Category Archives: Grants

“Doc Fix” Includes Home Visiting & Demo’s On Therapeutic Foster Care

On Monday, March 31 the Senate followed up House action from the week before and approved the Medicare “doc-fix.” As a result they also gave approval to extend the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program into 2015. The Senate vote on the measure (H.R. 4302) was 64 to 35 and it became P.L. 113-93 when the President signed it on Tuesday. It extends the home visiting program for half the fiscal year through the end of next March but provides a full year of $400 million in mandatory dollars. After passage, the House held a hearing on Home Visiting that is reported below.

The “doc fix” extension legislation also includes the bipartisan “Excellence in Mental Health Act,” which authorizes the creation of a 2-year pilot program to be awarded to 8 states that compete to create federally certified Community Behavioral Health Centers. The provision designates $900 million in the expansion of services to various populations in need of mental health services and establishes new standards for providers. One of those provider groups identified in the legislation are agencies licensed by the state to deliver therapeutic (or treatment) foster care (TFC). For the first time ever, TFC is defined under Medicaid (Social Security Act, Sec. 1905) as a reimbursable service provided by state licensed child placing agencies which are accredited by nationally recognized accrediting bodies.

The Foster Family-based Treatment Association (FFTA) has been working hard to strengthen the definition and the use of treatment foster care within Medicaid for several years. Traditional foster care and treatment foster care are distinct program models intended to serve different child populations. Children are referred to TFC programs to address serious levels of emotional, behavioral and medical problems. Treatment foster care is active and structured, and occurs in the foster family home. What people view as “traditional” foster care provides nurturing, safe, and custodial care for children who require placement outside of their family. The primary reason for placement in traditional foster care is the need for care and protection. The role of the foster parent is that of caregiver and nurturer. Treatment, if any, occurs outside of the foster home. Therapeutic care combines the treatment technologies typically associated with more restrictive settings and the nurturing, individualized family environment with foster parents who receive special training.

A day after the “doc fix” extension became law, the House Ways and Means Subcommittee on Human Resources held a hearing on MIECHV. The Chair of the Subcommittee, Congressman Dave Reichert (R-WA) opened the hearing with a statement that said in part, “Our purpose today is to review what we know about the effects of this program, so we can begin thinking about next steps…we need to review whether the actual outcomes of this program are living up to its promise in terms of producing better outcomes for children and families. We also need to think about whether the program’s mix of supporting proven and promising approaches continues to makes sense. And we should consider whether this program should continue to have 100 percent federal funding, especially since some of the positive outcomes we hope to see will benefit our state partners.”

Witnesses included Crystal Towne, Nurse-Family Partnership; Sherene Sucilla, Former Nurse Family Partnership (NFP) program participant; Darcy Lowell, Child First; Jon Baron, Coalition for Evidence-Based Policy; and Rebecca Kilburn, RAND Corporation.

Crystal Towne described the NFP model explaining that it has served over 190,000 families and currently has over 28,000 first-time families enrolled in 43 states. She said that for every 100,000 families served research demonstrates that,

  • 14,000 fewer children will be hospitalized for injuries in their first two years of life;
  • 300 fewer infants will die in their first year of life;
  • 11,000 fewer children will develop language delays by age two;
  • 23,000 fewer children will suffer child abuse and neglect in their first 15 years of life; and
  • 22,000 fewer children will be arrested and enter the criminal justice system through their first 15 years of life.

Jon Barton offered a strong endorsement for reauthorization summarizing:

  • “MIECHV represents an important, bipartisan departure from the usual approach to social spending: it uses scientific evidence of effectiveness as a main factor in determining which activities to fund.
  • This evidence-based design is important because there is great variation in the effectiveness of different home visiting program activities (“models”). Rigorous studies have identified several models that produce major improvements in the lives of children and mothers – such as 20-50% reductions in child maltreatment – as well as a larger number of models that produce no meaningful effects.
  • MIECHV’s evidence-based design has succeeded, in part, in focusing funds on the subset of effective models; and, with a few modest revisions, it could do even better.”

To read all the testimony, go the Human Resources website. Organizations can still submit testimony for the record to the subcommittee by April 16. Directions for public submissions for the record can be found here.

CLASP/CBPP Release New Information on Home Visiting Programs

With time running short before the reauthorization runs out on October 1, the Center on Budget and Policy Priorities and CLASP released a new report, “Effective, Evidence-Based Home Visiting Programs in Every State at Risk if Congress Does Not Extend Funding.” The paper highlights the effectiveness of the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program, examples of states’ use of MIECHV funds, and negative consequences of not extending the program.

The report outlines how MIECHV-funded programs are in place in every state and operating in 656 counties. Despite their documented success and broad, bipartisan support, they are now in jeopardy. MIECHV was originally authorized and funded for five years at a total of $1.5 billion, with $400 million for fiscal year 2014. The funding and authority expire at the end of FY 2014, and for the program to continue, Congress needs to extend it.

Following are examples from the paper of some state efforts.

  • Iowa is expanding home visiting to underserved communities and building a statewide infrastructure to foster high-quality local implementation. The state is using MIECHV funds to expand three evidence-based home visiting models (Early Head Start-Home Visiting, Healthy Families America, and Nurse Family Partnership) to 15 at-risk communities. The state selected these models because they target groups at especially high risk for negative childhood outcomes. Iowa is also using some of its MIECHV funds to build a statewide data-driven early childhood system with a focus on quality and systems coordination. Key components of Iowa’s infrastructure include a statewide data collection system, a centralized intake system for home visiting and other family support programs, and a mandatory state certification for all home visiting and family support practitioners.
  • Michigan is expanding evidence-based practices to underserved communities. Michigan is using MIECHV funds to expand home visiting services to 10 high-risk communities. The targeted populations include teen parents and African American and Latino populations in distinct geographic areas. The state is expanding four evidence-based models: Early Head Start- Home Visiting, Healthy Families America, Nurse Family Partnership, and Parents as Teachers.
  • New Mexico is expanding home visiting in tribal communities. Native American Professional Resources in New Mexico has used MIECHV funding to create the Tribal Home Visiting program, implementing the Parents as Teachers home visiting model in four New Mexico counties. In addition to providing regular home visits, the program sponsors monthly group meetings for parents and their children. The goal of the group sessions is to support the strengthening of tribal communities by bringing together Native parents to focus on their relationship with their children in a healthy and fun way. The program also works with parents and their children to develop a healthy Native identity and to support indigenous language use and cultural life ways. The home visitors work with resources in the community to incorporate traditional Native parenting practices into their home visits, including stressing the use of extended family members as support for parents and teachers.
  • Oregon is coordinating early intervention services that previously operated in a non- coordinated fashion and expanding home visiting services to first-time mothers. Oregon is using MIECHV funds to expand two evidence-based practices that were already operating in the state (Early Head Start-Home Visiting and Healthy Families America) and is using its competitive grant funds to implement the Nurse Family Partnership for first-time mothers in five counties. In addition to expanding services, Oregon is using its MIECHV funds to expand its capacity to develop a collaborative, coordinated early-intervention system.

There are several additional details and examples in the paper and the document is a useful tool for advocates contacting their members of Congress to make sure the program is extended.

HHS Hearings On Budget Focus on Health Care

Last Tuesday, March 11, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius came before the House Ways and Means Committee to testify on the President’s proposed budget for FY 2015. While much of the discussion focused on the Affordable Care Act and its implementation, the Secretary did include comments on the new proposal to target a small amount of funding between child welfare and Medicaid to address a better and more limited use of psychotropic medication and to improve alignment of health care services for children in foster care.

Sebelius described it as, “$500 million for a new Medicaid [Centers for Medicare and Medicaid Services (CMS)] demonstration in partnership with [the HHS Administration for Children and Families] ACF to provide performance-based incentive payments to states through Medicaid, coupled with $250 million in mandatory child welfare funding to support state infrastructure and capacity-building.” She went on to say, “This transformational approach will encourage the use of evidence based screening, assessment, and treatment of trauma and mental health disorders among children and youth in foster care in order to reduce the over prescription of psychotropic medications. This new investment and continued collaboration will improve the social and emotional outcomes for some of America’s most vulnerable children.”

The Administration proposes, for each of the next five years, $50 million through ACF along with an additional $100 million a year through Medicaid. Many of the specifics are still to be worked out, but the funding awarded through ACF would help build capacity by enhancing the child welfare workforce; providing reliable screening and assessment tools; and facilitating coordination between child welfare and Medicaid, especially Early and Periodic, Screening, Diagnosis, and Treatment (EPSDT); training for foster parents, adoptive parents, guardians, and judges; implementing evaluation tools and providing data. At the same time, CMS would provide incentive grants to state Medicaid agencies if they could achieve certain targets and goals regarding services to children in foster care and similar children.

The goal is to enhance services that would not just reduce the over use of psychotropic medications for children in foster care but also enhance the therapies and services to children and families in this population: it has the potential to improve services for a population of children and families beyond foster care placements. ACF data show that 18 percent of the approximately 400,000 children in foster care were taking one or more psychotropic medications at the time they were surveyed (NSCAW II data collected Oct. 2009 – Jan. 2011). The Government Accountability Office (GAO) has estimated an even higher range of 21 to 39 percent. Children in foster care are prescribed psychotropic medications at far higher rates than other children served by Medicaid, and often in amounts that exceed the Food and Drug Administration’s guidelines.

Passing the funding request in Congress may be a challenge since it is mandatory, requiring passage through the authorizing committees rather than going through the annual appropriations (which also would be a challenge). For the ACF funding, the authorizing committees are the House Ways and Means Committee and the Senate Finance Committee.

ACF Initiative Names Five Expansion Sites for Supportive Housing

Yesterday, the U.S. Department of Health and Human Services, Administration for Children and Families along with four private foundations (the Robert Wood Johnson Foundation, the Annie E. Casey Foundation, Casey Family Programs and the Edna McConnell Clark Foundation) named five state and local partners for a new $35 million initiative to stabilize fragile families and keep children out of foster care. Funding will be provided to test new models for preventing foster care placements by placing highly fragile families in supportive housing that integrates needed social and health services.

This initiative, in large part, is based on a successful 2007 pilot in New York City known as Keeping Families Together, which was funded by one of the aforementioned private foundations (the RWJF) and implemented by the Corporation for Supportive Housing. The pilot paired supportive housing with on-site case management and a comprehensive array of services for families experiencing chronic homelessness, substance abuse and mental health problems, and child welfare involvement.

Each expansion site will receive $5 million and technical assistance over five years to adapt this approach within their community. Their models will be evaluated to measure impact on housing stability, health, social and emotional outcomes among children and caregivers, as well as the need for involvement with the child welfare system.

As previously reported, CWLA supports the emphasis on integrating systems of care, which together can serve families who come to the attention of the child welfare system with complex, yet unique needs.