Prevention: NY Legislature Moves to Restore Home Visiting Funds

Last month, we were dismayed to learn that the Governor's proposed budget stripped funding for home visiting programs. Link

This month, we are delighted to learn that the Legislature intends to keep that funding in their budget bills.

Now, the challenge is to educate the Governor about the salutary benefit of home visiting services on the bottom line, and the consequences when those services are lost.

Prevent Child Abuse NY reports, and provides this sample letter. You can help by using this convenient PCANY site - Link:

I have good news! Both the Senate and Assembly restored funding to Healthy Families New York (HFNY) and other home visiting programs. We applaud the Legislature's commitment to New York's most effective prevention programs. And we thank you. This victory couldn't have been possible without the hundreds of emails, letters and phone calls from child abuse prevention advocates around the state.

Our work is not over.

Our next task is to ensure the Governor supports the legislative budget proposal. We can't do this without you.

Please email this letter asking the Governor to restore funding for Healthy Families New York.

You can also mail a letter. Below is a sample that you can copy, paste and edit.

The Honorable Andrew Cuomo
Governor of New York State
NYS State Capitol Building
Albany, NY 12224

Dear Governor Cuomo:

I am writing to urge you to fully restore funding for Healthy Families New York and other home visiting programs. Home visiting prevents child abuse, increases school readiness, and saves the state millions of dollars in Medicaid because it prevents low-weight births that require costly medical services.

As you know, vulnerable families that go unserved in the earliest years often need costly remediation services later on. Home visiting helps provide better outcomes for children and families. Full funding for Healthy Families New York will also allow New York to draw down millions in federal home visiting dollars to expand and strengthen our system.

Please restore funding for these critical programs.

Thank you.
Sincerely,
[Your Name]

It is critically important that Governor Cuomo hear from all corners of the state that HFNY and other home visiting programs prevent child abuse, increase school readiness, and save the state millions in Medicaid costs.

Please contact the Governor today.

Thank you.

Christine Deyss
Executive Director

Silo Hopping: Doris Duke, Child Abuse Prevention, Pew Trust, Home Visiting

Let's do a bit of silo hopping today...

The Doris Duke Charitable Foundation does quite a bit of child abuse prevention funding.

For example, they helped fund the special Future of Children issue on Preventing Child Maltreatment. They also helped the Urban Institute look at ways to improve services to new parents with depression.

And they help give policy perspectives. For example, Dr. Jack Shonkoff laid out the long term public health consequences of child abuse in his presentation at the CDC webinar on Child Maltreatment Prevention as a Public Health Priority.

In concert with the Pew Trust, DDCF has began to look at the advantages brought by home visiting programs, including reductions in child abuse. For example, the U.S. Triple P System Population Trial found lower rates of substantiated abuse cases, child out-of-home placements, and reductions in hospitalizations and emergency room visits [Medicaid cost cutting, anyone?] for child injuries in nine study counties in South Carolina where parenting interventions were implemented.

The need to identify and disseminate effective home visiting programs has gained speed now that significant federal funding is available. Link to webinar on Federal Home Visiting Funding.

Resources on home visiting:

Pew Trust issue brief that overviews the issues and makes the case for home visiting.

Pew Trust Campaign for Home Visiting

Pew Trust National Summit on Home Visiting

National Summit on Quality in Home Visiting Programs, an interactive forum for home visiting researchers, program leaders, and policy makers concerned about improving home visiting system quality and family outcomes.
Feb. 16-17, 2011
Omni Shoreham Hotel, Washington, D.C

Press release about the Summit.

Pew Trust National Overview on Home Visiting in the States

The Pew Center on the States surveyed state agency leaders in all 50 states and the District of Columbia and inventoried their state home visiting programs, models, funding and polices for fiscal year 2009-2010. The following findings emerged:

State home visiting programs: 46 states and the District of Columbia have some level of investment in home visiting;
Funding strategies: states made available $1.36 billion to home visiting programs via two primary funding strategies: categorical funds for home visiting only; and broad-based prevention funds that could be used for home visiting (although most states could not verify whether or how much funding was directed for this purpose);
Sources of state support: state general funds were the largest source of support for home visiting programs; and
Investment in national home visiting models: 34 states invested $277 million in national home visiting models.

Interview: how home visiting helps reduce child abuse...

Links to Home Visiting Programs

Nurse-Family Partnership
Nurse-Family Partnership® (NFP) helps change the lives of vulnerable first-time moms and their babies through ongoing home visits from registered nurses. This evidence-based community health program has proven results including long-term family improvements in health, education and economic self-sufficiency.

Triple P-Positive Parenting Program®
The Triple P-Positive Parenting Program® is a multi-level, parenting and family support strategy. Triple P aims to prevent behavioral, emotional and developmental problems in children by enhancing the knowledge, skills and confidence of parents (from the Triple-P website)

Legislative Alert: Home Visiting Services

In August, the Child Welfare League of America sent an email reminder about home visiting services.

It's still timely: action you can take to ensure your legislators are aware of the importance of providing new parents with home visiting services (Congress should be returning home at the end of October). Link to CWLA resources on home visiting...

Home visiting provides opportunity - not an obligation - for parents to learn more about raising children and keeping them safe...(and here's a link to take CWLA's survey about prevention initiatives: so far, "prevention of child abuse and neglect was ranked by 16% of respondents as the number one priority...ahead of other critical areas such as strengthening child protective services (14%) and youth transitioning out of foster care (11%)...CWLA is going to use these survey findings to gather more information on each of the critical issues.")

Home visiting provisions have been included in health reform legislation. While your U.S. Senators and Representative are back in your state and district...tell them to keep home visiting in the final health reform package!

Before making your call, review CWLA's one pager explaining why home visiting is important! See http://www.cwla.org/advocacy/HomeVisitingisImportant.pdf

ACTION REQUIRED

Call your U.S. Senators and Representative and tell them to support home visiting in health reform legislation. The toll-free number to be connected to your lawmakers' offices is 1-800-828-0498

Support comprehensive health reform legislation!

Support the home visiting amendments that will reduce child maltreatment and save on unnecessary healthcare costs down the road.

BACKGROUND

The U.S. House and Senate are debating comprehensive health reform legislation. This legislation is too important to be trampled by partisan politics. The home visiting elements that are in the current health reform legislation refer to evidence based models that deliver parent education and family support to parents with young children.

Home visitation is an effective, research-based and cost-efficient way to bridge the gap between vulnerable families and the resources that will ensure that children grow up healthy and ready to learn.

There are many families who are in need of the prenatal and maternal health services that these home visits can provide.

Children who experience maltreatment are at a greater risk of adverse health effects and home visiting not only educates parents, but also provides access to mental health, educational, and social services that might be available in the community.

For more information on current home visiting legislation, check out http://www.cwla.org/advocacy/homevisitation.htm

A Joint Vision for Home Visiting

Five programs* that have developed nationally-recognized home visiting programs have expressed their shared vision for home visiting services.

It's encouraging to see their shared vision includes collaboration on advocacy:

Prevention services in general are underfunded and a low priority on our nation’s domestic policy agenda. The complexity and volume of need among families and young children in this nation far exceeds the capacity of any one of our programs. Therefore, we will work together to advocate for a greater investment in effective prevention programs for children and families.

Home visitation is a service delivery strategy that is essential to better support our country’s youngest children. We are unified in our view that building relationships with parents and children in their home environments is a uniquely valuable approach to nurturing parental competence and successful early childhood development. Together, we intend to make this type of service delivery practice more broadly accepted and a welcome and trusted approach in family development.

Helping society understand the value - the return on the social investment - created when these opportunities are available to new parents is essential to making the "resource pie" larger for all of these programs. It's even more important in these difficult economic times...

Resources

* Healthy Families America, Home Instruction for Parents of Preschool Youngsters, Nurse-Family Partnership, Parents as Teachers, and The Parent-Child Home Program

RAND - The Economics of Early Childhood Policy: What the Dismal Science Has to Say
The fundamental insight of economics when comparing early childhood policies with other social investments is that a growing body of program evaluations ...
www.rand.org/pubs/occasional_papers/2008/RAND_OP227.pdf

National Home Visiting Services Shared Vision Statement
http://www.parentsasteachers.org/atf/cf/{00812ECA-A71B-4C2C-8FF3-8F16A5742EEA}/HV%20Shared%20Vision%20Statement.pdf

A Curriculum on Social Investment and Human Resources
http://salises.uwimona.edu.jm:1104/sa63f/Course%20Outline_63F.pdf

Heckman (Science, 2006) Skills Formation and the Economics of Investing in Disadvantaged Children
http://www.brainwave.org.nz/wp-content/uploads/2007/03/valuing_prevention.pdf

Minneapolis Federal Reserve Bank (2003)- "The Economics of Early Childhood Development: Lessons for Economic Policy"
http://www.minneapolisfed.org/publications_papers/pub_display.cfm?id=3351

RAND find Parents as Teachers Promising Practice

Courtesy of the MCH Listserv, which publishes a useful weekly alert

RAND'S Promising Practices Network Features Parent Education Program

The Parents as Teachers (PAT) program provides parents with child development information and parenting support.

RAND's Promising Practice Network (PPN) on Children, Families and Communities recently recognized it as a "program that works." PAT is a four-part intervention model in which trained and certified parent educators offer support to children and their families from pregnancy until the child is 5 years old.

Program services include home visits; child health, hearing, vision, anddevelopmental screenings; parent group meetings; and a resource network that links families with needed community resources. Studies have shown that PAT has proven effects on the number of infants born weighing 5.5 lbs or more as well as on young children's cognitive and physical development.

The PPN Web site contains a program overview as well as information on program
participants, evaluation methods, key evaluation findings, probable implementers, funding, implementation detail, and issues to consider.

Example sites, contact information, a list of resources, and a bibliography are also available at http://www.promisingpractices.net/program.asp?programid=88&ref=ppntext.

Resources

Parents as Teachers

Promising Practices Network

MCH Alert Newsletter
a weekly electronic newsletter that provides timely reference to research, findings, policy developments, publications, programs, and initiatives affecting the MCH community

The New York Times discussed the prospects (somehow that word doesn't seem appropriate in this context) for Medicaid cuts in New York. Actually, they're coming, in New York and most other states. It might be more appropriate to say the article gives a view into the abyss.

The relevance to prevention? Hospitals do wonderful things, and aren't just bricks and mortar edifices, but they constitute a significant investment in physical and organizational structure. Eliminating the clutter of inefficient and unnecessary things on hand is always hard than reducing spending on prevention.

It's also harder when organized constituencies are involved. Hospital unions will have a say in employee cuts. And, as noted in the article, a lot of Medicaid costs result from long term care for the elderly.

Those on the losing side are likely to be women and children, who make up the bulk of the Medicaid population, but don't require the same level of services. Unfortunately, if we cut primary care and prevention services, we cut the opportunities to ensure things stay that way.

Simple education for parents can save a significant portion of Medicaid dollars now being spent by parents who bring children to emergency departments. Similar results resulted in West Virginia (see fn 14)

New York State spends more on Medicaid than any other state, $2,283 per capita per year, twice the national average of $1,026, a state Health Department spokeswoman said.

Dr. Richard F. Daines, the state health commissioner, said the new budget would lay out a plan to pay more to primary care and clinic doctors, while shifting that money away from hospitals, which in theory would see fewer patients because of better preventive care.

At the health forum, Mr. Baker said, “It’s not about curtailing generosity, it’s about whether or not we’re getting real value for the money that we’re spending.”

Hospital executives say that they are not opposed to making that shift, but that cutting Medicaid is counterproductive if the goal is to promote primary care.

“There is a fundamental dilemma or contradiction here on the state level between their stated health care policy reform agenda, which is all about robust primary and preventive care and better disease management, and the inevitable outcome of these cuts,” Alan D. Aviles, president of the city’s Health and Hospitals Corporation, said. The corporation runs the city’s 11 public hospitals, which get about 65 percent of their income from Medicaid.

“I don’t know whether the executive proposal will find a way to balance those problems, or whether the deficit will be so overwhelming it’s going to trump everything else and it’s only going to be about cost-cutting,” Mr. Aviles said.

Resource: Education Begins At Home 2008 House Hearing

Worth reading - the House Committe on Education and Labor, chaired by Rep. George Miller, held a hearing on the Education Begins At Home Act.

The House report reviews the evidence and finds good reason to support home visiting services.

Research shows that these programs, which provide a variety of services ranging from pre-natal medical care to school readiness and family literacy programs, can help improve student achievement, reduce child abuse rates, improve early identification of developmental delays and disabilities, and improve access to health services.

What's not to like?

Funding won't be available until 2010 and, in a time when the President-elect is proposing to establish a Chief Technology Office for the federal government, there is absolutely no mention of using social media to effectively and efficiently reach new parents.

And while the SBS Prevention Act would provide $20 million for hospital based prevention education ($5 per birth), the EBAH was amended to reduce the funding for hospital based education to $1 million - for a broader hospital based education program.

Hospital based education is accessible to almost everyone, not just those states and regions that are fortunate enough to have a good home visiting program in place (and EBAH will only fund organizations in place for three years, which leaves some doubt as to how it will benefit states and communities without programs).

Perhaps we can persuade Congress to fund education now as an economic stimulus initiative: say $20 per birth for education about SIDS, SBS and colic. It might help hospitals offset, just a tiny bit, the coming wave of Medicaid cuts.

And reduce by 50% the amount of unreimbursed money that hospitals spend to treat the consequences of inflicted head injuries...

I wonder if the American Hospital Association has a blog search running....

Summer reading, part III - Prevent Child Abuse America makes it easy to support the Education Begins At Home Act.

April 1, 2007

Preventing harm requires two things: knowing what NOT TO do, and knowing what TO do -the "do's" and the "don'ts".

Hospital education about SBS does the first. There is clear evidence that home visiting programs do the second [including this recent RAND report]. This legislation will help expand home visiting programs.

From PCAA's Prevention Advocate

Take Action on the Senate Home Visitation Legislation
Ask Your Senators to Cosponsor S. 667

Please ask your Senators to cosponsor the Education Begins at Home Act (EBAH, S. 667), recently reintroduced in the Senate by Senators Kit Bond (R-MO) and Hillary Clinton (D-NY). EBAH would establish the first dedicated federal funding stream to support parents with newborns and young children through quality, voluntary home visitation. If enacted, EBAH would extend to a broad range of families the opportunity to benefit from home visiting programs like Healthy Families America. Making quality home visitation programs more widely available in all communities is one of Prevent Child Abuse America’s top priorities.
As of March 27th, the following Senators have already joined Senators Bond and Clinton as cosponsors to S. 667: Senators Jeff Bingaman (D-NM), Benjamin Cardin (D-MD), Susan Collins (R-ME), John Kerry (D-MA), Claire McCaskill (D-MO), Pat Roberts (R-KS) and John Rockefeller (D-WV). If your Senator is on this list, please be sure to thank him/her.

TAKE ACTION NOW

Why Congress Should Pass EBAH:

Home visitation is an effective, evidence-based, and cost-efficient way to bring families and resources together and help families to make choices that will give their children the chance to grow up healthy and ready to learn.
Home visitation delivers parent education and family support directly to parents with young children in their homes providing guidance on how parents can enhance their children’s development from birth through kindergarten entry.
Quality early childhood home visitation programs lead to proven, positive outcomes for children and families, including improved child health and development, improved parenting practices, improved school readiness, and reductions in child abuse and neglect.
Existing home visitation programs like Healthy Families America serve only a small percentage of families in need of prevention and family support services. EBAH dollars would enable programs to reach thousands more families who have very young children -- the same cohort of children that suffers disproportionately from abuse and neglect in this country.
Take Action on EBAH!
Take action by e-mailing your Senators through Prevent Child Abuse America’s Legislative Action Center. Prevent Child Abuse America has created a sample e-mail asking Senators to cosponsor EBAH that we encourage you to personalize. All Senators can (and should) be asked to cosponsor the EBAH. Support from the Senate Health, Education, Labor and Pensions (HELP) Committee is crucial, however, because it has jurisdiction over the legislation and can move EBAH forward.

Democrats
Edward M. Kennedy (MA), Chair
Christopher J. Dodd (CT)
Tom Harkin (IA)
Barbara A. Mikulski (MD)
Jeff Bingaman (NM)
Patty Murray (WA)
Jack Reed (RI)
Hillary Rodham Clinton (NY)
Barack Obama (IL)
Sherrod Brown (OH)

Independent
Bernard Sanders (VT)

Republicans
Michael B. Enzi (WY), Ranking Member
Judd Gregg (NH)
Lamar Alexander (TN)
Richard Burr (NC)
Johnny Isakson (GA)
Lisa Murkowski (AK)
Orrin G. Hatch (UT)
Pat Roberts (KS)
Wayne Allard (CO)
Tom Coburn