Michigan Maternal, Infant, and Early Childhood Home Visiting Program

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Michigan Maternal, Infant, and Early Childhood
Home Visiting Program

• November 4, 2010
• 100-200pm

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Purpose of the webinar

• Review activities to date
• Anticipated next steps
• Questions

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ACTIVITIES TO DATE
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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

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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

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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, Childrens Trust Fund
• ECIC Early Childhood System building and
  promotion
• MI League for Human Services

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(No Transcript)
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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?id19
  148

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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.

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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.

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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.

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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/homev
  isiting/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.

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STEP 2

• Michigans 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.

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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
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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.

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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.

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• 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

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ANTICIPATED NEXT STEPS
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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.

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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.

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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.

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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)
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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
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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.

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IMPORTANT CONCEPTS

• Implementation science

Major Implementation Initiatives occur in
stages Exploration Installation Initial
Implementation Full Implementation Fixsen,
Naoom, Blase, Friedman, Wallace, 2005
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IMPORTANT CONCEPTS

• Implementation Research A Synthesis of the
  Literature
• Fixsen, 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?resourceID31
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WHAT CAN BE FUNDED?

• State Infrastructure building
• e.g. cross-system database, linking funding
• Local Infrastructure building
• e.g. strengthening collaborative bodies,
  promoting readiness to implement
• Direct Services
• e.g. evidence-based models

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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

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LOCAL INFRASTRUCTURE

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

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DIRECT SERVICES

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

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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.

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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.

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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

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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?

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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.

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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.

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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.

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COMMUNICATIONS/INVOLVEMENT

• To contact the Home Visiting Program, please
  e-mail
• HomeVisitingProject_at_michigan.gov

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• QUESTIONS ANSWERS

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QA

• 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.

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QA

• 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.

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QA

• 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.

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QA

• 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.

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QA

• 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.

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QA

• 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 GSCs.

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QA

• 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.

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QA

• 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.

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QA

• 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.

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QA

• Other questions?

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• 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