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Audrey Yowell: Good morning, it's really nice to see you
all here. Many familiar faces, including my colleagues from the
Administration for Children and Families with whom we’re collaborating closely on this
project, and some familiar faces from previous work as
well. So, it's really nice to be included here. I don't want to
duplicate work that was already done this morning, so I'm just going to go over quickly
the funding for the Maternal, Infant and Early Childhood Home
Visiting program, which is $1.5 billion dollars over five
years. And as you can see, the amount of money increases each year through the fourth year,
and then it remains at $400 million for the last
two years. There is a three percent set aside for research,
evaluation, and technical assistance. There's also a three percent set aside for grants
to tribal organizations but what I'm going to be talking
about today is the $91 million dollars that were allocated
in this first fiscal year, FY2010 to the States. We were faced with an interesting challenge
when this law was passed because it was passed, as you may
know, on March 23rd, and we had two obligations to
fulfill within the first six months. First, we had to allocate all of our FY2010 dollars
and secondly, the law required that the states complete state-wide
needs assessments that I'm going to get to in a minute.
But, before I do, I wanna say something about the legislative purposes because usually when
people think about this program, they think about
the third purpose, which is to identify evidence-based home visiting programs and to provide the
comprehensive services to improve outcomes for families
who live in these at-risk communities. However, you'll see that the first two purposes are
in fact to strengthen and improve programs and activities
under Title V, which is the Maternal and Child Health
block grant. And, second, to improve coordination of services for at-risk communities, which
is an important component because we're now talking
about infrastructure, not just getting those services
out there. But you have to deliver the services in the context of a supporting infrastructure.
As I just mentioned, we had a challenge in getting our money out and getting this program
up and rolling in six months. And, the way we were
able to do that was really to divide the first year’s
implementation into a three-step process. The first was that we issued a funding opportunity
announcement to all of the 56 eligible entities, and we asked the states to complete their
applications to indicate that their intention to move forward
in implementing a home visiting program. And, we
required them to get sign off from multiple agencies across the state. So, we had to have
the governor designate a lead agency, which in most cases
has been the Title V or the public health agency, and
they had to have sign off from multiple, appropriate agencies within the state government, which
would include whichever agency was doing health, whichever was doing child abuse prevention,
and substance abuse treatment, and other agencies.
Because we really wanted to ensure that this was a
comprehensive system. This caused a little consternation among some of the states because,
like federal government, there isn’t always close
communication in the states among these different agencies. And, they had to sign off on a plan
that they all agreed upon. Which was challenging but I
think it is now paying off and we’ll talk about that a little later.
On the basis of this first application, we awarded our FY10 money to the states and it
was done on a formula basis. And, the formula was the same
as the Title V block grant formula, which is proportion of
children aged five and under who are below poverty. Second step was, because the states
were already grantees, to issue a supplemental
information request for the submission of the statewide
needs assessment which, of course, we had to receive and be able to evaluate, and approve,
and get into the system before the close of FY10.
Which was somewhat challenging because a statewide needs assessment is no small feat and the
needs assessment, as we’ll get into later, included multiple
elements. So, this was a huge challenge, both for us and for the states. But I have to say
that we did get the request out and the states all got
their needs assessments in on time and they all got their
FY11 block grant money. The third step, and we’re engaged in this right now, is the
supplemental information request for the states to submit
their updated state plans. And, it's an updated plan
because they had to have a preliminary plan in that first application to get their money.
And, when we sent their FY10 money out, it was restricted,
except for $500,000 dollars per state. That money could
be spent on the needs assessment itself and on planning, because needs assessments are
expensive and states didn’t have money for that. So,
they were able to spend up to $500,000 dollars apiece in
planning and needs assessment. The states now had twenty seven months from the date
of issuance to spend that money. So, we are able actually
to continue the FY10 process into FY11, which is
fortunate because otherwise it would never get done in any usable manner. Those final
updated state plans are due to us, we gave them 90
to 120 days from the date of issuance, so that they will
begin to submit on May ninth and the deadline finally is June 8th. The reason for that is
there are many, many steps that the states have to undertake,
some of them may want to have asked for a re-review
of certain programs they'd like to consider evidence-based. Or they may need some extra
time to get letters from model developers agreeing with
their plans, and so on. So, there are multiple steps that
the states have to engage in. Getting to the needs assessment, (pause) I
hope. Ok. As I mentioned, the law required that the states
had to conduct a statewide needs assessment, and that they had to complete this by the
end of fiscal ten in order for their FY11 Maternal and Child
Health block grant funds to be issued to them. Now, it's
somewhat confusing because the Maternal, Infant and Early Childhood Home Visiting program
is not tied to the MCH block grant, except that the
states had to do this state-wide needs assessment to get
their block grant monies. Once they submitted those needs assessments and they got their
money, the official tie between the two ended. We
certainly are hoping that there's going to be collaboration
at the state level between their block grant activities and the home visiting activity.
But it was something of a challenge for them to get this
done in order to get their block grant money which is
substantial. Without going through to read all of these
things which you can read yourselves, you'll see that the
needs assessment requirements were pretty extensive. That communities had to be identified
across the state with concentrations of these many
factors, including, health factors, poverty factors,
incidence of crime and domestic violence, school dropout rates, substance abuse, unemployment,
and, all of these things had to be coordinated with three other existing needs assessments,
one of which was the Title V Block Grant needs assessment.
Another was the community-wide, strategic planning and needs assessment that’s conducted
as part of Head Start. And, the third was the
inventory of current unmet needs and current community-based and prevention-focused programs
and activities under the Child Abuse Prevention and Treatment Act, CAPTA. So, we have all
of these requirements, and they all have to be coordinated
with these other needs assessments, which all, of
course, look at different kinds of things in different ways. In addition to that, the
states had to identify the quality and capacity of existing state
home visiting programs, including the number and types of
recipients, and the extent to which these programs were meeting family needs. And, they
had to address their capacity to provide substance
abuse treatment and counseling. So, you can imagine that
with only a very short time to get these things done, the states were in something of a panic
in some cases.
I’m gonna talk about what we've gone through to get that done, but first I want to explain
how we are set up. I am, as was said before, I'm the
Branch Chief of the Early Childhood Health and Development
Branch. We’re part of the Maternal and Child Health Bureau, which in turn is part of HRSA.
The way we are divided is, our project officers for the
states are the people in the ten regions. And, they are the
project officers for each of the states in their regions.
I have one minute, so I’m going to quickly talk about the categories of problems that
we have faced. One is data uniformity, the silos, lack of
connection among the data, and the unavailability of certain
kinds of data, particularly domestic, violence substance abuse, and the difficulty in achieving
data from the tribal areas. Another problem is that
we have many states that have identified the entire state as
being at risk. Or, there are pockets within urban areas that don't qualify as being at
risk that are, in fact, at risk and we have to deal with drilling
down problems. And, we are going to have to deal with the
problem of meeting community needs with models and that's going to be happening later on
in this presentation. I just want to end by saying
that there's a huge need for technical assistance out there in
the states and we have one of our providers here in the room. Child Trends has been one
of our technical assistance providers, and we have
done a number of webinars and a number of hands on TA,
and subsequently, the states have in fact been able to get these needs assessments done.
They are in the process of drilling down to identify their
communities at risk and that's where we are. Thanks.