Building a Prenatal and Early Childhood Home Visiting System in Los

Angeles County

Pritzker InitiativeDecember 2018

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• Understanding Why Los Angeles Matters• Demographics, Geography, Governance

• Existing Landscape of Supports• Initial System Building Efforts – Brief History• Universal and Targeted Expansion• Current Opportunity – Seizing Strategic Window• Vision – Integrated System of Progressive Universal Home Visiting• Conclusion and Implementation

Presentation Objectives

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Los Angeles County

• Size that is greater than Delaware and Rhode Island combined

• Population larger than all but 9 states

• About 224 spoken languages

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I forgot the titleHome Visiting Models in Los Angeles County:Intensity and Funding Source

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Home Visiting Models in Los Angeles County: Enrollment Periods

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Home Visiting Funding Estimates in LA County,

FY16-17

First 5 LA, $39 M

44%

Federal Administration for

Children & Families/Early

Head Start, $30M

33%

Dept of Children and

Family Services, State Re-

Alignment, $10.2 M

11%

Dept of Public Health, Net

County Costs and Title XIX

(TCM), $3.9M

4%

DPH, Maternal, Infant,

Early Childhood Home

Visting funds, $1.53M

2%

Dept of Mental Health,

Mental Health Services

Act, $4.7 M

5%

Federal

HRSA,Healthy

Start, $632K

1%

Private funding (LA PECHI)

& F5LA for the HV

Consortium, $166K

>1%

Note: Federal Administration for Children and Families/Early Head Start (EHS) funds is an estimate based on the volume of families served and approximate cost per family. EHS funds combine home and center-based services so this estimate is being further refined to represent the true cost of home-based services only.

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• Developed a Common Vision and Guiding Principles • Identified Common Data Collection Mechanisms • Establishing Target System Scale and Cost• Piloting New Referral Pathways (DMH, DPSS)• Improving Perinatal Mental Health Resources• Exploring Sustainable Funding Opportunities • Engaging the Private Sector• Fostering Cross-Departmental Collaboration

Our Vision for an Integrated System of Family Supports

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• Public Health Department• Office of Child Protection• Home Visiting Consortium• Children & Family Services Department• Public Social Services Department• Mental Health Department• Health Services Department• Probation Department• Libraries• Office of Education• Children’s Data Network

Los Angeles County Home Visiting Partners

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Home Visiting

Home VisitingEvidence based modelRegularityOccurs in the home or where the family is parentingFocuses on the parent-child relationshipUses a unique caseload approach for a home visitor-family relationshipEngages home visitor in reflective supervision

Defining Terms

Complex more than one source of funding is utilized to address the same issue

Restrictive control of: - administration of the funding- the population of children and families served- the eligible providers

Cost Implications for ProgramsUnderstanding current costs for programs◦ What are the drivers?

Understanding the impact of multiple models◦ Negotiating different program

requirements◦ Variations across: Primary Service;

Eligibility and Target Population; Length of Eligibility; Length of Program; Ratio and Group Size

Exploring the revenue utilized by programs

◦ What is the administration structure programs have built?

◦ How do they manage the funding and reporting?

◦ What is the budgetary approach?

Understanding Costs◦ Personnel

◦ Wages- Child Care Workers, Lead Teacher, Preschool Teachers,

Teacher Aides, Floaters, Substitutes, Assistant Teachers, Staff Supervisors

- Administrators, Child Care Center/Program Director, and Financial Manager

- Office and Administrative Support Workers

◦ Benefits

Understanding Costs◦ Non Personnel

◦ Education Program for Children and Staff◦ Child - food/food related, classroom/child supplies,

laundry, tuition assistance, parent activities, field trips, family transportation, child assessment materials, ongoing costs of additional quality-related materials

◦ Staff - professional consultants, training/professional development/conferences, staff travel

◦ Occupancy: rent/lease or mortgage, real estate taxes, maintenance, janitorial, repairs and other occupancy-related costs

◦ Administration and Management: office supplies, telephone, internet, insurance, legal and professional fees, permits, fundraising, memberships, administration fees

How Quality Affects the Cost1. Staff qualifications: Increasing qualifications

by level

2. Ratios: Reduced ratios for all, or for younger age children

3. Time: Staff time beyond what regulations require

Potential Funding StreamsFederal

- Infant and Early Childhood Home Visiting (MIECHV), Affordable Care Act

- Early Head Start

- TANF

- Medicaid billing

- SAMSHA

- Project LAUNCH grant

- Title V MCH Block Grant

State

- General Revenue

- Tobacco settlement, lottery

- May allow Community Based Child Abuse Prevention funds, or other federal resources that go to states to be used to pay for home visiting

Private Investments (foundations, United Way)