The document discusses guidelines and best practices for conducting home visits as a community health worker. It covers preparing for home visits, assessing safety, conducting assessments of clients' home environments, providing services like health education and counseling, and addressing common challenges. The goal of home visits is to directly support clients in their homes and communities.

1. Ch. 11 Home Visiting

2. What You Will Learn
 Define home visiting and provide examples of when and why
they are conducted
 Prepare for home visits
 Identify key safety concerns and plan for ways to address
them
 Discuss what to do (and what not to do) when you arrive at a
client’s home
 Conduct a subtle assessment of the home environment, and
explain why this is important
 Identify and respond to common challenges related to home
visiting

3. An Overview of Home Visiting
 Home visiting involves meeting with clients where they
live.
 Could be an apartment, home, trailer, single-room
occupancy (SRO) hotel, a shelter, jail, homeless
encampment, on the streets, in the park etc.
 Home visiting is one of the most direct and personal
ways to work with clients

4. Why Make Home Visits
 To visit clients who are unable to come to your office
 To follow up with clients who recently received services from your program
 To contact clients who have not kept in touch, to see whether they are all
right and interested in participating in services again
 To see clients who have recently experienced a decline in health
 Because family members or friends of a client contact you out of concern
for the client and ask you to visit that person

5. Why Make Home Visits continued
 To encourage clients to come to your agency for important services that
cannot be delivered at their homes
 To support new parents or guardians
 To enable clients to assess their home environments and possible health
risks, such as exposure to mold, dust, or other allergens that cause
asthma
 To provide support and guidance to clients regarding how to take
medication properly
 To notify clients that they may have been exposed to an infectious
disease and to encourage them to get screened
 To meet with clients who are in the hospital, jail, or other institutions
The Power of Home Visits

6. The Challenges of Home Visiting
 Clients may not want you to visit or may not want to talk with you right then
 Clients may be embarrassed about their living conditions
 Clients may be concerned about their privacy
 Clients may worry that you will judge them if they live in nontraditional families, or
they may have other cultural concerns
 They may worry that you will learn about or expose their immigration status, or worry
that they could lose certain health, housing, or social benefits
 Clients may have had bad experiences with home visits from child welfare, social
workers, the police, or other authorities
 You may witness or learn about drug use, neglect, or abuse
 You may face risks to your personal safety
 Your clients may be very ill or facing death

7. Preparing to Conduct a Home
Visit
 Put yourself in the client’s shoes
 How might it feel for a stranger to come into your home?
 What would you want from the CHW?
 What would you not want them to do, see, or ask?
 Respect a client’s right to privacy-discreet home visits
 Some clients may not want others to know they are
working with you/your agency.
 How do you protect their privacy during home visits?
 Ex. “Hey, Bernadette, good to see you today. Is this a good
time for a visit?”

8. Start Things off Right
 Shadow another CHW
 Observe what they do & how they interact with clients &
their families
 Review and Prepare Clients Files
 Review client files and key strengths, risks, needs, and
other health concerns
 Check to see if referrals were provided
 Bring copies of blank release forms

9. Organize and Pack Resources to Bring
on the Visit
 Your ID badge & business card
 Written info about your agency
 Client files, blank new client files, and other forms
 Copies of any test results that you are authorized to review with the client
 Any medications of tests that your are authorized to bring and administer
 Educational materials to use to explain something more clearly
 Risk-reduction or other health materials such as condoms, lubricants, hygiene kits,
nutritional supplements, food or transportation vouchers etc
 A map, phone or GPS in case you get lost
 A folding chair or stool
 A flashlight
 A cell phone

10. Plan How You Will Travel to the
Client’s Home
 Client’s address
 Landmarks nearby
 Public transportation or parking availability
 Anything you might need to know for your safety
If you have an appointment, try to determine:
 If there is a house, apartment, or room number clearly marked
 If the client has a dog or other pets
 If there is a gate or intercom at the home or building
 Any possible problems you may encounter

11. Identify Key Objects
 Write down what you hope to accomplish during the
home visit
 Don’t set too many goals for a single visit
 You need to be flexible
 Talk with the client to learn their current health status,
needs, and priorities

12. Preparing to Conduct a First Visit to a
New Client
 Obtain informed consent before you conduct an initial
assessment
 Check to see if client has already signed a HIPAA form
 Primary goals are to establish a positive connection with
the client, assess client’s resources and needs, and to
determine whether the person is interested in the
services that you can provide
Conducting Home Visits

13. Preparing for Follow-Up Visits
 Reintroduce yourself and the purpose of your visit
 Review your program’s services
 Answer the client’s questions and concerns
 Obtain informed consent, again, to continue with your visit and to provide services
 Ask what the client remembers about your previous work together
 Review any decisions, agreements, or accomplishments that the client previously made
 Assess their current concerns, needs and priorities
 Establish new goals that the client wants to work on
 Provide health education, client-centered counseling, and referrals
 Bring medications and assist clients with medications management
 Provide additional supplies as needed
 Set a date and time for your next visit

14. Respect the Client’s Time
 Show up on time- let client know if you are running late
 Discuss how much time you both have for the visit
 It is the client’s home, the client’s time, the client’s life
 If you don’t accomplish all of your goals during the visit,
schedule a follow-up

15. Announce and Introduce Yourself
 When you arrive at the client’s home, announce
yourself.
 Use your name but not your agency to protect client’s
identity
 Introduce yourself again
 Be sure to wear proper identification
 If the situation seems uncomfortable, ask the client if
they would like to reschedule

16. Dress for the Occasion
 Wear appropriate clothing- wear something comfortable
but also culturally appropriate
 Find out dress code if you’re visiting someone who is
incarcerated
 Use your own best judgment or ask other CHWs what
they would wear

17. Practice Cultural Humility
 Cultures, values, and traditions of clients and families
will be reflected in their homes
 Many things in their home may be different than what
you are familiar with
 View home visits as an opportunity to learn more about
other cultures
https://www.youtube.com/watch?v=lVZ71undTJ0

18. Speak Clearly
 A calming voice can serve to relax others
 Speak loudly enough for the client to hear you, but not
so loudly that you broadcast private info to others
 Listen carefully to clients- if you can’t hear or
understand what they say, ask them to tell you again

19. Maintain Healthy Boundaries
 Be cautious about disclosing personal information
 If a client asks personal questions that you do not feel
comfortable answering, explain and clarify your role as
a CHW
 Ex. “My role is to be here for you, to support you to
improve your health. I don’t talk about my private life
when I’m at work, because that will distract us-this is your
time.”
 If a client continues to push at your boundaries, you
may have to leave
https://www.youtube.com/watch?v=gBpDwbTsLlE

20. Stay On Topic
 Plan for how you will disengage from conversations that
are taking up too much time
 But, be prepared to do some casual visiting
 Some clients may want to talk for a very long time- this
may be a sign of their isolation and loneliness etc.
 Develop your own way to politely interrupt clients and
remind them of the time and main purpose for the visit

21. Overcoming Distractions
 Media: ask client if it would be possible to turn these off or down so that
you can focus on their needs and concerns
 Pets: if there is a pet such as a large dog that makes you uncomfortable,
ask if it would be possible to put it in another room
 Other people: if other people are a distraction, ask the client if it would
be possible to talk privately
 Drug and alcohol use: do your best to provide the services you are
authorized to provide & be sensitive to informed consent issues. Do not
ask client to make life-changing decisions when high. If client has a
history of being abusive or violent while high, do not attempt to work
under these circumstances
 Cluttering or Hoarding: do not make negative comments about the
clutter or attempt to move anything- this could upset the client. It is
recommended you bring a portable stool to sit on when you conduct
home visits

22. Safety Guidelines for Home Visits
 Be aware of your surroundings
 Don’t let your bias guide or distort the way that you
assess safety risks
 Take time to get to know the community you are
working in
 Listen to your instincts- they may be tipping you off to a
dangerous situation

23. Be Prepared
 Find out as much info as possible about the client you will visit
 Find out what type of housing the client lives in and where
 Find out detailed info about the locations you will be visiting
 Consider working with a partner in communities that have a reputation of being
risky
 Let your supervisor know whom you will be visiting, where you will be going, and
when
 Dress appropriately
 Avoid agency logos or signage on your car, clothing or anywhere else
 Bring a cell phone
 If you will be visiting a client after dark, bring a flashlight

24. Pay Attention, and Be Discreet
 Be discreet when visiting a new location
 Carry yourself with secure body language
 The risks to women are different from those of men- be
aware of these risks, and make good decisions to
preserve your safety
 Be aware of your surroundings
 Be ready to think on your feet

25. If Conflict or Danger Arises
 De-escalate conflict and work to calm the person
involved
 Apologize: you may have unintentionally done
something that provoked that person’s anger
 Leave if you don’t feel safe
 Report and document
 Only call the police if it is absolutely required

26. How to Conduct a Home Visit
 Introduce yourself
 Confirm you are talking to the client
 Be friendly and patient if other family members are
present
 Explain why you are there
 Ask if it is still a good time to visit and discuss what the
client would like to accomplish

27. Conduct and Assessment
During each home visit you will conduct some type of an
assessment, such as:
 A client’s knowledge about and interest in a particular service
 A client’s strengths, risks, and needs in order to develop a risk-
reduction plan
 A client’s current health status and needs for additional services
 Adherence to specific treatments such as taking daily
medications for diabetes or HIV diseases
 A client’s progress with a risk-reduction or case management
plan
 Exposure to environmental health risks

28. Conducting an Environmental
Assessment
You may observe:
 Client’s level of stress at home
 Basic living conditions, including access to clean sheets, clothing, and
resources for hygiene
 Availability of food
 Environmental risks such as mold, dust, insect or rodent issues, or safety
hazards for young children
 The presence or absence of friends, family, roommates, and the quality
of those relationships
 Challenges with mobility within or outside of the home
 Exposure to safety risks such as abuse or neglect

29. Providing Case Management, Client-
Centered Counseling, and Health
Education
 You may provide health education about a specific
condition-like hypertension or heart disease
 This may include assessing their levels of knowledge,
providing info, and supporting them in thinking about
relevant behavior changes
 You may provide client-centered counseling or coaching-
including parenting, domestic violence, or depression

30. Explain the Next Steps
 Clarify and document what the next steps will be
 Plan should address all concerns and priorities that client
discussed with you
 Confirm date and location of next appointment
 Write down plan and leave it for client- if they cannot
read, ask if there is someone who can review it with
them

31. Goodbye and Thank You
 Tell the client goodbye
 Thank them again for their time & hospitality

32. After the Visit
 Complete paperwork documenting the visit, any assessment
conducted, info you learned, services provided, and
agreements made
 Write down future appointments or visits in your planner or
calendar
 Find out info you needed during your visit but did not have,
such as specific resources
 Check in with the client by phone, with a follow-up visit, or
with an appointment at another location
 Talk with your supervisor or another colleague about any
remaining questions or concerns you may have

33. Common Challenges
Visits to People Without Traditional Homes
 Be as respectful of this space as you would any other
home
 If client expresses that they do not want you there,
leave
 Do you best to keep your communication confidential-
keep your voice low
 If others are nearby and may be listening, do not discuss
confidential matters

34. When Clients are Angry
 While their anger may sometimes be about you,
generally it is about other issues they are confronting,
such as experiences of discrimination, violence, mental
health conditions, separation, or conflict with family
members
 Be patient and stay calm
 Stay respectful, professional, and polite
 If client acts in ways that are threatening or physically
aggressive and you cannot de-escalate their anger, leave
immediately

35. Working with Clients Who are
Incarcerated
 Contact the jail to gain security clearance and ask what
to wear
 Assist client in making plans for what to do in the very
first hours and days when they are released
 If clients want to make changes regarding substance
abuse, assist them to figure out what they can do that
will reduce their risks of using
 You may ask them to call you when they know that they
will be released to schedule a time to meet

36. Workbook pg. 25
Motivational Interviewing: “Directive, client-centered
counseling style for eliciting behavior change by assisting clients
to explore and resolve ambivalence”
Doing Client-Centered Work
 Listen carefully to what the client is telling you
 Closely observe the client and his/her surroundings
 Speak less and listen more. Are you dominating the
discussion?
 This does NOT mean that you should always agree with the
client or support everything
WAIT- Why Am I Talking?

37. Workbook pg. 25
Attitudes and Behaviors Used in Motivational Interviewing
Enhance motivation for change:
 Respect
 Empathy
 Being nonjudgmental
 Curiosity
 Genuine interest
 Collaborative spirit
 Emphasis on client’s choice
 Support of client’s autonomy

38. Workbook pg. 25
Promote resistance to change:
 Arguing, coercing, imposing
 Blaming, shaming, criticizing
 Judging, labeling, warning
 Commanding, threatening
 Moralizing, preaching, lecturing
 Assuming the expert role

39. Workbook pg. 25
OARS
Open-ended questions
Affirmations
Reflective listening
Summarizing

40. Open-Ended Questions
 Using open ended questions allows the client to talk
more
 Opportunity for client to talk about feelings, desires,
and fears
 Listen to these answers without judgment- this will
build trust