Maternal Infant Health Outreach Worker (MIHOW)^®

The Maternal Infant Health Outreach Worker (MIHOW) Program serves families with low incomes, who are experiencing stress and isolation. Families enroll prenatally, and receive home visits until the child is 36 months old. The model is designed to improve child and maternal health, increase use of linkages and referrals to medical and social services, and build positive parenting skills. MIHOW employs community health workers from the local area as home visitors and role models. These workers provide participants with monthly visits that last about 60 minutes each. During visits, community health workers educate families about nutrition, health, child development, and positive parenting. They also provide links to medical and social services.

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The Maternal Infant Health Outreach Worker (MIHOW) model is based on systems theory, which views human behavior as the collective impact of multiple interrelated systems. To understand and assist individual program participants, MIHOW considers how participants are affected by families, organizations, societies, and other systems in which they are involved.

Community health workers (called outreach workers) from the local area serve as home visitors. These outreach workers assess all the systems at play in participants’ lives and then strive to strengthen those systems to help participants meet their goals. Outreach workers help bolster participants’ individual systems (immediate social environment), advocate for participants within larger systems, and support participants’ efforts to improve the systems in which they are involved. By training parents in the community to serve as outreach workers, MIHOW aims to generate broader system change.

MIHOW is a community- and strengths-based model focused on community development. It emphasizes that outreach workers and program participants are equal members of the community with a mutual investment in one another. The model links the parenting experiences of community members with community partners and the university that developed the model.

MIHOW is a partnership between Vanderbilt University School of Nursing (VUSN) and community-based organizations. VUSN and MIHOW regional consultants work with local sites during initial recruitment, training, and supervision of outreach workers; on case management issues; and on networking with other agencies.

MIHOW also provides local sites with ongoing technical assistance and sustainability assistance:

• MIHOW monitors site progress through site visits, phone calls, and meetings. It also provides additional training and advising when problems arise.
• MIHOW tailors sustainability assistance to match each site’s infrastructure and needs.

MIHOW primarily serves families with low incomes who are experiencing stress and isolation. Families enroll prenatally and receive home visits until the child is 36 months old.

The core components of MIHOW are (1) home visits, (2) case management and advocacy, (3) parent education, (4) role modeling for positive parent-child interaction, (5) health and developmental screening, (6) information about and referrals to medical and social services, and (7) peer support groups.

The outreach workers listen to parents’ concerns; educate parents about nutrition, health, and child development; model positive parenting practices; and provide links to medical and social services. MIHOW is flexible and can be tailored to the needs of the sponsoring agency and community.

The month-by-month MIHOW Home Visit Guides (The Prenatal Period, The First Year of Life, The Second Year of Life, and The Third Year of Life) provide outreach workers with objectives and strategies for each visit to improve maternal health behaviors, birth outcomes and early child health, nutrition (obesity prevention and reduction), problem-solving skills, goal setting, and self-advocacy. Outreach workers are also provided with REACH - The Five Step Recipe for a Home Visit, a pocket-size laminated quick reference card that lists the essential elements of an effective home visit.

MIHOW includes monthly home visits that last approximately one hour. It also includes opportunities for group interaction. Participants enroll in the program during pregnancy and receive visits until their child’s third birthday.

Local MIHOW programs are sponsored by child care centers, primary health care facilities, or nonprofit community agencies. Organizations implementing the model should value community health workers; embrace MIHOW’s strength-based approach; and have the administrative capacity to provide space, quality supervision, support services, and long-term sustainability for the site. Potential sites must complete a report indicating how their agency and community of interest fit the MIHOW criteria.

MIHOW requires sites and outreach workers to each meet a set of ongoing fidelity guidelines. Please contact the model developer for additional information about these guidelines.

MIHOW outreach workers are trained to implement the model, and staffing arrangements are tailored to the needs of individual sites. Some sites employ full-time outreach workers, and other sites use part-time workers. Sites must also employ an outreach worker supervisor.

Outreach workers must be from the local community and have at least a high school diploma or equivalent, a positive parenting history, and a similar background to program participants. In addition, outreach workers must demonstrate an understanding of the community and an acceptance of people different from themselves, including people with different religious beliefs, sexual orientations, socioeconomic status, and race.

There are no education or experience requirements for supervisors. However, the model recommends that supervisors have a bachelor’s degree or one year of experience with supervision. MIHOW recommends supervisors use reflective supervision, and at a minimum, they are required to complete the following activities:

• Hold one-on-one meetings with outreach workers at least monthly
• Provide individual and group opportunities for outreach workers to share successes and concerns
• Respond to concerns promptly and constructively
• Evaluate and be evaluated by the outreach workers annually

The MIHOW leadership team provides group support to supervisors during the MIHOW annual conference.

This model requires outreach workers to participate in pre-service training. Outreach workers must complete 40 hours of core training, shadow an experienced outreach worker, and receive an individual assessment from a supervisor. New supervisors must complete pre-service training with their staff and, for the first six months, participate in monthly one-hour check-ins with a member of the MIHOW leadership team. Please contact the model developer for additional information about the pre-service training requirement.

This model offers the following ongoing professional development:

• Monthly training—Local sites are responsible for monthly training of outreach workers on MIHOW-specific competencies for outreach workers and local needs.
• Annual conference—Each year, supervisors and outreach workers gather for three days of workshops, networking, and team building.
• Biennial Site Leaders’ Meeting—Supervisors gather every other year for networking, reflection, planning, evaluation, and training.
• Regional training—Regional consultants coordinate three training sessions per region each year for outreach workers and provide consultation to sites.

Please contact the model developer for additional information about ongoing professional development requirements.

Vanderbilt MIHOW

Email: mihow@vanderbilt.edu
Website: https://www.mihow.org