1. 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

2. 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

3. Updated State Plan Submission Date
days from SIR release date
May 8 – June 8
Will be reviewed & approved on a rolling basis

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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)

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. Benchmark III Improvements in school readiness & achievement
Parent
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

27. Benchmark IV Crime OR Domestic Violence
Caregiver arrests & convictions
Screening for DV
Of families identified for presence of DV:
# referrals made to relevant services
# completed safety plans

28. Benchmark V Family economic self-sufficiency
Household income & benefits
Employment & education of adult members of household
Health insurance status

29. Benchmark VI Coordination 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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 (?)

37. 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

38. 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

39. SIR and related HV Program information
KDHE website
HRSA website
Home Visiting Evidence of Effectiveness (HomVEE)

40. Debbie Richardson, Ph.D. Manager, Home Visiting Program Bureau of Family Health Kansas Dept. of Health & Environment 1000 SW Jackson, Suite 22o Topeka, KS