12 Critical Program Elements

Healthy Families America (HFA) programs are based upon a set of critical program elements, defined by decades of research. Over the past several years, states across the country have embraced the critical elements of Healthy Families America and are working toward implementing statewide home visitation policies and programs. The critical elements represent the field’s most current knowledge about how to implement successful home visitation programs.

All affiliated and credentialed HFA programs adhere to these critical elements which provide the framework for program development and implementation. Staff are trained on the critical elements. Programs are credentialed based on adherence to the critical elements. In addition to helping assure quality, the critical elements allow for flexibility in service implementation to permit integration into a wide range of communities and provide opportunities for innovation.

The following are descriptions of each critical element:

1. Initiate services prenatally or at birth.

2. Use a standardized (i.e. in a consistent way for all families) assessment tool to systematically identify families who are most in need of services. This tool should assess the presence of various factors associated with increased risk for child maltreatment or other poor childhood outcomes (i.e. social isolation, substance abuse, parental history of abuse in childhood).

3. Offer services voluntarily and use positive outreach efforts to build family trust.

4. Offer services intensively (i.e. at least once a week) with well-defined criteria for increasing or decreasing frequency of service and over the long-term (i.e. three to five years).

5. Services should be culturally competent such that the staff understands, acknowledges, and respects cultural differences among participants; staff and materials used should reflect the cultural, linguistic, geographic, racial and ethnic diversity of the population served.

6. Services should focus on supporting the parent as well as supporting parent-child interaction and child development.

7. At a minimum, all families should be linked to a medical provider to assure optimal health and development (e.g. timely immunizations, well-child care, etc.) Depending on the family’s needs, they may also be linked to additional services such as financial, food, and housing assistance programs, school readiness programs, child care, job training programs, family support centers, substance abuse treatment programs, and domestic violence shelters.

8. Services should be provided by staff with limited caseloads to assure that home visitors have an adequate amount of time to spend with each family to meet their unique and varying needs and to plan for future activities (i.e., for many communities no more than 15 families per home visitor on the most intense service level. And, for some communities the number may need to be significantly lower, e.g. less than 10).

9. Service providers should be selected because of their personal characteristics (i.e. non-judgmental, compassionate, ability to establish a trusting relationship, etc.), their willingness to work in or their experience working with culturally diverse communities, and their skills to do the job.

10. Service providers should have a framework, based on education or experience, for handling the variety of situations they may encounter when working with at-risk families. All service providers should receive basic training in areas such as cultural competency, substance abuse, reporting child abuse, domestic violence, drug-exposed infants, and services in their community.

11. Service providers should receive intensive training specific to their role to understand the essential components of family assessment and home visitation (i.e. identifying at-risk families, completing a standardized risk assessment, offering services and making referrals, promoting use of preventive health care, securing medical homes, emphasizing the importance of immunizations, utilizing creative outreach efforts, establishing and maintaining trust with families, building upon family strengths, developing an individual family support plan, observing parent-child interactions, determining the safety of the home, teaching parent-child interaction, managing crisis situations, etc.).

12. Service providers should receive ongoing, effective supervision so that they are able to develop realistic and effective plans to empower families to meet their objectives; to understand why a family may not be making progress and how to work with the family more effectively; and to express their concerns and frustrations so that they can see that they are making a difference and in order to avoid stress-related burnout.For a comprehensive review of the literature and supporting rationale, download Critical Elements: Rationale and Supporting Research online (Adobe PDf file) or contact the Quality Assurance Division at (312) 663-3520.

[Taken from Healthy Families America website.]