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,
1Affordable 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
2Affordable 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
3Affordable 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
4Affordable 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.
5Evidence-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
6Benchmark 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
7Priority 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
8Tribal 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
9Tribal 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
10Tribal 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
11FY 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)
12FY 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)
13Technical 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
14Evidence-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
15Models Selected by Grantees
- Cohort 1
- Parents as Teachers (8)
- Nurse-Family Partnership (3)
- Parent-Child Assistance Program (1)
- Family Spirit (1)
16Evidence-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
17Rigorous 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
18Cohort 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
19Cohort 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
20FY 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