Home Visiting Program – Another Early Win for Children in Affordable Care Act – Say Ahhh! A Children’s Health Policy Blog


By Tom Birch, National Child Abuse Coalition

For the first time, with the passage of health care
in March, federal funding will be available to states to support a range
of voluntary home visitation services to pregnant women, young parents and
their children, designed to improve maternal and child health, foster healthy
child development, and prevent child maltreatment.  Priority for services would go to low-income families living
in communities in need of services. 

The new measure authorizes $1.5 billion over five years –
with $100 million in 2010 – for the Maternal, Infant, and Early Childhood Home
Visiting Program funded by HRSA, in collaboration with the HHS Administration
for Children and Families (ACF), through the Title V maternal and child health
block grant.  A three-percent share
of the funds is reserved for grants to Indian tribes.

Research over the years has produced a strong body of
evidence that early childhood home visitation programs are effective in
reducing the incidence of child abuse and neglect and in improving child health
and development.  While a majority of states already provide early
childhood home visitation services to a relatively small number of families,
the challenge has been to take this proven effective prevention approach to
scale.  The new home visiting
program can help to move toward that goal.  

The new funding promises potential for a significant
positive impact on children’s health care.  Home visiting programs link families to health care
resources and focus on healthy outcomes. 
Through a strong emphasis on prenatal care, significant costs associated
with pre-term births and developmental disabilities are reduced.  Linking families to consistent primary
care and immunizations means reduced emergency room costs and reduction in
chronic illness. 

Studies have proven the results we hope to see.  Families who received home visiting
services were found to be more likely to have health insurance and a medical
home, to seek prenatal and well-child care, and to get their children
immunized.  Instances of child
maltreatment have been lowered significantly.  Babies of parents enrolled prenatally in home visitation
services have shown fewer birth complications and higher birth weights.  

On July 21, HHS announced the allocation of $88 million
for the first year of funding of the home visiting grants to states, the
District of Columbia and each of the five territories.  The allocations are based on the size
of the population of children under the age of five living at or below 100% of
the federal poverty level in each state. The grant amounts to the states in the
first year range in size from $7.78 million to California down to $557,408 to

States have completed or are now in the process of
conducting statewide assessments to identify existing home visiting programs
and areas of high need. States each have immediate access to $500,000 of their
allocations for preparing the needs assessments and begin planning their
programs.  The remainder of the
grant funds will be released in September, after approval of a state’s plan for
addressing the home visiting needs identified. The law directs states, in
conducting a needs assessment, to coordinate with and take into account other
needs assessments already ongoing, including those required by the Maternal and
Child Health Block Grant, Head Start, and Title II of the Child Abuse
Prevention and Treatment Act (CAPTA).

The Administration for Children and Families (ACF) is
taking the lead, in partnership with HRSA, in administering grant support for
the Tribal Maternal, Infant, and Early Childhood Home Visiting Grant
Program.  Applications are being
accepted for a total of $3 million in funding available for award in fiscal
year 2010.

In applying for the home visitation grants, states must
establish quantifiable benchmarks to demonstrate improvements at intervals of
three and five years for families participating in the program.  The benchmarks address maternal and
newborn health, prevention of child maltreatment, school readiness, reduced
crime or domestic violence, family economic self-sufficiency, and coordination
with community support services.

The new grant program requires states to allocate at
least 75 percent of funding to support home visiting models that are
research-based and rigorously evaluated through randomized control trials or
quasi-experimental research designs. 
The remaining 25 percent of grant funding could go to support promising approaches
yet to be evaluated by a similar rigorous process. 

On July 23, HHS published proposed criteria for evidence
of effectiveness of home visiting program models to inform the funding
decisions for the new program. Comments on the proposed criteria are due by
August 17, 2010. 

In future years, the funding for the program would
increase from $100 million in 2010 to $250 million in 2011, $350 million in
2012, and $400 million in each of 2013 and 2014 — HHS plans to allocate the
additional funds competitively. 
While HHS proposes to give significant weight to the strength of the
available evidence of effectiveness of the model or models employed by a state,
HRSA and ACF are open to comments on what criteria are appropriate to judge
states competitively.  It is
anticipated that the criteria for evidence-based models will need to be altered
over time as the state of the field changes, so HHS intends to review the
evidence base for home visiting models on an ongoing basis to ensure that new
evidence is incorporated.  How
program models are evaluated and rated will be the key to allocating the
competitive funds. 

The views expressed by guest bloggers do not necessarily reflect the views of the Center for Children and Families.

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