Affordable Care Act
Maternal, Infant and Early Childhood Home Visiting
(MIECHV) Programs Grant
U.S. Department of Health and Human Services
Health Resources and Services Administration
Maternal and Child Health Bureau
&
Administration for Children & Families
Rosa M. Biaggi, MPH, MPA
State Department of Public Health
Chief, Family Health Section
State Title V Maternal and Child Health Director
Principal Investigator - MIECHV Programs Grant
Connecticut Department of Public Health
Patient Protection and
Affordable Care Act (ACA)
• Signed into law March 23, 2010 by President Obama
• A provision of the Act authorized the creation of the
Maternal, Infant, and Early Childhood Home Visiting
Programs
Connecticut Department of Public Health - Keeping Connecticut Healthy
The MIECHV Program
is designed to
• strengthen and improve the Title V programs and
activities;
• improve coordination of services for at risk
communities; and
• identify and provide comprehensive services to
improve outcomes for families who reside in at risk
communities.
Connecticut Department of Public Health - Keeping Connecticut Healthy
Three Components of
FY 2010 ACA Funding
1.
Application for funding (submitted by DPH on July 9, 2010)
Required designation of the Lead Agency by Governor.
2.
Conduct a Statewide Needs Assessment (submitted by DPH
on September 16, 2010).
3.
Submission of an updated state plan that addresses the
needs of the targeted community(ies) identified in the needs
assessment (due June 8, 2011). Revised October 2012.
Connecticut Department of Public Health - Keeping Connecticut Healthy
Designation of Lead Agency
Lead Agency: Department of Public Health
Required partners:
• Department of Social Services
• Department of Children and Families
• Department of Mental health and Addiction
Services
Connecticut Department of Public Health - Keeping Connecticut Healthy
Additional Partners
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State Department of Education
Department of Developmental Disabilities
Department of Correction
Commission on Children
University of Connecticut
Yale University
CT Parents as Teachers
Child Health and Development Institute of CT
State Economic Resource Center
Women’s Health Subcommittee (Medicaid Care Management
Oversight Council)
Child FIRST
Connecticut Department of Public Health - Keeping Connecticut Healthy
Statewide Needs Assessment
(DPH and affiliates, 2010)
Purpose: To identify communities “at-risk”.
Looked at maternal and child health outcomes by town. Risk factors assessed
included, but were not limited to:
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Low birth weight, fetal and infant mortality
Poverty
Unemployment
Maltreatment
Education
Homelessness
Crime
Domestic violence
Tobacco use
Poverty
High school dropout rates
Teen parenthood
Perinatal depression
Connecticut Department of Public Health - Keeping Connecticut Healthy
Local Community Assessments
• What were the challenges of the community?
– i.e., Poor school readiness, low birth weight babies, high infant mortality,
high dropout rates, high unemployment, high crime, etc.
• Were there other characteristics that made a home
visiting program likely to make a difference?
– Non-English speaking, limited public transportation
• What are the strengths of the community?
– Existing partnerships
• What service systems are currently available?
Connecticut Department of Public Health - Keeping Connecticut Healthy
Needs Assessments
Findings
Sixteen (16) towns of VERY HIGH need
Connecticut Department of Public Health - Keeping Connecticut Healthy
Needs Assessments
Findings
Thirteen (13) towns of HIGH need
Connecticut Department of Public Health - Keeping Connecticut Healthy
Needs Assessments
Findings
Five (5) town of MODERATE need
Connecticut Department of Public Health - Keeping Connecticut Healthy
Needs Assessments
Findings
At least forty-nine (49) towns in the state had one
or more of at least twenty-three (23) home visiting
programs (or programs with a home visiting
component) in operation.
However, of these, ONLY TWO models:
• Parents as Teachers, and
• Early Head Start with a Home Visiting
component
had been approved by HRSA as evidence-based.
Connecticut Department of Public Health - Keeping Connecticut Healthy
(HRSA) Evidence-Based Models (as of 12/20/2012)
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Early Head Start
Family Check-Up
Healthy Families America (HFA)
Healthy Steps
Home Instruction for Parents of Preschool Youngsters (HIPPY)
Nurse Family Partnership
Parents as Teachers (PAT)
Child FIRST
Early Intervention Program for Adolescent Mothers
Early Start (New Zealand)
Oklahoma Community-Based Family Resource and Support Program
Play and Learning Strategies (PALS) Infant
Connecticut Department of Public Health - Keeping Connecticut Healthy
State Plan for Home Visiting
The overarching goals of the State Plan are to:
• Support improvements in maternal, child and family
health.
• Promote effective implementation and expansion of
evidence-based home visiting programs in the state
with fidelity to the model selected.
• Reach high-risk and hard-to-engage populations.
• Support a family-centered approach to home visiting.
Connecticut Department of Public Health - Keeping Connecticut Healthy
EBM in CT funded by the MIECHV
Programs Grant
• Parents as Teachers (PAT) – enhanced with increased frequency
of home visits, number/type of screening, fatherhood initiative, and
professional development training in all sites.
• Early Head Start (EHS) - with a home visiting component - No
enhancement or adaptations.
• Nurse Family Partnership (NFP)– No enhancements or
adaptations.
• Child and Family Interagency Resource, Support, and Training
(Child FIRST) – No enhancements or adaptations.
Connecticut Department of Public Health - Keeping Connecticut Healthy
Target Population
Connecticut Department of Public Health - Keeping Connecticut Healthy
Evidence of Favorable Outcomes
Connecticut Department of Public Health - Keeping Connecticut Healthy
Minimum Qualifications/Certifications
Connecticut Department of Public Health - Keeping Connecticut Healthy
Caseload Ratio
Connecticut Department of Public Health - Keeping Connecticut Healthy
Supervision Ratio
Parents As
Teachers (PAT)
1:12 FTEs
Early Head Start
(EHS)
1:3 FTEs
Nurse Family
Partnership
(NFP)
1:8 FTEs
Child FIRST
1:1 Team
Connecticut Department of Public Health - Keeping Connecticut Healthy
Federal Funds
Budget Period
7/15/2010-9/30/2012 $855,073
Award
9/30/2011-9/29/2015 $1,026,087 per year
3/31/2012-3/30/2015 $8,677,222 per year
TOTAL
$30,991,087
Connecticut Department of Public Health - Keeping Connecticut Healthy
Community Selection
Community Readiness
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Fidelity – Do they Really “Get” Fidelity?
– Some components to fidelity include: target population, staff
qualifications, supervision, number of families per worker.
Data Driven Decision Making and CQI
– Does the community demonstrate evidence of evaluating, measuring,
collecting and reflecting on outcomes? Is there evidence of data driven
decision making that informs program development, funding decisions,
and policy? Has the community engaged in planning processes for
initiatives and service development?
Model Specific Considerations
– How will EBHV fit within a continuum of services? Is there leadership or
history in bringing EBHV to the community? Is there support from
multiple community agencies? Is there evidence of community capacity
to support an EBHV? Is there staffing availability? A source of qualified
culturally-competent staff available? Is the community supportive of the
program with funding or other resources?
Connecticut Department of Public Health - Keeping Connecticut Healthy
Selected Home Visiting Program
Communities and EBHV models
Town
Ansonia-Derby
Grant
Formula & Competitive
EBM
EHS and Child FIRST
Bloomfield
Bridgeport
Bristol
Danbury
East Hartford
East Haven/West Haven
Killingly/Plainfield
Manchester/Vernon
Meriden
New London
New Britain
Norwich/Griswold/Sprague
Putnam/Windham
Torrington/Winchester
Windham
Windsor Locks/East Windsor
Competitive
Competitive
Competitive
Competitive
Competitive
Competitive
Competitive
Competitive
Competitive
Formula
Formula & Competitive
Competitive
Competitive
Competitive
Formula & Competitive
Competitive
Child FIRST and PAT
PAT
Child FIRST
Child FIRST
Child FIRST & PAT
PAT
PAT
PAT
Child FIRST & PAT
NFP
PAT
PAT
Child FIRST
Child FIRST & PAT
PAT
PAT
Connecticut Department of Public Health - Keeping Connecticut Healthy
Connecticut
Maternal, Infant and Early Childhood Home Visiting
Programs Grant
• Benchmarks (6)
• Constructs (35)
• Data Elements (223)
Connecticut Department of Public Health - Keeping Connecticut Healthy
1. Improved Maternal & Newborn Health
(8 constructs and 51 data elements)
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Prenatal care
Parental use of tobacco
Preconception care
Inter-birth intervals
Screening for maternal depressive symptoms
Breastfeeding
Well-child visits
Maternal and child health insurance status
Connecticut Department of Public Health - Keeping Connecticut Healthy
2. Child Injuries, Child Abuse, Neglect, or Maltreatment and Reduction of
Emergency Department Visits
(7 constructs and 56 data elements)
• Emergency Department visits: Children
• Emergency Department visits: Enrolled Women
• Health and safety information or training (Household safety: burns,
scalds, falls, accidental toxic ingestion, choking, second hand
smoke, safe sleeping, etc.)
• Incidence of child injuries requiring medical treatment
• Reported DCF suspected maltreatment (includes substantiated
and unsubstantiated cases)
• Reported substantiated maltreatment of children
• First time child victims of maltreatment
Connecticut Department of Public Health - Keeping Connecticut Healthy
3. School Readiness and Achievement
(9 constructs and 64 data elements)
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Parent support for child’s learning and development
Parent knowledge of child development and their child’s progress
Parenting behaviors and parent-child relationships
Parent emotional well-being or parenting stress
Child communication, language and emergent literacy
Child’s general cognitive skills
Child’s positive approaches o learning including attention
Child’s social behavior, emotional regulation, and emotional wellbeing
• Child’s physical health and development
Connecticut Department of Public Health - Keeping Connecticut Healthy
4. Crime or Domestic Violence
(3 constructs and 26 data elements)
• Screening for domestic violence
• Domestic violence: referrals made to relevant services
(i.e., shelters, food pantries, etc.)
• Domestic violence: number of families for which safety
plan completed
Connecticut Department of Public Health - Keeping Connecticut Healthy
5. Family Economic Self-Sufficiency
(3 constructs and 13 data elements)
• Household income and benefits
• Employment or education
• Health insurance status
Connecticut Department of Public Health - Keeping Connecticut Healthy
6. Coordination and Referrals for Other
Community Resources and Supports
(5 constructs and 13 data elements)
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Families identified for necessary (basic human needs) services
Referrals to available community resources
Number of completed referrals
Memoranda of agreements or other formal agreements with other
social service agencies in the community
• Community agencies with which the home visiting provider has a
clear point of contact in the collaborating agency that includes
regular sharing of information
Connecticut Department of Public Health - Keeping Connecticut Healthy
Environmental Considerations
The MIECHV Programs grant is a public health initiative. MIECHV
models begin with prenatal health and include inter-conception and
post-partum.
MIECHV models have a focus on:
• prenatal care
• birth outcomes
• positive parenting skills
• healthy child development.
Connecticut Department of Public Health - Keeping Connecticut Healthy
Overarching goal of the CT MIECHV
Programs Grant
CT will have a statewide, coordinated system of early
childhood home visiting that has the capacity &
commitment to provide infrastructure and supports to
assure high-quality, evidence-based practice that supports
life course development.
Connecticut Department of Public Health - Keeping Connecticut Healthy
Home Visit Program Contacts
Rosa M. Biaggi, Family Health Section Chief
Principal Investigator MIECHV Programs Grant
Title V Director
Janet Brancifort
Family Health Section Manager
Donna Maselli, Nurse Consultant
MIECHV Liaison
Mary Emerling, Nurse Consultant
MIECHV Liaison
Connecticut Department of Public Health - Keeping Connecticut Healthy