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Michigan Maternal, Infant, and Early Childhood Home Visiting Program

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Title: Michigan Maternal, Infant, and Early Childhood Home Visiting Program


1
Michigan Maternal, Infant, and Early Childhood
Home Visiting Program
  • November 4, 2010
  • 100-200pm

2
Purpose of the webinar
  • Review activities to date
  • Anticipated next steps
  • Questions

3
ACTIVITIES TO DATE
4
LEGISLATION
  • March 23, 2010 - The Patient Protection and
    Affordable Care Act (ACA) was signed into law.
  • Subtitle L, Section 2591 amends Title V of the
    Social Security Act by adding a new section to
    Title V, Section 511, addressing the Maternal,
    Infant, and Early Childhood Home Visiting
    Programs.
  • Full text for the ACA can be found at
    http//docs.house.gov/energycommerce/ppacacon.pdf

5
Anticipated process for Home Visiting Program
  • STEP 1 submit an Application for funding
  • STEP 2 submit a Statewide Needs Assessment
  • STEP 3 submit an Updated State Plan for
    implementation based on the Needs Assessment

6
WHO IS WORKING ON THE PROGRAM?
  • Great Start System Team
  • Home Visiting Workgroup
  • MDCH Public Health, Mental Health, Substance
    Abuse, Medicaid, Epidemiology
  • MDE Early Childhood Education Family Services
  • DHS Child Welfare, Child Care, Head Start State
    Collaboration Office, Childrens Trust Fund
  • ECIC Early Childhood System building and
    promotion
  • MI League for Human Services

7
(No Transcript)
8
STEP 1
  • June 10, 2010 - U.S. Department of Health Human
    Services, Health Resources Services
    Administration (HRSA) and Administration for
    Children Families (ACF) issued the Affordable
    Care Act (ACA) Maternal, Infant and Early
    Childhood Home Visiting Program Funding
    Opportunity Announcement (FOA).
  • The announcement is available at
  • http//apply07.grants.gov/apply/UpdateOffer?id19
    148

9
STEP 1
  • July 9, 2010 Michigan application was
    submitted.
  • The application was a state-level plan to plan
    and certifications which allow HHS to release the
    first funding to the state.

10
STEP 1
  • July 15, 2010 HRSA awarded Michigan a Home
    Visiting grant for 2,014,745 for FY10.
  • All but 500,000 is restricted pending receipt of
    an approvable Updated State Plan in response to
    STEP 3. In the interim, 500,000 can be used for
    needs assessment, planning, or implementation
    activities.

11
PUBLIC COMMENT
  • July 22, 2010 HRSA and ACF opened a public
    comment period for stakeholders to comment on how
    to assess evidence of effectiveness of home
    visiting program models.
  • August 17, 2010 Michigan submitted comments
    regarding proposed methodology for reviewing
    effectiveness and for distributing funding to
    states.

12
STEP 2
  • August 19, 2010 HRSA ACF released the
    Supplemental Information Request (SIR) for the
    Submission of the Statewide Needs Assessment
    (Home Visiting Program)
  • http//www.hrsa.gov/grants/apply/assistance/homev
    isiting/homevisitingsupplemental.pdf
  • September 16, 2010 HRSA awarded Michigan an
    additional 118,928 in Home Visiting funds, for a
    new total of 2,133,673 for FY10.
  • September 20, 2010 Michigan submitted its
    Statewide Needs Assessment.

13
STEP 2
  • Michigans response to the SIR included
  • A narrative describing the Statewide Needs
    Assessment results, including indicators and
    methods used to identify the counties with the
    highest concentration of risk
  • Brief descriptions of those 10 counties (state
    and local data tables and descriptions of
    state-level and local home visiting programs)
    and
  • An analysis of the state and local capacity for
    providing substance abuse treatment and
    counseling services in the 10 counties.

14
STEP 2
  • The 10 communities (counties) identified in the
    analysis with highest concentration of risk
    include

Berrien Calhoun
Genesee Ingham
Kalamazoo Kent
Muskegon Saginaw
St. Clair Wayne
15
STEP 2
  • September 22, 2010 HRSA notified Michigan that
    the Statewide Needs Assessment was reviewed and
    met requirements.
  • As a result, HRSA released Michigan's FY 2011
    Maternal and Child Health Title V Block Grant
    funds (approximately 19,000,000), and we have
    retained our FY 2010 Affordable Care Act (ACA)
    Maternal, Infant, and Early Childhood Home
    Visiting Program funds in the amount of
    2,133,673.

16
STEP 3
  • The guidance for STEP 3 has not yet been
    released.
  • The most recent information available is that the
    next guidance document is in development.
  • The original application estimated that STEP 3
    would be completed winter/spring 2011.

17
  • Information about activities to date is posted at
    two websites
  • www.michigan.gov/mihp, see Important News
  • www.greatstartfor4kids.org, under Early Childhood
    Home Visiting Program

18
ANTICIPATED NEXT STEPS
19
NEXT STEPS
  • Michigan was not able to provide all of the
    information requested in the Supplemental
    Information Request (SIR).
  • We anticipate that we will need to provide the
    missing information in STEP 3.
  • We are moving forward with collecting missing
    local Head Start Needs Assessments and developing
    the means to determine the extent to which
    existing home visiting programs are meeting the
    needs of eligible families.

20
IMPORTANT NOTES
  • Our understanding of this program and process is
    evolving.
  • The process is data-driven.
  • The process will play out differently in
    different states, and in different communities.
  • The program is part of a larger effort to build a
    SYSTEM for home visiting, and for early
    childhood.
  • The program will include several work streams,
    and is not solely focused on direct service
    provision.

21
IMPORTANT CONCEPTS
  • Evidence-based ACA, Subtitle L, Section 2591
    (d)(3)(A)(i)(I)(aa-bb)
  • (I) Model is evidence-based
  • (aa) randomized controlled research designs,
    and the evaluation results have been published in
    a peer-reviewed journal or
  • (bb) quasi-experimental research design.
  • An updated definition may be provided with the
    STEP 3 guidance.

22
IMPORTANT CONCEPTS
  • Fidelity to the model

I didn't have potatoes, so I substituted rice.
Didn't have paprika, so I used another spice. I
didn't have tomato sauce, so I used tomato paste.
A whole can not a half can -I don't believe in
waste. My friend gave me the recipe -she said
you couldn't beat it. There must be something
wrong with her, I couldn't even eat it!
Senior Center Newsletter (Blase, 2010)
23
IMPORTANT CONCEPTS
  • Highest concentration of risk SIR for Statewide
    Needs Assessment
  • Communities with highest concentration of

Premature birth Low birth-weight
Infant mortality Poverty
Crime Domestic violence
High school drop-outs Substance abuse
Unemployment Child maltreatment
24
IMPORTANT CONCEPTS
  • Highest concentration of risk SIR for Statewide
    Needs Assessment
  • Communities for which indicators, in comparison
    to statewide indicators, demonstrate that the
    community is at greater risk than is the state as
    a whole. The distinction is based on a
    comparison of statewide data and data for the
    community identified as being at risk.

25
IMPORTANT CONCEPTS
  • Implementation science

Major Implementation Initiatives occur in
stages Exploration Installation Initial
Implementation Full Implementation Fixsen,
Naoom, Blase, Friedman, Wallace, 2005
26
IMPORTANT CONCEPTS
  • Implementation Research A Synthesis of the
    Literature
  • Fixsen, D. L., Naoom, S. F., Blase, K. A.,
    Friedman, R. M. Wallace, F. (2005).
    Implementation Research A Synthesis of the
    Literature. Tampa, FL University of South
    Florida, Louis de la Parte Florida Mental Health
    Institute, The National Implementation Research
    Network (FMHI Publication 231).

Download all or part of the monograph
at http//www.fpg.unc.edu/nirn/resources/detail.
cfm?resourceID31
27
WHAT CAN BE FUNDED?
  • State Infrastructure building
  • e.g. cross-system database, linking funding
  • Local Infrastructure building
  • e.g. strengthening collaborative bodies,
    promoting readiness to implement
  • Direct Services
  • e.g. evidence-based models

28
STATE INFRASTRUCTURE
  • Impacts all communities
  • Includes building a linked, coordinated system of
    home visiting, within the context of an early
    childhood system
  • Includes looking at coordination of all home
    visiting funding streams

29
LOCAL INFRASTRUCTURE
  • Related to the State Infrastructure
  • Some components could happen statewide
  • Will vary by locality

30
DIRECT SERVICES
  • A data driven analysis of the extent to which
    existing home visiting programs are meeting the
    needs of eligible families.

31
OUTCOMES/RISKS
  • As defined in the legislation, related to risks
    (ACA, Subtitle L, Section 2591 (d)(2)(B)(i-vii))
  • Improvements in prenatal, maternal, and newborn
    health, including improved pregnancy outcomes.
  • Improvements in child health and development.
  • Prevention of child injuries and maltreatment.
  • Improvements in cognitive, language,
    social-emotional, and physical developmental
    indicators.
  • Improvements in parenting skills.

32
OUTCOMES/RISKS
  • continued
  • Improvements in school readiness and child
    academic achievement.
  • Reductions in crime or domestic violence.
  • Improvements in family economic self-sufficiency.
  • Improvements in the coordination of referrals and
    provision of other community resources and
    supports.

33
TARGET POPULATION
  • Identified based on 2nd cut analysis of
    risk/need who is it that is experiencing this
    concentrated risk?
  • Geographic
  • Sub-populations
  • Other characteristics

34
GAPS
  • What supports/services already exist to meet the
    identified needs/achieve outcomes, with this
    target population?
  • What are the gaps that can be filled to
    supplement (not supplant) existing services?

35
MODELS
  • Identify and implement the model that
  • Meets the identified outcomes/addresses
    identified risks.
  • For the population identified in the analysis.
  • To fill the gaps identified in the system for
    those outcomes and that audience.

36
COMMUNICATIONS/INVOLVEMENT
  • As infrastructure building and implementation
    moves forward, the number of stakeholders
    involved in the program will increase.
  • Communications will continue to be posted at the
    websites listed in slide 17.

37
COMMUNICATIONS/INVOLVEMENT
  • The federal guidance document about STEP 3 will
    provide important direction regarding next steps
    toward exploring, preparing to install, and
    implementing the Home Visiting Program.

38
COMMUNICATIONS/INVOLVEMENT
  • To contact the Home Visiting Program, please
    e-mail
  • HomeVisitingProject_at_michigan.gov

39
  • QUESTIONS ANSWERS

40
QA
  • Q How much money will be allocated to the
    different types of activities?
  • A This has not yet been determined. We
    anticipate that federal guidance plus analysis
    results will help make this determination.

41
QA
  • Q The legislation discusses the option of using
    25 of the funds for promising practices. What
    will Michigan be funding with that 25?
  • A Each state has the OPTION of using 25 for
    promising practices, which must still be
    associated with a national office. Michigan has
    not yet determined whether funding will be used
    for promising practices.

42
QA
  • Q Is the Home Visiting funding limited to the 10
    counties identified?
  • A We anticipate that funding will be utilized
    for both infrastructure building and some direct
    services. Infrastructure would impact more than
    the 10 counties funding for direct services
    would, at least initially, be limited to fewer
    communities.

43
QA
  • Q Will all 10 counties receive funding for
    direct services?
  • A 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 funding for direct services
    with FY10 funding.

44
QA
  • Q What will happen with future funding received?
  • A This will be determined based on federal
    guidance, results of analysis, readiness, and
    system building efforts.

45
QA
  • Q Who will receive funding in local communities?
  • A We anticipate it would go to the most
    appropriate fiduciary based on the analysis and
    model selected, and based on how to best leverage
    growth of local collaboration, for example,
    growth of GSCs.

46
QA
  • Q Does this funding replace 0-3 Secondary
    Prevention funding?
  • A No. The outcomes for the Home Visiting Program
    include abuse/neglect prevention, but are
    broader. The analysis will help determine which
    outcomes will be addressed, with which target
    populations.

47
QA
  • Q Will the funding be used to implement Nurse
    Family Partnership?
  • A The analysis will help determine which
    outcomes will be addressed, with which target
    populations, which service gaps exist, and which
    model best fits the need. Nurse Family
    Partnership may be one of the models that could
    be chosen, if appropriate.

48
QA
  • Q When will this webinar and presentation be
    available?
  • A As soon as we have the link to the archived
    webinar, we will post to the websites and
    distribute via our distribution lists.

49
QA
  • Other questions?

50
  • Please continue to check the following websites
    for additional information about the Home
    Visiting Program
  • www.michigan.gov/mihp, see Important News
  • www.greatstartfor4kids.org, under Early Childhood
    Home Visiting Program
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