1. Local Health Department Home Visitation Programs: Improving Health Outcomes for Children and Families Featured Program: Parents as Teachers Thursday, August 6, 2009 3:00 – 4:30 pm (Eastern) Sponsored by Health Resources and Services Administration Maternal and Child Health Bureau & CDC National Center on Birth Defects and Developmental Disabilities Prevention

2. CME: The Centers for Disease Control and Prevention is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Centers for Disease Control and Prevention designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity Continuing Medical Education for Non-Physicians (CME): The Centers for Disease Control and Prevention is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Centers for Disease Control and Prevention designated this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. CNE: The Centers for Disease Control and Prevention is accredited as a provider of Continuing Nursing Education by the American Nurses Credentialing Center's Commission on Accreditation. This activity provides 1.5 contact hours CECH: The Centers for Disease Control and Prevention is a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is a designated event for the CHES to receive 1.5 Category I contact hours in health education, CDC provider number GA0082. CEU: The CDC has been approved as an Authorized Provider by the International Association for Continuing Education and Training (IACET), 1760 Old Meadow Road, Suite 500, McLean, VA 22102. The CDC is authorized by IACET to offer.15 IACET CEU's for this program.

3. If you are interested in receiving continuing education units: - Go to the CDC Training and Continuing Education Online at http://www.cdc.gov/tceonline. If you have not registered as a participant, click on New Participant to create a user ID and password; otherwise click on Participant Login and login. You will need to enter the following verification code: NACCITYIPV1http://www.cdc.gov/tceonline - Once logged on to the CDC Training and Continuing Education Online website, you will be on the Participant Services page. Click on Search and Register. Use one of the 3 search options. Search for Course Number (EV1237) Click on View. - Scroll down and click on the program title. Select the type of CE credit you would like to receive and then click on Submit. Three demographic questions will come up. Complete the questions and then Submit. A message will come up thanking you for registering for the course. - If you have already completed the course you may choose to go right to the evaluation/posttest. Complete the evaluation/posttest and Submit. A record of your course completion and your CE certificate will be located in the Transcript and Certificate section of your record. If you have any questions or problems please contact: CDC Training and Continuing Education Online 800-41TRAIN or 404-639-1292 or Email at ce@cdc.govce@cdc.gov

4. Learning Objectives Recognize the general components of the Parents as Teachers home visitation program; Discuss lessons learned from local health department Parents as Teachers programs; Describe strategies for continued evaluation and quality improvement; and, Identify potential sources of funding for implementing Parents as Teachers programs.

5. Presenters Sue Sheehan Senior Director of International Born to Learn Trainings National Center for Parents as Teachers Julie Driscoll Program Manager Empowering Families of Milwaukee City of Milwaukee (WI) Health Department Joanne Hayward Supervisor of Community Nursing Wood County (OH) Health Department

6. Disclosure Statement CDC, our planners, and our presenters wish to disclose they have no financial interest or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters. Presentations will not include any discussion of the unlabeled use of a product or a product under investigational use. There is no commercial support for this activity.

7. Healthy Beginnings for Children with Parents as Teachers Sue Sheehan, M.Ed. Senior Director, International & National Training

9. Screenings & Connections to Resources Social Emotional and Developmental Delays Health, Hearing, Vision, Physical Delays

10. Personal Visits & Group Meetings

11. Key Outcomes Children are healthier and safer. Children are more ready for school. Parents are more involved in their children’s education.

12. Key Dimensions of Program Quality Parent educator training/recertification Standardized curriculum Quality standards and indicators Annual data reporting Self assessment and continuous improvement

13. Demographics

14. FEDERAL FUNDING  Education (Title I, Head Start)  Social Service (TANF, CAPTA)  Health (Medicaid, Title V, SAMHSA)  Contracts (Bureau Indian Education, Dept. of Defense) STATE/LOCAL FUNDING  Departments of Health, Education, Social Service  United Way  Private (hospitals, child care, foundations)

15. Contact Sue Sheehan, M.Ed. Senior Director, International/National Training National Center for Parents as Teachers 2228 Ball Drive St. Louis MO 63146 Sue.Sheehan@ParentsAsTeachers.org 1-866-PAT4YOU (866-728-4968) ext. 242 www.ParentsAsTeachers.org

16. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission. Empowering Families of Milwaukee A comprehensive, multi-disciplinary, public health approach to home visitation, utilizing the evidence- based curriculum of Parents as Teachers Julie Driscoll, MSW Program Manager, Empowering Families of Milwaukee August 6, 2009

17. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission. The City of Milwaukee Largest urban city in Wisconsin Approximately 600,000 residents Ranked 7 th highest in nation for disparities in infant mortality Ranked 2 nd highest unemployment rate Ranked 7 th poorest city in the U.S

18. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission. City of Milwaukee Demographics Median income $32,000 40% African- American families 15 % Latino families 60% of children live below the poverty line Largely segregated

19. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission. Empowering Families of Milwaukee Funded in 2006 by the State of Wisconsin Department of Health and Family Services as a focused-approach on eliminating racial and ethnic disparities in birth outcomes. Awarded to the City of Milwaukee Health Department through a competitive RFP process.

20. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission. Target Population Eight zip-code target area with the highest incidences of poverty, infant mortality, teen pregnancy, sexually transmitted diseases, lead poisoning, and child welfare reports Pregnant women are eligible to enroll and are provided service through the child’s fourth birthday.

21. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission. Empowering Families Family-centered, strength-based intervention Community-based and Culturally Competent Intensive Case Management 12 Critical Elements of Home Visitation Parents as Teacher Curriculum

22. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission. Empowering Families Triad Structure: Families receive services from a three member team that includes a Public Health Nurse, Social Worker, and Community Health Worker Social Worker Community Health Worker Public Health Nurse

23. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission. Empowering Families Public Health Nurses are employed through the City of Milwaukee Health Department Three community-based contracts were awarded by the MHD through a competitive RFP process for the provision of the Social Work and Community Health Worker components. All community agencies are embedded within the high-risk communities that we serve.

24. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission. EFM Goals Improve Birth Outcomes Enhance Family Functioning Support Child Health, Safety and Development Prevent Child Abuse and Neglect

25. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission. Parents as Teachers Core curriculum of home visitation program All home visitors are trained Allows the program to build health teaching components within child development Allows for continuous quality improvement Reflective Supervision

26. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission. EFM Assessment Tools Prenatal Assessment Nutrition Assessment Tobacco Use Screening AODA Screening Postpartum Assessment Infant Assessment HOME Inventory Child Care Coordination Assessment

27. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission. EFM Assessment Tools -continued- Ages and Stages Questionnaires at 4, 8, 16, and 24 months of age, then every three months until child’s 5 th birthday Ages and Stages – Social/Emotional Questionnaires every six months Home Safety Assessment every six month Eco-Cultural Family Interview

28. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission. Training Partnership Parents-Plus – PAT State leaders * PAT BTL –P-3 & 3-K UW-Extension – CORE program training & technical assistance * Home Visitation Foundations * ASQ – ASQ-SE * Home Observation Measurement of the Environment (HOME Inventory) * Emotional Intelligence * PACE Poverty Training * Ongoing Skill Enhancement Training

29. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission. EFM Outcomes Serviced over 365 women and their families Complete over 5,000 home visits each year Demonstrated a 75% retention rate for families who received more than one year of service Demonstrated a statistical significant impact on birth outcomes - EFM participants are 2.5 times more likely to have a healthy birth outcome than those who do not participate in the same target area.

30. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission. Lessons Learned Community buy-in is essential to successful program implementation The timeliness of training should not coincide with program design Attention to team dynamics and team building needs to be ongoing Reflective supervision must be a central component of program design to assure staff are supported and maintain effective boundaries Plan to address mental health needs of families need to be part of implementation

31. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission. Funding Sources & Sustainability Start up, Training, and Operating Costs * State of Wisconsin –TANF Funds * Third-Party Billing- Medicaid * Tax-Levy Match to the grant Community Partnership * Maintain relationships with referral sources * Shared success and minimize duplication of services * Decrease competition for limited dollars

32. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission.

33. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission. Think Health. Act Now!. CITY OF MILWAUKEE HEALTH DEPARTMENT. www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission. Julie Driscoll, MSW Program Manager, Empowering Families of Milwaukee City of Milwaukee Health Department (414) 286-6002 jdrisc@milwaukee.gov August 6, 2009

34. Wood County Ohio Parents As Teachers Home Visitation Program Presented by: Joanne Hayward BSN RN Wood County Health Department Bowling Green Ohio

35. Wood County Ohio  Population: 125,399  Area: 617.32 Square Miles  Per Capita Income: $33,528  Primary Land Use: Urban 9.42% Cropland 80.38% Cropland 80.38%

36. Wood County Ohio  Infant Mortality Rate: 4.8 per 1,000  Low Weight Births: 6.6%  Late or No Prenatal Care: 1.8%  Teen Pregnancy Rate:44.5 per 1,000  <100% Poverty Rate: 9.6%  Unemployment Rate: 12.8%

37. Parents as Teachers 2009 Family Demographics  Total Children Served = 122  Teen Parents = 18  Children with Disabilities = 23  Parent with Disabilities = 26  Low Educational Attainment = 31  Low Income = 111  Single Parent Household = 43  Mental Health Issues = 49

38. The Beginning - 2002  Incorporated Parents as Teachers into an existing program, Help Me Grow (Ohio’s Birth To Three Program)  Trained 1 Parent Educator and 1 Supervisor  39 Wood County families served in the first year  Existing Wood County Children’s Advisory Council functioned as the advisory group

39. Program Expansion  In 2006, received grant funding from United Way of Greater Toledo  $31,000 for three year funding cycle  Allowed additional Parent Educators to be trained  Increased numbers served to 122 children and their families by FY 2009

40. Budget for FY 2009  $61,564 Total Budget  $31,000 United Way Grant  $30,564 Federal Part C,TANF, State GRF and LHD Levy dollars  $504 Cost Per Participant

41. Program Outcomes Parent/Guardian:  demonstrates developmentally appropriate play with their child  has an increase in knowledge regarding appropriate behavior management techniques  has an increase in knowledge regarding early brain development

42. Outputs for Activities FY 2009  100% of parents were observed using developmentally appropriate play with their children  82.5% of parents scored at least 90% or higher on appropriate behavior knowledge post-tests  82.5% of parents scored at least 90% or higher on brain development post-tests

43. Group Meetings  Incorporated group meetings with the Help Me Grow program  Collaborated with county partners that serve children birth to three  Donations for supplies from area businesses and agencies  Advertised through parent newsletter and parent educators at home visits

44. “Back to School” Family Picnic  Wood County Board of MRDD provided location including adaptive playground, cafeteria, shelter house  MRDD also provided volunteers  ARC of Wood County provided food, prizes and craft supplies  Parents as Teachers parent educators coordinated programming including parent/child activities  Help Me Grow Family Support Specialist coordinated set-up, supplies, food prep and clean-up

45. Marketing for Family Picnic  Information in monthly newsletter  Mailed fliers to all Parents as Teachers/Help Me Grow participants  Fliers sent home with all Early Intervention center-based children Event was attended by 89 individuals including 47 children !!! Event was attended by 89 individuals including 47 children !!!

46. Fall Festival/Open House  Wood County Board of MRDD provided location including parent room, classroom and playroom  Parents as Teachers parent educator provided programming  Help Me Grow program provided refreshments  Wood County Public Library provided “storyteller” as well as bookmarks and activity calendars  Help Me Grow Family Support Specialist coordinated set-up and clean up

47. Fall Festival/Open House  Marketing was same as Family Picnic  Event was attended by 33 individuals including 15 children

48. Other Group Meetings  Monthly Coffee Club in Early Intervention Parent Room  Splish Splash in MRDD Therapy Pool  Family Information Network Educational Parent Meetings  Help Me Grow Parent Advisory Meetings

49. Factors for Successful Group Meetings  Collaboration with other child serving agencies  Frequent Reminders to families  Food  Door prizes and gifts  Evenings and Weekends  Accessibility: Offering meetings in various parts of the county

50. Future of Parents as Teachers in Wood County  United Way Grant funding continues for FY 2010  Continued Support from Wood County Health Department Local Levy funds  Help Me Grow will continue to be the infrastructure to support the program through referral system and staff support  Help Me Grow supervisor will continue to provide dual supervision to both programs  Pursue other grant opportunities

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52. Thank you for your participation! Please take a moment to submit the online evaluation form for this webcast using the link below: http://www.zoomerang.com/Survey/?p=WEB229H527QAQAhttp://www.zoomerang.com/Survey/?p=WEB229H527QAQA. To obtain continuing education credits, visit http://www.cdc.gov/tceonlinehttp://www.cdc.gov/tceonline Please join us for the next installment of the E-MCH Series on August 20, 2009. This webcast will focus on Children’s Mental Health and the ACES Study. Thank you. You may now disconnect.