1. The Maternal Infant and Early Childhood Home Visiting Program (MIECHV)
2018 National Early Childhood Inclusion Institute
Tuesday, May 8, 2018
Monique Fountain Hanna, M.D., M.P.H., M.B.A.
Senior Regional Medical Consultant
Division of Home Visiting and Early Childhood Systems (DHVECS)
Maternal and Child Health Bureau (MCHB)
Health Resources and Services Administration (HRSA)
The Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV Program) was created in 2010 to support voluntary, evidence-based home visiting services for at-risk pregnant women and parents with young children up to kindergarten entry.
The MIECHV Program gives pregnant women and families, particularly those considered at-risk, necessary resources and skills to raise children who are physically, socially, and emotionally healthy and ready to learn.

2. MIECHV Program Overview
What is home visiting?
Home visits are the primary strategy for delivery of services to families
A home visitor (nurse, early childhood educator, trained community member) regularly visits an expectant mother or father, parent or primary caregiver of a young child
Services can include:
Providing information about parenting, maternal and child health, child development, and school readiness
Linking families to community services, resources, and supports
Social support, advocacy, mentorship
Conducting screenings and providing referrals to address maternal depression, substance use, family violence and child developmental delays

3. MIECHV Legislative Authority
$400 million appropriation annually for
Awards to states and territories for implementation of evidence- based home visiting (Administered by HRSA)
3% set-aside for grants to Tribal entities (Tribal Program administered by ACF)
3% set-aside for research, evaluation, and corrective action technical assistance (Jointly administered by HRSA and ACF)
This funding supports grants to all fifty states, the District of Columbia, and five territories.
Per statute, a three percent set-aside supports awards to Indian tribes (or a consortium of Indian tribes), tribal organizations, and urban Indian organizations under the Tribal Home Visiting Program administered by ACF.
There is an additional three percent set-aside for research, evaluation, and corrective action technical assistance that is jointly administered by ACF and HRSA.
Via statute HRSA and ACF work are to work in collaboration, and we do so on policy decisions, data collection efforts, and quality improvement.
The partnership allows HRSA to leverage ACF’s research and evaluation expertise in the Office of Planning, Research, and Evaluation (OPRE) and extensive experience in working with tribal entities in other social service programs administered by ACF.

4. MIECHV Program Key Points
Funding
Majority of MIECHV funding allocated via formula awards with 5% allocated to 14 innovation awards (impacting 19 states and jurisdictions) in FY 2017
The period of availability for the expenditure of MIECHV Program funds is two years. For FY 2017, the period of availability starts September 30, 2017 and ends September 30, 2019.
Supports Families
Statewide needs assessments identify at-risk communities; states select home visiting models that best meet state and local needs
Partnership between parents and home visitors
Evidence-based
Built on four decades of rigorous research and evaluation
Program models meet HHS criteria for evidence of effectiveness as well as criteria identified in statute for implementation under MIECHV
Includes a national random assignment impact study and local evaluations
Formula Awards (slide 4)
Majority of MIECHV funding allocated via formula awards with 5 percent allocated to nine innovation awards in FY 2017.
On April 1, 2016, HRSA awarded approximately $345 million in funding to 56 states, territories, and nonprofit organizations to support the MIECHV Program.
In FY 2017, approximately $343 million is available to support state and territory recipients that currently receive Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program funding (56 current MIECHV funding recipients). Awards will be made in September.
The period of availability for the expenditure of MIECHV Program funds is two years. For FY 2017, the period of availability starts September 30, 2017 and ends September 30, After the second succeeding fiscal year after award, unexpended funding is deobligated and subsequently carried over and made available for new obligations.
These funds allow awardees to continue to expand voluntary, evidence-based home visiting services to women during pregnancy, and to parents with young children up to kindergarten entry.
Supports Families (slide 4)
As required in MIECHV statute, through a statewide needs assessment in 2010, states identified target populations and select home visiting service delivery models that best meet state and local needs. We will be providing a recommendation for an update for FY 2018.
Home Visiting is a partnership between home visitors and parents who have a shared investment in the healthy development of children.
Evidence-based (slide 4)
The MIECHV Program builds upon decades of scientific research that shows home visits by a nurse, social worker, early childhood educator, or other trained professional during pregnancy and in the first years of a child’s life improves the lives of children and families.
By law, state and territory awardees must spend the majority of their MIECHV Program grants to implement evidence-based home visiting models, with up to 25 percent of funding available to implement promising approaches that will undergo rigorous evaluation.
Program models meet HHS criteria for evidence of effectiveness as well as criteria identified in statute for implementation under MIECHV.

5. MIECHV Program Key Points
Voluntary
For families that ask to be empowered with better knowledge, health and parenting
Positive Return on Investment (ROI)
Home Visiting helps prevent child abuse and neglect, encourages positive parenting and promotes child development and school readiness
Higher parental earnings, decreased use of public assistance programs, reduced maternal depression, and reduced ADHD diagnosis
Locally designed and run
Provides states with maximum flexibility to tailor programs to fit needs of different communities
States choose from approved evidence-based models
Programs run by local organizations
Technical Assistance
Achieve critical outcomes for children, families, and at-risk communities by providing technical assistance for program implementation, performance measurement, and CQI
Program Key Points (slide 8)
Home Visiting is a voluntary program for families who ask to be empowered with better knowledge, better health, better parenting skills, and better opportunities for their children.
Research shows that evidence-based home visiting can provide a positive return on investment to society. Home Visiting helps prevent child abuse and neglect, encourages positive parenting and promotes child development and school readiness. It can also contribute to higher parental earnings, decreased use of public assistance programs, reduced maternal depression, and reduced ADHD diagnosis.
MIECHV programs are locally designed and run, providing states with maximum flexibility to tailor programs to fit needs of different communities. States choose from approved evidence-based models and programs are run by local organizations.
The MIECHV Program achieves critical outcomes for children, families, and at-risk communities by providing technical assistance for program implementation, performance measurement, and CQI.

6. MIECHV Program Growth
Programs are in all 50 states, D.C. and five territories and counties (FY 2016)
Programs have provided nearly 3.3M home visits since
In 2016, states reported serving 160,000 participants
Program Growth (slide 9)
In FY 2016, states reported serving approximately 160,000 parents and children in 893 counties through the MIECHV program.
Since FY 2012, the reported number of children and parents served increased nearly five-fold, and the number of home visits provided increased more than five-fold to nearly 1 million home visits in FY 2016.
Almost 3.3 million home visits were provided over the past five years.

7. MIECHV Families Populations Served in 2016 Low-income families
MIECHV Priority Populations
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 w/low student achievement
Families with children w/ DD or disabilities
Families with individuals who are serving or have served in the Armed Forces, including those with multiple deployments
Populations Served in 2016
77% of families < 100% federal poverty
46% of families < 50% federal poverty
66% did not go to college
68% minority
22% of newly enrolled pregnant teens
15% of newly enrolled with history of child abuse and neglect
12% of newly enrolled with history of substance abuse
Priority Populations (slide 11)
Per Social Security Act, Title V, §511(d)(4), priority for serving high-risk populations include the following:
Eligible families who reside in communities in need of such services, as identified in the statewide needs assessment required under subsection 511(b)(1)(A);
Low-income eligible families;
Eligible families with pregnant women who have not attained age 21;
Eligible families that have a history of child abuse or neglect or have had interactions with child welfare services;
Eligible families that have a history of substance abuse or need substance abuse treatment;
Eligible families that have users of tobacco products in the home;
Eligible families that are or have children with low student achievement;
Eligible families with children with developmental delays or disabilities; and
Eligible families that include individuals who are serving or formerly served in the Armed Forces, including such families that have members of the Armed Forces who have had multiple deployments outside of the United States 7

8. MIECHV Legislative Benchmarks
Benchmark Areas
Measures
I. Maternal and
Newborn Health
Preterm Birth; Breastfeeding; Depression Screening; Well-Child Visit; Postpartum Care; Tobacco Cessation Referrals
II. Child Injuries, Maltreatment, and Reduction of ED Visits
Safe Sleep; Child Injury; Child Maltreatment
III. School Readiness and Achievement
Parent-Child Interaction; Early Language and Literacy Activities; Developmental Screening; Behavioral Concerns
IV. Crime or
Domestic Violence
IPV Screening
V. Family Economic Self-Sufficiency
Primary Caregiver Education; Continuity of Insurance Coverage
Performance Measures (slide 20)
The legislation that established the MIECHV program requires that awardees demonstrate measurable improvement in at least four of the following six benchmark domains:
Improvement in maternal and newborn health
Reduction in child injuries, abuse, and neglect
Improved school readiness and achievement
Reduction in crime or domestic violence
Improved family economic self-sufficiency
Improved coordination and referral for other community resources and supports
MIECHV performance measures were recently standardized so all awardees are collecting and reporting consistent data for the first time. Awardees began collecting this information in October 2016 and will report it to HRSA this fall. We expect to conduct state and national-level analysis throughout the winter of
The new performance measures are based on the evidence of home visiting effectiveness, their importance to early childhood development and family well-being, and the benchmark areas outlined in statute.
VI. Coordination
and Referrals
Completed Depression Referrals; Completed Developmental Referrals; IPV Referrals 19

9. Contact Information
Monique Fountain Hanna, M.D., M.P.H., M.B.A. Senior Regional Medical Consultant Division of Home Visiting and Early Childhood Systems Maternal and Child Health Bureau (MCHB) Health Resources and Services Administration (HRSA) Web:

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