Home Visiting in Texas

1. Home Visiting in Texas Rebecca Pack Ph.D., RN, MN, Health and Human Services Commission Office of Health Coordination & Consumer Services

2. Early Childhood Matters

3. Early Stress and Adversity Matters Significant Adversity Healthy Developmental Trajectory Impaired Health and Development Supportive Relationships, Stimulating Experiences, and Health-Promoting Environments

4. Building an Enhanced Theory of Change that Balances Enrichment and Protection New Protective Interventions Significant Adversity Healthy Developmental Trajectory Supportive Relationships, Stimulating Experiences, and Health-Promoting Environments

5. Voluntary • No cost to clients • Trained professionals • Prenatal - 5 years of age • Positive parenting practices • Support • Resources • Most important: Not a one size fits all! What is Home Visiting?

6. Maternal and newborn health • School readiness and achievement • Family economic self-sufficiency • Coordination and referrals • Child injury, maltreatment, and ER use • Domestic violence • Decreased use of criminal justice system • Decreased costs to communities over time Expected Outcomes

7. MIECHV • State-funded through a grant received by HHSC under the Affordable Care Act 2011 • Current funding: $48 million • TNFP • Authorized by SB 156, 80th Legislature, Regular Session, 2007 • Current funding: $8.7 million/yr • SB 426 • Establishes the Texas Home Visiting Program • To serve at-risk pregnant women and families with children under the age of six through home visiting program that improve outcomes for parents and families HHSC Texas Home Visiting Programs

8. An Evidenced-Base Nurse Home Visiting Model

9. Texas Nurse-Family Partnership Nurse-Family Partnership is: • An evidence-based, nurse home visiting program • Transforms the lives of vulnerable first- time mothers living in poverty • Improves prenatal care, quality of parenting and life prospects for mothers and their infant by partnering them with a registered nurse What is Nurse-Family Partnership?

10. “There is a magic window during pregnancy…it’s a time when the desire to be a good mother and raise a healthy, happy child creates motivation to overcome incredible obstacles including poverty, instability or abuse with the help of a well-trained nurse.” David Olds, PhD, Founder, Nurse-Family Partnership

11. Overview • Program Goals • Improve pregnancy outcomes • Improve child health and development • Improve parents’ economic self-sufficiency • Reduce incidence of child abuse and neglect • Key Program Components • First-time, at-risk mothers • Registered nurses • Intensive services (intensity, duration) • Focus on behavior • Program fidelity Why Nurses? • Knowledge, judgment and skills • High level of trust, low stigma • Credibility and perceived authority • Nursing theory and practice at core of original model

12. Client participates voluntarily in the Nurse-Family Partnership program. • Client is a first-time mother. • Client meets low-income criteria at intake. (185% Federal Poverty Level) • Client is enrolled in the program early in her pregnancy and receives her first home visit by no later than the end of the 28th week of pregnancy. • Client is a Texas resident. Eligibility Criteria

13. 18 TNFP sites serving 28 counties - capacity to serve 2,650 clients • 13 sites GR funded implementing the TNFP program – total funding : $ 8.75 million/year Lubbock, Dallas, Tarrant County, Port Arthur, Houston, El Paso, Austin, San Antonio, City of Laredo) • 5 Federally funded sites - total cost: $3.12 million/year(Amarillo, Longview, Odessa, Corpus Christi, Edinburg) • MIECHV Expansion – two new NFP sites, Wichita Falls, San Antonio with a capacity to serve an additional 225 families. • TNFP Programs located in all Texas Department of Health Public Health Regions Current Status of TNFP

14. Total number of clients served in Texas between September 1, 2008 and February 1, 2104: >6500 • Total number of TNFP graduates as of February 1, 2104: > 1300 Texas NFP

15. Legislative Purposes • To strengthen and improve programs carried out under Title V • To improve coordination of services to communities; and • To identify and provide comprehensive services to improve outcomes for families MIECHV Maternal, Infant, and Early Childhood Home Visiting Program

16. Vision: - All Texas children will reach their full potential in nurturing family and community environments Texas Home Visiting

17. Early childhood comprehensive system within communities • Home visiting program • Matching/Intake and Referral System • Increased awareness of father engagement • Local training to develop a well-trained HV workforce • Continuous quality improvement Data Collection & EDI Outreach & Matching System THV program Key Elements Community Coalition Building ECCS/TECCS Home Visiting Programs HIPPY, NFP, PAT, EHS

18. Early Head Start- Home based Program Models

19. Capacity to serve over 2,700 families a year • 31 home visiting sites • 11 communities (Potter, Ector, Gregg, Dallas, Cherokee, Nueces, Wichita, Bexar counties) • 4 program models • 1 Vision By the numbers..

21. Home Visiting – A Good Policy Decision