DHS Program Resources

Parent Support Outreach Program (PSOP)

Spotlight

Scott County – PSOP and public health nurses: Lessons learned
In efforts to best serve children and families referred to PSOP, Scott County Health and Human Services PSOP and the county’s public health nurses (PHN) are committed to providing a collaborative approach for families with children under age 5, when appropriate. Both services are voluntary. The belief is that the joint approach will promote engagement and better overall outcomes.

Case example 1

Background: Prenatal exposure to drugs, relapse, parent in jail, followed by court and sober support services for parents. This family had been working with a Scott County child welfare worker due to the report of prenatal exposure. Public Health Nursing was already involved when the PSOP worker got involved. The child was born without any drugs in their system, but the family was in need of support, therefore, a referral was made to PSOP.

The PSOP and PHN workers completed the majority of home visits with the family together. The following are highlights of what worked well as a result of coordinated joint visits:

• The family had to tell their story and give updates only once.
• Provided direct help in the moment. With both services at the same visit, there was typically direct help for concerns at the moment without workers having to consult afterwards, or messages relayed back and forth, delaying problem-solving efforts/case progress.
• PHN ability to address the immediate questions/concerns that the parent had regarding feedings, rashes, child development, etc. PHN was able to provide/discuss basic parenting needs during visits that the PSOP worker was not as knowledgeable about, as a result, the PSOP worker learned a lot from the PHN worker that can be applied to other families.
• PHN completed the ASQs. If/when there were developmental concerns, they had a very delicate way of addressing/discussing with the family; that PSOP worker learned a lot that could apply when working with other families.
• PSOP worker was the primary worker to address safety concerns in the moment, lead difficult conversations, and coordinate safety planning. PHN noted they would also address concerns, as needed, if PSOP worker was not there, but felt that the PSOP worker had a different way of explaining concerns and was able to provide the family with information about child protection reports, etc. For example, what types of reports, behaviors, etc., would likely be screened in for child protection, and how to plan for and try to prevent incidents from happening.
• Increased efficiency in coordinating services and assigning tasks between professionals.
• Share resources.

Case example 2

Background: PHN referred family to PSOP when the mother was in the third trimester of pregnancy. She had significant mental health concerns (SPMI) that resulted in multiple hospitalizations. Former history with child protection for older children. This case was extremely complex and there were major barriers to mom being able to access resources. Mom is on medication and also works with a mental health team; she has been able to parent successfully when stable.

The PSOP and PHN workers completed many of the home visits with the family together. At times, visits were staggered for more check-ins being completed with the mother/baby. The following are highlights of what worked well as a result of coordinated joint visits:

• Expedited a Family Group Decision Making (FGDM) referral. PSOP worker was able to quickly arrange a FGDM meeting prior to baby’s arrival, which also helped to identify the mother’s natural supports (i.e., those who can be there for her 24/7).
• Facilitated a care coordination meeting. In addition to working with PSOP and PHN, the mother also worked with additional mental health professionals. The PSOP worker facilitated a care coordination meeting among professionals to address concerns/complicating factors for the family and next steps/workers responsible for tasks (also provided a space to share resources and ideas applicable to other families).
• Coordinated safety check-ins. PSOP and PHN were able to divide and conquer, completing more frequent check-ins with family.
• Provided support to the family, their safety network and peers. This was a very high burnout family to work with, as the case was so complex; by having PHN and PSOP (as well as other providers) involved not only created a support network for the family, but also all professionals involved.

Overall lessons learned

What was learned from using the coordinated response method includes:

• It is helpful to have identified roles/responsibilities. The PSOP worker’s role generally focuses on child safety and coordinating services to address safety and well-being needs. PHN typically completes ASQs, addresses child development concerns and parenting needs.
• As professionals, PSOP and PHN staff can provide coverage for each other if one is out of the office, being familiar with the family. Teaming service delivery is helpful in complex situations, as it allows professionals to debrief, “tag team,” and support each other in the process, reducing anxiety and burnout in high risk cases.
• Professionals are able to consult with the Multi-disciplinary Team (MDT) for complex cases involving PSOP and PHN families. The MDT members represent a cross section of professionals in the community who work with children and families. For example, health care professionals, domestic violence advocates, school staff, mental and chemical health professionals, housing workers, various county staff, etc.

The challenges identified in providing coordinated services are:

• Difficulty coordinating visits due to busy schedules
• On rare occasions, a few families were hesitant in meeting with more than one worker.

Reflecting on the process of collaboration between PSOP and PHN and how it has worked in Scott County overall, it has been a positive experience. Early in the process it felt like more work and time consuming to coordinate/collaborate with additional workers, however, it is just the opposite. It is believed that it has also been helpful for families to have their worker and nurse coordinate services and be aware of what each is focusing on and services being provided to a family.