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Title: Kansas Healthy Start Home Visitor Training


1
Kansas Healthy Start Home Visitor Training
  • Who are We and What do We Do?

2
Introduction
  • Welcome to your new role as a Kansas Healthy
    Start Home Visitor (HSHV).
  • Member of the public health team.
  • You can change the future of the families you
    serve.
  • You reach out to families in your community.

3
Purpose of Training
  • To provide information and education to local
    health department staff, including HSHVs and
    their nurse supervisors, for the development and
    enhancement of the Kansas Healthy Start Home
    Visitation program by

4
  • Providing a basis for understanding the home
    visitation model as a strategy for working with
    families.
  • Providing a framework for a home visitor.
  • Providing rationale for the home visitor.
  • Providing elements of the home visitor role that
    is most likely to bring about positive changes
    for children and families.
  • Providing principles that guide the home visitors
    role and application to the Kansas Healthy Start
    Home Visitor Program.

5
Whats on the Agenda?
  • History of home visitation, both nationally, and
    in Kansas.
  • Philosophy of Kansas Healthy Start Home Visitor
    program.
  • Strategy of service delivery.
  • Home visitation services.

6
Philosophy
  • Interventions that educate and support pregnant
    women, children and families can reduce the
    incidence of child abuse and neglect and increase
    the use of preventive health services.

7
Kansas Healthy Start Home Visitor Program
  • Is successful in preventing many crises,
    promoting healthy families, identifying those
    families at greatest risk, and providing linkages
    within the community systems for necessary
    services.

8
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9
Primary Focus of Kansas HSHV
  • Supporting parents in developing positive
    attachment relationships with their infants and
    children along with enhancing family
    self-sufficiency.

10
Basic Assumptions
  • Preservation of the family as the foundation of
    our social structure is essential.
  • The rights and integrity of the family must be
    recognized and respected.
  • The family will ultimately make important
    decisions about its interactions with community
    resources/services.
  • Healthy focused programs will improve the health
    status and increase usage of preventive health
    care for pregnant women, children and families.

11
History of Home Visitation
  • Latter part of the 19th century saw increasing
    industrialization, massive European immigration
    to the new world, and rapid urbanization.
  • Settlement houses emerged.
  • Public health nurses and social workers began
    providing in-home education and health care to
    women and children, primarily in poor urban
    environments.

12
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13
  • Florence Nightengale
  • 1858 Friendly Visitors
  • Lillian Walds Henry Street Visiting Nurse
    Service
  • 20th Century Progressive Era and social reform

14
  • 1909 First White House Conference on Children
  • G. Stanley Hall Parent Teacher Associations
  • Field of family support work expanded
  • Poor viewed as victims

15
  • 1920s decade when nursery schools, embraced
    parent education for middle class children.
  • 1960s President Lyndon B. Johnsons Great
    Society program
  • 1970s New York City Health Department
    implemented a home visitor program
  • Late 20th century home visitation focused on
    prematurity or low-birth weight, developmental
    delays, teen parents, and families identified as
    high risk for child abuse and neglect

16
Todays Ideation
  • The parent is the expert about their own child.
  • Effective home visiting is a partnership between
    professional and parent, not the expert
    teaching the parent!

17
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18
Research Best Practice
  • Lower incidence of child abuse and neglect
  • Reduction of welfare dependence and subsequent
    pregnancies
  • Decreased involvement in the criminal justice
    system by parents
  • Reducing serious anti-social behaviors in
    children involved in structured home visitation
    services
  • ( Kumpfer, Strengthening Americas Families, US
    Dept of Justice, 1999)

19
  • Home visitation programs may differ in dimension,
    (ie. populations they serve, to whom and how they
    deliver their services, and the outcomes that are
    measured), but they are all rooted in common
    belief. Parents play a critical role in shaping
    outcomes of their children and early childhood is
    the crucial time to provide support.

20
HSHVs
  • Believe that resources should be brought to the
    families through home visits to the home, and
    these are more beneficial than this expectation
    being left in the community for families to seek
    out individually.

21
HSHV Additional Value
  • The visitor not only educates the mother,
    provides feedback concerning her effectiveness in
    parenting, but serves as a positive role model as
    well. Through this model the mother receives
    approval and reassurance.

22
Kansas HSHV Program
  • 1977 A 2-year grant from the National Center
    for Child Abuse and Neglect was awarded to Kansas
    Dept of Social and Rehabilitation Services for a
    rural multi-county home visiting project.
    Administration of this grant was transferred to
    KDHE, in which a project was funded with 11
    counties in north central Kansas.

23
  • 1978 Discretionary funds, awarded a grant to
    Kansas City-Wyandotte County Health Department to
    provide home visits for the purpose of reducing
    child abuse and neglect.
  • 1979 Ks. Legislature provided state general
    funds to continue these projects and more funding
    came from the Childrens Trust Fund.

24
  • Also in 1979 funding from the Maternal and
    Child Health Block Grant, and the Preventive
    Health Block Grant expanded home visiting
    services within the state.
  • 1988 Governors Commission on Children and
    Families enhanced HSHV projects through statewide
    expansion.

25
  • 1999 funding increased to expand the program
    from 80-100 counties to 104 counties.
  • Childrens advocacy groups in Kansas have become
    strong supporters of the program, including
    Kansas Action for Children (KAC), Childrens
    Cabinet, and Kansas Child Abuse Prevention
    Council (KCAPC).

26
Kansas Healthy Start Home Visitor Program
  • Directly linked to Maternal Infant programs,
    physicians and communities to offer outreach and
    support for pregnant women, their infants,
    children and families.

27
Kansas HSHV Program
  • Uses a paraprofessional model for home service
    provision.
  • Paraprofessional an individual who has no
    academic credentials in a relevant field, such as
    nursing, education, or social work.
  • Kansas HSHVs are hired based on their personal
    qualities of warmth, self-assurance, cultural
    sensitivity and competence with parenting.

28
  • Knowledge of and involvement in community
    networks is vital in recruiting families into the
    program.
  • These professionals are non-stigmatizing,
    family-friendly, culturally competent members of
    the community.

29
Kansas HSHVs
  • Work under direct supervision of the registered
    professional public health nurse.
  • Supervision entails developing a relationship
    with another person that will foster professional
    growth, promoting a high-quality program,
    encouraging accountability and facilitates
    personal and professional growth for themselves
    and the home visitor.

30
  • Are community focused matching specific community
    needs, being culturally sensitive to the make-up
    of families served, and avoiding duplication of
    services.
  • Reduction of local barriers to care, and matching
    goals to the needs of the community.

31
  • Serve families through promotion of effective
    parenting, improving pregnancy outcomes, reducing
    the number of children in poverty, reducing the
    number of abused or injured children, providing
    health education and disease prevention
    information, case management to ensure access to
    medical home and other necessary community
    resources and advancement of social, emotional
    and intellectual development of children and
    families.

32
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33
Target Population
  • Kansas Healthy Start Home Visitor Services are
    available to all pregnant women and families with
    priority to high-risk families. Adoptive
    families and families who have lost a newborn are
    also eligible.

34
  • Focus of program should be on individual familys
    needs and stressors, rather than just on intended
    curriculum.
  • Services and educational endeavors should be
    geared toward teaching parents the skills
    necessary to function in the social environment
    in the future as well as making use of community
    services.

35
  • Focus should be on parenting confidence and
    comfort within existing social networks.
  • Assessment of linkages between social network
    factors and child maltreatment risk.
  • Enabling families to build on their own strengths
    and capacities promotes the healthy development
    of children.

36
Persons Served
  • Pregnant women, parents, infants and children.
  • Overall Goal To prevent or lessen the potential
    isolation of families by assisting them to assess
    and engage the existing informal support systems
    available in their community.

37
  • Goals
  • Prevention of negative birth outcomes (low
    birth weight, substance abuse, criminal activity,
    early prenatal care, and prematurity)
  • Prevention of infant mortality
  • Increase proper nutrition and physical
    activity for families

38
  • Prevention of child abuse and neglect
  • Prevention of unintentional injuries
  • Improvement of family coping skills
  • Promotion of positive family parenting skills
  • Promotion of child development/school
    readiness
  • Outreach and support for families to improve
    use of community resources, including access to
    provision of a medical home

39
Objectives
  • Identification of families at risk (targeting
    population of low-income, first-time mothers and
    their babies)
  • Reduce the incidence of child abuse and
    neglect by improving parents nurturing skills
  • Improve and enhance parenting and problem -
    solving skills

40
  • Enhance quality of care giving for infants
    and toddlers to prevent child maltreatment,
    childhood injuries, developmental delays, and
    behavioral problems
  • Promotion of early prenatal care to reduce
    the incidence of premature and low birth weight
    babies

41
  • Improvement of womens health behaviors
    related to alcohol and substance abuse, smoking
    and nutrition, risk factors for pre-term
    delivery, low birth weight and infant
    neuro-developmental impairment
  • Reduce health care costs by promotion of
    preventive health care and through enhancement of
    informal support by linking families with needed
    health and human services

42
  • Kansas Healthy Start Home Visitor works under
    direct supervision of the registered public
    health nurse supervisor.

43
Qualifications of the Nurse Supervisor
  • A graduate of an approved school of professional
    nursing (preferably have completed a
    baccalaureate degree program approved by the
    National League for Nursing)
  • Be a licensed registered professional nurse in
    the state of Kansas
  • Have a minimum of one (1) year experience as a
    professional RN

44
Supervision
  • Meet individually with the visitor at least two
    times per month to review client records and home
    visitor recommended follow-ups
  • Assist home visitor in prioritizing workload
  • Determine which families require Public Health
    Nurse visits after consultation with home visitor

45
  • Review and sign off documentation of the home
    visitor, including supervision of documentation
    of Client Visitor Records of encounters that are
    sent to Kansas Department of Health Environment
    for data collection, including mid-year and year
    end reports

46
Responsibilities of Nurse Supervisor
  • Consult with KDHE Kansas Healthy Start Home
    Visitor program manager to assist in filling a
    home visitor vacancy if needed
  • Supervise the activities of the home visitor
  • Consult with the home visitor on a regular basis
    and as needed

47
  • Complete an annual written personnel evaluation
  • Ensure that a PHN will make follow-up visits to
    families when the home visitor observes current
    or potential problems
  • Promote effective interagency cooperation with
    other community resources and programs
  • Consult with other professionals who have
    provided referrals to the Kansas Healthy Start
    Home Visitor program

48
  • Ensure that all reports are completed in a
    correct and timely manner
  • Include home visitors in appropriate local staff
    meetings
  • Periodically accompany home visitor on home
    visits to evaluate content of visit and
    effectiveness of the visitor
  • Assist home visitor in prioritizing workload
  • Review and sign documentation of home visitor

49
Qualifications of HSHV
  • Have a minimum of a high school diploma or GED
  • Be an experienced parent who has successfully
    nurtured a family
  • Demonstrate the ability to respect the
    confidentiality of a client relationship
  • Demonstrate effective communication skills

50
  • Present a warm, caring, concerned attitude toward
    families
  • Be knowledgeable of available community resources
    and how to utilize them
  • Be able to differentiate between home visitor and
    nursing supervisor responsibilities
  • Take direction and carry out decisions made by
    nurse supervisor

51
  • Work independently in a dependable manner
  • Speak bilingually, if population needs indicate
    this specialty
  • Be in good health and free from communicable
    disease
  • Model a healthy lifestyle
  • Complete reports in a correct and timely manner

52
Responsibilities of HSHV
  • Visit families with or expecting newborns to
    provide non-threatening, friendly support
  • Visit all families within seven (7) days of
    referral or sooner if indicated.
  • Observe families for any current or potential
    problems
  • Provide a resource list to families for local
    service options such as transportation,
    babysitting, child care, SRS, physicians,
    pharmacies, etc.

53
  • Make referrals to local resources
  • Alert PHN supervisors of existing or potential
    problems
  • Make return visits to give continued support to
    families as determined by the PHN supervisor
  • Alert PHN supervisor of existing or potential
    problems

54
  • Serves as a facilitator for crisis intervention
  • Seek client referrals from local health
    department programs, hospitals, physicians, SRS,
    and all available local resources to initiate
    visits to a client prior to delivery or during
    the hospitalization period

55
  • Ensure that all members within the family have
    access to a primary care provider or medical
    home
  • Participate in training workshops provided by
    KDHE
  • Complete reports in a correct and timely manner
    and distribute client survey postcards to
    families visited
  • Promote the HSHV program through all media
    resources in cooperation with PHN supervisors.
  • Collaborate and communicate with local, county,
    regional and state-wide visitors to increase
    coordination of services to all clients and
    families

56
CONFIDENTIALITY
  • Dont leave client records out in the open.
  • Write only what is necessary and, when you do, be
    objective and factual.
  • Subjective information, assumptions, and opinions
    should not be included in your documentation.
  • Parents have the right to read any and all
    portions of their files so be thoughtful about
    what you write.

57
  • Families are empowered when they have access to
    information other resources take action to
    improve the well-being of children, families, and
    communities.

58
Referrals to Other Services
  • Immunizations
  • WIC
  • Family Planning
  • Prenatal/Postnatal
  • Parental/Parenting
  • Other Medical

59
  • Early Childhood
  • Support Groups
  • Development
  • Child Care Services
  • Self-Help Groups

60
Resources and Services
  • Local Health Department (MI, WIC, Family
    Planning, Immunizations, Child Adolescent
    Health Services, including Well-Child/Kan Be
    Healthy)
  • Office of Social Rehabilitation Services (SRS)
  • Hospitals

61
  • Physicians that serve prenatal women, infants,
    children families
  • Mental Health Services
  • Extension homemaker units
  • Business and health coalitions
  • Professional associations

62
  • School Nurses and Administrators
  • Licensed and registered child care facilities
  • Ministerial alliances
  • Parents as Teachers
  • Head Start Programs

63
Role of the HSHV
  • Advocate Bridging cultural and other barriers
    to early and effective prenatal care/services
    to advise or accompany pregnant women to prenatal
    appointments and other community services and to
    assist children and families as needed.

64
  • Collaborator Working with numerous support and
    resource services available to secure appropriate
    services for women, children and families.

65
  • Consultant Finds answers to families questions
    about their pregnancy, relationships, and
    parenting.

66
  • Mobilizer Observation and early identification
    of unhealthy behaviors, disease processes, injury
    potential, and other lifestyle occurrences with
    prompt referral to supervising registered nurse.

67
  • Mediator Seeks solutions and assists families
    to work through problems that may arise.

68
  • Model Demonstrates positive lifestyle and
    parenting behaviors.

69
  • Coach Actively and attentively listens to what
    families need or want without being judgmental,
    and supports families efforts to obtain these.

70
  • Motivator Motivates families to make lifestyle
    changes and engage in healthy behaviors with the
    ultimate goal of a healthy pregnancy, and healthy
    children.

71
  • Record Keeper Documents and maintains accurate
    visitor records reviewed and co-signed by
    registered nurse supervisor, with appropriate
    completion of Client Visitor Encounter Records
    sent to KDHE.

72
  • Partner Supporting families through local
    community, surrounding county, and state-wide
    collaborative efforts.

73
  • Home visiting is not an easy job. It requires
    the patience of a saint, the diplomacy of a
    statesman, a sense of humor like Whoopi Goldberg,
    and the belief, like Dorothys, that dreams can
    come true. (Weiss, 1993).

74
Kansas HSHV Qualities, Skills Knowledge
  • Knowledge of program philosophy, goals and
    objectives.
  • Interpersonal skills such as empathy,
    flexibility, accessibility, patience,
    resourcefulness, enthusiasm, and non-judgmental
    demeanor.

75
  • Effective interpersonal and communication skills
    both verbally and in writing.
  • Effective listening and cultural sensitivity.
  • Support and respect of family competence, values
    and privacy.
  • Promotion of empowerment and self-sufficiency.

76
  • Problem solving and solution-seeking skills.
  • Teaching skills and motivating change.
  • Knowledge of and access to community resources.
  • Identification and response to warning signs.

77
  • To help ensure a quality, positive home visit
    environment, you must communicate acceptance and
    respect. You must foster interpersonal skills
    including sensitivity, empathy, flexibility,
    accessibility, resourcefulness, enthusiasm, and
    the ability to be non-judgmental.

78
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79
Cultural Information/Competency
  • Respecting and accepting a familys culture makes
    home visitation much more effective through
    competency and sensitivity.
  • Requires balancing awareness of the familys
    cultural patterns with awareness of ones own and
    using that awareness to track what is happening
    within home visits.

80
Knowing Oneself
  • Knowledge of Self
  • Awareness and understanding of ones own cultural
    values, beliefs, norms, and expectations.

81
Social Class Differences
  • Poverty increases the likelihood of the presence
    of risk factors such as unemployment, substandard
    housing, violence within neighborhoods, and
    social and emotional problems.
  • These families are not inherently weak,
    disorganized, or unhealthy.
  • These families need to be treated with respect
    and dignity.

82
What is a Home Visit?
  • Face-to-face interaction between the home visitor
    and a parent or family.
  • Scheduled in advance.
  • Planned for a specific period of time usually
    60-90 minutes.
  • Usually takes place in the home setting, but may
    take place at a mutually convenient location
    (such as a work place, library, etc.)

83
  • Offers social support and discussion of topics
    that are important to the families.
  • Involves planned activities and topics based both
    on the familys needs and the goals of the HSHV
    program.
  • Requires planning before the visit and follow-up
    after the visit as needed.

84
Where do I begin? How do I conduct a home visit?
  • Every visit requires you to plan beforehand,
    discuss planned topics during the visit, and
    complete follow-up activities afterwards.
  • First impressions are very important and lay the
    groundwork for future visits!

85
  • Consider cultural tradition/practices
  • State clearly expectations of the visitor
  • Stress issue of privacy and confidentiality
  • Use clear statements
  • Gain confidence of your families

86
Before the Home Visit
  • Call to schedule a time for your visit.
  • Review the information about the client or family
    and gather any other information you need.
  • Plan what you will discuss at the visit, and
    identify appropriate educational information to
    present.

87
  • Collect all the items you will need such as
    written materials, safety devices, toys, bags,
    packets, etc.
  • Kansas Healthy Start Home Visitors should provide
    parenting curriculum with clear objectives and
    structured information that directly address the
    needs of families within their cultural and
    individual contexts.

88
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89
Topics and educational information
  • Prenatal/Postpartum changes
  • Feeding, nutrition, and weaning
  • Attachment behaviors and nurturance, such as
    reading and responding to infant cues (ie
    crying), by soothing, making eye contact,
    providing tactile response and communicating
    verbally and nonverbally

90
  • Safety of the home environment and infant first
    aid
  • Babies biological cycles of sleep, feeding,
    elimination
  • Normative development and milestones
  • Developmentally appropriate play
  • Managing challenges such as sleep deprivation,
    physical recuperation after birth, and
    fussy/colicky babies

91
  • Early discipline and limit setting
  • Immunizations and Communicable Diseases
  • Medical home, food assistance, employment and
    other targeted assistance programs

92
During The Visit
  • Be on time!
  • Greetings and Introductions
  • Discuss information and topics planned for the
    visit
  • Observe and make mental notes of any concerns,
    threats, or dangers that may require further
    discussion, action or referral

93
  • Ask about any immediate concerns or expectations
    from the parent
  • Model desired parenting skills and parent-child
    interaction
  • Summarize purpose and information presented at
    the visit

94
  • Request topics that might be planned for the next
    visit
  • Confirm the date and time of next scheduled visit
  • Good-byes should be made to each person present

95
After the Home Visit
  • Complete CVR
  • Record and document accomplishments and
    discussions from the visit.
  • Note any referrals or follow-ups determined from
    the visit.
  • Take a moment for reflection Did I cover the
    important topics and education during the visit?
    Did I scan the environment and see any signs of
    problems?

96
  • Did I feel confident that the mother and
    children are in a safe place? Did I empower
    this family?
  • Follow-up with nurse supervisor to discuss any
    concerns
  • Document visit with any recommendations or
    actions taken

97
  • Maintaining and promoting safety are basic to
    effective home visitation.

98
Basic Safety Information for the Kansas HSHV
  • Use common sense and trust your own judgment. If
    you find yourself in a place that feels unsafe,
    it probably is GET OUT!!
  • Make sure your supervisor or other staff know
    your home visiting schedule, the name and address
    of the person you are visiting, and when you plan
    to return to your home or office.

99
  • Know the neighborhoods and areas in which your
    home visits will take place.
  • Do not go into dangerous neighborhoods after
    dusk.
  • Learn the safest route to and from your clients
    home.
  • Make sure the locks on your car doors work and
    that you have enough gas in your tank.

100
  • Dont carry more money with you than you will
    need to get through the day.
  • Dont wear expensive jewelry or clothing.
  • Protect yourself from contagious disease. If you
    find that someone in the clients home has a
    serious contagious illness, like measles, flu, or
    tuberculosis, reschedule your visit, or perhaps
    conduct the visit over the phone.

101
Preparation for the Visit
  • Car should be in good condition.
  • May require making visits in pairs.
  • Take a two-way radio or cell phone.
  • Let someone know where you are going and your
    estimated time of arrival back.

102
Assessing the Environment
  • Note any homes and/or businesses that could be
    utilized as a resource if needed.
  • Note any individuals or animals outside the home
    that could present danger.
  • Once inside, note the tone of voice and nonverbal
    behaviors of your client and family.

103
Uncooperative Clients
  • You will have some clients that just dont
    cooperate with scheduled visits.
  • Look at reasons why the client is not
    cooperative.
  • Remember some of your clients may have had bad
    experiences in the past with health professionals.

104
  • Development of a working, trusting relationship
    may be enhanced through the following skills

105
  • Positive Attitude
  • Respect, politeness and kindness
  • Role clarification
  • Praising and Encouraging
  • Being a Good Listener

106
  • Foster easy to understand methods for
    communication.
  • Nonverbal behavior
  • Do not be judgmental
  • Maintain Confidentiality
  • Reliability

107
Coping with Stress
  • Stress refers to mental or emotional strain or
    tension.
  • What causes stress?

108
HSHV Role in Assisting Families with Stress
  • Assist families in coping with stress caused by
    the demands of pregnancy and the birth of a baby.
  • Facilitate in the problem-solving process,
    through encouragement, assistance and goal
    setting for problems defined and outcomes desired.

109
  • Flexibility and non-judgmental attitude assists
    clients to share problems and implement
    solutions.
  • Give and take discussion and listening.
  • Clients need to define, think about, and take
    action to solve problems ultimately to assist in
    gaining control over lifes problems

110
  • Kansas Healthy Start Home Visitors should address
    specific barriers to ongoing service
    participation as well as ways to enhance
    motivation for ongoing service participation.

111
Barriers
  • Parents perceived needs and the degree to which
    home visits are viewed as meaningful to their
    needs.
  • Perceived stigma of home visitation services and
    the degree of positive/negative responses.
  • Obstacles such as time conflicts from employment,
    job training, family activities or even infants
    nap-time schedule.

112
  • Presence of other significant stressors that
    distract parents or impair self-help seeking
    skills.
  • Previous experiences of other service provision
    such as with nurses, social workers, SRS, child
    enforcement officials, immigration, etc.
  • Family privacy may inhibit their willingness to
    let an outsider in.

113
  • Family cultural and personal values may not be
    perceived as compatible with home visitors.
  • Influence of other family members (such as
    father, grandmother) encouraging or discouraging
    parents involvement in services.

114
  • Working with families to identify and enact
    strategies to overcome such barriers holds the
    potential to improve ongoing service
    participation and ultimately programs intended
    benefits.

115
Orientation/Training of Kansas HSHVs
  • The key to proficiency and success for home
    visitors is orientation to practice followed by
    continuous training.
  • Continuous in-service education is crucial to
    this program, with ongoing feedback allowing the
    program to be flexible to the changing needs of
    both the visitors and the families they serve.

116
Basic Knowledge for Kansas HSHVs
  • Prenatal Health Preparation
  • Postnatal/Postpartum Issues
  • Breastfeeding/Nutrition
  • Caring for Infant and Children
  • Growth Child Development
  • Child Health Care
  • Child Safety
  • Childhood Diseases and Immunizations
  • Guidance and Discipline
  • Parenting Skills
  • Abuse and Neglect

117
Methods for Learning
  • Education
  • Reflection on action
  • Learning by doing-practicing over time

118
Education
  • Involves gaining new knowledge and understanding
    of how that knowledge can be applied to ones
    practice.

119
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120
Reflection on action
  • Reflection on action means that home visitors
    stop and think about how they understand their
    work.

121
Practice
  • With practice, learning to think about what you
    are doing while you are doing it.
  • Being aware of the uniqueness of each person
    along with common themes among families is
    important through this process, as with the
    evolving relationship with the family, the home
    visitor should develop a series of expectations
    of the parents, child, and their own actions and
    reactions.

122
  • The Public Health Nurse must provide a clear
    program philosophy and principles to guide the
    home visitor. To ensure active, reflective
    learning, the PHN should structure regularly
    scheduled educational workshops or meetings where
    the home visitor can learn new content and then
    directly apply that content to their everyday
    work with families.
  • KDHE provides two trainings a year for the HSHVs
    and mandate they attend five trainings a year,
    which they report in the year-end narrative
    report that is completed and sent to KDHE at the
    end of each fiscal year.

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Program Evaluation and Self-Assessment
  • Program evaluation can provide information
    important to consider in hiring of staff as well
    as identification of training needs. Evaluation
    is also a method to determine if program goals
    and objectives are being met and if community
    needs are being addressed.

124
  • The Kansas Healthy Start Home Visitor program is
    evaluated through the Kansas Department of Health
    Environment (KDHE), Bureau for Children, Youth
    Families (BCYF) staff. Through funding
    provided through the Maternal Child Health Block
    Grant to local health departments and other
    agencies, a written MCH Monitoring Tool is used
    to document evaluation of this program, in
    collaboration with the Maternal Infant,
    Child/Adolescent Health and Children with Special
    Health Care Needs programs to provide quality
    assurance of client services for pregnant women,
    infants, children and families. These visits are
    conducted every other year for baseline data, and
    after review will be placed onto a one, three and
    five year visit cycle to be determined by
    KDHE/BCYF staff.

125
  • Most home visitors have an impression or a
    feeling about the effectiveness of their services
    to, or support for, a family or client. They see
    parents making progress towards self-sufficiency,
    and they see children growing, learning and
    playing appropriately. They can tell when a
    client needs extra encouragement to continue
    making progress toward a goal.

126
Determining Client Satisfaction
  • Is important because clients are more likely to
    follow through with the goals or procedures of
    programs that they like. The Kansas HSHV program
    uses a post-card evaluation system. These
    postcards are postage-paid by the local Healthy
    Start Home Visitor Program site and are addressed
    to KDHE. These postcards are an assessment tool
    on which clients can comment about the usefulness
    of the Kansas HSHV program services.

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  • Upon receiving these cards KDHE, BCYF program
    staff review this information and document into a
    database. The postcards are then mailed on a
    monthly basis, to the administrator and or the
    PHN supervisor to follow up with the visitor to
    address successes and/or problems.

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  • A yearly evaluation of the HSHV should be
    conducted by the PHN supervisor and/or local
    public health administrator. This evaluation
    should contain information including job
    performance, program philosophy goals and
    objectives being met, professional development,
    client satisfaction card review, with ongoing
    progress of individual clients and families being
    documented on a regular basis. This process
    should provide information about the overall
    effectiveness of the program for the clients and
    families served.

129
Referrals and Resources
  • Families are empowered when they have access to
    information other resources take action to
    improve the well-being of children, families, and
    communities.

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Outreach and Support
  • You must become familiar with whatever resources
    and services are available in your community.
    These resources may include health care, mental
    health counseling, assistance for battered women,
    immunization clinics, assistance with purchasing
    or preparing foods, homeless shelters, health
    care professionals (physicians, dentists,
    pharmacists).

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Tips for Successful Referrals
  • Tell your client what the service can do for
    them. Assist with questions that may be asked at
    the service provider to which they are referred.
  • If you refer a client to a service that is going
    to have a financial responsibility, make sure
    that they understand there will be a charge and
    that the client has the funds to do so.

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  • Make sure the client knows what paperwork, if
    any, she needs to bring with her. Ask her if she
    needs help getting copies of any of the papers
    she will need, such as babys birth certificate,
    proof of income, etc.
  • Provide her with information about the days and
    hours of operation for the referral agency.

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  • Make sure the client has accurate, up-to-date
    information about making an appointment. Perhaps
    you can make the appointment personally.
  • Let the client know the location of the referral
    agency, and provide her with written directions.

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  • Provide the client with the name of a contact
    person at the agency.
  • Provide the client with information on methods of
    transportation to use to get to the service.

135
  • Networking means talking to other people and
    finding out what is going on in other agencies
    that might be useful to your clients. The more
    contacts you have in the community, the more help
    you can be to your clients.

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Health Care
  • The HSHV should become familiar with their
    regional Social and Rehabilitation Services
    Medicaid contact person.
  • Clients should be instructed to contact their
    insurance company to find out what services are
    covered under their health insurance benefits.

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  • Pregnant clients will need to receive early and
    regular prenatal exams. The Kansas Healthy Start
    Home Visitor must identify agencies and
    facilities where pregnant women, both normal and
    high-risk, should be referred. HSHVs must also
    know which hospitals in their county area provide
    maternity services and which take Medicaid
    patients or provide low-cost delivery services
    for women.

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  • HSHVs must also know where to send clients for
    their check-ups, post-partum.
  • Well baby care and check ups are usually done by
    private providers or in local public health
    departments. The visitor must know who the
    providers for infant and child care are within
    their counties. They must also know which of
    these providers accept Medicaid and/or see
    indigent clients.

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  • For sick babies and children, usually the health
    care provider who sees the children for their
    well-baby check-ups also sees them if they are
    ill.
  • The HSHV should reinforce the concept of a
    medical home.

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Medical Home
  • It is not a building, house, or hospital, but
    rather an approach to providing health care
    services in a high quality and cost-effective
    manner. Children and their families who have a
    medical home receive the care that they need from
    a pediatrician, physician, or health care
    provider, who they know and trust. Health care
    professionals partner with parents to identify
    and access all the medical and non-medical
    services needed to help children and their
    families achieve their maximum potential.

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Social and Rehabilitation Services
  • Local and regional access point offices.
  • Areas for referrals and access.
  • Child abuse and neglect.
  • Foster-parents.
  • Day care.
  • Food and shelter.

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KAN Be Healthy/EPSDT
  • The Early and Periodic Screening, Diagnosis and
    Treatment (EPSDT) program provides eligible
    children under the age of 21 years with
    well-child screening, diagnostic, and medically
    necessary treatment services through their
    Medicaid program.

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  • The EPSDT program in Kansas is known as KAN Be
    Healthy (KBH).
  • Promotes regular check-ups where medical
    conditions can be prevented, detected, or
    corrected before further advancement.
  • KAN Be Healthy Program provides services to
    children, teenagers, and young adults who have a
    medical card.
  • For more info visit https//kmap-state-ks.us

144
Infant Toddler Program
  • Kansas Part C Infant Toddler Services is a
    statewide system of community-based,
    family-centered services that is designed to
    assist families in meeting the needs of their
    infants and toddlers, birth to three years of
    age, who have developmental delays or
    disabilities. Eligibility is determined by
    evaluation and assessment.
  • For more information visit http//www.kdhe.state
    .ks.us/its/index.html

145
Women, Infants and Children (WIC) Program
  • Special supplemental nutrition program.
  • USDA federally-funded program that provides
    nutrition education, medical assessment, food
    prescriptions and referrals to pregnant,
    breastfeeding and postpartum women, infants, and
    children up to five years of age.
  • For more information visit http//www.kdhe.state
    .ks.us/nws-wic/index.html

146
Parents as Teachers
  • Parents as Teachers is an award-winning nonprofit
    parent education organization providing parents
    of children prenatal-age 5 with support and
    information on their developing child through a
    network of local programs.
  • http//www.kpata.org/

147
Head Start
  • Head Start is a national child development
    program for children from birth to age 5, which
    provides services to promote academic, social and
    emotional development, as well as providing
    social, health and nutrition services for
    income-eligible families.

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  • Goals
  • To enhance children's physical, social, emotional
    and cognitive development
  • To enable parents to be better caregivers and
    teachers to their children
  • To help parents meet their own goals including
    economic independence

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  • History
  • Head Start was established in 1965 to help
    low-income families provide their children with
    developmentally appropriate education, health and
    social services to better prepare them to achieve
    in school and society.
  • Initially, Head Start served preschool children
    3-5.
  • Early Head Start (EHS) was created in 1994 to
    target the needs of pregnant women, infants and
    toddlers, thereby fostering positive development
    at even earlier stages

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  • For more information visit the Kansas Head Start
    website at
  • http//www.ksheadstart.org/home.html

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Schools
  • Kansas Department of Education
  • http//www.ksde.org
  • Coordinated School Health Program is a
    multifaceted approach to helping youth establish
    healthful behaviors and attitudes. Eight
    components Health Education, Physical
    Education, Health Services, Nutrition Services,
    Counseling, Healthy School Environment, Health
    Promotion for Staff and Family/Community
    Involvement. Visit http//www.kshealthykids.org

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153
Fatherhood
  • Given the multifaceted influence of strong-tie
    relationships, such as those with fathers or
    other male partners, strategies that promote
    positive partnerships and minimize ties that
    complicate parents efforts to succeed with their
    children, should be implemented.

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  • Fathers traditional role was financial provider
    and guardian of the family values.
  • In the 1970s, the role of many fathers changed
    dramatically.
  • Fathers as well as mothers bond to their baby
    shortly after birth and contribute significantly
    to the childs emotional, social, and
    intellectual development.
  • National Fatherhood Initiative
    800-790-DADS(3237.
  • or http//www.fatherhood.org

155
Children with Special Health Care Needs
  • CSHCN is a state and federally funded program.
  • Provides early identification of children at risk
    for, or with, disabilities or chronic illness.
  • To ensure availability of diagnostic and
    treatment services.
  • To promote the functional skills of young persons
    in Kansas who have a disability or chronic
    disease by providing or supporting a system of
    specialty health care.

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  • CSHCN can assist families, regardless of income,
    obtain a one time diagnostic evaluation at one of
    their specialty clinics, assist families with
    identification of local service providers and
    provision of case management for eligible
    children.
  • Make A Difference Hotline 800-332-6262
  • http//www.kdhe.state.ks.us/shs/index.html

157
Kansas Lead Screening Prevention Program
  • The Kansas Department of Health and Environment
    (KDHE) established the Kansas Childhood Lead
    Poisoning Prevention Program (KCLPPP) to respond
    to concerns about lead and its effect on the
    health of Kansans, most notably our children. 
    Lead is common in our environment and many
    individuals, especially children, show no outward
    signs of lead poisoning.  The Centers for Disease
    Control and Prevention (CDC) states lead
    poisoning is one of today's major preventable
    environmental health problems.  Blood lead levels
    (BLLs) as low as 10 micrograms per deciliter
    (ug/dL) are associated with harmful effects on
    children's learning and behavior.  BLLs as high
    as 70 ug/dL can cause seizures, coma, and death.

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  • The mission of the Childhood Lead Poisoning
    Prevention Program is to establish an
    infrastructure of trained personnel to screen,
    identify and recommend proper medical and
    environmental management of lead-poisoned
    children.  The most common cause of childhood
    lead poisoning today is the deterioration or
    disruption of a lead paint surface of a home.

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  • For more information visit the Kansas Lead
    Prevention Program at
  • http//www.unleadedks.com
  • Also to view the Kansas Childhood Blood Lead
    Testing and Case Management Guidelines visit
  • http//www.unleadedks.com/download/revised_ks_bloo
    d_lead_testing_and_case_management_guidelines.pdf

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Normal Child
  • The health needs of children are susceptible to
    ever-changing social, behavioral, economic, and
    psychosocial influences. The issues affecting
    the health of children and families are
    consequently broad in scope and continue to
    challenge intellect and imagination. Families
    are particularly receptive to health promotion
    messages after the birth of a child and during
    the first year. Home visitors address many
    issues related to child health during this time.

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Physical Health
  • The physical health of the mother, the infant and
    children is very important. Activities and
    education must be aimed at promoting the physical
    and emotional health of families served.

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Health Related Programs should target
  • Diet and exercise for mother, infant children.
  • Pregnancy and birth related complications.
  • Smoking and intake of alcohol and other drugs
    that affect pregnancy and parenting.
  • Common illnesses, and communicable diseases.

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  • Family planning and contraception.
  • Screening and education for environmental toxins,
    such as lead and mold.
  • Accident and poisoning prevention in the home,
    including first aid and CPR for infant and child.

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  • Screening for maternal/infant/child depression
    and other mental illness.
  • Well-baby care and immunizations.
  • Child Physical Sexual Abuse Prevention and
    Intervention.
  • Intimate Partner Violence Prevention and
    Intervention.

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  • To address these issues, the Kansas Healthy Start
    Home Visitor must strive to coordinate outreach
    and support with medical provider or other
    resources in local and surrounding communities.

166
Mental Health
  • Approximately one in five over 14 million
    children and adolescents in the U.S. have mental
    health problems. (US Dept of Health Human
    Services, 1999)

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  • There is a complex two-way interplay between
    mental and physical disorders.
  • Untreated mental disorders result in poor
    outcomes for co-morbid physical illness.
  • Persons with mental disorders have a heightened
    risk of suffering from physical illness because
    of diminished immune function, poor health
    behavior, non-compliance with prescribed medical
    regimens and barriers to obtaining treatment for
    physical disorders.
  • Persons with chronic physical illness are
    significantly more likely than other people to
    suffer from mental disorders.

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Kansas Healthy Start Home Visitor Role in Mental
Health
  • Assess
  • Refer if needed
  • Follow up to assure link to access of provider as
    for medical home

169
Nutrition
  • Good nutrition is important for everyone. A
    pregnant woman should eat healthy to make sure
    that her baby is born healthy. Nutrients are the
    building blocks needed to grow a healthy baby.

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  • Provide written information to your families to
    demonstrate the types of nutrients obtained in
    the foods that they eat.
  • Stress the importance of a well-balanced diet.
  • Encourage your families to visit with their
    health care provider, as well as their WIC
    nutritionist, if they are participating in WIC.

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  • Encourage and support exclusive breast-feeding
    through six months of age.
  • Refer to medical providers or other resources for
    nutrition counseling as needed.
  • Ensure access to referral sites.

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Nutrition Resources
  • Kansas Nutrition and WIC Services
  • http//www.kdhe.state.ks.us/nws-wic/
  • Bright Futures Nutrition Curriculum
  • http//www.brightfutures.org/nutrition/index.html
  • Bright Futures Physical Activity Curriculum
  • http//www.brightfutures.org/physicalactivity/abou
    t.htm

173
Child Abuse and Neglect
  • Although the wounds that maltreatment and abused
    children suffer differ in variety and severity,
    all abused and neglected children confront the
    reality that those who take care of them are also
    those who harm them (Gutterman, 2001).

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Can we stop child abuse before it starts?
  • Preventing child abuse and neglect before it
    occurs is a goal of the Kansas Healthy Start Home
    Visitor Program. Prevention of physical abuse
    and neglect through development of positive
    parent-child interaction may be achieved by
    providing in-home support to families with very
    young children, promoting child and family
    functioning during a vulnerable and opportune
    time.

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HSHV should discuss and provide education to
parents on topics such as
  • The need to develop an ongoing repertoire of
    skills and knowledge in parenting a new child.
  • The task of responding appropriately to the
    infants immediate and quickly evolving needs.
  • Dealing with possible sleep deprivation.
  • Biological changes accompanying pregnancy, birth
    and healing, as well as lactation.

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  • Reduction in autonomy.
  • Increased financial stressors.
  • Decreased time and energy for relationships.
  • New social influences and messages in parenting
    alteration in significant relationship as a
    result of new parenting role.

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Risk factors of child abuse and neglect
indicating an immediate referral
  • Physical injuries such as bruising, burn marks,
    subdural hemorrhage, retinal hemorrhages or bone
    fractures.
  • Delayed physical growth.
  • Neurological damage.
  • Problems with social relationships, trust,
    attachment and bonding.

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  • Problems with self-regulation of emotions.
  • Aggression, externalizing behavior problems,
    and/or criminal activity.
  • Depression, low self-esteem, suicidal ideation
    and behavior, post-traumatic stress disorder, and
    substance and/or alcohol abuse.
  • Cognitive or language deficit.

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  • Child abuse and neglect is a major social and
    health problem in the United States and in
    Kansas. To report child abuse and neglect call
    the Kansas Protection Report Center at
    800-922-5330, or your local law enforcement
    agency by dialing 911. For more information
    visit http//www.srskansas.org/services/child_pr
    otective_services.htm

180
Immunizations
  • A primary objective for HSHV is to educate Kansas
    families about the importance of immunizations.
    HSHVs must become familiar with current
    immunization schedules which can be downloaded
    at
  • http//www.cdc.gov/nip/recs/child-schedule.PDF

181
  • A second objective for the HSHV is to learn who
    the immunization providers are in their county
    and how to access these services. You must be
    able to refer a client for updates and completion
    of the immunization schedule.

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  • A third objective is for the HSHV to ensure
    linkages to the immunization provider for the
    client to receive their immunizations. You must
    ensure the client has a method of transportation,
    has health insurance or other funding to cover
    the immunization fee, and understand the
    importance of reducing communicable disease
    through immunization.

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Vaccine for Children Program (VFC)
  • Intended to help raise childhood immunization
    levels in the United States by supplying, at no
    cost to private and public health care providers
    who participate, federally purchased vaccine to
    administer to eligible children. For more
    information visit
  • http//www.kdhe.state.ks.us/immunize/

184
Child Safety
  • Preventable injuries are the leading cause of
    childhood morbidity and mortality in Kansas.
    Studies have found serious gaps in injury
    prevention knowledge among parents. Home
    visitors are in a position to provide home and
    auto safety guidance, as well as attend and
    training and become certified car safety seat
    technicians.

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  • Kansas Safety Seat Belt Office Jeff Halloran
  • Jhalloran_at_dccca.org or 800-416-2522
  • Kansas SAFE Kids Coalitions
  • http//www.kdhe.state.ks.us/safekids/
  • Poison Control Mid-America Poison Control
  • http//www.kumc.edu/poison/

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Teen Pregnancy
  • Comprehensive pregnancy services with support and
    follow-up of adolescent mothers and infants offer
    the best chances for healthy outcomes, including
    reducing the risk of early repeated pregnancies.
    Major changes in education, child day care,
    medical access, health education and social
    support for mothers and children are needed to
    help our children become productive adults in
    todays technological society. Kansas Healthy
    Start Home Visitors provide necessary support and
    referral services to this population.

187
Substance Abuse
  • Kansas Healthy Start Home Visitors should
    routinely and sensitively assess the home
    environment and parent for the presence of
    substance and/or alcohol use and abuse patterns.

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  • Substance abusing behavior is often accompanied
    by intense personal shame and cognitive processes
    such as denial and minimization, which require
    the visitor to employ sensitive and strategic
    probing with non-judgmental attitude. The
    visitor should convey an accepting tone and
    establish trust and alliance with their families.

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  • Instances where substance and/or alcohol abuse
    have been identified as concerns should be
    reported and referred to the registered nurse
    supervisor. Work with the family should remain
    ongoing to directly reduce the risks and harm the
    substance abuse may have on the children and the
    family.

190
  • The Kansas Healthy Start Home Visitor must work
    with families to enrich a supportive informal
    network and to minimize the negative influences
    in existing support networks to reduce substance
    abuse.

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Summing It All UP!
  • Pregnant women and families live in a network of
    family and culture and often need support form
    husbands, extended family, and friends. Each
    womans pregnancy experience is affected by past
    pregnancies, spousal and family support, and
    stressors in the womans life.

192
  • Kansas Healthy Start Home Visitors first tasks
    with pregnant women is to provide support,
    encouragement, and shared delight. They are also
    a source of information and referral to
    appropriate services.

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  • They provide information about the importance of
    avoiding alcohol, tobacco and other drugs
    proper nutrition and physical activity and the
    importance of seeking early prenatal care.

194
  • They provide outreach and support for family
    parenting skills and successful bonding.
  • Finally, they can ask open-ended questions to
    motivate the pregnant woman and families to share
    any stressors or changes they may be experiencing.

195
MCH 2010 Kansas Maternal and Child Health 5-Year
Needs Assessment
  • As a recipient of Title V funds, Kansas is
    legislatively required to complete a statewide
    needs assessment every five years to identify the
    need for
  • Preventive and primary care services for pregnant
    women and infants,
  • Preventive and primary care services for
    children, and
  • Services for children with special health care
    needs.

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Pregnant Women and Infants
  • Increase early and comprehensive health care
    before, during, and after pregnancy
  • Reduce premature births and low birthweight
  • Increase breastfeeding

197
Children and Adolescents
  • Improve behavioral/mental health
  • Reduce overweight
  • Reduce injury and death

198
Children with Special Health Care Needs
  • Increase care within a medical home
  • Improve transitional service systems for CSHCN
  • Decrease financial impact on CSHCN and their
    families

199
Three additional focus issues were chosen
  • Reduce teen pregnancy and sexually transmitted
    diseases
  • Improve oral health
  • Improve asthma diagnosis

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Kansas Healthy Start Home Visitors
  • Strengthening Kan
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