north carolina’s future...north carolina maternal & child health home visiting projects fy...
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Effectiveness of Evidence-Based Home Visitation:
An Investment in North Carolina’s Future
NC Child Fatality Task Force Intentional Death Prevention Committee
September 23, 2013
Catherine Joyner, MSW
Our Future Today’s children are our future leaders, parents and workers. NC’s prosperity depends on their healthy growth & development.
A full continuum of evidence-based home visitation programs is a proven strategy to help children reach his or her fullest potential and is prepared for success in a global community.
Why Home Visiting? The link below provides a short video (2:13) summarizing the effectiveness of home visiting.
http://www.youtube.com/watch?v=D_kUP4ZUqmg
This video was produced by the Pew Center on the States. For additional information from the Pew Center, please visit www.pewstates.org .
What is Home Visiting? • Services provided
by qualified professionals within the home to parents from pregnancy through birth and early childhood
• Home visitors provide family-focused information, support & referrals
How is “Evidence” Determined?
• The US DHHS launched Home Visiting Evidence of Effectiveness (HomVEE) to: – Conduct a thorough, transparent
review of the home visiting research literature &
– Provide an assessment of the evidence of effectiveness for home visiting programs models that target families with pregnant women and children from birth to age.
• The results of the HomVEE Project may be found at: http://homvee.acf.hhs.gov/Default.aspx
# of EBVHPs in North Carolina
• North Carolina is strategically supporting models with a significant history in the state: –Nurse-Family Partnership (16*) –Healthy Families America (7*) –Parents as Teachers (60+*) –Early Head Start (25*) –Triple P [10*, increasing to 30* with funds from the
ELC]
* = counties
North Carolina Maternal & Child Health Home Visiting Projects
FY 2013-2014
NC MIECHV
Adolescent Parenting Program
Young Moms Connect
Healthy Start
Durham
Alamance Alexander
Alleghany
Anson
Ashe
Avery
Beaufort
Bertie
Bladen
Buncombe
Burke
Cabarrus
Caldwell
Carteret
Caswell
Catawba
Cherokee
Clay
Cleveland
Columbus
Craven
Cumberland
Currituck
Dare Davidson
Davie
Duplin
Edgecombe
Forsyth Franklin
Gaston
Gates
Graham
Granville
Greene
Guilford
Halifax
Haywood
Henderson
Hertford
Hoke
Hyde
Iredell
Jackson
Johnston
Jones
Lee
Lenoir
Lincoln
Macon
Madison Martin
Mecklenburg Montgomery
Moore
Nash
New
Hanover
Northampton
Onslow
Orange
Camden
Pender
Person
Pitt
Polk
Randolph
Richmond
Robeson
Rockingham
Rowan
Rutherford
Sampson
Scotland
Stanly
Stokes Surry
Swain
Tyrrell
Union
Vance
Wake
Warren
Washington
Watauga
Wayne
Wilkes
Wilson
Yadkin
Yancey
Harnett
Chatham
McDowell
Brunswick
Nurse Family Partnership (NFP)
Healthy Families America (HFA)
Parents as Teachers (PAT)
NFP, HFA & PAT
HFA, PAT & EHS
Early Head Start (EHS)
NFP, PAT & EHS
No current home visiting affiliation or program Healthy Beginnings
Public Health Pyramid
Indicated
Selective or at-risk
Universal
Durham Connects; PAT; Triple P [Level 1]
HFA NFP PAT
Triple P [Levels 2-3]
Triple P [Levels 4-5]
HV Continuum Example - HFA • Designed to work
with overburdened families who are at-risk for adverse childhood (ACE) experiences, including child maltreatment.
.
• HFA begins working with families prenatally or by 3 months of age and continues until the child’s 3rd B-day.
HV Continuum Example - PAT • An early childhood parent
education, family support, & school readiness HV program.
• “Parents are their children’s first and most influential teachers”.
• The most flexible HV program in terms of target population.
PAT may begin services w/ families, at any point in the child’s development (including prenatally), & continue until the child’s 5th B-day (with at least 2 years of service].
Family Outcomes Influenced by Home Visiting
• Maternal Health
• Child Health
• Family Economic Self-Sufficiency
• Positive Parenting
• Child Development & School Readiness
• Juvenile Delinquency, Family Violence & Crime
Source:
Pew Center, 2010
A few examples….
• Maternal Health: Decrease rate of preterm birth by 50% (savings of 28- 40k for medical care); lower rates of low birth weight (HFA NY)
• Child Health: Reduction of ED use and need for tx for injuries & accidents; decrease in CM (NFP; Triple P)
• Child Development & School Readiness: Higher cognitive, vocab scores (PAT; NFP)
Home Visiting
=
Cost Savings
Home Visiting Influences Early Brain Development
The early years of life matter because
children’s experiences affect the architecture of the maturing brain, establishing either a sturdy or a fragile
foundation for all of the development and behavior that follows.
Development of Pathways
Source: “The Science of Early Childhood Development” Center on the
Developing Child, Harvard University at www.developingchild.harvard.edu
Toxic Stress Damages
Brain Architecture
Source: ”Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities:
Building a New Framework for Health Promotion and Disease Prevention”
Shonkoff, Boyce & McEwen (JAMA, June 3, 2009)
Developmental Delays Correlate With
Significant Adversity
Source: “The Science of Early Childhood Development” Center on the
Developing Child, Harvard University at Www.developingchild.harvard.edu
Adverse Childhood Experiences
Social, Emotional, &
Cognitive Impairment
Adoption of
Health-risk Behaviors
Disease,
Disability
Early Death
Death
Birth
ACE Study
Continuum of Care
HVP
Childcare Provider
Pregnancy Care
Manager
CC4C
Early Intervention
Child welfare
WIC
Social Services (TANF,
Medicaid)
Successful Implementation
What must be in place to achieve
full scale implementation of
EBHV?
© Fixsen & Blase, 2008
Performance Assessment
(Fidelity)
Coaching
Training
Selection
Systems
Intervention
Facilitative
Administration
Decision Support
Data System
Integrated &
Compensatory
Com
pete
ncy
Driv
ers
Com
pete
ncy
Driv
ers O
rganization Drivers
Organization D
riversLeadershipLeadership
Adaptive Technical
Thank You! For more information
please contact: Catherine Joyner @
919.995.4122