MIECHV Program: Performance Measurement November 27, 2012 Carlos Cano, MD, MPM Division of Home Visiting and Early Childhood Services Maternal and Child Health Bureau

Overview Legislatively Required Performance Measurement System Federal Data Collection Opportunities

Affordable Care Act MIECHV program: Section 2951 of the Affordable Care Act of 2010 (P.L. 111-148) Amends Title V of the Social Security Act to add the Maternal, Infant, and Early Childhood Home Visiting Program under Section 511 ACF and HRSA collaboration $1.5 billion over 5 years

Priority Populations Families in at-risk communities 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 with a history of tobacco use Families with children with low student achievement Families with children w/ developmental delays Families w/ individuals who served in Armed Forces

Evidence-based Home Visiting Models 1. Child First 2. Early Head Start-Home Visiting 3. Public Health Nursing Early Intervention Program for Adolescent Mothers (EIP) 4. Early Start (NZ) 5. Family Check-Up 6. Healthy Families America (HFA) 7. Healthy Steps 8. Home Instruction for Parents of Preschool Youngsters (HIPPY) 9. Nurse-Family Partnership (NFP) 10. Oklahoma CBFRS 11. Parents as Teachers (PAT) 12. PALS Infant 13. Safecare Augmented

Data Collection on Six Goals (Benchmark Areas) Maternal and newborn health (8 constructs) Child injuries; child abuse, neglect, or maltreatment; emergency department visits (7) School readiness and achievement (9) Crime (2) or domestic violence (3) Family economic self-sufficiency (3) Coordination/referrals to community resources (5)

Grantee Measurement System: Development Legislation: Three-year measurement cycle Report to Congress due December, 2015 Distinct from research/evaluation (MIHOPE) TA and Federal feedback during review of plans Refinement of benchmark indicators Federal-State Partnership Develop a robust measurement system Balancing two values: accountability and improvement Data reporting for first implementation year: Fall of 2012

Indicator Development: Roadmap Name of the performance measure Process or outcome Operational definition key terms specified; participants included and excluded from the calculation; type of scoring: if percent, numerator/denominator Measurement tool utilized or question(s) posed Definition of improvement Before and after comparisons (e.g., performance in year 1 vs. year 3) Data collection plan Persons responsible; source of data (e.g., self-report or administrative data); frequency of collection.

Overview Legislatively Required Measurement System Federal Data Collection Opportunities

Federal Collection System: Prerequisites Select an electronic collection system Select already existing applicable forms Develop new MIECHV-specific forms Obtain approval from OMB under PRA Specify system requirements for new forms Inform grantees on the use of the electronic system

Discretionary Grants Information System (DGIS) A web-based system Over 900 MCHB-funded grantees report data online Areas (Forms 1,2,4, 6, pubs and prods) Budget/Financial Programmatic

Interagency Data Work Group Selected 5 DGIS forms Developed 2 new HV forms for unique MIECHV data needs HV form 1: Socio-demographic data and service utilization HV form 2: Grantee-selected performance measures Modified DGIS contract to include collection and analysis capabilities for MIECHV Specified DGIS requirements for new forms Conducted webinars for grantees Obtained OMB approval

Accessing DGIS-HV Screenshot of Main Menu

Overview Legislatively Required Measurement System Federal Data Collection Opportunities

MIECHV Measurement: Opportunities Research (MIHOPE) Advance the knowledge in HV the maternal and early childhood heath and development field Improvement (Benchmark area-related data) Data can drive quality improvement efforts Common data framework: catalyst for collaboration & partnerships common agenda  system integration Across home visiting programs in a geographic area Other early childhood programs (child care and education) Medical homes

Flexibility for Grantees Select performance measures: process or outcome Select measurement tools Define improvement (targets not required) Design data collection plan Improvement shown for a fraction of constructs

Next Phase: Quality Improvement Pivoting from measurement towards QI Individualized TA Regional meetings Plan to establish a learning collaborative Enlisting grantees Selecting 4-6 areas of improvement Preliminary development of a shared sub-set of indicators

Resources and Contact Information HRSA/MCHB website: http://mchb.hrsa.gov/programs/homevisiting/ HomVEE website: http://homvee.acf.hhs.gov/ Monique Fountain Hanna, MD, MBA, Project Officer for Region III Office: (215) 861-4393 mfountain@hrsa.gov Carlos Cano, MD, MPM, Senior Medical Advisor, Office: (301) 443-8951 ccano@hrsa.gov

Thank you