Indiana University SPEA Edward J. Bloustein School of Planning and Public Policy University of Pennsylvania AIR American University

Panel Paper: The Implementation of a National Quality Improvement Model: The Home Visiting Coiin

Thursday, November 12, 2015 : 3:50 PM
Merrick I (Hyatt Regency Miami)

*Names in bold indicate Presenter

Mary Mackrain, Education Development Center, Carlos Cano, Health Resources and Services Administration and Mary Catherine Arbour, Harvard University
The Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN), is the first national learning collaborative of its kind based on the Breakthrough Series Model (BTS) which has been successfully utilized in health care and social service settings over the last couple of decades.

The HV CoIIN brings together 35 teams from local home visiting service agencies across 10 states, two tribal entities, and one non-profit grantee to seek collaborative learning, rapid testing for improvement, and sharing of best practices. The Health Resources and Services Administration, in cooperative agreement with Education Development Center, is working to close the gap between what we know works, and what we do on the ground to improve outcomes for families.

The HV CoIIN is a time-limited (6-18 months) learning activity that targets four program outcomes: (1) improve rates of initiation and extent of breast feeding, (2) improve the screening and surveillance of developmental delays as well as the linkage of clients to appropriate services, (3) improve the screening, referral and service provision for maternal depression, and (4) improve family engagement in home visits.  HV CoIIN SMART AIMS include: 

  • 85% of women who screen positive for depression and access services will report a 25% reduction in symptoms in 12 weeks (from first service contact).
  • Increase by 25% from baseline the % of children with developmental or behavioral concerns receiving identified services in a timely manner.
  • Increase by 20% from baseline the % of women exclusively breastfeeding at 3 months and 6months.
  • Increase by 25% the average proportion of expected in-person contacts between home visitor and family that are completed. 

The HV CoIIN uses the Model for Improvement which includes small tests of change (known as Plan-Do- Study-Act cycles) to adapt evidence-based practices recommended by faculty of the collaborative to the local context of participating agencies. The collaborative tracks individual agency and overall progress of the HV CoIIN using standardized outcomes and process measures for each target area. Each agency reports on these measures monthly as they test and adapt the recommended changes.

The HV CoIIN is generating promising outcomes across the four areas identified.  For example, within the first seven months of implementation:

  • Over 80% of mothers are being screened for maternal depression at appropriate intervals, well above the national average. This first step of identifying maternal depression is critical to the referral and a mother’s receipt of quality services that work to ameliorate symptoms.
  • Over 80% of the time, Home visitors are engaging in developmental surveillance and asking families about concerns with their child’s development— at every home visit, allowing for early detection and implementation of support services.
  • The percent of home visitors adequately trained in infant feeding and lactation is on the rise from a baseline of 60% upwards toward 80%, improving home visitors comfort and capacity to support mother’s intention, initiation and duration of breastfeeding. 

As data and findings become available, best practices will be scaled nationally.  Key implementation and data findings will be shared.

Full Paper: