techniques of home visit

Bag Technique in Nursing

The bag technique is a tool by which the nurse , during her visit will enable her to perform a nursing procedure with ease and deftness, to save time and effort with the end view of rendering effective nursing care to clients.

The public health bag is an essential and indispensable equipment of a public health nurse which she has to carry along during her home visits . It contains basic medication and articles which are necessary for giving care.

• Performing the bag technique will minimize, if not, prevent the spread of any infection.
• It saves time and effort in the performance of nursing procedures.
• The bag technique can be performed in a variety of ways depending on the agency’s policy, the home situation, or as long as principles of avoiding transfer of infection is always observed.

The following are the contents of a Public Health Nurse bag:

• Paper lining
• Extra paper for making waste bag
• Plastic/linen lining
• Soap in a soap dish
• Thermometers (oral and rectal)
• 2 pairs of scissors ( surgical and bandage)
• 2 pairs of forceps (curved and straight)
• Disposable syringes with needles (g. 23 & 25)
• Hypodermic needles (g. 19, 22, 23, 25)
• Sterile dressing
• Cotton balls
• Micropore plaster
• Tape measure
• 1 pair of sterile gloves
• Baby’s scale
• Alcohol lamp
• 2 test tubes
• Test tube holders
• 70% alcohol
• Zephiran solution
• Hydrogen peroxide
• Spirit of ammnonia
• Ophthalmic ointment
• Acetic acid
• Benedict’s solution

*BP apparatus and stethoscope are carried separately and are never placed in the bag.

Points to consider

• The bag should contain all the necessary articles, supplies and equipment that will be used to answer the emergency needs
• The bag and its contents should be cleaned very often, the supplies replaced and ready for use anytime.
• The bag and its contents should be well protected from contact with any article in the patient’s home.
• Consider the bag and its contents clean and sterile, while articles that belong to the patients as dirty and contaminated.
• The arrangement of the contents of the bag should be the one most convenient to the user, to facilitate efficiency and avoid confusion .

The following are steps in performing bag technique and rationale for each action:

• Nursing Home Visit
• Primary Health Care in the Philippines

5 thoughts on “Bag Technique in Nursing”

would u plz differentiate the parts or chamber of bag

tnx for the rationale sir matt

thanx really helped

Why are we not placing Bp cuff and stethoscope in the bag? In home health care, after cleansing and sanitizing hands our practice is to place equipment back into the clean side of the bag.

Are you kidding with this? A soap dish? Putting on an apron? Where are the gloves? Where is the hand sanitizer? I’d never get through my day with this technique. This is like a 1950 tutorial.

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How to undertake and record a home visit in social work

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6 Home Visiting: Essential Guidelines for Home Visits and Engaging With Families

• Published: August 2008
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Home visiting has a long history in education, family and child welfare, and physical and mental health services. Home visits are critical in serving children and youth from birth to high school and in addressing issues ranging from programs for pre-school children through school system concerns. Educational organizations rely on home visits to address a wide range of issues related to student behaviors such as attendance, discipline, physical or mental challenges, drug or alcohol abuse, depression, or antisocial activities. Other home visits focus on student characteristics relating specifically to school performance, such as risk for school failure among pre-school children or low academic achievement among school-aged children. This chapter presents information relevant for school social workers and others who provide services to school-aged students and their families. It begins with providing information on the prevalence of home visiting and a brief review of program outcomes. It then includes guidelines for home visiting, specific information for preparing for a home visit, and a framework and strategies to guide the actual home visit. Additional resources are provided to illustrate the various types of programs, purposes, and outcomes of home visitation.

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Article contents

Home visits and family engagement.

• Barbara Wasik Barbara Wasik University of North Carolina at Chapel Hill
•  and  Donna Bryant Donna Bryant University at North Carolina at Chapel Hill
• https://doi.org/10.1093/acrefore/9780199975839.013.1237
• Published online: 22 March 2023

The importance of engaging families in home visiting was recognized more than a century ago as M. E. Richmond provided guidelines for involving families in the visiting process. She stressed individualizing services and helping families develop skills that would serve them after the home visiting services ended. During the 20th century, early organized efforts in home visiting in the United States built on methods used in other countries, especially European countries. Although interest fluctuated in the United States during the past century, since 2010 interest has increased due primarily to the passage of the Patient Protection and Affordable Care Act that provided for home visiting services to respond to the needs of children and families in order to improve health and development outcomes for vulnerable children and their families.

Engaging families is essential for a productive home visiting experience requiring thoughtful program activities as well as knowledge and skills on the part of the visitor. Program responsibilities begin with the need to make good employment decisions regarding home visitors and then to provide effective training, supervision, and ongoing professional development. Providing professional training in helping skills such as observation, listening, and ways of asking questions to gain or clarify information is essential to ensure visitors can engage families. Using principles for effective home visiting—including establishing a collaborative relationship with the family; individualizing services; being responsive to family culture, language, and values; and prompting problem-solving skills—can enhance the ability of the visitor to engage the family. Programs can provide opportunities for visitors to enhance their skills in developing relationships with and engaging families. Engaging families is a reciprocal process. Some families will have a positive orientation toward working with visitors to accomplish their own goals and objectives; others may be less willing to engage. Although the program and visitors have the main responsibility for engagement, they will face challenges with some families and may need to seek creative solutions to actively engage.

Just as home visitors need to engage parents in order to facilitate new knowledge and skills, parents need to engage their children to foster development. Recent research identified a set of parent–child interactions that visitors can incorporate to foster parent engagement with young children. These challenges are shared across home visit programs, as well as across cultures and countries, regardless of the professional training of the visitors or the goals and procedures of the programs.

• home visiting
• essential principles
• engaging families
• professional training
• supervision
• parent training
• international developments

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date: 28 April 2024

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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.”

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Home Visitor Safety

You can work with other program administrators and community resources to implement policies, procedures, and strategies that can contribute to home visitors’ and families’ safety in unsafe situations. As you put safety plans and measures in place, keep the following concepts in mind [ 5 ]:

Sometimes situations, such as crises, arise that pose some degree of risk to the safety of family members and home visitors.  The potential for physical harm exists in any emotionally charged crisis. Staff should never overlook or discount that potential.

Home visitors’ skills in handling a potentially dangerous situation shape intervention decisions. Sometimes home visitors find themselves faced with, or caught up in, a family situation that is too complex or too dangerous for them to address directly. At such times, it is critical to recognize that the situation is beyond their intervention abilities and to discuss alternatives with their supervisor.

The best predictor of impending danger is behavior. Safety measures are called for if a family member's current or past behavior includes violent/abusive acts, threats of harm, criminal activities, the use of addictive substances, signs of a serious emotional disorder, or threats of suicide. These measures are needed at several points in the intervention process: before face-to-face visits with the family, during face-to-face visits, and as part of referral and follow-up services.

Home visitors must always be aware of behaviors and situations that signal danger. Some violent incidents may be predicted, but many helping professionals fail to recognize signs of potential violence. Signs of loss of control and impending danger include expressions of anger and hostility. Staff may also sense that a situation is dangerous; know the family has access to guns or other weapons; be aware of violent acts or threats by family friends or relatives; and recognize mounting tension, irritability, agitation, brooding, and/or limit testing in family members.

Home visitors must be and feel safe if they are to support families. Home visitor safety can and must be addressed at many levels. The threat of violence does not occur only in the homes of families or in high-crime neighborhoods, but also in seemingly secure workplaces. Work conditions favorable to violence prevention require action at management, supervisory, and personal levels.

Some general strategies that you may consider include the following:

• Have home visitors work in pairs, particularly when they go to more dangerous neighborhoods. Accompany home visitors, if needed.
• Forge a relationship with the local police department. When police are aware of home visitors’ presence in the community, they may be able to provide protection such as self-defense training and alerts as to potentially hazardous events in the community.
• Provide cell phones, beepers, or other communication devices. Work with finance and other program staff to ensure the budget covers this equipment.
• Involve families in home visitor safety. They often know of potential safety hazards in the neighborhood (e.g., high-crime areas, gang activity) and can inform home visitors of the safest way to travel through the area.
• Work with program administrators and community resources to develop crisis protocols and make sure home visitors are aware of them. Provide opportunities for home visitors to review and practice implementing protocols. Topics may include child abuse/child neglect, substance misuse, violence in the neighborhood, and the presence of a contagious disease.
• Make sure that you or another administrator is “on call” whenever a home visitor is in the field, including after hours and weekends, so that home visitors can get an immediate response when needed.
• Make sure you know home visitors’ schedules. This should include family names and contact information, date and time of visit, and when to expect the home visitor to return. 

In addition, you might encourage home visitors to do the following [ 4 ]:

• Trust their instincts. If they feel something is not right or see something in the home that makes them uncomfortable (e.g., physical or verbal violence, alcohol/drug use, evidence of firearms, or the presence of an acutely intoxicated individual), follow established protocols and leave, if necessary. Encourage home visitors to say to the parent, “Maybe this isn’t a good time for a visit. Let’s reschedule.” Before going on future visits, encourage home visitors to talk with you about how to ensure their safety in the home. Work with home visitors to talk with the parent about the issues that made them feel uncomfortable and to make referrals if needed.
• Wear comfortable shoes.
• Get clear directions to the neighborhood and the home or apartment building, especially for new visits. Take a practice drive to make sure the directions work. Confirm how to enter the home if it is a duplex or apartment.
• Ask families where it is best to park, and park as close to the home as possible. Always park in well-lit areas. If it is not possible for the home visitor to park in a safe place, discuss other options, such as meeting the family in another setting or being driven and picked up by a co-worker.
• Put any important or valuable items in the trunk of the car before arriving for the visit. Avoid carrying and wearing expensive items.
• Contact parents before a visit so they can be on the lookout for the home visitor.
• If no one answers the door, sit in the car or drive around the block rather than wait at the door. Make sure to specify the amount of time home visitors should wait if a family is not home as part of your home visit protocol.
• Make sure home visitors’ cars are in good working order and that there is plenty of gas in the tank.
• Organize belongings so they do not have to take time to search for them. For example, when they leave a home visit, they should have their keys in hand.

4 Rebecca Parlakian and Nancy Seibel, Help Me Grow Home Visitor Curriculum (Cuyahoga County, OH: Help Me Grow of Cuyahoga County, 2005).

5 Head Start Bureau, “Assessing Family Crisis.” Excerpts from Training Guides for the Head Start Learning Community: Supporting Families in Crisis (Washington, DC: Department of Health and Human Services, Administration for Children and Families, Administration for Children, Youth and Families, 2000), https://eclkc.ohs.acf.hhs.gov/mental-health/article/assessing-family-crisis.

Resource Type: Article

National Centers: Early Childhood Development, Teaching and Learning

Program Option: Home-Based Option

Last Updated: May 22, 2023

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PREPAREDNESS CHALLENGE 2021 COMPLETION FORM

Before you fill out the form below make sure you have completed ALL 4 STEPS

STAYING SAFE DURING HOME VISITS

Learning Goals and Objectives:

Name the steps needed when planning your visit.

Describe how to safely arrive at your visit.

Identify what red flags should you look for while at the visit.

Name three things that would indicate drug use in the home.

Identify how you would safely leave the area and what would you do if you were followed.

Identify the types of observations and concerns you should bring to your supervisors attention.

Course Description

Thousands of home visits are performed every year by Head Start and Early Head Start programs, teachers, family therapists, Child Protective Services, and many other government and licensing organizations. Most agencies enter the privacy of a family’s residence without any type of training on how to conduct a safe visit.

The Institute for Childhood Preparedness has developed a course which addresses specific  concepts that every family and early childhood professional need to know to make visits as safe as possible.

This course will cover concepts for pre-planning the visit, arriving safely, conducting the visit, departing the area, and after the visit activities, including checklists for staying safe. This course teaches the warning signs of domestic abuse, drug/alcohol abuse, and aggressive behavior. The attendees will learn techniques to keep everyone safe during a home visit.

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BRIAN K. UNWIN, MAJ, MC, USA, AND ANTHONY F. JERANT, M.D.

Am Fam Physician. 1999;60(5):1481-1488

See editorial on page 1337 .

With the advent of effective home health programs, an increasing proportion of medical care is being delivered in patients' homes. Since the time before World War II, direct physician involvement in home health care has been minimal. However, patient preferences and key changes in the health care system are now creating an increased need for physician-conducted home visits. To conduct home visits effectively, physicians must acquire fundamental and well-defined attitudes, knowledge and skills in addition to an inexpensive set of portable equipment. “INHOMESSS” (standing for: i mmobility, n utrition, h ousing, o thers, m edication, e xamination, s afety, s pirituality, s ervices) is an easily remembered mnemonic that provides a framework for the evaluation of a patient's functional status and home environment. Expanded use of the telephone and telemedicine technology may allow busy physicians to conduct time-efficient “virtual” house calls that complement and sometimes replace in-person visits.

In 1990, the American Medical Association (AMA) reported that approximately one half of primary care physicians polled in a national survey indicated that they performed home visits. 1 Although most of the physicians surveyed perceived home visits to be an important service, the majority performed only a few such visits per year. 1 Consistent with these self-reported behaviors are data indicating that only 0.88 percent of Medicare patients receive home visits from physicians. 2 In addition, the Health Care Financing Administration reported charges for only 1.6 million home visits in 1996, an extremely small percentage of the total number of annual physician-patient contacts in the United States. 3 These statistics stand in sharp contrast to medical practice before World War II, at which time about 40 percent of patient-physician encounters were in the home. 4

The low frequency of home visits by physicians is the result of many coincident factors, including deficits in physician compensation for these visits, time constraints, perceived limitations of technologic support, concerns about the risk of litigation, lack of physician training and exposure, and corporate and individual attitudinal biases. Physicians most likely to perform home visits are older generalists in solo practices. Health care providers who have long-established relationships with their patients are also more likely to utilize house calls. Rural practice setting, older patient age and need for terminal care correlate with an increased frequency of home visits. 5

Rationale for Home Visits

Studies suggest that home visits can lead to improved medical care through the discovery of unmet health care needs. 6 – 8 One study found that home assessment of elderly patients with relatively good health status and function resulted in the detection of an average of four new medical problems and up to eight new intervention recommendations per patient. 8 Major problems detected included impotence, gait and balance problems, immunization deficits and hypertension. Significantly, these problems had not been expected based on information obtained from outpatient clinic encounters. Other investigators have demonstrated the effectiveness of home visits in assessing unexpected problems in patient compliance with therapeutic regimens. 9 Finally, specific home-based interventions, such as adjusting the elderly patient's home environment to prevent falls, have also yielded health benefits. 10

Beyond the potential benefit of improved patient care, family physicians who conduct home visits report a higher level of practice satisfaction than those who do not offer this service. 5 Physicians with more positive attitudes about home visits are more likely to have conducted house calls during training. 11 Faculty mentorship and longitudinal exposure in training appear to be important for the development of positive attitudes toward home visits. 5 However, in 1994, only 66 of 123 medical schools offered specific instruction in the role and conduct of home visits. 12 Although 83 percent of the medical schools offered students the opportunity to participate in home visits, only three of the 123 schools required students to make five or more such visits. 12

Home Health Care Industry

Physician home visits have largely been supplanted by the extensive use of home health care services, a $22.3 billion industry that augments a medical system largely comprising facility-based health care providers. 13 The mean annual frequency of home health referrals was 43 per provider in a study published in 1992. 14

Family physicians have authorization and supervision responsibilities for a broad spectrum of skilled services that can be offered in the home. Such services include home health nursing, assistance from home health aides, and physical, occupational and speech therapy. Other health care support services are provided by medical supply companies, respiratory therapists, nutritionists, intravenous therapy services, hospice organizations, respite care services, Meals-on-Wheels volunteers and bereavement support staff. Family physicians also work extensively with social workers, who provide invaluable assistance in coordinating these services.

Thus, effective use of home care services has become a core competency for family physicians. In 1998, the AMA published the second edition of Medical Management of the Home Care Patient: Guidelines for Physicians . 15 The basic physician home care responsibilities outlined in that document are listed in Table 1 . 15

Recent data suggest that many physicians do not have the necessary knowledge and skills to perform these tasks effectively. For example, a survey found that 64 percent of physicians who had signed claims for care plans that were later disallowed had relied on a home health agency to prepare the plan of care, and 60 percent were not aware of the homebound requirement for home services. 16 Thus, increased physician education about home visits seems necessary if the responsibilities and obligations created by the expansion of home health care industry are to be fulfilled.

Types of Home Visits

The four major types of home visits are illness visits, visits to dying patients, home assessment visits and follow-up visits after hospitalization ( Table 2 ) . 17 , 18 The illness home visit involves an assessment of the patient and the provision of care in the setting of acute or chronic illness, often in coordination with one or more home health agencies. Emergency illness visits are infrequent and impractical for the typical office-based physician.

The dying patient home visit is made to provide care to the home-bound patient who has a terminal disease, usually in coordination with a hospice agency. The family physician can provide valuable medical and emotional support to family members before, during and after the death of a patient in the home environment. Family assistance involves evaluating the coping behaviors of survivors and assessing the medical, psychosocial, environmental and financial resources of the remaining family members.

The assessment home visit can also be described as an investigational visit during which the physician evaluates the role of the home environment in the patient's health status. An assessment visit is often made when a patient is suspected of poor compliance or has been making excessive use of health care resources. Medication use can be evaluated in the patient who is taking many drugs (polypharmacy) because of multiple medical problems. Evaluation of the home environment of the “at-risk” patient can reveal evidence of abuse, neglect or social isolation. Patients and family members who are trying to cope with chronic problems such as cognitive impairment or incontinence may particularly benefit from this evaluation. A joint assessment home visit facilitates coordination of the efforts of home health agencies and the physician. Finally, an assessment home visit is invaluable in assessing the need for nursing home placement of a frail elderly patient with uncertain social support.

The hospitalization follow-up home visit is useful when significant life changes have occurred. For example, a home visit after the birth of a new baby provides an excellent opportunity to discuss wellness and prevention issues and to address parental concerns. A home visit after a major illness or surgery can be useful in evaluating the coping behaviors of the patient and family members, as well as the effectiveness of the home health care plan.

Many aspects of physician home care have not been evaluated in the literature. However, it seems likely that properly focused and conducted home visits can enhance home health care delivery, improve patient satisfaction and strengthen the doctor-patient relationship.

Conducting the Home Visit

Equipment and planning.

Most equipment for a home visit can still be carried in the family physician's “black bag” ( Table 3 ) . Some additional items may be acquired from the patient's home.

One of the keys to conducting a successful home visit is to clarify the reason for the visit and carefully plan the agenda. Preplanning allows the physician to gather the necessary equipment and patient education materials before departure. The physician should have a map, the patient's telephone number and directions to the patient's home. The physician, patient and home care team should set a formal appointment time for the visit. Coordinating the house call to allow for the presence of key family members or significant others can enhance communication and satisfaction with care. Finally, confirming the appointment time with all involved parties before departure from the office is a common courtesy to the family as well as a wise time-management strategy.

HOME VISIT CHECKLIST: “INHOMESSS”

The INHOME mnemonic was devised to help family physicians remember the items to be assessed during the home visit directed at a patient's functional status and living environment. 19 This mnemonic can be expanded to “INHOMESSS,” which incorporates investigations of safety issues, spiritual health and home health agencies ( Table 4 ) . 19

Immobility . Evaluation of the patient's functional activities includes assessment of the activities of daily living (bathing, transfer, dressing, toileting, feeding, continence) and the instrumental activities of daily living (using the telephone, administering medications, paying bills, shopping for food, preparing meals, doing housework). The physician can ask the patient to demonstrate elements of the daily routine, such as getting out of bed, performing personal hygiene and leisure activities, and getting in and out of a car. Corrective interventions can be directed at any deficiencies noted. For example, modified pill-bottle caps can be obtained for the patient who has trouble opening medication containers because of a condition such as arthritis.

Nutrition . The physician should assess the patient's current state of nutrition, eating behaviors and food preferences. Permission to look in the refrigerator or cupboard can be obtained by asking open-ended but directed questions. For example, the physician might say, “We have been working hard on your diet to control your diabetes. Would you mind if I look in your refrigerator to see the types of foods you eat?” Improvements in product labeling allow the physician to assess serving sizes and the nutritional value of foods with relative ease. Healthy food preparation techniques can also be reviewed with the patient.

Home Environment . The patient's home environment should allow for privacy, social interaction and both spiritual and emotional comfort and safety. A safe neighborhood with close proximity to services is important for many older patients. The home may reflect pride in the patient's family and past accomplishments and reveal the patient's interests and hobbies. The physician should not make assumptions about social class or material wealth based on the patient's physical environment.

Other People . Having the patient's social support system present at the home visit clarifies the roles and concerns of family members. During routine visits, the physician can assess the availability of emergency help for the patient from family members and friends and can clarify specific issues, such as who is to serve as surrogate for the patient in the event of incapacitation. Discussion of a durable power of attorney and a living will may be more comfortably performed during the home visit than in the usual clinic visit. Evaluation of the caregiver's needs and risk of burnout is critically important.

Medications . To remedy or avoid polypharmacy, the physician must evaluate the type, amount and frequency of medications, and the organization and methods of medication delivery. An inventory of the patient's medicine cabinet can provide clues to previously unidentified drug-drug or drug-food interactions. A home medication review can also allow a direct estimate of patient compliance, uncover evidence of “doctor shopping” and identify the use or abuse of over-the-counter medications and herbal remedies.

Examination . The home visit should include a directed physical examination based on the needs of the patient and the physician's agenda. Practical, function-related examination techniques may include having the patient demonstrate getting on and off the toilet or in and out of the bathtub. The physician can have the patient demonstrate proper technique for the self-monitoring of blood glucose levels. In addition, the physician can weigh the patient and obtain a blood pressure measurement. In-person correlation of home and office measures provides useful information for future telephone and clinic contacts.

Safety . Common home safety issues are listed in Table 5 . The goal of the home safety assessment is to determine whether the patient's environment is comfortable and safe (no unreasonable risk of injury). To raise the subject, the physician should simply state the intention to identify and help modify potential safety hazards. For example, furniture placement or throw rugs may create problems for an elderly patient with gait instability, or the tap water may be so hot that the patient is at risk for scald injury. 20

Spiritual Health . If the home contains religious objects or reading materials, the physician can ask about the influence of spiritual beliefs on the patient's sense of physical and emotional health. This information may provide the impetus, as desired by the patient, for a discussion of spirituality as a coping and healing strategy.

Services . Having members of cooperating home health agencies present for the house call can enhance communication and cooperation among the physician, patient and agencies. Existing orders can be clarified, priorities for future care can be established and other perspectives on the care plan can be solicited. The patient's relationship with home health agency providers can also be assessed.

Elements of the INHOMESSS mnemonic may be used independently, based on the needs of the patient and the physician's agenda. For example, the physician may wish to focus on polypharmacy and safety in a patient with a recent fall, or to assess mobility and the extent of social support in a patient with newly diagnosed Alzheimer's disease. Figure 1 presents the major elements of the home visit in a checklist format that facilitates comprehensive assessment.

INTEGRATING HOME VISITS INTO CLINICAL PRACTICE

Lack of reimbursement and the busy pace of office practice are the reasons commonly cited for not conducting house calls. Poorly organized, sporadic home visits may indeed interfere with clinical practice. Therefore, it is important to develop a systematic approach for planning home visits. 21

Most practices will benefit from using home visits with patients who have difficulty accessing outpatient facilities because of sensory impairment, immobility or transportation problems. Removing such logistically difficult appointments from the clinic schedule and performing them in the home setting may actually enhance clinic functioning. Clustering home visits by geographic location and within defined blocks of time may also improve efficiency. Finally, nurse practitioners and physician assistants can conduct visits as part of a home health care delivery team.

The 1999 Current Procedural Terminology codes and corresponding Medicare reimbursement rates for common types of home visits are listed in Table 6 . 22

Telephone Calls and Telemedicine

Proactive telephone calls are an underutilized method of conducting highly focused and time-efficient “virtual” home visits. 23 Provider-initiated telephone calls can be used to reassure family members after a patient has had an acute illness or has been hospitalized. 23 These calls can also be helpful in reinforcing patient compliance with new medications, following patients with chronic diseases and reducing inappropriate use of primary care clinic or office services. 24

Telemedicine is the use of communication technologies, such as two-way video-conferencing, to provide patient care across distances. A variety of institutions are exploring these technologies as methods of delivering health care in the home. 25 , 26

Final Comment

As fewer patients are admitted to hospitals and hospital stays become ever briefer, the medical complexity of home care will increase, as will the demand for both in-person and “virtual” physician home visits. Physicians interested in obtaining additional information about home care provision can contact the American Academy of Home Care Physicians (P.O. Box 1037, Edgewood, MD 21040; Web address: http://www.aahcp.org/ ).

Shut in, but not shut out [Editorial]. Am Med News. 1996;39:47.

Meyer GS, Gibbons RV. House calls to the elderly: a vanishing practice among physicians. N Engl J Med. 1997;337:1815-20.

Boling PA. House calls [Letter]. N Engl J Med. 1998;338:1466.

Starr P. The social transformation of American medicine. New York: Basic Books, 1982:359.

Adelman AM, Fredman L, Knight AL. House call practices: a comparison by specialty. J Fam Pract. 1994;39:39-44.

Arcand M, Williamson J. An evaluation of home visiting of patients by physicians in geriatric medicine. Br Med J. 1981;283:718-20.

Fabacher D, Josephson K, Pietruszka F, Linderborn K, Morley JE, Rubenstein LZ. An in-home preventive assessment program for independent older adults: a randomized controlled trial. J Am Geriatr Soc. 1994;42:630-8.

Ramsdell SW, Swart J, Jackson JE, Renvall M. The yield of a home visit in the assessment of geriatric patients. J Am Geriatr Soc. 1989;37:17-24.

Bernardini J, Piraino B. Compliance in CAPD and CCPD patients as measured by supply inventories during home visits. Am J Kidney Dis. 1998;31:101-7.

Tideiksaar R. Environmental adaptation to preserve balance and prevent falls. Top Geriatr Rehabil. 1990;5:178-84.

Knight AL, Adelman AM, Sobal J. The house call in residency training and its relationship to future practice. Fam Med. 1991;23:57-9.

Steel RK, Musliner M, Boling PA. Medical schools and home care. N Engl J Med. 1994;331:1098-9.

Goldberg AI. Home healthcare: the role of the primary care physician. Compr Ther. 1995;21:633-8.

Boling PA, Keenan JM, Schwartzberg JG, Retchin SM, Olson L, Schneiderman M. Home health agency referrals by internists and family physicians. Am Geriatr Soc. 1992;40:1241-9.

American Medical Association. Medical management of the home care patient: guidelines for physicians. 2d ed. Chicago: The Association, 1998:1–60.

Klein S. Guidance for home care physicians. Am Med News. 1998;41:5-6.

Cauthen DB. The house call in current medical practice. J Fam Pract. 1981;13:209-13.

Scanameo AM, Fillit H. House calls: a practical guide to seeing the patient at home. Geriatrics. 1995;50:33-9.

Knight AL, Adelman AM. The family physician and home care. Am Fam Physician. 1991;44:1733-7.

Huyer DW, Corkum SH. Reducing the incidence of tap-water scalds: strategies for physicians. Can Med Assoc J. 1997;156:841-4.

American Academy of Home Care Physicians. Making house calls a part of your practice. Edgewood, Md.: American Academy of Home Care Physicians, 19981;1–35.

Kirschner CG, ed. Current procedural terminology: CPT. Standard ed. Chicago: American Medical Association, 1999:26–8.

Studdiford JS, Panitch KN, Snyderman DA, Pharr ME. The telephone in primary care. Prim Care. 1996;23:83-102.

Wasson J, Gaudette C, Whaley F, Sauvigne A, Baribeau P, Welch HG. Telephone care as a substitute for routine clinic follow-up. JAMA. 1992;267:1788-93.

Jerant AF, Schlachta L, Epperly TD, Barnes-Camp J. Back to the future: the telemedicine house call. Fam Pract Management. 1998;5:18-22.

Johnson B, Wheeler L, Deuser J. Kaiser Permanente Medical Center's pilot tele-home health project. Telemed Today. 1997;5:16-8.

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Nurses’ activities and time management during home healthcare visits

Heli vaartio‐rajalin.

1 Faculty of Pedagogy and Welfare Studies, Åbo Akademi University, Vasa Finland

2 Nursing Program, Novia University of Applied Sciences, Åbo Finland

Yvonne Näsman

Lisbeth fagerström.

3 Faculty of Health and Social Sciences, University of South‐Eastern Norway, Kongsberg Norway

To describe nurses’ activities and time management during HHC visits from the perspective of master’s‐level nursing students.

The shift from community‐based hospitals to home‐based, person‐centred services for patients with a variety of acute or chronic health problems challenges nurses’ professional competence and time management during home healthcare visits.

Design and methods

A cross‐sectional study in accordance with STROBE guidelines. Observation sheets (n = 196) from two municipal home healthcare organisations were analysed with descriptive quantitative analysis.

Ethical issues and approval

While no external ethical committee evaluation was necessary for this quality improvement study, research ethical principles were followed.

The nurses spent 50% of each eight‐hour shift on indirect patient contact activities and about 38% on direct patient contact activities. The majority of activities underlying the home visits could be linked to long‐term illnesses: medication (57%), blood samples (23%), wound care (17%) or measurement of blood pressure (14%). Patient education was offered during only 3.5% of visits.

Limitations

The accuracy of the students’ observations is related to their individual capacity to objectively and selectively observe.

Conclusions

There were a number of activities conducted for the patient , to promote continuous intra‐ and interprofessional patient care, but fewer nursing activities conducted with the patient. To ensure integrated, person‐centred, safe patient care, vital reforms are needed.

Relevance to clinical practice

The appropriate balance between indirect and direct patient contact activities should be discussed intra‐ and interprofessionally, delineated and made explicit in nurses’ work plans and nursing documentation, alongside discussions pertaining to relevant resource allocation.

Recognising that patients prefer to be treated at home and that home‐based care can reduce care delivery costs system‐wide, politicians and leaders have begun to prioritise noninstitutional care settings 1 and intermediate care 2 . This shift from community‐based hospitals to home‐based, person‐centred services for patients with a variety of acute or chronic health problems challenges nurses’ professional competence and time management during home healthcare (HHC) visits.

Traditionally, the aim of HHC has been to facilitate discharge from hospital and prolong individuals’ prospects of living at home, even for those with chronic conditions. HHC has generally been offered when other healthcare services have been deemed inconvenient or unsuitable for individuals with altered functional capacity or somatic illnesses. In Finland, HHC is comprised of physician‐ordered interventions and social services. This can include the taking of blood samples; monitoring of medicine compliance and/or patients’ clinical condition; or provision of functional support for activities of daily living. HHC in Finland can accordingly be considered integrated, highly interprofessional care. The majority of HHC patients have typically been older persons with primary care needs 3 , 4 . Still, during the three last decades, HHC has also been offered cumulatively to ill working‐age individuals, individuals with mental health problems, families with ill children and terminal‐phase patients.

As seen in a scoping review 5 , HHC nurses today are responsible not only for the provision of primary healthcare interventions in the home environment but also for advanced care. Advanced care includes holistic assessment of patients’ physical and psychological status; the planning, coordination, implementation and evaluation of patient‐centred care; management of advanced medication; and provision of patient and family caregiver education. It also includes the management of new technical/digital developments that facilitate interprofessional coordination, rehabilitation and research assistant duties. Embedded into these responsibilities is even that HHC nurses act as a ‘communications hub’, facilitating interprofessional communication, which has been shown to reduce the re‐hospitalisation of high‐risk patients by 8–33 per cent 6 . One can question whether it is possible for HHC nurses to accomplish all of the tasks mentioned above, especially because the number of HHC patients has increased but the number of HHC staff has not 7 , 8 . This disparity in numbers has resulted in increased pressure on HHC nurses’ time management skills 9 and discussions about HHC staff’s educational requirements and how to improve HHC staff motivation 7 , 8 , 10 .

The home as a context for care not only can promote patients’ autonomy and well‐being, but also can increase safety risks 5 . The HHC setting provides healthcare staff with an optimal opportunity to identify and respond to patients’ and their families’ needs, which can be perceived as the provision of patient‐ or person‐centred care. Person‐centred care can be defined as care that is respectful of and responsive to individual patient preferences, needs and values, where all clinical decisions are guided by the views of the patient 11 . Person‐centred care also includes respect for the personal narratives that reflect a person’s sense of self, lived experiences and relationships, that is personal knowledge, and the safeguarding of partnership in the caring relationship through shared decision‐making and meaningful activities in a personalised environment 12 , 13 , 14 .

A patient‐centred approach is one of the key components of high‐quality integrated care. Integrated care has been linked to increased service efficiency, decreased costs (60–70% reduction in emergency room admissions, 50% reduction in hospital admissions; Ref. 15 , improved equity in service uptake, better health literacy and self‐care, increased satisfaction with care, and improved patient–healthcare provider relationships 16 . Yet in an analysis of care and service plans (n = 437) in HHC in Finland 17 , researchers found that HHC care planning was often illness‐centred and focused on patients’ diseases and/or functional/cognitive disabilities, with the plans themselves heavily focused on classification and composed using passive expressions. Moreover, documentation was based on the philosophy of ‘doing for’ patients rather than ‘doing with’. Excepting components related to respiration, follow‐up treatment, life cycle and health behaviour, which were not investigated in that study, medication was the most reported component (93%), followed by self‐care (85%), coping (78%), physical activity (30%) and skin integrity (25%). The researchers also found that most care and service plans were designed emanating from care professionals’ point of view 17 .

Care delivery reforms worldwide will benefit HHC 1 , and it is expected that HHC will become a significant employer of Registered Nurses (RNs). Still, concerns have been raised about HHC staff turnover and clinical training, for example in skilled areas of care 18 . HHC internships for nursing students are not be systematically included in nursing education in Europe 19 , even though many nursing students work at HHC during school breaks. This may stem from assumptions that HHC work is easy and nonchallenging and entails providing primary care 20 .

To guarantee a competent, motivated and enabled HHC workforce in the future, it is vital to point out the reality of HHC to nursing students, nurse educators, leaders and policymakers. While there is evidence that the highest‐staffed nursing homes provide better care 21 , the relationship between number of staff and care quality is not linear 10 . Very few studies on HHC nursing interventions have been conducted since the turn of the century, and none have included an assessment of time management in the HHC setting.

The aim of this study was to describe nurses’ activities and time management during HHC visits from the perspective of master’s‐level nursing students. Unlike other studies in which a focus is placed on nurse–patient ratios, staffing numbers or workload, here the focus lay on students’ one‐to‐one nonparticipatory observations of nurses’ work in HHC. The research question was as follows:

• What does an HHC nurse do for patients before, after and during home visits?

This study is a part of research project with the overall aim to develop quality criteria for competent, safe, effective and person‐centred advanced care at home.

This was a cross‐sectional descriptive study at two municipal HHC organisations in Finland. Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines were followed throughout. In autumn 2017, students in a master’s‐level caring science programme (n = 18) received training in observation technique and, under the auspices of a healthcare administration course part of their degree programme, collected data at two municipal HHC organisations. The healthcare administration course that the students participated in encompassed the study of various classification systems and classification theories. The observation sheet for this study was based on a differentiation between activities involving indirect and direct patient contact 22 , 23 . Inspiration for this approach was taken from measurement instruments used in Finland to monitor nursing care intensity, which the students here also studied as part of their degree programme.

In this study, the students engaged in the one‐to‐one nonparticipatory observation of HHC nurses’ (n = 18) work, observing 2–3 work shifts per nurse. Nonparticipatory observation involves observing participants without active participation and is used to understand a phenomenon by accessing a setting while still maintaining detachment from the activities being observed 24 . To document the HHC nurses’ activities, observation sheets were created (see Table ​ Table1 1 ).

Structure of observation sheets

The data collected included students’ observations of HHC nurses’ activities and time management and some demographic patient data (gender, living/housing arrangements, main diagnosis, reason for home visit). The observation data (n = 196 observation sheets) were synthetised using quantitative descriptive methods (frequency, percentage, mean, mode), but due to small subsample sizes, no correlations or statistical significance tests were calculated.

Research ethics

The ethical principles delineated by the Finnish National Board on Research Integrity 25 were followed during the entire course of the study, including informant recruitment, data collection, data analysis and publication. No external ethical committee evaluation for the study was considered necessary, because the organisations overseeing the data collection procedures categorised it as the starting point for a quality improvement project.

The healthcare administration course part of the master’s‐level caring science programme was obligatory for those students seeking to minor in healthcare administration. Because the focus of the course was on healthcare administration research and development, those overseeing the degree programme sought a project whereby the students could gain practical research experience. This included students following a research process from start to finish: from plan (written by the research leader) to published results (written by the research team). The students’ were tasked with collecting data. While one can consider this project to be more of a didactical exploration than an ordinary research project, it nonetheless yielded useful information for the various stakeholders involved, that is the university offering the degree programme and the municipalities providing the HHC services.

The HHC nurses received a study information sheet from their respective nurse managers and were given an informed consent letter to fill in, providing agreement to participate in the study. The information sheet contained information about the aim of the study, quality improvement process, data collection procedures, informants’ right to self‐determination and aspects of confidentiality. The HHC nurses also received information about who to contact for additional study information. All of those given the study information sheet agreed to participate in the study.

The course teacher for the healthcare administration course, two members of the study research team and the HHC nurses’ nurse manager together created a schedule for the observations. The observation sheet was pilot‐tested when one volunteer HHC nurse was followed and observed by the course teacher during a workday. Following this pilot test, the observation sheet was revised, because the original, precise separation of nursing tasks was seen to be problematic. During the pilot test, for example, it was observed that an HHC nurse could provide emotional support (through a caring conversation) while simultaneously taking care of wounds or be interrupted by a telephone call while dispensing medication.

The course teacher and the HHC nurses’ nurse manager together paired the students and HHC nurses. The participating HHC nurses were guaranteed anonymity, and all information relating to their identity was coded in the data analysis and removed from the research report.

While the students did not participate in any nursing activities, the HHC patients were nonetheless asked whether they consented to the students’ presence during an HHC visit (informed consent).

The observation sheets were collected in separate boxes. All data were collected and are safely stored in a locked filing cabinet at the university where the researchers are employed. The data will not be used for any other purposes other than what was agreed upon with the informants prior to data collection.

Altogether, 18 HHC nurses were observed during 2–3 work shifts per nurse, and the observation data consisted of 196 observation sheets. The HHC nurses’ background data are presented in Table ​ Table2. 2 . However, due to their right to anonymity and integrity, their educational level is not presented in detail. In Finland, a specific HHC nursing programme does not currently exist.

Nurses’ background data (n = 18)

All of the HHC nurses had a professional nursing education, and the majority (56%) also had one or more specialisations, such as public health nurse, midwife, internal medicine and surgery, or acute care. The HHC nurses received their nursing degrees between 1987 and 2017, with the majority (85%) receiving degrees between 1997 and 2014. Their HHC work experience varied from 1.5 months to 21 years. Due to small subsample sizes, it was not possible to analyse any correlations between the demographic data and other variables.

The observation material consisted of one observation sheet per home visit, and patients can be visited several times during the data collection phase. The majority of HHC patients seen here (Table ​ (Table3) 3 ) were female (60%), lived alone (60%), and faced cardiological (47%), endocrinological (13%), oncological (12%) or psychiatric (7%) health problems or a combination of these, or dementia (18%). The majority had different health issues and received care related to medication (57%), blood samples (23%), wound care (17%) or blood pressure (14%). There could be several issues underlying each home visit, and the students documented these as best they could, based mainly on their observations and discussions with the HHC nurses.

Patients’ background data (n = 196 observation sheets)

During eight‐hour shifts, the HHC nurses in this sample (n = 196 observation sheets) spent from 75 to 410 minutes (mean = 241 minutes, mode = 242) on indirect patient contact activities (Table ​ (Table4), 4 ), which is 50% of the work shift. About 69 minutes (M) was spent on Planning, 50 minutes (M) on Documentation, 48 minutes (M) on Travel, 20 minutes (M) on Telephone calls, 42 minutes (M) on Professional meetings and 40 minutes (M) on Other activities. Thus, despite evidence of some variation, it would appear that indirect patient contact activities comprise a large part of HHC nurses’ daily work.

Comparison of indirect and direct patient contact activities per work shift

The HHC nurses spent from 2 to 196 minutes (M = 27 minutes, Mo = 10 minutes) per patient per visit on direct patient contact activities. On the majority of observation sheets, the only information recorded was categorised under the main categories (Indirect patient contact activities, Direct patient contact activities), with nothing under the subcategories (e.g. Planning, Nursing care). This, however, was not seen to be a detriment, because the subcategories were mainly used to exemplify the main categories and facilitate the students’ observations. About 15 minutes (M) was spent on Nursing care, 17 minutes (M) on Medication and 10 minutes (M) on Caring discussion (could include patient education). Explicit patient education was offered during only 3.5% of home visit. Information recorded under Other activities included the following: waiting for the patient to come and open the door (3–5 minutes), documentation during home visit (3–15 minutes), further situation analysis (5–10 minutes) and acute care situation (only one observation, 60 minutes). It was observed that the data for direct patient contact activities represent nurses’ time management during one home visit and should therefore be multiplied by the average number of home visits per nurse during a work shift, that is 3–6 home visits (Table ​ (Table4 4 ).

From the data, one sees that the HHC nurses spent 50% of their time on indirect patient contact activities and 38% on direct patient contact activities. Of the direct patient contact activities, the majority were illness‐centred and included a focus on clinical symptoms or medication. Altogether, 12% of activities were characterised as unclear (neither indirect nor direct), possibly because the students only recorded activities under the main categories in the observation sheet. It is also possible that this was related to methodical difficulties; the students may have been uncertain about how to record what they observed, for example if many activities occurred simultaneously. Prior to the start of the observations, the students were instructed to record any activities that they perceived as being unclear under the category Other activities in the observation sheet, along with a brief explanation.

The aim of this study was to describe HHC nurses’ activities and time management from the perspective of master’s‐level nursing students. With reference to Benner’s 26 stages of clinical competence, we saw in the analysis that while half of the nurses were not yet experts, the other half were (>7 years of working experience). Looking at their year of graduation, one sees that the majority of the nurses had begun employment in HHC directly after graduation. One can therefore assume that staff turnover in the two HHC settings seen here was quite low (see also Ref. 18 .

The majority of the patients in this sample received home visits because of a long‐term illness (cardiological, endocrinological, oncological or psychiatric illness; dementia) or multimorbidity. Also, the majority of activities underlying the home visits could, to some degree, be linked to long‐term illnesses: medication (57%), blood samples (23%), wound care (17%) or measurement of blood pressure (14%). Only a few observations of acute care activities were seen (acute bleeding, rash; congested urinary or pleura drainage). The sample corresponds well with long‐term illness prevalence statistics in Finland. Consequently, it can be considered relevant and comparable to other HHC populations (see also Ref. 1 .

Patient education was observed during only 3.5% of home visits. Still, the nurses may have also given emotional support, engaged in caring conversations, encouraged patients’ physical activity or conducted rehabilitative acts while performing other nursing activities. As noted previously, the simultaneous performance of nursing activities could be problematic with regard to characterisation, and the students were instructed to record any activities considered to be unclear under the Other activities category. Despite 12% of the patient sample having cancer and 2.5% having pain, there were no observations of palliative care as such. Based on the findings, we maintain that HHC is quite illness‐centred (see also Ref. 17 and reliant on a focus on clinical symptoms and medication. The HHC services offered here can be considered to partially contribute to hospital avoidance 1 or the enablement of early discharge. Nevertheless, with respect to the patient sample seen here (60% were older persons living alone), we maintain that to avoid risk, HHC must be reorganised and relevant resource allocation established (see also Ref. 21 .

In this sample, about half of each eight‐hour work shift was used on indirect patient contact activities 22 , 23 : Planning (Mo = 67 minutes/shift), Documentation (Mo = 30 minutes/shift), Travel (Mo = 39 minutes/shift), Telephone calls (Mo = 10 minutes/shift), Professional meetings (Mo = 40 minutes/shift) or Other activities (Mo = 40 minutes/shift). Indirect patient contact activities (about 4 hours per eight‐hour shift) appear to form the basis of HHC nurses’ daily work (see also Ref. 5 . Still, because the indirect patient activities were related to care coordination and collaboration, we find that they are nevertheless necessary and facilitate the actual home visits (see also Ref. 9 .

In comparison, the time spent on direct patient contact activities 22 , 23 seems disproportionately small. Again, some activities might have been conducted simultaneously and therefore not noted in the students’ observations. Also, a number of activities were recorded under Other activities, for example waiting for the patient to open the door, documentation or situation analysis during a home visit. We perceive that such activities limited the actual time that the nurses had for direct patient contact activities. Given this and that nurses could simultaneously perform different activities, it is therefore understandable that no observations of explicit patient counselling, psychosocial care, prevention, physical activity or rehabilitation (see also Ref. 17 were recorded.

We still note the possibility that missed care or care left undone due to unrealistic nurse‐to‐patient ratios, as seen by Aiken et al. in a hospital context 27 , could be a contributing factor. Also, the observations were dependent on individual student’s observational accuracy, and the structure of the observation sheet may have guided observations too much.

The aim of periodic or continuous HHC is the provision of holistic medical and nursing care. The patients here had different long‐ or short‐term health problems, and diverse nursing activities were required. As seen in the data, there were a number of activities conducted for the patient , to promote continuous intra‐ and interprofessional patient care (see also Ref. 5 , but fewer nursing activities conducted with the patient . Observation data on person‐centeredness as shared decision‐making and/or in meaningful activities in a personalised environment were not available (see also Refs 12 , 13 , 14 ), because the structure of the observation sheet did not accommodate such. Indirect patient contact activities consume a lot of time that could be used for health promotion, rehabilitation or other meaningful activities. Nonetheless, indirect patient contact activities are necessary for patient safety and person‐centred care. HHC staff in Finland are more and more comprised of primary care nurses with no advanced education or training. That is, they have no specific training in, for example, clinical screening, decision‐making, patient advocacy, documentation, evidence‐based care, interprofessional collaboration and communication, or person‐centeredness/integrated care. To promote patient safety, patient‐centred care and work satisfaction, the further education of or integrated care management certification for HHC nurses is recommended (see also Ref. 5 . The creation of interprofessional teams that are responsible for HHC patients’ intermediate care under the guidance of advanced nurse practitioners (ANPs) or clinical nurse specialists (CNSs) is also recommended. Both ANPs and CNSs have advanced competence in the holistic assessment of patients’ physical and mental status, and in planning, coordinating, implementing and evaluating patient‐centred evidence‐based care and rehabilitation. We maintain that such changes will also improve resource allocation.

Strengths and limitations

The accuracy of the students’ observations is related to their individual capacity to objectively and selectively observe, which is a limitation. Also, the structure of the observation sheet, which was based on a differentiation between activities involving indirect and direct patient contact 22 , 23 , may have been challenging or guided the observations too much. For purely economic reasons, we did not include the use of a validated instrument; classification systems are licensed and not freely available. In the future, we recommend that the background data collected with regard to main diagnosis be replaced with a nursing care category. Also, a validated instrument such as the Clinical Care Classification System (CCCS) should be used as a basis for structuring the observation sheet, and case load intensity measurement tools should be integrated into the study design and/or interviews to further investigate nurses’ time management. Still, the students here had received training in observation technique and with regard to the specific observation sheet used here. The observation sheet had also been pilot‐tested and revised prior to data collection. The course teacher’s instruction, which could be considered a form of coaching, might have affected the stringency of the students’ observations positively – or not. To overcome the observer effect, the data were derived from different students’ various observations of multiple HHC nurses over the course of several work shifts, which should raise the study’s inner validity. The findings cannot be generalised to describe HHC in all municipalities in Finland, because the data collection occurred during a certain period of time and the setting was comprised of two municipal HHC organisations.

Older and/or multimorbid clientele require integrated care skills, which at a minimum necessitates the further education and training of HHC staff or even standardised certification. To ensure integrated, person‐centred, safe patient care, these vital reforms should be immediately implemented alongside the reorganisation of HHC nurses’ work duties, that is HHC structures and processes. Performance effectiveness is related to the training and quality of individual nurses and the way care is organised.

In the observation data, 50% of the care provided by nurses during each eight‐hour work shift was spent on indirect patient contact activities and only 38% on direct patient contact activities. While the indirect patient contact activities did promote continuous intra‐ and interprofessional patient care and patient safety, such a difference could weaken person‐centeredness and rehabilitation. The appropriate balance between indirect and direct patient contact activities should be discussed intra‐ and interprofessionally, delineated and made explicit in nurses’ work plans and nursing documentation, alongside discussions pertaining to relevant resource allocation.

Impact Statement

What does this paper contribute to the wider global clinical community?

• During an eight‐hour work shift in an HHC setting, nurses spend more time on indirect than direct patient contact activities.
• Health issues related to long‐term illnesses underlie the majority of HHC visits. Thus, one can conclude that HHC is at present quite illness‐centred, with a focus on clinical symptoms and medication instead of person‐centred care.
• To ensure person‐centred, safe patient care in an HHC setting, vital reforms should be immediately implemented. These include standardised certification policies and the delineation of the balance between indirect and direct patient contact activities in nurses’ work plans and nursing documentation, in parallel with relevant resource allocation.

Conflict of interest

The authors have no conflicts of interests.

Author contributions

LF was responsible for the pilot study design and the observation sheet structure, and has participated the manuscript writing with critical appraisal. YN was responsible for the leadership course during which the data collection was organised, tested the observation sheet, instructed the master's students in use of it, and participated the manuscript writing. HVR was responsible for the data analysis and had responsibility over the manuscript, submission and correspondence.

Ethical approval

We have followed the journal’s authorship policy in the Editorial Policies and Ethical Considerations section on eligibility for author listing.

This manuscript is part of a research project funded by Eschnerska Foundation, Turku, Finland.

Scand J Caring Sci ; 2020; 34 : 1045–1053 Nurses’ activities and time management during home healthcare visits [ PMC free article ] [ PubMed ] [ Google Scholar ]

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Home Prices Stagnate in Florida and Texas as Supply Soars

• The number of homes for sale in Cape Coral, FL and North Port, FL surged roughly 50% from a year earlier in March—more than anywhere else in the country. And in McAllen, TX, supply jumped 25%.
• Housing supply is soaring because both states have been building a lot of homes, which is limiting home price growth. Buyer demand is also lackluster because many people are priced out. And in Florida, an insurance crisis is throwing a wrench into deals.
• Nationwide, new listings slowed in March as mortgage rates remained elevated. The Fed recently warned rates are likely to stay high longer than expected.

On the west coast of Florida, housing supply is surging, sellers are cutting their asking prices and the time it takes to sell a home is soaring—all at a faster rate than anywhere else in the U.S. The story is similar in parts of Texas.

Florida and Texas have been building more homes than anywhere else in the country, partly to accommodate the flood of newcomers that showed up during the pandemic homebuying boom. But the boom is over, in part because many people have been priced out. Now, homes are sitting on the market and price growth is stagnating.

Here’s how these trends showed up in U.S. housing-market data for March, which covers 85 major metropolitan areas: 

• Supply: Of the 10 metro areas that posted the largest year-over-year increases in supply, six are in Florida and two are in Texas. Cape Coral, FL saw the biggest jump in homes for sale (51%), followed by North Port-Sarasota, FL (48%), Fort Lauderdale, FL (30%), Tampa, FL (29%), McAllen, TX (25%), Orlando, FL (23%), Knoxville, TN (23%), Dallas (20%), West Palm Beach, FL (20%) and Cincinnati (17%).
• Price drops: Of the 10 metro areas where sellers were most likely to cut their list prices, five are in Florida and two are in Texas. In North Port-Sarasota , 48% of listings had a price cut—the highest share in the country. Next came Tampa (44%), Indianapolis (43%), Cape Coral (41%), Denver (37%), Orlando (35%), Portland, OR (34%), Houston (33%), San Antonio (33%) and Jacksonville, FL (33%).
• Prices: Median sale p rices fell from a year earlier in three metros, one of which is in Florida and one of which is in Texas: North Port-Sarasota (-4.6%), Oklahoma City (-1.5%) and San Antonio (-0.3%). Prices climbed least in Austin, TX (0%), El Paso, TX (0.5%), Memphis, TN (0.7%), Tampa (1.1%), Salt Lake City (1.1%), Omaha, NE (1.2%) and Charleston, SC (1.2%).
• Speed of sales: Of the 10 metros that saw the biggest upticks in median days on market, two are in Florida and two are in Texas: In Cape Coral , the typical home took 31 more days to sell than a year earlier—the largest jump in the nation. Next came North Port-Sarasota (20), McAllen (20), New Orleans (18), Tulsa, OK (13), Cincinnati (13), San Antonio (10), Greensboro, NC (8), Honolulu (7) and Knoxville (7).

“Out-of-town homebuyers no longer see Florida as a place to get amazing value. Now they’re moving to North Carolina or Tennessee to get a good deal. Many local blue-collar workers have been priced out of homeownership, too,” said Eric Auciello , a local Redfin sales manager. “Two years ago, the North Port metro was one of the most competitive housing markets in the country because it was affordable for remote workers and there was a shortage of homes for sale, but none of those things are true today. Sarasota, in particular, has been overvalued for decades, and the chickens have finally come to roost. The Tampa metro has been faring a bit better.”

Individual home sellers are having a tough time attracting buyers in part because builders are offering concessions that are hard for buyers to refuse. As a result, listings from regular sellers are sitting on the market. But homes are also sitting because many sellers are pricing their properties too high, and then being forced to cut later, Auciello said.

“The sharp ascent in Florida housing prices in recent years has driven a lot of homeowners to cash in on their equity, but some of them are having a hard time adjusting to the fact that it’s a buyer’s market,” Auciello said. “My advice to sellers is to price your home fairly; the comps from six months ago don’t exist now. And if you’re a buyer, know that the odds of getting an offer accepted below market value are pretty high.”

The insurance crisis in Florida is also throwing a wrench into home purchases and in some cases delaying deals. Nearly three-quarters of Florida homeowners say they or the area they live in has been affected by rising home insurance costs or changes in coverage, a recent Redfin survey found.

“One of our agents is representing a buyer who thought he’d be able to get insurance for $2,000 per year—the rate the existing homeowner has. But he found out at the eleventh hour that his insurance will be $4,000 because the house has had water damage. We’re seeing sellers offer a lot of concessions to hold deals together,” said Auciello, whose own home insurance is now $14,000 a year all in, up from around $8,000 two years ago. “We’re at an inflection point. A hefty insurance bill isn’t always a big deal for a luxury buyer, but it can be a really big issue for someone buying a waterfront home on a smaller budget.”

Connie Durnal , a Redfin Premier real estate agent in Dallas, said her market has also been sluggish.

“Last year was by far the slowest market I’ve seen in my 20 years as a real estate agent,” Durnal said. “Move-up buyers are almost nonexistent. Even though a lot of homeowners have built up a ton of equity, many don’t want to sell because their monthly payment would double or triple due to high mortgage rates.”

Nationwide, New Listings Slowed in March and Prices Rose From a Year Earlier

New listings dropped 6% month over month in March—the largest decline on a seasonally adjusted basis since January 2022. They rose 6% from a year earlier, but that marks a deceleration from the 14% annual gain in February.

New listings may have slowed because mortgage rates are staying higher longer than expected, which is exacerbating the lock-in effect . The average 30-year-fixed mortgage rate in March was 6.82% —the highest since December—and the Federal Reserve has warned that elevated inflation will probably delay the interest-rate cuts they had been planning this year.

Active listings, or the total number of homes for sale, rose 1% from February—the smallest seasonally adjusted increase since August—though their 4% increase from a year earlier was the biggest annual gain in 12 months.

Prices continued to rise, in part because there’s still a shortage of homes for sale. The median U.S. home sale price rose 5% year over year in March to $420,357, just 3% below the record high of $432,496 set in May 2022. 

Home sales were roughly flat compared with a month earlier on a seasonally adjusted basis, and were down 3% from a year earlier.

March 2024 Highlights: United States

Note: Data is subject to revision

Metro-Level Highlights: March 2024

Data in the bullets below came from a list of 85 U.S. metro areas with populations of at least 750,000. Select metros may be excluded from time to time to ensure data accuracy. A full metro-level data table can be found in the “download” tab of the dashboard in the monthly section of the Redfin Data Center . Refer to our metrics definition page for explanations of metrics used in this report. Metro-level data is not seasonally adjusted. All changes below represent year-over-year changes.

• New listings: New listings rose most from a year earlier in Sacramento, CA (20%), San Jose, CA (18%) and Las Vegas (15%). They fell most in Boston (-18%), Rochester, NY (-16%) and Atlanta (-14%).
• Closed home sales: Closed sales rose most in San Jose (3%), Milwaukee (2%) and Tulsa (2%). They fell most in Tacoma, WA (-24%), West Palm Beach (-24%) and Grand Rapids, MI (-22%).
• Sold above list price: In San Jose, 72% of homes sold above their final list price, the highest share among the metros Redfin analyzed. Next came Rochester (69%) and Oakland, CA (66%). The shares were lowest in North Port (7%) West Palm Beach (8%) and Cape Coral (8%).
• Off market in two weeks: In Rochester, 82% of homes that went under contract did so within two weeks—the highest share among the metros Redfin analyzed. Next came Seattle (77%) and Grand Rapids (75%). The lowest shares were in Honolulu (10%), Tucson, AZ (18%) and McAllen (20%).

As a data journalist, Lily is passionate about helping readers understand complex facets of the housing market. She is particularly interested in the issues of climate change, race and gender equality and housing affordability. Prior to working at Redfin, Lily spent four years as a reporter at Bloomberg News in New York City.

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