Transcript ACA Tribal MCH Home Visiting Program

Affordable Care Act
Tribal Maternal, Infant,
and Early Childhood
Home Visiting
Program Overview
Moushumi Beltangady
Administration for Children and Families
U.S. Department of Health and Human Services
National Tribal Public Health Summit
Tulsa, Oklahoma
May 31, 2012
Affordable Care Act Maternal, Infant, and
Early Childhood Home Visiting Program
 Section 2951 of the Affordable Care Act of 2010 (P.L. 111148) – March 23, 2010
 Amends Title V of the Social Security Act to add Section
511: Maternal, Infant, and Early Childhood Home Visiting
Programs
 $1.5 billion in mandatory funding over 5 years
◦ $100 m FY 2010
◦ $250 m FY 2011
◦ $350 m FY 2012
◦ $400 m FY 2013 and FY 2014
 Grants to States and Jurisdictions (with 3 percent set-aside
for grants to Tribes, Tribal Organizations, and Urban Indian
Organizations and 3 percent set-aside for research,
evaluation, and TA)
 Requirement for collaborative implementation by HRSA
MCHB and ACF
Affordable Care Act MIECHV Program
Legislation Purposes:
(1) To strengthen and improve the programs
and activities carried out under Title V of
the Social Security Act;
(2) To improve coordination of services for atrisk communities; and
(3) To identify and provide comprehensive
home visiting services to improve
outcomes for families who reside in at-risk
communities
Affordable Care Act MIECHV Program
Through high-quality, “evidence-based” home
visiting programs targeted to pregnant women,
expectant fathers, and parents and primary
caregivers of children aged birth to kindergarten
entry in at-risk communities identified through
a needs assessment, promote:
• Improvements in maternal and prenatal health, infant
health, and child health and development;
• Increased school readiness;
• Reductions in the incidence of child maltreatment;
• Improved parenting related to child development
outcomes;
• Improved family socio-economic status;
• Greater coordination of referrals to community
resources and supports; and
• Reductions in crime and domestic violence.
Evidence-Based Policy Initiative
• Requires State MIECHV grantees to implement
evidence-based home visiting models
– HHS conducted a systematic review of the
evidence of effectiveness, known as Home
Visiting Evidence of Effectiveness (HomVEE):
results at http://homvee.acf.hhs.gov
• Allows for implementation of promising strategies
– Up to 25% of funding can be used to fund
“promising and new approaches” that would be
rigorously evaluated
• Nine models currently meet “evidence-based
criteria” for the State MIECHV program
Benchmark Requirement
The legislation requires that grantees establish quantifiable,
measurable 3- and 5-year benchmarks for demonstrating that the
program results in measurable improvements for eligible families
participating in the program in each of the following benchmark
areas:
1. Improved maternal and newborn health
2. Prevention of child injuries, child abuse, neglect, or
maltreatment, and reduction of emergency department visits
3. Improvement in school readiness and achievement
4. Reduction in crime or domestic violence
5. Improvements in family economic self-sufficiency
6. Improvements in the coordination and referrals for other
community resources and supports
Priority Populations for
MIECHV Program
 Families in at-risk communities identified through a
needs assessment
 Low-income families
 Pregnant women under age 21
 Families with a history of child abuse or neglect
 Families with a history of substance abuse
 Families that have users of tobacco in the home
 Families with children with low student achievement
 Families with children with developmental delays or
disabilities
 Families with individuals who are serving or have served
in the Armed Forces, including those with multiple
deployments
Tribal Home Visiting Program
 Administered by ACF in collaboration with HRSA
 Tribal grants, to the greatest extent practicable, are to be
consistent with the MIECHV grants to States and Jurisdictions,
including conducting a needs assessment and establishing 3and 5-year benchmarks
 3 percent set-aside – $3 million FY 2010, $7.5 million FY 2011,
$10.5 million FY 2012, $12 million FY 2013 & 2014
 5-year discretionary grants (cooperative agreements) to Tribes
(including consortia of Tribes), Tribal Organizations, and Urban
Indian Organizations
 13 cooperative agreements awarded in FY 2010 (Cohort 1)
 6 cooperative agreements awarded in FY 2011 (Cohort 2)
 5-7 cooperative agreements to be awarded in FY 2012 (Cohort
3)
 Website
http://www.acf.hhs.gov/programs/ccb/initiatives/hvgp/index.
htm
Tribal Home Visiting Program Goals
 Supporting development of healthy, happy, and
successful AIAN children and families through
implementation of coordinated, high-quality, culturally
relevant, evidence-based home visiting programs
 Expanding the evidence base around effective home
visiting interventions for Native populations
 Supporting and strengthening cooperation and
coordination and promoting linkages among various
programs that serve pregnant women, expectant
fathers, young children, and families to build
coordinated, comprehensive early childhood systems
in grantee communities
Tribal Home Visiting Grants
Funds support 5-year cooperative agreements:
• Year 1: Needs assessment, planning, and capacitybuilding to implement, with fidelity to the chosen
model, home visiting programs
• Years 2-5:
– Implementation of high-quality, evidence-based
home visiting programs, including provision of
services to pregnant women, expectant fathers,
and parents and primary caregivers with young
children aged birth to kindergarten entry
– Establishing and measuring child and family
outcomes in benchmark areas
– Rigorous research and evaluation activities
FY 2010 Grantees (Cohort 1)
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Choctaw Nation of Oklahoma (Durant, OK)
Fairbanks Native Association, Inc (Fairbanks, AK)
Kodiak Area Native Association (Kodiak, AK)
Lake County Tribal Health Consortium (Lakeport, CA)
Native American Community Health Center, Inc (Phoenix, AZ)
Native American Professional Parent Resources (Albuquerque,
NM)
Northern Arapaho Tribe (Riverton, WY)
Port Gamble S'Klallam Tribe (Kingston, WA)
Pueblo of San Felipe (San Felipe, NM)
South Puget Intertribal Planning Agency (Shelton, WA)
Southcentral Foundation (Anchorage, AK)
White Earth Band of Chippewa Indians (White Earth, MN)
Yerington Paiute Tribe (Yerington, NV)
FY 2011 Grantees (Cohort 2)
• Confederated Salish and Kootenai Tribes (Pablo,
MT)
• Eastern Band of Cherokee Indians (Cherokee, NC)
• Native American Health Center, Inc. (Oakland, CA)
• Riverside-San Bernardino County Indian Health, Inc.
(Banning, CA)
• Taos Pueblo (Taos, NM)
• United Indians of All Tribes Foundation (Seattle,
WA)
Technical Assistance Providers
• Tribal Home Visiting Technical Assistance Center
– Walter R. McDonald and Associates, Arizona State
University Office of American Indian Projects, Chapel
Hill Training and Outreach Project
• Tribal Home Visiting Evaluation Institute (TEI)
– James Bell Associates, University of Colorado Denver
Centers for AIAN Health, Johns Hopkins University
Center for American Indian Health
• Tribal Early Childhood Research Center (TRC)
– UC Denver Centers for AIAN Health, JHU Center for
American Indian Health
Evidence-Based Policy and
Tribal Home Visiting
• ACF conducted a review of home visiting interventions with Native
communities (Tribal HomVEE)
• NO home visiting models implemented in tribal communities meet
the “evidence-based” criteria for the State MIECHV program
Tribal HV grantees may choose a PROMISING APPROACH that
is:
• Grounded in relevant empirical work
• Developed by or in partnership with a national organization
or university
• To be evaluated through rigorous research to determine its
effectiveness
• Grantees may choose an existing evidence-based model and adapt
to community needs, or develop a local innovation to meet needs
Models Selected by Grantees
Cohort 1
– Parents as Teachers (8)
– Nurse-Family Partnership (3)
– Parent-Child Assistance Program (1)
– Family Spirit (1)
Evidence-Based Policy and
Tribal Home Visiting
• Focus on FIT between model and community
• Recognition of need for adaptation of evidencebased models to culture and context
• Importance of grounding in implementation
science (what we know about implementing
evidence-based models)
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Well-trained, competent staff
High quality reflective supervision
Strong organizational capacity
Strong community capacity for referral
Monitoring fidelity of implementation
Participant recruitment and retention plan
Rigorous Research and
Evaluation Requirement
• All grantees are required to conduct rigorous
research and evaluation activities
• Goal is to inform practice and build the evidence
base of effective home visiting interventions with
Native populations
• Research and Evaluation activities could include:
– Examining effectiveness of home visiting models in
serving Native populations
– Examining effectiveness of adaptations of home
visiting models for Tribal communities
– Questions regarding implementation or
infrastructure necessary to support implementation
of home visiting programs in Tribal communities
Cohort 1 Year 1 Activities
• 9/30/2010 – Grants awarded
• 1/18 – 1/20/2011 – Tribal Home Visiting Kickoff
Meeting
• Winter and Spring 2011 – Grantees conducted needs
assessments
• Summer 2011 – Grantees developed Implementation
Plans (selected models, developed benchmark and
research and evaluation plans)
• 8/1/2011 – Needs Assessments and Implementation
Plans submitted to ACF
• 9/30/11 – Grantees receive Year 2 funding to begin
implementation
Cohort 1 Year 2 Activities
• Continue working with model developers to refine model to
meet community needs, culture, and context (cultural
adaptation)
• Manualize program (develop manuals, training plans,
recruitment plans, etc.)
• Continue working with community to plan for
implementation
• Refine benchmark and continuous quality improvement plan
• Hire home visitors
• Recruit participants
• Begin serving families
• Begin collecting benchmark data
• Refine rigorous evaluation plan and methodology
FY 2012 Funding Opportunity
• New FY 2012 Funding Opportunity Announcement for Tribal
Maternal, Infant, and Early Childhood Home Visiting Program
Under the Affordable Care Act
• $1.5 million available for 5-7 new cooperative agreements
• Funding Opportunity Announcement available at:
http://www.acf.hhs.gov/grants/open/foa/view/HHS-2012ACF-OCC-TH-0302
• Application Due Date 7/16/2012
• Pre-Application Webinar – more information at
http://www.acf.hhs.gov/programs/ccb/initiatives/hvgp/index
.htm - webinar will be archived
• For more information please contact
[email protected]