debbie richardson home visiting work group meeting february 25 2011
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Debbie Richardson Home Visiting Work Group Meeting February 25, 2011

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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