One piece of the Affordable Care Act legislation (ACA; P.L. 111-148) is federal funding for the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program, implemented through a partnership between two agencies within the U.S. Department of Health and Human Services (HHS): Health Resources and Services Administration (HRSA) and the Administration for Children and Families (ACF). The goals of the MIECHV Program are to “strengthen and improve the programs and practices carried out under Title V, 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.” Target at-risk communities were identified through needs assessments conducted in each state and the states have worked with the federal agencies in the final selection of targeted communities and the development of plans for home visiting services.
The MIECHV Program was developed using a life course development framework and a socio-ecological perspective. Thus, a key focus is on the influence of social, economic and environmental risk and protective factors upon health and developmental outcomes. The importance of comprehensive and collaborative service systems to promote the well-being of pregnant women, infants and young children is emphasized, with home visiting being one of many service strategies needed in communities.
The new home visiting programs operating with ACA funding may utilize any of twelve evidence- based home visiting programs and also have the option of adopting “promising practices” in at-risk communities. Evidence-based programs were selected through an HHS funded review and assessment of the literature on home visiting (Home Visiting Evidence of Effectiveness—HomVEE). Seventy-five percent of the funding must be used for evidence-based home visiting programs and up to 25% may be used for implementation and evaluation of promising practices. The twelve HHS determined evidence-based home visiting models include:
- Early Head Start (EHS) – Home Visiting Option
- Family Check-Up (FCU)
- Healthy Families America (HFA)
- Healthy Steps (HS) for Young Children
- Home Instruction Program for Preschool Youngsters (HIPPY)
- Nurse-Family Partnership (NFP)
- Parents as Teachers (PAT)
- Early Intervention Program for Adolescent Mothers (EIP)
- Child FIRST
- Early Start New Zealand
- Oklahoma Community-based Family Resources & Support Program
- Play and Learning Strategies (PALS) Infant
The initial wave of funding under MIECHV was in the form of “formula” grants to all states and six jurisdictions based on the size of the target population of pregnant women and young children. Most states designated their Department of Health as the lead agency to handle the program. In California, the program is being implemented by the Department of Public Health, Maternal, Child, and Adolescent Health (MCAH) division with funds going to MCAH programs in designated county/local health jurisdictions. Eleven at-risk communities were selected to receive the formula dollars in California; an additional 10 communities were selected for expansion dollars designed to determine critical factors in engaging and retaining very high-risk families. The two evidence-based home visiting programs selected for use in California are Healthy Families America and Nurse-Family Partnership.
Funding for the MIECHV Program was authorized for a five year period with a total of $1.5 billion across that period. Allocations include $100 million for FY 2010, $250 million for FY 2011, $350 million for FY 2012, $400 million for FY 2013 and $400 million for FY 2014. The annual funding includes both formula dollars and dollars for expansion or development of home visiting programs in the states. There is a 3% set aside each year for Tribal grants and an additional 3% for research and evaluation.
By: Karen Moran Finello, PhD