pennsylvania’s home visitation stakeholder committee meeting february 20, 2013 harrisburg, pa

Pennsylvania’s Home Visitation Stakeholder Committee Meeting

February 20, 2013 Harrisburg, PA

Introductions

Work Groups

Defining, Promoting, Sustaining Home VisitingChair: Cathy Palm

Collaborating Among Home Visiting PartnersChair: Lee Sizemore

Professional Development/CompetenciesChair: Mimi Gavigan

Continuous Quality ImprovementChair: Michelle Hill

In Your Work Group

Flesh out process

Fourth

Identify sequence

Review relevant

Second

Get clear about the tasks

Please take notes!

At 11:15

• Be ready to share your sequence of next steps

• Be ready to respond to questions or suggestions from the group

MIECHV UPDATESData & Evaluation

Michelle P. Hillmhill@pa.gov717.772.4850

11Departments of Education and Public Welfare | www.education.state.pa.us | www.dpw.state.pa.us

Home Visiting Stakeholders Meeting

2/20/2013

4 separate (but connected) pieces

MIECHVData & Evaluati

Demographic, Service

Utilization & Benchmark

State Evaluation (PolicyLab)

National Evaluation (MIHOPE –

Strong Start)

National Evaluation (MIHOPE)

Strong Start)

Baseline Data

• Year One• Formula Year One• Families enrolled 7/1/2011 –

6/30/2012

• Submitted to HRSA on February 4, 2013

490 Families Served

124 Pregnant Women349 Female Caregivers

17 Male Caregivers

490 Parents

232 Girls271 Boys

7 Unknown

510 Children

Benchmark Area 1: Maternal and Newborn Health

Construct 1.1: Prenatal Care

Percentage of pregnant women who arereceiving prenatal care by the 3rd trimester

Goal: INCREASE

Baseline Period: 07/01/2011-06/30/2012 (Comparison Period: 07/01/2012-06/30/2013)

Construct 1.2: Prenatal use ofalcohol, tobacco, or illicit drugs

Percentage of pregnant women who smoked in the 3rd trimester

Goal: DECREASE

Construct 1.3: Preconception care

Percentage of postpartum women who have a medical home prior to becoming

pregnant

Goal: INCREASEBaseline Period: 07/01/2011-06/30/2012 (Comparison Period: 07/01/2012-06/30/2013)

Construct 1.4: Inter-birth intervals

Percent of postpartum womenwho use birth control

Goal: INCREASE

Construct 1.5: Screening for maternal depressive symptoms

Percent of mothers who werescreened for maternal depression

Goal: INCREASE or MAINTAIN

Construct 1.6: Breastfeeding

Percentage of postpartum women whobreast-fed for at least the first six months

Goal: INCREASE

Construct 1.7: Well-child visits

Percentage of children who receive the recommend schedule of well-child visits

Goal: INCREASE* First data point is 1 Year Post Enrollment so no data to report yet

Construct 1.8: Maternal and childhealth insurance status

Percentage of mothers and childrenwho currently have health insurance

Goal: INCREASE

Benchmark Area 2: Child Injuries, Child Abuse, Neglect, or

Maltreatment; Emergency Department Visits

Construct 2.1: Visits for children to the emergency department from all

causes

Percentage of children whovisited the emergency department

Goal: DECREASEBaseline Period: 01/01/2012-12/31/2012 (Comparison Period: 01/01/2013-12/31/2013)

Construct 2.2: Visits of mothers to the emergency department from all

causes

Percentage of mothers whovisited the emergency department

Construct 2.3: Information provided or training of participants on prevention of

child injuries

Percentage of mothers who received information or training on child injury prevention

Goal: INCREASEBaseline Period: 07/01/2011-06/30/2012 (Comparison Period: 07/01/2012-06/30/2013)

Construct 2.4: Incidence of childinjuries requiring medical treatment

Percentage of children who had an injurythat required medical treatment

Construct 2.5: Reported suspected maltreatment for children in the

program

Percentage of children with acase of suspected maltreatment

Construct 2.6: Reported substantiated maltreatment for

children in the program

Percentage of children with a caseof substantiated maltreatment

Construct 2.7: First time victims of maltreatment for children in the

program

Percentage of children with a substantiated case

of maltreatment who are first time victims

Goal: DECREASE

Benchmark Area 3: School Readiness and

Achievement

Construct 3.1: Parent support for children’s learning and development

Percentage of mothers who report anIncrease in involvement (as related to their

children’s learning and development)

*Goal: INCREASE

* Comparison data point is 18 Months Post Enrollment sounable to determine who is included in the baseline

group yetBaseline Period: 01/01/2012-12/31/2012 (Comparison Period: 01/01/2013-12/31/2013)

Achievement

Construct 3.2: Parent knowledge of child development and of theirchild’s developmental progress

Percentage of mothers who report an increasein knowledge of their child’s development

*Goal: INCREASE

Achievement

Construct 3.3: Parenting behaviorsand parent-child relationship

Percentage of mothers who report a positivechange in their relationship with their child

*Goal: INCREASE

group yet

Achievement

Construct 3.4: Parent emotional well-being or parenting stress

Percentage of mothers who werescreened for maternal depression

Achievement

Construct 3.5: Child communication,language and emergent literacy

Percentage of children with age appropriatedevelopment in communication

*Goal: INCREASE

group yet

Achievement

Construct 3.6: Child general cognitive skills

Percentage of children with age appropriatedevelopment in general cognitive skills

*Goal: INCREASE

group yet

Achievement

Construct 3.7: Child’s positive approachesto learning including attention

Percentage of children with age appropriatedevelopment in positive approaches to learning

*Goal: INCREASE

group yet

Achievement

Construct 3.8: Child’s social behavior, emotional regulation, and emotional well-

Percentage of children with age appropriate development in social behavior, emotion regulation, and emotional well-

*Goal: INCREASE

group yet

Achievement

Construct 3.9: Child’s physical health and development

Percentage of children with age appropriatedevelopment in physical development

*Goal: INCREASE

group yet

Benchmark Area 4: Domestic Violence

Construct 4.1: Screening for domestic violence

Percentage of mothers who werescreened for domestic violence

Construct 4.2: Of families identified for the presence of domestic

violence, number of referrals made to domestic violence services

Percentage of mothers who screenedpositive for domestic violence who werereferred to domestic violence services

Goal: INCREASE or MAINTAINBaseline Period: 01/01/2012-12/31/2012 (Comparison Period: 01/01/2013-12/31/2013)

Construct 4.3: Of families identified for the presence of domestic violence,

number of families for which a safety plan was completed

Percentage of mothers who screened positive

for domestic violence who have a safety plan

Benchmark Area 5: Family Economic Self-Sufficiency

Construct 5.1: HouseholdIncome and/or benefits

Percentage of households that increased or maintained their income and benefits

Goal: INCREASE or MAINTAIN* Comparison data point is 1 Year Post Enrollment sounable to determine who is included in the baseline

Construct 5.2: Employment of participating adults

Total number of hours worked (paid andunpaid devoted to the care of aninfant) per month by each mother

Goal: INCREASE or MAINTAIN* Comparison data point is 1 Year Post Enrollment sounable to determine who is included in the baseline

Construct 5.3: Health insurance status of participating adults and index children

Percentage of household memberswho currently have health insurance

Goal: INCREASE* Comparison data point is 1 Year Post Enrollment sounable to determine who is included in the baseline

Benchmark Area 6: Coordination and Referrals for Other Community

Resources and Supports

Construct 6.1: Number of familiesidentified for necessary services

Percentage of families identifiedfor needed services

Construct 6.2: Number of families identified

that required services and received a referral

to available community resources

Percentage of families who required services who were referred to additional

community resources

Construct 6.3: Number of completed referrals

Percentage of families who werereferred to additional communityresources who received services

Construct 6.4: MOUs: Number of Memoranda of Understanding or other formal agreements with other social service agencies in the community

Number of MOUs or other formal agreements with other social service

agencies in the community

Construct 6.5: Information sharing: Number of agencies with which the home visiting provider has a clear point of contact in the collaborating community agency that includes regular

sharing of information between agencies

Number of agencies with which the home visiting provider has a clear point of contact in the collaborating community

agency that includes regular sharing of information between agencies

Next Steps

• Analyze data by sites, model

• Continuous Quality Improvement (CQI)

Strong Start)

• Currently in the process of collecting data from MIECHV sites and acquiring access to state-level administrative data

• Goals:o Understand the effect of the PA MIECHV expansion of

NFP, EHS, PAT, & HFA on maternal and child community health outcomes

o Analyze program effects for priority families (dual-language and children with disabilities)

o Investigate geographic disparities of program utilization

o Explore the influence of site context and professional development activities on program performance

Strong Start)

Mother and Infant Home VisitingProgram Evaluation (MIHOPE)

• Random assignment of families has begun in Pennsylvania – about 52 clients have been enrolled; several videos of home visits have been taken in Pennsylvania

• Other states approved by OPRE and HRSA to participate in MIHOPE: California, Georgia, Illinois, Kansas, Michigan, Nevada, Oregon, & Wisconsin

Mother and Infant Home VisitingProgram Evaluation (MIHOPE)

• The Hope of MIHOPE• Listen to the MIHOPE federal project

officer highlight the role of MIHOPE in informing the federal and state policy discussion

http://www.mdrc.org/hope-mihope?utm_source=MIHOPE+Newsletter&utm_campaign=bf61a6cc19-MIHOPE_Newsletter_January_20131_11_2013&utm_medium=email

Strong Start)

• Currently ironing out final details with HHS

• A second ‘arm’ of the MIHOPE study• 12 MIHOPE states + 8 additional =

20 states• Random selection• NFP & HFA• Goal: 20,000 families• Study enrollment and data collection

are expected in begin Summer 2013• Connection to Strong Start / Medicaid

Mother and Infant Home Visiting Program Evaluation (MIHOPE) –

Strong Start

Highlights from Quarterly Reports

A Toolkit for Implementing Parental Depression Screening, Referral, and Treatment Across Systems

Diving Deeper

Life Course Perspective –Pat Yoder

Strengthening Families – Karen Shanoski

Making Use of Common Ground

PRESENTATION TO OCDEL STAKEHOLDERSLIFECOURSE PERSPECTIVEFEBRUARY 20, 2013

Pat Yoder, presenter

PPP MEMBERS Maternal and Child Health programs

Title V- Federal block grant dollars to PA Dept of Health, which makes grants to 10 county and municipal health departments

and Healthy Start programs funded directly by

DHHS to 7 programs in PA

CONCEPTS AND LANGUAGE

OCDEL focus on early childhood from an educational perspective

MCH professionals focus on early childhood from a maternal/pregnancy/pre-pregnancy perspective

POSSIBILITIES

We serve the same people Our results are not as good as we’d like Collaboration should help improve our results If we do better, our clients should do better,

and there should be opportunities to increase funding

SO, LET’S TALK!

LIFE COURSE PERSPECTIVE FRAMEWORK

The current most promoted concept for thinking about maternal and child health

Designed to address the extremely resistant problem of racial disparities in infant mortality

IN THE BEGINNING

Adverse Childhood Experiences Study

Thanks to Dr. Ron Voorhees, M.D., M.P.H., Acting Director, Allegheny County Health Department. Several slides from his presentation on ACE, presented October 26, 2011 to PPP follow.

RELATIONSHIP OF CHILDHOOD ABUSE AND HOUSEHOLD DYSFUNCTION TO MANY OF THE LEADING CAUSES OF DEATH IN ADULTS: THE ADVERSE CHILDHOOD EXPERIENCE (ACE) STUDY

Vincent J. Felitti, Robert F. Anda, Dale Nordenberg, David F. Williamson, Alison M. Spitz, Valerie Edwards,

Mary P. Koss, James S. Marks

American Journal of Preventive Medicine, 1998; 14(4) 245-258

ADVERSE CHILDHOOD EXPERIENCES

More than 17,000 Kaiser patients were asked to recall their childhood experiences

Health conditions in the present were tabulated

ACE STUDY - CATEGORIES OF ADVERSE CHILDHOOD EXPERIENCES (ACE)

Psychological abuse

Physical abuse

Sexual abuse

Substance abuse in home

Mental illness in parent

Violence against mother

Incarceration of parent

KAISER HMO ENROLLEES HAD AT LEAST ONE TYPE OF ADVERSE CHILDHOOD EXPERIENCE:

0 Categories

4 Categories

6.2%3 Categories

2 Categories

1 Category

Data from Felitti, et. al.

GROWING UP WITH ADVERSE CHILDHOOD EXPERIENCES INCREASES THE RISK FOR MANY LATER ADVERSE HEALTH CONDITIONS – RANGING FROM SMOKING TO OBESITY TO DEPRESSION AND SUBSTANCE ABUSE.

FOUR OR MORE ACES DOUBLE THE RISK FOR BEING A SMOKER

1.1 1.5 2.22.0

Odds Ratio (relative to

0 ACEs)

Number of ACE Categories

ACES INCREASE RISK FOR CHRONIC BRONCHITIS/EMPHYSEMA

1 2 3 >=4

1.6 1.62.2

ACES INCREASE THE RISK OF STROKE

1 2 3 >=4

0.9 0.71.3

ACES INCREASE RISK OF ISCHEMIC HEART DISEASE

1 2 3 >=4

0.90.91.4 2.2

ACES INCREASE THE RISK OF CANCER

1 2 3 >=4

1.2 1.2 1.0 1.9

ACES INCREASE REPORTING OF HAVING AN STD

1 2 3 >=4

1.4 1.5 1.9 2.5

ACES INCREASE RISK OF HAVING HAD OVER 50 SEXUAL PARTNERS

1 2 3 >=4

1.7 2.3 3.1 3.2

ACES INCREASE THE RISK FOR DEPRESSION ALMOST FIVE TIMES

1.5 2.42.6

0 ACEs)

FOUR ACES INCREASE THE RISK FOR USING ILLICIT DRUGS 4.7 TIMES; EVEN ONE ALMOST DOUBLES THE RISK:

1.72.9

3.64.7

0 ACEs)

ACES INCREASE THE RISK FOR ALCOHOLISM

7.4 4.9

0 ACEs)

ACES INCREASE THE RISK FOR SUICIDE ATTEMPT OVER 12 TIMES:

0 ACEs)

SOCIOECONOMIC IMPACT OF CHILD ABUSE AND NEGLECT

David Zielinski (Duke University) estimated that almost 20% of unemployed adults report abuse or neglect as child

Adult victims of maltreatment:have less education

have more physical and mental health problems that interfere with their work

are twice as likely to be below federal poverty level

are twice as likely to be on Medicaid

DISPARITIES IN INFANT MORTALITY

Not so long ago, maternal and child health workers believed that just getting women in for at least ONE prenatal visit would make a difference in the rates of infant mortality

The science has changed; our understanding has deepened

Focus has shifted to racial disparities and why they are so persistent

Many studies have shown that the factors that might explain the racial disparities, don’t!

Genetics Behavior Prenatal Care SES Stress Infection

MULTIPLE RISK FACTORS

Explain less than 10% of the variation in low birth weights between white and African-American babies

EARLY PROGRAMMING

Emphasis on importance of sensitive developmental periods in utero or early life during which future reproductive potential becomes programmed

KNOWLEDGE IS INCREASING

In the last 20 years, David Barker, MD, PhD, FRS, studied what happens to a low birth weight baby

Health consequences in adult life, such as heart disease and diabetes

Mother’s consistent prenatal stress affects her hormones, which in turn, affects the baby’s brain development

Epigenetics =another continuing aspect of study (trust me!!)

STILL MORE COMPLEXITY

Cumulative pathways All that happens throughout the life of the

mother, and her mother (not to mention what we’re learning about dads!)

THESE ARE NOT MUTUALLY EXCLUSIVE!

Early programming and cumulative pathways affect the life course over generations

WHAT TO DO?12 POINT PROGRAM

Improving Health care Services Provide interconception care to women with

prior adverse pregnancy outcomes Increase access to preconception care for

women Improve the quality of prenatal care Expand health care access over the life

course

STRENGTHENING FAMILIES AND COMMUNITIES

Strengthen father involvement in families Parental resilience

Enhance service coordination and systems integration

Create reproductive social capital in communities

Invest in community building and urban renewal

ADDRESSING SOCIAL AND ECONOMIC INEQUITIES

Close the education gap Knowledge of parenting and child development

Reduce poverty Support working mothers and families Undo racism

OPPORTUNITIES ABOUND!

Break down barriers Talk and work with one another Recognize commonalities Keep hope alive

REFERENCES

Barker, David, http://www.thebarkertheory.org contains complete references

Lu, Michael and Neil Halfon, “Racial and Ethnic Disparities in Birth Outcomes: A Life-Course Perspective,” Maternal and Child Health Journal, Vol. 7, No. 1, March 2003”

Lu, Michael, “Strong Roots Healthy Fruit: Transforming Generations through the Life Course Perspective,” June 29, 2010, Philadelphia Department of Public Health, Division of Maternal and Child Health, DVD presentation

Ronald E. Voorhees, MD, MPH, “Improving Health: First Things First,”

PPP, October 26, 2011, Power Point Presentation

Strengthening Families

Parents say they want to…

• Know their children feel loved

• Be responsive to child

• Have connections• Meet basic needs• Show courage

Strengthening Families began as an approach to child abuse prevention

• Research based• Focus on strengths, not risks• For all families• Start where families already go• Build on and connect existing programs and

strategies, not invent new ones

Strengthening Families quickly moved beyond child abuse prevention for young children and was adapted for a wide variety of programs, integrating a common approach to the needs of families into many kinds of services.

Partners at the national levelFederal Agencies

•Administration for Children, Youth and Families, Office on Child Abuse and Neglect

•Substance Abuse and Mental Health Services Administration (SAMHSA)

•Administration on Children and Families, Child Care Bureau

•Maternal and Child Health Bureau

•Centers for Disease Control and Prevention, Division of Violence Prevention

The protective factors

Social and emotional competence

“My child feels loved, a

sense of belonging and can get along with others.”

Adequate knowledge of parenting and child development

“I stay curious and am responsive to what my child needs.”

An array of social connections

“I have people who know me –friends. And at least one person who supports my parenting.”

Concrete support in times of need

“My family can access basic needs when they need it.”

Parental resilience

“I will continue to have courage during stress or after a crisis.”

Protective Factors definitions from Community Café

Parental resilience cont.

HopeCommuni-

cation skills

Problem-solve

Make changes for the future

Gather resources

Make good choices

Belief system

Coping strategies

Acknowledge feelings

Recognize challenges

Take action

Relationships – the foundation

• Mutual respect and partnership

• Trusting relationships with others, developed over time

• Relationships with schools, community agencies and services

Resources

Strengthening Families National Network

www.strengtheningfamilies.net

Online Modules : www.ctfalliance.org

Karen ShanoskiFamily Partnerships Project ManagerCenter for Schools and Communities

275 Grandview Ave., Suite 200Camp Hill, PA 17011

kshanoski@csc.csiu.org 717-763-1661 x 139

PA Strengthening Families : Toolkit for Educatorswww.pa-strengthening-families.org

Contact

The Benefits of Home Visiting

http://www.youtube.com/watch?v=1RQMVKcNgFw

Building a brighter future for Pennsylvania’s children

Tom Corbett, Governor | Ronald Tomalis, Secretary of Education | Gary D. Alexander, Secretary of Public Welfare www.education.state.pa.us | www.dpw.state.pa.us

Thank you!

pennsylvania’s home visitation stakeholder committee meeting february 20, 2013 harrisburg, pa

comparison period

increasebaseline period

yetbaseline period

maintainbaseline period

decreasebaseline period

children15 benchmark

maternal depression

newborn health19construct

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