This presentation provides an overview of the Affordable Care Act's Maternal, Infant, and Early Childhood Home Visiting Program. It discusses the program's legislative authority, goals of improving maternal and child health outcomes, priority populations, implementation of evidence-based home visiting models, status of program implementation across states, and opportunities the program provides. Evaluation of program impacts is being led by MDRC and partners through the Mother and Infant Home Visiting Project Evaluation.

1. The Affordable Care Act
Maternal, Infant,
and Early Childhood
Home Visiting Program
Marilyn D. Stephenson, MSN, RN
HRSA Maternal and Child Health Bureau
Division of Home Visiting and Early Childhood Systems
Eastern Implementation Branch
2012 South Carolina Home Visiting Summit
U.S. Department of Health and Human Services
Health Resources and Services Administration, Maternal and Child Health Bureau
Administration for Children and Families

2. Overview of Presentation
• Legislative authority and program goals and
priorities
• Evidence-based home visiting models
• Status on program implementation and
opportunities for partnership

3. Legislative Authority
 Section 2951 of the Affordable Care Act of 2010 (P.L. 111-
148)
 Amends Title V of the Social Security Act to add Section 511:
Maternal, Infant, and Early Childhood Home Visiting
Programs
 $1.5 billion over 5 years
 Grants to states (with 3% set-aside for grants to
Tribes, Tribal Organizations, or Urban Indian Organizations
and 3% set-aside for research, evaluation, and TA)
 Requirement for collaborative implementation by HRSA and
ACF

4. Legislation Purposes
(1) To strengthen and improve the MCH
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
services to improve outcomes for families
who reside in at-risk communities.

5. Home Visiting Program Goals
Improvements in:
 Prenatal, maternal, and newborn health
 Child health and development, including the
prevention of child injuries and maltreatment
 Parenting skills
 School readiness and child academic achievement
 Reductions in crime or domestic violence
 Family economic self-sufficiency
 Referrals for and provision of other community
resources and supports

6. Additional Program Goals
 Support the development of statewide systems to ensure
effective implementation of evidence-based HV programs
grounded in empirical knowledge
 Establish HV as a key early childhood service delivery
strategy in high-quality, comprehensive statewide early
childhood systems
 Foster collaboration among maternal and child health,
early learning, and child abuse prevention
 Promote collaboration and partnerships among states,
the federal government, local communities, HV model
developers, families, and other stakeholders

7. 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 that have users of tobacco in the
home

8. Priority Populations
 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

9. “Evidence-Based” Policy
 Requires grantees to implement evidence-based
home visiting models
– Federal Register Notice published July 23rd inviting
public comment on proposed criteria for assessing
evidence of effectiveness of home visiting program
models
 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

10. Models that Meet the Criteria for
Evidence Base
 Child FIRST
 Early Head Start – Home-Based Option
 Family Check-Up
 Healthy Families America
 Healthy Steps
 Home Instruction for Parents of Preschool
Youngsters (HIPPY)
 Nurse-Family Partnership
 Parents as Teachers
 The Public Health Nursing Early Intervention
Program (EIP) for Adolescent Mothers

11. Models that Meet the Criteria for
Evidence Base
 Early Start (New Zealand)
 Oklahoma Community-Based Family Resource and
Support Program
 Play and Learning Strategies (PALS) Infant

12. Selection of Home Visiting Model(s)
States may:
• Select a model(s) that meets criteria for evidence of
effectiveness
• Propose another model not reviewed by HomVEE
study
• Request reconsideration of an already-reviewed
model
• Propose use of up to 25% of funds for a promising
approach

13. Status of MIECHV: PAST
 Needs Assessments (September 2010)
 Updated State Plans (June 2011)
 FY 2011 Formula Applications (July 2011)
 Competitive Grants (July 2011)
– The goal of the MIECHV competitive program is to award
additional funding to states that have sufficiently
demonstrated the interest and capacity to expand and/or
enhance their EBHV programs to improve outcomes for
children and families who reside in at-risk communities

14. FY 2011 Competitive Grant
Expansion Grants
 States and jurisdictions that have already made
significant progress towards implementing a high-
quality HVP
Development Grants
 States and jurisdictions that currently have modest
HVP and want to build existing efforts

15. Status of MIECHV: PRESENT
 Refinement of Benchmark Plans (FY 2012 to
present)
 Implementation (FY 2012 - pending approval of
Benchmark Plan)
 Refinement of State CQI Plan
 Ongoing Technical Assistance

16. Status of MIECHV: NEXT STEPS
 FY12 awards for ND and WY non-profit
 FY12 Non-Competing Continuation Progress
Report (Spring 2012)
 FY12 Competitive Development FOA
 Annual Reporting Requirements

17. Other MIECHV Activities
• Home Visiting Evidence of Effectiveness
Systematic Review (HomVEE)
• Mother and Infant Home Visiting Project
Evaluation (MIHOPE)
• Tribal Home Visiting Technical Assistance
Center (TTAC)
• Tribal Home Visiting Evaluation Institute (TEI)
• Tribal Early Childhood Research Center (TRC)

18. Mother and Infant Home Visiting
Project Evaluation (MIHOPE)
 Affordable Care Act legislative language for
evaluation:
– State-by-state analysis of needs assessment
– Efficacy and efficacy by variations in programs and
populations
– Potential for MIECHV, if scaled broadly, to reduce health
care costs and increase efficiencies
 The contract to conduct the evaluation was awarded
to: MDRC with partners James Bell Associates,
Johns Hopkins University, and Mathematica Policy
Research

19. HHS Goals for MIHOPE
 Evaluation must use a rigorous design to assess
effectiveness overall and for populations specified in
the legislation
 Examine effectiveness across all evidence-based
models and all participant outcomes and benchmark
domains
 Reflect the diversity of communities and populations
to the extent possible in all aspects of the evaluation.
 Conduct a thorough implementation study
 Produce results that will inform program-level
decision-making and increase the ability to
strengthen the program in the future

20. MIHOPE Research Questions
 What is the impact of MIECHV on participant
outcomes?
 How do impacts vary by participant and program
features?
– Who is in the system? Who provides the services?
What families are enrolled? And what services are
provided?
– How do community context and partners influence
the service model and delivery?
– How do staff and family characteristics mediate
service dosage, content, and quality?

21. MIHOPE Study Design & Sample
 Approximately 12 states, 85 local
implementing sites, 5100 pregnant women
and families with infants up to 6 months of
age
 Focused on the 4 models selected by at least
10 states: EHS-HBO, HFA, NFP, PAT
 Random assignment at the time of
enrollment and a follow-up assessment when
the child is approximately 15 months old

22. MIECHV Opportunities
• Advance the field of maternal and early childhood
heath and development
• Translate science into policy
• Data collection requirements provide a
framework for states to carry out their own data-
driven QI efforts

23. MIECHV Opportunities
• Develop infrastructure in places where none previously
existed – frontier, rural, and urban areas
• Focal point for collaborations and partnerships – forge
collaborations and partnerships were none previously
existed
• Systems integration of HV with other EC programs, Early
Childhood Comprehensive Systems (ECCS) grants –
integration across sectors including health, such as
medical home, EC care and education, early
intervention, and other family supports

24. Resources
HRSA/MCHB website:
http://mchb.hrsa.gov/programs/homevisiting/
HomVEE website:
http://homvee.acf.hhs.gov/

25. Questions?
Marilyn D. Stephenson
MStephenson@hrsa.gov
Thank you!