Family Foundations Early Head Start (FFEHS) began in 1996 as an outgrowth of several community programs that served families and children locally. The program is sponsored by the University of Pittsburgh’s Office of Child Development and provides home-based services to 310 low-income children and families spread across three sites in (more rural) Allegheny County, and three sites in the city of Pittsburgh. Twenty of those children are served in center-based child care.
Home-Visitor Services to Families
Families receive a weekly home visit and two socializations per month. The program uses the Ounce Curriculum, which emphas social-emotional development. It is supplemented by Starting Young, a curriculum that includes infant mental health activities that support parent-child relationships. Services take the form of an infant mental health model; that is, the program is parent-child focused and relationship-based. Home visitors use their relationship with families to model the family’s relationship with their children. Services are strengths-based, mutual, and transactional; that is, staff remain attuned to ways in which the child influences how the parent evolves in his or her role, and how those changes in turn influence the child’s development. Regular reflective supervision for home visitors is provided. Activities during the home visit include the following (adapted from the Weatherston and Tableman model, 2002):
Providing developmental guidance;
Identifying and providing resources;
Providing support for social and emotional needs;
Providing support for positive parent – child interactions, and to advocate for the child;
Providing opportunities for the parent to reflect on past experiences and their influence on current thoughts and feelings with the infant.
Parents and children are at the center of the work, an approach that has encouraged the inclusion of fathers. Because visits take place in the home, fathers are engaged as partners when available. Home visitors also encourage mothers to allow non-custodial fathers to participate in home visits. As the program’s approach is dyadic in nature—supporting parents in meeting the needs of the child and supporting the child’s development to coincide with parents’ expectations—father engagement is a critical ingredient in service delivery.
All home visitors have a strong background in infant mental health. Part of the intake process is an observation (Devereux Early Childhood Assessment for Infants and Toddlers) by the family’s home visitor, and an assessment (Early Learning Accomplishment Profile) by a child development specialist. An initial screening is conducted and families are asked to share what (if any) concerns they have about themselves or their child. These notes are reviewed and those parents or children who may be vulnerable and/or at risk receive referrals on an as-needed basis. These referrals are made to the appropriate member of the mental health team who then see parents and children in the home. Outside referrals are made when more intensive psychiatric services are needed. Mental health providers sometimes conduct support groups for the parents.
Mental Health Services
To support staff development and keep an emphasis on families’ mental health needs, weekly team meetings are held at each site. Members of the mental health team attend these meetings. In addition, two case conferences are held per month. The case is presented by the home visitor and, when applicable, includes the perspective of the psychiatrist, program’s nurse, mental health providers, infant mental health specialist, and others working with the family. The infant mental health specialist makes recommendations, or draws up intervention plans for the child and parent which are often implemented by the home-visitor.
Mental health services are provided by a team of professionals: a psychiatrist specializing in bi-polar issues who is contracted for about five hours a month. A half-time drug and alcohol specialist and two mental health counselors are also contracted from outside agencies. One of the mental health providers is a licensed social worker. An infant mental health specialist is employed full time.
Dr. Janet Shapiro, a developmental psychologist and social worker, brought the infant mental health approach to FFEHS when the program began and it serves as the foundational philosophy for service delivery. The home-visitor is seen as an integral part of the infant mental health team.
The program provides multiple avenues of M.H. support and treatment referrals for families, which helps home visitors in their efforts to help parents focus on positive relationships and play activities with their children.