MINNESOTA FAMILY
HOME VISITING NEWSLETTER
A publication from the Minnesota Department of Health Family Home Visiting Program
April 2016 | Volume 4 | Issue 1
GREETINGS FROM THE MINNESOTA
DEPARTMENT OF HEALTH FAMILY HOME
VISITING PROGRAM
Home visiting has a rich history dating back well over 100
years. Since these services began there has been debate over
the ideal qualifications necessary for home visitors to
conduct their work. This debate no doubt stems from the
diverse needs of families that home visitors encounter in
their day-to-day work, which range from basic health care
needs to more complex issues rooted in things such as
challenging mental health or socio-economic conditions.
FEATURED TOPIC:
Attributes of Effective Home Visitors
Home visiting programs across Minnesota
employ a variety of individuals to conduct
home visits with families. The knowledge and
skills that these home visitors bring to their
work varies based on their education/training
and former work experience. This newsletter
explores the steps necessary to hiring, building
and retaining an effective and competent
home visitor work force.
Contact Us
[email protected]
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Family Home Visiting Newsletter on the
MDH FHV website.
Depending on individual community needs and the
available work force, home visiting programs may focus
their efforts on hiring either paraprofessional or
professional level staff. Regardless, there are some basic
knowledge and skills that translate across all home visiting
programs, and training/professional development
opportunities that can benefit a variety of staff to ensure
their clients’ needs are met.
With the above in mind, the Minnesota Department of
Health (MDH) Family Home Visiting (FHV) Section has
decided to focus this year’s newsletter series on the home
visitor. The series begins with this issue, which explores
home visitor characteristics that can be built upon to deliver
effective services to families. In particular, this newsletter
includes discussion on interviewing and hiring home
visitors; building and assessing home visitor knowledge and
skills; the importance of relationship building with families;
and client preferences in a home visitor.
We hope you will find the content of this newsletter useful
in your work, and encourage you to share with us and fellow
home visiting programs in Minnesota your experience with
identifying and developing the attributes of home visitors
that have best served your program and community.
MN FHV Newsletter Vol. 4 (1), Page 1
INTERVIEWING AND HIRING HOME VISITORS
Purpose of Home Visiting
All home visiting programs have the central goal to improve the health, development, and well-being of mothers, children,
and their families. However, depending on the model and type of home visiting program (short- versus long-term) the
target outcomes may vary. The Home Visiting Evidence of Effectiveness (HomVEE) Executive Summary highlights eight
domains (child health, child development/school readiness, family self-sufficiency, linkage and referrals, maternal health
and family violence/crime) that home visiting models aim to improve with their services.1 According to the specific
structure and goals of a home visiting program, programs must decide the specific educational, professional and personal
experiences that are necessary to do the job in their community and agency.
Prerequisites for New Home Visitors
The relationship between a home visitor and the family is the foundation of home visiting services. Hiring and keeping
high quality staff will help assure program fidelity and improved family outcomes. In general, new home visitors must
have knowledge and experience in child development, early childhood education, maternal and child health, mental
health, family structures and cultural competency. They must be skilled in communicating and empathizing with people.
In addition, having knowledge of community resources and skills to link families with appropriate services are preferred.
In regards to education, some home visiting programs identify high school education as a minimum requirement, while
others require a bachelor’s degree or higher.
Paraprofessionals versus Professionals
Professional home visitors are staff who have accredited degrees and specialized training in a specific field (i.e. public
health, social work, etc.). The background of professional staff often include nursing, early childhood education, social
work, psychology and child development. Paraprofessionals are staff whose primary qualification is cultural competence
and life experience, rather than a specialized higher education, which lends to their ability to work with families from the
same communities.
Professional staff who hold experience and advanced degrees are recommended to offer help for high-risk families with
complex difficulties (i.e. mental health issues, child development and trauma). However, several home visiting programs
hire paraprofessionals who have only a high school education, but are often part of the community and share demographic
characteristics (e.g. ethnicity, race, language) of the community and families they serve.
The efficiency of professional versus paraprofessional home visitors in achieving outcomes is mainly dependent on the
goals of the home visiting program. For example, if a major program goal is to increase full-term births and pregnancy
outcomes in fewer number of home visits, you might consider employing professionals such as nurses who have specific
knowledge and training in the medical field. In contrast, if a home visiting program’s central aim is to reduce child
maltreatment and abuse outcomes then a social work background or an experienced paraprofessional with social service
experience and knowledge of diverse populations may be more beneficial to understand families at risk of child abuse and
neglect.
Desired Characteristics of a Home Visitor
Earlier this year, MDH and its partner, the Minnesota Coalition for Targeted Home Visiting (MCTHV), hosted a series of
web-based discussions focused on the topic of designing baseline training for new home visitors.2,3 These discussions
included significant input from home visitors and supervisors in short- and long-term home visiting programs who
identified interpersonal relationship skills ,open-mindedness, knowledge of job expectations for staff focusing on meeting
1 Avellar, S., Paulsell, D. Sama-Miller, E., Del Grasso, P. Akers, L. and Kleinman, R. (2016). Home Visiting Evidence of Effectiveness
Review: Executive Summary. Office of Planning, Research and Evaluation, Administration for Children and Families. US Department
of Health and Human Services. Washington, DC.
2 MDH and MCTHV. (2016). Common Job Standards and Training Needs. [Webinar].
3 MDH and MCTHV. (2016). Training Objectives and Methods for New Home Visiting Staff. [Webinar].
4 MDH (2016). Reflective Practice Fact Sheet. [PDF].
MN FHV Newsletter Vol. 4 (1), Page 2
family’s needs, teaching strategies for effective delivery of health and parenting information (background in parent-child
relationship); in addition to professional degrees in nursing, social work, parent education or counseling/psychology as
important hiring qualifications for a new home visitor. All these characteristics are not expected to be possessed before
hiring staff. However, further development of desired skills are possible through reflective practice, training and
mentoring after being hired. In addition, most evidence-based home visiting models require individual reflective practice
for an hour or more per week.4 This time is taken to evaluate what has transpired during a home visit and process new
ways of approaching parenting and relationships with clients. Home visitors are thus supported in understanding what
they observe during a home visit, and provided with the time and space needed to develop a plan with families and take
care of themselves and the relationships they build during the course of their work.
Hiring Barriers and Solutions
Hiring high quality staff can come with many challenges, particularly in terms of finding and hiring staff that meet the
unique skills and qualifications of any one home visiting program. Barriers to hiring often include a small candidate pool
of interested/qualified home visitors, especially in rural locations; lack of previous job experience or credentials (i.e.
BSNs); lack of culturally diverse staff; and lack of particular knowledge/skills (e.g. child development, cultural
competency, motivational interviewing). The challenge of retaining home visitors is also something to consider, as issues
of salary level, stress, safety and so on can be a factor in employee retention.
Some suggestions for tackling the aforementioned hiring barriers include:
 Providing detailed job description requirements/demands;
 Improving salaries and opportunity for upwards mobility;
 Recruiting potential candidates from diverse backgrounds through community outreach;
 Offering more professional development opportunities (i.e. cultural competency);
 Providing mentoring and reflective supervision;
 Making training adaptable for various learning styles; and
 Lowering caseloads and document burden when possible.
Training and Supervision
After the hiring process, a primary orientation, on-going training and supervision are essential components in the
application of any effective home visiting model. Orientation is the first step to help immerse staff to the environment and
guidelines of the home visiting agency. Depending on the model, home visiting agencies can have distinct ways of
functioning. Therefore, providing the necessary protocols on work flow, referral systems, documentation and reflective
practice/supervision during this period is essential for successful integration of new staff.
On-going training and supervision is vital in the home visiting profession, and should encompass resources to deal with
challenges or situations during home visits. Training that prioritized an introduction to the home visiting role; cultural
competency; family violence (domestic and child); infant/child mental health; substance use; and leadership basics for
supervisors are just some topics among many that were identified as particularly important to home visiting agencies
across Minnesota.4
Proper support and guidance through supervision for home visitors can reduce the experience of pressure and burn-out
on the job. Regular individual or group sessions of reflective supervision provides an opportunity for processing feelings
and experiences. This practice also assures home visitors to feel comfortable and trust their supervisors to support them at
times of need along with assuring compliance to program goals, training in evidence-based practice and providing
professional development.
BUILDING AND ASSESSING HOME VISITOR KNOWLEDGE AND SKILLS
“Assessing competency is a continuous process of persistently building knowledge, skills, etc.”5 For a home visiting
program, this knowledge and skills pertain to providing families with a range of information and tools, from prenatal and
pediatric health care to the establishment of social and community connections. 6 Having well-defined program outcomes
and a set of competencies by which these outcomes are based upon and can be evaluated from allows home visitors and
their supervisors to identify staff strengths and areas for development.
Op cit.
Employment Studies Institute. (2012). Assessing Competency. Retrieved March 18, 2016 from:
http://youremployment.biz/competency/assessing-competency/
6 MCTHV. (2016). Targeted Home Visiting: Invest In Our Future When It Matters Most. [Flyer]
4
5
MN FHV Newsletter Vol. 4 (1), Page 3
Core Competencies
In 2011, the MCTHV developed core competencies for home visitors (see summary in Table 1; the full description of the
core competencies can be accessed at this link). These competencies, revised in 2013, are intended to serve as a consensus
set of knowledge and skills for the broad practice of home visiting. “When professionals use knowledge competencies to
guide their assessment of their own professional practice, they are assured of utilizing a framework that represents the full
scope of home visitation. In addition, home visiting competencies can serve as a foundation for decisions and practices to
be carried out within home visitation programs.”
Table 1. Summary of MCTHV Core Competencies
Competency
In home visiting, relationships form the foundation upon
which all other work is built.
The home visitor will demonstrate understanding in
Strengthening Parent/Child Relationships, Positive
Parenting, Early Learning and School Readiness.
The home visitor will demonstrate understanding of
healthy and safe environments and parenting practices
that promote optimum development and provide for the
safety of all family members.
Leadership, supervision and program administration will
demonstrate skills related to the support of home visiting
programs and staff, such as reflective practice, reflective
supervision and an understanding of the parallel process
form the foundation of supervisory practice.
Knowledge/skill areas
Principles of relationships; Planning and conducting home
visits; Working with others; and Reflection
Family dynamic and child development; Early learning
and school readiness; Working with others; and Reflection
Safety; Health; Reflection; Working with others; and
Resources
Effective home visiting; Supervision; Reflective
supervision; Partnerships and collaborations; and Law,
regulation and agency policy
Having established competencies that a home visiting program can refer to and build upon offers multiple benefits,
including:
 Self-assessment in a particular competency area (both what’s going well and what can be improved upon);
 Program development, where such information can be used to determine what policies and procedures might be
necessary to enhance home visiting service delivery;
 Identification of any outstanding training needs/gaps; and
 Documentation of home visitor/program progress for funders and other home visiting supporters.
In addition to competencies serving an internal role of strengthening and improving program deliverables, they are
important in terms of recruiting, selecting, developing and retaining a competent and effective home visiting work force.
Competencies can lead to the development of program standards or procedures, which then allow for a more accurate
measure of both quantitative and qualitative performance. Competencies also serve as a basis for program outcomes, and
in the case of home visiting reflect the goals programs have in improving the health, development and overall well-being of
families.
Assessing competency is a continuous process of persistently building knowledge, skills, etc.
– Employment Studies Institute
Tracking and Monitoring Staff Competencies
Given that home visiting competencies “address skills, knowledge and [often times] attitudes that lay the foundation for
developing professional relationships and promoting a strength-based approach to working with families and for
continuous quality improvement,”7 it is helpful to have certain tools or methods in place to track and monitor staff’s
progress with these competencies.
Some sample tools for tracking and monitoring home visitor competence include:
7
Ibid.
MN FHV Newsletter Vol. 4 (1), Page 4



The Home Visitor's Skill Profile developed by the Office of Head Start, Administration for Children and Families,
U. S. Department of Health and Human Services;
Suggested Home Visitor Minimum Knowledge and Skills Checklist from the Alberta Home Visitation Network
Association; and the
Pennsylvania Home Visitor Competencies: Self-Assessment Checklist.
Professional Development Opportunities
Once a home visiting program has identified the core competencies that best fit the needs of their target community and
the level of professional development their staff require to serve clients, the next step in building the knowledge and skills
of their staff is the provision of/access to training. “Although each home visiting program’s approach [to training] is
different, it generally begins with: 1) the program’s history, principles, and philosophy; 2) curriculum and service delivery;
3) roles and responsibilities of home visitors; and 4) data requirements and reporting.” 8 The Mathematica Institute
identified additional training topics that may help a new home visitor acclimate to their role or help a more seasoned
home visitor hone their skills. Many of these topics are identical to those identified and noted in the above article,
INTERVIEWING AND HIRING HOME VISITORS, by Minnesota home visiting programs, and include:
 Domestic violence;
 Motivational interviewing;
 Safety;
 Child abuse and neglect;
 Substance abuse;
 Conflict prevention/intervention;
 Cultural competency;
 Therapeutic relationship;
 Child and maternal health; and
 Teen mothers.9
Regardless of the individual approaches home visiting programs may take to build home visitor knowledge and skills, it is
clear that having a training plan in place that centers around key competencies is critical to a home visitor’s – and
ultimately a program’s – success.
Depending on the type of family home visiting practice that your agency provides, and whether your program is rooted in
an evidence-based model or not – different training topics may better suit your professional development needs than
others. The MDH FHV nurse consultants can help guide your program regarding training needs and model requirements.
The Minnesota FHV Evaluation Benchmark Plan also refers to using several tools and training is offered by the MDH FHV
Section in the use of some of these tools. For more information on the training and professional development resources
that MDH offers home visiting programs in Minnesota, visit the MDH FHV Training and Professional Development
webpage or contact the nurse consultant assigned to your region of the state.
THE IMPORTANCE OF RELATIONSHIP-BUILDING WITH FAMILIES
Many research studies have shown that the parent-child relationship is important for a child’s early development.10
Relationships that caregivers have with home visiting providers can have an impact on the parent – child relationship.
Parallel process is a basic concept for evidence-based home visiting (EBHV) models, such as Family Spirit, Healthy
Families America and Nurse-Family Partnership. In the parallel process, all levels of relationships are attended to with the
Coffee-Borden, B. and Paulsell, D. (2010). Recruiting and Training Home Visitors for Evidence-Based Home Visiting (EBHV):
Experiences of EBHV Grantees. Mathematica Policy Research. Princeton, NJ.
9 Ibid.
10 Edelman, L. (2004). A Relationship-Based Approach to Early intervention [Electronic Version]. Resources and Connections, 3, 1-9.
MN FHV Newsletter Vol. 4 (1), Page 5
8
goal of ultimately supporting the caregiver to develop a nurturing, supportive relationship with their child. These
relationships include the supervisor -home visitor, home visitor – caregiver, and caregiver – child.
The target population for FHV in Minnesota is defined in Minnesota Statute, 145A.17. The definition includes many risk
factors as listed:
(1) adolescent parents; (2) a history of alcohol or other drug abuse; (3) a history of child abuse, domestic abuse or
other types of violence; (4) a history of domestic abuse, rape, or other forms of victimization; (5) reduced cognitive
functioning; (6) a lack of knowledge of child growth and development stages; (7) low resiliency to adversities and
environmental stresses; (8) insufficient financial resources to meet family needs; (9) a history of homelessness;
(10) a risk of long-term welfare dependence or family instability due to employment barriers; (11) a serious mental
health disorder, including maternal depression as defined in section 145.907; or (12) other risk factors as
determined by the commissioner.11
These risk factors are reflected in the target populations of pregnant and parenting families served by many home visiting
programs in Minnesota. Studies of adults who experienced Adverse Childhood Experiences (ACEs) have shown reduced
parenting capacity which in turn can continue the cycle of ACEs to the next generation.12 Proactive initiatives like home
visitation programs for high-risk families, though not widely disseminated, have incredible promise for the prevention or
mitigation of parent- and environment-mediated ACEs specifically because they are focused on critical periods in human
development—prenatal through the first 2 to 3 years of life.13
…Relationships between families and service providers are powerful influencers of participants’
engagement in home visiting programs…
– Brenda Jones Harden
Brenda Jones Harden explains the importance and challenges in developing relationships between home visitors and
families, particularly families at risk: “researchers know that relationships between families and service providers are
powerful influencers of participants’ engagement in home visiting programs as well as of their outcomes. These
relationships may be particularly important for high-risk families, who may have had negative encounters with service
providers in the past. Building relationships with such families may require more patience, creativity, and persistence than
with other families (e.g., returning to the home multiple and varying times to catch the family at home).” 14
One basic requirement of the home visitor – caregiver relationship is trust. Families must be able to trust home visitors
before they can benefit from the services being provided, beginning at the time of assessment. Communication and
interpersonal skills are also important in supporting successful relationships. Listening, being non-judgmental, being able
to feel and express empathy, using reflective practice and practicing self-regulation of emotions during interactions help to
build nurturing supportive relationships with families.15 Harden says the above characteristics in a relationship support
the family to experience relationships in a way they have not experienced in the past and subsequently, they are more
likely to continue those relationships with their child.16
Because the nature of the work that home visitors do with families is so intense, the role of the supervisor in supporting
the home visitor is crucial in helping the home visitor maintain the skills needed to continue to support families. The
parallel process of the supervisor supporting the home visitor’s work with the family, allows the home visitor to continue
her/his work to support the caregiver’s relationship with the baby.
2015 Minnesota Statutes, § 145A.17 Family Home Visiting Programs.
American Academy of Pediatrics (2014). Adverse Childhood Experiences and the Lifelong Consequences of Trauma. Retrieved March
21, 2016 from www.aap.org/traumaguide.
13 Ibid.
14 Harden, B. J. (2010). Home Visiting with Psychologically Vulnerable Families [Electronic Version]. Zero to Three, 30, 44-51.
15 Edelman, L. (2004). A Relationship-Based Approach to Early intervention [Electronic Version]. Resources and Connections, 3, 1-9.
16 Op cit.
MN FHV Newsletter Vol. 4 (1), Page 6
11
12
CLIENT PREFERENCES IN A HOME VISITOR
“Jane,” a local public health director in Minnesota, recently had a discussion with colleagues from her region. As they
talked about the home visiting programs in their counties, Jane shared a concern she had about one of her home visitors.
“We are trying to get our caseload up to our target number. We’ve done all the work to get referrals coming our way and
most of our home visitors are nearing capacity and our retention rates are great. Yet, ‘Cheryl’ is unable to get her caseload
built up. She also has a lot of canceled visits and the lowest client retention of anyone in our agency. She’s a very
professional and hard-working nurse. She’s been with our agency a long time and was very successful when she worked
with the elderly. I wonder what’s missing in her ability to develop relationships with our younger clients,” says Jane.
“Lisa”, another director, shares that her agency hired two new public health nurse home visitors in the past year with poor
results. “The first nurse quit three days into the job. She knew right away that the move from hospital nursing to public
health wasn’t for her. It was disappointing, but not as much as the second nurse, who had much of her home visiting
training completed when she decided that the only thing she really liked about her job was the 8-4:30 work hours. It can
be really difficult to determine if a potential new employee will be a good fit for home visiting. Both of these nurses were
successful working with families in the hospital and are caring people.”
“Ellen”, a home visiting supervisor, agrees. “I have two home visitors in my agency that are both very different in their
styles and approaches to clients. Yet, they both have great recruitment and retention rates. Just when I think its common
sense to know what makes a good home visitor, I can see that there may not be one specific type of person that is
successful in this work. It makes me wonder: what do families really value in their home visitor?”
Carol Klass, PhD, has spent most of her career studying home visiting, especially helping home visitors develop the skills
needed to make a difference in the families they serve. Her qualitative and quantitative research reveals several themes
about family’s preferences for home visitors:
1) Parents feel that the home visitor is genuine in her care and concern about them.
2) The home visitor enjoys the parent’s child and takes a mutual delight in his development of new skills.
3) The home visitor is warm and friendly and is comfortable working in the client’s home.
4) The home visitor actively listens to whatever the parents choose to discuss.
5) The home visitor is nonjudgmental and validating.
6) The parents are regarded as the expert on their child and the home visitor respects their decisions about their
child as long as they are not harmful.
7) The home visitor is knowledgeable and respectful about the family’s cultural beliefs and practices.17
None of these attributes may be a surprise to anyone working in the home visiting field. There are, however, other less
obvious things that Klass discovered.
“One of the first skills that a home visitor must utilize is being able to individualize her style to her family’s style,” states
Klass in her research. This means that he or she will assess the client’s preferred style of interaction and her relationships
in her family and community. The ability to holistically assess and be flexible with new clients underpins the later
relationship. One of the mantras of home visiting is the need to meet families wherever they are at. The home visitor’s
assessment skills and flexibility assure that that he or she is understanding exactly where that is.
Another finding that Klass shares is that families value a home visitor who is a good problem solver. While the home
visitor doesn’t come armed with advice to dole out to clients, she is an active participant in helping clients to define the
issue and find their own solutions. She helps clients to see that problems are not personal flaws, but simply situations that
can be made better through changes in perception and behavior. The home visitor also assists the client to tap into
community resources and build support for the client and her family. 18
17
18
Klass, C.S. (2003). The home visitor’s guidebook. 2nd edition. Baltimore: Paul H. Brookes Publishing Co.
Ibid.
MN FHV Newsletter Vol. 4 (1), Page 7
Families have been found to highly value a home visitor who can provide information about child development. This
information helps parents to understand and appropriately guide their child’s behavior and anticipate what is coming
next. The home visitor can interpret the child’s behavior to the parents. “Naughty” behavior by a one year old may very
well be simply normal development. The home visitor models delight in the child’s development and ability to do new
skills. For parents who have few others to share in the joy of their children, this is powerful medicine.
Klass, and others who study in this field, have found that some of the most common adjectives used to describe the
attributes home visitors that clients found helpful were “friendly,” “positive” and “respectful.” 19 These terms are actually
quite ambiguous and may mean something quite different for each home visitor and each client. Overall, though, one teen
parent captured the essence of those qualities and others mentioned earlier by sharing her experience. “My home visitor
was the only one – and I do mean the only one, besides me – who had a positive attitude about my pregnancy. It wasn’t
like she was happy I got pregnant at 16, but more like, ‘Well, here we are, let’s make the absolute best of this. You can be a
teen mom and still succeed. It’s not going to be easy, but I’ll walk the path with you.’ She taught me skills that made
parenting so much easier and enjoyable. But just as important, she taught me to believe in myself. When I struggled, she
listened. She helped me to see opportunity instead of just barriers. She would always say to me, ‘you got this.’ I find
myself being the same way and saying the same thing to my five year old now when she gets frustrated with learning new
things. Funny how that really stuck with me and made such a difference for me and my daughter.”
One of the first skills that a home visitor must utilize is being able to individualize her style to her
family’s style.
– Carol Klass, PhD
Each home visitor will bring his or her own style, including strengths and weaknesses, to the program. By understanding
what clients value, supervisors can hire staff that embody attributes and skills that reflect those values. Through reflective
supervision practices, supervisors can also help home visitors develop and strengthen skills and increase job satisfaction.
They will clearly communicate expectations and give feedback and support. Home visitors with this type of support are
much more likely to report liking their jobs. 20 When you think about the relationship based approach that family home
visiting requires, it would seem it’s absolutely necessary that a home visitor would see value and in and enjoy what she
does.
A seasoned home visitor shares this belief. “Sarah” states, “Early on in this program, I really wasn’t sure what I was doing
and I didn’t really like my job. Then we got a new supervisor who was able to share her vision of what family home visiting
could accomplish. Her passion was contagious. She also helped me work through difficult cases without judgement or
advice. She offered opportunities for training and I learned about strategies to address the challenging aspects of working
with families. She also had clear expectations. I became much more comfortable and began to really love my job. I went
to work most days positive and happy to be there. Interestingly, I noticed I started having many less cancelations and
fewer of my clients left the program. I also saw I was getting better outcomes with clients. It occurred to me how my
earlier, negative feelings about my job were communicated to my clients without me even being aware of it. Conversely, I
can see that’s it’s my genuine joy and hope that’s contagious to them now, just like my supervisor’s has been to me. It will
keep passing on, from the clients to their children…and as we all know, that’s the first step to changing those children’s
lives and the generations that come after them.”
19
20
Ibid.
Bulman, C. & Schultz, S. (2004). Reflective practice in nursing, 4th edition. West Sussex, UK: Blackwell Publishing.
MN FHV Newsletter Vol. 4 (1), Page 8
SPOTLIGHT ARTICLE: LEECH LAKE BAND OF OJIBWE’S APPROACH TO
EFFECTIVE HOME VISITING
By Birdie Lyons, Leech Lake Band of Ojibwe Family Spirit Program
Program Background
The Leech Lake Band of Ojibwe (LLBO) currently practices the Family Spirit evidence-based home visiting model.
Because LLBO’s Family Spirit Program has the word “FAMILY” in its title, the program serves a variety of families,
including:




Women who are pregnant up to the child being 3 years of age;
Fathers raising their newborn or child up to 3 years of age;
Foster parents with newborns and children up to 3 years of age; and
Grandparents, aunts, uncles, cousins, or other extended families who are caretakers of newborns and children up
to three years of age.
The LLBO Family Spirit Program also assists families whose children are older than 3 years of age depending on the
circumstance, such as a child or an adult caretaker with physical, emotional or spiritual needs and/or disabilities. In
addition, the LLBO Family Spirit Program offers assistance to any LLBO Band member requesting information or referral
to spiritual leaders or teachers, and to those people who wish to be in contact or need referrals for health care, health
insurance (i.e. Medicaid), county aid (i.e. the Minnesota Family Investment Program (MFIP)), housing or any other
referral needed to assist with daily living and survival.
Home Visitor Strengths/Characteristics
Some of the preferred strengths and characteristics that the LLBO program look for in a home visitor include:



That the home visitors be from the LLBO Territory and know the community resources very well;
The Supervisor be a nurse who has at least two years of nursing experience and knows the resources in the area of
LLBO territories and surrounding counties; and
The Supervisor and staff be somewhat literate in the Ojibwe culture and language.
Solutions to Hiring Barriers
LLBO’s Family Spirit Program has made efforts to increase billing for home visitors’ work with families. This, in turn, has
helped to secure the program’s work force. In particular, the LLBO Family Spirit Program is in the process of developing
billing procedures for newly hired Community Health Workers and the Nurse Supervisor through the Cass Lake Indian
Health Service Hospital and the LLBO Health Billing Department. The Cass Lake Indian Hospital Electronic Records
Department is also working on a template to be used by the LLBO Family Spirit for record-keeping and billing purposes.
Valuable Training and Resources
The LLBO Family Spirit has made use of monthly model-specific classes offered by Johns Hopkins University. The Nurse
Supervisor has encouraged staff to attend various Ojibwe cultural trainings, such as cradleboard making, regalia sewing,
doula training, birthing classes in the Ojibwe culture and tradition, baby wrapping, sweat lodges, drum ceremonies,
naming ceremonies, and any other training that may come to the Nurse Supervisor’s or staff’s attention regarding Ojibwe
teachings, traditions and culture. In addition, LLBO’s Family Spirit staff have attended safety training for home visitors,
and the program has implemented policies and procedures regarding home visitor safety that have become an important
component of LLBO’s home visiting program.
MN FHV Newsletter Vol. 4 (1), Page 9
Additional Attributes of Effective Home Visitors
A home visitor that works with the LLBO Family Spirit Program must be willing to participate in the Ojibwe trainings
offered without bringing in their own ideas, religion and feelings about the trainings. (Families/caregivers are looking for
answers on how and where to find resources in Ojibwe culture and the home visitor must be able to assist in referring to
various Ojibwe spiritual leaders or teachers.) As noted above, the home visitor must also be willing to learn some of the
Ojibwe language. Finally, the home visitor must be able to meet families where they are:
 Physically (i.e. some families are struggling with homelessness);
 Emotionally (i.e. some clients may be dealing with one or more mental health diagnoses);
 Spiritually (i.e. each family served has their own beliefs/religious practices); and/or
 Age (i.e. a variety of parents – including both teens and adults – are served in the program).
RESOURCES
In addition to the resources referenced throughout the above articles, the following offer additional information on topics
related to this newsletter’s featured topic, Attributes of Effective Home Visitors:
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Early childhood home visiting programme: factors contributing to success by Heaman, M. et al. (2006)
Home Visitor Characteristics and Quality by the Erikson Institute and the Illinois State Board of Education (2012)
Home Visitor's Handbook: For the Head Start Home-Based Program Option by the United States Department of
Health and Human Services
Mother and Home Visitor Personality Characteristics, the Mother-Home-Visitor Relationship, and Home Visit
Intensity by Ispa, J. et al. (2000)
Relations among mother and home visitor personality, relationship quality, and amount of time spent in home
visits by Sharp, E. et al. (2003)
Serving Highly Vulnerable Families in Home-Visitation Programs by Azzi-Lessing, L. (2013)
Supporting Replication and Scale-Up of Evidence-Based Home Visiting Programs: Assessing the Implementation
Knowledge Base by Paulsell, D. et al. (2014)
Which skillsets and other characteristics of a home visitor contribute to the effectiveness of home-based child
abuse and neglect prevention program? By Kimberly Quamme, St. Catherine University (2015)
MN FHV Newsletter Vol. 4 (1), Page 10