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, - PowerPoint PPT Presentation

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Title: 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,


1
Affordable Care Act Tribal Maternal, Infant,
and Early Childhood Home Visiting Program
OverviewMoushumi BeltangadyAdministration for
Children and FamiliesU.S. Department of Health
and Human ServicesNational Tribal Public Health
SummitTulsa, OklahomaMay 31, 2012
2
Affordable Care Act Maternal, Infant, and Early
Childhood Home Visiting Program
  • Section 2951 of the Affordable Care Act of 2010
    (P.L. 111-148) 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

3
Affordable Care Act MIECHV Program
  • Legislation Purposes
  • To strengthen and improve the programs and
    activities carried out under Title V of the
    Social Security Act
  • To improve coordination of services for at-risk
    communities and
  • To identify and provide comprehensive home
    visiting services to improve outcomes for
    families who reside in at-risk communities

4
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.

5
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

6
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
  • Improved maternal and newborn health
  • Prevention of child injuries, child abuse,
    neglect, or maltreatment, and reduction of
    emergency department visits
  • Improvement in school readiness and achievement
  • Reduction in crime or domestic violence
  • Improvements in family economic self-sufficiency
  • Improvements in the coordination and referrals
    for other community resources and supports

7
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

8
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 3-
    and 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/initia
    tives/hvgp/index.htm

9
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

10
Tribal Home Visiting Grants
  • Funds support 5-year cooperative agreements
  • Year 1 Needs assessment, planning, and
    capacity-building 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

11
FY 2010 Grantees (Cohort 1)
  • 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)

12
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)

13
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

14
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

15
Models Selected by Grantees
  • Cohort 1
  • Parents as Teachers (8)
  • Nurse-Family Partnership (3)
  • Parent-Child Assistance Program (1)
  • Family Spirit (1)

16
Evidence-Based Policy and Tribal Home Visiting
  • Focus on FIT between model and community
  • Recognition of need for adaptation of
    evidence-based models to culture and context
  • Importance of grounding in implementation science
    (what we know about implementing evidence-based
    models)
  • 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

17
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

18
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

19
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

20
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-20
    12-ACF-OCC-TH-0302
  • Application Due Date 7/16/2012
  • Pre-Application Webinar more information at
    http//www.acf.hhs.gov/programs/ccb/initiatives/hv
    gp/index.htm - webinar will be archived
  • For more information please contact
    tribal.homevisiting_at_hhs.gov
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