Online Model Implementation Training

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Online Model Implementation TrainingModule 2 Course Supplement

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Technical Requirements for Online Courses

Notes:

Operating systems:

PC

> Windows Vista, 2000, XP, or Windows 7

> Internet Explorer 7.0+, or Firefox 3.0+

> Adobe Acrobat Reader 8.0+

> Flash Player 10 or later

> A general audio output

MAC

> Macintosh OS X (10.5+)

> Mozilla Firefox 3.0+, or Safari 4.0+

> Adobe Acrobat Reader 8.0+

> Flash player 10 or later

> A general audio output

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Online Model Implementation Training

Notes:

Instructions for Using the Discussion Forum

Step 1 – Minimize the class window or click on the screen outside of the class window to return to the portal.

Step 2 – Click on the “Discussion” link to view the forum.

Step 3 – Note that the forum is in a Threaded View.

Step 4 – Locate the appropriate module of the course and click on the + to expand then, choose the sub-heading or post to respond to by clicking on the link. The directions for the post will appear at the bottom of the page.

Step 5 – Click on the Reply button at the top of the forum to post a response.

An Open Forum category is available for general thoughts and questions you would like to share with other students.

To maintain a manageable view, please avoid creating a “New Post”.

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Parents as Teachers Model Implementation Guide Design and Implementation | 51

Factors to consider regarding caseload size

Factors to consider Examples

Total responsibilities of parent educators in an affiliate

All families participating in Parents as Teachers services receive personal visits, screening, group connections, and linkages to community resources. However, different affiliates may structure staffing for these services in different ways. Most typically, parent educators deliver all of the above services, along with recruitment and retention strategies. However, sometimes affiliates contract out their hearing or screening services or designate staff who have responsibility for certain services such as recruitment or planning and facilitation of group connections.

In addition to their specific responsibilities, all parent educators participate in supervision, staff meetings, and professional development. Sometimes, parent educators also participate in advisory committee or community collaboration meetings.

Frequency and duration of individual, reflective supervision

An affiliate may provide more than the minimum required supervision monthly. (The minimum is two hours monthly for parent educators working more than .5 FTE and one hour monthly for parent educators working .5 FTE or less.)

Frequency and duration of staff meetings Parent educators may participate in more than the minimum of two hours of staff meetings monthly.

Expectations regarding professional development

Parent educators may be expected to obtain more professional development than the national requirement: > First year of certification: 20 clock hours of professional development required> Second year after certification: 15 clock hours> Third year after certification and beyond: 10 clock hours

Frequency of visitsParent educators may be expected to provide more than 24 personal visits annually to families with two or more high-needs characteristics or more than 12 visits annually to families with one or fewer high-needs characteristics.

Time will need to be set aside weekly or monthly for making up missed visits.

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Factors to consider regarding caseload size (continued)

Factors to consider Examples

Time allocated in total for each personal visit

Time allocation for personal visits needs to incorporate:> Planning and preparation> Travel to and from the visit> Delivery of the visit> Completion of the personal visit record, plus any additional data collection required by an affiliate

The breakout of time for each personal visit with one enrolled child averages approximately:> 20 minutes for planning and preparation > 20 minutes for travel> 60 minutes for delivery of the visit> 20 minutes for completion of personal visit recordAverage total = two hours per visit Certain circumstances will decrease the total number of visits the parent educator can complete monthly. These include visiting a family with more than one enrolled child or travel time that is significantly longer than average.

Visits per month parent educators will be expected to complete

The number of visits to be completed monthly should take into account the total amount of time allocated to each personal visit, time for making up missed visits, and time needed for the other responsibilities of the parent educators.

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Meeting the Mark

Personal Visits

Review the requirements for the personal visit component as described in the Essential Requirements and Quality Assurance Guidelines.

Consider each of the following questions:

1. Which requirements are you and your program already meeting?

2. What steps are needed to address short falls?

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Write a list of the group connection topics that your program is offering this year. Then, determine which area of emphasis each topic is connected to.

Making the Connection

Topic Area of Emphasis

Parent-Child Interaction

Child Development:Language, Intellectual, Social- Emotional, and Motor

Parenting Behaviors:Nurturing, Guiding/Designing,Responding, Communicating,Supporting Learning

Development-Centered Parenting

Developmental Topics:Attachment, Sleep,Safety, Health, Nutrition,Discipline, Transitions/RoutinesHealthy Births (prenatal)

Family Well-BeingProtective Factors:Parental resilienceSocial connectionsKnowledge of parenting and child developmentConcrete support in times of needSocial and emotional competence of children

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Format Descriptions and intended outcomes

Family activity

Family activities are designed primarily to focus on parent-child interaction as parents engage in active learning with their children. Family activities provide opportunities for parents and other family members to interact with their children to encourage learning and promote development. In a family activity group connection, children can benefit from opportunities to interact with other children and adults. In addition, parents build social connections with other parents as they play with their children.

Family activities may focus on messy play, art, gross motor, or language and reading, among other topics. Often, children create a project that they can bring home.

As a result of these activities, parents gain knowledge about children’s development and ways to promote development. Generalization to home is maximized when information about parent-child interaction and ways to encourage development are shared in multiple modalities, and handouts and how-tos are provided to take home.

Presentation

Presentations can be useful when specific information is needed and a parent educator, supervisor, or member of the community is able to provide knowledge on a particular issue or developmental topic. Multiple presentation approaches can (and should) be used to engage participants, including using multimedia, group discussion, or panel presentations. It is also important to include an interactive element that helps parents learn and apply the information, such as parent-parent activities that foster social connections or a parent-child activity that fosters parent-child interaction. As a particular benefit, presentations can also help parents make personal connections with representatives of community resources, making them more approachable for families. Because of the more passive nature of the presentation format, it is important to actively engage and involve the parents who attend. To maximize attendance, child care should be provided. Parents can walk away from a presentation with a greater understanding of child development and ways to promote their child’s development, with additional strategies and ideas for parent child interaction, as well as increased knowledge about a variety of issues related to family well-being.

Group connection formats (continued)

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Format Descriptions and intended outcomes

Ongoing group

Ongoing groups are small groups of parents facing similar issues. Group members build strong social connections and support networks over time. Opportunities to facilitate the group and determine topics of interest encourage parent empowerment. Resources and information shared also address family well-being issues, such as stress management and economic self-sufficiency. Group members learn new knowledge and practice skills.Because they occur over multiple sessions and may have a particular focus such as child behavior problems, ongoing groups are able to address all three areas of emphasis. Ongoing groups typically require child care for a portion of the group but can also include time for parent-child interaction. Not only can ongoing groups increase parents’ knowledge about children’s development and ways to promote it, but parents can learn and apply positive discipline techniques and stress reduction strategies, build social connections, get connected to needed resources, learn new information about topics pertaining to family well-being, and become empowered as leaders.

Community event

Community events may take place at various locations either as an event an affiliate hosts or as organized outings which build greater community awareness. Community events are often open to all families and can be a source for recruitment of new families. For example, a Safety Fair could involve local resources performing car seat checks and bike helmet fittings, representatives of the Back to Sleep campaign, and others. Community events primarily focus on family well-being while often incorporating developmental topics.

Parent café

Parent cafés are evenings of sharing, learning, and socializing in a space that appreciates all that parents have to offer and all that they need. Offered within community settings, Parent cafés are often led by parents for their peers (www.connectcommunitysupport.org/cafe.html).The most significant impact of parent cafés may be the development of social connections, thereby positively affecting family well-being. In addition, depending on the focus of the evening, increased knowledge of developmental topics, as well as ways to strengthen parent-child interaction, can result.

Group connection formats (continued)

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Group connections are designed so that families build social connections with each other, engage in parent-child interaction, and increase their knowledge of ways to support children’s development.

The three areas of emphasis introduced with the personal visit component of Parents as Teachers continue to weave throughout each of the other components, resulting in a dynamic and coordinated package of services. Thus, across the program year, staff will deliver group connections that focus on parent-child interaction, development-centered parenting, and family well-being.

Strengthening families through facilitated group connections

Parents learn a great deal from other parents, and group connections are an opportunity to increase social connections for parents. Group connections also can be a form of recruitment for “service shy” families.

While a family considers Parents as Teachers services, the family may attend a group connection before the home visit. Not only recruitment, but retention is also affected when families discover other friends and community members at group connections. Consequently, this networking can help to reduce any perceived stigma of social service or parent education.

The group connections also provide opportunities to share information about parenting issues and child development. Parents learn from and support each other, observe their children with other children and practice parenting skills, with the encouragement of parent educators during group connections. “Increasing the social connections of parents promises to prevent child maltreatment by strengthening families’ networks of informal social supports and, in the process, increasing the level of social capital within their communities” (Center for Study of Social Policy, 2008, p.2).

Parents as Teachers Model Component: Group ConnectionsThis section details the second of four dynamic components of the Parents as Teachers model. It is important to recognize that while each component is presented individually, they are closely interrelated and integrated. Together, the components create the overall impact and contribution of Parents as Teachers.

Notes:Group Connection PlansGroup Connectecion Planner and RecordGroup Connections Feedback Form

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Notes:


In addition, group connections build patterns of parent involvement during their children’s education. Parent involvement in early education is just as essential as in elementary school. Children whose parents are involved have a more positive attitude about school and attendance; “Parents involved with school in parent-related activities show increased self-confidence in parenting, more knowledge of child development, and an expanded understanding of the home as an environment for learning” (Eldridge, 2001, p.66).

Building capital

Group connections also offer opportunities for an array of natural support networks with additional families in the community, building “social capital” for families. Social capital is a family’s network of other parents and caregivers in the community. This protective factor contributes to prevention of child abuse and neglect. It focuses on building protection for children within their homes and communities, moving beyond identifying risk in homes and communities (Center for Study of Social Policy, 2008).

“Researchers believe that a community’s level of social capital is a critical determinant of the quality of life for the children and families that live there. A widely cited study by Garbarino and Kostelny (1992) found that social disorganization was the key factor

that explained why different neighborhoods with equivalent socioeconomic profiles had dramatically different rates of child abuse and neglect. The primary difference that separated high- from low-risk neighborhoods, in other words, was their level of social capital. Runyan et al. (1998) found that social capital was a key factor that explained different developmental and behavioral outcomes among high-risk preschool children. They concluded that social capital may have an impact on children’s well-being as early as the preschool years” (Center for Study of Social Policy, 2008, p. 13).

The more community and family relationships a family has, the less isolated they feel. These relationships assist families in discovering others who have gone through similar parental experiences. Networking within group connections can foster parental resilience – the ability to withstand moments of crisis. Parental stress especially can occur during times of developmental transitions, and parent-to-parent support networks can assist with timely child development information.

A unique and enriching aspect of Parents as Teachers group connections is that they bring together valuable content with opportunities for increased social connections. As a result, group connections contribute to multiple protective factors in families.

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Parents as Teachers Model Implementation Guide Additional Information, Resources, and Forms | 287

Facilitation reminders:

Group Connection Planner and RecordThis form is to be used for planning before the group connection and again after the group connection for documentation and continuous quality improvement purposes.This form is to be used for planning before the group connection and again after the group connection for documentation and continuous quality improvement purposes.

LogisticsFormat:

Intention/topic/purpose:

Agesofchildrenthegroupconnectionfocuseson:Title:Dateandtime:Numberofparticipantsexpected:Facilitators(parenteducators,supervisor,communitymembers):

Location/roomarrangements: Childcarearrangements:

>

After the group connectionHowmanychildrenofeachageattendedthemeeting?Under12months_________________1-year-old_________________2-year-olds_________________3-years-olds__________________4-year-olds_________________5-year-olds_________________Olderthan5__________________Notesonlogisticalarrangements:

oParent-Child Interaction oDevelopment-Centered Parenting oFamily Well-Being

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Materials and resources > Parent educator resources:

> Parent handouts:

> Multimedia tools:

> Additional materials:

After the group connectionNotesonmaterialsandresoures:

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Content and processWelcome

> Introductions and ice breaker (if appropriate):

> What participants can look forward to/expect:

> Group rules to establish (as appropriate):

> Housekeeping items:

> Other:

Estimatedduration:

Topics and activities

> Key points and discussion: Estimatedduration:

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> Activities and directions: Estimatedduration:

Closing > Review of key points:

> Thank participants for attendance.

> Highlight upcoming group connections and other Parents as Teachers activities:

> Feedback survey completion.

Estimatedduration:

After the group connectionNotesonwelcome:

Notesontopicsandactivities:

Notesondiscussionandclosing:

Itemsforfollow-up:

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Techniques for Facilitating Group Discussion

Communication techniques for encouraging and supporting participation in the group process

Facilitation is a kind of group leadership. A facilitator does not claim to know all the answers to group members’ concerns. Rather, a facilitator invites input from the whole group. By leading in this way, and explaining the process and skills used, group members will also learn these skills. Group members can improve their communication in the group as well as in their lives outside the group.

Facilitation of group connections can: > Promote experiential learning.

> Address the needs of diverse individuals.

> Guide groups through different stages of development.

> Foster an inclusive and non-hierarchical approach to the educational process.

Facilitators set the tone for the meetings. If a facilitator is excited about being at the group, that enthusiasm will be passed on to the group members. Group members who are excited to be at a group will learn more and continue coming (retention). This enthusiasm will spread to others who may wish to participate (recruitment).

Many of the techniques for facilitation are similar to those used when working one-on-one with families. As mentioned in the Parents as Teachers Foundational Curriculum, two attitudes that are essential to facilitating are responsiveness and flexibility. In addition, facilitation is different from presentation.

The definition of “facilitate” is “to make easy; lessen the labor of; help forward a process” (World Book Dictionary, 2004). When applied to groups, to facilitate means to make the work of the group easier and more effective.

Notes:Group Connection Planner and Record


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Key differences between being a facilitator and being a presenter Notes:

A facilitator … A presenter …

Asks questions. Keeps a distance from participants.

Feels close to members. Teaches, controls, and takes charge.

Gives support. Owns the agenda.

Shares similar experiences. Provides examples.

Listens instead of talking. Gives answers instead of opinions.

Encourages problem solving. Provides solutions.

Encourages discussion. Leads discussion.

Empathizes. Presents information and focuses on the facts.

Brings out the group’s knowledge. Presents and determines the knowledge to be learned.

Encourages participation. Brings in content or expertise in particular areas.

Is patient. Is viewed as the expert.

Clarifies what members want or say. Uses a “top-down” method.

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Strategies for facilitation

Use open-ended questions to spur discussion. Avoid using words that block listening and participation.

Invite parents to share information, ideas, opinions, experiences, observations, and feelings. Make this invitation at the very start of the group connection. The first few minutes may be awkward, but once parents learn that it is safe to participate, they usually warm up and contribute.

Use active listening. Restate what you hear from parents if there is a need for clarification.

Use good active listening phrases such as: > “You sound … [upset, annoyed, proud].”

> “Are you saying …?”

> “You think …?”

> “You feel …?”

Invite parents to express specific and immediate needs or desires, such as “Would you like to take a five-minute break now?”

Follow the parents’ suggestions for changes in the design or direction of the group connection. Respond supportively when parents initiate ideas or take responsibility. Publicly acknowledge the contributions of individuals or small groups.

Make a strong statement about your expectation of confidentiality: What is said in the group will remain confidential. Names will not be linked with any retelling of things said during the group meeting unless permission is explicitly given by a participant to share what he has said. This is particularly important to address with an ongoing group that is issue-oriented. At best, it will take time for all group members to come to trust in the confidential nature of the group.

Recognize and support differences among parents.

Linking: Helping individuals become a group

> Be alert for cues that suggest members have a common concern. You can point it out in order to promote member interaction and raise the level of group cohesion.

> Ask if others have had similar experiences or have suggestions to offer the parent who just spoke.

> Take frequent opportunities to relate what one person is doing or saying to the concerns of others in the group.

> Encourage parents to talk with one another by redirecting questions to, or soliciting knowledge from, other parents.

Notes:

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Blocking: Ending counterproductive behaviors in a group

A group facilitator is responsible for maintaining control of the group. The following behaviors need to be blocked for the sake of the group, but without attacking the person(s) behaving counterproductively.

> Story-telling. If one person tells long stories, ask him to say, briefly, how the story relates to the group’s topic. Linking techniques can be used in this situation, too.

> Side conversation. If a small group is having a separate conversation, the group leader might walk over and stand nearby, or make eye contact with those holding the side conversation. If that fails, a more direct technique is to say, “This group seems to have a lot of thoughts about this topic. Is there anything you feel like sharing with the whole group?”

> Breaking confidences. If someone starts to talk about a situation that occurred in another group or mentions what so-and-so has done, remind her that this group respects confidentiality. State that each group member should maintain confidentiality about their past group and personal experiences.

Notes:

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Meeting the Mark

Group Connection

Review the requirements for the group connection component as described in the Essential Requirements and Quality Assurance Guidelines.

Consider each of the following questions:

1. Which requirements are you and your program already meeting?

2. What steps are needed to address short falls?

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A primary goal of any early childhood program must be to support the healthy growth and development of all children. Healthy children are more prepared to learn, play, and participate in their families. Good health begins with knowing and understanding current scientific information and best practice guidelines. Sharing this information with parents supports parents’ efforts to raise healthy children. Building a trusting relationship and providing information and resources in a family-centered, culturally competent manner make a significant difference in how families receive and incorporate health-related information.

Through screening, families can be encouraged to keep their child healthy and well, gather information on each child’s health status, and assist in the identification and intervention of health and developmental concerns. Screening provides regular information about each child’s health and developmental progress, increases parents’ understanding of their child’s development, and identifies strengths and abilities, as well as areas of concern. When indicated, screening can provide the springboard for further comprehensive evaluations.

Parents as Teachers Model Component: Screening This section details the third of four dynamic components of the Parents as Teachers model. It is important to recognize that while each component is presented individually, they are closely interrelated and integrated. Together, the components create the overall impact and contribution of Parents as Teachers.

Notes:Parents as Teachers Approved Development, Hearing, and Vision Screening Tools for Children Milestones

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Hearing

Early identification of hearing concerns can have a profound impact upon a child’s development. Otoacoustic emissions (OAE) for children younger than 36 months of age and pure tone audiometry for children 36 months of age and older are the most accurate ways to identify hearing concerns. These methods must be used by all affiliates when conducting hearing screening or, if an affiliate contracts out hearing screening, by the contracted provider. (See Parents as Teachers Approved Development, Hearing, and Vision Screening Tools for Children for more information). Please note that following the Foundational and Model Implementation Trainings, additional training will be necessary to apply otoacoustic emissions (OAE) or pure tone audiometry. If an affiliate is not yet equipped to use these hearing screening methods, documentation of hearing screening by a healthcare provider can be used as the hearing screening portion of the complete screening. It is beneficial for the documentation to indicate the hearing screening method that was used by the healthcare provider. The parent educator will need to request the documentation from the family or have written permission from the family to request documentation of hearing screening from the healthcare provider. Once obtained, the parent educator reviews the documentation and places it in the family’s file.Newborn hearing screening: The newborn hearing screening results will satisfy the hearing screening requirement for up to the first 12 months of life as long as the child passed. However, best practice suggests that the hearing screening should be repeated at 6 months of age. Parent educators should request and review documentation of the newborn hearing screening results and include this information on the Health Record. If the child received a refer result, then he should return to the hospital for a rescreen. If the family is not following up on the refer result, it is important that the parent educator works with them to do so.

Vision

Researchers have shown that the most sensitive period for the development of vision occurs between birth and age 2. Parent educators provide functional vision screens, observing the muscle movement of the eyes and whether both eyes are working together, to help ensure that vision problems in children do not go unnoticed and untreated. The Model Implementation Training includes brief training on functional vision screening, which satisfies the essential requirement for vision screening and is suitable for children form birth onwards. Additional practice will be necessary. (See Parents as Teachers Approved Development, Hearing, and Vision Screening Tools for Children for a list of approved vision screening tools for use with children 30 months of age and older.) Documentation of vision screening by a healthcare provider can be used as the vision screening portion of the complete screening. It is beneficial for the documentation to indicate the vision screening method that was used by the healthcare provider The parent educator will need to request the documentation from the family or have written permission from the family to request documentation of vision screening from the healthcare provider. Once it has been obtained, the parent educator reviews the documentation and places it in the family’s file.

The screening component of the Parents as Teachers model specifically refers to the following four areas:

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Notes:

Health

A primary goal of any early childhood program must be to support the healthy growth and development of all children. To this end, while parent educators do not perform medical screenings, they do gather and maintain information on each enrolled child’s health status. This is done by completing a health record for each child using either the Parents as Teachers health record from the curriculum or a similar comprehensive health record. This information is updated each year to confirm that children are receiving necessary medical care and are current on their immunizations.

Development

Regular review of each child’s developmental progress identifies strengths as well as potential areas of concern that may require referral for further assessment. Following the Foundational and Model Implementation Trainings, additional training on how to use the specific developmental screening tool an affiliate selects will be necessary. Please note that if the developmental screening tool an affiliate chooses does not include social-emotional development (e.g., the Ages and Stages Questionnaire (ASQ), an additional tool focusing on social-emotional development must also be used (e.g., ASQ: Social-Emotional).

If the screening tool your program has chosen to use does not include social-emotional development (e.g., the Ages and Stages Questionnaire), an additional tool must be utilized (e.g., the Ages and Stages Questionnaire: Social-Emotional).

Note: It is important to emphasize to parents that any screening performed by Parents as Teachers staff is not a substitute for a physical or dental examination by the primary healthcare provider.

In addition to formal screening, the affiliate monitors and records children’s achievement of developmental milestones using the Parents as Teachers Milestones form.

Screening takes place within 90 days of enrollment for children 4 months or older and then at least annually thereafter (infants enrolled prior to 4 months of age are screened prior to 7 months of age). A complete screening includes developmental screening using PAT-approved screening tools, along with hearing and vision screening, and completion of a health record. Developmental domains that require screening include language, intellectual, social-emotional, and motor development.

Parents as Teachers Foundational Curriculum Development-Centered Parenting – Developmental Topics – Health – Parent Educator Resource | 595

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Health Care and Medical HomesRoutine health care is vitally important in the first three years of a child’s life. Following through with well-child visits, routine immunizations, and medications when indicated are part of the parent’s role.

To improve the quality of the health care for children with special needs, the concept of a medical home was introduced in the late 1960s. “A family-centered medical home is a trusting partnership between a child, a child’s family, and the pediatric team who oversees the child’s health and well-being” (AAP, n.d.).

A medical home facilitates an integrated health system with a team of primary care physicians, specialists, and sub-specialists; hospitals and healthcare facilities; public health agencies; and the community. They all work closely with patients and families (CMHI, 2006).

This is especially important for families of children with multiple chronic health conditions. A proactive team approach to chronic condition care includes planned visits, coordination of complex services, co-management with specialists, connecting with community-based services, and assistance with transitions.

“ We need a new and radical child-centered approach in which every program meant to help the poor first takes into account the health and development of children.” – Mariana Chilton, Ph.D., M.P.H., from

Children’s HealthWatch

How medical homes work

The American Academy of Pediatrics (AAP) introduced the concept of a medical home. It is described as “primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective” (AAP, n.d.). The medical home can become a valued partnership between the family and their healthcare team. The idea is now endorsed by the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), and the American Osteopathic Association (AOA).

A medical home combines place, process, and people.

> Place – Where the care is provided and records are kept.

> Process – The scope of care a patient receives.

> People – A team of professionals delivering coordinated care.

MEDICAL HOME


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Families should expect their medical home staff to:

> Know and remember them.

> Respect their ideas, customs, and beliefs.

> Help them to coordinate care and information among multiple professionals and services.

This is the gold standard of care. This team approach offers safe, efficient care while preventing unnecessary or duplicative services. Ideally, it will reduce healthcare costs and improve health outcomes and quality of life. In one study, hospitalizations and emergency room visits were reduced for children with severe chronic conditions due to care coordination in their medical home (Cooley et al., 2009). In the United States approximately 57 percent of children under age 17 receive care in a medical home (Data Resource Center, 2007). That said, about 42 percent do not.

The AAP is the home for the National Center for Medical Home Implementation. It and other national agencies are piloting projects to determine effective practices, cost savings, and long-term outcomes for patients. The Patient Protection and Accountable Care Act, passed by Congress in 2010, has provisions to support growth of the medical home model. Check on the needs of children in your state.

Challenges to a medical home

Many families establish routine medical care with ease. However, some families struggle to get the consistent care that their child requires. A total of 1.2 million infants and toddlers in the United States (or 14 percent) are uninsured, according to a report from the National Center for Children in Poverty (Wight & Chau, 2009).

For these families, there can be many barriers to finding a medical home. Government programs can help, but families may not be aware of them or may be deterred by the application process.

Uninsured families may also be served by nonprofits or emergency rooms as needed. There may not be any consolidation of their records or continuity of care, even if they have a medical home.

Underinsurance can be a problem as well. Families whose coverage does not pay for recommended prescriptions, lab work, or specialist visits may forgo them because they can’t pay out of pocket. Children who have private insurance are more likely to be underinsured than children with public insurance (Pascoe, Spears, & McNicholas, 2010).

Your role as a parent educator

Become familiar with the medical needs of the families you follow. Educate parents regarding the benefits of a medical home and how, by having one, they can better address the health issues they and their children may face. Reinforce this on subsequent visits where health is discussed and follow up on their efforts to find a medical home.

Families may receive treatment at many locations – for example, at urgent care clinics, emergency rooms, schools, or community health screenings. Encourage parents to share any test or screening results with their medical home (if they have one).

Strengthening families’ self-reliance when it comes to observing their child’s symptoms and giving them information about non-emergency illnesses can decrease their reliance on emergency room visits. The parent handout Your Baby Is Sick. Now What? is filled with information about symptoms and scenarios, and it may be helpful to review it with parents before it’s needed.


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Other parent handouts that can help families prepare for visits to their medical home or other healthcare professionals.

> Teamwork: Your Medical Home explains the benefits of regularly seeing the same healthcare providers.

> Keeping Germs Away gives tips on illness prevention and handwashing.

> Tips for Taking Your Child to the Doctor will be useful for first-time parents unaccustomed to interacting regularly with the medical system.

> At the Emergency Room deals with a topic parents hope never to experience – but most do at some point during their child’s early years.

> Well-Baby Checkups will be a helpful handout for expectant parents or parents of newborns.

You may want to provide extra copies of the My Child’s Medical Visit parent handout so they can get into the habit of bringing one along whenever their child goes for a checkup, immunization, or sick child visit.

If paying for care is an issue, educate the parents regarding medical coverage, Medicaid, CHIP programs, and other programs.

> Find out the steps for applying for coverage and the criteria for benefits so that you can assist in the process.

> Learn about the medical resources available in your area. Share their contact information with families.

> Collaborate with your local medical community.

Medicaid

Created in 1965, Medicaid is a federally funded, state-administered healthcare program for individuals and families. It is part of the Social Security Act. Eligibility is determined by income. A few groups may be eligible regardless of income (children in foster care, adoption assistance families, and those with extraordinary medical expenses).

Eligibility may vary from state to state. A child can be eligible in some states even if the parent is not. Some states allow higher income levels than the federally mandated level to ensure more healthcare coverage in their state.

As with other health insurance plans, Medicaid participants must choose healthcare providers who accept Medicaid. This can be challenging because the reimbursement rates can be lower, resulting in a limited pool of Medicaid providers or longer waits to receive services in some areas.

Medicare

Also created in 1965 under the Social Security Act, Medicare is a federal health insurance program for people ages 65 and older, certain disabled people under age 65, and people with permanent kidney failure.

Eligibility is determined by age and disability. Part A provides hospital coverage (usually at no cost) and Part B provides more traditional health coverage (for a fee).

Low-income persons over 65 or with disabilities may have both Medicare and Medicaid coverage (Qualified Medicare Beneficiary program). Participants may also buy prescription drug coverage through the Medicare program.

Children’s Health Insurance Program (CHIP)

CHIP is a state and federal partnership that targets uninsured children and pregnant women in families with incomes too high to qualify for most state Medicaid programs but often too low to afford private coverage. Within federal guidelines, each state determines the design of its individual CHIP program, including eligibility parameters, benefit packages, and administrative procedures.


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Title V

You may be familiar with Title V of the Social Security Act of 1935. This legislation lets states establish departments of health or public welfare. It is a federal-state partnership which has become know as the Maternal and Child Health (MCH) Services Block Grant. Its goal is to improve the health of all mothers and children. The homepage explains what is happening in each state.

Family-to-Family Health Information Centers

F2F HICs are nonprofit organizations that help families of children and youth with special healthcare needs and the professionals who serve them. F2F HICs are in a unique position to help families because they are typically staffed/run by parents. They have traveled through the maze of services and programs designed to help their children (NCMHI, 2009). All 50 states and the District of Columbia have a F2F HIC.

For more information

http://brightfutures.aap.org An American Academy of Pediatricians national initiative for health promotion and disease prevention.

Data Resource Center www.childhealthdata.org Children’s health statistics by state.

Medical Home Portal www.medicalhomeportal.org Information for parents and medical professionals about children and youth with special healthcare needs.

National Child Traumatic Stress Network www.nctsnet.org Wide-ranging information for parents about causes and treatments.

National Initiative for Children’s Healthcare Quality www.nichq.org Resources for parents on obesity, attention deficit and hyperactivity disorder, and special healthcare needs.

Refugee Health Information Network www.rhin.org Informational handouts on healthcare topics in many languages.

Related topics

Child WelfareResource NetworkHome EnvironmentDentalHearingProblem SolvingVision

References

American Academy of Pediatrics. (n.d.). What is a family-centered medical home? Retrieved April 15, 2010, from the National Center for Medical Home Implementation Web site: http://medicalhomeinfo.org.

Center for Medical Home Improvement. (2006). Explaining the medical home – talking points. Retrieved April 15, 2010, from www.medicalhomeimprovement.org.

Cooley, C., McAllister, J., Sherrieb, K., & Kuhlthau, K. (2009). Improved outcomes associated with medical home implementation in pediatric primary care. Pediatrics, 124(1), 358-364. doi: 10.1542/peds.2008-2600.

Child and Adolescent Health Measurement Initiative. (2007). 2007 national survey of children’s health. Retrieved July 21, 2010, from the Data Resource Center for Child and Adolescent Health Web site, www.nschdata.org.

Pascoe, J. M., Spears, W., & McNicholas, C. (2010). Parents’ perspectives on their children’s health insurance: The plight of the underinsured [Presentation]. American Academy of Pediatrics’ Annual Meeting. Retrieved Oct. 20, 2010, from http://aap.confex.com/aap/2010/webprogrampress1010/Paper11071.html.

Wight, V., & Chau, M. (2009, November). Basic facts about low-income children. Retrieved July 21, 2010, from www.nccp.org/publications/pub_894.html.

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Additional clarification of the screening essential requirement:

Early identification of hearing concerns can have a profound impact upon a child’s development. Otoacoustic emissions (OAE) for children younger than 36 months of age and pure tone audiometry for children 36 months of age and older are the most accurate ways to identify hearing concerns. Therefore, it is best practice for your affiliate to use these methods when conducting hearing screening. If your affiliate contracts out hearing screening, your contracted provider needs to use these methods as well.

Approved Hearing Screening Tools For the most recent information on costs and training guidelines, please see the company’s website.

Instrument Type Cost Company

AuDX®

Otoacoustic emissions technology

$3,580 Bio-logic: www.natus.com

Ero-Scan $3,920 Maico Diagnostics: www.maico-diagnostics.com

Otoread $4,195 Interacoustics: www.interacoustics--us.com

Echo-Screen $3,656 Natus: www.natus.com

Maico Pure Tone Screener Audiometer

Audiometry is not suitable for children below the age of 30 months

$900 Maico Diagnostics: www.maico-diagnostics.com

Pilot audiometer $2,195 Maico Diagnostics: www.maico-diagnostics.com

Please note that following the Foundational and Model Implementation trainings, additional training will be necessary to apply otoacoustic emissions (OAE) or pure tone audiometry.

If your affiliate is unable to use or contract out OAE or pure tone audiometry, parent report or documentation that the child’s hearing has been checked by a healthcare provider within the last 12 months can be used as the hearing screening portion of the complete annual screening. For the initial screening, parent report or documentation that the child’s hearing has been checked by a healthcare provider within the last 90 days can be used. Parent report that the child’s hearing has been checked by a healthcare provider is recorded on the Health

Record, using the updated form found in the Fillable Forms section within the Online Curriculum.

Newborn hearing screening: The newborn hearing screening results will satisfy the hearing screening requirement for up to the first 12 months of life as long as the child passed. However, best practice suggests that the hearing screening should be repeated at 6 months of age. You should request and review documentation of the newborn hearing screening results and include this information on the Health Record. If the child received a refer result then they should return to the hospital for a rescreen. If the family is not following up on the refer result, it is important that the parent educator works with them to do so.


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Hearing Screening“Congenital or acquired hearing loss in infants and children has been linked with lifelong deficits in speech and language acquisition, poor academic performance, personal-social maladjustments, and emotional difficulties” (Harlor & Bower, 2009). Many of these adverse consequences can be prevented with early detection of and intervention with hearing loss.

All states have a law requiring newborn hearing screening and most hospitals offer the screening. However, some infants will be missed. Infants not tested at birth should be screened before 3 months of age. When infants aren’t screened, the average age of detection of hearing loss is 14 months (“Hearing Screening,” n.d.) By then, the child’s language development may be impacted.

Another concern is acquired hearing loss. Annual hearing screening (with the objective procedures described by the American Speech-Language-Hearing Association), along with continued monitoring, will benefit the child’s development. Hearing screening may also be provided by an audiologist in the school district; a healthcare provider in your agency; or an outside agency. An agreement to share the results should be signed by all parties.

To assist in the identification of hearing loss – whether temporary or permanent, mild, moderate or severe – parent educators should:

> Monitor development by recording milestones including hearing and language development

> Attend to parental concerns regarding hearing

> Review high-risk factors

> Focus observations

Recurrent ear infections (or otitis media) are a leading cause of acquired hearing loss in children. Children living in poverty or those with disabilities are often at increased risk for ear infections. In the clinical report Hearing Assessment in Infants and Children: Recommendations Beyond Neonatal Screening (Harlor & Bower, 2009), the American Association of Pediatrics gives guidance regarding hearing screening in children.

Children who have one or more of these risk factors should be monitored at least every 6 months until 3 years of age, and at regular intervals thereafter, depending on the risk factor (“Hearing Screening,” n.d.).

Notes:Health Record


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Risk factors for hearing loss

> Family history of permanent childhood hearing loss

> Characteristics or other findings associated with a syndrome known to include a sensorineural and/or conductive hearing loss

> Infections associated with sensorineural hearing loss including bacterial meningitis and mumps

> In utero infections such as cytomegalovirus, herpes, rubella, syphilis, and toxoplasmosis

> Neonatal indicators, specifically conditions requiring transfusions or use of mechanical ventilation.

> Syndromes associated with progressive hearing loss such as neurofibromatosis, osteopetrosis, and Usher syndrome

> Neurodegenerative disorders, such as Hunter syndrome, or sensory motor neuropathies, such as Friedreich ataxia and Charcot-Marie-Tooth syndrome

> Head trauma > Recurrent or persistent ear infections for at least three months

> Disorders that affect eustachian tube function > Neurofibromatosis type II or neurodegenerative

Screening techniques

Begin by reviewing the questions on the Health Record with the parent. The questions target behaviors that may signal a concern with hearing. Then move on to one or more of the following procedures.

Tympanometry – This can help determine the status of the middle ear, specifically the function of the eardrum. A tympanogram is a graph of the results. A peaked pattern most often indicates normal functioning of the eardrum. This is not a hearing test, but it can be helpful in identifying middle ear problems that need attention by a medical professional. Fluid or wax (cerumen) can build up in the middle ear and diminish hearing.

Tympanometry screening is recommended for children 6 months of age and older. The screener should be trained in the use and maintenance of the equipment and interpretation of the results. An audiologist is the professional who can give training and support to programs using tympanometry in their screening protocols.

Notes:


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Otoacustic emissions (OAE ) – This screening can detect blockage in the outer ear canal, middle ear fluid, and damage to the outer hair cells in the cochlea. This procedure uses a probe that is placed in the ear canal. A series of sounds, clicks, or tones is used to present a stimulus to the ear. A normal healthy ear responds to the stimulation by producing an emission or “echo.” The probe tip measures these emissions and the results are shown on the screen as a pass or refer. A refer means there is a need for further evaluation.

Most often a rescreen is conducted a week or so from the first reading, and if a refer result is obtained again, a referral to the doctor for medical attention is indicated. Follow-up with an audiologist may also be recommended.

This is one of the techniques used for newborn hearing screening and can be also be used with toddlers and preschoolers by trained screeners. It is quick and easy to use and has been very successful in identifying young children at an earlier age. It is an efficient, objective, valid, and reliable screening method.

Screening updates

> For more information on hearing screenings, including a webinar on OAE technology, see the Affiliate Updates page at www.patnc.org/affiliate-updates.

Audiometry – There are different types of audiometry used to test different ages of children or types of sound. Some audiology tests are considered hearing screenings, while others will be a part of the evaluation of hearing loss. Audiometry can be conducted by audiologists or other trained personnel depending on the purpose of the testing or the need of the program.

Pure tone audiometry is used for screening purposes. A child needs to be willing to wear headphones, be able to understand and follow directions, and give a response to indicate that a sound was heard. Pure tone audiometry works best with an older toddler or preschooler.

These instruments can be costly, but they provide the best results. Many programs connect with a service agency in the community to help with funding. There may be grants available from other agencies in the state.

Notes:


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Vision screening procedures

Vision screening is recommended beginning at 6 months of age and then annually unless the parent educator or the parents have a concern, in which case it should be done earlier and/or more often. Screeners will be observing the muscle movement of the eyes and whether both eyes are working together. Screeners should explain to the parent what will happen and what the screening will be looking for.

The screener will need a penlight, a small, interesting toy (finger puppets are fun), and a protocol form on which to write the responses, such as the Health Record.

The screener should be positioned directly in front of the child at eye level. An infant or toddler will probably perform best while sitting on the parent’s lap. An older child may want to sit alone. It’s best to move quickly through the procedures, engaging the child with songs and games and humor. Some children may prefer the tracking and alternate cover tests first and the light presented towards the end. The order of presentation is not important. The screening time is usually brief – five to 10 minutes – if the child is cooperative.

Functional vision screenings

For guidance on when to administer these tests based on an infant’s age, visit www.patnc.org/affliate-updates.

Blink reflex – May be presented from birth to 1 year. To check for visual function, the screener should:

> Move an open hand with fingers spread out toward the infant’s nose, starting about 18 inches from the face. It’s important not to create air movement by moving too quickly.

> Pass if the child blinks in response to the approaching hand.

Reaching – May be presented to an infant to check gross visual functioning. The screener should notice if the infant can reach appropriately for a desired object placed in front of and off to each side of him.

Pupillary response – Tests the degree to which the pupils respond to light. This works best in a room that is not too bright. The screener should:

> Look at the pupils before beginning. (Remove glasses if the child wears them.)

> Use a penlight and shine it very briefly, from a distance of about 12 inches, into one eye to observe if the pupil constricts. Look for the pupil to shrink and then return to original size. Observe one eye at a time. Repeat for the other eye.

Notes:


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> Retest if the first time does not yield a satisfactory response. (This is very difficult to see in dark brown eyes. Try darkening the room.) The result is pass if both pupils constrict equally when the light is presented and dilate when the light is removed. If there are failures on two separate screenings, the child needs to be referred.

> Refer if the two eyes respond at different rates.

> Note that a white spot in the pupil could indicate a cataract and is cause for an immediate referral.

Corneal light reflex – Detects large degrees of constant eye deviation. The screener should:

> Direct a penlight at the bridge of the child’s nose at a distance of 8 to 12 inches.

> Ask the child to look at the light. (The child should wear his glasses if he has them.)

> Observe where the light reflection appears in each pupil. The result is pass if the light is reflected in the same position in each pupil.

> If there is a deviation, ask the parents if they have noticed any difference in the reflection of light in the eyes of the child in a photograph.

Cover/uncover test – Detects a deviation in the alignment of the child’s eyes.

> Have the child focus on a target object (penlight or finger puppet), held 8 to 12 inches from the face at eye level and lined up with the child’s nose.

Place the cover (a hand or a card) over the right eye and observe the left eye for movement.

> Repeat procedure by covering left eye and observing the right eye for movement.

> Pass if no movement is observed in the eye that is uncovered.

> Repeat as needed.

> Refer if any movement in the uncovered eye is noticed. If a child strongly objects to one eye being covered this may indicate a vision problem; the vision in the better eye is blocked.

Tracking – Determines if the child can follow a moving object and if the eyes can move fully without restriction. The screener should:

> Hold the penlight or toy 6 to 12 inches from the eyes; the child’s head should remain still.

> Move the penlight or toy horizontally, from left to right, in a 180 degree arc or about 8 inches out from each side.

> Move the light (or toy) vertically, from top to bottom, 180 degrees.

> Pass if the child follows the target with his eyes a full 180 degrees horizontally and vertically.

> Consider a referral if the expected response is not seen.

Notes:


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These screening procedures require practice with many people before beginning to use them with children. With continued practice, the procedures become easy and quick to administer (Missouri Department of Health & Senior Services, 2004; Moore, 1997; Parents as Teachers National Center, 2005).

Possible options for further screening

At 30 to 36 months many children will be able to respond cooperatively for acuity, stereopsis, and color vision.

Acuity is clear vision both near and far (tested using Tumbling E, LEA Symbols, or Broken Wheel). To perform acuity tests, the child can cover his eye with a hand, or an occluder, or wear special glasses that have one eye blocked. The screener should:

> Present the task and practice with the child at a close distance to determine if the child understands the directions.

> Ask the child to match letters or shapes that he sees on a chart or on cards that are held at a set distance from the child.

> Screen each eye separately and then both eyes together.

A test for stereopsis measures if both eyes are working together to achieve binocularity. The Random Dot E test is used most frequently with young children. The child wears polarized glasses to determine which cards have an “E.” The cards are shuffled between each of three presentations.

Pass criteria: Child identifies the card with an “E” four out of six presentations.

Refer criteria: Child is unable to identify the “E” on four out of six tries.

Another optional test measures color blindness. Color deficiency occurs to some degree in 1 of 15 boys, but only 1 of 200 girls. The child is asked to identify hidden pictures on cards. If the child has a deficiency, he will have difficulty finding the pictures.

Pas

s

Ages 3-4 years 20/40 in each eye

Ages 5-6 years 20/30 in each eye

Ref

er

Ages 3-4 years 20/50 or worse in two line difference between eyes

Ages 5-6 years 20/40 or worse in two line difference between eyes

Notes:


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Where to find suppliesMaterials for these tests can be purchased

from medical or school supply houses. Look for trainings in your community or read and follow the correct procedures found in the accompanying manuals.

Bernell VTP (source for PASS test, Broken Wheel acuity cards, Infant/Pediatric color test) www.bernell.com

Good-Lite Company (source for LEA Symbol charts) www.goodlite.com

Prevent Blindness America www.preventblindness.org

School Health (source for vision and hearing screening materials) www.schoolhealth.com

Stereo Optical Company (source for Stereo Fly and Random Dot E) www.stereooptical.com

Following up

When results for any of these tests are not typical, the screener should:

> Monitor the child and re-screen in a few weeks. Give the parents some behaviors to watch for as signs of difficulty seeing: rubbing eyes, closing one eye, tilting or turning the head to look at people or objects, eyes seem to move separately, holding books close to see, and so on.

> Refer the family to the healthcare provider with concerns. (Complete any necessary forms, such as releases or Screening Recommendation Record.) The doctor can examine the child and give treatment recommendations.

> Refer to a specialist, clinic, or hospital. Only an ophthalmologist or an optometrist has the expertise to diagnosis a visual impairment. There is free eye testing available in many communities. In 2005 a program for infants was initiated throughout the United States. (Information is available at www.infantsee.org). Another for preschoolers may be available from www.sightforstudents.org.

> Recommend activities to encourage strengthening vision skills (e.g., building with blocks, playing ball, sharing books, and so on).

Parent educators who have referred children for additional exams should ask parents what the results were in order to keep track of them in the family file.

References

American Academy of Ophthalmology. Policy statement: Vision screening for infants and children. Retrieved July, 28, 2010, from www.aao.org/aao/member/policy/children.cfm.

American Academy of Ophthalmology. (n.d.). Eye examinations in infants, children and young adults by pediatricians. Retrieved July 14, 2010 from http://one.aao.org/CE/PracticeGuidelines/ClinicalStatements_Content.aspx?cid=e57de45b-2c03-4fbd-9c83-02374a6c09e0.

American Optometric Association. (2002). Pediatric eye and vision examination. St. Louis, MO: Author.

Moore, B. (1997). Eye care for infants and young children. Boston: Butterworth-Heinemann.

Notes:

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Policies and procedures

Screening policies and procedures should address (but are not limited to) where, when, and how often screening will take place; record keeping; procedures for follow-up; recommendations or referrals; and a plan for evaluation of the screening program. In addition, regular review of screening protocols by supervisors will help to ensure high-quality screening services.

Chosen developmental

screening instrument

An organization must select an instrument(s) for developmental screening. There are a number of quality instruments available for screening young children, and no one tool is appropriate for all programs. It is important to choose an instrument(s) that fits the population(s) served and is approved by the Parents as Teachers national office.

Chosen health, hearing and

vision screening protocols

An organization must select protocols for health, hearing, and vision. Forms are available in the Additional Information, Resources, and Forms section to assist in completing the health screening, or programs may collaborate with an agency in the community that currently provides this service. If that is the case, procedures for exchange of information will need to be established.

Mechanisms for communicating

results

An organization must clearly determine how screening results are communicated to appropriate family members. Both verbal and written summaries of all screening results must be provided, ideally at the time of screening. Written and verbal summaries of screening results include information about the next stage of development and strategies parents can use to promote development.

Staff training

Screening is enhanced by well-trained personnel who have an understanding of child development. Parents as Teachers Model Implementation Training provides an excellent foundation for this. In addition, training on the specific instruments an organization chooses is essential. Each screening instrument has its own criteria for training.

Screening action plan for an agency Notes:

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Family Personal Visit RecordParenteducator: Dateofthevisit: Timestarted:Timeended:

Family(last)names: Check-inbeforevisit?oPhone oTextoE-mailoOther:

Location:oHomeoCenter oOther: Present:oMotheroFatheroGrandmotheroGrandfatheroOther:

(Optional)HN:012345+ Nextvisitscheduledfor(date/time):

Duringorafterthisvisit,wereanyofthefollowingcompleted?oFamily-centeredassessmentoParentingassessmentoDepressionscreeningoDOVEoOtheroutcomesmeasurement.Foranycompleted,listtoolused:

Visitplanused:F1F2F3F4F5F6F7F8PG Levelofservices:oWeeklyoBi-WeeklyoMonthlyoOther:

Handoutsgiven:

Family strengths and protective factors focused on in this visit: oParental resilience oSocial connections oKnowledgeofparentingandchilddevelopmentoConcretesupportintimesofneedoSocialandemotionalcompetenceofchildrenComments:Family well-being factors discussed in this visit (I = shared information; R = made referral):

o I oRHealthinsurance,CHIPo I oRMedicalhomeo I oRMedicalserviceso I oRDentalserviceso I oRFoodandnutritionresources(WIC,foodpantry)o I oRHousingandutilitieso I oRTransportation,driver’slicense,insuranceo I oREnglishlanguageclasseso I oRAdulteducation,jobtraining,collegeo I oREmploymentresourceso I oRImmigrationapplication,greencard

o I oRTobaccocessationo I oRSubstanceuse(drugs/alcohol)o I oRMentalhealth(Depressionmanagement,counseling,medication)o I oREmergencycrisisinterventionserviceso I oRChildabuse/neglecto I oRChildcare/preschool/HeadStartorEarlyHeadStarto I oREarlychildhoodinterventiono I oRRecreation/enrichmentactivitieso I oROther______________________________________________________o Nonediscussed

Discussion of well-being factors, informal and formal resources, and barriers to access:

Jointly planned family action steps towards goals:

Parent educator next steps/comments/reminders:

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Child Personal Visit Record Supplement Complete additional pages as needed for additional children.

Child name: D.O.B./age:

Screeningconducted?oDevelopmentaloHealthoHearingoVisionoSocial-emotionaloOther:

Milestonesupdated?YN Comments:

Parent-child interaction Parent-childactivitypageused:

Strengths-basedobservations(SOC).Recordtheinterplaybetweenchilddevelopmentandparentingbehaviors.

Development-centered parenting topics

oHealthybirthsoAttachmentoDisciplineoHealthoNutritionoSafetyoSleepoTransitions/routinesKeymessagesandlookingahead:

Child name: D.O.B./age:

Screeningconducted?oDevelopmentaloHealthoHearingoVisionoSocial-emotionaloOther:

Milestonesupdated?YN Comments:

Parent-child interaction Parent-childactivitypageused:

Strengths-basedobservations(SOC).Recordtheinterplaybetweenchilddevelopmentandparentingbehaviors.

Development-centered parenting topics

oHealthybirthsoAttachmentoDisciplineoHealthoNutritionoSafetyoSleepoTransitions/routinesKeymessagesandlookingahead:

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Each Parents as Teachers affiliate connects families to needed resources and takes an active role in the community, establishing ongoing relationships with other institutions and organizations that serve families.

In every community, there is an array of programs designed to nurture and help families. Parents as Teachers is not intended to be the only service a family will need. However, Parents as Teachers’ child development-focused approach to family support makes it a valuable part of the community’s network of human services programs. In addition, changes in the family and additional stressors have increased the necessity for parent educators to work as a team member in the community of collaborative services for families.

By developing effective collaborations and referring families to resources in times of need, concrete support for families (a protective factor) is strengthened. Further, when organizations, agencies, coalitions, government-supported programs, schools, and faith-based communities connect with each other, they provide a powerful network of support for families. To be most effective, all parent educators and their supervisors must have good knowledge – and be an active part – of this resource network.

Parents as Teachers Model Component: Resource NetworkThis section details the fourth dynamic component of the Parents as Teachers model. It is important to recognize that while each component is presented individually, they are closely interrelated and integrated. Together, the components create the overall impact and contribution of Parents as Teachers.

Notes:Permission to Exchange InformationResource Network Feedback FormResource Network Directory Template Page

Referrals to and coordination with other community resources and supports through Parents as Teachers services promote parental resilience, social connections, and concrete supports in times of need.

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The parent educator as a “broker of services”

The resource network component of the Parents as Teachers model takes into account the immediate and ongoing needs of families and the importance of linking them to resources outside the scope of services already provided. This important role of connecting families to concrete resources can serve to strengthen and promote their well-being. Because families often are not aware of services available in their community, the parent educator assumes a role of “broker of services” on behalf of a family, thereby bridging the gap between available resources and needed support. Identifying needs of the family, plus parent educators’ knowledge of community-based services, equals a partnership that builds on family strengths, supporting long-term self sufficiency.

In order to be effective with this, parent educators need to be familiar with community health, mental health, education, and social service organizations, as well as the names of individuals in those organizations who can assist families. It is also important that, whenever possible, an affiliate has in place working agreements with community agencies that explicitly address how it will connect families to the agencies’ resources.

An organization’s participation in interagency collaborations builds relationships with staff in other organizations that families may need and strengthens community interconnectedness. Continual collaboration with resources in the community will help an organization provide the best possible services to families. Organizations should consider having staff sit on community advisory committees or community boards to increase awareness of services offered and to make professional liaisons.

It is best practice for staff to work on a regular basis with other local providers of services and programs to address broad base of needs of the population the program serves. Ultimately, parent educators’ active collaboration with community resources complements and extends Parents as Teachers services.

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Notes:


Assessing support services needed

Since no agency or parent educator can provide all services to all families, it is essential to identify specific needs of families and link families to the appropriate resources and services. Listening to the family’s story and their history with community supports, and clarifying the type of support the family would like from the parent educator, should be done as part of the family-centered needs assessment.

Determining types of support services a family needs involves sensitivity in exploring their areas of need and challenges. A family can also provide insight about barriers they face so that realistic solutions can be tailored to meet their needs. Services a family needs may be short term or long term and address developmental issues of a child, economic support, health and medical care, adult behavioral or dependency issues, and so on.

Whatever the specific needs identified, the supports should serve to promote parental resilience and concrete support for parents, two protective factors. Once needed supports and services are jointly identified, the parent educator acts with the family as a broker of services to effectively link them to appropriate community-based resources.

Strategies for successfully connecting families to appropriate resources:

> Help families process what is going on by talking about issues without creating fear.

> Ask focused questions initially in order to determine the type of resource needed. Listen carefully to the family’s response to help clearly understand their needs.

> Use open-ended questions to determine more specifically what the family is looking for (“What does your doctor say?” “Tell me about what you’ve observed.” “What options have you considered?” “What type of ____ do you think would be most helpful?”) This process empowers the family as they reflect on their own strengths and needs.

> Provide immediate assistance and support in the event of an emergency and throughout a crisis. (More information on this appears in the following pages.)

> Initiate a referral when necessary, possibly based on screening, observations of parent or child, and so on. Concerns can be shared using the “sandwich” technique: State strength, state an observation that causes concern, discuss possible referral, and end with a strength of the family.

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> Know the referral agency, staff, and resources offered – it helps ensure the success of the referral and is a reflection of the parent educator’s knowledge and integrity.

> Give referrals to specific individuals at service agencies and provide transportation to those agencies as needed.

> Ask empowering questions, such as “What do you need from me to follow through with this resource?” or “How can I support you while I am here today?” Help families advocate for themselves once referrals are made or in process.

> Be attentive to professional boundaries and balance the importance of empowerment with the importance of follow-through.

> Once solid connections between families and services have been established, follow-up is essential. Discuss the results of interventions, the ways in which specific needs are being met; and the quality of services. If problems have occurred, follow-up discussion can generate solutions and, if necessary, advocacy for the family. Written permission to exchange information must be obtained before following up with a referral source.

> Record the referral, follow-up efforts, and the outcome in the management information system. The Personal Visit Record in the Additional Information, Resources, and Forms section can be used to document specifics of referrals and follow-up.

Types of community-based resources

Resources recommended may benefit all families or be specific to more vulnerable families.

Social resources such as library story hour, education open houses, health fairs, and community events offer opportunities for social networking that reduce isolation, as well as provide sources of information, emotional support, and a sense of community.

Economic resources based on current needs of a family and carefully discerned to ensure criteria are met may include housing, health, and child development services as well as family well-being resources such as domestic violence, mental health, and substance abuse.

For example, a parent educator might link family members to job training, jobs, and other economic stability service and provide locations of food pantries and clothing closets. In addition, an affiliate might be able to serve as an access point for health care, childcare subsidies, and other services.

Service-shy families may require additional emotional support and concrete information about what they can expect from a resource and what they can bring with them to make it a positive experience.

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When a family is in crisis

When disclosures are made that suggest a family is in crisis, it is essential that the parent educator be able to offer emotional support to the family. It is also important for the parent educator to continue to address the strengths that are apparent in the family, even during a crisis. The parent educator’s skills in listening, observing, and acknowledging strengths are critical components of this process. These skills model ways that the parent can respond to their own children in the midst of a challenging situation.

In addition, helping the family problem solve and access needed resources can make a significant impact on the family’s overall well-being and the parents’ ability to focus on parenting and child development issues.

Nonetheless, it is also important for both the parent educator and the family that the parent educator maintains appropriate professional and personal boundaries. Supervision and peer consultation can be particularly helpful when parent educators are working with families in crisis or at risk for crisis. It is also important that professionals be aware of their own values, attitudes and limitations. They must remain open to others’ values and attitudes, which are influenced by cultural background, socio-economic status, upbringing, and so on. These values and attitudes can influence families’ receptiveness to other community resources.

> Sometimes a family’s disclosure reveals a situation involving potential abuse or neglect. Since a parent educator is a mandated reporter, he or she “is legally required to report to authorities any suspected or confirmed abuse of children (”Mandated Reporter,” n.d., para 1). One of the most difficult decisions parent educators can face is determining if a child in a family being served is at risk of harm.

> When safety is an obvious issue, the parent educator must know what procedures to follow, whom to contact, how the parent(s) is to be communicated with, and what documentation needs to occur.

> Regulations vary from state to state and in different countries. It is therefore critical that the orientation of new parent educators includes training on local laws as well your organization’s policies and procedures for mandated reporting.

> Supervisors need to ensure that all parent educators understand their status as mandated reporters and the associated responsibilities. It is also vital that supervisors provide parent educators with ongoing education and support about how to handle challenging situations as they present themselves. One mechanism for doing this is to provide an annual review of the organization’s policies and procedure regarding child abuse and neglect.

> When there is evidence that a child’s physical or emotional safety appears to be in jeopardy, it is appropriate to take action. It is good policy to have parent educators contact a supervisor or administrator before making a referral. Supervisors need to be sure that when making a referral, parent educators know the best methods for the protection of those involved, as well as for their own safety. While this type of referral will not necessarily be a frequent occurrence, all programs need to be prepared in case the need arises.

Following a particularly stressful or difficult situation, the supervisor should provide the parent educator with an opportunity for debriefing. In debriefing, the supervisor and parent educator discuss what happened in a particular situation, the outcomes, and what new skills or knowledge would be useful for the parent educator’s future involvement in similar situations.

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Notes:


Linking families to services

Parent educators connect families to resources that help them reach their goals and address their needs. A current, comprehensive resource network directory facilitates parent educators’ ability to connect families quickly and accurately to services.

Such a directory may already exist in a local community. In this case, there is no need to recreate it. Staff in a program can add to the information by noting specific contact persons and other details about an agency. Staff must become and remain familiar with the contents of the resource network directory as it is updated regularly.

It is essential for programs and staff to build both knowledge of and relationships with comprehensive community-based resources on behalf of families. As time permits, it is beneficial for the Parents as Teachers supervisor to visit the community resources identified in the directory in order to build on existing relationships, encourage referrals of families to their Parents as Teachers affiliate, and learn how to make appropriate and effective referrals to that agency. It can also be beneficial to have agency representatives come to staff meetings so that they can give an overview of their operations and answer parent educators’ questions.

Building relationships with community-

based agency staff can be time consuming, but it is essential to share the commonalities of the work for families as well as the unique program mission. As commonalities of services are shared, the value of reciprocal relationships and complimentary service to families becomes evident.

As parent educators become, in effect, brokers of services for families, they serve as agents of change and strengthen protective factors, including linking families to relevant concrete support. The broker of service role means far more than providing a phone number and address. It includes being familiar with requirements to qualify for services, types of documentation required, physical location where services are offered, days and hours of operation, and names of staff contacts. It also entails a careful dialogue with families to help them feel comfortable and understand the resources and services available; know how they qualify; gather documentation to show they qualify; and know how to access the system and services. The goal is to increase awareness of services that will strengthen their family and provide seamless services.

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When parent educators are familiar with the resources that exist in a community, they feel more equipped to help and can be more confident in responding to families needs. Further, the more a parent educator knows and communicates about the agency they are referring a family to, the more likely the family will be to accept the referral.

Tips for developing a resource directory

As you identify, locate and organize local resources into a directory, consider the following:

> Start with personal experience – list resources already utilized or connected to, then add more about those resources.

> What are some of the most common resource/referral needs? What kind of information are families asking for? What topics or referral information do parent educators wish they had more resources about?

> Reflect on how families served have achieved positive results with this referral (called in the morning, ask for Mary, and so on).

> Consider the type of need each resource addresses.

> Determine if families would feel comfortable there. If other families have been referred, consider if they had a positive experience.

> Is there any “insider knowledge” that would help a family using this resource for the first time?

> Access existing resource directories and knowledgeable people in the community.

> Ask other professionals (inter and intra agency), and the families served, about local resources.

> Think about requests received and resources families are interested in but about which little is known. Do a quick Internet or phone book search, jot down some quick information, and make a phone call or two.

> Use the phone call as a networking opportunity. Share information about the program and seek input about theirs.

However resources are organized, consider formats that are easily accessible for the families, such as a directory in a small notebook or pamphlet form, a notebook with pages that can easily be removed and copied, a database, or a link on a Web site.

A useful resource network directory must be consistently updated and expanded according to program and participant needs.

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Notes:Barriers and challenges to effectively linking families to services

Families’ willingness to enter this process with the parent educator as well as their response to follow-up to suggestions may vary greatly depending upon the trust that has been built. Trust is essential to effectively working with any and all families, but when needs for services are identified, increased vulnerability on the families’ part may occur. The impact on follow-through to these needed resources as well as continued work with the family can be affected. A lack of trust on the part of a family toward agencies, experiences with prejudice or insensitive staff, low literacy, lack of knowledge of how to navigate the system, immigration issues, language barriers, and system problems within agencies such as long waits and complex application processes are common barriers to accessing services.

Transportation and location of resources add yet another challenge for vulnerable families wanting to access services. As brokers of services, parent educators need to be knowledgeable about these issues and develop a plan for seamless services to ensure that families hit as few bumps in the road as possible as they access resources and support services. For more information, consult the Permission to Exchange Information and Resource Network Feedback Forms in the Additional Information, Resources, and Forms section.

Enhancements and additional services provided to families

Many organizations offer multiple services to Parents as Teachers families. It can be very beneficial to provide additional services to more vulnerable families, layered upon compliance with the essential requirements. For example, in addition to the four-component Parents as Teachers model, an organization might provide case management or family literacy services to all or a subset of their Parents as Teachers families. In a randomized trial, children of adolescent mothers who received Parents as Teachers services in combination with case management were less likely to be subjects of child abuse investigations than adolescent mothers in the control group who received neither Parents as Teachers nor case management (Wagner & Clayton, 1999).

Further, as noted in the introduction, some organizations incorporate or blend Parents as Teachers with another early childhood home visitation model or family support program such as Early Head Start, Healthy Families America, or Even Start. Adding Parents as Teachers to existing services in your organization can greatly strengthen an affiliates impact on children and families.

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Goal statement: Why did we set this goal? Why is the goal important to us?

Timeline Action stepsWhat needs to happen?

Resources neededWho can help?

What do they offer?

ReviewWhen will we

check progress?

Progress made What has happened toward this goal?

Today’s date

Target dateWhen do we want to reach this goal?

What will we do now?

What will we do later?

What have we done in the short term?

What have we done in the long term?

Check goal:

Family Parent Child

Goal Setting: Begin With the End in Mind

Documents

Online Model Implementation Training