1 California’s Home Visiting Program Statewide Needs Assessment for the Affordable Care Act Maternal, Infant and Early Childhood Home Visiting Program Presentation for MCAH Action October 20, 2010

2 Background The Supplemental Information Request for the statewide needs assessment (referred to as the first SIR) was released on August 19, 2010 The statewide home visiting needs assessment was submitted on September 20, 2010 California received confirmation that the statewide needs assessment was accepted

3 Methods Extensive cross agency collaboration and coordination with key partners –California Department of Social Services (CDSS) –California Department of Alcohol and Drug Programs (CDADP) –California Head Start State Collaboration Office of the California Department of Education (CHSSCO/CDE) Local Capacity Assessment Home Visiting Survey The Home Visiting Program Collaborative Workgroup The Home Visiting Program webpage

4 Methods Input, data, evidence or reports were obtained from a number of other agencies to assist with this needs assessment –California Department of Health Care Services, California Department of Developmental Services, California Emergency Management Agency, the Safe and Active Communities Branch, the STOP Violence Against Women regional coordinator for California, the California Partnership to End Domestic Violence, the Domestic Violence Assistance Program, First 5 California, the First 5 Association of California, multiple County First 5 Commissions, and MCAH Action Coordination with existing Title V, Child Abuse and Prevention Treatment Act (CAPTA), and Head Start needs assessments Conceptual frameworks –Life Course Perspective –Social Determinants of Health –Socio-ecological Model

5 Major Needs Assessment Components To meet requirements for an approvable statewide home visiting needs assessment, state’s were required to: 1)Identify “at-risk” communities with concentrations of select risk factors 2)Describe the quality and capacity of existing early childhood home visitation programs in the State 3)Describe the State’s capacity for providing substance abuse treatment and counseling to those in need

6 Major Needs Assessment Components CDPH/MCAH organized the needs assessment according to the six components required by the first Supplemental Information Request (SIR): 1)Statewide data report 2)Defining “community” 3)Data report for each identified at risk community 4)Description of the quality and capacity of existing home visiting programs 5)Description of the state’s capacity to provide substance abuse counseling and treatment services 6)Summary of the needs assessment results, including a discussion of how the state will address unmet needs

7 Section 1. A Statewide Data Report Summary

8 Required Indicators The first SIR required that states report on the following required indicators:  Premature birth  Domestic violence  Low birth weight infants  School drop-outs  Infant mortality  Substance abuse (x4)  Poverty  Unemployment  Crime (x2)  Child maltreatment

9 Supplemental Indicators States were given the option to include “other indicators of at risk prenatal, maternal, newborn or child health” In consultation with its partner agencies, California chose to supplement the required indicators Selected based on one or more of the following criteria: –Identified as a priority by partner agencies –Can be altered through early childhood home visiting or reflect target populations for home visiting –Are measurable at the state and county level

10 Required Indicators The supplemental indicators include:  Prenatal care  Breastfeeding  Prenatal substance use  Children with special needs  Maternal depression  Foster care  Short birth interval

11 Appendix A IndicatorTitle VCAPTA Head StartSAMHSAOtherComments Premature birth -Percent: # live births before 37 weeks/total # live births -- Low birth weight infants -# resident live births less than 2500 grams/# resident live births -- Infant mortality -# infant deaths ages 0-1/1,000 live births -- Poverty -# residents below 100% FPL/total # residents -- Crime -# reported crimes/1000 residents -# crime arrests ages 0-19/100,000 juveniles age Domestic violence -As determined by each State in conjunction with the State agencies administering the FVPSA --

12 Appendix A IndicatorTitle VCAPTAHead StartSAMHSAOtherComments School Drop-out rates -Percent high school drop-outs grades Other school drop-out rates as per State/local calculation method -- Substance abuse -Prevalence rate: Binge alcohol use in past month -Prevalence rate: Marijuana use in past month -Prevalence rate: Nonmedical use of prescription drugs in past month -Prevalence rate: Use of illicit drugs, excluding marijuana in past month -- Unemployment -Percent: # unemployed and seeking work/total workforce -- Child maltreatment -Rate of reported substantiated maltreatment -Rate of reported substantiated maltreatment by type -- Other indicators of at risk prenatal, maternal, newborn, or child health --

13 Additional Analyses California developed a table and map to present county-level data to help inform the designation of at risk communities Tables and maps were created for each indicator (i.e. both required and supplemental indicators)

14 Example of an Indicator Table Lines indicate the state rate or percentage and state median State median was chosen due to the influence of large counties on the state rate

15 Example of an Indicator Map The maps assign counties to quantiles based on their rate or percentage for that indicator –Below the 50 th percentile (i.e. below the state median) –50 th -74 th percentile –75 th -89 th percentile –90 th -100 th percentile Begins to identify counties most in need based on that indicator

16 Example of an Indicator Map by SAMHSA Region Data for some required indicators were only available by regions Regional rates were applied to each county for the purposes of this needs assessment

17 Section 2. Community Unit Selection Summary

18 Consideration of Several Units for Defining “Community” The first SIR’s guideline in defining “community” stated that “Each state should describe its understanding of the term “community” in accordance with the unique structure and make-up of the State.” California considered several possible units for defining “community.” California chose to define “community” as county for this needs assessment. –California may refine this definition in response to the future SIR on the Updated State Plan.

19 Identifying At Risk Communities The first SIR provided a definition of “at risk community” whereby an ‘at risk community’ is a community for which indicators, in comparison to statewide indicators, demonstrate that the community is at a greater risk than the State as a whole. For this needs assessment, at risk communities in California were defined as those counties with a rate or percentage worse off than the statewide median for any one or more of the indicators.

20 At Risk Communities in California Every county has at least two indicators worse off than the statewide median. Based on California’s definition of at risk communities for this needs assessment, all 58 counties were designated as at risk. 54 of 58 counties, or 93%, had rates or percentages worse off than the statewide median for six or more indicators.

21 Section 3. Data Report for Each At Risk Community in the State Summary

22 Sample of a Data Report for Each At Risk Community California completed a data report, using the required Appendix A matrix, for each of the designated at risk communities, defined previously as all 58 counties. Below is a sample, the full data report includes all 14 required and 7 supplemental indicators as well as detailed comments. Alameda County Data Tables: Summary of Indicators IndicatorTitle VCAPTA Head Start SAMHSAOtherComments Premature birth -Percent: #live births before 37 weeks/total # live births Low birth weight infants -# resident live births less than 2500 grams/# resident live births Infant mortality -# infant deaths ages 0-1/1,000 live births Poverty -# residents below 100% FPL/total # residents Crime -# reported crimes/1000 residents -# crime arrests ages 0-19/100,000 juveniles age

23 Section 4. Information on the Quality and Capacity of Existing Programs/Initiatives for Early Childhood Home Visitation in At Risk California Communities Summary

24 Process to Assess Existing Home Visiting Programs/Initiatives Contacted state partners about their current home visitation efforts Obtained and reviewed existing local home visiting capacity surveys Contacted national/state representatives of evidence- based home visiting programs Developed and disseminated a Capacity Assessment Home Visiting Survey

25 Assessment of Home Visitation Programs at the Local Level Counties have at least one home visitation program and the majority have multiple programs Counties report use of a variety and, often, multiple funding streams, yet still report inadequate funding Counties report multiple gaps and unmet needs

26 Sample of the Survey Results for Each At Risk Community California completed a survey results report, for each of the designated at risk communities with survey data (n=54). Below is a sample, the full data report includes a narrative component. Name of the Program Model or approach Specific service provided Intended recipients/ Target population Targeted goals/ outcomes Demographic Characteristics Number of families served Waiting list for services Funding Source -- HFA-- Low income, Pregnant Women, Teens, Hx of DV, Hx of Substance Abuse, Low student achievement /Dropouts Other -- PAT-- Low Income, Pregnant Women etc HS/EHS Contra Costa County Survey Results

27 Section 5. Narrative Description of California’s Capacity for Providing Substance Abuse Treatment and Counseling Services to Individuals/Families in Need of these Services Who Reside in At Risk Communities Summary

28 Substance Abuse Treatment Capacity in California Information for this section provided by CDADP Alcohol and Other Drug (AOD) treatment capacity in California is estimated to be 110,623 –This includes 38,000 pregnant and parenting women served by 300 publicly funded alcohol and drug treatment and recovery programs An estimated 3.3 million Californians need but are not receiving AOD treatment

29 Section 6. Narrative Summary of Needs Assessment Results Summary

30 Summary of Needs Assessment Findings CDPH/MCAH worked in close collaboration with it’s partners to develop the home visiting application and needs assessment Input from other state agencies and local stakeholders and partners, including the Home Visiting Workgroup, was also obtained California defined “community” as County and designated all 58 counties as “at-risk”

31 Summary of Needs Assessment Findings Extensive local expertise exists for the provision of home visiting programs but current resources are inadequate CDADP estimates AOD treatment capacity to be 110,623 with 3.3 million Californians in need but not receiving AOD treatment

32 Conclusion and Next Steps California is waiting for the federal guidance for the Updated State Plan The Updated State Plan will provide an opportunity to refine the needs and resources assessment –To include additional indicators and data –To refine the definition of “community” (e.g., census tracts and/or MMSA’s) –To refine the designation of “at risk” communities

33 Questions? For additional questions or information on the Home Visiting Program, including a copy of California’s Home Visiting Needs Assessment, please visit the webpage: – s/HVP-HomePage.aspx Thank you!