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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

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Updates from Maternal Infant and Early Childhood Home Visiting

  1. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 24. ResourcesHRSA/MCHB website: website:
  25. 25. Questions?Marilyn D. StephensonMStephenson@hrsa.govThank you!