ACA MIECHV Program Updated State Plan Submission

1. Overview Supplemental Information Request (SIR) for the Submission of Updated State Plan(Released 2/8/11) ACA Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program Debbie Richardson Home Visiting Work Group Meeting February 25, 2011

2. Home Visiting • Primary service delivery strategy • Offered on voluntary basis to pregnant women or children birth to age 5 • Embedded in a comprehensive, high-quality early childhood system that promotes maternal, infant, & early childhood health, safety, development, and strong parent-child relationships

3. Updated State Plan Submission Date • 90-120 days from SIR release date • May 8 – June 8 • Will be reviewed & approved on a rolling basis

4. Funding to State • Will receive at least FY’10 allocation in FY’11-’15 ($936,464) • Additional competitive funds beginning FY’11 • Criteria to be provided prior to state plan due date

5. Maintenance of Effort • As required in initial FOA: • Funds shall supplement, not supplant, funds from other sources for early childhood HV programs & initiatives • Must maintain non-Federal funding (SGF) for grant activities at level not less than 3/23/10 • Received clarification that state’s Tobacco Settlement $ will not be considered

6. Updated State Plan Content & Criteria • Identification of targeted at-risk community(ies) • Goals & objectives • Selection of proposed HV model(s) • Implementation plan • Plan for meeting mandated benchmarks • Plan for administration • Plan for continuous quality improvement • Memorandum of Concurrence • Budget

7. 1. Identification of targeted at-risk community(ies) • Justify selection of the at-risk community(ies) from among those identified in the initial needs assessment • For the targeted community(ies), update & provide a more detailed needs and resources assessment • Specific community risk factors and strengths • Characteristics and needs of participants • Service systems for families including HV programs currently operating or discontinued since 3/23/10 • Existing mechanisms for screening, identifying, referring to HV programs • Referral resources available and needed

8. 1. Targeted community(ies) - cont’d • Plan for coordination among existing programs & resources in targeted communities • How program will address existing service gaps • Local & state capacity to integrate proposed HV services into early childhood system • List other communities identified in initial needs assessment but not being selected due to funding limitations

9. 2. Goals & Objectivesfor State HV program • Clearly articulated goals & objectives • How program can contribute to developing a comprehensive, high-quality EC system • Strategies for integrating the program with other programs & systems in state related to MCH and EC health, development, & well-being • Logic model

10. 3. Selection of proposed HV model(s) • One or more evidence-based HV models should be selected • Up to 25% of funds allowed to support promising approaches that do not yet qualify as EBM • Can request consideration or reconsideration of other models as EB • Engage targeted community(ies) in decision-making to assess fit of model and readiness to implement

11. HV MODELS THAT MEET EVIDENCE-BASED CRITERIA • Early Head Start - Home-Based Option • Family Check Up • Healthy Families America • Healthy Steps • Home Instruction Program for Preschool Youngsters (HIPPY) • Nurse Family Partnership • Parents as Teachers

12. Basis for State’s Selection of Model(s) • Selected HV model(s) match needs and address particular risks in targeted community(ies) • Characteristics and needs of local families • Target multiple risk factors to the extent possible • Consider service gaps • Model(s) will be complementary, not duplicative, of existing HV or other services for local families • Capacity and resources of the targeted community(ies) to implement the chosen model(s)

13. Local RFP process • State may request proposals for funding to provide services in state-identified communities and select strongest • State may identify 1 or more HV models for which it seeks proposals • If choose to use a competitive subcontracting process, must describe how RFP will be structured and meet federal requirements

14. Model Adaptations • May adapt model to meet needs of targeted communities such as broadening population served, additions, subtractions, or enhancements • Acceptable changes are those that have not been tested with rigorous research but are determined by the model developer not to alter the core components related to program impacts • Adaptations that alter core components may be funded as promising approaches

15. Promising Approaches • A HV model… • with little or no evidence of effectiveness, • does not meet criteria for EBM, or • modified version of EBM that includes significant alterations to core components • Should be grounded in empirical work • Must be developed by or identified with a national organization or higher ed institution • Must evaluate with well-designed & rigorous process

16. Model Developers • Must provide documentation of approval by developers of selected model(s) to implement model as proposed • Verifying developer… • has reviewed & agreed to plan as submitted • proposed adaptations • support for participation in nat’l evaluation • state’s status to any required certification or approval process required • Submit within 45 days (by 3/25/11) – may request extension

17. Other info regarding models • State’s current/prior experience with implementing and current capacity to support • State’s overall approach to HV quality assurance • Approach to program assessment and support of ensuring model fidelity • Anticipated challenges & risks to maintaining quality & fidelity and proposed responses

18. 4. Implementation plan for State HV Program • Process of engaging targeted at-risk community(ies) • Approach to development of policy and setting standards • Working with model developer(s); TA and support to be provided by nat’l model(s) • If used, plan for recruitment of subcontractor orgs • Timeline for obtaining curriculum & materials • Types of and how initial & ongoing training will be provided for HV personnel • Recruiting, hiring, and retaining staff

19. Implementation plan - Quality • Plan to ensure high quality clinical supervision and reflective practice for staff • Operational plan for coordination among existing HV programs and other related programs/services in the community(ies) • Plan for obtaining/modifying data systems for ongoing continuous quality improvement (CQI) • Approach to monitoring, assessing, and supporting implementation with model fidelity and maintaining quality assurance

20. Implementation plan - Participants • Estimated # of families served and estimated timeline to reach max caseload • Plan for identifying/recruiting participants, and minimizing attrition rates for enrolled participants • Individualized assessments will be conducted of participant families and services provided according to the assessments

21. Priority to serve eligible participants • Low incomes • Pregnant women < age 21 • History of child abuse or neglect; or interactions with child welfare services • History of substance abuse or need SA treatment • Use tobacco products in home • Have, or have children with, low student achievement • Have children with developmental delays or disabilities • Families with members who are serving or have served in armed forces

22. Research & Evaluation • Participate in national evaluation • Not required to conduct any add’l evaluation, other than research on promising approaches • May conduct research & evaluation outside of national evaluation – if so, must describe

23. 5. Plan for meeting mandated benchmarks • Must collect data on: • all benchmark areas and all constructs • eligible families enrolled in program who receive services funded with MIECHV program funds • Individual-level demographic & service-utilization data • Must demonstrate improvements in: • at least 4 benchmark areas by end of 3 years • at least ½ of constructs under each benchmark area

24. Benchmark I Improved maternal & newborn health • Prenatal care • Parental use of alcohol, tobacco, illicit drugs • Preconception care • Inter-birth intervals • Screening for maternal depressive symptoms • Breastfeeding • Well-child visits • Maternal & child health insurance status

25. Benchmark II Child injuries, CA/N, emergency visits • Visits for children and mothers to emergency dept – all causes • Info/training provided to participants on prevention of child injuries • Incidence of child injuries requiring medical treatment • Reported suspected maltreatment (allegations screened but not necessarily substantiated) and substantiated maltreatment for children in the program

26. Benchmark III Improvements in school readiness & achievement Parent Child • support for children’s learning & development • knowledge of child development of their child’s developmental progress • parenting behaviors and parent-child relationship • emotional well-being or stress • communication, language & emergent literacy • general cognitive skills • positive approaches to learning including attention • social behavior, emotion regulation, & emotional well-being • physical health & development

27. Benchmark IVCrimeORDomestic Violence Crime Domestic Violence • Caregiver arrests & convictions • Screening for DV • Of families identified for presence of DV: • # referrals made to relevant services • # completed safety plans

28. Benchmark VFamily economic self-sufficiency • Household income & benefits • Employment & education of adult members of household • Health insurance status

29. Benchmark VICoordination and referrals for other community resources & supports • # families identified for necessary services • # families that required services and received a referral to available community resources • # of MOUs or formal agreements with other social service agencies in community • # agencies with which HV provider has a clear point of contact that includes regular sharing of information • # of completed referrals

30. Plan for benchmarks – cont’d • Recommended/strongly encouraged: • standard measures for constructs across HV models • utilize standard measures and other appropriate data for CQI to enhance program operation, decision-making, and to individualize services • data collected across all benchmark areas be coordinated & aligned with other relevant state or local data collection efforts

31. Plan for benchmarks – cont’d • For each construct within each benchmark area: • Specify proposed measure(s) with various details • For use of administrative data, must include MOU from agency with responsibility/oversight • Proposed definition of improvement for each element of construct

32. Data collection & analysis plan • Sampling may be used for some or all benchmark areas • Schedule for collection & analysis of each measure • Ensure quality – min. qualifications, required training for relevant staff, time estimated for data collection-related activities by personnel • How data will be analyzed at local & state levels • Using data for CQI at local program, community, state levels • Data safety, monitoring, privacy, human subjects protections • Anticipated barriers/challenges & possible strategies

33. 6. Plan for Administration • Statewide administrative structure to support state HV program • How HV plan and program will be managed and administered at state & local levels • Collaborative public/private partners • If support more than one HV program in community – plan for coordination of referrals, assessment & intake procedures across models • Identify other related state or local evaluation efforts of HV programs (other than evals of promising approaches) • Key personnel – job descriptions & resumes • Organization chart

34. Coordination with Early Childhood System • Ensure Updated State Plan is coordinated with other state EC plans including State Advisory Council Plan and State EC Comprehensive Systems Plan • Any strategies for making modifications needed to bolster the State administrative structure in order to establish a HV program as a successful component of a comprehensive, integrated EC system

35. 7. Plan for Continuous Quality Improvement (CQI) • CQI – A systematic approach to specifying processes and outcomes of a program or set of practices through regular data collection and the application of changes that may lead to improvements in performance • Address how CQI strategies will be utilized at local & state levels

36. 8. Memorandum of Concurrence • Signed by required agencies signifying approval of Updated State Plan (1st four + 2): • Director, State’s Title V agency (KDHE) • Director, State’s agency for Title II of CAPTA (SRS) • State’s child welfare agency (Title IV-E and IV-B), if not also administering Title II of CAPTA (SRS) • Director, State’s Single State Agency for Substance Abuse Services (SRS) • Administrator, State’s Child Care and Development Fund (CCDF) (SRS – who?) • Director, Head Start State Collaboration Office (SRS) • State Advisory Council on Early Childhood Education and Care authorized by Head Start Act (?)

37. Other State Agencies… • Strongly encouraged to seek consensus from: • IDEA Part C and Part B lead agencies • Elementary & Secondary Education Act Title I or pre-K program • MCHIP and/or EPSDT programs • Strongly encouraged to coordinate with: • Domestic Violence Coalition • Mental Health agency • Agency charged with crime reduction • TANF and SNAP • Injury Prevention & Control

38. 9. Budget • Updated budget for use of FY’10 allocation • Funds awarded for FY’10 are available for expenditure thru 9/30/12 • Budget period – 27 months • Includes costs of statewide needs assessment, state plan, and initial implementation

39. SIR and related HV Program information • KDHE website www.kdheks.gov/bfh/home_visiting.htm • HRSA website www.hrsa.gov/grants/manage/homevisiting • Home Visiting Evidence of Effectiveness (HomVEE) http://homvee.acf.hhs.gov/

40. Debbie Richardson, Ph.D. Manager, Home Visiting Program Bureau of Family Health Kansas Dept. of Health & Environment 1000 SW Jackson, Suite 22o Topeka, KS 66612 785-296-1311 drichardson@kdheks.gov