INTRODUCTION TO THE MODEL: CONSIDERATIONS · PDF file... , Family Connects, CCFH Ben Goodman,...

INTRODUCTIONTOTHEMODEL:CONSIDERATIONSFORDISSEMINATION

July 2015 Family Connects Introduction 2

ThankyouforyourinterestintheFamilyConnectsnursehomevisitingprogram.We

providehereabriefdescriptionoftheprogrambackgroundandourapproachto

dissemination.

Pleasereviewthedescriptionwithyourcommunitycollaborators.Ifthereisinterestand

fundingavailableforimplementingandsustainingtheprogramaswellastrainingand

certificationasFamilyConnects,pleasecontactus.Wewilldiscusstogetherwhatis

neededinyourcommunitytoaddressyourlocalgoals,funding,andtimeline.

Contacts:KarenO’Donnell,Ph.D.,[email protected],Co-Director,FamilyConnects,CCFHBenGoodman,Ph.D.,[email protected],Co-Director,FamilyConnects,CCFPAshleyAlvord,MPH,[email protected],TrainingandDisseminationSpecialistJeffQuinn,MPH,[email protected],DirectorofCommunityOutreachCenterforChildandFamilyHealth(CCFH)andCenterforChildandFamilyPolicy(CCFP)DukeUniversity,Durham,NorthCarolina©2015–FamilyConnects

Family Connects’ parents say:

“We were referred to Family Connects by our pediatrician… We love our nurse, she was very friendly. She provided support, listened, and gave suggestions. She was very knowledgeable and came with resources… and she was a phone call away. Family Connects is a wonderful program for anyone.” “[The visit] was a lot more personal… you are more comfortable [in your own home] and you feel like you can ask any sort of question, which is different than when you’re in a clinical setting.” “Family Connects is such an important service to our community. Reaching out to new parents, especially first-time moms and their babies, is like providing a lifeline in some cases… to feel supported and “not alone” in the community.”


I.THEFAMILYCONNECTSPROGRAM

IntroductionFamilyConnectsisamodelforacommunity-basedprogramtosupportnewparentsincaringfortheirnewborn(s),toofferphysicalassessmentsofthemotherandthebaby,toaddressquestionsaboutcaringforthenewborn,todiscussparents’needsatthishappyandvulnerabletime,andtohelpthemaccesscommunityservicesorresourcesthatmatchtheirneeds.FamilyConnectsalsoworkstoidentifyfamilyresourcesthatarecriticalbutnotavailableinthecommunity,withthegoalofworkingtowardincreasingneededserviceslocally.TheaimoftheFamilyConnectshomevisitistoengagewiththefamilyand,withthefamily,tocelebratethenewarrival.Weacknowledgethatcaringforanewborncanbeajoyfulbutalsochallengingjobinvolvingparentslosingsleep,havingunansweredquestionsabouttheirownhealthorthatofthebaby,andneedingsupportfortheirnewrole.Weknowthateachcommunityhasbothformalandinformalservicesandresourcesthataparentmaynotknowaboutormaynotknowhowtocontact.WeusetheFamilyConnectsprogramtoconnecttothefamilyandtolinkfamilymemberstoresourcesthatsupportthisperiodofnewparenting.

ProgramBackgroundandLogicModelTheFamilyConnectsmodelwasdevelopedwithinthecontextoftheDurhamFamilyInitiative,fundedbytheDukeEndowmentin2002,withtheprimarygoalofreducingcommunityratesofchildmaltreatment(K.Dodge,PrincipleInvestigator).Theprogramcentersonatheory-drivenandevidence-basedassessmentofchildandfamilystrengthsandneeds,providedinaninformalandfamily-friendlymanner.Thecommunity-wideFamilyConnectsapproachisdesignedasanadditiontooralternativetotwo-andthree-yearlonghomevisitingprogramstargetingfamilieswithspecificriskfactors.Theuniversalapproachiscriticaltopromotingchildandfamilywell-beingasameansoffacilitatingcommunity-widechange.Thegoalofuniversal,ratherthantargeted,engagementisthatahighpercentageofparticipatingfamiliesisessentialfortheprogramtobesuccessfulinpromotingcommunitylevelchange.Theunderlyingassumptionisthatallfamilieswithnewbornsneedsupport,education,recommendations,andaccesstocommunityservicesandresources.FamilyConnectshasarigorousapproachtotheevaluationofprogramperformance,fidelitytothehomevisitprotocol,communitypenetration,andbenefitsforfamilyrecipients.


Thelogicmodelbelow(seeFigure1)depictstheFamilyConnectstheoryofchangeforinfantsandfamilies.Nursehomevisitsandassessmentsfacilitateincreasedconnectionstomatchedcommunityresourcesandservices.Increasedconnectionstothecommunity,inturn,promotefamilyfunctioningchildandfamilywell-beingovertime.

Figure 1. The Family Connects Logic Model

FamilyAssessmentTheprogramislinkedtoahighinferenceassessmentoffamilystrengths,risks,andneeds.Thenursevisitorengageswiththefamilyinafriendlyandsupportivedialoguewhileassessingandrating12factorswithinfourdomains(seeFigure2).Thesefactorsareknowntobeassociatedwithmaternalandchildhealthandwell-beingand,whenidentified,provideopportunitiesforpreventionandintervention.TheFamilySupportMatrixisthetoolusedtoaddressesfamilyhealthneeds,childcareandtheparent-childrelationship,householdneedsandsafety,andparentingsupport.Thehomevisitorrateseachofthe12factorsas:(1)norisk/needsatthistime,supportiveguidanceprovided;


(2)needsandconcernsaddressedbyeducationanddemonstrationduringvisit;(3)familyissuesbestaddressedbylinkagewithcommunityresources;and(4)urgentneed(s)requiringimmediateintervention.Figure2.DomainsandFactorsintheFamilySupportMatrixAssessment SupportforHealthCare

Factor1-MaternalHealth

Factor2-InfantHealth

Factor3-HealthCarePlans

SupportforCaringfortheInfant

Factor4-ChildCarePlans

Factor5-ParentandChildRelationship

Factor6-ManagementofInfantCrying

SupportforaSafeHome

Factor7-HouseholdSafety/MaterialSupports

Factor8-FamilyandCommunitySafety

Factor9-HistorywithParentingDifficulties

SupportforParents

Factor10-MaternalWellbeing

Factor11-SubstanceAbuse

Factor12-MaternalEmotionalSupport


Eachofthetwelvefactorscomeswithasetofqueriesforthevisitingnursetouseduringtheassessment,asneeded,andsupportiveguidancetodeliverforeachdomain/factor(seeFigure3forexample).

Figure3.ExampleofaFactorwithQueriesandSupportiveGuidanceFactor4.GoalforChildCarePlans–Parenthasaplanforchildcare,includingemergencies,respitecare,anddaycareasneeded.

SupportiveGuidance:

4.1Havingaplanaboutwhattodowhensomethingcomesuplastminuteisimportant.Havingsomeofthesedetailsworkedoutaspreventativemeasureswillrelieveyourstresswhentheunexpectedhappens.

QueriesWhohelpsyoutakecareof(baby’sname)now?Overthenextyearwhatareyourplansforworkorschool?Overthenextyearwhatareyourplansforchildcare?Ifyouneededababysitternow,isthereanyoneyoutrusttotakecareofhim/her?Whatifyouhadanemergencyandhadtoleaveyourhometogotothedoctororsomething,istheresomeoneyouwouldcallontotakecareofthebaby?(Ifnot,trytohelpmakeaplanforsuchemergencies.)Ifyoujustneededtogetaway,suchasgotothegrocerystorealoneforachange,istheresomeoneelseyoufeelgoodaboutleavingyourbabywith?

II.CRITICALCOMPONENTSOFTHEFAMILYCONNECTSPROGRAMTheFamilyConnectsapproachhasanumberofprogramcomponents,someofwhichareessentialforcommunitiestoreplicatethemodel.Thekeycomponentsarelistedanddescribedbelowasthoseneededforimplementationtobedistinguishedthoseactivitiesthatmaybeselectedasauxiliarytotheprogram.These“criticalcomponents”arenecessaryforreplicatingthemodelasanevidence-basedprogramderivedfromtheevaluationstudiesofDurhamConnects,theFamilyConnectsmodelinDurham,NorthCarolina.Otherprogramcomponentsmaybeincludedindisseminationlocationsasimportantoptions,auxiliaryresources,orthosethataddressspecificlocalneeds.Critical(essential)componentsfortheFamilyConnectsmodelwithcommentsfromtheDurham,NorthCarolinaexperience:

TheFamilyConnectsprogramiscommunity-basedwithcommunityownership,anditisseenaspartofthecontinuumofcarefornewbornsandtheirparentsinthecommunity.


LessonsLearned:FamilyConnectsinDurhamTheoriginalprojectinDurhamwasdevelopedbyDukeUniversity’sCenterforChildandFamilyPolicy,theCenterforChild&FamilyHealth,andtheDurhamCountyDepartmentofPublicHealthincollaborationwithcommunityleaders:Durham’sDepartmentofSocialServices,theDurhamCountyCommissioners,andtheDukeUniversityMedicalCenter,DepartmentsofObstetricsandPediatrics.Thesecommunityleaderssignedamemorandumofagreementtoaligncommunityresourceswithidentifiedbirth-familyneeds.Theprogrambecameapartofthelocalsystemofcareincloseliaisonwithbirthinghospitalsandpediatricprimarycare,andallfamiliesofDurhamCountyresidentnewbornsareentitledtotheprogram.

FamilyConnectshomevisitorsareRegisteredNurses,providinghealthandpsychosocialassessmentsofnewborn,mother,andfamily.

Nursevisitorsaretrainedtoprovidesystematiceducationinresponsetoparentqueriesandnurseobservationinareasofpossibledifficultiesinadaptingtothenewborn(e.g.,breastfeeding,supportfor“babyblues,”andothers).

Theprogramisdesignedforuniversalcommunitycoverageinordertopromotecommunity-widechangeforfamilies.Allfamilieswithnewbornsinacatchmentareaareeligible,whetherregion,state,city,orneighborhood.

LessonsLearned:UniversalImplementationByprovidingfundsforcommunityimplementationofevidence-basedhomevisitingprograms,thePatientProtectionandAffordableCareActof2010heightenedtheneedforprogramsimplementedatscaleincommunitysettings.Althoughevidencesupportsthepositiveimpactofhomevisitingprogramstargetedtohigh-riskgroups,whentheseprogramsareimplementedwithsmallstudysamples,scalingupoftheprogramscanresultindeclinedparticipationandretentionrates,decreasedimplementationfidelity,anddemandsforadequatecommunityresourcesthatexceedcommunitycapacity.FamilyConnectsisashort-term,universal,andrelativelyinexpensivepostnatalnursehomevisitingprogramdesignedtoprovidebriefchildhealthandparentingassessmentandinterventionandconnectionswithcommunityresourcesbasedonindividualizedassessmentsoffamilyneeds.Thisbriefuniversalprogramaddressesmanyfamilyneedsthatwouldnotnecessarilybeidentifiedbyaprogramthattargetsdemographicriskfactorsonly.Allfamiliesneedsupportatthisvulnerabletime,butnotallfamiliesneedthetwotothreeyearsofweeklyservices.DuringtheinitialrandomizedcontrolledtrialofFamilyConnectsinDurhamprogram,94%offamiliesseenwereassessedtohaveoneormoreneedsforspecificeducation,


recommendations,orcommunityservices.AllfamiliesbenefitfromthesupportiveguidanceprovidedbyFamilyConnectsnurses.

TheIntegratedHomeVisitincludesasystematicassessment(FamilySupportMatrix)offamilystrengths,risks,andneeds.

Anticipatoryandsupportiveguidanceforfamiliesarespelledoutintheprotocolandprovidedbyhomevisitorsatallvisits(e.g.,back-to-sleep,thebenefitsoftummytime).

Thefamilyandnurseplantogetherforindividualizedconnectionstoandrecommendationsforcommunityresourcesandservices.

Asindicatedclinically,theinitialhomevisitcanhaveoneormorefollowupvisits/telephonecallstocompletetheassessments,allowformoredirectintervention,andtoensurelinkagetolocalservicesandresources.Thegoaloffollowupistosupportthecommunityresourcelinkagebutnottobecome“casemanagement.”

Inadditiontotheclinicalfollowup,abriefcontactbyphoneormailedsurveyismaderegardingclientsatisfactionandsuccessfullinkagetoreferralsatonemonthafterthecaseisclosed.

Availablecommunityresourcesarecompiledinawebbasedformatand/orprinteddirectoryandupdatedregularly.Regularreviewshouldincludeunderstandingcapacityandaccessibilityofcommunityresourcesandidentifyinggapsinservices.

LessonsLearned:CommunityServicesforThoseWhoNeedThem

TheFamilyConnectsmodeldoesnotreplacemoreintensivetwo-andthree-yearhomevisitingprogramsforthosefamiliesthatneedandchoosethem,suchasHealthyFamiliesAmericaandNurseFamilyPartnership.Rather,theshort-termhomevisitsserveasauniversalscreeningandtriageapproachtoensureoptimalmatchingandfollow-throughoffamilieswithothercommunityservices.Inthisway,familieshaveaccesstowhattheyneedandtotheprogramsandservicestowhichtheyagree.Onlyfamilieswithidentifiedneedsformoreintenseandmoreexpensiveprogramsreceivethem,resultingincostefficientprogrammingandserviceutilizationforthecommunityasawhole.

AdirectlinkbetweenFamilyConnectsandthelocalDepartmentofSocialServicesisessentialtofacilitatethefamily’saccesstoandknowledgeabouteligiblebenefits,suchasMedicaideligibility,SNAPbenefits(foodstamps),andothers.

Systematicqualityassuranceincludes:homevisitprotocoladherence,accurateassessmentoffamilyrisksandneeds,inter-raterreliabilityinratingtheFamilySupport


Matrix,successfulconnectionswithneededresourcesinthecommunity,andconsumersatisfaction.

Documentationofthehomevisit(s)andcontactswithfamiliesandcommunityservicesrelatedtofamilyneedsinanelectronicmedicalrecordisrequiredforthemedicalrecordandforperformanceandoutcomereports.

TheclinicalteamhasweeklyindividualsupervisionfromtheNursingDirectorand/orteammeetingsforpeerreview.

Optionalorauxiliarycomponentsrecommendedandmayinclude:

Schedulingtheinitialhomevisitatthebirthhospital(s)isthepreferredmethodinordertoaccomplishuniversalservicedelivery.Otheroptionsmayhavetobeexploredfordifferencesinhospitalsandcommunities.

Inacommunitywithfewformalresources,identifyinginformalresourcesbyexamininglocalstandardsofcarethroughinterviewsofclientsandstakeholdersmaybehelpful.Referralstotheseresourcesshouldbedocumentedwithoutcomesreportedbacktoagenciestostrengthencommunitysystems.

ACommunityAdvisoryBoardthatincludesconsumersandcommunityresources/stakeholdersisstronglyadvised.

Electronicdocumentationof1)programpenetrationofthetargetedcommunityand2)childandfamilyoutcomes,canbeusedtoassistwithmarketingtheprogram,creatingalocallysustainablemodel,andfundraising.

LessonsLearned:EvaluationofFamilyConnectsinDurham

FamilyConnectsinDurhamwaspilotedatthepopulationlevelpriortoevaluationbyarandomizedcontrolledtrial(RCT)(1July2009–31December2010).FindingsfromtheRCTarefoundinjournalarticlesreferencedinAppendixB.AnyFamilyConnectsprogramwilldevelopitsownapproachtoformativeandsummativeevaluation,bothofwhichareneededforongoingandsustainablequalityimprovement.Usingadministrativeand/orindividuallycollecteddataaboutchildandfamilyoutcomesmayalsoassistinclaimingfundingforlocalprogramsustainability.

Forthe18monthtrial,Dodgeandcolleagues(2013)reportedacommunityparticipationrateof69%forfamiliesofeligiblenewborns,andnursesmaintainedanaverageof84%fidelitytotheFamilyConnectshomevisitprotocol.Byage6months,thoseeligiblefortheprogramhadmorefamilycommunityconnections,


betterpositiveparentingbehavior,lowerratesofmaternalanxiety,higherqualityhomeenvironments,anddecreasedemergencymedicalcarefortheinfants,whichresultedinestimatedhealthcaresavingsof$3.02forevery$1.00inprogramcosts.TheevaluationofFamilyConnectsinDurhamatinfantage12and24monthsindicatedcontinuedcostavoidanceforchildemergencycare(i.e.,emergencydepartment,urgentcare,inpatienthospitalization).

SummaryofProgramStepsThereareseveralconnectingsteps,involvedinFamilyConnects;theyare:

1) Anursevisitor,programsupportworker,ormemberofthehospitalstaffvisitsallnewparentsinthehospitalafterdeliverytodescribetheprogramandtoscheduleaninitialhomevisitwithaFamilyConnectsnurse.Allresidentsintheprogramserviceareaareeligible.Anycommunitymayexplorealternateandcombinedmethodsforschedulingthehomevisit,includingschedulingoverthephone,awebsiteforself-referral,workingwithmedicalcarepractices,andadvertising.

2) Thenursehomevisitorconductstheinitialhomevisit,referredtohereastheIntegratedHomeVisit(IHV).Thevisitisdesignedforthehomevisitingnursetomakeaconnectionwiththefamily,assesshealthandpsychosocialwellbeing,respondtoarangeofquestionsaboutpostpartumandnewborncare,andplanforconnectionsinthecommunitytoprovidesupportforthefamily.

3) Oneortwofollowuphomevisitsortelephonecontactsforfamiliesarescheduled,asneeded,toprovidefurthereducation,assessment,and/ortohelpsecurefamilyconnectionstocommunityresourcesandsupportsidentifiedduringtheinitialvisit.

4) Nursevisitorsmakeappropriatecontactsasneededtolinkthefamilytocommunityorganizations.Attimes,theworkinvolvesresearchingwhatisavailableinthecommunityforaspecificfamilyneed.

5) Afollowuptelephonecall(thePost-VisitConnection,orPVC)iscompletedonemonthafterthenurseclosesthecase.Astaffmemberdiscussesthevisitwiththeparentandevaluatesthesuccessofreferralstocommunityservicesaswellasconsumersatisfaction.Iftheclientcannotbereachedbyphone,awrittensurveymaybesentbymail.

6) TheinformationgatheredfromthePVCwillprovidetheprogramwithinformationabouttheeffectivenessofthevisitandthereferralsthatweremade.Inaddition,gapsinservicesareidentifiedandenabletheprogramtoprovidefeedbacktocommunitypartners.


TheoverallgoalofFamilyConnectsistoprovidehigh-qualityhomevisitswithconnectiontocommunityresources,thuspromotingcommunity-levelchangeforfamiliesandchildrenby

increasingthecommunity’scapacitytomeettheirneeds.

III.THEROLEOFFIDELITYANDQUALITYASSURANCE

FamilyConnectsaimstobeauniversalhomevisitingprogramforallnewbornsinadesignatedgeographicareaandtobedisseminatedtoothercitiesandotherstates.Inordertocontinuetoshowimplementationsuccessandoutcomeseffectiveness,itisimportantthatallclinicalprovidersparticipateinmonthlyorquarterlyassessmentsofadherencetothehomevisitprotocolandthetestinginter-raterreliabilityonratingontheFamilySupportMatrix.Fidelitytotheprotocolisassessedbydyadicvisitsduringwhichasupervisor(orpeer)participatesbycheckingoffcriticalitemsrequiredfortheIHV(usingaFidelityChecklist).Thegoalisatleast75%adherencetothevisitprotocol,whichprovidesinformationaboutpercentageofadherenceandalsoaforumforlearningandgrowthinconductingthevisit.Wehavelearnedthatpeerfeedbackandrecommendationsareveryhelpfulincreatingacultureofopennessandcompetency.Afterthevisit,bothvisitorscompletetheFamilySupportMatrix,andinter-rateragreementiscalculated.Asapartofqualityassurance,therearequarterlyauditsofimportantprotocolitems,forexample,informationrequiredforMedicaidbilling.

IV.DISSEMINATIONANDREPLICATIONOFTHEEVIDENCE-BASEDMODEL

FamilyConnectsdisseminationfollowsthetrainingmodelsinuseattheCenterforChild&FamilyHeathinDurham,NorthCarolina,includingLearningCommunities,LearningCollaboratives,and/oracascadingmodelofimplementationoftheevidence-basedprotocol.RecipientswillreceivearangeofinputfromtheDurham-basedteam,dependingoncommunityreadinessandneeds.AllcriticalcomponentsoftheFamilyConnectsmodelmustbeincorporatedintothenewsiteinordertobeconsideredaFamilyConnects(evidence-based)program.Additionally,insecuringfundingforFamilyConnectsprogramimplementation,considerationshouldbegiventocostsassociatedwiththeinitialtraining,consultation,andtravelrequiredtoreplicatethemodelandtosustaintheservices.TheLearningandMentoringModelforFamilyConnectsDisseminationAnextensivebodyofimplementationresearchemphasizesthatthebestresultsfordisseminatingevidence-basedpracticesareachievedwhenseveralkeyelementsareincluded:1)interactivelearningsessions;2)actionperiodsbetweenlearningsessionsforguidedlearningandpracticeofnewskills;3)consistentuseofamanualforintervention,case-basedconsultation,mentoring,performanceandfidelitymonitoring;and4)leadershipand


organizationalsupportforthenewpractice.InaLearningandMentoringmodel(O’Donnelletal.,2012;Chamberlinetal.,2012;Chamberlinetal.,2008),thecascadingknowledgeandmentoringfromexternalexpertstolocalexpertshasseveralbenefitsforprogramsadoptingtheevidence-basedpractice.ForFamilyConnects,advantagesofthisdisseminationmodelinclude:

• PreservesbestpracticesastheFamilyConnectsmodelreacheslargeraudiences;• Limitstheneedforexternalexpertstoconductlarger-scalelocaltrainingsessions,

systematicallyreplacingexternalexpertswithlocalleadership;• Promoteslocalownershipandexpertisetowardsustainability;• Providesamonitoringstructurefornewprogramstoadoptstandardstobecertifiedas

aFamilyConnectsprogram;and• ContinuessupportforongoingcertificationasaFamilyConnectsevidencebased

program.

Aneffectivedisseminationinvolvesaflexibleanditerativeprocesswithdidacticsessions,collaborativelearningactivities,andmentoredactionperiodsdescribedbrieflybelow. SummaryofImplementationSteps Step1:ReadinessAssessment–Assistthelocalprograminassessingcurrentstaffing,thelocalorganization,andcommunityreadiness.Theresultsofinitialconferencecallsandwrittenquerieshelpbuildamodelforcommunityneedsandapreliminarybudget. Step2:ProgramInstallation–Traininmodeldevelopmentandimplementationandsetupdatabaseforprogramdocumentationandreporting.Step3:InitialImplementation–ActionperiodbylocalprovidersimplementingtheFamilyConnectsmodel.Nursesreceivelocalsupervisiononallhomevisits,toincludefidelityandreliabilitychecks.ThisperiodincludesregularlyscheduledcommunicationwiththeDurham-basedteam.Step4:On-siteAssessmentandCertification–ObservationandreviewbytheDurhamteamwillbescheduledfollowingtheInitialImplementationperiod.Step5:FullOperation–Theprogramentersthesecondactionperiod,includingregularconsultationwiththeDurhamteam.FulldatacollectionandreportingshouldbeinplaceforreviewbytheDurhamteam.Step6:On-siteReview–Following6-12monthsoffulloperation,withtimingdeterminedbytheDurhamandlocalteams,anonsiteauditwilloccur.


Continuingyearlyaudits:ConsultationwilloccurregularlytoconfirmtheadherentimplementationoftheFamilyConnectsmodelandtoassessallcriticalprogramcomponents.Eachthirdyear,therewillbeanon-siteauditforcontinuedcertification.

V.REFERENCES

Alonso-Marsden,S.,Dodge,K.A.,O’Donnell,K.J.,Murphy,R.A.,Sato,J.M.,&Christopoulos,C.(2013).Familyriskasapredictorofinitialengagementandfollow-throughinauniversalnursehomevisitingprogramtopreventchildmaltreatment.ChildAbuse&Neglect,37,555-565.

Chamberlain,P.,Price,J.,Reid,J.,&Landsverk,J.(2008).Cascadingimplementationofafoster

andkinshipparentintervention.ChildWelfare,87(5),27-48.Chamberlain,P.,Roberts,R.,Jones,H.,Marsenich,L.,Sosna,T.,&Price,J.M.(2012).Three

collaborativemodelsforscalingupevidence-basedpractices.AdministrationandPolicyinMentalHealth,39(4),278-90.

Dodge,K.A.,Goodman,W.B.,Murphy,R.A.,O’Donnell,K.,Sato,J.,&Guptill,S.(2013).

Implementationandrandomizedcontrolledtrialevaluationofuniversalpostnatalnursehomevisiting.AmericanJournalofPublicHealth.Availableonlineat:http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2013.301361

Dodge,K.A.,Goodman,W.B.,Murphy,R.A.,O’Donnell,K.,&Sato,J.(2013).Randomized

controlledtrialevaluationofuniversalpostnatalnursehomevisiting:Impactsonchildemergencymedicalcareatage12-months[SpecialIssue].Pediatrics,132,S140-S146.Availableonlineathttp://pediatrics.aappublications.org/content/132/Supplement_2/S140.long

Dodge,K.A.,Goodman,W.B.,Murphy,R.A.,O’Donnell,K.,Sato,J.(2013).Towardpopulation

impactfromhomevisiting.ZerotoThree,33,17-23.O’Donnell,K.,Nyangara,F.,Murphy,R.,Cannon,M.,&Nyberg,B.(2008,Revised2014).Child

StatusIndexManual.ChapelHill,NC:MeasureEvaluation.

INTRODUCTION TO THE MODEL: CONSIDERATIONS · PDF file... , Family Connects, CCFH Ben Goodman,...

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