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Maternal, Infant, and Early Childhood Home Visiting Program
Supplemental Information Request (SIR) for the Submission of the
Statewide Needs Assessment Update
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 0906-XXXX. Public reporting burden for
this collection of information is estimated to average 120 hours per response, including the time
for reviewing instructions, searching existing data sources, and competing and reviewing the
collection of information. Send comments regarding this burden estimate or any other aspects of
this collection of information, including suggestions for reducing this burden, to HRSA Reports
Clearance Officer, 5600 Fishers Lane, Room 14N39, Rockville, Maryland, 20857.
Through this Supplemental Information Request (SIR), the Health Resources and Services
Administration provides state, jurisdiction, and nonprofit Maternal, Infant, and Early Childhood
Home Visiting (MIECHV) Program awardees guidance for the submission of a statewide needs
assessment update. The MIECHV Program is authorized by Social Security Act, Title V, §
511(c) (42 U.S.C. § 711(c)).1 Section 50601 of the Bipartisan Budget Act of 2018 (Pub. L. 115123) (BBA) extended appropriated funding for the MIECHV Program through FY 2022, while
section 50603 of the BBA requires states to conduct a statewide needs assessment (which may be
be separate from but in coordination with the statewide needs assessment required under section
505(a) and which shall be reviewed and updated by the State not later than October 1, 2020).
The BBA further establishes that conducting a MIECHV statewide needs assessment update is a
condition of receiving Title V Maternal and Child Health (MCH) Block Grant funding;
submission of the MIECHV needs assessment update in accordance with the guidance in this
SIR will meet this requirement. Instructions for completing a statewide needs assessment update
are set forth in this document. Nonprofit awardees will need to provide documentation to
demonstrate that they have been authorized or requested by the state in which they provide
services to submit a needs assessment on behalf of the state.
A separate SIR will provide detailed guidance on the needs assessment to territories eligible to
apply for MIECHV funds. This guidance does not apply to MIECHV Tribal Home Visiting
awardees; guidance for tribal awardees is provided by the Administration for Children and
Families.
I. Background
The MIECHV Program is authorized by Social Security Act, Title V, § 511(c) (42 U.S.C. §
711(c)) to support voluntary, evidence-based home visiting services for at-risk pregnant women
1
Social Security Act, Title V, § 511(c).
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and parents with young children up to kindergarten entry.2 Decades of scientific research shows
that home visits by a nurse, social worker, early childhood educator, or other trained professional
during pregnancy and in the first years of a child’s life improves the lives of children and
families. Home visiting helps prevent child abuse and neglect, supports positive parenting,
improves maternal and child health, and promotes child development and school readiness.3
The MIECHV Program is administered by the Health Resources and Services Administration
(HRSA) in partnership with the Administration for Children and Families (ACF). Program
awardees receive funding through the MIECHV Program to implement evidence-based home
visiting programs and promising approaches.4 Awardees have the flexibility to tailor their
program to serve the specific needs of their communities. Through a statewide needs assessment,
awardees identify target populations and select home visiting service delivery models that best
meet state and local needs.
As noted above, section 50603 of the BBA requires awardees to review and update their
statewide needs assessments. Through this statewide needs assessment update, awardees will
identify at-risk communities as those counties with concentrations of the following indicators:
premature birth, low-birth weight infants, and infant mortality, including infant death due to
neglect, or other indicators of at-risk prenatal, maternal, newborn, or child health; poverty;
crime; domestic violence; high rates of high-school drop-outs; substance abuse; unemployment;
or child maltreatment.5 Identifying at-risk communities through this needs assessment update
will enable MIECHV Program awardees to respond to the diverse needs of children and families
in their states.
II. Purpose
HRSA recognizes the needs assessment as a critical and foundational resource for awardees in
identifying at-risk communities, understanding the needs of families, and assessing services in
their early childhood systems. This needs assessment update may reveal population trends,
identify areas of increasing or decreasing risk, and outline resources to support families in need.
The results of the needs assessment update should also inform strategic decision making among
MIECHV awardees and their stakeholders and identify opportunities for collaboration to
strengthen and expand services for at-risk families. As this is the first statutory mandate to
complete a statewide needs assessment since 2010, this update will assist in ensuring awardees
have a more current understanding of the needs for home visiting services in their states.
2
Social Security Act, Title V, § 511(c).
U.S. Department of Health and Human Services, Administration for Children and Families, Home Visiting
Evidence of Effectiveness (HomVEE). Available at: http://homvee.acf.hhs.gov/.
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By law, state and territory grantees must spend the majority of their MIECHV Program grants to implement
evidence-based home visiting models, with up to 25 percent of funding available to implement promising
approaches that will undergo rigorous evaluation.
5
Social Security Act, Title V, § 511(b)(1)(A).
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By law, a needs assessment update must identify communities with concentrations of defined
risk factors, assess the quality and capacity of home visiting services in the state, and assess the
state’s capacity for providing substance abuse treatment and counseling services.6 MIECHV
awardees will continue to be able to select which at-risk communities - identified in the
update - they will target for provision of home visiting services. The purpose of updating the
statewide needs assessments is for awardees to gather more recent information on community
needs and ensure that MIECHV programs are being implemented in areas of high need.
However, the requirement for such an update should not be construed as requiring moving
MIECHV-funded home visiting programs, defunding of programs for the sole purpose of
moving services to other communities, or otherwise disrupting existing home visiting programs,
relationships in the community, and services to eligible families. Instructions in this SIR provide
flexibility for awardees to identify at-risk communities through a variety of methods.
HRSA anticipates MIECHV awardees may use their needs assessment updates to:
Understand the current needs of families and children, and at-risk communities.
Target home visiting services to at-risk communities with evidence-based and promising
approach home visiting models that meet community needs.
Support statewide planning to develop and implement a continuum of home visiting
services for eligible families and children prenatally through kindergarten entry.
Inform public and private stakeholders about the unmet need for home visiting and other
services in the state.
Identify opportunities for collaboration with state and local partners to establish
appropriate linkages and referral networks to other community resources and supports
and strengthen strong early childhood systems.
Direct technical assistance resources to enhance home visiting service delivery and
improve coordination of services in at-risk communities.
After submission of an updated needs assessment that meets the requirements outlined in this
SIR, awardees may wish to add content to or expand their updates in the future to ensure these
documents continue to meet unique state needs. For example, an awardee may wish to embed
their MIECHV needs assessment update into a larger document that serves other purposes for the
state or other stakeholders.
HRSA intends to use awardees’ needs assessment updates to better understand unmet needs and
availability of services in communities and states, which will help to ensure that MIECHV home
visiting programs are targeted to at-risk communities. Through the FY 2021 Formula Notice of
Funding Opportunity, HRSA will provide instruction on how awardees should describe their
plans to use the results of the needs assessment updates to inform use of MIECHV Program
funds. At that time, HRSA will request information about which at-risk communities awardees
intend to serve with MIECHV funds in response to the needs assessment update.
6
Social Security Act, Title V, § 511(b)(1)(C).
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For the purpose of this needs assessment update, HRSA interprets the term “community” to
mean a county or county equivalent7 in order to:
support awardees by providing them with standardized nationally available county-level
data,
reduce burden on awardees through the development of a simplified method to identify
at-risk counties that they may elect to use, and
describe a national picture of need for voluntary evidence-based home visiting services
through a standard definition of “community.”
Accordingly, where there are references to “at-risk counties” or “counties” throughout this
guidance, HRSA is referring to “at-risk communities” or “communities,” as appropriate.
While needs assessment updates must include a list of at-risk counties, awardees will continue to
be able to propose to serve targeted areas within at-risk counties based on local needs and
available resources. HRSA does not require awardees to serve entire counties.
The original needs assessments conducted in 2010 provided many lessons and guided the
direction of the MIECHV Program. For the current update, HRSA is providing nationally
available county-level data aligned with statutorily-defined risk factors to reduce burden on and
provide support to MIECHV awardees in identifying at-risk counties. In addition, HRSA
developed a simplified method for identifying at-risk counties that awardees may elect to use.
Some awardees may determine that the list of at-risk counties identified through the simplified
method represents a reasonable assessment of risk in the state. However, options exist for
awardees to modify the method through the addition of other valid data. Additionally, some
awardees may opt to add at-risk counties based on data related to risk and emerging trends
available at the local level. Finally, awardees may determine that the simplified method does not
meet individual state needs, and may opt to conduct the needs assessment update based on an
independent method that meets statutory requirements.
III. Due Date
Awardees are required to submit their needs assessment update to HRSA by October 1,
2020. Any awardee that does not submit an update by the statutory deadline of October 1, 2020
will be considered non-responsive to the requirements of this SIR, which may impact MIECHV
and Title V MCH Block Grant funding in FY 2021 or later. The MIECHV statewide needs
assessment update may be submitted anytime after the release of this guidance but before the
statutory deadline of October 1, 2020.
The term “county” is used throughout to indicate a county or county equivalent geographic and administrative unit
as defined by the United States Census Bureau. For the District of Columbia, “wards” may be considered county
equivalents for the purpose of this needs assement update.
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IV. Requirements of the Statewide Needs Assessment Update
Along with FY 2018 MIECHV formula awards, HRSA awarded up to $200,000 in supplemental
funds to eligible entities to complete a statewide needs assessment update.
To meet statutory requirements for a statewide needs assessment update, you must: 8
1. Identify communities with concentrations of risk, including: premature birth, lowbirth-weight infants, and infant mortality, including infant death due to neglect, or other
indicators of at-risk prenatal, maternal, newborn, or child health; poverty; crime;
domestic violence; high rates of high-school drop-outs; substance abuse; unemployment;
or child maltreatment.
2. Identify the quality and capacity of existing programs or initiatives for early
childhood home visiting in the state. Please include: a) the number and types of
programs and the numbers of individuals and families who are receiving services under
such programs or initiatives; b) the gaps in early childhood home visitation in the State;
and c) the extent to which such programs or initiatives are meeting the needs of eligible
families.
3. Discuss the State’s capacity for providing substance abuse treatment and counseling
services to individuals and families in need of such treatment or services.
4. Coordinate with and take into account requirements in: a) the Title V MCH Block
Grant program needs assessment; b) the communitywide strategic planning and needs
assessments conducted in accordance with section 640(g)(1)(C) of the Head Start Act;
and c) the inventory of current unmet needs and current community-based and
prevention-focused programs and activities to prevent child abuse and neglect, and other
family resource services operating in the State required under section 205(3) of Title II of
Child Abuse. Prevention and Treatment Act (CAPTA).
In addition to the required information, this update provides awardees the opportunity to take
into account the staffing, community resources, and other requirements to operate at least one
approved home visiting service delivery model and demonstrate improvements for eligible
families.9
A complete needs assessment update submitted to HRSA is composed of two sections:
1) A Needs Assessment Update Narrative that describes your methodological process and
the findings from your update, and does not exceed 50 pages excluding appendices (see
Appendix A for an outline of submission requirements); and
2) A completed Needs Assessment Data Summary (Excel file) for your state (See Appendix
B for an outline of submission requirements).
8
Social Security Act, Title V, § 511(b).
Social Security Act, Title V, §511(d)(4), as amended by the Bipartisan Budget Act of 2018, Title VI, § 50604,
indicates the priority for serving high-risk populations.
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Required of Nonprofit awardees only: Nonprofit awardees submitting the needs assessment on
behalf of a state will need to provide documentation that they are conducting and submitting the
needs assessment update on behalf of the state where they provide services. Documentation, such
as a letter, may come from a state’s Title V MCH Block Grant agency; another health, education
or human services state agency; or the governor’s office.
The following sections of this SIR will describe how to complete these components in full.
NOTE: If you recently completed a needs assessment update on your own (completed after
October 1, 2016), you may submit portions of that update ONLY IF the methodology and data
used in your update meet the requirements of the SIR.
NOTE FURTHER: The requirements outlined in this SIR are intended for state and District of
Columbia MIECHV awardees. Recognizing potential challenges related to the availability of
data, separate guidance describes requirements for territory MIECHV awardees (i.e., Puerto
Rico, the United States Virgin Islands, Northern Mariana Islands, American Samoa, and Guam)
for completing a needs assessment update.
V. Instructions for Completing the Statewide Needs Assessment Update
A complete statewide needs assessment update submission must include: 1) a Needs Assessment
Update Narrative that describes your process and findings; 2) a completed Needs Assessment
Data Summary (Excel file), and 3) documentation if a nonprofit awardee is submitting on behalf
of a state. HRSA will only consider submissions as complete if each part is completed. See
Appendix A for an outline of the Needs Assessment Update Narrative and Appendix B for an
outline of the Needs Assessment Data Summary.
1. Introduction
Begin your Needs Assessment Update Narrative with a brief introduction section that describes
your purpose for completing an update to your needs assessment.
2. Identifying At-Risk Communities (Counties) with Concentrations of Risk
The authorizing statute requires you to identify communities with concentrations of risk in your
needs assessment update.10 Identification of at-risk communities supports you in targeting
limited resources to at-risk communities and prioritizing families in greatest need for home
visiting services. In addition, understanding the needs of at-risk communities will support you in
providing effective services tailored to families’ needs.
10
Social Security Act, Title V, §511(b)(1)(A).
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For the purposes of this update, as noted above, HRSA interprets the term “community” as
a county or county equivalent.11 This is a change from the original needs assessment, which
allowed awardees to determine how to operationalize “community”, and is intended to reduce
burden on awardees and allow HRSA to describe a national picture of need for voluntary
evidence-based home visiting services through a standard definition of “community.” You must
report your final list of at-risk communities as at-risk counties in Table 7 of your Needs
Assessment Data Summary. This section describes what you must submit to HRSA to identify
at-risk communities (counties) with concentrations of risk. This section also describes the data
HRSA provided to you to support your update.
Description of Data Provided by HRSA
To support you in identifying at-risk counties and to decrease potential burden in completing an
update, HRSA has provided you with a Needs Assessment Data Summary (Excel-file) for your
state. You can use these data in a number of ways to identify at-risk counties. HRSA developed a
methodology that utilizes nationally available data so that each state receives a similar Needs
Assessment Data Summary. This methodology, termed the simplified method, is based on
indices of risk in five domains: low socioeconomic status, adverse perinatal outcomes, child
maltreatment, crime, and substance use disorder, based on nationally available county-level data.
Indicators within each domain align with the characteristics described in statute to identify
communities with concentrations of risk.12 The simplified method identifies a county as at-risk if
at least half of the indicators within at least two domains had z-scores greater than or equal to
one standard deviation higher than the mean of all counties in the state.
The Needs Assessment Data Summary contains eight separate tables with the following data for
your state (see Appendix C for detailed descriptions of the Needs Assessment Data Summary
tables):13
Table 1.
Table 2.
Table 3.
Simplified Method Overview – This table includes a description of the
methodology used to identify at-risk counties.
Description of Indicators – This table includes definitions for each indicator, the
year the data represent, sources for the data, descriptions of how each indicator
aligns with statute, and source notes.
Descriptive Statistics – This table includes definitions for each indicator, the year
the data represent, and statewide descriptive data including missing data, mean,
standard deviation, and median for each indicator.
The term “county” is used throughout to indicate a county or county equivalent geographic and administrative
unit. For the District of Columbia, wards may be identified in this needs assessment update, and may be considered
county equivalents.
12
Social Security Act, Title V, § 511(b)(1)(A).
13
The Needs Assessment Data Summary for the District of Columbia will include ward level data, rather than
county-level data.
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Table 4.
Table 5.
Table 6.
Table 7.
Table 8.
Raw Indicators – This table provides the raw data for each indicator based on the
definitions of each indicator (e.g. the poverty indicator is defined as the percent of
the population living below the Federal poverty line, so this table presents that
statistic for each county).
Standardized Indicators – This table presents z-scores for each indicator based
on the raw indicators and the statewide descriptive data.
At-Risk Domains – This table presents the population total for each county, the
proportion of indicators within each domain that are at-risk based on the
standardized data, and the total number of at-risk domains for each county.
Counties with two or more domains identified as at-risk (in column H) are
considered at-risk by the simplified method.
At-Risk Counties – This table is to be completed by each awardee. You will add
your at-risk counties and provide data on the quality and capacity of home visiting
services in each of those counties.
Example Formulas – This table provides the formulas used in the simplified
method.
Instructions for Developing a List of Identified At-Risk Counties:
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You are required to develop a list of at-risk counties. This section describes options you can use
to develop that list. You will submit this list through your Needs Assessment Data Summary by
following the complete instructions below. This text box provides a high-level summary of the
phases and steps related to developing the list of at-risk counties.
Overview: How to Develop a List of At-Risk Counties
Phase One (required)
Develop a list of at-risk counties by using one of the following methodologies.
Methodology #1: Simplified method
a. If the simplified method appropriately identified at-risk counties for your state, list your
at-risk counties, and consider Phase Two.
-- OR -b. Add data to the simplified method by adding to your Needs Assessment Data
Summary:
i. Additional indicators,
ii. Additional domains of risk factors, and/or
iii. Additional sub-county geographic data,
then list your at-risk counties, and consider Phase Two.
-- OR -Methodology #2: Independent method
a. Utilize an independent method to identify at-risk counties, list your at-risk counties,
and consider Phase 2.
-- OR -b. Present the results of a needs assessment update completed after October 1, 2016
ONLY IF the methodology and data used in that update meet the requirements of this
guidance.
Phase Two (optional)
If counties with communities you know are at-risk (including those currently receiving MIECHV
services) were not identified through the methods utilized in Phase 1, you may add at-risk
counties to the list and must provide local data that demonstrate the risk and describe why you
are adding the county.
NOTE: While you are required to submit a list of counties identified as at-risk, you may also use
sub-county data or information to identify a county as at-risk.
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Phase One Instructions: Develop your list of at-risk counties (required) by using one of the
following methodologies—the simplified method or an independent method.
1. Simplified method
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Instructions for 1.a. Review the pre-populated Needs Assessment Data Summary and
consider whether the simplified method appropriately identifies needs and at-risk
counties in your state. If it does, then:
o In your Needs Assessment Data Summary:
Add at-risk counties to Table 7 (At-Risk Counties), and consider Phase
Two.
o In the Needs Assessment Update Narrative:
Describe how the counties identified in your list reflect the level of risk in
your state.
Instructions for 1.b. Adding data to the simplified method: Review your Needs
Assessment Data Summary. If the data do not appropriately reflect the needs of your
state, you may add data indicators, domains, or geographic data, and incorporate
additional data into the simplified method analysis. You may wish to add indicators or
domains of specific risk factors if they are not already included in the simplified method,
but are of significant concern in your state. Added indicators and domains must align
with the statutory definition of risk.14 You may wish to add sub-county geographic data if
you know that data could identify risk within a county that is not apparent in county-level
data.
Instructions for 1.b.i - Adding indicators to existing domains: If you are
adding a new indicator(s) within a domain(s) identified in the simplified
method:
In your Needs Assessment Data Summary:
o Add a description of the new indicator(s) within the relevant domain(s)
to Table 2 (Description of Indicators).
o Add the descriptive statistics for the added indicator(s) to Table 3
(Descriptive Statistics) within the relevant domain(s).
o Insert new columns of raw data for the new indicator(s) to table 4
(Raw Indicators).
o Insert new columns to Table 5 (Standardized Indicators) and copy
appropriate cell formulas from Table 8 (Example Formulas) to
produce the standardized data for the added indicator(s).
Social Security Act, Title V, §511(b)(1)(A).
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o Update the formulas in Table 6 (At-Risk Domains) to incorporate the
new indicators into the formula that identifies the proportion of
standardized indicators that are at-risk within each domain.
o Add at-risk counties to Table 7 (At-Risk Counties), and consider Phase
Two.
In the Needs Assessment Update Narrative:
o Describe why the added indicators are important for identifying at-risk
counties in your state, and how added indicators align with statutory
goals for the program.
o Describe how the counties identified in your list reflect the level of
risk in your state.
Instructions for 1.b.ii - Adding indicators to new domains: If you are
adding a new indicator(s) that does not fit within the domain(s) identified in
the simplified method:
In your Needs Assessment Data Summary:
o Add a description of the new indicator(s) to the bottom of the list in
Table 2 (Description of Indicators) with an accompanying domain
name.
o Add the descriptive statistics to Table 3 (Descriptive Statistics) for the
added indicator(s) and domain(s).
o Add new columns and the raw data for the new indicator(s) to Table 4
(Raw Data).
o Add new columns to Table 5 (Standardized Indicators) and copy
formulas from Table 8 (Example Formulas) to produce the
standardized data for the added indicator(s).
o Add new columns to Table 6 (At-Risk Domains) to incorporate the
new domain(s), copy formulas to calculate the proportion of
standardized indicators within the new domain that are at-risk, and
update the formulas that calculate the number of at-risk domains for
each county.
o Add at-risk counties to Table 7 (At-Risk Counties), and consider Phase
Two.
In the Needs Assessment Update Narrative:
o Describe why the added indicators do not fit in existing domains, how
added indicators and domains align with statutory goals for the
program, and why new domains are important for identifying at-risk
counties in your state.
o Describe how the counties identified in your list reflect the level of
risk in your state.
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Instructions for 1.b.iii - Adding geographic data: If you are adding
geographic data to the simplified method:
In your Needs Assessment Data Summary:
o Ensure added geographic data are included in the descriptive statistics
in Table 3 (Descriptive Statistics), or revise those data to include the
added geographies (i.e. recalculate the mean and standard deviation
including the new sub-county areas and omitting the values for the
county(ies) where the sub-county areas are derived).
o Add rows to the bottom of Table 4 (Raw Data) in order to add raw
data for new geographies.
o Add rows to the bottom of Table 5 (Standardized Indicators) and copy
and paste formulas from Table 8 (Example Formulas) to standardize
the raw data for the added geographies on Table 5 (Standardized
Indicators).
o Add rows to the bottom of Table 6 (At-Risk Domains) and copy the
formulas to assess which domains are at-risk for the newly added
geographies.
o Add at-risk counties to Table 7 (At-Risk Counties), and consider Phase
Two.
In the Needs Assessment Update Narrative:
o Describe the added geographic data and why they are important for
identifying at-risk counties in your state.
o Describe how the counties identified in your list reflect the level of
risk in your state.
Instructions for 2.a - Independent method: Alternatively, you may choose not to use the
simplified method developed by HRSA, and instead use an alternative method of your choosing
for identifying at-risk counties within the parameters described below. Such an approach must
include the use of rigorous methods to collect new data and/or statistical methods to analyze data
that are different from the methodology used in the simplified method. Examples of alternative
rigorous statistical methods that you may want to consider are a county health ranking approach,
other composite indicator methods, factor or principle component analysis, applying a weighting
scheme to the simplified method, producing heat maps of key indicators, or correlation analysis
to understand how risk factors interact.
If you choose to conduct an independent method:
Utilize data sources that measure “at-risk” counties as having high concentrations of
(examples of recommended measures and data sources are listed in Appendix D):
o premature birth, low-birth weight infants, and infant mortality, including infant
death due to neglect or abuse, or other indicators of at-risk prenatal, maternal,
newborn, or child health;
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o
o
o
o
o
o
o
poverty;
crime;
domestic violence;
high rates of high-school dropouts;
substance abuse;
unemployment; or
child maltreatment.
In your Needs Assessment Data Summary:
Replace data in Table 2 (Description of Indicators) from your Needs Assessment Data
Summary with descriptions of the data sources used in your independent method.
Replace the data in Table 3 (Descriptive Statistics) to present state level descriptive
statistics from the data sources you used in your independent method.
Replace the data in Table 4 (Raw Data) to reflect the data sources used in their
independent analysis.
Replace the data in Table 5 (Standardized Indicators) and Table 6 (At-Risk Domains) to
demonstrate the calculations used in your independent method to identify at-risk counties.
Add at-risk counties to Table 7 (At-Risk Counties) of your Needs Assessment Data
Summary, and consider Phase Two.
In the Needs Assessment Update Narrative:
Describe in detail the rigorous methodology you used to develop a list of at-risk counties
in your state and the rationale for selecting this methodology to best meet the unique
needs of your state.
Describe how the counties identified in your list reflect the level of risk in your state.
Instructions for 2.b – Present results of a recent update: If you completed a needs assessment
update after October 1, 2016 that: 1) utilizes a rigorous method to identify at-risk counties (as
described above); 2) reflects the measures of risk identified in statute; and 3) reflects recent data,
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then, if you elect this option, you must:
In your Needs Assessment Data Summary:
o Submit the data and analysis used in your recent update in the format for
submission of an independent method (described in 2.a above) and operationalize
at-risk communities as at-risk counties.
In the Needs Assessment Update Narrative:
o Describe your rigorous methodology and data sources.
15
HRSA considers data to be recent if it is from 2014 or later. You may use earlier data if you are averaging over a
number of years to account for suppressed data, but average data must include 2014 or later data.
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o Describe the results of your needs assessment and how the counties identified in
your list reflect the level of risk in your state.
Phase Two: Adding Counties Known to be At-Risk (optional)
You may optionally add to your list of at-risk counties if the list produced in Phase One by either
method (simplified or independent) does not include counties that are at-risk based on other
factors. These may be counties that do not demonstrate risk based on county-level data but
include smaller, local areas of high or emerging need, such as communities your MIECHV
programs currently serve. To add these counties to your list:
In your Needs Assessment Data Summary:
o Add additional counties to Table 7 (At-Risk Counties).
In the Needs Assessment Update Narrative:
o Describe the local or emerging needs –that align with statutory criteria for
concentration of risk - and cite any relevant data points that indicate why
added counties are at-risk; and
o Describe how the counties identified in your list reflect the level of risk in
your state.
3. Identify Quality and Capacity of Existing Programs
Under the MIECHV authorizing statute, you must submit a statewide needs assessment that
identifies the quality and capacity of existing programs or initiatives for early childhood home
visiting in the state.16 Specifically, you must include:
the number and types of individuals and families who are receiving services under such
programs or initiatives;
the gaps in early childhood home visiting in your state; and
the extent to which such programs or initiatives are meeting the needs of eligible
families.
In addition, the MIECHV statute requires you to prioritize delivering services under the
MIECHV Program to eligible families who reside in communities in need of such services, as
identified in the statewide needs assessment, taking into account the staffing, community
resources, and other requirements to operate at least one approved evidence-based model of
home visiting and demonstrate improvements for eligible families (Appendix E provides a
definition and list of approved evidence-based home visiting models).17
16
Social Security Act, Title V, §511(b)(1)(B).
Social Security Act, Title V, §511(d)(4), as amended by the Bipartisan Budget Act of 2018, Title VI, § 50604,
indicates the priority for serving high-risk populations.
17
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Identification of the quality and capacity of existing home visiting programs supports you in
assessing gaps in home visiting service delivery and unmet need among MIECHV-eligible
families. In addition, consideration of staffing, community resources, and other requirements for
implementation of evidence-based home visiting services supports you in assessing the readiness
of communities to provide these services effectively, and planning statewide strategies to
strengthen the delivery of home visiting services that additionally support at-risk communities in
building their readiness.
For purposes of this needs assessment, “early childhood home visitation services” or “home
visiting programs” are programs that use home visiting as a primary intervention strategy for
providing services to pregnant women and/or children from birth to kindergarten entry. These
phrases, for purposes of the MIECHV program and this needs assessment, exclude programs
with few or infrequent visits or where home visiting is supplemental to other services.
In Table 7 (At-Risk Counties) of your Needs Assessment Data Summary, include the following
data for each at-risk county:
1. The county is served, in whole or in part, by at least one home visiting program (Yes or
No or Not Sure)
2. The county is served, in whole or in part, by at least one home visiting program that
implements evidence-based home visiting service delivery models eligible for
implementation by MIECHV (Yes or No or Not Sure) (See Appendix E for a list of
models.)
3. The county is served, in whole or in part, by home visiting programs which are funded by
the MIECHV Program (Yes or No or Not Sure)
4. Estimated number of families served by a home visiting program located in the county in
the most recently completed home visiting program fiscal year
5. Estimated need of eligible families in the county, defined as families with children under
6 years old that were living in poverty and met two additional risk factors (families in
which the mother has low educational attainment (high school education or less); families
with pregnant women (a child less than 1 year in the past year); or families with young
mothers (aged under 21)). These data will be provided by HRSA.
6. Optional Alternate estimated need of eligible families in the county as identified by you.
7. Optional In home visiting programs located in the county, percentage of home visitor
positions that were vacant in the most recently completed home visiting program fiscal
year.
In the Needs Assessment Update Narrative, use data in Table 7 (At-Risk Counties) from your
Needs Assessment Data Summary and other available data to:
If needed, describe your interpretation of need if using an alternate estimate of need.
Describe the gaps in early childhood home visiting in the state.
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Describe the extent to which home visiting programs are meeting the needs of eligible
families.
Describe gaps in staffing, community resource, and other requirements (such as an early
childhood system which includes health and social services and family supports targeted
to pregnant women and families with young children) to operate at least one evidencebased home visiting service delivery model and demonstrate improvements for
MIECHV-eligible families in your at-risk counties identified in this needs assessment
update.
In the Needs Assessment Update Narrative, you may optionally consider:
Demographics and characteristics of families served by home visiting programs
The cultural and language needs of families in at-risk communities to ensure that
programs are provided in a relevant and appropriate way
Attrition rates among families served by home visiting programs
Home visiting program waiting lists
Enrollment in alternative early childhood programs
Home visiting personnel staff qualifications and attrition rates, professional development
opportunities, and relevant labor statistics
Strengths and weaknesses in service utilization and outcome data of existing home
visiting programs
Barriers faced by home visiting programs in at-risk counties, including geographic
barriers and gaps in availability and accessibility of health and social services and family
supports
Costs of home visiting services in at-risk counties and reductions in funding for home
visiting services in at-risk counties
How existing home visiting programs, including service delivery models, and early
childhood systems of care address indicators of high need in at-risk counties
The presence of local early childhood systems coordination entities or councils, and
public support and community buy-in for evidence-based home visiting in at-risk
counties
4. Capacity for Providing Substance Use Disorder Treatment and Counseling Services
The MIECHV authorizing statute requires that a needs assessment update identify your state’s
capacity for providing substance use disorder counseling and treatment services to individuals
and families in need of such services.18 Assessment of the state’s capacity to meet the needs of
pregnant women and families with young children impacted by substance use disorder supports
you in identifying the system of care that is available for MIECHV-eligible families and ensuring
links to care for MIECHV families. In addition, this assessment may support you in identifying
18
Social Security Act, Title V, § 511(b)(1)(C).
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gaps and barriers in access to care and planning state and local activities to strengthen the system
of care for MIECHV families.
For the purposes of this needs assessment, HRSA adopts the Surgeon General’s definition of the
phrase “substance use disorder treatment and counseling services” to mean “a service or set of
services that may include medication, counseling, and other supportive services designed to
enable an individual to reduce or eliminate alcohol and/or other drug use, address associated
physical or mental health problems, and restore the patient to maximum functional ability.”19
In the Needs Assessment Update Narrative, describe:
The range of substance use disorder treatment and counseling services (i.e., intervention,
treatment, and recovery services) available in your state that aim to meet the needs of
pregnant women and families with young children who may be eligible for MIECHV
services.
Gaps in the current level of treatment and counseling services in meeting the needs of
pregnant women and families with young children who may be eligible for MIECHV
services. In this description, consider substance use disorder domain data in Table 6 (AtRisk Domains) and other available state or local data.
Barriers to receipt – for examples, lack of access or affordability - of substance use
disorder treatment and counseling services among pregnant women and families with
young children who may be eligible for MIECHV services.
Opportunities for collaboration with state and local partners, which may include
substance use disorder treatment providers, hospitals, the court system, and child welfare
agencies to address gaps and barriers to care for pregnant women and families with
young children impacted by substance use disorder who may be eligible for MIECHV
services.
If your state has one, a strategic approach or a state plan, including any coordination
between state agencies, to respond to substance use disorders among pregnant women
and families with young children. Identify key stakeholders that your state engages in its
response to substance use disorders among pregnant women and families with young
children (i.e., the state’s Single Agency for Substance Abuse Services, mental health
services, public health, clinical medicine, public safety, nonprofit agencies, etc.);
If your state has any, current activities to strengthen the system of care for addressing
substance use disorder among pregnant women and families with young children (e.g.,
state legislation or policies, training and capacity building for home visitors and other
service providers, an opioid task force, etc.).
Surgeon General Report’s Report on Alcohol, Drugs, and Health (2016). The term “substance use treatment” is
included in the Glossary linked here: https://addiction.surgeongeneral.gov/sites/default/files/glossary-andabbreviations.pdf.
19
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Optional Describe the availability of wrap around services to prevent and support
treatment of substance use disorders such as mental health services, housing assistance,
and other prevention and support services.
In the Needs Assessment Update Narrative, you may wish to incorporate available data from the
Substance Abuse and Mental Health Services Administration (SAMHSA) (see Appendix D for
more information) and consider the data provided to you in your Needs Assessment Data
Summary on counties identified as at-risk in the domain of substance use disorder.
5. Coordinating with the Title V MCH Block Grant, Head Start and CAPTA Needs
Assessment
Under the MIECHV authorizing statute, you must coordinate with and take into account
requirements in: (1) the Title V MCH Block Grant program needs assessment; (2) the
communitywide strategic planning and needs assessments conducted in accordance with section
640(g)(1)(C) of the Head Start Act; (3) the inventory of current unmet needs and current
community-based and prevention-focused programs and activities to prevent child abuse and
neglect, and other family resource services operating in the state required under section 205(3) of
Title II of CAPTA.20 Effective coordination of MIECHV statewide needs assessments with the
needs assessments required by Title V MCH Block Grant, Head Start, and CAPTA may support
you in leveraging other available data sources; strengthening coordination with other early
childhood system partners to assess and identify risk, unmet need, and gaps in care; and ensuring
that home visiting is well coordinated with the state’s early childhood system.
For this section, you will be required to describe how you coordinated with other agencies and
needs assessments, and how this coordination informed your assessment of risk, unmet need, and
gaps in care.
In the Needs Assessment Update Narrative:
Describe how you coordinated with and took into account findings of other appropriate
needs assessments conducted in your state. At a minimum, address how your statewide
needs assessment update was coordinated with:
o The state’s Title V MCH Block Grant Five-Year Needs Assessment which
includes the Title V maternal and child health priority needs.
o Head Start community-wide strategic planning and needs assessments; and
o Title II of the CAPTA -- the inventory of current unmet needs and current
community-based and prevention-focused programs and activities to prevent child
abuse and neglect.
20
Social Security Act, Title V, §511(b)(2).
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Discuss how findings or data from Title V MCH Block Grant, Head Start, and CAPTA
needs assessments informed your MIECHV needs assessment update. This discussion
may include:
1. Description of methods used to incorporate data or information from other needs
assessment into your MIECHV needs assessment update;
2. Identification of service gaps in at-risk counties that are represented across needs
assessments;
3. Identification of duplication of services;
4. Identification of challenges or barriers to receipt of services that are represented
across needs assessments; and
5. Identification of opportunities to strengthen and improve coordination of services
to MIECHV-eligible families.
Describe any efforts to convene stakeholders to review and contextualize the results of
your state’s relevant needs assessments in order to better assess risk, unmet need, and
gaps in care. Stakeholders may include early learning convening groups (e.g., State
Advisory Council on Early Childhood Education and Care, ECCS recipient,) or
stakeholders involved with Title V MCH Block Grant, Head Start, and CAPTA.
Describe any processes established for ongoing communication with Title V MCH Block
Grant, Head Start, and CAPTA representatives to ensure findings and data from
respective needs assessments are shared on an ongoing basis.
6. Conclusion
Conclude your Needs Assessment Update Narrative with a brief closing section that:
1) Summarizes major findings from your update, and
2) Describes any plans for disseminating the results of your needs assessment update to
stakeholders in your state.
7. Nonprofit Documentation (Required of Nonprofit awardees only)
States that have elected not to apply for or be awarded MIECHV funds are encouraged to work
with the nonprofit organizations that provide MIECHV-funded services within the state and
indicate whether they will submit their needs assessments directly or through the nonprofit
organization awardee. States submitting their needs assessment through a nonprofit organization
awardee will need to provide documentation that indicates this, such as a signed letter on state
letterhead indicating that they have authorized or requested the nonprofit organization to conduct
the update and submit it to HRSA on their behalf. Documentation, such as a letter, may come
from a state’s Title V agency; another health, education or human services state agency; or the
governor’s office.
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VI. Submission Information
A complete statewide needs assessment update submission must include the following sections:
1) A Needs Assessment Update Narrative that describes the methodological process and the
findings from your update (see Appendix A for an outline of submission requirements).
The Needs Assessment Update Narrative should not exceed 50 pages, excluding
appendices.
2) A completed The Needs Assessment Data Summary Excel file. (See Appendix B for an
outline of submission requirements).
Required of Nonprofit Awardees Only: Nonprofit awardees submitting the needs assessment on
behalf of a state will need to provide documentation that they have been given authority to
conduct and submit the needs assessment update on behalf of the state where they provide
services. Documentation, such as a letter, may come from a state’s Title V MCH Block Grant
agency; another health, education or human services state agency; or the governor’s office.
The completed needs assessment must include all required sections. You will submit your
updated statewide needs assessment through HRSA’s Electronic Handbooks (EHBs). You will
receive instructions regarding submission of the needs assessment update through the EHBs
approximately six months prior to the due date, as further described below. Please contact your
HRSA MIECHV Project Officer with any questions.
The Bipartisan Budget Act establishes that conducting a MIECHV statewide needs assessment
update is a condition of receiving Title V MCH block grant funding; submission of the MIECHV
needs assessment update in accordance with the guidance in this SIR will meet this requirement.
The MIECHV statewide needs assessment update may be submitted anytime after the release of
this guidance but before the statutory deadline of October 1, 2020.
VII. Review Process for Submitted Needs Assessment Updates
HRSA program staff will review all needs assessment updates for completeness and compliance
with the requirements outlined in this Supplemental Information Request. Based on the review,
HRSA staff will either accept the submission as complete and compliant with the requirements
outlined in the SIR or request additional information or clarification. MIECHV statute requires
awardees to update their statewide needs assessments no later than October 1, 2020, as a
condition of receiving Title V MCH Block Grant funding.21
Through the FY 2021 MIECHV Notice of Funding Opportunity, HRSA intends to provide
instructions to solicit proposed plans from awardees of how they intend to use the results of their
needs assessment updates to inform MIECHV program implementation. Beginning in FY 2021
and in subsequent years (pending the availability of future funding), HRSA will use the
21
Social Security Act, Title V, § 511(b)(1), as amended by the Bipartisan Budget Act of 2018, Title VI, § 50603.
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information submitted in this needs assessment update in tandem with information submitted
through funding applications to assure compliance with all statutory requirements regarding the
provision of services in at-risk communities.
VIII. Agency Contacts
Applicants may obtain additional information regarding their statewide needs assessment by
contacting their HRSA Project Officer.
Awardees desiring assistance when working online to submit information electronically through
HRSA’s Electronic Handbooks (EHBs) should contact the HRSA Call Center, Monday-Friday,
9:00 a.m. to 5:30 p.m. ET:
HRSA Call Center
Phone: (877) Go4-HRSA or (877) 464-4772
TTY: (877) 897-9910
Fax: (301) 998-7377
E-mail: [email protected]
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APPENDIX A: Outline for the Needs Assessment Update Narrative
Below is a sample outline for the narrative that you must submit to HRSA. Your Needs
Assessment Update Narrative should not exceed 50 pages, excluding any appendices you may
include.
1) Introduction
a. The purpose of the needs assessment update for your state
2) Identifying Communities with Concentrations of Risk
a. If adding data to the simplified method or using an independent method:
i. Description of added data (as applicable)
ii. Description of methodology (as applicable if using an independent
method)
b. Describe how the counties identified by your selected method reflects the level of
risk as you understand it in your state
3) Identifying Quality and Capacity of Existing Programs
a. Reflect on the data about the quality and capacity of home visiting services in
your state
i. Discuss gaps in the delivery of early childhood home visiting services
ii. Describe the extent to which home visiting services meet the needs of
families in your state
iii. Describe gaps in staffing, community resource, and other requirements for
delivering evidence-based home visiting services
iv. Discuss optional considerations
4) Capacity for Providing Substance Use Disorder Treatment and Counseling Services
a. Related to the needs of pregnant women and families with young children who
may be eligible for MIECHV services:
i. Describe range of treatment and counseling services
ii. Describe gaps in the current level of treatment and counseling services
available to home visiting service populations
iii. Describe barriers to receipt of substance use disorder treatment and
counseling services
iv. Describe opportunities for collaboration with state and local partners
v. Describe any current activities to strengthen the system of care for
addressing substance use disorder
vi. Discuss optional considerations
5) Coordination with Title V MCH Block Grant, Head Start, and CAPTA Needs
Assessments
a. Describe how you coordinated with and took into account other needs
assessments, and at a minimum, the needs assessments required by Title V MCH
Block Grant, Head Start, and CAPTA programs
b. Describe your efforts to convene stakeholders to review and contextualize results
from various needs assessments in your state
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c. Explain how findings or data from Title V MCH Block Grant, Head Start, and
CAPTA programs informed your MIECHV needs assessment update
6) Conclusion
a. Summarize major findings of the statewide needs assessment update
b. Describe dissemination of the statewide needs assessment update to stakeholders
7) Nonprofit Documentation (required of nonprofit awardees only)
a. Nonprofit awardees will need to provide documentation to demonstrate that they
have been authorized or requested by the state in which they provide services to
submit a needs assessment on behalf of the state
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APPENDIX B: Outline for Needs Assessment Data Summary
Below are instructions for completing the Needs Assessment Data Summary submission under
each option for identifying at-risk counties:
Identifying At-Risk Counties
Phase 1 – Develop list of At-Risk Counties (Required)
Simplified method
o If satisfied that the simplified method appropriately identified at-risk counties:
List your at-risk counties in Table 7 (At-Risk Counties)
o If adding data to the simplified method
Add data descriptions to Table 2 (Description of Indicators)
Add descriptive statistics to Table 3 (Descriptive Statistics)
Add raw data to Table 4 (Raw Indicators)
Add standardized data to Table 5 (Standardized Indicators)
Update formulas in Table 6 (At-Risk Domains)
List your at-risk counties in Table 7 (At-Risk Counties)
Independent Method
o Revise Table 2 (Description of Indicators)
o Revise Table 3 (Descriptive Statistics)
o Revise or replace Table 4 (Raw Data)
o Revise or Replace Tables 5 (Standardized Indicators) and 6 (At-Risk
Domains)
o List your at-risk counties in Table 7 (At-Risk Counties)
Phase 2 – Add Counties to Your List (Optional)
List your at-risk counties in Table 7 (At-Risk Counties) of your Needs Assessment
Data Summary
Identifying the Quality and Capacity of Home Visiting Programs
Add to Table 7 (At-Risk Counties)
o Counties that are identified as at-risk
o Indicator that county is served by a MIECHV eligible model
o Indicator that home visiting programs in the county receive MIECHV funds
o Estimated number of families served in county
o Estimate of need by county (provided by HRSA)
o Optional: Alternative estimate of need by county
o Optional: Percent of home visitor job vacancies by county
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APPENDIX C: Description of Needs Assessment Data Summary Tables
Table 1: Simplified Method Overview - This table describes the methodology used in the
simplified method to identify at-risk counties. It describes how indicators were selected (and why
certain indicators are not included in the method), how data is analyzed, how indicators are
identified as at-risk, and how counties are then identified as at-risk.
Table 2: Description of Indicators - This table groups each indicator by domain, provides
definitions for each indicator, and indicates how the selected indicators align with the statutory
definition of at-risk communities. The table presents information about the data utilized in the
simplified method such as the year it represents, sources for the data and links to those sources
when available, any relevant source notes, and the year in which updated data will be available.
Table 3: Descriptive Statistics - This table groups each indicator used in the simplified method
by domain, and repeats the definitions for each indicator, and year the data represents. The table
then presents statewide descriptive data including missing data, mean for each indicator, standard
deviation, median, interquartile range, minimum and maximum, other notes, and state estimate
for each indicator. Descriptive data are computed based on the county-level data collected for
each indicator.
Table 4: Raw Indicators - This table provides raw data for each indicator based on the
definitions of each indicator (e.g., the poverty indicator is defined as the percent of the
population living below the Federal poverty line, so this table presents that statistic for each
county).
Table 5: Standardized Indicators - This table presents standardize indicator values (computed
z-scores) for each county so that all indicators have a mean of 0 and a SD of 1. Data in this table
represent the Z-score for each indicator which is calculated using the mean and standard
deviation computed in Table 3, and the county values for each indicator presented in Table 4.
Specifically, the formula for computing the standardized indicators is: Z-score = (county value mean)/SD.
Table 6: At-Risk Domains - This table presents the population total for each county, the
proportion of indicators within each domain that are at-risk based on the standardized data, and
the total number of at-risk domains for each county. The table calculates the proportion of
indicators within each domain for which that county’s z-score was greater than 1, that is, the
proportion of indicators for which a given county is in the most at-risk 16% of all counties in the
state (16% is the percentage of values greater than 1 SD above the mean in the standard normal
distribution). If at least half of the indicators within a domain have z-scores greater or equal to 1
SD higher than the mean, then a county is considered at-risk on that domain. The total number of
domains at-risk (out of 5) is summed to capture the counties at highest risk across domains.
Counties with 2 or more at-risk domains are identified as at-risk.
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Table 7: At-Risk Counties - This table is to be completed by awardees. In this table, you will
list your at-risk counties and provide data on the quality and capacity of home visiting services.
in each of those counties.
Table 8: Example Formulas - This table provides the necessary formulas used in the simplified
method to conduct analyses for each table. For example, the table provides the formula used to
standardize (i.e., calculate the z-score) each of the raw indicator values. You can copy and paste
the formulas from this table to analyze any data added to the simplified method as described in
the Instructions for Identifying a List of At-Risk Counties section of this guidance.
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APPENDIX D: List of Potential Metrics and Data for Consideration in an
Independent Method
Below are metrics and data sources for you to consider if you choose to utilize an independent
method for identifying your state’s list of at-risk counties.
Metrics Used in the Simplified Method
Premature birth
- Percent: # live births before 37 weeks/total # live births
Low birth weight infants
- Percent: # resident live births less than 2500 grams/# resident live births
Poverty
- # residents below 100% FPL/total # residents
Unemployment
- Percent: # unemployed and seeking work/total workforce
School Dropout Rates
- Percent high school dropouts grades 9-12
- Other school dropout rates as per State/local calculation
Income Inequality
- Gini coefficient
Crime
- # reported crimes/1000 residents
- # crime arrests ages 0-19/100,000 juveniles age 0-19
Substance abuse
- Prevalence rate: Binge alcohol use in past month
- Prevalence rate: Marijuana use in past month
- Prevalence rate: Nonmedical use of prescription drugs in past month
- Prevalence rate: Use of illicit drugs, excluding Marijuana, in past month
Child Maltreatment
- Rate of maltreatment victims aged <1-17 per 1,000 child (aged <1-17) residents
Other Metrics for Consideration
Infant mortality (includes death due to neglect)
- # infant deaths ages 0-1/1,000 live births
Child maltreatment (substantiated/indicated/alternative response victim)
- Rate of reported substantiated maltreatment
- Rate of reported substantiated maltreatment by type
Domestic Violence
- Useful sources of data may include State service statistics, State and local hotline
statistics, fatality review teams, social service agencies, and other data already
collected by State and local domestic violence service providers.
Substance Use and Mental Health
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-
State estimates of mental health and substance use from the National Survey on
Drug Use and Health (NSDUH)22
Substance Use Disorder Treatment Facilities
- State information on substance abuse treatment facilities, including the services
they provide, which can be found in the National Directory of Drug and Alcohol
Abuse Treatment Facilities23
22
Substance use and mental health data can be found at https://nsduhweb.rti.org/respweb/estimates.html
Substance Abuse Treatment Facility data can be found at:
https://www.samhsa.gov/data/sites/default/files/2017%20SA%20Directory.pdf.
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APPENDIX E: Evidence-based Models Eligible to MIECHV Awardees
The models listed below have met HHS criteria for evidence of effectiveness and are available
for use by funding recipients in carrying out the MIECHV program.
HHS uses Home Visiting Evidence of Effectiveness (HomVEE, http://homvee.acf.hhs.gov/) 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 kindergarten.
NOTE: In addition to the HHS criteria for evidence of effectiveness, the statute specifies that a
model selected by a eligible entity “conforms to a clear consistent home visitation model that has
been in existence for at least 3 years and is research-based, grounded in relevant empiricallybased knowledge, linked to program determined outcomes, associated with a national
organization or institution of higher education that has comprehensive home visitation program
standards that ensure high quality service delivery and continuous program quality
improvement,” among other requirements.24
(NOTE: Models are listed alphabetically.)
24
Attachment and Biobehavioral Catch-Up (ABC) Intervention
Child FIRST
Durham Connects/Family Connects
Early Head Start – Home-Based Option
Early Intervention Program for Adolescent Mothers
Early Start (New Zealand)
Family Check-Up for Children
Family Spirit
Health Access Nurturing Development Services (HANDS) Program
Healthy Beginnings
Healthy Families America
Home Instruction for Parents of Preschool Youngsters
Maternal Early Childhood Sustained Home Visiting Program
Minding the Baby
Nurse-Family Partnership
Parents as Teachers
Play and Learning Strategies – Infant
SafeCare Augmented
Social Security Act, Title V, § 511(d)(3)(A).
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APPENDIX F: Glossary of Selected Terms
At-risk communities – Awardees are required to give service priority to eligible families residing
in at-risk communities identified by a statewide needs assessment. At-risk communities are
those for which indicators, in comparison to statewide indicators, demonstrated that the
community was at greater risk than the state as a whole. At-risk communities are further defined
as communities with concentrations of the following indicators: premature birth, low-birth
weight infants, and infant mortality, including infant death due to neglect, or other indicators of
at-risk prenatal, maternal, newborn, or child health; poverty; crime; domestic violence; high rates
of high school dropouts; substance abuse; unemployment; or child maltreatment. For the
purpose of this needs assessment update, HRSA interprets the term “community” to mean a
county or county equivalent.
Early childhood home visiting programs or initiatives– Programs or initiatives in which home
visiting is a primary service delivery strategy and in which services are offered on a voluntary
basis to at-risk pregnant women and parents with young children up to kindergarten entry,
targeting participant outcomes which may include improved maternal and child health;
prevention of child injuries, child abuse, or maltreatment, and reduction of emergency
department visits; improvement in school readiness and achievement; reduction in crime or
domestic violence; improvements in family economic self-sufficiency; or improvements in the
coordination and referrals for other community resources and supports.
Early childhood system – An early childhood system brings together health, early care and
education, and family support program partners, as well as community leaders, families, and
other stakeholders to achieve agreed-upon goals for thriving children and families. An early
childhood system aims to: reach all children and families as early as possible with needed
services and supports; reflect and respect the strengths, needs, values, languages, cultures, and
communities of children and families; ensure stability and continuity of services along a
continuum from pregnancy to kindergarten entry; genuinely include and effectively
accommodate children with special needs; support continuity of services, eliminate duplicative
services, ease transitions, and improve the overall service experience for families and children;
value parents and community members as decision makers and leaders; and catalyze and
maximize investment and foster innovation.
Substance use disorder treatment and counseling services – A service or set of services that
may include medication, counseling, and other supportive services designed to enable an
individual to reduce or eliminate alcohol and/or other drug use, address associated physical or
mental health problems, and restore the patient to maximum functional ability.25
See Surgeon General Report’s Report on Alcohol, Drugs, and Health (2016). The term “substance use treatment”
is included in the Glossary linked here: https://addiction.surgeongeneral.gov/sites/default/files/glossary-andabbreviations.pdf.
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Title V Needs Assessment – Title V of the Social Security Act (Section 505(a)(1)) requires each
state, as part of its application for the Title V Maternal And Child Health Services Block Grant
To States Program, to prepare and transmit a statewide needs assessment every five years that
identifies (consistent with the health status goals and national health objectives) the need for:
Preventive and primary care services for pregnant women, mothers and infants up to age
one;
Preventive and primary care services for children; and
Services for children with special health care needs. More details are provided in Part
Two, Section III.C. of the Guidance and forms for the Title V Application/Annual Report
for the Title V Maternal and Child Health Services Block Grant to States Program, which
can be found at:
https://mchb.tvisdata.hrsa.gov/uploadedfiles/Documents/blockgrantguidance.pdf.
31
| File Type | application/pdf |
| File Title | Needs Assessment SIR DRAFT 042518 |
| Author | Herzfeldt-Kamprath, Rachel (HRSA) |
| File Modified | 2018-07-25 |
| File Created | 2018-07-25 |