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

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

TABLE OF CONTENTS
Acknowledgements. ............................1
Introduction. ....................................2
Why Charlotte-Mecklenburg Would Benefit
from Expanded Home Visiting ................. 3
Why Smart Start?. ...............................4
The Landscape Analysis. ........................5
Research Methods ..............................5
Home Visiting Collaborative. ...................6
Group Model Building Sessions. ................7
Group Model Building Findings. ................8
Themes. ....................................... 10
2022 Mecklenburg County
Home-Visiting Survey. ........................ 11
Catawba Nation Home-Visiting Program. .... 12
Recommendations ............................ 13
Conclusion .................................... 15
Endnotes for Landscape Study. ............... 16
Appendices. ................................... 17
Appendix 1 .................................... 18
Appendix 2 .................................... 28
Appendix 3 .................................... 35
Appendix 4 .................................... 36

ACKNOWLEDGEMENTS
INTRODUCTION
Smart Start of Mecklenburg County (SSMC) would like to thank the
many individuals who provided their time, energy, attention, and
expertise to this project. The Home Visiting of Mecklenburg County
Landscape Analysis is a collaborative effort and demonstrates the
considerable interest on the part of many stakeholders in advancing
home-visiting support for families in our community.
We especially would like to thank the participants of the two-day,
group model-building session, which included practitioners, families,
policymakers, and community members dedicated to the work
of expanding home-visiting services. Thanks to Martie Bennett,
Omeika Dhanpaul, Angie Drakeford, Jake House, Dr. Devonya
Govan-Hunt, Melody Gurganus, Veronica Kirkland, Zach Lewis,
Pilar Perez, Katie Robinson, Sam Smith, Jennifer Stamp, Shakara
Taylor, and Amber Williams; and a huge thanks to our parent
participants, Darlyn Estrada and Chaivontre Ross.
We also want to give special recognition to Dr. Paul Lanier, Ph.D.,
Professor in the School of Social Work at the University of North
Carolina-Chapel Hill and Associate Director of the Jordan Institute
for Families, who assisted with the research and data analysis.
In Charlotte-Mecklenburg, we’re fortunate to have several highly
qualified organizations providing home-visiting services. Smart Start
of Mecklenburg County would like to sincerely thank the leaders of
these programs for their support and commitment to informing our
work, enhancing relationships, and completing a first-ever, extensive
survey of home-visiting programs. They are truly dedicated to
transforming the landscape of early-childhood home visiting by
developing and implementing strategies to scale-up services and
programs to serve more local parents, caregivers, and families. They
include the following:
• Angie Drakeford, Parent Child+
• Candance Hammonds and Trent Staton, Children’s Home Society,
Child First
• Hilary Harris, Catawba Nation, Tribal MIECHV
• Lisa Cloninger, Children’s Developmental Services Agency
• Lisa Sammons and Sybil Franklin, Mecklenburg County Maternal
Health Department
• Martiese Miller, Alliance Center for Education
• Omeika Dhanpaul, Care Ring, A Guided Journey
• Pilar Perez, YPAT, Parents As Teachers
• Piper Yerger and Nenneh Springs, Care Ring, Nurse Family
Partnership
• Quadisha Juarez, Thompson Family Focus, Child First
• Steffanie Lewis and Katie Vinson, Safe Journey, Parents As
Teachers
is a nationally recognized early-childhood
education initiative to expand and
improve services for children ages birth
to 5 and their families. Smart Start was
established in 1993 as a statewide,
nonprofit, public-private partnership to
help all North Carolina children enter
school healthy and ready to succeed.
Together the Smart Start network of 75
local partnerships serve all 100 counties
in North Carolina by funding programs to
the tune of $145 million each year.
Smart Start of Mecklenburg County
(SSMC) is the largest of the 75 local
partnerships. SSMC invests time and
money in local, evidence-based and
evidence-informed initiatives to improve
early care and education, family support,
health, and literacy. The experiences a
child has during the first 2,000 days—
from birth to kindergarten—have been
shown to have an impact throughout life.
SSMC has played a pivotal role in
supporting early-childhood initiatives
in our community, effectively managing
funds totaling nearly $40 million. This
includes the successful operation of
the nationally acclaimed universal
preschool program, MECK Pre-K. And,
as an incubator for groundbreaking and
forward-thinking concepts in earlychildhood
health and education, SSMC
has allocated over $700,000 in the last
two years through Innovation Grants
awarded to local nonprofits.
SSMC also serves as a hub for research
and collaboration. We organize and
host platforms to share information,
initiate discussion, and generate
support and action to promote and
align a comprehensive early-childhood
system. We also partner with other
early-childhood organizations to
provide advocacy and collaborative
opportunities. Our goal, simply stated, is
to ensure all children turn 5 ready
to thrive.
Early-childhood home visiting dates to the late
nineteenth century, when churches and private
philanthropies sent “friendly visitors” to engage
in “charitable work in the homes of the poor.” In a
handbook published in 1903, Mary E. Richmond writes,
“In dealing with the homemaker, the friendly visitor
becomes more directly a teacher, though it is often
necessary that she should first be a learner.” 1
As can be expected for the times in which it was
published, the handbook is rife with condescension.
Yet it illustrates a universal truth: Nearly all new and
expectant parents, no matter their socioeconomic
status, are better off not going it alone. Or, as Hillary
Clinton famously said, “It takes a village to raise a
child.” Early childhood is the period of their lives when
children are most vulnerable and, it can be argued,
when parents get their most gray hair.
If it takes a village, then home visiting is a crucial part of
the ecosystem.
Early-childhood home visiting, for the purpose of
this study, 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.
Within this broad definition, two large sub-categories
of home-visiting programs emerge: universal home
visiting-designed to serve all families with young
children regardless of risk factors or circumstances,
and targeted home visiting- specifically designed to
serve families with identified risk factors or challenges
that may impact their child’s development or wellbeing.
Home visiting programs are also recognized by
their evidence of effectiveness 2 , which demonstrate
long-term improved outcomes including increased
positive parenting, more responsive caregiver
interactions, increased parental knowledge of child
development, stronger parent-child bonds, and fewer
negative and stress reactions. 3
That said, the theoretical foundations of home-visiting
models are very similar. The common threads of home
visiting are prenatal and preventative care, promoting
secure parent-child attachments, and fostering
developmentally appropriate practices through
coaching—ultimately supporting parents’ role as their
children’s first and most important teachers. Whether
this coaching is provided by a registered nurse, a
health-care navigator, or some other type of parent
educator, what remains consistent between models
is the supportive relationship developed between the
home visitor and the family by tailoring services to the
unique needs of each family.
Early-childhood home visiting is particularly important
for families living in communities experiencing
inequities in health care, education, and economic
mobility. These disparities demonstrate the need for
proactive solutions that bridge gaps and dismantle
barriers to accessing maternal and child health care,
and other resources for family well-being.
Early-childhood home visiting answers this through
its versatility of programming which meets the unique
needs of families.
1 2

WHY CHARLOTTE-MECKLENBURG WOULD BENEFIT
FROM EXPANDED HOME VISITING
WHY SMART START?
Home visiting has a proven, positive impact on prenatal health and birth outcomes. It provides services to help
families thrive and give babies a healthy start. And research has shown that home-visiting programs yield a
return on investment of $1.75 to $5.70 for every dollar spent on other early childhood interventions. 4 Beyond
dollars and cents, we have an obligation to provide equitable health care in our community, which is a key
ingredient to upward economic mobility.
Maternal and infant mortality rates
Six out of 1,000 babies in the U.S. die before their first birthday,
most often due to unintentional injury. 5 And many infants are at risk
before they’ve even entered the world. 6 In North Carolina, infant
and maternal mortality rates are two to three times higher for Black
babies and pregnant women 7 . While 80% of White pregnant women
receive prenatal care within the first trimester of pregnancy, only
69% of Black pregnant women and 57% of Hispanic pregnant women
receive health care during pregnancy. 8 More alarming, little to no
data points on maternal and infant mortality rates are available for
indigenous communities in North Carolina.
Studies have found a
return on investment of
$1.80 to $5.70
for every dollar spent on
home visiting
Mecklenburg County is fortunate to have a strong
ecosystem of early-childhood service providers
and supporters. To tackle upward mobility in the
region, county leadership formed an Early-Childhood
Executive Committee (ECEC) to address inequity at its
earliest stage.
Providing access to high-quality public preschool
became a focal point, after five years of operation,
even after navigating the challenges of the Covid-19
pandemic, that same dedication and commitment led
to the next phase of work for the ECEC. In 2021, the
committee was relaunched under the leadership of
the county manager and the CEO of Smart Start of
Mecklenburg County (SSMC), this time with the goal of
improving the system of care for families from prenatal
to age 3, narrowing the work to three policy areas:
1. Healthy and equitable births
2. Optimal child health and development
3. Parental health and emotional well-being
In 2022, in the Landscape Study of Prenatal-Age 3
Services & Supports in Mecklenburg County, which
was commissioned by SSMC, stakeholders identified
the need to strengthen efforts at outreach and access
to quality services as one of their recommendations.
Increasing home-visiting services was identified as a
pathway to achieve this recommendation.
Disparities in birth outcomes
In Mecklenburg County 1 in 10 births are premature (less than
37 weeks gestational age) and low birth weight (less than 2500g).
Pregnant women of color are experiencing significant health
inequities in these birth outcomes. Of 15,061 total births in 2021,
15% of Black babies and 9% of Hispanic babies were low birthweight.
Only 5% of White babies were low birthweight. 9 Adverse health
complications such as impaired development, infections, and death
are a result of these disparities.
Child maltreatment
Child maltreatment is another area that disproportionately impacts
children of color. Although Black youth make up only 33% of
Mecklenburg County’s general population, 50% of youth entering
Youth and Family Services custody are children of color. 10 Black
families often face systemic barriers in accessing health care,
affordable housing, stable employment, and other economic drivers
of health.
Out of 15,061 total
births in 2021,
15% of Black babies and
9% of Hispanic babies were
low birthweight
Managing nearly $40 million in funds to assist early-childhood initiatives in our community, including the
nationally recognized universal preschool program, MECK Pre-K, SSMC, is currently a primary funding source for
three home-visiting models in our community:
Parents as Teachers: Nurse-Family Partnership: Child First:
Home visiting and parenting education can help eliminate racial
disparities in the health and well-being of children and families.
These programs have proven to be highly effective and
will continue to be a priority focus of SSMC’s funding.
However, these programs represent only three of 21
home-visiting models which meet U.S. Department
of Health and Human Services (HHS) criteria for an
evidenced-based delivery model for early-childhood
home visiting. Our community has both the capacity
and need to make additional home-visiting programs
available to children and families. Thanks to a
generous $342,500 American Rescue Plan Act grant
from Mecklenburg County, SSMC has embarked on a
journey to raise the profile of home visiting. Therefore,
our first step was to complete a landscape study with
the intention of evaluating and expanding home visiting
in Mecklenburg County.
3 4

THE LANDSCAPE ANALYSIS
HOME VISITING COLLABORATIVE
Initially, our research focused on HHS-approved
models that demonstrated evidence of effectiveness. 11
However, recognizing the importance of equity,
we decided to adopt a more inclusive approach to
conducting an equitable landscape analysis. Our
goal was to identify ways to enhance and improve
service accessibility for families in Mecklenburg
County, which is geographically expansive. Through
our discovery process, we brought together various
models, including evidence-based/early intervention
(EB/EI) models, promising EB/EI models, and programs
utilizing different variations of home-based delivery
services.
Universal screening strategies and approaches
are widely discussed both locally and nationally.
As previously discussed, universal home-visiting
approaches aim to provide services to all newborns
and their families, regardless of their risk factors or
circumstances. Alternatively, targeted approaches in
home visiting are more commonly known. They focus
on prevention strategies for families with identified
risk factors or challenges that may affect their child’s
development or well-being.
Both program types are crucial for adapting to the
changing landscape of Mecklenburg County, especially
given the county’s diverse and growing population,
the urgent matter of maternal- and infant-health
disparities, and the recovery challenges posed by the
Covid-19 pandemic. Throughout our conversations
with parents, they emphasized the importance of
programming that genuinely meets their family’s
needs. They also expressed a strong desire for a unified
access point where service providers communicate
effectively with one another, thereby avoiding
situations where families are referred to programs
that don’t meet their needs.
Increasing home-visiting services was recognized as a pathway to achieve one of the recommendations in the
Prenatal-to-Age-3 landscape study referenced above. Stakeholders identified the need to strengthen outreach
and increase access to quality services. SSMC convened local home-visiting programs and in the process
identified several organizations providing home visiting, including community agencies, various departments of
Mecklenburg County, and an emerging program for indigenous families.
MECKLENBURG COUNTY HOME VISITING PROGRAMS
Department of
Public Health -
County
Community-
Led
Organizations
Tribal
MIECHV
(emerging)
Community Health Worker’s
Initiative
• Care Ring-A Guided Journey
Child First
• Children’s Home Society
• Thompson’s Family Focus
Nųti Yapę
(Morning Sun)
This study, Home Visiting of Mecklenburg County
Landscape Analysis: Opportunities for Growth, Expansion,
& Building Infrastructure, was modeled on the methods
used in the 2018 seminal report, North Carolina Early
Home Visiting Landscape Analysis: Strengthening Systems
to Support Families, published by Dr. Paul Lanier,
Ph.D., Professor in the School of Social Work at the
University of North Carolina-Chapel Hill and Associate
Director of the Jordan Institute for Families.
Building upon the state research study, SSMC’s
landscape analysis is comprised of several
components, including group model-building, an online
survey conducted among local organizations that
provide home-visiting services, and input from the
Home Visiting Collaborative.
RESEARCH METHODS
Early Intervention
• Children’s Developmental
Services Agency
Maternal Health
• Care Management for At Risk
Pregnancies
• Care Management for At Risk
Children
Early Head Start - Home Based
• Alliance Center for Education
Nurse-Family Partnership
• Care Ring
Parents As Teachers
• Communities in Schools-
Safe Journey
• YMCA-YPAT
Parent Child +
• Charlotte Bilingual Preschool
• Inlivian
• Families First
5 6

GROUP MODEL BUILDING SESSIONS
GROUP MODEL BUILDING FINDINGS
In November 2022, SSMC hosted two participatory
group model-building (GMB) sessions attended by
16 participants. 12 Dr. Lanier and his team from the
Jordan Institute for Families led the sessions. GMB is
a systems-thinking approach that seeks to develop a
shared understanding of a complex system and build
consensus around priorities for improvement.
The purpose of the sessions was to develop a
common understanding of the current home-visiting
system, identify action steps to increase access for
families, and include stakeholders in the formation
of recommendations. The sessions also helped
participants build systems-thinking skills.
During the first session, participants were oriented
to the approach of systems thinking and GMB
overall as a participatory-change strategy. Next,
participants discussed the landscape of home visiting
in Mecklenburg County. Dr. Lanier and his team
presented data on statewide longitudinal service
trends and how trends in North Carolina are similar to
and different from Mecklenburg County. The statewide
trends suggest that while the number of families and
children who could benefit from services mostly stayed
the same over time, the number of families and children
who actually received services had been steadily
decreasing since 2018. 13
The research team from the Jordan Institute developed
a home-visiting system map for Mecklenburg County
using data from the 2018 statewide landscape study. 14
Agencies were asked to report on collaborations and
referrals made and received by local agencies.
Housing Support
Medicaid
Charitable
Services (e.g.
Crisis Assistance
Ministries)
Bright Blessings
Nurses
As illustrated in Figure 2, a heavily interwoven system
of agency-to-agency connections exists. Four homevisiting
programs, shown in orange, were connected
through some common agencies, but in general the
four programs operated in separate and distinct
subnetworks with no connection to one another.
Primary Care
Clinics
Dept of Social
Services
800,000
700,000
600,000
500,000
# of Children Who Could Benefit
600,000
500,000
400,000
# of Families Who Could Benefit
Reach Out and
Read
Relationship
Counseling
HV Program
3
Job Training
Mental Health
Services
Child Care
Resources
HV Program
2
Community LINK
400,000
300,000
300,000
200,000
SNAP
Vitamin Angels
Crisis Assistance
Ministries
Health Department
Local Faith
Group
200,000
100,000
100,000
Further Education
0
2018 2019 2020 2021 2022
0
2018 2019 2020 2021 2022
Primary Care
Clinic
Bethlehem Center
Head Start
Families
Forest Hill
Church -Charlotte
16,000
Children Received Home Visiting
16,000
Families Received Home Visiting
WIC
Baby Bundles
Thompson Child
Development
Center
Charlotte
Community
Health Clinic
14,000
12,000
14,000
12,000
Pregnancy
Resource
Center
Renaissance
West Community
Initiative
Smart Start
of Mecklenburg
County
Enlace -Latin
American Council
of Charlotte
10,000
10,000
8,000
6,000
4,000
8,000
6,000
4,000
OB offices
HV Program
4
CDSA
Charlotte Mecklenburg
Schools
HV Program
1
Legal Services
of Piedmont
YMCA of Greater
Charlotte
2,000
2,000
0
2018 2019 2020 2021 2022
Figure 1: Statewide Trends in Eligible Home Visiting Population and Service Recipients
For Mecklenburg County, participants shared that
programs have remained at full capacity with constant
waiting lists, and there is a sense that the number of
those receiving services has stayed stable. However,
as the population of eligible families has increased,
stagnant funding for home visiting likely results in
a decrease in the percentage of total families and
children in Mecklenburg County receiving services.
0
2018 2019 2020 2021 2022
Participants noted “grace” be given for the way the
Covid-19 pandemic has impacted the data and its
trends. The group also discussed the importance of
monitoring future growth, continuing to engage in
conversations about trends, and obtaining accurate,
up-to-date service numbers specific to Mecklenburg
County.
Legend
Opposite
Community Org.
Early Ed/Schools
Families
Government
Health/MH
HV
CC4C
Pregnancy Care
Management
Hospitals
Bottles-n-Bottoms
Loaves-n- Fishes
Figure 2: Mecklenburg County Home Visiting System Map 2018
The Learning
Collaborative
Levine Cancer
Institue
Care Ring
Lakewood Preschool
Charlotte Bilingual
Preschool
Howard Levine
Child Development
Center
Latin American
Coalition
7 8

GROUP MODEL BUILDING FINDINGS
THEMES
During the 2022 SSMC home-visiting survey, nine organizations reported on their current collaborations and
referrals. Again, Figure 3 shows common agency connections, but silos remain a common theme between the
various home visiting programs.
Elevation Church
Legend
Charlotte
Center
for Legal
Advocacy
Opposite
4
5
Community Org.
Home Visiting
Health/MH
Government
Higher Education
Early Ed/Schools
Faith-Based
Other
WellCare
Center
for Community
Alignment
4
Bright Blessings
6
4
4
CIS -Safe Journey
Parents As
Teachers
Beds For Kids
Mira Vida
Guided Journey
6
6
4
5
6
Care Ring
Nurse Family
Partnership
Safe Kids
Enlace
-Latin American
Council
Girl Scouts
Baby Bundles
6
School Health
MCHD
6
Alianza
-Prevention
Services
6
ICO4MCH
6
3
6
4
Meck County
Health
Department
Home Visiting
Central
United Methodist
Church
4
6
Child First
National Service
Office
6
5
YMCA
Parents As
Teachers
Children's
Home Society
Child First
6
Latin American
Coalition
4
5
6
5
Novant
Atrium
NC State
Legislature
Charlotte
Public
Library
Charlotte
Mecklenburg
Schools
4
Charlotte
Bilingual
Preschool
6
4
5
Care
Management
For At-Risk
Children
(CMARC)
6
6
Meck County
Children's
Developmental
Services Agency
Zfive
5
6
5
6
4
5
Parent Child+
Smart Start
YFS
6
Inlivian
6
CMARC
Center for
Child and
Family Health
Local
Pediatricians
Families First
Charlotte
Speach and
Hearing
6
6
Alliance Center
for Education-
Early Head Start
Home Based
6
Milestone
Therapy
6
Central
Piedmont
Community
College
Dancing Badger
Six themes emerged from participants’ engagement with the hopes and fears activity. Each theme is illustrated
below in a diagram mapping the participants’ conversations.
• Model flexibility and adaptability
• Trust with families and between home visiting programs
• Referral sources
• Workforce sustainability
• Funding
• Diversity, equity, and inclusiveness
Incusion of
diverse and
immigrant
communities
Allowing families
to be experts of
their lives
Work/Life
Balance
Unable to serve
due to long
waitlists
Workforce
Development
Pipeline
Degree
Requirements for
peer partners
Secondary
Trauma
Referral
Sources
More
partnerships
Community
buy-in
“bottom up”
Programming
Deficit
Trust
Diverse and
Representative of
communities served
Losing trust as a home visitor
due to saturated resources
(referrals don’t get accepted)
HV Sector becomes
well connected
internally and
externally
Norm that home
visiting programming
is safe space
System
Awareness
System of HV able
to establish trust
among families
System is intentional
and streemlined;
“no silos”
Family
Awareness
Funding
Model
adaptation
/flexibility
No clear
outcome
Knowledge of other
programs and info
sharing
Virtual
Options
Not continuing
innovations made
during crisis
Collective
voice!
Compassion
Fatigue
Workforce needs:
pay, respect,
investment
Inconsistent
funders/
decision makers
Lack of stable
funding stream
(i.e. Medicaid)
Powers that be get
distracted by the
next crisis
OR tunnel vision
and only one HV
model is supported
Lack of input from
specific models/
programs/sites
Figure 4: First Draft Causal Loop Diagram of Home Visiting Access
9 10

2022 MECKLENBURG COUNTY HOME-VISITING SURVEY CATAWBA NATION
HOME-VISITING PROGRAM
Guided by the 2018 statewide home-visiting survey,
SSMC presented a draft survey to GMB participants
who reviewed and included edits or additions to ensure
we would capture information relative to Mecklenburg
County. This was the first time a survey related to home
visiting was distributed to local home visiting program
organizations.
Data from seven reporting agencies 15 indicates just
over 1,000 families are being served, which equates to
just 7% of the live births in Mecklenburg County.
Figure 5: County mapping of community based home visiting programs
Given that home-visiting programs are designed to
support families during the crucial early years of a
child’s life, the relatively low percentage of families
being served highlights the need for increased efforts
to grow and expand the reach and accessibility of
these services, particularly in the wake of the Covid-19
pandemic.
Only
7%
of eligible families
being served in
Mecklenburg County
In 2022, Catawba Nation received a five-year, development
and implementation grant from the U.S. Department of
Health & Human Services (DHHS) to create the Nuti Yapę
(Morning Sun) Tribal Home-Visiting Program.
During the first 15 months of the grant period, Catawba
Nation undertook a comprehensive community needs and
readiness assessment, which included capacity-building,
program planning and design. The next steps will be to select
an approved DHHS model that allows for flexibility to meet
the cultural needs of tribal families, and then to design the
program activities.
Nuti Yapę will serve indigenous families from state and
federally recognized tribes in six counties in South
Carolina (York, Union, Fairfield, Chester,
Lancaster, and Kershaw) and seven counties in
North Carolina (Cleveland, Catawba, Gaston,
Mecklenburg, Rowan, Cabarrus, and Union).
While capacity is increasing within the
program, families within an approximate
30 minute driving radius from the Catawba
Reservation will be prioritized.
The target population will be prenatal
through age 3 initially. Once the Family Spirit
curriculum for ages 3-5 have completed their
pilots in Indigenous communities, the Nuti Yapę
program will expand to age 5. In Mecklenburg County alone,
there are nearly 9,000 indigenous people, including nearly
600 children under 5.
Data collected from a community survey, stakeholder
interviews, and four talking circles (focus groups) indicate the
following common themes:
1. Postpartum depression is common. Half of mothers
surveyed experienced postpartum depression with at
least one of their pregnancies, and most received no
support during this time.
2. Substance abuse is also a significant concern. Substance
use is a symptom of the effects of historical trauma.
Unfortunately, citizens of the Catawba Nation have
not been spared these effects of historical and ongoing
racism and trauma. Families have been impacted by
these effects and on the Catawba Reservation, many
grandparents are raising their grandchildren due to the
parents having substance use problems.
3. Catawba Nation has experienced a loss of community
and connection to culture, especially during the
Covid-19 pandemic. However, community leaders are
working to restore a sense of community and help its
members reconnect to their culture. Connection to
culture is a significant protective factor for indigenous
families, especially during the perinatal period and
childrearing.
4. Indigenous moms also expressed interest in receiving
breastfeeding and lactation support. While a significant
number of women attempted to breastfeed, most
found it challenging and many stopped breastfeeding
as a result. A common theme noted was that most
were unable to access lactation support or education,
and these challenges often exacerbated postpartum
depression.
5. Finally, early literacy and kindergarten readiness need
to be addressed. On the Catawba Reservation, only 58%
of high school students graduate on time or receive a
GED. Historical trauma and ongoing trauma at school
play a significant role. The community has experienced
years of removal of tribal children from their homes;
often children were sent to boarding schools
or placed in the foster care system or for
adoption, as poverty was mistaken for
neglect. Segregation of schools has
had a lasting impact on the Catawba
Reservation. Elders and grandparents
alive today were segregated to an
“Indian School” and provided only an
eighth-grade education.
As part of the research conducted for the
needs assessment, the Catawba Nation began
to build relationships with other recognized
tribes in the Carolinas to learn about the unique
needs of those tribal citizens. For example, in North Carolina,
Native Americans have some of the worst outcomes
in premature births, low birthweight, infant mortality,
breastfeeding at hospital discharge, new HIV cases, teen
pregnancy, unemployment, violent death, and incarceration. 16
Native American families are living in poverty at significantly
higher rates than that the general population, with the
median household income in North Carolina being $68,900,
compared to a median household income of $39,600 for
indigenous people in the state. 17
The Home-Visiting Collaborative, led by SSMC, recognizes
the critical importance of expanding and enhancing homevisiting
programs throughout Mecklenburg County. The
Catawba Nation is embarking on an important mission
to improve the lives of indigenous families by offering
a culturally sensitive home-visiting program. We firmly
believe that by embracing this invaluable partnership, we
can tap into the vast knowledge and immense strengths that
resonate within indigenous communities, while serving as
a steadfast resource and partner to Catawba Nation’s Nuti
Yapę program.
11 12

Based on the findings from the online survey of local home-visiting programs, the group model-building sessions,
and the analysis of county-specific data collected from the statewide landscape study, SSMC has developed the
following recommendations:
Improve navigation
and referral processes
between home visiting
programs and other
services to efficiently
meet the needs of
families by connecting
them with appropriate
programs.
Increase funding for
current programs and
curate new funding
streams for program
addition, growth, and
expansion.
RECOMMENDATIONS
What this looks like:
• Explore the scale-up of current Mecklenburg
County Public Health programs to serve as
the backbone agency to provide assessment
screenings and utilize a centralized data system
or coordinated intake system to link families to
appropriate resources.
• Integrate county referral tools to support data
collection for home-visiting services and resources
to support family needs.
What this looks like:
• Provide funding to enable programs to expand
their current capacity, moving from 7% to 14%
service coverage.
• Secure funding to fill gaps in services for families
that are underserved by current funding
mechanisms or programs.
• Explore the implementation of a new home-visiting
program to effectively reach and serve families
that are currently not being reached by existing
programs.
• Explore funding for an education-based, salarysupplement
program for in-home family support
professionals.
Build and support
a well-trained,
well-supported
home-visiting
workforce.
Increase opportunities
for parents to influence
program implementation
and development.
What this looks like:
• Ensure funding is directed towards raising the
compensation of home visitors across the county.
• Establish an ongoing process of assessing and
improving services and outcomes based on datadriven
feedback.
• Partner with local schools to increase sustainability
in the workforce through training and
apprenticeship opportunities.
• Develop and implement a workforce program that
provides ongoing training, support, and resources
for home-visiting and family-support professionals.
What this looks like:
• Increase awareness and opportunities for the
development of parent leadership to elevate the
voices of those directly affected by programming.
• Support capacity-building efforts of earlychildhood
collaborations seeking to increase
parent leadership and enhance engagement.
• Establish a resource center as a platform for
enhancing family well-being to promote change
through a human-delivery approach.
• Support sustainable growth and change within
home-visiting and family-support systems.
13 14

CONCLUSION
ENDNOTES FOR LANDSCAPE STUDY:
While we are proud of what we have accomplished to
date, our work is not done. Successful implementation
of the recommendations will require ongoing
monitoring and evaluation of progress. This is best
done through continuous convening efforts to update
models and frameworks, gather new data, and heighten
advocacy for home visiting.
Our research to date has uncovered a robust yet
disconnected infrastructure of home-visiting providers.
Therefore, one of the most important things SSMC
can do is serve as hub organization in partnership
with Mecklenburg County government. We aim to
take the lead in enhancing and broadening the local
home-visiting system through the collective efforts
of the Home Visiting Collaborative. Our objective is
to work in conjunction with Mecklenburg County and
our partners to eliminate gaps in services and reduce
fragmentation of the system. Collectively, we will need
to monitor our progress, keeping everyone informed
about successes and challenges as they relate to the
system of home visiting.
Our work will inevitably involve further research
and more connections with local and state programs.
Finally, and of utmost importance, we must fully
support the home-visiting workforce. This entails
intentional strategies to recruit, retain, and reduce
stress within the field. Achieving these goals will
necessitate significant support from the community
and its leaders as we embark on the next phase of
our work.
1
https://archive.org/details/friendlyvisiting00richrich/page/n5/mode/2up
2
https://www.acf.hhs.gov/opre/project/assessing-evidence-home-visiting-evidence-effectiveness-2011-2020
3
https://www.ncearlyeducationcoalition.org/wp-content/uploads/2019/04/Availability-Fact-Sheet.pdf
4
https://nhvrc.org/yearbook/2022-yearbook/about-home-visiting/results/
5
https://www.childhealthdata.org/browse/survey/results?q=5451&g=646&r=1
6
https://www.marchofdimes.org/find-support/topics/miscarriage-loss-grief/miscarriage#:~:text=For%20
women%20who%20know%20they,12th%20week%20of%20pregnancy.
7
https://www.cdc.gov/nchs/pressroom/sosmap/infant_mortality_rates/infant_mortality.htm
8, 9
North Carolina State Center for Health Statistics. Statistics and Reports, Vital Statistics, Basic Automated Birth
Yearbook 2021, Table 3
10
Mecklenburg County: Remaking a child welfare system. (Oct, 2021). The Annie E. Casey Foundation.
11
https://homvee.acf.hhs.gov
12
Martie Bennett, Omeika Dhanpaul, Angie Drakeford, Jake House, Devonya Govan-Hunt, Melody Gurganus,
Veronica Kirkland, Zach Lewis, Pilar Perez, Katie Robinson, Sam Smith, Jennifer Stamp, Shakara Taylor, Amber
Williams, and parents Darlyn Estrada and Chaivontre Ross.
13
National Home Visiting Resource Center. (2022). 2022 Home Visiting Yearbook. James Bell Associates and the
Urban Institute.
14
North Carolina Early Home Visiting Landscape Analysis: Strengthening Systems to Support Families, 2018
15
YMCA Parents As Teachers, YMCA Greater Charlotte, Parent Child+, Safe Journey Parents As Teachers, Community
In Schools, A Guided Journey, Care Ring in partnership with Mecklenburg County Health, Nurse-Family
Partnership, Care Ring, Child First, Children’s Home Society, Early Head Start Home Based, Alliance Center for
Education
16
National Center for Health Statistics. (2018). Health, United States, 2018: with chartbook on trends in the
health of Americans. Hyattsville, MD: US Dept. of Health and Human Resources. https://www.cdc.gov/nchs/data/
hus/hus18.pdf
https://cwoutcomes.acf.hhs.gov/cwodatasite/childrenReports/index
17
U.S. Department of Health and Human Services. (2005). Child welfare outcomes 2002: Annual report. Washington,
DC: Administration for Children, Youth, and Families, Children’s Bureau.
US Census Bureau. (2005). R0203, Percent of the total population who are American Indian and Alaska Native
Alone: 2004. Washington, DC: Willeto, A. A. A. (2002, Dec.). Native American kids 2002: Indian children’s well-being
indicators data book for 13 states. Portland, OR: National Indian Child Welfare Association
15 16

APPENDICES
SURVEY OF MECKLENBURG COUNTY
HOME VISITING PROGRAMS
Appendix 1: Home Visiting Program Inventory
Appendix 2: Mecklenburg County Survey
Appendix 3: A County System Graphs of Home Visiting Collaboration
Appendix 4: County Mapping by Zip Code
APPENDIX 1: Home Visiting Program Inventory
MECKLENBURG COUNTY HOME VISITING PROGRAMS
APPENDIX 2: Mecklenburg County Survey
Thank you for participating in this survey as part of the Mecklenburg County Landscape Study of Home Visiting,
administered by Smart Start of Mecklenburg County, developed by the Jordan Institute for Families in the School
of Social Work at the University of North Carolina at Chapel Hill.
If you have any questions please email us at: vkirkland@smartstartofmeck.org
The purpose of this survey is to:
1) Develop an inventory of all of the home visiting programs in the county
2) Better understand the families our programs service
Please answer each question to the extent that you are able. We understand all programs are different and we
want to capture the diversity of services in the continuum. You may want to have several people from your local
organization work together to fill out this survey.
Department of
Public Health -
County
Community Health Worker’s
Initiative
• Care Ring-A Guided Journey
Community-
Led
Organizations
Child First
• Children’s Home Society
• Thompson’s Family Focus
Tribal
MIECHV
(emerging)
Nųti Yapę
(Morning Sun)
There are 3 “modules” for this survey that request information regarding A) Program Administration, B) Service
Delivery, and C) Service Population. Different types of information and sources might be needed for each of the 3
modules.
A few terms that we want to define to clarify for this survey:
Home-Visiting Program: a specific home-visiting program or model being delivered at the local level (such as
Nurse-Family Partnership or Early Head Start-Home Visiting).
Local Organization: the agency that houses and administers the home-visiting program such as a health department
or local Smart Start. In some cases, the local organization is a home-visiting program affiliate.
National Organization: An organization, in most cases outside North Carolina, which provides support and oversight
regarding implementation of your home-visiting programs.
This 45-minute survey is necessary and rarely collected. Therefore, your knowledge and support are invaluable in
developing an equitable evaluation of our home visiting expansion project.
Early Intervention
• Children’s Developmental
Services Agency
Early Head Start - Home Based
• Alliance Center for Education
We will provide this information back to you in a final report. Our findings will describe the field of home visiting
in Mecklenburg County and will not evaluate any specific program.
Maternal Health
• Care Management for At Risk
Pregnancies
• Care Management for At Risk
Children
Nurse-Family Partnership
• Care Ring
Parents As Teachers
• Communities in Schools-
Safe Journey
• YMCA-YPAT
We thank you for your time.
Parent Child +
• Charlotte Bilingual Preschool
• Inlivian
• Families First
17 18

1. Contact Information
First/Last Name_______________________________________
Local Organization Name_____________________________
Local Organization Address__________________________
Email Address_________________________________________
Phone Number________________________________________
2. What is the role of the primary contact for
this survey?
__ Executive Director
__ Program Manager
__ Data/Evaluation Lead
__ Other (please specify)
Module A:
Program Administration
3. Organization Type:
__ Private For Profit
__ Private Nonprofit
__ Government
__ Other
4. Please select all of the positions/groups that
comprise your local organization’s structure:
__ Board of Director Community Advisory
__ Board
__ Non-clinical Management Staff
(e.g., Executive Director Administrator)
__ Full-time Home Visitor
__ Part-time Home Visitor Home
__ Visiting Supervisor
__ Evaluation/Data Team
__ In-house Clinical Consultant
__ Other (please specify)
5. What is the home visiting program model
that your organization implements?
__ Nurse Family Partnership
__ Parents as Teachers
__ Early Head Start Home Based
__ Children First
__ Parent Child +
__ A Guided Journey
__ Other (please specify)
6. Currently, how many home visitor positions,
both full-time and part-time, are employed on
your staff? Do not count vacant positions, only
those positions that are currently filled.
Full-time home visitors_______________________________
Part-time home visitors ______________________________
Supervisors (full & part-time) ________________________
7. With current level funding, how many home
visitor positions both full-time and part-time,
are needed to be fully staffed?
Full-time home visitors_______________________________
Part-time home visitors ______________________________
Supervisors (full & part-time) ________________________
8. What are the demographics of your
program’s current home visiting staff
(all home visitors and supervisors) in %
percentages?
Race
White__________________________________________________
Black or African American ___________________________
Hispanic or Latino ____________________________________
American Indian or Alaska Native ___________________
Native Hawaiian or other Pacific Islander ___________
Another Race _________________________________________
9. What are the demographics of your
program’s current home visiting staff
(all home visitors and supervisors) in %
percentages?
Hispanic Ethnicity
Hispanic ______________________________________________
Non-Hispanic _________________________________________
10. What are the demographics of your
program’s current home visiting staff
(all home visitors and supervisors) in %
percentages?
Gender Identity
Female ________________________________________________
Male __________________________________________________
Transgender __________________________________________
11. Percentage of home visitors who are able
to speak only English in home visits?
12. Percentage of home visitors who are able
to speak only Spanish in home visits?
13. Percentage of home visitors who are
able to speak languages other than Spanish/
English in home visits?
The next set of questions are about the funding of your home visiting program.
14. If you were asked to report it to your
funder, what would be your best estimate of
your average cost per family to deliver your
home visiting program as designed?
15. How did you (or would you) determine this
calculation (i.e. what factors or components
are you including – staff time, overhead costs,
materials, etc.)?
__ Staff time
__ Overhead
__ Materials
__ Other
16. Approximately what percentage of funding
is used for professional development?
17. What financial resources support your home-visiting program? For the past three years (2019,
2020, 2021), estimate the percent of support your home visiting program receives from each
funding source. Each column should add to 100%. On the next screen you will be asked to list
private foundation or other sources.
Federal Government State __________ __________ __________
Government __________ __________ __________
Local Government __________ __________ __________
Billable services/Medicade __________ __________ __________
Foundation Philanthropy __________ __________ __________
Other __________ __________ __________
2019 2020 2021
19 20

18. Please list each Foundation/Philanthropy
that supports your home visiting program.
19. Please list others sources of funding.
20. Does your local organization provide inkind
support for your home visiting program?
__ Yes
__ No
21. If Yes, what support does your local
organization provide in-kind?
23. For each organization you listed (by corresponding number above), please indicate the
strength of the organizational relationship for Collaboration.
1 = ‘weak single 2 = ‘moderate partnership, 3 = ‘strong partnership,
issue partnership we have worked together they are a consistent
requiring minimal contact’ on occasion, but inconsistently’ and reliable partner’
24. For each organization you listed (by corresponding number above), please indicate the
strength of the organizational relationship for Advocacy.
1 = ‘weak single 2 = ‘moderate partnership, 3 = ‘strong partnership,
issue partnership we have worked together they are a consistent
requiring minimal contact’ on occasion, but inconsistently’ and reliable partner’
We would like to know about partners you work with on collaboration and advocacy as an
organization.
Collaboration and advocacy partnerships can take many forms, so think about what makes sense
for your organization. For example, for “collaboration,” if you have written a grant to expand
home visiting services in your system of care, who have you worked with as a partner? For
“advocacy,” think about who you have worked with to advocate for home visiting funding at the
local or state level. We will ask you to first list organizations you have been involved with in any
way in the last year. Then, we will ask about the strength of that relationship.
22. Please list the names of the specific
organizations you have worked with in the last
year for either “collaboration” or for “advocacy.”
25. Does your organization currently
anticipate any substantial future changes to
service delivery in the next year regarding
your home visiting program in the following
areas?
__ No
__ Yes, Expanding service area
__ Yes, Reducing service area
__ Yes, Increasing enrollment capacity
__ Yes, Decreasing enrollment capacity
__ Other (please specify)
Module B: Program Model Service Delivery
26. Is your home visiting program currently
accredited or certified by the relevant
national organization?
__ Yes
__ No
27. If Yes, who accredits/certifies your
program?
28. If Yes, what year was your program first
accredited/certified?
29. What curriculum is used in your home
visiting program?
30. What processes does your home visiting
program use to monitor model fidelity?
21 22

31. What are your program’s primary target
outcomes? Check the top three (3).
__ Preventing child abuse and/or foster care Infant/
Toddler Mental
__ Health
__ Health & Nutrition
__ Maternal Health School
__ Readiness
__ Healthy Family Functioning Family
__ Economic Self-sufficiency
__ Referrals to or coordination with other services
__ Other
32. Does your program utilize a formal
enrollment process for participants?
__ Yes
__ No
33. If yes, what format is used: Select all that
apply
__ face-to-face encounter
__ telephone
__ online
__ other
38. Does your program utilize a case
management system?
__ Yes
__ No
39. If yes, please name
40. Is this system a requirement from your
national organization?
__ Yes
__ No
41. If you do not use a case management
system, how do your home visitors track case
plans?
42. How does your program report evaluation
data?
43. Please describe any outcome reporting
that is currently required by your funders or
other groups.
Module B: Program Model Service Delivery
The next set of questions are about staffing
requirements and qualifications
49. What is the typical starting salary range
for your home visitors?
50. What are the education requirements for
full-time home visitors employed at your local
organization?
51. Do you have a minimum level of
experience for full-time home visitors
employed at your local organization?
__ Yes
__ No
52. Are individual home visitors required to be
certified or accredited to work in your home
visiting program?
__ Yes
__ No
56. Does your national organization offer
any additional training or professional
development for home visitors?
__ Yes
__ No
57. Do home visitors in your program
complete developmental screenings?
__ Yes
__ No
58. What type of training is available locally?
__ History of Home Visiting & Program Model
Strengths Based Practice in Home Visiting Adult
Mental Health/Perinatal Depression
Understanding Family Systems
__ Child Brain Development
__ Cultural Competency & Implicit Bias Working w/
Special Populations
__ Maximizing Referrals & Community Resources
Motivational Interviewing Developmental
Screening
__ Recognizing/Reporting Child Abuse and Neglect
Infant/Child Mental Health & Attachment
34. What is the time frame from the referral
being received to initial contact?
35. What is the typical client’s level of interest
in home visiting services?
Low High
36. Does your program currently have a
waitlist?
__ Yes
__ No
37. About how many families are on the
current waitlist, if applicable?
44. What outcomes do you report and how
often?
45. Did the COVID pandemic impact the
delivery of service? Intake or waitlist
processes?
__ Yes
__ No
46. If yes, how?
47. If yes, are the changes made in service
delivery permanent?
48. If yes, are the changes approved by the
national model?
53. Please describe who accredits or certifies
individual home visitors:
54. Please describe the supervision
requirements for home visitors in your
program. (i.e., Hours per month for
individual, Hours per month for group, Direct
observations of home visitors by supervisors,
other)
55. Does your local organization offer any
additional training beyond what may be
provided by the program model?
__ Yes
__ No
Module B: Program Model Service Delivery
This next set of questions are about referrals
and service partners
59. Does your program participate in a
centralized intake system? (e.g. NCCARE 360)
__ Yes
__ No
60. If Yes, what is the format?
61. If Yes, about what percent of all
participants are identified through the
centralized intake process in an average
month?
23 24

62. What recruitment strategies (other than
referrals) are used by your program?
63. What is the process for receiving a referral
TO your home visiting program?
64. Please list up to 10 primary referral
sources TO your home visiting program. Then,
what percent of referrals to your organization
come from these sources (e.g. Clinic A
provides 30% of our referrals)
Module B: Program Model Service Delivery
65. What is the process for receiving a referral
FROM your home visiting program for other
services?
66. Who do you refer a family to after
completion of your program?
67. Please list up to 10 primary referral
destinations FROM your organization.
Then, what percent of referrals FROM your
organization go to each destination?
We want to know the local areas where programs provide services, so we are asking you to list
the specific ZIP codes you serve. We will use this information to create local service maps across
the state. This will help us all better understand where more services are needed. We realize that
you may not collect data at the ZIP code level, so please provide your best estimate based on the
information you do collect and your knowledge of your service area.
68. What is the total number of families served?
69. For each row, please select the:
• the total number of families currently on your caseload in that ZIP code
• the estimated maximum number of families that could be on your caseload in that ZIP code.
• Add “Other” zip codes served in the Other box along with corresponding details.
For example, if 28208 is in your service area, first determine how many total families are on your program’s caseload in
28208. Then, give your best estimate of the maximum number of families you could have on your program’s caseload
at one time given your current staffing and funding levels. So, if you are currently serving 10 families in 28208, but have
capacity to serve 20 families in 28208 at one time, then you would respond: *28208 *10 *20
Total # of Families Currently on Caseload Maximum # of families that Could be on Caseload
28205 _____________________________________________ ______________________________________________________
28206 _____________________________________________ ______________________________________________________
28208 _____________________________________________ ______________________________________________________
28210 _____________________________________________ ______________________________________________________
28211 _____________________________________________ ______________________________________________________
28212 _____________________________________________ ______________________________________________________
28213 _____________________________________________ ______________________________________________________
28215 _____________________________________________ ______________________________________________________
28216 _____________________________________________ ______________________________________________________
28217 _____________________________________________ ______________________________________________________
Other _______________________________________________
Module C. Target Population/Service
Population
This last set of questions is about the families
served by your program.
70. How familiar are you with other home
visiting programs?
__ Extremely familiar
__ Very familiar
__ Somewhat familiar
__ Not so familiar
__ Not at all familiar
71. Who would you identify as your program’s
primary target/priority populations?
__ Low-income children and families
__ Children with special needs/behavioral challenges
__ Families that speak a language other than English
__ Teen parents
__ Families who receive governmental assistance
__ Families with a history of chronic homelessness
__ Families with a history of child abuse and neglect
__ Families with a history of domestic violence
__ Families with a history of substance use
__ Mothers with maternal depression and other
mental health concerns
__ Other
72. What is the eligibility criteria to receive
home visiting services through your program?
73. Are there exclusion criteria that would
make someone ineligible for services? If yes,
please explain
74. What are the demographics of your
current program’s participants in %
percentages across all categories?
Race
White__________________________________________________
Black or African American ___________________________
Hispanic or Latino ____________________________________
American Indian or Alaska Native ___________________
Native Hawaiian or other Pacific Islander ___________
Another Race _________________________________________
75. What are the demographics of your
program’s current current program’s
participants in?
% percentages across all categories? Hispanic
Hispanic Ethnicity
Hispanic ______________________________________________
Non-Hispanic _________________________________________
76. What are the demographics of your
program’s current current program’s
participants in
% percentages across all categories? Gender Identity
Gender Identity
Female ________________________________________________
Male __________________________________________________
Transgender __________________________________________
77. Percentage of program participants who
are able to speak only English in home visits?
78. Percentage of program participants who
are able to speak only Spanish in home visits?
79. Percentage of program participants who
speak languages other than Spanish/English in
the home?
80. Percentage of program participants who
are Medicaid-Eligible?
81. Does your program model include a
formal parent/participant advisory group or
committee?
__ Yes
__ No
82. If no, what opportunities exist for parents
to influence program implementation and
development?
83. What is your metric for counting the
population served (e.g. child, family, or
individual)?
25 26

84. If your home-visiting program had
expanded funding and additional staff to
serve all qualified families in your service
area, how many families would you expect to
serve annually?
SURVEY RESPONSES SECTION
CATEGORICAL VARIABLE RESPONSES
85. Of the families who left the program last
year, what percent “completed” the program,
based on whatever program standard you use
to indicate “completion” or “graduation”?
86. What strategies exist to promote
continued participation in your program?
87. Please provide a summary estimate of the
total number of actual home visits provided
by your organization in calendar year 2021
This is the total aggregate number of home
visits across all families and all home visitors.
Feedback/End of Survey
This is the end of the survey, please use
the following space to fill in any additional
information that you think is important for
us to understand about your home visiting
program, or the field of home visiting in
Mecklenburg County.
88. Feedback & Comments
What is the home visiting model that your organization implements?
Other (please specify)
A Guided Journey
Parent Child +
Child First
Early Head Start Home Based
Parents as Teachers
Nurse Family Partnership
0
0.5 1 1.5 2 2.5
Other = NC Infant Toddler Program; Care Management with Medicaid Prepaid Health Plans (PHPs) through Local
Health Department Suggested language summarizing finding.
Other (please specify)
Yes, Decreasing enrolment capacity
Yes, Increasing enrolment capacity
Yes, Reducing service area
Yes, Expanding service area
Future changes to service delivery in the next year
No
0 1 2 3 4 5 6
Other = Creating new team for mental health services for children not eligible (ARPA funded); Enrollment Capacity
and Expanding Service Area
What are your program’s top three primary target outcomes?
Referrals to or coordination with other services
Family economic self-sufficiency
Healthy family functioning
School readiness
Maternal health
Health & nutrition
Infant/toddler mental health
Preventing child abuse and/or toddler care
0 1 2 3 4 5
27 28

9
8
7
6
5
4
3
2
1
0
Face-to-face
Does your program currently have a waitlist?
What ways can families enroll?
Telephone Online Other
Did the COVID pandemic impact the delivery
of service, intake or waitlist process?
Recognizing/Reporting Child Abuse and Neglect Infant/
Child Mental Health & Attachment
What type of training is available locally?
Developmental Screening
Maximizing Referrals & Community Resources
Motivational Interviewing
Working w/ Special Populations
Cultural Competency & Implicit Bias
Child Brain Development
History of Home Visiting & Program Model
Strengths Based Practice in Home Visiting
Adult Mental Health/Perinatal Depression
Understanding Family Systems
0 1 2 3 4 5 6 7 8 9
6
9
5
8
7
Do home visitors in your program complete
developmental screenings?
Does your program participate in centralized
intake system? (e.g. NCCARE 360)
4
6
9
6
3
5
4
8
7
5
2
3
6
4
1
2
1
5
4
3
0
Yes
No
0
Yes
No
3
2
1
2
1
Do you have a minimum level of experience
for full-time home visitors employed at your
local organization?
8
Are individual home visitors required to be
certified or accredited to work in your
home visiting program?
8
Yes
No
0
Yes
No
If Yes, what % of participants are identified through
centralized intake: “we don’t get referrals through
NCCARE360 so far”; “Less than 5%”; “10%”
7
7
How familiar are you with other home visiting programs?
6
5
6
5
6
5
4
4
4
3
3
3
2
2
2
1
1
1
0
0
Yes
No
Yes
No
0
Not at all familiar Not so familiar Somewhat familiar Very familiar Extremely familiar
29 30

Who would you identify as your program’s primary target/priority populations?
CONTINUOUS VARIABLE
RESPONSES
1. Currently, how many home visitor positions
(full-time, part-time, and supervisors) are
employed on your staff?
N = 9
Range = 4 to 92
Average = 23
Sum Total = 206; 173 home visitors and 33
supervisors
2. With current level funding, how many
additional home visitor positions (full-time,
part-time, and supervisors) are needed to be
fully staffed?
N = 9
Range = 0 to 25
Average = 5.2
Sum Total = 47; 34 home visitors and 13 supervisors
3. What is the time frame from the referral
being received to initial contact?
N = 8
Range = 1 to 7 days
Average = 3 days
Low-income children and families
Children with special needs/behavioral challenges
Families that speak a language other than English
Does your program model include
a formal parent/participant advisory
group or committee?
Teen parents
Families who receive governmental assistance
Families with a history of chronic homelessness
Families with a history of child abuse and neglect
Families with a history of domestic violence
Families with a history of substance abuse
Mothers with maternal depression and other mental health concerns
Other
7
6
5
4
3
2
1
0
0 1 2 3 4 5 6
Yes
4. What is the typical client’s level of interest
in home visiting services (0 Low to 100 High)?
N = 9
Range = 50 to 93
Average = 75
5. About how many families are on the current
waitlist, if applicable?
N = 6
One program (EI) not legally allowed to have a
waitlist
Range = 0 to 130
Average = 33
6. What is the typical starting salary range for
your home visitors?
N = 9
Range = $31,200 to $65,000
Average = $47,000
No
7. What are the demographics of your current home visiting staff? (Race/Ethnicity)
N = 0
White Range = 0% to 55%
White Average = 16%
Black Range = 25% to 75%
Black Average = 46%
Asian Range = 0% to 15%
Asian Average = 2%
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
White
N = 8
White Range = 0% to 25%
White Average = 9%
Black Range = 10% to 55%
Black Average = 36%
Asian Range = 0% to 5%
Asian Average = 1%
Black or
African American
Hispanic or
Latino
Asian or
Asian American
American Indian Range = 0% to 15%
American Indian Average = 2%
Other Race Range = 0% to 15%
Other Race Average = 4%
Hispanic/Latino Range = 0% to 70%
Hispanic/Latino Average = 33%
American Indian
or Alaska native
Native Hawaiian
or other
Pacific Islander
8. What are the demographics of your current program’s participants? (Race/Ethnicity)
0%
White
Black or
African American
Hispanic or
Latino
Asian or
Asian American
American Indian Range = 0% to 1%
American Indian Average = 0%
Other Race Range = 0% to 55%
Other Race Average = 36%
Hispanic/Latino Range = 20% to 85%
Hispanic/Latino Average = 49%
American Indian
or Alaska native
Native Hawaiian
or other
Pacific Islander
31 32
60%
50%
40%
30%
20%
10%
Another race
Another race

45%
9. What are the demographics of your home
visitors? (Gender)
N = 9
Female Range = 95% to 100%
Female Average = 99%
10. What are the demographics of your
current program’s participants? (Gender)
N = 9
Female Range = 40% to 100%
Female Average = 78%
16. Total number of actual home visits
provided by your organization in calendar
year 2021
N = 7
Range = 200 to 30,381
Average = 7,838
Sum Total = 54,871 (55% of these are EI program)
40%
17. Funding Source
35%
N = 8
Federal 30%
3-year Average = 13%
25%
Range = 0 to 100%
State
20%
3-year Average = 34%
Range 15% = 0 to 100%
Local
3-year 10% Average = 13%
Range = 0 to 100%
5%
Billable
3-year Average = 2%
Range = 0 to 15%
Foundation
3-year Average = 15%
Range = 0 to 80%
Other
3-year Average = 6%
Range = 0 to 20%
11. Home visitors language in home visits
N = 9
English only Range = 10% to 100%
English only Average = 65%
Spanish only Range = 0% to 50%
Spanish only Average = 16%
Other language Range = 0% to 25%
Other language Average = 7%
12. Participants language in home visits
N = 8
English only Range = 15% to 93%
English only Average = 54%
Spanish only Range = 7% to 85%
Spanish only Average = 40%
Other language Range = 0% to 10%
Other language Average = 2%
13. Participants who are Medicaid Eligible
Participants language in home visits
0%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
2% 2%
9% 9%
14%
15%
9%
2019 2020
41%
13%
31%
13%
2%
5%
N = 7
Range = 60% to 100%
Average = 83%
14. Participants who “completed” the program
N = 5;
some programs do not have a “completion” standard
Range = 30% to 92%
Average = 65%
15. Total number of families served in
calendar year 2021
N = 9
Range = 10 to 3,800
Average = 714
Sum Total = 6,430 (59% of these are EI program)
Federal
State
Local
Billable
Foundation
Other
24%
2021
31%
14%
6%
13%
33 34

APPENDIX 3: A County System Graphs of Home Visiting Collaboration
Appendix 4: County Mapping by Zip Code
County Mapping by Zip Code for Intensive Based Home Visiting
WellCare
Charlotte
Center
for Legal
Advocacy
Mira Vida
Center
for Community
Alignment
4
6
4
Guided Journey
5
Central
United Methodist Latin American
Alianza
Church
Coalition
-Prevention
Services
Enlace
-Latin American
Council
4 5
4
4
6
5
Charlotte
Public
Library
Charlotte
Bilingual
Preschool
6
5
Parent Child+
Inlivian
6
Families First
5
Girl Scouts
3
YMCA
Parents As
Teachers
5
Elevation Church
CIS -Safe Journey
Parents As
Teachers
4
4
Bright Blessings
6
Beds For Kids
6
4
6
Care Ring
Nurse Family
Partnership
Baby Bundles
6
Meck County
Health
Department
Home Visiting
6
6
Charlotte
Mecklenburg
Schools
6
Novant
4
4
Zfive
6
5
Meck County
Children's
Developmental
Services Agency
5
6
5
4
6
YFS
6
CMARC
Local
Pediatricians
Charlotte
Speach and
Hearing
6
6
Alliance Center
for Education-
Early Head Start
Home Based
Milestone
Therapy
Central
Piedmont
6
Community
College
6
Dancing Badger
Legend
Opposite
Community Org.
Home Visiting
Health/MH
Government
Higher Education
Early Ed/Schools
Faith-Based
Other
Safe Kids
School Health
MCHD
6
Atrium
6
6
Children's
ICO4MCH
Home Society
Child First
6
6
Child First
NC State
National Service
Legislature
Office
Care
Management
For At-Risk
Children
(CMARC)
Smart Start
Center for
Child and
Family Health
County Mapping by Zip Code w/ Early Intervention Services & Intensive Home Visiting programs
Surveyors were asked to list all Collaborative and Advocacy partnerships. The map depicts by arrows, the
partnerships and strength of each partnership.
• Local Home Visiting programs are depicted as Red circles
• Refer to key for other program types
• Referring relationships are depicted as one-directional or bi-directional arrows; the numbers assigned to
each line depict the strength of the relationship from 1-6, with 6 being a strong relationship.
Concluding analysis:
Home Visiting programs have weak connections to one another; displaying a highly siloed network
Relationships show that there are numerous resources, however are scattered and/or underutilized by home
visiting programs as supports.
35 36

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info@smartstartofmeck.org