Transcript Slide 1

The Maternal, Infant, & Early Childhood Home Visiting Program:
An Overview of the SIR and NFP Technical Assistance for States
SIR Overview and NFP Technical Assistance
Nurse-Family Partnership Presenters
Kammie Monarch, Chief Operating Officer
Tamar Bauer, Chief of Policy & Government Affairs
Erika Bantz, Director of Program Development
Molly O’Fallon, Director of Program Quality
Elly Yost, Director of Nursing Practice
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SIR Overview and NFP Technical Assistance
Agenda
• SIR Overview
– Timeline and important dates
– NFP and the HomVEE report findings
– Maintenance of Effort
– Future funding allocations (years 2-5)
• NFP Technical Assistance
• Resources available to support inclusion of NFP in state plans
• Securing NFP documentation by 3/25/11 (45-day deadline)
• How NFP meets the benchmarks
• Program quality support and data collection system
•Q&A
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SIR Overview
Important Dates and Timeline
• March 25, 2011: 45-day deadline for states to secure and submit
documentation from national offices of selected models, or request
extension.
• Between May 9, 2011 and June 8, 2011: 90- to120-day
deadline for states to submit their Updated State Plans.
• Additional guidance from HRSA/ACF is expected on:
o Competitive process for FY2011-2015 funding (years 2-5)
o HRSA/ACF technical assistance for states
o Building capacity and program-specific technical assistance to
support implementation with fidelity
o Data collection and evaluation processes to meet benchmark
requirements
© Copyright 2011 Nurse-Family Partnership. All rights reserved.
SIR Overview and NFP Technical Assistance
Why Consider Nurse-Family Partnership?
Nurse-Family Partnership was among the seven eligible programs
listed in the SIR.
Based on the ACF/Mathematica Home Visiting Evaluation of
Effectiveness (HomVEE) Report:
•NFP has the most favorable impacts on primary and secondary outcome
measures;
•NFP outcomes are sustained, lasting, and replicated; and
•NFP meets all nine program model implementation guidelines.
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SIR Overview
NFP and the ACF/Mathematica HomVEE Report
• HHS has launched Home Visiting Evidence of Effectiveness (HomVEE) to
conduct a thorough and transparent review of the home visiting
research literature, and provide an assessment of the evidence of
effectiveness for home visiting program models that target families with
pregnant women and children from birth to age 5.
• NFP is identified as demonstrating a total of 64 favorable impacts on
primary and secondary outcomes in seven domains: child health;
maternal health; child development and school readiness; reductions in
child maltreatment; positive parenting practices; family economic selfsufficiency; and reductions in juvenile delinquency, family violence and
crime (secondary outcomes only).
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SIR Overview
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SIR Overview
NFP Outcomes by Domain
Child
Health
Maternal
Health
Child
Development
and School
Readiness
Reduction in
Child
Maltreatment
Reduction in
Juvenile
Delinquency,
Family
Violence and
Crime
Positive
Parenting
Practices
Family
Economic
SelfSufficiency
Linkage
and
Referral
Primary
Outcomes
4
3
4
6
0
4
2
0
Secondary
Outcomes
2
17
2
0
4
1
15
0
Favorable
Impacts
(N-64)
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SIR Overview
Maintenance of Effort (MOE)
SIR maintains MOE definition as outlined in the legislation:
• Funds provided to an eligible entity receiving a grant shall supplement, and not
supplant, funds from other sources for early childhood home visitation programs
or initiatives. The grantee must agree to maintain non-Federal funding (State
General Funds) for grant activities at a level which is not less than expenditures
for such activities as of the date of enactment of this legislation, March 23,
2010.
• FY2011 Continuing Resolution (currently under consideration by the U.S.
Congress) includes language that would eliminate the MOE requirement
for this program.
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SIR Overview
Future Funding Allocations
• Funding breakdown by fiscal year:
•
•
•
•
•
FY2010: $100 million
FY2011: $250 million
FY2012: $350 million
FY2013: $400 million
FY2014: $400 million
• FY2010 formula allocation as baseline funding for all 5 years.
• HRSA intends to award competitive funding beginning in FY2011 based
on “states’ capacity and commitment to improve outcomes specified in
the law through improvements in service coordination and the
implementation of home visiting program models with fidelity to high
quality, evidence-based models.”
• HRSA to provide information on competitive funding prior to the due
date for Updated State Plans.
© Copyright 2011 Nurse-Family Partnership. All rights reserved.
NFP Technical Assistance
The National Service Office
What resources can the Nurse-Family Partnership National
Service Office provide to meet the federal requirements and
deadlines?
•The NFP NSO is a national non-profit organization supporting
development of the Nurse-Family Partnership model in state and
community settings;
•Regional staff are available to provide state-specific support; and
•Processes and products available to support successful
implementation of NFP.
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NFP Technical Assistance
Resources for state support
Specifically, we offer:
•Planning material to complete updated state plans, section by section;
•Implementation planning tools and requirements for local communities;
•Nurse home visitor and supervisor education specific to the NFP model;
•Ongoing nurse consultation to support successful implementation;
•Web-based quality assessment and evaluation system;
•Marketing/communications support;
•Public policy and advocacy services; and
•Consultation for development of management and support systems.
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NFP Technical Assistance
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NFP Process for Documentation Requirement (45-Day Deadline)
In this SIR, all eligible states and territories receiving funds from the
Affordable Care Act-Maternal, Infant, and Early Childhood Home
Visiting Program (MIECHVP) are required to provide
documentation of approval from the national office or model
developer within 45 days of the SIR posting.
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NFP Technical Assistance
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NFP Process for Documentation Requirement (45-Day Deadline)
This documentation must contain:
•Verification that the model developer has reviewed and
agreed to the plan as submitted;
•Support for participation in the national evaluation, and any
other related HHS effort to coordinate evaluation and
programmatic technical assistance; and
•The state’s status with regard to any required certification or
approval process as required by the developer.
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NFP Technical Assistance
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NFP Process for Documentation Requirement (45-Day Deadline)
States that would like to obtain a letter from Nurse-Family
Partnership can contact their designated program developer
directly or request a letter via our website.
Our program development staff will process requests and
accommodate your request in a responsive and timely fashion.
Once all steps in the process are complete, NFP NSO will send a
letter of approval to include in the revised state plan submission to
HRSA.
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NFP Technical Assistance
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How NFP Meets the Benchmarks
Some requirements from the SIR, Section 5:
• Data must be collected from all benchmark areas√
• Improvement must be demonstrated in at least half of the constructs under each benchmark
area by the end of three years
• Data should be collected routinely √
• It is recommended that data be used for CQI √
According to Appendix D, each benchmark and construct will have:
• Proposed measure (s) √
• Definition for quantifiable improvement √
• Sources of data√
• Format to report data √
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NFP Technical Assistance
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How NFP Meets the Benchmarks
• Data is collected for each benchmark and construct area√
• Data is collected for each client; sampling is not used√
• There is a definition for each measure√
• Data sources are generally by interview, self-report or a self-administered
standardized assessment such as the Edinburgh√
• Data is generally reported as a percentage √
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NFP Technical Assistance
Appendix B:
Data Collected from NFP Implementing Agencies within Each Benchmark
Area
Benchmark Area
(from SIR)
Improved Maternal
and Newborn
Health


Constructs
(from SIR)
Data Currently Collected by Nurse-Family Partnership*
Prenatal Care
Prenatal Care: Maternal entry point and routine prenatal
care
Parental use of
alcohol, tobacco
or illicit drugs
Use of alcohol, tobacco or illicit drugs: Use and reduction
of use from intake to 36 weeks pregnancy and one year
postpartum

Preconception care
Preconception care: Currently not collected.

Inter-birth intervals
Subsequent Pregnancies: Maternal subsequent pregnancies
while in the program

Screening for
maternal depressive
symptoms
Screening for Maternal Depression: Edinburgh Postnatal
Depression Scale (Optional for agencies)—
Pregnancy through one year postpartum. Screening tool with
client self report.

Breastfeeding
Breastfeeding: Length of time infant received breast milk.

Well-child visits
Well-child visits: While child is in the program.

Maternal and child
health insurance
status
Maternal and child health insurance status: Medicaid,
SCHIP, private insurance
Other Outcomes for which data are collected:
Adequate weight gain during pregnancy
Low birth weight
Preterm birth
NICU use
*Data sources are client self-report unless stated otherwise
Data is generally reported as a percent.
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NFP Technical Assistance
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Benchmark Example
Domain: Improved Maternal and Newborn Care (pg. 37of the SIR)
Construct: Parental use of alcohol (p. 37)
• SIR definition of quantifiable, measurable improvement (pg. 37):
Improvement is defined as changes over time
• SIR specifics on source of data (p. 38): Interviews, surveys, or
administrative data
• SIR specifics on format for reporting data (p. 38): Rates for each relevant
construct. For example, the percentage who receive the
recommended schedule of well-child visits.
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NFP Technical Assistance
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Benchmark Example
Measurement of alcohol use
• NFP definition of quantifiable improvement:
o The client will decrease or stop the use of alcohol during pregnancy
• NFP source of data:
o The client will be interviewed about the amount and frequency of alcohol
use at enrollment, at 36 weeks of pregnancy, and when the infant is 12
months old
o Data is entered into a web-based data management system
• NFP format to report the data
o Reported at 36 weeks as the % decrease in use of alcohol
Number of women who have had a decrease in use of alcohol
Total number of women who have answered the questions at both time frames
© Copyright 2011 Nurse-Family Partnership. All rights reserved.
NFP Technical Assistance
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NFP Program Quality Support and Data Collection System
Quality is monitored at every phase of the NFP program with a focus on:
•Client interaction;
•Program implementation; and
•Outcome achievement.
State, regional and national reports are compiled and analyzed on a
routine basis √
In collaboration, the Nurse Consultant and Quality Coordinator develop
interventions to improve outcomes and effectiveness √
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NFP Technical Assistance
NFP Quality Summary
January 2011
The Nurse-Family Partnership (NFP) model of home visitation for first-time, low-income moms has been tested in a series of randomized,
controlled trials with longitudinal follow-up. Visit Guidelines provide structure for the program. Registered nurses use the Visit Guidelines
and the Nursing Process to meet the client needs and implement the model. The NFP National Service Office (NSO) uses data to improve
practice through the provision of consultation and technical assistance to agencies and states implementing NFP as well as education to NFP
Nurse Supervisors and Nurse Home Visitors. NFP teams use data to implement the program with quality.
Comprehensive Tools and Reports to Assure Quality
Quality is monitored at every phase at the Nurse-Family Partnership and focuses on client interactions,
program implementation and outcome achievement. Illustrative examples of Tools and Reports are below.
PreImplementation
Implementation Plan
(IP)+
Feasibility Assessment^
Launch First Year
(see note)
Findings from IP
review are
incorporated into
the First Year
Annual Plan^
Year 1
Implementation
Report^
Administrative
Task Completion
Year 2
Year 3 and Beyond
Client Interaction
Nursing Practice Assessment +
Client Survey #
Nurse Supervisor Assessment *
Nurse Consultant Assessment *
Client Interaction
Nursing Practice Assessment+
Client Survey #
Nurse Supervisor Assessment*
Nurse Consultant Assessment *
Program Implementation
Critical Structural Elements Assessment*
Annual Plan *
Fidelity Report^
Program Implementation
Critical Structural Elements Assessment*
Annual Plan *
Fidelity Report^
Periodic Implementation Review ^
Outcome Achievement
Pregnancy Outcomes^
Maternal Outcomes^
Child Health and
Development Outcomes^
Federal Home Visitation Initiative Benchmarks ^
Outcome Achievement
Pregnancy Outcomes^
Maternal Outcomes^
Child Health and
Development Outcomes^
Federal Home Visitation Initiative Benchmarks ^
Note:
Agencies and States that are determined to be ready to launch will begin to make home visits after nurse home visitors and nurse supervisors complete
units 1 and 2 of NFPs orientation education.
After home visits begin to be made, data entry will begin using ETO: Efforts to Outcomes ™ performance management software. See Social
Solutions.com to learn more about ETO.
Key
For more information about the Nurse-Family Partnership
^Completed by NFP NSO +Completed at agency or state level
see www.nursefamilypartnership.org
*Completed jointly by NFP NSO and agency/state
#Completed by Clients
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NFP Technical Assistance
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NFP Program Quality Support and Data Collection System
• Data is collected by the NFP Nurse Home Visitor and entered directly into
a web-based data management system;
• Reports are delivered on-demand to the agency;
• NFP aggregates the reports into state, regional and national reports on a
routine basis, and uses this information for comparison and quality
improvement; and
• NFP provides a range of additional reports that monitor fidelity to the
model.
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Other Resources
Efforts to Outcomes
Efforts to Outcomes (ETOTM) is a robust data collection and management
system, capturing valuable evidence and outcomes of the Nurse Family
Partnership program.
• Web-based system that is focused on the client and NFP Nurse Home
Visitor caseload;
• Enables organized workflow within the agency - between supervisors,
nurse home visitors and clients, supporting client service;
• Provides multiple options in sorting data and reporting;
• “Point and click” user navigation and strong data validation at entry;
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Other Resources
Efforts to Outcomes
• Effective case management, including client searching capabilities and
ability to get an overview of entire client caseload (client dashboard);
• Focuses on managing data to support the fidelity of the model;
• Helps to identify our areas of impact and overall effectiveness;
• Gives agencies greater ability to communicate NFP’s impact and value;
and
• Flexibility to allow possible integration with other systems.
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Contact Us
Contact your Regional Program Developer
Western Region
•
•
•
•
Kristen Rogers (Regional Manager) [email protected] HI, ID, MT, OR, WA
Trinh Hartney [email protected] American Samoa, CA, Fed. States of Micronesia, Guam, Midway Is.
Laura Misuk [email protected] TX, OK
Blanche Brunk [email protected] AK, AZ, NM, NV, UT, WY
Midwest Region
• Mary Jo O’Brien (Regional Manager) [email protected] IA, MN, ND, SD, WI
• Jeanne Anderson [email protected] IL, KS, MO, NE
• Kimberly Friedman [email protected] IN, KY, MI, OH
Southern Region
• Veronica Creech (Regional Manager) [email protected] NC, SC, VA, WV
• Julie Rainbow [email protected] AL, FL, GA, TN
• Kimberly Williams [email protected] AR, LA, MS
Northeast Region
• Lisa Gale Reyes (Regional Manager) [email protected] DC, DE, MD, NJ, USVI
• Tara Dechert [email protected] PA
• Renée Nogales [email protected] CT, MA, ME, NH, NY, RI, VT, PR
Colorado (Invest In Kids)
• Michelle Neal [email protected]
Program Development Director: Erika Bantz, [email protected]
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Contact Us
State Specific Consultation
Available Now
• Coordinating multiple home visiting
programs;
• State and local planning;
• Evaluation and quality improvement
strategy; or
• Public policy and financing…
…other issues? Just ask!
We are here to assist you with every
step of the process to ensure successful
implementation of Nurse-Family
Partnership
© Copyright 2011 Nurse-Family Partnership. All rights reserved.