Association for Public Policy Analysis & Management

Using federal and state funding, the New Jersey (NJ) Departments of Health and Children and Families have collaborated for more than a decade to build the state’s home visiting (HV) infrastructure. NJ has continued to develop and improve strategies to engage families, not only seeking to enroll families in HV, but also working to ensure their engagement in HV over time. NJ uses two innovative strategies, recommended and supported by the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, to engage families in HV: Central Intake (CI) and Continuous Quality Improvement (CQI).

NJ’s statewide CI system uses a single entry point to screen and link families to a wide variety of community resources, including 65 HV programs serving all of NJ’s 21 counties. NJ’s CI aims to improve the identification of families in need of services, to connect families to needed resources, to increase the proportion of HV referrals eligible and interested in services, and to reduce duplication of effort across NJ’s early childhood system.

Each year, NJ’s CI receives screens for over 30,000 families and refers them to services, with about 9,000 families referred to HV programs. However, among families referred to HV, only 21% enrolled. The state-level capacity of HV programs (the number of families served compared to the number a program is funded to serve) has improved from 70% in 2013 to 87% in 2017, but in 2017 only about half of HV programs were meeting NJ’s program-level capacity target of 85%.

Simultaneously, NJ uses CQI tools to better understand and improve how CI and HV engage families. At the state-level, NJ uses process mapping, data analysis and interviews and at the local-level, HV program staff use Plan-Study-Do-Act (PDSA) cycles to test changes to improve family engagement. Since 2016, HV programs have used collaboratively-developed CQI dashboards to inform and track their PDSA cycles. These dashboards allow each program to track their progress on eight key indicators compared to their past performance and the performance of their peers.

This presentation will describe NJ’s use of both strategies and provide details on the use of CQI dashboards. Study findings will also be highlighted, including:

• Family outreach by CI staff prior to HV referral is a useful strategy for improving HV enrollment. Families who had a successful contact by CI prior to HV referral were nearly twice as likely to enroll.
• HV programs that never meet NJ’s capacity target have lower enrollment rates, higher discharge rates and do not receive an adequate number of referrals from CI.
• CQI at the state-level demonstrated that families with more referrals early in HV were significantly more likely to be enrolled at 6 months compared to families with no referrals. This informed HV program-level PDSA cycles to increase early referrals which in turn lead to significant increases in early referrals to families.

NJ’s use of both CI and CQI, including program-level dashboards, has informed and enhanced the state’s HV programs and early childhood system more generally.