Children - Key Activity 13

KEY ACTIVITY #13:

Coordinate Care with Home and Community Visiting Services

 

This key activity involves all seven elements of person-centered population-based care: proactive patient outreach and engagement; care coordination; address social needs.

Overview

This key activity provides tips and considerations for expanding access to home visiting services, which may be available to patients as a managed care plan benefit or through other public services.

Home visiting is an evidence-based strategy in which a professional or paraprofessional renders a service in a community or private home setting. Home visiting programs employ home visitors as a central component of a comprehensive service plan and vary widely with regard to population of the focus and goals. Home visiting initiatives are most effective when they are components of a comprehensive community-level early childhood system that reaches families as early as possible with needed services; accommodates children with special needs; respects the cultures of the families in the communities; and ensures continuity of care in a continuum from prenatal life to school entry.[1] As of 2020, 21 home visiting models met the criteria of the U.S. Department of Health and Human Services for evidence of effectiveness through the Home Visiting Evidence of Effectiveness (HomVEE) review.[2]

Home visiting can be an effective strategy for improving health and health equity for populations. Home visiting can involve a range of skill sets, qualifications and expertise of the individuals conducting the home visit and address a range of purposes or topics. Home visiting programs are an evidence-based method to enhance school readiness and reduce child maltreatment,[3] as well as a promising strategy to buffer the effects of stress related to social needs, including poverty. Multiple types of home visiting programs are covered under Medi-Cal.

Pediatric clinics are essential to the success of home visiting programs, serving as a referral source to home visiting programs as a strategy to engage families in services and strengthen the connection between home visiting and the medical home. In their role, clinics provide community-based leadership to promote home-visiting services to at-risk young pregnant people, children, and families; can develop the capacity to identify and refer eligible children and pregnant people to state and local home-visiting programs; and may consider opportunities to integrate or co-locate home visitors in their clinic. Notably, one of the CalAIM Community Supports is home visiting and remediation for asthma.

For children and youth, home visiting can help buffer the negative health effects of poverty and boost lifelong health and well-being. Home visiting can promote child development, early literacy, school readiness, informed parenting, and family self-sufficiency.[4] Home visiting is most effective when it is integrated with the family-centered medical home in a community-based system of care for families with young children.[5]

Depending on the structure and content of the home visiting program, home visiting can help families attain economic stability by connecting them with community support services while also encouraging parents to enroll in training opportunities that lead to employment. High-quality home-visiting programs “deliver family support and child development services that provide a foundation for physical health, academic success, and economic stability in historically marginalized families that are at risk for the adverse effects of poverty and other negative health-related social needs.[6]

Implementation tips

Understand what home visiting services may be available to your patients, both through the health plan or in your community as a public benefit. For newborns, the California Home Visiting Program (CHVP) is an excellent resource. Examples of covered Medi-Cal benefits which also have home visiting components include:

  • Enhanced Care Management and Community Supports (such as asthma home remediation, home-delivered medically tailored meals, respite care, etc.
  • Early and periodic screening, diagnosis and treatment (EPSDT) home visiting nurse and health aide services.
  • Durable medical equipment assessments.
  • Intensive home-based services for those with specialty mental health needs.
  • Home-based primary care programs (where offered by the patient’s health plan).
  • Hospital at-home programs where available.
  • California Children's Services.
  • Personal care, homemaker care and respite services.
  • Palliative and hospice care.
  • Long-term care.

Endnotes

  1. James H. Duffee, Alan L. Mendelsohn, Alice A. Kuo, Lori A. Legano, Marian F. Earls, COUNCIL ON COMMUNITY PEDIATRICS, COUNCIL ON EARLY CHILDHOOD, COMMITTEE ON CHILD ABUSE AND NEGLECT, Lance A. Chilton, Patricia J. Flanagan, Kimberley J. Dilley, Andrea E. Green, J. Raul Gutierrez, Virginia A. Keane, Scott D. Krugman, Julie M. Linton, Carla D. McKelvey, Jacqueline L. Nelson, Emalee G. Flaherty, Amy R. Gavril, Sheila M. Idzerda, Antoinette “Toni” Laskey, John M. Leventhal, Jill M. Sells, Elaine Donoghue, Andrew Hashikawa, Terri McFadden, Georgina Peacock, Seth Scholer, Jennifer Takagishi, Douglas Vanderbilt, Patricia G. Williams; Early Childhood Home Visiting. Pediatrics September 2017; 140 (3): e20172150. 10.1542/peds.2017-2150 
  2. Reviewing Evidence of Effectiveness [Internet]. 2020. Available from: https://www.acf.hhs.gov/sites/default/files/documents/opre/homvee_executive_summary_brief_2020%20%28certified%20for%20posting%29.pdf 
  3. Casillas KL, Fauchier A, Derkash BT, Garrido EF. Implementation of evidence-based home visiting programs aimed at reducing child maltreatment: A meta-analytic review. Child Abuse & Neglect. 2016 Mar;53:64–80. 
  4. AAP Updates Early Childhood Home Visiting Recommendations [Internet]. HealthyChildren.org. [cited 2024 Jan 16]. Available from: https://healthychildren.org/English/news/Pages/AAP-Updates-Early-Childhood-Home-Visiting-Recommendations.aspx 
  5. AAP Updates Early Childhood Home Visiting Recommendations [Internet]. HealthyChildren.org. [cited 2024 Jan 16]. Available from: https://healthychildren.org/English/news/Pages/AAP-Updates-Early-Childhood-Home-Visiting-Recommendations.aspx 
  6. James H. Duffee, Alan L. Mendelsohn, Alice A. Kuo, Lori A. Legano, Marian F. Earls, COUNCIL ON COMMUNITY PEDIATRICS, COUNCIL ON EARLY CHILDHOOD, COMMITTEE ON CHILD ABUSE AND NEGLECT, Lance A. Chilton, Patricia J. Flanagan, Kimberley J. Dilley, Andrea E. Green, J. Raul Gutierrez, Virginia A. Keane, Scott D. Krugman, Julie M. Linton, Carla D. McKelvey, Jacqueline L. Nelson, Emalee G. Flaherty, Amy R. Gavril, Sheila M. Idzerda, Antoinette “Toni” Laskey, John M. Leventhal, Jill M. Sells, Elaine Donoghue, Andrew Hashikawa, Terri McFadden, Georgina Peacock, Seth Scholer, Jennifer Takagishi, Douglas Vanderbilt, Patricia G. Williams; Early Childhood Home Visiting. Pediatrics September 2017; 140 (3): e20172150. 10.1542/peds.2017-2150