Transcript Lessons learned from a qualitative evaluation of the F.O.R

Massachusetts Department of Public Health F.O.R Families Program: A Qualitative Evaluation
Zobeida Bonilla-Vega, MPH, Ph D, Melissa Marlowe, RN, MS, and Karin Downs, RN, MPH.
Division of Perinatal, Early Childhood and Special Health Needs, Massachusetts Department of Public Health
Background
Recommendations
Conclusion
 The F.O.R. (Follow-up, Outreach, and Referral) Families program is a home visiting
program of the Massachusetts Department of Public Health and the Department of Transitional
Assistance to provide services to homeless families.
Overall Program
The program aims to assist families by identifying and addressing barriers that prevent them
from attaining and maintaining self-sufficiency and well-being
Develop specific program measures related to child and maternal health to
monitor and evaluate program outcomes.
The program goal is to improve families’ access to appropriate resources.
Using standard Maternal and Child Health measures could facilitate collection of
data, continuous evaluation, and sharing information with other programs and
agencies.
Rational and Methodology
The program has been a central player in:
identifying needs of families
Evaluation Objectives
Develop a client self-assessment mechanism where families report what was
helpful and how they see themselves moving towards stability and self-sufficiency.
1. identify the strengths of the F.O.R. Families program and promising practices for working
with homeless families
3. inform the development of a homeless screening tool, a F.O.R. Families home visitors
protocol, and a program logic model
4. make recommendations for program improvement.
Key Findings
 Clients interviewed reported positive experiences with the F.O.R. Families program and
indicated that the program was instrumental in their progress toward a more stable situation.
Help with housing and with finding health care services were the most useful services that
they received from program staff.
Clients also described counseling, parenting skills education, help with self-esteem and selfconfidence, advocacy, help navigating the system and interacting with government and
community agencies, phone calls to make appointments for health services, and provision of
tangible items such as books, school supplies, toys, clothing, and food as significant benefits
received from the program
Clients’ Experiences with F.O.R. Families: Perceptions of Program Benefits
Instrumental
Emotional
Structural
Informational
Finding money for expenses
such as rent, bills, and moving
expenses
School supplies
Food and groceries
Refrigerator and furniture for
apartment
Parenting skills
Counseling
Fast response to their
needs
Help getting SSI
Help to go to court
Phone calls to housing
authorities
Arrange appointments for
services such as dental
care, mental health,
prenatal care, and child
care
Lists of services in the
community
Health education materials
on depression
Information about schools
Contact Information
Karin Downs, RN MPH Assistant Director for Clinical Affairs
(617) 624-5967
[email protected]
Melissa Marlowe, RN MS F.O.R Families Project Director
(617) 624-5913
[email protected]
Sample Screening Process
Screen
Screen positive
ID sources of well-being
Defining Success
Referrals
How do you define success for the Of the families that were
What specifically about the F.O.R.
families that you work with?
successful, what factors do you
Families program do you think
think contributed to their success? contributed to the success of the
families that were successful?
Success is related to acknowledging
and changing behavior which is
mutually agreed upon
Acknowledging that there is a
problem and beginning to think about
how to resolve this problem
Having services in place: health
care, substance abuse, mental
health, domestic violence
Self-advocacy
Clients personality: self-motivation
and determination, positive attitude,
goal oriented, wanting more for their
children and for themselves, being
someone who will ask for help, hope
Lack of substance abuse, mental
health issues, and domestic violence
or presence of services in these areas
History that allowed them to have
examples of success (i.e., parents,
friends, mentors)
Client’s engagement
F.O.R. Families provide a safe place
for families to identify and begin to
work on problem areas
Staff usually act as positive role
models and offer positive actionoriented interventions
On-going support
Home visiting and personal
connections
Home visitors have encouraged positive, change-oriented actions that have helped families
move closer to attaining self-sufficiency or to move out of homelessness.
The relationship built between home visitors and clients appears to be central to the clients’
positive experiences with the program.
advocating for families
Develop clear goals with clients at the outset and monitor progress of client vis-àvis realistic self-sufficiency goals.
Explore collaborations with the Massachusetts Homeless Management
Information System.
2. assess the role of the F.O.R. Families program in facilitating the transition of the clients from
homelessness into a more stable situation
assembling/aligning resources
providing caring and respectful support to the families in their journey towards selfsufficiency at different moments of their lives
Services Provided to the Families
An evaluation was initiated to document how the program had benefited clients served. A
qualitative research model was chosen for this evaluation to learn from the experiences of
program beneficiaries and providers about promising practices for working with homeless
families.
delineating strategies to address identified needs
Suggestions for the Development of Relevant and Appropriate Measures of Success to
Evaluate F.O.R. Families Program
Is the family connected to programs and services?
Knowledge and awareness of resources
Number of family members among all families served by program that are able to hold jobs over a 3, 6,
12 month period
Number of families who obtained permanent housing
Number of times child misses school
Ask clients how they think they are doing and conduct self-evaluation of their own progress toward
stability and self-sufficiency
DTA
F.O.R. Families
Other agencies
Screen negative
End process
Factors to Consider in Developing a Screening Tool for Homeless Families
Risk Factors
Possible Screening Settings
Family not paying bills
DTA offices
Income levels
Emergency rooms
Substance abuse present
Community Health Centers across the state
Domestic violence present
Community action programs
Mental health issues present
Immigration services
Eviction and reasons for eviction
WIC offices
CORI issues
Psychiatric hospitals
Immigration status
Schools
Family left shelter
DSS involvement
Education history
When they had first job
Longest sustaining job
Out of work for 6 months
Money management history
Weak or non-existing social support system
Sample screening/assessment questions
Do you have safe and permanent housing?
Where are you staying?
How long have you been there?
Have there been changes in your housing situation since your last visit?
Do you have any concerns about your housing?
How many times have you moved in the last year?
What keeps you strong? What keeps you going every day?
Creation of an individualized plan and goals with the client and re-examining them on a regular basis to
monitor progress.
Changes in behaviors and habits
We wish to thank staff from the Mass Department of Public Health and the Housing and Homeless Unit of the
Department of Transitional Assistance who asssited with this project. We especially thank the families, F.O.R.
Families home visitors, and key informants who shared with us their time and experiences with the program.