Improving Home Visiting Practice with the Life Skills Progression™ (LSP)

Improving Home Visiting
Practice with the
Life Skills Progression™
(LSP)
Linda Wollesen, M.A., R.N., LMFT
Director
Life Skills Outcomes, LLC
© 2013 Life Skill Outcomes, LLC

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Purposes of the LSP
 Identify individual parent/child strengths,
needs, progress & regression over time,
across 43 scales
 Case summary for family intervention planning
 Capture family changes over time
 Cohort data for funding, research program
improvement

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Utilization focused evaluation
 Useful to the staff scoring it
 Reflective practice using the LSP increases
the likelihood of improved client and program
outcomes

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LSP measures:
35 parent life skills categories
 Relationships
 Family, Extended family
 FOB, boyfriend, spouse
 Children- Parenting skills
 Home visitor
 Resources

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LSP measures:
 Education & Employment
 Language
 High School & other education
 Employment
 Immigration

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LSP measures:
 Parent & Child Health
 Prenatal
 Parent sick care
 Family Planning
 Child well & sick care
 Immunizations
 Dental care

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LSP measures:
 Mental Health & Substance Use
 Drugs & Alcohol
 Tobacco
 Depression & Mental illness
 Self-esteem
 Cognitive development & learning

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LSP measures:
 Basic Essentials
 Housing
 Food
 Transportation
 Health care coverage
 Income
 Child care

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LSP measures:
 Child Development: Ages 0-5 yrs
 Communication
 Fine & gross motor
 Problem solving
 Personal-social skills
 Social-emotional characteristics
 Regulation
 Breastfeeding

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Developmental Screening
 Child development scales require valid
developmental screening tools
 Ages & Stages Questionnaires®, Third Edition
(ASQ-3™)
 LSP summarizes findings & special
educational outcomes

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Frequency of use
 Intake
 Every 6 months
 Closure
 Scoring takes 5-10 min.
<30 min per year per family

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Validity
 The inter-rater reliability 78-90%
 Content validity confirmed by national experts
and program staff
 Found useful in practice over 10 years
by >75 systems with multiple programs and
individual program sites.

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Training
 8 hrs
 < 40 participants
 On-site training, provided through Brookes on
Location
 Training packet
 Train-the-trainer support
 For more information, visit
www.brookesonlocation.com

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LSP Training Objectives
 Format & terminology
 Scoring judgment & procedures
 Practice scoring anonymous families
 Practice using scored cases for reflective
practice: strengths, needs, progress,
regression
 Complete & interpret cumulative score
sheet on scored family
 Design Reflective Questions for key
issues © 2013 Life Skill Outcomes, LLC

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Target Range
 Each scale has a unique target range
 Target Range = parent/child has adequate or
optimal skill for each scale.
 Target ranges are more useful than means

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Reflective Practice & the LSP
 Reflective Function is the ability
 To THINK about behaviors, feelings, events,
relationships and consequences
 To LINK these to new or needed information
 To choose a purposeful RESPONSE
(Smith & Wollesen, Beginning Guides Handbook
2008)

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Think-Link-Respond
Behaviors
Feelings
Relationships
Events
Consequences
New or Known
Information
Design,
Carry out,
Evaluate,
Modify a Plan of
Action
Think
LinkRespond

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Cumulative Score Sheet
 Used to see an individual parent’s strengths,
needs, progress, regression over time.
 Plan a series of Reflective Questions to
support parent awareness of a strength, a
need or blind-spot
 “Teach by Asking” to support Reflective
Functions which are the core of parenting, of
living.

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Data Management
 Databases available
 Reports
 # & % in target range
 Low Literacy
 Cumulative score sheets
 Multiple sites
 Easy migration to stats programs
 $1500-3000/site
orientation & ongoing support

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MIECHV Benchmarks Crosswalk
 Benchmark
 1. Maternal Newborn Health
 Item 17 Prenatal Care
 Item 24 Substance Use/Abuse
 Item 26 Depression/Suicide
 Item 20 Well Child Care
 Item 23 Immunizations
 Item 43 Breastfeeding

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 2. Child injuries, Abuse, Neglect, ER Visits
 LSP Item 8 Safety
 LSP Item 21 Child Sick Care
 LSP Item 6 Discipline
 Note: Programs must provide official child
abuse reports to document incidence of child
abuse

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 3. School Readiness & Achievement
 LSP Item 4 Attitudes to Pregnancy
 LSP Item 5 Nurturing
 LSP Item 7 Support of Development
 LSP Items 26 & 28 Depression, Self Esteem
 LSP Items 36-40 Child Development w
ASQ
 LSP Items 41-42 Personal Social & Social
Emotional w ASQ-SE

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 4. Crime or Domestic Violence
 LSP Item 1 Family Relationships
 LSP Item 2 Boyfriend, FOB, Spouse
Relationships

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 5. Economic Self-sufficiency
 LSP Item 34 Income
 LSP Items 13-15 Education and
Employment
 LSP Item 33 Medical/Health Insurance

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 6. Coordination and Referral to other
Community Resources and Supports
 LSP Item 10 Use of Information
 LSP Item 11 Use of Resources
 Note: These items measure parent’s skills;
programs must provide referral log data
(program output)

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Research Studies using LSP
 AHRQ, NIH: Home Visitation/FHL 2008-9
 NLM: Home Visitation/FHL & Depression 2011
 NLM: Home Visitation/FHL & Child
Development

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LSP Self-care Literacy Scale
 Managing personal & child health at home
 LSP Item 4 Attitudes to Pregnancy
 LSP Item 7 Support of Development
 LSP Item 8 Safety
 LSP Item 11 Use of Resources
 LSP Item 24 Substance Use/Abuse
 LSP Item 25 Tobacco Use
 LSP Item 28 Self Esteem

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LSP Healthcare Literacy Scale
 Use of information and services for health
 LSP Item 10 Use of Information
 LSP Item 17 Prenatal Care
 LSP Item 18 Parent Sick Care
 LSP Item 19 Family Planning
 LSP Item 20 & 21 Child Well & Sick Care
 LSP Item 22 Child Dental Care
 LSP Item 23 Child Immunizations
 LSP Item 33 Medical/Health Insurance

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Research
 Does Home Visitation Promote Maternal
Health Literacy?
 N = 2572 parents
 Funders:
 Agency for Healthcare Research & Quality
 NIH Office of Behavioral & Social Science Research
 National Institute for Child Health & Human
Development
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Key Findings
 Overall parents achieved significant improvement in
health literacy scores after 12-18 months in home
visitation (P<.001)
 Estimated reading level at baseline predicted entry level
health literacy scores, but did not predict who progressed
or how much.
 Lower functioning parents and those with lower estimated
reading level achieved the greatest gains.
 The LSP can be used to meaningfully measure maternal
health literacy.
 Smith, S. A. (2009). Promoting Health Literacy Concept, Measurement & Intervention. Literacy, 170.
Dissertation. Union Institute and University.
 AHRQ Innovations Exchange: Home Visits Using Reflective Approach Improve Functional Health Literacy
Among Low-Income Pregnant Women and New Parents http://www.innovations.ahrq.gov/content.aspx?id=2533
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Health Literacy & Depression
 N= 750 parents with 4 observations
 Funder: National Library of Medicine through
contract with University of WA
 Findings:
 Health literacy & depression closely related p<.001
 Depression does not interferes with home visitors’
ability to promote health literacy
 Smith, S. A., & Moore, E. J. (November 26, 2011). Health Literacy and Depression
in the Context of Home Visitation. Maternal and Child Health Journal DOI
10.1007/s10995-011-0920- 8
http://www.ncbi.nlm.nih.gov/pubmed/22120425
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Health Literacy & Child Development
 N= 1301 parents with 2+ ASQ
 Funder: National Library of Medicine through a
contract with University of WA
 Health literacy scores predict child
developmental outcomes (p<.001)
 Healthcare literacy scores predict
participation in Early Intervention (p<.001)
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Lessons Learned
 Maternal Health Literacy can be promoted
 Reflective skills key
 Reflective Questioning promising
 LSP meaningful measure
 Home based programs effective channel
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For more information
 www.HealthLiteracyPromotion.com/Research-
Summaries.html
 www.BeginningsGuides.com
 www.LifeSkillsProgression.com
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Key Findings
 Depressed mothers demonstrated lower baseline health
literacy scores than not- depressed parents; however,
they achieved greater gains (P < .001).
 While depression is linked with lower maternal health
literacy, after 1 year of enhanced home visitation,
vulnerable mothers were better able to manage personal
and family health and healthcare.
 Enhanced home visitation could be an effective channel
to develop health literacy as a life skill, and to improve
depression.
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Thanks for joining us!
To order:
www.brookespublishing.com
1-800-638-3775
To learn more:
http://www.brookespublishing.com
/resource-center/screening-and-
assessment/lsp/
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