REACH: Strengthening Families

Child Care Subsidy

The Child Care and Development Fund (CCDF) is the primary federal program specifically devoted to child care services and quality. CCDF subsidies enable low-income parents and parents receiving welfare benefits through the federally authorized Temporary Assistance for Needy Families (TANF) program to work or to participate in the educational or training programs they need in order to work. Funds may also be used to serve children in protective services. One important provision of CCDF is that states, which manage the funding, must use a portion of CCDF resources on efforts to improve the quality of child care and to expand its availability.52

CCDF resources have the potential to improve children’s school readiness and performance in at least two important ways. First, by making it easier for parents in low-income families to work, CCDF can help prevent the poverty that is associated with less success in school. Second, the program can support efforts to ensure that young children receive the high-quality early education that can, in turn, boost the chances that they will enter school ready to learn. While providing high-quality early education is possible through the CCDF program, the current focus of this program remains basic health and safety. To address quality standards beyond health and safety, Virginia has established a quality rating and improvement system (QRIS) called Virginia’s Star Quality Initiative, a voluntary opportunity for early learning sites to receive objective feedback about the quality of their services and supports to improve the level of care they offer. Virginia’s Star Quality Initiative, which began as a pilot, is available to classrooms, centers, and family child care settings statewide as of July 1, 2013. Currently, there are 341 classroom-based sites and 77 family child care homes participating, serving more than 15,000 children. The average rating is 3 stars (of a maximum 5 stars).

The most recent data the federal government reported on CCDF shows that Virginia’s number of children served dropped in 2007, eliminating services for approximately 3,000 children.

As of 2011, Virginia was serving 23,300 children in 14,900 families with CCDF child care subsidies. In 2011, 71% of children were served by child care centers and 25% were served in family home programs.53 Further, the majority of children served (71%) are under age 6.

Average number of children served, CCDF

SOURCE: Child Care Development Fund Statistics, http://www.acf.hhs.gov/programs/occ/resource/ccdf-statistics. *2011 data are preliminary estimates published May 3, 2013.

Home Visiting

Home visitation programs in Virginia offer a variety of family focused services to pregnant women and families with infants and young children. Trained home visitors work with families that have complex challenges related to poverty, mental health and other chronic health conditions, domestic violence, employment, and parenting. Their needs go beyond the services provided by any one agency. National and local research demonstrates that well-designed and well-run programs can have a positive effect on parenting attitudes and skills, and improve children’s physical health, social competence, and cognitive and language development.54,55

In Virginia, there are eight home visiting models across several state agencies (see http://homevisitingva.com/programs.php for details). Since 2006, there has been a concerted multi-agency initiative to improve the efficiency, effectiveness, and quality of all of the home visiting models and to enhance the linkages of home visiting to other early childhood programs. While each program is distinctive in their objectives and communities served, leaders from each program convene in a collaborative effort called the Home Visiting Consortium. This cooperative effort has worked to reduce duplication and gaps in services, increase standardization and clarity in data collection, and strengthen professional development through common training modules.

Although there has been additional federal funding to support home visiting through federal fiscal year 2015, state funding for the two largest programs, CHIP and Healthy Families, has decreased by more than 35% since 2009; it is estimated that home visiting programs are only serving 15-20% of the eligible families in Virginia. The Consortium has identified other challenges. The lack of an integrated data system results in duplication of efforts at the state and program level and hinders the ability to evaluate outcomes across programs, especially beyond the preschool years.

Nevertheless, CHIP has shown a short-term return on investment by significantly reducing premature births and Medicaid spending on costly health care services provided in Neonatal Intensive Care Units. Healthy Families has documented success in reducing child abuse and neglect, thus saving costs in foster care.

The Comprehensive Health Investment Project (CHIP) works with families, caught in the cycle of poverty, who are committed to creating a better life for their children and themselves. Intervening early and using proven practices, CHIP registered nurses and parent educators work hand-in-hand with parents. Families must be pregnant or have a child under the age of 6, and have an income level of no more than 200% of the federal poverty level. CHIP services are available in 27 cities and counties across the Commonwealth, administered by 7 local organizations. The holistic CHIP model is unique in its team approach in that a Registered Nurse and Parent Educator work with families in their homes, focusing broadly on ensuring that children have a medical home, promoting wellness and safety, assessing children’s psycho-social and physical development and teaching parents how to manage their lives in ways that improve economic self-sufficiency. CHIP and other home visiting programs use the national Parents as Teachers curriculum to ensure that parents know how to be their child’s first and best teacher. Families participate in CHIP for an average of two years. In FY12, CHIP served more than 3,100 young children living in 2,600 families.56

Healthy Families is a nationally established program with goals to prevent child abuse and to promote child health. Virginia’s Healthy Families programs that use a home visiting model to provide education and support services for first-time parents until the child is 3 to 5 years old. A family support worker visits the family to provide education in parenting, health, nutrition, problem-solving, stress management and other areas as needed. Services provided include parenting education (e.g., stages of child development), and assisting families with obtaining health care (e.g., immunizations, well-child care, preventive care, and nutrition information).57

Healthy Families Virginia programs are part of a network of 33 sites which are coordinated by Prevent Child Abuse Virginia, and provide home visiting services to over 4,500 families each year.58

The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program facilitates collaboration and partnership at the federal, state, and community levels to improve health and development outcomes for at-risk children through evidence-based home visiting programs. The statutory purposes defined in the Affordable Care Act for the program are to (1) strengthen and improve the programs and activities carried out under Title V of the Social Security Act; (2) improve coordination of services for at-risk communities; and (3) identify and provide comprehensive services to improve outcomes for families who reside in at-risk communities. The legislation requires that grantees demonstrate improvement among eligible families participating in the program in six benchmark areas:

MIECHV is an evidence-based policy initiative that requires 75% of grant funds be spent on programs to implement evidence-based home visiting models. In Virginia, the grants are administered through the Virginia Department of Health which receives funding to serve an additional 1,315 families. VDH currently receives two MIECHV grants, a formula grant and a competitive expansion grant. The formula grant expands evidence-based home visiting services through three national models, Healthy Families America, Nurse Family Partnership and Parents As Teachers, in eleven at-risk communities that include Danville City, Fredericksburg City, Norfolk City, Suffolk City, Southampton County, Radford City, Montgomery County, Lynchburg City, Campbell County, Newport News City, and Williamsburg City. The expansion grant expands these three evidence-based home visiting models in an additional fourteen communities. The communities are Roanoke City, Portsmouth City, Accomack County, Northampton County, Fairfax County, Hampton City, Emporia City, Greensville County, Sussex County, Bristol City, Richmond City, Petersburg City, Winchester City, and Warren County.

Through this funding, VDH is also evaluating the Virginia Resource Mothers Program to determine if it is an evidence-based program and evaluating a centralized intake and referral system in four areas of Virginia.60




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