Implementing Health Access Nurturing Development Services (HANDS) Program Meets HHS Criteria

Model implementation summary last updated: 2015

Model overview

Theoretical approach

The Health Access Nurturing Development Services (HANDS) program is based on several key assumptions:

  • All families have strengths.
  • Families are responsible for their children.
  • Families are the primary decision makers regarding their children.
  • Communities recognize their roles in children’s lives.
  • Communities recognize that all children must succeed.
  • Prevention and early intervention improve the community’s well-being.
  • Public and private partnerships are vital to a successful program.
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Implementation support

The HANDS program is a voluntary statewide home visitation program authorized by the Kentucky Legislature in 2000. The program is administered by the Department for Public Health (DPH) through local health departments and contracted sites. Within DPH there is a central office team consisting of a program administrator, quality assurance coordinator, training coordinator, technical assistance coordinator, data coordinator, epidemiologist, Maternal, Infant and Early Childhood Home Visiting (MIECHV) grant administrator, system of care coordinator, Moving Beyond Depression™ coordinator, quality assurance specialists, technical assistance specialists, and administrative staff. In addition, six Growing Great Kids™ certified trainers provide training to HANDS staff throughout the state.

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Technical assistance

The regional technical assistance team consists of six quality assurance specialists (QAs) and four technical assistance specialists (TAs) who have had prior experience in the HANDS program as either HANDS coordinator and/or supervisor, and have completed the HANDS QA or TA training.

Both QAs and TAs work with other HANDS team members to identify and address concerns, promote program growth, and evaluate outcomes.

QAs assess site productivity and implementation of regulations, policies, procedures, and best practices reflected in the HANDS Core Components through annual quality assurance site visits to each HANDS site. The site receives written documentation about its overall performance and areas for growth. TAs support the implementation of the HANDS Core Components, with the goal of consistent implementation at local HANDS sites throughout the state. TAs help sites prioritize needs based on areas for growth identified during the QA site visit, and develop a plan to address the needs, including the steps the site will take in the upcoming year and time lines for each step. The regional TA is responsible for contacting each site, via phone, mail, email or on-site visit, once per quarter to provide technical assistance, as needed.

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Intended population

HANDS targets first-time parents beginning during pregnancy or any time before a child is 3 months old. Eligible families face multiple challenges, including single-parent status, low incomes, substance abuse, and domestic violence.

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Targeted outcomes

HANDS is designed to improve pregnancy and birth outcomes, enhance child growth and development, create safe homes, and promote self-sufficient families.

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Model services

HANDS providers first screen referred families for risk factors. Screening may occur prenatally or after birth until the child is 3 months old. Risk factors include unemployment; isolation; substance abuse; unstable housing; low parental education; domestic violence; poor prenatal care; depression; single parenting; noncompliance with prenatal care; unsuccessful abortion; or current use of tobacco, including prenatal and infant exposure to secondhand smoke. Any family that (1) is single, separated, or divorced; (2) began prenatal care after 12 weeks of pregnancy or has had poor care compliance or no prenatal care; (3) has considered abortion during this pregnancy; or (4) has two or more risk factors is eligible to receive services.

A trained home visitor conducts home visits; frequency is determined on the basis of the family’s needs. Home visitors use the Growing Great Kids™ (GGK) curriculum and provide services that focus on supporting the family, family-child interaction, child development, and personal responsibility. Services include developmental and social-emotional screenings for children and domestic violence and perinatal depression screening for parents. Health prevention is also a key focus of HANDS home visitation. Visitors work with families to establish medical homes and maintain up-to-date immunizations and well-child checks. In addition, a registered nurse or social worker provides quarterly visits to focus on the signs of premature labor, labor and delivery, home safety, basic care, nutrition, exercise, safe sleeping, effects of smoking and secondhand smoke, stress, babies’ cues, injury prevention, child development and temperament, and adjusting to parenting.

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Sites are required to follow the Growing Great Kids™ Curriculum, developed by Great Kids, Inc.

In addition, a registered nurse or social worker provides quarterly visits to focus on the signs of premature labor, labor and delivery, home safety, basic care, nutrition, and exercise through a series of questions and parent handouts called Helping HANDS for Homes.

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Model intensity and length

The family support worker, supervisor, and family determine the intensity of services based on a family’s progression through the HANDS program and their assessed need. Families progress as they successfully meet criteria outlined in the level system, which includes six options: Level 1-P (prenatal), Level 1, Level 2, Level 3, Level 4, and Level 0. It is not expected that all families will move through all levels. Home visits average an hour in duration.

Level 1-P: Adults and teens who enter the program prenatally have the option to receive weekly visits. The visits focus on obtaining regular prenatal care and topics such as fetal development, early brain development, preparation for newborn care, injury prevention, and community resources.

Level 1: Families that enter the program during the infant’s first three months are assigned to Level-1. Families receive weekly visits for a minimum of 9 to 12 months. The visits focus on observing parent-child interaction and conducting activities to promote bonding, attachment, and positive parent-child interaction.

Level 2: Families receive biweekly visits (phone/other contact between visits). The visits include activities to promote positive parent-child interaction, family life stability, and self-sufficiency.

Level 3: Families receive monthly visits (phone/other contact between visits). The focus of the visits continues to be the promotion of positive parent-child interaction, family life stability, and self-sufficiency.

Level 4: Families receive visits every three months until age 2. The focus of the visits is monitoring health, development, and progress toward goals.

Level 0: These families have not chosen to receive HANDS visits after four weeks of outreach.

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Adaptations and enhancements

HANDS currently implements Moving Beyond Depression™ (MBD), a model developed by researchers Robert Ammerman and Frank Putnam from Every Child Succeeds at the Cincinnati Children’s Hospital Medical Center. MBD uses a 15-session treatment called in-home cognitive-behavioral therapy (IH-CBT), which focuses on alleviating symptoms of depression and increasing coping skills. A licensed and trained therapist travels to the mother’s home to facilitate the IH-CBT sessions. The therapy concludes with a joint session in which the therapist and home visitor verbalize the mother’s accomplishments, use of coping skills, and future recommendations for treatment and success.

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Type of implementing program

HANDS is implemented by Kentucky’s local public health agencies or a local health or human service agency that serves as a subcontractor to local public health agencies.

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Fidelity standards

A policies and procedures handbook is available in written form or can be accessed through the HANDS web-based system. 

HANDS programs must adhere to the model’s guiding principles.

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Staffing requirements

Local implementing agencies employ a program coordinator, supervisor, parent visitor, a registered nurse or social worker visitor, a family support worker (professional or paraprofessional), and data entry personnel. In smaller sites these roles may be combined.

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Staff education and experience

Kentucky regulations state that both professionals and paraprofessionals may serve as home visitors.

Paraprofessional home visitors must (1) be at least 18 years old; (2) complete training in family needs and strengths assessment, service plan development, home visiting, coordination of services, and evaluation; (3) have a high school diploma or equivalent; and (4) be supervised by a licensed public health nurse or social worker.

Professional home visitors and program coordinators may be (1) licensed public health nurses or registered nurses, (2) licensed social workers, (3) individuals with a bachelor’s or master’s degree in social work from an accredited program, (4) individuals with a bachelor’s degree in the social or behavioral sciences with at least one year of case management experience, or (5) individuals with an associate’s degree in early childhood education with training in home visitation.

The supervisor must be a licensed professional such as a nurse or social worker.

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Supervision requirements

Supervision is required weekly for all employees for a minimum of one hour for full-time employees and half an hour for part-time employees. The expectations of supervision are:

  • Skill development through home visit observation
  • Skill development through parent survey observation
  • Systematic chart review
  • Review and sign off on forms by licensed personnel
  • Evaluation of family needs by licensed personnel
  • Staff support to prevent turnover
  • Discussion of: caseload, engagement strategies, family strengths/concerns, family goal, follow-up plans, use of curriculum, parent-child interaction, and staff development
  • Tracking of completed/declined services and active/exits
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Pre-service staff training

Home visitors and family support workers must complete the following pre-service training requirements:

  • Sixty (60) hours of training (30 hours of training per home visitor role and 30 hours of training per family support worker role) that describes HANDS’ philosophy, purpose, goals, staff roles, and service delivery approach
  • Thirty-seven and a half (37.5) hours of training to become certified in the GGK Tier I curriculum

Supervisors also attend the 60 hours of preservice training on the HANDS model and receive additional training on supervision.

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In-service staff training

HANDS program staff must also fulfill the following ongoing training requirements:

  • Thirty (30) hours of wraparound training within the first year of hire
  • Fifteen (15) hours of GGK Tier II curriculum training and 15 hours of ongoing training within two years of hire
  • Fifteen (15) hours of GGK Tier III curriculum training and 10 hours of ongoing training within three years of hire
  • Ten (10) hours of developmental training each year after the first three years of service
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