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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 Richardson Home Visiting Work Group Meeting February 25, 2011. Home Visiting.

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Debbie richardson home visiting work group meeting february 25 2011

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 Richardson

Home Visiting Work Group Meeting

February 25, 2011

Home visiting
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

Updated state plan submission date
Updated State Plan Submission Date

  • 90-120 days from SIR release date

  • May 8 – June 8

  • Will be reviewed & approved on a rolling basis

Funding to state
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

Maintenance of effort
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

Updated state plan content criteria
Updated State Plan Content & Criteria

  • Identification of targeted at-risk community(ies)

  • Goals & objectives

  • Selection of proposed HV model(s)

  • Implementation plan

  • Plan for meeting mandated benchmarks

  • Plan for administration

  • Plan for continuous quality improvement

  • Memorandum of Concurrence

  • Budget

1 identification of targeted at risk community ies
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

1 targeted community ies cont d
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

2 goals objectives for state hv program
2. Goals & Objectivesfor 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

3 selection of proposed hv model s
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

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

Basis for state s selection of model s
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)

Local rfp process
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

Model adaptations
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

Promising approaches
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

Model developers
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

Other info regarding models
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

4 implementation plan for state hv program
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

Implementation plan quality
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

Implementation plan participants
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

Priority to serve eligible participants
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

Research evaluation
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

5 plan for meeting mandated benchmarks
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

Benchmark i improved maternal newborn health
Benchmark I Improved 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

Benchmark ii child injuries ca n emergency visits
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

Benchmark iii improvements in school readiness achievement
Benchmark III Improvements in school readiness & achievement



  • 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

Benchmark iv crime or domestic violence
Benchmark IVCrimeORDomestic Violence


Domestic Violence

  • Caregiver arrests & convictions

  • Screening for DV

  • Of families identified for presence of DV:

    • # referrals made to relevant services

    • # completed safety plans

Benchmark v family economic self sufficiency
Benchmark VFamily economic self-sufficiency

  • Household income & benefits

  • Employment & education of adult members of household

  • Health insurance status

Benchmark vi coordination and referrals for other community resources supports
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

Plan for benchmarks cont d
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

Plan for benchmarks cont d1
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

Data collection analysis plan
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

6 plan for administration
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

Coordination with early childhood system
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

7 plan for continuous quality improvement cqi
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

8 memorandum of concurrence
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 (?)

Other state agencies
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

9 budget
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

Sir and related hv program information
SIR and related HV Program information

  • KDHE website

  • HRSA website

  • Home Visiting Evidence of Effectiveness (HomVEE)

Debbie Richardson, Ph.D.

Manager, Home Visiting Program

Bureau of Family Health

Kansas Dept. of Health & Environment

1000 SW Jackson, Suite 22o

Topeka, KS 66612