Project Description and Overview

The Maternal and Child Health Bureau’s (MCHB) Division of Home Visiting and Early Childhood Systems has launched a Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN) through a three-year cooperative agreement with Education Development Center, Inc. (EDC).

The Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN), is the first national initiative using the Institute for Healthcare Improvement’s  Breakthrough Series Model to close the gap and improve critical outcomes for families.  The HV CoIIN brings together teams from local home visiting service agencies across 11 states, and one non-profit grantee to seek collaborative learning, rapid testing for improvement, sharing of best practices and building of QI capacity.

The Health Resources and Services Administration, in cooperative agreement with Education Development Center, is working to close the gap and improve outcomes for families targeting four program outcomes: (1) improve rates of initiation and duration of exclusive breastfeeding, (2) improve promotion, early detection and early intervention of developmental risk and delay (3) improve screening, referral, access to treatment and symptoms for maternal depression, and (4) improve family engagement and retention. 

The HV CoIIN provides working technical documents developed by faculty experts and stakeholders that establish a common vision and mission for each of the topic areas.

First, for each topic a charter was developed which clearly identifies the gap between what we know works and what is happening on the ground, the SMART AIM that the collaborative is trying to accomplish, process aims and accompanying measures, and roles and expectations of participation.  Each team signs the charter. The charters for the Year 4 Scale-up are below:

The HV CoIIN uses the Model for Improvement to conduct small tests of change (known as Plan-Do- Study-Act cycles) to adapt evidence-based practices to the local context of participating agencies. The collaborative tracks individual agency and overall progress of the HV CoIIN using standardized outcomes and process measures for each target area. Each agency reports on these measures monthly as they test and adapt the recommended changes.

The specific aims by topic area are:

  • Breastfeeding Topic Aim:  30% of infants will be fed exclusively breastmilk at 3 months and 15% at 6 months
  • Developmental Promotion, Early Detection and Intervention Aim:  80% of children with developmental or behavioral concerns will receive assessment and intervention in a timely manner
  • Maternal Depression Aim:  85% of women who screen positive for depression and access services will report improvement in symptoms 
  • Family Engagement Aim:  85% of enrolled families will receive 100% of expected home visits

List of current AIMS and measures for 2016

Year 4 Toolkits

To guide testing and adapting evidence-based practices by local agencies, the HV CoIIN staff, faculty, improvement advisors and stakeholders have developed toolkits for each topic area based on the learning and accomplishments of local implementing agencies (LIAs) participating in the first two phases of the CoIIN from May 2014 to August 2016. These toolkits consist of refined Key Driver Diagrams (KDDs), instructions for collecting and understanding data, and change packages.

The KDDs offer a theory of change and provide a mechanism to direct the improvement work by laying out the aim, primary drivers (i.e., what needs to be in place to accomplish the aim), and the change ideas (i.e., how those primary drivers might be put in place). Teams then select which of these change ideas might work in their particular contexts, and design Plan-Do-Study-Act (PDSA) cycles to test those changes and drive improvement. The Change Packages provide examples of successful tests of change conducted by other LIAs and sample tools and resources for teams to adapt. To measure progress and inform testing, the toolkits include a data collection file with automated run charts and sample data registries; an instructions document with operational definitions for each measure; a cheat sheet listing the measures, numerators and denominators; and an orientation powerpoint mapping the measures with the Key Driver Diagram.

To see the Toolkits by Topic Area:

For more information contact Project Director, Mary Mackrain at mmackrain@edc.org or for more information on the HV CoIIN structure and outcomes see:

HV CoIIN Summary Document

HV CoIIN Leadership Team

Project Sponsor:
David Willis, Director of the Division of Home Visiting and Early Childhood Systems

Project Officer:
Monique Fountain Hanna, Medical Officer, Division of Home Visiting and Early Childhood Systems

Project Director:
Mary Mackrain, Project Director, Education Development Center, Inc.

Improvement Advisor:
MaryCatherine Arbour, Associate Physician for Research, Division of Global Health Equity, Brigham and Women’s Hospital

Improvement Advisor:
Karen Zeribi

Faculty Chair:
Jon Korfmacher, Associate Professor, Erikson Institute


This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UF4MC26525, Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.