Affordable Care Act Tribal Maternal, Infant, and Early Childhood Home Visiting Program Overview Moushumi Beltangady Administration for Children and Families U.S. Department of Health and Human Services National Tribal Public Health Summit Tulsa, Oklahoma May 31, 2012

Affordable Care Act Maternal, Infant, and Early Childhood Home Visiting Program  Section 2951 of the Affordable Care Act of 2010 (P.L ) – March 23, 2010  Amends Title V of the Social Security Act to add Section 511: Maternal, Infant, and Early Childhood Home Visiting Programs  $1.5 billion in mandatory funding over 5 years ◦ $100 m FY 2010 ◦ $250 m FY 2011 ◦ $350 m FY 2012 ◦ $400 m FY 2013 and FY 2014  Grants to States and Jurisdictions (with 3 percent set-aside for grants to Tribes, Tribal Organizations, and Urban Indian Organizations and 3 percent set-aside for research, evaluation, and TA)  Requirement for collaborative implementation by HRSA MCHB and ACF

Affordable Care Act MIECHV Program Legislation Purposes: (1)To strengthen and improve the programs and activities carried out under Title V of the Social Security Act; (2)To improve coordination of services for at- risk communities; and (3)To identify and provide comprehensive home visiting services to improve outcomes for families who reside in at-risk communities

Affordable Care Act MIECHV Program Through high-quality, “evidence-based” home visiting programs targeted to pregnant women, expectant fathers, and parents and primary caregivers of children aged birth to kindergarten entry in at-risk communities identified through a needs assessment, promote: Improvements in maternal and prenatal health, infant health, and child health and development; Increased school readiness; Reductions in the incidence of child maltreatment; Improved parenting related to child development outcomes; Improved family socio-economic status; Greater coordination of referrals to community resources and supports; and Reductions in crime and domestic violence.

Evidence-Based Policy Initiative Requires State MIECHV grantees to implement evidence-based home visiting models – HHS conducted a systematic review of the evidence of effectiveness, known as Home Visiting Evidence of Effectiveness (HomVEE): results at Allows for implementation of promising strategies – Up to 25% of funding can be used to fund “promising and new approaches” that would be rigorously evaluated Nine models currently meet “evidence-based criteria” for the State MIECHV program

Benchmark Requirement The legislation requires that grantees establish quantifiable, measurable 3- and 5-year benchmarks for demonstrating that the program results in measurable improvements for eligible families participating in the program in each of the following benchmark areas: 1.Improved maternal and newborn health 2.Prevention of child injuries, child abuse, neglect, or maltreatment, and reduction of emergency department visits 3.Improvement in school readiness and achievement 4.Reduction in crime or domestic violence 5.Improvements in family economic self-sufficiency 6.Improvements in the coordination and referrals for other community resources and supports

Priority Populations for MIECHV Program  Families in at-risk communities identified through a needs assessment  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 that have users of tobacco in the home  Families with children with low student achievement  Families with children with developmental delays or disabilities  Families with individuals who are serving or have served in the Armed Forces, including those with multiple deployments

Tribal Home Visiting Program  Administered by ACF in collaboration with HRSA  Tribal grants, to the greatest extent practicable, are to be consistent with the MIECHV grants to States and Jurisdictions, including conducting a needs assessment and establishing 3- and 5-year benchmarks  3 percent set-aside – $3 million FY 2010, $7.5 million FY 2011, $10.5 million FY 2012, $12 million FY 2013 & 2014  5-year discretionary grants (cooperative agreements) to Tribes (including consortia of Tribes), Tribal Organizations, and Urban Indian Organizations  13 cooperative agreements awarded in FY 2010 (Cohort 1)  6 cooperative agreements awarded in FY 2011 (Cohort 2)  5-7 cooperative agreements to be awarded in FY 2012 (Cohort 3)  Website htm htm

Tribal Home Visiting Program Goals Supporting development of healthy, happy, and successful AIAN children and families through implementation of coordinated, high-quality, culturally relevant, evidence-based home visiting programs Expanding the evidence base around effective home visiting interventions for Native populations Supporting and strengthening cooperation and coordination and promoting linkages among various programs that serve pregnant women, expectant fathers, young children, and families to build coordinated, comprehensive early childhood systems in grantee communities

Tribal Home Visiting Grants Funds support 5-year cooperative agreements: Year 1: Needs assessment, planning, and capacity- building to implement, with fidelity to the chosen model, home visiting programs Years 2-5: – Implementation of high-quality, evidence-based home visiting programs, including provision of services to pregnant women, expectant fathers, and parents and primary caregivers with young children aged birth to kindergarten entry – Establishing and measuring child and family outcomes in benchmark areas – Rigorous research and evaluation activities

FY 2010 Grantees (Cohort 1) Choctaw Nation of Oklahoma (Durant, OK) Fairbanks Native Association, Inc (Fairbanks, AK) Kodiak Area Native Association (Kodiak, AK) Lake County Tribal Health Consortium (Lakeport, CA) Native American Community Health Center, Inc (Phoenix, AZ) Native American Professional Parent Resources (Albuquerque, NM) Northern Arapaho Tribe (Riverton, WY) Port Gamble S'Klallam Tribe (Kingston, WA) Pueblo of San Felipe (San Felipe, NM) South Puget Intertribal Planning Agency (Shelton, WA) Southcentral Foundation (Anchorage, AK) White Earth Band of Chippewa Indians (White Earth, MN) Yerington Paiute Tribe (Yerington, NV)

FY 2011 Grantees (Cohort 2) Confederated Salish and Kootenai Tribes (Pablo, MT) Eastern Band of Cherokee Indians (Cherokee, NC) Native American Health Center, Inc. (Oakland, CA) Riverside-San Bernardino County Indian Health, Inc. (Banning, CA) Taos Pueblo (Taos, NM) United Indians of All Tribes Foundation (Seattle, WA)

Technical Assistance Providers Tribal Home Visiting Technical Assistance Center – Walter R. McDonald and Associates, Arizona State University Office of American Indian Projects, Chapel Hill Training and Outreach Project Tribal Home Visiting Evaluation Institute (TEI) – James Bell Associates, University of Colorado Denver Centers for AIAN Health, Johns Hopkins University Center for American Indian Health Tribal Early Childhood Research Center (TRC) – UC Denver Centers for AIAN Health, JHU Center for American Indian Health

Evidence-Based Policy and Tribal Home Visiting ACF conducted a review of home visiting interventions with Native communities (Tribal HomVEE) NO home visiting models implemented in tribal communities meet the “evidence-based” criteria for the State MIECHV program Tribal HV grantees may choose a PROMISING APPROACH that is: Grounded in relevant empirical work Developed by or in partnership with a national organization or university To be evaluated through rigorous research to determine its effectiveness Grantees may choose an existing evidence-based model and adapt to community needs, or develop a local innovation to meet needs

Models Selected by Grantees Cohort 1 – Parents as Teachers (8) – Nurse-Family Partnership (3) – Parent-Child Assistance Program (1) – Family Spirit (1)

Evidence-Based Policy and Tribal Home Visiting Focus on FIT between model and community Recognition of need for adaptation of evidence- based models to culture and context Importance of grounding in implementation science (what we know about implementing evidence-based models) – Well-trained, competent staff – High quality reflective supervision – Strong organizational capacity – Strong community capacity for referral – Monitoring fidelity of implementation – Participant recruitment and retention plan

Rigorous Research and Evaluation Requirement All grantees are required to conduct rigorous research and evaluation activities Goal is to inform practice and build the evidence base of effective home visiting interventions with Native populations Research and Evaluation activities could include: – Examining effectiveness of home visiting models in serving Native populations – Examining effectiveness of adaptations of home visiting models for Tribal communities – Questions regarding implementation or infrastructure necessary to support implementation of home visiting programs in Tribal communities

Cohort 1 Year 1 Activities 9/30/2010 – Grants awarded 1/18 – 1/20/2011 – Tribal Home Visiting Kickoff Meeting Winter and Spring 2011 – Grantees conducted needs assessments Summer 2011 – Grantees developed Implementation Plans (selected models, developed benchmark and research and evaluation plans) 8/1/2011 – Needs Assessments and Implementation Plans submitted to ACF 9/30/11 – Grantees receive Year 2 funding to begin implementation

Cohort 1 Year 2 Activities Continue working with model developers to refine model to meet community needs, culture, and context (cultural adaptation) Manualize program (develop manuals, training plans, recruitment plans, etc.) Continue working with community to plan for implementation Refine benchmark and continuous quality improvement plan Hire home visitors Recruit participants Begin serving families Begin collecting benchmark data Refine rigorous evaluation plan and methodology

FY 2012 Funding Opportunity New FY 2012 Funding Opportunity Announcement for Tribal Maternal, Infant, and Early Childhood Home Visiting Program Under the Affordable Care Act $1.5 million available for 5-7 new cooperative agreements Funding Opportunity Announcement available at: ACF-OCC-TH ACF-OCC-TH-0302 Application Due Date 7/16/2012 Pre-Application Webinar – more information at - webinar will be archived For more information please contact