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Maternal Infant and Early Childhood Home Visiting

Maternal, Infant and Early Childhood Home Visiting Programs (MIECHV)

Table of Contents


2 adults with a babyOverview

Home visiting is a voluntary, home-based prevention strategy used to support pregnant mothers and new parents to promote infant and child health, foster healthy child development, prevent child abuse and neglect, and improve school readiness and family self-sufficiency. Services are most often delivered by trained nurses, social worker or child development specialists.  Evaluation findings of home visiting programs that are considered evidence-based show positive outcomes for children and families while creating long-term savings for states. For every dollar spent on these programs can provide a return on investment up to $5.70 per taxpayer dollar invested by reducing future costs associated with child abuse and neglect, poor health, academic failure.

Lawmakers have been investing state funds in home visiting programs for over a decade but with the passage of the federal Maternal, Infant and Early Childhood Home Visiting (MIECHV) grant program, a provision within the Patient Protection and Affordable Care Act, home visiting has gained national attention. Since 2010 this federal initiative has provided states with substantial resources for home visiting: $1.5 billion over five years (FYs 2010-2014) with an option for reauthorization. In March 2014, the U.S. Senate extended funding for the program through March 31, 2015. 

State lawmakers play an important role in establishing effective home visiting policies in their states. They can determine how different sources of funding can be leveraged to sustain and improve the quality of states’ existing home visiting systems. They may also develop legislation to ensure the state is investing research-based home visiting models that demonstrate effectiveness and that accountability measures are in place. Examples of state enacted legislation from 2008-2014.

In 2010 a new federal maternal, infant and early childhood home visiting initiative was created by the Patient Protection and Affordable Care Act (H.R. 3590 and H.R. 4872). The law appropriated $1.5 billion over five years (from FYs 2010-2014) to establish this program, which is administered by the Health Resources and Services Administration (HRSA), in collaboration with the Administration for Children and Families (ACF).

The MIECHV program is intended to result in a system that coordinates and improves existing home programs as well as expands home visiting services to at-risk communities where existing services are currently limited, as well as to embed home visiting into a states larger early childhood system.

The legislation emphasizes evidence-based home visiting models, fourteen of which meet specified federal criteria, with 75 percent of the federal funding directed to such programs. It entails a strong accountability component requiring the achievement of identified benchmarks and outcomes. The MIECHV program is meant to facilitate collaboration at the federal, state and community level as a strategy for strengthening families and providing a cost savings to the state. Because the legislation requires program to be research-based there is a high level of accountability. Programs are being measured and evaluated at the state level to ensure that the programs are being implemented and operated effectively, achieving desired outcomes.

The first funding opportunity announcement was released in June 2010 and required states to submit a plan to complete a statewide needs assessment and a plan to develop a state home visiting program. Forty-seven states and D.C. have claimed federal formula funding that ranges from $1 million to $11.5 million per year (Florida, North Dakota and Wyoming have chosen not to participate.) Thirty-two states have also received additional competitive grant funding. (View examples of state-by-state funding.)

Federal Requirements: Elements of MIECHV

  • States were required to conduct a needs assessment and target services to at-risk families.
  • Funds had to be used to support programs with proven effectiveness. Seventy-five percent (75%) of MIECHV program funds had to be used for evidence-based home visiting models and no more than 25% for promising practice models. To date, the Department of Health and Human Services has identified fourteen programs that meet the evidentiary level of effectiveness.
  • States must show improvement in specified benchmark areas:
    • Improvements in maternal and newborn health;
    • Childhood injury or maltreatment prevention and reduced emergency room visits;
    • School readiness and achievement;
    • Crime or domestic violence;
    • Family self-sufficiency; and  
    • Coordination with community resources and support.

Policy Considerations for State Lawmakers:

  • Determine how different sources of funding can be leveraged to sustain and improve the quality of states’ existing home visiting systems.
  • Develop legislation to ensure the state is investing in research-based home visiting models that demonstrate effectiveness.
  • Require that accountability measures are in place and reporting happens at the legislative and executive level.
  • Require coordination across state agencies and program that serve young children including coordination of data collection.
  • Since the passage of the MIECHV program there has been a lot of activity in state around home visiting. View examples of state enacted legislation from 2008-2014.

NCSLResources

Home Visiting: Improving Outcomes for Children (coming soon)

Home Visiting Enacted Legislation in States (2008-2014)

State Home Visiting Programs Video

Early Childhood Overview - NCSL webpage

In June 2012, NCSL held the "Investing in Families Through State Home Visiting Programs" meeting in Hartford, Connecticut. The meeting provided an overview of the Child FIRST home visiting program in Connecticut, an overall picture of the home visiting system in Connecticut, an update of home visiting as it relates to the federal budget and the Patient Protection and Affordable Care Act, and information about legislative policy options related to home visiting data, infrastructure and funding issues. 

Additional Resources

For the latest information on MIECHV grantees please click on the links below:

Affordable Care Act: Maternal, Infant, and Early Childhood Home Visiting Program - Health Resources and Services Administration webpage

Home Visiting Evidence of Effectiveness - U.S. Department of Health and Human Services webpage

Maternal, Infant, and Early Childhood Home Visiting Program - Maternal and Child Health Bureau Webcast, June 17, 2010

Pew Inventory of State Home Visiting Programs

A Compendium of Local Health Department Home Visitation Program Case Studies - National Association of County and City Health Officials, August 2010


For more information contact Robyn Lipkowitz at robyn.lipkowitz@ncsl.org or 303-856-1420. 

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