FY25: For Better off measure #1, #/% of full-term births for parents that enrolled in home visiting during their 1st or 2nd trimester, the cohort fell 3% short of the target. Individually, Sinai Hospital and The Family Tree did not meet their set targets for the fiscal year. In Baltimore, mothers face challenges reaching full-term pregnancies due to chronic health conditions, housing instability, and financial stress. Systemic racism and trauma further affect Black families, increasing risks of preterm birth and impacting access to care.

FY24: For the FY24 actuals, our Healthy Families America Programs (HFA) were below target on the following measures:

For How Much measure #1, # of families participating in home visiting services during the reporting period, the performance measure actual data of 304 fell below the target of 340 in FY24, which can be explained by the transition and turnover of home visitors, notably at The Family Tree. When a home visitor leaves their role, it takes time to hire and fill their position, and then roughly an additional three months for the new home visitors to receive all of their required training before they are able to begin seeing and enrolling families. It is worth nothing that the target number of families was reduced from 380 in FY23 to 340 in FY24. The reduction was intended to allow the partners to use grant dollars to increase home visitor salaries and promote retention. With more senior staff, the caseloads will be able to grow again, and the number of families reached will increase. While the impact of this intervention and the sites’ ability to serve more families may not be seen immediately, we anticipate seeing the number of families grow over time. In FY25, Family League will be braiding in additional funding for home visiting partners to increase home visitor salaries even further, so we look forward to seeing the impact this has on staff retention and the growth in caseloads across sites.

For How Well measure #2, #/% of primary caregivers enrolled in home visiting who are screened for depression using a validated tool within 3 months of enrollment (for those not enrolled prenatally) or within 3 months of delivery (for those enrolled prenatally), the combined total of the three sites fell slightly below the target of 80%, with only 79% of eligible parents meeting the measure. Staffing shortages, particularly at The Family Tree in the second half of the year in FY24, have contributed to the depression screenings not being completed in the window defined by the measure. We also know that for screenings like depression and intimate partner violence screenings, the parent needs privacy to answer honestly and safely. Sometimes the home visitor must skip the screening to protect the client's privacy and safety if someone else is in the room.

For Better Off measure #2, #/% of parents enrolled in home visiting prenatally or within 30 days after delivery who received a postpartum visit with a healthcare provider within 8 weeks (56 days) of delivery, the combined total of the three sites fell below the target of 75%, with only 50% of eligible parents meeting the measure. We know that challenges meeting this measure relate to transportation issues, childcare coverage for additional children in the household, being unable to get a postpartum visit scheduled in the window, and missing appointments. Furthermore, parents are finding it challenging to receive the postpartum visit in the window defined by this measure. One site has seen more success with parents meeting this measure since they began supporting families with the cost of rides to their postpartum appointments and keeping a close eye on the window for completing the visits in advance.

Better Off measures #3 and #4, % of participants not working or in school who report a connection to work/school and % of participants at-risk of disconnection who report maintaining the connection throughout program/service delivery, were both under the target for the FY24 Jan.-Jun. actuals and overall FY24 actuals. Of the five participants who fell within the parameters as an Opportunity Youth, two of the participants are working, one is on maternity leave but is still looking for work, one is having challenges finding childcare to return to work but looking for in-home jobs in the meantime, and one is on Creative Outreach, meaning the site is unable to get in touch with her but is working to regain contact.

FY23: Our Healthy Families America Programs (HFA) were below target on the following measures: For How Much measure #1, # of families participating in home visiting services during the reporting period, we fell below the target of 380 and served 305 unduplicated families this year. Staff vacancies and transitions account for the shortfall in participating families so far this year. In Q4, all three HFA sites were open for referrals and new enrollments. We have already seen growth since Q3 and anticipate an increase in the number of families receiving home visiting service as a result of new home visitors being onboarded and slowly growing their caseloads. We have learned that the HFA model provides a good structure for service delivery, which is a positive component, but it also includes many requirements that can overwhelm staff. We are continuing to support the funding partners with implementation of the Home Visiting Strategy to layer in support for the Home Visitors, but the salary is a contributing factor in the site's ability to staff the vacancies. As a result, our FY24 annual target will be reduced, it will be set at 340. For Better Off measure #2, #/% of parents enrolled in home visiting prenatally or within 30 days after delivery who received a postpartum visit with a healthcare provider within 8 weeks (56 days) of delivery, the combined total of the three sites fell below the Target of 75%, with only 66% of eligible parents meeting the measure. We know that challenges meeting this measure relate to transportation issues, childcare coverage for additional children in the household, being unable to get a postpartum visit scheduled in the window, and missing appointments.

FY21: Home visiting programs enroll women during pregnancy and provide intensive home-based services through the child's third birthday. Home visitors help ensure mothers have a healthy pregnancy and assist families in addressing social, economic, educational, and parenting issues that influence child health and education outcomes. The services are provided using the evidence-based Healthy Families America (HFA) model. This reporting period, 312 families were served, and 2592 home visits were conducted through the three HFA programs in Baltimore City. 

Although we greatly exceeded our annual target for number of home visits conducted (4864/3350), we did not reach our target for number of families served (335/380). The number of families participating in home visiting did not meet the target of 380 for various reasons. First, while the programs have been able to retain most of their existing families despite continued challenges associated with the COVID-19 pandemic, engaging new families while limited to virtual home visiting sessions has been challenging. Programs continue to brainstorm innovative outreach techniques and gain insight on techniques that other programs have successfully implemented during monthly HFA Home Visiting and Babystat meetings. Next, one site discharged a larger number of families who were on creative outreach or no longer eligible to receive services. Finally, staff turnover continues to impact the number of families each site can serve.  

Dru/Mondawmin Healthy Families (DRUM) was unable to report on the new opportunity measures during this reporting period. They have onboarded a Youth Opportunity Specialist who manages this work. Family League will continue to support the specialist with project implementation. 

FY24 Successes and/or Challenges: DRUM Healthy Families (DRUM) hosted Healthy Families America (HFA) for an accreditation site visit during the second half of the year. DRUM’s accreditation site visit provided them with the opportunity to show the important role the organization plays in the community and the lives of the families they serve. The organization faced some challenges while preparing as they experienced technical difficulties on site and issues with accessing needed information. This led the site to have to close to new referrals as the team dedicated their efforts to serving enrolled families and preparing for the accreditation visit. DRUM has since reopened to referrals and is currently in the response period with HFA.

During Sinai Hospital’s (Sinai) HFA site visit, parents had the opportunity to share about the impact being enrolled in home visiting has had on them. One participant said, " I don't know what I'd do without the HFA program " and another parent said that the program, “Makes me feel like I am doing something good as a mom.”

Sinai implemented a new strategy to help address the challenge of getting parents to their postpartum visit within the 8-week timeframe. By increasing review of family records to closely monitor their postpartum appointment status, the program manager was able to provide additional reminders to the Family Support Specialists for their clients, who were then able to follow up individual clients to ensure they made their appointment and were able to get there.

In May, in honor of Mental Health Awareness month, home visitors and other direct service staff from the B’more for Healthy Babies (BHB) network came together for the BHB Refresh organized by Family League. The Refresh took place at the Reginald F. Lewis Museum of African American History and Culture. Attendees could participate in different self-care activities of their choice, including chair massage, acupuncture, yoga, a sound bath, Zumba, and art activities. The purpose of the Refresh was to provide a day of self-care for home visiting teams and support sites in building a culture of self-care for their teams to increase home visitor wellbeing and satisfaction in their role. Family League offered Compassion Fatigue training in January, which was open to home visiting staff, and provided skills to cope in roles where compassion fatigue might occur and lead to burn out. In FY25, we will continue emphasizing staff wellbeing through professional development and working with sites to increase the baseline for home visitor salaries.

FY23: Funding will support the evidence-based, two-generation Healthy Families America (HFA) home visiting strategy. This strength-based, trauma-informed strategy works to support positive outcomes for children and families. In FY23, this strategy will continue to have an increased focus on supporting the needs of those at risk of becoming or who have become Opportunity Youth, removing systemic barriers participants have faced/continue to face.

FY21: Home visiting programs enroll women during pregnancy and provide intensive home-based services, through the child’s third birthday. Home visitors help ensure mothers have a healthy pregnancy and assist families in addressing social, economic, educational and parenting issues that influence child health and education outcomes. The services are provided using an evidence-based model, Healthy Families America (HFA). 

FY23: Across Baltimore, the Healthy Families America (HFA) home visiting strategy serves people with a previous poor birth outcome, medical condition, or the presence of psychosocial risk factors. DRU/ Mondawmin (DRUM) Healthy Families, the funded partner, is one of Baltimore’s HFA home visiting programs. Traditionally, DRUM serves families from select west and northeast Baltimore communities. In FY23, DRUM will continue to have an Opportunity Youth Coach who will be supporting the needs of HFA home visiting participants and their families who are at risk of becoming or who have become Opportunity Youth.

FY21: Home visiting programs serve women who are at the highest risk of experiencing a poor birth outcome.  The target population is identified through HealthCare Access Maryland (HCAM), which serves as Baltimore’s central intake system into pregnancy and early childhood services, including evidence-based home visiting. HCAM uses a carefully researched vulnerability index to assess each pregnant woman, identify risk factors, and triage each high-risk woman to the appropriate home visiting model that most effectively meets her needs. 

FY25: By the end of the year, all Healthy Families America sites hit their target number of families served, bringing the total number of families served across all three sites to 316 in FY25, exceeding the annual target of 290 families. Teams continue to support families to connect with resources to meet their needs and provide them with support to meet their goals. Home visiting staff participated in professional development opportunities during the reporting period, including the National Home Visiting Summit in Washington, D.C., Home Visitor Safety training hosted by Family League, and the B’more for Healthy Babies (BHB) Refresh, which provided a day of self-care for home visitors and BHB partner staff to help reduce burn out and retain staff.  

The Family Tree (Family Tree) worked to improve enrollment processes and build up caseloads over the third quarter. In the third quarter, Family Tree enrolled 20 new families. In quarter 3 (Q3), Family Tree hired a new HFA supervisor. This is a vital role within the program, and the new supervisor has already impacted the team's success by identifying areas where the team can grow. The HFA Supervisor provides direct engagement with the Family Support Specialists (FSS) to ensure program compliance, that the HFA Best Practice Standards are met, and family outcomes are furthered. The Family Tree team held consistent meetings focused on Continuous Quality Improvement (CQI) initiatives in Q3 and Q4, promoting data-driven decision-making and program enhancement. Family Tree HFA celebrated the graduation of families from the program with a ceremony in June, marking a significant milestone in their journey. They are currently preparing for HFA reaccreditation in August and September. 

After a long-serving FSS at Sinai Hospital (Sinai) transitioned out in Q2, a new FSS was hired, trained by February, and began serving families in March. The Sinai HFA team continued helping families navigate systems and access resources. In June, Sinai HFA celebrated with families at their annual Sesame Place trip. A graduating parent shared feeling more confident in parenting and joined the HFA Community Advisory Board as a parent advocate. During the spring, Sinai HFA prepared to transition their team to Family Tree as an additional HFA program within the organization. 

DRUM HFA reached a major milestone by completing the first step in the Medicaid Reimbursement process by submitting their electronic Provider Revalidation and Enrollment Portal (ePREP) application and receiving their ePREP number. The program manager demonstrated strong initiative by proactively starting the next step, engaging with Managed Care Organizations (MCOs), initiating early MOU discussions. The team celebrated births and the personal achievements of primary caregivers who earned degrees, obtained employment, and reached housing goals. During the reporting period, two families supported by DRUM received a bachelor's degree from Coppin State University in Business Administration. Another participant graduated from Baltimore City Community College with an AA in Histology. During her time with DRUM, she completed internships at Mercy Hospital, Johns Hopkins Hospital, and Franklin Square Hospital. In Q4, DRUM reintroduced an in-person Literacy Learning Play Group and Entrepreneurship Group for parents. In March, the program received a letter of Good Standing from Healthy Families America (HFA) and has since submitted materials for full accreditation, which are currently under review. The program also celebrated families’ milestones, such as one child completing her first Ramadan and families transitioning into Head Start and PreK programs. DRUM’s home visitors are among the most experienced in the Baltimore City HFA network, managing heavy caseloads with support from site leadership. Staffing gaps were addressed in June by hiring two Family Support Specialists and one supervisor, which will help ease some of the team who have been at capacity. 

FY24: One HFA parent has been caring for her daughter with special health care needs that doctors believed would prevent her from being able to sit up, walk, or feed herself. However, the parent was determined to get the best care for her daughter. She and the Family Support Specialist (FSS) worked with her child to improve her developmental skills. The parent consistently advocated for her daughter and was admitted in early intervention services at Mt. Washington Hospital and Kennedy Krieger. With the support of early intervention services, her daughter is now able to feed herself, play patty cake, wave hi/bye, sit up on her own, and stand up with the hope of walking soon. Her daughter will be starting at a new school in August.

FY23: In the second half of the year our Healthy Families America Programs have had tremendous success with their families. All sites are currently staffed and open to referrals. One example of success is a mom who had trouble getting to appointments and work due to lack of reliable transportation. Because she is receiving housing support, she saved up additional funds and purchased a vehicle for her family. She is now better connected to health care, work, learning, social activities, and civic engagement opportunities. In addition, one site has graduated 10 families, and 3 of the parents they have been working with graduated from College in Nursing in Q4. Additionally, one of their parents graduated from high school.

FY21: Home visiting sites continue to serve families virtually and have placed a great emphasis on quality improvement to ensure that families are receiving effective supportive services and connection to resources. There has been a high number of depression, substance use, ASQ, and ASQ-SE screenings amongst all sites during this period. Additionally, due to the relationships that staff have with the families that they serve as well as the creative strategies for engagement implemented by the programs, sites have exceeded their target for the number of expected home visits that are completed.  

Despite the pandemic, families continue to see success. Families have found employment, achieved educational goals, purchased homes, and gotten married. 

Family League continues to support DRUM with implementation of the Opportunity Youth project by providing technical assistance regarding data collection and referral process.  

FY2021 Jan-Jun:

#/% of participants not working or in school who report a connection to work/school 

#/% of participants at-risk of disconnection who report maintaining the connection 

DRUM was unable to report on the new opportunity measures during this reporting period. They onboarded a Youth Opportunity Specialist who manages this work who started in April. Family League will continue to support the specialist with project implementation and expects to report on the project in the next reporting period.