Pediatric Social Work & Home Visiting

What if all babies had a secure relationship with one caregiver--a relationship that sent the message with words and actions "you matter"?

Photo of Jana Habrock
5 2

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Founding Story: Share a story about a key experience or spark that helps the network understand why this project got started or a story about how you became inspired about the potential for this project to succeed.

My agency, Child Saving Institute (CSI) developed an outreach program many years ago that provides mental health consultation to community childcare programs. Most of the children referred were preschool age and had BIG behaviors that put them in jeopardy of being expelled from their child care setting. Digging deeper into these children's histories led to trends regarding early risk factors of maternal depression, other mental health issues, domestic violence and parental trauma. The data was not surprising and it matched what we knew from the ACE study and research about toxic stress & brain development. We wondered a few things: if these risk factors were addressed earlier would children have stronger social emotional skills to impact school success and was anyone else in our community already addressing these challenges for young children and their families. Most of the children in our community attend their first well-child check up at 2 weeks of age; we surveyed several pediatric offices and asked if they routinely completed social emotional screenings and/or maternal depression screenings. The survey found these screenings were not routine; this information assisted in scraping together funding and piloting the program at two pediatric clinics. The program provides screening, promotion of parent-child engagement and home visiting to connect family to community resources to meet needs that may interfere with a strong parent-child relationship.

Which categories describe you? (the answer will not be public)

  • White (for example: German, Irish, English, Italian, Polish, French, Caucasian)

Website

http://www.childsaving.org

Location: Where is your organization headquartered? [State]

  • Nebraska

Location: Where is your organization headquartered? [City]

Omaha

Location: Where is your project primarily creating impact? [State]

  • Nebraska

Location: Where is your project primarily creating impact? [City]

Omaha

Problem: What problem is this project trying to address?

The problem Pediatric Social Work and Home Visiting is addressing is two-fold: early identification of developmental and behavioral health risk factors for young children and families and increased access to intervention, treatment and supports. We know the parent-child relationship is so important for early development and the mental wellness of adults plays a critical role in how young children develop. Maternal depression is particularly worrisome
because of its prevalence. The US Department of Health and Human Services Administration for Children and Families estimates that one in eleven infants will experience their mothers’ major depression in their first year of life; the rates are even higher for mothers living in poverty. Further impacting mother's mental health is the barrier for access to services for families living in poverty.

The science of child development shows the foundation for sound mental health is built early in life, as early experiences shape the architecture of the developing brain. We know that children whose early care allows for frequent parent-child interaction in safe, positive, language-rich environments  are well on their way to developing the skills that will support all future learning. Unfortunately this is not the case for all children, especially those whose caregivers are living in poverty and experiencing the chronic stress that often accompanies it.

Pediatric Social Work and Home Visiting is a program of Child Saving Institute that partners with pediatric clinics serving high levels of low-income populations to promote screening and early identification of  risk factors in children 0-5 years of age. The Ages and Stages-Social Emotional screening tool is administered during regularly scheduled well-child check-ups. During the well child visit of children two to twelve months, mothers are also screened using the Edinburgh Depression Scale. The parents of children whose score does not show a need for services receive a brief consultation on how to continue to support their child’s developmental growth and empower parents to be a part of their child’s healthy development.

For individuals scoring in the “concern” range, the program provides consultation to the pediatrician regarding the needs of the family. The family is provided with follow-up in person either at the clinic site or in the family’s home or community setting to provide support and assess the child and/or parent needs and strengths and make appropriate referrals. Interim home visitation occurs at least bi-weekly providing support until the community referral source begins services, ensuring the linkage to service is made.


More vulnerable families with high needs are provided home visitation more frequently. Additionally, longer term home visitation is provided if there is a waiting list for the community referral resource or the parent has needs that can not be met by more traditional resources.


Strong communication between the child’s pediatrician and the program is imperative to the success of the family and ensures that needs are not missed and contributing factors are identified. The following comments are from clinic professionals:


  • “The social worker learned things that doctors don’t. The social worker has a set of tools and the context to ask questions that the medical professionals do not have. Sometimes families are “evasive” but they seem to open up to the social worker.”—Pediatrician
  • “The pediatric social worker program opened our eyes to what is going on. The conditions are much poorer for families than we ever thought. We wouldn’t know this without having the social worker and her ability to do home visits.”—Pediatrician
  • Patients share information with the social worker that they do not tell the doctors or nurses. Social workers are in a unique position to learn more about patient’s lives. In the clinic they have more time to spend with patients; doctors often have patient appointments every ten minutes.”—Pediatric Nurse


In addition to clinic screenings and home visits, the program also provides play groups to increase parent support networks and parent-child interaction.  The program works to integrate positive parent-child interactions and provide parents with child development knowledge through supportive play experiences and builds on the family’s natural interaction style.

Is your model focused on any of the following traditionally underserved communities?

  • Communities of color
  • Low-income communities

Does your model work within any of the following sectors?

  • Other

If you chose "other," please share the sector you work within here:

pediatric clinic

Year Founded

2011

Project Stage

  • Growth (the pilot has already launched and is starting to expand)

Example: Walk the network through a specific example of what happens when a person or group engages with your solution.

The program met a mom at her son’s 9-month check up; mom scored in the concern range on the screening. While talking through the program services, mom insisted she was fine; later calling to say she did not feel she could talk in front of her husband but often experienced symptoms of depression. During the first home visit, mom sat with her arms wrapped around her baby and cried as she described her feelings of isolation in her unsafe neighborhood and relationship with her husband.The baby had little affect; he did not squirm, grasp or vocalize.The program assisted mom in accessing free community counseling, housing in a safer neighborhood and positive parent-child interaction activities. Child's social emotional development is now strong.

Impact: What was the impact of your work last year? Please also describe the projected future impact for the coming years.

3,143 clients screened
2,633 education consultation provided
382 home visits completed
100% of clients seeking in-home support were successfully connected to appropriate intervention or treatment.
100% of parents or guardians responding 6 months to a year after the completion of Pediatric Social Work services report that their own or their children’s social emotional, behavioral health and overall wellbeing has improved and/or been supported.
100% of client’s parents or guardians report they are able to support their children’s development.
100% of client’s parents or guardians report that their children are safe and remained in custodial parents’ or guardians’ care.

Organization Type

  • nonprofit/NGO/citizen sector

Annual Budget

  • $100k - $250k

Financial Sustainability Plan: What is your solution’s plan to ensure financial sustainability?

The program is currently starting the 3rd year of a 5 year private grant. We are hoping to bring on financial support from clinics as they see the benefit of the program.

Unique Value Proposition: How else is this problem being addressed? Are there other organizations working in the same field, and how does your project differ from these other approaches?

Our program intervenes early, meeting families at their child's 2 week well-child visit. Clinics in our community offer patient care coordination through a medical home model but they do not provide home visitation to assess needs or support follow through to resources. Our program differs in that social emotional development is the focus. We are grounded in the belief that positive nurturing relationships are important to children's development. Because we believe this so strongly it influences the relationships we build with doctors and nurses and our staff have become trusted partners.

Reflect on the Field and its Future: Stepping outside of your project, what do you see as the most important or promising shifts that can advance children’s wellbeing?

We serve many families without medical insurance who have limited access to traditional services for supporting mental health issues; our program looks to more holistic approaches such as diet and exercise. We have been following the mindfulness movement and thinking about how to implement it into our work. We are excited to learn how these practices can support parents being fully present with their children but also provide children with tools for emotional literacy and wellbeing. We continue work on trauma informed practices and cultural humility to support families to build resilience.

Source: How did you hear about the Children’s Wellbeing Challenge? (the answer will not be public)

  • Email

Program Design Clarity

The program collaborates with 2 pediatric clinics serving low income families from the most poverty blighted areas of Omaha. Social emotional and/or maternal depression screenings administered during well child checks for children 2 weeks to 5 years are the point of entry for services. Main activities include these screenings, consultations to parents on interactions to support the social emotional development of their child; weekly home visits and connection to resources are provided to families identified as needing more support. All services are provided by Child Saving Institute staff.

Community Leadership

My agency has multiple programs that are collaborations with other community providers. Several staff including myself serve on community coalitions and leadership teams to better understand the needs of community stakeholders. On the client level, all clients are involved in developing their own goals and we have a robust Continual Quality Improvement process which includes client feedback that is used to follow trends and improve programming.

Age of Children Impacted

  • 0-1.5
  • 1.5 -3
  • 3 - 5

Spread Strategies

Omaha is one of the few urban communities with the rest of the state being rural; culture, systems, resources and barriers for children and families are different in each area of the state. While our model can work in other systems it would be important to connect with community leaders across the state to understand these differences. Advocating for legislative changes would be one of the first steps towards sustaining this model statewide.

Reflect on how your work helps children to thrive. How are you cultivating children’s sense of self, belonging, and purpose through your model?

This project begins with our youngest children and equips the adult in their life with skills to build healthy relationships and find supports for their emotional health. This in turn supports the child to feel safe and secure, one of the most important ingredients to cultivating emotional well being. When children feel confident that they matter they are able to build a strong sense of self, purpose and belonging.

Leadership Story

My first job with children and families was with teens in a group home. It was clear from the very beginning how important relationships are to your sense of self and feeling of belonging. I somehow innately knew that we had to start earlier, with babies and their care givers to see real change. I have now spent over 20 years working with infants and toddlers and their caregivers. The more I research and learn about attachment, brain development, trauma and infant mental health--the more I know this is where social change must begin! My next step is working to create systems that support this.

Organization's Twitter Handle

@childsaving

Organization’s Facebook Page (URL)

https://www.facebook.com/csiomaha/

Leader's LinkedIn Profile (URL)

https://www.linkedin.com/in/jana-habrock-463aa94

Evaluation results

3 evaluations so far

1. Relevance: Does this project seem to help children (ages 0 to 12 years) develop a strong sense of self, belonging, and purpose?

5 - Yes, this is great! The project lays out a strong, compelling case for how its model nurtures children’s wellbeing. - 33.3%

4 - It seems like a good fit, and the model talks explicitly about children’s wellbeing. - 66.7%

3 - I think so. The project seems related to children’s wellbeing, but the logic is vague. - 0%

2 - Not sure. The project doesn’t have much to do with wellbeing, or it doesn’t give enough information. - 0%

1 - Nope, this project definitely doesn’t fit the challenge brief (e.g., It doesn’t help kids younger than 12, isn’t in the U.S., etc.) - 0%

2. Innovation: Does this project tackle children’s wellbeing from a new angle?

5 - I loved this! The project describes a novel model that addresses important cultural or systemic barriers. - 33.3%

4 - This is pretty cool. The project is addressing an important problem in a new or compelling way. - 33.3%

3 - I feel like there’s something there, but I want more details about what makes it distinctive. - 0%

2 - It’s a good project, but I’ve seen others like it before. - 33.3%

1 - It was confusing or hard to tell what it made it different. - 0%

3. Social Impact: What is this project’s potential for creating positive social impact?

5 - Lots of potential. This project is achieving impressive results, and it’s growing quickly. It could absolutely inspire changes in the ways we approach caring for kids nationally, across sectors (e.g. childcare, healthcare, education). - 33.3%

4 - Pretty good potential. This project demonstrates significant positive impact so far, and it could scale regionally or nationally one day and fundamentally change how a system operates (e.g. childcare, healthcare, education). - 33.3%

3 - Budding potential. This project is creating local impact, but it would take a few adjustments before it could scale. - 33.3%

2 - Some potential. This project demonstrates some initial positive impact, but it would require major changes before it could scale. - 0%

1 - Limited potential. This project has great intentions, but it looks like it does not include key drivers of a shift towards children’s wellbeing. - 0%

4. Overall, how do you feel about this idea?

5 - This idea rocked my world. It’s awesome! - 0%

4 - This idea seems really exciting. With a little more polishing, it’d be among my favorites. - 66.7%

3 - I think the idea is great, but it needs some work before it moves onto the next round. - 0%

2 - I liked it fine but preferred others. - 33.3%

1 - It didn’t make my heart beat faster. Needs significant revisions. - 0%

5. Offer some feedback. Where should this participant spend some time revising?

DEFINING THE PROBLEM. Make sure to articulate the root causes or main barriers of the social issue your project addresses. (Founding Story, Problem, Solution). - 0%

CLARITY OF MODEL. Make sure to mention (a.) the beneficiary, b) the main activities, and c) how those activities drive social impact. Keep it streamlined! - 50%

MARKETPLACE. Make sure to research other players in this space and articulate how this project is different. I didn’t get a complete sense of how this project compares to others. - 0%

IMPACT POTENTIAL. Make sure to use specific numbers to describe what your project has achieved so far! And consider how you might scale the model or its insights, through partnerships, trainings, or franchising. - 100%

WRITING STYLE. Try to stay concise and make it vivid. Avoid jargon. - 0%

Nothing stands out! I thought it was great. - 0%

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Photo of Fred Cardenas
Team

Would very much be interested in connecting with your program. Our program, Early Childhood Well Being is soing similar work for 0-6 year olds but we become the resource that get referred to.  So I would be curious to learn from you how you connect to and identify those pediatricians, their receptiveness, and then how well the community provides a network of developmentally appropriate services. We sometimes get kids as young as 2 or 3 being prematurely diagnosed and medicated with significant mental health issues when it is often many other factors contributing to those social emotional concerns and medical and psych professionals may not be equipped or prepared to serve those children in more developmentally appropriate manner.

Photo of Jana Habrock
Team

Thanks Fred. I would love to connect with you. It was challenging at first to connect with pediatricians and get them to allow another person into their busy practice but they are overwhelmingly appreciative of the work we do with their families and are the first to write letters of support for grants/funding opportunities. As they better understand the child's home life, trauma, social emotional concerns we have seen them move towards therapy or other resources rather than diagnosing and medicating. We have a good number of providers who understand early childhood mental health but we often run into barriers of waiting lists, Medicaid/insurance issues and we also have a large Spanish speaking population with very few bi-lingual providers. Another program that I manage provides mental health consultation to childcare centers so I understand the perspective too of being the resource that kids with social emotional concerns get referred to and the challenge of working with pediatricians outside of our pediatric social work program. We see some of those same issues. Tell me more about how kids get referred to your program and the services you provide.

Photo of Fred Cardenas
Team

Thanks for your response Jana.  The few pediatricians we have connected with do seem to be very interested and open but my understanding is that of all medical professionals, they are often the quietest, most modest and maybe not the most experiemental, generally.  But once they see the benefit I imagine many would be very open.  Our program receives referrals from many partners we have developed over the years, primarily head start, early head start, some school districts, childcare centers, family/homeless shelters, a community health clinic organization (FQHC), baby court, and less frequently, other mental health providers and we do serve some rural communities in Texas.  We have contracts with some of these partners and provide services at no cost to others through local long-term foundation support (now 5 years).  We have grown from a staff of 3 starting 5 years ago to now a staff of 12 to become 15 with a new grant we've just received from the state (coming from SAMHSA).  OUr 12 staff members are typically social workers, counselors, and family therapists and typically we get 2-3 graduate interns per semester.  Most of our staff have provisional and some full clinical licenses.  We've learned that early childood education or early  child mental health are the most desired experience vs a full clinical license although having both is ideal.

Referrals we receive come primarily from teachers, caregivers, parents, school support staff, child protective services, and child psychiatrists.  Children referred are usually exhibiting some type of disruptive behavior or have experienced some form of trauma. About 6% of kids we serve who are referred are already getting psychotropic medication (as young as age 3) when the referral comes to us and about 20-30% are in need of educational or developmental support/services (IDEA part b and c) and often primarily due to language delays.  To give you an idea of our services I'll describe what one of our early childhood clinicians may experience in a typical day.  They often start at a campus to observe a referred child and conludue their 1-2 hour visit with a consultaiton for the teacher with written recommendations (usually classroom or behavioral management strategies).  They will visit several campuses in a day.  After so many visits for a referred child, the clincian may develop a behavioral plan in collaboration with the teacher and we do follow up coaching and support for the teacher. We hold off on full family integration (for classroom referrals until after 2-3 visits) as 50-80% of those referrals are due to classroom management problems and not a true mental health problem.  We do home visits after a few classroom observations to do a family assessment and then begin individualized parenting sessions (PCIT and Incredible Years strategies used) with an option of brief counseling for child, parents, or other family members. Most of the interventions are integrated into the classroom so lots of training, coaching and guidance is given to teachers.  Staff may attend and IEP meeting (called ARD meetings in Texas) to help parents advocate for their child. Then all staff provide community behavioral management training (program does an average of 1-2 training sessions per month with teachers and parents beign the primary participants).  Late afternoon, eves or Saturday mornings may include home visits. We are quite excited about a new project Early Intervention Court (baby court) in which 0-3 year olds in the foster care system get our comprehensive services that may include foster parents, biological parents, other caregivers and the child. It is modeled after drug courts so parents get increased visits and depending on progress, expedited reunification.  We have collaborted with some doctors who have agreed to allow us to do baseline measures of behavior without the medication through classroom observations and parental consent.  The program is very relationship based (with child, teachers, parents, families, collaborators, etc.). Of course some case managemetn is provided at times with our own staff or with head start support.  Please feel free to email if you'd like to further connect and share info fcardenas@family-service.org

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