Appendix C: Orientation Checklist for New Home Visitors
Public Health Home Visitor Orientation Process
Welcome to nurse home visiting in Oregon! Home visiting is important work that can change the course of a life. We are excited to have you as part of the team and we thank you for making a commitment to children and families in Oregon!
Below we will outline the orientation process for staff orienting to the Babies First! and CaCoon programs. We recognize that many home visitors will also be tasked with implementing other home visiting programs (Family Connects or Nurse Family Partnership). Each of these home visiting models has different program and orientation requirements. Because of this, it is extremely difficult to orient to all programs simultaneously. For new home visitors, we generally recommend gaining some proficiency with one program before embarking on orienting to other programs. Develop a plan with your supervisor about how best to approach your orientation and consult with a state nurse consultant if further guidance is needed.
Babies First! and CaCoon Orientation Process
Onboarding and orienting to your new role as a Babies First!/CaCoon home visitor will take place over many months, allowing you to build up your knowledge, skills and confidence. There are three components of your orientation: the Babies First!/CaCoon orientation checklist, the Babies First!/CaCoon Virtual Orientation and TCM 201 trainings, and local orientation and client encounter ramp up.
Babies First!/CaCoon Orientation Checklist
The Babies First!/CaCoon Orientation Checklist is available from Day 1 to guide you in your learning. On the checklist we provide a list of required learning resources (online courses, readings, videos, etc.) that will provide you with the foundational knowledge needed to be an effective home visitor. The learnings on the Checklist are recommended to be completed over three months, although this recommendation is flexible depending on your learning style and your other duties in your county. If have already oriented to another nurse home visiting program, some of the learning on the BabiesFirst!/CaCoon Orientation Checklist may be duplicative. You and your supervisor can use your discretion to decide if you have already covered a given topic sufficiently. If so, you can make note of the substitution on your Checklist. You and your supervisor can consult with a state nurse consultant if further guidance is necessary.
You will notice that the Checklist is in Excel format, allowing you to sort the learnings by month, topic, role (nurse or CHW), and program. Although most learnings on the Checklist are for all home visitors, please note there are some learnings specific to nurses, and some learnings that are specific to Babies First! or CaCoon. No matter how you approach the checklist, during the first month, it is recommended that you focus solely on orientating to the program(s). Do not plan on taking on any clients of your own during your first month. There is a lot of information on the Checklist, and the first month contains the most information. Be kind to yourself, take it slow, and ask questions when you have them.
If you encounter any issues with the Orientation Checklist, such as broken links, please reach out to a state nurse consultant or complete this form so we can ensure you can access all necessary materials.
Babies First! and CaCoon Virtual Trainings
The state nurse consultants provide a Babies First!/CaCoon Virtual Orientation twice a year (in June and December). This orientation takes place over four mornings. TCM 201 training is also offered twice a year (in January and July). This training takes place over one morning. Information about registering for these trainings can be found in the Orientation Checklist. It is important that you attend all days of each of these virtual trainings.
Local Orientation and Client Encounter Ramp Up
Orientation to hands-on skills, assessments, and your charting and billing systems will take place at the local level. Ideally, you are in a county with a supervisor and/or other nurses who can help guide you on processes already in place. Just as time is required to complete the orientation checklist, learning about the systems in place in your county should also be deliberate. Consider first shadowing at least one home visit (including being involved in planning for the visit and completing charting afterwards), then having another nurse join you on visits you lead (as well as observing your charting), before you become independent in your visits. If you are the only nurse in your county, consider connecting with a neighboring county to see if there might be opportunity to ask questions of or shadow a nurse there. Reach out to your state nurse consultant if you need help arranging this. If you are the only nurse in your county, or if you are rebuilding a program, the orientation and ramp-up process should be expected to take more time.
As you build your caseload, the actual number of visits per week you complete will depend on your previous experience as a home visitor, whether visits are done virtually or in-person, whether you are taking on an existing caseload or enrolling new clients, and whether you also need to establish/re-establish community connections for referrals. The below example assumes a new nurse that must build their caseload from zero and who conducts all visits in-person (but has a ready source of referrals). You can see that even in a county with an established home visiting program, it is still expected to take at least 7 months for a home visitor to have a full caseload.
Continuing Education
Remember that your learning does not stop after completing orientation. Plan regular and reoccurring time in your schedule to stay up to date on best practices, including attending the monthly nurse home visiting Community of Practice meetings. Please also note the equity continuing education requirements outlined in Chapter 5 of the manual. Further information on professional development can be found in Chapter 9 of the manual. We hope you enjoy the personal and professional growth you will experience as you complete your orientation journey and continue with lifelong learning!
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Appendix D: Community Health Care Worker Role
Babies First! and CaCoon are public health nurse (PHN) home visiting programs. Non-nurse professionals may provide services within these programs including interpretation, data entry, administrative support, and home visiting services. This document will provide a guideline specifically for the role of the non-nurse home visitor. While a variety of terms have been used to describe the non-nurse home visitor role in the past, the current recommendation is to define the role as a Community Health Worker (CHW) and to adhere to the guidance provided for job description, competency validation, and TCM billing.
This document will serve as a guide for how the PHN and CHW should work together to provide services to families. Other roles may continue to exist in a PHN home visiting program, but the role of non-nurse home visitor in the Babies First! or CaCoon program should align with this guideline.
Babies First! and CaCoon CHW Job Description
A CHW is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served.
The CHW:
- Has expertise or experience in public health;
- Works in an urban or rural community, either for pay or as a volunteer in association with a local health care system;
- To the extent practicable, shares ethnicity, language, socioeconomic status and life experiences with the residents of the community where the worker serves;
- Assists members of the community to improve their health and increases the capacity of the community to meet the health care needs of its residents and achieve wellness;
- Provides health education and information that is culturally appropriate to the individuals being served;
- Assists community residents in receiving the care they need. (e.g. may give peer counseling and guidance on health behaviors, and
- May provide direct services such as first aid or blood pressure screening (if competency validated (see below).
CHW Certification is not required for CHWs working in the Babies First! or CaCoon program at this time, but it is recommended. Certification provides a standard of professional excellence and accountability. Information about certification can be found at the OHA Community Health Worker site. A bill for Targeted Case Management (TCM) services may be submitted for a visit provided by the CHW, if the visit activities meet the requirements outlined in the TCM Rules. Please see Targeted Case Management section for more details. The following description of the minimum qualifications for the non-nurse home visitor role from the TCM rules should be taken into consideration when creating a job description for the CHW in the Babies First! or CaCoon programs. The TCM rule (OAR 410-138-0060) defines the minimum qualifications for a CHW providing TCM services in a PHN home visiting program as follows:
- High School graduate or GED
- Two years' experience in public health, mental health, or alcohol drug treatment settings
- Any satisfactory combination of experience and training that demonstrates the ability to perform case management services
- Must work under the policies, procedures, and protocols of the state MCH Program.
Training and Competency Validation
The Core Competencies specific to the CHW role are:
- Outreach and mobilization
- Community and Cultural Liaising
- Case Management
- Care Coordination
- System Navigation
- Health Promotion and Coaching
It is the responsibility of the local implementing agency to ensure CHWs are educated and competency validated to perform the responsibilities of their position within the respective organization. It is also the responsibility of the local implementing agency to ensure the work of the CHW is adequately supervised.
A variety of methods may be used to validate competencies. The local implementing agency should consider validating competencies upon hire and yearly thereafter. For the yearly competency validation, the supervisor may choose to use the yearly chart review and observation of a home visit as a time to validate competency. Local implementing agencies might also consider a yearly skills fair for more tactile skills like blood pressuring screening or newborn weight checks.
The following tools are available in the Babies First! and CaCoon manual to assess learning needs, guide orientation, and validate competencies:
Nurse Home-Visiting: Nursing Process and Assignment of Care
Public Health Nurses (PHN) in the Babies First! and CaCoon programs are required to be Registered Nurses. The term PHN will be used to describe the role of the Registered Nurse practicing nursing within the Babies First! and CaCoon programs. The Nurse Practice Act provides guidance for the RN's responsibility for nursing practice. Before we can understand the role of assignment to the CHW, we must understand the nursing process. The PHN is responsible to use the nursing process in their care of the client. The PHN conducts a comprehensive assessment and develops reasoned conclusions which identify client problems or risks. The PHN then develops an individualized nursing plan of care for the client. As the PHN develops their nursing plan of care, they take into consideration the condition of the client and how to administer the nursing plan of care. The PHN may then assign aspects of the nursing plan of care to a CHW as per their nursing judgment.
The nursing plan of care is not the same as the TCM care plan, and the nurse and client should work together to create the TCM care plan. For information about the requirements around the TCM care plan, please see
Chapter 4 of the Babies First! manual. Regardless of how they decide to administer the nursing plan of care (independently or by assignment to CHW), the complete nursing process must be followed.
The PHN is responsible to evaluate the client's responses to the nursing interventions and their progress toward identified outcomes. The nursing plan of care is then updated or modified by the PHN based on ongoing client assessment and evaluation of data.
Assignment to the CHW
In the Babies First! and CaCoon programs, the CHW is a trained, competency validated, and professional home visitor. In this context, the relationship between the PHN and the CHW is one of assignment of aspects of the nursing plan of care, not one of delegation of specific tasks. Care should be taken to follow the
Nurse Practice Act's guidance on assignment of care.
The PHN assigns activities within the CHW competencies as per their job description and ensures accountability to the individualized nursing plan of care for the client. As stated previously, it is the responsibility of the local implementing agency to ensure that CHWs are prepared and competency validated to perform the responsibilities of their position within the respective organization. It is the responsibility of the PHN to know which activities may be performed by the CHW under their job description and to use the nursing process and critical thinking to discern if an assignment to a CHW is appropriate for the client. The nurse supervises the activities assigned to the CHW in the nursing plan of care. The local implementing agency is responsible to supervise the individual.
When making an assignment to the CHW, the PHN is also responsible to ensure documentation of the activity by the CHW and to evaluate the effectiveness of the assignment. In the Babies First! and CaCoon programs, the PHN must review and sign CHW documentation in the chart and in any TCM specific documentation within a specific time frame defined by the local implementing agency.
The PHN is also responsible for periodically reassessing the client in person to determine if the client's needs or preferences have changed. This in-person reassessment shall be conducted at least every 3 months or more frequently if changes occur in the client's condition. In order to ascertain the need for a more frequent reassessment, the PHN must review documentation notes after each home visit (as noted above) and be in regular communication with the CHW regarding their interactions with the client.
1. Can a CHW administer a screening such as PSQ-9 or ASQ?
For the PHN to assign a screening such as PSQ-9 or ASQ to the CHW, the CHW must first be competency validated in that skill. In addition, when the PHN develops the plan for the CHW to administer the screening, they must carefully consider the screening tool. If the screening tool provides clear guidance about how to follow-up, the CHW may complete the screening independently, document their findings, and follow-up accordingly. If the PHN observes that the tool asks for judgment to be exercised regarding how to discern the appropriate next steps, the PHN should either provide clear parameters for when the CHW must report back to the PHN and/or clear parameters to help the CHW determine the appropriate next steps.
2. Can the CHW provide direct services such as blood pressure screening or height/ weight?
The role description above notes that the CHW may provide some direct services such as first aid or blood pressure screening. If the PHN determines it is appropriate given the client's condition, the PHN may assign BP screening to the CHW provided that the CHW is competency validated in that skill. When the PHN develops the nursing plan of care, they must define specific parameters regarding follow-up steps and when the CHW should report back to the PHN.
3. May we rename our administrative staff role to “CHW”?
No. Other roles may continue to exist in a PHN home visiting program, including administrative and other support staff. The role of the non-nurse home visitor in the Babies First! or CaCoon programs should be defined as a CHW if they are providing home visiting services.
4. Is my nursing license on the line for CHW activities?
The CHW does not work “under the license" of the PHN. The CHW works for the local implementing agency to which they have been hired and the local implementing agency is responsible for their training and competency validation. The PHN is accountable to the nursing plan of care they create. The PHN must use their nursing judgment ensure that any assignment is appropriate for the CHW role given the client's specific condition. The PHN must provide appropriate parameters for follow-up if necessary.
5. Should the CHW submit THEO data for their visit?
Yes. The CHW must submit THEO data for any home visiting service just as the PHN would.
6. Can CHWs be used as interpreters?
While a CHW may provide interpretation services, a CHW and an interpreter are not interchangeable. Each role has distinct sets of competencies and skills and some individuals may have both. If a CHW will provide interpretation services, consider appropriate training and compensation. Interpretation services are not considered TCM billable.
References
1. American Public Health Association. (2020). Community Health Workers. Retrieved from https://www.apha.org/apha-communities/member-sections/community-healthworkers.
2. Oregon Revised Statues (ORS) 414.025, 2020. Retrieved from https://www. oregonlegislature.gov/bills_laws/ors/ors414.html
3. Oregon Administrative Rules (OAR) 410-138-0060. Retrieved from https://secure.sos. state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=268911 60
4. Oregon Health Policy Board. (n.d.). The role of non-traditional health workers in Oregon's health care system. Retrieved from https://www.oregon.gov/oha/oei/ Documents/nthw-report-120106.pdf.
5. Meeting with Ruby Jason, MSN, RN, NEA-BC, Executive Director of Oregon State Board of Nursing on March 9, 2020.
6. Oregon Administrative Rules (OAR) 851-045-0060. Retrieved from https://secure.sos. state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=216346
7. Oregon State Board of Nursing. (2019). Oregon State Board of Nursing interpretive statement: “Delegation process" and “assignment and supervision". Retrieved from https://www.oregon.gov/osbn/Documents/IS_Delegation_Assignment_Supervision. pdf.
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Appendix E: Supervisory Support Material
MCH Home Visiting Supervision Meeting Documentation Form
This is a sample of a generic supervision form that could be used to document and track meetings between a supervisors and home visitor. Consider how this information can be shared between the supervisor and home visitor.
Download Supervision Meeting Documentation Form
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Appendix F: Client Bill of Rights
Click to download printable PDF versions.
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TCM documents are located in Basecamp, Docs & Files, TCM folder
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Appendix H: Basecamp Instructions
Use of Basecamp for Nurse Home Visiting Programs
Basecamp provides an online platform for the sharing of resources and documents as well as fostering a community of support with home visitors and supervisors across the state. The platform provides a unique opportunity to ask each other questions and share tools, resources and documents. This supports peer learning and the ability for home visitors and supervisors to “share seamlessly and steal shamelessly" with each other across the state. Please note that shared documents have been voluntarily offered by different counties as example documents. They have not all been vetted by state nurse consultants.
*Do not post any client identifiable information anywhere in Basecamp. The goal of Basecamp is to share resources and to find support across counties. Any disclosure of information which could potentially identify a client is strictly prohibited.
Technical Requirements for Using Basecamp
Basecamp works everywhere you do. Just sign in with your desktop, phone or tablet web browser, or download the free apps for Windows, Mac, iOS and Android. Basecamp is available anywhere you have an internet connection. If you are not sure if you have the right browser, check the Basecamp System Requirements for All.
Basecamp Access
Please ensure you or
your supervisor has submitted the Home
Visitor Workforce Update Form with your information. This will ensure program consultants know you
have started onboarding to their program. Once this form is submitted, OHA
staff will sign you up for Basecamp and you will be emailed a Basecamp
invitation.
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References
- Kruger, B. (2004). Care Coordination. In P. Jackson Allen & J. Vessey (eds.), Primary Care of the Child with a Chronic Condition (4th ed.). St. Louis, MO: Mosby.
- Oh, Hans and Lee, Christina. Culture and Motivational Interviewing. Patient Educ Couns. 2016 November; 99(11): 1914–1919. doi:10.1016/j.pec.2016.06.0
- Venner KL, Greenfield B, Hagler K, Simmons J, Lupee D, et al. Pilot outcome results of culturally adapted evidence-based substance use disorder treatment with a Southwest Tribe. Addictive Behaviors Reports. 2016;(3): 21–27.
- First Nations Health Authority [Internet]. Cultural Safety and Humility Key Drivers and Ideas for Change; c2024 [cited 2024 February]. Available from:
https://www.fnha.ca/Documents/FNHA-Cultural-Safety-and-Humility-Key-Drivers-and-Ideas-for-Change.pdf
- Hockenberry, M. Wong's Essentials of Pediatric Nursing. 7th ed. St. Louis: Mosby (2004).
- United Spinal Association [Internet]. Disability Etiquette Guide; c2020 [cited 2024 February]. Available from:
https://www.unitedspinal.org/pdf/DisabilityEtiquette.pdf?_gl=1*1pmxv83*_ga*MTI1OTAwNzAyNS4xNzAxMzg5NDgz*_ga_ZS2Q737YSD*MTcwMTM4OTQ4My4xLjEuMTcwMTM4OTUxMy4zMC4wLjA.
- Minnesota Department of Health [Internet]. Reflective Practice in Home Visiting; c2024 [cited 2024 February]. Available from:
https://www2cdn.web.health.state.mn.us/communities/fhv/refpract.html
- Hopkins Medicine [Internet]. Evidence Based Practice; c2024 [cited 2024 February]. Available from:
https://www.hopkinsmedicine.org/nursing/center-nursing-inquiry/nursing-inquiry/evidence-based-practice
- Bradley.edu [Internet]. How does evidence-based practice differ from evidence-informed practice; [cited 2024 February]. Available from:
https://onlinedegrees.bradley.edu/blog/how-does-evidence-based-practice-differ-from-evidence-informed-practice/
- Pew Charitable Trusts [Internet]. Family Support and Coaching Program; c2015 [cited 2024 February]. Available from:
https://www.pewtrusts.org/~/media/assets/2015/10/hvmessagingbrief.pdf
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Powell C, Grantham-McGregor S. Home visiting of varying frequency and child development. Pediatrics. 1989 Jul;84(1):157-64. PMID: 2740166.
- Association of Maternal and Child Health Programs [Internet]. Facilitating Attuned Interactions; c2020 [cited 2024 February]. Available from:
https://amchp.org/2020/02/15/facilitating-attuned-interactions-fan/
- Agency for Healthcare Research and Policy [Internet]. Care Coordination; c2018 [cited 2024 February]. Available from:
https://www.ahrq.gov/ncepcr/care/coordination.html#:~:text=Care%20coordination%20involves%20deliberately%20organizing,safer%20and%20more%20effective%20care.
- Minnesota Department of Health [Internet]. Public health interventions: Applications for public health nursing practice (2nd ed.); c2019 [cited 2024 February]. Available from:
https://www.health.state.mn.us/communities/practice/research/phncouncil/docs/PHInterventions.pdf
- Healthy Outcomes from Positive Experiences [Internet]. HOPE-informed screenings and assessments; c2023 [cited 2024 February]. Available from: https://positiveexperience.org/wp-content/uploads/2024/11/HOPE-Informed-screenings-and-assessments-guide-.pdf
- Kumah EA, McSherry R, Bettany-Saltikov J, van Schaik P, Hamilton S, Hogg J, et al. Evidence-informed practice versus evidence-based practice educational interventions for improving knowledge, attitudes, understanding, and behavior toward the application of evidence into practice: A comprehensive systematic review of UG student. Campbell Syst Rev. 2022 Apr 16;18(2):e1233. doi: 10.1002/cl2.1233. PMID: 36911346; PMCID: PMC9013402.
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