States and the New Federal Home Visiting Initiative

An assessment from the starting line

Report August 24, 2011 Read time:

Projects: Home Visiting Project

The resulting report, States and the New Federal Home Visiting Initiative: An Assessment from the Starting Line, along with the Pew Home Visiting Inventory, provides state leaders, agency administrators and program directors with individual state snapshots and a national overview of home visiting programs, models and funding.

With the new federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program beginning to make grants to states to improve and expand home visitation, these data and Pew's findings and recommendations give policy makers—for the first time—a much-needed account of home visiting investments and programs as well as strategies to maximize federal and state resources.

Together, the report and inventory will help state and federal policy makers evaluate current home visiting approaches, compare systems across states, prepare for the upcoming infusion of MIECHV grant dollars and make informed decisions to ensure the best results for families and strongest returns to taxpayers.

Downloads States and the New Federal Home Visiting Initiative (PDF)

NATIONAL OVERVIEW

National Overview

The Pew Center on the States surveyed state agency leaders in all 50 states and the District of Columbia and inventoried their state home visiting programs, models, funding and polices for fiscal year 2009-2010. The following picture of nationwide home-visiting investments emerged:

State home visiting programs

46 states and the District of Columbia have some level of fiscal year 2009-2010 investment in home visiting.

Pew found a total of 119 home visiting programs across 46 states and the District of Columbia:

34 states support more than one home visiting program administered within and across their health, education and human service agencies
21 states administer three or more home visiting programs
Four states—Alaska, Idaho, Nevada, Mississippi—do not administer home visiting programs
The state health department was the most common administering agency of state-administered home visiting programs.
State agencies administering home visiting programs: health department, children family services, education/early learning, children's trust fund, workforce/welfare, children's cabinet/council and other.

Funding strategies

In fiscal year 2009-2010, states made $1.4 billion available to home visiting programs via two primary funding strategies: categorical funding and broad-based prevention funding

Categorical funding: 43 states and the District of Columbia directed $462 million through dedicated, categorical funding streams narrowly defined by the state for the exclusive purpose of home visiting.
Broad-based funding: 22 states made available $912 million in block grant-style funding through 29 programs to meet a range of objectives including child abuse prevention, parent education, school readiness and early childhood systems development. Under this strategy, communities may elect to use home visiting as a method of service delivery, but they are not required to do so by the states.
Nineteen of the 29 broad-based programs were able to account for $52 million used by communities for home visiting; 10 programs were unable to identify their broad-based initiatives' home visiting expenditures.

State funding strategy:

Home Visiting Inventory Funding Strategies

Sources of state support:

State general funds were the largest source of support for home visiting programs in fiscal year 2009-2010

Home visiting dollars are drawn from a variety of state sources—including general revenues, tobacco settlement funds and taxes—and federal streams, such as Temporary Assistance for Needy Families, the Maternal Child Health Block Grant and Medicaid.

98 state-administered programs (83 percent) reported funding sources
State general funds—$182 million—were the most common funding source among categorically funded programs
California's tobacco tax-funded “First Five” initiative was the single largest source of the broad-based funding

State investments in evidence-based home visiting models:

A total of 39 programs reported investments of $266 million in fiscal year 2009-2010 in the three most widely used of the federally approved, evidence-based models: Healthy Families America, Nurse-Family Partnership and Parents as Teachers.

In contrast to “programs,” home visiting “models” refer to the specific curricula and content used by certain state or local programs. Federally approved, evidence-based models have evaluations using a high-quality, rigorous design. The three listed above not only meet this criterion but also have national organizations and require accreditation. In addition, many states have developed their own models, which may be adapted versions of the evidenced-based models or entirely original curricula created by a state or community. Get more information on each of the models.

Evidence-based Models Used:

Home Visiting Inventory Evidence-Based Models

Healthy Families America

Nurse-Family Partnership

Parents as Teachers

Key Findings

Pew's analysis of the survey data revealed five top-level findings that state leaders should consider when deciding how to improve the efficacy and efficiency of home visiting investments and in preparing to deploy new federal grant dollars.

Most home visiting funding was not adequately tracked at the state level.

In FY2010, states made almost $1.4 billion available for home visiting programs. Of these dollars, states could not document the use of $575 million, or more than 40 percent of available funds. States that dedicated funds exclusively for home visiting (categorical funding) effectively tracked spending of $462 million. States that provided broad-based funding to local communities to support a variety of child and family services could document only the allocation of $337 million—$52 million to home visiting and $285 million to other services. Collection of spending data was likely more robust at the local level, but states too infrequently required reporting and tracking of statewide expenditures. To ensure the most effective investments, states must more efficiently track taxpayer money supporting specific programs.

States frequently provided funding with few, if any, requirements that programs invest in models with a proven record of success.

Leading home visiting models have been subjected to rigorous testing with scientifically validated control groups. Evidence-based models do not come with guarantees, but when well implemented they have a proven record of effectiveness and return on public investments. Yet, 58 percent of FY2010 state funding (48 programs in 32 states) was provided with minimal guidance regarding selection of models, quality standards or expected outcomes. In these instances, service-delivery decisions such as curricula, training and caseloads were left to local discretion, and states could not ensure program quality or cost effectiveness.

States did not adequately monitor publicly funded programs to ensure effectiveness.

States generally did not provide enough oversight of programs to guarantee that services are of high quality, reach targeted populations and deliver desired results. Most states did not provide even basic data on program performance, such as the cost of the program, the number of visits per family and, most important, if parents and families who received services did better. Programs should be required to track both program performance and child and family outcomes, and states need to use those data to inform funding and policy decisions.

States did not consistently target at-risk families, where the return on investment is highest.

While states can choose to serve more families, prioritizing high-risk populations yields the best return on public investments. Yet, more than half of available home visiting funding—nearly $727 million—was allocated to programs without state-designated eligibility requirements. States can do more to provide clear guidelines about who is eligible for services and to ensure that state dollars are directed as intended.

In every state, far too few at-risk families got home visiting services.

No state had either sufficient funding or the infrastructure to reach all of its highest-risk families. To reap meaningful savings from home visiting investments, state funding must be sufficient to significantly lower the rates of costly problems.

Policy Recommendations

In light of the survey findings, Pew offers five recommendations to help states prepare to deploy new federal resources and get the highest returns on their investments in home visiting.

Require the tracking of all home visiting funds.

Policy makers should require home visiting programs to track and document the use of funds, whether broad-based or categorical, to guide allocation decisions and help both local- and state-level agencies manage resources efficiently, avoid duplication, ensure quality and deliver services effectively.

Insist on—and invest in—programs with a foundation in research.

Policy makers should look to the federal guidance on the appropriate use of evidence to ensure that models and standards are data-driven and rigorously evaluated, and should require that at least 75 percent of public home visiting funding supports evidence-based delivery models. Mandates for use of evidence must be accompanied by sufficient resources to ensure that models are implemented with fidelity.

Support and require programs to monitor performance and evaluate key outcomes.

Policy makers should both mandate and provide necessary resources and training to enable local and state programs to coordinate services, monitor performance measures and track participant outcomes using criteria aligned with federal benchmarks.

Set clear, evidence-based eligibility guidelines and develop systems to ensure compliance.

Policy makers should identify target populations using risk factors outlined in the federal initiative; require and fund administering agencies to ensure that programs adhere to established eligibility standards, especially in states with limited guidance, for use of state early childhood funds; and ensure the continuity of services as family circumstances change.

Use the best available data about families to determine appropriate home visiting allocations and to establish a realistic plan for expansion.

As they prepare for the new federal dollars, state policy makers should look to cost-benefit, demographic and other data to determine the number of eligible families, existing program capacity and potential long-term savings; identify available funding streams, including Medicaid, Temporary Assistance to Needy Families, public health and early childhood resources; ensure that allocations are sufficient to serve the entire target population; and allow time for agencies to build capacity and conduct outreach to targeted families.

Definitions

For the purposes of creating an inventory of comparable programs, Pew defined “home visiting” as a voluntary, sustained effort that:

Pairs new and expectant families with home visitors who provide parenting information and connections to community-based services and support during pregnancy and throughout early childhood;
Delivers services primarily in the family's home, although programs may complement home visits with socialization activities such as group classes and parent outings; and
Is supported through state allocations (using either state or federal dollars).

Excluded from the survey were programs that employ home visiting as a strategy but do not fully satisfy the definition above, such as:

Involuntary visits resulting from a child protective services investigation or a court order;
Programs targeting children four or older, unless they are enrolled before the age of two;
Programs that use home visiting as a component of a broader family support strategy but do not identify the home as the primary location for service delivery (such as Family Resource Centers or other primarily center-based initiatives;
Home-based services delivered as required by the federal Individuals with Disabilities Education Act (IDEA);
Federal funding allocated directly to localities and not state-administered, such as Healthy Start and Early Head Start; and
Funding from private organizations and communities.

State Home Visiting Programs

For the purposes of this inventory, a state home visiting “program” is defined as an initiative that:

Is administered through state agencies—such as health and human services—that direct funding to local communities to support service delivery, articulate standards and regulations, set performance measures and provide oversight and infrastructure;
Delivers services mainly in families' homes, though visits may be complemented with socialization activities such as group classes and parent outings;
Receives support through state allocations, using either state or federal dollars.

Federally Approved, Evidence-based Home Visiting Models

Healthy Families America

Healthy Families America (HFA) is designed to serve families at-risk for child abuse and neglect. The home visitor provides parent education and support, linkages to community resources and child development screenings. ^{^[1]}

Nurse-Family Partnership

The Nurse-Family Partnership (NFP) provides home visitation services to low-income, first-time mothers by registered nurses beginning early in pregnancy and continuing through the child's second year of life. The program targets a wide range of outcomes, with a focus on maternal and child health and family self-sufficiency. ^{^[2]}

Parents as Teachers

Parents as Teachers (PAT) focuses on supporting a parent's role in promoting school readiness and healthy development. PAT visitors provide information on children's development, teach parents to encourage their child's learning, provide referrals to community resources when needed and conduct screenings of children's development, health, hearing and vision. ^{^[3]}

Spending Per Low-Income Child

The estimated number of children age 0-3 whose families live at or below 125 percent of poverty line. These estimates are derived from the Current Population Survey Table Creator and represent a three-year average between 2007 and 2009.

[1] http://www.healthyfamiliesamerica.org/about_us/index.shtml

[2] http://www.nursefamilypartnership.org/assets/PDF/Policy/Sprinkle_Written_testimony (page 1)

[3] http://www.parentsasteachers.org/about/what-we-do

[4] http://www.parent-child.org/about-us/vision-mission/

[5] http://www.parent-child.org/downloads/WhatWeDo.pdf

METHODOLOGY

Methodology

The Pew Center on the States surveyed all 50 states and the District of Columbia about home visiting funding and polices as of fiscal year 2009-2010.

The survey asked three critical policy questions:

Investment: How much are states investing in home visiting? What are the scale, breadth and range of state-directed funds? What strategies are states using to fund programs?
Evidence base: Does the state use empirical standards or evidence of program effectiveness to drive funding allocation decisions and to what extent?
Evaluation: How do states hold local programs accountable for meeting performance measures?

Because many states do not track outcomes, this study did not consider or evaluate the merit of individual programs, models or services. Forthcoming, independent, Pew-funded research will explore some of these topics and seek to answer critical questions of quality and effectiveness that can guide state efforts to maximize investments. Additionally, the standards that will accompany new federal funding will outline specific criteria for selecting models and delivering services.

Data Sources

As a first point of contact in the state, Pew interviewed the State Maternal and Child Health Early Childhood Comprehensive Systems (ECCS) Coordinator, who represents the federal designee to coordinate states' early childhood systems. In some cases, the ECCS coordinator served as an informant about a specific program, and referred the data collector to other agencies that may oversee home visiting programs.

Because home visiting programs are often administered across different agencies in the state, Pew also contacted multiple state agencies to gather information about programs that may not be housed in the Maternal Child Health office, including Departments of Early Learning, Children's Trusts, the lead Child Abuse Prevention Agencies and any Children's Cabinets or Children's Bureaus.

Data collectors conducted phone interviews with staff at these agencies and used information from interviews to complete surveys. A draft of each completed survey was returned to agency staff to verify data and fill in any gaps. After data collection was finished, data were summarized and returned to program staff to verify.

Data collection period:

Data were collected between December 2009 and May 2010, and focused on funding for FY2009-2010. Some programs may have experienced agency cuts during the course of the year, which are reflected in the final data when possible. Unless noted, service population data is from FY2009, which often was the most recent data available during the data collection period.

Per capita spending:

To assess the size and scale (geographic breadth) of state investments, Pew examined state funding in proportion to the number of low-income children. The per capita expenditure was calculated by dividing a state's home visiting investment by the number of estimated low-income infants and toddlers who live at or below 125 percent of poverty, based on the U.S. Census's Current Population Survey.

Accuracy and Comprehensiveness

To ensure the accuracy of the data presented in this report, Pew staff implemented numerous quality control measures. First, Pew identified multiple informants to verify data. When possible, all data were compared with publicly available documents, such as legislative reports, agency budget documents and evaluation reports. Second, all agency staff were given the opportunity to review the final survey and a fact sheet summarizing the data. In August 2010, the U.S. Department of Health and Human Services released a list of the new governor-appointed designees to lead states' efforts on home visiting. As a final data check, Pew sent summaries of all of a state's programs to the state home visiting lead for verification.

Inventory Data

Program	FY10 Program Funding	Administering Agency	Source of Funds	Models Used
Alabama (FY10 Total State Funding: $803,000 — State Spending Per Low-Income Child: $13)
Child Abuse Prevention Grants	$803,000	Department of Child Abuse and Neglect Prevention; Department of Children's Affairs	Tobacco settlement funds (Children's First Trust Fund); Education Trust Fund; CBCAP; TANF; Mentoring Children of Promise; State general funds	Broad early childhood funds; specific to program selected by community
Alaska (FY10 Total State Funding: $0 — State Spending Per Low-Income Child: $0)
Arizona (FY10 Total State Funding: $27,476,000 — State Spending Per Low-Income Child: $222)
Early Childhood Development Initiative	$19,176,000	First Things First	Tobacco Tax	Multiple national models, with some locally developed
Healthy Families Arizona	$6,200,000	Department of Economic Security	State lottery	Healthy Families America
Health Start Program	$2,100,000	Department of Health Services	State lottery	State-developed program
Arkansas (FY10 Total State Funding: $1,186,000 — State Spending Per Low-Income Child: $20)
Arkansas Better Chance for School Success Fund	$732,000	Division of Child Care and Early Childhood Education	State general funds; TANF	Parents as Teachers
Child Abuse Prevention Grants	$454,000	Children's Trust Fund	CBCAP; surcharge on marriage license fees	Specific to home visiting model program selected by community
California (FY10 Total State Funding: Unavailable — State Spending Per Low-Income Child: Unable to calculate)
First 5 California County Commissions	Unavailable	First 5 California	Tobacco tax	Multiple national models, with some locally developed
Colorado (FY10 Total State Funding: $14,848,000 — State Spending Per Low-Income Child: $270)
Nurse Home Visitor Program	$14,037,000	Department of Public Health and Environment	Tobacco settlement funds; Medicaid	Nurse-Family Partnership
Tony Grampsas Youth Services Program	$811,000	Department of Public Health and Environment	Tobacco settlement funds	Broad early childhood funds; specific to program selected by community
Connecticut (FY10 Total State Funding: $14,848,000 — State Spending Per Low-Income Child: $270)
Nurturing Families Network	$9,000,000	Children's Trust Fund	State general funds	Parents as Teachers
Case Management for Pregnant Women	$349,000	Department of Public Health	MCH Block Grant	Case management
Child First	$292,000	Department of Children and Families	State general funds	State-developed program
Healthy Choices for Women & Children	$180,000	Department of Public Health	State general funds; Children's Health Initiative	Case management
Delaware (FY10 Total State Funding: $3,809,000 — State Spending Per Low-Income Child: $290)
Smart Start	$2,156,000	Department of Health & Social Services, Division of Public Health	State general funds; MCH Block Grant	State-developed program
Parents as Teachers	$1,122,000	Department of Education	State general funds	Parents as Teachers
Nurse-Family Partnership	$531,000	Department of Health & Social Services, Division of Public Health	EBHV Grant; State general funds	Nurse-Family Partnership
District of Columbia (FY10 Total State Funding: $750,000 — State Spending Per Low-Income Child: $75)
Children and Family Services Agency	$750,000	Department of Health	General funds	Specific to program selected by community
Florida (FY10 Total State Funding: $18,114,000 — State Spending Per Low-Income Child: $77)
Healthy Families Florida	$18,114,000	Department of Children and Families	State general funds; TANF; CBCAP	Healthy Families America
Georgia (FY10 Total State Funding: $2,294,000 — State Spending Per Low-Income Child: $12)
System of Care Grant Program	$1,310,000	Governor's Office for Children & Families	CBCAP; State general funds	Broad early childhood funds; home visiting programs must meet state-developed standards
SafeCare	$984,000	Department of Human Services	TANF	SafeCare
Hawaii (FY10 Total State Funding: $1,320,000 — State Spending Per Low-Income Child: $120)
Healthy Families	$1,320,000	Department of Health	TANF	Healthy Families America
Idaho (FY10 Total State Funding: $0 — State Spending Per Low-Income Child: $0)
Illinois (FY10 Total State Funding: $21,870,000 — State Spending Per Low-Income Child: $124)
Healthy Families Illinois	$10,123,000	Department of Human Services	State general funds	Healthy Families America
Parents Too Soon	$6,940,000	Department of Human Services	State general funds	Healthy Families, Nurse-Family Partnership, Parents as Teachers
Targeted Intensive Case Management	$4,807,000	Department of Human Services	State general funds	Case management
Indiana (FY10 Total State Funding: $50,999,000 — State Spending Per Low-Income Child: $520)
Early Childhood Block Grant/Infant & Toddler Set Aside	Unavailable	State Board of Education	State general funds	Multiple national models, with some state developed
Healthy Families Indiana	$35,346,000	Department of Children and Families	TANF	Healthy Families America
Community Partners for Child Safety	$15,653,000	Department of Child Services/Kids First Trust Fund	Kids First Trust Fund; CBCAP; PSSF/Title IV- B; Special fees	State-developed program
Iowa (FY10 Total State Funding: $15,879,000 — State Spending Per Low-Income Child: $441)
Community Empowerment: Family Support	$10,194,000	Department of Management	State general funds	Multiple national, state, and locally-developed models
Family Development and Self-Sufficiency Program	$4,947,000	Department of Management	TANF; State general funds	Localities select program
Healthy Opportunities for Parents to Experience Success/Healthy Families Iowa	$738,000	Department of Public Health	State general funds	Healthy Families America
Iowa Child Abuse Prevention Program	Unavailable	Department of Human Services	PSSF/Title IV-B; TANF; State general funds; Birth certificate fees	Multiple national, state, and locally-developed models
Community Partnerships for Protecting Children	Unavailable	Department of Human Services	State general funds	Multiple national, state, and locally-developed models
Kansas (FY10 Total State Funding: $11,331,000 — State Spending Per Low-Income Child: $202)
Parents as Teachers	$7,567,000	Department of Education	Tobacco settlement funds/Children's Initiative Fund; State general funds	Parents as Teachers
Early Childhood Block Grant	$1,950,000	Children's Cabinet and Trust Fund	Tobacco settlement funds/Children's Initiative Fund	Multiple national models
Healthy Start Home Visitor	$1,151,000	Department of Health and Environment	Tobacco settlement funds/Children's Initiative Fund; State general funds; MCH Block Grant	State-developed program
Smart Start	$629,000	Children's Cabinet and Trust Fund	Tobacco settlement funds/Children's Initiative Fund	Multiple national models
Child Abuse Prevention Grants	$34,000	Children's Cabinet and Trust Fund	CBCAP; License fees	Multiple national models
Kentucky (FY10 Total State Funding: $31,685,000 — State Spending Per Low-Income Child: $391)
Health Access Nurturing Development Services (HANDS)	$31,685,000	Department for Public Health	State general funds (tobacco settlement); Medicaid	State-developed program
Louisiana (FY10 Total State Funding: $12,363,000 — State Spending Per Low-Income Child: $167)
Nurse-Family Partnership	$12,300,000	Department of Health and Hospitals	TANF; MCH block grant; Medicaid; State general funds	Nurse-Family Partnership
Children's Trust Fund	$63,000	Children's Trust Fund	CBCAP; duplicate birth certificate fees	Broad early childhood funds; specific to program selected by community
Maine (FY10 Total State Funding: $9,740,000 — State Spending Per Low-Income Child: $400)
Maine Families	$5,200,000	Department of Health and Human Services	Tobacco settlement funds	Parents as Teachers; Healthy Families America
Maine Public Health Nursing	$4,540,000	Department of Health and Human Services	State general funds; MCH Block Grant	State-developed program
Maryland (FY10 Total State Funding: $4,590,000 — State Spending Per Low-Income Child: $92)
Healthy Families	$4,590,000	Department of Education	TANF	Healthy Families America
Massachusetts (FY10 Total State Funding: $13,584,000 — State Spending Per Low-Income Child: $234)
Healthy Families	$10,538,000	Department of Early Education and Care/Children's Trust Fund	State general funds; TANF	Healthy Families America
Parent-Child Home Program	$1,800,000	Department of Early Education and Care	TANF; CCDF Grant	Parent-Child Home Program
Early Intervention Partnership Program	$715,000	Department of Public Health	MCH Block Grant; Medicaid	State-developed program
Fresh Start	$531,000	Department of Public Health	State general funds; EBHV Grant	State-developed program
Michigan (FY10 Total State Funding: $21,458,000 — State Spending Per Low-Income Child: $234)
Maternal Infant Health Program	$16,000,000	Department of Community Health	Medicaid	State-developed program
Zero to Three Secondary Prevention	$4,000,000	Department of Human Services	TANF	Specific to program selected by community
Childhood Lead Poisoning Prevention Program	$1,358,000	Department of Community Health	State general funds; MCH Block Grant; Centers for Disease Control and Prevention	State-developed program
Children's Trust Fund	$100,000	Department of Human Services	CBCAP	Broad early childhood funds; specific to program selected by community
Great Parents, Great Start	Unavailable	Department of Education	State general funds	Broad early childhood funds; specific to program selected by community
Minnesota (FY10 Total State Funding: $7,785,000 — State Spending Per Low-Income Child: $124)
Family Home Visiting	$7,785,000	Department of Health	TANF; State general funds	Localities select program
Early Childhood Family Education	Unavailable	Department of Education	State general funds	State-developed program
Missouri (FY10 Total State Funding: $28,095,000 — State Spending Per Low-Income Child: $316)
Parents as Teachers	$23,918,000	Department of Elementary and Secondary Education	State general funds	Parents as Teachers
Stay at Home Parent Program	$2,884,000	Department of Social Services	Gaming fees	Localities select program
Building Blocks of Missouri	$1,043,000	Department of Health and Senior Services	MCH block grant	Nurse-Family Partnership
Missouri Community-based Home Visiting Program	$250,000	Department of Health and Senior Services	MCH block grant	State-developed program
Mississippi (FY10 Total State Funding: $0 — State Spending Per Low-Income Child: $0)
Montana (FY10 Total State Funding: $591,000 — State Spending Per Low-Income Child: $42)
Public Health Home Visiting Program	$591,000	Department of Public Health and Human Services	State general funds; Special state funds	State-developed program
Family Resource Centers	Unavailable	Children's Trust Fund	CBCAP; Interest earnings from state child endowment; Divorce filing fees	Broad early childhood funds; specific to program selected by community
Nebraska (FY10 Total State Funding: $1,792,000 — State Spending Per Low-Income Child: $69)
Sixpence Early Learning Fund	$1,051,000	Children and Families Foundation	Earnings from Educational Lands and Trust Funds endowment	Broad early childhood funds; home visiting programs must meet state-developed standards
Home Visitation Program	$600,000	Department of Health & Human Services	State general funds	Healthy Families America; Hawaii Healthy Start; Nurse-Family Partnership; Intensive Home Visiting for At-Risk Parents
Child Abuse Prevention Grants	$141,000	Children and Families Foundation	CBCAP; PSSF/Title IV-B	Broad early childhood funds; specific to program selected by community
New Hampshire (FY10 Total State Funding: $1,598,000 — State Spending Per Low-Income Child: $228)
Home Visiting New Hampshire	$1,582,000	Department of Health and Human Services	TANF; Medicaid ; MCH Block Grant	State-developed program
Family Centers	$16,000	Children's Trust Fund	Children's Trust Fund endowment; CBCAP	Broad early childhood funds; specific to program selected by community
New Jersey (FY10 Total State Funding: $11,100,000 — State Spending Per Low-Income Child: $161)
Comprehensive Home Visiting Initiative	$11,100,000	Department of Children and Families	TANF; PSSF/Title IV-B; State general funds; EBHV Grant	Healthy Families America; Nurse-Family Partnership; Parents as Teachers
New Mexico (FY10 Total State Funding: $2,572,000 — State Spending Per Low-Income Child: $64)
New Mexico Home Visiting Services	$2,572,000	Children, Youth and Families Department	State general funds; ARRA	State-developed program; specific to program selected by community
New York (FY10 Total State Funding: $40,142,000 — State Spending Per Low-Income Child: $171)
Healthy Families New York	$21,742,000	Office of Children and Family Services	TANF; State general funds	Healthy Families America
Nurse-Family Partnership	$11,600,000	Department of Health	TANF (one-time only); Medicaid	Nurse-Family Partnership
Community Health Worker	$4,800,000	Department of Health	MCH Block Grant; State general funds; Medicaid	State-developed program
Healthy Mom, Healthy Baby	$2,000,000	Department of Health	State general funds	Discretion given to home visitor
Nevada (FY10 Total State Funding: $0 — State Spending Per Low-Income Child: $0)
North Carolina (FY10 Total State Funding: $9,033,000 — State Spending Per Low-Income Child: $61)
Smart Start: Family Support Initiatives	$8,033,000	Department of Health and Human Services	State general funds	Multiple national models
Nurse-Family Partnership	$1,000,000	Department of Health and Human Services	MCH block grant	Nurse-Family Partnership
North Dakota (FY10 Total State Funding: $250,000 — State Spending Per Low-Income Child: $50)
Healthy Families America	$250,000	Department of Human Services	State general funds	Healthy Families America
Ohio (FY10 Total State Funding: $26,569,000 — State Spending Per Low-Income Child: $134)
Help Me Grow	$24,841,000	Department of Health	State general funds	Multiple national models, with some locally developed; programs must meet state- developed standards
Infant Mortality Reduction Initiative	$1,728,000	Department of Health	State general funds; MCH block grant	State-developed program
Oklahoma (FY10 Total State Funding: $19,046,000 — State Spending Per Low-Income Child: $307)
Children First (Nurse-Family Partnership)	$12,680,000	Department of Health	State general funds; Medicaid	Nurse-Family Partnership
Start Right	$3,915,000	Department of Health	State general funds; CBCAP	State-developed program
Oklahoma Parents as Teachers	$2,451,000	Department of Education	State general funds	Parents as Teachers
Oregon (FY10 Total State Funding: $13,356,000 — State Spending Per Low-Income Child: $334)
Healthy Start/Healthy Families	$9,121,000	Oregon Commission for Children and Families	State general funds; Medicaid	Healthy Families America
Family Support and Connections	$2,152,000	Department of Human Services	State general funds; CBCAP; TANF	State-developed program
Maternity Case Management	$1,402,000	Department of Human Services	Medicaid	Case management
Babies First!	$681,000	Department of Human Services	State general funds	State-developed program
Pennsylvania (FY10 Total State Funding: $21,321,000 — State Spending Per Low-Income Child: $106)
Nurse-Family Partnership	$11,178,000	Office of Child Development and Early Learning, Department of Public Welfare	State general funds	Nurse-Family Partnership
Family Centers	$6,741,000	Office of Children, Youth and Families, Department of Public Welfare	State general funds; CBCAP; PSSF/Title IV-B	Parents as Teachers
Parent-Child Home Program	$3,402,000	Office of Child Development and Early Learning, Department of Public Welfare	PSSF/Title IV-B; State general funds	Parent-Child Home Program
Rhode Island (FY10 Total State Funding: $1,407,000 — State Spending Per Low-Income Child: $100)
Rhode Island Nurse-Family Partnership Initiative	$650,000	Department of Health; Department of Children, Youth and Families; Department of Human Services	EBHV; Family Care Community Partnerships; WIC; TANF	Nurse-Family Partnership
The First Connections Program	$643,000	Department of Health	State general funds; IDEA Part C; Medicaid	Broad discretion given to home visitor using state-developed standards
Children's Trusts Fund Grants	$100,000	Department of Children, Youth and Families	CBCAP	Specific to program selected by community
Child Opportunity Zones	$14,000	Department of Education	State general funds	Discretion given to home visitor
South Carolina (FY10 Total State Funding: $6,905,000 — State Spending Per Low-Income Child: $102)
First Steps	$6,232,000	Department of Education	State general funds	Multiple national models, with some locally developed; programs must meet state-developed standards
Nurse-Family Partnership	$673,000	Children's Trust Fund	EBHV Grant	Nurse-Family Partnership
Family Literacy	Unavailable	Department of Education	State general funds	Multiple national models, with some locally developed
South Dakota (FY10 Total State Funding: Unavailable — State Spending Per Low-Income Child: Unable to calculate)
Bright Start	Unavailable	Department of Health	TANF; Medicaid	Nurse-Family Partnership
Tennessee (FY10 Total State Funding: $12,113,000 — Spending Per Low-Income Child: $114)
Help Us Grow Successfully (HUGS)	$6,500,000	Department of Health	TennCare/Medicaid	State-developed program
Healthy Start/Hawaii Healthy Families America	$3,000,000	Department of Health	PSSF/Title IV-B	Healthy Families America
Nurse-Family Partnership	$1,625,000	Department of Health	State general funds; EBHV Grant	Nurse-Family Partnership
Child Health and Development Projects (CHAD)	$538,000	Department of Health	SSBG	State-developed program
Child Abuse Prevention Services	$450,000	Department of Children's Services	CBCAP; State general funds; License fees	Localities select program
Texas (FY10 Total State Funding: $8,900,000 — State Spending Per Low-Income Child: $15)
Texas Nurse-Family Partnership	$8,900,000	Health and Human Services Commission	State general funds; TANF	Nurse-Family Partnership
Prevention and Early Intervention Division	Unavailable	Department of Family and Protective Services	State general funds; PSSF/Title IV-B; CBCAP; Children's Trust Fund	Broad early childhood funds; specific to program selected by community
Utah(FY10 Total State Funding: $1,469,000 — State Spending Per Low-Income Child: $37)
Office Home Visiting	$614,000	Department of Health	EBHV Grant	Multiple national models
Child Abuse Prevention Funds	$591,000	Department of Human Services	CBCAP; PSSF/Title IV-B	Multiple national models, with some state developed
P-5 Home Visiting	$264,000	Department of Health	MCH block grant	Localities select program
Children's Trust Fund	Unavailable	Department of Human Services	Birth certificate fees	Broad early childhood funds; specific to program selected by community
Vermont(FY10 Total State Funding: $5,209,000 — State Spending Per Low-Income Child: $1,042)
Healthy Babies Kids & Families	$2,645,000	Agency for Human Services	Medicaid; State general funds	Discretion given to home visitor
Early Childhood and Family Mental Health	$2,564,000	Agency for Human Services	Medicaid; State general funds	Discretion given to home visitor
Children's Trust Fund Foundation	Unavailable	Agency for Human Services	State general funds	Broad early childhood funds; specific to program selected by community
Virginia(FY10 Total State Funding: $10,451,000 — State Spending Per Low-Income Child: $100)
Healthy Families Virginia	$5,400,000	Department of Social Services	TANF; State general funds	Healthy Families America
CHIP of Virginia	$2,550,000	Department of Health	State general funds	Parents as Teachers; Bright Futures
Resource Mothers	$2,501,000	Department of Health	MCH block grant; Medicaid; State general funds	Resource Mothers
Washington(FY10 Total State Funding: $1,180,000 — State Spending Per Low-Income Child: $18)
Evidence-Based Home Visiting	$1,180,000	Council for Children and Families	State general funds	Nurse-Family Partnership; Parents as Teachers; Parent-Child Home Program; Parenting Partnership
West Virginia(FY10 Total State Funding: $2,755,000 — State Spending Per Low-Income Child: $106)
Right from the Start	$2,005,000	Department of Health and Human Resources	Medicaid; MCH block grant	State-developed program with discretion given to the home visitor
In-Home Family Education Program	$750,000	Department of Health and Human Resources	CBCAP; State general funds	Healthy Families America; Maternal Infant Health Outreach Workers; Parents as Teachers
Wisconsin(FY10 Total State Funding: $2,910,000 — State Spending Per Low-Income Child: $106)
Empowering Families of Milwaukee	$1,424,000	Department of Children and Families	TANF; Project LAUNCH grant	Locally-developed program
Family Foundations	$986,000	Department of Children and Families	State general funds	Specific to program selected by community
Racine Home Visiting Program	$250,000	Department of Health Services	State general funds	Specific to program selected by community
Milwaukee Nurse-Family Partnership	$250,000	Department of Health Services	MCH block grant	Nurse-Family Partnership
Wyoming(FY10 Total State Funding: $3,252,000 — State Spending Per Low-Income Child: $650)
Public Health Nurses Infant Home Visitation Services	$3,252,000	Department of Health	TANF; MCH block grant	Nurse-Family Partnership