volume 27 number 1
Federal Home Visiting Legislation and its Implementation in Region X
The spring 2013 issue of the Northwest Bulletin is the first in a two-part series focusing on the Affordable Care Act and its implications for Title V Maternal and Child Health. This issue provides a brief overview of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) legislation and its implementation in Region X.
The delivery of health services to low-income pregnant women and new mothers in their homes is not new. Home visiting in the United States can be traced to several major, largely philanthropic efforts in the late 19th century to improve the health and social conditions of women and children in impoverished inner-city and immigrant communities. (For a history of home visiting in the United States, go to MCH Timeline: History, Legacy and Resources for Education and Practice.) What is new is the decades of research, begun in the 1970s, that established an evidence base for the benefits of specific models of home visiting services, delivered to specific groups of high-risk families, at specific points in their lives. Also new is increased attention and funding for home visiting programs by local private foundations and state governments.
The most recent milestone in home visiting in the United States is the creation and massive federal investment in the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, authorized by the Affordable Care Act, and signed into law by President Obama in 2010. Its goal is to deliver home visiting services, on a national scale, to families in high-risk communities and evaluate the impact on maternal and newborn health, childhood morbidities, school readiness, inter-personal violence, and family self-sufficiency.
- Dr. David Willis, Director of the Division of Home Visiting and Early Childhood Systems, Maternal and Child Health Bureau, highlights key requirements of the legislation, including the use of evidence-based home visiting models, the integration of services with existing early childhood systems of support, and the collection of data to measure improvements in six benchmark areas. According to Dr. Willis, "The alignment of MIECHV indices and benchmarks, state aggregate data, and metrics from the Children's Health Insurance Program Reauthorization Act and the Maternal and Child Health Bureau improves the quality of reporting of early childhood programs across the country and represents a new level of accountability."
- Lorrie Grevstad, Region X Project Officer for the MIECHV program, describes the implementation of the legislation in Region X, including state needs assessments and model implementation. She also describes opportunities for state and tribal MIECHV grantees provided by the legislation. According to Ms. Grevstad, the legislation is challenging because it requires that grantees reach "… the highest risk, hardest-to-serve communities with evidence-based home visiting models that require the most rigor and fidelity to the model."
- Region X has the largest population of American Indian and Alaska Natives in the United States, and the highest number of tribal MIECHV grantees. This issue has two reports from tribal grantees. Katie Hess and Lynnette Jordan describe outcomes from the Ina Maka Family Program's home visiting needs assessment. And Cassie Hickey describes the implementation of the Cama'i Home Visiting Program on Kodiak Island, Alaska.
- The states of Alaska, Idaho, Oregon, and Washington describe their progress in implementing MIECHV. The states are using four home visiting models: Early Head Start Home Visiting, Healthy Families America, Nurse Family Partnership, and Parents as Teachers. Alaska has implemented the Nurse Family Partnership program for low-income, first-time mothers in the municipality of Anchorage. Idaho has created the first ever cross-state Nurse Family Partnership between the Panhandle Health District and the Spokane County Health District in Washington. Oregon, with their competitive grant, created four staff positions, including a specialist in community development, to change how home visiting services are coordinated at the local level. And Washington has created a Home Visiting Services Account to centralize technical assistance and training.