Since the 1960s, the primary approach to dealing with families-at-risk has been to involve paraprofessionals to effectively deliver education and social service while providing the paraprofessionals employment and training (Pearl & Reisman, 1965). Extension has employed paraprofessionals in the Expanded Food and Nutrition Education Program (EFNEP) and more recently through the Family Nutrition Program (FNP) with great success.

Training has been identified as a critical component to any program that employs paraprofessionals (Larner and Halpern, 1992; Chapman, Seigel & Cross, 1990. Many agencies provide structured initial training and some ongoing inservice training. Some agencies employing outreach workers lack the financial and educational resources to provide staff with quality inservice training. Pre-service training, buddy system of training, field training, on-site interactive, procedural training, and conferences are all methods used. (Giblin, 1989; Price 1995). One day conferences are a valuable tool to educate large numbers of paraprofessionals about a variety of topics. Conferences allow paraprofessionals to network and share ideas with other paraprofessionals and professionals. Workers' self-esteem improve as they are treated in aprofessional manner.

Representatives of outreach/home visiting programs met at the invitation of the Cleveland Federation for Community Planning's Family Policy Committee and the Maternity and Infant Care project. The primary reason the meeting was to work towards fundamental changes in the human service system in Cuyahoga County. Cuyahoga County has the largest number of Aid to Families with Dependant Children (ADCF) and Temporary Assistance for Needy Families (TANF) cases in the state of Ohio and one of the highest infant mortality rates in the United States. A more integrated and comprehensive outreach and home visiting system was proposed by moving from a program approach to a systems approach (McClellan, 1996). A working group of professionals was formed.

The workgroup, of which the EFNEP agent was a member, identified common issues in working with high risk families and paraprofessionals and conducted a literature review. Agencies represented in the work group were the Metropolitan Housing Health Services, Family Life Education program of the Cleveland Public Schools, March of Dimes, Headstart, and other social service agencies employing outreach staff. The group identified the following issues: access to updated information on existing resources for families; adequate training for paraprofessionals, institutionalization of recognized core competencies and skills; career ladder employment opportunities for paraprofessional workers; the role of outreach and home visiting in Medicaid managed care; and fragmentation of services when different agencies targeted the same neighborhoods with multiple workers duplicating services to the same families.

Out of this workgroup a conference was planned called, "Reaching Out to Families." Ohio State University Extension, Cuyahoga County, co-sponsored the event with the Federation for Community Planning. Extension provided financial assistance in the form of an innovative grant to produce an Outreach and Home Visitors Service Manual. Other financial and in-kind services were provided by the Council for Economic Opportunities in Greater Cleveland, The Federation, and Mandel School of Applied Social Services at Case Western Reserve University. Scholarships were made available to some agencies. An African-American church with a strong sense of community was selected as the workshop site. "Reaching Out to Families" was the first forum of this kind open to outreach workers, supervisors, program administrators, other professionals could interact.

Organizing a conference with multiple agencies requires at least one year of planning. The committee met monthly, then weekly as the date approached. Tasks included securing speakers, locating a caterer, finding a dynamic keynote speaker, writing grants to seek additional financial support, registration, and designing the conference logo and flyer. Agreeing on concurrent speakers was a challenge because so many topics needed to be addressed. Ten concurrent sessions were selected by prioritizing. Each committee member identified and contacted a well-known expert to speak on the subject.

The conference was a huge success. Four hundred and twenty- five people attended. The EFNEP staff in Cuyahoga County networked with key agencies and supported and connected with other paraprofessionals. Evaluations were completed by 157 people. Of those 157, four were supervisors, three were program directors, and 125 were outreach workers. Concurrent sessions were rated on a scale of 1-10 with 10 being the highest. No speaker scored lower than 8.4. The top three choices were Working with Neighborhood Families, Home Visiting Safety: A Realistic Approach, and Supervising Paraprofessionals. Ninety-five percent found the conference a useful tool for meeting workers from other agencies, and 96% would be interested in attending another conference. The conference attendees were overwhelmingly interested in additional training with many different topics suggested. The following evaluation suggests topics for similar workshops:

Other suggestions on the evaluations for future conferences included longer sessions, fewer people, more time for networking, shorter day, and job information exchange.

Extension's involvement with the Outreach and Home Visiting Conference has been a positive growth experience for this agent. Extension was viewed as a leader in the training of paraprofessionals. Economic and social problems of limited resource families are so complex that resolution depends on interagency cooperation and a well developed plan of action. EFNEP educators in Cuyahoga County have grown in subject matter knowledge, self confidence, and teaching skills as a result of continuous training efforts. (Warrix, personal communication, March, 1997).

One day conferences like "Reaching Out to Families" can begin to help other agencies employing paraprofessionals to achieve the same success. Treating paraprofessionals as professionals and respecting their "neighborhood knowledge" is critical. Future conferences need to be organized to continue networking efforts and provide educational training to upgrade outreach workers' skills.

Chapman, J., Siegel, E., & Cross, A. (1990). Home visitors and child health: Analysis of selected programs. Pediatrics, 85 (6), 1059-1068.

Giblin, P.T., (1989). Effective utilization and evaluation of indigenous health care workers. Public Health Reports, 104 (4), 361-368.

Larner, M.& Halpern, R. (1992). Lay home visiting programs: Strengths, tensions, and challenges. In E. Fenichel (Ed) Learning through supervision and mentorship to support the development of infants, toddlers, and their families: A source book. (pp.91-99). Richmond , Va.

McClellan, N. (1996). Outreach and home visiting summary report and recommendations. (Federation for Community Planning, Cleveland, Ohio)

Pearl, A., & Reisman, F. (1965). New careers for the poor. New York: Free Press.

Price, A. (1994). Peer workers: Professionals based on experience. The Source. 4 (2), 1-14.

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