2.7 Jessie Buerlin


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  • HRSA and ACF are collaborating on all aspects of implementation, including development of policy and program guidance, technical assistance, and research and evaluation. HRSA is the administering agency for the State grants and ACF is the administering agency for the Tribal grants. We have also been convening interagency workgroups since last fall including agencies across HHS and the government in order to ensure that this program is coordinated with other programs serving young children and vulnerable communities – and intend to maintain these interagency relationships as the program develops. Administered by ACF Office of Child Care, in collaboration with HRSA 3 percent set-aside - $3 million in FY 2010 Discretionary grants to Tribes (including consortia of Tribes), Tribal Organizations, and Urban Indian Organizations 13 five-year cooperative agreements awarded September 28, 2010 5 additional grants anticipated to be awarded in FY2011 Tribal grants, to the greatest extent practicable, are to be consistent with the grants to States and territories and include conducting a needs assessment, meeting evidence-based criteria, and establishing benchmarks $100 m FY 2010 $250 m FY 2011 $350 m FY 2012 $400 m FY 2013 and FY 2014
  • Through high-quality, “evidence-based” home visiting programs targeted to pregnant women, expectant fathers, and parents and primary caregivers of children aged birth to kindergarten entry in at-risk communities, promote: Benchmark and outcome areas specified by the legislation
  • MIECHV is an evidence-based policy initiative. At least 75% of the grant funds must be spent on home visiting programs that show evidence of effectiveness. Up to 25% of funds may be spent on promising practices that must be rigorously evaluated. HHS conducted a systematic review of the evidence regarding home visitation programs and developed criteria for evidence of effectiveness. Currently eight home visiting models meet the HHS criteria and are eligible for the 75% funding.
  • Models meeting criteria for evidence of effectiveness are specified in Appendix B and on the Home Visiting Evidence of Effectiveness Review (HomVEE) website: http://homvee.acf.hhs.gov/
  • Early Head Start (EHS) targets low-income pregnant women and families with children from birth to age 3 years, most of whom are at or below the federal poverty level or who are eligible for Part C services under the Individuals with Disabilities Education Act in their state. Target Population: Pregnant Women, Birth-11 months, 1-2 years, 2-3 years Family Check-Up the Family Check-Up model is designed as a preventative program to help parents address typical challenges that arise with young children before these challenges become more serious or problematic. Target Population: 1-2 years, 2-3 years, 3-4 years, 4+ years Healthy Families America (HFA) Healthy Families America (HFA) is designed to help families manage life’s challenges by building on their strengths, rather than focusing on correcting weaknesses. Target Population: Pregnant Women, Birth-11 months, 1-2 years, 2-3 years, 3-4 years, 4+ years
  • Healthy Steps Healthy Steps for Young Children (Healthy Steps) is designed to support the physical, emotional, and intellectual development of the child by enhancing the relationship between health care professionals and parents. Target Population: Birth-11 months, 1-2 years, 2-3 years Home Instruction for Parents of Preschool Youngsters (HIPPY) The Home Instruction for Parents of Preschool Youngsters (HIPPY) model aims to promote preschoolers’ school readiness by supporting parents in the instruction provided in the home. Target Population: 3-4 years, 4+ years Nurse Family Partnership (NFP) The Nurse Family Partnership (NFP) is designed for first-time, low-income mothers and their children. It includes one-on-one home visits by a trained public health nurse to participating clients. Target Population: Pregnant Women, Birth-11 months, 1-2 years
  • Parents as Teachers (PAT) The goal of the Parents as Teachers (PAT) model is to provide parents with child development knowledge and parenting support. The PAT model includes home visiting, professional development, and advocacy. Target Population: Birth-11 months, 1-2 years, 2-3 years, 3-4 years, 4+ years
  • States must describe how the model(s) meets need of community(ies) proposed
  • Needs assessment: Within 6 months of enactment, States were required to conduct a statewide needs assessment in order to receive FY2011 MCH Services block grant. All States submitted the assessment as required. The assessment identified: Communities with concentrations of premature birth, low-birth weight infants, and infant mortality, including infant death due to neglect, or other indicators of at-risk prenatal, maternal, newborn, or child health; poverty; crime; domestic violence; high rates of high-school drop-outs; substance abuse; unemployment; or child maltreatment.
  • Major requirements: States must collect data on all 6 benchmark areas States must collect data for all constructs under each benchmark area To demonstrate improvements, the state must show improvement in at least half of the constructs under each benchmark area We recommend that programs utilize these and other appropriate data for continuous quality improvement
  • State child welfare agency is required if this agency is not also administering Title II of CAPTA Please note: new required sign-off: state’s Elementary and Secondary Education Act Title I or state pre-kindergarten program
  • Data on the number of homeless families within the state have historically been difficult to quantify as they are often transient and periodic sweeps of the state’s beaches keep these individuals moving. A recent cleanup of homeless encampments of a beach on the Waianae coast yielded more than 200 homeless people, 70 of them children. The state conducted a “point in time” count in January 2011, and although final numbers were not yet available, the state preliminarily reported that the numbers of homeless families with children are increasing. DHS is the agency responsible for the licensing of child care facilities and is the agency assigned Child Care Development Funds (CCDF) to implement child care services and to conduct activities to improve the quality of child care settings. The DHS utilizes funds for families as support for employment activities (child care subsidies), as well as provides for quality activities that support families and child care providers through contracts provided for training and scholarship services, resource and referral services, supporting Healthy Child Care Hawaii efforts, nutrition evaluation and consultation and child care advocacy and facilitation. The DHS also houses the Homeless Concerns Office which administers and monitors federal and state grants to emergency and transitional shelters, many of which enroll and provide support to families with young children. Parents as Teachers services also provide key support to parents who are homeless, helping them recognize and strengthen their parenting role even in the midst of very difficult circumstances. In addition to supporting families, Parents as Teachers can also play a valuable role in the shelter environment, educating staff about child development, promoting the importance of parenting and facilitating the importance of play in a child’s development.   Through parent education and family support, fundamental elements that can help break the cycle of homelessness are emphasized principles of child development parent education strengthening support networks building upon parents’ strengths helping to provide a solid foundation for children’s educations   1. Power of Play Through the Power of Play Initiative, an adaptation of the PAT model to work with homeless and transient parents and children was developed. The goal was to integrate play into shelter activities and help homeless parents understand the importance of play for their children’s development.   Parents as Teachers programs in Ft. Worth and San Antonio, TX implemented the Power of Play program at homeless shelters in 2004-2005.   The PAT programs provided the four core components of the model- Personal visits, group meetings, screenings and connections to a network of community resources – adapted to meet the needs of the population being served. Note: the services offered in the Power of Play approach would not likely meet all of the Parents as Teachers Essential Requirements. This adaptation would therefore be considered a promising approach.   Accomplishments in working with homeless families The project helped open doors at the shelter There was a consistent parent educator and a consistent place to meet The project provided increased routine and familiarity The PAT programs were able to commit longer term to providing services Residents had more interaction with their babies Residents were more attentive to their children’s needs Power of Play was an initiative funded by the Toy Industry Foundation and implemented in partnership with Parents as Teachers national office. Haven of Grace Haven of Grace, in St. Louis, MO, provides transitional housing and services for pregnant and parenting teens. This organization became a Parents as Teacher affiliate in 2011 under the new PAT approach, and will be utilizing all components of the model and adhering to the Essential Requirements.
  • Reporting requirements: No later than March 31, 2015, the Secretary shall submit a report to Congress on the results of the evaluation conducted And shall make the report publicly available
  • 2.7 Jessie Buerlin

    1. 1. Affordable Care Act Maternal, Infant, and Early Childhood Home Visiting Program Jessie Buerlein, MSW U.S. Department of Health and Human Services Health Resources and Services Administration, Maternal and Child Health Bureau Administration for Children and Families
    2. 2. Overview of Presentation <ul><li>Legislative authority and program goals and priorities </li></ul><ul><li>Evidence-based home visiting models </li></ul><ul><li>Status on program implementation and opportunities for partnership </li></ul>
    3. 3. Legislative Authority <ul><li>Section 2951 of the Affordable Care Act of 2010 (P.L. 111-148) </li></ul><ul><li>Amends Title V of the Social Security Act to add Section 511: Maternal, Infant, and Early Childhood Home Visiting Programs </li></ul><ul><li>$1.5 billion over 5 years </li></ul><ul><li>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) </li></ul><ul><li>Requirement for collaborative implementation by HRSA and ACF </li></ul>
    4. 4. Legislation Purposes <ul><li>To strengthen and improve the MCH programs and activities carried out under Title V of the Social Security Act; </li></ul><ul><li>To improve coordination of services for at-risk communities; and </li></ul><ul><li>To identify and provide comprehensive services to improve outcomes for families who reside in at-risk communities. </li></ul>
    5. 5. Home Visiting Program Goals <ul><li>Improvements in prenatal, maternal, and newborn health </li></ul><ul><li>Improvements in child health and development, including the prevention of child injuries and maltreatment </li></ul><ul><li>Improvements in parenting skills </li></ul><ul><li>Improvements in school readiness and child academic achievement </li></ul><ul><li>Reductions in crime or domestic violence </li></ul><ul><li>Improvements in family economic self-sufficiency </li></ul><ul><li>Improvements in referrals for and provision of other community resources and supports </li></ul>
    6. 6. Additional Program Goals <ul><li>Support the development of statewide systems to ensure effective implementation of evidence-based HV programs grounded in empirical knowledge </li></ul><ul><li>Establish HV as a key early childhood service delivery strategy in high-quality, comprehensive statewide early childhood systems </li></ul><ul><li>Foster collaboration among maternal and child health, early learning, and child abuse prevention </li></ul><ul><li>Promote collaboration and partnerships among states, the federal government, local communities, HV model developers, families, and other stakeholders </li></ul>
    7. 7. Priority Populations <ul><li>Families in at-risk communities </li></ul><ul><li>Low-income families </li></ul><ul><li>Pregnant women under age 21 </li></ul><ul><li>Families with a history of child abuse or neglect </li></ul><ul><li>Families with a history of substance abuse </li></ul><ul><li>Families that have users of tobacco in the home </li></ul>
    8. 8. Priority Populations <ul><li>Families with children with low student achievement </li></ul><ul><li>Families with children with developmental delays or disabilities </li></ul><ul><li>Families with individuals who are serving or have served in the Armed Forces, including those with multiple deployments </li></ul>
    9. 9. “ Evidence-Based” Policy <ul><li>Requires grantees to implement evidence-based home visiting models </li></ul><ul><ul><li>Federal Register Notice published July 23 rd inviting public comment on proposed criteria for assessing evidence of effectiveness of home visiting program models </li></ul></ul><ul><li>Allows for implementation of promising strategies </li></ul><ul><ul><li>Up to 25% of funding can be used to fund “promising and new approaches” that would be rigorously evaluated </li></ul></ul>
    10. 10. Models that Meet the Criteria for Evidence Base <ul><li>Early Head Start – Home-Based Option </li></ul><ul><li>Family Check Up </li></ul><ul><li>Healthy Families America </li></ul><ul><li>Healthy Steps </li></ul><ul><li>Home Instruction for Parents of Preschool Youngsters </li></ul><ul><li>Nurse-Family Partnership </li></ul><ul><li>Parents as Teachers </li></ul><ul><li>The Public Health Nursing Early Intervention Program (EIP) for Adolescent Mothers </li></ul>
    11. 11. Favorable Outcomes <ul><li>EHS: Child Development and School Readiness, Positive Parenting Practices, Family Economic Self-Sufficiency </li></ul><ul><li>Family Check-Up: Maternal Health, Child Development and School Readiness, Positive Parenting Practices </li></ul><ul><li>HFA: Child Health, Child Development and School Readiness, Reductions in Child Maltreatment, Positive Parenting Practices, Family Economic Self-Sufficiency, Linkages and Referrals </li></ul>
    12. 12. Favorable Outcomes <ul><li>Healthy Steps: Child Health, Positive Parenting Practices </li></ul><ul><li>HIPPY: Child Development and School Readiness, Positive Parenting Practices </li></ul><ul><li>NFP: Maternal Health, Child Health, Child Development and School Readiness, Reductions in Child Maltreatment, Reductions in Juvenile Delinquency, Family Violence, and Crime, Positive Parenting Practices, Family Economic Self-Sufficiency </li></ul>
    13. 13. Favorable Outcomes <ul><li>PAT: Child Development and School Readiness, Positive Parenting Practices </li></ul><ul><li>The Public Health Nursing Early Intervention Program (EIP) for Adolescent Mothers: Child Health, Family Economic Self-Sufficiency </li></ul>
    14. 14. Selection of Home Visiting Model(s) <ul><li>States may: </li></ul><ul><li>Select a model(s) that meets criteria for evidence of effectiveness </li></ul><ul><li>Propose another model not reviewed by HomVEE study </li></ul><ul><li>Request reconsideration of an already-reviewed model </li></ul><ul><li>Propose use of up to 25% of funds for a promising approach </li></ul>
    15. 15. Timeline for FY 2010 State MIECHV Funding Step 1: State applications in response to Funding Opportunity Announcement Due July 9, 2010 Step 2: Supplemental Information Request for the Submission of the Statewide Needs Assessment Due September 20, 2010 Step 3: Supplemental Information Request for the Submission of the Updated State Plan for a State Home Visiting Program Due May 9 through June 8, 2011
    16. 16. Funding for FY2010 and FY2011 <ul><li>FY11 funding: $224 million </li></ul><ul><li>$99 to be awarded competitively, $125 to be awarded by formula </li></ul><ul><li>Each state will continue to receive at least its FY10 allocation in FY11 through FY14; HHS will also be awarding funds on a competitive basis beginning in FY11 </li></ul>
    17. 17. Updated State Plan <ul><li>The third and final step in the FY10 application process </li></ul><ul><li>Provides guidance for making the final designation of the targeted at-risk community(ies), updating and providing a more detailed needs and resources assessment, and submitting a specific plan tailored to address these needs, including selection of evidence-based models </li></ul><ul><li>Identifies criteria for establishing evidence of effectiveness of home visiting models, and lists the models determined to be evidence-based </li></ul>
    18. 18. Meeting Legislatively-Mandated Benchmarks <ul><li>States must provide a plan for data collection for each of the 6 benchmark areas: </li></ul><ul><li>Improved maternal and newborn health </li></ul><ul><li>Prevention of child injuries, child abuse, neglect, or maltreatment, and reduction of emergency department visits </li></ul><ul><li>Improvement in school readiness and achievement </li></ul><ul><li>Reduction in crime or domestic violence </li></ul><ul><li>Improvements in family economic self-sufficiency </li></ul><ul><li>Improvements in the coordination and referrals for other community resources and supports </li></ul>
    19. 19. Memorandum of Concurrence: Required <ul><li>Title V Agency </li></ul><ul><li>Agency for CAPTA </li></ul><ul><li>State child welfare agency </li></ul><ul><li>Single State Agency for Substance Abuse Services </li></ul><ul><li>Child Care and Development Fund Administrator </li></ul><ul><li>Head Start State Collaboration Office </li></ul><ul><li>State Advisory Council on Early Childhood Education and Care of the Head Start Act </li></ul><ul><li>Elementary and Secondary Education Act Title I or State Pre-K Program </li></ul>
    20. 20. Memorandum of Concurrence: Recommended <ul><li>Individuals with Disabilities Education Act (IDEA) Part C and Part B Section 619 lead agency(ies) </li></ul><ul><li>State’s Medicaid/CHIP program </li></ul><ul><li>Domestic Violence Coalition </li></ul><ul><li>Mental Health agency </li></ul><ul><li>Public Health agency (if not Title V) </li></ul><ul><li>Agency charged with crime reduction </li></ul><ul><li>TANF agency </li></ul><ul><li>Supplemental Nutrition Assistance Program agency </li></ul><ul><li>Injury Prevention and Control program </li></ul>
    21. 21. Partnering with Homeless Populations: Examples <ul><li>Parents as Teachers: Power of Play Initiative </li></ul><ul><li>Integrating home visiting programs into transitional housing </li></ul><ul><li>Hawaii MIECHV program </li></ul>
    22. 22. Resources <ul><li>HRSA/MCHB website: http://mchb.hrsa.gov/programs/homevisiting/ </li></ul><ul><li>HomVEE website: </li></ul><ul><li>http://homvee.acf.hhs.gov/ </li></ul>
    23. 23. Questions? <ul><li>Jessie Buerlein, HRSA </li></ul><ul><li>[email_address] </li></ul><ul><li>Thank you! </li></ul>