Existing law establishes the State Department of Public Health, which is responsible for various programs relating to the health and safety of people in the state. Existing law requires the department, to the extent resources are available, to maintain a program of maternal and child health that includes the provision of educational, preventative, diagnostic, and treatment services, including medical care, hospitalization and other institutional care and aftercare, appliances and facilitating services directed toward reducing infant mortality, and improving the health of mothers and children.

This bill would establish within the Health and Safety Code the California Home Visiting Program, a voluntary maternal, infant, and early childhood program originally created administratively, under which the State Department of Public Health provides funds to local health departments to support pregnant people and parents with young children who live in communities that face greater risks and barriers to achieving positive maternal and child health outcomes, as provided.

Existing law establishes the State Department of Public Health, which is responsible for various programs relating to the health and safety of people in the state. Existing law requires the department, to the extent resources are available, to maintain a program of maternal and child health that includes the provision of educational, preventative, diagnostic, and treatment services, including medical care, hospitalization and other institutional care and aftercare, appliances and facilitating services directed toward reducing infant mortality, and improving the health of mothers and children.

This bill would establish within the Health and Safety Code the California Home Visiting Program, a voluntary maternal, infant, and early childhood program originally created administratively, under which the State Department of Public Health provides funds to local health departments to support pregnant people and parents with young children who live in communities that face greater risks and barriers to achieving positive maternal and child health outcomes, as provided.

Existing law establishes the State Department of Public Health, which is responsible for various programs relating to the health and safety of people in the state. Existing law requires the department, to the extent resources are available, to maintain a program of maternal and child health that includes the provision of educational, preventative, diagnostic, and treatment services, including medical care, hospitalization and other institutional care and aftercare, appliances and facilitating services directed toward reducing infant mortality, and improving the health of mothers and children.

This bill would establish within the Health and Safety Code the California Home Visiting Program, a voluntary maternal, infant, and early childhood program originally created administratively, under which the State Department of Public Health provides funds to local health departments to support pregnant people and parents with young children who live in communities that face greater risks and barriers to achieving positive maternal and child health outcomes, as provided.

Existing law establishes the State Department of Public Health, which is responsible for various programs relating to the health and safety of people in the state. Existing law requires the department, to the extent resources are available, to maintain a program of maternal and child health that includes the provision of educational, preventative, diagnostic, and treatment services, including medical care, hospitalization and other institutional care and aftercare, appliances and facilitating services directed toward reducing infant mortality, and improving the health of mothers and children.

This bill would establish within the Health and Safety Code the California Home Visiting Program, a voluntary program originally created administratively, under which the State Department of Public Health provides funds to local health departments to support pregnant people and parents with young children who live in communities that face greater risks and barriers to achieving positive maternal and child health outcomes, as provided.

Existing law establishes the State Department of Public Health, which is responsible for various programs relating to the health and safety of people in the state. Existing law requires the department, to the extent resources are available, to maintain a program of maternal and child health that includes the provision of educational, preventative, diagnostic, and treatment services, including medical care, hospitalization and other institutional care and aftercare, appliances and facilitating services directed toward reducing infant mortality, and improving the health of mothers and children.

This bill would establish within the Health and Safety Code the California Home Visiting Program, a voluntary program originally created administratively, under which the State Department of Public Health provides funds to local health departments to support pregnant people and parents with young children who live in communities that face greater risks and barriers to achieving positive maternal and child health outcomes, as provided.

GOVERNOR'S VETO

GV Bill Id:AB 1057

Author:(Weber)

As Enrolled Ver:September 18, 2023

2/3 vote

SUMMARY

Codifies and establishes parameters regarding the existing California Home Visiting Program (CHVP), a program administered by the Department of Public Health (DPH) to support pregnant people and parents with young children who are at risk of poor maternal and child health outcomes.

Senate Amendments

1. Expand the list of stakeholders DPH is required to consult with.
2. Require DPH to incorporate at least one new evidence-based model in the program by January 1, 2025.
3. Specify the provision of supplemental mental health support, depending on the model administered by the local health department.
4. Require legislative reports, as specified.
5. Recast requirements related to federally funded programs.

Governor’s Veto Message

This bill would codify the existing California Home Visiting Program (CHVP) and require the California Department of Public Health (CDPH) to allocate funds to participating Local Health Departments to implement the CHVP using any federally approved home visiting model. CDPH would be required to submit a report to the Legislature every two years on performance outcomes.

I support the author's goal to improve maternal, child, and infant health outcomes, and cultivate strong families and communities. For this reason, I am instructing CDPH to ensure there is collaboration with home visiting partners, local health directors, local health officers, and other affected stakeholders to meet local CHVP needs. However, this bill creates new General Fund costs that are not included in the budget, as well as cost pressures if the CHVP approves additional home visiting models outside of the annual budget process.

In partnership with the Legislature, we enacted a budget that closed a shortfall of more than $30 billion through balanced solutions that avoided deep program cuts and protected education, health care, climate, public safety, and social service programs that are relied on by millions of Californians.

This year, however, the Legislature sent me bills outside of this budget process that, if all enacted, would add nearly $19 billion of unaccounted costs in the budget, of which $11 billion would be ongoing.

With our state facing continuing economic risk and revenue uncertainty, it is important to remain disciplined when considering bills with significant fiscal implications, such as this measure.

COMMENTS

According to an issue brief published by the Kaiser Family Foundation in 2022 entitled "Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them," Black and American Indian and Alaska Native (AIAN) people have higher rates of pregnancy-related death compared to white people. Pregnancy-related mortality rates among Black and AIAN people are over three and two times higher, respectively, compared to the rate for white people (41.4 and 26.2 vs. 13.7 per 100,000). Black, AIAN, and Native Hawaiian and Other Pacific Islander (NHOPI) people also have higher shares of preterm births, low birthweight births, or births for which they received late or no prenatal care compared to white people. Infants born to Black, AIAN, and NHOPI people have markedly higher mortality rates than those born to white people. Maternal death rates increased during the COVID-19 pandemic and racial disparities widened for Black people.

Maternal and infant health disparities are symptoms of broader underlying social and economic inequities that are rooted in racism and discrimination. Differences in health insurance coverage and access to care play a role in driving worse maternal and infant health outcomes for people of color. However, inequities in broader social and economic factors and structural and systemic racism and discrimination are primary drivers for maternal and infant health. Notably, disparities in maternal and infant health persist even when controlling for certain underlying social and economic factors, such as education and income, pointing to the roles racism and discrimination play in driving disparities.

The increased awareness and attention to maternal and infant health have contributed to a rise in efforts and resources focused on improving health outcomes in these areas and reducing disparities. These include efforts to expand access to coverage and care, increase access to a broader array of services and providers that support maternal and infant health, diversity in the health care workforce, and enhance data collection and reporting. However, addressing social and economic factors that contribute to poorer health outcomes and disparities will also be important. Moreover, the persistence of disparities in maternal health across income and education levels, points to the importance of addressing the roles of racism and discrimination within the overall health care system as part of efforts to improve health and advance equity.

Maternal, Infant and Early Childhood Home Visiting Program (MIECHV). This bill would make local health departments (LHDs) eligible for grants for implementing one of the 20 MIECHV models. In 2010, the MIECHV was established under the administration of the federal Health Resources and Services Administration, in partnership with Administration for Children and Families, to fund states, territories, and tribal entities to develop and implement home visiting programs (HVPs). HVPs support pregnant people and parents with young children who live in communities that face greater risks and barriers to achieving positive maternal and child health outcomes. Families choose to participate in home visiting programs, and partner with health, social service, and child development professionals to set and achieve goals that improve their health and well-being. These programs must be based on the best evidence showing that they are effective at meeting the needs of families.

The MIECHV aims to improve maternal and child health, prevent child abuse and neglect, reduce crime and domestic violence, increase family education level and earning potential, promote children’s development and readiness to participate in school, and connect families to needed community resources and supports.

MIECHV Models. There are currently 20 home visiting models available under MIECHV. These models were reviewed under the Home Visiting Evidence of Effectiveness to ensure the models effectively meet family needs. These models include: attachment and behavioral catch-up; child first; early intervention program for adolescent mothers; family connects; healthy beginnings; nurse-family partnership; and, play and learning strategies.

MIECHV awardees annually report program performance on 19 measures across six benchmark areas defined in law, which are aimed at improving the well-being of both parents and children. Beginning in the fiscal year 2020 reporting period and every three years thereafter, awardees are required to demonstrate improvement in at least four of six benchmark areas. Most states that have implemented the program have implemented four or five models.

In December 2022, MIECHV was reauthorized for an additional five years, with a $500 million funding annually beginning fiscal year 2023.

CHVP. This bill codifies into statute the CHVP and expands the number of models that would be implemented and funded by DPH. According to DPH's website, CHVP is designed for overburdened families who are at risk for Adverse Childhood Experiences, including child maltreatment, domestic violence, substance use disorder and mental health related issues. Home visiting gives parents the tools and know-how to independently raise their children. It's a preventive intervention focused on promoting positive parenting and child development. Decades of research on home visiting shows that home visits by a trained professional during pregnancy and in the first few years of life improves the lives of children and families. Giving children a solid start in their first few years of life increases the opportunity for a brighter, more prosperous future. In 2019, $23 million in new State GF were provided to DPH for evidence-based and innovative home visiting services.

Out of the 20 models authorized by MIECHV, California implemented three of the models (spread throughout 34 California counties): the Healthy Families America, Nurse-Family Partnership, or Parents as Teachers home visiting model, based on the specific needs of the region. All three models are strengths-based and focus on a participant's individual interests. The goals are also the same across the models: increase parent knowledge of early childhood development and improve parenting practices; provide early detection of developmental delays and health issues; prevent child abuse and neglect; and increase children's school readiness and success. Below are additional characteristics of each model:

1. Healthy Families America. Serves low-income families who must be enrolled within the first three months after an infant's birth. A trained paraprofessional provides one-on-one home visits to parents and their babies primarily through three years postpartum.
2. Nurse-Family Partnership. Serves low-income, first-time moms who must be enrolled by the 28th week of pregnancy. A Public Health Nurse provides one-on-one home visits to parents and their babies through two years postpartum.
3. Parents as Teachers. Serves families with children (between pregnancy and Kindergarten entry) experiencing one or more stressors in their lives. A Parent Educator conducts personal visits with parents and their children, as well as monthly group events.

According to the Author

This bill gives local health jurisdictions additional flexibility to administer more home visiting programs that address the unique needs of each community. It also provides opportunities to supplement home visiting with mental health supports and training; a service needed more as we emerge from the pandemic. Currently, there are 20 evidence-based home visiting models that meet federal requirements, however, only three of these programs are currently approved by the state. The author concludes this bill will give counties the opportunity to have access to all 20 programs.

Arguments in Support

Numerous LHDs write in support of this bill and state that with this bill, the expansion of models would give LHDs additional tools to better meet the needs of the families and children served by CHVP. They state that the COVID-19 pandemic highlighted a growing need to support the mental health needs of many families. Home visiting programs are uniquely positioned to reach new parents and families during the perinatal period when they are vulnerable to maternal and mental health disorders and early childhood. They conclude that home visiting programs need the flexibility to supplement the program with mental health support for their families.

Arguments in Opposition

The Department of Finance is opposed to this measure because the additional workload associated with this bill creates new General Fund costs for DPH that are not included in the Administration's spending plan and, to the extent the MIECHV program approves additional home visiting models in the future, the bill’s provisions could create additional General Fund cost pressures. Additionally, Finance opposes this bill because its provisions could potentially put the receipt of federal funds at risk.

FISCAL COMMENTS

According to the Senate Appropriations Committee, unknown, ongoing General Fund costs for DPH for administration, depending on which specific models are selected, the number of counties electing to implement additional models, data systems, and training needs associated with the new models.

VOTES

ASM HEALTH: 15-0-0

YES: Wood, Waldron, Aguiar-Curry, Arambula, Boerner Horvath, Wendy Carrillo, Flora, Vince Fong, Maienschein, McCarty, Joe Patterson, Rodriguez, Santiago, Villapudua, Weber

ASM APPROPRIATIONS: 15-0-1

YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Pellerin, Sanchez, Weber, Ortega

ABS, ABST OR NV: Robert Rivas

ASSEMBLY FLOOR: 80-0-0

YES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones‑Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

SENATE FLOOR: 38-0-2

YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk

ABS, ABST OR NV: Caballero, Grove

ASSEMBLY FLOOR: 80-0-0

YES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones‑Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Luz Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

UPDATED

VERSION: September 18, 2023

CONSULTANT: Lisa Murawski / HEALTH / (916) 319-2097 FN: 0002541

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 1057

Author:(Weber)

As Amended Ver:September 1, 2023

Majority vote

SUMMARY

Codifies and establishes parameters regarding the existing California Home Visiting Program (CHVP), a program administered by the Department of Public Health (DPH) to support pregnant people and parents with young children who are at risk of poor maternal and child health outcomes.

Senate Amendments

1. Expand the list of stakeholders DPH is required to consult with.
2. Require DPH to incorporate at least one new evidence-based model in the program by January 1, 2025.
3. Specify the provision of supplemental mental health support, depending on the model administered by the local health department.
4. Require legislative reports, as specified.
5. Recast requirements related to federally funded programs.

COMMENTS

According to an issue brief published by the Kaiser Family Foundation in 2022 entitled "Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them," Black and American Indian and Alaska Native (AIAN) people have higher rates of pregnancy-related death compared to white people. Pregnancy-related mortality rates among Black and AIAN people are over three and two times higher, respectively, compared to the rate for white people (41.4 and 26.2 vs. 13.7 per 100,000). Black, AIAN, and Native Hawaiian and Other Pacific Islander (NHOPI) people also have higher shares of preterm births, low birthweight births, or births for which they received late or no prenatal care compared to white people. Infants born to Black, AIAN, and NHOPI people have markedly higher mortality rates than those born to white people. Maternal death rates increased during the COVID-19 pandemic and racial disparities widened for Black people.

Maternal and infant health disparities are symptoms of broader underlying social and economic inequities that are rooted in racism and discrimination. Differences in health insurance coverage and access to care play a role in driving worse maternal and infant health outcomes for people of color. However, inequities in broader social and economic factors and structural and systemic racism and discrimination are primary drivers for maternal and infant health. Notably, disparities in maternal and infant health persist even when controlling for certain underlying social and economic factors, such as education and income, pointing to the roles racism and discrimination play in driving disparities.

The increased awareness and attention to maternal and infant health have contributed to a rise in efforts and resources focused on improving health outcomes in these areas and reducing disparities. These include efforts to expand access to coverage and care, increase access to a broader array of services and providers that support maternal and infant health, diversity in the health care workforce, and enhance data collection and reporting. However, addressing social and economic factors that contribute to poorer health outcomes and disparities will also be important. Moreover, the persistence of disparities in maternal health across income and education levels, points to the importance of addressing the roles of racism and discrimination within the overall health care system as part of efforts to improve health and advance equity.

Maternal, Infant and Early Childhood Home Visiting Program (MIECHV). This bill would make local health departments (LHDs) eligible for grants for implementing one of the 20 MIECHV models. In 2010, the MIECHV was established under the administration of the federal Health Resources and Services Administration, in partnership with Administration for Children and Families, to fund states, territories, and tribal entities to develop and implement home visiting programs (HVPs). HVPs support pregnant people and parents with young children who live in communities that face greater risks and barriers to achieving positive maternal and child health outcomes. Families choose to participate in home visiting programs, and partner with health, social service, and child development professionals to set and achieve goals that improve their health and well-being. These programs must be based on the best evidence showing that they are effective at meeting the needs of families.

The MIECHV aims to improve maternal and child health, prevent child abuse and neglect, reduce crime and domestic violence, increase family education level and earning potential, promote children’s development and readiness to participate in school, and connect families to needed community resources and supports.

MIECHV Models. There are currently 20 home visiting models available under MIECHV. These models were reviewed under the Home Visiting Evidence of Effectiveness to ensure the models effectively meet family needs. These models include: attachment and behavioral catch-up; child first; early intervention program for adolescent mothers; family connects; healthy beginnings; nurse-family partnership; and, play and learning strategies.

MIECHV awardees annually report program performance on 19 measures across six benchmark areas defined in law, which are aimed at improving the well-being of both parents and children. Beginning in the fiscal year 2020 reporting period and every three years thereafter, awardees are required to demonstrate improvement in at least four of six benchmark areas. Most states that have implemented the program have implemented four or five models.

In December 2022, MIECHV was reauthorized for an additional five years, with a $500 million funding annually beginning fiscal year 2023.

CHVP. This bill codifies into statute the CHVP and expands the number of models that would be implemented and funded by DPH. According to DPH's website, CHVP is designed for overburdened families who are at risk for Adverse Childhood Experiences, including child maltreatment, domestic violence, substance use disorder and mental health related issues. Home visiting gives parents the tools and know-how to independently raise their children. It's a preventive intervention focused on promoting positive parenting and child development. Decades of research on home visiting shows that home visits by a trained professional during pregnancy and in the first few years of life improves the lives of children and families. Giving children a solid start in their first few years of life increases the opportunity for a brighter, more prosperous future. In 2019, $23 million in new State GF were provided to DPH for evidence-based and innovative home visiting services.

Out of the 20 models authorized by MIECHV, California implemented three of the models (spread throughout 34 California counties): the Healthy Families America, Nurse-Family Partnership, or Parents as Teachers home visiting model, based on the specific needs of the region. All three models are strengths-based and focus on a participant's individual interests. The goals are also the same across the models: increase parent knowledge of early childhood development and improve parenting practices; provide early detection of developmental delays and health issues; prevent child abuse and neglect; and increase children's school readiness and success. Below are additional characteristics of each model:

1. Healthy Families America. Serves low-income families who must be enrolled within the first three months after an infant's birth. A trained paraprofessional provides one-on-one home visits to parents and their babies primarily through three years postpartum.
2. Nurse-Family Partnership. Serves low-income, first-time moms who must be enrolled by the 28th week of pregnancy. A Public Health Nurse provides one-on-one home visits to parents and their babies through two years postpartum.
3. Parents as Teachers. Serves families with children (between pregnancy and Kindergarten entry) experiencing one or more stressors in their lives. A Parent Educator conducts personal visits with parents and their children, as well as monthly group events.

According to the Author

This bill gives local health jurisdictions additional flexibility to administer more home visiting programs that address the unique needs of each community. It also provides opportunities to supplement home visiting with mental health supports and training; a service needed more as we emerge from the pandemic. Currently, there are 20 evidence-based home visiting models that meet federal requirements, however, only three of these programs are currently approved by the state. The author concludes this bill will give counties the opportunity to have access to all 20 programs.

Arguments in Support

Numerous LHDs write in support of this bill and state that with this bill, the expansion of models would give LHDs additional tools to better meet the needs of the families and children served by CHVP. They state that the COVID-19 pandemic highlighted a growing need to support the mental health needs of many families. Home visiting programs are uniquely positioned to reach new parents and families during the perinatal period when they are vulnerable to maternal and mental health disorders and early childhood. They conclude that home visiting programs need the flexibility to supplement the program with mental health support for their families.

Arguments in Opposition

The Department of Finance is opposed to this measure because the additional workload associated with this bill creates new General Fund costs for DPH that are not included in the Administration's spending plan and, to the extent the MIECHV program approves additional home visiting models in the future, the bill’s provisions could create additional General Fund cost pressures. Additionally, Finance opposes this bill because its provisions could potentially put the receipt of federal funds at risk.

FISCAL COMMENTS

According to the Senate Appropriations Committee, unknown, ongoing General Fund costs for DPH for administration, depending on which specific models are selected, the number of counties electing to implement additional models, data systems, and training needs associated with the new models.

VOTES:

ASM HEALTH: 15-0-0

YES: Wood, Waldron, Aguiar-Curry, Arambula, Boerner Horvath, Wendy Carrillo, Flora, Vince Fong, Maienschein, McCarty, Joe Patterson, Rodriguez, Santiago, Villapudua, Weber

ASM APPROPRIATIONS: 15-0-1

YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Pellerin, Sanchez, Weber, Ortega

ABS, ABST OR NV: Robert Rivas

ASSEMBLY FLOOR: 80-0-0

YES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones‑Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

UPDATED

VERSION: September 1, 2023

CONSULTANT: Lisa Murawski / HEALTH / (916) 319-2097 FN: 0001758

 THIRD READING  

Bill No: AB 1057

Author: Weber (D), et al.

Amended: 9/1/23 in Senate

Vote: 21

SENATE HEALTH COMMITTEE: 12-0, 6/21/23

AYES: Eggman, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Roth, Rubio, Wahab, Wiener

SENATE APPROPRIATIONS COMMITTEE: 7-0, 9/1/23

AYES: Portantino, Jones, Ashby, Bradford, Seyarto, Wahab, Wiener

ASSEMBLY FLOOR: 80-0, 5/30/23 - See last page for vote

SUBJECT: California Home Visiting Program

SOURCE: County Health Executives of California

DIGEST:

This bill codifies the California Home Visiting Program within the California Department of Public Health.

ANALYSIS:

Existing law:

1. Establishes the California Department of Public Health (CDPH), directed by a state Public Health Officer (PHO), to be vested with all the duties, powers, purposes, functions, responsibilities, and jurisdictions as they relate to public health and licensing of health facilities, as specified. Gives the PHO broad authority to detect, monitor, and prevent the spread of communicable disease in the state. Requires CDPH to examine the causes of communicable disease in man and domestic animals occurring or likely to occur in this state. [HSC §131050, §120130, et seq., §120125]
2. Requires each county board of supervisors to appoint a local health officer (LHO). Requires LHOs to enforce and observe orders and ordinances of the board of supervisors, pertaining to the public health and sanitary matters, orders, including quarantine and other regulations, prescribed by CDPH, and statutes relating to public health. [HSC §101000 and §101030]
3. Requires CDPH to maintain a program of maternal and child health. Requires CDPH to develop and maintain a statewide comprehensive community-based perinatal services program and enter into contracts, grants, or agreements with health care providers, in medically underserved areas or areas with demonstrated need, to deliver these services in a coordinated effort to the extent permitted under federal law and regulation, as specified. [HSC §123225 and §123490]
4. Requires CDPH to maintain a program that addresses the special needs of high-risk pregnant women and infants, as specified. Defines “high-risk pregnant woman” as a woman considered highly likely for any reason to suffer personal mortality or morbidity from her pregnancy, or to deliver a defective, disabled, high-risk, or stillborn infant. [HSC §123560, §123565]

This bill:

1. Codifies the California Home Visiting Program (CHVP) within CDPH with the goals and objectives to promote the health and well-being of pregnant people and parents, improve infant and child health and development, strengthen family functioning, educe child maltreatment, promote economic mobility, and cultivate strong communities. Requires CHVP encourage participants to enroll their child in a high-quality early learning setting, or to participate in playgroups or other child enrichment activities, as appropriate.
2. Requires CDPH to allocate funds to participating local health departments (LHDs) to administer the CHVP. Requires funding allocations to balance the need to spread funding to as many LHDs as possible and the need to ensure sufficient funding for meaningful activities, and shall be determined in collaboration with organizations representing LHDs, LHOs, and other affected stakeholders.
3. Requires CDPH, in awarding funds, to authorize LHDs to implement home visiting model or models as follows:
   1. Administer one of the evidence-based models approved by CDPH and the federal Health Resources and Services Administration (HRSA) Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program, as specified;
   2. Requires approval of an alternative home visiting model that prioritizes the unique needs of individuals in the city, county, or city and county served by the LHD; and,
   3. Administer one or more of these models.
4. Permits CDPH, in awarding funds, to also authorize LHDs to supplement home visiting with mental health supports that includes, but are not limited to:
   1. Implementing evidence-based approaches for supporting the mental health of program recipients, including programs aimed at reducing the risk of postpartum depression or programs that embed mental health support into home visits;
   2. Providing mental health training for LHD staff engaging in home visits;
   3. Providing mental health screenings and referrals for program recipients; and,
   4. Hosting family events to strengthen family engagement and promoting peer support among program participants.
5. Requires LHDs that administer a model that offers mental health support to adhere to the model guidelines, but permits the model to be supplemented with additional mental health support. Permits LHDs that administer a model that does not offer mental health support to supplement the model with mental health support.
6. Permits CDPH to provide funding to LHDs that did not participate in CHVP to support planning activities for future participation in CHVP.
7. Requires CDPH to implement a phased approach for increasing the number of evidence-based models beyond the models offered as of July 1, 2023, based on LHD assessments of their community needs and in collaboration with organizations representing LHD directors. Requires CDPH to incorporate at least one new model by January 1, 2025.
8. Requires CDPH, to the extent that the Legislature appropriates new funding for CHVP, to collaborate with organizations representing LHD directors to determine the number of new models to be incorporated.
9. Requires CDPH, if it does not incorporate at least two new models with each funding augmentation, to include the process conducted to make that determination in the report submitted to the Legislature pursuant to 12) below.
10. Requires CDPH to seek to maximize funds from the federal government, as specified. Requires CDPH, to the extent that federal funding is provided for these purposes, to only authorize the use of those funds in a manner that complies with applicable federal requirements.
11. Requires CDPH, without taking regulatory action, to implement, interpret, or make specific this bill by means of policy letters. Requires CDPH to collaborate with affected stakeholders, including organizations representing LHD directors, First 5 California, home visiting model developers, and home visiting program advocates before taking such action and to post policy letters on its website.
12. Requires CDPH to submit a report, as specified, every two years to the Senate and Assembly Committees on Health on performance outcomes for CHVP participants in the following domains: maternal and newborn health; child injuries, abuse, neglect, and maltreatment and emergency department visits; school readiness and achievement; crime or domestic violence; family economic self-sufficiency; and, coordination and referrals for other community resources and supports.
13. Requires implementation of this bill to be contingent upon funding appropriated by the Legislature. Specifies that this does not apply to funding provided to the state under MIECHV.

Comments

1. Author’s statement. According to the author, this bill gives local health jurisdictions additional flexibility to administer more home visiting programs that address the unique needs of each community. It also provides opportunity to supplement home visiting with mental health supports and training; a service needed more as we emerged from the pandemic. Currently, there are 20 evidence-based home visiting models that meet federal requirements, however, only three of these programs are currently approved by the state. This bill will give counties the opportunity to have access to all 20 programs.
2. Adverse Childhood Experiences (ACEs). CHVP is designed for overburdened families who are at risk for ACEs, including child maltreatment, domestic violence, substance use disorder and mental health related issues. According to the Center for Disease Control and Prevention, ACEs are potentially traumatic events that occur in childhood, such as experiencing violence, abuse, or neglect, witnessing violence in the home or community, or having a family member attempt or die by suicide. Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding, such as growing up in a household with substance abuse or mental health problems, or instability due to parental separation or household members being in jail or prison. There are many other traumatic experiences that could impact health and wellbeing. ACEs are linked to chronic health problems, mental illness, and substance use problems in adulthood. ACEs can also negatively impact education, job opportunities, and earning potential. About 61% of adults surveyed across 25 states reported that they had experienced at least one type of ACE, and nearly one in six reported they had experienced four or more types of ACEs. Women and several racial/ethnic minority groups were at greater risk for having experienced four or more types of ACEs. The economic and social costs to families, communities, and society totals hundreds of billions of dollars each year. Up to 1.9 million cases of heart disease and 21 million cases of depression could have been potentially avoided by preventing ACEs.
3. CHVP. According to the CDPH website, the goal of CHVP is to promote maternal health and well-being, improve infant and child health and development, strengthen family functioning and cultivate strong communities. CHVP serves pregnant and newly parenting families who have one or more of the following risk factors: domestic violence; inadequate income; unstable housing; education less than 12 years; substance use disorder; and, depression and/or mental health related issues. In 34 counties, services are provided by a Public Health Nurse (PHN) or paraprofessional in the family’s home, begin prenatally or right after the birth of a baby, and are offered voluntarily and usually continue until age three. Home visitors build relationships as they provide services tailored to each family’s needs, such as: teaching parenting skills and modeling parenting techniques; providing information and guidance on a range of topics, such as safe sleep position, injury prevention and nutrition; providing referrals to address substance use disorder, family violence and maternal depression; screening children for developmental delays and facilitating intervention; and, promoting early learning in the home that emphasizes positive parenting and building a language-rich environment. According to CDPH, research has shown that evidence-based home visiting programs produce positive outcomes that save taxpayer dollars by reducing societal costs associated with intimate partner violence, child maltreatment, youth crime, substance use disorder and need for government assistance.

The Patient Protection and Affordable Care Act of 2010 established the MIECHV Program, which provides funds for evidence-based home visiting in every state. In 2019, $23 million in General Funds were provided to CDPH for evidence-based and innovative home visiting services. Out of the 20 models authorized by MIECHV, CHVP implemented three:

• 1. Healthy Families America: Serves low-income families who must be enrolled within the first three months after an infant's birth. A trained paraprofessional provides one-on-one home visits to parents and their babies primarily through three years postpartum;
  2. Nurse-Family Partnership: Serves low-income, first-time moms who must be enrolled by the 28th week of pregnancy. A PHN provides one-on-one home visits to parents and their babies through two years postpartum; and,
  3. Parents as Teachers: Serves families with children (between pregnancy and Kindergarten entry) experiencing one or more stressors in their lives. A Parent Educator conducts personal visits with parents and their children, as well as monthly group events.

The federal Home Visiting Evidence of Effectiveness (HomVEE) review determines which home visiting models have enough evidence to meet the U.S. Department of Health and Human Services (HHS) criteria for an “evidence-based early childhood home visiting service delivery model.” A June 2023 HomVEE review of models that use home visiting as their primary way to deliver services and that work to improve outcomes in at least one of eight domains: maternal health; child health; positive parenting practices; child development and school readiness; reductions in child maltreatment; family economic self-sufficiency; linkages and referrals to community resources and supports; and, reductions in juvenile delinquency, family violence, and crime. HomVEE reviewed the available evidence on 67 home visiting models, including reviews of 524 research manuscripts, and found that 26 models meet the HHS criteria for an evidence-based early childhood home visiting service model. According to HHS, to be eligible as an evidence-based model with MIECHV funding, a model must both meet HHS criteria for evidence of effectiveness (as determined by HomVEE) and meet all other statutory requirements for model eligibility (as required by HRSA). Statutory requirements for an evidence-based model to be implemented under MIECHV are that it: “conforms to a clear consistent home visitation model that has been in existence for at least three years and is research-based, grounded in relevant empirically-based 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.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee, unknown, ongoing General Fund costs for CDPH for administration, depending on which specific models are selected, the number of counties electing to implement additional models, data systems, and training needs associated with the new models.

SUPPORT: (Verified 8/23/23)

County Health Executives Association of California (source)

American Association of University Women, San Jose

American College of Obstetricians and Gynecologists, District IX

Board of Registered Nursing

California Academy of Family Physicians

California Catholic Conference

California Hospital Association

California State Association of Counties

City and County of San Francisco, the San Francisco Department of Public Health

City of Long Beach

City of Pasadena

Children Now

County of Alameda Board of Supervisors

County of Alpine Health and Human Services

County of Contra Costa Board of Supervisors

County of Del Norte Department of Health & Human Services, Public Health

Branch

County of Fresno Board of Supervisors

County of Humboldt County Administrative Office

County of Imperial Board of Supervisors

County of Inyo Health and Human Services Department

County of Kings Department of Public Health

County of Lassen County Health and Social Services Department

County of Los Angeles Board of Supervisors

County of Mendocino Board of Supervisors

County of Monterey Board of Supervisors

County of Monterey Health Department

County of Napa Board of Supervisors

County of Nevada Board of Supervisors

County of Orange Board of Supervisors

County of Riverside Board of Supervisors

County of Sacramento Board of Supervisors

County of San Diego

County of San Mateo Board of Supervisors

County of Santa Barbara Board of Supervisors

County of Santa Clara Office of the County Executive

County of Solano Department of Health and Social Services

County of Ventura

First 5 Monterey County

Health Officers Association of California

LA Best Babies Network

National Service Office for the Nurse-Family Partnership and Child First

Plumas County Public Health Agency

Rural County Representatives of California

The Children’s Partnership

Urban Counties of California

Western Center on Law & Poverty

OPPOSITION: (Verified 8/23/23)

Department of Finance

ARGUMENTS IN SUPPORT: The County Health Executives Association of California (CHEAC), the sponsor of this bill, writes that while they applaud the three models that are currently funded by CHVP and the great impact they have, there are limitations. For example, if a LHD wants to use a PHN for the home visits, they could only utilize one of the three models, which requires individuals to be first-time parents that enroll during pregnancy at 28 weeks or earlier. CHEAC states that this bill would allow LHDs to administer other evidence-based models, including one that uses public health nurses and targets pregnant Latina and African American adolescents and new parents with babies, or another that targets low-income pregnant individuals and families with children up to three years old. CHEAC further writes that many of the evidence-based models require participating families to engage in home visits at regular intervals, which may be difficult for some of our most vulnerable parents and families that would otherwise benefit from home visiting. This bill would allow LHDs to submit an alternative public health nursing model to CDPH for approval. That alternative public health nurse model would be required to target a unique need in their community, such as pregnant persons or new parents experiencing homelessness. Numerous counties state that many families need more support as a result of enduring the COVID-19 pandemic, as mental health supports have been limited in the existing home visiting program. Maternal mental health disorders (MMHDs) are the most common complication during the perinatal period, which often goes both undetected and untreated. MMHDs are even more prevalent for birthing people of color with rates that are often as high as 20% for African American and Latino women, attributed to a lack of awareness and stigma of mental health issues within their respective communities, higher levels of stress and other factors. While new mandates require pregnant and postpartum people to be screened for MMHDs, the CHVP is uniquely positioned to support parents and children who may not otherwise engage in care as part of the home visit.

ARGUMENTS IN OPPOSITION: The Department of Finance is opposed to this measure because the additional workload associated with this bill creates new General Fund costs for DPH that are not included in the Administration’s spending plan, and, to the extent the MIECHV program approves additional home visiting models in the future, the bill’s provisions could create additional General Fund cost pressures. Additionally, Finance opposes this bill because its provisions could potentially put the receipt of federal funds at risk.

ASSEMBLY FLOOR: 80-0, 5/30/23

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

Prepared by: Melanie Moreno / HEALTH / (916) 651-4111

9/2/23 12:11:00

**** END ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2023 - 2024 Regular Session

AB 1057 (Weber) - California Home Visiting Program

Bill Summary:

AB 1057 would codify the California Home Visiting Program (CHVP) within the California Department of Public Health (CDPH).

*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********

The following information is revised to reflect amendments

adopted by the committee on September 1, 2023

Fiscal Impact:

Unknown, ongoing General Fund costs for the CDPH for administration, depending on which specific models are selected, the number of counties electing to implement additional models, data systems, and training needs associated with the new models.

Author Amendments:

Author amendments provide for a phased-in approach for implementing home visiting models.

-- END --

SENATE COMMITTEE ON

Senator Anthony Portantino, Chair

2023 - 2024 Regular Session

AB 1057 (Weber) - California Home Visiting Program

Bill Summary:

AB 1057 would codify the California Home Visiting Program (CHVP) within the California Department of Public Health (CDPH).

Fiscal Impact:

The CDPH estimates annual General Fund costs ranging from $315,000 to $750,000 per model. CDPH currently administers two federal models and one state model, in which administrative costs fall within this cost range. CDPH indicates there are many unknown variables which could significantly impact costs, including which specific model is selected, the number of counties electing to implement additional models, data systems, and training needs associated with the new models.

Background:

Current law requires the CDPH to maintain a program of maternal and child health and to develop and maintain a statewide comprehensive community-based perinatal services program. According to CDPH, the goal of CHVP is to promote maternal health and well-being, improve infant and child health and development, strengthen family functioning and cultivate strong communities. CHVP serves pregnant and newly parenting families who have one or more of the following risk factors: domestic violence; inadequate income; unstable housing; education less than 12 years; substance use disorder; and, depression and/or mental health related issues. In 34 counties, services are provided by a public health nurse or paraprofessional in the family’s home, begin prenatally or right after the birth of a baby, and are offered voluntarily and usually continue until age three.

Home visitors build relationships as they provide services tailored to each family’s needs, such as: teaching parenting skills and modeling parenting techniques; providing information and guidance on a range of topics, such as safe sleep position, injury prevention and nutrition; providing referrals to address substance use disorder, family violence and maternal depression; screening children for developmental delays and facilitating intervention; and, promoting early learning in the home that emphasizes positive parenting and building a language-rich environment.

Proposed Law:

Specific provisions of the bill would:

• Codify the CHVP within the CDPH and specify requirements for programs and funding allocations.
• Require CDPH to submit a report every two years to the Senate Committee on Health and the Assembly Committee on Health on performance outcomes, as specified.
• Require implementation to be contingent upon funding appropriated by the Legislature.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Dr. Susan Talamantes Eggman, Chair

BILL NO: AB 1057

SUBJECT: California Home Visiting Program

SUMMARY:

1. Codifies the California Home Visiting Program within the California Department of Public Health.

Existing law:

1. Establishes the California Department of Public Health (CDPH), directed by a state Public Health Officer (PHO), to be vested with all the duties, powers, purposes, functions, responsibilities, and jurisdictions as they relate to public health and licensing of health facilities, as specified. Gives the PHO broad authority to detect, monitor, and prevent the spread of communicable disease in the state. Requires CDPH to examine the causes of communicable disease in man and domestic animals occurring or likely to occur in this state. [HSC §131050, §120130, et seq., §120125]
2. Requires each county board of supervisors to appoint a local health officer (LHO). Requires LHOs to enforce and observe orders and ordinances of the board of supervisors, pertaining to the public health and sanitary matters, orders, including quarantine and other regulations, prescribed by CDPH, and statutes relating to public health. [HSC §101000 and §101030]
3. Requires CDPH to maintain a program of maternal and child health. Requires CDPH to develop and maintain a statewide comprehensive community-based perinatal services program and enter into contracts, grants, or agreements with health care providers, in medically underserved areas or areas with demonstrated need, to deliver these services in a coordinated effort to the extent permitted under federal law and regulation, as specified. [HSC §123225 and §123490]
4. Requires CDPH to maintain a program that addresses the special needs of high-risk pregnant women and infants, as specified. Defines “high-risk pregnant woman” as a woman considered highly likely for any reason to suffer personal mortality or morbidity from her pregnancy, or to deliver a defective, disabled, high-risk, or stillborn infant. [HSC §123560, §123565]

This bill:

1. Codifies the California Home Visiting Program (CHVP) within CDPH with the goals and objectives to promote the health and well-being of pregnant people and parents, improve infant and child health and development, strengthen family functioning, and cultivate strong communities.
2. Requires CDPH to allocate funds to participating local health departments (LHDs) to administer the CHVP. Requires funding allocations to balance the need to spread funding to as many LHDs as possible and the need to ensure sufficient funding for meaningful activities, and shall be determined in collaboration with the County Health Executives Association of California.
3. Requires CDPH, in awarding funds, to authorize LHDs to implement home visiting model or models as follows:
   1. Administer one of the evidence-based models approved by the federal Health Resources and Services Administration (HRSA) Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program, as specified;
   2. Submit an alternative public health nursing model that prioritizes the unique needs of individuals in the city, county, or city and county served by the LHD; and,
   3. Administer more than one of these models.
4. Permits CDPH, in awarding funds, to also authorize LHDs to supplement home visiting with mental health support that includes, but is not limited to:
   1. Implementing evidence-based approaches for supporting the mental health of program recipients, including programs aimed at reducing the risk of postpartum depression or programs that embed mental health support into home visits;
   2. Providing mental health training for LHD staff engaging in home visits;
   3. Providing mental health screenings and referrals for program recipients; and,
   4. Hosting family events to strengthen family engagement and promoting peer support among program participants.
5. Permits CDPH to provide funding to LHDs that did not participate in CHVP to support planning activities for future participation in CHVP.
6. Requires CDPH to seek to maximize funds from the federal government, as specified. Requires CDPH, to the extent that federal funding is provided for these purposes, to only authorize the use of those funds in a manner that complies with applicable federal requirements.
7. Requires CDPH, without taking regulatory action, to implement, interpret, or make specific this bill by means of policy letters. Requires CDPH to collaborate with affected stakeholders, including the County Health Executives Association of California, before taking such action and to post policy letters on its website.
8. Requires implementation of this bill to be contingent upon funding appropriated by the Legislature. Requires CDPH to comply with MIECHV, to the extent federal moneys are appropriated by the Legislature for these purposes. Permits CDPH to additionally supplement and expand the program, to the extent General Fund moneys are appropriated by the Legislature for these purposes.

FISCAL EFFECT:

According to the Assembly Appropriations Committee:

CDPH estimates ongoing annual costs ranging from $300,000 to $750,000 per home visiting program model added (General Fund). CDPH currently administers two federal models and one state model, with administrative costs falling within the cost range cited. For each additional model, the cost includes two positions to develop and provide oversight of the program, meet with stakeholders, publish policy letters, and evaluate and maintain data systems. Actual costs will depend on the particular model and whether CDPH/CHVP or a contracted developer will manage the model's data infrastructure, among other things.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, this bill gives local health jurisdictions additional flexibility to administer more home visiting programs that address the unique needs of each community. It also provides opportunity to supplement home visiting with mental health supports and training; a service needed more as we emerged from the pandemic. Currently, there are 20 evidence-based home visiting models that meet federal requirements, however, only three of these programs are currently approved by the state. This bill will give counties the opportunity to have access to all 20 programs.
2. Adverse Childhood Experiences (ACEs). CHVP is designed for overburdened families who are at risk for ACEs, including child maltreatment, domestic violence, substance use disorder and mental health related issues. According to the Center for Disease Control and Prevention, ACEs are potentially traumatic events that occur in childhood, such as experiencing violence, abuse, or neglect, witnessing violence in the home or community, or having a family member attempt or die by suicide. Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding, such as growing up in a household with substance abuse or mental health problems, or instability due to parental separation or household members being in jail or prison. There are many other traumatic experiences that could impact health and wellbeing. ACEs are linked to chronic health problems, mental illness, and substance use problems in adulthood. ACEs can also negatively impact education, job opportunities, and earning potential. About 61% of adults surveyed across 25 states reported that they had experienced at least one type of ACE, and nearly one in six reported they had experienced four or more types of ACEs. Women and several racial/ethnic minority groups were at greater risk for having experienced four or more types of ACEs. The economic and social costs to families, communities, and society totals hundreds of billions of dollars each year. Up to 1.9 million cases of heart disease and 21 million cases of depression could have been potentially avoided by preventing ACEs.
3. CHVP. According to the CDPH website, the goal of CHVP is to promote maternal health and well-being, improve infant and child health and development, strengthen family functioning and cultivate strong communities. CHVP serves pregnant and newly parenting families who have one or more of the following risk factors: domestic violence; inadequate income; unstable housing; education less than 12 years; substance use disorder; and, depression and/or mental health related issues. In 34 counties, services are provided by a Public Health Nurse (PHN) or paraprofessional in the family’s home, begin prenatally or right after the birth of a baby, and are offered voluntarily and usually continue until age three. Home visitors build relationships as they provide services tailored to each family’s needs, such as: teaching parenting skills and modeling parenting techniques; providing information and guidance on a range of topics, such as safe sleep position, injury prevention and nutrition; providing referrals to address substance use disorder, family violence and maternal depression; screening children for developmental delays and facilitating intervention; and, promoting early learning in the home that emphasizes positive parenting and building a language-rich environment. According to CDPH, research has shown that evidence-based home visiting programs produce positive outcomes that save taxpayer dollars by reducing societal costs associated with intimate partner violence, child maltreatment, youth crime, substance use disorder and need for government assistance.

The Patient Protection and Affordable Care Act of 2010 established the MIECHV Program, which provides funds for evidence-based home visiting in every state. In 2019, $23 million in General Funds were provided to CDPH for evidence-based and innovative home visiting services. Out of the 20 models authorized by MIECHV, CHVP implemented three:

• 1. Healthy Families America: Serves low-income families who must be enrolled within the first three months after an infant's birth. A trained paraprofessional provides one-on-one home visits to parents and their babies primarily through three years postpartum;
  2. Nurse-Family Partnership: Serves low-income, first-time moms who must be enrolled by the 28th week of pregnancy. A PHN provides one-on-one home visits to parents and their babies through two years postpartum; and,
  3. Parents as Teachers: Serves families with children (between pregnancy and Kindergarten entry) experiencing one or more stressors in their lives. A Parent Educator conducts personal visits with parents and their children, as well as monthly group events.

The federal Home Visiting Evidence of Effectiveness (HomVEE) review determines which home visiting models have enough evidence to meet the U.S. Department of Health and Human Services (HHS) criteria for an “evidence-based early childhood home visiting service delivery model.” A June 2023 HomVEE review of models that use home visiting as their primary way to deliver services and that work to improve outcomes in at least one of eight domains: maternal health; child health; positive parenting practices; child development and school readiness; reductions in child maltreatment; family economic self-sufficiency; linkages and referrals to community resources and supports; and, reductions in juvenile delinquency, family violence, and crime. HomVEE reviewed the available evidence on 67 home visiting models, including reviews of 524 research manuscripts, and found that 26 models meet the HHS criteria for an evidence-based early childhood home visiting service model. According to HHS, to be eligible as an evidence-based model with MIECHV funding, a model must both meet HHS criteria for evidence of effectiveness (as determined by HomVEE) and meet all other statutory requirements for model eligibility (as required by HRSA). Statutory requirements for an evidence-based model to be implemented under MIECHV are that it: “conforms to a clear consistent home visitation model that has been in existence for at least three years and is research-based, grounded in relevant empirically-based 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.

1. CDPH letter of intent. A March 24, 2023 letter of intent sent to all LHDs announced that CDPH intends to award with state General Fund expansion funding for the purposes of implementing or expanding an approved home visiting models. The estimated annual CHVP allocation for fiscal year 2023-24 will be $49.7 million. CDPH states that the goal of this funding is to increase the number of families participating in the three evidence-based home visiting models supported by CHVP. Each LHD that accepts funds will receive an annual allocation with a base amount of $400,000 plus an additional amount related to each LHD’s proportional three-year aggregated Medi-Cal birth data. Starting July 1, 2023, new annual agreements will be established with all LHDs that opt-in for CHVP allocations. Final allocation amounts may be higher after CHVP redistributes funds from any LHJs who opt-out of the funding.
2. Related legislation. AB 1701 (Weber) expands the entities eligible to apply for funding through the California Perinatal Equity Initiative to include city health departments, in addition to county health departments. AB 1701 is pending on the Senate Floor.
3. Support. CHEAC, the sponsor of this bill, writes that while they applaud the three models that are currently funded by CHVP and the great impact they have, there are limitations. For example, if a LHD wants to use a PHN for the home visits, they could only utilize one of the three models, which requires individuals to be first-time parents that enroll during pregnancy at 28 weeks or earlier. CHEAC states that this bill would allow LHDs to administer other evidence-based models, including one that uses public health nurses and targets pregnant Latina and African American adolescents and new parents with babies 0-11 months, or another that targets low-income pregnant individuals and families with children ages 0 to 3. CHEAC further writes that many of the evidence-based models require participating families to engage in home visits at regular intervals, which may be difficult for some of our most vulnerable parents and families that would otherwise benefit from home visiting. This bill would allow LHDs to submit an alternative public health nursing model to CDPH for approval. That alternative public health nurse model would be required to target a unique need in their community, such as pregnant persons or new parents experiencing homelessness. Numerous counties state that many families need more support as a result of enduring the COVID-19 pandemic, as mental health supports have been limited in the existing home visiting program. Maternal mental health disorders (MMHDs) are the most common complication during the perinatal period, which often goes both undetected and untreated. MMHDs are even more prevalent for birthing people of color with rates that are often as high as 20% for African American and Latino women, attributed to a lack of awareness and stigma of mental health issues within their respective communities, higher levels of stress and other factors. While new mandates require pregnant and postpartum people to be screened for MMHDs, the CHVP is uniquely positioned to support parents and children who may not otherwise engage in care as part of the home visit.
4. Support if amended. Children NOW and the National Service Office for the Nurse-Family Partnership and Child First community-based home visiting programs write with a support if amended position, stating that they understand concerns about current home visiting policy not being flexible enough to serve the universe of families who could benefit from home visiting, but request amendments to require that new programs permitted through the bill to adhere to the same performance standards reporting as existing home visiting programs.

SUPPORT AND OPPOSITION:

Support: County Health Executives Association of California (sponsor)

American Association of University Women, San Jose

American College of Obstetricians and Gynecologists, District IX

Board of Registered Nursing

California Academy of Family Physicians

California Catholic Conference

California Hospital Association

California State Association of Counties

City and County of San Francisco, the San Francisco Department of Public Health

City of Long Beach

City of Pasadena

County of Alameda Board of Supervisors

County of Alpine Health and Human Services

County of Contra Costa Board of Supervisors

County of Del Norte Department of Health & Human Services, Public Health Branch

County of Fresno Board of Supervisors

County of Humboldt County Administrative Office

County of Imperial Board of Supervisors

County of Inyo Health and Human Services Department

County of Kings Department of Public Health

County of Lassen County Health and Social Services Department

County of Los Angeles Board of Supervisors

County of Mendocino Board of Supervisors

County of Monterey Board of Supervisors

County of Monterey Health Department

County of Napa Board of Supervisors

County of Nevada Board of Supervisors

County of Sacramento Board of Supervisors

County of San Diego

County of San Mateo Board of Supervisors

County of Santa Clara Office of the County Executive

County of Solano Department of Health and Social Services

County of Ventura

First 5 Monterey County

Plumas County Public Health Agency

Rural County Representatives of California

The Children’s Partnership

Urban Counties of California

Western Center on Law & Poverty

Oppose: None received.

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 1057

Author:(Weber)

As Amended Ver:April 20, 2023

Majority vote

SUMMARY

Codifies the existing California Home Visiting Program (CHVP) that is administered by the State Department of Public Health (DPH) to support pregnant people and parents with young children who live in communities that face greater risks and barriers to achieving positive maternal and child health outcomes.

Major Provisions

COMMENTS

According to an issue brief published by the Kaiser Family Foundation in 2022 entitled "Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them," Black and American Indian and Alaska Native (AIAN) women have higher rates of pregnancy-related death compared to white women. Pregnancy-related mortality rates among Black and AIAN women are over three and two times higher, respectively, compared to the rate for white women (41.4 and 26.2 vs. 13.7 per 100,000). Black, AIAN, and Native Hawaiian and Other Pacific Islander (NHOPI) women also have higher shares of preterm births, low birthweight births, or births for which they received late or no prenatal care compared to white women. Infants born to Black, AIAN, and NHOPI people have markedly higher mortality rates than those born to white women. Maternal death rates increased during the COVID-19 pandemic and racial disparities widened for Black women.

Maternal and infant health disparities are symptoms of broader underlying social and economic inequities that are rooted in racism and discrimination. Differences in health insurance coverage and access to care play a role in driving worse maternal and infant health outcomes for people of color. However, inequities in broader social and economic factors and structural and systemic racism and discrimination are primary drivers for maternal and infant health. Notably, disparities in maternal and infant health persist even when controlling for certain underlying social and economic factors, such as education and income, pointing to the roles racism and discrimination play in driving disparities.

The increased awareness and attention to maternal and infant health have contributed to a rise in efforts and resources focused on improving health outcomes in these areas and reducing disparities. These include efforts to expand access to coverage and care, increase access to a broader array of services and providers that support maternal and infant health, diversity in the health care workforce, and enhance data collection and reporting. However, addressing social and economic factors that contribute to poorer health outcomes and disparities will also be important. Moreover, the persistence of disparities in maternal health across income and education levels, points to the importance of addressing the roles of racism and discrimination within the overall health care system as part of efforts to improve health and advance equity.

Maternal, Infant and Early Childhood Home Visiting Program (MIECHV). This bill would make local health departments (LHDs) eligible for grants for implementing one of the 20 MIECHV models. In 2010, the MIECHV was established under the administration of the federal Health Resources and Services Administration, in partnership with Administration for Children and Families, to fund states, territories, and tribal entities to develop and implement home visiting programs (HVPs). HVPs support pregnant people and parents with young children who live in communities that face greater risks and barriers to achieving positive maternal and child health outcomes. Families choose to participate in home visiting programs, and partner with health, social service, and child development professionals to set and achieve goals that improve their health and well-being. These programs must be based on the best evidence showing that they are effective at meeting the needs of families.

The MIECHV aims to: improve maternal and child health; prevent child abuse and neglect; reduce crime and domestic violence; increase family education level and earning potential; promote children’s development and readiness to participate in school and connect families to needed community resources and supports.

MIECHV Models. There are currently 20 home visiting models available under MIECHV. These models were reviewed under the Home Visiting Evidence of Effectiveness to ensure the models effectively meet family needs. These models include: attachment and behavioral catch-up; child first; early intervention program for adolescent mothers; family connects; healthy beginnings; nurse-family partnership; and, play and learning strategies.

MIECHV awardees annually report program performance on 19 measures across six benchmark areas defined in law, which are aimed at improving the well-being of both parents and children. Beginning in the fiscal year 2020 reporting period and every three years thereafter, awardees are required to demonstrate improvement in at least four of six benchmark areas. Most states that have implemented the program have implemented four or five models.

In December 2022, MIECHV was reauthorized for an additional five years, with a $500 million funding annually beginning fiscal year 2023.

CHVP. This bill codifies into statute the CHVP and expands the number of models that would be implemented and funded by DPH. According to DPH's website, CHVP is designed for overburdened families who are at risk for Adverse Childhood Experiences, including child maltreatment, domestic violence, substance use disorder and mental health related issues. Home visiting gives parents the tools and know-how to independently raise their children. It's a preventive intervention focused on promoting positive parenting and child development. Decades of research on home visiting shows that home visits by a trained professional during pregnancy and in the first few years of life improves the lives of children and families. Giving children a solid start in their first few years of life increases the opportunity for a brighter, more prosperous future. In 2019, $23 million in new State GF were provided to DPH for evidence-based and innovative home visiting services.

Out of the 20 models authorized by MIECHV, California implemented three of the models (spread throughout 34 California counties): the Healthy Families America, Nurse-Family Partnership, or Parents as Teachers home visiting model, based on the specific needs of the region. All three models are strengths-based and focus on a participant's individual interests. The goals are also the same across the models: increase parent knowledge of early childhood development and improve parenting practices; provide early detection of developmental delays and health issues; prevent child abuse and neglect; and increase children’s school readiness and success. Below are additional characteristics of each model:

1. Healthy Families America. Serves low-income families who must be enrolled within the first three months after an infant's birth. A trained paraprofessional provides one-on-one home visits to parents and their babies primarily through three years postpartum.
2. Nurse-Family Partnership. Serves low-income, first-time moms who must be enrolled by the 28th week of pregnancy. A Public Health Nurse provides one-on-one home visits to parents and their babies through two years postpartum.
3. Parents as Teachers. Serves families with children (between pregnancy and Kindergarten entry) experiencing one or more stressors in their lives. A Parent Educator conducts personal visits with parents and their children, as well as monthly group events.

According to the Author

This bill gives local health jurisdictions additional flexibility to administer more home visiting programs that address the unique needs of each community. It also provides opportunities to supplement home visiting with mental health supports and training; a service needed more as we emerge from the pandemic. Currently, there are 20 evidence-based home visiting models that meet federal requirements, however, only three of these programs are currently approved by the state. The author concludes this bill will give counties the opportunity to have access to all 20 programs.

Arguments in Support

Numerous LHDs write in support of this bill and state that with this bill, the expansion of models would give LHDs additional tools to better meet the needs of the families and children served by CHVP. They state that the COVID-19 pandemic highlighted a growing need to support the mental health needs of many families. Home visiting programs are uniquely positioned to reach new parents and families during the perinatal period when they are vulnerable to maternal and mental health disorders and early childhood. They conclude that home visiting programs need the flexibility to supplement the program with mental health support for their families.

Arguments in Opposition

There is no known opposition to this bill.

FISCAL COMMENTS

According to the Assembly Appropriations Committee: DPH estimates ongoing annual costs ranging from $300,000 to $750,000 per home visiting program model added (General Fund). DPH currently administers two federal models and one state model, with administrative costs falling within the cost range cited. For each additional model, the cost includes two positions to develop and provide oversight of the program, meet with stakeholders, publish policy letters, and evaluate and maintain data systems. Actual costs will depend on the particular model and whether DPH/CHVP or a contracted developer will manage the model's data infrastructure, among other things.

VOTES

ASM HEALTH: 15-0-0

YES: Wood, Waldron, Aguiar-Curry, Arambula, Boerner Horvath, Wendy Carrillo, Flora, Vince Fong, Maienschein, McCarty, Joe Patterson, Rodriguez, Santiago, Villapudua, Weber

ASM APPROPRIATIONS: 15-0-1

YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Pellerin, Sanchez, Weber, Ortega

ABS, ABST OR NV: Robert Rivas

UPDATED

VERSION: April 20, 2023

CONSULTANT: Rosielyn Pulmano / HEALTH / (916) 319-2097 FN: 0000759

Date of Hearing: May 10, 2023

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Chris Holden, Chair

ABPCA Bill Id:AB 1057

Author:(Weber) – As Amended Ver:April 20, 2023

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill, contingent on an appropriation by the Legislature, codifies within the Health and Safety Code the California Home Visiting Program (CHVP), which the California Department of Public Health (CDPH) created administratively, to provide funds to local health departments to support pregnant people and parents with young children who live in communities facing greater risks and barriers to achieving positive maternal and child health outcomes.

Specifically, this bill requires CDPH to seek to maximize funds from the federal government and authorizes local health departments to:

1. Administer any of the evidence-based models approved by a specified federal program.
   
2. Submit an alternative public health nursing model to target a unique need in the community.
   
3. Administer more than one of the models in 1) and 2), above.
   
4. Integrate mental health supports into the local health departments’ home visiting programs.

FISCAL EFFECT:

CDPH estimates ongoing annual costs ranging from $300,000 to $750,000 per home visiting program model added (General Fund). CDPH currently administers two federal models and one state model, with administrative costs falling within the cost range cited. For each additional model, the cost includes two positions to develop and provide oversight of the program, meet with stakeholders, publish policy letters, and evaluate and maintain data systems. Actual costs will depend on the particular model and whether CDPH/CHVP or a contracted developer will manage the model’s data infrastructure, among other things.

COMMENTS:

1. Purpose. This bill is sponsored by the County Health Executives Association of California. According to the author:

AB 1057 gives local health jurisdictions additional flexibility to administer more home visiting programs that address the unique needs of each community. It also provides opportunity to supplement home visiting with mental health supports and training; a service needed more as we emerged from the pandemic. Currently, there are 20 evidence-based home visiting models that meet federal requirements, however, only three of these programs are currently approved by the state. This bill will give counties the opportunity to have access to all 20 programs.

1. CHVP. CDPH established the CHVP in 2010 by authority from the federal Affordable Care Act. According to CDPH’s CHVP website:

Early childhood home visiting pairs nurses or paraprofessionals with pregnant and newly parenting women. Trained home visitors provide support and education to families to promote positive parenting and improve child health and development. The [CHVP] administers funds from the federal Maternal, Infant and Early Childhood Home Visiting grant. During the 2018-19 federal fiscal year, CHVP funded 23 local home visiting programs implementing one of two evidence-based home visiting models—Healthy Families America or Nurse-Family Partnership.

In the 2018-19 federal fiscal year, CHVP providers completed 29,626 home visits and served 2,979 women and 2,318 children, of whom 81% were Medi-Cal beneficiaries, 5% were uninsured, 57% were Latina/o, and 10% were Black or African American.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: April 18, 2023

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 1057

Author:(Weber) – As Introduced Ver:February 15, 2023

SUBJECT: California Home Visiting Program.

SUMMARY: Codifies the existing California Home Visiting Program (CHVP) that is administered by the State Department of Public Health (DPH) to support pregnant people and parents with young children who live in communities that face greater risks and barriers to achieving positive maternal and child health outcomes. Specifically, this bill:

1. Establishes the CHVP, a voluntary program originally created by DPH, to support pregnant people and parents with young children who live in communities that face greater risks and barriers to achieving positive maternal and child health outcomes. Requires DPH to administer the CHVP under to the requirements of this bill.
   
2. Specifies the goals and objectives CHVP are to promote the health and well-being of pregnant people and parents, improve infant and child health and development, strengthen family functioning, and cultivate strong communities.
   
3. Requires DPH to allocate funds to participating local health departments (LHDs) to administer CHVP.
   
4. Requires funding allocations to balance the need to spread funding to as many LHDs as possible with the need to ensure sufficient funding for meaningful activities, and to be determined in consultation with the County Health Executives Association of California (CHEAC).
   
5. Requires DPH, in awarding funds, to authorize LHDs to implement a home visiting model or models as follows:
   
   1. Administer one of the evidence-based models approved by the federal Health Resources and Services Administration (HRSA) Maternal, Infant and Early Childhood Home Visiting Program (MIECHV), which is administered by HRSA in partnership with the Administration for Children and Families (ACF);
      
   2. Submit an alternative public health nursing model that prioritizes the unique needs of individuals in the city, county, or city and county served by the LHD; and,
      
   3. Administer more than one of the models outlined in a) and b) above.
      
6. Permits DPH, in awarding funds to also authorize LHDs to supplement home visiting with mental health support that includes, but is not limited to, all of the following:
   
   1. Implementing evidence-based approaches for supporting the mental health of program recipients, including programs aimed at reducing the risk of postpartum depression or programs that embed mental health support into home visits;
   2. Providing mental health training for LHDs staff engaging in home visits;
      
   3. Providing mental health screenings and referrals for program recipients; and,
      
   4. Hosting family events to strengthen family engagement and promoting peer support among program participants.
      
7. Permits DPH to provide funding to LHDs that did not participate in the CHVP, as originally established by DPH before the enactment of this bill, to support planning activities for future participation in the CHVP.
   
8. Requires DPH to maximize funds from the federal government, as specified. Requires DPH, if federal funding is provided, to only authorize the use of federal funds in a manner that complies with applicable federal requirements.
   
9. Requires DPH, without taking regulatory action, as specified, to implement, interpret, or make specific this bill by means of policy letters. Requires DPH to consult with affected stakeholders, including CHEAC, before implementing policy letters. Requires DPH to publicly post policy letters on its internet website.
   
10. Makes implementation of this bill contingent upon funding appropriated by the Legislature.
    
11. Requires DPH, to the extent federal moneys are appropriated by the Legislature for these purposes, to comply with the MIECHV.
    
12. States that to the extent General Fund (GF) moneys are appropriated by the Legislature for these purposes, DPH may additionally supplement and expand the program, as specified.
    

EXISTING LAW:

1. Establishes DPH, directed by a state Public Health Officer (PHO), to be vested with all the duties, powers, purposes, functions, responsibilities, and jurisdiction as they relate to public health and licensing of health facilities, as specified. Gives the PHO, broad authority to detect, monitor, and prevent the spread of communicable disease in the state. [Health & Safety Code (HSC) § 131050 and § 120130, et seq.]
   
2. Requires each county board of supervisors to appoint a LHO. Requires LHOs to enforce and observe orders and ordinances of the board of supervisors, pertaining to the public health and sanitary matters, orders, including quarantine and other regulations, prescribed by DPH, and statutes relating to public health. [HSC § 101000 and § 101030]
   
3. Establishes the Maternal, Child and Adolescent Health program within DPH to improve the health and well-being of women, infants, children and adolescents throughout the state. [HSC § 123225-12360]
4. Defines an LHD as any one of the following public health administrative organizations:
   1. An LHD serving one or more counties that provide services to all cities whose population is less than 50,000 in addition to the unincorporated territory of the county or counties;
   2. A county health department that does not serve all of the cities of less than 50,000 population, but that has the provisional approval of DPH, as specified;
   3. The health department of a city of 50,000 or greater population, except that the governing body of the city by resolution may declare its intention to be included under the jurisdiction of the county health department, as provided by existing statutes;
   4. The LHD of any county that had under its jurisdiction on September 19, 1947, a population in excess of 1,000,000, or the LHD of any city and county. [HSC § 101175-101185]

FISCAL EFFECT: Unknown. This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. The author states this bill gives local health jurisdictions additional flexibility to administer more home visiting programs that address the unique needs of each community. It also provides opportunities to supplement home visiting with mental health supports and training; a service needed more as we emerge from the pandemic. Currently, there are 20 evidence-based home visiting models that meet federal requirements, however, only three of these programs are currently approved by the state. The author concludes this bill will give counties the opportunity to have access to all 20 programs.
2. BACKGROUND. According to an issue brief published by the Kaiser Family Foundation in 2022 entitled “Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them,” Black and American Indian and Alaska Native (AIAN) women have higher rates of pregnancy-related death compared to white women. Pregnancy-related mortality rates among Black and AIAN women are over three and two times higher, respectively, compared to the rate for white women (41.4 and 26.2 vs. 13.7 per 100,000). Black, AIAN, and Native Hawaiian and Other Pacific Islander (NHOPI) women also have higher shares of preterm births, low birthweight births, or births for which they received late or no prenatal care compared to white women. Infants born to Black, AIAN, and NHOPI people have markedly higher mortality rates than those born to white women. Maternal death rates increased during the COVID-19 pandemic and racial disparities widened for Black women.
   
   Maternal and infant health disparities are symptoms of broader underlying social and economic inequities that are rooted in racism and discrimination. Differences in health insurance coverage and access to care play a role in driving worse maternal and infant health outcomes for people of color. However, inequities in broader social and economic factors and structural and systemic racism and discrimination are primary drivers for maternal and infant health. Notably, disparities in maternal and infant health persist even when controlling for certain underlying social and economic factors, such as education and income, pointing to the roles racism and discrimination play in driving disparities.
   
   The increased awareness and attention to maternal and infant health have contributed to a rise in efforts and resources focused on improving health outcomes in these areas and reducing disparities. These include efforts to expand access to coverage and care, increase access to a broader array of services and providers that support maternal and infant health, diversity in the health care workforce, and enhance data collection and reporting. However, addressing social and economic factors that contribute to poorer health outcomes and disparities will also be important. Moreover, the persistence of disparities in maternal health across income and education levels, points to the importance of addressing the roles of racism and discrimination within the overall health care system as part of efforts to improve health and advance equity.
   1. MIECHV. This bill would make LHDs eligible for grants for implementing one of the 20 MIECHV models. In 2010, the MIECHV was established under the administration of HRSA, in partnership with ACF, to fund states, territories, and tribal entities to develop and implement HVPs. HVPs support pregnant people and parents with young children who live in communities that face greater risks and barriers to achieving positive maternal and child health outcomes. Families choose to participate in home visiting programs, and partner with health, social service, and child development professionals to set and achieve goals that improve their health and well-being. These programs must be based on the best evidence showing that they are effective at meeting the needs of families.
      
      The MIECHV aims to: improve maternal and child health; prevent child abuse and neglect; reduce crime and domestic violence; increase family education level and earning potential; promote children’s development and readiness to participate in school and connect families to needed community resources and supports.
      

MIECHV Models. There are currently 20 home visiting models available under MIECHV. These models were reviewed under the Home Visiting Evidence of Effectiveness to ensure the models effectively meet family needs. These models include: attachment and behavioral catch-up; child first; early intervention program for adolescent mothers; family connects; healthy beginnings; nurse-family partnership; and, play and learning strategies.

MIECHV awardees annually report program performance on 19 measures across six benchmark areas defined in law, which are aimed at improving the well-being of both parents and children. Beginning in the fiscal year 2020 reporting period and every three years thereafter, awardees are required to demonstrate improvement in at least four of six benchmark areas. Most states that have implemented the program have implemented four or five models.

In December 2022, MIECHV was reauthorized for an additional five years, with a $500 million funding annually beginning fiscal year 2023.

• 1. CHVP. This bill codifies into statute the CHVP and expands the number of models that would be implemented and funded by DPH. According to DPH’s website, CHVP is designed for overburdened families who are at risk for Adverse Childhood Experiences (ACEs), including child maltreatment, domestic violence, substance use disorder and mental health related issues. Home visiting gives parents the tools and know-how to independently raise their children. It’s a preventive intervention focused on promoting positive parenting and child development. Decades of research on home visiting shows that home visits by a trained professional during pregnancy and in the first few years of life improves the lives of children and families. Giving children a solid start in their first few years of life increases the opportunity for a brighter, more prosperous future. In 2019, $23 million in new State GF were provided to DPH for evidence-based and innovative home visiting services.
     
     Out of the 20 models authorized by MIECHV, California implemented three of the models (spread throughout 34 California counties): the Healthy Families America, Nurse-Family Partnership, or Parents as Teachers home visiting model, based on the specific needs of the region. All three models are strengths-based and focus on a participant’s individual interests. The goals are also the same across the models: increase parent knowledge of early childhood development and improve parenting practices; provide early detection of developmental delays and health issues; prevent child abuse and neglect; and increase children’s school readiness and success. Below are additional characteristics of each model:
     
     1. Healthy Families America. Serves low-income families who must be enrolled within the first three months after an infant‘s birth. A trained paraprofessional provides one-on-one home visits to parents and their babies primarily through three years postpartum.
        
     2. Nurse-Family Partnership. Serves low-income, first-time moms who must be enrolled by the 28th week of pregnancy. A Public Health Nurse provides one-on-one home visits to parents and their babies through two years postpartum.
        
     3. Parents as Teachers. Serves families with children (between pregnancy and Kindergarten entry) experiencing one or more stressors in their lives. A Parent Educator conducts personal visits with parents and their children, as well as monthly group events.
        
  2. Notice of Intent to Award State GF Expansion Funding for CHVP (notice of intent). In March 24, 2023, DPH sent a notice of intent to LHDs and indicated that the estimated annual CHVP State GF allocation for State Fiscal Year 2023-24 is based on the approved funding formula applied to the full DPH/CHVP State GF funding for evidence-based home visiting models (three approved models) of $49.7 million. The goal of this funding is to increase the number of families participating in the three models supported by DPH/CHVP. Each LHD that accepts funds will receive an annual allocation with a base amount of $400,000 plus an additional amount related to each LHDs proportional three-year aggregated Medi-Cal birth data.
  3. CalWORKs Home Visiting Initiative. AB 1811 (Committee on Budget), Chapter 35, Statutes of 2018, establishes, on and after January 1, 2019, the CalWORKs Home Visiting Initiative as a voluntary program for the purpose of supporting positive health, development, and well-being outcomes for eligible pregnant and parenting women, families, and infants born into poverty, expanding their future educational, economic, and financial capability opportunities, and improving the likelihood that they will exit poverty. Subject to an appropriation in the annual Budget Act, AB 1811 requires the Department of Social Services (DSS) to award funds to participating counties for the purposes of the program. AB 1811 defines evidence-based home visiting as a home visiting model approved by DSS, which shall be evaluated considering criteria developed by the United States Department of Health and Human Services for evidence-based home visiting (models approved under the MIECHV).
     
  4. Prevalence of Mental Illness. According to a July 2022 report by the California
     HealthCare Foundation, mental illnesses are among the most common health conditions faced by Californians. Nearly one in seven California adults experiences a mental illness, and one in 26 has a serious mental illness that makes it difficult to carry out daily activities. One in 14 children has an emotional disturbance that limits functioning in family school or community activities. It is further reported that nearly two-thirds of adults with a mental illness and two-thirds of adolescents with major depressive episodes did not get treatment.
     1. Maternal Mental Health. Maternal mental health conditions, such as depression, anxiety, substance use disorder and postpartum “blues” or depression are the most prominent complications of pregnancy, child birth and postpartum affecting one in five women. According to the Centers for Disease Control and Prevention, one in eight women experience postpartum depression and 50% of them are untreated. Between 5% and 14% of pregnant and postpartum people have thoughts or intentions of self-harm or suicidal ideation.
     2. ACEs. It is reported that ACEs affect nearly two million children in California across socioeconomic lines, putting them at risk for health, behavioral and learning problems. ACES are traumatic childhood experiences which include abuse, neglect, and being exposed to violence, mental illness, divorce, substance abuse, or criminal activity in the home. These experiences often leave children more vulnerable to environments and behaviors that can lead to poor health. The more ACES an individual has experienced, the higher their risk climbs.

As with most diseases, prevention and early intervention provides the greatest promise of successfully addressing these illnesses and experiences. Programs such as CHVP are among the resources the State has provided to help identify concerns with individuals and families before they reach crisis stage, providing education and tools to assist in removing the potential for long term impacts.

• 1. LHDs. California’s local health departments, led by local health officers (LHOs), play a vital role in preparing for and responding to public health emergencies. There are 58 county LHDs and three city (Berkeley, Long Beach and Pasadena) LHDs in the state. LHOs have a broad mandate to take measures necessary to preserve and protect public health. While LHOs administer many of the programs identified under DPH, LHOs have a fundamental role as the front line for delivery of public health services to California’s communities. Maternal, child, and adolescent health programs are among those responsibilities. LHOs work to identify, disseminate, and promote emerging and evidence-based information about early interventions in prenatal and early childhood periods that promote lifelong health, positive social-emotional development, and reduce health disparities.
     

1. SUPPORT. Numerous LHDs write in support of this bill and state that with this bill, the expansion of models would give LHDs additional tools to better meet the needs of the families and children served by CHVP. They state that the COVID-19 pandemic highlighted a growing need to support the mental health needs of many families. Home visiting programs are uniquely positioned to reach new parents and families during the perinatal period when they are vulnerable to maternal and mental health disorders and early childhood. They conclude that home visiting programs need the flexibility to supplement the program with mental health support for their families.
2. RELATED LEGISLATION. AB 1701 (Weber) expands the definition of local health jurisdictions eligible to apply for the California Perinatal Equity Initiative to include a city or city and county. AB 1701 is pending in Assembly Appropriations Committee.
3. SUGGESTED AMENDMENTS. This bill requires DPH to consult with CHEAC in determining funding allocations to LHDs. Additionally, DPH is required to also consult with affected stakeholders, including CHEAC before issuing policy letters to implement this bill. Consultation would require DPH to obtain CHEAC’s approval or permission for the funding allocations and policy letters. The Committee recommends that DPH instead collaborates with CHEAC since DPH has ultimate responsibility for administration of CHVP.
4. POLICY COMMENTS. This bill expands the number of models that DPH administers under the CHVP to the 20 models authorized by MIECHV and also allow for alternative public health models. Since DPH has only implemented three models, this bill is a huge expansion of what DPH currently administers. The Committee recognizes the diversity of needs that exists across California but given the additional workload that this expansion necessitates, as this bill moves forward, the author may wish to engage with DPH and determine which additional models would be most effective at meeting the needs of families.
   

REGISTERED SUPPORT / OPPOSITION:

Support

County Health Executives Association of California (sponsor)

Alameda County Board of Supervisors
Alpine County Health and Human Services
American College of Obstetricians and Gynecologists District Ix
Board of Registered Nursing
California Academy of Family Physicians
California Catholic Conference
Children's Partnership, the
City of Long Beach
City of Pasadena
County of Del Norte Department of Health and Human Services
County of Fresno
County of Humboldt
County of Mendocino
County of Monterey
County of Nevada
County of Nevada, California
County of Santa Clara
County of Ventura
CSAC
Fresno County Board of Supervisors
Inyo County HHS, Public Health and Prevention
Lassen County Health and Social Service Agency
Lassen County Public Health
Plumas County Public Health Agency
Public Health
RCRC
Sacramento; County of
San Mateo County Board of Supervisors
Solano County Health and Social Services
Urban Counties of California
Western Center on Law & Poverty, INC.

Opposition

None on file.

Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097