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CHIP of Virginia CHIP SITE OPERATIONS MANUAL Introduction and Overview This Site Operations Manual is designed to support a beginning understanding of The CHIP model and offer resources from CHIP of Virginia local CHIP sites and from leading experts in early childhood and home visiting The forms and sample templates are current as of the publication of this manual but you should check the password protected portal at www familiesforwardva org for the most up to date versions of these materials coming in late spring 2018 The CHIP Model The Comprehensive Health Investment Project CHIP of Virginia is a statewide network of local programs which provide access to healthcare and family support for children from low income families in Virginia The CHIP mission statement is as follows CHIP works with families caught in the cycle of poverty who are committed to creating a better life for their children and themselves using proven best practices to intervene early and prepare parents to be their child s first and most important teacher CHIP was started in Roanoke Virginia by a group of citizens concerned about the health of children The model was developed to address the gaps in services and the barriers to health care faced by low income families and their young children in Virginia These citizens realized that poverty itself is a major barrier for many families and children When families face lack of employment and struggle to meet basic needs the health development and safety of their children is at risk Additional barriers may be created by fragmented health services lack of information about health services or systems lack of insurance and or lack of reasonable transportation systems Barriers of education culture or class may also impede a family s ability to find and use health care services effectively Because of its success in Roanoke CHIP of Virginia was created to replicate the model throughout the Commonwealth CHIP has targeted its services at Virginia s most needy communities Statewide the percentage of Virginia s children in poverty is over 14 while the localities served by CHIP of Virginia average 23 Many CHIP localities have unemployment rates infant mortality rates and or teen birth rates that are much higher than the state average In addition several years after the passage by Congress of the State Children s Health Insurance Program and the implementation of Virginia s Children s Medical Security Insurance Program now FAMIS approximately 17 of Virginia s low income children almost 109 000 children still do not have health insurance These are children who may be receiving fragmented care including expensive emergency room care inadequate or nonexistent well child care and little or no dental care Uninsured children often do not receive needed preventive or acute medical care sometimes leading to unnecessary disease disability or death Many uninsured children see a health care provider only when a condition has become so severe that it can no longer be ignored and without health insurance many parents frequently delay taking their children to a doctor hoping the illness will go away Guiding Principles CHIP services and programs are based on a set of values and guiding principles We value families recognize their unique qualities and build on family strengths We value children and work to enhance each child s potential We believe in and support the capacity of families to provide for the well being of their children CHIP of Virginia 2018 Site Operations Manual Introduction Page 1

CHIP of Virginia We believe in the value of a medical home for all children to promote wellness and improve the health status of children and their families We believe that the multifaceted needs of low income families are best addressed through a family centered comprehensive coordinated community based approach We believe that when provided with knowledge and the resources to act on that knowledge families will have the power to make positive life decisions for their members and to make a contribution to their communities Essential Elements The essence of the CHIP model lies in the interaction of three different but interrelated elements Access to a Medical Home CHIP is committed to the philosophy that the promotion of wellness and the improvement of health for children begin with a medical home that provides accessible continuous comprehensive family centered coordinated and compassionate healthcare Traditionally children from low income families receive fragmented limited and sporadic services from clinics and hospital emergency rooms CHIP personnel work with families and communities to ensure that each child has and uses a medical and dental home Health Supervision CHIP provides coordinated health supervision that promotes wellness helps to prevent illness and injury and enhances normal growth and development These CHIP services support and complement the efforts of the medical home The American Academy of Pediatrics Bright Future Guidelines form the basis for the Health Supervision services provided by CHIP Family Support and Parenting Education CHIP addresses complex social needs through partnerships with families and other community programs CHIP family support services build on the strengths of caregivers to provide for the total well being of their children The Parents As Teachers evidencebased curriculum forms the basis for the parenting education activities offered through CHIP Standards of Quality CHIP of Virginia and local CHIP programs have developed and refined a set of Standards of Quality that define minimum standards for service delivery and administration of CHIP programs While CHIP of Virginia remains committed to maintaining flexibility for local programs in executing the CHIP Essential Elements these Standards of Quality insure that excellence and consistency are promoted across the statewide network During the first phase of development of the Standards of Quality workgroups addressed the most important administrative and programmatic standards Benchmarks and monitoring elements were added to quantify critical standards and enable the use of data to demonstrate adherence to the Standards of Quality Quality Assurance Monitoring Processes occur every 2 years assist sites in their compliance with the Standards and provide technical assistance with areas of challenge COV and local staff will continue to monitor and further refine the Standards to ensure they are relevant over time These policies procedures and practices lay the foundation for our commitment to the provision of quality home visiting services in partnership with local communities and families in Virginia See the CHIP Standards of Quality as well as the Overview of CHIP PAT Formal Monitoring Process CHIP is a strengths based program CHIP staff members work with the family to complete a strengths based family needs assessment that identifies the attributes skills and resources that each family can use as a foundation on which to build CHIP staff members assist each family in setting goals then develop plans to meet those goals CHIP of Virginia 2018 Site Operations Manual Introduction Page 2

CHIP of Virginia Any referred family who meets the eligibility criteria may choose to participate in CHIP based on available capacity and may decline CHIP services at any time Eligibility To be enrolled in CHIP a family these criteria may vary slightly from site to site Has one or more children between birth and six years old or is expecting a baby Has an income level at or below 200 of the federal poverty level Lives in a locality with a CHIP program CHIP Core Services Standards II A 5 6 Screening Assessment and Planning Services to assess family child and or household needs and strengths leading to the development of family service plans Education Support and Follow up Services to assist parents in acquiring parenting skills learning about child health growth and development and promoting health and well being in their families Follow up activities ensure that necessary services are received by families and are effective in meeting family needs Referral and Outreach Services Services that link families to available community resources and ensure connection to appropriate community agencies Staffing see suggested local CHIP Organizational Chart in Appendices CHIP Director Coordinator CHIP sites generally have a CHIP Director Coordinator responsible for overall operations fund development community relationships marketing and board or advisory board maintenance Supervisors Most large CHIP sites employ supervisors who report directly to the CHIP Director Coordinator provide regular reflective supervision of staff and oversee program operations Some sites have separate supervisors for parent educator and for RN staff Regardless of structure RN staff must have access to an RN supervisor for clinical supervision while administrative and reflective supervision can be provided by a non nurse supervisor Supervisors generally do not carry caseloads Teams CHIP is built on the partnership between the parent educator and the nurse who work as a team with the family and other service providers to help each family reach full potential Other supports Some CHIP sites employ additional staff to offer enhanced services such as Licensed Clinical Social Workers to provide counseling or drivers to provide transportation Support Staff Most CHIP sites utilize support staff for general office management human resources and or data entry Appendices CHIP of Virginia Logic Model Sample Local CHIP Organizational Chart CHIP of Virginia 2018 Site Operations Manual Introduction Page 3

CHIP of Virginia A Brief History of CHIP 1987 1988 1989 1990 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 UVA Meeting Unmet Health Care Needs of Virginia s Children Hotel Roanoke Meeting planning for CHIP and its first components Primary care medical home Care coordination case management services Virginia Department of Health awards the Total Action Against Poverty Maternal and Child Health Block Grant funds for CHIP model CHIP Roanoke program is established W K Kellogg Foundation funds expansion of CHIP model components Family support services Transportation services W K Kellogg Foundation funds replication of CHIP model to other sites in Virginia CHIP of Virginia is established to lead statewide replication component of Total Action Against Poverty First meeting of CHIP Statewide Coordinating Council is held First round replication sites established Charlottesville Richmond Southwest Virginia CHIP of Virginia is incorporated as independent non profit organization Second round replication sites established Chesapeake Norfolk Williamsburg New River Valley Network serves 1 500 children in 800 families Virginia awarded Family Resource and Support Grant from Department of Health and Human Services Administration for Children Youth and Families CHIP of Virginia is lead agency enables significant expansion of network Third round replication sites established Petersburg Portsmouth First comprehensive outcome evaluation report on CHIP children and families published Network serves 3 500 children in 1 800 families Virginia General Assembly awards CHIP 1 4 million for 1996 1998 10th replication site begins development in Arlington Initial major grants to establish and expand CHIP network end Virginia General Assembly awards CHIP additional 1 million for 1997 1998 Network serves 4 000 children in 2 100 families Network emphasis shifts from rapid site growth to continuous quality improvement Virginia General Assembly awards CHIP 3 2 million for 1998 2000 CHIP of Virginia implements performance based contracts with the sites CHIP of Virginia partners with MELD of Minnesota to add MELD parenting programs to the network with funding from the Hasbro Children s Foundation and the Ford Foundation Virginia General Assembly awards CHIP 4 3 million for 2000 2002 CHIP of Virginia office moves to Richmond CHIP recognized as MELD network of the year CHIP of Virginia develops long range strategic plan MCHB Healthy Tomorrows grant awarded to CHIP of Virginia for sub grants to sites CHIP named finalist in competition for Premier Cares Award for exemplary innovative services to the medically underserved CHIP of Virginia 2018 Site Operations Manual Introduction Page 4

CHIP of Virginia 2004 2006 2007 2009 2012 2014 2017 2010 2011 CHIP enters into unique partnership with Optima Health Care and the Center for Health Care Strategies to provide services to high risk pregnant women and their children Virginia General Assembly awards CHIP 2 7 million for 2007 08 CHIP enters into collaborative partnership with PEATCH and Healthy Families to begin using the evidence based Parents As Teachers PAT curriculum in CHIP sites CHIP of Virginia celebrates 15th Anniversary CHIP begins its second managed care contract partnering with Virginia Premier to provide fee for service case management for high risk pregnant women babies discharged from the NICU and young children with asthma or other special health care needs AMCHP Association of Maternal Child Health Programs selects CHIP of Virginia s Partners in Pregnancy program as one of two Promising Practices identified nationwide CHIP of Chesapeake and Portsmouth merge CHIP of Richmond and CHIP of Petersburg merge CHIP of Virginia becomes the Parents As Teachers State Office for Virginia CHIP of Virginia receives MIECHV funds from VA Department of Health CHIP of Chesapeake and Portsmouth takes over CHIP of Norfolk and becomes CHIP of South Hampton Roads CHIP of Virginia 20th Anniversary CHIP of Arlington is closed and search for a new partner begins Funding is set aside for a pilot project with a pediatric practice to be determined at a later date CHIP of Virginia and Prevent Child Abuse Virginia merge to become Families Forward CHIP of Virginia 2018 Site Operations Manual Introduction Page 5

CHIP of Virginia CHIP Team Approach I P ed C H te r s s g i r se e R Nu Families provide Strengths and resources Information about their family values and beliefs Advocacy for themselves and the community Information and participation to improve the lives of family members CH an Me d Pr d D ica ov en l id ta er l s Families IP W Ou or tr ke ea rs ch ity un es m m urc o C so Re CHIP Registered Nurses provide proactive and preventive health assessment and education Reviews all information collected at enrollment to determine potential health needs of the family Completes health assessments and health plans for the infant child pregnant and postpartum women and others in the home as appropriate Educates and explains the physiology of health conditions and interpreting the medical visit to families and provides preventive focused health education Reviews all ASQS and ASQ SE 2 screenings completed by the Parent Educator and following up with all children whose score is in the monitoring area Facilitated goal setting for improved health outcomes Basic physical assessment of health status of parents and children CHIP Parent Educators provide family support activities Participates in the enrollment process by assessing family needs Provides developmental and educational activities curriculum using Parents As Teachers to build on the parent s skills and competencies Offers assistance to families in utilizing strengths to improve family self sufficiency Mobilization of formal and informal community resources Facilitated goal setting for improved family well being and increased problem solving skills Medical and Dental Professionals provide a medical home Family centered comprehensive continuous care Coordination referral and follow up with specialty services Compassionate culturally effective and accessible Community Resources provide Services to meet the basic needs of children and families Emergency services to address needs in times of crisis Educational and training programs for parents CHIP of Virginia 2018 Site Operations Manual Introduction Page 6

CHIP of Virginia The CHIP team More about Nurse and Parent Educator Roles The unique cornerstone of CHIP is the team approach of a Nurse and a Parent Educator who work together on a daily basis to deliver health and parenting information and support services to children and families Their ability to coordinate and execute a prescribed plan in partnership with families is the key to their success The ability to identify the specific role each plays is a step in developing a strong working relationship CHIP Nurses role The nurse is responsible for the assessment and implementation of all health needs for the child and family Her responsibility includes ongoing conversation with the Parent Educator as to the health of the family and how visits by the Parent Educator can complement the nurse s role with the family The nurse Provides through regular home visits proactive and preventive health assessment and education Reviews all information collected at enrollment to determine potential health needs of the family Is responsible for completing health assessments and health plans on the infant child pregnant and postpartum women and others in the home as appropriate Is responsible for explaining the physiology of health conditions and interpreting the medical visit Is responsible for reviewing all ASQS and ASQ SE completed by the Parent Educator and following up with all children whose score is in the monitoring area Other tasks to be performed include blood pressures weights temperatures and evaluation of heart lungs The Parent Educator role The Parent Educator is responsible for providing learning activities for the parent and child that build both the parent s confidence and her skills in understanding and meeting the development needs of the child The Parent Educator works to promote family self sufficiency She is responsible for sharing information with the nurse to complement the role of the nurse The Parent Educator Provides developmental and educational activities curriculum such as PAT Participates in the enrollment process by assessing family needs Using information collected through interviews to help families identify and use community resources Team Approach From the first day of enrollment the team process between the Nurse and the Parent Educator is instrumental in determining the success of their working relationship with the family There should be a clear statement of roles as defined above Building this relationship is enhanced by working in close proximity to each other daily conversations easy sharing of charts documentation and other information Their roles complement each other and promote the optimal health of the family While the PE may encourage the pregnant women to keep appointments and may even help with transportation it is the nurse who must explain the health issues and clarify health needs Likewise the nurse may follow up on a parenting question but the PE is responsible for providing the activity By working together as a team they build on the skills each brings to the family to maximize the health of the family CHIP of Virginia 2018 Site Operations Manual Introduction Page 7

CHIP of Virginia CHIP of Virginia Functions CHIP of Virginia provides the following functions in support of the local CHIP programs Grant funding and resource development o CHIP of Virginia seeks ongoing funding to help ensure long term sustainability of the network and all of its local sites o Pursuant to approved work plans budgets and contractual agreements and based upon fund availability CHIP of Virginia reimburses local sites or partner agencies for a portion of budgeted expenditures o CHIP of Virginia assists local sites in identifying additional local funding sources and obtaining funds in order to help ensure sustainability of the local program Quality assurance training and technical assistance o CHIP of Virginia provides training and technical assistance to support sites in providing continued high quality family centered services with measurable positive outcomes for children families and communities o CHIP of Virginia serves as the Parents As Teachers state office for Virginia In this role we provide training and TA to PAT sites that are independent of CHIP as well as CHIP programs using the PAT curriculum o CHIP of Virginia assists sites through data analysis and regular communications o CHIP of Virginia ensures network compliance with Standards of Quality through quarterly individualized quality assurance reports and a site Monitoring Process that occurs at minimum every 2 years including site visits interviews and data analysis Evaluation o CHIP of Virginia facilitates site participation in a comprehensive network wide outcomes evaluation o CHIP of Virginia provides necessary forms protocols and technical assistance to facilitate data collection o CHIP of Virginia analyzes data and disseminates evaluation information Facilitation of statewide network o CHIP of Virginia provides opportunities for partner agency administrators and local CHIP or PAT personnel to participate in networking information sharing and statewide advocacy with other CHIP sites o CHIP of Virginia offers stationery and other network written materials to promote consistency across sites Sites may use their own branding and stationary if they choose State and national information dissemination and advocacy o CHIP of Virginia acts as the representative for the network and its local sites in state and national policy and advocacy efforts o CHIP of Virginia produces and disseminates manuals reports brochures newsletters and other documents to inform the public of the CHIP model and network activities Model replication and new site development o CHIP of Virginia works with representatives of local governments and child serving organizations to replicate the CHIP model in unserved areas o CHIP of Virginia provides awareness activities training and technical assistance to sites interested in initiating a CHIP program o As available CHIP of Virginia provides partial funding to localities to build capacity for a local CHIP program CHIP of Virginia 2018 Site Operations Manual Introduction Page 8

CHIP of Virginia 1 CHIP of Virginia Main Office 8100 Three Chopt Road Suite 212 Richmond VA 23229 www chipofvirginia org Contact Lisa Specter Dunaway President and CEO LSpecter familiesforwardva org Phone 804 783 2667 Fax 804 783 2723 Mylinda Moore Director of Training and Technical Assistance mmoore chipofvirginia org 2 CHIP of Arlington is no longer in operation 3 Jefferson Area CHIP 1469 Greenbrier Place Charlottesville VA 22901 Phone 434 964 4700 ext 4701 www jachip org 4 CHIP of South Hampton Roads 1302 Jefferson Street Chesapeake VA 23324 Phone 757 543 9100 www chipshr org 5 CHIP of New River Valley 114 A North Franklin Street Christiansburg VA 24073 540 633 5133 ext 436 www nrcaa org 6 CHIP of Greater Richmond and Petersburg 2325 West Broad Street Richmond VA 23220 Phone 804 282 4255 700 South Sycamore Street Suite 2A Petersburg VA 23803 804 733 9961 Contact Jon Nafziger Executive Director jon nafziger jachip org Communities Served Charlottesville Albemarle Louisa and Fluvanna Contact Trish O Brien Executive Director tobrien chipshr org Communities Served Chesapeake Norfolk Portsmouth Contact Angie Nichols Coordinator angie nrcaa org Communities Served Radford Floyd Montgomery Pulaski and Giles Contact Pat Purcell Senior VP of Early Childhood Programs ppurcell familylifeline org Communities Served Richmond Henrico Chesterfield Petersburg www familylifeline org 7 CHIP of Roanoke Valley 1201 3rd Street SW Roanoke VA 24016 540 857 6993 www chiprv org Contact Robin Haldiman CEO robin haldiman chiprv org Communities Served Roanoke Salem Roanoke County Botetourt and Craig 8 CHIP of Southwest Virginia at People Inc of Virginia 1173 West Main Street Abingdon VA 24210 276 619 2224 www peopleinc net Contact Amy Compton Coordinator acompton peopleinc net Communities Served City of Bristol Buchanan Dickinson Russell and Washington CHIP of Virginia 2018 Site Operations Manual Introduction Page 9