INNOVATIONS IN HOME VISITING: CREATING SUPPORTS FOR FAMILIES

EXPERIENCING HOMELESSNESS

Mark Valentine and Carie Bires

Ounce of Prevention Fund

Abigail Velikov and George Askew

New York City Department of Health and Mental Hygiene

Agenda

• Background information on family homelessness

• Overview of two approaches to serving families experiencing homelessness with home visiting

• Policy and practice considerations and resources

• Reflections to Action Worksheet

Who are homeless children?

• Sharing the housing of other

persons due to the loss of housing,

economic hardship, or a similar

reason

• Living in hotels, motels, trailer parks,

camping grounds due to lack of

alternative accommodations

• Living in emergency or transitional

shelters

• Abandoned in hospitals

• Awaiting foster care placement (until

12/10/16)

• Primary nighttime residence is a

public or private place not designed

for or ordinarily used as a regular

sleeping accommodation for human

beings

• Living in cars, parks, public spaces,

abandoned buildings, substandard

housing, bus or train stations, or

similar settings

• Defined as “migratory children” who

are living in the above

circumstances

• Unaccompanied youth who are

living in the above circumstances

Children who lack a fixed, regular, and adequate nighttime residence—

Fixed, regular, and adequate• Fixed: Securely placed; not subject to change or fluctuation

– A fixed residence is one that is stationary, permanent, and not subject to change.

• Regular: Normal, standard

– A regular residence is one which is used on a regular (i.e. nightly) basis.

• Adequate: Sufficient for a specific requirement; lawfully and reasonably sufficient

– An adequate residence is one that is sufficient for meeting both the physical and psychological needs typically met in home environments.

Prevalence of homelessness among children

• 2.5 million children experience homelessness each year in the U.S.

• During the 2013-2014 school year, schools identified 1,301,239

children experiencing homelessness

• Over the past three years, there has been a 15% increase in the

number of homeless children identified by schools; the greatest

increases were in preschool aged children and ninth grade

students

• Between 2007 and 2014, shelter use by families increased in

suburban and rural areas by 48.1%

• Children of color are disproportionately represented among all

children experiencing homelessness

Annual Percentage Rates of Shelter Use By Age (National)

0.00%

0.10%

0.20%

0.30%

0.40%

0.50%

0.60%

0.70%

0.80%

0.90%

1.00%

Under 1 1 to 5 6 to 12 13 to 17 18 to 30 31 to 50 51 to 61 62+

Source: 2012 AHAR (HUD, 2012) and Census DataSlide courtesy of Beth Shinn, Professor and Chair, Department of Human and Organizational Development; Vanderbilt University

Ages of children experiencing homelessness

< 1 1-5 6-12 13-17

12%

41%

31%

16%

Impacts of homelessness on children

• Lower birth weights

• More likely to have moderate to severe acute or chronic health problems

• Three times the rate of emotional and behavioral problems

• Four times the rate of developmental delays

• Twice as likely to go hungry

• Twice as likely as others to repeat a school grade, be expelled or suspended, or drop out of high school

• More likely to experience a traumatic event

Challenges facing homeless children and families

• Invisibility

• Transience

• Schedules

• Histories of family violence/trauma

• Extreme poverty

• Stressed attachments to caregivers

• Parenting in public

• Lack of access to food & health care

• Lack of developmentally-appropriate living spaces

Billings Gazette, November 2012, Montana Rescue Mission, http://billingsgazette.com/news/local/women-s-group-refurbishes-room-at-women-s-and-family/article_313cd52f-0a1b-560f-9a91-5703e8a44679.html

“Invisible Child” New York Times, December 2013, http://www.nytimes.com/projects/2013/invisible-child/#/?chapt=1

Institute for Human Services Hawaii, Kaaahi Women and Family Shelter, https://ihshawaii.org/what-we-do/emergency-shelter

“Trying to Live, Trying to Learn” Denver Post, http://extras.denverpost.com/homelessstudents/

Compromised

health and

development

Cramped

Crowded

Chaotic

Noisy

Lack of child-friendly

spaces/policies

Dirty

Dangerous

REFLECTION 1

Home Visiting Can Help!

The goal of home visiting is to promote healthy developmental trajectories for young children by supporting healthy

parent-child relationships.

Ten Things Every Child Needs

Positive Interactions

Physical Affection

Stable Relationships

Safe, Healthy Home

Strong Self-Esteem

Engage in Conversation

Music Play

ReadingQuality Child

Care

Scaffolding children’s development

In order to thrive a child needs:

1. a nourishing physical environment (i.e., fixed, regular, adequate) and,

2. a nourishing psychological environment (i.e., secure attachments with primary caregivers)

Each affects the other and each has equal urgency!

Supporting Families in New York City

Homeless Shelters

Sixth National Summit on Quality in Home Visiting Programs

11.17.2016

Abigail M. Velikov, PhDGeorge L. Askew, MD, FAAP

Division of Family and Child HealthNYC Department of Health and Mental Hygiene

Family Homelessness in NYC

• 41,814 children in 25,732 families residing in shelters⁻ 18,984 children under age 6

• Families average 427 days in shelters⁻ 12.5% return to shelter

within 1 year of leaving• Minimal programming for

infants and toddlers

Source: Center for NYC Affairs The New School, Child Welfare Watch, Winter 2015

New York City Births 2014

122,084 births

59% Medicaid

60% Married

47% Mothers age < 30

51% Foreign-born mothers

Source: EpiQuery: NYC Vital Statistics: Birth Data. 2014

Newborn Home Visiting Program

• Offers post-discharge support to families with a new infant

⁻ Topic specific education⁻ Practical support⁻ Assessments⁻ Referrals

• Voluntary and free to families

Key Health Messages

Maternal and infant health education

Infant feeding

Breastfeeding education and practical support

Safe sleep and injury prevention

Early childhood development

Environmental assessments

Maternal depression screening

Community resource connection

NHVP Shelter Initiative

Strengthen the support and education provided

to mothers, infants, and their families residing in

Department of Homeless Services (DHS) shelters

Identification via daily listing of eligible families

provided by DHS via secured server

Visits offered to all mothers with infants up to 2

months old

NHVP Shelter Initiative Service Area

NHVP serves families in NYC shelters citywide

Phase I: November 2015Brooklyn Queens

Staten Island

Phase II: April 2016Bronx

Manhattan

NHVP Visit Structure and Timeline

•Maternal and infant health education-Infant feeding education; breastfeeding support

• Safe sleep education

•Environmental screening

•Resource review and referrals initiated

1st Home visit

1st week of life

•Early Child Development/Early Literacy

•Breastfeeding support if needed

• Follow up on referrals with client and/or DHS social service staff

•Prepare for upcoming medical appointments

2nd Home visit

2nd week of life

•Maternal depression screening

•Reinforce key health messages

•Prepare for upcoming medical appointments

3rd Home visit

4-6 weeks old

•Follow up on outcome of medical appointments

•Reinforce key health messages and referral follow up

•Positive affirmation

Phone call

7-8 weeks old

Lessons Learned

Families residing in shelters

Breastfeeding and infant supports needed

High number of environmental issues identified

Reported smoking by mothers

Lessons Learned

Implementation and Planning

Allocate sufficient time for planning and implementation

Establish formal relationships with key stakeholders

Include program staff and target families in model development

Successful collaboration with another city agency is possible

Systems Development

Identify data collection and sharing system

Conduct routine data review

Want to protect our future? Invest in early education.

Home Visiting for Homeless Families Demonstration Project

Carie Bires – Illinois Policy Team

Mark Valentine – Illinois Birth to Three Institute

Seeks to bring two service universes together to improve developmental trajectories for families affected by homelessness and to inform future program development.

HVHF Pilot

• Cross-sector collaboration

• Cross training

• Model and funder flexibility

• Ongoing TA and support

• Service coordination

• Increasing home visiting capacity

• Identifying policy and systems needs

• Ongoing evaluation and program development

Core Elements of Pilot

• The Ounce

• MIECHV

• HV Programs: New Moms, Family Focus Lawndale, Family Focus Englewood, Pilsen

• Homeless Service Providers: Primo Center, A Safe Haven, The Night Ministry, All Chicago

• Beacon Therapeutic

Key Partners

1. All Home Visitors receive training and carry small caseload

2. Specialized home visitor focuses exclusively on homeless families, serves as resource to others in program

3. Shelter staff are trained in EBHV model and receive support

4. ?

Approaches

• Funding for project

• Service reductions due to budget impasse

• Lack of data and research on children in homeless families

• Normalizing services to children within the homeless service provider community

• Overcoming inertia to impel cross-sector work forward

Struggles and lessons learned

REFLECTION 2

DISCUSSION

Policy and practice considerations

• Data collection, reporting, sharing and usage• Priority access to home visiting for families experiencing

homelessness• Strengthening HUD policies to promote referral to HV• Strengthening homeless education policies to promote

referrals to HV• Training and professional development for both home

visitors and homeless service providers• Research• Ensure flexible, accessible, and effective home visiting

models that meet the unique needs of homeless families

• Questions?

• Share a reflection

• Share your action plan

ResourcesECHV and supportive housing: http://www.csh.org/wp-content/uploads/2016/07/Crosswalk.pdf

Early Childhood Self-Assessment Tool for Family Shelters: http://www.acf.hhs.gov/ecd/interagency-projects/ece-services-for-homeless-children/self-assessment-tool-family-shelters

Guide to Developmental and Behavioral Screening for housing providers: https://www.acf.hhs.gov/sites/default/files/ecd/shelter_screening_guide.pdf

National Association for the Education of Homeless Children and Youth Early Childhood Resource Page: http://naehcy.org/educational-resources/early-childhood

ACF Early Childhood Homelessness Resource Page: http://www.acf.hhs.gov/ecd/interagency-projects/ece-services-for-homeless-children

HUD-HHS-ED Joint Policy Statement on Early Childhood Homelessness: http://www.acf.hhs.gov/ecd/joint-policy-statement-on-meeting-the-needs-of-families-with-young-children-experiencing-and-at-risk-of-homelessness-released

Guidance to MIECHV, Tribal MIECHV, and Healthy Start programs on serving homeless families; complementary guidance distributed to HUD grantees:

• https://www.hudexchange.info/news/opportunities-for-coc-partnerships-with-home-visiting-programs/

• https://www.acf.hhs.gov/sites/default/files/ecd/tribal_miechv_letter_homelessness_letter_2016.pdf

Contact information

Carie Bires: cbires@theounce.org, 312-291-2160

Mark Valentine: mvalentine@theounce.org

Abby Velikov: ajewkes@health.nyc.gov