Pennsylvania's Affordable Care Act Maternal, Infant, and Early

142 Pages·2010·6.08 MB·English

Pennsylvania’s Affordable Care Act
Maternal, Infant, and Early Childhood
Home Visiting Plan and Needs Assessment

Revised: December 1, 2010

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Front Matters

Summary of revision, Dec 1, 2010:
The implementation plan was revised from a two cohort approach to a single cohort.
Further clarification is also given on method of selecting grantees and use of one-time
planning grants.

Prepared by:

Research and Evaluation Unit
Office of Child Development and Early Learning
Pennsylvania Departments of Education and Public Welfare

Philip Sirinides, Ph.D., contact author
Director of Research and Evaluation
Office of Child Development and Early Learning
333 Market St., 6th Floor | Harrisburg, PA 17126
[email protected] | Phone: [phone]

Emily Smith
Research Intern
Research and Evaluation Unit
Office of Child Development and Early Learning

Carrie Collins
Family Support Program Manager
Bureau of Early Learning Services
Office of Child Development and Early Learning

Susan Mitchell
Chief, Division of Standard
Bureau of Early Learning Services
Office of Child Development and Early Learning

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Table of Contents

FRONT MATTERS ...................................................................................................................................... 2
TABLE OF CONTENTS ................................................................................................................................ 3
PENNSYLVANIA’S MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PLAN .......................... 5
TWO PHASE NEEDS ASSESSMENT....................................................................................................................... 5
PARTNER COLLABORATION ............................................................................................................................... 5
QUALITY AND CAPACITY OF EXISTING HOME VISITATION PROGRAMS AND SERVICES .................................................... 6
SUBSTANCE ABUSE TREATMENT AND COUNSELING SERVICES .................................................................................. 8
IMPLEMENTATION PLAN ................................................................................................................................... 9
IDENTIFICATION OF COMMUNITIES AT RISK ........................................................................................................ 12
Target Indicators ................................................................................................................................. 12
Communities with High Need .............................................................................................................. 12
Communities with Low Reach ............................................................................................................. 13
PROPOSED EVALUATION STRATEGY .................................................................................................................. 13
Implementation Evaluation ................................................................................................................. 13
Program Impact Evaluation ................................................................................................................ 14
PENNSYLVANIA’S MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING NEEDS ASSESSMENT 15
COORDINATION WITH RELATED PENNSYLVANIA NEEDS ASSESSMENTS ..................................................................... 15
Title V Needs and Capacity Assessment .............................................................................................. 15
Head Start ........................................................................................................................................... 16
Community-Based Child Abuse Prevention Report ............................................................................. 17
DATA GATHERING ......................................................................................................................................... 17
Preterm Birth ....................................................................................................................................... 19
Low Birth Weight ................................................................................................................................ 19
Infant Mortality Rate .......................................................................................................................... 20
Population Living Below 100% of the Federal Poverty Level ............................................................... 21
Serious Crime Rate .............................................................................................................................. 22
Juvenile Disposition Rate ..................................................................................................................... 23
High School Dropouts .......................................................................................................................... 23
Drug Violation Rate ............................................................................................................................. 24
Alcohol Violation Rate ......................................................................................................................... 25
Binge Alcohol Use ................................................................................................................................ 25
Unemployment Rate ........................................................................................................................... 26
Substantiated Cases of Child Abuse and Neglect ................................................................................ 27
SUMMARY OF HOME VISITING TARGET INDICATORS ............................................................................................ 28
RISK FACTORS .............................................................................................................................................. 29
Maternal Risk ...................................................................................................................................... 31
Health Care Risk .................................................................................................................................. 33
Birth Outcome Risk .............................................................................................................................. 35
Health Risk .......................................................................................................................................... 36
Economic Risk ...................................................................................................................................... 38
Academic Risk ..................................................................................................................................... 39
Behavioral Risk .................................................................................................................................... 40
MAPS OF HV INDICATORS, RISK FACTORS AND PROGRAM REACH .......................................................................... 41
COUNTY PROFILES ........................................................................................................................................ 51

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NEEDS ASSESSMENT SUPPLEMENTAL MATERIALS ............................................................................... 119
LETTERS OF SUPPORT .................................................................................................................................. 120
SOURCES AND DEFINITIONS .......................................................................................................................... 125
DATA TABLES ............................................................................................................................................. 129
APPENDIX A .............................................................................................................................................. 142

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Pennsylvania’s Maternal, Infant, and Early Childhood Home Visiting Plan

The Office of Child Development and Early Learning (OCDEL) was designated as the lead
Commonwealth agency for the Affordable Care Act Maternal, Infant and Early Childhood
Home Visiting Program by Governor Edward Rendell.

Two Phase Needs Assessment

Pennsylvania’s approach to conducting the needs assessment will occur in two phases,
first statewide and then local. The Phase I statewide needs assessment, conducted in
accordance with guidelines provided by the Maternal and Child Health Bureau within
the Health Resources and Services Administration, will identify communities with
concentrations of high-risk populations. Phase II will assess the local needs and barriers
to service in target communities, as well as support the development of infrastructure
to implement or expand evidence-based home visiting programs. This two-tiered plan
will allow for both a comprehensive view of statewide needs and capacity and an in-
depth, community specific view of localized needs, which will enable the allocation of
resources to best serve vulnerable children and families.

Partner Collaboration

OCDEL has coordinated with partners and stakeholders to solicit feedback on the two-
phase needs assessment approach, the data points informing the needs assessment,
and the methodology used to assess need.

The Home Visiting Plan and Needs Assessment has very much been a collaborative
effort among state offices and stakeholder groups. The Department of Health have
provided peer review of the Needs Assessment as well as identified and provided
valuable data. The Office of Mental Health and Substance Abuse has provided input and
data to the assessment regarding substance abuse and treatment. Economic,
employment, and household-related data was acquired from the Office of Income
Maintenance. Data pertaining to academic risk factors and school-age children was
collected from the Department of Education. The Bureau of Drug and Alcohol
Prevention has aided in the collection of data points to inform the assessment, and has
supported the statewide needs assessment by identifying service gaps in substance
abuse treatment and counseling across the state.

Community stakeholders have also provided useful feedback and critique. The Protect
Our Children Committee, and the Pennsylvania Perinatal Partnership have each been
extremely helpful in identifying and providing useful data and recommendations for
consideration.
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OCDEL has also benefited from the external evaluation of pediatric epidemiologist,
Ronald Voorhees, M.D., M.P.H., who has conducted a peer review of the Needs
Assessment.

Quality and Capacity of Existing Home Visitation Programs and Services

Pennsylvania’s current structure of supports to vulnerable families and children includes
the integration of several existing home visiting programs administered by multiple
state agencies.

The Department of Public Welfare’s Office of Child Development and Early Learning
(OCDEL) manages statewide grants for the Nurse-Family Partnership, Parent-Child Home
Program and the federally-funded Early Head Start program.

The Nurse-Family Partnership (NFP) is a nationally-replicated, evidence-based model
program that utilizes registered nurses to provide home visits to low-income, first-
time pregnant women. Visits begin before the woman’s 28th week of pregnancy and
continue until her child is two years of age. The program is designed to help women
improve their prenatal health and the outcomes of pregnancy; improve the care
provided to infants and toddlers in an effort to improve the children’s health and
development; and improve women’s own personal development, giving particular
attention to the planning of future pregnancies, women’s educational achievement,
and parents’ participation in the work force. More than 4,600 women and their
children were served in 2009-2010 in 40 counties.

The Parent-Child Home Program (PCHP) promotes early literacy and positive parent-
child interaction for families with children two and three years old who are
challenged by low levels of income, education and literacy. Home visitors model for
parents how to read and play with their children in educational ways that will
promote brain and language development and prepare them for school success.
PCHP is an internationally-replicated model program with 25 sites in 25 counties in
Pennsylvania. In 2009-2010, over 1,300 children were served and provided with
books and toys, which they are able to keep.

Early Head Start (EHS) is a federally-funded support program for low-income families
with infants, toddlers and pregnant women. The goals of the program are to
promote healthy pregnancies, enhance the development of young children and
promote healthy family functioning. Many EHS programs in Pennsylvania utilize the
Parents As Teachers curriculum within their core home visitation services to families.
Over 4,370 families were served in 42 counties in 2009-2010.

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The Department of Public Welfare’s Office of Children, Youth and Families administers
the state network of Family Centers federally-funded under Community-Based Child
Abuse Prevention and Promoting Safe and Stable Families funds.

Pennsylvania’s network of Family Centers provides services to help families become
healthy, well-educated and self-sufficient and is open to the community. For families
that are identified as higher risk due to economic, health or educational
circumstances, additional home visitation services are provided using the Parents As
Teachers (PAT) curriculum to enhance child development and school achievement
through parent education and support. In 2009-2010, a total of 4,225 families were
provided PAT home visitation services in 29 counties statewide.

The Pennsylvania Department of Education’s Bureau of Student and Community
Services oversees the state’s Project ELECT program, and the Bureau of Adult Basic
Literacy Education administers the federally-funded Even Start program and the state-
funded Family Literacy program.

Project ELECT (Education Leading to Employment and Career Training) helps teen
parents stay in school, obtain a high school diploma or GED, have healthy babies,
become capable parents and prepare to become self-sufficient adults. All ELECT
programs are located in public local schools and provide teens with: pregnancy
prevention information, individual and group counseling, assistance with day care
and transportation, health and nutrition instruction, and parent and child
development education via intensive case management at school and within the
home. Many ELECT programs utilize the Parents As Teachers curriculum with
families within their homes. Project ELECT sites are located in 36 counties serving
nearly 3,200 teen parents.

Two Family Literacy programs are administered by the Pennsylvania Department of
Education, one through state funds, and Even Start, through federal funds, and
address the literacy needs of all members of the family while promoting parents'
involvement in their children's education as their children's first teachers and most
powerful influence on their academic success. These programs improve educational
opportunities of eligible families by integrating early childhood education and adult
education in a unified program. Family Literacy and Even Start programs operate in
53 counties and serve over 2,000 families, some of which provide services within the
home.

The Department of Health, Pennsylvania’s Title V lead agency, administers the federally-
funded Healthy Start program and other home visitation services through their network
of county and municipal health departments.

County/municipal health departments offer home visiting services to high risk
pregnant women to increase positive birth outcomes by providing education, social
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support and links to community services. Uninsured pregnant women are assisted in
obtaining services and/or applying for Medical Assistance. Information is provided on
healthy nutrition through pregnancy, smoking cessation, abstaining from drugs and
alcohol, dental care and mental health during and after pregnancy, with some sites
utilizing the Healthy Start model to achieve healthy results for mothers and their
children. Over 7,300 women are served in 12 counties.

Pennsylvania is fortunate to have available an array of home visitation services that
support families in a variety of ways and provide a continuum of services prenatally until
children are ready to enter Kindergarten. These programs serve those most in need,
particularly those with low levels of income, education, employment and support from
family, friends and the community. Home visiting services provided within communities
are not duplicative, rather they nicely complement each other to provide families with
the most comprehensive services possible.

However, these services only reach a small percentage of those who are in need of
them. Financial resources, both at the state and local level, are not adequate to meet
the needs of the community. Many of our home visitation programs have waiting lists of
families they are not able to serve due to financial constraints and limited capacity. A
number of Pennsylvania’s 67 counties have very limited or no supportive services for
families within their homes. Additionally, Pennsylvania’s rural geography makes it
difficult or intimidating for many families to reach supportive services and resources
that are typically located in more populated areas.

Substance Abuse Treatment and Counseling Services

In fiscal year 2008 – 2009, there were 77,292 admissions to substance abuse treatment
facilities, and 57,296 unique substance abuse facility clients that were admitted only
once during the time period. The treatment available to clients in Pennsylvania is varied;
the most prevalent mode of treatment received is Outpatient Drug-free, with 53
percent of clients receiving services in this way, followed by Inpatient, Non-Hospital
Drug-free type serving 24 percent of admissions.

Approximately 0.5% of Pennsylvania’s population was treated for substance abuse at
some point during the fiscal year, and 48 counties had a treatment capacity of less than
the statewide level. Pike County had the lowest treatment capacity, with availability to
serve just over 0.1% of the county’s population at a time. Pike County had 268
admissions for treatment in 2008-2009, but had only 70 spaces available at any point in
time. Montour, Potter and Perry counties also had low capacities: Montour County had
42 admissions for treatment and 30 treatment spaces, Perry County had 218 admissions
for treatment and 91 treatment spaces, and Potter County had 120 admissions for
treatment and 35 treatment spaces.

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Conversely, there were also counties that had a treatment capacity much higher than
the statewide level. While Forest County had 19 admissions for treatment out of a
population of 6,775 residents, they had the capacity for 146 patients at a time, or for
just over 2.0% of the population. Blair and Philadelphia counties also had high treatment
capacities; Blair County had 1,422 admissions for treatment and a capacity for 2,061
admissions, while Philadelphia County had 4,109 admissions for treatment and a
capacity for 17,702 admissions.

Implementation Plan

Pennsylvania is building an infrastructure for home visitation programs that will expand
access to high quality, evidence-based home visitation programs for at-risk populations.
The Maternal, Infant and Early Childhood Home Visiting Program grant will enable the
Office of Child Development and Early Learning (OCDEL) to use both state and local
needs assessment data to better understand community level needs and barriers to
service and to offer varying types of technical assistance and support to communities to
identify and implement home visitation programs that best meet the identified needs of
their specific at-risk populations.

The statewide needs assessment, detailed below, will identify counties of high risk
where targeted support will be provided. After these high-risk communities are
identified using the multiple risk factors developed as part of the Needs Assessment,
OCDEL will then facilitate a community-based, cooperative approach to offering home
visitation. Communities may be redefined during the local planning process to be one or
more geographic areas within the county. The boundaries of communities may also be
defined such that it extends beyond the county border.

OCDEL will solicit Letters of Intent (LOIs) from interested provider agencies with
established services in or near geographic areas target for home visiting services as
identified by the statewide Needs Assessment. OCDEL will be able to fund one agency
from each county or county-cluster. It is preferred that collaboration and coordination
occur so that each county submits only one LOI. If OCDEL receives multiple Letters of
Intent for the same county or county-cluster, it will notify the agencies in an attempt to
have them work collaboratively with each other and with community stakeholders to
determine a single applicant.

One-time planning grants will be awarded to a single grantee to serve the identified
community. The selected grantee will be responsible for the oversight of the planning
grant award, completion of the local needs assessment, and identify a home visitation
program that best addresses the identified risks. This agency must demonstrate the
capacity to administer the grant funds and to convene a stakeholder decision-making
group.

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The Home Visitation Planning funds will enable selected communities to convene a
collaborative decision-making team that brings together stakeholders from county
agencies that provide services to at-risk families. Each grantee will be awarded up to
$10,000 in planning funds to cover the costs of completing the local needs assessment,
researching and identifying an evidence-based home visitation that would best address
the identified local risk, and selecting a sponsoring agency to administer the home
visiting program.

Technical assistance will be offered to develop local needs assessments and to identify
needed resources to conduct necessary research, followed by support for collaborative
decision-making at the county level. Together, community representatives and
stakeholders will be able to identify gaps in current services and challenges to service
delivery as well as the types of home visitation services most needed to best serve the
area’s families. These services may be an expansion of already-existing programs, the
extension of programs offered in Pennsylvania but not in the targeted area, or the
implementation of a new-to-Pennsylvania evidence-based or promising home visit
program.

Two limited-term contractors and/or staff persons, funded by grant dollars, will
facilitate and coordinate the statewide and local efforts to systematize high-quality,
community-responsive home visitation services in Pennsylvania.

A Research Consultant will analyze the statewide assessment data to identify those
targeted geographic areas for enhanced support, ultimately offering home visitation
services in these areas. This staff person will then:

Monitor the targeted communities’ in-depth needs assessment and decision-
making process. This involves guiding the compilation and benchmarking of
localized data by working closely with the targeted communities, offering
assistance in gathering and analyzing the data to be used for decision-making
about evidence-based home visitation services.

Develop a data analysis and reporting system that will be integrated into state
administrative data systems and coordinate child and family outcome data
collection to inform both the ongoing needs assessment and the program impact
evaluation.

Develop and conduct an ongoing evaluation related to meeting identified needs
and program model fidelity. Analyze and evaluate service delivery data to
identify achievement of participant outcomes and benchmark measures, as well
as cost benefit information, for the statewide network of home visitation
programs.

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