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Home Visiting in Texas
Rebecca Pack Ph.D., RN, MN,Health and Human Services Commission
Office of Health Coordination & Consumer Services
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Early Childhood Matters
Significant Adversity
Supportive Relationships, Stimulating Experiences, and Health-Promoting Environments
Healthy Developmental Trajectory
Impaired Health and Development
Early Stress and Adversity Matters
New Protective Interventions
Building an Enhanced Theory of Change that Balances Enrichment and Protection
Significant Adversity
Healthy Developmental Trajectory
Supportive Relationships, Stimulating Experiences, and Health-Promoting Environments
What is Home Visiting?
Voluntary
No cost to clients
Trained professionals
Prenatal - 5 years of age
Positive parenting practices
Support
Resources
Most important: Not a one size fits all!
Expected Outcomes
• Maternal and newborn health
• School readiness and achievement
• Family economic self-sufficiency
• Coordination and referrals
• Child injury, maltreatment, and ER use
• Domestic violence
• Decreased use of criminal justice system
• Decreased costs to communities over time
TNFP • Authorized by SB
156, 80th Legislature, Regular Session, 2007
• Current funding: $8.7 million/yr
MIECHV • State-funded
through a grant received by HHSC under the Affordable Care Act 2011
• Current funding: $48 million
SB 426• Establishes the
Texas Home Visiting Program
• To serve at-risk pregnant women and families with children under the age of six through home visiting program that improve outcomes for parents and families
HHSC Texas Home Visiting Programs
What is Nurse-Family Partnership?
Nurse-Family Partnership is:
An evidence-based, nurse home visiting program
Transforms the lives of vulnerable first- time mothers living in poverty
Improves prenatal care, quality of parenting and life prospects for mothers and their infant by partnering them with a registered nurse
Texas Nurse-Family Partnership
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“There is a magic window during pregnancy…it’s a time when the desire to be a good mother and raise a healthy, happy child creates motivation to overcome incredible obstacles including poverty, instability or abuse with the help of a well-trained nurse.”
David Olds, PhD, Founder, Nurse-Family Partnership
Program Goals• Improve pregnancy
outcomes• Improve child
health and development
• Improve parents’ economic self-sufficiency
• Reduce incidence of child abuse and neglect
Key Program Components
• First-time, at-risk mothers
• Registered nurses• Intensive services
(intensity, duration)
• Focus on behavior• Program fidelity
• Knowledge, judgment and skills
• High level of trust, low stigma
• Credibility and perceived authority
• Nursing theory and practice at core of original model
Overview
Why Nurses?
Eligibility Criteria
Client participates voluntarily in the Nurse-Family Partnership program.
Client is a first-time mother. Client meets low-income criteria at intake. (185% Federal Poverty Level) Client is enrolled in the program early in her pregnancy and receives her first home visit by no later than the end of the 28th week of pregnancy.
Client is a Texas resident.
18 TNFP sites serving 28 counties - capacity to serve 2,650 clients
• 13 sites GR funded implementing the TNFP program – total
funding : $ 8.75 million/year Lubbock, Dallas, Tarrant County, Port Arthur, Houston, El Paso, Austin, San Antonio, City of Laredo)
• 5 Federally funded sites - total cost: $3.12 million/year(Amarillo, Longview, Odessa, Corpus Christi, Edinburg)
• MIECHV Expansion – two new NFP sites, Wichita Falls, San Antonio with a capacity to serve an additional 225 families.
TNFP Programs located in all Texas Department of Health Public Health Regions
Current Status of TNFP
Texas NFP
Total number of clients served in Texas between September 1, 2008 and February 1, 2104: >6500
Total number of TNFP graduates as of February 1, 2104: > 1300
Maternal, Infant, and Early Childhood Home Visiting Program
Legislative Purposes
To strengthen and improve programs carried out under Title V
To improve coordination of services to communities; and
To identify and provide comprehensive services to improve outcomes for families
MIECHV
Texas Home Visiting
Vision:- All Texas
children will reach their full potential in nurturing family and community environments
THV program Key Elements
Early childhood comprehensive system within communities
Home visiting program
Matching/Intake and Referral System
Increased awareness of father engagement
Local training to develop a well-trained HV workforce
Continuous quality improvement
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Data Collection
& EDI
Outreach & Matching System
Community Coalition Building
ECCS/TECCS
Home Visiting Programs
HIPPY, NFP, PAT, EHS
By the numbers..
Capacity to serve over 2,700 families a year 31 home visiting sites
11 communities (Potter, Ector, Gregg, Dallas, Cherokee, Nueces, Wichita, Bexar counties)
4 program models
1 Vision
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Home Visiting – A Good Policy Decision
