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Summary of the Patient Protection and Affordable Care Act (Health Care Reform Act H.R. 3590-216)

Sec. 2951 Maternal, Infant, and Early Childhood Home Visiting Programs
Pages 216-225

Needs Assessment

Home Visiting Program Requirements

Award of Grant

Purpose of the Law

  • To strengthen and improve programs and activities carried out under this title.
  • To improve coordination of services for at risk communities.
  • To identify and provide comprehensive services to improve outcomes for families who reside in at risk communities.

Needs Assessment [Section 2951, page 216 (b)]

  • Must be completed no later than six months after the date of enactment/signature (September 1, 2010).
  • Condition of receiving payment from existing MCH Block grant allotment is under section 502 for FFY 2011.
  • Is separate from the statewide MCH Five Year Needs Assessment currently required under section 505(a) - Maternal and Child Health Services Block Grant Statewide Needs Assessment.

Needs Assessment Must…

  • Identify communities with concentrations in the following areas:
    • Premature birth, low-birth weight infants, and infant mortality, including infant death due to neglect, or other indicators of at-risk prenatal, maternal, newborn, or child health.
    • Poverty and crime.
    • Domestic violence.
    • High rates of high-school dropouts.
    • Substance abuse.
    • Unemployment.
    • Child maltreatment.
  • Identify the quality and capacity of existing programs or initiatives for early childhood home visitation in the State including:
    • Number and types of individuals and families who are receiving services.
    • Gaps in early childhood home visitation.
    • Extent to which programs or initiatives are meeting the needs of eligible families.
  • Identify the State’s capacity for providing substance abuse treatment and counseling services to individuals and families in need of such treatment or services.
  • Coordinate with other assessments:
    • Maternal and Child Health Services Block Grant Statewide Needs Assessment - Section (505)(a).
    • Head Start community strategic planning and needs assessment – Section 640(g)(1)(C).
    • Section 205(b) of Child Abuse Prevention and Treatment Act (CAPTA).

Needs Assessment Submission

  • Must show the results of the statewide needs assessment.
  • Must include a description of how the State intends to address needs identified by the assessment, which may include applying for a grant to conduct an early childhood home visitation program.

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Home Visiting Program Requirements [Section 2951, page 217-220 (d)]

Home Visiting Programs Must…

  • Show quantifiable, measurable improvement in (three and five year) benchmarks such as:
    • Maternal and newborn health.
    • Prevention of child injuries, child abuse, neglect, or maltreatment, and reduction of emergency department visits.
    • School readiness and achievement.
    • Reduction in crime or domestic violence.
    • Family economic self-sufficiency.
    • Coordination and referrals for other community resources and supports.
  • Demonstrate improvement after three years in at least four of the specified areas.
  • Demonstrate required outcomes for participants, identified based on an individualized family assessment for reduction in crime or domestic violence and improvements in:
    • Prenatal, maternal, and newborn health, including improved pregnancy outcomes.
    • Child health and development, including the prevention of child injuries and maltreatment, and improvements in cognitive, language, social-emotional, and physical developmental indicators.
    • Parenting skills.
    • School readiness and child academic achievement.
    • Families economic self-sufficiency.
    • The coordination of referrals for, and the provision of, other community resources and supports for eligible families, consistent with State child welfare agency training.

Home Visiting Program Core Components

  • The model must conform to a clear consistent home visitation model per the following guidelines:
    • Has existed for at least three years.
    • Be research-based.
    • Be grounded in relevant empirically-based knowledge.
    • Be linked to program determined outcomes.
    • Be associated with a national organization or institution of higher education with comprehensive home visitation program standards that ensure high quality service delivery and continuous program quality improvement.
    • Demonstrate significant, sustained positive outcomes per required benchmarks and participant outcomes when evaluated using well-designed and rigorous:
      • Randomized controlled research designs and the results are published in a peer-reviewed journal or
      • Quasi-experimental research designs.
  • The model must conform to a promising and new approach which achieves the required benchmarks and participant outcomes, which will be:
    • Developed or identified by a national organization or institution of higher education.
    • Evaluated through a well-designed and rigorous process.

Home Visiting Program Goals

  • Home Visiting Program Goals include improvements in the following areas:
    • Maternal and prenatal health.
    • Infant health.
    • Child health and development.
    • Parenting related to child development outcomes.
    • School readiness.
    • Socioeconomic status of the family.
    • Reductions in child abuse, neglect, and injuries.

Home Visiting Program Overall Demonstration of Improvements

  • At the end of the third year, the Home Visiting Program must submit a report demonstrating improvement in at least four (4) of the specified areas.
  • If improvement is not demonstrated, a corrective action plan must be submitted.
  • Technical assistance will be provided to implement the improvement plan (corrective action plan).
  • Grant funds may be terminated if improvement is not demonstrated, or if an improvement plan (corrective action plan) is not submitted.
  • By December 31, 2015, a report demonstrating improvements (if any) in each of the specified areas must be submitted.

Additional Requirements for Home Visiting Programs

  • A Home Visiting Program must also:
    • Be grounded in empirically-based knowledge and linked to benchmark areas and participant outcomes.
    • Employ well-trained and competent staff, demonstrated by education or training.
    • Provide ongoing and specific training on the model being delivered.
    • Maintain high quality supervision to establish home visitor competencies.
    • Demonstrate strong organizational capacity to implement the activities involved.
    • Establish appropriate linkages and referral networks to other community resources and supports for eligible families.
    • Monitor the fidelity of program implementation to ensure that services are delivered pursuant to the specified model.

Home Visiting Program Priority for High-Risk Populations

  • Priority for high-risk populations are for eligible families meeting the following criteria:
  • Reside in communities in need of such services, as identified in the statewide needs assessment.
  • Are low-income eligible.
  • Include pregnant women under 21 years of age.
  • Have a history of child abuse or neglect or have had interactions with child welfare services.
  • Have a history of substance abuse or need substance abuse treatment.
  • Use tobacco products in the home.
  • Are or have children with low student achievement.
  • Include children with developmental delays or disabilities.
  • Include individuals who are serving or formerly served in the Armed Forces, including families that have members of the Armed Forces how have had multiple deployments outside of the United States.

Home Visiting Program “Eligible Families” [Section 2951, page 225 (k)(2)]

  • Pregnant women, and the father of the child, if the father is available.
  • Parent or primary caregiver of a child, including grandparents or other relatives of the child, and foster parents, who are serving as the child’s primary caregiver from birth to kindergarten entry, and including a noncustodial parent who has an ongoing relationship with, at times provides physical care for, the child.

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Award of Grant   [Section 2951, page p.217 (c)]

  • Grant funds may be used during the first six (6) months of the period for which the grant is made for planning or implementation activities.
  • The Secretary will determine the length of the grant.
  • Technical assistance will be made available.
  • No more than 25 percent of the grant award (per fiscal year) may be used to conduct promising practices or new approach models – majority of the grant funds shall be used for evidence-based models [p.220 (d)(3)(A)(ii)].

Grants for Early Childhood Home Visitation Program Requirements

  • The grant must promote the following:
  • Improvements in maternal and prenatal health, infant health, child health and development.
  • Parenting related to child development outcomes, school readiness, and the socioeconomic status of such families.
  • Reductions in child abuse, neglect, and injuries.

Home Visiting Needs Assessment Grant Application Requirements [Section 2951, page 221-222 (e)]

  • The Home Visiting Needs Assessment Grant Application must include:
  • A description of the populations to be served, including at-risk populations.
  • Assurance that priority will be given to low-income eligible families and eligible families who reside in at-risk communities identified in the statewide needs assessment.
  • A description of the service delivery model(s) to be used.
  • A statement identifying how the selection of the population to be served and service delivery model(s) are consistent with the statewide needs assessment.
  • A description of quantifiable, measurable benchmarks.
  • Assurance that the entity will obtain and submit documentation from the organization or entity that developed the service delivery model(s) to verify that the program is implemented and services are delivered according to the model specifications.
  • Assurances that the entity will establish procedures that assure services are voluntary and provided in accordance with individual family assessments.
  • Assurances that the entity will submit annual reports, and participate in and cooperate with data and information collection.
  • A description of other State programs that include home visitation services, including (if applicable):
  • 502(c) - The Maternal and Child Health Block Grant.
  • Programs funded under Title IV of this act.
  • Title II of the Child Abuse Prevention and Treatment Act Community-Based Family Resource and Support Grants.
  • Section 645A of the Head Start Act (Early Head Start).
  • Other information as required by the Secretary.

Grants for Early Childhood Home Visitation Program Appropriations [Section 2951, page 225 (j)(1)]

  • $1 billion for Federal Fiscal Year (FFY) 2010.
  • $2.5 billion for FFY 2011.
  • $3.5 billion for FFY 2012.
  • $4 billion for FFY 2013.
  • $4 billion for FFY 2014.

Others Entities Able to Apply for Home Visiting Needs Assessment Grant [Section 2951, page 223 (h)(2)]

  • Indian Tribes, Tribal Organizations or Urban Indian Organizations may apply for a Home Visiting Needs Assessment Grant.
  • If by the beginning of FFY 2012, the State has not applied for or been approved a grant, the Secretary may make amounts appropriated available to eligible nonprofit organization within the state.

To view Section 2951 Maternal, Infant, and Early Childhood Home Visiting Programs of the Patient Protection and Affordable Care Act Health Care Reform Act H.R. 3590 (PDF), please scroll down to pages 216-225.  (Large File, viewing may be slow)

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