Improving Referral Rates for an Early Childhood Home Visitation Program


Impact Statement: 
Clark County Health Department increased the percent of eligible families that are referred to Kentucky’s home visitation program for new and expectant parents from 24% to 56%. Evidence indicates that increased participation in this program will positively impact preterm birth rates, low and very low birth rates, and incidence of child abuse and neglect.

The Clark County Health Department’s quality improvement (QI) initiative goal was to improve the number of families benefiting from home visitation services provided by Kentucky’s Health Access Nurturing Development Services (HANDS) program. For a patient to be offered home visitation from HANDS, a referral screen is completed first, followed by a parent assessment. The referral screen is most often conducted at a family planning or Women, Infants, and Children (WIC) appointment and does not require much of the patient’s time. The parent assessment takes longer and usually requires a return visit to the health department or occurs at the patient’s home. HANDS services are offered free to patients once it is determined that they would benefit from the home visitation program. For a referral screen to be considered “assessed,” a parent assessment must be completed. The yearly audit revealed an opportunity for improvement in the rate of referral screens assessed. The project aim statement was to increase the percentage of referral screens assessed from 24% to 36%.

The QI team used the Plan, Do, Study, Act (PDSA) process to examine the referral screen assessment process. Process mapping, brainstorming, the 5-Whys, run charts, and cause-and-effect diagramming were among the QI tools used to manage the project. After identifying root causes and developing improvement theories, process changes were implemented for 3 months. To evaluate performance, the percentage of referral screens assessed was measured and referral screen audits were conducted to capture reasons why a referral screen was not being assessed. The team met and exceeded its aim statement goal of 36%, with an average referral screen assessment rate of 54% during the study period. The HANDS team adopted the changes into its standard process and will continue to track performance measures to sustain the gains made from this QI initiative.

Organization that conducted the QI initiative: 
Clark County Health Department

Willett, E. Public Health Quality Improvement Exchange. Improving Referral Rates for an Early Childhood Home Visitation Program. Wed, 03/08/2017 - 14:38. Available at Accessed June 21, 2024.

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Grace Gorenflo's picture
Submitted by Grace Gorenflo on

Clark County offers an impressive example of a QI effort, in that 6 months after the initial pilot began, the team achieved a 100% referral screening rate (up from the 24% baseline and significantly exceeding the aim 36% within three months). In addition, the pilot study trend and radar charts both offer excellent examples of the value of these tools. Thanks for sharing your work!

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