Early Intervention Home Visiting Program Information for Referring Agents Introduction The Tresillian in Murrumbidgee Family Care Centre (Murrumbidgee FCC) Early Intervention Program Home Visiting (EIHVP) provides a home visiting program of 6-12 visits for parents/carers who require additional support to develop their capacity to parent due to identified vulnerabilities that compromise or potentially compromise parent-infant interaction. The main focus of the program is to provide an intervention that enhances the carer’s ability to respond sensitively to infant’s behaviour and therefore improve the quality of the interaction. This program is based on previous experience of providing an extended nurse home visiting service to Tresillian clients and the broader and long term evidence of home visiting interventions. The program has adopted an intersectoral partnership model with a strong commitment to building community capacity and to ensure that families receive consistent messages about optimal parenting. Aims of the program To assist parents with multiple issues that impact on their ability to parent and the quality of the carer- infant relationship. Program Entry Criteria All families accepted for the service will meet the criteria for families requiring a level 2 service response. All families will have a parenting issue that cannot be addressed by a level 1 primary health service response. Geographic boundary within the EIHV area boundaries (Appendix 1) Families with children 0-3 years of age including siblings Priority will be given to families with a child 12 months or under. Parents (in this instance the mother) in a rehabilitation program, e.g. drug and alcohol and transition services from the criminal justice system. Parents with a drug issue currently being managed by a case worker, e.g. involved in a methadone or similar program. Parents with current or past treatment for mental health but not in the acute phase at the time of admission to the service; with a case worker and/or links to appropriate support which can include a mental health workers, GP or a community Allied Health worker. Families will have identified life stressors/risk factors that may be impacting on their parenting capacity and the quality of the relationship and interactions with their child/ren. August 2017 Examples of family risk factors include but are not limited to: o A learning difficulty, depression, anxiety, poverty, recently migrated, trauma, developmental delay o A previous intervention / engagement with child protection services o Previous history of drug misuse, domestic / family violence or abuse o Parents under 20 years with minimal supports o Grief and loss associated with the death of a child or other significant family members o History of or current mental health condition o A child with a disability. Exclusion criteria Acute conditions that interfere with the cognitive and emotional ability of parents to focus on their parenting skills including: Exacerbation of mental illness that requires acute specialist mental health interventions (the family will be accepted into the program once acuity has subsided). Families that need an interpreter (the program has limited funding) Carers with active substance misuse. Counseling needs only. Referrals Referrals are accepted from: CFHNs, Midwives, GPs, Perinatal Mental Health Workers, Drug and Alcohol Workers; and workers from Children of Parents with a Mental Illness (COPMI), Family and Community Services, Brighter Futures, Non Government Parenting support services, psychologists and social workers. Referrals are done online at https://www.tresillian.org.au/health-professionals/make-a-referral When completing parent details (Step 3) please note under parent issue, that you are requesting access to the EIHVP and complete as many of the parent issues as relevant. All referrals will be assessed for appropriateness and the referral agent will be notified if the family is accepted or declined. Parents that are offered and accepted to be part of the program will be given the program pamphlet. If the parent declines the offer to participate in the program the referring agent will be notified. Parents who have been referred to the program but initially decline the offer can reactive their initial referral by contacting the service if their circumstances change. If accepted onto the program the referring agent will be notified. Duration It is anticipated most carer’s will receive between 6 – 12 visits, the first 2 visits being dedicated to engagement and assessment. The frequency of the visits will be flexible enough to accommodate the specific needs of the families. Program Approach This program will be implemented as part of the woman’s and infant’s care management plan/process commencing if possible during the antenatal period. This will mean that the program is not implemented in isolation and at the conclusion of the program the woman will have current linkages with her main support system with other service providers. August 2017 Intervention Outline As clearly identified within the professional literature successful home visiting programs must have a clear framework of assessments and activities. The Murrumbidgee FCC Early Intervention Home Visiting program aims to be adaptable to the families needs. All elements of the program have a strong relationship and strengths based focus, drawing and building on the parent’s existing knowledge and skills. An essential component of the project is the linking of the parent with or maintaining the link with appropriate community services and resources. The program has been developed using key elements from existing evidenced based programs and tools. In particular: NCAST Keys to CareGiving this program is from the University of Washington and focuses on infant communication through the identification of infant cues and infant states. A framework is provided for parents to increase their sensitivity to their infant’s needs. Seeing is Believing from the University of Minnesota. This program aims to increase maternal sensitivity through understanding how an infant may be experiencing a specific situation. NCAST Parent Child Interaction (PCI) Assessment Scale from the University of Washington. This provides a framework for assessment, development of an intervention and evaluation of the implementation outcome. Nurses using these assessments in clinical practice must have gained reliability at 85% (reliability is tested annually). The NCAST assessments are used within the David Olds Nurse Family Partnership Home Visiting program and are accepted within the US Child Protection system. Parent under Pressure (PuP) offers families who are experiencing high levels of stress and difficulty functioning across many domains, an intervention using an integrated framework. The PUP therapist and family work together to identify the problems impacting on parenting and work in a strengths based model to determine goals and actions plans to help resolve the issue or reduce the associated stress and anxiety. The program offers structured but not sequential, individual models that are adapted and priorised to meet the families’ individual needs. PuP objectives include: Identification of long term developmental outcomes of the children; consideration of the family environment and parenting practices in achieving these goals and identification of therapeutic goals that will help create the family environment and promote the parenting practices identified. This approach provides outcome measures through the use of the NCAST PCI assessment scale (feeding and teaching), use of the HOME questionnaire and the Parents under Pressure structured program. The intent of this program is not to offer the home visiting in isolation from other services but to contribute to the services that are already involved with the family. The main focus of the program is to provide support to enhance maternal sensitivity and parent and infant interaction. It is essential that the existing coordinating service maintains their coordinating roles and that there is clear communication channels between the EIHV program and the other service providers. August 2017 For further information about the program please contact: Alanna Millar or Elizabeth Horton Early Intervention Home Visiting Program CFHN Phone: 0437 886 556 Email: [email protected] Ms Karen Griffin Tresillian in Murrumbidgee NUM Phone: 02 5943 2713 Email: [email protected] Appendix 1: Tresillian in Murrumbidgee Family Care Centre Early Intervention Home Visiting Program Areas Wagga Wagga and surrounding towns The Rock 2655 with 2650 postcode ( less than 40 Kilometre from FCC) Coolamon 2701 Junee 2663 Mangoplah 2652 Marrar 2652 Old Junee 2652 Uranquinty 2652 Tarcutta 2652 August 2017 .