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Home visiting programs have less funding available

The budget for a program that provided in-home support for parents and their babies has lost 40% of its federal funding, which could leave counties and service providers without enough money to operate programs.

Montana’s voluntary Maternal, Infant and Early Childhood Home Visiting Program works with pregnant women and families with children from birth through kindergarten through a variety of services that includes home visits by nurses, social workers, early childhood educators and more able to help families navigate the early years of a child’s life. The services can be provided by counties or organizations that are awarded the contracts.

The program has been found to help reduce abuse and neglect, improve parents’ and children's health and promote school readiness.

“What you see with families that engage in home visiting services is that they are more economically stable, they pursue post-secondary education, the kiddos are more successful in school, there’s less abuse and neglect, there’s less engagement in the criminal justice system and health needs are cared for,” said Drenda Niemann, the board chair of the Association of Montana Public Health Officials and public health officer in Lewis and Clark County.

The models used in Montana are Parents as Teachers, which help with preparedness for school; Nurse-Family Partnership, which has registered nurses visit pregnant women and children through age 2 in their homes; Safe Care, which helps with home safety; and Family Spirit, which is designed specifically for Native families with children up to age 3.

The program is paid for mostly with federal money, with 6% of funding coming from the state. Over the last few budget cycles, temporary funding sources that are no longer available boosted the amount of home visiting services that could be provided.

“Over the years, the program has benefited from various additional temporary funding sources that are no longer available,” state Department of Public Health and Human Services spokesperson Jon Ebelt wrote in a recent email.

The program is funded in two-year budget cycles and in 2018 about $1.4 million in temporary federal funding plus carry-over money not spent in prior years put the program’s budget at $4.8 million. This year that extra federal funding is gone and the carry-over money was all spent, so the budget is now $2.9 million.

The state health department’s most recent request for proposals to operate programs had 18 providers respond. Previously the program supported 23 contracts in 19 counties and four tribal reservations. Over the last year, 1,326 families received one to two home visits a month, Ebelt said.

Ebelt said a committee including home visiting providers, legislators, state and tribal partners and others met several times in late 2020 and gathered information to “ensure we are making the most of our limited home visiting dollars and the funding is allocated to meet the greatest need.”

The group’s top priorities, Ebelt wrote, included transparent funding allocation models and targeting priority populations and money to best serve Montanans.

“Going forward, the state is committed to long-term, sustainable funding models for home visiting services within existing resources,” Ebelt wrote. “We look forward to issuing these funds and continuing a program that services thousands of families and children statewide.”

On Monday, Niemann said Lewis and Clark Public Health was awarded funding to continue its Nurse-Family Partnership and Parents as Teachers home visiting services.

“As expected, the contracts are significantly less (than) what is needed to operate these programs,” Niemann wrote in an email. “We have requested local county ARPA funds to help fill the gap and maintain services through the remainder of this fiscal year (June 30, 2022) so we don’t lose staff which would impact our ability to serve high-risk families.” ARPA is the federal American Rescue Plan Act passed by Congress earlier this year.

The Association of Montana Public Health Officials is also working to ask legislators, the state health department and the governor’s office to use some of the state’s funding from the American Rescue Plan Act “to help make these programs whole and lessen the burden on the locals to find the necessary funds to supplement the shortfall in the state contract,” Niemann wrote.

“We are lucky here in Lewis and Clark County in having support to sustain these programs. Not all counties are willing to use their local ARPA funds in this way,” Niemann wrote, adding the association has not heard back from the state on its request.

In Lewis and Clark County, Niemann said, home visiting services have been expanded over the last decade, but the need is still greater than the capacity.

“Especially knowing in this past year COVID has wreaked havoc on families, the stress, the economic issues that have happened with people not being able to work, housing challenges, all of those things have caused so much stress on families,” Niemann said.

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