Increasing Home Visiting in Michigan

Challenge:

• Many states implement home-visiting programs as one way to offer supportive services to expecting parents and families with new babies or young children. Michigan has a long-standing home visiting program service array, including a mix of national evidence-based programs and home-grown Michigan variations.
• However, leaders at the Michigan Department of Health and Human Services (MDHHS) learned that many families who might benefit from these programs were not being served as often as they could be. Michigan leaders wanted to figure out how to prioritize families including Black mothers, Latino families, families impacted by substance use, Tribal citizen families, and families in rural areas and better connect these families to home visiting services.

Innovation:

• The GPL helped DHHS leaders design and execute an engagement pilot program to increase the number of prioritized families reached by home visiting services. State leaders worked with one home visiting agency in Macomb County and five agencies in Kent County. Leaders prioritized working with providers who they thought were equipped to best support the populations they hoped to reach.
• The GPL supported DHHS leaders as they worked to: 1) identify what priority families they have been missing in outreach, 2) identify which home visiting agencies could connect with those families, and 3) test engagement strategies to successfully identify and refer families to home visiting (e.g., speak with staff in doctors’ offices to help them refer families to home visiting).
• The GPL supported DHHS as they refined outreach tools and mentored providers on ways to demystify the outreach process by breaking it down into concrete, manageable steps including:
  1. Identify priority families. Agency leaders should review data and have conversations with staff and community members to select a population that may be underserved. For example, staff may want to reach pregnant Latina women dealing with substance use issues. Staff should consider where to find those families, such as in the local community health center.
  2. Engage families. Agency leaders must often rely on other trusted messengers to introduce the concept of home visiting. For example, the intake nurse at the community health center speaks Spanish and is also a mother. She visits with each mother when they come into the center, and the women seem to trust her. Agency staff can prepare information about their home visiting program and give it to the intake nurse who can then share it with families as they arrive.
  3. Enroll priority families. Agency leaders can train their staff to ensure priority populations actually get signed up for services. For example, staff can practice conversations using client-centered, strength-based language that seeks to understand the family’s context and empower the parent as the decision maker.
• The GPL educated state leaders about challenges that providers tend to face in outreach, and then shared promising strategies that some providers were testing to address those challenges.
  • The state’s Home Visiting Leadership team included staff from the MDHHS Division of Child & Adolescent Health, MDHHS Division of Maternal and Infant Health, the MDHHS Children’s Services Administration (CSA), MDHHS Division of Program and Grant Development and Quality Monitoring, Michigan Department of Lifelong Education, Advancement, and Potential, Children Trust Michigan, Inter-Tribal Council of Michigan, Michigan Council for Maternal and Child Health, and Center for Healthy Communities at MPHI.
• The GPL led two “Train the Trainers” workshops for the state’s home visiting program managers on ways to bridge the gap between knowing about promising engagement strategies and actually helping service providers conduct effective outreach.
• The GPL outlined how to expand the pilot to the county and state levels. The GPL then worked with state leaders to identify their highest priority next steps, both short- and long-term, while weighing feasibility, impact for priority families, and coordination with other initiatives.