Title V Partnerships are Key to Implementation

By Kay Johnson
Johnson Group Consulting 

Over the past 20 years, the field of home visiting has expanded dramatically. In the absence of a federal program dedicated to home visiting, states and communities have led the way. As of 2008, state-based home visiting programs were reported by 40 states, representing 70 distinct programs. Most states described one or two state-based home visiting programs. Five states had three or more programs. An estimated 3,000 or more local sites exist. At the same time, the home visiting field has been divided due to disagreements over models, tensions between researchers and practitioners, and lack of a federal policy and finance anchor. The challenge of the coming year will be to maximize the existing knowledge, talent and resources, while dramatically expanding both the number and quality of home visiting services. 

The Patient Protection and Affordable Care Act (PPAC) established a home visiting grant program for states as a new section of the Title V Maternal and Child Health Services Block Grant program. The Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration (HRSA), as well as the Administration on Children and Families (ACF) and other federal agencies, will have roles to play in the development and administration of this new program. Moreover, both federal and congressional leaders have encouraged state-level interagency planning and development. State MCH program leaders will play a key role in implementation and will have an opportunity to use their partnership skills. 

The law provides $1.5 billion over five years for maternal, infant and early childhood home visitation programs. Funds are to be used to supplement, and “not supplant funds from other sources for early childhood home visitation programs or initiatives.” So, now is not a good time to have budget cuts in state-based home visiting programs (including Title V or Medicaid). You may want to advise your governor’s office of the prohibition on supplanting funds. 

I propose three key next steps for states. First, form your partnership – build an interagency group and add leaders from community-based home visiting programs. Second, use this partnership to generate a needs assessment that is about more than demographic data on poverty and so forth; it must describe existing home visiting capacity (staff, training, waiting lists, sources of funds, etc.). Third, form a workgroup to study how the state can augment an existing model or adopt a composite home visiting program design that is evidence based. Such a workgroup would consider how your state’s proposed program could help to achieve benchmarks for improvement in maternal and child health, childhood injury prevention, school readiness, crime, domestic violence, family economic self-sufficiency and coordination with community resources. 

The policy process and potential competition for new funding has heightened awareness of, interest in and tensions about how to create high quality and effective home visiting programs. But, this is the time to pull together, not apart. Leveraging and sharing knowledge is essential to successful implementation. This begins within your state as described above, but also will involve sharing across states through AMCHP, the Pew Home Visiting Campaign and other national organizations.