Early Care Healthy Families (Garrett County FY17 and Beyond) - Annual

Garrett County Department of Social Services, Garrett County Health Department, Garrett County Board of Education, Garrett County Community Action, Garrett County Judy Center, Garrett County Regional Medical Center, Garrett College, Dove Center, James Isaac House, Garrett County Lighthouse, Maryland Extension Office, Christian Crossings/Christian Coalition, Mountain Haven, Garrett County Rotary Club, Maryland Job Service, HART for Animal, Western Maryland Consortium Job Training, Appalachian Crossroads, Goodwill, House of Hope, Burlington- United Methodist, Ruth Enlow Library, Maryland Bar Lawyer Referral, Legal Aide, Veteran of Foreign Wars, Habitat for Humanity, Lions Club, Allegany College of Maryland, DORS, Oak Park Church of the Brethren, Warm the Children, Garrettland, Guardian Apartments, Meadow View Apartments, Mountain Laurel Federally Qualified Health Center, District Court/Public Defenders, Gail Smith, MCHP, Loch Lynn Church of God, Cornerstone Church, Bethel UMC, MLP.

The Garrett County Early Care Healthy Families program provides ongoing home visits from registered nurses and trained paraprofessionals to low-income, at-risk mothers and families.  Through home visitation, these families receive the care and support they need to have a healthy pregnancy, provide responsible and competent care for their children, and become economically self-sufficient.  Early Care Healthy Families is a key component of the Early Care System of Care (ECSOC) at the Garrett County Health Department.  ECSOC serves as a centralized intake for family support programs.  The program provides one single point of entry for access, assessment, and referral to local family support services for expecting families and families with newborns who reside in Garrett County.  Healthy Families Garrett County is an accredited program that implements evidence-based home visiting services according to Healthy Families America (HFA) Best Practice Standards (BPS).  The mission of the Early Care Healthy Families program in implementing the evidence-based curriculums is to enhance family functioning and promote child health and development by creating for all prospective and new parents' home-visiting support at their level of need and/or desire.

The Early Care Healthy Families program includes; at-risk pregnant mothers and families with newborns up to age three months, who reside in Garrett County, meet Healthy Families America assessment criteria, and meet one or more of the Governor's Office of Crime Prevention, Youth, and Victim Services priority areas.

1.  Reducing the impact of parental incarceration on children, youth, families, and communities;

2.  Reducing youth homelessness;

3.  Improving outcomes for disconnected/opportunity youth;

4.  Reducing childhood hunger;

5.  Increasing opportunities for community-based programs and services for youth (including diversion) and/or,

6.  Preventing out-of-State placements

Highlights for HFY1 23: 

• New Client Enrollment:  There was a 150% increase in new family enrollment during the second quarter.  Five (5) new enrollments occurred in the first quarter and fifteen (15) in the second.  
• Program Update:  Early Care Healthy Families program served 63 families in the first quarter of FY23 with 550 home visits completed.  95% (60/63) met at least one (1) of the "Strategic Goal Populations" while 47% (28/60) met more than one (1) of the goal populations.
• Accreditation:  Healthy Families Garrett County accreditation process has begun with a review scheduled for February 26-28th, 2023.
• Outreach Events:  Five (5) Community Block Parties took place during the first quarter of FY23 where Healthy Families staff shared program brochures, a safe sleep display, and car seat installation tips.  
• Cooking Project:  This project is now a 12-month program including a PowerPoint lesson on financial goal planning and family mealtime engagement suggestions as well as budget-friendly recipes.  
• Socialization:  "Little Movers" continues into the 2nd quarter with events occurring monthly.  The December event was "Winter Wonderland Fun" and was held at the Garrett County Health Department.
• FES Update:  36 individuals served;  15/36 (42%) served do not have a high school diploma; 12 received services to assist in getting a high school diploma, 5 are under 18 years of age - homeschooling; 12/36 (33%) received services to promote or link to college/training; 20/36 (56%) face transportation barriers; 18 received assistance in working towards and/or obtaining a driver's license; 21/36 (58%) are employed; 14 assisted with employment through job searches, gas cards, application assistance, and obtaining work clothing.

Highlights for FY22:  

• COVID Operations:  HFGC continues to operate under the HFA Policy on Disease Outbreak and Health Crisis which allows virtual visits to continue. 
• Program Update:  The Early Care Healthy Families program served 71 families in FY22 with 1,024 home visits completed.  97% (69/71) of those families met at least one (1) of the "Strategic Goal Populations" while 46% (33/71) met more than one (1) of the goal populations.
• FES Update:  42 total participants with 24 new enrollments and 18 who remained in services from FY21.  17 participants were discharged in FY22 and 27 participants remain enrolled at the end of FY22 and will continue services in FY23.  16/24 (38%) served do not have a high school diploma; 14 received services to further their education; 1 participant obtained an HS diploma during FY22.  14/42 (33%) received services to promote or link to college/training; 1 participant obtained as Associated Degree online from Eastern Ohio College; 1 participant obtained a certificate in Fundamentals of Accounting I & II and Quick Books; and enrolled in Grammar for English as a Second Language through ED2go;  4 additional participants have enrolled in various certification/Bachelor programs; 8 participants received support to problem solve training/college programs to start enrollment. 5 participants obtained a learner's permit; 2 participants obtained a Maryland driver's license; 6 participants completed driver's license education classes.
• Outreach Events: Trauma-Informed Town Hall at Southern Middle School, Community Baby Shower hosted by the Judy Center, Trauma Informed Care Town Hall at Northern Middle School, Community Block Party at Pysell Ridge, Mountain Village, and Mountain View income-based apartment complexes and on the southern end at Pine Woods income-based apartment complex hosted by the Federally Qualified Health Center - Mt. Laurel Medical Center.
• Socialization:  Socializations were switched to in-person during the 4th quarter and partnered with Health Education and Outreach for 2 events to provide education on tobacco, marijuana use, and resources for smoking cessation and substance use.  
• The Cooking Project:  The cooking project continued in the 4th quarter.  The project includes a monthly recipe (food provided) and financial activities.

Highlights for HFY1 22:  

• Healthy Families Garrett County Operating Procedures:  HFGC continues to operate under the HFA Policy on Disease Outbreak and Health Crisis including COVID screenings, proper use of PPE, social distancing & masking on face-to-face encounters, and good hand hygiene practices.  Use of Doxy.Me continue to conduct video visits with families that receive virtual visit(s).
• FES Update:  31 total participants with 11 new enrollments and 20 carried over from 2021.  12/31 (39%) served do not have a high school diploma; 10 received services to assist; 2 enrolled in high school.  College/Training: 8/31 (26%) received services to promote or link to the training.  Obtaining Driver's License/Transportation:  15/31  (48%) face transportation barriers; 11 received assistance in working towards and/or obtaining a license; 2 obtained a learner's permit; 1 obtained an MD license; others are in the process. Securing employment:  14/31 (45%) are employed; 4 assisted with employment search.
• Outreach Events:  Judy Center Trunk or Treat; three public media blasts for SIDS awareness month in October; three public media blasts on smoking cessation and gun safety in November.
• School Readiness Bags:  School readiness bags were distributed to participating families.
• Cooking Project:  The program chooses recipes that are low-cost, healthy, and easily replicated.  FY22 recipes included Taco Braid, Black Bean Burgers, and Breakfast Egg Muffins.  The Cooking Project includes financial activities each month including "Wheels to Work", "Taking Charge of Your Money", and "Earned Income Tax Credit", among others.  

Highlights for FY21:

• CY 2021 Action Plan: (January 1, 2021 -  December 31 - 2021) Fully Implemented.
• Healthy Families Garrett County (HFGC): Reopened February 2nd to allow face-to-face home visits for families that are comfortable with in-person contact.  Staff returned to the office full-time on July 1st.
• FES Update:  34% (16/47) had less than a high school diploma at enrollment; 56% (9/16) parents received services to assist in obtaining a high school diploma.  18 parents received services to promote or link to post-secondary training; 50% (9/18) successfully enrolled or completed post-secondary education programs/courses.  45% (21/47) face transportation barriers as they lack an LP/Dr. License; 21 parents received assistance in working towards and/or obtaining a driver's license.  43% (20/47) of parents assisted with employment through job searches, job applications, transports, gas cards, resume writing, or assistance with expunging records; 57% (16/28) who were assisted have obtained/maintained employment.  
• Socialization:  Socialization events were completed virtually during FY21.  Prior to the events, an activity packet, school readiness/developmental education, and a bag lunch were delivered to families and children who signed up.  Families were permitted to join by video or phone.  Face-to-face socializations are to resume in August of 2021. 
• Childbirth and Breastfeeding:  The program conducted 12 childbirth classes and 12 breastfeeding classes in FY21 for new and expecting parents.  Classes were instructed as a Nurse Supported Independent Study model during the pandemic.  
• Kids in Safety Seats:  Car seats are distributed on a sliding scale fee which starts at $20 and goes up to $65.  Collected fees are utilized to purchase additional car seats.  Forty-four seats were distributed during FY21.
• Cooking Project:  During FY21, the project served families that met one or more of the following criteria: 1) was not working or in school, 2) scored positive on the Food Security Screen, 3) was receiving food stamps, or 4) by the clinical judgment of the home visitor and supervisor.  The project provides a monthly recipe, all items to prepare the meal, an incentive that is used to prepare the meal (skillet, paring knife, mixing bowl, etc.), and financial education.  
• School Readiness Bags:  Bags were distributed during the 4th quarter to provide families with additional materials (educational and hands-on) to promote school readiness during the pandemic.  The bags focus on child social-emotional development.  For families receiving virtual home visits, home visitors leave the School Readiness Bags with families during a drive-by/drop-off and then review the items and educational materials during a virtual home visit.  
• Training:  Staff received training from 1) Ruth Enlow Library on services for families and children, 2) Be A Loving Mirror intervention, 3) Dove Center on Intimate Partner Violence, and 4) Personal Health Services.
• Program/Strategy Priorities Served:  Disconnected Youth - 30 families, Incarceration (current/past Incarceration/DJJ) - 19 families, Food Insecurity - 64 families, Youth Homelessness - 7 families.

Highlights for HFY1 21:

• Socialization:  To address Childhood Hunger & Food Insecurity within the service population, a box lunch is delivered by Door Step Drop Off to adults and children with a "Feeding is More Than Eating" lesson included
• Family Economic Self-sufficiency (FES): continues to provide clients with links to adult education/GED testing and class enrollment along with drivers education support, job searches, connections to local services, and transportation when needed
• Training:  Staff completed the Center for Mind-Body Medicine (CMBM) training learning how to help relieve stress, heal trauma, and build resilience to utilize with enrolled families
• Substance Use Training:  Home visitors received training on Narcan and Fentanyl test strips
• Partnership with the University of Maryland Extension Food Supplement Nutrition Education (FSNE) Program:  Activities are planned to provide additional nutritional support to families and staff
• School Readiness Bags:  For January - March bags are provided to families with educational, hands-on materials to promote school readiness during the pandemic

Highlights for FY20:  

• FY20 ends with full staffing
• Partnership with the University of Maryland Extension Food Supplement Nutrition Education (FSNE) Program
• Kids in Safety Seats (KISS) Program
• Early Care Self-Sufficiency Coordinator helped 58 individuals meet personal goals of increased self-sufficiency
• Home Visiting Expansion funds were awarded and served 20 families with 331 home visits
• Program management groups established on mygarrettcounty.com to track data and trends

Highlights for HFY1 20:

• Cheers Check-In Tool Implementation
• Kids in Safety Seat (KISS) Program
• Partnership with the University of Maryland Extension Food Supplement Nutrition Education (FSNE) Program
• Home Visiting Expansion
• National Prevent Child Abuse America (PCAA) National Conference, Moving Upstream, and Healthy Families (HFA) Pre-Conference
• Maryland Apprenticeship and Training Program (MATP)
• ACEs Screenings

Highlights for FY 2019:

• Healthy Families Garrett County received Re-Accreditation and was found to be in adherence to 100% of all 153 standards and will be expedited through to re-accreditation
• 100% of families enrolled currently meet one of the four Governor's Initiatives
• Since 2001, the ECHF program has assisted in enrolling parents in obtaining their high school diplomas, certifications, college degrees, driver's license, and employment
• FY19 the program obtained full staffing by October 3, 2018
• Healthy Families Garrett County was awarded funding to participate in Evidenced Based Home Visiting for High-Risk Pregnant Women and Children through the Age 2 Expansion Pilot Program

FY22:  Healthy Families Garrett County continues to operate under the HFA Policy on Disease Outbreak and Health Crisis allowing for virtual visits to continue.  The majority of home visits were conducted face-to-face during the third and fourth quarter of FY22.  Virtual visits are related to a COVID diagnosis, symptoms, or exposure of staff or families.

HFY1 22:  Healthy Families Garrett County continues to operate under the HFA Policy on Disease Outbreak and Health Crisis.  COVID screenings, proper use of PPE, social distancing & masking on face-to-face encounters, and good hygiene practices continue for home visitors and families.  The program continues the use of Doxy.Me to conduct video visits with families that prefer virtual visits.  

The Maryland Statewide Security Incident:  Challenges exist with supervision, program management, and quality assurances in accessing forms, drives, and databases.  

FY21:  Healthy Families Garrett County reopened February 2nd to allow face-to-face home visits for families that are comfortable with in-person contact.  Staff returned to the office full-time on July 1st, 2021.  No telework is approved beyond that timeframe.

• The program continues to adhere to policy and procedures in conducting COVID screenings, proper use of PPE, and proper hand hygiene.
• The program is operating under a hybrid model allowing phone, video, and face-to-face home visits.
• Statistics:  76.8% of home visits by HFGC (includes expansion and Child Welfare Protocol home visits) in FY21 were conducted virtually.

HFY1 21:  November 4th, most face-to-face home visits were put on "pause" as a result of the increased COVID rates in Garrett County.  Most families are receiving virtual home visits.  Some face-to-face visits continue with moms, dads, and babies with COVID screenings in place and the use of PPE.  Face-to-face visits are permitted if families are:

• Receiving visits at the Department of Social Services;
• Faced with housing/homelessness, residing at Rose Terrace, or;
• Determined to be in need of a face-to-face visit based on assessment and approval by the supervisor.  

The Kindergarten Readiness Assessment was not conducted for the 2020-2021 school year because of COVID.  The performance measures pertaining to the KRA assessment will not be current for FY21.

October 2020 - The Early Care Healthy Families program was notified by the Local Management Board Grant Monitor that the program's request to revise Performance Measure targets due to mandatory budget cuts implemented by the Governor's Office of Crime Prevention, Youth, and Victim Services was approved.  The adjustments have been made as follows:

• Families served per year - target moved from 100 to 90
• Home Visits completed per year - target moved from 1,400 to 1,125

COVID-19 Program Changes:

Home Visitors continue "Door Step Drop-Offs" and phone call "check-ins" to ensure needs are met in between home visits.  Drop off bags include health/safety/developmental education materials, school readiness materials, incentives that go with the virtual visit/parent-child activity (books, nesting cups, balls, etc.), cooking project materials (food), socialization lunches (food), and other items to meet the needs of the family including formula, applications, diapers, etc.

November 4th - Most face-to-face home visits were put on "pause" as a result of the increasing COVID rates in Garrett County.  Most families are receiving virtual home visits with the exception of the following:

• Families receiving visits at the Department of Social Services
• Faced with housing/homelessness
• Determined to be in need of a face-to-face visit based on assessment and approved by the supervisor

For FY20:

 Maryland State of Emergency -COVID-19 Pandemic Timeline:
Note: Early Care Healthy Families service provisions continued with modifications at the end of the 3rd quarter and throughout the 4th quarter. See the following timeline detailing ongoing changes in operations:
• March 10, 2020 – Program Manager inquired of plan to address HFA home visiting during COVID-19 pandemic if modifications became necessary in Garrett County. Inquiry made to Healthy Families America (HFA) National Office.
• March 10th Home Visitors implemented COVID-19 pre-screening with client face-to-face home visit appointments prior to contact. Pre-screening completed over the phone or, if unable to contact via phone, in person (at a distance) prior to entering the client’s home. Positive screens on March 10th were advised to call their physician to report symptoms and discuss any necessary treatment plan/obtain orders. Home visit appointments on positive pre-screens were rescheduled.
• March 10th -Program Manager and Supervisor began planning for possible home visitor, supervisor, FES Coordinator, quality assurance, and other staff teleworking if necessary. Teleworking checklists completed on staff and equipment assigned as needed (laptops, tablets, internet access, cell phones, etc.) so that staff could perform normal job duties if assigned to teleworking.
• March 11, 2020 - Healthy Families America (HFA) approved “Virtual Home Visits” during times of a “Community Safety Advisory” for all HFA sites. COVID-19 Pandemic is a “Community Safety Advisory”. The policy on “Disease Outbreak and Health Crisis” received from HFA National Office.  HFA approved Virtual Home Visits must meet certain assurances, i.e. length and focus must be consistent with criteria for face-to-face home visit, etc. Staff informed.
• March 11, 2020– Virtual Home Visits Offered to positive COVID-19 pre-screen clients in accordance with HFA Policy on “Disease Outbreak and Health Crisis”.
• March 16, 2020 – 12 PM--HFGC home visitors, FES Coordinator, and Quality Assurance Staff placed on “Teleworking” with limited office time to promote social distancing within our vulnerable service population. HFGC Supervisors placed on a “Teleworking” rotation. Home Visitors provided equipment and permissions to access the FamilyWise Data Collection database off-site. Home Visitors continued face-to-face home visits with negative COVID-19 pre-screens when placed on “Teleworking”.
• Supervisors accommodated staff needs for vehicles for travel to/from home visits, client supplies for home visiting, etc. by staff calling the office to discuss needs and by supervisors meeting staff at the exit door one by one to hand out necessary supplies to meet the overall goals of individual home visits and client needs.
• March 16th – Supervision sessions with staff began “Virtually” in compliance with the HFA policy on “Disease Outbreak and Health Crisis”. Sessions remain in compliance with Best Practice Standards of 1.5 – 2 hours per week per home visitor with full caseloads and prorated for part-time home visitors; and cover the required components of administrative, clerical, and reflective supervision.
• March 19, 2020 by 2 pm: COVID-19 Pandemic Operational Update- Home Visitors only permitted to complete Virtual Home visits (no face-to-face visits). They are permitted to complete drop offs at client doors if things need dropped off for activities or to meet other program/client needs (Cooking Project, etc.). No face-to-face contact during drop offs permitted.
• March 19, 2020- New Referral Outreach from physician and the hospital began to be conducted by phone, fax, and email. Outreach for new client enrollment is continuing by phone.
• Throughout program modifications, Family Wise and the Cultural Matrix continue to be the main source of data collection for home visitor data collection. Quality Assurance continues to develop data tracking sheets and send out necessary tools. HFGC home visitors, FES Coordinator, and Quality Assurance staff are required to email their supervisor at the beginning of shift and at end of shift to notify of begin and end work times. For home visitor safety, home visitors are emailing their supervisor of community travel. This is in place of the “Daily Travel Log” completed when working in the office. HFGC staff are required to complete a “Teleworking Activity Log” daily and submit the log to their supervisor at the end of each workday, which details blocks of work time and activities completed. Telework Logs are filed on-site in a COVID-19 program binder.
• In cases where clients do not have the technology (data plans, video ability, etc.), short calls are placed with clients and needs are met by the assigned home visitor. These clients are being served under an “outreach” versus home visiting level of service. This complies with HFA policy. Although these contacts do not count as home visits, family needs are still being met.