In Focus: Systems and Financing

Mar 27, 2015  |  PERMALINK »

House Passes Important Extension for Home Visiting

By Stephanie Schmit

Yesterday, the U. S. House of Representatives passed the “Medicare Access and CHIP Reauthorization Act of 2015,” which provided a bipartisan, long-term solution for Medicare payments to physicians (this legislation is referred to as the Sustainable Growth Rate (SGR) repeal bill–and more informally as the “doc fix” bill) and reauthorized for an additional two years the Children’s Health Insurance Program (CHIP), scheduled to expire in September. The legislation also reauthorized the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program—which is slated to expire March 31, 2015—at current funding levels of $400 million per year. Overall, the legislation is an important win for vulnerable children and families across the country.

MIECHV, a federal and state partnership that has had broad bipartisan support, provides voluntary, evidence-based family- and child-related home visiting programs in every state. The bill will extend the program to March 2017. MIECHV targets high-risk families who are most likely to benefit from intensive home visiting services, which use trained professionals (often nurses, social workers, or parent educators) to help parents acquire the skills to promote their children’s development. The home visiting programs also help families connect to necessary services, such as health care or community resources, and monitor child development and progress on developmental milestones.

Our recent report, based on interviews with 20 states and 2 tribal grantees, highlights many early successes from MIECHV and demonstrates how its federal funding is being used to expand home visiting services to reach more families while also building the infrastructure to support well-coordinated and effective home visiting programs. Corresponding state profiles describe how grantees are evaluating the direct impact of home visiting and expanding and improving services for vulnerable communities. Complementing our qualitative research is a recently released brief and series of state profiles from the federal Department of Health Resources and Services Administration (HRSA), which administers MIECHV, highlighting quantitative data and other demographic information. The report shows that MIECHV home visiting programs in all 50 states, DC, and five territories served 115,500 parents and children (from birth to kindergarten entry) in 787 counties in FY 2014. Additionally, the first report from a federally mandated study on the program was recently released and showed early findings on what home visiting models are being used, who the recipients are, what needs they have, and other demographic information. With the two-year extension for MIECHV included in the House bill, continued data collection and reporting can assess the value of the program for vulnerable young children and families, adding to the growing body of evidence that includes this latest data.

The House took an important step by extending MIECHV, but continued funding depends on the Senate taking similar action. President Obama has already signaled that he will sign the bill when it reaches his desk. MIECHV has brought evidence-based home visiting services to more vulnerable children in the most at-risk communities. Our report has shown how essential MIECHV has been for the development of statewide home visiting systems, with states building the infrastructure needed to support lasting, effective programs. Research validates the notion that home visiting programs can enhance parenting and support young children’s early development--and can do so with significant public cost savings. The Senate should pass the Medicare Access and CHIP Reauthorization Act of 2015 and continue its commitment to investing in evidence-based home visiting to promote positive, long-term outcomes for children, families, and the nation.

The Senate is expected to take up the bill upon return from recess in April.

Mar 24, 2015  |  PERMALINK »

Five out of Six Eligible Children Unable to Access Child Care Assistance

By Christina Walker 

Child care assistance helps low-income families obtain the child care they need so parents can go to work or school. The Child Care and Development Block Grant (CCDBG) is the primary federal program that funds child care subsidies for low-income, working parents. States also direct funds from the federal Temporary Assistance for Needy Families (TANF) block grant to child care, although those funds have declined significantly in recent years. Research has shown that subsidies provide stability for families struggling to gain economic security while allowing families to access higher-quality child care than they could otherwise afford.

A new issue brief released by The Office of the Assistant Secretary for Planning and Evaluation (ASPE) at the U.S. Department of Health and Human Services recently updated estimates of the share of eligible children served by all funding sources, including CCDBG and TANF. In 2011, only 17 percent—or one in six children—eligible under federal rules actually received any help, leaving five in six children without any assistance. When compared to ASPE’s prior estimate in 2009, the share of eligible children receiving child care assistance declined about 1.5 percent: 100,000 fewer children overall received assistance, even though the number of eligible children increased by nearly 500,000. 

This report highlights the worsening trend in the number of children receiving child care assistance. In 2013, only 1.46 million children received CCDBG-funded subsidies (including TANF transfers to CCDBG) in an average month, which is the lowest number of children served in 15 years. Spending on child care assistance has simultaneously been on the decline, reaching its lowest level since 2002.

From 2011 to 2013, more than 168,000 children lost assistance through CCDBG funds – a 10 percent decrease, suggesting that future analyses may show an even smaller share of eligible children receiving subsidies. This decline comes at a time when states are just beginning to understand and address the increased costs of implementing new requirements included in the 2014 CCDBG reauthorization. Increasing investment in child care assistance should be a top priority for federal and state policymakers to support the costs of reauthorization and stem the tide on the declining number of children getting help. CCDBG is an important investment that helps families gain employment stability and economic security and promotes continuity in child care arrangements that benefits children’s development.

Feb 11, 2015  |  PERMALINK »

New CLASP Report Highlights the Impact of the MIECHV Program in States and Tribal Communities

By Christina Walker and Stephanie Schmit

A new CLASP report, An Investment in Our Future: How Federal Home Visiting Funding Provides Critical Support for Parents and Children, written in collaboration with the Center for American Progress, highlights how the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program funding has played a central role in expanding home visiting services to vulnerable families - including in hard-to-reach rural areas and tribal communities. Research shows that home visiting can lead to improved outcomes, such as better maternal and child health, increased school readiness, and the prevention of child injuries, abuse, and neglect. MIECHV is set to expire at the end of March without further Congressional action. 

Based on interviews with 20 states and 2 tribal organizations, An Investment in Our Future shows how federal MIECHV funding is being used to expand home visiting services to reach more families while also building the infrastructure to support well-coordinated and effective home visiting programs. Early successes from MIECHV include:

  • Expansion of evidence-based home visiting to serve and retain more vulnerable children and families in high-risk communities and keep them engaged in the programs.
  • Establishment of formal referral and intake systems within home visiting communities and across services that support children and families, ensuring they receive the best services to meet their needs.
  • Provision of systemic training, technical assistance, and professional development to support the home visiting workforce.
  • Creation of data collection systems, allowing grantees to analyze, evaluate, and report on data to demonstrate achieved child and family outcomes and improve program quality.
  • Coordination among home visiting and other early childhood programs as well as the creation of centralized intake systems, which are collaborative approaches to engaging, recruiting, and enrolling families in home visiting programs across programs and organizations.
  • Use of promising practices and other innovations to better serve at-risk populations with unmet needs.

Twenty-two in-depth state and tribal MIECHV grantee profiles are also available. The profiles describe how grantees are evaluating the direct impact of home visiting and expanding and improving services for vulnerable communities.

MIECHV grantees have built home visiting systems that reach some of the most vulnerable children and families in all 50 states, the District of Columbia, 25 tribal communities, and many U.S. territories. Continuing this investment and ensuring its sustainability will allow states and tribal grantees to continue expanding services to new communities and other underserved populations, as well as sustain the positive outcomes achieved thus far.  Congress should ensure that funding for the MIECHV program continues.  Failure to do so would result in reduced services and the dismantling of the statewide systems-building progress for families in communities in every state.

Visit www.clasp.org/miechv to read the full report, Executive Summary, and state and tribal profiles.

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