Children’s Integrated Services (CIS) in Vermont are a variety of services that help families provide for Vermont children. In this video, Ann Dillenbeck, the CIS Program Improvement Manager, hosts a panel of Children’s Integrated Services coordinators from around Vermont. Each of them explains what services they and their project provide for Vermont families.
The panelists are:
- Christle Davis, CIS Early Intervention Manager. Family Center of Washington County.
- Maura Shader, Clinical Social Worker and Supervisor. Health Care and Rehabilitation Services of Southeastern Vermont.
- Karen Bielawski-Branch, MSW, Family & Child Health Program Manager. Family and Child Health Division, Vermont Department of Health.
- Kimberlie Buxton, CIS Specialized Child Care Coordinator. Umbrella Kingdom Child Care Connection.
- Heidi Gillespie, BSN, RN, CLC, Clinical Manager of Children’s and Family Services. Visiting Nurses Association & Hospice of the Southwest Region.
- Shelly McSweeney, Family Educator. Lund.
- Kelly French BSN, RN, CIS Early Intervention Program Supervisor and Strong Families Vermont Responsive Nurse. The Family Place, Hartford Region.
An Introduction to Children’s Integrated Services in Vermont
00:00:00:00 – 00:00:38:06
Unknown
Hi. Welcome to a panel discussion of the sets of services within Children’s Integrated Services or c. I. S my mandolin back. NCIS State Team Member. My role is program improvement Manager and we have a panel today of representatives from each of the four sets of services, which are early intervention, specialized child care, early childhood and family, mental health and strong families.
00:00:38:06 – 00:01:19:16
Unknown
Vermont home visiting. Our panel also represents various SES regions across the state of Vermont. These services are each their own specialty, and together they share some serious fundamentals, such as a strength based and client centered approach, the provision of service coordination, the connection of families and clients to community resources and information sharing, information about healthy child development. So I’d like to tell you who you’ll be hearing from today.
00:01:19:18 – 00:01:57:20
Unknown
We have Crystal Davis from Early Intervention, Maura Shader from early childhood and family Mental health. Kimberly Buxton from Specialized Child Care and for Strong Families. Vermont Home Visiting. We have a group Kelly French, Shelly McSweeney, Caryn Brylawski Branch and Heidi Gillespie. And they’ll introduce themselves and you’ll see their titles as they answer a series of questions about their set of services.
00:01:57:22 – 00:02:37:05
Unknown
We thought we’d start with early intervention and turn to Crystal, who works in Washington County. So, Crystal, welcome. Could you just introduce yourself a bit? Hi. My name is Crystal Davis, and I manage early intervention in Washington County. I’ve been with the program for about four years now, and I manage a crew of about six early interventionists and as well as some specialty providers in our region.
00:02:37:07 – 00:03:17:17
Unknown
Wonderful. So, Crystal, what would you say is the goal of this early intervention? What outcomes are we looking for when families receive CCI? I would say that the desired outcomes for our set of services is to improve child’s quality of life and to work toward, if not meet their developmental milestones. And we do this by coordinating as well as providing services to children and supporting parents by modeling skills that they can use with their child in between visits.
00:03:17:19 – 00:04:06:04
Unknown
And what age group of children does CCI serve? We serve children. First up through to age three or 36 months. Great. And you talked a little bit about modeling. What else does E-I offer? We offer coordination of specialty providers, such as speech therapy, physical therapy, sometimes nutritional consultation. And we also also will respond sorry, refer to early Head Start, the Vermont Association for the Blind and Visually Impaired, or the UVM Parent Infant Program, which assists children who are deaf or hard of hearing.
00:04:06:06 – 00:04:37:13
Unknown
We also provide developmental education for families and tips for parents about how to encourage learning through play and services are provided at no cost to families and are delivered to our families in the child’s most natural environment, which is which is typically in their home space or in child care. Sometimes we do go out into the community playgrounds and provide services there as well.
00:04:37:15 – 00:05:17:17
Unknown
Great. I’m glad you talked about tips for families. And so when you’re working with a family, do you consider your services only for the child? No, it’s really for the whole family, because when you’re working with a little one, parents are always concerned about making sure that their little one meets the milestones that have been expected, I guess, is the right word for them.
00:05:17:19 – 00:06:10:12
Unknown
And sometimes families rely on the early intervention team to help support them through that. And you mentioned early childhood education. If a child is attending a child care program. How might you collaborate with them? We will make appointments to go into childcare. Don’t just drop in or make appointments to go in and see the child there. We always visit notes with child care and have discussions with them about and give them tips as well as there to help the child in their time there at school.
00:06:10:16 – 00:06:46:24
Unknown
Child care. And then we also will sometimes include them in teaming when we have a team meeting with a parent who may have a child that has some extensive needs to involve them there as well. Right. And you would always have family consent. Absolutely. So, Crystal, thinking statewide, what type of agencies deliver this service? In Vermont, a variety of agencies deliver the service.
00:06:47:04 – 00:07:21:16
Unknown
The most common are parent child centers. But I also know of a home health agency as well. So in Washington County, we are housed within the Parent Child Center, which is the family center of Washington County in Montpelier. Great. Thank you. So to just finish up, Crystal, could you share one example of this early intervention supporting a family in partnership with at least one other service within the CIA array?
00:07:21:18 – 00:08:07:13
Unknown
Sure. The example that I can think of was a young family whose child was born while they were homeless and living in a hotel. The baby had some medical issues as well, so they were served by nursing to begin with and they went to the hotel and saw the family there. And then they also received services from family supportive home visiting to help the family by coordinating some mental health support and also help them fill out some housing applications and things like that.
00:08:07:15 – 00:08:47:09
Unknown
And then when the child aged got a little bit older, they were referred for early intervention. And we saw him in the home and at childcare for developmental delay, which eventually went on to a diagnosis of autism spectrum disorder. And then once he turned three and he unquote aged out of the early intervention program, he continued to be they continue to be supported by family, supportive, home visiting, and they were eventually housed, which is wonderful.
00:08:47:11 – 00:09:15:19
Unknown
And they have throughout the whole process were supported, the whole family was supported and it really improved their lives. The most recent follow up that I have on them is that both Mom and Dad are in college programs and they’re just working through life as it comes to them. I believe the Family Center is still involved with Family Support, home visiting and some housing support as well.
00:09:15:21 – 00:09:50:12
Unknown
So yeah, it’s a really nice one. Thank you, Crystal. That’s a great example of the wraparound support that CIA can provide. Thanks so much. Now we’re going to explore a little bit about early childhood family mental health and speak with Mora. Mora. Could you introduce yourself? Hi, my name is Moira Shader. I’m a clinical supervisor and with them in Windsor County over here at H.C. Rescue Partners with CIC and Mora.
00:09:50:12 – 00:10:20:19
Unknown
What would you say the goal of early childhood family mental health is? What are the desired outcomes for families receiving this service? We are really a preventative model, as much of CIS as so we are trying to prevent major mental health diagnoses for young children later on down the road who have experienced stressful events, trauma or aces, as we often refer to them, to adverse childhood experiences.
00:10:21:00 – 00:10:50:20
Unknown
So we’re trying to make sure that with early intervention to the child and the whole family, that we are preventing later on more complications happening for that child down the road. So what does ECF each offer CIS clients? We offer a lot of different services. It really depends on what the family is looking for and what they’re looking for support around.
00:10:50:22 – 00:11:18:18
Unknown
So we can offer really short term services around consultation and that might be one or two visits with a family that might be really concerned about an event that’s happened in their life or behaviors that they’re not sure if they should get further assessment with for their young child, or we might offer long term support that might be closer to a year or just over a year of of clinical support consultation, providing psychoeducation to the family.
00:11:18:23 – 00:11:52:22
Unknown
We really view that even though the child’s being referred to our program, our early child and family mental health program, it’s really the relationship that’s coming in that we’re trying to support because we as a program approach that we’re going to help that child through the relationship that they have with their primary caregiver. So our goal is to support and scaffold that relationship and answer what that might be providing parenting consultation or working one on one with a parent around their concerns, providing education, around development, around psychoeducation.
00:11:52:22 – 00:12:22:11
Unknown
If they’re coming in and they’re having really concerns about like, is this something a mental health issue that I should be looking further into what our program also also really focuses on is adverse childhood experiences and trauma and how much those when a child experiences that in their life, how much that can kind of mimic other mental health symptoms that can be that can become really confusing for parents and providers in the community.
00:12:22:17 – 00:12:54:05
Unknown
So our goal is to kind of provide education if an intervention to prevent a diagnosis from happening for that child, if the child is turning six and it seems like those concerns are still present or have gotten worse or of kind of shifting into something else, we might support that parent and and getting connected with more intensive clinical based services or further assessment through our state, whether that be through an area mental health facility.
00:12:54:05 – 00:13:17:07
Unknown
I’m located at the designated mental health facility for our region for Windham and Windsor County and that might look different for other areas as well. Great. Thank you. More, I think, like you said, it usually is the designated agency is the community mental health agency in the region that delivers these services. And you mentioned when a child turns six.
00:13:17:07 – 00:13:48:19
Unknown
So what age group of children do you serve? We support zero through six year olds, but we are also currently providing consultation education for parents who are currently pregnant or postpartum. And that’s kind of new for our program just to provide some early intervention for parents who are concerned about possible postpartum or have just concerns about a new family member that’s about to arrive or who have just given birth.
00:13:48:19 – 00:14:13:01
Unknown
And there’s just in general concern that there might be postpartum happening for that parent. So that’s a little bit newer for our program. But zero through six is what we provide services for. So exciting. I think in other regions it may the age may go from zero through five. But thank you for sharing what happens in your region.
00:14:13:01 – 00:14:45:20
Unknown
There is variation across the state. And sort of last question, could you share an example of CIC CSM each supporting a client, a family in partnership with at least one other service within the CSA array? There’s very there’s many I think it’s very common for us to partner for many different families, whether that be early child in family, mental health, partnering with someone in case management to help support a family get housing or oftentimes we get referrals.
00:14:45:24 – 00:15:22:20
Unknown
A child has gone through the early intervention program, the zero through three program for developmental concerns, and there’s still something going on for the family. So our partners will refer to our program to kind of pick up and work with the families. So an example that I have is a is is a child that was that was born and referred to E.I. right off the bat due to kind of coming into custody ten days after they were born and heading the nice requirements for the early intervention.
00:15:22:20 – 00:16:00:01
Unknown
So early intervention provided support when the children, the children did phase out and graduate from the early intervention programs. That program ended but then came back through to our program, which I think is very common through this. When kids, kids can come in and out through that, those age ranges many different times. The behavioral support person, I’m not really child and family mental health team provided support to that child and their parents and the daycare sorry, the child care provider, but they were hoping to have more mental health interventions.
00:16:00:03 – 00:16:32:12
Unknown
So they referred to our team. And so we kind of even though there’s different providers, maybe kind of happening in succession on our team, I think it’s a good example because we held this family for the full six years of providing support and intervene shown along the way and then refer that family on for clinical intervention after they had finished with our program, they received different areas of service support along the way that I think we’re very helpful.
00:16:32:13 – 00:16:55:14
Unknown
I think it was a good example of how we can kind of stay with the family from that 0 to 6 age and in many different programs. Yeah, And just for for everyone, can you define any that’s Oh, can I be a little abstinent. Yes. Thank you. Yeah. I’m like, no, I don’t know. Can I just in jargon.
00:16:55:17 – 00:17:20:21
Unknown
Jargon. Testing. Yeah. Thank you so much, Mara. That’s a great introduction to your set of services. So we’re going to go ahead and hear a little bit about specialized child care and hear from Kim. Could you introduce yourself? Hi. Yes, I’m Kimberly Buxton. I am the specialized child care provider for the Saint Johnsbury and Southern Essex Counties. Great.
00:17:20:22 – 00:17:51:02
Unknown
And what’s the goal of specialized child care? Really? Yeah. There are several goals for specialized child care. One is for children being able to access child care, and the second is for those children to be able to attend child care programs that are considered specialized. So those specialized child care programs will have an extra designation as being a specialized child care program, which requires an extra set of trainings.
00:17:51:04 – 00:18:19:09
Unknown
Great. And so what what do providers offer for clients of specialized child care? Sure. So when I am working with the family and other specialized child care for senators or working with families, we offer sometimes we’re the lead for a family and we help case manage. And then we will also help families find specialized childcare that they can attend.
00:18:19:11 – 00:18:56:07
Unknown
And we authorize the use of the child care financial assistance so that families can receive help paying for those child care services for their entire family. And then we will also work with providers to help them. Child care programs to help them with their program if they need help in the child care setting, if they have concerns about how their routine is going or maybe how their environment is set up so that we can help offer guidance and resources for them as well.
00:18:56:09 – 00:19:25:05
Unknown
And so you answered part of my next question in talking about serving early childhood educators, what age group of children do you serve? Sure. So children can enter child care starting at six weeks. Sometimes they can enter earlier if there is a need. And then we serve children up past age 13, sometimes children with children in special needs can attend child care after their 13th birthday.
00:19:25:07 – 00:20:06:13
Unknown
But through this it’s really through age 12. I’m sure we can authorize past age 13 for child care financial assistance right Thinking statewide, what type of agencies deliver specialized child care? Sure. So there are a range of local agencies. There are 12 that have specialized child care coordinators in the state of Vermont. A lot are housed at parent child centers and then others are housed at local community support agencies like Umbrella and Saint Johnsbury and in Newport, which is where you are.
00:20:06:15 – 00:20:10:18
Unknown
Yes, great.
00:20:10:20 – 00:20:43:06
Unknown
So as I’ve asked others, could you share an example of specialized child care supporting a child or a family in partnership with one other service or more within the CIA story? Sure. So it’s very common for families that are working with specialized child care quitters to also be working with other services, children’s integrated services. So early intervention, maybe working with a family that’s also working with a family support home visitor.
00:20:43:08 – 00:21:29:08
Unknown
And they may also have worked with speech, occupational therapy, physical therapy. There could be a range of services that a family might use and may also visit the child care program to provide those services as well. And so when all those services are involved, what does a team meeting look like? Sure. So when there’s a bunch of services assisting a family, we try to work together and be one point of contact for the family so that there’s one case manager for the families, one plan, and then those services all kind of coordinate their visits and time with the family so that a family doesn’t get overwhelmed with everything that might be supporting them because it
00:21:29:08 – 00:21:56:10
Unknown
could feel overwhelming if there are a lot of professionals working with a family. Thank you, Kimberly. It’s great to hear about all that specialized child care offers for the fourth set of services. Not that they’re in any order, but just in the order of our conversation. And today, we’re going to talk about six strong families, Vermont, which is our home visiting services within strong families.
00:21:56:10 – 00:22:22:19
Unknown
Vermont, we have sustained home visiting and responsive home visiting. So you’ll hear a little different, a little bit about the difference between those as we go through. So we’re going to start with sustained nursing home visiting, and Karen will introduce herself and talk about what that program’s actually called. Hi, I’m Karen Belsky, branch network for the Department of Health and the Family and Child Health Division.
00:22:22:19 – 00:23:01:05
Unknown
And we did administer the sustained talking visiting programs and the nursing home visiting program is one of the two sustained or evidence based home testing programs that Vermont provides. So often what we talk about is the state where it’s synonymous with evidence based, where we are operationalizing and implementing a particular model. And so for nursing home visiting, we are using the mesh model, which stands for maternal and early child sustained home visiting.
00:23:01:08 – 00:23:42:09
Unknown
That’s a mouthful. Or mesh meets C. FH is the acronym and this is the International Home Visiting Program out of Australia that Vermont began to implement about four years ago. And so we have nurse home visitors across the state who are trained and certified as mesh nurse home visitors, and they provide this very specific, sustained or long term nurse home visiting program for families and within strong families Vermont.
00:23:42:09 – 00:24:15:08
Unknown
We also offer a responsive home visiting, and one set of services is responsive Nurse home visiting. And Kelly is going to talk with us about that. Kelly, if you could introduce yourself and tell a little about your set of services. Sure. I’m Kelly French. I work at the Family Place in the Hartford region. I’m the responsive nurse and visitor there, and I also work in the early intervention program as a supervisor and the responsive nursing home visits.
00:24:15:10 – 00:24:45:22
Unknown
Those services are desired outcome is to improve the health and well-being of clients and families, fostering positive parenting skills and healthy habits we build on and enhance client and family strengths and families identify goals that they want to work on, and we support them in feeling confident in their decision making, in their health care and their parenting. And where do you offer those services?
00:24:45:24 – 00:25:11:00
Unknown
The most common agency or I would say the parent child centers is where you would most commonly find the responsive nursing home visiting. And also home health agencies provide that as well. But where do you know? Where do the families receive the services? So we provide home visits, but we can be flexible. We can meet families at a park, we can meet them on their lunch break at work.
00:25:11:00 – 00:25:46:09
Unknown
We can do telehealth. It’s really meeting the families where they’re at. Great. And what population do you serve? What age of children and people do you? So, yeah, we serve prenatal and postpartum up to 60 days. And then children birth through age five. Great. And could you share an example, Kelly of responsive nursing home visiting, supporting a client or family in partnership with another service with NCIS?
00:25:46:11 – 00:26:18:02
Unknown
Sure. I echo what was said earlier. I think that this program partners with many other programs, but an example that comes to mind is a child who was enrolled in the nursing program following birth. The child was born exposed in utero and was receiving it was a foster situation. So the the mom was receiving some new baby support, parenting support and also developmental monitoring.
00:26:18:04 – 00:26:41:24
Unknown
And around the age of two and a half, the child began to experience what the parent described as explosive and rageful tantrums. And this was during the period of COVID. At that same time, the child lost child care placements due to staffing shortages and had been in that child care since about six weeks of age. So it was a huge transition.
00:26:42:01 – 00:27:09:17
Unknown
So there was consultation between the nurse, home visitor and the early childhood family mental health clinician, just for some strategies to support the family and also supporting the parent with local support groups and other resources. There was also a seminar being offered locally on handling big emotions from children to adult, and the parent utilized those resources but was still having a very hard time.
00:27:09:17 – 00:27:43:12
Unknown
So refer to early childhood family mental health. That provider became involved and the to the nurse and the early childhood family mental health provider worked together to support the parent with supporting her child. What a great example. Thank you so much, Kelly. And last but certainly not least, we’re could to talk about responsive family support, home visiting another part of Strong Families Vermont with NCIS.
00:27:43:14 – 00:28:19:16
Unknown
And for that, we’ll turn to Shelly. Hi, I’m Shelly McSweeney, and I am a home visitor, my title at land in Burlington is Family Educator. I Land is one of three parent child centers in Chittenden County, and I provide home visiting services to at risk pregnant and parenting families throughout Chittenden County. And the goals of our program are very similar to what Kelly just described.
00:28:19:16 – 00:28:57:12
Unknown
In fact, I was really psyched that Kelly went first because I was trying to figure out how to describe that. But really, I wrote it down, you know, improve health and well-being, positive parenting, and definitely preventing or reducing ACES, reducing isolation, creating more connection. Gosh, there’s so many goals that I feel like we often meet those goals just by being kind of a consistent, loving presence in somebody’s home and and being available.
00:28:57:14 – 00:29:44:01
Unknown
Re Parenting the parent is a big piece of what I do. What does that mean? Cheli Can you talk a little more? I think often the families that I work with haven’t had enough connection to somebody who provides sort of steady connection and leadership and kind of a wholehearted relationships in their lives. And so helping in many ways provide that for a person so that they can see themselves as worthy and then can can feel that connection to their own child, that that that kind of wholehearted connection to their community and to their children and to themselves.
00:29:44:03 – 00:30:16:09
Unknown
It sounds kind of heady, but I really believe that’s what we’re doing. Yeah, Thank you for describing it that way. And what age group of children do you serve? Birth through their I would have to discharge at their sixth birthday and in some cases I’m working with families for several years. That is not the norm, but it has happened because of multiple children either being born or because of all the many aces in their family adverse childhood experiences.
00:30:16:11 – 00:30:58:05
Unknown
Yeah. So statewide, it’s usually the parent child centers that deliver the service. Sometimes the home health agency might also provide responsive family support. So, Shelley, to get concrete, could you share an example of responsive family support for a client or a family in partnership with another service with NCIS? Sure. There’s many examples. I’m thinking about a mom who completed her residential treatment at lunch with her her child, and she had a couple older children.
00:30:58:05 – 00:31:45:00
Unknown
Her weren’t with her at that time and is reunited with her kids. She had significant challenges with her mental health and with had a diagnosis of a substance use disorder and was back in the community and doing quite well and experienced relapse. And at that point, her youngest child went into custody and then I was brought in. So was connecting was working closely with DCF and could see that the child also was struggling with their speech articulation, at least in my less than trained perspective, seemed like there needed to be more support.
00:31:45:00 – 00:32:11:00
Unknown
So I made a referral to I. At the same time, I was worried about what the children had experienced in the home. There was had been a history with domestic violence and lots of chaos. And so I pulled in the staff from Howard Center and was able to create really a beautiful, a very effective team that worked really well with this mom.
00:32:11:00 – 00:32:40:21
Unknown
And she was in many ways kind of the quarterback she was was able to see herself as as the leader in this group of people and helping to she really understood her children’s strengths and her own strengths. And we were able to come together to support her in a way that she felt really was effective. And I could see the changes in her own kind of sense of of self.
00:32:40:21 – 00:33:13:11
Unknown
And she’s doing quite well right now, like she was the children that her youngest child with completed her treatment with Howard Center is now in kindergarten, is getting some still getting some speech support at school. This mom is working part time and is saving as you know, has a beautiful place to live. And it’s really the family’s doing quite well.
00:33:13:11 – 00:33:57:13
Unknown
I continue with them and will discharge soon and that’s going to be hard. Yeah, because it’s about that relationship that you were describing. And so that’s a transition and at the same time use the the support. It will enable her to continue. Well, without you. Yeah. I think one of the things that we might not talk about as much is one thing that often happens as a child is approaching public school is approaching school is navigating that system, helping children enroll in in preschool and then accessing services through school.
00:33:57:13 – 00:34:39:20
Unknown
And what kindergarten might mean for families, especially if a parent didn’t have a great school experience themselves. And so that’s another piece of it kind of role modeling, situational kind of coaching, how to approach teachers, how to be be their child’s best advocate in a way that works. Everybody. And one last thing before we close, Cheli, just to distinguish responsive family support from some of the other services that we talk about, do you work very much with child care or early childhood education providers?
00:34:39:22 – 00:35:10:03
Unknown
I do. I do. I, I am I’m sometimes I go to a child care and I am in classrooms sometimes just trying to observe what might be happening and creating sort of that home child care connection, home school connection. I make referrals to child care, I make referrals to child care, resource and shipping and county for looking for for a slot.
00:35:10:05 – 00:35:49:10
Unknown
So I definitely am involved in that system quite a bit. Great. Thank you so much, Shelley. Give us a good one. No amniocentesis. So Heidi will turn to you next. And want to talk about strong families Vermont. One of the services in that group is sustained nurse home visiting. And in Vermont, that’s delivered as mesh maternal early childhood, sustained home visiting.
00:35:49:12 – 00:36:21:13
Unknown
And it comes from Australia. But we’ve been using the model here for a while and I know you’ve been implementing it in your region, so what are the desired outcomes for mesh? Okay, yeah, we have a lot of desired outcomes, but primarily I’m going to focus on for the first one is improve maternal health and well-being, and that’s to help parents through helping parents transition into their parenting journey with support in pregnancy.
00:36:21:15 – 00:36:50:10
Unknown
So the goal for Mesh is to start as early in pregnancy as possible. And we also want to help parents connect and bond with their children, not just the target child or the primary child involved in the services, but with all of their children. So which is why we call this family services, because everyone is involved. We want to help families to parent effectively despite the challenges they might face and to develop skills to adapt and self-manage on their own.
00:36:50:10 – 00:37:25:08
Unknown
Once the nurse is no longer involved in the in the services them. That’s probably the most important and primary goal that we have is that the families don’t become dependent on the nurse, but that they become and develop that ability to self manage without that extra support. And then another very big point of ours is to help families feel connected to their communities so that they have that confidence and that comfort in reaching out for support when they are in that period of life where they’re on their own and they don’t have that nurse in the home.
00:37:25:08 – 00:37:52:11
Unknown
Primarily, we want them to to know how to reach out and who to reach out to and to feel like they’re a part of their community and can do that on their own. And those are the minister. Yeah. Thank you, Heidi. And what do nurses four mesh sustain nursing home visiting offers these clients. Wow, that’s a big one.
00:37:52:17 – 00:38:25:02
Unknown
We offer We offer home visits primarily. That’s that’s the big thing. We offer them home visits so that we can help and observe them and help them to develop these skills. We’re discussing in their own home environment where where they spend most of their time, where the things that they have available to them are. And so we we also should that not be comfortable for them at the time we offer them home visits in community spaces as well.
00:38:25:02 – 00:38:47:21
Unknown
So we would be more than willing to meet in a library or maybe at a local office that has a room that’s available for meetings. We do want to always get back into the home eventually, because the goal is for these to be home visits. But when that’s not an option, we offer them visits. Wherever we can deliver this service, we offer community support.
00:38:47:23 – 00:39:20:07
Unknown
As far we will accompany them to a playgroup or to a service that’s offered in the community the first couple of times until they’re comfortable to go on own. We do developmental screenings, we screen for depression and anxiety, postnatal and in pregnancy, and then we offer referrals to the the places in the community that can help to fill that need that may be discovered during those screening times.
00:39:20:09 – 00:39:59:13
Unknown
Right. It sounds really comprehensive. And what population does this does match serve our population is we try to, as I mentioned earlier, try to get in as early in pregnancy as possible. So we’re serving families in early pregnancy. And until child is two years of age, that really pregnancy, there’s a little bit of a caveat there in the sense that moms can be enrolled in the program any time up until six weeks postpartum or in the event of an extended hospitalization for the child, say, the baby was premature or had a health issue when it was born.
00:39:59:19 – 00:40:32:10
Unknown
It’s six weeks post discharge from the hospital. So that’s always figured out based on the individual need of the client. But primarily we prefer to start in pregnancy until this the age of two of the child. So this could be adoptive families, this could be foster families, it could even be transitional fostering. So if a mom needs extra support and the child happens to be in a foster home, we would support the foster family and the mother through reunification and then continue with the mother after that point.
00:40:32:12 – 00:41:05:18
Unknown
This could be grandparents. It could be anyone that is serving that child in that early childhood time as the primary caregiver. So how do you thinking statewide? What type of agencies deliver the service? And specifically which agency in your region delivers mesh? Okay, so mesh is delivered primarily through the vendors throughout the state of Vermont. In my region, it is delivered through the VNA and Hospice of the Southwest region and is also delivered through home health agencies.
00:41:05:24 – 00:41:36:21
Unknown
Sometimes not. It. And if you could share an example of delivering MASH and involving other services within the CSA, Right. Sure. I actually probably couldn’t deliver an example of something where that doesn’t happen because that’s such a primary purpose of what mesh is. When we’re working with families. I can think of one family in particular that children had quite a few needs.
00:41:36:21 – 00:42:01:17
Unknown
They had quite a few of those despite that we’re talking about. So the family was receiving a lot of services in different areas. So they would have strong families, Vermont in the area, but they also had a child getting services through early childhood family, mental health. They also had their child involved in the parent child center receiving services through the eye for developmental concerns.
00:42:01:19 – 00:42:31:07
Unknown
And then they also were taking advantage of the family support and child care services. So that family was completely wrapped in this. We did a lot of co visits, We did some team meetings and just all worked together to support that family. And that really happens throughout. It’s not like I said, there’s rarely a circumstance where a family doesn’t have another service involved.
00:42:31:09 – 00:43:09:16
Unknown
So it’s the focus is to always be wrapping that family in services that will help them get the support need and they’re launched into parenthood and family development. Thank you so much, Heidi. You really giving us a picture before we close? I just have one other question about the population served because MASH talks about maternal early childhood. I just wonder if there if other, you know, parents other than the birthing parent, you talked about foster parents and adoptive parents and grandparents, but could it be a father could it be another mother?
00:43:09:18 – 00:43:37:03
Unknown
Absolutely. And that whoever is the primary caregiver of that that child that we start with in infancy so we actually had a circumstance and unfortunately it never came to fruition. But where a dad had contacted us early on and the mom in this family had already decided prior to the child’s birth that she was not going to stay involved and dad was going to be the primary caretaker of that child, and he wanted to receive our services.
00:43:37:05 – 00:44:06:10
Unknown
And so we absolutely any time in that situation, it’s whoever is the primary caretaker of that that baby, when it comes into the world and whoever is going to be parenting it. Thank you so much. You’re welcome. So, Karen, I would turn to you, Karen MALESKY Branch, to talk about another sustained home visiting program. This one is called Patty.
00:44:06:10 – 00:44:39:11
Unknown
Or are parents as teachers, parents as teachers or Patty? And I’ll run through the ask you the same things. What are the desired outcomes for parents as teachers? Well, similar to mesh because it’s an evidence based model, they are built off of research, right. That shows that if you if you really provide that model to fidelity that you will see these positive outcomes or impacts on families.
00:44:39:11 – 00:45:11:15
Unknown
So for parents as teachers, it includes things like identifying possible developmental delays for children early, that’s a big one. Also helping to improve school readiness for children who will be entering school. That’s part of why we were interested in the parents of teachers model, in part because it also, as I know what about it provides services through the age of five for a child.
00:45:11:15 – 00:45:57:22
Unknown
So it does focus very much on helping helping children and helping families prepare children for school more positively. It also has a focus on improving parent child interaction and a big focus on parenting and really supporting parents in their ability to parent. Okay. And what took well, first of all, who delivers parents as teachers? Well, in Vermont, we have you know, we have both the nurse sustained home visiting model that we have parents as teachers, which is the model we use for our family support home visiting model.
00:45:57:24 – 00:46:36:02
Unknown
So it’s really family support, home visitors. So these are human service professionals. They may be social workers. They’re folks that have a human service or social service background and are trained to not only to provide these services, but trained in the model itself, to provide parents as teachers. Okay. And what do the families support? Home visitors delivering patty offers as clients, they offer a lot of different things.
00:46:36:02 – 00:47:03:22
Unknown
Parents, teachers is there is kind of four components to parents teachers that one is what they call the personal visit or the home visit. And so the work that happens there, it’s also about helping to support families and making connections to resources and which could be services, but it could also just be, you know, different community resources, building relationships.
00:47:03:24 – 00:47:36:00
Unknown
There’s a group connections component. So it’s also very much about helping to decrease kind of parent isolation and family isolation. So that’s one one of the four components is to create regular and consistent group connections with And among the families that are participating in parents, teachers. And it’s it’s pretty much everything and anything that a family might need.
00:47:36:02 – 00:48:03:18
Unknown
So a lot and it is around helping families identify their goals, how they want to accomplish their goals. There’s, as I said, a big focus on screening for developmental concerns with children, also looking at the parent’s health and wellbeing and really focusing as well on what are what are some of the stressors or challenges that a family may be facing.
00:48:03:18 – 00:48:39:11
Unknown
So it could include things like supporting families around issues of housing, mental health issues, childcare, and there is a big component around that parent child relationship and really working with the parents or caregivers in how they’re relating with understanding and supporting their child’s development. I know there’s an emphasis on recognizing and interpreting children’s cues. Yes, right. As part of the relationship building.
00:48:39:11 – 00:49:15:22
Unknown
Yes, absolutely. Yeah. And a lot of that’s done through play and really supporting parents in understanding the importance of play in a child’s development. You know, how how are they building that in? And yes, that through play, how are they kind of gaining more of an understanding of their child and what their child needs and setting up routine and ways of really supporting the family overall, but really focusing on supporting and understanding the child’s developmental needs.
00:49:15:24 – 00:49:45:14
Unknown
And I think you might have already said this, but could you reiterate what population parents as teachers serves? Sure. So it’s it is a program that can be offered prenatally up through age five. And Vermont, our focus is really working with families, with children after after six weeks postpartum. That’s part of why we have to sustain home visiting models because they’re complementary to each other.
00:49:45:16 – 00:50:20:08
Unknown
And so and that can go up through the age of five. So it’s primarily for families with children, six weeks postpartum all the way up through five. Great. And it’s really kind of same similar in that it’s any kind of family. So whatever whatever whoever is in the child’s family and and it also includes even though there is kind of in that know there’s an identified childhood because there needs to be for billing in other aspects.
00:50:20:10 – 00:50:49:16
Unknown
It is also very much a family centered, family focused model. So it’s really working with the whole family. So who who’s parenting the child and if there are any other children in the home and really focusing on supporting the entire family, it’s terrific. It sounds like really meeting the family where it is and whoever it is. Yes. So thinking statewide, what type of agency is deliver this service?
00:50:49:18 – 00:51:32:07
Unknown
Well, at this point in Vermont, we have eight what are called affiliates. And these are agencies are programs within agencies that have met the parents, the teachers requirements to become an affiliate, which means the program is going to be providing the service to fidelity and everything that that means has many, many essential requirements that go into doing the model to fidelity, primarily the programs or agencies that are providing this are parent child centers.
00:51:32:09 – 00:52:11:18
Unknown
And then we have one agency that is in there region is the the that the parent child education center. And they don’t have that designation at the parent child center. But they and they’re absolutely doing all of many of the services in that region including parents teachers. And as I’ve asked others, could you share an example of delivering parents as teachers, along with another service within SES?
00:52:11:20 – 00:52:50:17
Unknown
Sure. Well, I think it really often there are other services involved and I think that, you know, one of the things that’s such a strength of CNS is that even if there may not be other services that are open to the family, you know, there’s, there’s that ongoing aspect of consultation and collaboration that happens. So I think there are a number of ways, I think that that families support home visitors to parents as teachers are doing that in collaboration with other SES programs.
00:52:50:17 – 00:53:27:22
Unknown
I will say I think that sometimes what what also happens is that it may be the parents teachers is the primary provider that’s in the home, but because especially because some of these children are older, so they may be getting ready to go to child care, go to preschool with it. Certainly working with the support of child care or specialized child care coordinators, I think is often a way that they collaborate to really support families around that particular charity of dealing with child care.
00:53:27:24 – 00:53:52:14
Unknown
I think also early childhood to family health, if they may have a child that’s a little older or the child that they’re working with may be experiencing some particular social and emotional challenges that would bring early childhood family mental health in. And certainly I think early intervention, if they’re working with a younger child that may have some developmental delays.
00:53:52:16 – 00:54:22:09
Unknown
And because one of parents, teachers big outcomes is doing a lot around child element and screening, they are often a good a good resource. So they may be in there first and then recognize that there is a developmental delay or something happening for the child and can bring early intervention in or vice versa. So I think they go both ways.
00:54:22:11 – 00:54:49:01
Unknown
And if the child is older, you know, past the age of three, you know, it’s not under six. But early childhood special education would also exactly be part of the team. Yes. Right. And so if they are working with a child that is, you know, moving to is either in preschool or moving towards kindergarten, then certainly working in teaming with with with that team as well.
00:54:49:03 – 00:55:01:19
Unknown
Great. Thank you so much, Karen. You’re welcome. It’s really great to hear about Patty from you. Thank you.
