Maternal, infant, and early childhood home visiting programs
Purposes
The purposes of this section are—
to strengthen and improve the programs and activities carried out under this subchapter;
to improve coordination of services for at risk communities; and
to identify and provide comprehensive services to improve outcomes for families who reside in at risk communities.
Requirement for all States to assess statewide needs and identify at risk communities
In general
Each State shall, as a condition of receiving payments from an allotment for the State under section 702 of this title, conduct a statewide needs assessment (which may be separate from but in coordination with the statewide needs assessment required under section 705(a) of this title and which shall be reviewed and updated by the State not later than
communities with concentrations of—
premature birth, low-birth weight infants, and infant mortality, including infant death due to neglect, or other indicators of at-risk prenatal, maternal, newborn, or child health;
poverty;
crime;
domestic violence;
high rates of high-school drop-outs;
substance abuse;
unemployment; or
child maltreatment;
the quality and capacity of existing programs or initiatives for early childhood home visitation in the State including—
the number and types of individuals and families who are receiving services under such programs or initiatives;
the gaps in early childhood home visitation in the State; and
the extent to which such programs or initiatives are meeting the needs of eligible families described in subsection (k)(2); and
the State’s capacity for providing substance abuse treatment and counseling services to individuals and families in need of such treatment or services.
Coordination with other assessments
Submission to the Secretary
Each State shall submit to the Secretary, in such form and manner as the Secretary shall require—
the results of the statewide needs assessment required under paragraph (1); and
a description of how the State intends to address needs identified by the assessment, particularly with respect to communities identified under paragraph (1)(A), which may include applying for a grant to conduct an early childhood home visitation program in accordance with the requirements of this section.
Grants for early childhood home visitation programs
Authority to make grants
Authority to use initial grant funds for planning or implementation
Authority to use grant for a pay for outcomes initiative
Grant duration
Technical assistance
Requirements
The requirements of this subsection for an early childhood home visitation program conducted with a grant made under this section are as follows:
Quantifiable, measurable improvement in benchmark areas
In general
The eligible entity establishes, subject to the approval of the Secretary, quantifiable, measurable 3- and 5-year benchmarks for demonstrating that the program results in improvements for the eligible families participating in the program in the following areas:
Improved maternal and newborn health.
Prevention of child injuries, child abuse, neglect, or maltreatment, and reduction of emergency department visits.
Improvement in school readiness and achievement.
Reduction in crime or domestic violence.
Improvements in family economic self-sufficiency.
Improvements in the coordination and referrals for other community resources and supports.
Demonstration of improvements after 3 years
Report to the Secretary
Corrective action plan
Technical assistance
In general
Advisory panel
No improvement or failure to submit report
Final report
Demonstration of improvements in subsequent years
Continued measurement of improvement in applicable benchmark areas
Corrective action plan
Technical assistance
No improvement or failure to submit report
Improvements in outcomes for individual families
In general
Participant outcomes
The participant outcomes described in this subparagraph are the following:
Improvements in prenatal, maternal, and newborn health, including improved pregnancy outcomes 1
Improvements in child health and development, including the prevention of child injuries and maltreatment and improvements in cognitive, language, social-emotional, and physical developmental indicators.
Improvements in parenting skills.
Improvements in school readiness and child academic achievement.
Reductions in crime or domestic violence.
Improvements in family economic self-sufficiency.
Improvements in the coordination of referrals for, and the provision of, other community resources and supports for eligible families, consistent with State child welfare agency training.
Core components
The program includes the following core components:
Service delivery model or models
In general
Subject to clause (ii), the program is conducted using 1 or more of the service delivery models described in item (aa) or (bb) of subclause (I) or in subclause (II) selected by the eligible entity:
The model conforms to a clear consistent home visitation model that has been in existence for at least 3 years and is research-based, grounded in relevant empirically-based knowledge, linked to program determined outcomes, associated with a national organization or institution of higher education that has comprehensive home visitation program standards that ensure high quality service delivery and continuous program quality improvement, and has demonstrated significant,2
randomized controlled research designs, and the evaluation results have been published in a peer-reviewed journal; or
quasi-experimental research designs.
The model conforms to a promising and new approach to achieving the benchmark areas specified in paragraph (1)(A) and the participant outcomes described in paragraph (2)(B), has been developed or identified by a national organization or institution of higher education, and will be evaluated through well-designed and rigorous process.
Majority of grant funds used for evidence-based models
Criteria for evidence of effectiveness of models
Additional requirements
The program adheres to a clear, consistent model that satisfies the requirements of being grounded in empirically-based knowledge related to home visiting and linked to the benchmark areas specified in paragraph (1)(A) and the participant outcomes described in paragraph (2)(B) related to the purposes of the program.
The program employs well-trained and competent staff, as demonstrated by education or training, such as nurses, social workers, educators, child development specialists, or other well-trained and competent staff, and provides ongoing and specific training on the model being delivered.
The program maintains high quality supervision to establish home visitor competencies.
The program demonstrates strong organizational capacity to implement the activities involved.
The program establishes appropriate linkages and referral networks to other community resources and supports for eligible families.
The program monitors the fidelity of program implementation to ensure that services are delivered pursuant to the specified model.
Priority for serving high-risk populations
The eligible entity gives priority to providing services under the program to the following:
Eligible families who reside in communities in need of such services, as identified in the statewide needs assessment required under subsection (b)(1)(A), taking into account the staffing, community resource, and other requirements to operate at least one approved model of home visiting and demonstrate improvements for eligible families.
Low-income eligible families.
Eligible families who are pregnant women who have not attained age 21.
Eligible families that have a history of child abuse or neglect or have had interactions with child welfare services.
Eligible families that have a history of substance abuse or need substance abuse treatment.
Eligible families that have users of tobacco products in the home.
Eligible families that are or have children with low student achievement.
Eligible families with children with developmental delays or disabilities.
Eligible families who, or that include individuals who, are serving or formerly served in the Armed Forces, including such families that have members of the Armed Forces who have had multiple deployments outside of the United States.
Application requirements
An eligible entity desiring a grant under this section shall submit an application to the Secretary for approval, in such manner as the Secretary may require, that includes the following:
A description of the populations to be served by the entity, including specific information regarding how the entity will serve high risk populations described in subsection (d)(4).
An assurance that the entity will give priority to serving low-income eligible families and eligible families who reside in at risk communities identified in the statewide needs assessment required under subsection (b)(1)(A).
The service delivery model or models described in subsection (d)(3)(A) that the entity will use under the program and the basis for the selection of the model or models.
A statement identifying how the selection of the populations to be served and the service delivery model or models that the entity will use under the program for such populations is consistent with the results of the statewide needs assessment conducted under subsection (b).
The quantifiable, measurable benchmarks established by the State to demonstrate that the program contributes to improvements in the areas specified in subsection (d)(1)(A) that the service delivery model or models selected by the entity are intended to improve.
An assurance that the entity will obtain and submit documentation or other appropriate evidence from the organization or entity that developed the service delivery model or models used under the program to verify that the program is implemented and services are delivered according to the model specifications.
Assurances that the entity will establish procedures to ensure that—
the participation of each eligible family in the program is voluntary; and
services are provided to an eligible family in accordance with the individual assessment for that family.
Assurances that the entity will—
submit annual reports to the Secretary regarding the program and activities carried out under the program that include such information and data as the Secretary shall require; and
participate in, and cooperate with, data and information collection necessary for the evaluation required under subsection (g)(2) and other research and evaluation activities carried out under subsection (h)(3).
A description of other State programs that include home visitation services, including, if applicable to the State, other programs carried out under this subchapter with funds made available from allotments under section 702(c) of this title, programs funded under subchapter IV, title II of the Child Abuse Prevention and Treatment Act [42 U.S.C. 5116 et seq.] (relating to community-based grants for the prevention of child abuse and neglect), and section 9840a of this title (relating to Early Head Start programs).
Other information as required by the Secretary.
Maintenance of effort
Evaluation
Independent, expert advisory panel
The Secretary, in accordance with subsection (h)(1)(A), shall appoint an independent advisory panel consisting of experts in program evaluation and research, education, and early childhood development—
to review, and make recommendations on, the design and plan for the evaluation required under paragraph (2) within 1 year after
to maintain and advise the Secretary regarding the progress of the evaluation; and
to comment, if the panel so desires, on the report submitted under paragraph (3).
Authority to conduct evaluation
On the basis of the recommendations of the advisory panel under paragraph (1), the Secretary shall, by grant, contract, or interagency agreement, conduct an evaluation of the statewide needs assessments submitted under subsection (b) and the grants made under subsections (c) and (h)(3)(B). The evaluation shall include—
an analysis, on a State-by-State basis, of the results of such assessments, including indicators of maternal and prenatal health and infant health and mortality, and State actions in response to the assessments; and
an assessment of—
the effect of early childhood home visitation programs on child and parent outcomes, including with respect to each of the benchmark areas specified in subsection (d)(1)(A) and the participant outcomes described in subsection (d)(2)(B);
the effectiveness of such programs on different populations, including the extent to which the ability of programs to improve participant outcomes varies across programs and populations; and
the potential for the activities conducted under such programs, if scaled broadly, to improve health care practices, eliminate health disparities, and improve health care system quality, efficiencies, and reduce costs.
Report
Other provisions
Intra-agency collaboration
The Secretary shall ensure that the Maternal and Child Health Bureau and the Administration for Children and Families collaborate with respect to carrying out this section, including with respect to—
reviewing and analyzing the statewide needs assessments required under subsection (b), the awarding and oversight of grants awarded under this section, the establishment of the advisory panels required under subsections (d)(1)(B)(iii)(II) and (g)(1), and the evaluation and report required under subsection (g); and
consulting with other Federal agencies with responsibility for administering or evaluating programs that serve eligible families to coordinate and collaborate with respect to research related to such programs and families, including the Office of the Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services, the Centers for Disease Control and Prevention, the National Institute of Child Health and Human Development of the National Institutes of Health, the Office of Juvenile Justice and Delinquency Prevention of the Department of Justice, and the Institute of Education Sciences of the Department of Education.
Grants to eligible entities that are not States
Indian tribes, tribal organizations, or Urban Indian Organizations
The Secretary shall specify requirements for eligible entities that are Indian Tribes (or a consortium of Indian Tribes), Tribal Organizations, or Urban Indian Organizations to apply for and conduct an early childhood home visitation program with a grant under this section. Such requirements shall, to the greatest extent practicable, be consistent with the requirements applicable to eligible entities that are States and shall require an Indian Tribe (or consortium), Tribal Organization, or Urban Indian Organization to—
conduct a needs assessment similar to the assessment required for all States under subsection (b); and
establish quantifiable, measurable 3- and 5-year benchmarks consistent with subsection (d)(1)(A).
Nonprofit organizations
If, as of the beginning of fiscal year 2012, a State has not applied or been approved for a grant under this section, the Secretary may use amounts appropriated under paragraph (1) of subsection (j) that are available for expenditure under paragraph (3) of that subsection to make a grant to an eligible entity that is a nonprofit organization described in subsection (k)(1)(B) to conduct an early childhood home visitation program in the State. The Secretary shall specify the requirements for such an organization to apply for and conduct the program which shall, to the greatest extent practicable, be consistent with the requirements applicable to eligible entities that are States and shall require the organization to—
carry out the program based on the needs assessment conducted by the State under subsection (b); and
establish quantifiable, measurable 3- and 5-year benchmarks consistent with subsection (d)(1)(A).
Research and other evaluation activities
In general
Requirements
The Secretary shall ensure that—
evaluation of a specific program or project is conducted by persons or individuals not directly involved in the operation of such program or project; and
the conduct of research and evaluation activities includes consultation with independent researchers, State officials, and developers and providers of home visiting programs on topics including research design and administrative data matching.
Report and recommendation
Not later than
information regarding the extent to which eligible entities receiving grants under this section demonstrated improvements in the areas specified in subsection (d)(1)(A);
information regarding any technical assistance provided under subsection (d)(1)(B)(iii)(I), including the type of any such assistance provided; and
recommendations for such legislative or administrative action as the Secretary determines appropriate.
Data exchange standards for improved interoperability
Designation and use of data exchange standards
Designation
Data exchange standards must be nonproprietary and interoperable
Other requirements
In designating data exchange standards under this paragraph, the Secretary shall, to the extent practicable, incorporate—
interoperable standards developed and maintained by an international voluntary consensus standards body, as defined by the Office of Management and Budget;
interoperable standards developed and maintained by intergovernmental partnerships, such as the National Information Exchange Model; and
interoperable standards developed and maintained by Federal entities with authority over contracting and financial assistance.
Data exchange standards for Federal reporting
Designation
Requirements
The data exchange reporting standards required by clause (i) shall, to the extent practicable—
incorporate a widely accepted, nonproprietary, searchable, computer-readable format;
be consistent with and implement applicable accounting principles;
be implemented in a manner that is cost-effective and improves program efficiency and effectiveness; and
be capable of being continually upgraded as necessary.
Incorporation of nonproprietary standards
Rule of construction
Application of other provisions of subchapter
In general
Exceptions
The following provisions of this subchapter shall apply to a grant made under this section to the same extent and in the same manner as such provisions apply to allotments made under section 702(c) of this title:
Section 704(b)(6) of this title (relating to prohibition on payments to excluded individuals and entities).
Section 704(c) of this title (relating to the use of funds for the purchase of technical assistance).
Section 704(d) of this title (relating to a limitation on administrative expenditures).
Section 706 of this title (relating to reports and audits), but only to the extent determined by the Secretary to be appropriate for grants made under this section.
Section 707 of this title (relating to penalties for false statements).
Section 708 of this title (relating to nondiscrimination).
Section 709(a) of this title (relating to the administration of the grant program).
Appropriations
In general
Out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary to carry out this section—
$100,000,000 for fiscal year 2010;
$250,000,000 for fiscal year 2011;
$350,000,000 for fiscal year 2012;
$400,000,000 for fiscal year 2013;
$400,000,000 for fiscal year 2014;
for fiscal year 2015, $400,000,000;
for fiscal year 2016, $400,000,000; and
for each of fiscal years 2017 through 2022, $400,000,000.
Reservations
Of the amount appropriated under this subsection for a fiscal year (or portion of a fiscal year), the Secretary shall reserve—
3 percent of such amount for purposes of making grants to eligible entities that are Indian Tribes (or a consortium of Indian Tribes), Tribal Organizations, or Urban Indian Organizations; and
3 percent of such amount for purposes of carrying out subsections (d)(1)(B)(iii), (g), and (h)(3).
Availability
In general
Funds for pay for outcomes initiatives
Allocation of funds
Definitions
In this section:
Eligible entity
In general
Nonprofit organizations
Eligible family
The term “eligible family” means—
a woman who is pregnant, and the father of the child if the father is available; or
a parent or primary caregiver of a child, including grandparents or other relatives of the child, and foster parents, who are serving as the child’s primary caregiver from birth to kindergarten entry, and including a noncustodial parent who has an ongoing relationship with, and at times provides physical care for, the child.
Indian Tribe; Tribal Organization
Pay for outcomes initiative
The term “pay for outcomes initiative” means a performance-based grant, contract, cooperative agreement, or other agreement awarded by a public entity in which a commitment is made to pay for improved outcomes achieved as a result of the intervention that result in social benefit and direct cost savings or cost avoidance to the public sector. Such an initiative shall include—
a feasibility study that describes how the proposed intervention is based on evidence of effectiveness;
a rigorous, third-party evaluation that uses experimental or quasi-experimental design or other research methodologies that allow for the strongest possible causal inferences to determine whether the initiative has met its proposed outcomes as a result of the intervention;
an annual, publicly available report on the progress of the initiative; and
a requirement that payments are made to the recipient of a grant, contract, or cooperative agreement only when agreed upon outcomes are achieved, except that this requirement shall not apply with respect to payments to a third party conducting the evaluation described in subparagraph (B).