Massachusetts Department of Public Health F.O.R Families Program: A Qualitative Evaluation Zobeida Bonilla-Vega, MPH, Ph D, Melissa Marlowe, RN, MS, and Karin Downs, RN, MPH. Division of Perinatal, Early Childhood and Special Health Needs, Massachusetts Department of Public Health The program has been a central player in:  identifying needs of families  delineating strategies to address identified needs  assembling/aligning resources  advocating for families  providing caring and respectful support to the families in their journey towards self- sufficiency at different moments of their lives We wish to thank staff from the Mass Department of Public Health and the Housing and Homeless Unit of the Department of Transitional Assistance who asssited with this project. We especially thank the families, F.O.R. Families home visitors, and key informants who shared with us their time and experiences with the program. Rational and Methodology  The F.O.R. (Follow-up, Outreach, and Referral) Families program is a home visiting program of the Massachusetts Department of Public Health and the Department of Transitional Assistance to provide services to homeless families.  The program aims to assist families by identifying and addressing barriers that prevent them from attaining and maintaining self-sufficiency and well-being  The program goal is to improve families’ access to appropriate resources. BackgroundConclusion Contact Information Karin Downs, RN MPH Assistant Director for Clinical Affairs (617) Melissa Marlowe, RN MS F.O.R Families Project Director (617) Overall Program  Develop specific program measures related to child and maternal health to monitor and evaluate program outcomes.  Using standard Maternal and Child Health measures could facilitate collection of data, continuous evaluation, and sharing information with other programs and agencies. Services Provided to the Families  Develop clear goals with clients at the outset and monitor progress of client vis-à- vis realistic self-sufficiency goals.  Develop a client self-assessment mechanism where families report what was helpful and how they see themselves moving towards stability and self-sufficiency.  Explore collaborations with the Massachusetts Homeless Management Information System. An evaluation was initiated to document how the program had benefited clients served. A qualitative research model was chosen for this evaluation to learn from the experiences of program beneficiaries and providers about promising practices for working with homeless families. Evaluation Objectives 1.identify the strengths of the F.O.R. Families program and promising practices for working with homeless families 2.assess the role of the F.O.R. Families program in facilitating the transition of the clients from homelessness into a more stable situation 3.inform the development of a homeless screening tool, a F.O.R. Families home visitors protocol, and a program logic model 4.make recommendations for program improvement.  Clients interviewed reported positive experiences with the F.O.R. Families program and indicated that the program was instrumental in their progress toward a more stable situation.  Help with housing and with finding health care services were the most useful services that they received from program staff.  Clients also described counseling, parenting skills education, help with self-esteem and self- confidence, advocacy, help navigating the system and interacting with government and community agencies, phone calls to make appointments for health services, and provision of tangible items such as books, school supplies, toys, clothing, and food as significant benefits received from the program  Home visitors have encouraged positive, change-oriented actions that have helped families move closer to attaining self-sufficiency or to move out of homelessness.  The relationship built between home visitors and clients appears to be central to the clients’ positive experiences with the program. Clients’ Experiences with F.O.R. Families: Perceptions of Program Benefits InstrumentalEmotionalStructuralInformational  Finding money for expenses such as rent, bills, and moving expenses  School supplies  Food and groceries  Refrigerator and furniture for apartment  Parenting skills  Counseling  Fast response to their needs  Help getting SSI  Help to go to court  Phone calls to housing authorities  Arrange appointments for services such as dental care, mental health, prenatal care, and child care  Lists of services in the community  Health education materials on depression  Information about schools Recommendations Defining Success How do you define success for the families that you work with? Of the families that were successful, what factors do you think contributed to their success? What specifically about the F.O.R. Families program do you think contributed to the success of the families that were successful?  Success is related to acknowledging and changing behavior which is mutually agreed upon  Acknowledging that there is a problem and beginning to think about how to resolve this problem  Having services in place: health care, substance abuse, mental health, domestic violence  Self-advocacy  Clients personality: self-motivation and determination, positive attitude, goal oriented, wanting more for their children and for themselves, being someone who will ask for help, hope  Lack of substance abuse, mental health issues, and domestic violence or presence of services in these areas  History that allowed them to have examples of success (i.e., parents, friends, mentors)  Client’s engagement  F.O.R. Families provide a safe place for families to identify and begin to work on problem areas  Staff usually act as positive role models and offer positive action- oriented interventions  On-going support  Home visiting and personal connections Key Findings Suggestions for the Development of Relevant and Appropriate Measures of Success to Evaluate F.O.R. Families Program Is the family connected to programs and services? Knowledge and awareness of resources Number of family members among all families served by program that are able to hold jobs over a 3, 6, 12 month period Number of families who obtained permanent housing Number of times child misses school Ask clients how they think they are doing and conduct self-evaluation of their own progress toward stability and self-sufficiency Creation of an individualized plan and goals with the client and re-examining them on a regular basis to monitor progress. Changes in behaviors and habits Screen Screen positive ID sources of well-being Referrals DTA F.O.R. Families Other agencies Screen negative End process Sample Screening Process Factors to Consider in Developing a Screening Tool for Homeless Families Risk FactorsPossible Screening Settings  Family not paying bills  Income levels  Substance abuse present  Domestic violence present  Mental health issues present  Eviction and reasons for eviction  CORI issues  Immigration status  Family left shelter  DSS involvement  Education history  When they had first job  Longest sustaining job  Out of work for 6 months  Money management history  Weak or non-existing social support system  DTA offices  Emergency rooms  Community Health Centers across the state  Community action programs  Immigration services  WIC offices  Psychiatric hospitals  Schools Sample screening/assessment questions  Do you have safe and permanent housing?  Where are you staying?  How long have you been there?  Have there been changes in your housing situation since your last visit?  Do you have any concerns about your housing?  How many times have you moved in the last year?  What keeps you strong? What keeps you going every day?