By Catherine J. Bodkin, LCSW, MSHA
Director, Virginia MIECHV Project
Virginia Department of Health
Developing the Updated Home Visiting State Plan, which was required by the Affordable Care Act, Maternal, Infant and Early Childhood Home Visiting (MIECHV) Grant, presented opportunities and challenges for each state.
For Virginia, the grant provided a major opportunity to expand local services and initiate a link between the home visiting data and the state’s early childhood education data system. The Memorandum of Concurrence grant requirement resulted in conversations that increased understanding about home visiting as a component in the early childhood system among high-level administrators and the Early Childhood Advisory Council
Conversely, the major challenge for Virginia involved identifying communities at risk for poor health and developmental outcomes for children and families. Virginia met this challenge through a new level of teamwork and creative thinking by building on the existence of an interagency coalition — the Home Visiting Consortium (HVC), which has been existence since 2007 — to develop a formula for selecting at-risk communities. Using combined data from all HVC agencies resulted in community rankings at variance with the usual high-priority list a single partner agency might have compiled. The MIECHV benchmark measures being defined as rates resulted in the HVC ranking small communities at higher risk. Assisted by the Title V Maternal and Child Health Services epidemiology team’s analysis and data presentations, the HVC was able to determine needs and gaps, consider how the quality of data might influence decisions, and discuss the interaction between risk factors. Under the HVC’s at-risk communities selection process, each of the 134 cities and counties received a score for two domains: “individual factors” and “community factors.” Individual factors were indicators that home visiting interventions would potentially impact. Community factors were indicators that home visitors would have to contend with while working in a community. For each factor, a community received a point if its rate was above the overall state rate. Small communities (i.e., populations less than 50,000) and large communities were separated. Twenty-eight small and ten large communities were identified as high risk by the domain scores being cross-tabulated on a two-factor table. With HRSA’s approval, Virginia included a provision for neighborhoods to present data that would qualify them as high risk by this method.
To determine which at-risk communities would be included for funding in the Updated State Plan, Virginia used the Request for Proposal (RFP) process with the eligible communities. The state RFP mirrored the federal requirements, including a local Memorandum of Concurrence and the justification of a program model selection as required elements. To ensure quality applications, the HVC used a variety of methods (i.e., webinars, web site postings, e-mail, regional meetings, and conference calls) to provide information and technical assistance statewide. A beneficial outcome of the Updated State Plan process was the increased discussion among community partners about steps to improve local referral systems. The challenge for Virginia in the future will be maintaining its efforts to develop a state system with a continuum of accessible, quality home visiting services in all communities while simultaneously implementing the MIECHV project with its specialized focus on at-risk communities.