OVERVIEW SUPPLEMENTAL INFORMATION REQUEST (SIR) FOR THE SUBMISSION OF UPDATED STATE PLAN(RELEASED 2/8/11) ACA Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program

Debbie RichardsonHome Visiting Work Group MeetingFebruary 25, 2011

Home Visiting

•Primary service delivery strategy

•Offered on voluntary basis to pregnant women or children birth to age 5

•Embedded in a comprehensive, high-quality early childhood system that promotes maternal, infant, & early childhood health, safety, development, and strong parent-child relationships

2

Updated State Plan Submission Date

•90-120 days from SIR release date

•May 8 – June 8

•Will be reviewed & approved on a rolling basis

3

Funding to State

•Will receive at least FY’10 allocation in FY’11-’15 ($936,464)

•Additional competitive funds beginning FY’11

▫Criteria to be provided prior to state plan due date

4

Maintenance of Effort

•As required in initial FOA:▫Funds shall supplement, not supplant,

funds from other sources for early childhood HV programs & initiatives

▫Must maintain non-Federal funding (SGF) for grant activities at level not less than 3/23/10

•Received clarification that state’s Tobacco Settlement $ will not be considered

5

Updated State Plan Content & Criteria1. Identification of targeted at-risk

community(ies)

2. Goals & objectives

3. Selection of proposed HV model(s)

4. Implementation plan

5. Plan for meeting mandated benchmarks

6. Plan for administration

7. Plan for continuous quality improvement

8. Memorandum of Concurrence

9. Budget

6

1. Identification of targeted at-risk community(ies)• Justify selection of the at-risk community(ies) from

among those identified in the initial needs assessment

• For the targeted community(ies), update & provide a more detailed needs and resources assessment

▫Specific community risk factors and strengths▫Characteristics and needs of participants▫Service systems for families including HV programs

currently operating or discontinued since 3/23/10▫Existing mechanisms for screening, identifying,

referring to HV programs▫Referral resources available and needed

7

1. Targeted community(ies) - cont’d•Plan for coordination among existing programs

& resources in targeted communities

•How program will address existing service gaps

•Local & state capacity to integrate proposed HV services into early childhood system

•List other communities identified in initial needs assessment but not being selected due to funding limitations

8

2. Goals & Objectives for State HV program•Clearly articulated goals & objectives

•How program can contribute to developing a comprehensive, high-quality EC system

•Strategies for integrating the program with other programs & systems in state related to MCH and EC health, development, & well-being

•Logic model

9

3. Selection of proposed HV model(s)

• One or more evidence-based HV models should be selected

• Up to 25% of funds allowed to support promising approaches that do not yet qualify as EBM

• Can request consideration or reconsideration of other models as EB

• Engage targeted community(ies) in decision-making to assess fit of model and readiness to implement

10

HV MODELS THAT MEET EVIDENCE-BASED CRITERIA

• Early Head Start - Home-Based Option

• Family Check Up

• Healthy Families America

• Healthy Steps

• Home Instruction Program for Preschool Youngsters (HIPPY)

• Nurse Family Partnership

• Parents as Teachers

11

Basis for State’s Selection of Model(s)• Selected HV model(s) match needs and address

particular risks in targeted community(ies)

• Characteristics and needs of local families

• Target multiple risk factors to the extent possible

• Consider service gaps

• Model(s) will be complementary, not duplicative, of existing HV or other services for local families

• Capacity and resources of the targeted community(ies) to implement the chosen model(s)

12

Local RFP process

•State may request proposals for funding to provide services in state-identified communities and select strongest

•State may identify 1 or more HV models for which it seeks proposals

•If choose to use a competitive subcontracting process, must describe how RFP will be structured and meet federal requirements

13

Model Adaptations• May adapt model to meet needs of targeted

communities such as broadening population served, additions, subtractions, or enhancements

• Acceptable changes are those that have not been tested with rigorous research but are determined by the model developer not to alter the core components related to program impacts

• Adaptations that alter core components may be funded as promising approaches

14

Promising Approaches

•A HV model…▫with little or no evidence of effectiveness,▫does not meet criteria for EBM, or ▫modified version of EBM that includes

significant alterations to core components

• Should be grounded in empirical work

• Must be developed by or identified with a national organization or higher ed institution

• Must evaluate with well-designed & rigorous process

15

Model Developers• Must provide documentation of approval by

developers of selected model(s) to implement model as proposed

• Verifying developer… ▫has reviewed & agreed to plan as submitted▫proposed adaptations▫support for participation in nat’l evaluation▫state’s status to any required certification

or approval process required

• Submit within 45 days (by 3/25/11) – may request extension

16

Other info regarding models

•State’s current/prior experience with implementing and current capacity to support

•State’s overall approach to HV quality assurance

•Approach to program assessment and support of ensuring model fidelity

•Anticipated challenges & risks to maintaining quality & fidelity and proposed responses

17

4. Implementation plan for State HV Program• Process of engaging targeted at-risk

community(ies)

• Approach to development of policy and setting standards

• Working with model developer(s); TA and support to be provided by nat’l model(s)

• If used, plan for recruitment of subcontractor orgs

• Timeline for obtaining curriculum & materials

• Types of and how initial & ongoing training will be provided for HV personnel

• Recruiting, hiring, and retaining staff

18

Implementation plan - Quality

•Plan to ensure high quality clinical supervision and reflective practice for staff

• Operational plan for coordination among existing HV programs and other related programs/services in the community(ies)

•Plan for obtaining/modifying data systems for ongoing continuous quality improvement (CQI)

•Approach to monitoring, assessing, and supporting implementation with model fidelity and maintaining quality assurance

19

Implementation plan - Participants

•Estimated # of families served and estimated timeline to reach max caseload

•Plan for identifying/recruiting participants, and minimizing attrition rates for enrolled participants

•Individualized assessments will be conducted of participant families and services provided according to the assessments

20

Priority to serve eligible participants• Low incomes

• Pregnant women < age 21

• History of child abuse or neglect; or interactions with child welfare services

• History of substance abuse or need SA treatment

• Use tobacco products in home

• Have, or have children with, low student achievement

• Have children with developmental delays or disabilities

• Families with members who are serving or have served in armed forces

21

Research & Evaluation

•Participate in national evaluation

•Not required to conduct any add’l evaluation, other than research on promising approaches

•May conduct research & evaluation outside of national evaluation – if so, must describe

22

5. Plan for meeting mandated benchmarks•Must collect data on:

▫all benchmark areas and all constructs▫eligible families enrolled in program who

receive services funded with MIECHV program funds

▫Individual-level demographic & service-utilization data

•Must demonstrate improvements in: ▫at least 4 benchmark areas by end of 3 years▫at least ½ of constructs under each

benchmark area

23

Benchmark IImproved maternal & newborn health

• Prenatal care

• Parental use of alcohol, tobacco, illicit drugs

• Preconception care

• Inter-birth intervals

• Screening for maternal depressive symptoms

• Breastfeeding

• Well-child visits

• Maternal & child health insurance status

24

Benchmark II Child injuries, CA/N, emergency visits • Visits for children and mothers to emergency dept – all causes

• Info/training provided to participants on prevention of child injuries

• Incidence of child injuries requiring medical treatment

• Reported suspected maltreatment (allegations screened but not necessarily substantiated) and substantiated maltreatment for children in the program

25

Benchmark III Improvements in school readiness & achievementParent Child

• support for children’s learning & development

• knowledge of child development of their child’s developmental progress

• parenting behaviors and parent-child relationship

• emotional well-being or stress

• communication, language & emergent literacy

• general cognitive skills

• positive approaches to learning including attention

• social behavior, emotion regulation, & emotional well-being

• physical health & development

26

Benchmark IVCrime OR Domestic Violence

Crime Domestic Violence

•Caregiver arrests & convictions

•Screening for DV

•Of families identified for presence of DV: ▫# referrals made to

relevant services▫# completed safety

plans

27

Benchmark VFamily economic self-sufficiency

•Household income & benefits

•Employment & education of adult members of household

•Health insurance status

28

Benchmark VICoordination and referrals for other community resources & supports

•# families identified for necessary services

• # families that required services and received a referral to available community resources

• # of MOUs or formal agreements with other social service agencies in community

• # agencies with which HV provider has a clear point of contact that includes regular sharing of information

• # of completed referrals

29

Plan for benchmarks – cont’d•Recommended/strongly encouraged:

▫standard measures for constructs across HV models

▫utilize standard measures and other appropriate data for CQI to enhance program operation, decision-making, and to individualize services

▫data collected across all benchmark areas be coordinated & aligned with other relevant state or local data collection efforts

30

Plan for benchmarks – cont’d

•For each construct within each benchmark area:

▫Specify proposed measure(s) with various details

▫For use of administrative data, must include MOU from agency with responsibility/oversight

▫Proposed definition of improvement for each element of construct

31

Data collection & analysis plan• Sampling may be used for some or all benchmark areas

• Schedule for collection & analysis of each measure

• Ensure quality – min. qualifications, required training for relevant staff, time estimated for data collection-related activities by personnel

• How data will be analyzed at local & state levels

• Using data for CQI at local program, community, state levels

• Data safety, monitoring, privacy, human subjects protections

• Anticipated barriers/challenges & possible strategies

32

6. Plan for Administration• Statewide administrative structure to support

state HV program

• How HV plan and program will be managed and administered at state & local levels

• Collaborative public/private partners

• If support more than one HV program in community – plan for coordination of referrals, assessment & intake procedures across models

• Identify other related state or local evaluation efforts of HV programs (other than evals of promising approaches)

• Key personnel – job descriptions & resumes

• Organization chart

33

Coordination with Early Childhood System

•Ensure Updated State Plan is coordinated with other state EC plans including State Advisory Council Plan and State EC Comprehensive Systems Plan

•Any strategies for making modifications needed to bolster the State administrative structure in order to establish a HV program as a successful component of a comprehensive, integrated EC system

34

7. Plan for Continuous Quality Improvement (CQI)

•CQI – A systematic approach to specifying processes and outcomes of a program or set of practices through regular data collection and the application of changes that may lead to improvements in performance

•Address how CQI strategies will be utilized at local & state levels

35

8. Memorandum of Concurrence

• Signed by required agencies signifying approval of Updated State Plan (1st four + 2):▫Director, State’s Title V agency (KDHE)▫Director, State’s agency for Title II of CAPTA (SRS)▫State’s child welfare agency (Title IV-E and IV-B), if

not also administering Title II of CAPTA (SRS)▫Director, State’s Single State Agency for Substance

Abuse Services (SRS)▫Administrator, State’s Child Care and Development

Fund (CCDF) (SRS – who?)▫Director, Head Start State Collaboration Office (SRS)▫State Advisory Council on Early Childhood Education

and Care authorized by Head Start Act (?)

36

Other State Agencies…• Strongly encouraged to seek consensus from:

▫IDEA Part C and Part B lead agencies▫Elementary & Secondary Education Act Title I

or pre-K program

▫MCHIP and/or EPSDT programs

• Strongly encouraged to coordinate with:▫Domestic Violence Coalition▫Mental Health agency ▫Agency charged with crime reduction▫TANF and SNAP ▫Injury Prevention & Control

37

9. Budget

•Updated budget for use of FY’10 allocation

•Funds awarded for FY’10 are available for expenditure thru 9/30/12

•Budget period – 27 months

•Includes costs of statewide needs assessment, state plan, and initial implementation

38

SIR and related HV Program information

•KDHE websitewww.kdheks.gov/bfh/home_visiting.htm

• HRSA website

www.hrsa.gov/grants/manage/homevisiting

• Home Visiting Evidence of Effectiveness (HomVEE) http://homvee.acf.hhs.gov/

39

40

Debbie Richardson, Ph.D.Manager, Home Visiting Program

Bureau of Family HealthKansas Dept. of Health & Environment

1000 SW Jackson, Suite 22oTopeka, KS 66612

785-296-1311drichardson@kdheks.gov