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Connecticut Department of Public Health
U.S. Department of Health and Human ServicesHealth Resources and Services Administration
Maternal and Child Health Bureau&
Administration for Children & Families
Rosa M. Biaggi, MPH, MPA
State Department of Public Health
Chief, Family Health Section
State Title V Maternal and Child Health Director
Principal Investigator - MIECHV Programs Grant
Affordable Care Act Maternal, Infant and Early Childhood Home Visiting
(MIECHV) Programs Grant
Connecticut Department of Public Health - Keeping Connecticut Healthy
Patient Protection and Affordable Care Act (ACA)
• Signed into law March 23, 2010 by President Obama
• A provision of the Act authorized the creation of the Maternal, Infant, and Early Childhood Home Visiting Programs
Connecticut Department of Public Health - Keeping Connecticut Healthy
The MIECHV Program is designed to
• strengthen and improve the Title V programs and activities;
• 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.
Connecticut Department of Public Health - Keeping Connecticut Healthy
Three Components of FY 2010 ACA Funding
1. Application for funding (submitted by DPH on July 9, 2010) Required designation of the Lead Agency by Governor.
2. Conduct a Statewide Needs Assessment (submitted by DPH on September 16, 2010).
3. Submission of an updated state plan that addresses the needs of the targeted community(ies) identified in the needs assessment (due June 8, 2011). Revised October 2012.
Connecticut Department of Public Health - Keeping Connecticut Healthy
Designation of Lead Agency
Lead Agency: Department of Public Health
Required partners: •Department of Social Services•Department of Children and Families•Department of Mental health and Addiction Services
Connecticut Department of Public Health - Keeping Connecticut Healthy
Additional Partners
• State Department of Education
• Department of Developmental Disabilities
• Department of Correction
• Commission on Children
• University of Connecticut
• Yale University
• CT Parents as Teachers
• Child Health and Development Institute of CT
• State Economic Resource Center
• Women’s Health Subcommittee (Medicaid Care Management Oversight Council)
• Child FIRST
Connecticut Department of Public Health - Keeping Connecticut Healthy
Statewide Needs Assessment(DPH and affiliates, 2010)
Purpose: To identify communities “at-risk”.Looked at maternal and child health outcomes by town. Risk factors assessed included, but were not limited to:
– Low birth weight, fetal and infant mortality – Poverty – Unemployment – Maltreatment – Education– Homelessness– Crime– Domestic violence– Tobacco use– Poverty– High school dropout rates– Teen parenthood– Perinatal depression
Connecticut Department of Public Health - Keeping Connecticut Healthy
Local Community Assessments
• What were the challenges of the community?– i.e., Poor school readiness, low birth weight babies, high infant mortality,
high dropout rates, high unemployment, high crime, etc.
• Were there other characteristics that made a home visiting program likely to make a difference?
– Non-English speaking, limited public transportation
• What are the strengths of the community?– Existing partnerships
• What service systems are currently available?
Connecticut Department of Public Health - Keeping Connecticut Healthy
Needs AssessmentsFindings
Sixteen (16) towns of VERY HIGH need
Connecticut Department of Public Health - Keeping Connecticut Healthy
Needs AssessmentsFindings
Thirteen (13) towns of HIGH need
Connecticut Department of Public Health - Keeping Connecticut Healthy
Needs AssessmentsFindings
Five (5) town of MODERATE need
Connecticut Department of Public Health - Keeping Connecticut Healthy
Needs AssessmentsFindings
At least forty-nine (49) towns in the state had one or more of at least twenty-three (23) home visiting
programs (or programs with a home visiting component) in operation.
However, of these, ONLY TWO models:•Parents as Teachers, and •Early Head Start with a Home Visiting component
had been approved by HRSA as evidence-based.
Connecticut Department of Public Health - Keeping Connecticut Healthy
(HRSA) Evidence-Based Models (as of 12/20/2012)
1. Early Head Start
2. Family Check-Up
3. Healthy Families America (HFA)
4. Healthy Steps
5. Home Instruction for Parents of Preschool Youngsters (HIPPY)
6. Nurse Family Partnership
7. Parents as Teachers (PAT)
8. Child FIRST
9. Early Intervention Program for Adolescent Mothers
10. Early Start (New Zealand)
11. Oklahoma Community-Based Family Resource and Support Program
12. Play and Learning Strategies (PALS) Infant
Connecticut Department of Public Health - Keeping Connecticut Healthy
State Plan for Home Visiting
• Support improvements in maternal, child and family health.
• Promote effective implementation and expansion of evidence-based home visiting programs in the state with fidelity to the model selected.
• Reach high-risk and hard-to-engage populations.• Support a family-centered approach to home visiting.
The overarching goals of the State Plan are to:
Connecticut Department of Public Health - Keeping Connecticut Healthy
EBM in CT funded by the MIECHVPrograms Grant
• Parents as Teachers (PAT) – enhanced with increased frequency of home visits, number/type of screening, fatherhood initiative, and professional development training in all sites.
• Early Head Start (EHS) - with a home visiting component - No enhancement or adaptations.
• Nurse Family Partnership (NFP)– No enhancements or adaptations.
• Child and Family Interagency Resource, Support, and Training (Child FIRST) – No enhancements or adaptations.
Connecticut Department of Public Health - Keeping Connecticut Healthy
Target Population
Connecticut Department of Public Health - Keeping Connecticut Healthy
Evidence of Favorable Outcomes
Connecticut Department of Public Health - Keeping Connecticut Healthy
Minimum Qualifications/Certifications
Connecticut Department of Public Health - Keeping Connecticut Healthy
Caseload Ratio
Connecticut Department of Public Health - Keeping Connecticut Healthy
Supervision Ratio
Parents As Teachers (PAT)
Early Head Start (EHS)
Nurse Family Partnership
(NFP)
Child FIRST
1:12 FTEs 1:3 FTEs 1:8 FTEs 1:1 Team
Connecticut Department of Public Health - Keeping Connecticut Healthy
Federal Funds
Budget Period Award7/15/2010-9/30/2012 $855,073
9/30/2011-9/29/2015 $1,026,087 per year
3/31/2012-3/30/2015 $8,677,222 per year
TOTAL $30,991,087
Connecticut Department of Public Health - Keeping Connecticut Healthy
Community Selection Community Readiness
• Fidelity – Do they Really “Get” Fidelity?
– Some components to fidelity include: target population, staff qualifications, supervision, number of families per worker.
• Data Driven Decision Making and CQI
– Does the community demonstrate evidence of evaluating, measuring, collecting and reflecting on outcomes? Is there evidence of data driven decision making that informs program development, funding decisions, and policy? Has the community engaged in planning processes for initiatives and service development?
• Model Specific Considerations– How will EBHV fit within a continuum of services? Is there leadership or
history in bringing EBHV to the community? Is there support from multiple community agencies? Is there evidence of community capacity to support an EBHV? Is there staffing availability? A source of qualified culturally-competent staff available? Is the community supportive of the program with funding or other resources?
Connecticut Department of Public Health - Keeping Connecticut Healthy
Selected Home Visiting Program Communities and EBHV models
Town Grant EBMAnsonia-Derby Formula & Competitive EHS and Child FIRST
Bloomfield Competitive Child FIRST and PAT
Bridgeport Competitive PATBristol Competitive Child FIRST
Danbury Competitive Child FIRSTEast Hartford Competitive Child FIRST & PAT
East Haven/West Haven Competitive PATKillingly/Plainfield Competitive PAT
Manchester/Vernon Competitive PATMeriden Competitive Child FIRST & PAT
New London Formula NFPNew Britain Formula & Competitive PAT
Norwich/Griswold/Sprague Competitive PATPutnam/Windham Competitive Child FIRST
Torrington/Winchester Competitive Child FIRST & PATWindham Formula & Competitive PAT
Windsor Locks/East Windsor Competitive PAT
Connecticut Department of Public Health - Keeping Connecticut Healthy
• Benchmarks (6)
• Constructs (35)
• Data Elements (223)
Connecticut Maternal, Infant and Early Childhood Home Visiting
Programs Grant
Connecticut Department of Public Health - Keeping Connecticut Healthy
1. Improved Maternal & Newborn Health (8 constructs and 51 data elements)
• Prenatal care• Parental use of tobacco• Preconception care • Inter-birth intervals• Screening for maternal depressive symptoms• Breastfeeding• Well-child visits• Maternal and child health insurance status
Connecticut Department of Public Health - Keeping Connecticut Healthy
•Emergency Department visits: Children•Emergency Department visits: Enrolled Women•Health and safety information or training (Household safety: burns, scalds, falls, accidental toxic ingestion, choking, second hand smoke, safe sleeping, etc.)•Incidence of child injuries requiring medical treatment•Reported DCF suspected maltreatment (includes substantiated and unsubstantiated cases)•Reported substantiated maltreatment of children•First time child victims of maltreatment
2. Child Injuries, Child Abuse, Neglect, or Maltreatment and Reduction of Emergency Department Visits
(7 constructs and 56 data elements)
Connecticut Department of Public Health - Keeping Connecticut Healthy
•Parent support for child’s learning and development•Parent knowledge of child development and their child’s progress•Parenting behaviors and parent-child relationships•Parent emotional well-being or parenting stress•Child communication, language and emergent literacy•Child’s general cognitive skills•Child’s positive approaches o learning including attention•Child’s social behavior, emotional regulation, and emotional well-being•Child’s physical health and development
3. School Readiness and Achievement (9 constructs and 64 data elements)
Connecticut Department of Public Health - Keeping Connecticut Healthy
4. Crime or Domestic Violence (3 constructs and 26 data elements)
• Screening for domestic violence• Domestic violence: referrals made to relevant services
(i.e., shelters, food pantries, etc.)• Domestic violence: number of families for which safety
plan completed
Connecticut Department of Public Health - Keeping Connecticut Healthy
5. Family Economic Self-Sufficiency (3 constructs and 13 data elements)
• Household income and benefits• Employment or education• Health insurance status
Connecticut Department of Public Health - Keeping Connecticut Healthy
6. Coordination and Referrals for Other Community Resources and Supports(5 constructs and 13 data elements)
• Families identified for necessary (basic human needs) services• Referrals to available community resources• Number of completed referrals• Memoranda of agreements or other formal agreements with other
social service agencies in the community• Community agencies with which the home visiting provider has a
clear point of contact in the collaborating agency that includes regular sharing of information
Connecticut Department of Public Health - Keeping Connecticut Healthy
Environmental Considerations
The MIECHV Programs grant is a public health initiative. MIECHV models begin with prenatal health and include inter-conception and post-partum.
MIECHV models have a focus on:• prenatal care• birth outcomes• positive parenting skills• healthy child development.
Connecticut Department of Public Health - Keeping Connecticut Healthy
Overarching goal of the CT MIECHV Programs Grant
CT will have a statewide, coordinated system of early childhood home visiting that has the capacity &
commitment to provide infrastructure and supports to assure high-quality, evidence-based practice that supports
life course development.
Connecticut Department of Public Health - Keeping Connecticut Healthy
Home Visit Program Contacts
Rosa M. Biaggi, Family Health Section ChiefPrincipal Investigator MIECHV Programs Grant
Title V Director
Janet BrancifortFamily Health Section Manager
Donna Maselli, Nurse ConsultantMIECHV Liaison
Mary Emerling, Nurse ConsultantMIECHV Liaison