1

Michigan Maternal, Infant, and Early Childhood

Home Visiting Program

November 4, 2010

1:00-2:00pm

2

Purpose of the webinar

Review activities to date

Anticipated next steps

Questions

3

ACTIVITIES TO DATE

4

LEGISLATION

March 23, 2010 - The Patient Protection and Affordable Care Act (ACA) was signed into law.

Subtitle L, Section 2591 amends Title V of the Social Security Act by adding a new section to Title V, Section 511, addressing the Maternal, Infant, and Early Childhood Home Visiting Programs.

Full text for the ACA can be found at: http://docs.house.gov/energycommerce/ppacacon.pdf

5

Anticipated process for Home Visiting Program

STEP 1 – submit an Application for funding

STEP 2 – submit a Statewide Needs Assessment

STEP 3 – submit an Updated State Plan for implementation based on the Needs Assessment

6

WHO IS WORKING ON THE PROGRAM?

Great Start System Team– Home Visiting Workgroup

MDCH – Public Health, Mental Health, Substance Abuse, Medicaid, Epidemiology

MDE – Early Childhood Education & Family Services DHS – Child Welfare, Child Care, Head Start State

Collaboration Office, Children’s Trust Fund ECIC – Early Childhood System building and promotion MI League for Human Services

7

8

STEP 1

June 10, 2010 - U.S. Department of Health & Human Services, Health Resources & Services Administration (HRSA) and Administration for Children & Families (ACF) issued the Affordable Care Act (ACA) Maternal, Infant and Early Childhood Home Visiting Program Funding Opportunity Announcement (FOA).

The announcement is available at:

http://apply07.grants.gov/apply/UpdateOffer?id=19148

9

STEP 1

July 9, 2010 – Michigan application was submitted.

The application was a state-level “plan to plan” and certifications which allow HHS to release the first funding to the state.

10

STEP 1

July 15, 2010 – HRSA awarded Michigan a Home Visiting grant for $2,014,745 for FY10.

All but $500,000 is restricted pending receipt of an approvable Updated State Plan in response to STEP 3. In the interim, $500,000 can be used for needs assessment, planning, or implementation activities.

11

PUBLIC COMMENT

July 22, 2010 – HRSA and ACF opened a public comment period for stakeholders to comment on how to assess evidence of effectiveness of home visiting program models.

August 17, 2010 – Michigan submitted comments regarding proposed methodology for reviewing effectiveness and for distributing funding to states.

12

STEP 2

August 19, 2010 – HRSA & ACF released the Supplemental Information Request (SIR) for the Submission of the Statewide Needs Assessment (Home Visiting Program):http://www.hrsa.gov/grants/apply/assistance/homevisiting/homevisitingsupplemental.pdf

September 16, 2010 – HRSA awarded Michigan an additional $118,928 in Home Visiting funds, for a new total of $2,133,673 for FY10.

September 20, 2010 – Michigan submitted its Statewide Needs Assessment.

13

STEP 2

Michigan’s response to the SIR included: A narrative describing the Statewide Needs

Assessment results, including indicators and methods used to identify the counties with the highest concentration of risk;

Brief descriptions of those 10 counties (state and local data tables and descriptions of state-level and local home visiting programs); and

An analysis of the state and local capacity for providing substance abuse treatment and counseling services in the 10 counties.

14

STEP 2

The 10 communities (counties) identified in the analysis with highest concentration of risk include:

Berrien Calhoun

Genesee Ingham

Kalamazoo Kent

Muskegon Saginaw

St. Clair Wayne

15

STEP 2

September 22, 2010 – HRSA notified Michigan that the Statewide Needs Assessment was reviewed and met requirements.

As a result, HRSA released Michigan's FY 2011 Maternal and Child Health Title V Block Grant funds (approximately $19,000,000), and we have retained our FY 2010 Affordable Care Act (ACA) Maternal, Infant, and Early Childhood Home Visiting Program funds in the amount of $2,133,673.

16

STEP 3

The guidance for STEP 3 has not yet been released.

The most recent information available is that the next guidance document is in development.

The original application estimated that STEP 3 would be completed winter/spring 2011.

17

Information about activities to date is posted at two websites:

www.michigan.gov/mihp, see Important News

www.greatstartfor4kids.org, under Early Childhood Home Visiting Program

18

ANTICIPATED NEXT STEPS

19

NEXT STEPS

Michigan was not able to provide all of the information requested in the Supplemental Information Request (SIR).

We anticipate that we will need to provide the missing information in STEP 3.

We are moving forward with collecting missing local Head Start Needs Assessments and developing the means to determine the extent to which existing home visiting programs are meeting the needs of eligible families.

20

IMPORTANT NOTES

Our understanding of this program and process is evolving.

The process is data-driven. The process will play out differently in different

states, and in different communities. The program is part of a larger effort to build a

SYSTEM – for home visiting, and for early childhood. The program will include several work streams, and

is not solely focused on direct service provision.

21

IMPORTANT CONCEPTS

Evidence-based ACA, Subtitle L, Section 2591 (d)(3)(A)(i)(I)(aa-bb)

(I) Model is evidence-based(aa) randomized controlled research designs, and the evaluation results have been published in a peer-reviewed journal; or(bb) quasi-experimental research design.

An updated definition may be provided with the STEP 3 guidance.

22

IMPORTANT CONCEPTS

Fidelity to the model

I didn't have potatoes, so I substituted rice. Didn't have paprika, so I used another spice. I didn't have tomato sauce, so I used tomato paste. A whole can not a half can -I don't believe in waste. My friend gave me the recipe -she said you couldn't beat it. There must be something wrong with her, I couldn't even eat it! ~ Senior Center Newsletter (Blase, 2010)

23

IMPORTANT CONCEPTS

Highest concentration of risk SIR for Statewide Needs Assessment

Communities with highest concentration of:

Premature birth Low birth-weight

Infant mortality Poverty

Crime Domestic violence

High school drop-outs Substance abuse

Unemployment Child maltreatment

24

IMPORTANT CONCEPTS

Highest concentration of risk SIR for Statewide Needs Assessment

Communities for which indicators, in comparison to statewide indicators, demonstrate that the community is at greater risk than is the state as a whole. The distinction is based on a comparison of statewide data and data for the community identified as being at risk.

25

IMPORTANT CONCEPTS

Implementation scienceMajor Implementation Initiatives occur in stages:

Exploration

Installation

Initial Implementation

Full Implementation

Fixsen, Naoom, Blase, Friedman, & Wallace, 2005

2 -4 Years

26

IMPORTANT CONCEPTS

Implementation Research: A Synthesis of the LiteratureFixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. & Wallace, F. (2005). Implementation Research: A Synthesis of the Literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).

Download all or part of the monograph at:http://www.fpg.unc.edu/~nirn/resources/detail.cfm?resourceID=31

27

WHAT CAN BE FUNDED?

State Infrastructure buildinge.g. cross-system database, linking funding

Local Infrastructure buildinge.g. strengthening collaborative bodies, promoting readiness to

implement

Direct Servicese.g. evidence-based models

28

STATE INFRASTRUCTURE

Impacts all communities Includes building a linked, coordinated

system of home visiting, within the context of an early childhood system

Includes looking at coordination of all home visiting funding streams

29

LOCAL INFRASTRUCTURE

Related to the State Infrastructure Some components could happen statewide Will vary by locality

30

DIRECT SERVICES

A data driven analysis of the extent to which existing home visiting programs are meeting the needs of eligible families.

2. Targ

et

population

1. Outcomes

3. Gaps

4

.

Models

31

OUTCOMES/RISKS

As defined in the legislation, related to risks (ACA, Subtitle L, Section 2591 (d)(2)(B)(i-vii)):

– Improvements in prenatal, maternal, and newborn health, including improved pregnancy outcomes.

– Improvements in child health and development.– Prevention of child injuries and maltreatment.– Improvements in cognitive, language, social-

emotional, and physical developmental indicators.– Improvements in parenting skills.

32

OUTCOMES/RISKS

continued:– Improvements in school readiness and child

academic achievement.– Reductions in crime or domestic violence.– Improvements in family economic self-sufficiency.– Improvements in the coordination of referrals and

provision of other community resources and supports.

33

TARGET POPULATION

Identified based on 2nd cut analysis of risk/need; who is it that is experiencing this concentrated risk?– Geographic– Sub-populations– Other characteristics

34

GAPS

What supports/services already exist to meet the identified needs/achieve outcomes, with this target population?

What are the gaps that can be filled to supplement (not supplant) existing services?

35

MODELS

Identify and implement the model that:– Meets the identified outcomes/addresses

identified risks.– For the population identified in the

analysis.– To fill the gaps identified in the system for

those outcomes and that audience.

36

COMMUNICATIONS/INVOLVEMENT

As infrastructure building and implementation moves forward, the number of stakeholders involved in the program will increase.

Communications will continue to be posted at the websites listed in slide 17.

37

COMMUNICATIONS/INVOLVEMENT

The federal guidance document about STEP 3 will provide important direction regarding next steps toward exploring, preparing to install, and implementing the Home Visiting Program.

38

COMMUNICATIONS/INVOLVEMENT

To contact the Home Visiting Program, please e-mail:

HomeVisitingProject@michigan.gov

39

QUESTIONS & ANSWERS

40

Q&A

Q: How much money will be allocated to the different types of activities?

A: This has not yet been determined. We anticipate that federal guidance plus analysis results will help make this determination.

41

Q&A

Q: The legislation discusses the option of using 25% of the funds for promising practices. What will Michigan be funding with that 25%?

A: Each state has the OPTION of using 25% for promising practices, which must still be associated with a national office. Michigan has not yet determined whether funding will be used for promising practices.

42

Q&A

Q: Is the Home Visiting funding limited to the 10 counties identified?

A: We anticipate that funding will be utilized for both infrastructure building and some direct services. Infrastructure would impact more than the 10 counties; funding for direct services would, at least initially, be limited to fewer communities.

43

Q&A

Q: Will all 10 counties receive funding for direct services?

A: We anticipate that funding will be utilized for both infrastructure building and some direct services; it is possible that fewer than 10 counties will receive funding for direct services with FY10 funding.

44

Q&A

Q: What will happen with future funding received?

A: This will be determined based on federal guidance, results of analysis, readiness, and system building efforts.

45

Q&A

Q: Who will receive funding in local communities?

A: We anticipate it would go to the most appropriate fiduciary based on the analysis and model selected, and based on how to best leverage growth of local collaboration, for example, growth of GSC’s.

46

Q&A

Q: Does this funding replace 0-3 Secondary Prevention funding?

A: No. The outcomes for the Home Visiting Program include abuse/neglect prevention, but are broader. The analysis will help determine which outcomes will be addressed, with which target populations.

47

Q&A

Q: Will the funding be used to implement Nurse Family Partnership?

A: The analysis will help determine which outcomes will be addressed, with which target populations, which service gaps exist, and which model best fits the need. Nurse Family Partnership may be one of the models that could be chosen, if appropriate.

48

Q&A

Q: When will this webinar and presentation be available?

A: As soon as we have the link to the archived webinar, we will post to the websites and distribute via our distribution lists.

49

Q&A

Other questions?

50

Please continue to check the following websites for additional information about the Home Visiting Program:

www.michigan.gov/mihp, see Important News

www.greatstartfor4kids.org, under Early Childhood Home Visiting Program