Child Health 

Annual Report Year 2021

Families living in the District of Columbia often face challenges when navigating the complex healthcare system. Birth to three are critical years of social, emotional, and cognitive development that prepare children for school and beyond. Caring and supportive environments that promote optimal early childhood development greatly increases a child’s chances of a successful transition to school. Many families need help understanding and supporting their child’s development and may not know how to find the resources they need. Closing the chasm between clinical medicine and public health is one of DC Health’s strategic priorities. Opportunities for health are created primarily outside of the health care and traditional public health systems. Differential opportunities for better health are the result of a much broader spectrum of societal structural and institutional norms, laws, policies, and practices. DC Health recognizes the special opportunity to lead many of the major health initiatives in the District of Columbia. By doing so, DC Health works with a variety of critical partners who assist in making sure District of Columbia youngest residents are receiving optimal services and care.

The need for a sustainable system of interaction and service delivery within early childhood are paramount to the success of families and children ages 0-5 years old in the District of Columbia.  Maintaining a coordinated and effective cadre of partners within the arena of early childhood, lends to credible and long-lasting positive youth development (in forecasting the future of children, past the formative years of 0-5). Responsive caregiving and nurturing, balanced nutrition, and safe communities are important for children to live, learn, grow, and develop to their full potential. When the quality of stimulation, support and nurturance is deficient, child development is seriously affected. Early years of childhood form the basis of intelligence, personality, social behavior, and capacity to learn and nurture oneself as an adult.  Additionally, these factors can have long-term benefits. Caring and supportive environments that promote optimal early childhood development greatly increases a child’s chances of a successful transition into school. 

 

Priority 1: Improving coordination to early intervention services and supporting healthy child development

 

Objective 1: Increase early identification of developmental delays and linkages to care (modified for FY23)

Strategies: Utilize private and public partnerships to identify and serve key populations

 

Performance Measures:

• National Performance Measure 6: Percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool in the past year
• Evidence- Based-or-Informed Performance Measure 6.1: Number of children who received a developmental screening
• Evidence- Based-or-Informed Performance Measure 6.2: Operationalize the use of a centralized registry (ASQ HUB) to track data on developmental screening

 

Activities:

DC Health continues to oversee the DC Maternal, Infant, Early Childhood Home Visiting (MIECHV) program. DC Health’s goal is to provide evidence-based home visiting services to at least 170 eligible families of prenatal women and children ages 0-5 years old, living in very low-income communities through the implementation of two (2) evidence-based home visiting models with fidelity. In FY 21, DC MIECHV implemented home visiting models: Parents as Teachers (PAT) and Healthy Families America (HFA) within one (1) Local Implementing Agency (LIA): Mary’s Center. This funding targeted Health Planning Groups (formerly called Neighborhood Clusters) located within Wards 4,5,7, and 8, which have been identified as the geographical areas with the lowest socio-economic indicators and poorest health outcomes. The overarching goal of DC’s MIECHV program, is to give pregnant women and families living in communities at risk for poor maternal and child health outcomes the necessary resources and skills to raise children who are physically, socially, and emotionally healthy and ready to succeed, and to improve health outcomes by providing quality voluntary evidence-based home visiting services to eligible families.  In FY 21, DC Health collaborated and provided oversight of various programs to ensure the early identification of development delays were met for District families. 89.5% of children received developmental screening (hence received an opportunity for early identification of risk for developmental delay and readiness for school).

Additionally in FY 21, MIECHV continued to focus on its recruitment efforts and ensured that there was sufficient support for families from identified high priority neighborhoods. As a result:

 

• 404 participants (i.e., 219 children and 185 adults) were enrolled from high-risk neighborhoods.
• 9.7% of the households served by MIECHV were homeless.
• 86% of MIECHV families served were low-income households (i.e. 51.9% of them came from households with income 50% and under in relation to the federal poverty guidelines; & 34.1% of them came from households with income 51-100% in relation to the federal poverty guidelines).
• 83.8% of adults served came from households where someone in the household has attained low student achievement or had a child with low student achievement.
• Most of the children served came from Wards 4, 5, 7 and 8. Children by Ward:
• Ward 1 (n=30); Ward 2 (n=1); Ward 3 (n=3); Ward 4 (n=57); Ward 5 (n=28); Ward 6 (n=8); Ward 7 (n=33); Ward 8 (n=50); homeless (n=7); Foster out of District (n=2)
• By age, 92 children were <1 year old; 66 children were 1-2 years old; 57 children were 3-4 years old; 4 children were 5-6 years old
• 16% of adults served were pregnant
• By ethnicity, 91 children were Hispanic or Latino; 128 children were non-Hispanic or Latino
• By race, 125 children were AA, 43 were White; 49 were more than one race; 1 was Native Hawaiian/Pacific Islander; 1 was American Indian or Alaskan Native
• 125 adults had never been married; 32 were married; 21 were not married but living with a partner; and 7 were separated/divorced
• 136 adult participants were unemployed. 13 were employed full time and 24 were employed part-time. Data was missing on 12 adults.
• 2424 visits were conducted despite the prevailing COVID pandemic.
• Program reached targeted locations (most families came from neighborhoods mostly at risk i.e., Wards 5, 7, & 8.
• Families mostly in need of HV services were reached. 86% of program participants came from low-income households.
• 94.1% of primary caregivers received timely screenings for depression using a validated screening tool. Those found to be positive for depression were given referrals to services.
• 100% of women enrolled in MIECHV who received positive screens for intimate partner violence received referral information to intimate partner violence resource
• 97.3% of primary caregivers in MIECHV had continuous health insurance coverage for the most recent 6 consecutive months.

 

In FY 21, DC Health continued to work closely with the Office of the State Superintendent of Education (OSSE) in collaboration with DC Health’s MIECHV program to share data on MIECHV participants referred for a developmental screening with OSSE’s Strong Start program. OSSE serves as the implementing agency for the Part C/Strong Start Early Intervention Program (Strong Start) which provides early intervention therapeutic and other services for infants and toddlers with disabilities and developmental delays and their families. DC Health worked to complete agreements that will link OSSE’s ASQ and DC Health’s ASQ Enterprise to better facilitate data sharing across agencies and promote connection to timely services.  This ASQ hub is intended to reduce the monitor screening duplication. Agreements were created and are in the process of review with DC Health’s Office of General Counsel, OSSE’s General Counsel, and Brooke’s Publishing (the operating organization). Additionally, OSSE strategized methods to standardize online ASQ screening across child development providers participating in the Quality Improvement Network (QIN) and pre-Kindergarten enhancement sites receiving subsidized childcare. OSSE increased staff members’ ASQ foundational knowledge through Brookes Publishing’s train-the-trainer model.

 

Help Me Grow DC (HMG DC) serves as a centralized access point, commonly referred to as a call center for District residents, child health providers and other professionals seeking information, support and referrals for pregnant women and children from birth to age five. HMG DC aims to improve early childhood outcomes by connecting at risk children with prevention and early intervention services, promoting child development and school readiness, and providing referrals to maternal and child health programs while encouraging positive parenting.  HMG DC provides services to District of Columbia residents through a comprehensive and integrated system designed to address the maternal and child needs of families. HMG DC works with the cooperation of the four system model components established by Help Me Grow National, an early childhood system founded in 1997 dedicated to maximizing the potential of all young children.  These four components include: (1) a centralized telephone access point for connection of children and their families to services, (2), community and family outreach to promote the use of Help Me Grow, (3) child health provider outreach to support early detection and early intervention, and (4) a data collection and analysis to understand all aspects of the Help Me Grow system. Through the HMG DC centralized access point, both families and providers can navigate a real-time, locality specific directory of resources, from basic needs (diapers, formula, and housing) to child development supports like home visiting, speech therapy, and much more. One of the main priorities for HMG DC is to support families in the detection of developmental delays. In FY21, 22.7% of children between the age of 9-35 months received a developmental screening completed by a parent and or guardian. Help Me Grow DC aims to serve all Wards of the District including individuals who may report being homeless. During FY21, data suggests that HMG DC service utilization were mostly in Wards 1, 4, 5, 7, and 8. Of the support provided, 236 families received services to include 152 inquiries and 84 completed intakes. Inquiries are requests that do not require extensive coordination, such as baby items. Intakes are completed when extensive coordination will be provided due to increased need and multiple referrals. Of the inquiry and intakes completed, 98 were prenatal moms, 9 were children diagnosed with a disability, and 1 an individual who reported being homeless. Of these children that received support through the HMG DC program, 121 were male, 109 females, and 6 did not report a gender. 98 children were prenatal, 83 children were less than 12 months, 25 children were between the ages of 13-24 months, 12 between the age of 25-36 months, 6 between the age of 37-48 months, and 12 children over 49 months of age. This data reveals that HMG DC provided more support to expecting moms and families with children less than 12 months. Of these children, 135 identified their ethnicity as Hispanic or Latino and 90 reported they were not of Hispanic or Latino ethnicity. 79 families reported to be African American, 1 White, and 108 identified as “Other”. This data reflects the increase in diversity within the District and HMG DC’s partnerships reflecting the various communities being served.  Since the inception of the HMG DC program, HMG DC has built and sustained numerous partnerships in the District of Columbia. These partnerships are vital to address any gaps and barriers identified. HMG’s data collection and analysis component enables identification of gaps and fosters collaboration and innovation to build on existing assets. HMG is not a stand-alone program, but rather a collaborative systems model that leverages resources from various partnerships to develop and enhance a comprehensive approach to maternal and child health system building in the District of Columbia.

 

For a child to thrive amongst any culture or environment, UNICEF reports that children need the five interrelated and indivisible components to include nurturing care, good health, adequate nutrition, security and safety, responsive caregiving, and opportunities for learning. HMG DC understands that the first five years of life present a small window of opportunity to build a strong foundation of support. Throughout the pandemic all these components have been threatened. To support the optimal development of all children, HMG DC utilizes data to maximize efficiency. Ensuring system improvement and proficiency, data collection and analysis occurs focusing on the key components of the HMG system model. To ensure HMG DC is connecting families to resources within the District, Care Coordinators complete resource referrals within three months of the family’s initial intake. To better capture relative data, measures are put into place to support overall improvement. The increase in referrals at the peak of the COVID-19 pandemic by 28% (183 in FY20 to 254 in FY21). Calls and referrals to HMG also went up in FY21 by 10%.

 

Healthy Steps is an evidence-based national model that integrates a child development specialist into primary care. The Healthy Steps DC team has innovated the model further by hiring mental health clinicians (psychologists) as the Healthy Steps Specialists (HSS) in order to integrate parental behavioral health support into primary care.  The Healthy Steps program involves the following core components: 1) team-based well-child visits conducted jointly between pediatricians and the Healthy Steps Specialist involving child development guidance, parent coaching and the dissemination of early learning resources, 2) screening that includes assessment of child development, social-emotional skills, and behavioral functioning in addition to family protective/risk factors and social determinants of health, 3) access to community resources through targeted referrals (e. g., to early intervention, community-based behavioral health agencies) and system navigation/care coordination provided by a Family Services Coordinator (FSC) or Family Services Associate (FSA), and 4) access to mental health support between well-child visits for families with greater need of support. In FY21 Healthy Steps focused on three main goals and various key activities to support improving the coordination to early invention services and supporting healthy child development.

 

Goal 1: Expand access to Healthy Steps for children and families receiving care at the Children’s Health Center at Anacostia (CHA)

Key Activities

• The Healthy Steps team will recruit parents and children receiving care at CHA, based on established criteria and protocol.
• The Healthy Steps team will review Healthy Steps eligibility criteria and referral protocol with pediatric providers and new residents at CHA throughout the grant period.
• The Healthy Steps team will facilitate monthly meetings of the PAC in which families have opportunity to inform and provide co-creation of supports Healthy Steps could provide to families in the areas of parenting, mental health needs and access, and social connectedness.

 

Goal 2: Promote child development.

 

Key Activities

• Healthy Steps patients will be administered child development screens, using the ASQ:3 and ASQ: SE, in accordance with the program and clinic administration schedules.
• Healthy Steps will facilitate referrals to early intervention and community-based child behavioral health providers, as needed, providing follow-up to determine outcome of the referral and to troubleshoot barriers to care.
• Healthy Steps will implement a texting system that will alert families to preventive care and other age-related developmental information.

 

Goal 3: Promote parental well-being.

 

Key Activities

• Healthy Steps parents/caregivers will be administered depression screens, using the EPDS, in accordance with the program and clinic administration schedules.
• The Healthy Steps Specialist will provide mental health intervention to parents with positive depression screens, during or outside the well-child visit.
• Healthy Steps will facilitate referrals to community-based providers, as preferred by the parent, providing follow-up to determine outcome of referrals and to troubleshoot barriers to care. Community of Hope (COH) is an organization located in the District that works to improve health and end family homelessness to make Washington, DC more equitable. In FY 21 COH utilized the Parents as Teachers evidence-based home visiting program model to provide support to pregnant and parents of children ages 0-3.  Their goal is to provide wraparound services to improve the health and well-being of infants, toddlers, and their families, promoting healthy pregnancies, and strong parent-child bonds. With these supports, they hope to improve birth outcomes, reduce rates of child abuse and neglect through improved parent-child relationships and parental resilience by offering emotional wellness supports; and demonstrate increased involvement and confidence by families in their child’s care and education as well as satisfaction with home visiting services. As a result, in FY 21 COH’s home vising program, served 42 families with an 88% retention rate of the intended 85%. The program served the following populations: Homeless (n=1); Ward 1 (n=1); Ward 4 (n=1); Ward 5 (n=10); Ward 6 (n=2); Ward 7 (n=15); Ward 8 (n=21). There were 18 female and 33 male participants. 51 participants identified as not Hispanic or Latino, 49 African American, 1 White and 1 more than one race. 24 children under the age of one, 23 1-year-old, three 2-year-olds and one 4-year-old.  The program sought to improve their monitoring plan through changing capacity of the Family Assess, and Data Specialist position, team meeting structure, and data sharing, and implementation of a new creative outreach plan and document. Community of Hope-PAT maintains relationships with DC Breastfeeding Coalition offering breastfeeding support and classes, Martha’s Table: Parent Café which is a topic focused discussion group and referrals to programs like DC Safe and Early Intervention.

 

Priority 2: Improving access to healthcare and healthful foods among children.

 

Objective 2: Increase linkages to and navigation through a medical home (modified for FY23)

Strategies: Utilize private and public partnerships to identify and serve key populations

 

Performance Measures:

• National Performance Measure 11: Percent of children with and without special health care needs, ages 0 through 17, who have a medical home
• Evidence- Based-or-Informed Performance Measure 11.1: Number of children and adolescents with and without special health care needs referred to a medical home

 

Activities:

 

Help Me Grow DC (HMG DC) was able to a partnership in FY21 with all the Managed Care Organizations within the District. This includes CareFirst, Amerihealth, MedStar, and Health Services for Children with Special Needs. With this intimate partnership, HMG DC can streamline processes to provide effective care coordination to families who do not have medical insurance and need additional services and supports. Mary’s Center is another long standing partnership that supports many of our families who identify as Hispanic or Latino. Within FY21, HMG DC received 49 referrals. The HMG DC program has experienced a plethora of program successes and some challenges. With the challenges of children not completing preventative visits and obtaining age-appropriate vaccinations due to other family priorities, health insurance coverage declined. However, during this time 75% of children who received support through the HMG DC program were enrolled in health insurance. 10% had no health insurance and 15% of the data was missing. Of those families calling to get assistance with health insurance 100% were successfully connected. For families that received support with at least one concern, 99% of them were connected to supports and services. For each individual referral out of many given, 66.5% of referrals were successfully linked. Considering the world was still in the height of the COVID-19 pandemic the concerns families had were vast. Many to include, food, baby items, housing, and income.

 

In FY21, DC Health continued to support and fund the Smart from the Start Program (Smart). Smart is a family support, community engagement and school readiness organization with a mission to prevent the achievement gap, and to promote the healthy development of children living in Boston and Washington, DC. Smart works to prevent the achievement gap by preparing young children for school success, while empowering youth, families, and communities to provide the stable and supportive living conditions necessary to nurture and sustain strong, confident, and well-balanced children. Smart also uses a two-generational approach to combine parent and child interventions to interrupt the cycle of poverty while collaborating closely with traditional and non-traditional stakeholders and partners to share resources and to problem-solve as a collective. The DC Housing Authority provided a six-bedroom unit in Woodland Terrace for program space including classrooms, a computer lab, and a relaxation space for counseling and parent support. Smart conducts their programing from this space and they use it as an anchor space for other service providers and partners to reach families in Woodland Terrace.  Over the years, Smart has expanded their anchor space to include several community spaces near their original unit. Smart has worked with approximately 423 families with children 0-5 years old and 620 individuals through various programming which include ensuring all children have access through healthcare by linking families to needed services. Additionally, in FY21 Smart focused on three main goals. These goals included key activities.

Goal 1: Use two-generational approach to provide neighborhood children and families with programs and services to ensure positive short term and long-term outcomes

Key Activities

• Develop and utilize new strategies to keep families engaged during COVID.
• Program staff will conduct/facilitate program sessions and events on Zoom and in-person, socially distanced
• Create an updated list of community priorities
• Update programming and services based on Needs Assessment results.
• Partner with other agencies to build capacity and increase resources

Goal 2: Increase the numbers of children and families served in trauma informed programs and services that enhance physical and mental health 

Key Activities

• Update and Expand upon outreach plan to engage new families during COVID
• Increase the number of fathers served in our LEAP/Professional Development and Enrichment Programs
• Increase network of community partners and providers to facilitate or co-facilitate programming or provide services to Smart families.

Goal 3: Conduct Robust Evaluation

Key Activities

• Ensure that all families are completing baseline assessments at the time of enrollment
• Maintain schedule of assessments for each enrolled child/parent/family
• Adapt evaluation protocol to effectively collect data during COVID
• Partnerships
• Maintained relationships and partnerships with various community organizations including Martha’s Table, Community of Hope, WIC, Jumpstart, Children of Mine, Collaborative Solutions for Communities, Help Me Grow, House of Ruth, and Mary’s Center.

The Early Childhood Innovation Network (ECIN) continued to be supported and funded by DC Health in FY 21 and is a local collaborative of health and education providers, community-based organizations, researchers, and advocates promoting resilience in families and children from pregnancy through age 5 in Washington, DC. Community members and ECIN developed the Resilient Communities – District of Columbia (RC-DC) intervention model with funding from DC Health. RC-DC is a place-based, cross-sector, peer support model designed to improve the behavioral and mental health of under-resourced families with children ages zero to five years in Ward 8. RC-DC incorporates Neighborhood Family Champions (NFCs), who operate out of community-based locations to deliver a neighborhood-based model of peer support to families with young children. NFCs engage and support families through the following strategies: On-Location Community Outreach, Health Promotion and Educational Events and Workshops. RC-DC focused on three main goals supported by key activities.

Goal 1: Families in target neighborhoods will have access to needed resources & social services.

Key Activities

• Maintain ongoing contact with community-based providers and local initiatives
• Update RC-DC mobile-adaptive website monthly with current information about community events and resources.
• Distribute materials describing the RC-DC mobile-adaptive website to community providers, organizations, and families with young children.
• Screen families for social needs using the family needs screener (adapted from the Health Leads and SWYC)
• Refer any eligible parent/caregiver with a positive family needs screen to NFC services.
• NFCs will provide community-based peer support to community families as needed.
• Monitor families using the Protective Factors Survey.

Goal 2: Families in target neighborhoods will be more knowledgeable about parenting, feel socially connected to others and feel a greater sense of community.

Key Activities

• Attend key community events, both in-person and virtual, where the NFCs will have an opportunity to meet families.
• Share information about the RC-DC project and NFCs with families in target neighborhood.
• Conduct universal educational and health promotion activities with parents and caregivers.

Goal 3: Monitor and evaluate the implementation of the RC-DC program

Key Activities

• Finalize and submit Outcome Evaluation Plan.
• Collect data needed for Outcome Evaluation.

RC-DC continued to support families by linking families to various resources. As a result:

• Served approximately 1,688 individuals through NFC outreach (at grocery stores, bus stops, childcare centers etc.), NFC universal health promotion or educational activities, and one-on-one peer support from NFCs. (The 1,688 may not represent unique individuals.  Participants' personal information is not added into the database until they receive more intensive one-on-one support).
• NFCs provided 10 caregivers with one-on-one peer to peer support via telephone and text during the pandemic.  This included assisting in mental and behavioral health, food access, transitioning to at home learning, keeping healthy and active, and developmental disabilities.
• The NFCs planned and implemented 7 (goal was 10) community health promotion/educational events.

Priority 3: Reducing grief and trauma-related symptoms among children and adolescents.

Objective 1: Improve access to and utilization of behavioral health services (modified for FY23)

Strategies: Utilize private and public partnerships to identify and serve key populations

 

Performance Measures:

• State Performance Measure 3: Mental Health- Percent of children and adolescents, ages 3-17 with mental health needs who did not receive counseling

Activities:

It is estimated that as many as one in five children and adolescents may have a mental health disorder. However, only about half of all children in need of behavioral and emotional services receive them. Additionally, it is vital that parents and caregivers receive the mental health services that are needed. A recent study supported by the Centers for Disease Control and Prevention (CDC) found that 1 in 14 children has a caregiver with poor mental health. Parents and other caregivers who have the role of parent—need support, which, in turn, can help them support their children’s mental health. DC Health continued to work closely with the District’s Behavioral Health Department programs to ensure resources and services were available to District families. As families were coping with the stressors of the COVID-19 pandemic, the need for mental health support has had an increase demand.  In FY21, Help Me Grow (HMG) Care Coordinators experienced an increase of expecting mothers, parents, and caregivers requesting support in response to high levels of stress and postpartum depression. The effects of the pandemic have produced feelings of isolation, trauma, and early adverse life experiences. Leading to the overall impairment of one’s emotional, psychological, and social wellbeing.

In FY21, HMG DC continued to partner with the District of Columbia Mental Health Access to Pediatrics (DC MAP) to leverage support for District families to receive urgent mental health support without anticipating a waitlist. DC MAP is a district-wide initiative, funded in part by the DC Health through an interagency partnership with the Department of Behavioral Health (through American Rescue Plan Act – Pediatric Mental Health Care Access New Area Expansion project funding), that help health care providers take better care of children and adolescents with behavioral health needs. In FY21, HMG referred 17 families to DC MAP.  When families are referred to the HMG DC program, Care Coordinators assist by ensuring that there identified needs have been met. To ensure quality assurance, prior to closing out a case, Care Coordinators obtain feedback on the service provided and inquire if there is any additional services that can be of support. Of the families who have received support, 99% of families expressed satisfaction with the program and that their needs were met. Beginning in FY 2021, HMG DC saw an increase in the number of referrals, correspondences, and support offered through the program. It has become more evident that through traditional and non-formal contact, HMG DC’s role in the District of Columbia as a primary epicenter of early childhood inclusion is expanding. Within this context the program continually seeks options to create cross collaboration across already defined sectors in recognizing new ways of meeting and supporting families throughout the District of Columbia. HMG DC Care Coordinators take the time to identify a families’ needs and concerns, in order to successfully link families to the right services and navigating through the multifaceted healthcare system. Below is vignette that helps demonstrate the impact of DC Health’s Help Me Grow and various partnerships:

 

“As the bilingual Care Coordinator for HMG DC, I have been supporting the DC Spanish speaking families. Ms. V, a Mom of two children one of which is under five years old contacted the HMG DC program to seek help with many challenges she was facing during her current pregnancy. As the Care Coordinator, I was able to identify symptoms of depression and basic needs such as food. Mom was referred to DC MAP for short term mental health support while on the waitlist for long term support. Mom was then connected to WIC, Capitol Hill Pregnancy Center, Bread for the City and Mary’s Center. Through motivational interviewing, HMG care coordinator encouraged mom to receive professional mental health services through DC Map. Although the HMG DC program is known for offering support to expecting moms and parents and caregiver with children 0-5 years of age, Ms. V had a daughter aged 15 who also needed support with mental health. I was able to successfully connect both Mom and daughter to mental health services. Mom expressed extreme gratitude and appreciation for taking the time to listen and support her.” 

 

Georgetown Parenting Support Program (PSP) is a home visiting program which supports individuals with Intellectual and other Developmental Disabilities (IDD) who are pregnant or parenting children from 0-5 years of age in the District. The PSP uses Parents As Teachers (PAT) materials and resources and the Health & Wellness Curriculum for At Risk Families (Tymchuck).  The program provides personal visits in the home, virtual or in community settings (In FY21, visits took place virtually due to COVID-19 precautions). The visits consist of parent and child screenings on growth and development (ASQ3 & ASQ:SE2), health, mental health and wellbeing, referrals to community resources, and parent education specific to the family needs. In FY21, served 36 families and there was participation from men and women ages 18 and up identifying as black, white, or multiethnic predominately in Ward 5 and 7. PSP has maintained collaborations with, various District agencies and programs such as Child and Family Services CFSA, Department of Disability Services, DC Family Ties, Health Services for Children with Special Needs Help Me Grow, Med Star Health and Washington Hospital Center’s Women and Infant’s Clinic. PSP continues to collaborate with the Developmental Disabilities Administration and its providers and service coordinators involved with families enrolled in PSP. PSP used an innovative photo voice evaluation activity with families to document their successes and challenges they face in the program. The FAN (Facilitating Attuned Interactions) Approach is also used in practice and supervision to access fidelity. The FAN focuses on parents’ urgent concerns and assist home visitors in supporting the family best in the moment.