Family Home Visiting Screening and Assessment Recommendations
MDH FHV Program recommends universal screening for child development, child’s social-emotional growth, caregiver depression, intimate partner violence (domestic/sexual violence and coercion), chemical and tobacco use and home safety. Screening reinforces parent and child strengths and supports the home visitor in strategizing interventions.
- Which home visiting model, agency protocol and screening tool used are all considerations when considering when to screen.
- Home visitors might also consider screening between the ages your program recommends (intervals) if professional judgement indicates it is needed or previous screens indicate a need for monitoring or rescreening.
- Screening will lead to referrals. Part of screening is preparing for referrals by developing a referral network and protocol for home visitors. Tips for developing referrals are included in some protocols linked to this page.
The words screening and assessment are often used inter-changeably. For purposes of these materials, screening is short in length, quick to administer and score, and typically identifies if there is a need for further evaluation. Screening results can be used by the home visitor to partner with the family to set goals, plan for activities and develop resources to strengthen parenting skills.
Assessment is comprehensive and may be used by health care providers or other professionals to diagnose a health condition and to plan for treatment or intervention services. An assessment in home visiting programs can also be used in partnership with the family to set goals, plan for interventions and activities and develop resources to strengthen parenting skills. There are tools that have both screening and assessment components.
MDH Family Home Visiting encourages programs follow the Minnesota Interagency Developmental Screening Task Force (Task Force) recommendations. Public screening programs should transition from the ASQ: SE to the Second Edition: the ASQ: SE-2 by July 1, 2017.
Ages & Stages Questionnaires®: The ASQ 3 and the ASQ SE 2 are reliable, family-friendly ways to screen children for strengths and areas of concern and provide guidance as to the need for further assessment. The tools screen children between one month and five and a half years of age. MDH provides training on scoring and interpreting the ASQ’s, Introduction to Using the Ages Stages Questionnaires (ASQ) Training (PDF). Brookes Publishing has more information about the tool and materials available for purchase.
- ASQ SE2 Algorithm (Decision Tree) (PDF)
- ASQ SE2 Referral Guidance (PDF)
- Referral: Minnesota Help Me Grow: helpmegrowmn.org Help Me Grow is an interagency initiative partnering with local services agencies to provide a referral mechanism for Early Intervention (EI) and Early Childhood Special Education (ECSE)s. The site also includes parent and caregiver friendly information and short videos about developmental milestones.
The US Preventive Services Task Force found convincing evidence that:
- Screening improves the accurate identification of adult patients with depression, including pregnant and postpartum women.
- Programs combining depression screening with adequate support systems in place improve clinical outcomes.
Depression Screening Tools:
The following list is not comprehensive but includes frequently used and evidence based depression screening tools.
- Crisis Algorithm (Decision Tree) to adapt or adopt: Crisis Intervention Algorithm (PDF)
- Edinburgh Postnatal Depression Scale (EPDS) (PDF) A ten question self-rating scale identifying perinatal depression and scoring instructions.
- EPDS Algorithm 062016 (PDF). A sample decision tree for agencies to adapt or adopt.
- PHQ Screeners - Copies of PHQ's and GAD7- forms and instructions on how to use the forms
- Patient Health Questionnaire (PHQ-9) (PDF) - The Patient Health Questionnaire (PHQ) is a concise, self-administered mental health screening and diagnostic tool. Nine (9) refers to the number of questions (There are shorter versions of the PHQ available on-line).
- Home Visiting PHQ-9 Sample Algorithm (Decision Tree): PHQ-9 Algorithm 062016 (PDF)
- Generalized Anxiety Disorder 7-item (GAD-7) scale (PDF). A self-reported questionnaire for screening and severity measuring of generalized anxiety disorder. The GAD-7 form and how to score: Generalized Anxiety Disorder Screener GAD7 (PDF)
- Depression or Anxiety During and After Pregnancy Information Sheet and Maternal Well Being Plan Information sheets in English and translated into other languages for distribution to new moms.
- Guidance for Maternal Depression Screening & Treatment (PDF)
- Maternal Depression Screening Algorithms (PDF)
The Home Safety Checklist (HSC) is neither a screening nor an assessment tool and can be left with a client or reviewed in person. The checklist is meant to be used as a teaching tool. Reading the Home Safety Reference Guide will give home visitors the research and reasoning behind the checklist. TIP: Introduce the checklist by saying “There are so many things that can be unsafe for babies. They grow so fast it’s hard to keep up with the new things they are learning to do. We use this home safety checklist to help you and I look at what to do to anticipate your baby’s increased mobility”. The Home Safety Checklist Resource Guide has information about resources that will support a caregiver's access to safe equipment.
- The Home Safety Checklist Reference Guide (PDF) was developed as background information for professionals who use the Home Safety Checklist. Updated November 2015.
- The Home Safety Checklist - English (PDF) is a tool designed for use with parents about safety risks for babies and young children.
- Home Safety Checklist - Spanish (PDF)
- For translations in Burmese, Karen, Russian and Somali go to: Health Reach Health information in Many Languages.
Infant Mortality Reduction Initiative: For information about safe sleep and other initiatives, visit the Infant Mortality Reduction webpage.
Domestic violence and abuse, sometimes called intimate partner violence, is the use of physical, emotional, financial, reproductive coercion and sexual force or threats by the perpetrator to achieve and maintain control over others in intimate relationships. For information about prevalence go to Violence Data Brief: Intimate Partner Violence (PDF). It is recommended that home visiting agencies develop protocol that includes home visitor safety as well as guidance about “what to do” with an IPV screen that indicates violence or coercion.
- Injury and Violence Prevention Sample Protocol for Home Visiting Agencies (PDF) Includes the Relationship Assessment Tool in the appendix (RAT).
- Intimate Partner Violence Sample Algorithm (Decision Tree) (PDF)
- Intimate Partner Violence Crisis Intervention Sample Algorithm (Decision Tree) (PDF)
- HARK is an abuse assessment screen which measures intimate partner violence.
- Futures Without Violence Healthy Moms Happy Babies Safety Cards: After developing a protocol, the cards can be given universally to all clients. They were developed to support the home visitor in teaching about healthy relationships which may lead to a conversation about abuse. To download (free PDF form) or order free copies: https://www.futureswithoutviolence.org/healthy-moms-healthy-babies-home-visitor-safety-card/
The Parent Survey (also called HFA Assessment Core Training) is an evidence-based, standardized, and comprehensive home visiting assessment tool. It is designed to learn about the strengths and challenges facing new and expectant parents and determine which families in your community will most benefit from intensive home visiting and other available parenting resources. The Parent Survey tool is used to assess for factors that could contribute to increased risk for child maltreatment or other adverse childhood experiences.
This tool is used by Healthy Families America and other home visiting programs. Training is required for home visitors and supervisors in order to use the Parent Survey and is offered by MDH FHV. See the Training and Professional Development web page.
Assessing parent-child interaction offers the following benefits: home visitors are able to observe and build on parent strengths, provides opportunities to build parent skills and abilities to interpret and respond to their child’s cues and supports planning interventions based on evidence-based assessment.
Parent-Child Interaction Assessment Tools:
- NCAST-PCI scales are used for assessing parent-child interaction and communication behaviors. The Sleep Activity Record (SAR) can help caregivers promote predictable behaviors in their babies through specific activities, routines and interactions. Professional level practitioners who are serving families through home visiting, are required to take in-depth training before using NCAST-PCI Feeding and Teaching scales. After taking NCAST-PCI it is recommended to take NCAST Re-Reliability every three years. Training is offered by MDH FHV. See the Training and Professional Development web page.
- NCAST guidance for supervisors who oversee NCAST implementation (PDF)
- DANCE: Available to Nurse Family Partnership sites only. Contact the National Service Office NFP National Service Office.