1. Home Visiting in Texas Home Visiting in Texas Rebecca Pack Ph.D., RN, MN, Health and Human Services Commission Office of Health Coordination & Consumer Services 1

2. Early Childhood Matters

3. Significant Adversity Supportive Relationships, Stimulating Experiences, and Health-Promoting Environments Healthy Developmental Trajectory Impaired Health and Development Early Stress and Adversity Matters

4. New Protective Interventions Building an Enhanced Theory of Change that Balances Enrichment and Protection Significant Adversity Healthy Developmental Trajectory Supportive Relationships, Stimulating Experiences, and Health-Promoting Environments

5. What is Home Visiting? Voluntary No cost to clients Trained professionals Prenatal - 5 years of age Positive parenting practices Support Resources Most important: Not a one size fits all!

6. Expected Outcomes Maternal and newborn health School readiness and achievement Family economic self- sufficiency Coordination and referrals Child injury, maltreatment, and ER use Domestic violence Decreased use of criminal justice system Decreased costs to communities over time

7. TNFP Authorized by SB 156, 80 th Legislature, Regular Session, 2007 Current funding: $8.7 million/yr MIECHV State-funded through a grant received by HHSC under the Affordable Care Act 2011 Current funding: $48 million SB 426 Establishes the Texas Home Visiting Program To serve at-risk pregnant women and families with children under the age of six through home visiting program that improve outcomes for parents and families HHSC Texas Home Visiting Programs

8. An Evidenced-Base Nurse Home Visiting Model

9. What is Nurse-Family Partnership? Nurse-Family Partnership is: An evidence-based, nurse home visiting program Transforms the lives of vulnerable first- time mothers living in poverty Improves prenatal care, quality of parenting and life prospects for mothers and their infant by partnering them with a registered nurse Texas Nurse-Family Partnership

10. 10 “There is a magic window during pregnancy…it’s a time when the desire to be a good mother and raise a healthy, happy child creates motivation to overcome incredible obstacles including poverty, instability or abuse with the help of a well-trained nurse.” David Olds, PhD, Founder, Nurse-Family Partnership

11. Program Goals Improve pregnancy outcomes Improve child health and development Improve parents’ economic self- sufficiency Reduce incidence of child abuse and neglect Key Program Components First-time, at-risk mothers Registered nurses Intensive services (intensity, duration) Focus on behavior Program fidelity Knowledge, judgment and skills High level of trust, low stigma Credibility and perceived authority Nursing theory and practice at core of original model Overview Why Nurses?

12. Eligibility Criteria Client participates voluntarily in the Nurse-Family Partnership program. Client is a first-time mother. Client meets low-income criteria at intake. (185% Federal Poverty Level) Client is enrolled in the program early in her pregnancy and receives her first home visit by no later than the end of the 28 th week of pregnancy. Client is a Texas resident.

13. 18 TNFP sites serving 28 counties - capacity to serve 2,650 clients 13 sites GR funded implementing the TNFP program – total funding : $ 8.75 million/year Lubbock, Dallas, Tarrant County, Port Arthur, Houston, El Paso, Austin, San Antonio, City of Laredo) 5 Federally funded sites - total cost: $3.12 million/year(Amarillo, Longview, Odessa, Corpus Christi, Edinburg) MIECHV Expansion – two new NFP sites, Wichita Falls, San Antonio with a capacity to serve an additional 225 families. TNFP Programs located in all Texas Department of Health Public Health Regions Current Status of TNFP

14. Texas NFP Total number of clients served in Texas between September 1, 2008 and February 1, 2104: >6500 Total number of TNFP graduates as of February 1, 2104: > 1300

15. Maternal, Infant, and Early Childhood Home Visiting Program Legislative Purposes To strengthen and improve programs carried out under Title V To improve coordination of services to communities; and To identify and provide comprehensive services to improve outcomes for families

16. Texas Home Visiting Vision: - All Texas children will reach their full potential in nurturing family and community environments

17. THV program Key Elements Early childhood comprehensive system within communities Home visiting program Matching/Intake and Referral System Increased awareness of father engagement Local training to develop a well-trained HV workforce Continuous quality improvement 17 Data Collection & EDI Outreach & Matching System Community Coalition Building ECCS/TECCS Home Visiting Programs HIPPY, NFP, PAT, EHS

18. Program Models Early Head Start- Home based

19. By the numbers.. Capacity to serve over 2,700 families a year 31 home visiting sites 11 communities (Potter, Ector, Gregg, Dallas, Cherokee, Nueces, Wichita, Bexar counties) 4 program models 1 Vision 19

21. Home Visiting – A Good Policy Decision