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Seven-month Pilot of an Integrated, Continuous Evaluation, and Quality Improvement System for a State-Based Home-Visiting Program

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Abstract

The objective of this study is to report the findings of a 7-month pilot for an integrated system evaluating a state-wide home visiting program. A cross-sectional study design was used to determine baseline process and outcome measures for Tennessee’s home visiting program which provides services to families, from pregnancy through 5-years-old. Baseline process measures included: time to initiate service after referral; frequency, duration and intensity of visits; completion of continuous assessment; and time from identification of a need to referral. The baseline outcome measures included: needs of eligible services (e.g. developmental screenings, WIC); prenatal care utilization; biological risks (prematurity; low birth weight); tobacco use and second-hand smoke exposure; and family planning utilization. During the pilot, 3,794 families were enrolled, representing 68% (± 1.5%) of incoming referrals. Enrollment dropped from 82% (90 days) to 69% (120 days); 52% of the families received a visit every month. Ninety percent of families had at least one full assessment after enrollment; 60% occurred within the first 60 days. Over 92% of outgoing referrals were made within 7 days. Immunization status (70%) is below the state level (80.8%). A quarter of the infants enrolled in the program are low birth weight and premature (state level 9.2%). Current tobacco use by the prenatal population is 16% compared to the state, 19.7%. The HUGS program serves high risk/high need clients and is consistent with other national home visiting models that have shown higher levels of attrition and lower levels of visits than intended by the model.

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Notes

  1. Citation is companion paper by same authors and submitted as a separate paper along with this paper.

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Acknowledgments

The authors would like to thank the entire HUGS Program staff including Lynette Hicks, State HUGS Program Director, and Mary Jane Dewey, Director of Women’s Programs in the Tennessee Maternal Child Health Section. We also thank John Hutcheson, Lacy Lesmeister, Ernest Miser, Michael Creighton, and Lori Isaacs for their work in developing the information technology system that is the foundation of the program evaluation system. For critical review of the manuscript, the authors wish to thank Dr. Lorraine MacDonald. This work was partially supported by HRSA Maternal and Child Health Services Block Grant CFDA #93.994.

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Authors and Affiliations

  1. Bureau of Health Services, Tennessee Department of Health, Cordell Hull Building, 4th Floor, 425 5th Avenue North, Nashville, TN, 37243, USA

    Bridget K. McCabe, Dru Potash, Ellen Omohundro & Cathy R. Taylor

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  1. Bridget K. McCabe
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  2. Dru Potash
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  3. Ellen Omohundro
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Correspondence to Bridget K. McCabe.

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McCabe, B.K., Potash, D., Omohundro, E. et al. Seven-month Pilot of an Integrated, Continuous Evaluation, and Quality Improvement System for a State-Based Home-Visiting Program. Matern Child Health J 16, 1401–1412 (2012). https://doi.org/10.1007/s10995-011-0905-7

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  • DOI: https://doi.org/10.1007/s10995-011-0905-7

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