Home Visits

I. DEFINITION

Home visits give the Healthy Steps Specialist a chance to build a supportive relationship with families by focusing on children's development and behavior in the setting that is usually most familiar and comfortable. They strengthen the relationship between mothers and fathers and the practice, opening the door for the Healthy Steps Specialist to use or create "teachable moments." The first home visit focuses on infant care, breast or bottle feeding, and understanding infant behavior. Subsequent visits focus more on child development and behavior issues such as play, learning, and discipline. With parental consent, developmental checkups will be conducted. Through home visits, the Healthy Steps Specialist can gain insight into how the child's home environment can help foster his or her growth and development, and share this information with parents.

Objectives:

• To build a supportive relationship between the Healthy Steps^SM practice and the family.
• To enable the Healthy Steps Specialist to better understand how the child's home environment can help foster growth and development and use this information in working with mothers and fathers.
• To provide information on child behavior and development, infant care, safety, and injury prevention within the context of the home environment.
• To conduct developmental checkups.

II. SPECIFICATIONS

A. Hours of Operation: Because every household has its own rhythm, home visiting schedules must be flexible. Although Healthy Steps Specialists will visit families during the day, especially where there are very young infants, evening and weekend hours should be available to working parents. Each home visit should be scheduled to last between 60-90 minutes.

The following table outlines the recommended home visiting schedule. All mothers and fathers will receive written information about the availability of home visits in the Welcome to the Practice book and in their Child Health and Development Record. The Healthy Steps Specialist will call the parents two to four weeks before a recommended home visit to schedule the date and time and will follow up with a reminder two days before the visit. Mothers and fathers should be encouraged to request a home visit with the Healthy Steps Specialist at any time. The practice can also suggest a home visit with the family.


Recommended Home Visiting Schedule




Home Visit	Child's Age
1	3-5 days
2	9 months
3	12 months
4	18 months
5	24 months
6	30 months

B. Content: Suggested topics for each recommended home visit are included in Strategies for Change: Child Development in Primary Care for Young Children. No medical procedures will be conducted during home visits. The Healthy Steps Quick Check Sheets can guide the Healthy Steps Specialist in observing child development. The suggested questions are intended to elicit information and generate discussion of potential concerns of mothers and fathers or the Healthy Steps Specialist. The Child Health and Development Record should be used at each recommended visit to record questions and comments.

C. Reference: Information on home visiting is found in Chapter 6 of Strategies for Change: Child Development in Primary Care for Young Children. The Healthy Steps Specialist will document all attempts to schedule a visit and the reason(s) that any mothers and fathers refuse a recommended home visit. Scheduled visits that do not occur because a parent is not home when the Healthy Steps Specialist arrives will be followed up with a phone call by the Healthy Steps Specialist to re-schedule and inquire about the reason for their absence.

D. Documentation for Implementation: Each Healthy Steps Quick Check Sheet should be used to write case notes and to pass information on to other members of the practice. These sheets should be kept in Healthy Steps files. Before each well child office visit, the Healthy Steps Specialist will ensure that the physician/pediatric nurse practitioner is aware of the significant issues(s) covered at the last home visit.

• Visits will be scheduled by the Healthy Steps Specialist and carried out.
• A positive, supportive relationship will evolve between the Healthy Steps Specialist/ practice and the family.
• Mothers and fathers will feel comfortable requesting additional home visits, as needed.
• The Healthy Steps team will have more information about a child's home environment (e.g., safety, comfort, toys, etc.) so they can better advise mothers and fathers on how to promote the child's health and development.

IV. MEASURES FOR HOME VISITS (PARTIAL LIST)

• Number of home visits requested by mothers and fathers.
• Number of attempts by the Healthy Steps Specialist to schedule home visits.
• Number of completed visits.
• Health and development topics (e.g., sleep, feeding, safety, reading, etc.) covered in home visits.
• Parental satisfaction.
• Provider satisfaction.
• Household hazards corrected during home visits.