NOVEMBER 2020 - TexProtects · 2020. 11. 10. · AVANCE Partnership Nurse-Family (NFP) Early Head Start Home Base Nurturing Parenting. H. ealthy Families America (HFA) Home Instructions

This is the fourth release of TexProtects' Home Visiting in Texas report. In it, we overview the landscape of home visiting, including history, families and communities served, funding, return on investment and demonstrated outcomes, and program descriptions. We hope it will serve as a useful resource for those new to home visiting and advocates in need of tools to communicate about its footprint and impact.

HOME VISITING Home visiting is a prevention strategy used to support pregnant moms and new families to promote maternal and child health, foster school readiness, and prevent child abuse and neglect. Home visiting programs take a two-generational approach to decrease risk and increase protective factors to support caregivers and their children.

Recognizing parents as their child's first and often best teachers is the foundation of home visiting. Decades of research in neurobiology has made clear the importance of children's early experiences and the opportunities inherent in the first years. The quality of these early experiences shapes brain development, which impacts future biology, behavior, and health across the lifespan. This research points to the value of ensuring access to safe, stable, nurturing caregiving during the early years.

Home visiting is a vehicle to connect parents and their young children to resources to protect children and foster child development by ensuring families have support when needed.

HOME VISITING IN TEXAS 4.0 NOVEMBER 2020

CORE COMPONENTS OF HOME VISITING

Numerous home visiting programs operate in Texas

and around the country. While differences exist in the approach and intended

population for each model, the following principles are

consistent.

Services are voluntary and flexible; Services engage the caregiver and child together; Services are for families with children under age 6; Services are most often delivered in the home; and Services are delivered by trained professionals – these may include registered nurses, social workers, early childhood specialists, or certified paraprofessionals.

Assess for developmental

delays

Provide child development

information and early learning

activities

Facilitate group connections and social support

Offer referrals to community

services if needed

Coach on positive parenting practices

Improved coordination and referrals for

community resources

Improved maternal and newborn

health

Reduced child injuries, abuse, and neglect

Improved school readiness and achievement

Reduced crime or domestic violence

Many families are stressed and strained during a child's critical years of development.

For families who choose home visiting, a knock on the door and the support and

coaching of their home visitor can empower them to be stronger and safer despite

challenges.

HOME VISITING SUPPORTS FAMILIES SO THAT THEY CAN GIVE THEIR

CHILDREN A STRONG START

Improved family economic self-sufficiency

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For every $1 invested in home visiting programs, there is a return between $1.80 and $8.08.

Home visiting saves dollars and makes sense. Investments in home visiting programs demonstrate positive impacts and cost savings across two generations and multiple domains. The following outcomes have been demonstrated by one or more evidence-based home visiting programs.

IMPROVED MATERNAL AND NEWBORN HEALTH 18% Reduction in premature delivery 69% Reduction in infant deaths 50% Reduction in low birth weight babies 36% Fewer subsequent teen births

IMPROVED SCHOOL READINESS AND ACHIEVEMENT 45% Reduction in language delays at 21 months

IMPROVED FAMILY ECONOMIC SELF-SUFFICIENCY 83% Increase in mom's labor force (child age 4)

20% Reduction in months on welfare

REDUCED CHILD INJURIES, ABUSE, AND NEGLECT 35-45% Reduction in ER visits28-48% Reduction in child abuse and neglect

REDUCED CRIME OR DOMESTIC VIOLENCE

53% Reduction in child arrests at age 17

IMPROVED COORDINATION AND REFERRALS FOR COMMUNITY RESOURCES

44% Reduction in out-of-home placements

HOME VISITING RETURN-ON-INVESTMENT AND OUTCOMES

1

2

3

4

5

6

1,906,057412,60915,613

In Texas, evidence-based home visiting is administered across several initiatives by thePrevention and Early Intervention Department at (PEI), Department of Family andProtective Services (DFPS), including Project Healthy Outcomes for Prevention andSupport (HOPES), Texas Home Visiting (THV), and Texas Nurse-Family Partnership (TNFP).

LIMITED ACCESS TO HOME VISITINGPROGRAMS IN TEXAS

In 2018, 45 counties had one or

more home visiting programs

available; however, 209 counties

had none.

ONLY 3.8% OF THOSE MOST LIKELY TO BENEFIT FROM HOME VISITING CURRENTLY HAVE ACCESS.

Number of families with three or more risk factors and are most likely to benefit fromhome visiting.

Number of families in Texas with a child under age 6 who could be served by homeVisiting.

Number of families that currently benefit from home visiting.

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AGE OF CHILDREN SERVED PRIMARY LANGUAGE 50%

60%

40%

30%

20%

40%

20%

10%

0%

Age <1 Age 1-2 Age 3-5

0% English Spanish Other

70% HISPANIC OR LATINO INSURANCE COVERAGE RACE EDUCATION LEVEL

None Multiple 4%

Black 14%

Private 10%

No High School Diploma

43%

57%

White 79.2%

Source: National Home visiting Resource Center. (2019). 2019 Home visiting Yearbook. Arlington, VA: James Bell Associates and the Urban Institute.

15,613 F S AMILIE C HILDRE

15,918 N

SERVED SERVED 212,878

HOME VISITS

HOME VISITING FOOTPRINT IN TEXAS

19%

Public 71%

HOME VISITING FUNDING

Federal and State funding flows through the Prevention and Early Intervention Division,which works like a grant-making entity to 162 local contractors around the state whodeliver prevention services in their communities. 69 of those local contractors are offeringhome visiting programming to parents with children under age 6.

FEDERAL AND STATE FUNDS FLOW TOCOMMUNITY PROVIDERS

STATE GR

(ARTICLE 2

STRATEGY C.1.4

AND C.1.5)

FEDERAL

MIECHV

FEDERAL

TANF

FEDERAL

CHILD ABUSE

PREVENTION

GRANTS

DEPARTMENT OF

FAMILY AND

PROTECTIVE

SERVICES

TEXAS

NURSE FAMILY

PARTNERSHIP

PROJECT

HOPES

TEXAS

HOME VISITINGPROJECT HIP

PREVENTION AND

EARLY

INTERVENTION

DIVISION

Only 5% of the DFPSbudget is spent onpreventing abuse andneglect. 87% is spent on ChildProtective Services.

CHILD

PROTECTIVE

SERVICES

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(69) Local Contractors

CPS

$1, 909, 473, 727

87% PEI$107,089, 243

5%

TEXAS SPENDS MORE ON CHILD PROTECTIVE SERVICES THAN ONPREVENTING ABUSE AND NEGLECT.

Only 5% of the DFPS budget is spent on preventing abuseand neglect. 87% is spent on Child Protective Services.

Growth in CPS spending has far outpaced growth inprevention spending.

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DFPS 2021 Budget

STATE AND FEDERAL FUNDING FOR HOME VISITING

Funding for home visiting in Texas is included in strategies C.1.4 and C.1.5 in the DFPSBudget which is part of Article 2. These strategies fund Texas Nurse FamilyPartnership, Texas Home Visiting, and Other At Risk Prevention Programs. ProjectHOPES and Project HIP are included in Other At Risk Prevention Programs.

Federal dollars through MIECHV have provided critical funding for home visiting hereand around the country; however, the majority of home visiting growth in Texas hasresulted from innovative investments of state general revenue dollars.

Despite increased spending on CPS, neither the number of child abuse/neglect reportsnor the number of confirmed victims has decreased significantly.

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According to Section 265.004 of the Texas Family Code, PEI must expend no less than 75% of the funds appropriated for parenting education on evidence-based programs. The remaining dollars should be spent on promising practice programs.

An evidence-based program is a parenting education program that: 1. Is research-based and grounded in relevant, empirical knowledge and program-

determining outcomes;2. Has comprehensive standards ensuring the highest quality service delivery with

continuous improvement in the quality of service delivery;3. Has demonstrated significant positive short-term and long-term outcomes;4. Has been evaluated by at least one rigorous, random, controlled research trial across

heterogeneous populations or communities with research results that have beenpublished in a peer-reviewed journal;

5. Substantially complies with a program manual or design that specifies the purpose,outcomes, duration, and frequency of the program services; and

6. Employs well-trained and competent staff and provides continual relevantprofessional development opportunities to the staff.

The evidence-based programs operating in Texas are included below. Click on any program to learn more about it.

AVANCE Nurse-Family Partnership

(NFP)

Early Head Start

Home Base

Nurturing Parenting

Healthy Families America (HFA)

Home Instructions of Parents of Preschool Youngsters (HiPPY)

Parents as Teachers (PAT)

SafeCare

Family Connects

Incredible Years

Systematic Training for Effective Parenting (STEP)

Triple P

EVIDENCE-BASED MODELS OF HOME VISITING IN TEXAS

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The Healthy Outcomes for Prevention and Support (HOPES) program is intended to address child abuse and neglect prevention by focusing on community collaboration in high-risk counties and by increasing protective factors of families served. In designing HOPES, PEI sought to identify communities of greatest risk for child maltreatment to target prevention funding to show the greatest impact. Thirty-three Texas counties were identified based on their rates of domestic violence, substance abuse, teen pregnancy, child poverty, and child abuse fatalities.

ORIGINS & FUNDING The 83rd Texas legislature increased funding for at-risk prevention programs for child abuse and neglect. With this increased funding, the first round of Project HOPES provided grants to eight Texas communities to address child abuse and neglect prevention.

ELIGIBILITY Families with children ages 0-5 years old who are considered at risk for abuse and neglect qualify for project HOPES.

CHARACTERISTICS OF FAMILIES SERVED 50% of caregivers indicate a concern for mental health; 32% of caregivers had four or more adverse childhood experiences, a measure of a person's history of childhood trauma; and 75% had two or more risk factors.

FOOTPRINT Currently, Project HOPES is available in 56 counties and is projected to serve 5,630 families in 2020. 5,630

PROGRAMS AVANCE, HiPPY, Family Connects, Incredible Years, Nurturing Parenting, Parents as Teachers, SafeCare, STEP, and Triple P

PREVENTION AND EARLY INTERVENTION (PEI) PROJECT HOPES

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Texas Nurse-Family Partnership (NFP) program is a voluntary, evidence-based program that helps transform the lives of vulnerable, first-time mothers and their babies through regular home visitation by specially trained registered nurses.

ORIGINS & FUNDING In 2007, the Texas Nurse-Family Partnership (TNFP) competitive grant program was established by SB 156 in the 80th Legislature. The Department of Family and Protective Services (DFPS) leverages funds from the TNFP competitive grant program to award grants to community-based organizations to implement and operate the Nurse-Family Partnership (NFP) programs.

Two state-supervised funds provide funding for TNFP sites: Temporary Assistance for Needy Families (TANF) Block Grant and Texas General Revenue.

ELIGIBILITY To enroll in the TNFP program, clients must the following eligibility requirements:

have no previous live births; have an income at or below 185% of the federal poverty level; be a Texas resident; be enrolled before the end of the 28th week of pregnancy, and agree to participate voluntarily

CHARACTERISTICS OF FAMILIES SERVED 99.6% of newly enrolled TNFP clients were first-time mothers; 99.2% met low-income criteria at intake; and 97.2% were enrolled before their 28th week of pregnancy.

FOOTPRINT Currently, the Texas Nurse-Family partnership is available in 22 counties and is projected to serve 2,800 families in 2020.

2,800

PROGRAMS Nurse-Family Partnership

PREVENTION AND EARLY INTERVENTION (PEI) TEXAS NURSE-FAMILY PARTNERSHIP

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4,172

Texas Home Visiting (THV) is a free, voluntary program through which early childhood and health professionals regularly visit the homes of at-risk pregnant women or families with children under age 6.

ORIGINS & FUNDING The Texas Home Visiting program was funded in 2012 by the Federal Maternal, Infant, and Early Childhood home visiting program (MIECHV) and Texas Senate Bill 426.

ELIGIBILITY This program is available for expecting parents, parents, and caregivers of pre-kindergarten children who need help getting school-ready, raising multiple children, and/or getting back together after being apart.

CHARACTERISTICS OF FAMILIES SERVED 61.2% of households were low income; 9.3% of households included pregnant teens; and 7.7% of households reported a history of child maltreatment.

FOOTPRINT Currently, Texas Home Visiting is available in 24 counties and is projected to serve 4,172 families in 2020.

PROGRAMS NFP, HiPPY, Parents as Teachers, Family Connects, and Healthy Families America.

PREVENTION AND EARLY INTERVENTION (PEI) TEXAS HOME VISITING

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Helping through Intervention and Prevention (Project HIP) provides evidence-based parent education and basic needs support.

ORIGINS & FUNDING In 2014, the Department of Family and Protective Services (DFPS) funded Project HIP to provide support services to high-risk families with newborns. The services are offered by local community service providers that contract with PEI.

ELIGIBILITY Families with a new child and a prior history of a confirmed child maltreatment fatality or termination of parental rights; and former and current foster youth who are expecting and/or are new parents qualify for Project HIP.

FEDERAL SUPPORT Project HIP is specifically targeted to serve pregnant and parenting foster youth. State dollars invested in Project HIP could qualify for a federal match from the Federal First Prevention Services Act (FFPSA), which makes available funds for evidence-based prevention programs that serve populations deemed by the state to be at imminent risk of entering foster care. Click here to read more on FFPSA.

FOOTPRINT Currently, Project HIP is available in 64 counties and is projected to serve 387 families in 2020.

PROGRAMS Nurturing Parenting, STEP, and Triple P.

PREVENTION AND EARLY INTERVENTION (PEI) PROJECT HIP

387

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HOME VISITING IN TEXAS TIMELINE Home visiting is a family support strategy with a long history. Over the last 100 years, various models have emerged to support young families. Home visiting began to attract support from private donors and governments with increased demand and evidence of effectiveness. Since the 1990s, lawmakers have increasingly promoted voluntary home visiting programs to bolster families and provide a strong start for children. Texas did not have an identified strategy specific to home visiting until 2007.

1990s Fragmented investments in home visiting through multiple agencies, including DFPS, Health and Human Services Commission, and Texas Education Agency.

2003 Prevention funding was almost entirely cut due to budget shortfalls.

2007

2010

Nurse-Family Partnership (NFP) Legislation–SB 156 in 2007; $7.9 million initial funding.. In response to increased demand from communities across the country, President George W. Bush proposed a $10 million federal investment in home visiting in 2008 through a program called 'Evidence-Based Home visiting' (EBHV).

With bipartisan support, the federal government established the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV), leading to a significant expansion of Home visiting in states, territories, and tribal communities.

2011 Texas receives first federal funding for home visiting (MIECHV).

2013 Texas Home visiting Legislation–SB 426 Home visiting Accountability and Expansion–Formally establishes Texas Home visiting Program and provides funding and accountability framework. The bill also established the definitions of and funding for evidence-based and promising programs (75% and 25%, respectively). SB 1836 established the Texas Home visiting Program Trust Fund providing voluntary donations on copies of birth certificates, marriage licenses and divorce decrees and initial marriage license applications to fund the Texas Home visiting Program. Project HOPES is established to create community-based prevention initiatives with home visiting at the core.

2015 SB 200 consolidates prevention services, including family support home visiting under DFPS' PEI division (formerly at HHSC).

2017 SB 1549 outlines framework and strategy for home visiting expansion.

2018 Federal government reauthorizes MIECHV for another five years. Federal Family First Prevention Services Act makes Title IV-E dollars available to provide in-home parenting programs to families at imminent risk of entering foster care.