Expanding Home Visiting to Communities in Need
Before receiving Maternal, Infant and Early Childhood Home Visiting (MIECHV) Progam funds, states and territories first figured out what home visiting services already existed in their communities and which communities most needed home visiting programs. To do this, they completed detailed needs assessments, including determining the level of risks to family and child well-being (such as poverty, child maltreatment rates, and unemployment) in their communities as well as the existence of home visiting and other services to address those risks.
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MIHOPE includes the four evidence-based home visiting models most commonly chosen by states under MIECHV Early Head Start (EHS) Healthy-Families America (HFA) Nurse-Family Partnership (NFP) Parents as Teachers (PAT) |
Targeting services to the communities with the greatest need, states and territories then selected the model(s) that best met the needs of their populations, and used MIECHV funds to support the expansion of service delivery in those communities.
MIHOPE studied this expansion process by reviewing the states’ and territories’ needs assessments and initial state plans (created in federal fiscal years 2010 and 2011) and interviewing MIECHV state leads in the 12 MIHOPE states in 2012 and 2013.
The study found that the average state planned to use MIECHV funds in eight high-risk communities and that states aimed to implement evidence-based home visiting programs in communities where a high proportion of families face risks that can harm early childhood health and development. For instance, states generally selected communities with relatively high rates of poverty. Specifically, in 34 states the poverty rate in the average target community was greater than the state average poverty rate by 25 percent or more. States also selected communities with other characteristics that could benefit from home visiting. Forty-one states selected communities with higher rates of premature birth, and 37 states selected communities with higher unemployment rates and child maltreatment rates than the statewide average.
The initial state plans showed that 33 states aimed to use funds from the Home Visiting Program to expand the availability of evidence-based models that were already operating in their states, eight states funded only evidence-based models that had not previously operated in their states, and 14 states both expanded existing models and funded new evidence-based models.
According to the state MIECHV leads participating in MIHOPE, states often found themselves balancing two different goals in their early planning: to reach families in the highest-risk communities and to ensure that the organizations chosen to operate local home visiting programs had the capacity to implement the programs well. To develop and execute service delivery plans, many states used cross-agency collaborations, including representatives from the state departments of health, human services, and education, and some included nonprofit and educational organizations as well.
