National Home Visiting Collaborative Improves Developmental Risk Detection and Service Linkage.

OBJECTIVE: Fewer than 50% of children with developmental delay are identified before they start school, and only 10% of those identified receive services. Between May 2014 and August 2016, the Home Visiting Collaborative Improvement and Innovation Network (HV-CoIIN) aimed to improve early detection and linkage to services so that 80% of children with an identified developmental concern would receive timely, targeted developmental support. METHODS: HV-CoIIN enrolled 13 home visiting programs in 8 states and 1 tribe in a Breakthrough Series Collaborative (BTS). These programs tested interventions aligned with 5 key drivers: early detection, referral and follow-up, home visitor capacity, families engaged in developmental promotion, and data systems. Run charts were used to study measures. The main outcome was the percent of children with an identified concern who were linked to developmental support. Process measures included the percent of visits where parents were asked if they had any concerns about their child's development and the percent of children screened every 6 months. RESULTS: The percent of children with an identified developmental concern who received support increased from 70% to 82%. Parents were asked about developmental concerns at 95% of visits (baseline = 75%), and 90% of children were screened every 6 months (baseline = 51%). CONCLUSIONS: Home visiting programs can reliably execute early detection and linkage to services for at-risk populations they serve. BTS holds promise for improving implementation of federal public health programs to improve population health outcomes.

Addressing maternal depression in home visiting: Findings from the home visiting collaborative improvement and innovation network.

BACKGROUND: Maternal depression is common among low-income women enrolled in home visiting programs, yet there is considerable variability in the extent to which it is identified and addressed. This study examines outcomes related to postpartum depression screening, receipt of evidence-based services, and reductions in depressive symptoms among clients of home visiting programs in the Health Resources and Services Administration's Maternal, Infant, and Early Childhood Home Visiting Program Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN), the first U.S. national application of the Institute for Healthcare Improvement's Breakthrough Series (BTS) Model in home visiting programs. METHODS AND FINDINGS: Fourteen home visiting programs in eight states, serving a geographically and racially diverse caseload of pregnant women and new mothers, took part in the HV CoIIN. Women in participating home visiting programs received the intervention strategies implemented by their program during participation in the collaborative. HV CoIIN strategies included specific policies and protocols for depression screening and home visitor response to screening results; home visitor training and supervision; delivery of prevention and treatment interventions; and tracking systems for screening, referral, and follow-up. HV CoIIN's proposed primary outcome was that 85% of women who accessed evidence-based services would experience a 25% reduction in depressive symptoms three months after accessing services. Secondary outcomes included an increased percentage of women who were screened for depression within three months of enrollment or birth, who verbally accepted a referral to evidence-based services, and who received one or more evidence-based service contacts. HV CoIIN resulted in improved symptoms among women who accessed services, from 51.1% to 59.9%. HV CoIIN also improved the percent of women screened for depression, from 83.6% to 96.3%, and those with positive depression screens who accessed evidence-based services, from 41.6% to 65.5%. Home visiting programs in this study were early adopters of quality improvement activities, which may limit the generalizability of these results to other home visiting programs. CONCLUSIONS: Home visiting programs can play an important role in closing gaps in maternal depression identification, referrals, service access, and symptom alleviation. Continuous quality improvement and BTS collaborative methods can be used to improve home visiting services in ways that advance national public health priorities and improve population health outcomes.

National Quality Improvement Initiative in Home Visiting Services Improves Breastfeeding Initiation and Duration.

OBJECTIVE: To improve breastfeeding through home visiting. METHODS: From 2013 to 2016, the Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN) enrolled 15 home visiting agencies serving 1000 families in 7 states. Using the Breakthrough Series Collaborative model, HV CoIIN faculty taught a theory of change and continuous quality improvement (CQI) skills, as well as facilitating opportunities for networked learning. RESULTS: HV CoIIN improved home visitors' breastfeeding competencies and use of data to inform practice. Breastfeeding initiation increased from 47% to 61%. Exclusive breastfeeding of 3-month-old babies increased from 10% to 13.5%, and for babies 6 months old it increased from 5% to 8%. CONCLUSIONS: Home visiting programs can improve breastfeeding among participants with very low baseline breastfeeding rates. Continuous quality improvement and the Breakthrough Series Collaborative model can be used to improve home visiting services in ways that advance national public health priorities.

Enhancing home visiting with mental health consultation.

Home visiting programs have been successful in engaging and enrolling families who are at high risk for stress, depression, and substance abuse. However, many of these mothers may not be receiving mental health services because home visitors lack the knowledge and skills to identify mental health or determine how to appropriately address these problems. In response, a growing number of home visiting programs are expanding their capacity by integrating a mental health provider into their ongoing operations. This approach, referred to as early childhood mental health consultation, involves a partnership between a professional consultant with early childhood mental health expertise and home visiting or family support programs, staff, and families. This integrated model holds the promise of promoting parent and child behavioral health by enhancing the capacity of home visitors to identify and appropriately address the unmet mental health needs of children and families. The article highlights efforts under way in several federally funded Linking Actions for Unmet Needs in Children's Health Project sites where local programs are testing the effectiveness of this model.

Implementing a statewide early childhood mental health consultation approach to preventing childcare expulsion.

State- and local-level mental health administrators and practitioners can work collaboratively to provide effective early childhood mental health consultation (ECMHC) services that address the growing need in communities to promote healthy socioemotional functioning in infants and young children and prevent longer term mental health challenges. This article describes one state's model of ECMHC, the Child Care Expulsion Prevention Program (CCEP), as well as preliminary evaluation findings on consultants' fidelity to the developed approach to service within 31 counties in Michigan. The CCEP approach is flexible, yet adheres to six cornerstones which are essential to effectively and consistently carrying out services across local projects, including the provision of relationship-based programmatic and child/family-centered consultation, hiring and supporting high-quality consultants through professional development and reflective supervision, ongoing provision of state-level technical assistance, use of evidence-based practices, and collaboration with other early childhood service providers. In addition to the overview of CCEP's approach and effectiveness, lessons learned are provided to guide those engaged in policy development, practice, and applied research pertaining to ECMHC. Abstracts translated in Spanish, French, German, and Japanese can be found on the abstract page of each article on Wiley Online Library at http://wileyonlinelibrary.com/journal/imhj.