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Home Visiting of Mecklenburg County LANDSCAPE ANALYSIS: Opportunities for Growth, Expansion & Building Infrastructure

For the purpose of this study, early childhood home visiting is a program that expectant parents and caregivers of young children voluntarily participate in to improve the health and well-being of their families. This broad definition is necessary because the various home-visiting models differ from each other in their level of intensity, target population, and mode of delivery.

For the purpose of this study, early childhood home visiting is a program that expectant parents and caregivers of young children voluntarily participate in to improve the health and well-being of their families. This broad definition is necessary because the various home-visiting models differ from each other in their level of intensity, target population, and mode of delivery.

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<strong>Home</strong> <strong>Visiting</strong> <strong>of</strong><br />

<strong>Mecklenburg</strong> <strong>County</strong><br />

<strong>LANDSCAPE</strong><br />

<strong>ANALYSIS</strong>:<br />

<strong>Opportunities</strong> <strong>for</strong> <strong>Growth</strong>,<br />

<strong>Expansion</strong> & <strong>Building</strong> <strong>Infrastructure</strong>


TABLE OF CONTENTS<br />

Acknowledgements. ............................1<br />

Introduction. ....................................2<br />

Why Charlotte-<strong>Mecklenburg</strong> Would Benefit<br />

from Expanded <strong>Home</strong> <strong>Visiting</strong> ................. 3<br />

Why Smart Start?. ...............................4<br />

The Landscape Analysis. ........................5<br />

Research Methods ..............................5<br />

<strong>Home</strong> <strong>Visiting</strong> Collaborative. ...................6<br />

Group Model <strong>Building</strong> Sessions. ................7<br />

Group Model <strong>Building</strong> Findings. ................8<br />

Themes. ....................................... 10<br />

2022 <strong>Mecklenburg</strong> <strong>County</strong><br />

<strong>Home</strong>-<strong>Visiting</strong> Survey. ........................ 11<br />

Catawba Nation <strong>Home</strong>-<strong>Visiting</strong> Program. .... 12<br />

Recommendations ............................ 13<br />

Conclusion .................................... 15<br />

Endnotes <strong>for</strong> Landscape Study. ............... 16<br />

Appendices. ................................... 17<br />

Appendix 1 .................................... 18<br />

Appendix 2 .................................... 28<br />

Appendix 3 .................................... 35<br />

Appendix 4 .................................... 36


ACKNOWLEDGEMENTS<br />

INTRODUCTION<br />

Smart Start <strong>of</strong> <strong>Mecklenburg</strong> <strong>County</strong> (SSMC) would like to thank the<br />

many individuals who provided their time, energy, attention, and<br />

expertise to this project. The <strong>Home</strong> <strong>Visiting</strong> <strong>of</strong> <strong>Mecklenburg</strong> <strong>County</strong><br />

Landscape Analysis is a collaborative ef<strong>for</strong>t and demonstrates the<br />

considerable interest on the part <strong>of</strong> many stakeholders in advancing<br />

home-visiting support <strong>for</strong> families in our community.<br />

We especially would like to thank the participants <strong>of</strong> the two-day,<br />

group model-building session, which included practitioners, families,<br />

policymakers, and community members dedicated to the work<br />

<strong>of</strong> expanding home-visiting services. Thanks to Martie Bennett,<br />

Omeika Dhanpaul, Angie Drake<strong>for</strong>d, Jake House, Dr. Devonya<br />

Govan-Hunt, Melody Gurganus, Veronica Kirkland, Zach Lewis,<br />

Pilar Perez, Katie Robinson, Sam Smith, Jennifer Stamp, Shakara<br />

Taylor, and Amber Williams; and a huge thanks to our parent<br />

participants, Darlyn Estrada and Chaivontre Ross.<br />

We also want to give special recognition to Dr. Paul Lanier, Ph.D.,<br />

Pr<strong>of</strong>essor in the School <strong>of</strong> Social Work at the University <strong>of</strong> North<br />

Carolina-Chapel Hill and Associate Director <strong>of</strong> the Jordan Institute<br />

<strong>for</strong> Families, who assisted with the research and data analysis.<br />

In Charlotte-<strong>Mecklenburg</strong>, we’re <strong>for</strong>tunate to have several highly<br />

qualified organizations providing home-visiting services. Smart Start<br />

<strong>of</strong> <strong>Mecklenburg</strong> <strong>County</strong> would like to sincerely thank the leaders <strong>of</strong><br />

these programs <strong>for</strong> their support and commitment to in<strong>for</strong>ming our<br />

work, enhancing relationships, and completing a first-ever, extensive<br />

survey <strong>of</strong> home-visiting programs. They are truly dedicated to<br />

trans<strong>for</strong>ming the landscape <strong>of</strong> early-childhood home visiting by<br />

developing and implementing strategies to scale-up services and<br />

programs to serve more local parents, caregivers, and families. They<br />

include the following:<br />

• Angie Drake<strong>for</strong>d, Parent Child+<br />

• Candance Hammonds and Trent Staton, Children’s <strong>Home</strong> Society,<br />

Child First<br />

• Hilary Harris, Catawba Nation, Tribal MIECHV<br />

• Lisa Cloninger, Children’s Developmental Services Agency<br />

• Lisa Sammons and Sybil Franklin, <strong>Mecklenburg</strong> <strong>County</strong> Maternal<br />

Health Department<br />

• Martiese Miller, Alliance Center <strong>for</strong> Education<br />

• Omeika Dhanpaul, Care Ring, A Guided Journey<br />

• Pilar Perez, YPAT, Parents As Teachers<br />

• Piper Yerger and Nenneh Springs, Care Ring, Nurse Family<br />

Partnership<br />

• Quadisha Juarez, Thompson Family Focus, Child First<br />

• Steffanie Lewis and Katie Vinson, Safe Journey, Parents As<br />

Teachers<br />

is a nationally recognized early-childhood<br />

education initiative to expand and<br />

improve services <strong>for</strong> children ages birth<br />

to 5 and their families. Smart Start was<br />

established in 1993 as a statewide,<br />

nonpr<strong>of</strong>it, public-private partnership to<br />

help all North Carolina children enter<br />

school healthy and ready to succeed.<br />

Together the Smart Start network <strong>of</strong> 75<br />

local partnerships serve all 100 counties<br />

in North Carolina by funding programs to<br />

the tune <strong>of</strong> $145 million each year.<br />

Smart Start <strong>of</strong> <strong>Mecklenburg</strong> <strong>County</strong><br />

(SSMC) is the largest <strong>of</strong> the 75 local<br />

partnerships. SSMC invests time and<br />

money in local, evidence-based and<br />

evidence-in<strong>for</strong>med initiatives to improve<br />

early care and education, family support,<br />

health, and literacy. The experiences a<br />

child has during the first 2,000 days—<br />

from birth to kindergarten—have been<br />

shown to have an impact throughout life.<br />

SSMC has played a pivotal role in<br />

supporting early-childhood initiatives<br />

in our community, effectively managing<br />

funds totaling nearly $40 million. This<br />

includes the successful operation <strong>of</strong><br />

the nationally acclaimed universal<br />

preschool program, MECK Pre-K. And,<br />

as an incubator <strong>for</strong> groundbreaking and<br />

<strong>for</strong>ward-thinking concepts in earlychildhood<br />

health and education, SSMC<br />

has allocated over $700,000 in the last<br />

two years through Innovation Grants<br />

awarded to local nonpr<strong>of</strong>its.<br />

SSMC also serves as a hub <strong>for</strong> research<br />

and collaboration. We organize and<br />

host plat<strong>for</strong>ms to share in<strong>for</strong>mation,<br />

initiate discussion, and generate<br />

support and action to promote and<br />

align a comprehensive early-childhood<br />

system. We also partner with other<br />

early-childhood organizations to<br />

provide advocacy and collaborative<br />

opportunities. Our goal, simply stated, is<br />

to ensure all children turn 5 ready<br />

to thrive.<br />

Early-childhood home visiting dates to the late<br />

nineteenth century, when churches and private<br />

philanthropies sent “friendly visitors” to engage<br />

in “charitable work in the homes <strong>of</strong> the poor.” In a<br />

handbook published in 1903, Mary E. Richmond writes,<br />

“In dealing with the homemaker, the friendly visitor<br />

becomes more directly a teacher, though it is <strong>of</strong>ten<br />

necessary that she should first be a learner.” 1<br />

As can be expected <strong>for</strong> the times in which it was<br />

published, the handbook is rife with condescension.<br />

Yet it illustrates a universal truth: Nearly all new and<br />

expectant parents, no matter their socioeconomic<br />

status, are better <strong>of</strong>f not going it alone. Or, as Hillary<br />

Clinton famously said, “It takes a village to raise a<br />

child.” Early childhood is the period <strong>of</strong> their lives when<br />

children are most vulnerable and, it can be argued,<br />

when parents get their most gray hair.<br />

If it takes a village, then home visiting is a crucial part <strong>of</strong><br />

the ecosystem.<br />

Early-childhood home visiting, <strong>for</strong> the purpose <strong>of</strong><br />

this study, is a program that expectant parents and<br />

caregivers <strong>of</strong> young children voluntarily participate in<br />

to improve the health and well-being <strong>of</strong> their families.<br />

This broad definition is necessary because the various<br />

home-visiting models differ from each other in their<br />

level <strong>of</strong> intensity, target population, and mode <strong>of</strong><br />

delivery.<br />

Within this broad definition, two large sub-categories<br />

<strong>of</strong> home-visiting programs emerge: universal home<br />

visiting-designed to serve all families with young<br />

children regardless <strong>of</strong> risk factors or circumstances,<br />

and targeted home visiting- specifically designed to<br />

serve families with identified risk factors or challenges<br />

that may impact their child’s development or wellbeing.<br />

<strong>Home</strong> visiting programs are also recognized by<br />

their evidence <strong>of</strong> effectiveness 2 , which demonstrate<br />

long-term improved outcomes including increased<br />

positive parenting, more responsive caregiver<br />

interactions, increased parental knowledge <strong>of</strong> child<br />

development, stronger parent-child bonds, and fewer<br />

negative and stress reactions. 3<br />

That said, the theoretical foundations <strong>of</strong> home-visiting<br />

models are very similar. The common threads <strong>of</strong> home<br />

visiting are prenatal and preventative care, promoting<br />

secure parent-child attachments, and fostering<br />

developmentally appropriate practices through<br />

coaching—ultimately supporting parents’ role as their<br />

children’s first and most important teachers. Whether<br />

this coaching is provided by a registered nurse, a<br />

health-care navigator, or some other type <strong>of</strong> parent<br />

educator, what remains consistent between models<br />

is the supportive relationship developed between the<br />

home visitor and the family by tailoring services to the<br />

unique needs <strong>of</strong> each family.<br />

Early-childhood home visiting is particularly important<br />

<strong>for</strong> families living in communities experiencing<br />

inequities in health care, education, and economic<br />

mobility. These disparities demonstrate the need <strong>for</strong><br />

proactive solutions that bridge gaps and dismantle<br />

barriers to accessing maternal and child health care,<br />

and other resources <strong>for</strong> family well-being.<br />

Early-childhood home visiting answers this through<br />

its versatility <strong>of</strong> programming which meets the unique<br />

needs <strong>of</strong> families.<br />

1 2


WHY CHARLOTTE-MECKLENBURG WOULD BENEFIT<br />

FROM EXPANDED HOME VISITING<br />

WHY SMART START?<br />

<strong>Home</strong> visiting has a proven, positive impact on prenatal health and birth outcomes. It provides services to help<br />

families thrive and give babies a healthy start. And research has shown that home-visiting programs yield a<br />

return on investment <strong>of</strong> $1.75 to $5.70 <strong>for</strong> every dollar spent on other early childhood interventions. 4 Beyond<br />

dollars and cents, we have an obligation to provide equitable health care in our community, which is a key<br />

ingredient to upward economic mobility.<br />

Maternal and infant mortality rates<br />

Six out <strong>of</strong> 1,000 babies in the U.S. die be<strong>for</strong>e their first birthday,<br />

most <strong>of</strong>ten due to unintentional injury. 5 And many infants are at risk<br />

be<strong>for</strong>e they’ve even entered the world. 6 In North Carolina, infant<br />

and maternal mortality rates are two to three times higher <strong>for</strong> Black<br />

babies and pregnant women 7 . While 80% <strong>of</strong> White pregnant women<br />

receive prenatal care within the first trimester <strong>of</strong> pregnancy, only<br />

69% <strong>of</strong> Black pregnant women and 57% <strong>of</strong> Hispanic pregnant women<br />

receive health care during pregnancy. 8 More alarming, little to no<br />

data points on maternal and infant mortality rates are available <strong>for</strong><br />

indigenous communities in North Carolina.<br />

Studies have found a<br />

return on investment <strong>of</strong><br />

$1.80 to $5.70<br />

<strong>for</strong> every dollar spent on<br />

home visiting<br />

<strong>Mecklenburg</strong> <strong>County</strong> is <strong>for</strong>tunate to have a strong<br />

ecosystem <strong>of</strong> early-childhood service providers<br />

and supporters. To tackle upward mobility in the<br />

region, county leadership <strong>for</strong>med an Early-Childhood<br />

Executive Committee (ECEC) to address inequity at its<br />

earliest stage.<br />

Providing access to high-quality public preschool<br />

became a focal point, after five years <strong>of</strong> operation,<br />

even after navigating the challenges <strong>of</strong> the Covid-19<br />

pandemic, that same dedication and commitment led<br />

to the next phase <strong>of</strong> work <strong>for</strong> the ECEC. In 2021, the<br />

committee was relaunched under the leadership <strong>of</strong><br />

the county manager and the CEO <strong>of</strong> Smart Start <strong>of</strong><br />

<strong>Mecklenburg</strong> <strong>County</strong> (SSMC), this time with the goal <strong>of</strong><br />

improving the system <strong>of</strong> care <strong>for</strong> families from prenatal<br />

to age 3, narrowing the work to three policy areas:<br />

1. Healthy and equitable births<br />

2. Optimal child health and development<br />

3. Parental health and emotional well-being<br />

In 2022, in the Landscape Study <strong>of</strong> Prenatal-Age 3<br />

Services & Supports in <strong>Mecklenburg</strong> <strong>County</strong>, which<br />

was commissioned by SSMC, stakeholders identified<br />

the need to strengthen ef<strong>for</strong>ts at outreach and access<br />

to quality services as one <strong>of</strong> their recommendations.<br />

Increasing home-visiting services was identified as a<br />

pathway to achieve this recommendation.<br />

Disparities in birth outcomes<br />

In <strong>Mecklenburg</strong> <strong>County</strong> 1 in 10 births are premature (less than<br />

37 weeks gestational age) and low birth weight (less than 2500g).<br />

Pregnant women <strong>of</strong> color are experiencing significant health<br />

inequities in these birth outcomes. Of 15,061 total births in 2021,<br />

15% <strong>of</strong> Black babies and 9% <strong>of</strong> Hispanic babies were low birthweight.<br />

Only 5% <strong>of</strong> White babies were low birthweight. 9 Adverse health<br />

complications such as impaired development, infections, and death<br />

are a result <strong>of</strong> these disparities.<br />

Child maltreatment<br />

Child maltreatment is another area that disproportionately impacts<br />

children <strong>of</strong> color. Although Black youth make up only 33% <strong>of</strong><br />

<strong>Mecklenburg</strong> <strong>County</strong>’s general population, 50% <strong>of</strong> youth entering<br />

Youth and Family Services custody are children <strong>of</strong> color. 10 Black<br />

families <strong>of</strong>ten face systemic barriers in accessing health care,<br />

af<strong>for</strong>dable housing, stable employment, and other economic drivers<br />

<strong>of</strong> health.<br />

Out <strong>of</strong> 15,061 total<br />

births in 2021,<br />

15% <strong>of</strong> Black babies and<br />

9% <strong>of</strong> Hispanic babies were<br />

low birthweight<br />

Managing nearly $40 million in funds to assist early-childhood initiatives in our community, including the<br />

nationally recognized universal preschool program, MECK Pre-K, SSMC, is currently a primary funding source <strong>for</strong><br />

three home-visiting models in our community:<br />

Parents as Teachers: Nurse-Family Partnership: Child First:<br />

<strong>Home</strong> visiting and parenting education can help eliminate racial<br />

disparities in the health and well-being <strong>of</strong> children and families.<br />

These programs have proven to be highly effective and<br />

will continue to be a priority focus <strong>of</strong> SSMC’s funding.<br />

However, these programs represent only three <strong>of</strong> 21<br />

home-visiting models which meet U.S. Department<br />

<strong>of</strong> Health and Human Services (HHS) criteria <strong>for</strong> an<br />

evidenced-based delivery model <strong>for</strong> early-childhood<br />

home visiting. Our community has both the capacity<br />

and need to make additional home-visiting programs<br />

available to children and families. Thanks to a<br />

generous $342,500 American Rescue Plan Act grant<br />

from <strong>Mecklenburg</strong> <strong>County</strong>, SSMC has embarked on a<br />

journey to raise the pr<strong>of</strong>ile <strong>of</strong> home visiting. There<strong>for</strong>e,<br />

our first step was to complete a landscape study with<br />

the intention <strong>of</strong> evaluating and expanding home visiting<br />

in <strong>Mecklenburg</strong> <strong>County</strong>.<br />

3 4


THE <strong>LANDSCAPE</strong> <strong>ANALYSIS</strong><br />

HOME VISITING COLLABORATIVE<br />

Initially, our research focused on HHS-approved<br />

models that demonstrated evidence <strong>of</strong> effectiveness. 11<br />

However, recognizing the importance <strong>of</strong> equity,<br />

we decided to adopt a more inclusive approach to<br />

conducting an equitable landscape analysis. Our<br />

goal was to identify ways to enhance and improve<br />

service accessibility <strong>for</strong> families in <strong>Mecklenburg</strong><br />

<strong>County</strong>, which is geographically expansive. Through<br />

our discovery process, we brought together various<br />

models, including evidence-based/early intervention<br />

(EB/EI) models, promising EB/EI models, and programs<br />

utilizing different variations <strong>of</strong> home-based delivery<br />

services.<br />

Universal screening strategies and approaches<br />

are widely discussed both locally and nationally.<br />

As previously discussed, universal home-visiting<br />

approaches aim to provide services to all newborns<br />

and their families, regardless <strong>of</strong> their risk factors or<br />

circumstances. Alternatively, targeted approaches in<br />

home visiting are more commonly known. They focus<br />

on prevention strategies <strong>for</strong> families with identified<br />

risk factors or challenges that may affect their child’s<br />

development or well-being.<br />

Both program types are crucial <strong>for</strong> adapting to the<br />

changing landscape <strong>of</strong> <strong>Mecklenburg</strong> <strong>County</strong>, especially<br />

given the county’s diverse and growing population,<br />

the urgent matter <strong>of</strong> maternal- and infant-health<br />

disparities, and the recovery challenges posed by the<br />

Covid-19 pandemic. Throughout our conversations<br />

with parents, they emphasized the importance <strong>of</strong><br />

programming that genuinely meets their family’s<br />

needs. They also expressed a strong desire <strong>for</strong> a unified<br />

access point where service providers communicate<br />

effectively with one another, thereby avoiding<br />

situations where families are referred to programs<br />

that don’t meet their needs.<br />

Increasing home-visiting services was recognized as a pathway to achieve one <strong>of</strong> the recommendations in the<br />

Prenatal-to-Age-3 landscape study referenced above. Stakeholders identified the need to strengthen outreach<br />

and increase access to quality services. SSMC convened local home-visiting programs and in the process<br />

identified several organizations providing home visiting, including community agencies, various departments <strong>of</strong><br />

<strong>Mecklenburg</strong> <strong>County</strong>, and an emerging program <strong>for</strong> indigenous families.<br />

MECKLENBURG COUNTY HOME VISITING PROGRAMS<br />

Department <strong>of</strong><br />

Public Health -<br />

<strong>County</strong><br />

Community-<br />

Led<br />

Organizations<br />

Tribal<br />

MIECHV<br />

(emerging)<br />

Community Health Worker’s<br />

Initiative<br />

• Care Ring-A Guided Journey<br />

Child First<br />

• Children’s <strong>Home</strong> Society<br />

• Thompson’s Family Focus<br />

Nųti Yapę<br />

(Morning Sun)<br />

This study, <strong>Home</strong> <strong>Visiting</strong> <strong>of</strong> <strong>Mecklenburg</strong> <strong>County</strong><br />

Landscape Analysis: <strong>Opportunities</strong> <strong>for</strong> <strong>Growth</strong>, <strong>Expansion</strong>,<br />

& <strong>Building</strong> <strong>Infrastructure</strong>, was modeled on the methods<br />

used in the 2018 seminal report, North Carolina Early<br />

<strong>Home</strong> <strong>Visiting</strong> Landscape Analysis: Strengthening Systems<br />

to Support Families, published by Dr. Paul Lanier,<br />

Ph.D., Pr<strong>of</strong>essor in the School <strong>of</strong> Social Work at the<br />

University <strong>of</strong> North Carolina-Chapel Hill and Associate<br />

Director <strong>of</strong> the Jordan Institute <strong>for</strong> Families.<br />

<strong>Building</strong> upon the state research study, SSMC’s<br />

landscape analysis is comprised <strong>of</strong> several<br />

components, including group model-building, an online<br />

survey conducted among local organizations that<br />

provide home-visiting services, and input from the<br />

<strong>Home</strong> <strong>Visiting</strong> Collaborative.<br />

RESEARCH METHODS<br />

Early Intervention<br />

• Children’s Developmental<br />

Services Agency<br />

Maternal Health<br />

• Care Management <strong>for</strong> At Risk<br />

Pregnancies<br />

• Care Management <strong>for</strong> At Risk<br />

Children<br />

Early Head Start - <strong>Home</strong> Based<br />

• Alliance Center <strong>for</strong> Education<br />

Nurse-Family Partnership<br />

• Care Ring<br />

Parents As Teachers<br />

• Communities in Schools-<br />

Safe Journey<br />

• YMCA-YPAT<br />

Parent Child +<br />

• Charlotte Bilingual Preschool<br />

• Inlivian<br />

• Families First<br />

5 6


GROUP MODEL BUILDING SESSIONS<br />

GROUP MODEL BUILDING FINDINGS<br />

In November 2022, SSMC hosted two participatory<br />

group model-building (GMB) sessions attended by<br />

16 participants. 12 Dr. Lanier and his team from the<br />

Jordan Institute <strong>for</strong> Families led the sessions. GMB is<br />

a systems-thinking approach that seeks to develop a<br />

shared understanding <strong>of</strong> a complex system and build<br />

consensus around priorities <strong>for</strong> improvement.<br />

The purpose <strong>of</strong> the sessions was to develop a<br />

common understanding <strong>of</strong> the current home-visiting<br />

system, identify action steps to increase access <strong>for</strong><br />

families, and include stakeholders in the <strong>for</strong>mation<br />

<strong>of</strong> recommendations. The sessions also helped<br />

participants build systems-thinking skills.<br />

During the first session, participants were oriented<br />

to the approach <strong>of</strong> systems thinking and GMB<br />

overall as a participatory-change strategy. Next,<br />

participants discussed the landscape <strong>of</strong> home visiting<br />

in <strong>Mecklenburg</strong> <strong>County</strong>. Dr. Lanier and his team<br />

presented data on statewide longitudinal service<br />

trends and how trends in North Carolina are similar to<br />

and different from <strong>Mecklenburg</strong> <strong>County</strong>. The statewide<br />

trends suggest that while the number <strong>of</strong> families and<br />

children who could benefit from services mostly stayed<br />

the same over time, the number <strong>of</strong> families and children<br />

who actually received services had been steadily<br />

decreasing since 2018. 13<br />

The research team from the Jordan Institute developed<br />

a home-visiting system map <strong>for</strong> <strong>Mecklenburg</strong> <strong>County</strong><br />

using data from the 2018 statewide landscape study. 14<br />

Agencies were asked to report on collaborations and<br />

referrals made and received by local agencies.<br />

Housing Support<br />

Medicaid<br />

Charitable<br />

Services (e.g.<br />

Crisis Assistance<br />

Ministries)<br />

Bright Blessings<br />

Nurses<br />

As illustrated in Figure 2, a heavily interwoven system<br />

<strong>of</strong> agency-to-agency connections exists. Four homevisiting<br />

programs, shown in orange, were connected<br />

through some common agencies, but in general the<br />

four programs operated in separate and distinct<br />

subnetworks with no connection to one another.<br />

Primary Care<br />

Clinics<br />

Dept <strong>of</strong> Social<br />

Services<br />

800,000<br />

700,000<br />

600,000<br />

500,000<br />

# <strong>of</strong> Children Who Could Benefit<br />

600,000<br />

500,000<br />

400,000<br />

# <strong>of</strong> Families Who Could Benefit<br />

Reach Out and<br />

Read<br />

Relationship<br />

Counseling<br />

HV Program<br />

3<br />

Job Training<br />

Mental Health<br />

Services<br />

Child Care<br />

Resources<br />

HV Program<br />

2<br />

Community LINK<br />

400,000<br />

300,000<br />

300,000<br />

200,000<br />

SNAP<br />

Vitamin Angels<br />

Crisis Assistance<br />

Ministries<br />

Health Department<br />

Local Faith<br />

Group<br />

200,000<br />

100,000<br />

100,000<br />

Further Education<br />

0<br />

2018 2019 2020 2021 2022<br />

0<br />

2018 2019 2020 2021 2022<br />

Primary Care<br />

Clinic<br />

Bethlehem Center<br />

Head Start<br />

Families<br />

Forest Hill<br />

Church -Charlotte<br />

16,000<br />

Children Received <strong>Home</strong> <strong>Visiting</strong><br />

16,000<br />

Families Received <strong>Home</strong> <strong>Visiting</strong><br />

WIC<br />

Baby Bundles<br />

Thompson Child<br />

Development<br />

Center<br />

Charlotte<br />

Community<br />

Health Clinic<br />

14,000<br />

12,000<br />

14,000<br />

12,000<br />

Pregnancy<br />

Resource<br />

Center<br />

Renaissance<br />

West Community<br />

Initiative<br />

Smart Start<br />

<strong>of</strong> <strong>Mecklenburg</strong><br />

<strong>County</strong><br />

Enlace -Latin<br />

American Council<br />

<strong>of</strong> Charlotte<br />

10,000<br />

10,000<br />

8,000<br />

6,000<br />

4,000<br />

8,000<br />

6,000<br />

4,000<br />

OB <strong>of</strong>fices<br />

HV Program<br />

4<br />

CDSA<br />

Charlotte <strong>Mecklenburg</strong><br />

Schools<br />

HV Program<br />

1<br />

Legal Services<br />

<strong>of</strong> Piedmont<br />

YMCA <strong>of</strong> Greater<br />

Charlotte<br />

2,000<br />

2,000<br />

0<br />

2018 2019 2020 2021 2022<br />

Figure 1: Statewide Trends in Eligible <strong>Home</strong> <strong>Visiting</strong> Population and Service Recipients<br />

For <strong>Mecklenburg</strong> <strong>County</strong>, participants shared that<br />

programs have remained at full capacity with constant<br />

waiting lists, and there is a sense that the number <strong>of</strong><br />

those receiving services has stayed stable. However,<br />

as the population <strong>of</strong> eligible families has increased,<br />

stagnant funding <strong>for</strong> home visiting likely results in<br />

a decrease in the percentage <strong>of</strong> total families and<br />

children in <strong>Mecklenburg</strong> <strong>County</strong> receiving services.<br />

0<br />

2018 2019 2020 2021 2022<br />

Participants noted “grace” be given <strong>for</strong> the way the<br />

Covid-19 pandemic has impacted the data and its<br />

trends. The group also discussed the importance <strong>of</strong><br />

monitoring future growth, continuing to engage in<br />

conversations about trends, and obtaining accurate,<br />

up-to-date service numbers specific to <strong>Mecklenburg</strong><br />

<strong>County</strong>.<br />

Legend<br />

Opposite<br />

Community Org.<br />

Early Ed/Schools<br />

Families<br />

Government<br />

Health/MH<br />

HV<br />

CC4C<br />

Pregnancy Care<br />

Management<br />

Hospitals<br />

Bottles-n-Bottoms<br />

Loaves-n- Fishes<br />

Figure 2: <strong>Mecklenburg</strong> <strong>County</strong> <strong>Home</strong> <strong>Visiting</strong> System Map 2018<br />

The Learning<br />

Collaborative<br />

Levine Cancer<br />

Institue<br />

Care Ring<br />

Lakewood Preschool<br />

Charlotte Bilingual<br />

Preschool<br />

Howard Levine<br />

Child Development<br />

Center<br />

Latin American<br />

Coalition<br />

7 8


GROUP MODEL BUILDING FINDINGS<br />

THEMES<br />

During the 2022 SSMC home-visiting survey, nine organizations reported on their current collaborations and<br />

referrals. Again, Figure 3 shows common agency connections, but silos remain a common theme between the<br />

various home visiting programs.<br />

Elevation Church<br />

Legend<br />

Charlotte<br />

Center<br />

<strong>for</strong> Legal<br />

Advocacy<br />

Opposite<br />

4<br />

5<br />

Community Org.<br />

<strong>Home</strong> <strong>Visiting</strong><br />

Health/MH<br />

Government<br />

Higher Education<br />

Early Ed/Schools<br />

Faith-Based<br />

Other<br />

WellCare<br />

Center<br />

<strong>for</strong> Community<br />

Alignment<br />

4<br />

Bright Blessings<br />

6<br />

4<br />

4<br />

CIS -Safe Journey<br />

Parents As<br />

Teachers<br />

Beds For Kids<br />

Mira Vida<br />

Guided Journey<br />

6<br />

6<br />

4<br />

5<br />

6<br />

Care Ring<br />

Nurse Family<br />

Partnership<br />

Safe Kids<br />

Enlace<br />

-Latin American<br />

Council<br />

Girl Scouts<br />

Baby Bundles<br />

6<br />

School Health<br />

MCHD<br />

6<br />

Alianza<br />

-Prevention<br />

Services<br />

6<br />

ICO4MCH<br />

6<br />

3<br />

6<br />

4<br />

Meck <strong>County</strong><br />

Health<br />

Department<br />

<strong>Home</strong> <strong>Visiting</strong><br />

Central<br />

United Methodist<br />

Church<br />

4<br />

6<br />

Child First<br />

National Service<br />

Office<br />

6<br />

5<br />

YMCA<br />

Parents As<br />

Teachers<br />

Children's<br />

<strong>Home</strong> Society<br />

Child First<br />

6<br />

Latin American<br />

Coalition<br />

4<br />

5<br />

6<br />

5<br />

Novant<br />

Atrium<br />

NC State<br />

Legislature<br />

Charlotte<br />

Public<br />

Library<br />

Charlotte<br />

<strong>Mecklenburg</strong><br />

Schools<br />

4<br />

Charlotte<br />

Bilingual<br />

Preschool<br />

6<br />

4<br />

5<br />

Care<br />

Management<br />

For At-Risk<br />

Children<br />

(CMARC)<br />

6<br />

6<br />

Meck <strong>County</strong><br />

Children's<br />

Developmental<br />

Services Agency<br />

Zfive<br />

5<br />

6<br />

5<br />

6<br />

4<br />

5<br />

Parent Child+<br />

Smart Start<br />

YFS<br />

6<br />

Inlivian<br />

6<br />

CMARC<br />

Center <strong>for</strong><br />

Child and<br />

Family Health<br />

Local<br />

Pediatricians<br />

Families First<br />

Charlotte<br />

Speach and<br />

Hearing<br />

6<br />

6<br />

Alliance Center<br />

<strong>for</strong> Education-<br />

Early Head Start<br />

<strong>Home</strong> Based<br />

6<br />

Milestone<br />

Therapy<br />

6<br />

Central<br />

Piedmont<br />

Community<br />

College<br />

Dancing Badger<br />

Six themes emerged from participants’ engagement with the hopes and fears activity. Each theme is illustrated<br />

below in a diagram mapping the participants’ conversations.<br />

• Model flexibility and adaptability<br />

• Trust with families and between home visiting programs<br />

• Referral sources<br />

• Work<strong>for</strong>ce sustainability<br />

• Funding<br />

• Diversity, equity, and inclusiveness<br />

Incusion <strong>of</strong><br />

diverse and<br />

immigrant<br />

communities<br />

Allowing families<br />

to be experts <strong>of</strong><br />

their lives<br />

Work/Life<br />

Balance<br />

Unable to serve<br />

due to long<br />

waitlists<br />

Work<strong>for</strong>ce<br />

Development<br />

Pipeline<br />

Degree<br />

Requirements <strong>for</strong><br />

peer partners<br />

Secondary<br />

Trauma<br />

Referral<br />

Sources<br />

More<br />

partnerships<br />

Community<br />

buy-in<br />

“bottom up”<br />

Programming<br />

Deficit<br />

Trust<br />

Diverse and<br />

Representative <strong>of</strong><br />

communities served<br />

Losing trust as a home visitor<br />

due to saturated resources<br />

(referrals don’t get accepted)<br />

HV Sector becomes<br />

well connected<br />

internally and<br />

externally<br />

Norm that home<br />

visiting programming<br />

is safe space<br />

System<br />

Awareness<br />

System <strong>of</strong> HV able<br />

to establish trust<br />

among families<br />

System is intentional<br />

and streemlined;<br />

“no silos”<br />

Family<br />

Awareness<br />

Funding<br />

Model<br />

adaptation<br />

/flexibility<br />

No clear<br />

outcome<br />

Knowledge <strong>of</strong> other<br />

programs and info<br />

sharing<br />

Virtual<br />

Options<br />

Not continuing<br />

innovations made<br />

during crisis<br />

Collective<br />

voice!<br />

Compassion<br />

Fatigue<br />

Work<strong>for</strong>ce needs:<br />

pay, respect,<br />

investment<br />

Inconsistent<br />

funders/<br />

decision makers<br />

Lack <strong>of</strong> stable<br />

funding stream<br />

(i.e. Medicaid)<br />

Powers that be get<br />

distracted by the<br />

next crisis<br />

OR tunnel vision<br />

and only one HV<br />

model is supported<br />

Lack <strong>of</strong> input from<br />

specific models/<br />

programs/sites<br />

Figure 4: First Draft Causal Loop Diagram <strong>of</strong> <strong>Home</strong> <strong>Visiting</strong> Access<br />

9 10


2022 MECKLENBURG COUNTY HOME-VISITING SURVEY CATAWBA NATION<br />

HOME-VISITING PROGRAM<br />

Guided by the 2018 statewide home-visiting survey,<br />

SSMC presented a draft survey to GMB participants<br />

who reviewed and included edits or additions to ensure<br />

we would capture in<strong>for</strong>mation relative to <strong>Mecklenburg</strong><br />

<strong>County</strong>. This was the first time a survey related to home<br />

visiting was distributed to local home visiting program<br />

organizations.<br />

Data from seven reporting agencies 15 indicates just<br />

over 1,000 families are being served, which equates to<br />

just 7% <strong>of</strong> the live births in <strong>Mecklenburg</strong> <strong>County</strong>.<br />

Figure 5: <strong>County</strong> mapping <strong>of</strong> community based home visiting programs<br />

Given that home-visiting programs are designed to<br />

support families during the crucial early years <strong>of</strong> a<br />

child’s life, the relatively low percentage <strong>of</strong> families<br />

being served highlights the need <strong>for</strong> increased ef<strong>for</strong>ts<br />

to grow and expand the reach and accessibility <strong>of</strong><br />

these services, particularly in the wake <strong>of</strong> the Covid-19<br />

pandemic.<br />

Only<br />

7%<br />

<strong>of</strong> eligible families<br />

being served in<br />

<strong>Mecklenburg</strong> <strong>County</strong><br />

In 2022, Catawba Nation received a five-year, development<br />

and implementation grant from the U.S. Department <strong>of</strong><br />

Health & Human Services (DHHS) to create the Nuti Yapę<br />

(Morning Sun) Tribal <strong>Home</strong>-<strong>Visiting</strong> Program.<br />

During the first 15 months <strong>of</strong> the grant period, Catawba<br />

Nation undertook a comprehensive community needs and<br />

readiness assessment, which included capacity-building,<br />

program planning and design. The next steps will be to select<br />

an approved DHHS model that allows <strong>for</strong> flexibility to meet<br />

the cultural needs <strong>of</strong> tribal families, and then to design the<br />

program activities.<br />

Nuti Yapę will serve indigenous families from state and<br />

federally recognized tribes in six counties in South<br />

Carolina (York, Union, Fairfield, Chester,<br />

Lancaster, and Kershaw) and seven counties in<br />

North Carolina (Cleveland, Catawba, Gaston,<br />

<strong>Mecklenburg</strong>, Rowan, Cabarrus, and Union).<br />

While capacity is increasing within the<br />

program, families within an approximate<br />

30 minute driving radius from the Catawba<br />

Reservation will be prioritized.<br />

The target population will be prenatal<br />

through age 3 initially. Once the Family Spirit<br />

curriculum <strong>for</strong> ages 3-5 have completed their<br />

pilots in Indigenous communities, the Nuti Yapę<br />

program will expand to age 5. In <strong>Mecklenburg</strong> <strong>County</strong> alone,<br />

there are nearly 9,000 indigenous people, including nearly<br />

600 children under 5.<br />

Data collected from a community survey, stakeholder<br />

interviews, and four talking circles (focus groups) indicate the<br />

following common themes:<br />

1. Postpartum depression is common. Half <strong>of</strong> mothers<br />

surveyed experienced postpartum depression with at<br />

least one <strong>of</strong> their pregnancies, and most received no<br />

support during this time.<br />

2. Substance abuse is also a significant concern. Substance<br />

use is a symptom <strong>of</strong> the effects <strong>of</strong> historical trauma.<br />

Un<strong>for</strong>tunately, citizens <strong>of</strong> the Catawba Nation have<br />

not been spared these effects <strong>of</strong> historical and ongoing<br />

racism and trauma. Families have been impacted by<br />

these effects and on the Catawba Reservation, many<br />

grandparents are raising their grandchildren due to the<br />

parents having substance use problems.<br />

3. Catawba Nation has experienced a loss <strong>of</strong> community<br />

and connection to culture, especially during the<br />

Covid-19 pandemic. However, community leaders are<br />

working to restore a sense <strong>of</strong> community and help its<br />

members reconnect to their culture. Connection to<br />

culture is a significant protective factor <strong>for</strong> indigenous<br />

families, especially during the perinatal period and<br />

childrearing.<br />

4. Indigenous moms also expressed interest in receiving<br />

breastfeeding and lactation support. While a significant<br />

number <strong>of</strong> women attempted to breastfeed, most<br />

found it challenging and many stopped breastfeeding<br />

as a result. A common theme noted was that most<br />

were unable to access lactation support or education,<br />

and these challenges <strong>of</strong>ten exacerbated postpartum<br />

depression.<br />

5. Finally, early literacy and kindergarten readiness need<br />

to be addressed. On the Catawba Reservation, only 58%<br />

<strong>of</strong> high school students graduate on time or receive a<br />

GED. Historical trauma and ongoing trauma at school<br />

play a significant role. The community has experienced<br />

years <strong>of</strong> removal <strong>of</strong> tribal children from their homes;<br />

<strong>of</strong>ten children were sent to boarding schools<br />

or placed in the foster care system or <strong>for</strong><br />

adoption, as poverty was mistaken <strong>for</strong><br />

neglect. Segregation <strong>of</strong> schools has<br />

had a lasting impact on the Catawba<br />

Reservation. Elders and grandparents<br />

alive today were segregated to an<br />

“Indian School” and provided only an<br />

eighth-grade education.<br />

As part <strong>of</strong> the research conducted <strong>for</strong> the<br />

needs assessment, the Catawba Nation began<br />

to build relationships with other recognized<br />

tribes in the Carolinas to learn about the unique<br />

needs <strong>of</strong> those tribal citizens. For example, in North Carolina,<br />

Native Americans have some <strong>of</strong> the worst outcomes<br />

in premature births, low birthweight, infant mortality,<br />

breastfeeding at hospital discharge, new HIV cases, teen<br />

pregnancy, unemployment, violent death, and incarceration. 16<br />

Native American families are living in poverty at significantly<br />

higher rates than that the general population, with the<br />

median household income in North Carolina being $68,900,<br />

compared to a median household income <strong>of</strong> $39,600 <strong>for</strong><br />

indigenous people in the state. 17<br />

The <strong>Home</strong>-<strong>Visiting</strong> Collaborative, led by SSMC, recognizes<br />

the critical importance <strong>of</strong> expanding and enhancing homevisiting<br />

programs throughout <strong>Mecklenburg</strong> <strong>County</strong>. The<br />

Catawba Nation is embarking on an important mission<br />

to improve the lives <strong>of</strong> indigenous families by <strong>of</strong>fering<br />

a culturally sensitive home-visiting program. We firmly<br />

believe that by embracing this invaluable partnership, we<br />

can tap into the vast knowledge and immense strengths that<br />

resonate within indigenous communities, while serving as<br />

a steadfast resource and partner to Catawba Nation’s Nuti<br />

Yapę program.<br />

11 12


Based on the findings from the online survey <strong>of</strong> local home-visiting programs, the group model-building sessions,<br />

and the analysis <strong>of</strong> county-specific data collected from the statewide landscape study, SSMC has developed the<br />

following recommendations:<br />

Improve navigation<br />

and referral processes<br />

between home visiting<br />

programs and other<br />

services to efficiently<br />

meet the needs <strong>of</strong><br />

families by connecting<br />

them with appropriate<br />

programs.<br />

Increase funding <strong>for</strong><br />

current programs and<br />

curate new funding<br />

streams <strong>for</strong> program<br />

addition, growth, and<br />

expansion.<br />

RECOMMENDATIONS<br />

What this looks like:<br />

• Explore the scale-up <strong>of</strong> current <strong>Mecklenburg</strong><br />

<strong>County</strong> Public Health programs to serve as<br />

the backbone agency to provide assessment<br />

screenings and utilize a centralized data system<br />

or coordinated intake system to link families to<br />

appropriate resources.<br />

• Integrate county referral tools to support data<br />

collection <strong>for</strong> home-visiting services and resources<br />

to support family needs.<br />

What this looks like:<br />

• Provide funding to enable programs to expand<br />

their current capacity, moving from 7% to 14%<br />

service coverage.<br />

• Secure funding to fill gaps in services <strong>for</strong> families<br />

that are underserved by current funding<br />

mechanisms or programs.<br />

• Explore the implementation <strong>of</strong> a new home-visiting<br />

program to effectively reach and serve families<br />

that are currently not being reached by existing<br />

programs.<br />

• Explore funding <strong>for</strong> an education-based, salarysupplement<br />

program <strong>for</strong> in-home family support<br />

pr<strong>of</strong>essionals.<br />

Build and support<br />

a well-trained,<br />

well-supported<br />

home-visiting<br />

work<strong>for</strong>ce.<br />

Increase opportunities<br />

<strong>for</strong> parents to influence<br />

program implementation<br />

and development.<br />

What this looks like:<br />

• Ensure funding is directed towards raising the<br />

compensation <strong>of</strong> home visitors across the county.<br />

• Establish an ongoing process <strong>of</strong> assessing and<br />

improving services and outcomes based on datadriven<br />

feedback.<br />

• Partner with local schools to increase sustainability<br />

in the work<strong>for</strong>ce through training and<br />

apprenticeship opportunities.<br />

• Develop and implement a work<strong>for</strong>ce program that<br />

provides ongoing training, support, and resources<br />

<strong>for</strong> home-visiting and family-support pr<strong>of</strong>essionals.<br />

What this looks like:<br />

• Increase awareness and opportunities <strong>for</strong> the<br />

development <strong>of</strong> parent leadership to elevate the<br />

voices <strong>of</strong> those directly affected by programming.<br />

• Support capacity-building ef<strong>for</strong>ts <strong>of</strong> earlychildhood<br />

collaborations seeking to increase<br />

parent leadership and enhance engagement.<br />

• Establish a resource center as a plat<strong>for</strong>m <strong>for</strong><br />

enhancing family well-being to promote change<br />

through a human-delivery approach.<br />

• Support sustainable growth and change within<br />

home-visiting and family-support systems.<br />

13 14


CONCLUSION<br />

ENDNOTES FOR <strong>LANDSCAPE</strong> STUDY:<br />

While we are proud <strong>of</strong> what we have accomplished to<br />

date, our work is not done. Successful implementation<br />

<strong>of</strong> the recommendations will require ongoing<br />

monitoring and evaluation <strong>of</strong> progress. This is best<br />

done through continuous convening ef<strong>for</strong>ts to update<br />

models and frameworks, gather new data, and heighten<br />

advocacy <strong>for</strong> home visiting.<br />

Our research to date has uncovered a robust yet<br />

disconnected infrastructure <strong>of</strong> home-visiting providers.<br />

There<strong>for</strong>e, one <strong>of</strong> the most important things SSMC<br />

can do is serve as hub organization in partnership<br />

with <strong>Mecklenburg</strong> <strong>County</strong> government. We aim to<br />

take the lead in enhancing and broadening the local<br />

home-visiting system through the collective ef<strong>for</strong>ts<br />

<strong>of</strong> the <strong>Home</strong> <strong>Visiting</strong> Collaborative. Our objective is<br />

to work in conjunction with <strong>Mecklenburg</strong> <strong>County</strong> and<br />

our partners to eliminate gaps in services and reduce<br />

fragmentation <strong>of</strong> the system. Collectively, we will need<br />

to monitor our progress, keeping everyone in<strong>for</strong>med<br />

about successes and challenges as they relate to the<br />

system <strong>of</strong> home visiting.<br />

Our work will inevitably involve further research<br />

and more connections with local and state programs.<br />

Finally, and <strong>of</strong> utmost importance, we must fully<br />

support the home-visiting work<strong>for</strong>ce. This entails<br />

intentional strategies to recruit, retain, and reduce<br />

stress within the field. Achieving these goals will<br />

necessitate significant support from the community<br />

and its leaders as we embark on the next phase <strong>of</strong><br />

our work.<br />

1<br />

https://archive.org/details/friendlyvisiting00richrich/page/n5/mode/2up<br />

2<br />

https://www.acf.hhs.gov/opre/project/assessing-evidence-home-visiting-evidence-effectiveness-2011-2020<br />

3<br />

https://www.ncearlyeducationcoalition.org/wp-content/uploads/2019/04/Availability-Fact-Sheet.pdf<br />

4<br />

https://nhvrc.org/yearbook/2022-yearbook/about-home-visiting/results/<br />

5<br />

https://www.childhealthdata.org/browse/survey/results?q=5451&g=646&r=1<br />

6<br />

https://www.march<strong>of</strong>dimes.org/find-support/topics/miscarriage-loss-grief/miscarriage#:~:text=For%20<br />

women%20who%20know%20they,12th%20week%20<strong>of</strong>%20pregnancy.<br />

7<br />

https://www.cdc.gov/nchs/pressroom/sosmap/infant_mortality_rates/infant_mortality.htm<br />

8, 9<br />

North Carolina State Center <strong>for</strong> Health Statistics. Statistics and Reports, Vital Statistics, Basic Automated Birth<br />

Yearbook 2021, Table 3<br />

10<br />

<strong>Mecklenburg</strong> <strong>County</strong>: Remaking a child welfare system. (Oct, 2021). The Annie E. Casey Foundation.<br />

11<br />

https://homvee.acf.hhs.gov<br />

12<br />

Martie Bennett, Omeika Dhanpaul, Angie Drake<strong>for</strong>d, Jake House, Devonya Govan-Hunt, Melody Gurganus,<br />

Veronica Kirkland, Zach Lewis, Pilar Perez, Katie Robinson, Sam Smith, Jennifer Stamp, Shakara Taylor, Amber<br />

Williams, and parents Darlyn Estrada and Chaivontre Ross.<br />

13<br />

National <strong>Home</strong> <strong>Visiting</strong> Resource Center. (2022). 2022 <strong>Home</strong> <strong>Visiting</strong> Yearbook. James Bell Associates and the<br />

Urban Institute.<br />

14<br />

North Carolina Early <strong>Home</strong> <strong>Visiting</strong> Landscape Analysis: Strengthening Systems to Support Families, 2018<br />

15<br />

YMCA Parents As Teachers, YMCA Greater Charlotte, Parent Child+, Safe Journey Parents As Teachers, Community<br />

In Schools, A Guided Journey, Care Ring in partnership with <strong>Mecklenburg</strong> <strong>County</strong> Health, Nurse-Family<br />

Partnership, Care Ring, Child First, Children’s <strong>Home</strong> Society, Early Head Start <strong>Home</strong> Based, Alliance Center <strong>for</strong><br />

Education<br />

16<br />

National Center <strong>for</strong> Health Statistics. (2018). Health, United States, 2018: with chartbook on trends in the<br />

health <strong>of</strong> Americans. Hyattsville, MD: US Dept. <strong>of</strong> Health and Human Resources. https://www.cdc.gov/nchs/data/<br />

hus/hus18.pdf<br />

https://cwoutcomes.acf.hhs.gov/cwodatasite/childrenReports/index<br />

17<br />

U.S. Department <strong>of</strong> Health and Human Services. (2005). Child welfare outcomes 2002: Annual report. Washington,<br />

DC: Administration <strong>for</strong> Children, Youth, and Families, Children’s Bureau.<br />

US Census Bureau. (2005). R0203, Percent <strong>of</strong> the total population who are American Indian and Alaska Native<br />

Alone: 2004. Washington, DC: Willeto, A. A. A. (2002, Dec.). Native American kids 2002: Indian children’s well-being<br />

indicators data book <strong>for</strong> 13 states. Portland, OR: National Indian Child Welfare Association<br />

15 16


APPENDICES<br />

SURVEY OF MECKLENBURG COUNTY<br />

HOME VISITING PROGRAMS<br />

Appendix 1: <strong>Home</strong> <strong>Visiting</strong> Program Inventory<br />

Appendix 2: <strong>Mecklenburg</strong> <strong>County</strong> Survey<br />

Appendix 3: A <strong>County</strong> System Graphs <strong>of</strong> <strong>Home</strong> <strong>Visiting</strong> Collaboration<br />

Appendix 4: <strong>County</strong> Mapping by Zip Code<br />

APPENDIX 1: <strong>Home</strong> <strong>Visiting</strong> Program Inventory<br />

MECKLENBURG COUNTY HOME VISITING PROGRAMS<br />

APPENDIX 2: <strong>Mecklenburg</strong> <strong>County</strong> Survey<br />

Thank you <strong>for</strong> participating in this survey as part <strong>of</strong> the <strong>Mecklenburg</strong> <strong>County</strong> Landscape Study <strong>of</strong> <strong>Home</strong> <strong>Visiting</strong>,<br />

administered by Smart Start <strong>of</strong> <strong>Mecklenburg</strong> <strong>County</strong>, developed by the Jordan Institute <strong>for</strong> Families in the School<br />

<strong>of</strong> Social Work at the University <strong>of</strong> North Carolina at Chapel Hill.<br />

If you have any questions please email us at: vkirkland@smartstart<strong>of</strong>meck.org<br />

The purpose <strong>of</strong> this survey is to:<br />

1) Develop an inventory <strong>of</strong> all <strong>of</strong> the home visiting programs in the county<br />

2) Better understand the families our programs service<br />

Please answer each question to the extent that you are able. We understand all programs are different and we<br />

want to capture the diversity <strong>of</strong> services in the continuum. You may want to have several people from your local<br />

organization work together to fill out this survey.<br />

Department <strong>of</strong><br />

Public Health -<br />

<strong>County</strong><br />

Community Health Worker’s<br />

Initiative<br />

• Care Ring-A Guided Journey<br />

Community-<br />

Led<br />

Organizations<br />

Child First<br />

• Children’s <strong>Home</strong> Society<br />

• Thompson’s Family Focus<br />

Tribal<br />

MIECHV<br />

(emerging)<br />

Nųti Yapę<br />

(Morning Sun)<br />

There are 3 “modules” <strong>for</strong> this survey that request in<strong>for</strong>mation regarding A) Program Administration, B) Service<br />

Delivery, and C) Service Population. Different types <strong>of</strong> in<strong>for</strong>mation and sources might be needed <strong>for</strong> each <strong>of</strong> the 3<br />

modules.<br />

A few terms that we want to define to clarify <strong>for</strong> this survey:<br />

<strong>Home</strong>-<strong>Visiting</strong> Program: a specific home-visiting program or model being delivered at the local level (such as<br />

Nurse-Family Partnership or Early Head Start-<strong>Home</strong> <strong>Visiting</strong>).<br />

Local Organization: the agency that houses and administers the home-visiting program such as a health department<br />

or local Smart Start. In some cases, the local organization is a home-visiting program affiliate.<br />

National Organization: An organization, in most cases outside North Carolina, which provides support and oversight<br />

regarding implementation <strong>of</strong> your home-visiting programs.<br />

This 45-minute survey is necessary and rarely collected. There<strong>for</strong>e, your knowledge and support are invaluable in<br />

developing an equitable evaluation <strong>of</strong> our home visiting expansion project.<br />

Early Intervention<br />

• Children’s Developmental<br />

Services Agency<br />

Early Head Start - <strong>Home</strong> Based<br />

• Alliance Center <strong>for</strong> Education<br />

We will provide this in<strong>for</strong>mation back to you in a final report. Our findings will describe the field <strong>of</strong> home visiting<br />

in <strong>Mecklenburg</strong> <strong>County</strong> and will not evaluate any specific program.<br />

Maternal Health<br />

• Care Management <strong>for</strong> At Risk<br />

Pregnancies<br />

• Care Management <strong>for</strong> At Risk<br />

Children<br />

Nurse-Family Partnership<br />

• Care Ring<br />

Parents As Teachers<br />

• Communities in Schools-<br />

Safe Journey<br />

• YMCA-YPAT<br />

We thank you <strong>for</strong> your time.<br />

Parent Child +<br />

• Charlotte Bilingual Preschool<br />

• Inlivian<br />

• Families First<br />

17 18


1. Contact In<strong>for</strong>mation<br />

First/Last Name_______________________________________<br />

Local Organization Name_____________________________<br />

Local Organization Address__________________________<br />

Email Address_________________________________________<br />

Phone Number________________________________________<br />

2. What is the role <strong>of</strong> the primary contact <strong>for</strong><br />

this survey?<br />

__ Executive Director<br />

__ Program Manager<br />

__ Data/Evaluation Lead<br />

__ Other (please specify)<br />

Module A:<br />

Program Administration<br />

3. Organization Type:<br />

__ Private For Pr<strong>of</strong>it<br />

__ Private Nonpr<strong>of</strong>it<br />

__ Government<br />

__ Other<br />

4. Please select all <strong>of</strong> the positions/groups that<br />

comprise your local organization’s structure:<br />

__ Board <strong>of</strong> Director Community Advisory<br />

__ Board<br />

__ Non-clinical Management Staff<br />

(e.g., Executive Director Administrator)<br />

__ Full-time <strong>Home</strong> Visitor<br />

__ Part-time <strong>Home</strong> Visitor <strong>Home</strong><br />

__ <strong>Visiting</strong> Supervisor<br />

__ Evaluation/Data Team<br />

__ In-house Clinical Consultant<br />

__ Other (please specify)<br />

5. What is the home visiting program model<br />

that your organization implements?<br />

__ Nurse Family Partnership<br />

__ Parents as Teachers<br />

__ Early Head Start <strong>Home</strong> Based<br />

__ Children First<br />

__ Parent Child +<br />

__ A Guided Journey<br />

__ Other (please specify)<br />

6. Currently, how many home visitor positions,<br />

both full-time and part-time, are employed on<br />

your staff? Do not count vacant positions, only<br />

those positions that are currently filled.<br />

Full-time home visitors_______________________________<br />

Part-time home visitors ______________________________<br />

Supervisors (full & part-time) ________________________<br />

7. With current level funding, how many home<br />

visitor positions both full-time and part-time,<br />

are needed to be fully staffed?<br />

Full-time home visitors_______________________________<br />

Part-time home visitors ______________________________<br />

Supervisors (full & part-time) ________________________<br />

8. What are the demographics <strong>of</strong> your<br />

program’s current home visiting staff<br />

(all home visitors and supervisors) in %<br />

percentages?<br />

Race<br />

White__________________________________________________<br />

Black or African American ___________________________<br />

Hispanic or Latino ____________________________________<br />

American Indian or Alaska Native ___________________<br />

Native Hawaiian or other Pacific Islander ___________<br />

Another Race _________________________________________<br />

9. What are the demographics <strong>of</strong> your<br />

program’s current home visiting staff<br />

(all home visitors and supervisors) in %<br />

percentages?<br />

Hispanic Ethnicity<br />

Hispanic ______________________________________________<br />

Non-Hispanic _________________________________________<br />

10. What are the demographics <strong>of</strong> your<br />

program’s current home visiting staff<br />

(all home visitors and supervisors) in %<br />

percentages?<br />

Gender Identity<br />

Female ________________________________________________<br />

Male __________________________________________________<br />

Transgender __________________________________________<br />

11. Percentage <strong>of</strong> home visitors who are able<br />

to speak only English in home visits?<br />

12. Percentage <strong>of</strong> home visitors who are able<br />

to speak only Spanish in home visits?<br />

13. Percentage <strong>of</strong> home visitors who are<br />

able to speak languages other than Spanish/<br />

English in home visits?<br />

The next set <strong>of</strong> questions are about the funding <strong>of</strong> your home visiting program.<br />

14. If you were asked to report it to your<br />

funder, what would be your best estimate <strong>of</strong><br />

your average cost per family to deliver your<br />

home visiting program as designed?<br />

15. How did you (or would you) determine this<br />

calculation (i.e. what factors or components<br />

are you including – staff time, overhead costs,<br />

materials, etc.)?<br />

__ Staff time<br />

__ Overhead<br />

__ Materials<br />

__ Other<br />

16. Approximately what percentage <strong>of</strong> funding<br />

is used <strong>for</strong> pr<strong>of</strong>essional development?<br />

17. What financial resources support your home-visiting program? For the past three years (2019,<br />

2020, 2021), estimate the percent <strong>of</strong> support your home visiting program receives from each<br />

funding source. Each column should add to 100%. On the next screen you will be asked to list<br />

private foundation or other sources.<br />

Federal Government State __________ __________ __________<br />

Government __________ __________ __________<br />

Local Government __________ __________ __________<br />

Billable services/Medicade __________ __________ __________<br />

Foundation Philanthropy __________ __________ __________<br />

Other __________ __________ __________<br />

2019 2020 2021<br />

19 20


18. Please list each Foundation/Philanthropy<br />

that supports your home visiting program.<br />

19. Please list others sources <strong>of</strong> funding.<br />

20. Does your local organization provide inkind<br />

support <strong>for</strong> your home visiting program?<br />

__ Yes<br />

__ No<br />

21. If Yes, what support does your local<br />

organization provide in-kind?<br />

23. For each organization you listed (by corresponding number above), please indicate the<br />

strength <strong>of</strong> the organizational relationship <strong>for</strong> Collaboration.<br />

1 = ‘weak single 2 = ‘moderate partnership, 3 = ‘strong partnership,<br />

issue partnership we have worked together they are a consistent<br />

requiring minimal contact’ on occasion, but inconsistently’ and reliable partner’<br />

24. For each organization you listed (by corresponding number above), please indicate the<br />

strength <strong>of</strong> the organizational relationship <strong>for</strong> Advocacy.<br />

1 = ‘weak single 2 = ‘moderate partnership, 3 = ‘strong partnership,<br />

issue partnership we have worked together they are a consistent<br />

requiring minimal contact’ on occasion, but inconsistently’ and reliable partner’<br />

We would like to know about partners you work with on collaboration and advocacy as an<br />

organization.<br />

Collaboration and advocacy partnerships can take many <strong>for</strong>ms, so think about what makes sense<br />

<strong>for</strong> your organization. For example, <strong>for</strong> “collaboration,” if you have written a grant to expand<br />

home visiting services in your system <strong>of</strong> care, who have you worked with as a partner? For<br />

“advocacy,” think about who you have worked with to advocate <strong>for</strong> home visiting funding at the<br />

local or state level. We will ask you to first list organizations you have been involved with in any<br />

way in the last year. Then, we will ask about the strength <strong>of</strong> that relationship.<br />

22. Please list the names <strong>of</strong> the specific<br />

organizations you have worked with in the last<br />

year <strong>for</strong> either “collaboration” or <strong>for</strong> “advocacy.”<br />

25. Does your organization currently<br />

anticipate any substantial future changes to<br />

service delivery in the next year regarding<br />

your home visiting program in the following<br />

areas?<br />

__ No<br />

__ Yes, Expanding service area<br />

__ Yes, Reducing service area<br />

__ Yes, Increasing enrollment capacity<br />

__ Yes, Decreasing enrollment capacity<br />

__ Other (please specify)<br />

Module B: Program Model Service Delivery<br />

26. Is your home visiting program currently<br />

accredited or certified by the relevant<br />

national organization?<br />

__ Yes<br />

__ No<br />

27. If Yes, who accredits/certifies your<br />

program?<br />

28. If Yes, what year was your program first<br />

accredited/certified?<br />

29. What curriculum is used in your home<br />

visiting program?<br />

30. What processes does your home visiting<br />

program use to monitor model fidelity?<br />

21 22


31. What are your program’s primary target<br />

outcomes? Check the top three (3).<br />

__ Preventing child abuse and/or foster care Infant/<br />

Toddler Mental<br />

__ Health<br />

__ Health & Nutrition<br />

__ Maternal Health School<br />

__ Readiness<br />

__ Healthy Family Functioning Family<br />

__ Economic Self-sufficiency<br />

__ Referrals to or coordination with other services<br />

__ Other<br />

32. Does your program utilize a <strong>for</strong>mal<br />

enrollment process <strong>for</strong> participants?<br />

__ Yes<br />

__ No<br />

33. If yes, what <strong>for</strong>mat is used: Select all that<br />

apply<br />

__ face-to-face encounter<br />

__ telephone<br />

__ online<br />

__ other<br />

38. Does your program utilize a case<br />

management system?<br />

__ Yes<br />

__ No<br />

39. If yes, please name<br />

40. Is this system a requirement from your<br />

national organization?<br />

__ Yes<br />

__ No<br />

41. If you do not use a case management<br />

system, how do your home visitors track case<br />

plans?<br />

42. How does your program report evaluation<br />

data?<br />

43. Please describe any outcome reporting<br />

that is currently required by your funders or<br />

other groups.<br />

Module B: Program Model Service Delivery<br />

The next set <strong>of</strong> questions are about staffing<br />

requirements and qualifications<br />

49. What is the typical starting salary range<br />

<strong>for</strong> your home visitors?<br />

50. What are the education requirements <strong>for</strong><br />

full-time home visitors employed at your local<br />

organization?<br />

51. Do you have a minimum level <strong>of</strong><br />

experience <strong>for</strong> full-time home visitors<br />

employed at your local organization?<br />

__ Yes<br />

__ No<br />

52. Are individual home visitors required to be<br />

certified or accredited to work in your home<br />

visiting program?<br />

__ Yes<br />

__ No<br />

56. Does your national organization <strong>of</strong>fer<br />

any additional training or pr<strong>of</strong>essional<br />

development <strong>for</strong> home visitors?<br />

__ Yes<br />

__ No<br />

57. Do home visitors in your program<br />

complete developmental screenings?<br />

__ Yes<br />

__ No<br />

58. What type <strong>of</strong> training is available locally?<br />

__ History <strong>of</strong> <strong>Home</strong> <strong>Visiting</strong> & Program Model<br />

Strengths Based Practice in <strong>Home</strong> <strong>Visiting</strong> Adult<br />

Mental Health/Perinatal Depression<br />

Understanding Family Systems<br />

__ Child Brain Development<br />

__ Cultural Competency & Implicit Bias Working w/<br />

Special Populations<br />

__ Maximizing Referrals & Community Resources<br />

Motivational Interviewing Developmental<br />

Screening<br />

__ Recognizing/Reporting Child Abuse and Neglect<br />

Infant/Child Mental Health & Attachment<br />

34. What is the time frame from the referral<br />

being received to initial contact?<br />

35. What is the typical client’s level <strong>of</strong> interest<br />

in home visiting services?<br />

Low High<br />

36. Does your program currently have a<br />

waitlist?<br />

__ Yes<br />

__ No<br />

37. About how many families are on the<br />

current waitlist, if applicable?<br />

44. What outcomes do you report and how<br />

<strong>of</strong>ten?<br />

45. Did the COVID pandemic impact the<br />

delivery <strong>of</strong> service? Intake or waitlist<br />

processes?<br />

__ Yes<br />

__ No<br />

46. If yes, how?<br />

47. If yes, are the changes made in service<br />

delivery permanent?<br />

48. If yes, are the changes approved by the<br />

national model?<br />

53. Please describe who accredits or certifies<br />

individual home visitors:<br />

54. Please describe the supervision<br />

requirements <strong>for</strong> home visitors in your<br />

program. (i.e., Hours per month <strong>for</strong><br />

individual, Hours per month <strong>for</strong> group, Direct<br />

observations <strong>of</strong> home visitors by supervisors,<br />

other)<br />

55. Does your local organization <strong>of</strong>fer any<br />

additional training beyond what may be<br />

provided by the program model?<br />

__ Yes<br />

__ No<br />

Module B: Program Model Service Delivery<br />

This next set <strong>of</strong> questions are about referrals<br />

and service partners<br />

59. Does your program participate in a<br />

centralized intake system? (e.g. NCCARE 360)<br />

__ Yes<br />

__ No<br />

60. If Yes, what is the <strong>for</strong>mat?<br />

61. If Yes, about what percent <strong>of</strong> all<br />

participants are identified through the<br />

centralized intake process in an average<br />

month?<br />

23 24


62. What recruitment strategies (other than<br />

referrals) are used by your program?<br />

63. What is the process <strong>for</strong> receiving a referral<br />

TO your home visiting program?<br />

64. Please list up to 10 primary referral<br />

sources TO your home visiting program. Then,<br />

what percent <strong>of</strong> referrals to your organization<br />

come from these sources (e.g. Clinic A<br />

provides 30% <strong>of</strong> our referrals)<br />

Module B: Program Model Service Delivery<br />

65. What is the process <strong>for</strong> receiving a referral<br />

FROM your home visiting program <strong>for</strong> other<br />

services?<br />

66. Who do you refer a family to after<br />

completion <strong>of</strong> your program?<br />

67. Please list up to 10 primary referral<br />

destinations FROM your organization.<br />

Then, what percent <strong>of</strong> referrals FROM your<br />

organization go to each destination?<br />

We want to know the local areas where programs provide services, so we are asking you to list<br />

the specific ZIP codes you serve. We will use this in<strong>for</strong>mation to create local service maps across<br />

the state. This will help us all better understand where more services are needed. We realize that<br />

you may not collect data at the ZIP code level, so please provide your best estimate based on the<br />

in<strong>for</strong>mation you do collect and your knowledge <strong>of</strong> your service area.<br />

68. What is the total number <strong>of</strong> families served?<br />

69. For each row, please select the:<br />

• the total number <strong>of</strong> families currently on your caseload in that ZIP code<br />

• the estimated maximum number <strong>of</strong> families that could be on your caseload in that ZIP code.<br />

• Add “Other” zip codes served in the Other box along with corresponding details.<br />

For example, if 28208 is in your service area, first determine how many total families are on your program’s caseload in<br />

28208. Then, give your best estimate <strong>of</strong> the maximum number <strong>of</strong> families you could have on your program’s caseload<br />

at one time given your current staffing and funding levels. So, if you are currently serving 10 families in 28208, but have<br />

capacity to serve 20 families in 28208 at one time, then you would respond: *28208 *10 *20<br />

Total # <strong>of</strong> Families Currently on Caseload Maximum # <strong>of</strong> families that Could be on Caseload<br />

28205 _____________________________________________ ______________________________________________________<br />

28206 _____________________________________________ ______________________________________________________<br />

28208 _____________________________________________ ______________________________________________________<br />

28210 _____________________________________________ ______________________________________________________<br />

28211 _____________________________________________ ______________________________________________________<br />

28212 _____________________________________________ ______________________________________________________<br />

28213 _____________________________________________ ______________________________________________________<br />

28215 _____________________________________________ ______________________________________________________<br />

28216 _____________________________________________ ______________________________________________________<br />

28217 _____________________________________________ ______________________________________________________<br />

Other _______________________________________________<br />

Module C. Target Population/Service<br />

Population<br />

This last set <strong>of</strong> questions is about the families<br />

served by your program.<br />

70. How familiar are you with other home<br />

visiting programs?<br />

__ Extremely familiar<br />

__ Very familiar<br />

__ Somewhat familiar<br />

__ Not so familiar<br />

__ Not at all familiar<br />

71. Who would you identify as your program’s<br />

primary target/priority populations?<br />

__ Low-income children and families<br />

__ Children with special needs/behavioral challenges<br />

__ Families that speak a language other than English<br />

__ Teen parents<br />

__ Families who receive governmental assistance<br />

__ Families with a history <strong>of</strong> chronic homelessness<br />

__ Families with a history <strong>of</strong> child abuse and neglect<br />

__ Families with a history <strong>of</strong> domestic violence<br />

__ Families with a history <strong>of</strong> substance use<br />

__ Mothers with maternal depression and other<br />

mental health concerns<br />

__ Other<br />

72. What is the eligibility criteria to receive<br />

home visiting services through your program?<br />

73. Are there exclusion criteria that would<br />

make someone ineligible <strong>for</strong> services? If yes,<br />

please explain<br />

74. What are the demographics <strong>of</strong> your<br />

current program’s participants in %<br />

percentages across all categories?<br />

Race<br />

White__________________________________________________<br />

Black or African American ___________________________<br />

Hispanic or Latino ____________________________________<br />

American Indian or Alaska Native ___________________<br />

Native Hawaiian or other Pacific Islander ___________<br />

Another Race _________________________________________<br />

75. What are the demographics <strong>of</strong> your<br />

program’s current current program’s<br />

participants in?<br />

% percentages across all categories? Hispanic<br />

Hispanic Ethnicity<br />

Hispanic ______________________________________________<br />

Non-Hispanic _________________________________________<br />

76. What are the demographics <strong>of</strong> your<br />

program’s current current program’s<br />

participants in<br />

% percentages across all categories? Gender Identity<br />

Gender Identity<br />

Female ________________________________________________<br />

Male __________________________________________________<br />

Transgender __________________________________________<br />

77. Percentage <strong>of</strong> program participants who<br />

are able to speak only English in home visits?<br />

78. Percentage <strong>of</strong> program participants who<br />

are able to speak only Spanish in home visits?<br />

79. Percentage <strong>of</strong> program participants who<br />

speak languages other than Spanish/English in<br />

the home?<br />

80. Percentage <strong>of</strong> program participants who<br />

are Medicaid-Eligible?<br />

81. Does your program model include a<br />

<strong>for</strong>mal parent/participant advisory group or<br />

committee?<br />

__ Yes<br />

__ No<br />

82. If no, what opportunities exist <strong>for</strong> parents<br />

to influence program implementation and<br />

development?<br />

83. What is your metric <strong>for</strong> counting the<br />

population served (e.g. child, family, or<br />

individual)?<br />

25 26


84. If your home-visiting program had<br />

expanded funding and additional staff to<br />

serve all qualified families in your service<br />

area, how many families would you expect to<br />

serve annually?<br />

SURVEY RESPONSES SECTION<br />

CATEGORICAL VARIABLE RESPONSES<br />

85. Of the families who left the program last<br />

year, what percent “completed” the program,<br />

based on whatever program standard you use<br />

to indicate “completion” or “graduation”?<br />

86. What strategies exist to promote<br />

continued participation in your program?<br />

87. Please provide a summary estimate <strong>of</strong> the<br />

total number <strong>of</strong> actual home visits provided<br />

by your organization in calendar year 2021<br />

This is the total aggregate number <strong>of</strong> home<br />

visits across all families and all home visitors.<br />

Feedback/End <strong>of</strong> Survey<br />

This is the end <strong>of</strong> the survey, please use<br />

the following space to fill in any additional<br />

in<strong>for</strong>mation that you think is important <strong>for</strong><br />

us to understand about your home visiting<br />

program, or the field <strong>of</strong> home visiting in<br />

<strong>Mecklenburg</strong> <strong>County</strong>.<br />

88. Feedback & Comments<br />

What is the home visiting model that your organization implements?<br />

Other (please specify)<br />

A Guided Journey<br />

Parent Child +<br />

Child First<br />

Early Head Start <strong>Home</strong> Based<br />

Parents as Teachers<br />

Nurse Family Partnership<br />

0<br />

0.5 1 1.5 2 2.5<br />

Other = NC Infant Toddler Program; Care Management with Medicaid Prepaid Health Plans (PHPs) through Local<br />

Health Department Suggested language summarizing finding.<br />

Other (please specify)<br />

Yes, Decreasing enrolment capacity<br />

Yes, Increasing enrolment capacity<br />

Yes, Reducing service area<br />

Yes, Expanding service area<br />

Future changes to service delivery in the next year<br />

No<br />

0 1 2 3 4 5 6<br />

Other = Creating new team <strong>for</strong> mental health services <strong>for</strong> children not eligible (ARPA funded); Enrollment Capacity<br />

and Expanding Service Area<br />

What are your program’s top three primary target outcomes?<br />

Referrals to or coordination with other services<br />

Family economic self-sufficiency<br />

Healthy family functioning<br />

School readiness<br />

Maternal health<br />

Health & nutrition<br />

Infant/toddler mental health<br />

Preventing child abuse and/or toddler care<br />

0 1 2 3 4 5<br />

27 28


9<br />

8<br />

7<br />

6<br />

5<br />

4<br />

3<br />

2<br />

1<br />

0<br />

Face-to-face<br />

Does your program currently have a waitlist?<br />

What ways can families enroll?<br />

Telephone Online Other<br />

Did the COVID pandemic impact the delivery<br />

<strong>of</strong> service, intake or waitlist process?<br />

Recognizing/Reporting Child Abuse and Neglect Infant/<br />

Child Mental Health & Attachment<br />

What type <strong>of</strong> training is available locally?<br />

Developmental Screening<br />

Maximizing Referrals & Community Resources<br />

Motivational Interviewing<br />

Working w/ Special Populations<br />

Cultural Competency & Implicit Bias<br />

Child Brain Development<br />

History <strong>of</strong> <strong>Home</strong> <strong>Visiting</strong> & Program Model<br />

Strengths Based Practice in <strong>Home</strong> <strong>Visiting</strong><br />

Adult Mental Health/Perinatal Depression<br />

Understanding Family Systems<br />

0 1 2 3 4 5 6 7 8 9<br />

6<br />

9<br />

5<br />

8<br />

7<br />

Do home visitors in your program complete<br />

developmental screenings?<br />

Does your program participate in centralized<br />

intake system? (e.g. NCCARE 360)<br />

4<br />

6<br />

9<br />

6<br />

3<br />

5<br />

4<br />

8<br />

7<br />

5<br />

2<br />

3<br />

6<br />

4<br />

1<br />

2<br />

1<br />

5<br />

4<br />

3<br />

0<br />

Yes<br />

No<br />

0<br />

Yes<br />

No<br />

3<br />

2<br />

1<br />

2<br />

1<br />

Do you have a minimum level <strong>of</strong> experience<br />

<strong>for</strong> full-time home visitors employed at your<br />

local organization?<br />

8<br />

Are individual home visitors required to be<br />

certified or accredited to work in your<br />

home visiting program?<br />

8<br />

Yes<br />

No<br />

0<br />

Yes<br />

No<br />

If Yes, what % <strong>of</strong> participants are identified through<br />

centralized intake: “we don’t get referrals through<br />

NCCARE360 so far”; “Less than 5%”; “10%”<br />

7<br />

7<br />

How familiar are you with other home visiting programs?<br />

6<br />

5<br />

6<br />

5<br />

6<br />

5<br />

4<br />

4<br />

4<br />

3<br />

3<br />

3<br />

2<br />

2<br />

2<br />

1<br />

1<br />

1<br />

0<br />

0<br />

Yes<br />

No<br />

Yes<br />

No<br />

0<br />

Not at all familiar Not so familiar Somewhat familiar Very familiar Extremely familiar<br />

29 30


Who would you identify as your program’s primary target/priority populations?<br />

CONTINUOUS VARIABLE<br />

RESPONSES<br />

1. Currently, how many home visitor positions<br />

(full-time, part-time, and supervisors) are<br />

employed on your staff?<br />

N = 9<br />

Range = 4 to 92<br />

Average = 23<br />

Sum Total = 206; 173 home visitors and 33<br />

supervisors<br />

2. With current level funding, how many<br />

additional home visitor positions (full-time,<br />

part-time, and supervisors) are needed to be<br />

fully staffed?<br />

N = 9<br />

Range = 0 to 25<br />

Average = 5.2<br />

Sum Total = 47; 34 home visitors and 13 supervisors<br />

3. What is the time frame from the referral<br />

being received to initial contact?<br />

N = 8<br />

Range = 1 to 7 days<br />

Average = 3 days<br />

Low-income children and families<br />

Children with special needs/behavioral challenges<br />

Families that speak a language other than English<br />

Does your program model include<br />

a <strong>for</strong>mal parent/participant advisory<br />

group or committee?<br />

Teen parents<br />

Families who receive governmental assistance<br />

Families with a history <strong>of</strong> chronic homelessness<br />

Families with a history <strong>of</strong> child abuse and neglect<br />

Families with a history <strong>of</strong> domestic violence<br />

Families with a history <strong>of</strong> substance abuse<br />

Mothers with maternal depression and other mental health concerns<br />

Other<br />

7<br />

6<br />

5<br />

4<br />

3<br />

2<br />

1<br />

0<br />

0 1 2 3 4 5 6<br />

Yes<br />

4. What is the typical client’s level <strong>of</strong> interest<br />

in home visiting services (0 Low to 100 High)?<br />

N = 9<br />

Range = 50 to 93<br />

Average = 75<br />

5. About how many families are on the current<br />

waitlist, if applicable?<br />

N = 6<br />

One program (EI) not legally allowed to have a<br />

waitlist<br />

Range = 0 to 130<br />

Average = 33<br />

6. What is the typical starting salary range <strong>for</strong><br />

your home visitors?<br />

N = 9<br />

Range = $31,200 to $65,000<br />

Average = $47,000<br />

No<br />

7. What are the demographics <strong>of</strong> your current home visiting staff? (Race/Ethnicity)<br />

N = 0<br />

White Range = 0% to 55%<br />

White Average = 16%<br />

Black Range = 25% to 75%<br />

Black Average = 46%<br />

Asian Range = 0% to 15%<br />

Asian Average = 2%<br />

50%<br />

45%<br />

40%<br />

35%<br />

30%<br />

25%<br />

20%<br />

15%<br />

10%<br />

5%<br />

0%<br />

White<br />

N = 8<br />

White Range = 0% to 25%<br />

White Average = 9%<br />

Black Range = 10% to 55%<br />

Black Average = 36%<br />

Asian Range = 0% to 5%<br />

Asian Average = 1%<br />

Black or<br />

African American<br />

Hispanic or<br />

Latino<br />

Asian or<br />

Asian American<br />

American Indian Range = 0% to 15%<br />

American Indian Average = 2%<br />

Other Race Range = 0% to 15%<br />

Other Race Average = 4%<br />

Hispanic/Latino Range = 0% to 70%<br />

Hispanic/Latino Average = 33%<br />

American Indian<br />

or Alaska native<br />

Native Hawaiian<br />

or other<br />

Pacific Islander<br />

8. What are the demographics <strong>of</strong> your current program’s participants? (Race/Ethnicity)<br />

0%<br />

White<br />

Black or<br />

African American<br />

Hispanic or<br />

Latino<br />

Asian or<br />

Asian American<br />

American Indian Range = 0% to 1%<br />

American Indian Average = 0%<br />

Other Race Range = 0% to 55%<br />

Other Race Average = 36%<br />

Hispanic/Latino Range = 20% to 85%<br />

Hispanic/Latino Average = 49%<br />

American Indian<br />

or Alaska native<br />

Native Hawaiian<br />

or other<br />

Pacific Islander<br />

31 32<br />

60%<br />

50%<br />

40%<br />

30%<br />

20%<br />

10%<br />

Another race<br />

Another race


45%<br />

9. What are the demographics <strong>of</strong> your home<br />

visitors? (Gender)<br />

N = 9<br />

Female Range = 95% to 100%<br />

Female Average = 99%<br />

10. What are the demographics <strong>of</strong> your<br />

current program’s participants? (Gender)<br />

N = 9<br />

Female Range = 40% to 100%<br />

Female Average = 78%<br />

16. Total number <strong>of</strong> actual home visits<br />

provided by your organization in calendar<br />

year 2021<br />

N = 7<br />

Range = 200 to 30,381<br />

Average = 7,838<br />

Sum Total = 54,871 (55% <strong>of</strong> these are EI program)<br />

40%<br />

17. Funding Source<br />

35%<br />

N = 8<br />

Federal 30%<br />

3-year Average = 13%<br />

25%<br />

Range = 0 to 100%<br />

State<br />

20%<br />

3-year Average = 34%<br />

Range 15% = 0 to 100%<br />

Local<br />

3-year 10% Average = 13%<br />

Range = 0 to 100%<br />

5%<br />

Billable<br />

3-year Average = 2%<br />

Range = 0 to 15%<br />

Foundation<br />

3-year Average = 15%<br />

Range = 0 to 80%<br />

Other<br />

3-year Average = 6%<br />

Range = 0 to 20%<br />

11. <strong>Home</strong> visitors language in home visits<br />

N = 9<br />

English only Range = 10% to 100%<br />

English only Average = 65%<br />

Spanish only Range = 0% to 50%<br />

Spanish only Average = 16%<br />

Other language Range = 0% to 25%<br />

Other language Average = 7%<br />

12. Participants language in home visits<br />

N = 8<br />

English only Range = 15% to 93%<br />

English only Average = 54%<br />

Spanish only Range = 7% to 85%<br />

Spanish only Average = 40%<br />

Other language Range = 0% to 10%<br />

Other language Average = 2%<br />

13. Participants who are Medicaid Eligible<br />

Participants language in home visits<br />

0%<br />

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18<br />

2% 2%<br />

9% 9%<br />

14%<br />

15%<br />

9%<br />

2019 2020<br />

41%<br />

13%<br />

31%<br />

13%<br />

2%<br />

5%<br />

N = 7<br />

Range = 60% to 100%<br />

Average = 83%<br />

14. Participants who “completed” the program<br />

N = 5;<br />

some programs do not have a “completion” standard<br />

Range = 30% to 92%<br />

Average = 65%<br />

15. Total number <strong>of</strong> families served in<br />

calendar year 2021<br />

N = 9<br />

Range = 10 to 3,800<br />

Average = 714<br />

Sum Total = 6,430 (59% <strong>of</strong> these are EI program)<br />

Federal<br />

State<br />

Local<br />

Billable<br />

Foundation<br />

Other<br />

24%<br />

2021<br />

31%<br />

14%<br />

6%<br />

13%<br />

33 34


APPENDIX 3: A <strong>County</strong> System Graphs <strong>of</strong> <strong>Home</strong> <strong>Visiting</strong> Collaboration<br />

Appendix 4: <strong>County</strong> Mapping by Zip Code<br />

<strong>County</strong> Mapping by Zip Code <strong>for</strong> Intensive Based <strong>Home</strong> <strong>Visiting</strong><br />

WellCare<br />

Charlotte<br />

Center<br />

<strong>for</strong> Legal<br />

Advocacy<br />

Mira Vida<br />

Center<br />

<strong>for</strong> Community<br />

Alignment<br />

4<br />

6<br />

4<br />

Guided Journey<br />

5<br />

Central<br />

United Methodist Latin American<br />

Alianza<br />

Church<br />

Coalition<br />

-Prevention<br />

Services<br />

Enlace<br />

-Latin American<br />

Council<br />

4 5<br />

4<br />

4<br />

6<br />

5<br />

Charlotte<br />

Public<br />

Library<br />

Charlotte<br />

Bilingual<br />

Preschool<br />

6<br />

5<br />

Parent Child+<br />

Inlivian<br />

6<br />

Families First<br />

5<br />

Girl Scouts<br />

3<br />

YMCA<br />

Parents As<br />

Teachers<br />

5<br />

Elevation Church<br />

CIS -Safe Journey<br />

Parents As<br />

Teachers<br />

4<br />

4<br />

Bright Blessings<br />

6<br />

Beds For Kids<br />

6<br />

4<br />

6<br />

Care Ring<br />

Nurse Family<br />

Partnership<br />

Baby Bundles<br />

6<br />

Meck <strong>County</strong><br />

Health<br />

Department<br />

<strong>Home</strong> <strong>Visiting</strong><br />

6<br />

6<br />

Charlotte<br />

<strong>Mecklenburg</strong><br />

Schools<br />

6<br />

Novant<br />

4<br />

4<br />

Zfive<br />

6<br />

5<br />

Meck <strong>County</strong><br />

Children's<br />

Developmental<br />

Services Agency<br />

5<br />

6<br />

5<br />

4<br />

6<br />

YFS<br />

6<br />

CMARC<br />

Local<br />

Pediatricians<br />

Charlotte<br />

Speach and<br />

Hearing<br />

6<br />

6<br />

Alliance Center<br />

<strong>for</strong> Education-<br />

Early Head Start<br />

<strong>Home</strong> Based<br />

Milestone<br />

Therapy<br />

Central<br />

Piedmont<br />

6<br />

Community<br />

College<br />

6<br />

Dancing Badger<br />

Legend<br />

Opposite<br />

Community Org.<br />

<strong>Home</strong> <strong>Visiting</strong><br />

Health/MH<br />

Government<br />

Higher Education<br />

Early Ed/Schools<br />

Faith-Based<br />

Other<br />

Safe Kids<br />

School Health<br />

MCHD<br />

6<br />

Atrium<br />

6<br />

6<br />

Children's<br />

ICO4MCH<br />

<strong>Home</strong> Society<br />

Child First<br />

6<br />

6<br />

Child First<br />

NC State<br />

National Service<br />

Legislature<br />

Office<br />

Care<br />

Management<br />

For At-Risk<br />

Children<br />

(CMARC)<br />

Smart Start<br />

Center <strong>for</strong><br />

Child and<br />

Family Health<br />

<strong>County</strong> Mapping by Zip Code w/ Early Intervention Services & Intensive <strong>Home</strong> <strong>Visiting</strong> programs<br />

Surveyors were asked to list all Collaborative and Advocacy partnerships. The map depicts by arrows, the<br />

partnerships and strength <strong>of</strong> each partnership.<br />

• Local <strong>Home</strong> <strong>Visiting</strong> programs are depicted as Red circles<br />

• Refer to key <strong>for</strong> other program types<br />

• Referring relationships are depicted as one-directional or bi-directional arrows; the numbers assigned to<br />

each line depict the strength <strong>of</strong> the relationship from 1-6, with 6 being a strong relationship.<br />

Concluding analysis:<br />

<strong>Home</strong> <strong>Visiting</strong> programs have weak connections to one another; displaying a highly siloed network<br />

Relationships show that there are numerous resources, however are scattered and/or underutilized by home<br />

visiting programs as supports.<br />

35 36


www.smartstart<strong>of</strong>meck.org<br />

info@smartstart<strong>of</strong>meck.org

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