Michigan Infant, Maternal and Early Childhood Home Visiting Program

1
Michigan Infant, Maternal and Early Childhood
Home Visiting Program

• Building County-Level Home
• Visiting Systems
• Videoconference for
  Teams from
• Berrien, Calhoun,
  Genesee, Ingham,
• Kalamazoo,
  Kent, Muskegon,
• 
  Saginaw, St. Clair
  and
• 
  Wayne Counties

2
1. Welcome and Introductions
3
Agenda

1. Welcome Introductions
2. Videoconference Objectives
3. Context for HRSA HV Program
4. Building a HV System
5. Michigan HV Program Logic Model
6. How Can Communities Begin to Participate?
7. Expectations for each County
8. Seed Funds to Support County Activities
9. QA
10. Next Steps

4
2. Videoconference Objectives
5
Videoconference Objectives

• Update on current status of HRSA Home Visiting
  Program.
• Ensure understanding of purpose of Home Visiting
  Program (HVP).
• Describe Michigan HVPs Logic Model development
  efforts.
• Describe steps county HVP teams can take to
  prepare for response to HRSA guidance (Step 3).

6
Objectives, contd

• Describe state expectations for county HVP
  teams.
• Discuss seed funding to support initial work.
• Conduct Q A.
• Identify next steps and future TA opportunities.

7
3. Context HRSA Home Visiting Program
8
Context

• Policy Brief from The Future of Children
• Social Science Rising A Tale of Evidence
  Shaping Public Policy
• http//www.princeton.edu/futureofchildren/publicat
  ions/docs/19_02_PolicyBrief.pdf

9
Social Science Rising

• Social scientists have taken a step toward the
  goal of getting policy makers to consider
  high-quality evidence when making program funding
  decisions.
• President Obama put provisions in the budget to
  support home visiting programs that will produce
  sizable, sustained improvements in the health,
  well-being, or school readiness of children or
  their parents.
• The resulting bill gives priority funding to
  programs that adhere to clear evidence-based
  models of home visitation that have demonstrated
  significant positive effects on important
  program-determined child and parenting outcomes.

10
Social Science Rising, contd

• The Obama administration will evaluate as many
  programs as possible, cut off funding for those
  that are not working and expand those that are.
• The administration endorses a two-tier approach
  of giving more money to the programs with the
  strongest evidence of success and less money to
  programs that have some supportive evidence, but
  not as much.
• The federal policy process now hinges importantly
  on evidence, a clear sign that the administration
  and Congress want to do everything they can to
  fund successful programs.

11
Resources

• We will be sending out
• An updated resource list of articles about
  evidence-based home visiting.
• A list of webinars you may wish to view regarding
  home visiting models and systems.

12
Affordable Care Act Funding Status

• Michigan has received funding for FY 2010.
• We have 27 months to spend the funds that we were
  awarded.
• We are awaiting the next federal guidance for
  Step 3.
• There is talk that Congress may repeal this
  legislation.
• It is critical for our state need to think about
  whats important with respect to a home visiting
  system regardless of federal funding.

13
HRSA Funding can be used for

• Three major activities
• Develop a state Home Visiting System embedded in
  a comprehensive, high-quality Early Childhood
  System.
• Develop local home visiting systems based on the
  state system.
• Within the system, implement and evaluate
  evidence-based home visiting programs.

14
HRSA Next Steps

• Step 3 guidance not yet available
• We still need to move forward in anticipation of
  what HRSA will require
• Determine infrastructure priorities.
• Revise logic model.
• Bring all of the key participants to the table.
• Inventory county-level data about target
  audiences.
• Develop database of home visiting programs.
• Once released, we likely will not have much time
  to complete our State Plan, which will build on
  the above.

15
4. Building a Home Visiting System
16
Building a Home Visiting System

• The Great Start System Team has appointed the
  Home Visiting Work Group.
• Purpose is to guide the development of the
  state-level home visiting system.
• The state-level system will guide and support the
  county efforts.

17
Based on Lessons from Other States

• Michigan might choose to focus on one or more of
  the following system components
• Public Engagement Ongoing Professional
  Development/
• Program Support Core Competencies of Staff
• Governance Evaluation and Information Systems
• Administration Needs Assessment and Planning
• Coordination Centralized Point of Referral
• Monitoring Early Childhood Partnerships
• Funding Program Standards
• CQI
• Some of the 10 counties have already begun
  systems development work.

18
5. MI Home Visiting Program Logic Model
19
MI Home Visiting ProgramLogic Model

• The Home Visiting Work Group is working with
  Michigan Public Health Institute (MPHI)
  evaluators on a Logic Model.
• The Logic Model will continue to be modified and
  expandedmay need to be revised based on Step 3
  guidance.
• This draft Logic Model represents the larger
  effort to build a home visiting system, and is
  not limited to just the ACA funding.

20
Home Visiting Program Logic Model
21
Comments

• We welcome your comments or questions about the
  draft Logic Model. Please send comments to
• HomeVisitingProject_at_michigan.gov

22
6. How Can Communities Begin to Participate in
the HV Program Activities?
23
6a. Local Governance Structure

• A group or committee will need to provide
  leadership locally regarding this home visiting
  system building work.
• You know your local structure and partners best
  what will work for you?
• Ideas entire GSC, GSC subcommittee, other
  existing or new committee that will be affiliated
  with the GSC, etc.
• The entity providing leadership might be
  different than the fiduciary.

24
Who must be involved?

• Your Great Start Collaborative contract already
  includes a list of required partners.
• The federal HV legislation identifies several
  required participants for HV planning
• Public Health (Title V)
• Substance Abuse
• Department of Human Services/CAN Council
  (CAPTA/CBCAP)
• Early Head Start/Head Start

25

• Additional key representatives for HV planning
  include
• Community Mental Health
• Education community
• Existing Home Visiting programs/providers,
  including those providing perinatal services
  (e.g. MIHP, Healthy Start)
• Families

26
Why Substance Abuse Services Are a Fit

• Addictive behaviors
• Lying
• Stealing
• Being unreliable
• Manipulation
• Moods swings
• Abuse
• Acting compulsively
• Neglect of medical needs of both parent and child
• Potential for poor or inadequate nutrition

27
Family Implications

• Children often model parental substance using
  behaviors.
• Sometimes develop self preservation skills (Hero,
  scapegoat, mascot and the lost child).

28
Consequences

• Often children of addicts are linked with
• Victimization (violent crime, sexual abuse, DV).
• Serious school problems.
• Drinking-related traffic crashes, vandalism,
  other delinquent crimes.
• Youthful deaths by drowning, suicide, and
  homicide.
• Exposure to media and movie messages that
  glamorize use.
• Peers who drink/drug.

29
Problems Manifested in Several Domains

• Families
• Communities
• Schools
• Employers
• Social relationships
• Social services

30
Community Wellness

• Prevention or early intervention, enhance
• chances for family and community wellness
• Less ATOD use.
• Fewer family problems.
• More productive citizenry.

31
Michigan Structure for Substance Abuse Services

• Bureau of Substance Abuse and Addiction Services
  (BSAAS) oversees prevention, treatment and
  recovery efforts related to substance use
  disorders and gambling addiction.
• 16 Coordinating Agencies (CAs) who are under
  agreement with MDCH to ensure quality substance
  abuse prevention and treatment services.

32
Examples of Services

• Prevention Underage Drinking Tobacco Use,
  Adult Senior Problem Use, Communicable Disease,
  Parenting Awareness, Prescription
  Over-The-Counter Drug Abuse.
• Treatment Driving Under the Influence insight
  education (DUI), Interventions, Methadone,
  Women's Treatment Programs, Fetal Alcohol
  Syndrome Disorder Screening and referral,
  Co-Occurring Disorders.
• Substance Use Disorder Recovery Recovery
  Oriented Systems of Care (ROSC), Peer
  Coaching/Mentoring, Recovery Supports and
  Resources.
• Problem Gambling 24 hour Help-line, Assessment
  Questions, Treatment, Prevention, Speakers
  Bureau, Therapist Training.

33
Regional Substance Abuse Services Representatives

• Kalamazoo and Calhoun - Kalamazoo Community
  Mental Health Substance Abuse Services
• Achiles Malta, Prevention Coordinator (269)
  553-7076 amalta_at_kazoocmh.org
• Berrien and Muskegon - Lakeshore Coordinating
  Council
• Kori White Bissot, Prevention Coordinator (616)
  846-6720 kbissot_at_lakeshoreca.org
• Genesee - Genesee County Community Mental Health
• Lisa Coleman, Manager S.A. Prevention (810)
  496-5544 lcoleman_at_gencmh.org
• Ingham - Mid-South Substance Abuse Commission
• Joel Hoepfner, Prevention Coordinator (517)
  337-4406 ext. 102 joel_at_mssac.com

34
Regional SAS Representatives (contd)

• Kent County - network180
• Denise Herbert, Prevention Coordinator (616)
  855-5245 deniseh_at_network180.org
• Saginaw - Saginaw County Department of Public
  Health
• Bryant J. Wilke, R.S., Interim Dir. of S.A.
  Serv. [phone] bwilke_at_saginawcounty.com
• St. Clair - St. Clair County Community Mental
  Health (DBA) Thumb Alliance
• Andy Kindt, Regional Prevention Coord. (810)
  966-4490 akindt_at_scccmh.org
• Wayne - Detroit Department of Health Wellness
  Promotion
• Karra Thomas, CPC-M, Prevention Coord. (313)
  876-0154 thomaskw_at_detroitmi.gov

35
Services for Pregnant Women Mothers of Young
Children

• 9 out of 10 counties have in-county womens
  specific substance abuse programming available.
• Some programs are residential and accept both
  women and their dependent children.
• Three statewide residential treatment programs
  accept women and dependent children, and provide
  gender specific treatment.
• Parent at risk of losing her children considered
  a priority with regards to Tx, and they are
  placed in treatment ahead of the general
  population.

36
6a. Next Steps for Local Governance

• Identify your governance group.
• Support each member to understand the purpose and
  scope of this program.
• Ask each member to review
• The November 4, 2010 state Home Visiting webinar
• This presentation/powerpoint
• Ensure that all members agree to collaboratively
  build the county-level home visiting system.

37
Questions?
38
6b. Data/Federal Indicators

• We anticipate that Step 3 will include a 2nd cut
  analysis of risk/need to identify the target
  audience in each county who is it that is
  experiencing the high concentration of risk?
• Geographic
• Sub-populations
• Other characteristics

39
Data/Federal Indicators, cont.

• We will have to provide data about these target
  populations and the system/services as part of
  the national cross-site evaluation of the
  project.
• Access to this data is an important component of
  being 'ready' to participate in the project.
• Data will be required for each of the 10 federal
  indicators.

40
6b. Next Steps for Data
Take inventory of what local data you have about
sub-populations for each of the 10 federal
indicators

• Premature birth ()
• Low birth-weight infants ()
• Infant mortality
• (rate/1,000 births)
• Poverty ( below FPL)
• Crime (rates/1,000 residents)

• Domestic violence (rate/1,000)
• High School drop-out ()
• Substance abuse ()
• Unemployment ()
• Child maltreatment ( reports)

see HV Analysis tables for detailed information
on indicators and sub-indicators
41
For the local data you do have

• How was each indicator measured is it the same
  as the federal metric (e.g. of premature births
  vs. rate)?
• At what level do you have the data (e.g. zip
  code, census tract, city, county, etc.)?
• Can you run analysis by sub-populations, (e.g.
  race, ethnicity, etc.)?

42
For the data you do NOT have

• How can you quickly begin to build this data
  collection into local projects and into existing
  local data systems?

43

• We anticipate that the 2nd cut analysis will be a
  collaborative state-local effort.
• We also anticipate having follow-up conversations
  with each county about the analysis work.

44
Questions?
45
6c. Update information about existing HV Programs
46
Database

• The state is developing a database with
  standardized definitions, that will capture
  information statewide and will be shared with
  local communities.

47
6c. Next Steps for the Database

• Review your county table of HV programs are any
  missing (table is available on websites)?
• Work with the state to assemble additional
  information.

48
Existing system coordination

• We would also like to identify efforts that have
  been undertaken to build a county-level HV system

• Coordinated enrollment?
• Local database of programs?
• Locally shared training across programs?

49
Questions?
50
7. State Expectations for each County
51
Process

• The State is still developing the process to
  determine which counties would receive first
  round funding, and for which activities.
• We anticipate that funding will be utilized for
  both infrastructure building and some direct
  services.
• It is possible that fewer than 10 counties will
  receive FY10 funding.

52
Process

• The process will likely take in to account
• A readiness assessment
• Results of 2nd cut analysis of need
• Follow-up discussions/meetings regarding
  readiness and analysis results.

• The steps outlined above (for 6a,6b,6c) will help
  you prepare for this process.
• The process will be finalized once the Step 3
  federal guidance is released.

53
8. Seed Funds to Support County Activities
54
Seed Funds

• The State will offer each of the 10 counties
  8,000 in seed funds to support participation in
  Step 3 activities.
• This funding would help offset costs for
  activities weve discussed today, as well as
• Data gathering and reporting
• Epidemiology support for data analysis and
  reporting
• Parent involvement
• Local participation in the development of the
  Step 3 response.

55
Seed Funds

• MDCH will establish contracts with local public
  health, as that is the easiest mechanism for us
  to quickly distribute these funds.
• We anticipate establishing contracts in early
  January, 2011.

56
Seed Funds

• Once we receive the Step 3 federal guidance, we
  will prepare an addendum to the contract.
• Each county will prepare a response to the
  addendum, explaining how they will use the funds
  to support Step 3 activities in their
  community.

57
9. Questions Answers
58
10. Next Steps
59
Next Steps - STATE

• Establish a contract with local public health to
  provide seed funds for Step 3 activities.
• Send information regarding data needed for state
  database on HV programs.
• Notify you when HRSA releases the Step 3
  guidance.
• Send an contract addendum for the seed funds,
  related to the federal guidance and analysis
  needed from local communities.
• Conduct additional information sharing
  webinars/meetings.

60
Next Steps - LOCAL

• Begin working on the tasks outlined in this
  presentation
• Provide comments on the draft Logic Model
• Identify and build your local governance group
• Start an inventory of currently available local
  data
• Begin to develop plans to collect/provide
  additional data that will be needed
• Review and update information about existing HV
  Programs for the statewide database.
• Participate in upcoming informational
  webinars/meetings

61
Upcoming Webinars/Meetings(Tentative)

• Wednesday, January 19, 1000-1130am
• Webinar regarding Lessons learned from Project
  LAUNCH (available statewide)
• Thursday, February 3, 100-300 in Lansing
• Meeting with 10 communities regarding next steps
  on Home Visiting program

62

• Please continue to reference the following
  websites for additional information about the
  Home Visiting Program
• www.michigan.gov/mihp, see Important News
• www.greatstartforkids.org, under Early Childhood
  Home Visiting Program
• Contact HomeVisitingProject_at_michigan.gov

63
THANK YOU!

• We appreciate your interest and willingness to
  work through this process with us!