Michigan Infant, Maternal and Early Childhood Home Visiting Program

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Michigan Infant, Maternal and Early Childhood
Home Visiting Program

• Building County-Level Home
• Visiting Systems
• Videoconference for
  Teams from
• Berrien, Calhoun,
  Genesee, Ingham,
• Kalamazoo,
  Kent, Muskegon,
• 
  Saginaw, St. Clair
  and
• 
  Wayne Counties

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1. Welcome and Introductions
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Agenda

• Welcome Introductions
• Videoconference Objectives
• Context for HRSA HV Program
• Building a HV System
• Michigan HV Program Logic Model
• How Can Communities Begin to Participate?
• Expectations for each County
• Seed Funds to Support County Activities
• QA
• Next Steps

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2. Videoconference Objectives
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Videoconference Objectives

• Update on current status of HRSA Home Visiting
  Program.
• Ensure understanding of purpose of Home Visiting
  Program (HVP).
• Describe Michigan HVPs Logic Model development
  efforts.
• Describe steps county HVP teams can take to
  prepare for response to HRSA guidance (Step 3).

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Objectives, contd

• Describe state expectations for county HVP
  teams.
• Discuss seed funding to support initial work.
• Conduct Q A.
• Identify next steps and future TA opportunities.

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3. Context HRSA Home Visiting Program
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Context

• Policy Brief from The Future of Children
• Social Science Rising A Tale of Evidence
  Shaping Public Policy
• http//www.princeton.edu/futureofchildren/publicat
  ions/docs/19_02_PolicyBrief.pdf

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Social Science Rising

• Social scientists have taken a step toward the
  goal of getting policy makers to consider
  high-quality evidence when making program funding
  decisions.
• President Obama put provisions in the budget to
  support home visiting programs that will produce
  sizable, sustained improvements in the health,
  well-being, or school readiness of children or
  their parents.
• The resulting bill gives priority funding to
  programs that adhere to clear evidence-based
  models of home visitation that have demonstrated
  significant positive effects on important
  program-determined child and parenting outcomes.

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Social Science Rising, contd

• The Obama administration will evaluate as many
  programs as possible, cut off funding for those
  that are not working and expand those that are.
• The administration endorses a two-tier approach
  of giving more money to the programs with the
  strongest evidence of success and less money to
  programs that have some supportive evidence, but
  not as much.
• The federal policy process now hinges importantly
  on evidence, a clear sign that the administration
  and Congress want to do everything they can to
  fund successful programs.

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Resources

• We will be sending out
• An updated resource list of articles about
  evidence-based home visiting.
• A list of webinars you may wish to view regarding
  home visiting models and systems.

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Affordable Care Act Funding Status

• Michigan has received funding for FY 2010.
• We have 27 months to spend the funds that we were
  awarded.
• We are awaiting the next federal guidance for
  Step 3.
• There is talk that Congress may repeal this
  legislation.
• It is critical for our state need to think about
  whats important with respect to a home visiting
  system regardless of federal funding.

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HRSA Funding can be used for

• Three major activities
• Develop a state Home Visiting System embedded in
  a comprehensive, high-quality Early Childhood
  System.
• Develop local home visiting systems based on the
  state system.
• Within the system, implement and evaluate
  evidence-based home visiting programs.

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HRSA Next Steps

• Step 3 guidance not yet available
• We still need to move forward in anticipation of
  what HRSA will require
• Determine infrastructure priorities.
• Revise logic model.
• Bring all of the key participants to the table.
• Inventory county-level data about target
  audiences.
• Develop database of home visiting programs.
• Once released, we likely will not have much time
  to complete our State Plan, which will build on
  the above.

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4. Building a Home Visiting System
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Building a Home Visiting System

• The Great Start System Team has appointed the
  Home Visiting Work Group.
• Purpose is to guide the development of the
  state-level home visiting system.
• The state-level system will guide and support the
  county efforts.

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Based on Lessons from Other States

• Michigan might choose to focus on one or more of
  the following system components
• Public Engagement Ongoing Professional
  Development/
• Program Support Core Competencies of Staff
• Governance Evaluation and Information Systems
• Administration Needs Assessment and Planning
• Coordination Centralized Point of Referral
• Monitoring Early Childhood Partnerships
• Funding Program Standards
• CQI
• Some of the 10 counties have already begun
  systems development work.

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5. MI Home Visiting Program Logic Model
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MI Home Visiting ProgramLogic Model

• The Home Visiting Work Group is working with
  Michigan Public Health Institute (MPHI)
  evaluators on a Logic Model.
• The Logic Model will continue to be modified and
  expandedmay need to be revised based on Step 3
  guidance.
• This draft Logic Model represents the larger
  effort to build a home visiting system, and is
  not limited to just the ACA funding.

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Home Visiting Program Logic Model
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Comments

• We welcome your comments or questions about the
  draft Logic Model. Please send comments to
• HomeVisitingProject_at_michigan.gov

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6. How Can Communities Begin to Participate in
the HV Program Activities?
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6a. Local Governance Structure

• A group or committee will need to provide
  leadership locally regarding this home visiting
  system building work.
• You know your local structure and partners best
  what will work for you?
• Ideas entire GSC, GSC subcommittee, other
  existing or new committee that will be affiliated
  with the GSC, etc.
• The entity providing leadership might be
  different than the fiduciary.

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Who must be involved?

• Your Great Start Collaborative contract already
  includes a list of required partners.
• The federal HV legislation identifies several
  required participants for HV planning
• Public Health (Title V)
• Substance Abuse
• Department of Human Services/CAN Council
  (CAPTA/CBCAP)
• Early Head Start/Head Start

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• Additional key representatives for HV planning
  include
• Community Mental Health
• Education community
• Existing Home Visiting programs/providers,
  including those providing perinatal services
  (e.g. MIHP, Healthy Start)
• Families

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Why Substance Abuse Services Are a Fit

• Addictive behaviors
• Lying
• Stealing
• Being unreliable
• Manipulation
• Moods swings
• Abuse
• Acting compulsively
• Neglect of medical needs of both parent and child
• Potential for poor or inadequate nutrition

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Family Implications

• Children often model parental substance using
  behaviors.
• Sometimes develop self preservation skills (Hero,
  scapegoat, mascot and the lost child).

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Consequences

• Often children of addicts are linked with
• Victimization (violent crime, sexual abuse, DV).
• Serious school problems.
• Drinking-related traffic crashes, vandalism,
  other delinquent crimes.
• Youthful deaths by drowning, suicide, and
  homicide.
• Exposure to media and movie messages that
  glamorize use.
• Peers who drink/drug.

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Problems Manifested in Several Domains

• Families
• Communities
• Schools
• Employers
• Social relationships
• Social services

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Community Wellness

• Prevention or early intervention, enhance
• chances for family and community wellness
• Less ATOD use.
• Fewer family problems.
• More productive citizenry.

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Michigan Structure for Substance Abuse Services

• Bureau of Substance Abuse and Addiction Services
  (BSAAS) oversees prevention, treatment and
  recovery efforts related to substance use
  disorders and gambling addiction.
• 16 Coordinating Agencies (CAs) who are under
  agreement with MDCH to ensure quality substance
  abuse prevention and treatment services.

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Examples of Services

• Prevention Underage Drinking Tobacco Use,
  Adult Senior Problem Use, Communicable Disease,
  Parenting Awareness, Prescription
  Over-The-Counter Drug Abuse.
• Treatment Driving Under the Influence insight
  education (DUI), Interventions, Methadone,
  Women's Treatment Programs, Fetal Alcohol
  Syndrome Disorder Screening and referral,
  Co-Occurring Disorders.
• Substance Use Disorder Recovery Recovery
  Oriented Systems of Care (ROSC), Peer
  Coaching/Mentoring, Recovery Supports and
  Resources.
• Problem Gambling 24 hour Help-line, Assessment
  Questions, Treatment, Prevention, Speakers
  Bureau, Therapist Training.

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Regional Substance Abuse Services Representatives

• Kalamazoo and Calhoun - Kalamazoo Community
  Mental Health Substance Abuse Services
• Achiles Malta, Prevention Coordinator (269)
  553-7076 amalta_at_kazoocmh.org
• Berrien and Muskegon - Lakeshore Coordinating
  Council
• Kori White Bissot, Prevention Coordinator (616)
  846-6720 kbissot_at_lakeshoreca.org
• Genesee - Genesee County Community Mental Health
• Lisa Coleman, Manager S.A. Prevention (810)
  496-5544 lcoleman_at_gencmh.org
• Ingham - Mid-South Substance Abuse Commission
• Joel Hoepfner, Prevention Coordinator (517)
  337-4406 ext. 102 joel_at_mssac.com

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Regional SAS Representatives (contd)

• Kent County - network180
• Denise Herbert, Prevention Coordinator (616)
  855-5245 deniseh_at_network180.org
• Saginaw - Saginaw County Department of Public
  Health
• Bryant J. Wilke, R.S., Interim Dir. of S.A.
  Serv. [phone] bwilke_at_saginawcounty.com
• St. Clair - St. Clair County Community Mental
  Health (DBA) Thumb Alliance
• Andy Kindt, Regional Prevention Coord. (810)
  966-4490 akindt_at_scccmh.org
• Wayne - Detroit Department of Health Wellness
  Promotion
• Karra Thomas, CPC-M, Prevention Coord. (313)
  876-0154 thomaskw_at_detroitmi.gov

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Services for Pregnant Women Mothers of Young
Children

• 9 out of 10 counties have in-county womens
  specific substance abuse programming available.
• Some programs are residential and accept both
  women and their dependent children.
• Three statewide residential treatment programs
  accept women and dependent children, and provide
  gender specific treatment.
• Parent at risk of losing her children considered
  a priority with regards to Tx, and they are
  placed in treatment ahead of the general
  population.

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6a. Next Steps for Local Governance

• Identify your governance group.
• Support each member to understand the purpose and
  scope of this program.
• Ask each member to review
• The November 4, 2010 state Home Visiting webinar
• This presentation/powerpoint
• Ensure that all members agree to collaboratively
  build the county-level home visiting system.

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Questions?
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6b. Data/Federal Indicators

• We anticipate that Step 3 will include a 2nd cut
  analysis of risk/need to identify the target
  audience in each county who is it that is
  experiencing the high concentration of risk?
• Geographic
• Sub-populations
• Other characteristics

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Data/Federal Indicators, cont.

• We will have to provide data about these target
  populations and the system/services as part of
  the national cross-site evaluation of the
  project.
• Access to this data is an important component of
  being 'ready' to participate in the project.
• Data will be required for each of the 10 federal
  indicators.

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6b. Next Steps for Data
Take inventory of what local data you have about
sub-populations for each of the 10 federal
indicators

• Premature birth ()
• Low birth-weight infants ()
• Infant mortality
• (rate/1,000 births)
• Poverty ( below FPL)
• Crime (rates/1,000 residents)

• Domestic violence (rate/1,000)
• High School drop-out ()
• Substance abuse ()
• Unemployment ()
• Child maltreatment ( reports)

see HV Analysis tables for detailed information
on indicators and sub-indicators
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For the local data you do have

• How was each indicator measured is it the same
  as the federal metric (e.g. of premature births
  vs. rate)?
• At what level do you have the data (e.g. zip
  code, census tract, city, county, etc.)?
• Can you run analysis by sub-populations, (e.g.
  race, ethnicity, etc.)?

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For the data you do NOT have

• How can you quickly begin to build this data
  collection into local projects and into existing
  local data systems?

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• We anticipate that the 2nd cut analysis will be a
  collaborative state-local effort.
• We also anticipate having follow-up conversations
  with each county about the analysis work.

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Questions?
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6c. Update information about existing HV Programs
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Database

• The state is developing a database with
  standardized definitions, that will capture
  information statewide and will be shared with
  local communities.

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6c. Next Steps for the Database

• Review your county table of HV programs are any
  missing (table is available on websites)?
• Work with the state to assemble additional
  information.

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Existing system coordination

• We would also like to identify efforts that have
  been undertaken to build a county-level HV system

• Coordinated enrollment?
• Local database of programs?
• Locally shared training across programs?

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Questions?
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7. State Expectations for each County
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Process

• The State is still developing the process to
  determine which counties would receive first
  round funding, and for which activities.
• We anticipate that funding will be utilized for
  both infrastructure building and some direct
  services.
• It is possible that fewer than 10 counties will
  receive FY10 funding.

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Process

• The process will likely take in to account
• A readiness assessment
• Results of 2nd cut analysis of need
• Follow-up discussions/meetings regarding
  readiness and analysis results.

• The steps outlined above (for 6a,6b,6c) will help
  you prepare for this process.
• The process will be finalized once the Step 3
  federal guidance is released.

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8. Seed Funds to Support County Activities
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Seed Funds

• The State will offer each of the 10 counties
  8,000 in seed funds to support participation in
  Step 3 activities.
• This funding would help offset costs for
  activities weve discussed today, as well as
• Data gathering and reporting
• Epidemiology support for data analysis and
  reporting
• Parent involvement
• Local participation in the development of the
  Step 3 response.

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Seed Funds

• MDCH will establish contracts with local public
  health, as that is the easiest mechanism for us
  to quickly distribute these funds.
• We anticipate establishing contracts in early
  January, 2011.

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Seed Funds

• Once we receive the Step 3 federal guidance, we
  will prepare an addendum to the contract.
• Each county will prepare a response to the
  addendum, explaining how they will use the funds
  to support Step 3 activities in their
  community.

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9. Questions Answers
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10. Next Steps
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Next Steps - STATE

• Establish a contract with local public health to
  provide seed funds for Step 3 activities.
• Send information regarding data needed for state
  database on HV programs.
• Notify you when HRSA releases the Step 3
  guidance.
• Send an contract addendum for the seed funds,
  related to the federal guidance and analysis
  needed from local communities.
• Conduct additional information sharing
  webinars/meetings.

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Next Steps - LOCAL

• Begin working on the tasks outlined in this
  presentation
• Provide comments on the draft Logic Model
• Identify and build your local governance group
• Start an inventory of currently available local
  data
• Begin to develop plans to collect/provide
  additional data that will be needed
• Review and update information about existing HV
  Programs for the statewide database.
• Participate in upcoming informational
  webinars/meetings

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Upcoming Webinars/Meetings(Tentative)

• Wednesday, January 19, 1000-1130am
• Webinar regarding Lessons learned from Project
  LAUNCH (available statewide)
• Thursday, February 3, 100-300 in Lansing
• Meeting with 10 communities regarding next steps
  on Home Visiting program

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• Please continue to reference the following
  websites for additional information about the
  Home Visiting Program
• www.michigan.gov/mihp, see Important News
• www.greatstartforkids.org, under Early Childhood
  Home Visiting Program
• Contact HomeVisitingProject_at_michigan.gov

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THANK YOU!

• We appreciate your interest and willingness to
  work through this process with us!