HEALTHY FAMILIES MASSACHUSETTS POLICIES & PROCEDURES

ELIGIBILITY
HEALTHY FAMILIES MASSACHUSETTS (HFM) Newborn Home Visiting program offers services universally, to ALL first-time expecting and parenting mothers and fathers 20 years old and under, who are Massachusetts residents. Any parent who meets these criteria is eligible to receive HFM services and the support that comes from involvement in the program. HFM eligibility policies and procedures are divided into the following sections: Determining eligibility; Ineligibility; Second pregnancies; Ongoing eligibility; and Transitioning out of services Attached to this policy is the following appendix: Appendix A: Guidelines for Participant Referrals Outside a Programs Catchment Area I. DETERMINING ELIGIBILITY A. All first-time expectant mothers and fathers 20 years of age and under residing within the program catchment area, are eligible to enroll as primary participants in HFM. Eligible families may receive HFM services starting prenatally and continuing up to the childs third birthday. B. All first-time parents 20 years old and under, residing within the program catchment area, with an infant under 12 months of age at the time of enrollment, are eligible to enroll as primary participants in HFM. Eligible families may receive HFM services up to the childs third birthday. C. First-time Parents - For the purposes of HFM, a first-time parent is any biological mother or father age 20 and under who is parenting her/his child for the first time, defined as: a woman who is pregnant with her first child or is parenting her first-born child; a man who is expecting his first child or is parenting his first-born child; a woman who has experienced a previously terminated pregnancy for any reason (miscarriage or abortion), and for whom this is the first live birth; a parent who has lost his/her child due to death (e.g. stillbirth or medical complications) before the infant reached the age of three months, and for whom this is the first subsequent live birth; and/or
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 a parent who has legally and permanently relinquished parental rights (e.g. due
to adoption or child welfare issues) before the infant reached the age of three months, and for whom this is the first subsequent live birth. D. Previous HFM Participants Participants previously enrolled in an HFM program who are no longer eligible as defined in sections A, B, or C may be eligible to re-enroll or transfer into a program only after consultation with the HFM Implementation Team (HFMIT), and are not guaranteed re-enrollment.

Participants must meet criteria A-C in the previous section in order to be enrolled in HFM.
Please contact the HEALTHY FAMILIES MASSACHUSETTS Implementation Team (HFMIT) by submitting a Technical Assistance (TA) ticket via the TA Help Desk at CTF_TAhelpdesk@massmail.state.ma.us if there is any question regarding the initial eligibility of a referral. D. Screening for Eligibility Programs must screen all referrals to determine if the referred participant is eligible to receive HFM services. Upon receipt of a referral, the HFM program staff screen a potential participant for eligibility by: verifying his or her birth date; verifying his or her childs due date or birth date; verifying his or her status as a first-time parent; verifying his/her residence within the program catchment area (see Appendix B for guidelines); and establishing whether the parent was previously enrolled in HFM. NOTE: For instances when a program establishes that a new referral is someone who was previously enrolled in an HFM program, please see Appendix A for guidelines on how to proceed. The screening may be conducted with the participant by telephone or in person. Confirmation of eligibility is documented on the participants profile page, confirmed on the Status & Demographics page of the participant record in the Participant Data System (PDS), and noted on the Family Profile. E. Primary Participants and Secondary Participants Only first-time biological mothers and fathers 20 years old and under are eligible to enroll as primary participants in HFM. 1. Eligible primary participants can decline to participate as primary and engage instead as secondary participants if their partner engages as the primary participant. This is noted in the PDS, as well as in the supervision log. These secondary participants may convert to primary participants at any time as long as they remain eligible.
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2. Partners of HFM primary participants in a significant care-giving role of a child, whether or not they are biological parents, are encouraged to participate in program activities and services as a part of the family. Although they are not eligible to enroll as primary participants, they can enroll as secondary participants. 3. Other extended family members of HFM primary participants are encouraged to participate in program activities and services as a part of the family. However, they are not eligible to enroll as primary or secondary participants. Examples: A biological mother or father of a child in an HFM program, who is over 20 years of age, may participate in program activities and services as a secondary participant in conjunction with the parent of the child who is the primary participant. A partner of an HFM primary participant parent, who is in a significant caregiving role of a child in the HFM program, may participate in program activities and services as a secondary participant in conjunction with his/her partner. Grandparents and other extended family members who are in a significant caregiving role of a child in the HFM program may participate in program activities and services in conjunction with the parent of the child who is the primary participant. NOTE: The examples above are not all-inclusive and, therefore, may not list all of the possible situations with which HFM programs may be presented. Please submit a TA ticket via the TA Help Desk at CTF_TAhelpdesk@massmail.state.ma.us with any questions. F. First-time parents 20 years and under that are concurrently enrolled in other programs and receiving services may still be eligible to enroll in HFM and receive services. However, HFM programs must ensure that there is no duplication of services for HFM participant families. REMINDER: The decision by the family to participate in HFM is VOLUNTARY.

II. INELIGIBILITY A parent is ineligible to participate as the primary participant in an HFM program if: the referred parent does not have, or is not expecting, a baby; the parent is over the age of 20 years at the time of referral; the infant is over 12 months of age at the time of referral; the enrolled child reaches his/her third birthday; the parent is expecting the birth of a second child at the time of referral and therefore is not considered to be a first-time parent, as defined by this policy; the parent does not reside within the programs catchment area (see Appendix B for Guidelines for Participant Referrals Outside a Programs Catchment Area); families involved with the Department of Children and Families (DCF) may be ineligible for HFM under the following circumstances:
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a parent under the age of 20 whose first child was removed from the home by the DCF, even if the child was younger than three months of age, is not eligible for HFM services for any subsequent children if he/she is legally contesting the decision for his/her first child and continues to relate to the child in a parenting role; and/or in cases where the parent has physical custody of his/her infant but the DCF has legal custody, the determination of eligibility must be reviewed by the HFMIT prior to enrollment. the program has no capacity to serve new participants.

REMINDER: All families who are ineligible for HFM services should be referred to other programs and services for which they are eligible.

PDS NOTE: Families found to be ineligible for HFM services should be indicated as such in the PDS. When assigning the reason for ineligibility, be as specific as possible, reviewing all possible categories of ineligibility. PLEASE SEE APPENDIX O: PDS USERS MANUAL OF THE PROGRAM ADMINSTRATION POLICY SECTION CREATING A REFERRAL. For participants that are ineligible because the program has no capacity, programs must record their referrals in PDS with no capacity marked as the reason they are not enrolled in services; this documentation ensures that HFM is able to demonstrate the need and demand for the statewide program.

III. SECOND PREGNANCIES If a primary participant in an HFM program becomes pregnant with a second child or fathers a second child while enrolled, HFM services may continue to be offered until the third birthday of the first child. After this time, families requesting further services should be referred to other programs and services for which they are eligible. IV. ONGOING ELIGIBILITY A. DCF Involvement There are times when HFM program participants become involved with DCF. DCF provides a variety of services and interventions. At times, DCF intervention may affect the placement of a child whose parents are HFM participants. In such cases, the following applies. 1. Temporary Placement If a child has been temporarily placed by DCF, the HFM program is encouraged to continue to work with the family for UP TO TWO MONTHS following the removal of the child. The purpose of service delivery in this period is to assess the appropriateness of continuing services, dependent upon the likelihood of the child being returned to the family. The goals of the continuing work with the family will include the following:
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a. Supporting the family to meet any requirements that are necessary to facilitate the return of the child to the family. b. If there is visitation with the child, using program visits to facilitate positive parenting experiences with the child. c. Transitioning the family to other community services as appropriate, upon a determination to discontinue services. d. If services are to be discontinued, to thoughtfully transition the family out of HFM services. If the child is returned to the family before reaching 1 year of age, the family will be eligible to re-engage or re-enroll in the HFM program. 2. Permanent Placement If a child has been permanently placed by DCF, HFM services will be discontinued. If this takes place after the child has turned three months of age the family will no longer be eligible for HFM services. In this circumstance, the HFM program, based upon supervisory discretion, is encouraged to continue working with the family for UP TO TWO MONTHS following the removal of the child in order to: support the family; actively transition the family to other community services, as appropriate; and thoughtfully transition the family out of HFM services. NOTE: DCF is the state agency mandated to protect children and is responsible for the provision of services to families where there have been substantiated findings of abuse and/or neglect. Families who are involved with DCF are not necessarily ineligible to participate in HFM. However, because HFM is a voluntary primary prevention program, it is not designed to meet the needs of families who have been found to have abused and/or neglected their children, or to serve as a substitute for DCF protective services. Families may not be mandated or coerced to participate in the HFM program under any circumstances. PARTICIPATION IN HFM MUST ALWAYS BE ON A COMPLETELY VOLUNTARY BASIS. Families who have been found to have abused or neglected their children are often in need of intensive types of therapeutic services. Although most HFM home visitors have not been trained to provide this kind of service, all HFM home visitors should be able to provide parenting support and assist these families to find the most appropriate services. B. Terminated Pregnancy or Child Death If a participant in HFM experiences spontaneous abortion, therapeutic abortion, fetal demise, stillbirth, or the death of a child during the period of enrollment, the HFM program is encouraged to continue to work with the family for UP TO TWO MONTHS following the demise of the fetus or death of the child. The goals of the continuing work with the family will include the following: supporting the family during their time of grief;
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 transitioning the family to other community services, as appropriate; and thoughtfully transitioning the family out of HFM services.
NOTE: If a formerly enrolled parent experiences the death of his/her child before the child reaches three months of age, he/she is eligible to enroll in HFM for the first subsequent live birth. This applies provided that the parent remains within the eligibility guidelines for HFM at the time of the second referral. C. Transfers and Re-Enrollment HFM provides services in all communities in the Commonwealth of Massachusetts. If an active primary participant moves within Massachusetts (and outside of the catchment area of the current program), she/he can transfer to a new HFM program. In so doing, she/he maintains eligibility in HFM. Please refer to the HFM Service Transitions Policy & Procedure for guidance on following proper transfer procedures. There are times when HFM participants move out of the catchment area and do not notify their program. If the previously enrolled primary participant contacts a new program seeking HFM services, that program should follow guidance as set out in the HFM Service Transitions Policy & Procedure. V. TRANSITIONING OUT OF SERVICES Services provided through HFM programs are family-centered and relationship-based. The very nature of family support work requires thoughtful attention to all aspects of service delivery and at all stages of the relationship between the family and the program. It is particularly important to provide thoughtful transitions for families as they move out of HFM services. There are many reasons why services may end for families: the child turning three years of age, moving out of the service area, loss of a child, loss of custody of child, or voluntarily choosing to opt of out services. Programs must provide thoughtful transition plans for all primary participants within the parameters of the circumstance. This includes discussion in individual reflective supervision of plans for reviewing the familys overall participation in the program, goals achieved and yet to be achieved, and how to support the family as they leave services (referrals to community services, skill building, information, etc.). This discussion should be documented in the supervision log and activities in the course of service delivery should support these thoughtful transition plans.

Please submit a TA ticket via the TA Help Desk at CTF_TAhelpdesk@massmail.state.ma.us with any questions regarding this policy.

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Guidelines for Participant Referrals Outside a Programs Catchment Area In the event that: You receive a referral with information that indicates that the referred parent lives outside your catchment area. You contact a referred parent and upon first contact discover that the parent lives outside of your catchment area. Program course of action is: Contact the referral source to give him or her the contact information for the appropriate HFM program site and ask him or her to send the referral to the appropriate site. Enter the referral into PDS and under Outcome of Contact select Not Eligible and in the Not enrolled in services section of the referral form, select Out of service area. Tell the referred parent that you cannot serve him or her but another HFM program site can provide services. Give the parent the contact information for the appropriate site and offer to make the referral to the appropriate site for him or her. Enter the referral into PDS and under Outcome of Contact select Not Eligible and in the Not enrolled in services section of the referral form, select Out of service area. Request new contact information from the secondary source and the referral source and attempt to contact the parent. If you make contact with the parent: Tell the referred parent that you cannot serve him or her but another HFM program site can provide services. Give the parent the contact information for the appropriate site and offer make the referral to the appropriate site for him or her. Enter the referral into PDS and under Outcome of Contact select Not Eligible and in the Not enrolled in services section of the referral form, select Out of service area.
HEALTHY FAMILIES MASSACHUSETTS Appendix A: Eligibility Policy Guidelines for Participant Referrals Outside a Programs Catchment Area September 2007 Page 1

You attempt to contact a referred parent and learn from a secondary source (i.e. grandmother, sibling, friend, etc.) that the parent lives outside your catchment area.

If you are unable to make contact with the parent: Enter the referral into PDS and list the Outcome of Contact as Not Located and in the Not enrolled in services and If not located, reason sections of the referral form, select Location unknown.