Implementing Home Visiting Programs in High Risk Communities: Progress and Challenges

The purpose of this paper is to describe the scaling up of the Illinois Maternal, Infant and Early Childhood home visiting program funded under the Affordable Care Act of 2010.  This scaling up process involved a comprehensive needs assessment, community identification and rolling out the new programs. Six high need communities and 25 community-based and public health agencies were funded to implement four different model programs – Healthy Families America, Parents as Teachers, Early Head Start and Nurse Family Partnership.  Home visiting programs began enrolling families in late spring of 2011, and Illinois most recently submitted their 3^rdyear of performance benchmarks.  To date, the following factors and indicators captured the scaling up processes and barriers to implementation.

The multi-level challenges and successes of implementing Illinois MIECHV programs will be discussed at the macro and micro levels - scaling up at the state, community and program levels.  At the state level, the macro-challenges included contracting vendors, community-based agencies and a number of other administrative and bureaucratic barriers.  Specifically, the state had to identify and contract with a data management system, contract with local communities, create a training and technical system to support home visiting programs, and identify a local evaluator. 

At the community level, a coordinated intake system and collaborative network to coordinate, communicate and improve the quality of services had to be established.  Community level implementation was challenged by the lack of training, leadership, community support, and trust.  

The 25 local implementation agencies (LIA) had to hire, train and monitor over 100, mostly new home visitors. An annual survey of home visitors reported that 60% were in their first year of their position, which likely resulted in substantial staff turnover (39%).  Staff turnover ranged from 0% to almost 100% in some agencies.  Inexperience and staff turnover created multiple challenges for local programs such as rehiring, and training.  Furthermore, it appears to have also contributed to high attrition rates among home visiting participants.   

The best evidence for the successful implementation and scaling up of the four home visiting programs was captured in the improved capacity of home visiting services to meet their performance benchmarks and improvements as a result of a continuous quality improvement process.  Additional indicators of multi-level implementation and challenges will be discussed.