spend all MIECHV Program grant funds, which includes base funds, matching funds, and additional matching funds (when applicable).

What services can matching funds be used for?

The federal contribution to matching funds may be used to support any services within the scope of the MIECHV award.

What happens if a MIECHV Program awardee does not obligate the non-federal match as planned?

Awardees that do not obligate their non-federal match as planned must make sure that their federal match is in line with actual obligations. If an awardee obligates less than the non-federal funds they produced to qualify for the match as planned, they must return excess federal funds distributed as match funds that were not ultimately obligated.

When will states be able to apply for leftover matching dollars that other states did not use?

Starting in FY25, HRSA will distribute additional matching funds to awardees who express interest, if funds are available.

What happens if an awardee decides later that they want to be considered for additional matching funds?

If an awardee does not express interest in receiving additional matching funds, the awardee will not be eligible to apply for additional matching funds for the relevant fiscal year, even if they become available. For example, awardees who did not respond to the request for information by September 6, 2023, will not be eligible for additional matching funds in FY25. Not expressing interest now does not mean an awardee cannot apply for matching funds or additional matching funds in future fiscal years.

What data will awardees need to submit for HRSA to populate the new dashboard?

Data for the new outcomes dashboard will come from existing performance measures, like Forms 1, 2, and 4. Reporting requirements for these forms are not changing at this time to accommodate data needed for the dashboard. HRSA will work with awardees and other partners to decide which data to show on the dashboard.

Will awardees be required to submit separate annual performance reports (Forms 1 and 2) for MIECHV participants supported through matching funds?

No, data across all active grants (X10 base and matching funds) must be consolidated into one Annual Performance Report submission, due in October of each year. Families served using matching funds must be included in your Annual Performance Report (Forms 1 and 2). Annual performance reporting for matching funds should be consolidated with annual performance reporting for MIECHV formula awards (base funds) for the corresponding fiscal year.

What performance data will be required for non-federal funds used for the match?

HRSA will not require any performance data for families served through non-federal funds (for matching funds). The only reporting requirement on non-federal funds will be included in the number of participants and household served using non-MIECHV funds in Table 3 of Form 1 (PDF - 251 KB) (Unduplicated Count of Participants and Households Served by State Home Visiting Programs (non-MIECHV)). Awardees can provide any additional context on non-MIECHV funds in the comments section in Table 3 of Form 1.

For the quarterly performance reports (Form 4), will awardees be required to account for and submit information about MIECHV participants and staff supported through base and matching funds?

If awardees use matching funds to support service delivery, they will be required to report information about MIECHV participants and staff supported with both matching and base funds combined on the X10 Quarterly Performance Report.

Will awardees be required to submit separate Final Reports for base and matching funds?

No, awardees will submit one Final Report for the grant project period for all activities across both base and matching funds.

For Maximum Service Capacity (Table 1, Column D) on Form 4, should the maximum service capacity reflect the maximum number of households that could potentially be enrolled for the X10 grant?

Yes, on Form 4 (PDF - 81 KB) , the maximum service capacity should reflect the number of households that could potentially be enrolled at the end of the quarterly reporting period if the program were operating with a full complement of hired and trained home visitors for the X10 grant inclusive of base and matching funds.

For awardees using the home visitor personnel cost method, how should households be reported for cases where home visitors are supported through both base and matching funds?

Under the home visitor personnel cost method, families are designated as MIECHV families at enrollment based on the designation of the home visitor they are assigned. Under this methodology, recipients designate all families as MIECHV families that are served by home visitors for whom at least 25% of their personnel cost (salary/wages including benefits) are paid for with MIECHV funding. “MIECHV funding” includes both base and matching funds, meaning all families for a home visitor for whom at least 25% of their FTE is MIECHV funding, regardless of whether that is base funds, matching funds, or a combination of both, would qualify as a MIECHV family.

How does a household status change if the funding source changes from base to matching funds for reporting purposes?

A household is considered as a “MIECHV household” (a family served during the reporting period by a trained home visitor implementing services with fidelity to the model and that is identified as a MIECHV household at enrollment) regardless of whether the funding source is from base or matching funds. A household supported through non-federal funds (for matching funds) is considered as a non-MIECHV household. Please refer to Appendix A of the Form 1 Toolkit (PDF - 625 KB) or Appendix D of the Form 2 Toolkit (PDF - 1 MB) for additional guidance around household status changes.

Funding expenditure by model

Why are awardees required to report funding expenditures by model.

The reauthorization of the MIECHV Program requires an annual Report to Congress that must include “a description of each service delivery model funded under this section by the eligible entities in each State, and the share (if any) of the grants expended on each model” (42 U.S.C. 711(j)(6)).

What is the deadline for reporting the funding expenditures by model?

This information must be included in your annual Final Report. Guidance is available in the Final Report instructions released each fall.

Should funding expenditures by model be reported based on what was spent or what was budgeted?

Reporting should reflect actual amounts spent, and not the budgeted amounts.

How frequently will awardees have to report these funding expenditures?

Awardees must report funding expenditures by model on an annual basis and submit the information in their Final Reports.

Is there a reporting template that awardees can use to track and report the costs?

Yes, HRSA has developed an optional report template which will be included as an attachment when you receive your Final Report instructions via EHBs.

What are some examples of model costs?

Model costs should include costs spent on each evidence-based home visiting model or promising approach implemented by your program. Some examples of model costs include:

• Model training costs
• Model conferences
• Service delivery costs, including LIA contractual costs
• Model tool or curricula costs
• Model data systems

Should awardees include American Rescue Plan (ARP) Act funding in the report?

Do not include ARP funding in the report. Awardees only need to report the dollar amount of base and matching funds spent on each model implemented.

What are examples of labor costs that must be reported?

Report labor costs if they are easy to identify and associated with implementing a specific model. Examples of labor costs include, but are not limited to, home visitors, supervisors, and other staff paid in full or in part using MIECHV funding.

Include labor costs if you can allocate those costs to implementing or overseeing a specific model. Do not include labor costs for grant administration or required grant oversight, such as subrecipient monitoring.

Do affiliation and conference fees count towards the total share of the expenditure for each model? How should those be reported?

Count only costs that are easy to identify and allocate to a specific model, such as model-specific fees, training, and curricula. Do not include costs that are not related to a specific model, such as those for overseeing the grant or supporting the infrastructure. For example:

• Model accreditation or membership fees
• Non-model-specific membership fees
• MIECHV Annual Grantee Meeting
• Non-model-specific home visiting conferences

What is included in the costs associated with delivering a home visiting model?

Service delivery costs typically include labor, fringe benefits, supplies, travel, and overhead associated with implementing a specific model. If you have contracts with LIAs to deliver services, include the contractual costs. Also include any other costs that are easy to identify and allocate to a specific model, such as model-specific fees, data systems, training, and curricula.

How do awardees break down awardee-level costs?

Each awardee should assess if costs are primarily used to implement a specific model. Examples of awardee-level costs that should be categorized as model-specific costs include:

• Service delivery costs, including contracted services and LIA contracts
• Model costs associated with certification, tools, curricula, and model-specific trainings
• Any other costs that are easy to identify and allocated to a specific model

Awardees should not include the following awardee-level costs:

• Administrative costs
• Other recipient-level infrastructure costs that are not used for a specific model

Should awardees include awardee-level administrative costs?

The MIECHV Program defines administrative costs as the costs of administering a MIECHV award. These costs are not specific to any one model, so you do not need to include them in your calculation of model costs unless they can be clearly identified and allocated to a specific model.

Administrative costs can include, but are not limited to:

• Reporting costs (MCHB Administrative Forms in HRSA’s EHBs, Home Visiting Information System, Federal Financial Report, and other reports required by HRSA as a condition of the award)
• Project-specific accounting and financial management
• Payment Management System drawdowns and quarterly reporting
• Time spent working with the HRSA Grants Management Specialist and HRSA Project Officer
• Programmatic or fiscal monitoring of subrecipients or local implementation agencies
• Complying with FFATA subrecipient reporting requirements
• Supporting HRSA site visits
• The portion of regional or national meetings dealing with MIECHV grants administration
• Audit expenses
• Supporting HHS Office of Inspector General (OIG) or Government Accountability Office (GAO) audits

Should awardees include other awardee-level infrastructure costs?

The MIECHV Program defines recipient-level infrastructure costs as the costs that are necessary to enable the awardee to deliver MIECHV services, but not the costs of delivering services themselves. These activities are generally not specific to any one model, so you do not need to include them in the calculation of model costs unless they can be clearly identified and allocated to a specific model, such as model affiliation and accreditation fees.

In addition to MIECHV administrative costs, other awardee recipient-level infrastructure costs may include awardee-level personnel, contracts, supplies, travel, equipment, rental, printing, and other costs to support the following (excluding costs related to state evaluation):

• Professional development and training for awardee-level staff
• Model affiliation and accreditation fees
• Continuous quality improvement (CQI) and quality assurance activities, including development of CQI and related plans
• Technical assistance provided by the recipient to the LIAs
• Information technology, including data systems
• Coordination with comprehensive statewide early childhood systems
• Indirect costs (also known as “facilities and administrative costs”)

Should awardees include costs for a promising approach evaluation?

If you implement a promising approach and are using MIECHV funds to evaluate the model, the evaluation costs should be included and reported as costs specific to that model.

For awardees participating in coordinated state evaluation (CSE), should awardees include evaluation costs?

If you are participating in CSE, generally, the evaluation will not be specific to a particular model and should be considered as part of awardee-level infrastructure cost and not included as model-specific cost. If you have specific questions regarding your evaluation project, reach out to your HRSA Project Officer.

If an awardee has an LIA that implements multiple models, how should the awardee report model expenditures for each model?

Allocate the cost to each model based on how much it benefits each model or promising approach. (See 45 CFR 75.405 for additional information on allocation.) If you cannot determine the share of a cost because the work is interrelated (for example, shared costs like general office supplies), then you may allocate the costs based on any reasonable and documented basis. If you have questions specific to your program, reach out to your Project Officer.

What do you mean by “reasonable and documented basis”?

For this reporting requirement, “reasonable” is typically meant to describe making a decision that another prudent person, in similar circumstances, would find appropriate. Then, how the cost was allocated and the reasonable rationale for why a cost was allocated in such a way should be documented and saved as supporting information in your internal records. It does not need to be submitted to HRSA as part of the FY21 Final Report.

See 45 CFR 75.405 , Allocable Costs section of the Cost Principles subpart for more information.

How should awardees report costs if they do not have any LIAs?

If you do not have any LIAs, report service delivery costs and any other costs that are easy to identify and allocate to a specific model. If you have questions specific to your program, reach out to your Project Officer.

Will the reported model expenditure be shared with the models?

The model expenditure information is being collected to meet the requirement for the annual Report to Congress. Awardee-specific model expenditure information will not be shared directly with models. National data may be made public through the Report.

What data on virtual home visits are MIECHV Program awardees required to submit to HRSA?

HRSA requires awardees to collect data on virtual home visits. This includes the number of virtual home visits conducted each year, broken down by home visiting model. HRSA collects this data as part of the Annual Performance Report (APR). Awardees report these data on Form 1, Table 15. Please submit data for all home visits conducted during the reporting period, regardless of how long a family was enrolled.

Table 15: Virtual Home Visit Data Collection

* When the percent of data that is "Unknown/Did not Report" is >10%, a table note should be provided that addresses the reason for the missing data, and if possible, plans to reduce the amount of missing data in future reporting.

How many in-person home visits are required for each family in a given year?

Awardees must ensure that each client family receives at least one in-person home visit within each 12-month period that they are enrolled. HRSA also requires that your program conduct at least 60% of home visits in person, as demonstrated by FY25 performance data. HRSA anticipates that this threshold will increase in the next few years.

What circumstances justify the use of virtual home visits?

The law requires MIECHV awardees to describe how they will decide when to use virtual home visits. Awardees should consider client consent, preference, location, fidelity to the model, and safety. Awardees should clearly explain their process in their application.

Does statute define a specific method of delivery for virtual home visits?

The MIECHV statute defines a virtual home visit as a visit conducted only using electronic information and telecommunications technologies.

Can awardees using MIECHV funds to implement universal intake and referral programs like Family Connects?

Your award must be used to provide or support targeted, intensive home visiting services, as required by statute. Home visiting models that provide universal services (or offer only a limited number of visits) do not qualify as targeted and intensive. If LIAs are using a universal model for family outreach and referral, they must do so using funds not allocated to service delivery. Additionally, the awardee must establish processes to ensure families are referred to targeted and intensive home visiting models. Note that universal models used for family outreach and referral do not qualify for use as service delivery expenditures. For a complete definition and examples of service delivery expenditures, see Appendix B of the FY24 NOFO.

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Community-Based Outpatient Services

Early childhood mental health services.

Early Childhood Mental Health Services provides services to children between birth and eight years of age with emotional disturbance or risk factors for emotional and behavioral disturbances and associated developmental delays. The goal of services is to strengthen parent-child relationships, support the family’s capacity to care for their children and to enhance the child’s social and emotional functioning.

• Comprehensive mental health assessments
• Individual, family, and group therapies
• Psychiatric services - medication evaluation and management
• Day treatment
• In-home and in-office therapy options
• Childcare consultation, outreach, and training
• Targeted case management
• Psychological assessment and evaluation
• 24-hour on-call emergency professional coverage
• Clinical care coordination

Children’s Clinical Services

The Children’s Clinical Services provides community-based outpatient, individual and family oriented mental health services for children from 6 through 17 years of age. These services include:

Mobile Crisis Response Team

The Mobile Crisis Response Team (MCRT) provides immediate, mobile crisis response for assessment, intervention and support to all Nevada youth who are experiencing a mental health or behavioral health crisis.  The goal of MCRT is to provide immediate response in order to stabilize and support youth to safely remain in their homes, communities and schools, utilizing a team comprised of a master’s level clinician and a bachelor’s level psychiatric caseworker to assess, provide short term mental health interventions, safety plan, and link to needed immediate and ongoing services. MCRT Is available to all youth under the age of 18 (18 if still in high school). 

• Responses and stabilization services provided at the family location of choice
• MCRT works collaboratively with the youth, family and support systems to create and implement safety plans for youth
• MCRT can stay connected with a youth and family for up to 45 days to provide intensive, short term clinical interventions and build skills to further stabilize youth and family
• MCRT provides linkage to immediate and long-term services in the community
• “Crisis” is defined by the caller and can include, but is not limited to behavioral or mental health concerns that pose a threat to youth stability in their home, school of community such as:

Suicidal thoughts or actions

Homicidal thoughts or actions  

Self-Injury

Parent-Child Conflict

Peer conflict/bullying

School problems

Behavioral or mental health concerns that pose a threat to youth stability in their home, school, or community.

Additional information on the Mobile Crisis Response Team can be found at: www.knowcrisis.com

The Mobile Crisis response team can be reached 24 hours a day by calling 702-486-7865 or 775-688-1670. 

Wraparound in Nevada for Children and Families (WIN)

Wraparound In Nevada (WIN) is a statewide, community-based program that offers a tiered care coordination approach to serving children and youth with Severe Emotional Disturbances (SED) and complex behavioral and mental health needs. Using evidence-based and evidence-informed model approaches, the overall goal of WIN is to provide individualized and strength-based support for children, youth, and families in reaching their goals or “family visions” with a decrease in need for higher levels of care, including out of home placements.

• High-Fidelity Wraparound

• Team-Based planning process where children, youth, and their families are involved at every step.
• Children/Youth have complex behavioral health needs that have not been met through other system interventions.
• Multi-System Involvement to include the reduction of multiple plans into collaborative comprehensive plans that reflect all areas of need. Children are often involved in multiple services/systems to help meet needs in areas of behavioral health, educational, social services, primary care, juvenile justice, child welfare, etc. WIN looks to incorporate plans from other system partners so that 1 family = 1 plan, helping to move towards common goals and ease the burden of potential, conflicting priorities.
• Safety/Crisis Needs: WIN partners with families to help define their crisis and looks to link them to community resources to avoid further, deeper system involvement.
• Approximately 12-14 months
• Ratio of 10 Families: 1 Facilitator to help maximize the effectiveness of the process.
• For children, youth, and families just entering the child serving system and hope to avoid further, deeper system involvement.
• FOCUS care coordination links families to services immediately so they can start accessing care.
• Families needing assistance in beginning to access care.
• Behavioral health needs and/or crisis concerns are beginning to develop or become concerning.
• Family and Care Coordinator develop the plan collaboratively with the family driving the planning process.
• Approximately 6-9 months
• Ratio of 15 Families: 1 Care Coordinator

For additional information and referral information please reach out to [email protected]