connecticut department of public health u.s. department of health and human services health...

Connecticut Department of Public Health

U.S. Department of Health and Human ServicesHealth Resources and Services Administration

Maternal and Child Health Bureau&

Administration for Children & Families

Rosa M. Biaggi, MPH, MPA

State Department of Public Health

Chief, Family Health Section

State Title V Maternal and Child Health Director

Principal Investigator - MIECHV Programs Grant

Affordable Care Act Maternal, Infant and Early Childhood Home Visiting

(MIECHV) Programs Grant

Connecticut Department of Public Health - Keeping Connecticut Healthy

Patient Protection and Affordable Care Act (ACA)

• Signed into law March 23, 2010 by President Obama

• A provision of the Act authorized the creation of the Maternal, Infant, and Early Childhood Home Visiting Programs


The MIECHV Program is designed to

• strengthen and improve the Title V programs and activities;

• improve coordination of services for at risk communities; and

• identify and provide comprehensive services to improve outcomes for families who reside in at risk communities.


Three Components of FY 2010 ACA Funding

1. Application for funding (submitted by DPH on July 9, 2010) Required designation of the Lead Agency by Governor.

2. Conduct a Statewide Needs Assessment (submitted by DPH on September 16, 2010).

3. Submission of an updated state plan that addresses the needs of the targeted community(ies) identified in the needs assessment (due June 8, 2011). Revised October 2012.


Designation of Lead Agency

Lead Agency: Department of Public Health

Required partners: •Department of Social Services•Department of Children and Families•Department of Mental health and Addiction Services


Additional Partners

• State Department of Education

• Department of Developmental Disabilities

• Department of Correction

• Commission on Children

• University of Connecticut

• Yale University

• CT Parents as Teachers

• Child Health and Development Institute of CT

• State Economic Resource Center

• Women’s Health Subcommittee (Medicaid Care Management Oversight Council)

• Child FIRST


Statewide Needs Assessment(DPH and affiliates, 2010)

Purpose: To identify communities “at-risk”.Looked at maternal and child health outcomes by town. Risk factors assessed included, but were not limited to:

– Low birth weight, fetal and infant mortality – Poverty – Unemployment – Maltreatment – Education– Homelessness– Crime– Domestic violence– Tobacco use– Poverty– High school dropout rates– Teen parenthood– Perinatal depression


Local Community Assessments

• What were the challenges of the community?– i.e., Poor school readiness, low birth weight babies, high infant mortality,

high dropout rates, high unemployment, high crime, etc.

• Were there other characteristics that made a home visiting program likely to make a difference?

– Non-English speaking, limited public transportation

• What are the strengths of the community?– Existing partnerships

• What service systems are currently available?


Needs AssessmentsFindings

Sixteen (16) towns of VERY HIGH need



Thirteen (13) towns of HIGH need



Five (5) town of MODERATE need



At least forty-nine (49) towns in the state had one or more of at least twenty-three (23) home visiting

programs (or programs with a home visiting component) in operation.

However, of these, ONLY TWO models:•Parents as Teachers, and •Early Head Start with a Home Visiting component

had been approved by HRSA as evidence-based.


(HRSA) Evidence-Based Models (as of 12/20/2012)

1. Early Head Start

2. Family Check-Up

3. Healthy Families America (HFA)

4. Healthy Steps

5. Home Instruction for Parents of Preschool Youngsters (HIPPY)

6. Nurse Family Partnership

7. Parents as Teachers (PAT)

8. Child FIRST

9. Early Intervention Program for Adolescent Mothers

10. Early Start (New Zealand)

11. Oklahoma Community-Based Family Resource and Support Program

12. Play and Learning Strategies (PALS) Infant


State Plan for Home Visiting

• Support improvements in maternal, child and family health.

• Promote effective implementation and expansion of evidence-based home visiting programs in the state with fidelity to the model selected.

• Reach high-risk and hard-to-engage populations.• Support a family-centered approach to home visiting.

The overarching goals of the State Plan are to:


EBM in CT funded by the MIECHVPrograms Grant

• Parents as Teachers (PAT) – enhanced with increased frequency of home visits, number/type of screening, fatherhood initiative, and professional development training in all sites.

• Early Head Start (EHS) - with a home visiting component - No enhancement or adaptations.

• Nurse Family Partnership (NFP)– No enhancements or adaptations.

• Child and Family Interagency Resource, Support, and Training (Child FIRST) – No enhancements or adaptations.


Target Population


Evidence of Favorable Outcomes


Minimum Qualifications/Certifications


Caseload Ratio


Supervision Ratio

Parents As Teachers (PAT)

Early Head Start (EHS)

Nurse Family Partnership

(NFP)

Child FIRST

1:12 FTEs 1:3 FTEs 1:8 FTEs 1:1 Team


Federal Funds

Budget Period Award7/15/2010-9/30/2012 $855,073

9/30/2011-9/29/2015 $1,026,087 per year

3/31/2012-3/30/2015 $8,677,222 per year

TOTAL $30,991,087


Community Selection Community Readiness

• Fidelity – Do they Really “Get” Fidelity?

– Some components to fidelity include: target population, staff qualifications, supervision, number of families per worker.

• Data Driven Decision Making and CQI

– Does the community demonstrate evidence of evaluating, measuring, collecting and reflecting on outcomes? Is there evidence of data driven decision making that informs program development, funding decisions, and policy? Has the community engaged in planning processes for initiatives and service development?

• Model Specific Considerations– How will EBHV fit within a continuum of services? Is there leadership or

history in bringing EBHV to the community? Is there support from multiple community agencies? Is there evidence of community capacity to support an EBHV? Is there staffing availability? A source of qualified culturally-competent staff available? Is the community supportive of the program with funding or other resources?


Selected Home Visiting Program Communities and EBHV models

Town Grant EBMAnsonia-Derby Formula & Competitive EHS and Child FIRST

Bloomfield Competitive Child FIRST and PAT

Bridgeport Competitive PATBristol Competitive Child FIRST

Danbury Competitive Child FIRSTEast Hartford Competitive Child FIRST & PAT

East Haven/West Haven Competitive PATKillingly/Plainfield Competitive PAT

Manchester/Vernon Competitive PATMeriden Competitive Child FIRST & PAT

New London Formula NFPNew Britain Formula & Competitive PAT

Norwich/Griswold/Sprague Competitive PATPutnam/Windham Competitive Child FIRST

Torrington/Winchester Competitive Child FIRST & PATWindham Formula & Competitive PAT

Windsor Locks/East Windsor Competitive PAT


• Benchmarks (6)

• Constructs (35)

• Data Elements (223)

Connecticut Maternal, Infant and Early Childhood Home Visiting

Programs Grant


1. Improved Maternal & Newborn Health (8 constructs and 51 data elements)

• Prenatal care• Parental use of tobacco• Preconception care • Inter-birth intervals• Screening for maternal depressive symptoms• Breastfeeding• Well-child visits• Maternal and child health insurance status


•Emergency Department visits: Children•Emergency Department visits: Enrolled Women•Health and safety information or training (Household safety: burns, scalds, falls, accidental toxic ingestion, choking, second hand smoke, safe sleeping, etc.)•Incidence of child injuries requiring medical treatment•Reported DCF suspected maltreatment (includes substantiated and unsubstantiated cases)•Reported substantiated maltreatment of children•First time child victims of maltreatment

2. Child Injuries, Child Abuse, Neglect, or Maltreatment and Reduction of Emergency Department Visits

(7 constructs and 56 data elements)


•Parent support for child’s learning and development•Parent knowledge of child development and their child’s progress•Parenting behaviors and parent-child relationships•Parent emotional well-being or parenting stress•Child communication, language and emergent literacy•Child’s general cognitive skills•Child’s positive approaches o learning including attention•Child’s social behavior, emotional regulation, and emotional well-being•Child’s physical health and development

3. School Readiness and Achievement (9 constructs and 64 data elements)


4. Crime or Domestic Violence (3 constructs and 26 data elements)

• Screening for domestic violence• Domestic violence: referrals made to relevant services

(i.e., shelters, food pantries, etc.)• Domestic violence: number of families for which safety

plan completed


5. Family Economic Self-Sufficiency (3 constructs and 13 data elements)

• Household income and benefits• Employment or education• Health insurance status


6. Coordination and Referrals for Other Community Resources and Supports(5 constructs and 13 data elements)

• Families identified for necessary (basic human needs) services• Referrals to available community resources• Number of completed referrals• Memoranda of agreements or other formal agreements with other

social service agencies in the community• Community agencies with which the home visiting provider has a

clear point of contact in the collaborating agency that includes regular sharing of information


Environmental Considerations

The MIECHV Programs grant is a public health initiative. MIECHV models begin with prenatal health and include inter-conception and post-partum.

MIECHV models have a focus on:• prenatal care• birth outcomes• positive parenting skills• healthy child development.


Overarching goal of the CT MIECHV Programs Grant

CT will have a statewide, coordinated system of early childhood home visiting that has the capacity &

commitment to provide infrastructure and supports to assure high-quality, evidence-based practice that supports

life course development.


Home Visit Program Contacts

Rosa M. Biaggi, Family Health Section ChiefPrincipal Investigator MIECHV Programs Grant

Title V Director

Janet BrancifortFamily Health Section Manager

Donna Maselli, Nurse ConsultantMIECHV Liaison

Mary Emerling, Nurse ConsultantMIECHV Liaison

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