MIHOW is a home visiting program for pregnant women and young families. Trained mothers visit young mothers in their own neighborhoods, teaching them and mentoring them about pregnancy, delivery, breastfeeding, positive parenting, nutrition, etc. While several elements of MIHOW programs can be tailored to fit the structure of its partner agencies (i.e. child care centers, primary healthcare facilities, multi-service community agencies), all MIHOW programs have certain components which are uniform throughout the network. These five core components are outlined below.
1. Strength-based approach
Recognizing that regardless of living conditions or circumstances, every family has strengths, MIHOW workers are taught to recognize and document family strengths and focus on the needs identified by the family. To set the stage for healthy living, lasting motivation, and self-sufficiency, they help the family recognize its own strengths and use those strengths to address their own needs.
2. Trained community mothers who mentor their peers
All outreach workers must meet the following requirements:
- member of the target community with a similar background (e.g. the same race, culture, language) of families served,
- strong problem solving and communication skills,
- respect for children, and
- enjoyment of parenting their own child(ren).
Outreach workers complete at least 40 hours of initial training and shadow an outreach worker on a home visit before they begin to serve families. In addition, outreach workers attend ongoing monthly training sessions. MIHOW training has been approved by the West Virginia State Training and Registry System (WV STARS) as early childhood education professional development and aligns with MIHOW’s Competencies for Outreach Workers. The Competencies for Outreach Workers consists of four levels of increasing knowledge base and skills (communication, advocacy, etc.) needed for home visiting. Though outreach workers have varying areas of interest and expertise, each worker must be assessed as proficient at Level 1 in order to begin home visits and will complete work on Level 2 within the first year to continue employment. Since 1982, an estimated 100 MIHOW workers have completed training. Because most enjoy and even thrive in this role, outreach worker turnover is low with a mean outreach worker tenure of 7.25 years. As peers, they model and articulate the mother's significant role in nurturing children. In home visits, they help mothers set goals, develop self-esteem, and practice advocating for themselves and their children.
3. Monthly home visits and education groups
Monthly home visits occur from early pregnancy until the child’s third birthday, and families are also encouraged to attend group gatherings. The home visit curriculum includes three or four objectives for each visit and provides the outreach worker with content and activities for each approximately hour-long visit. During the visits, trained community workers respond to each family’s unique strengths and needs, listen attentively to parents’ concerns, and teach them about nutrition, health, and child development. In addition, each site provides MIHOW participants the opportunity to come together for socialization and mutual problem solving several times per year. Each site determines both the number of group meetings and the content. Some group meetings are education based (e.g. promoting early literacy) and others provide opportunities for parents to socialize (e.g. holiday gatherings, summer picnics). The frequency and content of gatherings are guided by annual participant feedback.
4. Well-defined program structure
MIHOW has a program structure that supports community mothers and links them across communities and to a university base. At each local site, a site leader is responsible for worker recruitment, training, and supervision. Site leaders also raise funds for the program and serve as the program’s spokespersons in the community. In each state or multi-state region, a regional consultant serves as liaison between the region and the program headquarters, based in a major university (blinded for review), and provides ongoing assistance to sites in program management, supervision, accreditation, etc.
MIHOW headquarters staff develop and disseminate curriculum materials, training materials, and a monthly newsletter and assist sites in program management, data collection, and grant writing. MIHOW also coordinates a site accreditation system and organizes annual MIHOW conferences, which bring site leaders, outreach workers and regional consultants together for training and networking.
The MIHOW Home Visit Guides are the curriculum the outreach workers follow in their work with families. These month-by-month education and resource guides cover the prenatal period until age three. They give outreach workers step-by-step instructions to help mothers reach program objectives related to trimester of pregnancy or age of child. They include strategies to improve mother’s self-image, sharpen problem-solving skills, and promote planning, goal setting, and self-advocacy. Objectives pertain to such issues as parent understanding the baby’s appropriate growth and development, attachment, infant feeding, attention to cues, early literacy, establishing routines, and finding quality child care. Objectives related to parents’ other goals include self-esteem building, budgeting, returning to work, educational attainment, etc. The curriculum was developed by a multidisciplinary team comprised of nurses, social workers, and community representatives and has been reviewed by pediatric health and early education experts from the (blinded for review) Center and the (blinded for review) Department of Pediatrics. The MIHOW Home Visit Guides are periodically reviewed and revised based on the needs of the outreach workers and participants served and updated to reflect current research.
MIHOW has an accreditation system that monitors program fidelity across sites, sponsoring organizations, and cultural groups. To assure that each site operates the MIHOW model as designed, each local site must be accredited through the Commitment to Excellence MIHOW Accreditation Program (CEMAP©) and must be reaccredited every five years. Accreditation begins with a self-appraisal, submission of program materials and an in-depth interview with the MIHOW Director. Then an accreditation team consisting of a MIHOW Administrative Team member, a site leader from an accredited site outside of the agency’s region, and an outreach worker from an accredited site within the agency’s region performs an on-site review. The three day review includes interviews with community stakeholders, agency staff, and program participants, and chart and training reviews. Interviews and chart/material reviews assess understanding and use of the strength-based approach, quality and relevance of monthly training programs, quality of caseload management, and adherence to MIHOW confidentiality and safety policies. Currently, seven sites have successfully achieved accreditation, one is in early steps, and one has failed review (failure rate of 13%).
The accreditation process measures a site’s progress in meeting the MIHOW Standards of Practice for Sponsoring Agencies (SoP) which outline the MIHOW practice protocols and philosophy. For example, Standard 6 addresses the training of outreach workers, requiring that training be regular and ongoing, and that outreach workers participate in the planning, implementation and evaluation of the training. Training must be research based and address a specific set of prenatal, birth and early childhood issues. To meet the needs of the community outreach workers, the training sessions must be interactive and include opportunities for peer-to-peer education, case presentations, and mentoring.