7a2. Home Visit Plan Form Procedure

• Created 03/98
• Reviewed 07/22

---

1. Prior to each formal family contact (home visits and parent/teacher conferences), the Family Advocate and/or Teacher will examine the electronic case management system and the contents of the file for pertinent information related to the following areas, completing the form as follows:
2. This is the form to write the feedback from parents at the visit or contact. What is the parent saying or telling you?
   Family Contact Form (SS HVs, School Readiness HVs, Parent/Teacher Conference)
   • Child’s Name and Date of Visit
   • Who was present?
     • Any person in the household participating in the visit (i.e. Angela, mom).
   • Attendance:
     • Review information on ChildPlus attendance module prior to the home visit.
     • Give a percentage of attendance OR document how many days present (5 of 5 days present).
     • Update and review any plans to support the family with maintaining or achieving full attendance.
   • Family Engagement/Follow-Up (What happened at home visit/things to do):
     • Review contact information on ChildPlus report #1520 for accuracy.
     • If needed, make changes on a COS form.
     • Ensure the Family Interest Survey, Family Assessment, and Family Picture are updated and accurate. Any social service needs are addressed here.
   • Family Goal/Update:
     • Discuss Family Partnership Agreement (FPA) and discuss steps to achievement.
     • Re-evaluate the FPA goal and adjust based on family input.
   • Education (ASQ/TS Gold Readiness focus/activity/parent ideas for the classroom/home learning):
     • List school readiness individualized activity that was completed with family.
     • Parent feedback on curriculum and activities begin done in the classroom.
     • Inform about child’s routines, activities and behavior in the classroom.
     • Review developmental SR Individualized learning plan and create goals under each domain.
     • Listen and document parent’s observations about their child’s strengths and interests.
     • Share screening and assessment information with the parent.
     • Strengths and interests of the child, projects for the classroom, ideas for classroom curriculum, provide home learning sheets and discuss the value of in-kind.
     • Complete the child profile with parent/guardian.
   • Need/Referrals (transportation, food, etc.):
     • List the agencies that family was referred to or the subject matter that is needed for FLUP.
   • Health:
     • Review information in the ChildPlus health module prior to the home visit, review and/or complete the health history, discuss barriers in each section as indicated (physical, dental, nutrition), any appointments/treatment, discuss any needed health referrals for family.
       

       Topic	Information for Parent/Guardian	Information from Parent/Guardian
       WCE	WCE next month 06/23/23	Appt. scheduled 06/25/23
       Dental	6-month dental recall due next month 06/23/23	Dental appointment made for 07/01/23 at HKD
       Nutrition	Provide 'picky eater' handout	Would like more info on dietician referral
       Specialists	Hearing appointment made yet for hearing referral?	Primary doctor not concerned need to send for last exam results to confirm
       Physical Activities	Nature walk	Playing sidewalk chalk, takes trupes to park each week.

   • Other Items Completed (i.e. parent surveys, etc.):
     • List what other items were completed (parent survey, food service survey, etc.).
   • Things to Do:
     • Document what you as the staff will be doing next to support the family and/or list what the family will be doing next.
   • Parent Meeting/Family Night:
     • Provide dates and important information of upcoming parent meetings and/or family nights.
   • Parent/Guardian Signature:
     • Parent/Guardian Signature
   • Staff Signature:
     • Staff Signature
   • Length of Visit:
     • Document length of visit.
   • Distribution: White – Parent, Yellow – Site File
3. Home visits provide opportunities for family/child goal setting and discussion of each child/families’ individual development and progress. Additional home visits may be added on an individual basis. Home visits should be well planned for with all family information viewed ahead of time. Location and time options should be available to best meet the needs of individual parents most appropriately. Tips for a successful visit include:
   • Be punctual and prepared.
   • Confirm with the parent upon arrival the length of the visit (1 1/2 hours) to determine any barriers, which may interfere with the visit.
   • If you are not sure of the parent’s response, ask....
   • Acknowledge his/her response by restating what you think it is: "Sounds like...", "You agree something needs to happen...", "So you think..."
   • Keep good eye contact, look at and relate to parents and acknowledge others who may be in the home.
   • Clearly state the purpose of the visit.
   • Get to know the family. Ask questions. Be a good model when you interact with them by being willing to share about yourself in an appropriate manner.
   • Use family friendly language. Do not assume all parents can read and write.
   • Show enthusiasm and acceptance.
   • Make sure to leave your home visiting schedule at your site, including the family’s name, the date and time of your visit and when you expect to return.
4. If your home visit has been cancelled or was a no show, document this in case management with your plan for follow-up.