An Introduction to Home Visiting Funding: State Substance Abuse Agencies’ Roles in g

Planning Efforts

Sid Gardner, M.P.A., Senior Policy AdvisorNational Center on Substance Abuse and Child Welfare

Webinar Overview

Welcome and IntroductionsWelcome and IntroductionsOverview: Home Visiting Funding

Options for Agency RolesDefining Capacity and Need

Home Visiting Expansion

• $100 million in new funding; $1 5 billion/5 years• $100 million in new funding; $1.5 billion/5 years

• Allocated by formula to states

St t i d t d d t l d J l• States required to do a needs assessment: plan due July 9, 2010; full needs assessment by September 1

• Priority status for 17 grants made by the Children’s• Priority status for 17 grants made by the Children s Bureau (EBHV: Evidence-based Home Visiting grantees)

• Strong emphasis on evidence-based modelsStrong emphasis on evidence based models

• Substance abuse referenced explicitly as a risk factor

The Purpose

• Affordable Care Act (ACA) Maternal Infant and Early• Affordable Care Act (ACA) Maternal, Infant and Early Childhood Home Visiting Program– “The funds are intended to assure effective coordination and

delivery of critical health, development, early learning, child abuse and neglect prevention, and family support services to these children and families through home visiting programs. This new program plays a crucial role in the national effort to build quality, comprehensive statewide early childhood systems for pregnant women, parents and caregivers, and children from birth t 8 f d lti t l t i h lth dto 8 years of age – and, ultimately, to improve health and development outcomes.”1

Questions

Are o no participating on the interagenc• Are you now participating on the interagency group to develop the needs assessment?A ili d t b t b• Are you compiling data on substance abuse agency capacity for the needs assessment?A ili th i f ti th d• Are you compiling other information on the need for services for parents of younger children for the needs assessment?the needs assessment?

• Are you working with SA providers to prepare them for roles in HV programs?them for roles in HV programs?

Home Visiting Models

Healthy Families America h lth f ili iwww.healthyfamiliesamerica.org

Nurse Family Partnershipwww nursefamilypartnership orgwww.nursefamilypartnership.org

Parents as Teachers www parentsasteachers orgwww.parentsasteachers.org

Positive Parenting Programwww 5triplep netwww.5triplep.net

SafeCarewww.chhs.gsu.edu/safecare

TEXT PAGE

www.chhs.gsu.edu/safecare

How is Evidence-Based Defined?

• Detailed criteria to be published in mid August• Detailed criteria to be published in mid-August

• “To encourage exemplary programs, HHS plans to allocate the increase in funds based upon States’allocate the increase in funds based upon States capacity and commitment to improve child outcomes specified in the statute through the implementation of home isiting programs ith fidelit to high q alithome visiting programs with fidelity to high-quality evidence-based models.”2

• Not necessarily defined in terms of links to substanceNot necessarily defined in terms of links to substance abuse as a risk factor3

Other Provisions

“priorit ill be gi en to ser ing lo income• “priority will be given to serving low-income eligible families and eligible families in at-risk communities in adherence with the completedcommunities, in adherence with the completed statewide needs assessment”4

• “if the State has one of the 17 ACF funded• if the State has one of the 17 ACF funded projects in the Evidence-Based Home Visiting cluster, the new funds will be used to support , ppthat current grantee.”5

States with Evidenced-Based Home Visiting GrantsVisiting Grants

Source: Supporting Evidence-Based Home Visiting. http://supportingEBHV.org

Children’s Bureau FY 2008 Grantees• FY 2008 Children's Bureau Discretionary Grant and Cooperative Agreement Awards6

• Supporting Evidence-Based Home Visitation Programs to Prevent Child Abuse and Neglect (CFDA # 93 670) Up to $500 000 per year for 5 yearsNeglect (CFDA # 93.670) Up to $500,000 per year for 5 years

• University of Oklahoma - Health Sciences Center, Oklahoma City, OK

• DePelchin Children's Center, Houston, TX TREATMENT

• The Children's Trust Fund of South Carolina, Columbia, SC

• Child and Family Tennessee, Knoxville, TN• County of Solano Department of Health and

• St. Vincent Mercy Medical Center Foundation, Toledo, OH

• Rhode Island KIDS COUNT, Providence, RI• Utah Department of Health, Salt Lake City, UT

Social Services, Fairfield, CA• Rady Children's Hospital, San Diego, CA• Illinois Department of Human Services,

Springfield, IL

• Colorado Judicial Department, Denver, CO• State of Hawaii Department of Health, Honolulu,

HI• Children and Families First Delaware Incp g ,

• Minnesota Department of Health State Treasurer, St. Paul, MN

• Le Bonheur Community Outreach, Memphis, TNRochester Society for the Prevention and Cruelty

• Children and Families First Delaware, Inc., Wilmington, DE

• State of New Jersey Department of Children and Families, Trenton, NJ

• Rochester Society for the Prevention and Cruelty to Children, Rochester, NY

Options for Agency Roles

• Participate on advisory group to compile data for needs• Participate on advisory group to compile data for needs assessment; ensure State Director role

• Respond to requirement for assessing “the State’s p q gcapacity for providing substance abuse treatment and counseling services to individuals and families in need of such treatment or services”7such treatment or services

• Compile data on prenatal exposure to alcohol, tobacco, or illicit drugs, where available, to document this major risk factor affecting first-time parents and their children

• Prepare information on HV models that emphasize substance abuse as a risk factorsubstance abuse as a risk factor

Options for Agency Roles II

• Compile data from SAMHSA TEDS websites on entry of pregnant• Compile data from SAMHSA TEDS websites on entry of pregnant women to treatment:

– For overall admission: http://wwwdasis.samhsa.gov/webt/NewMapv1.htm

– For details on pregnant admissions: https://www.icpsr.umich.edu/ticketlogin

– Compare these numbers with prevalence data/estimates for the state or locality

• Meet with home visiting providers to determine how they currently• Meet with home visiting providers to determine how they currently address these issues and what their screening indicates about the prevalence of prenatal exposure and post-natal effects of substance abuse as risk factorsabuse as risk factors

• Comment on forthcoming HHS proposed evidence-related criteria for public comment through the Federal Register concerning different models of HV and the evidence of effectiveness associated

TEXT PAGE

different models of HV and the evidence of effectiveness associated with them.

Key Indicators*

• Admissions of pregnant and parenting women• Admissions of pregnant and parenting women

• Number of clients admitted under 48-hour rule

• Total admissions of womenTotal admissions of women

• Percentage of admissions who are parents

• Percentage of admissions referred from child welfare or mandated gby the dependency court

• % of positive outcomes for the above groups

• Number of slots in family treatment programs

• Length of time to treatment and in treatment for above groups

*where available, compared to national averages and/or to all admissions

Useful Data Sets

• Office of Applied Studies Substance Abuse and Mental• Office of Applied Studies, Substance Abuse and Mental Health Services Administration http://oas.samhsa.gov

– Residential Substance Abuse Treatment Facilities Offering gResidential Beds for Clients’ Children8

• http://www.oas.samhsa.gov/2k9/219/219ResChildBed2k9.htm

– Outpatient Substance Abuse Treatment Facilities that Provide– Outpatient Substance Abuse Treatment Facilities that Provide Child Care for Their Clients’ Children9

• http://www.oas.samhsa.gov/2k9/220/220OutPtChildcare2k9.htm

Child Li i ith S b t D d t S b t– Children Living with Substance-Dependent or Substance-Abusing Parents: 2002 to 200710

• http://www.oas.samhsa.gov/2k9/SAparents/SAparents.htm

Defining Capacity and Need:

Need s demand s capacit• Need vs. demand vs. capacity:

– Three different concepts

– Those needing treatment services may not be identified or may not voluntarily enroll

– Those seeking services may exceed current capacity to provide treatment slots or treatment slots providing family oriented treatmentfamily-oriented treatment

Need, Demand, and Capacity

• Need: use of screening and assessment tools to identify• Need: use of screening and assessment tools to identify clients with substance use disorders

• Demand: self-referral and other agencies’ referrals toDemand: self referral and other agencies referrals to treatment create different levels of demand, from suggestions that clients seek voluntary enrollment to mandated referrals from agencies and co rts ith themandated referrals from agencies and courts with the legal authority to end parental rights and sanction parents; and

• Capacity: available treatment slots and treatment agencies’ ability to provide the child care, health,

l t d t t ti i d d temployment, and transportation services needed to make treatment effective for many clients.

Background Information on HV and SAin HRSA-10-275in HRSA-10-275

• Lawrence, S., Chau M., & Lennon M. (2004). Depression, Substance Abuse, and Domestic Violence: Little is Known About Co-Occurrence and Combined Effects on Low-Income Families. National Center for Children in Poverty. http://nccp.org/publications/pub_546.html

• Gruber, K.J., & Fleetwood, T.W. (2004). In-Home Continuing Care Services ( )for Substance Use Affected Families. Vol. 39, No. 9, pp. 1379-1403. http://www.thefreelibrary.com/In-Home+Continuing+Care+Services+for+Substance-Affected+Families:+The...-a077416539

• Family Health Outcomes Project (FHOP) Department of Family andFamily Health Outcomes Project (FHOP) Department of Family and Community Medicine. (2006). Findings from the MCAH Action Home Visiting Priority Workgroup Survey “Home Visiting for Pregnant Women, Newborn Infants, and/or High-Risk Families.” www.ucsf.edu/fhop

• Home Instruction for Parents of Preschool Youngsters (HIPPY). (2009). HIPPY Research Summary. http://www.hippyusa.org/research.php

• Daro D McCurdy K & Nelson C (2005) Engagement and Retention in

TEXT PAGE

Daro D., McCurdy K., & Nelson, C. (2005). Engagement and Retention in Voluntary New Parent Support Programs: Final Report. Chapin Hall Center for Children at the University of Chicago. http://www.chapinhall.org/research/report/engagement-and-retention-voluntary-new-parent-support-programs

Background Information on HV and SAin HRSA-10-275in HRSA-10-275

• Health Resources and Services Administration Funding Opportunity• Health Resources and Services Administration Funding Opportunity Announcement :

– http://www.hrsa.gov./about/news/pressreleases/100610.html

• Statement for the Record Submitted to Hearing by Children and Family S a e e o e eco d Sub ed o ea g by C d e a d a yFutures on Proposals to Provide Federal Funding for Early Childhood Home Visitation Programs U.S. House Committee on Ways and Means Subcommittee on Income Security and Family Support

http://www cffutures org/presentations/statement record children and family futures hearing– http://www.cffutures.org/presentations/statement-record-children-and-family-futures-hearing-proposals-provide-federal-funding

• DelGrosso, P., & Daro, D. (2009). Cross-site evaluation of the supporting Evidence-Based Home Visiting grantees: Summary of the planning g g y p gyear. Children’s Bureau, Administration for Children and Families, US Department of Health and Human Services. Contract No. GS10F-0050L/HHSP233200800065W. Available from Mathematica Policy Research Princeton NJResearch, Princeton, NJ

– http://library.childwelfare.gov/cwig/ws/library/docs/gateway/Record?rpp=10&upp=0&m=1&w=+NATIVE('recno%3D69362')&r=1

Background Information on HV and SAin HRSA-10-275in HRSA-10-275

• The Pew Home Visiting Campaign Federal Health Care• The Pew Home Visiting Campaign Federal Health Care Reform Legislation Home Visiting Summary :

– http://www.health.state.mn.us/divs/fh/mch/fhv/documents/PEWHVSummary.pdf

CLASP Detailed S mmar of Home Visitation Program in the Patient• CLASP Detailed Summary of Home Visitation Program in the Patient Protection and Affordable Care Act:

– http://www.clasp.org/admin/site/publications/files/home-visiting-detailed-summary.pdf

• Supporting Evidence-Based Home Visiting Monthly EBHV newsletter:• Supporting Evidence-Based Home Visiting Monthly EBHV newsletter: – http://www.supportingebhv.org

Contacting the Lead State Agency

T picall the state agenc ith responsibilit for• Typically, the state agency with responsibility for maternal and child health is the lead agency for home visiting planninghome visiting planning

• For example, in California it is the California Department of Public HealthDepartment of Public HealthMaternal, Child & Adolescent Health Program– http://www cdph ca gov/programs/mcah/Pages/HVP-http://www.cdph.ca.gov/programs/mcah/Pages/HVP

ContactUs.aspx

Other Questions?

• Send to Michelle Freeman, mfreeman@cffutures.org

• If questions relate to HV funding announcement, contact HRSA and/or ACF staff contacts referenced in their webinar of 6/17, available online at http://www.mchcom.com/liveWebcastDetail.asp?leid=424

• Or the contacts mentioned on pp 21-22 of the announcement HRSA 10-275

• To access the materials from Thursday’s webinar by HRSA:http://www.mchcom.com/liveWebcastDetail.asp?leid=424http://www.mchcom.com/liveWebcastDetail.asp?leid 424

References1,2,4,5,7 Affordable Care Act (ACA) Maternal, Infant and Early Childhood Home Visiting Program, Announcement Number: HRSA-10-275, Catalog of Federal Domestic Assistance (CFDA) No. 93 50593.5053 Statement for the Record by Submitted by Children and Family Futures for Hearing on Proposals to Provide Federal Funding for Early Childhood Home Visitation Programs U.S. House Committee on Ways and Means Subcommittee on Income Security and Family Support J 9 2009June 9, 2009 6 FY 2008 Children's Bureau Discretionary Grant and Cooperative Agreement Awards. http://www.afterschool.ed.gov/programs/cb/programs_fund/discretionary/2008.htm8 Substance Abuse and Mental Health Services Administration, Office of Applied Studies. pp(2008). National Survey of Substance Abuse Treatment Services (N-SSATS): 2007. Data on Substance Abuse Treatment Facilities (DASIS Series: S-44, DHHS Publication No. (SMA) 08-4348). Rockville MD: Author.9 Substance Abuse and Mental Health Services Administration, Office of Applied Studies. , pp(2008). National Survey of Substance Abuse Treatment Services (N-SSATS): 2007. Data on Substance Abuse Treatment Facilities (DASIS Series: S-44, DHHS Publication No. (SMA) 08-4348). Rockville MD: Author.10 Office of Applied Studies. (2008). Results from the 2007 National Survey on Drug Use and

TEXT PAGE

pp ( ) y gHealth: National findings (DHHS Publication No. SMA 08-4343, NSDUH Series H-34). Rockville, MD: Substance Abuse and Mental Health Services Administration.