L.A. County Needs More Home Visiting, But Dollars Decline

This has been compounded by a short-term reduction in state funding, and uncertainty about Congress’ commitment to a $400 million home visiting program, which will play out as lawmakers return to Washington this week.

While there is wide variation in what home visiting looks like from program to program, the through-line is that mothers get home- or community-based parenting training starting as early as pregnancy.

In an effort to analyze the effectiveness of L.A.’s current home visiting programs, the Los Angeles County Department of Public Health released a report chronicling the impact of the seven programs offered within the county.

The analysis, released in June, found a “strong base of quality home visiting programs,” but noted a “fundamental shortage of resources to meet the full potential need for home-based support in L.A. County.”

There are 55 non-profit organizations providing these services in the county, delivering seven models of home visiting: Nurse-Family Partnership, Healthy Families America, Parents as Teachers, Partnerships for Families, Early Head Start, Welcome Baby and Healthy Start.

The report cites a litany of existing research on the impact these models have made on nine different outcomes, including family safety, improved child health, cost savings and crime reduction.

All of the models except for Healthy Start have shown positive impact on at least one of the nine outcomes, according to the report.

The total capacity of these programs is 24,500 families per year, including 9,500 families deemed to be “high-risk.” That is a significant but small fraction of the county’s need for home visiting. According to county data, there are 78,000 families giving birth each year that exhibit at least one “high-risk” factor, and 33,000 with two or more risk factors.

Exacerbating this shortfall is the fact that existing funds the county uses for home visiting are dwindling. First 5 LA supplies $38 million a year for home visiting, but its funding is pegged to state  tobacco taxes. According to the report, declining rates of tobacco use in the state could present a challenge: “First 5 LA funding continues to decline with the loss of tobacco revenue.”

Another major funder of home visiting in Los Angeles is federal dollars from the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. The report notes that the county’s MIECHV funding for the 2017-2018 fiscal year has been reduced by 45 percent.

MIECHV was established under the Affordable Care Act in 2010, and has been extended at $400 million per year since its initial authorization ran out. Unless Congress passes another reauthorization for the program by the end of the month, its funding will at least temporarily expire.

The report discusses possible financing strategies that could be implemented to expand the reach of the county’s home visitation programs. It stresses the underused potential of Medicaid for home visiting, honing in strongest on the potential for partnering with the Department of Health Services (DHS) to expand the programs through a Medicaid 1115 waiver.

The report also recommends advocating for MIECHV reauthorization, and for the pursuit of state funds through the Mental Health Services Act and state realignment funds.

One of the most significant themes, the report states, “is the importance of pursuing and implementing multiple sustainability strategies … in a blended or braided fashion, to achieve a truly universal system of home visiting.”

Stephanie Pham also contributed to this article.