Initiate Services Prenatally Or at Birth

HFA Best Practice Standards and PIMS reporting ESS

8/4/2015

1. Initiate services prenatally or at birth
Standard / Description / Pre-Site Evidence Required / PIMS Report available?
1-1.A / Target population / Definition of TP, how decided on, and community data used in decision-making / ·  PIMS02: Screen Summary can count # screens in last year and referral sources. (see tip sheet)
·  Custom reports from Participant Key Stats can gather age of mother, town of residence and other demographics; and from Screen risk factors (marital status, inadequate income, history of drug use, late prenatal care, etc.) (see tip sheet)
·  Can show trends in preceding years to determine if adjustments need to be made.
1-1.B / Referring organizations / Places where TP is found, types of organizational relationships / ·  PIMS02: Screen Summary to monitor # referrals from various community organizations
1-1.C / 75%+ of target population identified, measured and monitored annually / %age of families in TP screened/identified in last year, plans to address / ·  PIMS02: Screen Summary to count # screens in last year
·  Enter data into HFA spreadsheet (mostly for sites offering HV based on positive screen)
1-2.A / Policy for screening process / Policy / Not applicable
1-2.B / Policy followed / Form used for tracking referrals/screens / ·  PIMS01: Screen Information by Individual
1-2.C / Screen/assessment timeframes / Report with timeframes of screens and assessments / ·  PIMS02: Screen Summary for sites offering HV based on positive screen (see tip sheet)
·  PIMS04: Assessment Summary for sites offering HV based on positive assessment (see tip sheet)
1-2.D / Monitor/address families not assessed/offered HV after screening / Narrative / ·  PIMS02: Screen Summary
·  Custom reports from Participant Key Stats – demographics on those not assessed/offered HV services (based on positive screen)
1-2.E / Monitor/address verbal refusals for HV services / Narrative / ·  PIMS02: Screen Summary, PIMS04: Assessment Summary, and PIMS07: Service Acceptance Analysis (see tip sheet)
1-3.A / Process and timeframe for 1st HV / Policy / Not applicable
1-3.B / 1st HV within 3 months / Report / ·  PIMS8A: First HV Summary (see tip sheet)
1-4.A / Measure acceptance rate / Narrative, how measured, current rate / ·  PIMS04: Assessment Summary (see tip sheet)
·  PIMS07: Service Acceptance Analysis (see tip sheet)
1-4.B / Acceptance analysis / Narrative plus analysis / ·  Same as above
1-4.C / Plan to increase rate / Plan / Not applicable
2. Standardized Assessment Tool
Standard / Description / Pre-Site Evidence Required / PIMS Report available?
2-1.A / Eligibility policy / Policy and copy of tool with risk factors / ·  Copy of PIMS screen and assessment forms (see tip sheet)
2-1.B / Policy followed / ·  PIMS3A: Assessment Information by Disposition (see tip sheet) can demonstrate adherence to policy.
2-2.A / Assessment policy / Policy / Not applicable
2-2.B / Policy followed / Not applicable
3. Offer services voluntarily and use positive, persistent outreach efforts to build family trust.
Standard / Description / Pre-Site Evidence Required / PIMS Report available?
3-1.A / Voluntary services / Policy / Not applicable
3-1.B / Policy followed / Not applicable
3-2.A / Policy & procedures on trust building / Policy / Not applicable
3-2.B / Policy followed / Not applicable
3-3.A / Policy & procedures on creative outreach / Policy / Not applicable
3-3.B / Policy followed / ·  PIMS39B: Service Level History for Creative Outreach Recipients can demonstrate adherence to policy (see tip sheet)
3-4.A / Measure retention / Definition of retention, method for calculating, and results of calculation / ·  PIMS30: Retention Trend
3-4.B / Retention analysis / Narrative and most recent retention analysis / ·  PIMS40: Retention Analysis
·  PIMS44: Retention by FSW
·  PIMS09: Termination Analysis
·  Custom Query for termination analysis for volume year only.
·  See tip sheet
3-4.C / Retention plan / Copy of plan to increase retention based on analysis / ·  Same as above
4. Offer services intensely (e.g., at least once a week) with well-defined criteria for increasing or decreasing intensity of service and over the long term (e.g., three to five years).
Standard / Description / Pre-Site Evidence Required / PIMS Report available?
4-1.A / Policy & procedures offering weekly HVs for 6 months / Policy / Not applicable
4-1.B / Policy followed / HFA Tracking Form 4-1B or other database report / ·  PIMS14C: Summary of Intensive Services for New Families (see tip sheet)
4-2.A / Level change policy / Policy / Not applicable
4-2.B / Policy followed on HV completion rates / HFA Tracking Form 4-2B or other data base report / ·  PIMS35: HV Completion Summary by Individual for most recent quarter (see tip sheet)
4-2.C / Monitor & address HV rate / Narrative / Not applicable
4-2.D / Family progress is basis for level change / Policy / Not applicable
4-3.A / Policy on services offered for minimum 3 years / Policy / Not applicable
4-3.B / Policy followed / ·  PIMS11: Length of Services (see tip sheet)
4-4.A / Transition policy / Policy / Not applicable
4-4.B / Policy followed / Not applicable
5. Services should be culturally sensitive such that staff understands, acknowledges, and respects cultural differences among families; staff and materials used should reflect the cultural, linguistic, geographic, racial and ethnic diversity of the population served.
Standard / Description / Pre-Site Evidence Required / PIMS Report available?
5-1 / Service population / Description of service population / ·  PIMS12: Intake Characteristics (see tip sheet)
5-2.A / Appropriate staff, materials, community partnerships / Narrative / ·  PIMS P3: Staff Demographics Summary
5-2.B / Cultural characteristics taken into account when overseeing staff-family interactions / Narrative / Not applicable
5-3 / Training on unique characteristics / Narrative and training logs / ·  PIMS46: Staff Training on Annual Topics (see tip sheet)
5-4.A / Cultural Sensitivity Review / Copy of CSR / ·  Use information gathered in PIMS reports for Standards 1-1, 3-4, 4-2, 4-3, 5-1, and 5-3 to compile the Cultural Sensitivity Review.
5-4.B / Family & staff input / Copy of CSR / Not applicable
5-4.C / Strategies for growth identified / Copy of CSR / Not applicable
6. Services should focus on supporting the parent(s) as well as supporting parent-child interaction and child development . /
Standard / Description / Pre-Site Evidence Required / PIMS Report available? /
6-1.A / Policy to address risk factors identified on PS/FSC / Policy / Not applicable
6-1.B / Policy followed / Forms used to document discussions between FSW and supervisor / Not applicable
6-1.C / Policy followed / Forms used to document discussions between FSW and family / ·  Copy of PIMS Home Visit form, highlighting section “Review of Family Issues…” (see tip sheet)
6-2.A / Policy for Family Goal Plan re: goal development, review & resources / Policy / Not applicable
6-2.B / FSW & family collaborate / Forms for FGP, tools, HV form, supervision form / ·  Copy of PIMS Home Visit and Family Goal Plan forms, highlighting section on Home Visit form where FGP updates are documented (see tip sheet)
6-2.C / FGP reviewed regularly by FSW & supervisor
6-2.D / FGP used in HV activities and referrals
6-3.A / Policy & procedures for assessing, promoting & addressing PCI, attachment & bonding / Policy / Not applicable
6-3.B / Policy followed / Home visit forms / ·  Copy of PIMS Home Visit form, highlighting sections “Observations of Parent-Child Relationship (CHEEERS)” and “Supporting the Parent-Child Relationship” (see tip sheet)
6-4.A / Policy for promotion of child development, parenting skills, and health & safety / Policy / Not applicable
6-4.B / Policy followed re: child development and parenting skills / Home visit forms / ·  Copy of PIMS Home Visit form, highlighting sections where updates are documented for child development, parenting skills, and health and safety topics (see tip sheet)
6-4.C / Policy followed re: health and safety / Home visit forms / ·  Copy of PIMS Home Visit form, highlighting sections where updates are documented for health and safety topics (see tip sheet)
6-5.A / Policy for evidence-informed curriculum used / Policy / Not applicable
6-5.B / Policy followed / Description of curriculum / Not applicable
6-6.A / Policy & procedures on administration of developmental screens / Policy, sample tool, and sample tracking form / ·  PIMS Child Outcomes Record for individual children
6-6.B / Implementation of policy / Report on developmental screens for all target children / ·  PIMS17: Child Outcomes by FSW (see tip sheet) and PIMS56: Child Outcome Checkpoints to Date
6-6.C / Staff trained on screening tool / Report on staff and training dates / ·  PIMS45: Staff Training on Instruments (see tip sheet)
6-7.A / Policy & procedure on tracking and follow-up on delays / Policy for referring and monitoring interventions / Not applicable
6-7.B / Implementation of policy / Sample forms / ·  PIMS Child Outcomes Record for individual children shows monitoring
·  PIMS58: ASQ Referrals
·  PIMS58A: ASQ Referrals Summary
7. At a minimum, all families should be linked to a medical provider to assure optimal health and development (e.g., timely immunizations, well-child care, etc.) Depending on the family’s needs, they may also be linked to additional services such as financial, food, and housing assistance programs, school readiness programs, child care, job training programs, family support centers, substance abuse treatment programs, and domestic violence shelters.
Standard / Description / Pre-Site Evidence Required / PIMS Report available?
7-1.A / Policy for medical providers of TCs / Policy / Not applicable
7-1.B / Policy followed / Report on medical homes for TCs / ·  PIMS18B: Linkage to Medical Providers for Participating Children (see tip sheet)
7-2.A / Policy for timely receipt of immunizations / Policy / Not applicable
7-2.B / Policy followed / IZ schedule, report on target children and percentage up-to-date at age 1 and 2 / ·  PIMS19G: Immunizations Req’d at Age 1 and 2 and PIMS19H: Immunization Req’d at Age 1 and 2 Summary (see tip sheet)
7-3.A / Policy for provision of info, referrals & linkages to health care and other resources, and follow-up process / Policy / Not applicable
7-3.B / Policy followed for health care resources / Description of process for referrals & linkages to health care and other resources for participating family members, and how follow-up is tracked. Submit tracking forms. / ·  PIMS18A: Linkage to Medical Providers for Participating Family Members (see tip sheet)
·  PIMS21: Referral Info (see tip sheet)
7-3-C / Policy followed for connection to appropriate referral sources
7-3.D / Policy followed re: follow-up on referrals
7-4.A / Policy for addressing challenging issues / Policy / Not applicable
7-4.B / Policy followed / Assessment tools for SA, IPV, MH, etc.; and tracking forms for referrals and follow-ups. / ·  PIMS21: Referral Info (see tip sheet)
7-5.A / Policy for administration of standardized depression screen/tool / Policy / Not applicable
7-5.B / Standardized tool for depression screening / Submit copy of tool and report on enrolled mothers screened, TC DOB, and date of screens / ·  PIMS63: Depression Screening (see tip sheet)
7-5.C / Referral and follow-up for mothers with elevated screen / Report on all enrolled mothers with positive screening postpartum and referrals / ·  PIMS63A: Depression Followup (see tip sheet)
7-5.D / Training prior to administering / Report on staff training / ·  PIMS45: Staff Training on Instruments (see tip sheet)
8. Caseload Management
Standard / Description / Pre-Site Evidence Required / PIMS Report available?
8-1.A / Policy for caseload size / Policy / Not applicable
8-1.B / Policy for maximum caseload / Policy / Not applicable
8-1.C / Policies followed / Report on caseloads for past year and detailed breakdowns for last quarter / ·  PIMS16C: Annual Weighted Caseload (see tip sheet)
·  PIMS16A: Monthly Caseload Management – Weighted Caseload – run for the most recent quarter (see tip sheet)
8-2.A / Policy on managing caseloads / Policy / Not applicable
8-2.B / Policy followed / Same as 8-1.C / See above
9. Service providers should be selected because of their personal characteristics (e.g., non-judgmental, compassionate, ability to establish a trusting relationship, etc.), their willingness to work in or their experience working with culturally diverse communities, and their skills to do the job.
Standard / Description / Pre-Site Evidence Required / PIMS Report available?
9-1.A / Screening & selection of PMs / Policy / Not applicable
9-1.B / Screening & selection of supervisors / Policy / Not applicable
9-1.C / Screening & selection of direct service staff / Policy / Not applicable
9-2 / EOE / Policy / Not applicable
9-3.A / Job postings, interviews, references / Policy and narrative / Not applicable
9-3.B / Background checks / Policy and narrative / Not applicable
9-4 / Staff retention / Narrative on monitoring and addressing retention, data report / ·  PIMS47: Staff Turnover
·  Note: Report shows demographic information but does not include reason for staff terminations (not included in staff information records)
10. Service providers receive intensive training specific to their role to understand the essential components of family assessment, and home visitation and supervision
Standard / Description / Pre-Site Evidence Required / PIMS Report available?
10-1.A-F / Orientation training / Policy, narrative, and tracking forms / ·  PIMSP4: Staff Training and PIMSP6: Staff Training Completion Grid (see tip sheet)
10-2.A / Policy for stop-gap training / Policy / Not applicable
10-2.B-D / Policy followed / ·  PIMSP4: Staff Training and PIMSP6: Staff Training Completion Grid (see tip sheet)
10-3.A / HFA core assessment training / Tracking forms / ·  PIMSP4: Staff Training, and PIMSP6: Staff Training Completion Grid (see tip sheet)
10-3.B / HFA core home visitor training
10-3.C / HFA core supervisor training
11. Service providers should have a framework, based on education or experience, for handling the variety of experiences they may encounter when working with at-risk families. All service providers should receive basic training in areas such as cultural competency, reporting child abuse, determining safety in the home, managing crisis situations, responding to mental health, substance abuse, and/or domestic violence issues, drug-exposed infants, and services in their community.