The Vision for Early Childhood Home
Visiting Services in Arizona
A Plan of Action 2010-2015
Early Childhood Home Visiting Task Force - June 2010
“Confident, supported families raising healthy children, ready to succeed in school and life”

PREFACE
The Vision for Early Childhood Home Visiting Services in Arizona has been a collaborative effort
among state and local government agencies, providers of home visiting services, and advocates
for young children. The purpose of this Plan is to position Arizona for the provision of home
visiting services as part of an overall system of early childhood development and to provide a
framework for future growth and development of this effective strategy.
Many home visiting models of service delivery are evidence based family support strategies with
proven results for pregnant women, first time parents and families with children birth through
age five. Arizona has embraced home visiting strategies such as Healthy Families Arizona, the
Nurse Family Partnership, Parents as Teachers, Health Start, Early Head Start and others
through multiple funding sources and local government and community based organizations in
numerous communities throughout the State.
To ensure an ongoing system-wide, collaborative approach to the future expansion of high
quality home visiting services, the Home Visiting Task Force has provided Recommendations
and an Implementation Plan.
The Implementation Plan calls for
1. Continued involvement and collaboration among funders and providers of service,
2. Methods to assure high quality, effective home visiting services, and
3. Priorities for targeting new funding opportunities.
Our vision of ―Confident, supported families raising healthy children, ready to succeed in
school and life” can be achieved through this ongoing collaborative effort.
The Arizona Early Childhood Home Visiting Task Force
June 2010

The Vision for Early Childhood Home Visiting Services in Arizona
Executive Summary
In October 2009, First Things First and the Arizona Departments of Health Services, Economic
Security and Education along with community providers of home visiting services convened the
Early Childhood Home Visiting Task Force. The purpose of the Vision for Early Childhood
Home Visiting in Arizona – Plan of Action is to position Arizona for the provision of home visiting
services as part of an overall system of early childhood development and to provide a
framework for future growth and development of this effective strategy. It seeks to provide a
pathway for delivery of consistent, high quality home visiting services in the context of Arizona’s
statewide early childhood development and health system.
Research of home visiting services finds that the earlier in a child’s life this support is provided
the greater the potential for having long lasting positive results. Home visiting with pregnant
women specifically helps create the environment for a healthy birth by incorporating the
importance of healthy behaviors throughout the pregnancy such as accessing prenatal care,
appropriate nutrition, not smoking, and exercise. Additionally, research has confirmed home
visiting as an effective strategy for families at risk due to poverty, health conditions of the child
or parents, child maltreatment and low literacy levels.
While Arizona has many home visiting programs providing quality services to some of Arizona’s
young families, there is not a systematic approach for planning, funding, and collaborating in
providing accessible, quality home visiting services. Currently available programs include
evidence based models as well as models that have not undergone extensive evaluation.
Approximately 53,000 children birth to age five and their families will be provided home visitation
services in FY 2010. Geographic availability of home visiting services ranges from
approximately 64% of young children in Santa Cruz County receiving some type of home
visiting services to less than 3% in Pinal County.
To ensure an ongoing system-wide, collaborative approach to the future expansion of high
quality home visiting services, the Home Visiting Task Force has provided Recommendations
and an Implementation Plan.
The Implementation Plan calls for
4.
5.
6.

Continued involvement and collaboration among funders and providers of service,
Methods to assure high quality, effective home visiting services, and
Priorities for targeting new funding opportunities.

The Arizona system of home visiting services is intended to be an integral part of Arizona’s early
childhood development and health continuum. The system of home visiting services provides
the opportunity for pregnant women and families with young children to voluntarily access home
visiting services:
Within their own communities,
With the level of service appropriate to their needs and desires,
With assurance of high quality, and
Within the context of their families’ culture, values and beliefs.
To achieve a comprehensive, coordinated system of quality home visiting services, the essential
components of the continuum of home visiting services must include:
Outreach, Engagement and Access to Services – providing information, supporting
voluntary participation of families and referring families to appropriate services and
supports in their communities.

Screening and Assessment - determining the appropriate level of service; number of
visits, skill building techniques appropriate for a specific family based on their strengths
and needs.
Service delivery – provision of high quality home visiting services relevant to the families’
needs, culture and values of the family, and circumstances including parent education,
family support, and facilitation of access to health care.
Quality Assurance – adherence to statewide standards of practice, work force
requirements and monitoring of quality and a system of ongoing training and technical
assistance.
Continuous Improvement – including ongoing evaluation based on a common set of core
outcomes and research designed to determine the short and long term effectiveness of
various home visiting models in Arizona.
Public Awareness – raising the understanding among Arizonans of the importance of
early childhood development and the significant difference early childhood experiences
can make in terms of children achieving their full potential.
Policy and Funding – ensuring access and quality through coordination of policy,
practice and funding opportunities statewide, across all service systems.
Our vision of ―Confident, supported families raising healthy children, ready to succeed in school
and life” can be achieved through this ongoing collaborative effort.

The Early Childhood Home Visiting Task Force
June 2010

TABLE OF CONTENTS
INTRODUCTION ............................................................................................................................ 1
HOME VISITING CONTINUUM OF SERVICES.............................................................................. 4
ARIZONA FAMILIES WITH YOUNG CHILDREN ............................................................................ 8
General Population ...................................................................................................................... 8
Births in Arizona .......................................................................................................................... 8
Risk Factors ................................................................................................................................ 9
Summary of Selected Indicators by County ............................................................................... 13
ARIZONA’S HOME VISITING SYSTEM........................................................................................ 14
Number of Children Served by County and Tribal Nation .......................................................... 14
Home Visiting Programs by County or Tribal Location ............................................................... 17
Funding for Home Visiting Programs ......................................................................................... 19
Cost of Home Visiting Services.................................................................................................. 19
Current Research Underway in Arizona..................................................................................... 20
Workforce Development Options ............................................................................................... 20
Coalitions in Arizona .................................................................................................................. 21
THE VISION FOR HOME VISITING SERVICES IN ARIZONA ..................................................... 22
RECOMMENDATIONS ................................................................................................................. 26
GOALS & OBJECTIVES ............................................................................................................... 28
Goal I: To provide the right services for the right family at the right time through collaboration. 28
Goal II: To provide high quality home visiting services which are accessible in all geographic
areas of Arizona. ....................................................................................................................... 28
Goal III: To provide home visiting services that demonstrate adherence to quality standards. .. 29
Goal IV: Arizonans value and invest in “supporting” parents. .................................................... 30
APPENDICES ............................................................................................................................... 32
Appendix A: Home Visiting Task Force Membership ................................................................ 33
Appendix B: Examples and Descriptions of Home Visiting Programs in Arizona ....................... 35
Appendix C: Arizona Population and Risk Factor Tables .......................................................... 40
Appendix D: Risk Factors by County ........................................................................................ 49
Appendix E: Proposed Standard Home Visitor Qualifications and Training Requirements ........ 50
END NOTES ................................................................................................................................. 51

INTRODUCTION
Families provide the early environment that prepares children for success in school and later
life. Children who feel loved, safe and secure develop the cognitive, emotional, motor and
social skills that prepare them for life. The purpose of home visiting services is to build parent’s
capacity and skills so they can support the healthy development of their child. Home visiting, as
a key component of a comprehensive early childhood system, enhances the relationship
between the parent and child to foster the child’s positive social-emotional and language and
literacy development and thus their readiness for school.
In October 2009, First Things First and the Arizona Departments of Health Services, Economic
Security and Education along with community providers of home visiting services convened the
Early Childhood Home Visiting Task Force. While Arizona has a number of home visiting
programs currently providing quality services to some of Arizona’s young families, there is not a
systematic approach for planning, funding, and collaborating in providing accessible, quality
home visiting services. The purpose of the Task Force, therefore, was to define a system-wide
strategy for the future development and delivery of quality home visiting services throughout
Arizona. The Home Visiting Task Force is comprised of representation from State and local
government agencies serving young children, community based service providers and child
advocates. (See Appendix A for Membership)
Background
Comprehensive early childhood systems include high quality, accessible, affordable early
education; health care delivered through a medical home and a system of family support
programs and services. Home visiting represents a core strategy for delivery of family support
services with the aim of increasing family self sufficiency so families acquire and maintain a
basic set of skills to thrive independently and support their child’s early development.
Nationally, home visiting has been embraced as an effective strategy to support families in
providing their children with every opportunity to reach their full potential and be prepared to
enter kindergarten.
For many families, the challenge is simply having the information to know what actions on their
part have the most positive impact on their child’s development. However, there are families
who, for a variety of environmental, economic, or health reasons are not able to achieve a level
of adult interaction with their child that supports their child’s optimum development. Factors that
influence family functioning may include a history of abuse or neglect, violence in the home,
substance abuse, limited parenting or problem-solving skills, single or teen parenting, economic
instability, isolation, and/or health, mental health or learning challenges.
“Home visiting programs provide young and vulnerable parents and parents-tobe with a range of information and skills to help keep their children and families
healthy, safe, and ready to learn. As a prevention tool, home visitation is one of
the few widely-evaluated interventions that have been proven effective in
reducing child abuse and neglect. i
Home visiting programs have been shown to be an effective strategy in preventing child abuse,
improving child development and establishing strong and nurturing parent-child relationships
while preventing harm to children.ii

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Several home visiting models have undergone extensive research which consistently
documents the positive outcomes from home visiting strategies. Three such models include
Health Families America, Nurse Family Partnership, and Parents as Teachers. Through
voluntary participation, home visiting services have been provided as part of a family focused
intervention that strengthen families and reduce the risk of child abuse and neglect. According
to a report released by the Carnegie Corporation of New York, ―the earliest years of a child’s life
are society’s most neglected age group, yet new evidence confirms that these years lay the
foundation for all that follows.‖
The Healthy Families America model emphasizes the belief that programs that begin working
with parents right after the birth of their child stand the greatest chance of reducing the risk of
child abuse for several reasons:
New parents are eager and excited to learn about caring for their babies;
Positive parenting practices are supported before patterns are established;
Most physical abuse and neglect occurs among children under the age of two;
Forty-four percent of fatalities due to child maltreatment occur before the first birthday;
Children need to be immunized from childhood disease during the first two years of life;
and
The most critical brain development occurs during the first few years of life.
The Nurse-Family Partnership home visiting research study is a 30 year randomized, controlled
trial targeting first-time, low-income mothers. While the study is ongoing, the strongest evidence
to date includes consistent positive effects in the following areasiii:
Improved prenatal health
Fewer childhood injuries
Fewer subsequent pregnancies
Increased intervals between births
Increased maternal employment
Improved school readiness for children born to mothers with low psychological resources
The Parents as Teachers has conducted research into the outcomes to be achieved since its
inception and results have been confirmed through multiple studies over the past 25 years.
Among the recent research findings are:
Children who participate in Parents as Teachers are healthier.
Parents as Teachers children score high on kindergarten readiness tests and on
standardized measures of reading, math and language in elementary grades.
Parents as Teachers parents are more knowledgeable about child development and
child-rearing practices.
Parents as Teachers parents engage in more language- and literacy-promoting
behaviors with their children.
Parents as Teachers together with preschool, not only positively impacts children's
school readiness and school achievement scores, but also narrows the achievement gap
that poor children typically face as they enter kindergarten.

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Evidence Based Home Visiting Programs1
There is substantial evidence available to establish the factors that define evidence based
practice in home visiting. Factors which if incorporated into the design and system of home
visiting services can be expected to result in positive outcomes for children and families. The
significant factors found by the research to maximize the positive outcomes include:
Intervention provided earlier in life, rather than later, is likely to be more effective and
less costly.
Prevention services initiated prenatally or when the baby is born.
Quality home visiting programs have well-trained, experienced staff and minimal staff
turnover.
For maximum impact on later academic success and mental health, early childhood
programs should give the same level of attention to young children’s emotional and
social needs, as to their cognitive skills.‖iv
v

Federal Policy Action

An unprecedented opportunity to enhance and expand home visiting services is currently being
considered at the Federal level through two legislative proposals. Arizona’s opportunity is to be
prepared to incorporate a strong home visiting strategy through a statewide, intentional system
of comprehensive, quality services.
The two Congressional proposals that have been introduced will, if passed, expand early
childhood home visiting opportunities.
Early Support for Families Act (H.R. 2667): Introduced in June 2009, the legislation establishes
a new state grant program under Title IV-B of the Social Security Act to provide mandatory
funding to create and expand early childhood home visitation programs. The grant award is
based on the number of families in each state that live below the poverty line, with emphasis on
communities with high numbers of low income families or high incidents of maltreatment.
Evidence-based Home Visitation Act (S.1267): Introduced in June 2009 this legislation amends
Title V of the Social Security Act to provide grants to local agencies to establish or expand home
visitation for low-income pregnant women or families with children. Grant eligibility will be based
on the local agency’s ability to offer an approved home visiting model, specifically defined as
one that has ―demonstrated significant positive effects on parent and child outcomes‖, such as
reducing abuse and neglect, improving prenatal health, improving school readiness, reducing
juvenile delinquency, and improving family economic self-sufficiency.
At this time, Health Care Reform has been signed into law and includes funding specifically for
home visiting services. Detailed information about the requirements and process to access this
funding are not yet available.

1

Evidence Based Practice – For purposes of this report, evidence based practice means the approach, tools, and
content of home visiting services are proven practices based on the results of outcome research of various models of
early childhood home visiting services.

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HOME VISITING CONTINUUM OF SERVICES
Home visiting provides individualized support in the safety of a family’s home and is focused on
the parent and the parent-child relationship. It builds on family strengths and provides homebased individual interventions with the child, helps families make the best use of sometimes
limited resources and links them to health, social service and education resources.
Home visitors work with families who are pregnant and/or parenting children birth through age
five. Parents are helped to assess and articulate their needs so resources can be acquired and
education and skill building is provided for parent(s). Home visiting is the core service delivery
method, which differentiates it from programs which may incorporate visits to the home as part
of the delivery of services, for example a visit to a home by a preschool teacher.
Models that are research based with a commitment to continuous program improvement where
research drives practice have the most impact on positive family functioning and child
development.
Characteristics of Home Visiting Services
Home visiting is provided for families experiencing a range of challenges and varies in levels of
intensity, staffing and funding mechanisms. Home visiting programs integrate research into the
program design and delivery of services. Descriptions of some of the home visiting models
operating in Arizona are in Appendix B.
Home visiting services include key characteristics which result in a comprehensive approach to
facilitate access to services, ensure the appropriate service based on the individual family, and
specifically incorporate the education and skill building components needed by the family. The
key characteristics are engagement, assessment, and education/parent skill building and
service delivery.
Engagement: Home visiting is offered to families on a voluntary basis, sometimes when a
mother first discovers she is pregnant, sometimes at the hospital at the time of birth and
sometimes through a service delivery program that encounters preschool-aged children or their
parents, such as a clinic, early education program, community event or social service agency.
Assessment: Once a family accepts an offer of service, the home visitor completes an initial
assessment. Depending on the program purpose, approach and needs of the family, there may
be further assessment(s). The information obtained allows the home visitor, working in
partnership with the family, to determine the appropriate level of service, number of visits,
frequency of visits, and skill building practices which would be most beneficial for the family.
This becomes an individualized plan of action for the family and home visitor to implement
collaboratively.
Education/Parent Skill-Building and Service Delivery: Implementation of the family plan
promotes a trusting relationship between the parent(s) and home visitor. This relationship
provides a foundation for accomplishment of the actions jointly agreed to in the plan. Services
provided include various levels of parent education and skill building, information about and
referrals to community resources and delivery of interventions for a specific child or the parent.
Specific child and parent education may include health education, literacy and early learning
components to enhance the child’s readiness to begin school. Home visitors all work to forge a
strong relationship with the parent(s) and have a range of education and expertise. Depending
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on the program model and approach home visitors may be lay health workers,
paraprofessionals, nurses, or masters level health and social services professionals.
The Pyramid Model for Promoting the Social and Emotional Development of Young
Children
The Pyramid Model is a tiered intervention framework for evidence based practice that
promotes the social, emotional and behavioral development of young children.vi It describes
tiers of intervention practice depending on the needs of the child and his or her family. The
Pyramid which is based on the public health model of services includes: Promotion (Universal),
Prevention (Targeted Populations) and Intervention (Intensive Individual Services). All tiers
have as a foundation an effective work force and systems and policies that promote and sustain
the use of evidence-based practices.

Universal (dark green levels) indicates a system of services and supports for all children and
families; targeted (light green level) indicates services for children that reduce risk factors and
intensive (orange level) indicates services for children and families in need of intensive
individualized interventions.
High Quality Supportive Environments and Nurturing and Responsive Relationships are
represented by two tiers of the pyramid that are considered universal in that all children benefit
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from strategies to ensure the environments and relationships in a child’s life are supportive and
of high quality.
Targeted Social and Emotional Supports includes home visiting approaches that include
systemic methods to reach at-risk families. The approaches are designed to teach social and
emotional development of young children, parenting, and child development skills for young
families who may not have had prior opportunities to understand early childhood development.
Targeted home visiting services are designed for teen parents, first time parents, families living
in poverty and/or families with parent or child health concerns. In this context, home visiting
services can reduce the incidence of child abuse or neglect, increase access to health care, and
to help parents better prepare their children to enter school healthy and ready to succeed.
Intensive Intervention (top of the pyramid) addresses those services that are specifically
designed as interventions for high risk populations such as newborns with special health care
needs, families involved with child protective services and/or children who have been identified
as having specific developmental disabilities. The home visiting interventions are based on an
assessment that results in a very individualized approach to addressing the specific needs of
the family and child. For example, for children who spend time in neo-natal intensive care units
following their birth, the home visiting intervention may focus on education for the parent(s)
about how to care for their baby who may have physical and developmental challenges and to
better understand and meet the health care needs of their child. A comprehensive network of
intensive social, emotional, health, education and family supports are needed for children and
families who are experiencing very challenging conditions. Home visiting can augment this
network.
The tiers or levels of intensity and intervention are differentiated by several factors:
Primary risk factor(s) the home visiting strategy is designed to address. For example,
Healthy Families addresses families at risk of child abuse or neglect, Head Start and
Early Head Start are designed to promote school readiness for families below the federal
poverty level, Arizona Early Intervention Program (AZEIP) provides intervention for
children with special needs and Health Start targets low income communities.
Age of the child (including prenatal). Some programs begin prenatally with a focus on
healthy birth outcomes while others target specific age groups from birth through age
five.
Education, training and discipline of the staff. Programs employ different levels of
professionals who deliver home visiting services. For example, intense interventions are
typically provided by staff with masters-level social work education, registered nurses or
specifically trained lay health workers.
Program content. Program models have research that demonstrates positive outcomes
as a consequence of program participation. Home visitors receive intensive training and
supervision to ensure fidelity to the curriculum or program content that lead to these
outcomes.
Duration. Duration of home visiting programs vary according to the target population the
model was designed to serve and the outcomes to be achieved by the home visiting
intervention. For example, a program model aimed at reducing the risk of abuse and
neglect may begin prenatally with the goal of providing support to the family, as
appropriate, until the child enters kindergarten. Another model with the aim of
supporting a healthy birth outcome may begin during pregnancy and extend through the
first year or two of the life of the baby.

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Frequency of Visits. Some home visiting services are offered weekly and taper off as the
family gains skills and confidence and risk factors are reduced. Others are offered on a
scheduled but less frequent basis.

The Continuum of Home Visiting Services
Level of
Intensity

Intensive
Intervention

Targeted
Services –
reducing risk
factors

Services /
Supports for all
Children and
Families

Elements of Home Visiting

Characteristics

Access to Health Care
Parent / Child Relationship
Development
Education & Skill Building in Early
Childhood Development and
Parenting
Access to Health Care
Parent / Child Relationship
Parent Education & Skill Building
Language & Literacy Development

o Based on an individual
assessment and interventions
specific to the child and family.
o More frequent visits.
o Specifically trained staff based
on the type of intervention.
o Serves at risk populations.
o Duration and intensity based
on the risk factors present.
o Focus on parental education
and skill building.

Access to Health Care
Information about:
o Health
o Child Development
o Parenting

o Provided primarily as parent
education and information.
o Less frequent visits (maybe
one visit).
o Foundational information
relevant to all parents and
children.

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ARIZONA FAMILIES WITH YOUNG CHILDREN
Arizona population characteristics provide a snap shot of the general population and the specific
at risk populations that may access home visiting services. Research of home visiting services
finds that the earlier in a child’s life this support is provided the greater the potential for having
long lasting positive results. Home visiting with pregnant women specifically helps create the
environment for a healthy birth by incorporating the importance of healthy behaviors throughout
the pregnancy such as accessing prenatal care, appropriate nutrition, not smoking, and
exercise. Additionally, research has confirmed home visiting as an effective strategy for families
at risk due to poverty, health conditions of the child or parents, child maltreatment and low
literacy levels.

General Population
Between 2000 and 2008 Arizona’s population increased by 25%, with children under age 5
growing faster than the general population. Overall population growth from 2000 through 2008
in Arizona has increased in nearly all counties, with Pinal County experiencing a dramatic 80%
increase and four counties climbing 20 percent or more.
During this same time, the number of children under age five increased by 30.9% from 382,386
in 2000 to 500,531 in 2008.vii
Children Under Age Five by County 2008

County
Apache
Cochise
Coconino
Gila
Graham
Greenlee
La Paz
Maricopa

% of
Children
Under Age
Five
1.2%
1.8%
2%
.7%
.5%
.2%
.2%
64.9%

# of
Children
Under Age
Five
5,854
8,955
9,957
3,410
2,515
933
1,115
324,159

County
Mohave
Navajo
Pima
Pinal
Santa Cruz
Yavapai
Yuma

% of
Children
Under Age
Five2.4%
1.8%
13.7%
4.7%
.5%
2.3%
3.3%

# of Children
Under Age
Five
12,190
9,103
68,534
23,283
2,495
11,594
16,434

Source: U.S. Census: American Community Survey Demographic and Housing Estimates, 2006-2008

Births in Arizona
The number of births in Arizona has decreased from 102,042 in 2006 to 92,244 in 2009, a
decrease of 9.6%.
Over 42% of the births in 2009 were to mothers who identified themselves as White –
non-Hispanic and 41.6% were mothers who identified themselves at Hispanic or
Latino.viii

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Total Births in Arizona by County 2006 - 2009

Total State
Apache
Cochise
Coconino
Gila
Graham
Greenlee
La Paz
Maricopa
Mohave
Navajo
Pima
Pinal
Santa Cruz
Yavapai
Yuma
Unknown

2006 Total
Births
102,042
1,189
1,808
2,062
667
540
110
229
66,160
2,468
1,877
13,929
4,467
753
2,380
3,354

2007 Total
Births
102,687
1,149
1,860
2,132
694
582
138
230
65,931
2,439
2,012
13,798
5,285
766
2,411
3,252

2008 Total
Births
99,215
1,211
1,781
1,985
697
644
131
246
62,667
2,301
1,944
13,503
5,731
796
2,216
3,362

2009 Total
births
92,244
1,196
1,844
1,861
704
645
130
175
57,662
1,948
1,882
12,835
5,306
760
2,060
3,235
1

Source: Arizona Department of Health Services, Vital Statistics, Provisional Number of Births by County,
Data as of January 12, 2010.

Risk Factors
The risk factors described below provide a state level view of targeted populations that
specifically benefit from home visiting strategies. Where available, data by County has been
included in Appendix C.
Low Birth Weight Babies
In 2009, 7.1% of all births were low birth weight births. Santa Cruz County had the highest
percentage of low birth weight births at 9.6% followed by Cochise County (8.2%) and Coconino
County at 8.1%.ix
Teen Mothers
Teen mothers experience poor birth outcomes and less education more frequently than mothers
over the age of 19. In 2009, 92,244 children were born in Arizona. Of those children 10,936
were born to mothers 19 years or younger (11.9%). A baby born to a teenage mother is at
higher risk for premature birth, low birth weight, and other serious health problems. Teen
mothers are more likely to drop out of high school and more than 75 percent of all unmarried
teen mothers go on welfare within 5 years of the birth of their first child.x
Infant Mortalityxi
The major causes of infant mortality are low birth weight, preterm birth, and multiple births.
Births of infants weighing less than 1,000 grams accounted for 0.6 percent of births, and 43
percent of all infant deaths. Preterm infants (those born at less than 37 weeks of gestation)
accounted for 10.6 percent of births and 68.9 percent of all infant deaths. Multiple births
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accounted for 2.8 percent of births, but 13.4 percent of all infant deaths. A weight gain of 31
pounds or more by the mother was correlated with lower infant mortality.
Infant mortality was lowest for babies born to Asian and White mothers. Black infants have the
lowest survival chances among the ethnic groups. The infant mortality rate for these babies
increased by 31.3 percent during 2005 to 2006. In contrast, the rate for American Indian infants
declined by 22.9 percent 2005 to 2006.
Developmental Risk Indicatorsxii
Based on the 2007 National Survey of Children's Health, the indicators of the status of children
who are 4 months to 5 years old and are at risk for developmental or behavioral problems
indicated over 27% are at moderate or high risk for developmental, behavioral, or social delays.
Hispanic children had the highest percentage of children 4 months to 5 years old at
moderate or high risk of developmental or behavior problems at 39.7% followed by White,
non Hispanic and Multi-racial, non-Hispanic at 23.4% and Other, non-Hispanic at 6.4%.
Hispanic children, Spanish primary language had the highest percentage of children 4
months to 5 years old at moderate or high risk of developmental or behavior problems at
50.0% compared to Hispanic children, English primary language at 27.2% and Non-Hispanic
children at 20.8%.
Two-parent (at least one step parent) families with children 4 months to 5 years old at
moderate or high risk of developmental or behavior problems had the highest percentage at
59.9%, followed by all other family structures at 55.2%, Mother only (no father present) at
28.6% and two-parent (biological or adoptive) at 24.9%.
Special health care need families had 41.5% of children 4 months to 5 years old at
moderate or high risk of developmental or behavior problems and no special health care
needs families are at 26.6%.
In families who are currently uninsured or have had periods with no coverage, 44.3% of the
children 4 months to 5 years old are at moderate or high risk of developmental or behavior
problems compared with 23.3% for families who are consistently insured.
Unemployment
According to the Special Unemployment Report 2010, Arizona’s unemployment rate for
February 2010 was 9.5%. Yuma County had the highest unemployment rate in February 2010
at 19.9% followed by Apache County (17.1%), Navajo County (16.2%) and Santa Cruz County
(15.2%). The lowest unemployment rates were in Cochise County (8.4%) and Pima County
(8.9%). Unemployment rates include Native American Reservations in the County.
Poverty
Poverty Among Children Under Age Five

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Based on the American Community Survey 3-year estimates for 2006 - 2008, there were 48,914
children age five and under living below the poverty level in the past 12 months.
Families at 100-199% of the Federal Poverty Level (FPL) with children 4 months to 5 years old
at moderate or high risk of developmental or behavior problems had the highest percentage at
46.2% followed by 0-99% FPL at 30.3%, 400% FPL or higher at 19.8% and 200-399% FPL at
17.9%.xiii
Single Parents and Poverty
Single parent households experience more poverty. In 2007, children living in households
headed by single mothers were more than five times as likely as children living in households
headed by married parents to be living in poverty.xiv More than 45% of the children (44,728)
were born to unwed mothers. Fifty four percent (54%) of these births had a public payer for the
birth expenses indicating low income status of these families and the clear dependence on the
public health care system in Arizona.xv In nearly all Arizona counties over one-quarter of births
to families living below the poverty level were to single headed households with children 5 years
old and younger.xvi
Health
Health of Motherxvii
Mothers perceive health status as good less frequently than women nationally: 53.2% of
Arizona mothers of children age 2 to 5 years old report excellent or very good physical and
mental health less frequently when compared to a national rate of 59.1%.xviii A similar trend
exists for mental and emotional health. Approximately two thirds (67.6%) of Arizona mothers of
children age 2 to 5 years old report excellent or very good mental and emotional health
compared with almost three fourths (72.6%) of mothers nationally. Single fathers in Arizona
reported excellent or very good mental and emotional health in greater numbers (75.3%) than
single mothers (67.6%).xix
Childhood Obesity
Among children 2 to 5 years old, obesity has increased from 5.0% in 1980 to 12.4% in 2006.xx
Childhood obesity is a leading health concern that disproportionately affects low-income and
minority children. One of 7 low-income, preschool-aged children is obese. In 2008, the
prevalence of obesity among Arizona children was 14.6%. The Inter Tribal Council of Arizona
reports that 23.5% of Native American children are impacted by obesity with 16.9% of children
on the Navajo Nation impacted. Children who are obese in their preschool years are more likely
to be obese in adulthood and to develop diabetes, asthma, and other health concerns.xxi One
study found that if indications of being overweight begin before 8 years of age, obesity in
adulthood is likely to be more severe.xxii
Immunizations
Statewide, 66.57% of children born between July 1, 2008 and June 2009 had completed the
recommended immunizations for 12 – 24 month olds.xxiii
Child Abuse and Neglect
From April 1, 2009 through September 30, 2009 the number of child protective services reports
(all ages: birth to age 18) received was 16,134. Of those, 6,942 (43%) were assessed as being
low risk while 14.2% were considered high risk and 31.9% were considered moderate – low
risk.xxiv

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Child Fatalities
The 2008 Child Fatality Review Report found that 1,038 children younger than 18 years of age
died from preventable causes, a decline from 2007. However the percentage of children ages
one through four years increased from 10 percent of all child deaths in 2007 (n=113) to 12
percent of all child deaths in 2008 (n=126). The largest percentage of deaths was among infants
younger than 28 days which accounted for 42 percent (n=423) of the total number of child
deaths.
The primary causes of death among young children include prematurity, substance abuse
related fatalities, automobile accidents, drowning, homicides and child maltreatment. Ninety
(90) infants died in unsafe sleep environments, including 44 infants who were placed to sleep in
adult beds and 13 who were placed to sleep on couches or chairs. Thirty one (31) infants were
placed to sleep on their sides or stomachs, forty-eight (48) infants were bed sharing with adults
and/or other children, and twenty-five (25) of the adults who bed shared were using illegal
drugs, prescription drugs, and/or alcohol.
Fourteen percent of all child deaths occurred in or around the home, and 89% of these deaths
were determined to have been preventable (n=126). In 2008, 141 children died in or around the
home, due to causes such as drowning, sleep-related suffocations, poisonings, falls, and fires.
Seventy percent (70%) of these deaths were among children younger than five years of age
(n=120).
Substance Abuse2
The Arizona Statewide Substance Abuse Epidemiology Profile, Dec, 2009, reported an increase
in the percentage of adults who reported using any illicit drug (other than marijuana) in the past
30 days from 2005 (3.5%) to 2007 (5.5%). In 2007, 3.7% of the respondents Nationwide
reported illicit drug use. Detailed data can be found in the Profile Report at:
http://gocyf.az.gov/SAP/PR_SAEP09.asp
Linguistic Isolation
According to the 2006-2008 US Census population estimates, 25.9% (1,229,237) of Arizona’s
population 5 years old and over speak a language other than English at home. This compares
to 17.9% nationally.
In Arizona, 121,289 household with a primary language of Spanish, 8,437 families with other
Indo-European languages and 9,002 Asian and Pacific Island languages were considered
linguistically isolated. A linguistically-isolated household is defined by the U.S. Census Bureau
as one in which 1) no member 14 years old and over speaks only English or 2) no member 14
years and over speaks a non-English language and speaks English "very well". In other words,
all members 14 years old and over have at least some difficulty with English. See Appendix D
for detailed information by County.

2

Data are from the National Survey on Drug Use and Health and are not available by County.

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Summary of Selected Indicators by County
Apache, Maricopa and Yuma Counties have the highest percentages of children under the age
of five. A review of the County level information about population risk factors provides insight
into possible priorities for targeted home visiting services.
The three Counties with the highest percentages of risk by indicator included:
For teen birth rates and low birth weights, all the counties with the highest percentages
are rural counties including Cochise, Coconino, Gila, Greenlee, Navajo and Santa Cruz.
For poverty related indicators, all the counties with the highest percentages are rural
counties including Apache, La Paz, and Navajo for percent of families living below
poverty and Gila, Mohave and Yavapai for the number of single parents living below
poverty.
The highest unemployment rates as of February 2010 are in rural counties; i.e. Yuma,
Apache, and Navajo Counties. (Unemployment rates include Native American
Reservations in each County.)
Apache, Maricopa, and Yuma County have the highest rates of linguistic isolation.
The high percentage of families with risk factors in three of the categories is driven by high
population centers; i.e. Maricopa, Pima and Pinal Counties have the largest populations,
therefore would have the largest percent of infant mortality, child abuse reports, and child
fatalities.
Review of the remaining indicators finds that Apache, Gila and Navajo Counties have the
highest percentages of families at risk in three of the indicators. Apache County has the 2nd
highest unemployment rate, the highest percent of families living below poverty and the highest
number of linguistically isolated families. Gila County has the highest teen birth rates and
number of single parents and the lowest immunization rate for 12-24 month olds. Navajo county
has the third highest unemployment rate, the third highest teen pregnancy rate, and the third
highest percentage of families living below poverty.
Counties with the Three Highest/Lowest Percentages in Risk Factors

Category
% of Unemployment
% of Teen Births
% of Low Birth Weight (LBW)
% of Families Below Poverty
% of Single Parents Below Poverty
% of Immunizations Not Complete
% of Linguistically Isolated Families
Indicators that are population driven
% of Infant Mortality (2006)
% of Child Abuse Reports (all ages)
% of Child Fatalities

Highest %

2nd Highest %

3rd Highest %

County

County

County

Yuma
Gila
Cochise
Apache
Gila
Gila
Apache

Apache
Greenlee
Coconino
La Paz
Mohave
Yavapai
Maricopa

Navajo
Navajo
Santa Cruz
Navajo
Yavapai
Graham
Yuma

Maricopa
Maricopa
Maricopa

Pima
Pima
Pima

Pinal
Pinal
Pinal

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ARIZONA’S HOME VISITING SYSTEM
Across Arizona county health departments and community based providers have implemented
home visiting strategies to support families in their communities. The current home visiting
programs represent the range of models from new born support to intensive interventions. The
Arizona system also has an array of State level and local home visiting coalitions and
professional training institutions. The strength of the existing services, collaborations and
training options provides the foundation for establishing the future system of quality home
visiting service.
Like many States, Arizona budget decisions over the past two years, have reduced the health
and human service system capacity. Among the programs dramatically impacted were home
visiting services.

Number of Children Served by County and Tribal Nation
Approximately 53,000 children will be provided home visiting services during FY2010. Among
Arizona counties there is wide variation in the percent of children birth through age five receiving
services. Approximately 64% of young children in Santa Cruz County receive some type of
home visiting services compared to Pinal County where an estimated 2.6% of the young
children are provided home visiting services.
Without a system of standard reporting, a precise number of children served is not possible;
however, the estimates provide a starting point for understanding current levels of service and
for planning strategic methods for expanding quality home visiting services to the most
underserved areas of the state.
About the Data
The following assumptions have been made to provide the most accurate estimate based on
currently available data:
1.

The number of children served reflects a.) actual counts of children reported by program
administrators and b) where number of families (versus children) served was reported, one
family was estimated to represent 2.2 children. Based on US Census 2008; there were
1,670,377 children under the age of 18 in Arizona and there were 747,659 families with
children under the age of 18; an average of 2.2 children under the age of 18 per family (US
Census Tables B11004 and B17006).

2.

Where contracts were awarded to serve multiple counties, estimates were made to attribute
a share of the reported children to each County in the service area.

3.

Since many contracts in La Paz and Mohave Counties and in Apache and Navajo Counties
report their service area as being across both Counties, for purposes of this comparison,
the number of children served and the population estimate for those counties have been
combined.

4.

Number of Children Under Age Five is from the US Census Fact Finder 2006-2008
Population Estimates. County population estimates include populations residing on Tribal
Lands; therefore, Tribal programs are included in the totals for each County.

5.

The percent of children receiving home visiting services is inflated as a result of the
comparison to the population under age five, while most of the home visiting programs
identified serve children through age five.

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Note: The number of children served by AzEIP (5,688) is not available by County; therefore is
not included in the by County number of children or percentages.

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Arizona Home Visiting Services
Number and Percent of Children Served by County
Fiscal Year 2010 Estimates
County # Children
County / Tribal
# of Children
Under Age Five
Statewide

AZEIP

% Children
served

5,688

N/A

N/A

Apache / Navajo

1,190

14,957

8.0%

Cochise County

2,491

8,955

27.8%

Coconino County

1,588

9,957

16.0%

Gila County

203

3,410

6.0%

Graham Greenlee

636

3,448

18.4%

2,157

13,305

16.0%

Maricopa County and the Fort
McDowell Yavapai Nation

22,863

324,159

7.1%

Pima County and the Tohono
O'odham Nation

6,903

68,534

10.1%

615

23,283

2.6%

Santa Cruz

1,609

2,495

64.0%

Yavapai

4,214

11,594

36.0%

Yuma County and the Cocopah
Tribe

3,032

16,434

18.4%

53,289

500,031

10.7%

La Paz Mohave Total

Pinal County and Gila River
Indian Community

Statewide Total

Source: The number of children served is based on reports from the funders of home visiting programs for Fy2010
and as needed, with clarification from the agencies providing services.

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Home Visiting Programs by County or Tribal Location
At this time there are home visiting services available in each county in Arizona. Healthy
Families, Early Head Start and Arizona Early Intervention Services have a presence in all
Counties. The Home Visiting Task Force defined home visiting programs as programs that
have as their core strategy through which services are delivered and where participation is
always voluntary on the part of the parent(s). This inventory of programs provides a snapshot of
what currently exists and was developed based on self-identification by program administrators.
While several of the programs identified below are based on national evidence based models,
others have not undergone intensive of evaluations. Data about AzEIP services is not available
by County or Tribal location; therefore AzEIP is not included in the matrix or in the map on Page
18.
Type of Program by County
County

Apache /
Navajo
Cochise
Coconino
Gila
Graham
Greenlee
La Paz
/Mohave
Maricopa
Pima
Pinal
Santa
Cruz
Yavapai
Yuma

Healthy Early
High
Choices Parents
Nurse
Migrant Other*
Families Head
Risk
as
Family
Education
Start Perinatal
Teachers Partnership
x

x

x

x
x
x
x

x
x
x
x
x

x
x
x
x
x

x

x

x

x
x
x

x
x
x

x
x
x

x

x

x
x

x
x

x
x

x

x
x

x

x
x
x
x

x

x
x

x
x

x
x
x

x
x
x

x
x

x
x

x

x
x

―Other‖ includes programs identified in one or two counties such as Healthy Steps; Health Start; Healthy Start,
Adolescent Child Health Program; Bright Start; In-home Parent Aide; Building Bright Futures; Parent Connection;
First Steps; Pregnancy, Parenting and Play; Teen Outreach Pregnancy Services; Raising Healthy Kids; Parent
Partners; Building Blocks for Children; Healthy Babies; Early Steps; and Smart and Healthy.

Type of Program by Tribal Nation
Tribal Nation
Cocopah Tribal Community
Fort McDowell Indian Community
Gila River Indian Community
Hopi Tribal Community
Hualapai Tribe
Navajo Nation
Salt River Pima Maricopa Indian
Community
San Carlos Indian Community
Tohono O’Odham Nation
White Mountain Apache

FACE

x
x
x
x

Other
Early Steps
Early Intervention Home Visiting
Building Blocks for Children
Maternal & Child Health
Early Head Start

x
x

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The circles represent the type of program only and are not proportional to the number of
children served by each program. Since the number of children served by AzEIP is not
available by County, AzEIP is not included in the type of program map.

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Funding for Home Visiting Programs
Major funders of current home visiting programs include five state agencies and the Federal
Bureau of Indian Education which provides funding for the Family and Child Education (FACE)
program on Tribal Lands. Total funding from State and Federal funding sources for State Fiscal
Year 2010 is $60,741,030.
Arizona Department of Economic Security, Healthy Families FY 2009/2010

$

6,300,000

Arizona Early Intervention Program (AZEIP) ADES Only:

$

9,600,0003

Arizona First Things First: FY 2010

$ 21,228,400

Arizona Department of Education, Migrant Home Visiting

$

189,722

Arizona Department of Health Services: High Risk Perinatal

$

1,787,000

Arizona Department of Health Services Health Start

$

1,517,956

Early Head Start

$ 20,117,9524

Total:

$ 60,741,030

Federal Bureau of Indian Education (FACES Programs)

$Not Available

Cost of Home Visiting Services
The cost of implementing home visiting services depends upon the service model of the
program and may range from $1,000 to $10,000 per family depending upon intensity of the
program. Costs include:
Staff
Mileage
Staff Training
Outreach and Promotion
Screening Instruments including training to utilize tools
Curriculum (including specific materials that augment the program such as the Arizona
Parent Kit5 or Brain Boxes6)
Space
Supervision
The National Resource Center for Child Abuse and Neglect Prevention FRIENDS Factsheet,
“Home Visiting Programs: A Brief Overview of Selected Models” (December 2007) reported the
following approximate program costs7:
3

Arizona Master List of Programs, ADES, AZEIP, 2009 Estimate
Based on Arizona total Head Start Allocation of $107,014,507 (ECLKC); 1,908 EHS Enrollments; Average Cost of
$10,544.
5
The Arizona Parents Kit – developed by Virginia A Piper Trust, provides expert advice, parenting tips, and national
and local resources to help parents navigate the first critical years. New parents receive a kit free-of-charge either
during childbirth classes or upon discharge after childbirth. The kits contain an 80-page Arizona Parents Guide, six
videos/DVDs and an infant board book, all available in both English and Spanish.
6
The Brain Box® is a unique patented educational product for caregivers to use with children from birth to 5½ years
old. Each box contains activity guides and all the materials needed for adult-child interaction that encourages healthy
brain development.
7
The program costs listed above are based upon national data. Local costs may vary.
4

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1. Healthy Families America-$3,500 per year per family
2. Home-based Instruction for Parents of Preschool Youngsters (HIPPY)-$1,250 per year
per family
3. Nurse-Family Partnership-$5000 per year per family
4. Healthy Steps-between $402 and $933 per family in 2000 dollars
5. Parents as Teachers-$2000 per year per family
6. The Parent-Child Program-$2,400 per year per family
7. Early Head Start-in 2002, the average cost per child was $10,544

Current Research Underway in Arizona
Through research, Arizona can develop an effective and efficient system of home visiting
services based on evidence based practice. At this time there is one research effort specific to
home visiting services in Arizona that is in the planning stage and that will provide foundational
information for improving the quality of Arizona home visiting programs.
The Arizona Department of Economic Security and Lecroy and Milligan have received Federal
Department of Health and Human Services funding for research into the Arizona Healthy
Families Program.

Workforce Development Options
Each model of home visiting service has its own training requirements, and some organizations
provide a specific training curriculum that all staff must attend before providing service.
Programs that support the training and education of early childhood professionals to provide
quality home visiting services include but are not limited to the following:
Arizona’s Community College System provides multiple opportunities for degree and
certification programs in early childhood. Examples include:
o Central Arizona College – provides Associates of Arts Degrees and Certifications
in Early Childhood Education: Family Child Care, Infant/Toddler, Management,
Preschool and School-age.
o South Mountain Community College – provides an early childhood development
program which emphasizes a multi-linguistic and multi-cultural approach in
working with children to equip teachers and home visitors to work effectively with
children and families in both school and home environments.
o Northland Pioneer College provides Associate Degrees in Early Childhood
Infant/Toddler, Special needs Educational Assistant, Preschool and
Management.
o Pima Community College offers an Associates Degree in early childhood
education as well as certificates in basic early childhood studies and advance
early childhood studies and a post degree certificate in early childhood, birth –
age 8.
Healthy Families Institute – Healthy Families America provides a Train-the-Trainers
Institute that leads to a certification as a HFA Trainer of Family Support Workers or of
Family Assessment Workers (www.HFA.org).
NCAST provides workshops designed to give professionals, parents and other
caregivers the knowledge and skills to provide nurturing environments for young children
by developing and disseminating innovative research-based products and training
programs used in many disciplines and settings, (www.ncast.org).

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Coalitions in Arizona
Arizona has 9 coalitions of providers of home visiting services. Local coalitions provide
opportunities for building locally and regionally the network of providers who can ensure
coordination of the provision of services, access to the most appropriate type of home visiting
services and an unduplicated approach to building the system of services.
First Things First Southeast Regional Partnership Council (Maricopa County)
Head Start Association (Statewide)
Health Start Consortium (Statewide)
Healthy Families Statewide Steering Committee (Statewide)
Interagency Coordinating Council (Statewide)
North Phoenix Home Visitation Providers
Parents as Teachers Consortium – Tanner Community (Maricopa County)
Southern Arizona Family Support Alliance
Yavapai County Coalition

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THE VISION FOR HOME VISITING SERVICES IN ARIZONA
The Arizona system of home visiting services is intended to be an integral part of Arizona’s early
childhood development and health continuum. The system of home visiting services provides
the opportunity for pregnant women and families with young children to voluntarily access home
visiting services:
Within their own communities,
With the level of service appropriate to their needs and desires,
With assurance of high quality, and
Within the context of their families’ culture, values and beliefs.
Our Vision
Confident, supported families raising healthy children, ready to
succeed in school and life.
Values and Beliefs
To guide the development of the Statewide Early Childhood Home Visiting Plan and the ongoing
delivery of home visiting services, the values and principles that must be considered throughout
the planning and delivery of services are:
Children’s earliest experiences have the most impact on their future development.
Comprehensive home visiting is an effective approach to strengthening families.
All aspects of home visiting must be family-centered and strengths-based.
Evidence based, quality home visiting services are the foundation for home visiting
services in Arizona.
A coordinated, collaborative planning and service delivery process results in an effective
and efficient system that is seamless for participating families.
Ongoing research and evaluation form the basis for continuously improving the quality of
home visiting services.
Culturally competent service planning and delivery must be present in all service
strategies.
A strong financial base allows for consistency and high quality of home visiting services.
Strong political support is essential for the ongoing delivery of quality home visiting
services.
Engagement in home visiting services is based on voluntary participation by families.
Target population
The Arizona population served by home visiting programs includes expectant parents and
families with children birth through age 5 or entry into kindergarten.

System Components
To achieve a comprehensive, coordinated system of quality home visiting services, the essential
components of the continuum of home visiting services must include:

The Vision for Home Visiting Services in Arizona 2010 - 2015

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Outreach, Engagement and Access to Services – providing information, supporting
voluntary participation of families and referring families to appropriate services and
supports in their communities.
Family Screening and Assessment - determining on an ongoing basis the appropriate
level of service; number of visits, skill building techniques appropriate for a specific
family based on their strengths and needs.
Developmental and sensory screening – though the use of appropriate screening tools,
assists parents and other caregivers in identifying children who may be in need of
additional intervention or support services to support healthy development.
Service delivery – provision of high quality home visiting services, according to approved
standards and curriculum; and relevant to the families’ needs, culture, values and
circumstances. May include parent education, family support including referral to
community resources and facilitation of access to health care.
Quality Assurance – adherence to statewide standards of practice, work force
requirements and monitoring of quality and a system of ongoing training and technical
assistance.
Continuous Improvement – including ongoing evaluation based on a common set of core
outcomes and research designed to determine the short and long term effectiveness of
various home visiting models in Arizona.
Public Awareness – raising the understanding among Arizonans of the importance of
early childhood development and the significant difference early childhood experiences
can make in terms of children achieving their full potential.
Policy and Funding – ensuring access and quality through coordination of policy,
practice and funding opportunities statewide, across all service systems.
Outcomes to be Achieved
The outcomes represent the results to be achieved from implementation of high quality,
comprehensive home visiting services. The outcomes and indicators relevant to specific home
visiting programs will vary depending on the target population and the home visiting model
being implemented. With each outcome are the possible indicators that when measured would
signal progress toward achieving the outcome.
Outcomes for Children
#1: Children are safe in their homes and in their communities.
Indicators of Progress
o Decrease in child abuse and neglect
o Decrease in domestic violence incidents involving young children
o Decrease in preventable childhood injuries
o Decrease in infant mortality
o Increase in parent understanding of early childhood development
o Increase in effective parenting skills
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#2. Children are healthy8.
Indicators of Progress
o Decrease in the number of low birth weight babies
o Decrease in obesity rates among young children
o Increase in the number of 19 to 35 month olds who receive a full schedule of age
appropriate immunizations
o Decrease in the percentage of children determined to be at moderate to high risk of
developmental or behavioral problems based on parent’s specific concerns
#3. Children are developmentally on track and prepared to enter school, ready to succeed.
Indicators of Progress
o Increase in the number of young children who are at appropriate developmental
milestones – ages and stages
o Increase in readiness for school
o Increase in parental engagement, including absent parents as well as custodial
parents, in their child’s learning
#4. Children have healthy relationships.
Indicators of Progress
o Number of children with attachment to at least one person who provides the safe,
healthy environment
o Proportion of mothers of children under age 6 screened and appropriately referred
for depression
o Decrease in substantiated abuse and neglect reports
Outcomes for Parents and other family members
#1. Parents are competent and confident – feeling competent in their knowledge and skills to be
a parent.
Indicators of Progress
o Increase in effective parenting skills
o Increase in Parents understanding of early childhood development.
o Increase in the involvement of fathers in child rearing
o Increase in parent involvement in their child’s learning
#2. Families are more resilient.
Indicators of Progress
o Increase in parents’ utilization of community resources
o Increase in parents’ problem solving skills
o Increase in social supports outside the home visiting program

8

Child health is a state of physical, mental, intellectual, social and emotional well-being and not merely the
absence of disease or infirmity. Healthy children live in families, environments, and communities that provide
them with the opportunity to reach their fullest developmental potential. This is the definition developed by
the FTF Health Committee, September 2007 and used in policy papers and recommendations to the Board.

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#3. Families are increasingly self sufficient
Indicators of Progress:
o Increase in participation in training and/or education programs
o Increase in the ability of families to meet their basic needs
o Increase in parents accessing and using community resources
#4. Parents maintain a healthy lifestyle for themselves and their children.
Indicators of Progress
o Increase in the understanding of how the parent’s health impacts the long term
health of children
o Decrease in children’s exposure to tobacco smoke
o Increase in knowledge of nutrition
o Increase in health literacy9
o Increase in physical activity
o Decrease in the percentage of pregnant women who smoke.
o Increase in the percentage of infants born to pregnant women receiving prenatal
care beginning at the first trimester
o Increase in use of family planning
o Increase in the percentage of women who breastfeed
o Increase in the percent of mothers who breastfeed their infants to at least 6 months
of age.
o Decrease in maternal depression
o Decrease in substance use / abuse

9

Health Literacy - Health literacy is defined in Health People 2010 as: "The degree to which individuals have the
capacity to obtain, process, and understand basic health information and services needed to make appropriate health
decisions". (http://www.healthypeople.gov/Document/pdf/uih/2010uih.pdf),

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RECOMMENDATIONS
The purpose of the Vision for Early Childhood Home Visiting in Arizona plan is to provide a
pathway for delivery of consistent, high quality home visiting services in the context of Arizona’s
statewide early childhood development and health system.
This Five Year Plan and the recommendations herein will help ensure Arizona is, first and
foremost, increasing the number of Arizona children who are ready to succeed when they start
school. The recommendations provide guidance for systematically targeting funding and
system development activities as resources become available to areas that would have the
most positive impact on children and their families.
Recommendation 1: Prioritize Arizona’s home visiting services by A) ensuring all parents of
infants* are offered home visiting services, and B) developing capacity for home visiting
services in geographic areas of Arizona that have the lowest availability of home visiting
services and the population with the highest combination of risk factors.
Research has demonstrated that starting early in a child’s life has the most potential for
achieving positive outcomes. While Arizona currently has an array of home visiting services
that span the age group of prenatal to age five, an emphasis on targeting funding and capacity
building starting with infants provides the best opportunity for use of available resources.
*up to age 1
Recommendation 2: Establish a structure of collaborative decision-making at the state and the
local level with one state agency taking the lead to facilitate a State Level Steering Committee
that will ensure coordination of Home Visiting services at the state and local level.
The Home Visiting Task Force recommends that the agency to fulfill the lead agency role have
an early childhood system building focus, and ideally will have as its mission early childhood
development, health and school readiness.
A) State Level Early Childhood Home Visiting Steering Committee would recommend
policies that support collaboration, foster joint decision making, leverage public and
private resources, and assure quality standards are met. The Steering Committee would
be comprised of state and local government agencies providing and/or funding home
visiting services, providers of home visiting services, and private funders of home visiting
services.
B) At the local level, service planning and delivery across local agencies would address but
not be limited to: 1) common, jointly funded strategies for outreach, 2) collaborative
assessment and referral to the most appropriate provider agency, and 3) sharing of
information and practice knowledge across providers.
C) Areas of priority development for the State Level Early Childhood Home Visiting Steering
Committee are:
Assure high quality home visiting services by defining statewide minimum
professional qualifications, training, and practice standards, obtaining commitment to
those standards, assuring fidelity to the requirements of evidence based home visiting
models, and implementing training and technical assistance options.
Establishment of minimum home visitor qualifications, work force development and
practice standards provides a quality foundation for all Arizona home visiting
programs. This foundation creates an opportunity to support the development of
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innovative approaches to home visiting while assuring quality, based on evidence
based practices. See Appendix E for a proposed set of standard qualifications that
every home visitor should meet regardless of the program model.
Establish a system of continuous quality improvement including ongoing review and
assessment of system-wide results and the development and implementation of
system-wide recommendations for quality improvement.
Commitment to a system of continuous quality improvement by all agencies /
organizations funding and providing home visiting services is essential to achieve the
full potential of home visiting services for children and families. The Home Visiting
Steering Committee, in partnership with community stakeholders would establish core
standards of practice, a monitoring protocol for use by all providers and guidelines for
evaluation.
Establish a research agenda to ensure ongoing research is conducted about the
effectiveness of home visiting programs in Arizona.
To ensure maximum use of resources for home visiting services, ongoing research
must be planned and funded. The research plan and agenda must be: a.) inclusive
of interagency collaboration, b) systematic and intentional in its allocation of
resources to priority research topics, and c.) specific in its methods to integrate
national and Arizona based research into practice.
Implement a public awareness program designed to inform the community about the
value and benefits of family support services, including home visitation.
As clear as the evidence is with regard to the benefits to families and young children
of high quality home visiting services, the information is not widely known among the
public, policy makers, practitioners and families with young children.
Implement a collaborative effort to increase funding for a quality home visiting
continuum through the identification multiple funding opportunities including federal,
state and the philanthropic community and through a coordinated effort to access
those opportunities.
Arizona will be better positioned to respond to and successfully access future funding
opportunities through a collaborative approach which promotes statewide priorities,
provides access to the most current and accurate information to support funding
applications and clearly demonstrates a planned and intentional approach to family
support throughout the State.

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GOALS & OBJECTIVES
To implement the Home Visiting recommendations, goals, objectives and possible strategies
have been defined that provide the next steps to achieving a statewide, collaborative network of
high quality early childhood home visiting services.

Goal I: To provide the right services for the right family at the right time
through collaboration.
Objective 1.1: By June 2011, a detailed community and state (multi level) system design is
defined.
Strategies:
a. Establish agreed upon standards, definitions and expectations.
b. Establish a coordinated access, screening, and assessment system for early
identification of strengths, critical issues, families’ goals and risks.
c. Develop marketing that is inclusive of all family support programs – not just home
visiting.
d. Establish a system for shared information and data.
Objective 1.2: By January 2012, policy, practice standards, training and technical assistance
methods for a coordinated system of service delivery are implemented.
Strategies:
a. Establish an on-line, comprehensive directory of home visiting services. Provide the
ability for all providers with internet access to update their own information in order to
maintain current, specific information about Arizona home visiting services.
b. Secure the commitment from partners / agencies to the collaborative process.
c. Establish confidentiality agreements based on applicable Federal and state
requirements.
d. Implement joint local planning to establish the collaborative process and facilitate
access to services for families at the local level.
e. Consider establishing a co-op model of agencies.

Goal II: To provide high quality home visiting services which are accessible in
all geographic areas of Arizona.
Objective 2.1: By January 2013, increase by 10% the capacity to provide home visiting services
for families with children birth through age five in the geographic areas of rural Arizona that are
most underserved.
Strategies:
a. Establish a multi-year timetable based on geographic and service intensity level needed.
b. Develop a model to determine which geographic areas are the highest priority for
enhancing home visiting services based on the number of current programs and risk
factors in the communities.
c. Identify priority geographic areas, assess capacity, and develop a fund development
plan to support the expansion.
d. Establish a universal application – consider lessons learned in other home visiting
practices. Build on Healthy E application process.
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e. Conduct outreach through individual contact and with materials printed in the primary
language of the families in that community.
1. Define outreach strategies that are culturally relevant to engaging families in the
priority communities.
2. Provide information about accessing services through community organizations such
as Family Resource Centers, churches, food banks, parks and recreation centers,
child care homes and centers, Head Start Programs, Chapter Houses in Tribal
communities,
3. For families most at risk, provide information through WIC and DES eligibility offices
4. Engage the private sector in providing information about accessing services.
Objective 2.2: By January 2013, increase by 20% enrollment in home visiting services of
pregnant women who have not accessed prenatal care in the first trimester of their pregnancy.
Strategies:
a. Conduct Outreach at OB/GYN offices, mid wives, high schools, twitter/web sites / social
media, family planning clinics, community based pregnancy centers, resource centers,
libraries, community colleges, and GED course locations.
b. Establish the process of engagement, screening and family assessment (assessment
tool that is not program specific).
Objective 2.3: By January 2015, 50% of all families with infants are offered home visiting
services. (50% would be approximately 50,000 newborns per year).
Strategies:
a. Establish a collaborative process of screening, referral and engagement to appropriate
programs.
b. Focus on high risk newborns first, through the public health system.
c. Connect families to home visiting services at the hospital at the time of birth by
conducting screening and assessment while the family is in the hospital.
d. Add home visiting to the hospital discharge check list.
e. Establish multiple points of contact for families in the medical community including but
not limited to at hospitals at the time of birth, pediatricians, community health clinics,
midwives, and medical homes.

Goal III: To provide home visiting services that demonstrate adherence to
quality standards.
Objective 3.1: By June 2011, establish the ongoing system for assuring continuous quality
improvement throughout the home visiting service system.
Strategies:
a. Implement core standards of practice.
b. Ensure the standards are consistent with the Early Learning Standards.
c. Provide access to training for home visiting staff in the standards of practice.
d. Establish the protocol for quality monitoring and the implementation structure for quality
assurance.

Objective 3.2: By January 2012, implement a system of workforce development based on core
competencies, training standards, and current practice research.
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Strategies:
a. Explore options for providing and assuring core competencies are met.
b. Establish a system for training and technical assistance using multiple options for
delivery.
c. Through partnerships and collaboration develop methods to provide mentoring and
technical assistance to individuals and organizations new to the home visiting field.
Objective 3.3: By January 2013, establish a broad based statewide evaluation plan to assess
goal achievement on an ongoing basis across home visiting services and programs.
Strategies:
a. Engage current Arizona evaluation and research experts in the definition of the
evaluation plan.
b. Define a multi-year strategy for ongoing evaluation in which all home visiting providers
participate.
c. Determine priority research needs.
d. Identify possible costs and explore funding options for ongoing evaluation of programs
and research.
Objective 3.4: By June 2013, 80% of home visiting programs demonstrate adherence to core10
quality standards.
Strategies:
a. Establish ―Quality Standards Alliance‖ with a regional foundation.
b. Develop and adopt Core Practice Standards including intake, triage, and quality
assurance.
c. Provide training on core standards.
d. Monitor quality assurance of core standards.
e. Establish criteria for being a member of the Alliance based on adherence to quality
standards and a timeline for implementation of the criteria

Goal IV: Arizonans value and invest in “supporting” parents.
Objective 4:1: By January 2013, increase the public’s awareness of the importance of early
learning and the benefits of home visiting services as demonstrated by an increase in the
number of families voluntarily accessing home visiting services.
Strategies:
a. Develop, fund and implement social marketing campaign.
b. Incorporate messages into the FTF Communication Plan.
c. Develop consistent messaging that can be used by all programs, anywhere in the state.
d. Secure private funding for Spanish messaging, and ensure that message is culturally
appropriate and in relevant media outlets.
e. Identify a ―champion‖ public spokesperson.
f. Establish an Interagency public policy advocacy effort lead by an Arizona Advocacy
Organization to obtain support for home visiting.

10

―Core Standards‖ references standards applicable to all home visiting programs. Based on the home visiting
program model, there may be additional standards that are required.

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Objective 4.2: By January 2013 and each year thereafter, increase funding invested in home
visiting services for pregnant women and families with children from birth through age five by
5% per year.
Strategies:
a. Advocate at local, state, and federal level for family support revenue.
b. Apply for grant resources as state or multi-program collaborations. Create a central
source of current information to support grant writing efforts. (For discussion - describe
this.)
c. Recruit and secure major contributor(s), including
d. A family support champion.
e. Research and secure fee based (i.e. marriage license, birth certificates, etc.) revenue for
family support.
f. Create a cadre of "alumni‖ of home visiting services to promote and speak on behalf of
the benefits of home visiting.
g. Establish a fund development position to raise funding collaboratively to be used to
support implementation of the priorities in the plan.
h. On an ongoing basis, publish, and distribute evaluation information on progress /
outcomes for children and families through home visiting efforts.

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APPENDICES

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Appendix A: Home Visiting Task Force Membership
Amy Corriveau
Deputy Associate Superintendent
Early Childhood Education
Head Start State Collaboration Director
Arizona Department of Education

Judy Krysik, Ph.D.
Associate Professor
Arizona State University

Chris Scarpati
CEO
Child Crisis Center

Judy Walruff
Senior Policy Specialist, Interagency
Coordinator FTF – AzECDH Board
Early Childhood Division – Policy & Research

Colleen Day, MSW
Program Manager
Maricopa County Health Department
Office of Family Health

K. Vilay
Senior Policy Specialist – Family Support
FTF – AzECDH Board
Early Childhood Division - Policy & Research

Connie Mitchell, ACSW, LCSW
Director
Arizona Partnership for Children LLP (AzPaC)

Karen Bulkeley, MSW
Manager
DES - Office of Prevention & Family Support

DeAnn Davies
Director, Early Childhood Development
Healthy Steps for Young Children
Scottsdale Healthcare, Community Health

Karie Taylor
Arizona Early Intervention Program (AzEIP)
Arizona Department of Economic Security

Dee Ann Barber, ACSW, LCSW
Senior Vice President & Chief Operating
Officer
Arizona Children’s Association

Kim Metz
Director
The Parent Connection

Ginger Ward
CEO/Development Department
Southwest Human Development

LaVonne Douville
Vice President, Community Development
United Way of Tucson and Southern Arizona

Joan Katz
Coordinator
Sunnyside Unified School District
Parents as Teachers (PAT)

Mary Ellen Cunningham, M.P.A., R.N.
Chief
Arizona Department of Health Services
Bureau of Women’s Health
Division for Children

Joan Miles
Education Specialist for Title I
and Migrant Education
Arizona Department of Education

Mary Haluska
Education Program Specialist
Arizona Department of Education

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Melanie O’Neil
President
Arizona Head Start Association

Rebecca Ruffner
Executive Director
Prevent Child Abuse Arizona

Melissa Webb
Center Manager
Northland Pioneer College
Springerville/Eagar Center

Steve Lazere
Interagency Coordinator
Arizona Department of Health Services
Division of Behavioral Health Services

Michelle Katona
Assistant Director
FTF – AzECDH Board
Early Childhood Division – Regional Councils

Susan Fender
Home Visitor Director
Arizona Head Start Association

Molly Dries Bright, M.S.
Arizona Early Intervention Program (AzEIP)
Arizona Department of Economic Security

Susie Huhn
Executive Director
Casa de los Niño’s

Patty Merk, Ph.D.
Family and Youth Agent
Maricopa County Cooperative Extension

Toni Means
Office Chief, Arizona Department of Health
Services, Bureau of Women’s and Children’s
Health, Office of Women’s Health

Pauline Haas-Vaughn
Program Manager
Child & Families, Inc.
Healthy Families Arizona

Wendy Sabatini
Regional Manager
FTF – AzECDH Board
Early Childhood Division – Regional Councils

Linda Cannon
Facilitator
Linda Cannon & Associates, Inc.

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Appendix B: Examples and Descriptions of Home Visiting Programs in Arizona
The list below includes programs identified as being provided in Arizona at the time of this
report. Included are programs that represent models of evidence based practice, have
demonstrated positive results from local evaluations, include some elements of national
evidence based practice and/or may be in the program development stage of implementation.11
Arizona Early Intervention program (AzEIP) –is the statewide interagency system of early
intervention for families and their children, birth to three years old, with disabilities or
developmental delays. AzEIP and its contracted providers conduct timely, comprehensive,
multidisciplinary evaluations of each child, birth through age two, who is referred to them. This
evaluation must include a family-directed identification of the needs of each child's family to
appropriately assist in the development of the child. Early Intervention happens in places where
children and families live, learn, and play; the families’ natural environments—most often their
home. AzEIP is governed by the federal Individuals with Disabilities Education Act (IDEA), Part
C. Children eligible for AzEIP, as defined by state law, must be between birth and 36 months old
and be developmentally delayed – defined as a child who has not reached 50 percent of their
developmental milestones expected at her/his chronological age in one or more of the following
areas: cognitive development; physical development, including vision and hearing,
communication development; social or emotional development; self-help/adaptive development.
Children may also qualify for AzEIP if they have a defined, established medical condition that
creates a high probability of developmental delay.
Bright Start, a program of Arizona’s Children Association (AzCA), is an early childhood home
visitation program which utilizes brain development training and activities to support parents in
promoting optimal development of their infants and young children. The cornerstone of the
Bright Start in-home model for families with children birth to age five is the S.T.E.P.S. to Early
Brain DevelopmentSM curriculum of New Directions Institute, a partner agency of AzCA,
targeting five critical developmental areas: Security, Touch, Eyes (vision), Play, and Sound.
The Bright Start program includes individualized training utilizing the S.T.E.P.S. curriculum of
New Directions Institute and incorporates in-home support visits for families. This home
visitation program provides hands-on opportunities for parents and caregivers to work with their
young children to help them develop healthy learning patterns, reaching their maximum learning
potential by the time they enter school. Activities introduced by Bright Start offer families funfilled opportunities to bond with their children. Home visits incorporate many elements of
parent/child interaction around books and learning toys in an age-focused approach that is
infused with simple, understandable messages about the developing young brain. Bright Start
is based on the understanding that the foundational architecture of early learning patterns forms
in a brain during the earliest years and it forms, in large part, as a result of a child’s experiences.
Parents and caregivers can be helped to understand that what they do with young children
matters. Bright Start focuses on teaching parents/caregivers what to do to encourage healthy
brain development.
Building Bright Futures offers a community-based, culturally appropriate family centered
program that provides for child safety, school readiness and the enhanced ability for families to
create a stable and nurturing home environment. Services are delivered to the family through
home visitation. All services to families are free and voluntary.
Choices for Families provides short term (up to one year) case management and in-home
parenting education through the development of individual goals related to parenting, life skills,
health care and self-sufficiency. Services are delivered through weekly or bi-weekly home visits
11

Definitions are from national web sites and local program descriptions in the First Things First Resource Guide.

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as well as through parent/child activity groups. Developmental screenings are also provided for
each enrolled child. The goals of the program are to prevent child abuse and neglect, assist
families in becoming successful parents, and the education of parents on their child’s physical,
emotional, social, intellectual, and language development with a strong emphasis on brain
development. Choices for Families serves pregnant and parenting families with children ages
birth through age five. Source: Home Visitation Resource Guide: Present through June 30,
2010 – First Things First Regional Partnerships Councils
Choices for Teens provides a continuum of services both in the home and in a facility,
individually and in groups for pregnant and parenting teens. The services are delivered through
ongoing case management on a weekly to twice-monthly basis, with the primary goal of
preventing child abuse and neglect. The program meets this goal by assisting teens in
becoming successful parents; providing education on their child’s physical, emotional, social,
intellectual, and language development; offering support and guidance for life goals such as
self-sufficiency and job readiness, family planning; information and referral to other agencies,
and obtaining health care. Pregnant and Parenting Teens, ages 21 years and younger whose
children are birth through age 5 and reside in Yuma County. Source: Home Visitation Resource
Guide: Present through June 30, 2010 – First Things First Regional Partnerships Councils.
Early Head Start: The goal of this home-based option is to enhance children's physical, social,
emotional, and mental development; enable parents to be better caregivers and teachers to
their children, and to help parents meet their own goals, including economic independence. The
program:
Provides early, individualized child development and parent education services to lowincome families with infants and toddlers according to a plan developed jointly by the
parents and staff
Provides these services through an appropriate mix of home visits and experiences at
the Early Head Start center
Provides opportunities for infants and toddlers with and without disabilities to grow and
develop together in nurturing and inclusive settings
Ensures that the Early Head Start program is supportive and nurturing to families
Responds to the needs of families, including, where appropriate, the need for child care
while families attend school or work
Connects with other service providers at the local level to ensure that a comprehensive
array of health, nutrition, and other services is provided to the program's pregnant
women, very young children, and their families
Recruits, trains, and supervises high quality staff, ensuring the kind of warm and
continuous relationships between caregivers and children that are crucial to learning and
development for infants and toddlers
Ensures parent involvement in policy and decision making
Coordinates with local Head Start and other child development programs in order to
ensure continuity of services for these children and families
Family and Child Education Program (FACE) in Tribal Communities - The FACE program
was created in 1990 by the Bureau of Indian Affairs (now the Bureau of Indian Education) within
the Office of Indian Education Programs to develop an integrated model for an American Indian
early childhood/parental involvement program. The program was designed to serve (1) birth-toage five children and their parents, providing early childhood education and adult education —
including academic and parenting services - in home- and center-based settings; and (2)
children in grades K-3, providing opportunities for active learning.
(www.famlit.org/educators/advocacy-and-policy/bills-acts/face)

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Health Start utilizes community health workers to provide education, support, and advocacy
services to pregnant/postpartum women and their families in targeted communities across the
state. The community health workers live in and reflect the ethnic, cultural and socioeconomic
characteristics of the communities they serve. Families receive home visits and case
management with oversight by nurses and social workers, through the enrolled child’s second
year of life. Pregnant women are connected to prenatal care providers and receive on-going
education about fetal development and health behaviors that can impact birth outcomes.
Mothers are screened for post partum depression and receive information regarding
interconception health. Clients are referred to various services as needed and assistance with
accessing those services. The community health workers educate parents about child
development, immunizations, home safety and vehicle safety. The community health workers
also screen each child on a periodic basis using the Ages and Stages Questionnaire to identify
potential developmental delays and refer the family to the appropriate provider. Health Start
community health workers acquire new skills and knowledge on an on-going basis to ensure
they are providing the most accurate information.
Source: http://www.azdhs.gov/phs/owch/healthstart.htm
Healthy Families Arizona is a national program model designed to help expectant and new
parents get their children off to a healthy start. Families participate voluntarily in the program
and receive home visiting and referrals from trained staff. By providing services to families,
Healthy Families America fits into the continuum of services provided to families in many
communities. (www.healthyfamiliesamerica.org). See also the description of Healthy Families
on page 2 of this report.
Healthy Start provides maternal, well woman and infant case management throughout
pregnancy and during the first two years of the baby’s life. Home visits are conducted before,
during and after pregnancy and provide assessment and screening, family development
planning, care and service coordination along with emotional and social support for the mother
and her family. Healthy Start provides individualized, one-on-one, small group and communitybased perinatal health classes (including preconception focus), male involvement activities,
referrals for prenatal, well woman and infant care, checkups and screenings and links women
and families to community resources for job and educational assistance and training, WIC
(healthy foods for mom and her baby), Early Head Start and Head Start, smoking and other
substance cessation interventions, immunizations, family planning, food, housing,transportation,
child care and counseling services.
Healthy Steps - Healthy Steps is an evidence based program using a team approach to
primary health care for children ages birth through age three. A professional staff member,
called a Healthy Steps Specialist, whose background in child development, nursing, or social
work is complemented by Healthy Steps training and is a member of the health care team who
provides an effective link between the family and the pediatric and family practice. The Healthy
Steps Specialist can be a current member or a new addition to the practice team. Healthy
Steps offers the flexibility to customize the following services to best serve their families:
Home visits offered at birth and at key developmental stages
Well-child visits with a clinician and Healthy Steps Specialist
A dedicated parent telephone information line
Child development and family health check-ups
English- and Spanish-language written materials on topics such as toilet training,
discipline, and nutrition
Age-appropriate books for mothers and fathers to read to their children
Parent support groups
Linkage to community resources and referrals
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High Risk Perinatal / Newborn Intensive Care – has the goal of reducing maternal and infant
mortality and morbidity utilizing the following strategies:
Early identification of women and children at high risk for mortality and morbidity;
Education for health professionals, families and communities;
Linkage of infants, toddlers and pregnant women to risk appropriate services and
Establishing standards of care.
The Community Health Nurse facilitates the transition of the child and family from the Newborn
Intensive Care Unit to their home and community. Periodic monitoring of the child’s medical and
developmental needs identifies infants who would benefit from referral to other early intervention
programs. Through these home visits, the family receives support and education as well as
referral to appropriate community resources.
Home Instruction for Parents of Preschool Youngsters (HIPPY) is a parent involvement,
school readiness program that helps parents prepare their three, four, and five year old children
for success in school and beyond by providing a curriculum of books and materials designed to
strengthen their children’s cognitive development, early literacy skills, social/emotional and
physical development. By empowering parents as primary educators of their children at home
and fostering parental involvement in school and community life, HIPPY is designed to
maximize the chances of successful early experiences, literacy and school readiness. To
accomplish these goals, the program brings families, organizations and communities together
and removes any barriers to family participation such as the lack of financial resources.
(www.hippyusa.org)
Migrant Education Program – Preschool Home Visits - The Migrant Education Program
(Title I Part C) defines a migratory child as ―a child who is, or whose parent or spouse is a
migratory agricultural worker, including a migratory dairy worker, or a migratory fisher, and who,
in the preceding 36 months, in order to obtain, or accompany such parent or spouse, in order to
obtain, temporary or seasonal employment in agricultural or fishing workIn Arizona, there are six (6) counties in which migrant labor is concentrated. These counties are
Maricopa, Pinal, La Paz, Pima and Cochise, with the largest population of migrants in Yuma
County. The Local Education Agencies (LEAs) are responsible for the identification and
recruitment of migrant families, including those with preschool-age children. In Arizona, the
education needs of migratory children are met by either enrolling the child in an LEA’s
established preschool program or by participating in the Migrant Preschool Home Visiting
Program. In the Migrant Preschool Home Visiting Program, Migrant Liaisons employed by the
LEAs make a minimum of nine preschool/school readiness home visits to the Migrant families.
During these visits, the Migrant Liaisons prepare preschoolers and their families for kindergarten
and provide information relating to other education, health, nutrition, and social services.
Nurse-Family Partnership® (NFP) helps change the lives of vulnerable first-time mothers and
their babies through ongoing home visits from registered nurses. This evidence-based
community health program has proven results including long-term family improvements in
health, education and economic self-sufficiency. While helping low-income families, an
investment in Nurse-Family Partnership saves communities more than it costs by reducing
welfare, health care and juvenile justice expenditures. See page 2 for additional description.
Nurse Home Visiting for Infants and Toddlers in Foster Care provides a nurse home visitor
to monitor the growth and development of the foster child; working in partnership with other
healthcare providers to ensure that needed services are identified and provided in a timely
manner; providing information and support to foster parents who may not have sufficient
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knowledge to deal appropriately with the emotional and physical health needs of an abused
infant or toddler.
Parenting Arizona Home Visitation Program promotes health and development and improves
school readiness for children age five or younger. The program is designed to teach child
development, child health, effective parenting techniques and provide linkage to community
resources. Services are provided until the child turns 5 years of age.
Parents as Teachers Born to Learn® (PAT) is an early childhood family education and
support program serving families throughout pregnancy until their child enters kindergarten. The
teachers are the parents, supported by professional educators who suggest ways they can
effectively teach and nurture their young children. Certified parent educators with a strong
background in early childhood development use a research-based curriculum to provide age
appropriate information to parents and help them lay a strong foundation for school and life
success. The goals of the program are: 1) to promote school readiness and improve academic
achievement 2) Increase parent knowledge of child development and appropriate ways to
stimulate their child’s intellectual, language, social, motor development and literacy skills,
promoting the importance of reading to children from birth 3) Enhancing parent-child interaction
and strengthening family relationships 4) early detection of developmental problems in order to
prevent reading and learning difficulties once the child enters school 5) Parents As Teachers
increases a child’s school readiness and success, improves parenting practices and provides
early detection of developmental delays and health issues. Parents As Teachers educators
achieve these goals by providing monthly/bimonthly home visits, group meetings, Stay and Play
programs for parents and children together, developmental screenings, hearing and vision
screening, bimonthly library/story hour, evening programs for fathers, and connecting families
with community resources. The Parents As Teachers Born to Learn curriculum is based on
current research in the areas of neuroscience and child development.
Raising Healthy Kids – Casa de los Niño’s in partnership with Easter Seals Blake Foundation.
A Community Health Specialist/home visitor will provide support for child/children with special
health care needs, including those with a broad range of developmental delays and/or medical
challenges such as spina bifida, congenital heart defects, cancer, traumatic brain injury, cystic
fibrosis, failure to thrive, or children with significant behavioral issues. This program also
provides information and activities on child development, as well as facilitation and support to
access community resources based on family identified needs. Source: Home Visitation
Resource Guide: Present through June 30, 2010 – First Things First Regional Partnerships
Councils
Verde Valley Parenting Partnership provides tools for coping, problem-solving, stress
management, life skills and home management skills with a goal of family self-sufficiency.
Home visits begin prenatally or immediately after birth. Child development is assessed at
regular intervals starting at 4 months of age.

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Appendix C: Arizona Population and Risk Factor Tables
Table 1 - Arizona Population by County
County
Apache
Cochise
Coconino
Gila
Graham
Greenlee
La Paz
Maricopa

% of Population
Change
2000-2008
1%
9.3%
10.2%
1.6%
8.7%
-6.3%
2.3%
27.7%

County
Mohave
Navajo
Pima
Pinal
Santa Cruz
Yavapai
Yuma
Arizona

% of Population
Change
2000-2008
25.7%
15.2%
19.3%
80.6%
11.4%
27.6%
20.9%
25%

Source: US Census Bureau, Population Estimates

Table 2 - Births in Arizona 2006 - 2009

Total State
Apache
Cochise
Coconino
Gila
Graham
Greenlee
La Paz
Maricopa
Mohave
Navajo
Pima
Pinal
Santa Cruz
Yavapai
Yuma
Unknown

2006 Total
Births
102,042
1,189
1,808
2,062
667
540
110
229
66,160
2,468
1,877
13,929
4,467
753
2,380
3,354

2007 Total
Births
102,687
1,149
1,860
2,132
694
582
138
230
65,931
2,439
2,012
13,798
5,285
766
2,411
3,252

2008 Total
Births
99,215
1,211
1,781
1,985
697
644
131
246
62,667
2,301
1,944
13,503
5,731
796
2,216
3,362

2009 Total
births
92,244
1,196
1,844
1,861
704
645
130
175
57,662
1,948
1,882
12,835
5,306
760
2,060
3,235
1

Source: Arizona Department of Health Services, Vital Statistics, Provisional Number of Births by County, Data as of
January 12, 2010.

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Page 40

Table 3: Births by Mothers Race / Ethnicity

Total State
Apache
Cochise
Coconino
Gila
Graham
Greenlee
La Paz
Maricopa
Mohave
Navajo
Pima
Pinal
Santa Cruz
Yavapai
Yuma
Unknown

White nonHispanic
39,504
174
911
861
297
348
57
99
24,645
1,357
631
5,040
2,892
58
1,439
695
0

Black or
African
American

American
Indian or
Alaska
Native

38,367
47
760
204
169
189
66
45
24,952
446
146
6,146
1,612
693
524
2,367
1

4,379
3
83
17
1
5
2
0
3,359
31
9
552
246
1
10
60
0

6,116
953
16
728
230
98
3
30
1,835
70
1,066
594
386
4
59
44
0

Asian
or
Pacific
Islande
r
3,396
6
53
36
4
3
2
1
2,592
32
19
419
149
3
17
60
0

Other

State /
County

Hispanic
or
Latino

120
2
15
1
1
0
0
0
78
3
1
12
3
0
1
3
0

Unknown

Arizona Births 2009 By Mother's Race/Ethnicity

362
11
6
14
2
2
0
0
201
9
10
72
18
1
10
6
0

Source: Arizona Department of Health Services, Vital Statistics, Provisional Number of Births by County, Data as of
January 12, 2010.

Table 4 - Low-Birth Weight Babies by County
Arizona Births 2009
Percent of Low Birth Weight Births By County
Total births
2009
Total State
Apache
Cochise
Coconino
Gila
Graham
Greenlee
La Paz
Maricopa
Mohave
Navajo
Pima

92,244
1,196
1,844
1,861
704
645
130
175
57,662
1,948
1,882
12,835

LBW births
(<2,500
grams at
birth)
6,548
87
152
151
55
46
7
9
4,111
121
148
894

The Vision for Home Visiting Services in Arizona 2010 - 2015

% of all
births
7.1%
7.3%
8.2%
8.1%
7.8%
7.1%
5.4%
5.1%
7.1%
6.2%
7.9%
7.0%
Page 41

Arizona Births 2009
Percent of Low Birth Weight Births By County
Total births
2009
Pinal
Santa Cruz
Yavapai
Yuma
Unknown

5,306
760
2,060
3,235
1

LBW births
(<2,500
grams at
birth)
353
73
153
188
0

% of all
births
6.7%
9.6%
7.4%
5.8%

Source: Arizona Department of Health Services, Vital Statistics, Provisional Number of Births by
County, Data as of January 12, 2010.

Table 5 - Births to Arizona Teen Parents – 2009

State / County
Arizona
Apache
Cochise
Coconino
Gila
Graham
Greenlee
La Paz
Maricopa
Mohave
Navajo
Pima
Pinal
Santa Cruz
Yavapai
Yuma
Unknown

2009 Total
Births

Mother 19 years
or younger

92,244
1,196
1,844
1,861
704
645
130
175
57,662
1,948
1,882
12,835
5,306
760
2,060
3,235
1

% of All Births

10,936
202
256
248
150
110
29
31
6,251
298
339
1,525
560
113
287
537

11.9%
16.9%
13.9%
13.3%
21.3%
17.5%
22.3%
17.7%
10.8%
15.3%
18.0%
11.9%
10.6%
14.9%
13.9%
16.6%
0

Source: Arizona Department of Health Services, Vital Records, December 2009

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Table 6 - Poverty: Single Parents Below Poverty

Single Parents Below Poverty Level with Child Age 5 & under 2008
% of all parents
% of all parents
County
Number
County
Number
in poverty
in poverty
Apache
Cochise
Coconino
Gila
Graham
La Paz
Maricopa

1,391
1,880
1,457
886
581
365
39,856

16%
24%
23%
31%
25%
25%
22%

Mohave
Navajo
Pima
Pinal
Santa Cruz
Yavapai
Yuma

2,432
1,392
11,710
3,613
375
2,122
3,459

27%
14%
24%
25%
11%
27%
22%

Source: U.S. Census 2008 Population Estimates

Table 7 - Child Abuse and Neglect - Number of Reports Received by Risk Level; April 1,
2009 – September 30, 2009
County
Apache
Cochise
Coconino
Gila
Graham
Greenlee
La Paz
Maricopa
Mohave
Navajo
Pima
Pinal
Santa Cruz
Yavapai
Yuma
Statewide
Percent of Total

High

Moderate

Low

Potential

Total

11
51
53
11
14
2
3
1,424
78
40
365
153
0
45
47
2,297
14.2%

25
141
111
22
37
6
12
3,006
174
80
939
308
0
164
111
5,136
31.9%

32
202
157
38
33
7
17
4,052
263
109
1,244
405
2
220
161
6,942
43.0%

7
42
42
9
13
1
3
1,024
39
24
325
136
1
51
42
1,759
10.9%

75
436
363
80
97
16
35
9,506
554
253
2,873
1,002
3
480
361
16,134
100%

% of
Total
0.5%
2.7%
2.3%
0.5%
0.6%
0.1%
0.2%
58.9%
3.4%
1.6%
17.8%
6.2%
<0.1%
3.0%
2.2%
100%

Source: Arizona Department of Economic Security, Child Welfare Reporting Requirements, Semi Annual Reports for
April 2009 – September 2009.

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Table 8 - Child Fatality 2007 – 2008 by County
Deaths Among Children by Arizona County of Residence
2007-2008
County
Number
Percent
Number
Apache
13
1%
20
Cochise
27
2%
24
Coconino
25
2%
21
Gila
17
1%
15
Graham
12
1%
11
Greenlee
0
1
La Paz
1
>1%
5
Maricopa
648
57%
577
Mohave
27
2%
11
Navajo
39
3%
30
Pima
148
13%
165
Pinal
64
6%
52
Santa Cruz
6
>1%
6
Yavapai
28
2%
17
Yuma
35
3%
39
Outside Arizona
53
54%
44
Total
1,143
1,038

Percent
2%
2%
2%
1%
1%
>1%
56%
1%
3%
16%
5%
>1%
2%
4%
4%

Among Children by County of Residence, Arizona 2007-2008

Table 9 - Infant Mortalityxxv

State / County

Infant Mortality By County of Residence, Arizona
2000-2006
2000
2001
2002
2003
2004

2005

2006

Arizona

568

587

552

586

622

653

642

Apache

16

8

6

6

12

14

6

Cochise
Coconino

11
16

12
6

13
13

19
11

13
14

19
14

17
10

Gila

6

4

8

6

6

7

3

Graham
Greenlee

1
0

4
1

6
1

2
0

1
1

3
1

2
0

La Paz
Maricopa

3
356

2
371

1
361

2
369

2
396

1
383

1
406

Mohave

16

12

9

21

16

27

18

Navajo

11

10

7

15

12

17

9

Pima

76

92

90

84

99

109

100

Pinal

25

21

16

19

20

30

29

3

2

4

1

7

4

4

Yavapai

12

14

9

8

6

10

19

Yuma
Unknown

16
0

25
3

8
0

23
0

17
0

14
0

18
0

Santa Cruz

Source: ADHS http://www.azdhs.gov/plan/report/ahs/ahs2006/pdf/text_infants.pdf)

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Table 10 - Families Below Poverty Levels By County and Family Characteristics – Estimates by County
Navajo

Pima

Pinal

Santa
Cruz

Yavapai

40,998
22.3%

32,881
29.8%

231,254
21.2%

73,782
19.3%

13,066
25.2%

40,515
19.7%

53,318
29.1%

184,944

9,154

9,805

48,991

14,211

3,291

7,997

15,529

353

73,398

2,694

4,652

15,689

5,363

1,759

2,525

5,942

258
26

53
28

27,398
4,998

1,058
191

1,189
138

4,352
897

1,653
210

177
167

778
65

1,769
445

624

299

272

41,002

1,445

3,325

10,440

3,500

1,415

1,682

3,728

4,921

1,961

1,703

1,099

111,546

6,460

5,153

33,302

8,848

1,532

5,472

9,587

692

378

95

142

169

16,715

586

1,100

4,615

1,103

288

611

678

133
8
439

198
39
455

84
37
257

21
0
74

63
0
79

61
28
80

6,208
1,040
9,467

94
88
404

443
0
657

1,975
251
2,389

230
151
722

122
23
143

403
0
208

223
14
441

3,945

4,187

4,543

1,866

1,561

930

94,831

5,874

4,053

28,687

7,745

1,244

4,861

8,909

1,286
105

1,587
293

1,077
380

833
53

455
126

286
79

34,094
5,762

1,917
515

1,244
148

10,098
1,612

3,114
499

357
18

1,970
152

3,105
354

Apache

Cochise

Coconino

Gila

Graham

La Paz

Maricopa

21,184
41.4%

30,684
25.1%

32,260
20.0%

11,893
25.4%

8,949
25.5%

3,585
40.5%

1,035,952
17.9%

8,770

7,714

6,476

2,896

2,286

1,452

In marriedcouple family:

4,245

2,835

1,555

935

583

Under 5 years
5 years

1,051
336

563
132

632
39

229
82

6 to 17 years

2,858

2,140

884

In other family:
Male
householder,
no wife
present:

4,525

4,879

580

Under 5 years
5 years
6 to 17 years
Female
householder,
no husband
present:
Under 5 years
5 years

Total:
% in Poverty
Income in the
past 12
months below
poverty level:

Mohave

6 to 17 years
2,554
2,307
3,086
980
980
565
54,975
3,442
2,661
16,977
4,132
869
2,739
Source: U. S. Census B17006. POVERTY STATUS IN THE PAST 12 MONTHS OF RELATED CHILDREN UNDER 18 YEARS BY FAMILY TYPE BY AGE OF RELATED
CHILDREN UNDER 18 YEARS - Universe: RELATED CHILDREN UNDER 18 YEARS Data Set: 2006-2008 American Community Survey 3-Year Estimates Survey:
American Community Survey

The Vision for Home Visiting Services in Arizona 2010 - 2015

Page 45

Yuma

5,450

Table 11 - Immunization Rates by County – 12-24 Months

County

Apache
Cochise
Coconino
Gila
Graham
Greenlee
La Paz
Maricopa
Mohave
Navajo
Pima
Pinal
Santa Cruz
Yavapai
Yuma

Number of
Children

Completed
Vaccine
Series

Completed
%

1,275
1,832
1,799
453
361
94
151
59,652
1,738
2,297
14,473
5,418
556
1,207
2,819

1,150
1,253
1,539
233
213
58
115
38,975
1,154
1,887
9,241
3,671
356
709
2,106

90.2%
68.4%
85.5%
51.4%
59%
61.7%
76.2%
65%
66.4%
82.2%
63.9%
67.8%
64%
58.7%
74.7%

Source: ADHS, Office of Women’s and Children’s Health, May 2010
About the Data
3:2:2:2 completion series for the 12-24 month olds. This is 3 DTaP, 2 Polio, 2 Hib, and 2 Hepatitis B vaccines
Any zip code that had a denominator of less than 20 was suppressed.
Any zip code that indicated multiple counties designations were assigned to the county in which the denominator was greater.
7/1/08 - 6/30/09 for the 12 – 24 month olds for the 2009 table, yet looked at vaccines that were administered from birth through 12/31/2009.
ASIIS data is information that is reported to the registry by the providers. Although there is a state statute requiring vaccine reporting, it is our assumption that
not all vaccines are captured.
Denominators are greater than reality, as there may be a considerable number of records not identified as ―no longer active‖. Unless there are indications that
a child has died or has moved out of Arizona, they are not deleted from our queries.
There can be multiple records for one child, with different vaccines reported, therefore any one record would be considered as incomplete in a vaccination
series.
Address data used was the last reported address. Not all children had their zip codes reported to ASIIS. Invalid and out of state zip codes were not counted.

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Table 12 - Language by Linguistic Isolation by County - Estimates

Total:
English
Spanish:
Linguistically
isolated
Not linguistically
isolated
Other IndoEuropean
languages:
Linguistically
isolated
Not linguistically
isolated
Asian and Pacific
Island languages:
Linguistically
isolated
Not linguistically
isolated
Other languages:
Linguistically
isolated
Not linguistically
isolated
Number
Linguistically
Isolated
% Linguistically
Isolated

Apache

Cochise

Coconino

18,425
4,635
1,691

47,829
33,683
11,556

44,530
31,595
4,319

31

2,931

1,660

Gila

Graham

Maricopa

Mohave

Navajo

Pima

Pinal

Yavapai

Yuma

18,795
14,980
2,653

10,829
7,691
2,112

1,338,048
995,184
253,461

75,010
65,569
6,811

35,104
19,907
2,959

371,799
264,766
83,614

110,631
82,801
22,739

86,555
76,279
6,983

69,432
38,989
28,802

693

404

248

84,770

1,206

500

16,141

4,212

1,897

8,256

8,625

3,626

2,249

1,864

168,691

5,605

2,459

67,473

18,527

5,086

20,546

266

1,304

780

132

66

46,987

1,534

322

11,681

2,202

2,320

655

0

85

41

6

0

6,565

166

0

1,255

68

203

48

266

1,219

739

126

66

40,422

1,368

322

10,426

2,134

2,117

607

74

1,094

495

53

106

27,946

677

87

7,476

1,306

431

740

0

120

89

0

10

6,407

47

0

2,074

110

23

122

74
11,759

974
192

406
7,341

53
977

96
854

21,539
14,470

630
419

87
11,829

5,402
4,262

1,196
1,583

408
542

618
246

1,842

15

1,147

0

0

2,342

84

1,530

544

32

20

15

9,917

177

6,194

977

854

12,128

335

10,299

3,718

1,551

522

231

1,873

3,151

1,970

410

258

100,084

1,503

2,030

20,014

4,422

2,143

8,441

10.2%

6.6%

4.4%

2.2%

2.4%

7.5%

2.0%

5.8%

5.4%

3.9%

2.5%

12.2%

B16002. HOUSEHOLD LANGUAGE BY LINGUISTIC ISOLATION - Universe: HOUSEHOLDS Data Set: 2006-2008 American Community Survey 3-Year Estimates,
Survey: American Community Survey; Source: U.S. Census Bureau, 2006-2008 American Community SurveyTable 13: Unemployment Rates February

2010
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ARIZONA UNEMPLOYMENT STATISTICS PROGRAM
Special Unemployment Report 2010
County
Apache County
Apache County less Native American Reservations

Feb-10
17.1%
6.6%

Cochise County

8.4%

Coconino County
Coconino County less Native American Reservations

9.4%
6.5%

Gila County
Gila County less Native American Reservations

11.9%
8.9%

Graham County
Graham County less Native American Reservations

15.0%
11.6%

Greenlee County

12.7%

La Paz County
La Paz County less Native American Reservations

9.7%
8.0%

Maricopa County
Maricopa County less Native American Reservations

9.1%
9.0%

Mohave County
Mohave County less Native American Reservations

11.2%
11.0%

Navajo County
Navajo County less Native American Reservations

16.2%
8.8%

Pima County
Pima County less Native American Reservations

8.9%
8.7%

Pinal County
Pinal County less Native American Reservations

12.2%
11.3%

Santa Cruz County

15.2%

Yavapai County
Yavapai County less Native American Reservations

10.4%
10.4%

Yuma County
Yuma County less Native American Reservations

19.9%
19.9%

Source: http://www.workforce.az.gov/admin/uploadedPublications/SpecRates2000+.xls

The Vision for Home Visiting Services in Arizona 2010 - 2015

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Appendix D: Risk Factors by County
Ruth – Add % or #
State /
County

% of All
Az.
Children
< Age
Five

Cochise
Coconino
Gila
Graham
Greenlee
La Paz
Maricopa
Mohave
Navajo
Pima
Pinal
Santa Cruz
Yavapai
Yuma

% of
LBW

% of
Families
Below
Poverty

9.5%

11.9%

7.1%

19.8%

1.2%

17.1%

16.9%

7.3%

41.4%

16%

90.2%

0.5%

2%

<1%

10.2%

1.8%

8.4%

13.9%

8.2%

25.1%

24%

68.4%

2.7%

2%

2.6%

6.6%

2%

9.4%

13.3%

8.1%

20.0%

23%

85.5%

2.3%

2%

1.6%

4.4%

.7%

11.9%

21.3%

7.8%

25.4%

31%

51.4%

0.5%

1%

<1%

2.2%

.5%

15.0%

17.5%

7.1%

25.5%

25%

59.0%

0.6%

1%

<1%

2.4%

.2%

12.7%

22.3%

5.4%

Not
Available

Not
Available

61.7%

0.1%

0

0

Not
Available

.2%

9.7%

17.7%

5.1%

40.5%

25%

76.2%

0.2%

>1%

<1%

64.9%

9.1%

10.8%

7.1%

17.9%

22%

65.0%

58.9%

56%

63.2%

Not
Available
7.5%

2.4%

11.2%

15.3%

6.2%

22.3%

27%

66.4%

3.4%

1%

2.8%

2.0%

1.8%

16.2%

18.0%

7.9%

29.8%

14%

82.2%

1.6%

3%

1.4%

5.8%

13.7%

8.9%

11.9%

7.0%

21.2%

24%

63.9%

17.8%

16%

15.6%

5.4%

4.7%

12.2%

10.6%

6.7%

19.3%

25%

67.8%

6.2%

5%

4.5%

3.9%

.5%

15.2%

14.9%

9.6%

25.2%

11%

64.0%

<0.1%

>1%

<1%

2.3%

10.4%

13.9%

7.4%

19.7%

27%

58.7%

3.0%

2%

2.9%

Not
Available
2.5%

3.3%

19.9%

16.6%

5.8%

29.1%

22%

74.7%

2.2%

4%

2.8%

12.2%

The Vision for Home Visiting Services in Arizona 2010 - 2015

% of Single
Parents
Below
Poverty

% of
Immunizations
Complete
12-24 mo.
66.6%

% of
Teen
Births

Arizona
Apache

%
Unemploy
ment

% of Child
Abuse
Reports

% of Child
Fatalities

% Infant
Mortality
2006

%
Linguis tically
Isolated

642

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Appendix E: Proposed Standard Home Visitor Qualifications and Training
Requirements
Standard Home Visitor Qualifications and Training Requirements
Minimum Staff Qualifications
Regardless of the model of home visiting that is implemented, all home visitors need to meet the
following minimum staff Qualifications
Educational requirements specific to the home visiting model
Relevant experience can be substituted for educational requirement
Knows the community
Ability to communicate in language of families served
Fingerprint clearance
An understanding and appreciation of the history and traditions of diverse cultures – cultural,
linguistic, geographic, racial and ethnic diversity of the population served.
Possesses personal characteristics such as non-judgmental, compassionate, ability to
establish a trusting relationship.
Minimum Training Requirements
CPR / First Aid training specific to infants and children
All service providers should receive basic training in areas such as cultural competency,
substance abuse, reporting child abuse, domestic violence, drug exposed infants and services
in their community
Service providers should receive intensive training specific to their role to understand the
essential components of family assessment and home visitation (i.e. identifying at risk families,
completing a standardized risk assessment, offering services and making referrals, promoting
use of preventive health care, securing medical homes, emphasizing the importance of
immunizations, utilizing creative outreach efforts, establishing and maintain trust with families,
building upon family strengths, developing an individual family support plan, observing parentchild interactions, determining the safety of the home, teaching parent-child interaction,
managing crisis situations, etc. (Healthy Families)
Communication
Confidentiality
Personal safety
Child development
Managing crisis situation
Brain development
Building on family strength
Safe home assessment
Cultural responsiveness
Language/Literacy Development
Minimum Training – Establish an understanding of the following:
Health care
o Pre-natal
o Medical home
Community resources
Nutrition
Family engagement
Professional boundaries
Understanding Other Systems of care
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Standard Home Visitor Qualifications and Training Requirements
Behavioral Health Services
Division of Developmental Disabilities
Arizona Early Intervention
AHCCCS
Child Protective Services
Supervision
Caseload – weighted to intensity (Consider Supervisor / Staff ratio)
Supervision – Set minimum Standards / Add Reflective Supervision Training
Supervised home visiting – mentoring

END NOTES
i

Family Violence Prevention Fund, AVON Foundation for Women, Safe Start, Realizing the Promise of
Home Visitation: Addressing Domestic Violence and Child Maltreatment; p. 7
ii

Embedding Home Visitation Programs within a System of Early Childhood Services. Daro, Deborah.
Chapin Hall at the University of Chicago. September 2009.
iii

Nurse Family Partnership, Research Evidence; nursefamilypartnership.org

Child and Family Policy Center. April 4, 2009. Thirst to Learn Dialogue Paper: Building an Early Childhood
Development System for America’s Future.
iv

v

Family Violence Prevention Fund, AVON Foundation for Women, Safe Start, Realizing the Promise of
Home Visitation: Addressing Domestic Violence and Child Maltreatment; p. 17
vi

Response to Intervention and the Pyramid Model. Fox, L, Carta, et. al. University of South Florida, Technical
Assistance Center on Social Emotional Intervention for Young Children; www.challengingbehavior.org. 2009.
vii

U.S. Census Bureau, American Fact Finder, ACS Demographic and Housing Estimates: 2006-2008.

viii

Arizona Department of Health Services, Vital Statistics, Provisional Number of Births by County, Data as of
January 12, 2010.
ix

Arizona Department of Health Services, Vital Statistics, Provisional Number of Births by County, Data as of January
12, 2010.
x

http://www.marchofdimes.com/professionals/14332_1159.asp

xi

ADHS http://www.azdhs.gov/plan/report/ahs/ahs2006/pdf/text_infants.pdf)

xii

Child and Adolescent Health Measurement Initiative, 2007 National Survey of Children's Health, Data
Resource Center for Child and Adolescent Health website. Retrieved June 18, 2009 from
www.nschdata.org)
xiii

2007 National Survey of Children's Health

xiv

http://www.childtrends.org/Files//Child_Trends-2009_04_07_RB_ChildreninPoverty.pdf

xv

Arizona Department of Health Services, Vital Records, Births By Mothers Age Group and Community,
Arizona 2008 and Selected Characteristics of Newborns and Mothers by Community, Arizona 2008;
www.ADHS.vitalrecords.

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xvi

U. S. Census B17006. Poverty Status in the Past 12 Months of Related Children Under 18 Years by
Family Type, by Age of related Children under 18 Years- Universe: Related Children Under 18 Years
Data Set: 2006-2008 American Community Survey 3-Year Estimates Survey: American Community
Survey.
xvii

Overall Physical/Mental Health Status: National Survey of Children’s Health, Data Resource Center;
http://nschdata.org/DataQuery.aspx
xviii

The National Survey of Children’s Health is conducted every four years and is based on a sample of
information from parents across the country. All responses are parent responses to the survey. The
current survey is from 2007. All data are State level.
xix

Overall Physical/Mental Health Status: National Survey of Children’s Health, Data Resource Center;
http://nschdata.org/DataQuery.aspx
xx

National Health and Nutrition Examination Survey (NHANES)
http://www.cdc.gov/obesity/childhood/index.html).
xxi

(http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5828a1.htm)

xxii

(http://www.cdc.gov/obesity/childhood/index.html)

xxiii

Arizona Department of Health Services, ASIS, December 2009

xxiv

Arizona Department of Economic Security, Child Welfare Reporting Requirements, Semi Annual Reports for April
2009 – September 2009.
xxv

ADHS http://www.azdhs.gov/plan/report/ahs/ahs2006/pdf/text_infants.pdf)

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