f service level policy

7/31/2019 F Service Level Policy

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HEALTHY FAMILIES MASSACHUSETTSPOLICIES & PROCEDURES

SERVICE LEVEL

HEALTHY FAMILIES MASSACHUSETTS (HFM) offers intensive services on a long-term basis for allparticipants so that families may achieve the greatest benefits and attain the most positiveoutcomes. The voluntary nature of the HFM program provides the basis upon which familiesand program staff review family strengths, needs and accomplishments to determine theintensity of the services received. The intensity of services offered to a family may changethroughout the enrollment period as the family is strengthened and parents achieve their goalsand become more comfortable in their parenting roles, as well as when challenges arise thatmay require more intensive services. HFM offers intensive services starting prenatally andcontinuing up to the childs third birthday.

HFM service level policies and procedures are divided into the following sections: Service level assignment and change protocol; Service level intents, expectations, and implementation; Service level and use of creative outreach strategies; Timelines;

Criteria for service level intensity; and Structure of case reviews related to service level.

Attached to this policy are the following appendices:


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The protocol includes the following steps:

Initial service level assignment- All participants are assigned a service level atinitial contact with HFM. Service levels in HFM are defined later in thispolicy;

Service level review- Service levels are reviewed periodically and regularly toensure that the service level matches the strengths, challenges,accomplishments and needs of the participant; and

Service level change- Participants service levels are changed based on casereview indicators of family progress and discussion with the participant.

II. SERVICE LEVEL INTENTS, EXPECTATIONS, AND IMPLEMENTATIONIn HFM, the six months of intensive home visiting with a family immediatelyfollowing babys birth is critical for many reasons, including relationshipdevelopment, parent-child attachment, newborn care and safety, and adjustment toparenthood.HFM produces the most benefits when participants receive scheduledweekly visits for a minimum of six months following babys birth, or followingenrollment, if the family enters the program postnatally. After this initial period of

intensive weekly visits, HFM programs offer family-centered and strengths-basedapproach services to participating families at varying levels of intensity, based on thedifferent needs of each family over the course of their time in the program.Supervisors, home visitors, and participants collaborate together to decide onappropriate changes in service level using specific criteria. At enrollment, i.e. date offirst contact, programs must have the capacity to offer participants intensive servicesappropriate to their parenting status. If programs do not have capacity toaccommodate new participants then they must close intake.

The various service levels offered to HFM participant families are as follows:

A OUTREACH


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All attempts to contact the referred participant must be documented in theReferral Contact Log in the PDS. Programs assign an Outcome of Contact

and change a participants service level from Outreach only after a firstcontact. First contact with the participant is considered made when theprogram has successfully reached the participant either by phone or face toface, whichever comes first.

Programs may discontinue attempts to make first contact with a referredparent prior to three months only if the program discovers it has incorrectcontact information (e.g. wrong address, telephone number) for the parent

and all attempts to locate the correct information have been exhausted or theparent declines all HFM services. If a parent for whom the program hascorrect contact information cannot be located despite all program efforts,outreach attempts can be ended after three months.

Once the program decides to end outreach efforts, the program must send aletter to the parent indicating that he/she may contact the program withinten days to indicate further interest in HFM (See Appendix D: Final Closing

Letter Example). The letter should also state the date when his/her eligibilityfor the program ends (parents 21st,or the childs first birthday) and thathe/she may contact the HFM program regarding possible service before thisdate should she/she wish to do so. A copy of the letter must be kept in theparticipants records.

B. ENGAGEMENT: Intent: At this service intensity, programs deliver HFM by introducing HFM

to participants and attempting to engage participants in intensive servicesappropriate to their parenting status (prenatal/post partum).

Expectation: This service level is assigned to participants with whom the


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program. See Appendix F: Engagement Intensity Guidelines forrecommendations regarding structuring the intensity of engagement efforts.

Case weights for these participants should reflect the potential for deliveringweekly visits (i.e., home visitors with participants on Engagement shouldhave the capacity to provide weekly visits if desired).

Supervisors and home visitors should carefully review the cases ofparticipants who are approaching the end of the three month minimumOutreach and Engagement period but are still not engaging in weekly homevisits. Together they should determine if additional time on this service level

may be beneficial to the participants long term involvement with theprogram. In these cases, Engagement may be extended up to one year fromDate of First Contact with ongoing review. The rationale for these decisionsmust be documented in supervision logs and home visit records, asappropriate.

Participants service level is changed from Engagement once a commitmentto regular home visit schedule is made and noted on the appropriate form

(see Appendix A); typically, this will be to the Weekly or more Frequentservice level.

o For prenatal participants: Indicate the assignment of the first regularlyscheduled service level on the Prenatal Home Visits form. In the weeksleading to the participants due date, use the Ready for Weekly Visitsform to transition the participant to Weekly visits, if s/he is not alreadyreceiving them.

o For postpartum participants: Indicate the assignment to Weekly visitson the Ready for Weekly Visits form.


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also appropriate for times when participants desire more intensive supportfrom HFM, such as during crises. This service level represents a regular

schedule of home visits.

Implementation:o For prenatal participants: HFMIT recommends a weekly visit

schedule at the start of their tenure in HFM, to promote trust andrelationship building. Participants may receive less intensive servicesduring the prenatal period but programs should transition them toweekly visits as they prepare for the birth of the baby (see Prenatal

Home Visit form).

o For postpartum participants: HFM participants must be offered, andshould be assigned to Weekly after Engagement. Participants shouldremain on Weekly for a minimum of six months immediatelypostpartum or post engagement in HFM, moving to Biweekly onlywhen the criteria for a service level change are met. Isolated instancesmay occur when programs change a participants service level to a

less intensive regular schedule of visits prior to the end of this sixmonth period; these instance may not exceed 10% of the programstotal caseload for the year. Programs must document the reasons forthese service level changes (in supervision logs and home visitrecords) and be prepared to provide documentation to programspecialists.

o For participants requesting a move to more intensive services:Participants who are on less intensive home visiting schedules butwho seek additional support from HFM for a period of time (e.g.during a crisis) may request a move to Weekly. The home visitor and

ti i t h ld f ll i th l f th l d k


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home visitors must highlight the importance of and begin to offer Weeklyservices to prenatal participants on Biweekly in the weeks leading up to their

due dates to ensure that those participants receive six months of Weeklyservices after the birth of their baby. Participants on Biweekly may request amove to more intensive services should their life circumstances change.

E. MONTHLY: Intent: At this service intensity, programs deliver HFM by providing home

visits to participants every month (one visit per month).

Expectation: Programs deliver less intensive services to participants whohave progressed through HFM and/or are preparing for a transition fromHFM due to graduation. This represents a regular schedule of home visits.

Implementation: Participants move to Monthly only after they have met therequired number of criteria on the HFM Biweekly to Monthly service levelchange form and have discussed this change with their home visitor.Similarly, participants on Monthly may request a move to more intensive

services should their life circumstances change.

F. OTHER, SPECIFY REASON: Intent: At this service intensity, programs deliver HFM by assigning

participants when it is most appropriate based on program circumstances(i.e. during a staff transition when remaining home visitor caseload capacitycannot to accommodate participants at their previous service level).

Expectation: All program participants are offered continuity of servicesduring their HFM tenure by having an HFM staff person who can offer some

ll h l l h h


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G. RE-ENGAGEMENT: Intent: At this service level, programs deliver HFM by attempting to re-

engage with participants that have disengaged from services.

Expectation: This service level is assigned to families who have beenreceiving regularly scheduled home visits but have been absent/disengagedfrom program services for an extended period of time.

Implementation: Participants who have been receiving a regular home visitservice, i.e., Weekly, Biweekly, or Monthly, should be assigned the Re-

Engagement service level if they have not been present for at least fourscheduled home visits or the program has been unable to contact themdespite persistent effort for at least three weeks. Programs are not requiredto inform participants that they have been moved to Re-Engagement. Using avariety of creative outreach strategies (see Appendix B: Ideas for CreativeOutreach Strategies), home visitors then make multiple and varied attemptsto re-engage these participants in HFM.

The supervisor and home visitor design creative re-engagement approachesto strive for regular contact with the participant with the goal of re-establishing a regular service level (weekly, bi-weekly, or monthly). Thesere-engagement approaches include tailoring unique strategies and activitiesto demonstrate to the family that the program is not giving up on him/herand welcomes him/her back into HFM services. See Appendix G: Re-Engagement Intensity Guidance for recommendations regarding structuringthe intensity of re-engagement efforts.

Participants who disengage without informing the program must beplaced on Re-Engagement for a minimum of three months (unless they

i h b f h d f h h h ) d


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temporary disengagement. The program is encouraged, however,to maintain contact with the family in some manner, if possible.

During the Re-Engagement period, programs must send a Pre-ClosingLetter (see Appendix H: Pre-Closing Letter Example Re-Engagement) asa way to remind participants of the benefits of their participation in theprogram, while underscoring the voluntary nature of the program. IfHFM cannot re-engage a family in scheduled program services throughre-engagement efforts and all strategies are completed, the program mustsend a letter to the participant indicating that he/she should contact the

program within ten days to indicate further interest in HFM (seeAppendix D: Final Closing Letter Example). The letter should also statethe date when his/her eligibility for the program ends (parents 21st, orthe childs first birthday) and that he/she may contact the HFM programregarding possible service before this date should she/she wish to do so.A copy of the letter must be kept in the participants records.

Participants move from Reengagement either to another regular scheduleof home visits, appropriate to their parenting status or are dischargedfrom HFM. For postpartum participants, this time on Re-Engagementdoes not count toward the six month postpartum weekly visitexpectation.

Waiting for Full ServicesDue to a staff persons caseload capacity, there may be times when a participant is receivingfewer visits than s/he would like (e.g. during a home visitors leave, another home visitormay provide Monthly services to a participant that would otherwise receive Biweeklyservices until the first home visitor returns to work). In such instances, programs shouldthen assign that participant to the most intensive service level available and designate him

h i th PDS iti f f ll i O th it ll th


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III. SERVICE LEVEL AND USE OF CREATIVE OUTREACH STRATEGIESAn important subset of service levels (Outreach, Engagement, and Re-Engagement )employs creative outreach strategies to engage families in intensive services. Families areoften reluctant to engage in services and may have difficulty building trusting relationships;therefore, program staff must identify positive ways to establish a relationship with thefamily and keep families interested and connected over time. Often families that haveexperienced trauma in their own histories find it difficult to openly trust and welcomeothers into their homes.

Creative outreach methods seek to fully engage participants in the program, demonstrate to participants that the program will not give up on them or deny services

without making every effort to engage them, and

help to establish trusting relationships between the program and the participant.When employing creative outreach strategies with participants, staff should use thefollowing three essential foci for engaging families.

1. Trust Building. The home visitor builds trust by demonstrating consistency, bylistening to the family in a non-judgmental way, offering assistance withneeds/concerns, building on the existing family strengths, and, in general, beingsupportive. Additionally the home visitor uses strengths-based and flexibleapproaches, which allows the program to address the participants multiple needsand/or issues that may otherwise preclude their participation in program services.

2. Self Reliance. From the beginning of service provision, families are encouraged tobe self-reliant and to determine their own needs and solutions to their situations.The program demonstrates the family-centered nature of program services through


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contacts should be recorded in the Secondary Activity section of the PDS as SecondaryActivities.

Spotlight on Supervision: The supervisor and the home visitor meet and discuss thefamily as well as creative outreach approaches. A significant early step is to clarifyexpectations and responsibilities of the family and the home visitor, program goals, andthe importance of establishing trust and credibility of the home visitor with the family.During the Engagement period, the Family Profile can be a useful tool to help establisha trusting relationship through demonstrating interest in the participants uniquehistory, as well as helping to clarify ways in which the program can be supportive.

During the Re-engagement period, essential in these discussions are explorations ofdynamic issues, such as possible interruptions in the relationship between the homevisitor and the participant and how to repair them, and a participants past history (fearof disappointment, disapproval, experiences of being judged, as well as experienceswith strengths-based support systems).

IV.TIMELINESA. Timeline for Assigning Service Levels

Programs ensure that participants are assigned a service level upon referral to theprogram. The initial service level assigned must be Outreach until the program makesfirst contact with the participant. Upon first contact, the program assigns theappropriate service level that reflects the participants commitment to HFM, whether itis Engagement or a regular schedule of visits.

B. Timeline for Documentation of Service Level Assignment and Changes1. Initial service level assignments:

Supervisors must document a participants initial service levels in the PDS, as well asi dditi l itt ti i t d d b th h th


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written participant records as soon as the change becomes effective and no later thanthe 10th of the month following the month in which the change is made.

PDS NOTE: Only supervisors can change service level assignment in the PDS.Supervisors should complete the service level change in the PDS prior to when the homevisitor records the next participant contact in order to ensure accuracy in documentationof service delivery.

V. CRITERIA FOR SERVICE LEVEL INTENSITYThe decision to move a family from one service level to another is a thoughtful and

deliberate process, which is based on clearly defined criteria, and evidenced bydocumentation of discussion with participants in home visit records, service level changeforms, and supervision. Service level intensity should be an indicator of the participantsstrengths, accomplishments, challenges, and ongoing needs, making service level change anopportunity to discuss or review these factors with participants. Service level changediscussions may be initiated by either the participant or the home visitor; the need forreview of criteria to determine the appropriateness of the change, however, is the sameregardless of which party initiates the discussion.

All HFM programs must use the statewide Service Level Change protocol and forms (seeAppendix A: HFM Service Level Assignment and Change Forms) to review familiesprogress and accomplishments using the criteria indicators on the forms.

Criteria used by programs for determining indicators of family progress include thefollowing:

Familys progress on meeting their goals Development and growth in familys strengths Crisis management skills Problem solving skills Attendance at scheduled visit times


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Participant availability for home visitsVI. STRUCTURE OF CASE REVIEWS RELATED TO SERVICE LEVEL

Service level changes are well planned, thoughtful, and ensure that the process is family-centered and integrates service level change indicators. To support this, programs use casereview to ensure that families are involved and understand the process and rationale for aservice level change.

Supervisors should clearly define the expectations and responsibilities of the home visitor,

the program, and the family whenever there is a change in a familys service level. Toachieve this, supervisors should ensure that case review related to service level changeincludes:

Assessing and building home visitor knowledge and skills regarding the processof service level change;

Monitoring family progress and timelines for service level change; Ensuring completion of service level change forms and documentation in PDS;

and

Exploring participant response to service level change conversations.Spotlight on Supervision: Building home visitor skills in how to engage with families indiscussion about service level intensity is an important focus in reflective supervision inthe HFM program. Service level change forms as a part of discussion in supervision canbe useful tools in building home visitor knowledge, skills, and attitudes.

A.

Documentation for Service Level Changes

Service level changes should be seen as an opportunity to review with participants theprogress they have made toward their goals, their personal accomplishments, ongoing


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documentation of attempts to contact the family must be made in the PDS, and in thesupervision log.

Supervisors and home visitors must document all changes in a familys service level assoon as they complete the case review upon which the service level change is based.They should document the change in the PDS, a service level change form, and anyother written participant records as soon as the change becomes effective and no laterthan the 10th of the month following the month in which the change is made.

If you have any questions regarding this policy, please submit a TA Ticket via the TA Help

Desk [email protected]
mailto:[email protected]:[email protected]:[email protected]:[email protected]


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Healthy Families Service Level Assignment

Prenatal Home Visits

Participant Name: _________________________________________________

Currently, I am pregnant and am ready to receive regular home visits.

My home visitor is responsible for:

Arriving on time for visits Bringing information about pregnancy

and parenting

Connecting me to other resources in mycommunity

Bringing invitations for groups withother young parents

I am responsible for:

Being available for visits Calling when I need to reschedule a visit Asking questions to make sure I

understand all the topics we discuss

Together we will:

Meet each week to talk about me and prepare for my baby Set goals for my family/me and work together to achieve them Explore my babys development

My service level is (circle one): Weekly Biweekly

My family strengths:


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Healthy Families Service Level Assignment

Ready for Weekly Visits


I am ready for Weekly Healthy Families services. Healthy Families works the best when we meetweekly in the beginning, especially in the first six months after my baby is born. Meeting weeklygives my home visitor a chance to get to know me and my family, and I get the chance to get to knowmy home visitor. Working together will help me be the best parent I can be!

My home visitor is responsible for:

Arriving on time for visits Bringing information about parenting and

my baby

Connecting me to other resources in mycommunity

Bringing invitations for groups with otheryoung parents

I am responsible for:

Being available for visits Calling when I need to reschedule a visit Asking questions to make sure I

understand all the topics we discuss

Together we will:

Meet each week to talk about me and my new baby Set goals for my family/me and work together to achieve them Explore and screen my babys development


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Healthy Families Service Level Change

Participant Name: ________________________________________________________

Weekly to Biweekly ServicesAccomplishments & Perspectives

(At least 10 of the following)

____ My IFSP is up to date.

____ I have completed one of my IFSP goals during my time in Healthy Families.

____ My home visitor and I have completed the most recent ASQ.

____ I completed 6 out of the expected 12 home visits for the last three months or I called to reschedule whenI needed to miss them.

____ I interact with my child in a positive way during my home visits.

____ My home visitor and I regularly talk about child development and parenting strategies during myhome visits.

____ I have at least one positive informal/social support system.

____ I successfully access a network of formal/community resources with my home visitor.

____ I attend HFM groups.

____ I have received home visits for at least six months.

____ My childs immunizations are up to date.


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Participant Name: ________________________________________________________

Biweekly to Monthly Services

Accomplishments & Perspectives(At least 10 of the following)

____ My IFSP is up to date.

____ I have completed two of my IFSP goals during my time in Healthy Families.

____ My home visitor and I have completed the most recent ASQ.

____ I completed 9 out of the expected 12 home visits for the last six months or I called to reschedule when Ineeded to miss them.

____ I interact with my child in a positive way during my home visits.

____ My home visitor and I regularly talk about child development and parenting strategies during myhome visits.

____ I have at least one positive informal/social support system.

____ I successfully access a network of formal/community resources without my home visitor.

____ I attend HFM groups.


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Move to Re-Engagement

Home Visitor Name: ___________________________________________________________

Supervisor Name: _____________________________________________________________

Todays Date: ____________________________

Reasons for placement on Re-Engagement (select at least one):

____ Participant has not been present for at least four scheduled home visits.

____ Home visitor has been unable to contact participant for at least three weeks.

____ Participant is leaving the area for at least one month and plans to return.


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Move to More Frequent Visits


Currently I receive ______________________ services, and I would like to receive home

visits more frequently. My new service level is ______________________.

Reason for increase in services:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

My family strengths:_______________________________________ ___________________________________

_______________________________________ ___________________________________


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Move to Service Level Other


My current service level is ______________________, and I am changing to Other.

Reason for change to Other and expected frequency of visits on this service level:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

My family strengths:

_______________________________________ ___________________________________

_______________________________________ ___________________________________


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IDEAS FOR CREATIVE OUTREACH

Positive, persistent outreach efforts build family trust.

The following ideas have been collected from HEALTHYFAMILIESMASSACHUSETTS sites across thestate. It is not expected that all of the following ideas will be implemented. They are presented simplyas IDEAS, and/or SUGGESTIONS for home visitors and supervisors to consider when working withtheir families.

GENERAL

Make trust a priority. Be clear and honest with familiesfrom the beginning. Respect and affirm the values, traditions and customs of the family. Consider how various aspects of culture may be influencing the familys receptivity to

the program. Be extremely creative in order to engage mom/dad. Approach the family with a warm, supportive attitude acknowledging the right of the

family to choose whether or not to accept services. Use different terminology: e.g. get together vs. appointment. Use several different types of contact at different times of day, etc. Inquire if any current participants might be willing to contact potential program families

to share their experiences. Give hesitant families a copy of your program brochure that describes the program and

clarifies the voluntary nature of services.


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Offer families opportunities to change their minds. Involve mom/dad in deciding how home visiting might support her/him.

Work with DAD. If dad is eligible for services as a primary participant, make sure youINVITE him to enroll in addition to Mom. Encourage Just to meet with us, Just to see who we are Work with other agencies/programs that the family is screened out of. Link with community gate keepers/community leaders who can provide liaison and

connection with prospective and/or interested participants. Link family to medical resources. Keep connected during the pregnancy. Stay aware of the due dates of babies for families

who have not engaged; they may be more receptive after the birth of the baby. Go where families are, such as childbirth classes and clinics. Allow the family to take a short-term respite from home visits. When you feel discouraged, use supervision as a means to support your positive efforts.

Supervisors are available, willing to go out with you on your home visits and to discussany issues of importance to you and the family.

If the personalities of the parent and the home visitor are not a match, considerchanging the home visitor who will work with the family.

BY PHONE

Contact families initially by phone. If you sense reluctance, continue contact by phone at least weekly for a short time until

the family feels more comfortable with setting up a visit. Allow plenty of time to talk with participant. Focus conversation on the parent (amount and quality of sleep, labor and delivery

experience, etc.) or on the baby (eating, crying, sleeping, etc.). Offer toll-free 1-800 number for self-referrals. Call at appropriate times just to say you were thinking of her/him This can be


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BY MAIL

After receiving the referral, send a short letter to the family explaining the program andthe home visitors desire to meet with them. Include program brochure, etc.

Use friendly stationery and brochure (i.e. non-agency looking). Send a personalized letter indicating your interest in the family and your desire to

schedule or reschedule appointments. Send notes or letters with information on topics of interest including child development,

prenatal development, parenting information/tips, and developmental screenings.

Send invitations to parenting groups, program celebrations, etc. Send congratulations on the birth of the baby using language that teens use. Send get-well cards. Send a schedule of agency events. Create and send a program newsletter. Offer families the opportunity to view your

groups and events through pictures. Send a parent a poem or other inspirational note to remind them of your interest. For

example, send something that interests them, or that celebrates some milestone for them

or for their baby. Send a note card at the end of the three-month period letting them know The door is

still open and information on how to contact you in the future, should they wish to doso.

GIFTS

Offer child and family-focused gifts as incentives for engaging in the program. For families who continue to show signs of reluctance, bring a small gift as an incentive

for them to remain in the program, and also as a sign of caring. Use donated or purchased baby-related merchandise as incentives. Give incentives for currently enrolled families for recruiting others


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HOME VISITS WITH THE PARENT

Encourage participants to help define visit schedule. Use flex-time to let a familyknow you respect their schedule.

Stay for a home visit only if convenient for the family--if it is not, schedule a moreconvenient time.

Address concrete basic needs in the initial visits. Offer hesitant participants a test home visit to see if they like it and want to continue. Ask the family if they have any suggestions as to how the visits can be more valuable to

them. Listen to their responses/input and follow through with their ideas. Use different/alternative sites for visits. Try changing the atmosphere of the home visits

by suggesting a visit to the local park or the local library. If the parent is not home, leave a brief, short, friendly note letting the parent know you

were there to see them, that you hope things are going well, that you are availableshould they want assistance and that you look forward to seeing them soon.

Invite your supervisor to accompany you on a home visit. Often, this technique helps tofurther remind the parent of our interest in their remaining in the program and offers

them an opportunity to review what the program can offer them. Contact other family members in an effort to send a message to the family of your

persistent interest in locating and seeing them. Remember to maintain theconfidentiality of the family.

Drop by visits to leave information and/or gifts. It can be a useful thing to obtainpermission from a family for drop-by visits at the start of a relationship, in case therecomes a time later when they temporarily disengage.

OTHER ACTIVITIES WITH THE PARENT

Offer concrete services, not just home visits--give other ways toparticipate. Collaborate with other programs to co lead groups together


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Healthy Families Massachusetts Service Level PolicyAppendix C: Outreach Intensity Guidelines without Pre-Closing Letter

September 2009

Guidance for Outreach Intensity

TimeLine

Week1

Week2

Week3

Week4

Week5

Week6

Week7

Week8

Week9

Week10

Week11

Week12

OutreachIntensity

Participant

referral is

received.

Attemptcontacteveryday(5)

Attemptcontacteveryother day(3)

Attemptcontacttwice (2)

Attemptcontactonceper week(1)


Attemptcontact2-3timesduringweeks6-9

SendFinalClosingletter

DocumentOutcomeof Contact

Examples of attempting contact include

Phone calls and voice messages

Personalized mailings

Drop by visits

Text messages, emails

Incentives, giftsPlease see Appendix B of the HFM Service Level policy for more ideas for creative outreach strategies to be used during the Outreach phase. All attempts atcontact must be documented in the Contact Log on the Participant Referral page in the PDS.

Final Closing letter (please see Appendix D in HFM Service Level policy for an example) maintains a positive, welcoming tone while informing the referred parentthat unless s/he contacts the program by a certain date, their case will be closed.

HFM policy states that combined Outreach and Engagement efforts must be conducted for a minimum of three months. For example, if it takes one month untilDate of First Contact (DoFC) is established, and the participant does not begin to actively engage in services, Engagement efforts need last only two months (for atotal of three months of Outreach/Engagement).


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Sample Final Closing letter

[date]

Dear [name]

Were so sorry weve had a hard time getting in touch with you about the Healthy Families program. We

are so excited about Healthy Families and the support it can offer. Because its totally up to you, we want

to make sure you have every opportunity to decide whether it would be a helpful service for you and your

family. If you have questions about our free and voluntary program, wed love to hear from you by [date

of intended closing]. Healthy Families is only available for first-time parents, age 20 and under, with

babies under one year of age. You can call us about getting involved with Healthy Families until you turn

21 or your baby turns one.

Sincerely,


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Sample Pre-Closing letter (Engagement)

[date]

Dear [name]

Were so sorry weve had a hard time getting in touch with you about the Healthy Families program. We

are so excited about Healthy Families and the support it can offer. Because its totally up to you, we want

to make sure you have every opportunity to decide whether it would be a helpful service for you and your

family.

Wed really love to hear from you if you have questions about our free and voluntary program, Healthy

Families is only available for first-time parents, age 20 and under, with babies under one year of age.

You can call us about getting involved with Healthy Families until you turn 21 or your baby turns one.

If its easier for you, you can email us too! Were at ______________________. If, after we meet, you

decide this isnt the program for you, thats fine with us youre the boss!


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[Type text]

Healthy Families Massachusetts Service Level PolicyAppendix F Engagement Intensity Guidelines

September 2009Page 1

Guidance for Engagement Intensity

TimeLine

Week1

Week2

Week3

Week4

Week5

Week6

Week7

Week8

Week9

Week10

Week11

Week12

Week13

Week 14

Engagem

ent

Intensity

Attemptcontacteveryday

(5)

Attemptcontacteveryother

day (3)

Attemptcontacttwice (2)

Attemptcontactonceper week

(1)


(1)


(1)


(1)


(1)

Attemptcontact2-3times

duringweeks9 -12

SendPre-Closingletter


Dischargeordocumentrationale

forkeepingopen

Date of First Contact




Drop by visits

Text messages, emails Incentives, gifts

Please see B of the HFM Service Level policy for more ideas for creative outreach strategies to be used during the Engagement phase. All attempts at contactmust be documented as secondary activities in the PDS.


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[Type text]

Healthy Families Massachusetts Service Level PolicyAppendix F Engagement Intensity Guidelines


Pre-Closing (Engagement) letter (please see Appendix E in HFM Service Level policy for an example) indicates the program is interested in providing services tothe participant, emphasizing the voluntary nature of the program, but that the program would really like the opportunity to share more information so that thereferred parent can make an informed decision.

Final Closing letter (please see Appendix D in HFM Service Level policy for an example) maintains a positive, welcoming tone while informing the referred parent

that unless s/he contacts the program by a certain date, their case will be closed.

HFM policy states that combined Outreach and Engagement efforts must be conducted for a minimum of three months. For example, if it takes one month untilDate of First Contact (DoFC) is established, and the participant does not begin to actively engage in services, Engagement efforts need last only two months (for atotal of three months of Outreach/Engagement). In addition, HFM policy requires that participants on Engagement service level must receive a minimum of 1-4home visits per month.


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Sample Pre-Closing letter (Re-Engagement)

[date]

Dear [name]

Were so sorry weve had a hard time getting in touch with you about the Healthy Families program. I

miss seeing you and ________ (name of baby, name of participants partner as appropriate). Weve

done a lot of good work together, like ________________________ (positive example of work

accomplished together).

I know that life changes and can get very busy if thats the case, I want you to know that Healthy

Families is still here foryou and Im hoping we can find a way to make the program fit into your busy life!

If youre thinking that Healthy Families isnt the right program for you anymore dont worry, my feelings

wont be hurt! Remember, its a voluntary program and you get to decide! If thats the case, Im hoping

we can still get together so we can celebrate the work you have done in the program and have a chance


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Healthy Families Massachusetts Service Level PolicyAppendix I Guidelines for Service Intensity


Guidelines for Service Intensity

This map demonstrates requirements and recommendations for service level assignments and changes for participants in HFM.Programs must make service level changes in collaboration with families and in accordance with the indicators of family progress asdetailed on HFM service level change forms.

Weekly Weekly Weekly

Biweekly Biweekly

Monthly Monthly

Key:

Required

Strongly Recommended

Acceptable (varies by participant)

No box: Not Recommended


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Healthy Families Massachusetts Service Level PolicyAppendix I Guidelines for Service Intensity


Rationale for Service Delivery Guidelines

Service level decisions (i.e. initial assignment and changes) must be made following standard criteria adopted by each HFM

program. These criteria must be written, a part of program policy, and used regularly in supervision to help guide conversationsbetween supervisor and home visitor, as well as home visitor and participant, regarding service level. Participant choice is one

criterion, among many, to help decide what service level is most appropriate. Please see HFM Service Level policy for more details

on this process.

Weekly visits for at least the first six months after birth:

Most effective window for influence for positive family outcomes

Most chance to be of use during potentially stressful times

Required by the HFA model and Critical Elements

Strongly Recommend:

Weekly visits when service are begun (regardless of pregnancy status or age of baby) to allow a chance for participant and

home visitor to get to know each other and establish trust.

Transitioning services (final six months): the default service level should be monthly home visits as a way to build

independence and prepare the family for the time when they are no longer eligible for HFM services.


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Healthy Families Massachusetts Service Level PolicyAppendix G Re-Engagement Intensity Guidelines


Guidance for Re-Engagement Intensity

TimeLine

Week1

Week2

Week3

Week4

Week5

Week6

Week7

Week8

Week9

Week10

Week11

Week12

Week13

Week 14

Re-Engag

ement

Intensity

Participanthas missedat least fourscheduledhome visitsor theprogramhas beenunable tocontact

themdespitepersistenteffort for atleast threeweeks.

Attemptcontacteveryotherday(2)

Attemptcontacteveryotherday (2)

Attemptcontacteveryotherday (2)






Attemptcontact2-3timesduringweeks9 -12

SendPre-Closingletter


Dischargeordocumentrationaleforkeepingopen

Service level is changed to Re-Engagement




Drop by visits

Text messages, emails

Incentives, giftsPlease see Appendix B of the HFM Service Level policy for more ideas for creative outreach strategies to be used during the Re-Engagement phase. All attemptsat contact must be documented as secondary activities in the PDS.


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Healthy Families Massachusetts Service Level PolicyAppendix G Re-Engagement Intensity Guidelines


Pre-Closing (Re-Engagement) letter (please see Appendix H in HFM Service Level policy for an example) indicates the program is interested in providingservices to the participant, emphasizing the voluntary nature of the program, and that the program would really like the opportunity to check in and support the bestan informed decision by the participant regarding continuing or ending participation in the program.

Final Closing letter (please see Appendix D in HFM Service Level policy for an example) maintains a positive, welcoming tone while informing the referred parentthat unless s/he contacts the program by a certain date, their case will be closed.

f service level policy

Documents