Building Successful Early Childhood Home Visitation State Systems

Lisa Schreiber, Consultant

ZERO TO THREE Policy Center

June 22, 2010

Mike Schreiber

Overview of Webinar

•New home visiting legislation and application process

•ZERO TO THREE’s new self-assessment tool

•State panel discussion with four model states: CO, NJ, VA, WA

•Q&A

•Update from Pew Center on the States’ Home Visiting Initiative

The Patient Protection and Affordable Care Act- A New Opportunity for Home Visitation Programs

•$1.5b in mandatory funding (5 years) for high quality, evidence-based, voluntary early childhood home visitation

•Title V of the Maternal and Child Health block grant (Social Security Act)- administered by DHHS (MCHB and ACF)

•Targeted to “at risk” communities/populations (e.g. low income, pregnant under 21, history of child welfare/abuse, history of substance abuse, children with developmental delays, military families)

•State assessment plan due 7/9/10, state needs assessments due 9/1/10, final state plans due early FY2011

•Governor’s office to determine administrative agency

•Up to 25% of funds can be used towards promising models

The Patient Protection and Affordable Care Act- Funding Breakdown and FY2010 Allocation

•$1.5 billion over 5 years:

$100M for FY2010

$250M for FY2011

$350M for FY2012

$400M for FY2013

$400M for FY2014

•Formula grant to all states based on:

-$500K base allocation to each state

-An amount equal to funds provided under the current EBHV ACF grant

(CA, CO, DE, HI, IL, MN, NJ, NY, OH, OK, RI, SC, TN, TX, UT)

-An amount based on children in families at/below 100% poverty

•Chart of FY2010 funding levels can be found at: grants.gov or hrsa.gov

LifeStockPhoto

The Patient Protection and Affordable Care Act-Full Needs Assessment Requirements

• Needs assessment plan due 7/9/10 (FOA on grants.gov)

• Full needs assessment guidance published late June, due 9/1/10

• Full needs assessment must include:-Data identifying communities at risk-The quality and capacity of existing programs for early childhood home visiting -State’s capacity for providing substance abuse

treatment/counseling-Connection with other assessments/planning for the

Head Start Act, MCH Block Grant and CAPTA

The Patient Protection and Affordable Care Act- Criteria for Model Evidence of Effectiveness

•Announcement to be published in

mid-August, response (“Updated State

Plan”) due early FY2011

•Will specify criteria for evidence of

effectiveness of home visiting models

that qualify for funding and what state

applications must include to meet the

evidence criteria set forth by HHS

•Proposed criteria available for public comment prior to issuance

Andrea Booher

Key Components of a Successful Early Childhood Home Visitation System- A Self-Assessment Tool for States

 

www.zerotothree.org/homevisitingtool

Key Components of a Successful Early Childhood Home Visitation System- A Self-Assessment Tool for States

 

•Purpose:

-Define the home visiting system

-Assess the home visiting system’s capacity

-Prioritize areas for improvement

•Useful for federal home visiting grant application process but also for ongoing assessment and continuous quality improvement

Debbie Rappaport

Key Components of a Successful Early Childhood Home Visitation System- A Self-Assessment Tool for States

 

• Eight components of systems-building detailed through strategic questions

• Each component has room for state status and next steps

• Encouraged to rank priority of individual components

• Templates provided for state-specific additions

• Priority ranking summary at end to set stage for action plan/next steps

 Key Components of a Home Visiting State System

 

•Needs Assessment and Program Planning•Evaluation and Quality Assurance•Program Standards•Professional Development and Technical Assistance•Early Childhood Partnerships and Collaboration•Public Engagement•Administration and Governance•Financing and Sustainability Debbie Rappaport

 Tips for Using the Self-Assessment Tool

 

•Involve key stakeholders

•Divide responsibility for the self assessment

•Use the results

www.zerotothree.org/homevisitingtool

 State Panel Discussion

 

Panelists:

•Melissa Kelley, Executive Director- Colorado Parent & Child Foundation

•Sunday Gustin, Home Visitation Program Manager- New Jersey Department of Children and Families

•Catherine Bodkin, Chair, Home Visiting Consortium- Virginia Department of Health

•Joan Sharp, Executive Director- Council for Children & Families, Washington State

 Colorado State Profile

 

Colorado’s Home Visitation Coalition

Models Being Implemented: Promotion: Colorado Bright Beginnings, Prevention: Family Visitor Program, Baby Bear Hugs, HIPPY (Home Instruction for Parents of Preschool Youngsters), Parents As Teachers (PAT), Nurse Family Partnership (NFP), Intervention: Family Advocacy, Care, Education and Support (FACES)

Program Reach and Families Served: Over 20,000 families served last year with one of the above programs

Administration and Funding:1 Program Model (NFP) has a designated line item of State funding, which is administered through the Colorado Department of Public Health and Environment

All other Programs/Models are administered through statewide or local/regional organizations and receive funding from a variety of public and private sources (foundations, state and federal government grants, local public monies, and individual donors)

 Colorado State Profile

 

State Systems Strengths:Early Childhood Colorado Framework and Framework in Action State Plan that is comprehensive and inclusive of home visitingActive home visiting coalition, since the mid-1980sVery strong spirit of collaboration amongst home visiting and early childhood programsContinuum of models and programs to support a variety of families and their needs

Key Stakeholders:Colorado Home Visitation Coalition, Colorado Early Childhood Partners (statewide/state level early childhood groups), Colorado’s Early Childhood Funders, Office of the Lt. Governor and Various State Agencies (Education, Health, Human Services)

State Systems Definition:Colorado has an active early childhood systems building initiative that is guided by the Early Childhood Colorado Framework. Home visiting is part of a broad continuum of services working across multiple domains. System level work of the CHVC includes advocacy for home visiting as an effective service delivery model; cross-program/model communication; cross-program/model coordination as appropriate.

 New Jersey State Profile

 

New Jersey Home Visitation Initiative

Models Being Implemented: DCF Funded: Healthy Families America, Nurse Family Partnership and Parents As Teachers and Family Connections site (special needs population), Non-DCF Funded: additional PAT, Parent-Child Home Program and HIPPY

Program Reach and Families Served: Approximately 3,200 this year. At least one program in all 21 counties in the state.

Administration and Funding: Division of Prevention and Community Partnerships within the Department of Children and Families (DCF)•Federal: Title IVB, TANF, ACF, OJJDP; State Funds; and Local Leveraged Funds•HV program/administrative oversight in collaboration with NJ EBHV model developers

– HF and PAT—Prevent Child Abuse New Jersey– NFP—Public/Private Ventures and NFP National Service Office Nurse Consultant

 New Jersey State Profile

 

State System Strengths:Unified and committed state level leaders/advocates – early strategic planningBroad-based state and local partnerships and collaborationStable core funding commitments – DCF (Title IVB), DHS (TANF) Shared program goals and objectives across modelsStrong model developer/training and technical assistance partnerships

Key Stakeholders:DCF (Prevention/CBCAP, CPS, Child Behavioral Health), Health (MCH, Perinatal Addictions/Depression, WIC), Human Services (TANF, Addiction Services, Medicaid), Education (Early Childhood, Early Head Start), Juvenile Justice (Prevention), Regional MCH Consortia, Funding Partners (United Way, Nicholson Foundation), State/National EBHV Developers (HFA, PAT, NFP)

State Systems Definition: Prenatal/MCH Interagency Collaboration. Central intake with links to: a) Home Visitation and/or b) Other services/supports. DCF and state partners provide leadership, technical assistance and support. Six of 21 counties have a formal HV System with lead agency for local collaboration.

 Virginia State Profile

  Virginia Home Visiting Consortium

Models Being Implemented:

National: Head Start/EHS; Healthy Families; Healthy Start; Early Intervention; Part B; Parents as Teachers.  State-Level: BabyCare (targeted case management for high risk pregnant women and infants); CHIP of Virginia (nurse-chw team promoting family health and medical home); Project Link (targeted care coordination for women at risk for substance use); Resource Mothers Program (community health workers mentoring pregnant teens); Medicaid Managed Care (care coordination and education)

Program Reach and Families Served:•27,245 children ages 0-5 years old and their families (2008), 9 localities = no perinatal programs•128 of 137 Virginia cities and counties

Administration and Funding: •Consortium Infrastructure Project- Consortium MOA with 5 state agencies, coordinated by health department•Funding Sources: Federal agencies, state general funds, local foundations, United Way, Medicaid reimbursement, Medicaid Administrative, local governments

 Virginia State Profile

  State System Strengths:

•Shared vision for healthy child development in strong families and healthy communities•Early childhood system public-private partners in diverse agencies and disciplines •Core training topics for all home visitors identified •Shared data indicators across programs•Commitment to standardized screening tools•Sustained energy; openness to new approaches and partners

Key Stakeholders:•Home visiting program state managers and local program staff•Early childhood professionals in education, health care and social services•Virginia Early Childhood Foundation •Early Childhood Advisory Council•Communities, especially the 25 Smart Beginnings Early Childhood coalitions

State System Definition: A collaboration of state home visiting programs serving families from pregnancy to age 5 as part of the overall state comprehensive early childhood system working with families and communities to promote children’s health, and readiness for school and readiness for life.

 Washington State Profile

 

Washington Evidence Based Home Visiting System

Models Being Implemented: Nurse Family Partnership, Parents As Teachers, Parent Child Home Program, Steps Toward Enjoyable Effective Parenting (STEEP), Early Head Start

Program Reach and Families Served:

Approximately 4,700 families served annually

Administration and Funding:

•Historically, administered by a single state agency

•CAPTA Title II (CBCAP) lead/Children’s Trust Fund

(now in transition)

•State funded (local match)- new funding in 2007

State System Strengths:

•Legislative and philanthropic commitment

•Home Visiting Coalition

•Evidence-based approachLifeStockPhoto

 Washington State Profile

  Key Stakeholders:

•Home Visiting Coalition, state agencies (health, early learning, social services), foundations/private funders (Gates, United Way of King County)

State Systems Definition:

Historically

• Established approach to build a “portfolio” of programs built on practice, programs and community needs

• Conducted outreach and education

• Defined “evidence” – levels with criteria

• Co-learning around continuous quality improvement for program development and building organizational capacity

• Evaluating and conducting advocacy on behalf of system

Currently

• Evolving (and expanding)

• Early learning, health, child welfare, economic services (TANF), Medicaid, behavioral health, mental health

• Governance, accountability, standards, professional development, financing etc.

 Coalition-Building and Collaboration

 

In your experience, what are keys to success and what are the major challenges for coalition building?

Respondents: Melissa

Colorado

Coalition-Building and Collaboration

What are the goals for the coalition work in your state and how are those goals actualized?

Respondents: Catherine

Virginia

 Program Implementation

 

Much has been discussed about the “black box” of implementation. How do we “unpack” the box and find out what is really going on during an effective home visit and inform the state system?

Respondent: Joan

Washington

 Program Implementation

 

An innovation that seems to be bringing communities and programs together is the concept of a centralized intake/assessment system. How do these structures work and how are they an example of systems integration?

Respondents: Sunday

New Jersey

 Program Implementation

 

Training/professional development seems to be an area where systems-wide collaboration is taking place successfully. How has your state created efficiencies in the training arena?

Respondents: Melissa and Catherine

Virginia

Colorado

 Quality Assurance

 

How do you address issues of program quality system-wide?

Respondent: Sunday

New Jersey

Sustainability and Financing 

How has your state approached the financing of the home visiting field to ensure the sustainability of the programs and state system?

Respondent: Joan

Washington

 Early Childhood Partnerships- Maternal and Child Health

 

How have your state home visiting efforts connected with maternal and child health services and systems?

Respondents: Sunday and Catherine

New Jersey

Virginia

Early Childhood Partnerships- Early Care and Education

 

How have your state home visiting efforts connected with other early care and education services and systems?

Respondents: Melissa

Colorado

 Evidence-Based Practice

 

How can evidence of home visiting’s effectiveness guide decisions about strategic/program planning?

Respondents: Joan and Catherine

WashingtonVirginia

 Planning and Expansion

 

Given the tremendous opportunity afforded by the new home visiting funds, how will your state approach the planning for the grants in terms of determining needs, defining risk, selecting models and distributing funds?

Respondents: Catherine

Virginia

Planning and Expansion

 

How will you expand home visiting for those most in need in your state and what will be the challenges of expansion?

Respondents: Sunday and Joan

New Jersey

Washington

 Planning and Expansion

 

What advice do you have for those viewing the webinar who are coming from evolving states, where not much systems development has taken place, about how to build and sustain a strong home visitation system?

Respondents: Sunday, Melissa and Joan

New JerseyColorado Washington

 Contact Information

 

Lisa Schreiber

Lisaschreiber2@yahoo.com

Melissa Kelley

www.cpcfonline.org

Sunday Gustin

http://www.state.nj.us/dcf/prevention/

Catherine Bodkin

www.homevisitingva.com

Joan Sharp

http://www.ccf.wa.gov/funded-programs/ebp-home-visiting-funding

 The Pew Home Visiting Campaign: Webinar Series

 

A series of four webinars highlighting promising practices in administering state home visiting systems:

•Using Evidence to Guide and Direct State Home Visiting Investments: Leaders from three Pew campaign states—Washington, North Carolina and Ohio—will discuss their experiences promoting evidence-based policy and practice in home visiting. •Implementation, Implementation, Implementation: Best practices and strategies for monitoring implementation of state home visiting programs. •Evaluating for Impact: State-sponsored efforts to evaluate home visiting programs for process and outcome measures, as well as cost-benefit.•Systems Coordination: Successful state efforts to centralize intake, standardize policies and procedures, identify core indicators and performance measures, and train home visiting professionals.

 Resources

 

Link for ZERO TO THREE webinar information (including this power point, self-assessment tool and state one-pagers)

www.zerotothree.org/policywebinars

Link to federal home visiting grant announcement:

http://www.grants.gov/search/search.do?mode=VIEW&oppId=55133

E-mail for federal home visiting grant questions: homevisiting@hhs.gov