The information in this profile reflects feedback from this model’s developer as of the above date. The description of the implementation of the model here, including any adaptations, may differ from how it was implemented in the studies reviewed to determine this model’s evidence of effectiveness. Inclusion in the implementation report does not mean the practices described meet the DHHS criteria for evidence of effectiveness.
The Health Access Nurturing Development Services (HANDS) program is a voluntary statewide home visitation program authorized by the Kentucky Legislature in 2000. The program is administered by the Department for Public Health (DPH) through local health departments and contracted sites. Within DPH there is a central office team consisting of a program administrator, quality assurance coordinator, training coordinator, technical assistance coordinator, data coordinator, epidemiologist, Maternal, Infant and Early Childhood Home Visiting (MIECHV) grant administrator, system of care coordinator, Moving Beyond Depression™ coordinator, quality assurance specialists, technical assistance specialists, and administrative staff. In addition, six Growing Great Kids™ certified trainers provide training to HANDS staff throughout the state.
HANDS is based on several key assumptions:
- All families have strengths.
- Families are responsible for their children.
- Families are the primary decision makers regarding their children.
- Communities recognize their roles in children's lives.
- Communities recognize that all children must succeed.
- Prevention and early intervention improve the community's well-being.
- Public and private partnerships are vital to a successful program.
HANDS targets first-time parents beginning during pregnancy or any time before a child is 3 months old. Eligible families face multiple challenges, including single-parent status, low incomes, substance abuse, and domestic violence.
HANDS is designed to improve pregnancy and birth outcomes, enhance child growth and development, create safe homes, and promote self-sufficient families.
Program Model Components
HANDS providers first screen referred families for risk factors. Screening may occur prenatally or after birth until the child is 3 months old. Risk factors include unemployment; isolation; substance abuse; unstable housing; low parental education; domestic violence; poor prenatal care; depression; single parenting; noncompliance with prenatal care; unsuccessful abortion; or current use of tobacco, including prenatal and infant exposure to secondhand smoke. Any family that (1) is single, separated, or divorced; (2) began prenatal care after 12 weeks of pregnancy or has had poor care compliance or no prenatal care; (3) has considered abortion during this pregnancy; or (4) has two or more risk factors is eligible to receive services.
A trained home visitor conducts home visits; frequency is determined on the basis of the family’s needs. Home visitors use the Growing Great Kids™ (GGK) curriculum and provide services that focus on supporting the family, family-child interaction, child development, and personal responsibility. Services include developmental and social-emotional screenings for children and domestic violence and perinatal depression screening for parents. Health prevention is also a key focus of HANDS home visitation. Visitors work with families to establish medical homes and maintain up-to-date immunizations and well-child checks. In addition, a registered nurse or social worker provides quarterly visits to focus on the signs of premature labor, labor and delivery, home safety, basic care, nutrition, exercise, safe sleeping, effects of smoking and secondhand smoke, stress, babies’ cues, injury prevention, child development and temperament, and adjusting to parenting.
Program Model Intensity and Length
The family support worker, supervisor, and family determine the intensity of services based on a family’s progression through the HANDS program and their assessed need. Families progress as they successfully meet criteria outlined in the level system, which includes six options: Level 1-P (prenatal), Level 1, Level 2, Level 3, Level 4, and Level 0. It is not expected that all families will move through all levels. Home visits average an hour in duration.
Level 1-P: Adults and teens who enter the program prenatally have the option to receive weekly visits. The visits focus on obtaining regular prenatal care and topics such as fetal development, early brain development, preparation for newborn care, injury prevention, and community resources.
Level 1: Families that enter the program during the infant’s first three months are assigned to Level-1. Families receive weekly visits for a minimum of 9 to 12 months. The visits focus on observing parent-child interaction and conducting activities to promote bonding, attachment, and positive parent-child interaction.
Level 2: Families receive biweekly visits (phone/other contact between visits). The visits include activities to promote positive parent-child interaction, family life stability, and self-sufficiency.
Level 3: Families receive monthly visits (phone/other contact between visits). The focus of the visits continues to be the promotion of positive parent-child interaction, family life stability, and self-sufficiency.
Level 4: Families receive visits every three months until age 2. The focus of the visits is monitoring health, development, and progress toward goals.
Level 0: These families have not chosen to receive HANDS visits after four weeks of outreach.
HANDS is implemented in all 120 Kentucky counties.
Adaptations and Enhancements
HANDS currently implements Moving Beyond Depression™ (MBD), a model developed by researchers Robert Ammerman and Frank Putnam from Every Child Succeeds at the Cincinnati Children’s Hospital Medical Center. MBD uses a 15-session treatment called in-home cognitive-behavioral therapy (IH-CBT), which focuses on alleviating symptoms of depression and increasing coping skills. A licensed and trained therapist travels to the mother’s home to facilitate the IH-CBT sessions. The therapy concludes with a joint session in which the therapist and home visitor verbalize the mother’s accomplishments, use of coping skills, and future recommendations for treatment and success.
The information contained on this page was last updated in June 2015. Recommended Further Reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by the HANDS program office on April 24, 2015. HomVEE reserves the right to edit the profile for clarity and consistency.