Updates from Maternal Infant and Early Childhood Home Visiting

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M. Stephenson presentation S.C. Federal Updates from the 012 South Carolina Home Visiting Summit

M. Stephenson presentation S.C. Federal Updates from the 012 South Carolina Home Visiting Summit

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  • Three new models approved in July, 2012. Models meeting criteria for evidence of effectiveness are specified in Appendices and on the Home Visiting Evidence of Effectiveness Review (HomVEE) website: http://homvee.acf.hhs.gov/Home Visiting ModelNumber of States Implementing Early Head Start15Parents as Teachers29Healthy Families America37Healthy Steps4Nurse-Family Partnership31HIPPY6Family Check-Up1Early Intervention Program for Adolescent Mothers0Child FIRST1
  • Three new models added in July, 2012:Early Start (New Zealand)Early Start is a home visiting program for at-risk families with newborns and children up to age 5, which is designed to improve child health; reduce child abuse; improve parenting skills; support parental physical and mental health; encourage family economic well-being; and encourage stable, positive partner relationships.Oklahoma’s Community-Based Family Resource and SupportOklahoma’s Community-Based Family Resource and Support (CBFRS) program was developed to improve maternal and child health and child development through weekly or biweekly visits with first-time mothers in 12 rural counties.Play and Learning Strategies InfantPlay and Learning Strategies (PALS) Infant consists of 10 home visiting sessions for families with children 5 months to one year, which are designed to strengthen parent-child bonding and stimulate children’s early language, cognitive, and social development.
  • States must describe how the model(s) meets need of community(ies) proposed
  • In September 2011, HRSA has awarded a total of $224 million to states and territories; $124 million by formula, and $100 million by competition-- to those States that have sufficiently demonstrated the interest and capacity to expand and/or to enhance the development of their home visiting efforts. Competitive funding was awarded through Expansion and Development grants.
  • FY 2011 Competitive Grant ProgramPurpose of Competitive Grants: The goal of the MIECHV competitive program is to award additional funding to states that have sufficiently demonstrated the interest and capacity to expand and/or enhance their EBHV programs. Expansion Grants: Approximately $66 million was awarded to 9 states and jurisdictions that have already made significant progress towards implementing a high-quality home visiting program as part of a comprehensive, early childhood system. Arizona, Arkansas, California, Illinois, Indiana, Louisiana, Maine, Massachusetts, OklahomaDevelopment Grants: Approximately $34 million was awarded to 13 States and jurisdictions that currently have modest home visiting programs and want to build on existing efforts. Alabama, Delaware, Georgia, Hawaii, Michigan, Montana, New Hampshire, New Mexico, Oregon, Rhode Island, Texas, West Virginia, WisconsinWe anticipate a total of four Expansion grant cycles and two Development grant cycles, awarding one more cycle of development grants in FY 2012. The next competition should be available sometime this spring.FY12 Expansion 10 states received grants of nearly $72 million in funding for expansion grants. These states are: Colorado, Connecticut, Iowa, Kentucky, Minnesota, New Jersey, Commonwealth of Pennsylvania, Tennessee, Commonwealth of Virginia, Washington State
  • Grantees will begin service delivery after the benchmark plans have been approved. As of 4/18/2012, 44 states have had their benchmark plans approved (out of 54 grantees). Some of the grantees are still finishing up their plans, but have already begun to provide home visiting services to their at-risk communities. It is difficult to determine exactly the number of families currently being served. We anticipate based on the updated state plans submitted in August 2011 that at least 28,000 families will be enrolled in MIECHV home visiting services with FY 2010 and FY 2011 funds.There are currently two contractors supporting the technical assistance efforts of the MIECHV Program: Design Options Home Visiting Evaluation (DOHVE) and the Technical Assistance Coordinating Center (TACC). The DOHVE contractors—comprised of technical assistance specialists from MDRC, RAND, and James Bell Associates—provide data-related technical assistance (TA) support to the MIECHV grantees. So far, this TA has mainly focused on intense technical assistance and support to the grantees (and Regional Project Officers) in the development of the state’s benchmark plans and the development of related issue briefs and other documents. In collaboration with expert consultants, DOHVE has also provided TA to grantees to support the development of continuous quality improvement (CQI) plans. In September 2011, HRSA awarded ZERO TO THREE (ZTT) a contract to develop the MIECHV program’s Technical Assistance Coordinating Center (TACC). ZTT subcontractors include Walter R. McDonald & Associates, Inc. (WRMA), the Association of Maternal and Child Health Programs (AMCHP), and Chapin Hall.  The TACC provides support to HRSA grantees in implementing MIECHV-funded home visiting programs. The TACC brings extensive experience and a wealth of expertise in achieving high quality program implementation, creating integrated service systems, and improving program outcomes. Supportive services include facilitating connections with technical experts, offering opportunities for shared learning, and identifying best practices. Services are provided in multiple formats including webinars, phone calls, email, an interactive website portal, along with in-person opportunities for regional meetings and individual site visits.In addition to the TA provided by DOHVE and the TACC, the regional project officers are a valuable resource for grantees in the identification and coordination of technical assistance. Technical assistance Multifaceted, ongoingWebinar, compendium of measures, individualizedFacilitate State-to-State partnershipsPeer learning networks
  • We anticipate a total of 4 Expansion grant cycles and 2 Development grant cycles, awarding one more cycle of development grants in FY 2012. An interagency Data Reporting Work Group has created a set of data collection instruments for the program. We will be using the HRSA MCHB system (Discretionary Grant Information System (DGIS)) but adapting the data collection instruments to meet the unique data reporting needs of the HV program.  The two new forms designed for collection will include demographic characteristics and service utilization by participants and the state-defined performance measures. We engaged with several states to review these forms to ensure that we balance the federal reporting needs with the needs of the state grantees and importantly that they will not pose an onerous burden on their staffs. The Federal Register Notice published Feb 16th.  See this link: http://www.gpo.gov/fdsys/pkg/FR-2012-02-16/html/2012-3710.htm The first post-award reports due from grantees will be by the end of FY 2012. The legislation requires that the demonstration of improvements in 4 of the 6 benchmarks must occur at 3 years and 1 month after the start of the program which we determined was August 2011 when states’ updated plans were all approved. We eagerly anticipate this reporting at the end of the 2014 fiscal year.
  • We named the national evaluation “Mother and Infant Home Visiting Program Evaluation or “MIHOPE”. The results from MIHOPE will provide important input into the national debate about policies and practices designed to improve the well-being of at-risk families and children. ACF, HRSA, the study team along with the advice of experts on the Secretary’s Advisory Committee on Program Evaluation have worked together to determine the study design.
  •  The experimental study includes: an analysis of the state needs assessments that were provided in the State MIECHV applications; an effectiveness study that includes an impact analysis to measure what difference home visiting programs make for the at-risk families they serve, focusing on areas like prenatal, maternal, and newborn health, child development, parenting, domestic violence, and referrals and service coordination. The effectiveness study will also include an implementation analysis that will examine how the program models operate in their local and State contexts and describe the families who participate; and an economic analysis that will examine the financial costs of operating the programs.
  • A special goal of this study is the linking of implementation strategies to program impacts, thus informing the field about the types of program features or strategies that might lead to even greater impacts on families. For example, understanding how, and at what level, the average family participates in the program will provide context to any variation in impacts we find in the health of families. The primary data used in the study will be collected by the research team through surveys, review of administrative records, interviews, observations, and staff logs.
  • Data Collection Activities and Timeline:Anticipated state/site recruitment will begin February 2012Anticipated sample recruitment will begin summer 2012Anticipated time to recruit sample 18 monthsAnticipated follow up data collection will begin early 2013Report to Congress: March 2015Impact Report: 2017Local programs participating in the evaluation will reflect the national diversity of communities implementing MIECHV programs and the populations they serve. Local programs will operate one of four models that meet HHS’ criteria for being considered evidence-based and that were chosen by at least 10 States for their MIECHV programs. These include: Early Head Start – Home Visiting, Healthy Families America, Nurse-Family Partnership, and Parents as Teachers. Approximately 85 local home visiting program sites in 12 States will be selected to participate. Participating sites will recruit families, will determine family eligibility criteria and, among those who are eligible, will use a lottery-like process, also known as random assignment, to select which families to enroll in home visiting services. The use of random assignment means that each program will need to have more people eligible for services than can be enrolled into home visiting. The research team will work with each program to build on their existing outreach and assessment processes to help recruit enough families. All families in the lottery will be invited to participate in the evaluation. Those selected for home visiting services will form the program group, and those not selected will form a comparison group. The research team will monitor both groups over time to see if differences emerge in the outcome areas that I mentioned. A total of 5,100 families are expected to participate in the study.
  • HV can serve as a bridge HRSA and ACF believe that home visiting should be viewed as one of several service strategies embedded in a comprehensive, high-quality early childhood system that promotes maternal, infant, and early childhood health, safety, and development that includes a range of other programs such as child care, Head Start, pre-kindergarten, special education and early intervention, and early elementary education.   For example, the State Advisory Councils (SACs) funded by ACF, Project LAUNCH funded by SAMHSA, and the Early Childhood Comprehensive Systems (ECCS) program, funded by HRSA, are contributing to the integration of the MIECHV program with other state early childhood initiatives. In fact, to receive MIECHV funding, states are required to obtain concurrence among a number of state agencies serving young children and their families. Also, the Department of Education’s Race to the Top (RTT) program in 2011 required state applicants to participate in the MIECHV program in order to be eligible for RTT funding.or gateway to other services.


  • 1. The Affordable Care Act Maternal, Infant, and Early Childhood Home Visiting Program Marilyn D. Stephenson, MSN, RN HRSA Maternal and Child Health Bureau Division of Home Visiting and Early Childhood Systems Eastern Implementation Branch 2012 South Carolina Home Visiting Summit U.S. Department of Health and Human ServicesHealth Resources and Services Administration, Maternal and Child Health Bureau Administration for Children and Families
  • 2. Overview of Presentation• Legislative authority and program goals and priorities• Evidence-based home visiting models• Status on program implementation and opportunities for partnership
  • 3. Legislative Authority Section 2951 of the Affordable Care Act of 2010 (P.L. 111- 148) Amends Title V of the Social Security Act to add Section 511: Maternal, Infant, and Early Childhood Home Visiting Programs $1.5 billion over 5 years Grants to states (with 3% set-aside for grants to Tribes, Tribal Organizations, or Urban Indian Organizations and 3% set-aside for research, evaluation, and TA) Requirement for collaborative implementation by HRSA and ACF
  • 4. Legislation Purposes(1) To strengthen and improve the MCH programs and activities carried out under Title V of the Social Security Act;(2) To improve coordination of services for at- risk communities; and(3) To identify and provide comprehensive services to improve outcomes for families who reside in at-risk communities.
  • 5. Home Visiting Program GoalsImprovements in: Prenatal, maternal, and newborn health Child health and development, including the prevention of child injuries and maltreatment Parenting skills School readiness and child academic achievement Reductions in crime or domestic violence Family economic self-sufficiency Referrals for and provision of other community resources and supports
  • 6. Additional Program Goals Support the development of statewide systems to ensure effective implementation of evidence-based HV programs grounded in empirical knowledge Establish HV as a key early childhood service delivery strategy in high-quality, comprehensive statewide early childhood systems Foster collaboration among maternal and child health, early learning, and child abuse prevention Promote collaboration and partnerships among states, the federal government, local communities, HV model developers, families, and other stakeholders
  • 7. Priority Populations Families in at-risk communities Low-income families Pregnant women under age 21 Families with a history of child abuse or neglect Families with a history of substance abuse Families that have users of tobacco in the home
  • 8. Priority Populations Families with children with low student achievement Families with children with developmental delays or disabilities Families with individuals who are serving or have served in the Armed Forces, including those with multiple deployments
  • 9. “Evidence-Based” Policy Requires grantees to implement evidence-based home visiting models – Federal Register Notice published July 23rd inviting public comment on proposed criteria for assessing evidence of effectiveness of home visiting program models Allows for implementation of promising strategies – Up to 25% of funding can be used to fund “promising and new approaches” that would be rigorously evaluated
  • 10. Models that Meet the Criteria forEvidence Base Child FIRST Early Head Start – Home-Based Option Family Check-Up Healthy Families America Healthy Steps Home Instruction for Parents of Preschool Youngsters (HIPPY) Nurse-Family Partnership Parents as Teachers The Public Health Nursing Early Intervention Program (EIP) for Adolescent Mothers
  • 11. Models that Meet the Criteria forEvidence Base Early Start (New Zealand) Oklahoma Community-Based Family Resource and Support Program Play and Learning Strategies (PALS) Infant
  • 12. Selection of Home Visiting Model(s)States may:• Select a model(s) that meets criteria for evidence of effectiveness• Propose another model not reviewed by HomVEE study• Request reconsideration of an already-reviewed model• Propose use of up to 25% of funds for a promising approach
  • 13. Status of MIECHV: PAST Needs Assessments (September 2010) Updated State Plans (June 2011) FY 2011 Formula Applications (July 2011) Competitive Grants (July 2011) – The goal of the MIECHV competitive program is to award additional funding to states that have sufficiently demonstrated the interest and capacity to expand and/or enhance their EBHV programs to improve outcomes for children and families who reside in at-risk communities
  • 14. FY 2011 Competitive GrantExpansion Grants States and jurisdictions that have already made significant progress towards implementing a high- quality HVPDevelopment Grants States and jurisdictions that currently have modest HVP and want to build existing efforts
  • 15. Status of MIECHV: PRESENT Refinement of Benchmark Plans (FY 2012 to present) Implementation (FY 2012 - pending approval of Benchmark Plan) Refinement of State CQI Plan Ongoing Technical Assistance
  • 16. Status of MIECHV: NEXT STEPS FY12 awards for ND and WY non-profit FY12 Non-Competing Continuation Progress Report (Spring 2012) FY12 Competitive Development FOA Annual Reporting Requirements
  • 17. Other MIECHV Activities• Home Visiting Evidence of Effectiveness Systematic Review (HomVEE)• Mother and Infant Home Visiting Project Evaluation (MIHOPE)• Tribal Home Visiting Technical Assistance Center (TTAC)• Tribal Home Visiting Evaluation Institute (TEI)• Tribal Early Childhood Research Center (TRC)
  • 18. Mother and Infant Home VisitingProject Evaluation (MIHOPE) Affordable Care Act legislative language for evaluation: – State-by-state analysis of needs assessment – Efficacy and efficacy by variations in programs and populations – Potential for MIECHV, if scaled broadly, to reduce health care costs and increase efficiencies The contract to conduct the evaluation was awarded to: MDRC with partners James Bell Associates, Johns Hopkins University, and Mathematica Policy Research
  • 19. HHS Goals for MIHOPE Evaluation must use a rigorous design to assess effectiveness overall and for populations specified in the legislation Examine effectiveness across all evidence-based models and all participant outcomes and benchmark domains Reflect the diversity of communities and populations to the extent possible in all aspects of the evaluation. Conduct a thorough implementation study Produce results that will inform program-level decision-making and increase the ability to strengthen the program in the future
  • 20. MIHOPE Research Questions What is the impact of MIECHV on participant outcomes? How do impacts vary by participant and program features? – Who is in the system? Who provides the services? What families are enrolled? And what services are provided? – How do community context and partners influence the service model and delivery? – How do staff and family characteristics mediate service dosage, content, and quality?
  • 21. MIHOPE Study Design & Sample Approximately 12 states, 85 local implementing sites, 5100 pregnant women and families with infants up to 6 months of age Focused on the 4 models selected by at least 10 states: EHS-HBO, HFA, NFP, PAT Random assignment at the time of enrollment and a follow-up assessment when the child is approximately 15 months old
  • 22. MIECHV Opportunities• Advance the field of maternal and early childhood heath and development• Translate science into policy• Data collection requirements provide a framework for states to carry out their own data- driven QI efforts
  • 23. MIECHV Opportunities• Develop infrastructure in places where none previously existed – frontier, rural, and urban areas• Focal point for collaborations and partnerships – forge collaborations and partnerships were none previously existed• Systems integration of HV with other EC programs, Early Childhood Comprehensive Systems (ECCS) grants – integration across sectors including health, such as medical home, EC care and education, early intervention, and other family supports
  • 24. ResourcesHRSA/MCHB website: http://mchb.hrsa.gov/programs/homevisiting/HomVEE website:http://homvee.acf.hhs.gov/
  • 25. Questions?Marilyn D. StephensonMStephenson@hrsa.govThank you!