The Affordable Care Act Maternal, Infant,

and Early Childhood Home Visiting Program

Marilyn D. Stephenson, MSN, RNHRSA Maternal and Child Health Bureau

Division of Home Visiting and Early Childhood SystemsEastern 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

Overview of Presentation

• Legislative authority and program goals and priorities

• Evidence-based home visiting models

• Status on program implementation and opportunities for partnership

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

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.

Home Visiting Program Goals

Improvements 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

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

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

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

“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

Models that Meet the Criteria for Evidence 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

Models that Meet the Criteria for Evidence Base

Early Start (New Zealand)

Oklahoma Community-Based Family Resource and Support Program

Play and Learning Strategies (PALS) Infant

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

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

FY 2011 Competitive Grant

Expansion Grants States and jurisdictions that have already made

significant progress towards implementing a high-quality HVP

Development Grants States and jurisdictions that currently have modest

HVP and want to build existing efforts

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

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

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)

Mother and Infant Home Visiting Project 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

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

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?

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

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

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

Resources

HRSA/MCHB website: http://mchb.hrsa.gov/programs/homevisiting/

HomVEE website:

http://homvee.acf.hhs.gov/

Questions?

Marilyn D. Stephenson

MStephenson@hrsa.gov

Thank you!