Connecticut Department of Public Health 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 Affordable Care Act Maternal, Infant and Early Childhood Home Visiting (MIECHV) Programs Grant

Connecticut Department of Public Health - Keeping Connecticut Healthy 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 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: –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) 1.Early Head Start 2.Family Check-Up 3.Healthy Families America (HFA) 4.Healthy Steps 5.Home Instruction for Parents of Preschool Youngsters (HIPPY) 6.Nurse Family Partnership 7.Parents as Teachers (PAT) 8.Child FIRST 9.Early Intervention Program for Adolescent Mothers 10.Early Start (New Zealand) 11.Oklahoma Community-Based Family Resource and Support Program 12.Play and Learning Strategies (PALS) Infant

Connecticut Department of Public Health - Keeping Connecticut Healthy State Plan for Home Visiting 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. The overarching goals of the State Plan are to:

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) Early Head Start (EHS) Nurse Family Partnership (NFP) Child FIRST 1:12 FTEs1:3 FTEs1:8 FTEs1:1 Team

Connecticut Department of Public Health - Keeping Connecticut Healthy Federal Funds Budget PeriodAward 7/15/2010-9/30/2012$855,073 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 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 TownGrantEBM Ansonia-DerbyFormula & CompetitiveEHS and Child FIRST BloomfieldCompetitiveChild FIRST and PAT BridgeportCompetitivePAT BristolCompetitiveChild FIRST DanburyCompetitiveChild FIRST East HartfordCompetitiveChild FIRST & PAT East Haven/West HavenCompetitivePAT Killingly/PlainfieldCompetitivePAT Manchester/VernonCompetitivePAT MeridenCompetitiveChild FIRST & PAT New LondonFormulaNFP New BritainFormula & CompetitivePAT Norwich/Griswold/SpragueCompetitivePAT Putnam/WindhamCompetitiveChild FIRST Torrington/WinchesterCompetitiveChild FIRST & PAT WindhamFormula & CompetitivePAT Windsor Locks/East WindsorCompetitivePAT

Connecticut Department of Public Health - Keeping Connecticut Healthy Benchmarks (6) Constructs (35) Data Elements (223) Connecticut Maternal, Infant and Early Childhood Home Visiting Programs Grant

Connecticut Department of Public Health - Keeping Connecticut Healthy 1. Improved Maternal & Newborn Health (8 constructs and 51 data elements) 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 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 2. Child Injuries, Child Abuse, Neglect, or Maltreatment and Reduction of Emergency Department Visits (7 constructs and 56 data elements)

Connecticut Department of Public Health - Keeping Connecticut Healthy 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 well- being Child’s physical health and development 3. School Readiness and Achievement (9 constructs and 64 data elements)

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) 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