Corrected: An earlier version of this story misstated the number of states where Healthy Families America operates. The program works with families that are at-risk for adverse childhood experiences, including but not limited to child maltreatment.
Advocates for a federal program that pays for nurses and trained workers to make home visits to families facing a range of economic and social risks are angling for Congress to renew the program before it sunsets at the end of March.
The Maternal, Infant and Early Childhood Home Visiting Program began its life in 2009 as a $1.5 billion portion of the Affordable Care Act. States were given funds to pay for home-visiting programs intended to change the health and educational trajectories of some of their most vulnerable families.
The federal funding would have run out in fiscal 2014, but was extended to the tune of $400 million from October 2014 to March 2015. The last extension for the program, formally known as MIECHV, was made as a rider to a bill that temporarily delayed cuts to doctor reimbursements under Medicare. If Congress does not fund home visiting separately, supporters hope that it might be included again in the next bill on doctor reimbursements. Sen. Chuck Grassley, R-Iowa, a senior member of the Senate finance and budget committees, and Sen. Patty Murray, D-Wash., the ranking member of the Senate education committee, have in the past supported federal home-visiting funding.
The fiscal 2016 budget proposed by the White House would provide an additional $500 million to the program.
Home visiting fits well with state and federal ambitions to expand access to preschool, said Karen Howard, the vice president for early-childhood policy for the Washington-based advocacy group First Focus. The organization is among hundreds of groups calling for renewed funding.
The federal government paid for home-visiting programs as early as 2008 under President George W. Bush’s administration. The program now known as Maternal Infant and Early Childhood Home Visiting got a huge boost in 2009 with $1.5 billion in funding as a part of the Affordable Care Act. The money is expected to expire at the end of March if Congress does not take action.
The Program:
- Operates in all 50 states and over 700 communities;
- Targets families facing a range of economic and social challenges that have children up to age 5;
- Devotes 75 percent of its funding to one of 16 programs deemed evidence-based; 25 percent can be spent on other promising home-visiting programs; and
- Has supported more than 1.4 million visits to date.
SOURCES: U.S Health and Human Services, the White House
“Home visiting has been called the pre-preschool for a reason,” Ms. Howard said. Several studies have talked about the effects of what’s known as “toxic stress” on a child’s life, created by poverty, neglect, abuse, or severe maternal depression. Such stressors may leave children struggling well before they start any kind of formal educational program, she added. Addressing those problems leaves children better prepared to succeed.
Parent-Child Home Program, a Garden City, N.Y.-based home-visiting program that offers services in 12 states, receives federal home-visiting funds as well as local and state money. Its trained home visitors meet with families twice a week, bearing educational books and toys, to help parents prepare their children for school.
“One of the critical roles that home visiting plays is that it is part of the continuum of getting that child to be successful in a classroom and performing on grade level by grade 3,” said Sarah Walzer, the executive director of Parent-Child Home Program. “Children need a certain level of development to really get all that a rich pre-K program has to offer them.”
Federal Investment
A variety of circumstances could prompt a family to be eligible for home visiting, including young maternal age, poverty, family risk for domestic or substance abuse, maternal mental-health issues, and joblessness.
The U.S. Department of Health and Human Services funds home-visiting programs in all 50 states, supporting more than 1.4 million visits in over 700 communities, according to a fact sheet from the White House released in December. At least 75 percent of the money that states receive must be spent on one of 16 home-visiting programs that have research-based evidence of effectiveness; the remaining 25 percent is set aside for a competitive-grant program. Researchers are currently studying the effectiveness of home-visiting programs funded by the federal program, and a report is scheduled to be delivered to Congress this year.
Customized Approaches
Though all the home-visiting models work on a voluntary basis with vulnerable families and young children in a comfortable home environment, the individual evidence-based programs focus on different needs. For example, the Nurse-Family Partnership, which is based in Denver and operates in 43 states, sends registered nurses into the homes of first-time, expectant mothers who are no later than in their second trimester of pregnancy; its focus is on maternal health and child development until age 2.
In contrast, Home Instruction for Parents of Preschool Youngsters, which is based in Little Rock, Ark., and has programs in 23 states, works with families who have children between 3 and 5 years old. It focuses more on early learning and offers home visits and group programs.
State agencies pick the programs that most closely fit the needs of their community and often run several in combination, said Sally Baggett, the director of patient and family services at Carolina Health Centers in Greenwood, S.C. Her agency serves rural mothers who might not otherwise get early prenatal care, so it chose home-visiting programs that offer prenatal care through nurses, as well as the program Parents as Teachers, which bolsters parents’ comfort with reading and talking to their children.
Her organization is looking for additional sources of funding; losing federal funding now would mean a dramatic service cut. Currently, Carolina Health Centers reaches between 400 and 500 families, she said, and the federal support is allowing the organization not only to reach more families, but to study which programs seem to have the most positive effect on the community. Once the organization has that information, it will be in a stronger position to advocate for other sources of money, she said.
“I think everyone understands their responsibility not to look to the federal government to keep renewing this,” Ms. Baggett said. “But we do need time to build our case.”
Janet Horras, the state home-visitation program director for the Iowa Department of Public Health, said Iowa uses Healthy Families America, a Chicago-based program deemed evidence-based that operates in 40 states and zeroes in on families who may have histories of trauma, intimate partner violence, mental health issues or substance abuse.
The rural communities served by the home-visiting program would otherwise have no access to mental-health services, Ms. Horras said.
The federal funding accounts for about 1,300 families in Iowa. The state also provides home-visiting money to serve an additional 12,000, which makes Iowa unusual among states, Ms. Horras said. Iowa has been able to use its federal money for infrastructure improvements as well as services, Ms. Horras said.
"[The federal] funding really enabled our state to be able to do some of the things we’ve only dreamed about,” she said. “We’ve had a strategic plan, we had things that we would like to accomplish, but we weren’t able to do that because we didn’t have the funding.”
