MINNESOTA FAMILY
HOME VISITING NEWSLETTER
A publication from the Minnesota Department of Health Family Home Visiting Program
December 2015 | Volume 3 | Issue 3
GREETINGS FROM THE MINNESOTA
DEPARTMENT OF HEALTH FAMILY HOME
VISITING PROGRAM
FEATURED TOPIC:
Home Visiting Program Sustainability
The concept of sustainability is focused around
the maintenance and continuation of program
services beyond a specific funding period.
Sustainability efforts may vary from one home
visiting program to the next, but most involve
some level of community awareness, support
and/or participation, as well as the formation
of partnerships and access/creation to diverse
funding streams. This newsletter explores
these various topics tied to sustainability, and
provides resources for further exploration.
Contact Us
[email protected]
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MDH FHV website.
As 2015 draws to a close, Minnesota’s home visiting
programs are likely taking stock of their achievements over
the past year, as well as any challenges faced in terms of
meeting service goals and objectives. At the same time,
planning is taking place for the future. Several factors arise
around things, such as the financial and political climate,
staff capacity and community involvement, that indicate a
need for sustainability planning.
This year’s newsletter series began with a discussion on
considering evidence-based home visiting implementation
and continued with information on assessing need,
capacity, resources and support for home visiting programs.
To round-out the series, this volume of the newsletter
focuses on program sustainability.
Regardless of what stage of home visiting planning and
implementation your program may be in, sustainability is
undoubtedly on the mind of all of its major stakeholders.
Having home visiting recognized as valuable and stationed
as a permanent community resource is the goal of all such
programs. Understanding that sustainability is achieved
through multiple efforts and is an ongoing,
transformational process helps put this goal into
perspective.
We hope you find the information in this newsletter useful
and look forward to working with you and learning more
from your program’s experience. From all of the Minnesota
Department of Health (MDH) Family Home Visiting (FHV)
staff, we wish you the best in the new year!
MN FHV Newsletter Vol. 3 (3), Page 1
TOOLS AND TECHNIQUES FOR ACHIEVING SUSTAINABILITY
In considering the long term potential of a program, such as home visiting, it is important to understand the resources
available to build and strengthen the program within the community. Various tools and techniques exist to help programs
determine the value of continued service provision and methods toward achieving sustainability. The following list offers
suggestions of some tools/techniques home visiting programs may find of interest on this topic.
Strategic Plan
“A strategic plan is a tool that provides guidance in fulfilling a mission with maximum efficiency and impact. If it is to be
effective and useful, it should articulate specific goals and describe the action steps and resources needed to accomplish
them. As a rule, most strategic plans should be reviewed and revamped every three to five years.” 1 Strategic planning is a
means for programs to assess any internal strengths and weaknesses and external opportunities and threats that may
impact program/service delivery. Such plans are generally lead by a core group/committee and are strengthened by
including the voice of multiple stakeholders (i.e. board members, clients and staff) in the planning process. Surveying
comparable organizations/programs on their successes and challenges and applying these lessons learned to the strategic
plan will help prevent previous programs’ mistakes. Such information is also extremely helpful in setting the goals and
objectives necessary to implement the strategic plan. 2
A strategic plan is a tool that provides guidance in fulfilling a mission with maximum efficiency and
impact. If it is to be effective and useful, it should articulate specific goals and describe the action
steps and resources needed to accomplish them. As a rule, most strategic plans should be reviewed
and revamped every three to five years.
– R. Mittenthal
Communications Plan
“A communication plan will help ensure the success of your [program] planning effort by engaging stakeholders in the
process and shaping the way the effort is perceived by everyone invested in or affected by the issue.” 3 In general, a good
communications plan takes into account the following questions: 4
•
Who are the key staff responsible for generating/disseminating communications?
•
What are the communication goals and objectives?
•
Who is the target audience(s)?
•
When and how often will communications occur?
•
How will results of program initiatives be communicated?
•
What resources (i.e. financial and media) are available for communicating?
Examples of communications plans developed by home visiting programs in the United States are accessible online, such
as the First 5 El Dorado 2013-2014 Communication Plan out of California. Note, while the El Dorado Communication Plan
is focused on more of an external audience, having an internal communications plan is also important, especially when it
comes to engaging and retaining employees. In developing an internal communications plan, consider:
1
Mittenthal, R. Ten Keys to Successful Strategic Planning for Nonprofit and Foundation Leaders. TCC Group, 2002.
Ibid.
3 The Wallace Foundation. “Workbook A: Creating a Communications Plan.” Accessed November 18, 2015.
https://bch.cbd.int/protocol/outreach/wallacefoundation.pdf
4 The Pell Institute for the Study of Opportunity in Higher Education, the Institute for Higher Education Policy, and Pathways to College Network.
“Develop a Communications Plan.” Created 2015. Accessed November 18, 2015. http://toolkit.pellinstitute.org/evaluation-guide/communicateimprove/develop-a-communications-plan/
2
MN FHV Newsletter Vol. 3 (3), Page 2
•
•
•
•
“Are employees receiving accurate information?
How are employees receiving regular information?
Are messages consistent across the agency/department?
Do employees understand both the goals and the results of communications?” 5
Data Collection and Evaluation
Collecting accurate and meaningful evaluation data is important for planning, continuous quality improvement,
measuring outcomes and accountability to families, communities and funders. In addition, public and private partners use
this information to make decisions about investing in home visiting programs and to improve early childhood and health
care services. Per the 2015 Minnesota Statutes (Section 145A.17 Family Home Visiting Programs), MDH collects data on
statewide outcomes and measures of FHV services (see the FHV Evaluation Benchmark Plan). MDH also provides
resources and other support to public and tribal health programs on data collection, analysis and reporting related to
evaluation.
Community Outreach and Engagement
Employing outreach activities in the community served is key to improving program participation and support. Similarly,
hiring outreach staff that are a part of the community can make a big difference in reaching a program’s target population,
especially those who may have specific cultural/linguistic needs and interests. Yet another outreach strategy is partnering
with advocacy groups with a similar mission. These groups tend to have a broader membership base than any one agency,
as well as access to media resources and political stakeholders that smaller agencies, in particular, may not. Just as it is
important to develop plans for strategies and communications, having an outreach plan that outlines a schedule with key
activities, objectives, methods, messaging, review and evaluation will help move a program forward.
Engagement of Policy Makers
Beyond the community advocate work mentioned above, engaging policy makers on a broader state and national level has
an impact on program infrastructure and success particularly as funding and policy changes are likely and the popularity
of social issues rise and fall. Nurse-Family Partnership, for example, has played an active role in providing
recommendations to the Governor’s Task Force on the Protection of Children to prevent child abuse and neglect through
evidence-based home visiting in Minnesota.
In addition to the above, consider reaching out to an MDH FHV staff member for sustainability information and
resources. The FHV nurse consultants are knowledgeable and experienced in addressing questions related to program
structure, including that related to evidence-based home visiting models. The evaluation staff can assist with questions
related to data collection, and the grant management staff are knowledgeable in various funding resources. To contact a
specific staff member, visit the 'Contact Us' page on the MDH FHV website.
5
RAPIDBI. “How to Write an Internal Communications Plan and Strategy.” Accessed December 22, 2015.
https://rapidbi.com/howtowriteaninternalcommunicationsplanandstrategy/#.VnqxpUbZB1A
MN FHV Newsletter Vol. 3 (3), Page 3
FUNDING/FINANCING STRATEGIES
Long term sustainability includes utilizing current funding and planning for the future by securing funding from a variety
of sources. Financing strategies can include federal, state and local funds as well as other financing options such as public
and private partnerships. Some grant funding is time limited so it is risky to put all financing eggs into the grant fund
basket. Funding plans can include a variety of options with the percentage of stable funding sources increasing year by
year.
As Kay Johnson from the National Center for Children in Poverty noted in 2009, “most state-based home visiting
programs are blending funding, including a variety of federal funds, some state general revenues and some local or private
funding. Using funds in more strategic and innovative ways can help to grow and sustain successful programs.” 6
Federal sources
Federal investment in family home visiting includes funds provided through the American Recovery and Reinvestment Act
(ARRA) and the Patient Protection and Affordable Care Act (ACA). The two types of funding streams used most often in
home visiting programs are categorical and broad-based (for programs serving children and families. The federal
Maternal, Infant and Early Childhood Home Visiting (MIECHV) grant, part of the ACA, is an example of categorical
funding as it is specifically desginated for family home visiting. These grants are awarded to states and tribal governments
and organizations. Federal Early Head Start funds, part of ARRA, can be used in local communities for a variety of early
childhood programs including home visiting and are an example of broad-based funding. In addition, Temporary
Assistance for Needy Families (TANF) and the Title V Maternal and Child Health Services Block Grant funds are used to
supplement home visiting programs. Medicaid is an important resource for home visiting programs to tap into. Within the
Medicaid program there are various ways that home visiting services can be covered including the Early and Periodic,
Screening, Diagnosis and Treatment program that promotes preventive and comprehensive health care for children. Low
income pregnant women can also receive enhanced prenatal care, as well as ongoing traditional medical assistance
services.
State and local sources
State legislatures have appropriated state and general funds, set-up Children’s Trust Funds with targeted dollars and
designated early childhood funds all for home visiting. Some state legislatures have set aside specific tax money for home
visiting. For example, the California legislature appropriated tobacco tax money for early childhood home visiting. Other
state legislators have appropriated state funds for evidence-based home visiting. Local funding sources for home visiting
programs can include city and county tax levies, local public health grants and foundation grants.
MDH is in the process of surveying MIECHV programs about Medicaid billing. The survey requests information about
services billed. This information will allow MDH to identify missed billing opportunities and to assist local public health
agencies with maximizing reimbursement.
If your agency has comments, questions or issues around billing for services provided, please contact Genie Potosky at
[email protected] or 651-201-5025.
6
Johnson, K. State-based Home Visiting: Strengthening Programs through State Leadership. February 2009.
MN FHV Newsletter Vol. 3 (3), Page 4
Minnesota’s state Medicaid agency, the Department of Human Services (DHS), has several resources for providers of
medical services. Local public health agencies can increase reimbursements by taking advantage of the following resources
offered by DHS:
•
•
•
•
•
From the MN Health Care Provider Manual, providers can access current covered services information. The public
health clinic, community health worker, and public health nursing clinic information is under the Clinic Services
section.
Providers with billing issues and questions can contact the Provider Call Center. Use your National Provider
Identifier to access the call center.
Providers with enrollment questions or issues around enrolling as a Minnesota Health Care Programs (MHCP)
provider should contact Provider Enrollment.
DHS has a computer training lab where provider billing staff can access hands-on training on entering claims into
the DHS system. Providers Services staff are on hand to walk billing staff through the process of submitting
MHCP claims.
ICD-10 coding - On December 20, 2015, DHS posted the following information for providers regarding ICD-10
coding: All MHCP health care transactions for dates of service on or after October 1, 2015, must include ICD-10
diagnosis codes for reporting a diagnosis. However, you must continue to submit ICD-9 codes for dates of service
before October 1, 2015. Providers experiencing difficulty submitting claims with ICD-10 codes through their
organization’s systems may submit claims with ICD-10 codes through MN-ITS. For more information:



•
MHCP ICD-10 web page for general transition information and other resources
New MHCP ICD-10 Frequently Asked Questions (FAQ) page
Provider Update, MN–ITS Screens Changing for ICD-10 Implementation
Managed Care Organizations (MCOs), sometimes called Pre-paid Medical Assistance Providers (PMAPs), which
cover MHCP services have published and distributed a Billing Guide with service and coding information. For
information about payment rates and coding requirements, contact the client’s MCO. This guide is posted on the
MDH FHV website.
To obtain reimbursement from private insurers, providers should contact private health care plans directly. Contact
information is typically found on the back of client’s health insurance cards.
Other sources
Public and private partnerships can be highly successful. The Washington state legislature established the Washington
Home Visiting Services Account to support early childhood home visiting. Thrive Washington and the Department of
Early Learning administer the Washington Home Visiting Services Account. Thrive Washington, Washington state’s home
visiting system, is funded through a unique private, federal and state partnership. Washington state is in year five of a ten
year plan.
Social Impact Bond (SIB) is another public-private partnership model. Social Impact Bond is also known as Pay for
Success and Social Benefit Bond. In this model, governments contract with the private sector. Private sector funds are
used to pay for improved social outcomes.
“Family support home visiting programs in Texas have already demonstrated effectiveness and are providing a return on
investment, yet these programs are only reaching 10% of families that qualify and high-need for services. Thus, expanding
these programs and bringing them to scale using social impact financing would benefit the state, potential investors and
recipients of these much-needed services.”
MN FHV Newsletter Vol. 3 (3), Page 5
IDENTIFY AND EXPAND UPON PROGRAM CAPACITY
Often when the word sustainability is mentioned in a conversation there is a leap in the discussion to funding. Funding is
an important piece to sustain home visiting programs but it is not the only piece. It is important when looking at
sustainability to consider program capacity including staff, organizational, and reflective practice capacity. In looking at
program capacity you must be aware of future potential needs whether related to staff turnover, expected or unexpected
staff leaves, partner changes, or growth of the program. Let’s look a bit closer at some of those key areas.
As mentioned program capacity involves a variety of components. One key component is staff capacity. Often we think of
staff capacity as how many families can a home visitor see or carry on a caseload. While this is important to look at, staff
capacity when thinking of it in relation to sustainability is more than that. In thinking about sustainability, you must
consider current staff capacity such as caseload and training needs of staff. You must also think about the future. What
will be the plan if a home visitor becomes ill or needs surgery and is on leave for an extended period of time? How will you
meet the needs of families that home visitor was seeing? Can other staff temporarily take on additional families? Do you
have a way to partner with others who may be able to support a temporary reduction in your agency’s staff? Just as we
pose questions to families about the “what ifs” we need to ask ourselves “what if” questions so that we are prepared when
the inevitable happens and a home visitor is out for an extended period of time. If we fail to do that, we can find ourselves
with a program that falters and regresses when the unexpected happens and a program that partners may not see as viable
if it is not able to maintain regular ongoing implementation.
Along with considering staffing capacity including caseload, maintaining home visits when staff are on leave and training
needs, thought must be given to staff support for the program. If staff support the program it potentially may impact the
quality of home visits, recruitment and engagement of families and staff may be better advocates for the program in the
community. Engaging staff in support of the program can happen in a multitude of ways. Ideally it would start prior to
program implementation when consideration is being given to the home visiting model/design that will be chosen.
Involving staff in that process and discussion and gathering their input begins to lay a foundation of ownership in the
program. Periodically sharing information about program implementation and soliciting their perspective about how
implementation is going and changes that could enhance the program also supports staff engagement. Other opportunities
to engage staff include sharing outcomes of the program utilizing data that they submit and having them participate in
quality improvement projects.
MDH family home visiting nurse consultants are available to help you think through agency capacity, support you in
development of policies and procedures, problem solve with you issues regarding staffing, share resources and identify
additional ways that the FHV staff can support you in your sustainability work.
Often we devote energy to the home visits themselves, doing outreach to families, seeking funding and doing
documentation. Some administrative tasks that actually may support sustainability sink to the bottom of the pile. Most
evidence-based models require some policies and procedures to be in place, so to assure model fidelity and consistent
model implementation in an effort to achieve demonstrated outcomes. Policies and procedures also serve as an
opportunity to implement a program with standards that influence the quality of the program. A high quality program is
more likely to be viewed by others as effective.
Policies and procedures can also elevate the value of a program. I think about how many times I’ve sat down to prepare for
my performance review. I reflect back and often wonder what I actually did in the past year. I start putting down what I
did on paper and share it eventually with my supervisor. Often I am surprised about what was actually accomplished and
it changes the conversation I have with my supervisor. The same analogy can apply to policies and procedures. We can
assume that things are getting done and they are getting done consistently but it changes the dynamics when we take the
time to discuss how best to do things and actually have something to refer back to. When developing policies and
MN FHV Newsletter Vol. 3 (3), Page 6
procedures it can send a message that says our work is important and this is valuable work we are doing. It is worth the
time and effort to write it down and make sure we are doing things consistently. It also provides an opportunity for review
and quality improvement. All of which support sustainable programs.
As mentioned earlier, staff are a critical component in sustainability of a home visiting program. It is challenging to
sustain a program where staff are ambivalent about the program or work they do, or a site experiences ongoing staff
turnover. Reflective practice or reflective supervision is a tool that can support sustainability.
Reflective practice provides a space to understand the meaning of one’s work and its impact on families. It is a holding
environment where staff will feel secure enough to expose insecurities, mistakes, questions and differences. Staff may then
experience:
•
A feeling of being “attended to” because others have listened closely;
•
A greater sense of collaboration and trust among group members;
•
Deeper understanding of the complexities of the work;
•
Less burnout;
•
Better clarity and confidence about their roles or purpose or what they need to do next about a situation;
•
Improved sense of well-being, calmness; and/or
•
Group members feeling “we are with you and for you.”
•
All of these things work toward decreasing staff turnover and elevate the value of the work the staff do in their
own eyes. This in turn elevates it for others, thus influencing the sustainability of the home visiting program being
implemented.
Lastly, often a home visitor is told when s/he starts seeing a family to begin planning for closure from the very first visit.
Home visitors set goals with the family and move toward achieving those goals. The same is true when considering
sustainability of a home visiting program. Thinking about sustainability when the program is facing a critical point or a
grant is ending is often too late and makes sustainability overwhelming and sometimes unattainable. Planning for
sustainability and building it in from the very beginning will help a program with whatever storms it faces and will cause it
to be a stronger and more sustainable program. Take the time and energy up front and regularly throughout program
implementation. Strategically planning to build program capacity will influence the sustainability of the program.
THE ROLE OF PARTNERSHIPS IN SUSTAINABILITY
One of the essential keys to building a sustainable family home visiting program is developing partnerships. The Zero to
Three Home Visiting Community Planning Tool 7 highlights the need for collaboration in developing a family home
visiting program to truly understand a community’s needs, its strengths and its service gaps. However, once a program is
in place, collaboration takes on an even deeper importance. What is the role of partnerships in sustainability? A couple of
points may seem obvious:
7 ZERO TO THREE National Center for Infants, Toddlers and Families, “ZERO TO THREE Community Planning Tool.” Retrieved December 2, 2015
from: http://www.zerotothree.org/public-policy/state-community-policy/home-visiting-community-planning-tool-fillable-pdf.pdf
MN FHV Newsletter Vol. 3 (3), Page 7
Reduce duplication
While family home visiting generally provides a unique service to a specific population set, understanding what your
community partners are providing can help you to make the most of your visits and resources, and understand where your
program emphasis should be. By offering services that are not necessarily found elsewhere, agencies can also reduce
competition for clients.
Leverage funding and resources
Through partnerships, communities can gain a working knowledge of what exists and help consumers connect to needed
programs and services. In addition to not duplicating services for the needs of clients, like-minded collaborations can
work together to gain joint funding and larger grants. Understanding the role of all providers in the community can assure
you are seeking funding for your unique program and can support others seeking funding for providing what you cannot.
In this way, home visiting programs can decrease the competition for funding. Also, how can agencies receive referrals
from community partners who don’t know what they do? When thinking of referrals as a resource to be maintained, it
becomes apparent how important partnerships are. Maintaining partnerships can help you stay visible and relevant.
There is a third area that underscores the need for maintaining partnerships as part of sustainability that may be less
apparent, but no less important:
Allow for a unified, influential voice
The goal of family home visiting is to increase the holistic health of individuals, families and ultimately communities. If
we view it from this perspective, we can see that communities have an important role in helping to support and promote
that health. In this model, we move from individual actions to the power of shared ideas, efforts and resources to create
those healthier communities. 8 Indeed, the overall health of a community is impacted by societal forces that individual
community members have little control over. Overcoming complex societal problems, such as crime rates and poverty,
and creating healthier communities requires collaboration. It is only through collaboration and community partnerships
that we can begin to address deeply rooted issues that keep communities from being healthy. Each partner is a spoke in
the wheel.
One partnership that is often overlooked in sustainability is working with the population that is actually being served to
gather input. How does your program get feedback from the people you work for and with? Do you use satisfaction
surveys or focus groups? What other data can you use to gauge satisfaction with your services?
The vital role that forming and maintaining partnerships has in sustaining your family home visiting program cannot be
stressed enough. From decreasing competition for clients and funding, to assuring you are meeting the true needs of the
population you serve to help create healthy individuals, families and communities - collaboration is key. However,
building relationships and continued collaboration take time, a resource that many busy agencies may feel short of. Yet
remember, you are not alone in this work.
A key partnership that family home visiting programs in Minnesota have for assistance is that with MDH. Nurse
Consultants and the rest of the FHV Section Staff are here to support your work in all aspects, from assisting with budget
and work plan development, helping with developing better billing infrastructures, data entry, training… and everything
in between. We are all working toward the goal of healthier communities, each in our own way – yet none of us can do it
on our own. In the words of Henry Ford, “Coming together is the beginning; keeping together is progress; but it is in
working together that we truly achieve success.”
Greene-Moton E. Exploring the Role of Partnerships for Health Promotion. Invited Presentation, Australian Health Promotion Association Conference,
May 2010.
8
MN FHV Newsletter Vol. 3 (3), Page 8
Attention All Home Visiting Programs!
MDH FHV staff are here to work with you on your home visiting program’s needs as they relate to sustainability and
other important topics. Visit the 'Contact Us' page on the MDH FHV website.
SPOTLIGHT: HIGHLIGHT YOUR HOME VISITING PROGRAM’S EXPERIENCE HERE!
MDH FHV would like to feature an article(s) from home visiting programs around the state in each newsletter. This is
your chance to share your knowledge and experience with peers in the field, and shine some light on your successes. If you
would like to contribute to a future newsletter, and/or have ideas on topics you would like to see discussed, please email
[email protected].
RESOURCES
In addition to the resources referenced throughout the above articles, the following offer additional information on topics
related to planning for and maintaining program sustainability:
•
Community Toolbox: Planning for Sustainability by the Work Group for Community Health and Development at
the University of Kansas (2015)
•
Community Tool Box: Using Outreach to Increase Access by the Work Group for Community Health and
Development at the University of Kansas (2015)
•
Drafting a Strategic Plan by MDH (2014)
•
Early Childhood Home Visiting in California: The Right Place at the Right Time by Ch1ldren Now (September
2014)
•
Getting to Outcomes for Home Visiting Toolkit by the RAND Corporation (2013)
•
Home Visiting Advocacy: A Guide for Providers by Prevent Child Abuse New York (2006)
•
Home Visiting Financing and Sustainability by Kay Johnson, Johnson Consulting Group, Inc. (August 2015)
•
Home Visiting Services Account by Thrive Washington and the Department of Early Learning (May 2015)
•
Making Public Health Programs Last: Conceptualizing Sustainability by P. Pluye, L. Potvin and J.L. Denis (2004)
•
Medicaid Financing of Early Childhood Home Visiting Programs: Options, Opportunities and Challenges by the
Pew Center on the States (June 2012)
•
Michigan Uses the Sustainability Cohort to Explore Options and Press Forward with a Sustainability Plan by
Deborah Roderick Stark, MIECHV TACC Consultant (August 2015)
•
Program Sustainability by the United States Department of Housing and Urban Development
•
Program Sustainability: Developing Strategies for Maintaining Programs Over the Long-Term by American Indian
Development Associates (2001)
•
Social Impact Bonds by J. Liebman with American Progress.Org (February 2011)
•
Sustainability Framework and Assessment Tool by Washington University in St. Louis (2015)
•
Thrive By Five Washington Strategic Plan: 2012-2015 (November 19, 2012)
•
Washington Continues Along Journey to Sustainability by Deborah Roderick Stark, MIECHV TACC Consultant
(August 2015)
MN FHV Newsletter Vol. 3 (3), Page 9