The Tennessee Department of Health is making data accessible and telling powerful stories to create longitudinal change through its section devoted to Early Childhood Initiatives in the Division of Family Health and Wellness.
Infancy and early childhood are critical life-stages in safeguarding the long-term health and well-being of an individual. In fact, maximizing the well-being of a child starts even before birth. Expectant families and young children who benefit from early intervention programs—like those focused on breastfeeding, safe sleep education, or partner violence and depression screenings — are better positioned for the future.
Located in Nashville, Tenn., the Tennessee Department of Health’s (TDH) section focused on Early Childhood Initiatives (ECI), in the Division of Family Health and Wellness (FHW), is committed to ensuring the highest level of protection and prosperity for the state’s youngest citizens and their caregivers. Within FHW, TDH facilitates programs in Maternal and Child Health, Special Supplemental Nutrition, and Chronic Disease and Health Promotion.
ECI employs three different evidence-based home visiting (EBHV) models – Healthy Families America (HFA), Parents as Teachers (PAT), and Nurse Family Partnership (NFP) – delivered through the field work of different local implementing agencies (LIAs). These models address physiological, social, psychological, economic, family, and other factors influencing child health and development. These models are evidence-based so they are built on the importance of using concrete data for effective decision-making.
EBHV empowers and teaches new mothers in their journey of motherhood, focusing on underserved families and children and following evidence-based approaches. EBHV programs are in all 95 Tennessee counties and are provided through networks of local and regional health departments, nonprofit organizations, and hospitals. ECI functions as the grantee state agency and provides oversight of funded programs. Joana Rosales, ECI clinical applications coordinator and epidemiologist, and her team work closely with funders and grantees to carry out the mission of the programs and ensure reporting requirements are met. ECI held a competitive procurement process to identify a statewide data system to help the section improve access to data and better document the work of the EBHV programs.
ECI is the central administrator of the Healthy Families America (HFA) multi-site state system. Joana explained, “This requires a statewide database where we capture key information so we can serve families.”
Additionally, Joana and her ECI colleagues manage several concurrent and complex relationships across three different EBHV models, in 95 counties, with multiple local and federal funders. This has introduced the need for a high level of intricacy in tracking communication and data across multiple programs and agencies.
Large amounts of data exchanged between home visitors, program directors, funders, and state agencies equated to time-intensive tasks and a lot of unstandardized data. Accessibility and intuitiveness were some of the team’s priorities when evaluating different case management solutions. The ECI team knew they could improve care with better accessibility for program personnel, and with a user-friendly, configurable platform, Joana also knew her team could maintain a better understanding of the needs of families.
ECI had been using a free and extremely basic system. Joana and her colleagues were pulling manually-constructed reports using Excel, which drained time and resources for LIAs required to enter their collected data in the ECI tool. Some LIAs also maintained Excel spreadsheets with additional model-required data or entered information into LIA-specific databases. Some of the data going into these other platforms meant duplicating efforts. Additionally, different versions of the spreadsheets existed, making efficiency and standardization needed that much more.
Following its procurement effort, ECI selected Social Solutions’ case management software, Apricot, to address the challenges and improve access to data across all the EBHV models. Joana and her ECI colleagues currently are in the deployment phase with Apricot and according to Joana, “Social Solutions has worked in the space we’re in right now. Having the company’s experience will be helpful to us as we get into the HFA state official role.”
ECI will use Apricot to drive innovation using a single, unified system of care for EBHV in Tennessee. ECI will also consolidate and modernize its data collection on all fronts. The team envisions, and expects, to make huge improvements in their interactions with constituents and families throughout Tennessee. “My goals are to get users more access to data, to use that data to drive more of the decisions we make at a state level, and to better understand how programs are serving families,” Joana said.
Social Solutions has a high level of configuration and, according to Joana, this was a compelling differentiator. The case management software allows endless configuration of data entry screens data is easily captured for each model.
Other components such as intake forms, goal plans, and targeted variables can be configured for each program or each individual client within the platform. “ECI partners always had concerns around data entry,” Joana said, “And they couldn’t really do anything about it. Once Apricot is fully deployed, they will be able to improve data entry.”
The depth of Social Solutions’ experience with the curriculum models ECI supports is another appealing factor of the company. This experience is beneficial in the onboarding process, according to Joana. Deeper understanding exists in the type of work EBHV does, and this means Social Solutions is always willing to answer questions the ECI team has along the way. Social Solutions provides endless proof points, references, and referrals, which she said is reassuring as implementation continues.
“They have truly researched and made themselves fully aware of what we’re dealing with,” Joana said. “When the Apricot team asks us questions, it is to facilitate getting us thinking about additional things that we can add. Our time is so efficient because they have that back-end information.”
In the implementation process of Apricot, Joana said TDH has identified duplicate efforts in information collection among different LIAs.
“This is an area that we can talk about and share best practices, learn how each agency is getting the data, and how families are being asked,” Joana said. “We’ve gotten more interaction between the models and the agencies, learned their perspectives, and are talking with each other about Apricot, which helps everyone improve.”
After the selection of Social Solutions, the onboarding began. Sidekick, the implementation partner of Social Solutions, was especially outstanding and impactful to this team. Sidekick works with new and existing Social Solutions customers to set up and streamline their software with a range of services, from onboarding and implementation to data migration, audits, cleanups, and results reporting. Joana emphasized how exceptional Sidekick is in lending help, in understanding, and in utilizing the case management solution to its full potential.
“Sidekick Solutions clearly communicates every step of the way and explains precisely what they’re going to do, what they need, and what the process looks like getting there, so it’s very helpful to me. If we ask them for something they don’t say, ‘no.’ They always find a way to help us and make things happen,” Joana explained.
A single, EBHV case management system in Tennessee will give much-needed visibility into a wide range of data. Both ECI and LIA users now will be able to access and manipulate data directly, leading to more effectively connecting the dots between gaps in care and resources, needs and efficiencies, the quality of care and improved outcomes, language barriers, and much more. Managing data in real time will allow ECI to address gaps quickly.
Once implemented, ECI will be able to track longitudinal outcomes that will make a big difference for Tennessee families, potentially up to adding programs that will serve the community in new and exciting ways.
ECI uses collaborative meetings to bring together all LIA staff to share best practices and keep everyone up-to-date. The ECI team envisions adding topics and subjects to these meetings and incorporating discussions based on cohesive, real-time data from Apricot. Having standardized data across all of the agencies gives ECI more confidence in identifying which agencies serve the
most people in the best ways. In particular, it is expected that better data will empower ECI to discern best practices across the different agencies and care models.
Joana explained the usage of Apricot is intended to address feedback from home visiting providers about data entry which has the potential to positively change the way things are done for everyone. There are 15 agencies across Tennessee that are either large or extremely small. Some counties have only one home visitor while others have 10. So, each agency functions differently. The data collected in Apricot will allow Joana and her team to discern different methodologies across different regions.
In addition to agency size, the demographic landscape is also diverse between agencies. Some operate in very rural settings and others serve more metropolitan residents. Some have a higher percentage of non-English speakers than others. Visibility into how these different groups are served will help ECI drive best practices across the state.
Once Apricot is fully deployed, home visiting providers anticipate more efficiency.
“We are building Apricot to merge different, identified models into one data entry platform. This reduces the data entry for home visitors because we’re only asking them to enter it once,” Joana said. “Because the data is all in one place, we can pull it for funders, and LIAs can pull it for their model by only inputting data once.”
The buildout process is also providing the ECI team with a deeper comprehension of how the different EBHV models work. Once deployed, Joana expects Apricot to help her colleagues and team better interpret the data they receive, make more informed decisions, and more effectively report to funders.
Apricot will enable ECI staff to see how model requirements interact with funder requirements, and how they can merge and view the two within the platform. For example, if multiple agencies or models are collecting the same forms, ECI can use Apricot to compare data, identify best practices, and stimulate discussion around common pain points or unmet needs across the state.
Joana said she spends a lot of time downloading data from ECI’s free data entry tool, correcting code from quarter-to-quarter, updating code, and manually imputing numbers into Excel spreadsheets, often because this is how funders like these reports submitted.
However, Apricot will be able to present data in real time giving ECI the ability to aggregate relevant data on a constant, rolling basis throughout a given month. This will eliminate the need to devote hours to generating reports when, within minutes, reports can be created at any time. Additionally, the ECI team will be able to generate reports across different projects and make more accurate comparisons between agencies quickly and easily.
A comprehensive case management system also frees up time so staff at nonprofit and public sector organizations staff can serve more people.
According to Joana, there are agencies within EBHV with dedicated positions for data collection, migration, entry, auditing, and cleanup. With Apricot’s implementation, staff in these positions could potentially shift to other roles that improve the efficiency and overall effect on serving families. Joana believes LIAs that do not have an agency-specific case management system will benefit the most from improvements made possible by Apricot.
Visualizing data quickly and easily is one of the ECI team’s biggest, initial hopes. Also, they want Apricot to guide LIAs better with data-backed best practices so LIAs identify gaps and the resources needed. While ECI isn’t directly responsible for enrollment, intake, or coordinating care, it does have a responsibility to ensure the right programs are available to constituents, and that programs are doing the work efficiently and effectively.
Once Apricot is fully-deployed, ECI expects more accessible data will allow staff to tell powerful stories to create longitudinal change. With this move to Apricot, ECI plans to consolidate further and modernize data collection from partner agencies; and, therefore improve how they communicate and advocate on behalf of the state to funders. This is a huge leap forward in improving the way ECI interacts with its constituents and families throughout Tennessee.
|_biz_flagsA||1 year||A Cloudflare cookie set to record users’ settings as well as for authentication and analytics.|
|_biz_pendingA||1 year||A Cloudflare cookie set to record users’ settings as well as for authentication and analytics.|
|_biz_sid||30 minutes||This cookie is set by Bizible, to store the user's session id.|
|ARRAffinity||session||ARRAffinity cookie is set by Azure app service, and allows the service to choose the right instance established by a user to deliver subsequent requests made by that user.|
|ARRAffinitySameSite||session||This cookie is set by Windows Azure cloud, and is used for load balancing to make sure the visitor page requests are routed to the same server in any browsing session.|
|BIGipServerab09web-nginx-app_https||session||This cookie is associated with a computer network load balancer by the website host to ensure requests are routed to the correct endpoint and required sessions are managed.|
|cookielawinfo-checbox-analytics||11 months||This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics".|
|cookielawinfo-checbox-functional||11 months||The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".|
|cookielawinfo-checbox-others||11 months||This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.|
|cookielawinfo-checkbox-advertisement||1 year||Set by the GDPR Cookie Consent plugin, this cookie is used to record the user consent for the cookies in the "Advertisement" category .|
|cookielawinfo-checkbox-necessary||11 months||This cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".|
|cookielawinfo-checkbox-performance||11 months||This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".|
|CookieLawInfoConsent||1 year||Records the default button state of the corresponding category & the status of CCPA. It works only in coordination with the primary cookie.|
|__atuvc||1 year 1 month||AddThis sets this cookie to ensure that the updated count is seen when one shares a page and returns to it, before the share count cache is updated.|
|__atuvs||30 minutes||AddThis sets this cookie to ensure that the updated count is seen when one shares a page and returns to it, before the share count cache is updated.|
|__cf_bm||30 minutes||This cookie, set by Cloudflare, is used to support Cloudflare Bot Management.|
|_biz_nA||1 year||This cookie, set by Bizible, is a sequence number that Bizible includes for all requests, for internal diagnostics purposes.|
|_biz_uid||1 year||This cookie is set by Bizible, to store user id on the current domain.|
|bcookie||1 year||LinkedIn sets this cookie from LinkedIn share buttons and ad tags to recognize browser ID.|
|lang||session||LinkedIn sets this cookie to remember a user's language setting.|
|lidc||1 day||LinkedIn sets the lidc cookie to facilitate data center selection.|
|UserMatchHistory||1 month||LinkedIn sets this cookie for LinkedIn Ads ID syncing.|
|_gaexp||2 months 10 days 10 hours||Google Analytics installs this cookie to determine a user's inclusion in an experiment and the expiry of experiments a user has been included in.|
|_uetsid||1 day||Bing Ads sets this cookie to engage with a user that has previously visited the website.|
|_uetvid||1 year 24 days||Bing Ads sets this cookie to engage with a user that has previously visited the website.|
|SRM_B||1 year 24 days||Used by Microsoft Advertising as a unique ID for visitors.|
|_BUID||1 year||This cookie, set by Bizible, is a universal user id to identify the same user across multiple clients’ domains.|
|_ga||2 years||The _ga cookie, installed by Google Analytics, calculates visitor, session and campaign data and also keeps track of site usage for the site's analytics report. The cookie stores information anonymously and assigns a randomly generated number to recognize unique visitors.|
|_ga_33YSH1JFFW||2 years||This cookie is installed by Google Analytics.|
|_gcl_au||3 months||Provided by Google Tag Manager to experiment advertisement efficiency of websites using their services.|
|_gd_session||4 hours||This cookie is used for collecting information on users visit to the website. It collects data such as total number of visits, average time spent on the website and the pages loaded.|
|_gd_visitor||2 years||This cookie is used for collecting information on the users visit such as number of visits, average time spent on the website and the pages loaded for displaying targeted ads.|
|_gid||1 day||Installed by Google Analytics, _gid cookie stores information on how visitors use a website, while also creating an analytics report of the website's performance. Some of the data that are collected include the number of visitors, their source, and the pages they visit anonymously.|
|_hjAbsoluteSessionInProgress||30 minutes||Hotjar sets this cookie to detect the first pageview session of a user. This is a True/False flag set by the cookie.|
|_hjFirstSeen||30 minutes||Hotjar sets this cookie to identify a new user’s first session. It stores a true/false value, indicating whether it was the first time Hotjar saw this user.|
|_hjIncludedInPageviewSample||2 minutes||Hotjar sets this cookie to know whether a user is included in the data sampling defined by the site's pageview limit.|
|_hjIncludedInSessionSample||2 minutes||Hotjar sets this cookie to know whether a user is included in the data sampling defined by the site's daily session limit.|
|_hjTLDTest||session||To determine the most generic cookie path that has to be used instead of the page hostname, Hotjar sets the _hjTLDTest cookie to store different URL substring alternatives until it fails.|
|at-rand||never||AddThis sets this cookie to track page visits, sources of traffic and share counts.|
|CONSENT||2 years||YouTube sets this cookie via embedded youtube-videos and registers anonymous statistical data.|
|undefined||never||Wistia sets this cookie to collect data on visitor interaction with the website's video-content, to make the website's video-content more relevant for the visitor.|
|uvc||1 year 1 month||Set by addthis.com to determine the usage of addthis.com service.|
|_fbp||3 months||This cookie is set by Facebook to display advertisements when either on Facebook or on a digital platform powered by Facebook advertising, after visiting the website.|
|_mkto_trk||2 years||This cookie, provided by Marketo, has information (such as a unique user ID) that is used to track the user's site usage. The cookies set by Marketo are readable only by Marketo.|
|ANONCHK||10 minutes||The ANONCHK cookie, set by Bing, is used to store a user's session ID and also verify the clicks from ads on the Bing search engine. The cookie helps in reporting and personalization as well.|
|fr||3 months||Facebook sets this cookie to show relevant advertisements to users by tracking user behaviour across the web, on sites that have Facebook pixel or Facebook social plugin.|
|loc||1 year 1 month||AddThis sets this geolocation cookie to help understand the location of users who share the information.|
|MUID||1 year 24 days||Bing sets this cookie to recognize unique web browsers visiting Microsoft sites. This cookie is used for advertising, site analytics, and other operations.|
|test_cookie||15 minutes||The test_cookie is set by doubleclick.net and is used to determine if the user's browser supports cookies.|
|VISITOR_INFO1_LIVE||5 months 27 days||A cookie set by YouTube to measure bandwidth that determines whether the user gets the new or old player interface.|
|YSC||session||YSC cookie is set by Youtube and is used to track the views of embedded videos on Youtube pages.|
|yt-remote-connected-devices||never||YouTube sets this cookie to store the video preferences of the user using embedded YouTube video.|
|yt-remote-device-id||never||YouTube sets this cookie to store the video preferences of the user using embedded YouTube video.|
|_an_uid||7 days||No description available.|
|_clck||1 year||No description|
|_clsk||1 day||No description|
|_dc_gtm_UA-718299-1||1 minute||No description|
|_hjSession_2602456||30 minutes||No description|
|_hjSessionUser_2602456||1 year||No description|
|6suuid||2 years||No description available.|
|AnalyticsSyncHistory||1 month||No description|
|CLID||1 year||No description|
|d-a8e6||1 year||No description available.|
|dpi_test||1 day||No description|
|dpi_utmOrigVals||5 months 27 days||No description|
|intercom-id-rbb6qelf||8 months 26 days 1 hour||No description|
|intercom-session-rbb6qelf||7 days||No description|
|li_gc||5 months 27 days||No description|
|loglevel||never||No description available.|
|referrer||session||No description available.|
|s-9da4||15 minutes||No description available.|
|SM||session||No description available.|
|xtc||1 year 1 month||No description|