MCHB/DCAFH Webcast

Infant and Early Childhood Home Visiting Program

June 17, 2010

AUDREY YOWELL: Good afternoon, welcome to this webinar on the first funding opportunity announcement for the "Maternal, Infant and Early Childhood Home Visiting Program". I'm Audrey Yowell and I work in the Health Resources and Services Administration and I’m the National Program Director for this exciting new program. During this webinar we're going to provide an overview of the new program and we're going to walk through the first of three funding announcements that are going to be issued this fiscal year.

But before we get started I want to give you some instructions for the most effective way to participate in the webinar. The slides will appear in the central window and should advance automatically. The slide changes are synchronized with the speaker's presentations and you don't need to do anything to advance the slides. You may need to adjust the timing of the slide changes to match the audio by using slide delay control at the top of the messaging window. We recommend you change this setting to 12 seconds as that seems to work best for most people.

We encourage you to submit questions at any time during the presentation. Simply type your question in the message window on the lower right-hand side of the interface, select question for speaker from the dropdown menu and hit send. Please include your state or organization so we’ll know from where you’re participating. However, pease note we aren't going to be responding to questions during this live broadcast but we want to send written answers to all participants via email as soon as possible after the webinar. You'll be getting an email from homevisiting@HHS.gov with answers to the questions.

On the left of the interface is the video window. You can adjust the volume of the audio using the volume control slider which you can access by clicking on the loudspeaker icon. Those of you who selected accessibility features when you registered will see text captioning underneath the video window. At the end of the broadcast, the interface will close automatically and you'll have the opportunity to fill out an evaluation. Please take a couple of minutes to do this. Your response will help us plan future broadcasts in the series and help improve our technical support. I'll apologize right now. I have a cold so I apologize for whatever my voice might do. To begin, I am very pleased to introduce Dr. Peter van Dyck, the Associate Administrator for Maternal and Child Health in the Health Resources & Services Administration. Dr. van Dyck?

PETER VAN DYCK: Thanks, Audrey. Welcome, everybody. This is a wonderful opportunity to share with you issues related to the home visiting application process and I want to add a special warm welcome to our collaborators at the Administration for Children and Families. Recognizing the importance of promoting healthy development and improving maternal and child health outcomes, ACA, or the Affordable Care Act provides funding for the maternal infants and early childhood home visiting program. This program will rely on evidence-based home visiting strategies that help families create a nurturing environment for young children and help connect them to a range of services, including health, early education, early intervention and more. The program will be administered by the Health Resources and Services Administration's Maternal and Child Health Bureau in collaboration with the Administration for Children and Families.

The programs that these grants will fund will build on partnerships at the federal, state and community level. The idea is to coordinate and deliver critical health, development, early learning, child abuse and neglect prevention and support services for families who live in at-risk communities. We hope that this federal collaboration can be a model for the eventual state collaborations and applications that we’re going to receive later on.

Our goal for the program is an early childhood service system in every state that supports high quality, evidence-based practice. We look forward to your applications, to working with you to improve the well-being of all our vulnerable citizens. Thanks very much.

>> AUDREY YOWELL: Thank you, Dr. van Dyck. Next I want to introduce Dr. Joan Lombardi, the Deputy Assistant Secretary and interdepartment liaison for early childhood development in the Administration for Children and Families. Dr. Lombardi.

JOAN LOMBARDI: Thanks, Audrey, and welcome, everyone. I'm just delighted to be on this call and to share the excitement over this very important step forward to assure healthy child development for some of the most vulnerable children in the country. This is particularly exciting for us at the Administration for Children and Families because it is a very strong partnership with Maternal and Child Health Bureau that we hope you'll see reflected in the announcement and in the upcoming years. As many of you know, the Administration for Children and Families administers the Head Start program and Early Head Start, child care, linkages with education, child welfare, child abuse prevention, and the state prevention grants, so we have a lot of experience in partnership with Maternal and Child Health around these issues that we are very much looking forward to working with you on this effort.

As Peter mentioned, we are very interested in moving forward on evidence-based practice and learning and sharing with you as we take an important step forward on using evidence to improve services and provide essential services for very young children and their families. We think here at the Administration for Children and Families, we're trying to take a prenatal to eight focus on early childhood and we think that this home visiting program is a very important first step in that continuum and we hope that everyone across the country is thinking of it that way as seeing this as part of a continuum, as we know children need developmental services along that continuum. And the great thing about this new program is that it provides real leadership at all levels to make sure that continuum is strong for the most at-risk children.

We are excited to continue to hear from you to make sure that we're moving the program forward in the upcoming years in a way that reflects your needs and your priorities and the priorities that are outlined in the law. So like Peter and the whole HRSA team, I just want to say greetings from the Administration for Children and Families and best wishes as we move forward.

AUDREY YOWELL: Thanks, Dr. Lombardi. I want to introduce now Moushumi Beltangady, she is special assistant to Dr. Lombardi. Next slide, please. Moushumi?

MOUSHUMI BELTANGADY: Hi, everyone. This is Moushumi Beltangady. I am the special assistant to Joan Lombardi who -- and I'm working on the coordination aspect of the program between ACF and HRSA and I'm very happy to be here with you all today. So we are going to present to you today on the home visiting program including the first funding opportunity announcement. So we're first going to take a look at the legislative authority, the program purpose and guiding principles and the key features of the program, which is the evidence-based policy and the needs assessment and then I'll turn it over to Audrey who will talk about the FY10 funding award process and the funding opportunity announcement. First the legislative authority of the program is section 2951 of the Affordable Care Act which amends Title V of the Social Security act to create section 511, the "Maternal, Infant and Early Childhood Home Visiting Program." And the program invests $1.5 billion over five years into high quality evidence-based home visiting. So this year the allocation is $100 million and it goes up rather quickly so $250 in FY11, $350 in FY12 and $400 million in FY13 and 14. This program will be grants to states and territories and there is a 3% set aside for grants to tribes and tribal organizations or urban Indian organizations. There is also a 3% set aside for research, evaluation and technical assistance for related to corrective action.

The legislation also has a requirement for collaborative implementation by HRSA and ACF which both Dr. van Dyck and Dr. Lombardi have alluded to and I really want to stress that HRSA and ACF have been collaborating on all aspects of the implementation of this program including the development of program guidance, technical assistance and research and evaluation. HRSA will be the administrating agency for the state grants and ACF will be the administering agency for the tribal grants. They've been convening work groups since last fall in preparation for this program including agencies across the government in order to ensure this program is coordinated with other programs serving young children. We intend to maintain these interagency relationships as the program develops.

The purposes of the legislation are three-fold. The first is to strengthen and improve the programs and activities carried out under Title V of the Social Security Act. Second is to improve the coordination of services for at-risk communities, and third is to identify and provide comprehensive home visiting services to improve outcomes for families who reside in at-risk communities. The program purpose is to promote, through evidence-based home visiting programs, improvements in materrnal and prenatal health, infant health and child health and development, increase school readiness, reductions in the incidents of child maltreatment, improve parenting related to child development outcomes, improve family socio-economic status, greater coordination of referrals to community resources and supports and reductions in crime and domestic violence. And these are all benchmark areas specified by the legislation.

Obviously this program has a very broad focus and as Dr. Lombardi mentioned, that's part of the reason why our agencies have been tasked to work together. We feel that across our agencies we are able to address many of these issues. Now I want to talk a little bit about the guiding principles of this program and I might be repeating some of what Dr. van Dyck and Dr. Lombardi mentioned but I think this is really important to stress.

First, the program will promote high-quality early childhood home visiting services by funding states to implement effective evidence-based programs grounded in empirical knowledge.

Second the program will set high standards, provide extensive support and hold states accountable for implementing such high-quality evidence-based early childhood home visiting programs.

Third, the program will allow for continued experimentation with new models and evaluation of both new and existing approaches so that over time policymakers and practitioners will have more refined information about the approaches that work best. How different approaches work for different kinds of target populations are targeted outcomes and the relative costs and benefits of different models.

Fourth, the program will advance a nationwide effort to build high quality, comprehensive, statewide early childhood systems in every state for pregnant women, parents and caregivers and young children as well as expectant fathers, assuring that all individuals can reach their full potential for health and well-being throughout the course of their lives and regardless of their societal context.

Fifth, the program will establish home visiting as a key early childhood service delivery strategy to promote health and development among young children and families at risk.

Sixth, the program will bring together and foster collaboration among Maternal and Child Health, early learning and child abuse prevention leaders in every state to create a successful national program.

And seventh, the program will promote broad based collaboration and partnerships among states, federal government, local communities, home visit program developers, families and other stakeholders and we feel it's such a key part of this program.

There are a couple features of the program that are I think particularly important to note. First is evidence-based policy. And that requires states… basically the legislation requires states to implement evidence-based home visiting models and we will be providing an opportunity for public comment on proposed criteria for assessing evidence of effectiveness of home visiting program models and we hope to be issuing federal register notice very shortly that will allow for this comment and we very much look forward to the comments of the field as hopefully they will help us to create the best program possible. And the criteria will be finalized for inclusion in the third funding opportunity announcement.

This program also will allow for continued experimentation with new models and the legislation specifies that 25% of the funding can be used to fund promising and new approaches that would be rigorously evaluated and we are also committed to really supporting this aspect of the program.

Another important feature of the program is the needs assessment which I know is a key point of stress right now for many of the states. But I think it's an important aspect of this program because it will ensure that the programs that states implement are really responsive to the needs of communities. So the needs assessment requirement is that within six months of enactment states must conduct a statewide needs assessment that identifies communities with concentrations of premature birth, low birth weight infants and infant mortality including infant death due to neglect or other indicators of at risk child health. Poverty, crime, domestic violence, high rates of high school drop-outs, substance abuse, unemployment or child maltreatment. These -- and these requirements are legislatively mandated.

Next the needs assessment must include the state's capacity for providing substance abuse treatment and counseling services to individuals and families in need of such treatment or services.

Third, the needs assessment must assess the quality and capacity of existing programs or initiatives for early childhood home visiting in the state including the number and types of individuals of families who are receiving services. The gaps in early childhood home visiting in the state and the extent to which such programs or initiatives are meeting the needs of eligible families.

Finally, the needs assessment must be coordinated with and take into account the following needs assessments. First, the needs assessment required by the Title V Maternal and Child Health Block Grant program. Second, the communitywide strategic planning and needs assessment conducted in accordance with Section 640(g)(1)(c) of the Head Start Act. The needs assessments that are conducted by local Head Start grantees. And third, the inventory of current unmet needs and current community-based and prevention-focused programs and activities to prevent child abuse and neglect and other family resource services operating in the State under Section 205(3) of Title V of the child abuse prevention and treatment act or CAPTA.

All the requirements I just mentioned are legislatively mandated. States must also submit a plan for responding to identified needs according to the legislation. And I really want to stress here that failure to complete and submit a needs assessment that meets the requirements will delay a state's FY2011 allotment under the Title V Block Grant. Regardless of whether a state decides to apply for home visiting funds it must complete a needs assessment in order to receive its Title V Block Grant allocation whether or not the state Maternal and Child Health agency will be coordinating the needs assessment we encourage agencies to stay on top of the process to ensure that deadlines are met. Now I'm going to turn it back over to Audrey who will discuss the FY10 funding announcement process and the first funding opportunity announcement. Audrey.

>> AUDREY YOWELL: Thanks, Moushumi. First I want to correct one error that I had failed to detect in the slides before. Failing to submit a needs assessment will not delay the state's allotment under the Title V Block Grant. It means the state will not receive it. It won't be delayed, it just won't come to you. So it's really critical that every single state respond to these first two program announcements that I'm going to talk about because not only would you not get a home visiting grant, but you won't get your Title V Block Grant allotment. So it's really critical, every single state and territory that wants to get this Title V 2011 money needs to respond to these announcements.

So that being said, as you know, probably from reading the funding announcement yourself, we have divided the first year's application process into three. The reason we did this is to try to allow us to get money out quickly, to be able to get the needs assessment in on time and also to allow the states to use the results of their needs assessment to develop a thoughtful and careful plan for how they would implement a home visiting program.

Next slide, please. This first funding opportunity announcement was published, as you know, on June 10th and the application is due July 9th, 2010. That gives you 30 days. Now, we realize that that is a very tight time frame but we want to remind you that this application doesn't require a great deal of detail and we set a very small page limit so that we'll restrict the amount of information that you need to provide. When you look in the instructions of the funding announcement you're going to see that we ask you to assess the availability of data presently available in your state that you will need to complete the needs assessment in response to the second funding opportunity. Do not report your data to us in this, just tell us what you've got on hand.

Number two, identify for us additional information that you are going to need to collect. You don't have it on hand? What will you need to collect? Number three, how are you going to go about collecting the information and conducting the needs assessment overall? What’s your process? And we would like you to talk to us about how you are going to meet the requirements for the maternal, infant and early child hood home visiting program funding to the extent that we have provided information in this FOA.

I want to stress again that if we didn't ask for something in this funding announcement it's not required. I know some people were wondering well, you didn't ask for this. Will we have to submit it? No. If we don't ask for it in the funding announcement you don't have to submit it. If we don't provide the information about the details of the program as it will be implemented down the road, then you don't need that information in order to fill out this first application. So I know it's very stressful and it is distracting to think about what the model criteria might be or what the needs assessment data requirements are going to be. Just do your best to focus and get this first announcement in. We'll be getting the second announcement out shortly and we will be providing you with technical assistance throughout the whole process.

Next slide, please. Again, we're talking about this first funding opportunity that's due on July 9th. It includes an explanation of your FY2010 funding allocations. Information on eligible applicants and administering entity. The maintenance of that requirement, summary of what the elements of the needs assessment are going to be and instructions for submitting this particular application. Now if you go to appendix B you'll find that your 2010 funding allocation is estimated there and we say estimated because until we get final figures in, we don't know for certain.

But using the formula as discussed in the funding announcement, you are going to see that you have 2010 funds that are allocated according to the following formula. Every state gets an equal base allocation of $500,000. In addition to that, every state is going to get an amount based on the number of children and families at or below 100% of the federal poverty level in the state as compared to the number of such children nationally. That's your formula.

On top of that, there are 15 states that have 17 evidence-based home visiting programs located within their states. For those states we have added on funding for those evidence-based home visiting programs that are now currently being administered by the Children's Bureau of the Administration for Children and Families.

Just want to explain, I know there has been some confusion about the evidence-based home visiting funding. If funds are currently being provided to a state for these existing programs, then funds have been added to this program to support the current grantees. In other words, our intention is that because these existing grants which are currently in their third year of a five-year project period, they were defunded in the FY2010 Congressional appropriations process under the assumption that Health Reform funding would allow them to continue. This evidence-based home visiting portion of the state's allocation is meant to restore funding to these grantees and the requirement that the states use the funds to support these programs does not constitute a reduction in a state's total allocation. When the evidence-based home visiting grant period ends, the state allegation is going to decrease by that amount. If a state does not apply for or receive home visiting program funds, however, the evidence-based home visiting grantees will not receive any allocation under this program. So those evidence-based programs are not going to be administered differently. They aren't part of the home visiting programs per se. This is a way to get those grantees to continue to receive their funding so that they continue these valuable projects throughout the end of the intended period.

Okay. As soon as we receive an approvable application under this first announcement, a notice of grant award is going to be issued for the states' formula allocation and including the evidence-based home visiting funds. All but $500,000 of that allocation is going to be restricted and they will not be available for expenditure until the state submits an approvable needs assessment under the second program announcement and an updated state plan for the home visiting program, which will be applied for in response to a third program announcement. These $500,000 of unrestricted funds can be used to plan and implement activities associated with establishing early childhood home visiting programs and that includes using these funds to support your needs assessment and to develop your plan. So as soon as you get those funds, you can start to use as much of that $500,000 as you feel you need to conduct the needs assessment and do your planning.

Next slide, please. Eligible applicants include single applications from each state, the District of Columbia, Puerto Rico, Guam, the Virgin Islands, northern Northern Mariana Islands and American Samoa. The governor has the responsibility and the authority to designate which entity or group of entities will apply for and administer the home visiting program funds on behalf of the state. And I just want to point out again that the state is the grantee, not the agency chosen. If no entity is chosen the state is not going to receive a grant. Starting in FY2012, non-profit entities will be eligible to apply for funds in a state to operate a statewide visiting program if the states haven't applied for or received a grant. Just want to say I think Moushumi already said this, the governor is not required to submit a letter designating the administering agency to HHS. You can include such a letter if you want to but it is not required.

Next slide, please. The entity designated by the governor should have strong organizational capacity to implement the activities involved in carrying out an evidence-based home visiting program. The entity should have experience administering early childhood home visiting programs, experience working across systems and in partnership with diverse stakeholders at the state and local levels to plan, implement and sustain programs and have the capacity to review the evidence criteria established by Health and Human Services and determine how these requirements will be met.

Next slide, please. I want to stress the next -- the information in this next slide that regardless of what entity or group of entities that the governor designates as the lead, the state's application must contain concurrence through letters of support from the director of the state's Title V agency, the director of the state's agency for title II of CAPTA, the director for the single state agency for substance abuse services and the director of the state's Head Start collaboration office. This was done very deliberately. We know there is an effort involved in bringing people together in many cases but that's exactly why we're asking you to do this. All four are key contributors to the needs assessment process and the program development process and we're encouraging states to get started immediately in seeking out the concurrence of these agencies and for you all to work together to develop your needs assessment and if you want to apply for a grant, to work together to plan for an effective home visiting program that really demonstrates collaboration and cooperation across state agencies.

Next slide, please. We recognize, as I said, the difficulty of pulling everybody together at once but we really would encourage you to coordinate the strategic planning with the strategic plan developed by the state advisory council that was established under section 642 of the Head Start Act, the state's childcare agency, the state's education agency, and the state's child welfare agency if this agency is not also administering title II of CAPTA. Just as we're working across agencies at the federal level, we are really hoping to encourage states to mirror that coordination and partnership with other early childhood entities across the state because as our other speakers have all indicated we're really hoping we can use this home visiting program as one strategy to encourage an early childhood system across every state.

Next slide, please. The maintenance of effort. Funds provided to an eligible entity receiving a grant shall supplement and not supplant funds from other sources for early childhood home visitation programs or initiatives. This is legislatively required. What we are doing is saying that the MOE requirement includes all funds appropriated for home visiting conducted by all state agencies that use state general funds. It does not include private funding, local funding, federal funding, other sorts of things. Now, I want to say that we're very much aware that this is a cause of concern for a number of states. So when you send in your questions and your comments, would you please give us any information that you think we need to have to address this issue of the maintenance of effort. We're looking at this closely. We understand it's a problem but it will really be helpful to us if you'll let us know what the issues are.

Next slide, please. Looking at the application instructions for this first funding announcement, again, the states must submit an inventory of the information or data that's currently available to you. Again, don't send us actual data, just describe the existing sources that are available to you.

Number two, discussion in the gaps of the currently available information. What is not readily available to you and I should add let us know what help you would like -- you think you will need in order to address these gaps and any problems that you have. Also include a discussion of the state's capacity to locate, gather and assemble the information that you are going to need for the needs assessment and include a discussion of the expected obstacles, too, as well as opportunities for comprehensive, timely, quality data collection. Just want to reiterate your responses can be general and non-specific but let us know what you've got, what you don't have and problems you're going to have to get it or special opportunities that you can take advantage of to get it done. Next slide, please. Continuing to talk about the application instructions. States must submit a discussion of the barriers to and opportunities, as I said, for insuring that the needs assessment is coordinated with and takes into account the state Title V Block Grant, the grant needs assessment and community-wide strategic planning and needs assessment conducted in accordance with section 640G1C. Head Start act and the inventory of current unmet needs and current prevention focused programs and other activities to prevent child abuse and neglect and other family resource services operating in the state that are required under section 2053 of the child abuse prevent and treatment act.

Next slide. I know we're repeating these things but we want to make sure this is clear that we need every state to submit a general description of your approach to conducting the assessment of needs and available resources. A description of your anticipated technical assistance needs. That will help us gear up to give you the help you need. A statement indicating whether you intend to apply for funds under this program, along with required assurances that are listed and a simple response to these assurances is required. Just give us what we say we need. A statement designated the entity or entities within the state that will administer the funds under this program and describing the capacity of this lead entity to carry out the program.

Next step. This month we are hoping to be able to publish the Federal register announcement that describes proposed criteria for evidence of effectiveness for home visiting programs and we do hope that when that is issued, if you have comments that you will submit them. In July, we're going to be publishing the second funding announcement. This is the funding announcement that is going to give you the information you need to conduct your full needs assessment and this is going to be due by September 1st. We have to have the needs assessment application in by September 1st if your state wants to get its Title V Block Grant money. If you have problems with any of these announcements, please get in touch with us, ask for technical assistance and we'll work with you but you must get this submitted by September 1st. Your 2010 funds are going to be awarded to you with restrictions in the middle of July and, of course, we're estimating these dates, except for the September 1st due date for the needs assessment. That is non-negotiable. It has to be by September 1st. You'll receive your money in mid July and draw down that $500,000 to help you finish any other tasks that you have before you in completing these next steps.

Next slide, please. The FOA for the updated state plan, which will include your response for the plan that you are going to carry out in your state and it will include the way you'll apply the evidence-based criteria and the announcement is going to include those criteria. That will be coming out in August this year. Your updated state plan is going to be due early in fiscal year 2011. Your needs assessment is due September 1st. That's the second program announcement and your second application you'll be submitting and the date for submission of your updated state plan will be announced later when we have a better handle on what the schedule is going to be. Next slide, please. We are asking for questions as we've said multiple times. But before we take this last set of slides I just want to say that I'm going to emphasize again and I'm sure you're tired of us saying but every single state has to submit an application in response to this funding announcement and the second one on the needs assessment that is forthcoming otherwise you will not get your FY2011 allocation under the Title V Block Grant.

Number two, the governor already has the authority and the responsibility to appoint the lead entities in your state. There will be no further letter, no further appointment of authority. This funding announcement in itself gives the governor the authority and the responsibility for pointing the lead entity that will administer and apply for these grants. That can either be a single agency or it can be a collaborative of agencies.

Number three. The money for the evidence-based home visiting programs is being provided under this program, as we've said, it is dedicated money for the evidence-based home visiting program and it has been added to restore the funding for these existing programs. This add-on has no effect on any state's funding for the new home visiting program. No state is being added advantaged, no state is being dinged. It is just a way to add onto your formula allocation in order to keep these important programs running.

Number four, the budget project period is -- look on page 11 of your funding announcement. The budget project period is July 15th, 2010, to September 30th, 2012. I know this is very confusing, but we are talking about FY2010 funding. This is one-year funding. States have up to the 30th of September in 2012 to spend it but your budget for this announcement should be for one program year. This would include your estimated expenditures for program implementation which I know doesn't make a lot of sense because it doesn't coordinate with what we shall -- we're asking for in the application. Do your best guess of what you might be planning to spend this money on in order to implement your home visiting program when it is approved. Send us the one-year budget. There is going to be an opportunity to update your budget with your updated plan when you apply under program announcement number three. Technical assistance will be provided to you throughout the program. The Federal register notice to get public comment on the criteria for evidence effectiveness will be forthcoming, we hope soon. There will be a widespread announcement of its availability as well as its appearance in the Federal register. Please send us your comments. Again, about the maintenance of effort issue, we know that you have questions and concerns. You'll be very helpful if you'll contact us. You can either contact us by sending questions during this webinar or you can send them to us.

Change slide, please. At homevisiting@HHS.gov. Audrey and Moushumi, both of us have access to this email address and we'll be collecting your questions and your comments and we will get back to you -- to everyone as soon as we can answering your questions. Again, I just want to encourage you to focus on getting this application in on time. Address the issues in this first application. You will be getting more information on the needs assessment soon and you will be getting even more information later on this summer about model criteria and all the other issues I know everyone is concerned about. We're hoping that every state will apply for home visiting program. We're hoping that we can use this opportunity to assist you in creating a really well coordinated system of early childhood interventions. I want to thank you very much for joining us on the webinar today. Again, you can contact us with any questions at homevisiting@HHS.gov and we look forward to hearing from you. Thank you very much. Have a good afternoon.