Affordable Care Act Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) and Tribal MIECHV
On March 23, 2010, the President signed into law the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act of 2010) (P.L. 111-148) (see pages 216-225). It amends Title V of the Social Security Act to authorize the creation of the Maternal, Infant, and Early Childhood Home Visiting program (MIECHV), which allows collaboration and partnership at the federal, state, tribal, and community levels to improve health and development outcomes for at-risk children through evidence-based home visiting programs.
The MIECHV program is administered by the Health Resources and Services Administration (HRSA) in cooperation with ACF. HRSA’s Maternal and Child Health Bureau administers the State MIECHV program which includes grants to states and six jurisdictions to develop statewide home visiting programs. ACF administers the Tribal MIECHV program, which provides grants to Tribes, Tribal Organizations, and Urban Indian Organizations to develop home visiting programs in native communities.
The MIECHV program is designed to (1) strengthen and improve the programs and activities carried out under Title V of the Social Security Act; (2) improve coordination of services for at-risk communities; and (3) identify and provide comprehensive services to improve outcomes for families who reside in at-risk communities.
The program is administered by the Health Resources and Services Administration (HRSA) in collaboration with the Administration for Children and Families (ACF) both agencies of the U. S. Department of Health and Human Services (HHS). In addition to awarding funds to states/territories and tribes, HRSA and ACF are administering several other MIECHV activities to support the MIECHV program and grantees.
What is Home Visiting?
Home visiting, under MIECHV, is a primary service delivery strategy (excluding programs with infrequent or supplemental home visiting). It is offered on a voluntary basis to pregnant women, expectant fathers, or parents and primary caregivers of children, birth to kindergarten entry. Home visits target one or more of the benchmark and participant outcomes in the ACA legislation, including:
- Improved in maternal, infant, and child health;
- prevention of child injuries, child abuse, or maltreatment, and reduction of emergency department visits;
- improvement in school readiness and child academic achievement;
- improvement in parenting skills;
- reduction in crime or domestic violence;
- improvements in family economic self-sufficiency; and
- improvements in the coordination and referrals for other community resources and supports.
The MIECHV program is one of several service strategies embedded in a complete, high quality early childhood system that promotes maternal, infant, and early childhood health and development that relies on the best available research evidence to inform and guide practice.
Tribal Home Visiting
ACF administers the Tribal MIECHV program through the Office of Child Care. The Tribal MIECHV program consists of cooperative agreements (grants) to Tribes, Tribal Organizations and Urban Indian Organizations.
In addition to these grants, ACF funds the Tribal Early Childhood Research Center (TRC) and two technical assistance providers, the Tribal Evaluation Institute (TEI), which provides technical assistance to Tribal MIECHV grantees on benchmarks, evaluation, data systems, and continuous quality improvement, and the Tribal Home Visiting Technical Assistance Center (Tribal Home VisTA), which provides programmatic technical assistance to Tribal MIECHV grantees.
Tribal MIECHV Program Goals
The Tribal MIECHV program mirrors the state program to the greatest extent possible, with goals of:
- Supporting the development of happy, healthy, and successful American Indian and Alaska Native (AIAN) children and families through a coordinated home visiting strategy that addresses critical maternal and child health, development, early learning, family support, and child abuse and neglect prevention needs;
- Implementing high-quality, culturally-relevant, evidence-based home visiting programs in AIAN communities;
- Expanding the evidence base around home visiting interventions with Native populations; and
- Supporting and strengthening cooperation and coordination and promoting linkages among various programs that serve pregnant women, expectant fathers, young children, and families, resulting in coordinated, comprehensive early childhood systems in grantee communities.
Home Visiting Providers
Through the home visiting program, nurses, social workers, or other trained home visitors meet with at-risk families in their homes, evaluate the families’ circumstances, and connect families to the type of assistance that can make a real difference in a child’s health, development, and ability to learn - such as health care, developmental services for children, early education, parenting skills, child abuse prevention, and nutrition education or assistance.
Evidence-Based Policy Initiative
MIECHV is an evidence-based policy initiative and the authorizing legislation requires that at least 75 percent of grant funds to State MIECHV grantees be spent evidence-based home visiting models. Additionally, up to 25 percent may be spent on promising approaches that must be rigorously evaluated.
Participating states are required to use evidence-based home visiting models. MIECHV provides an exciting opportunity for states and the federal government to work together to set up programs and build upon the existing evidence base. The program allows for continued experimentation with new models and adaptations with evaluation of both new and existing approaches.
In support of MIECHV, the Department of Health and Human Services launched Home Visiting Evidence of Effectiveness (HomVEE) to conduct a thorough and transparent review of the home visiting research literature and provide an assessment of the evidence of effectiveness for home visiting program models that target families with pregnant women and children from birth to age five.
HHS has established criteria for determination of evidenced based home visiting models for the purposes of the MIECHV program. Any state or model developer may request a review by HomVEE to be deemed an evidence-based model. The HomVEE results, including the list of models that are deemed to be evidence-based, can be found at http://homvee.acf.hhs.gov.