Washington State has a long history of supporting high-quality, community-drive family support services, including home visiting. This history is evidenced by community and state level initiatives and funding for high quality services for our youngest Washingtonians and their families. For the past 16 years, Washington State led the way in establishing a cabinet level state agency focused on early learning – the first of its kind in the country. Washington has continued to see the critical nature of the youngest children and their families through consistent policy efforts and focus on pregnant women, infants and toddlers, including the establishment of the Home Visiting Services Account (HVSA) in 2010.
The HVSA integrates funding from various state and federal sources to support implementation, evaluation and support of the home visiting. Since its establishment in 2010, the HVSA has increased in the number of funding sources, amount of funding and number of home visiting models supported. The increases are a testament to the quality of services that families experience and partnerships to support families across our states. As home visiting programs, you play a critical role to support strong families, recognizing and building resilience to enable strong kids and families. Home visitors recognize and support strengths of parents, understanding parenting at any stage of life can be full of challenges, especially challenging are the phases of parenting when many nights are short, everything is new, and stressors of navigating parenthood in the current era. Strong partnerships developed with parents through the relationships with home visitors and use of vetted content and approaches offered by the well-supported home visiting models make lasting impacts in families’ lives. We look forward to developing partnership with your organization with our mutual goal of supporting healthy and resilient children and families in Washington.
DCYF and the HVSA
The Department of Children, Youth, and Families (DCYF) formed in July 2018. It combined the Washington State Department of Early Learning, Children's Administration from DSHS, Juvenile Rehabilitation and the Office of Juvenile Justice. The vision of DCYF is that all Washington's children and youth grow up safe and healthy – thriving physically, emotionally and educationally, nurtured by family and community.
Within DCYF resides the Home Visiting Services Account (HVSA), which funds our Home Visiting Local Implementing Agencies (LIAs), referred to as contractors in this manual. In 2010, the Washington State Legislature established the HVSA. The purpose of the account is to increase the availability of high-quality evidence-based, research-based, and promising home visiting practices in Washington. Through these home vising practices, the goals are to enhance child development and well-being, alleviate effects of poverty and other known risk factors, reduce the incidence of child abuse and neglect, and promote school readiness for young children and their families. HVSA legislation guides the expenditures, bid process, and values of this work, including that funds must be administered through a competitive bid process.
HVSA funding is administered and overseen by DCYF in close partnership with Start Early Washington through the Implementation HUB and Department of Health (DOH) through data and evaluation supports.
The HVSA currently funds 47 contractors, with an annual investment of $20.7 million. The HVSA takes a portfolio approach, by funding a range of home visiting models to meet the diverse needs across communities in Washington. The HVSA values diverse representation, from diverse geographic, racial and cultural communities. It also funds contractors with a range of capacities, investing in organizations along a wide spectrum of capacity, small to large organizations. The HVSA also values contractor participation, fostering partnerships between contractors, technical assistance, continuous quality improvement, and evaluation. This work is guided by the collaborative work of Washington’s many home visiting stakeholders, including the HVSA Advisory Committee.
The HVSA has developed an aligned measurement framework to assess the impact of home visiting that is derived from the work of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV), the HVSA’s federal funder. This framework is applied across all HVSA funded home visiting programs and addresses the domains below:
- Improve: maternal and newborn health
- Prevent: child abuse and neglect
- Reduce: crime and domestic violence
- Improve: family education level and earning potential
- Promote: children’s development and readiness to participate in school
- Connect: families to needed community resources and supports (HRSA MCHB, 2021).
HVSA Funding
The HVSA has three primary funding sources: Maternal, Infant, and Early Childhood Home Visiting (MIECHV) administered through the Health Resources and Services Administration (HRSA), Temporary Assistance for Needy Families (TANF) funding, and two strands of State funding [i502 (Dedicated Marijuana Account funds) and State General Funds]. Each contractor will have at least one of these sources and many will have multiple sources. If a contractor receives multiple funding sources to provide home visiting, it will be important to establish systems to track each source uniquely.
The Maternal, Infant, and Early Childhood Home Visiting program (MIECHV) is a federal program funded through the Health Resources and Services Administration (HRSA). This funding makes up the largest portion of home visiting funds for the HVSA. Many contractors implementing Nurse-Family Partnership (NFP) and Parents as Teachers (PAT) home visiting models in Washington are funded through MIECHV.
Since 2010, Washington has received several formula and competitive grants to both fund existing contractors and expand the contractors’ reach across the state. Through the original MIECHV grant, Washington received $1.8 million annually, which has grown to almost $10 million annually to support direct home visitation services in local communities and to develop systems to build quality implementation of evidence-based home visiting, to integrate home visiting as a strategy in a comprehensive statewide system for early childhood services, and to collaborate with and partner across agencies and throughout communities. For more information, visit DCYF’s Home Visiting Services Account webpage.
TANF funds come from the Department of Social and Health Services (DSHS) and targets TANF/WorkFirst families with children prenatal through 3 years of age that are receiving TANF assistance from DSHS.
Initiative 502 (i502) established a system, overseen by the Liquor and Cannabis Board, to license, regulate, and tax the production, processing, and wholesale of marijuana. It created a dedicated marijuana account (DMA), consisting of excise taxes, license fees, penalties, and forfeitures and specifies the disbursement of this money for a variety of health, education, and research purposes with the remainder distributed to the state general fund. A minimum of 85% of the i502 funding for home visiting must support evidence-based or research-based home visiting services.
During numerous legislative sessions, the Washington State Legislature authorized funds to expand the number of home visiting slots and a small allocation to provide enhancements to contractors funded prior to 2013. These funds are built into the ongoing state budget, and so will continue each year. Expected deliverables for this funding align with the ongoing MIECHV and i502 funding, and contractors are expected to braid these funds along with any other HVSA funds they receive.
Each funding source for the HVSA (e.g., MIECHV, TANF, i502, State General Funds) require the HVSA to account for the expenditures and services these funds support. As a result, all contractors are expected to "braid" rather than "blend" funding.
Blending refers to wrapping funds from two or more funding sources together to fund a specific part of a program or initiative. In blending, costs are not necessarily allocated and tracked by individual funding sources.
When funds are braided, two or more funding sources are coordinated to support the total cost of a service. Revenues are allocated and expenditures tracked by different categories of funding sources. In braiding, cost-allocation methods are required to ensure that there is no duplicate funding of service costs and that each funding source is charged its fair share across the partners (Wallen and Hubbard, 2013).
Contractors funded through the HVSA must be able to independently track and account for all expenses by the individual HVSA funding sources supporting the home visiting program. In order to accomplish this, accounting systems must be able to distinguish expenditures by fund sources and maintain documentation. This braiding filters down into documentation of time and effort, meaning that staff time cards must have clear delineations of time spent on the work funded by each fund source independently. Annual budget percentages are not sufficient documentation for time and effort. In addition, the contractor must have systems in place that allows for a reasonable process to allocate those expenses that are shared across fund sources and across programs, if applicable; this is often called a “cost allocation plan”. This delineation of funds - as well the cost allocation plan - are reviewed in detail during the annual fiscal review performed by DCYF.
The Trio
The Home Visiting work is primarily guided by three entities: DCYF, DOH, and Start Early Washington. This group is often referred to as the Trio. The three groups work closely together to support contractors in the implementation of their home visiting program.
Department of Children, Youth & Families (DCYF) is the contracting agency for home visiting services. DCYF will procure, negotiate, and administer the contracts. This includes monitoring for contract compliance in the areas of reporting requirements, enrollment targets, home visiting dosage, and other key elements that will be specified in each contractor’s unique contract. The primary source of information on this contract will be the contractor’s assigned Program Specialist on the DCYF Home Visiting Team. DCYF contracts with Department of Health and Start Early to provide additional home visiting data monitoring, evaluation, technical assistance and program implementation and systems support.
Department of Health (DOH) leads the data monitoring and evaluation efforts for the HVSA. This includes data sharing agreements (DSA) with each contractor to facilitate reporting of program data to DOH. DOH manages the data processing and reporting to meet state and national funding requirements. They also work closely with funded contractors to ensure complete and timely data reporting, as well as providing data back to programs to support continuous quality improvement and overall HVSA evaluation efforts. DCYF Home Visiting Data Collection webpage.
Start Early Washington's Implementation Hub ("the Hub") supports new and experienced home visiting programs through individual technical assistance, peer learning opportunities, training and professional development, and targeted coaching on continuous quality improvement (CQI). Serving as collaborative thought partners to develop or strengthen program implementation processes, knowledge application, and service delivery, Start Early Hub members celebrate and explore successes while working through challenges by modeling principles of reflective supervision and parallel practice.
The Start Early Washington model is structured to support quality home visiting based on the National Implementation Research Networks (NIRN) four stages of implementation: Exploration, Installation, Initial Implementation, and Full Implementation. The primary informant for Start Early Washington supports are the Model Leads for Nurse-Family Partnership, Parents as Teachers, and ParentChild+. These Model Leads provide technical assistance and serve as the designated representative for these models’ Washington state offices. Contractors implementing these models also receive targeted supports to meet model-specific fidelity requirements on training, reporting processes, and outcomes.
Tribal Programs
American Indian (AI) and Alaska Native (AN) maternal and infant health is an important and serious issue. AI/AN pregnant women/persons on Medicaid in Washington State experience higher risk factors impacting pregnancy outcomes, including mental health issues, alcohol, and/or substance abuse, smoking, resulting in higher rates of preterm births, infant mortality, and low/high birth weight babies. Home Visiting has been identified as a powerful resource to support AI/AN mothers/parents and babies. Contractor programming provides valuable support and tools to positively impact children’s well-being. US Administration for Children and Families administers the Tribal MIECHV program, offers additional resources on this topic.
Beginning in 2018, the HVSA began adding tribal home visiting programs into the portfolio of home visiting services funded by Washington. Over time this work has expanded to bring in more contractors serving tribal families and communities. To date, there are three federally recognized tribes and one tribal organization funded by the HVSA to offer home visiting in tribal communities. Starting in FY2023, the HVSA expects to double the number of programs and families served from tribal communities.
New Programs
As HVSA funding increases, additional programs may be contracted to perform home visiting services. After notification of award, DCYF works with new contractors to negotiate contract details and determine start-up or expansion activities. Coordination occurs with the Start Early Washington Implementation Hub to plan for successful program start-up or expansion. This includes support and time for contractors to build up to full staffing and enrollment levels. During the period that a contractor is working toward full capacity, contractors should anticipate more frequent check-in phone calls, emails, and/or meetings (in-person or virtual). DCYF, DOH, and the Start Early Washington Implementation Hub are committed to offering a full array of supports for contractors in their installation phase to ensure they have a strong foundation for a sustainable, high quality home visiting program.
For each fiscal year in which programs are a contractor for providing home visiting services, a contract will be issued by DCYF. The contract will lay out details about the services that are expected to be provided, compliance elements, and deliverables. It is important to make sure to read through the contract carefully and understand all of the elements contained within it. The assigned DCYF Program Specialist will be the primary source for any questions or clarifications regarding the contract. Resources can be found on the DCYF Home Visiting Contracts & Budget webpage.
The Statement of Work (SOW) contains expectations on home visiting service delivery and compliance with DCYF, the State of Washington, and applicable Federal agency requirements. Each contract will contain elements related to achieving and maintaining model fidelity for the agency’s home visiting services, including enrollment, retention, dosage, and home visit content. There will also be specifications around the staffing plan for the program as well as enrollment levels, priority populations, and service area. All of these elements, along with data, technical assistance, and continuous quality improvement, are focused on providing quality services to families and children.
Contractors must meet or exceed DCYF, Washington State, and applicable Federal agency regulations. This includes participation in meetings, continuous quality improvement, technical assistance, and data collection. Fiscal accountability is also a focus of the SOW, ensuring that programs are adhering to financial regulations and accountability as a recipient of public funds. In addition, each year programs will receive a site visit from the assigned DCYF Program Specialist who may or may not bring a team from DCYF to visit the agency, as well as an in-depth fiscal review, as required by the DCYF federal funding sources.
The budget section of the contract presents each of the payment points (by fund source) for the entire term of the contract. If the contract spans more than one state fiscal year, the budget will depict these payment points according to each fiscal year. These payment points are the larger expense categories developed in the contractor budgets as part of the Pre-Contract Questionnaire (PCQ) and contract negotiation process.
While the total budget is non-negotiable, transfers within these expense categories are allowable unless they exceed 10% of the total for the fund source. If the transfer exceeds 10% of the budget, a new budget must be negotiated, triggering the need for a contract amendment. All deviation (either less or more than 10%) should be discussed with the DCYF Program Specialist in advance to make sure it is allowable.
The budget also identifies if there are federal funds attached to the contract, and if so, includes details of those funds to identify that for the contractors and any ensuing requirements of the federal funding source.
The General Terms and Conditions (GT&C) are contained in Exhibit C of the contract and contain requirements of all contractors receiving funds from DCYF. Typically, these terms are non-negotiable. If concerns arise, contractors should discuss this with their DCYF Program Specialist.
The deliverables section of the contract is required for the DCYF contract system. The SOW outlines a number of contract expectations that are required for completion by the contractor. The Deliverables Section of the contract presents only those deliverables related to reporting and submissions: Monthly Enrollment and Quarterly Progress Reports as well as the annual Pre-Contract Questionnaire. A summary of annual deliverables posted on the DCYF Home Visiting Contracts & Budget webpage and reporting expectations are detailed in the reporting section below.
There are several standard attachments that are included in most DCYF Home Visiting contracts. These attachments are listed below:
- Certification of Data Disposition: required forms to be completed by the contractor at the termination of their final contract in regards to how they dispose of confidential data relating to clients receiving services under the contract.
- Statement of Confidentiality and Nondisclosure: required forms to be signed by all staff working under the contract in regards to the assurance of confidentiality.
- Contract Monitoring, Compliance, and Non-Compliance: summarizing the HVSA contract monitoring approach and including processes for addressing noncompliance.
- Data Collection Reporting and Aligned Measures: General guidance on the consent and data collection processes, timing of data submissions, and a summary of the definitions of the HVSA Aligned Measures, Demographic, and Service Data. The attachment also includes the list of reporting requirements including definitions of the Aligned and Performance-Based Measures, Demographics, Service Data and Consents. Additional details on data collection processes, timing of data submissions, and consent process.
- Federal Terms and Conditions of Award: Includes those additional terms that are expected of contractors who receive federal funds (MIECHV).
The legislation guiding the merging of Department of Early Learning (DEL) into the new DCYF agency introduced the requirement for performance-based contracts (PBC). The DCYF framework requires each contract to identify service, quality, and outcome milestones; home visiting was ahead because we had started performance awards for enrollment (service), dosage and depression screening/referral (quality). This framework is an incentive-based framework, meaning that for achieving milestones contractors receive additional – incentive – funds rather than experiencing monetary hold backs until achievement of a performance threshold.
The Strengthening Families Washington team’s intent behind the performance awards was to encourage contractors to focus on a few important indicators related to quality practice and to recognize accomplishments in those areas. Three questions guide the selection of performance metrics:
- Is it achievable – Is it reasonable to expect improvement in this metric?
- Is it available – Can data for this metric be collected objectively and in a timely manner?
- Is it aligned – Does the metric align with key priorities of DCYF, contractors and clients?
Performance Based Contracting (PBC) is a system-wide initiative, and so it is framed beyond the nuances and unique successes of an individual contractor. Each home visiting program has unique strengths and skills, and thereby makes unique impacts on participating families. Attaining a performance milestone is not the only indicator of success, particularly given the complex scope of each home visiting program and the diversity of participant populations.
PBC Milestones are reviewed annually and updated as needed. For the most recent several years, the PBC milestones include:
- Enrollment: Program meets or exceeds enrollment of 90% of their Maximum Service Capacity (caseload) during a quarter.
- Family Retention: Number of participants who remain engaged in the program for 12 and 18 months after enrollment.
- Caregiver Depression Screening and Follow-Up: Number of participants with completed depression screens for an enrolled primary caregiver within 3 months postpartum or enrollment; number of participants with completed second depression screens 3 to 6 months following the initial screen; number of participants with a documented referral or follow-up of positive screens with connection to appropriate services.
- Healthy Birthweight– for NFP and Outreach Doula programs: Number of NFP participants who give birth to an infant of healthy birthweight during the year.
For a detailed description of the milestones, please see the HVSA Performance Payment Awards fact sheet on the DCYF Home Visiting Performance-Based Contracts webpage.
Routine service utilization and performance data submitted monthly or quarterly to DOH from contractors is used to assess Milestone progress. DOH produces performance milestone results for use by DCYF to determine the monetary performance award. DCYF shares the performance award determination with the contractor, and the contractor invoices DCYF for the award. Contractors may invoice for payment of their earned quarterly enrollment awards after Quarters 2 and 4. Performance for all other awards are produced annually, and contractors may invoice for payment of their earned awards after Quarter 4.
The terms of earning the award are met once the program achieves the performance milestone, as documented through the data housed with DOH. While there is no time limit on expenditure of the award, contractors must use the award funds received towards advancing the goals of the home visiting program as described in the contract.
Contract Monitoring
DCYF’s overarching approach to monitoring contract is based on:
- What we read (monthly enrollment reports, quarterly progress reports, and monthly invoices with backup documentation, and a few other deliverables. We review these items using the guidance of the attached “monitoring principles.” This includes tracking financial expenditures against budget).
- What we hear (regular check-in calls with programs to hear progress and share insights from reading progress reports and reviewing invoices; agendas for these calls are customized to program issues and may include other system-wide topics).
- What we see (annual on-site or virtual monitoring visits; additional visits may occur, depending upon programs’ implementation phase, individual needs and circumstances).
As a public agency, DCYF takes seriously the role in stewarding the management of public funds while, at the same time, aiming to support contractors in successfully delivering high quality services to vulnerable families. Our goal is to maintain strong relationships with contractors and use a monitoring approach that:
- acknowledges the incredible effort to maintain fidelity to the home visiting models while serving vulnerable families, and
- encourage performance that leads to: high quality service delivery, maximum outreach and enrollment capacity, and adequate home visit dosage to make a sustained difference in the lives of participating children and their caregivers.
Program Specialists are assigned to each contractor and perform the majority of contract monitoring activities. The Program Specialist will also be responsible for reviewing all submitted reports, budgets, invoices, and other documents submitted by their assigned programs. They will also regularly check in with programs through a phone call or other means. Program Specialist monitoring is used to support contractors in their program implementation to ensure that contractors are able to continue providing high quality home visiting services to Washington families.
Based on submitted reports and communication with contractors, DCYF Program Specialists review performance in the areas listed below. If areas of concern arise, contractors may expect direct communication and support from DOH, and Start Early Washington to address these areas. If performance concerns continue, a more formal process of performance improvement activities will ensue. Monitoring areas include at least the following:
- Model Fidelity
- Staffing, Supervision, and Training
- Service Area and Recruitment of Priority Populations
- Participant Enrollment, Retention and Caseload Maintenance
- Visit Frequency and Content
- Systems Connections
- Data Collection, Reporting and Evaluation Requirements
- Continuous Quality Improvement Activities
- Quality Improvement Technical Assistance
- Financial/expenditure documentation
One aspect of contract monitoring is the annual on-site review. During the annual monitoring visit, DCYF Program Specialists review program documentation supporting the contract program expectations, administrative policies and procedures addressing the contract’s general and federal terms and conditions (if applicable). The intent of the visit also includes relationship building and a time to hold real-time conversations on topics of concern to both the Program Specialist and the funded program. The site visit is an opportunity to spend in-person time with each contractor, deepen DCYF’s understanding of the program, hear contractors brag about successes and share challenges. The basic outline of the site visit will typically include:
- a review of home visiting program progress including meeting requirements and deliverables
- review of administrative policies and procedures
While aspects of the site visit include monitoring of programmatic and administrative components, contractors also work collaboratively with DCYF Program Specialists to develop the site visit agenda and offer opportunities for DCYF Program Specialists to learn from contractors about the program and the local community. After the conclusion of the annual site visit, contractors receive a written summary of the visit, notice of any areas for improvement, and a request for input in planning future annual reviews. DCYF has begun to institute virtual site visits in response to the COVID-19 pandemic; future reviews may include both virtual and on-site options.
In order to meet federal funding requirements, contractors will also have an annual fiscal review. These can be a “desk review,” where documents are requested by email for the DCYF fiscal review team, or can be done at a contractor’s offices. The fiscal reviewer is a resource for contractors to help ensure State and Federal guidelines are being met, which can help ensure continued funding. At least once every four years, the fiscal review will be conducted on-site. For additional information, visit the DCYF Home Visiting Contracts & Budget webpage, section Financial Monitoring.
The DCYF team continues to refine a consistent approach to monitoring so that contractors know what to expect from the process and Program Specialists are equipped to monitor in a meaningful way, and the team is open to reflecting on and reviewing the process going forward.
Reporting
Contractors are expected to submit regular reports to DCYF. These reports are used to monitor program compliance as well as learn what successes and challenges contractors are facing. Using this information, DCYF is able to advocate for policy changes to support contractors in being successful. These reports are submitted via the Prevention Services Reporting System (PSRS) on the DCYF Home Visiting Contracts & Budget webpage. Contractors may download a PDF of their PSRS reports from the PSRS system. The PSRS User’s Guide is available on the DCYF Home Visiting webpage; sign-in or register for PSRS.
The Monthly Enrollment Report is due by the 20th of the month immediately following the end of the month of service. The primary information collected through this report is the status of program enrollment. Contractors report on the cumulative families served, number of newly enrolled clients, number of exited clients, and the percentage of families currently enrolled. There is also an opportunity to provide any narrative about enrollment successes, changes, challenges and/or barriers. Contractors with enrollment below 85% of their funded caseload are asked to report on their CQI activities supporting stronger enrollment performance.
Quarterly Progress Reports are due 20 days after the end of each quarter. The report includes additional information about program participation and other areas of the program progress including staffing, supervision, service delivery, referral pathways, use of technical assistance, community partnerships, CQI activities and learnings, participant feedback, and reflections on program data and performance. The quarterly report is an opportunity for programs to share both program successes and challenges. While the majority of the questions are the same across every quarter, additional topics are reported semi-annually or annually, so each quarter the questions are slightly different. Report content is shared with DOH and Start Early, and it supports DCFY reporting to funders.
Performance Improvement
DCYF Program Specialists monitor home visiting contractors on their contract compliance in the ten areas noted in the contracts monitoring section above. Delay or challenges encountered in meeting two or more of the category areas above and/or non-compliance related to financial activity during a quarter, may result in development of an enhanced monitoring plan between the DCYF Program Specialist and the contractor, to include a plan with action steps, a timeline, and quarterly review. The contractor and DCYF Program Specialist would use the plan as a way of monitoring progress towards improvement. Continued low performance lasting 12 months or longer may result in a formal Quality Review. A Quality Review would partner the contractor with key Trio members to perform a deeper exploration into program data and the drivers related to the chronicity of performance challenges. This partnership effort would lead to developing a Performance Plan to address organizational, infrastructure, program drivers and include action steps, a timeline, and quarterly review steps. The contractor and DCYF Program Specialist would use the Performance Plan as a way of monitoring progress towards improvement quarterly. Should low performance issues continue another 12 months, then the DCYF Program Specialist will work with the contractor to move to modify the terms of the contract or move to the contractor to noncompliance status that might lead to termination of the contract.
The Quality Review is an opportunity for contractors, Start Early Model Leads, and DCYF Program Specialists to explore causes of implementation challenges and offer additional resources to support success. Often, this process will include a self-assessment to be completed by the program and then a joint effort at developing a plan for improvement (an implementation improvement plan or IIP). This process is outlined in detail in the “Contract Monitoring, Compliance and Non-Compliance” attachment in the contract.
While the purpose of implementation improvement process is to explore implementation challenges, the plan serves as documentation of the contractor’s efforts to address systemic or organizational barriers. Low enrollment is the most common example of a performance area addressed in an improvement plan. Other performance issues include continuous staff turnover and model fidelity. DCYF’s primary aim is to support contractors in providing high quality services to as many families as possible, demonstrated through meeting the fidelity and contract requirements, some unique to the different funding sources. This approach is depicted in Appendix A.
Overall, DCYF’s aim is to provide assistance to contractors to support them in meeting their contract deliverables.Program data helps build understanding of the impact of home visiting on the families served – what works, what doesn’t work, what can be changed or improved. This allows DCYF, DOH and Start Early to tell the Home Visiting success story to stakeholders and, as stewards of public resources, to demonstrate accountability for the use of public funds which are reported to federal, state, and private funders.
The HVSA data collection and evaluation requirements are designed to (1) inform the various stakeholders of home visiting in Washington State, (2) provide an understanding of how home visiting programs are working, and (3) describe how home visiting programs contribute to an early learning system that ensures all children start life with a solid foundation for success. DCYF Home Visiting Data Collection webpage.
Contractors are required to collect data for all HVSA-funded participants who receive home visiting services. Contractors are contractually obligated to collect enrollment, service utilization, demographic and performance data for HVSA-funded participants. The Aligned Measures are a set of eight systems and performance measures; MIECHV funded programs collect an additional set of performance measures. The Aligned Measures can also be reviewed on the DCYF Home Visiting Data Collection webpage under the HVSA Aligned Measures section. The contract’s Attachment on Data Collection and Reporting Requirements contains information about the data collection and sharing process as well as tables defining all data collection expectations:
- HVSA Aligned Measures (and for MIECHV funded contractors MIECHV Performance Measures) including all System and Program Performance Indicators
- Enrollment and Service Utilization measures
- Demographic Information: The contractor shall collect and share data for all demographic information outlined for participating caregivers and children.
- Performance Awards Milestone measures as defined in the contract.
DOH provides training and documentation that offers additional detail on data collection, timing, tools, and submission instructions to help contractors navigate their own data systems and meet compliance with reporting requirements.
The HVSA expects contractors to follow model guidance for data collection and reporting, with additional HVSA requirements incorporated into their routine reporting. Data must be collected on all enrolled adults, children, and families. Contractors are required to enter data into their data system within five business days of when the data were collected (typically within five business days of the home visit) and to ensure the data are accurate and represent the experience at the home visit. Reporting data to DOH is either monthly or quarterly noted in each individual contract.
Contractors are expected to abide by an executed data sharing agreement with the DOH. Typically, DOH will draft the Data Sharing Agreement (DSA) and negotiate that agreement with the contractor in the same manner as a contract. The DSA is a DOH contract and binding as such. DOH maintains data sharing agreements with each contractor to codify sharing, management and use of data across HVSA partners. Contractors should refer to their DCYF contract for unique or additional data requirements that include the relationship with their model National Service Office, to facilitate data sharing. The DCYF contract details the required data elements to be shared with DOH. The DOH data sharing agreement specifies how data will be shared with DOH, how data may be used by DOH, when DOH may share these data with DCYF and other entities, and responsibilities of DOH and all implicated parties to take action in the event of a data breach.
For contractors funded through the HVSA with TANF funds, they must also enter into a DSA with DSHS to allow for transfer of referral information between DSHS and the contractor via eJas.
Data collected for the HVSA, including all model required data, must be stored, maintained and protected in a secure data system. DCYF data security standards are detailed in the contract Exhibit C General Terms and Conditions, and they are intended to preserve and maintain client confidentiality and prevent any unauthorized disclosure of sensitive information. Data shared with DOH is similarly protected by the DSA.
In order to more fully understand and evaluate the impact of home visiting on families, the HVSA examines home visiting data alongside other administrative data (e.g., CPS, birth certificates, OSPI school readiness). Linkage of home visiting data with other sources provides an opportunity to compare outcomes among those receiving services and those eligible but not receiving services, thereby deepening our understanding of the benefits of home visiting. However, this link requires temporary access to personally identifiable data from the child and parent/guardian enrolled in home visiting. To allow for access to confidential client data, the parent or guardian must consent to share this data with DOH and DCYF. Secure storage and use of this confidential data are protected by the data sharing agreements between DOH and the contractors and between DOH and DCYF. Collecting this data will support in-depth program planning and evaluation for the following purposes:
- Describing where home visiting services are currently provided (and to whom – age groups, demographic groups, etc.) and where there are gaps.
- Understanding the experience of families, in general, and specific risk factors overall, by region, by program model, and other factors.
- Evaluating the impact of home visiting services on children and families (in combination with and in the absence of other early learning services). We are particularly interested in exploring the impact of home visiting on children’s kindergarten readiness and other educational outcomes, and will use the identifiable data to match participants with their educational progress. Without consent, we currently have no means of determining this for our programming and can only cite national research.
- Corroborating findings from other research on home visiting, in particular to understand how home visiting supports parent-child interactions and reduces involvement with Child Protective Services (CPS).
For example, to understand participants’ experiences with Child Protective Services (CPS) and assess child maltreatment rates, the most reliable source of child maltreatment data is housed in CPS. The HVSA team works with CPS to identify any HVSA clients who were reported to CPS for a formal investigation. DOH works with an independent analyst who searches the CPS database for any HVSA clients. HVSA client data is never added to the CPS database, rather CPS data is added to the HVSA database for evaluation purposes using the data protections described previously.
To achieve these evaluation aims, contractors are expected to make every effort to seek consent from all participants to share confidential information. For those parents who consent to share confidential information, contractors then share that information with DOH through a secure data transfer that maintains the participant’s confidentiality. When consent is not given, this information is not transferred. All medical, social, or economic information that is shared is kept secure and confidential following state and federal law. This confidential information allows DOH and DCYF to link home visiting data with other service data to better understand the array of services a family is receiving or not receiving compared to other similar families to better plan for future services.
The suggested language used by contractors to seek parental consent is available in English and Spanish and can also be found on the DCYF Data Collection webpage.
The method of data submission to the DOH is dependent on the data system used by the contractor and is noted in the DCYF contract. Contractors using a national data system that has a pre-arranged data transfer process with DOH, are expected to enter all data into these systems, and the national system will then share data extracts with DOH monthly. Current national systems with data transfer arrangements with DOH include Flo (used exclusively by NFP), VisitTracker, and DAISY. For other contractors, the data must be transferred directly from the contractor to DOH via Secure File Transfer (SFT) to ensure data security. The transfer is expected to occur, at a minimum, quarterly on or before the sixth business day following the end of each quarter.
The following graphic depicts the data collection cycle:
Data quality is a priority that starts at the point of data collection by the home visitor through data transfer to DOH and production of results for reporting and evaluation. The DOH team develops an annual quality assurance (QA) plan that sets quality standards and identifies areas for improvement each year. Activities may include working individually with a contractor to ensure correct and complete data entry into their national data system, trouble-shooting data discrepancies between a national data system and the data extract provided to DOH, or streamlining data reporting for those working with their local data system. This QA work relies on routine, predictable data transfers to DOH with data validation and integration into the data warehouse maintained by DOH. The HVSA works very closely with the national model offices and local models to align Washington’s data collection requirements with model requirements. This alignment supports robust data collection on a number of routine service statistics and performance measures, ensuring consistent, routine, site-level reporting to DOH. Aggregated data is produced by DOH into quarterly and annual statistics for DCYF to use in federal and state reporting.
Training is another key component to ensure best data quality. DOH, along with DCYF and Start Early, provides training webinars as well as direct, hands-on, in-person training and technical assistance to contractors to support local data collection and reporting. These are posted on the DCYF Home Visiting webpage.
DOH produces program-specific Quality Assurance (QA) reports in quarters 1 and 3; these provide contractors with their participant-specific data for eight of the Performance Measures as well as demographics. For each measure, contractors receive information on which of their participants were included or which had missing data and need follow-up. This information has helped contractors focus efforts on acquiring missing data from participants or completing screenings or services, when possible.
Data Dashboards
Following the end of each quarter, DOH produces data dashboards for the contractors and state partners to support exploration of the data and to monitor progress on performance measures and Continuous Quality Improvement activities. This has generated rich dialogue among contractors and between contractors and the State’s technical advisors.
Contractors are encouraged to use their dashboards to track monthly progress on active enrollment and to observe trends over time; here enrollment is measured as a “point-in-time” snapshot of performance. Additionally, the dashboards present data on other measures that align with contract performance measures awards Continuous Quality Improvement activities. The dashboards present comparisons for each site against their model average, state average, and state’s CQI goal. This information serves as a teaching and tracking tool for the CQI teams.
The founding legislation of the HVSA requires impacts to support families and investment in evidence-based programs, research-based programs and promising practices because these programs have documentation of impacts on children and families. Model fidelity is a contractor’s adherence to the standards and practices outlined by the program model, and thus resulting in those positive outcomes.
Contractors are required to deliver home visiting services according to their program model requirements, and Start Early Washington Technical Assistance Providers support program implementation in alignment with model fidelity. DCYF asks contractors to provide evidence they are in fidelity with their program model, with a letter of fidelity status either from the national model office or from Start Early Washington’s Technical Assistance Provider if no national office exists. For NFP, PAT, and ParentChild+, the HVSA collaborates with the Start Early Washington Model Leads and national model offices through a formal partnership to assure communication related to contractor’s model implementation.
Washington continues to grow and implement a robust continuous quality improvement (CQI) strategy led by Start Early Washington Implementation Hub and offering quality improvement coaching and technical assistance to contractors. Each program is guided to implement local CQI projects and reports on their learnings and impacts through the Quarterly Progress Reports. Start Early Implementation Hub support strengthening of CQI capacity at the State and contractor level and in-depth peer learning opportunities.
CQI promotes the regular and meaningful use of data, tools, and rapid-cycle improvement processes to inform practice and decision-making. CQI is an integrated element of all Hub processes, and Start Early’s Manager of Quality Improvement and Innovation provides targeted expertise to support discrete process improvement projects with each contractor’s home visiting program and within the home visiting system. Hub staff provide customized, individual coaching to CQI teams with contractors to coach them through a specific CQI project and Plan-Do-Study-Act (PDSA) cycles. The Hub also regularly synthesizes and disseminates home visiting specific CQI-tools and resources as well as lessons learned that emerge with the contractors.
The CQI approach used by the State of Washington includes both reflection and data elements, while ultimately drawing on the expertise and invaluable knowledge of contractor home visiting staff and families. Through thoughtfully implemented CQI projects, contractors are supported to optimize program outcomes, identify and test innovative approaches, disseminate best practices, and enhance program efficiency and effectiveness. CQI is intended to prompt deep reflection of current practice and outcomes, while recognizing the value of learning and development.
HVSA priorities include:
- Supporting diverse communities: Ensuring that all contractors effectively respond to the needs of their clients through strengths-based approaches; they attend to cultural competency in alignment with the demographics of the families served; they incorporate elements of trauma informed practice in their work and support staff training to continuously enhance its service provision to the community.
- Funding a range of home visiting programs and organizations: Funding a diverse array of program models to better serve the State’s diverse communities; sufficiently balance service expansion between existing programs and building capacity in start-up programs.
- Statewide representation: Continuing to balance the portfolio of home visiting programs across the diverse geography and need of Washington State
DCYF works closely with contractors to offer culturally and linguistically relevant services; encourages contractors to hire bilingual and bicultural staff. DCYF seeks to include cultural humility, sensitivity, and awareness in coaching and training for supervisors and home visitors. Additionally, the HVSA is exploring ways to assess interest, develop awareness and capacity of Tribal communities to implement home visiting in Washington State, particularly aiming for implementing home visiting programs developed specifically for and by Native communities.
Exploring equitable implementation and policy making is an ongoing work at DCYF, DOH and Start Early influencing HVSA practice and decision making.
Budget
Each contractor is required to submit an annual budget to DCYF in the Spring prior to the upcoming contract year as a component of the Pre-Contract Questionnaire (PCQ). Budgets should include 12-months of salaries and benefits for all staff who charge time to the HVSA funds. Goods and services should include any ongoing training expenses (tuition, conference fees), supplies and materials which may include cell phones or cellular plans, computer equipment, and office supplies. Travel costs should include routine costs related to travelling to family’s homes for visits as well as travel costs associated with trainings and meetings, including the required HVSA All Program meetings. Contracted and professional services should include those costs that are either professional services supporting the program and/or contracted services to entities outside of the organization; these may include annual model and curricula fees, data/IT support, marketing, outreach services, communications, interpretation/translation, and reflective supervision/consultation (if not provided by current program supervisor). Budgets may include equipment expenses when they exceed $5,000 per unit (any equipment purchases less than this would be considered supplies). All costs that are fully expensed to the home visiting program (e.g. not shared across the agency) may be direct charged in the budget.
As part of their approved budget, contractors may claim an indirect rate based on one of three options:
- the rate negotiated with its cognizant federal agency, also known as the federally approved cost allocation plan;
- the rate negotiated with DCYF, not to exceed the federally approved cost allocation plan; or
- the rate calculated at 10% of modified total direct costs.
If a contractor claims the federally negotiated rate, the contractor must supply documentation (federal certification), preferably via email, verifying the federally approved rate. If the calculated indirect rate includes allocated program supports such as rent, utilities or other expenses incurred across the agency, the contractor must have an approved process for determining the allocation formula; in addition, these expenses that fall within that allocation may not also be direct charged in the budget.
The assigned DCYF Program Specialist will review budgets, to be sure the proposed budget will adequately support the model-required caseload, and to ensure that costs are allocated appropriately to each funding source the program receives, if more than one. In addition, the review checks to see that the budget supports any model requirements as well, such as model fees or model-required trainings; contractors should work with the model leads at Start Early to include these required model elements.
DCYF understands that budgets are planning tools and derived well ahead of their implementation year, and unanticipated changes in implementation are likely to occur. If mid-year changes are needed to a budget due staffing turnover or other unforeseen circumstances, the contractor is expected to communicate this to the DCYF Program Specialist as soon as the changes are known; DCYF will determine if this will trigger the need for a contract amendment.
Each month, contractors should submit a completed A-19 Voucher (invoice) by the end of the following month. The invoice must indicate the month in which is being billed for, total costs by funding source, and the signature of the person preparing the invoice. Invoices are submitted to DCYF according to contract requirements. The invoice needs to be accompanied by an expense summary by funding, the payroll summary by fund source, and documentation of any single expense exceeding $5,000.
The backup documentation may be produced individually or by an accounting system that clearly details a summary of the expenses incurred for each payment point in the A-19 invoice. While the level of detail does not need to be the agency’s general ledger summary for the month, the detail should offer sufficient detail to understand how the payment point was calculated in general components. Detailed documentation supporting any single expenses exceeding $5,000 must be provided, which may include subcontractor charges at the same level of detail supporting the A-19. In addition, the monthly A-19 invoice must be accompanied by the Payroll summary by fund source for the month that indicates the number of hours charged, distributed by staff person to the HVSA. This may include a summary of benefits as well. Contractors should direct questions to their DCYF Program Specialist and visit the DCYF Home Visiting Contracts & Budget webpage for more resources.
Performance data is reviewed quarterly, and performance awards are made twice per year for enrollment and annually for all other performance awards. Contractors will be notified by a Program Specialist about the total award amount earned. If contractors earn an award, they must submit an A-19 invoice to DCYF in order to be paid. Invoices may be combined with a monthly A-19 invoice or in a separate A-19, but performance awards are not required to have back-up documentation nor any plan for how the money will be spent. Performance awards may be used at the contractor’s discretion as long as they are used to advance the goals of the home visiting program.
Financial Review
DCYF receives federal funding as a part of the HVSA and home visiting program contractors are considered “Sub-Recipients.” Requirements of this funding indicate that each of the DCYF contractors must receive an annual fiscal and site review. Fiscal reviews are conducted on-site at least once every four years. These fiscal reviews are conducted in sufficient depth to allow for the reduced detail supporting the monthly invoicing.
The DCYF Fiscal Review Team will conduct reviews typically beginning in September and ending by the end of June during the grant year (typically, this is a July through June period). The fiscal team will allocate reviews throughout the year and they may, or may not, coincide with a site review with the assigned Program Specialist. The DCYF Fiscal Review Team will notify a program at least six weeks prior to the start of the review. In this notice, programs are given between two and four weeks to respond by emailing the requested documents. The most common documents are:
- Financial policies of the organization
- Most current financial audit and, if applicable, the single or program-specific audit
- Most current IRS Form 990
- General Ledger activity detail for all expenditures charged to the DCYF Home Visiting contract as indicated by submitted invoices for the entire fiscal year, unless otherwise directed.
- Indirect cost allocation plan or indirect rate agreement (whichever is applicable)
- Chart of accounts
These documents, and others if requested, are then reviewed. Substantiating documents may be requested for specific items, this may include such items as receipts, time sheets, travel documentation, etc. The DCYF Fiscal Review Team wants to be a resource for programs, and are available to answer program questions if there is any confusion either during, before, or after the review. Concerns that are found will start a conversation between DCYF and the contractor to help both parties better understand contractor processes. If after a dialogue there are remaining concerns, our DCYF Fiscal Review Team will work with contractors to resolve the issue to work for both the program and the DCYF fiscal requirements.
The DCYF financial review has identified a few areas that regularly arise as areas for concern. Contractors must review time sheets to reflect actual time and effort of all staff whose time is charged to the HVSA (and not budgeted time and effort). If the home visiting contract includes more than one fund source, contractor staff must charge hours individually to each fund source. Time sheets must also be signed by a supervisor after the ending time of the time sheet, not before the end of that period. Travel expenses must align with the State of Washington Office of Financial Management Travel Regulations, which can be found on their website. If it is not possible to stay within the guidelines, programs must have a system in place to document and justify why costs deviated and demonstrate prior supervisor or managerial approval. The allowability of expenses are determined by the DCYF fund sources and must abide by HRSA federal rules.
For additional information, visit the DCYF Home Visiting Contracts & Budget webpage, section Financial Monitoring.
DCYF Program Specialists
The DCYF Program Specialists are a contractor’s primary point of contact. A Program Specialist provides management and performance-based contracting, including contract negotiation, consultation, program monitoring, and technical assistance to contractors. Program Specialists assist with the implementation and evaluation efforts of statewide home visiting systems. They also support planning efforts through research of key issues, analysis, and development of reports. The team of Program Specialists also collaborate with early learning, health, education and human service partners to increase collaborative efforts in the home visiting system development and provide staff support to work groups and planning groups focused on home visiting implementation.
This team is split into home visiting model expertise areas, although they may not work exclusively with one home visiting model group. Contractors are assigned a Program Specialist as their primary point of contact for DCYF.
The Community Prevention Services Contracting Team oversees the development and implementation of aligned policies and procedures to support procurement, contract development, fiscal and program monitoring, and reporting requirements to achieve a high standard of accountability.
Communications, Monthly Email, and Monthly Newsletter
DCYF has a goal of ensuring contractors are kept up to date on the changes, adjustments, and status of Home Visiting in Washington State. Each month an email and a newsletter are sent out to all Home Visiting partners, including key contract personnel. In these communications are reminders of upcoming events, professional development opportunities, and updates about the DCYF, DOH, and Start Early Washington teams. There are also links to webinars and resources that could be useful to programs in the field.
Email communications are typically sent from the Home Visiting email account home.visiting@dcyf.wa.gov. This email address may also be used as a first point of contact with the HVSA; however, data questions should be directed to DOH (HomeVisiting@doh.wa.gov) and model technical assistance to Start Early Washington. DCYF staff will direct all questions received in the DCYF Home Visiting inbox to the most relevant supports. For submission of deliverables and invoices, DCYF asks contractors to submit to the DCYF Home Visiting inbox as well as the contractor’s Program Specialist. The DCYF Home Visiting email address is able to be accessed by multiple team members, so is an effective communication tool for contractors.
The Monthly HVSA Email is sent primarily to home visiting supervisors. The message will include necessary updates and reminders about upcoming due dates. The monthly email is meant to be a reminder of HVSA requirements, and not for use outside of the HVSA. If programs need to change who receives this email, a message should be sent to home.visiting@dcyf.wa.gov.
Each month, the DCYF Home Visiting team will send out a newsletter. The newsletter provides educational materials and information relating to home visiting in Washington State. This communication is shared to all interested parties in the HVSA as well as statewide partners and home visiting champions. The newsletter highlights the high quality work being done across the state as well as sharing national home visiting trends and training opportunities. Anyone interested in receiving the newsletter should email home.visiting@dcyf.wa.gov.
DCYF, DOH, and Start Early Washington also host webinars for contractors. Participation in webinars is strongly encouraged. When possible, webinars are recorded and posted on the DCYF webpage for later viewing if staff are unavailable during the scheduled webinar time. Topics may include changes to procedures or contract language, professional development opportunities, clarification or instructional information, and many other subjects. Webinars are one way the Trio can communicate with programs regularly that allows for some interaction between the program and the Trio staff.
DCYF Webpage
The DCYF Home Visiting webpage includes resources for Contracts & Budget, Performance-Based Contracts, Data Collection, Training & Technical Assistance, Home Visiting Service Account, and Home Visiting Workforce and Professional Development Resources.
Contractors can find key announcements, links to newsletters, and links to contractor resources. DCYF keeps the website as up to date as possible, but if something is not on the website, contact home.visiting@dcyf.wa.gov or the appropriate Program Specialist for assistance.
DOH Data Assistance
Department of Health (DOH) staff are available to support contractors with their data needs. DOH provides HVSA-specific supplemental materials as companions to national data system manuals. On-site, face-to-face trainings and technical assistance can also be requested. DOH strives to help programs report accurate data that is used to inform Washington State’s home visiting partners to understand how home visiting is working in the state including home visiting’s role in helping ensure all children start life with a solid foundation for success.
DOH is Washington State’s lead data process partner. DCYF is provided with state-wide summaries on the progress of Home Visiting, and contractors receive site-specific data to monitor their own performance. DOH can support contractors in working on:
- Data Collection
- Data Sharing
- Reporting Process
- Analysis and Interpretation of Data
- Quality Assurance
Model Fidelity and Start Early Technical Assistance
The Start Early Washington Implementation Hub works with governing agencies, private funders, and home visiting programs to support capacity building, innovation, and sustainability by providing training and technical assistance to home visiting professionals. The Hub is informed by the following values and frameworks:
- Strengths-based, client-centered principles
- Reflective practice
- Trauma-informed practice
- Diversity, Equity, and Inclusion Implementation Science
- Quality Parallel Process
Home visiting programs supported by the Hub receive support from both a model-specific lead as well as continuous quality improved (CQI) lead. The Hub also provides cross-model trainings and opportunities for peer connection, in addition to serving as a key collaborator in both state and national home visiting governance systems. Serving as supportive thought partners to develop or strengthen program implementation processes, knowledge application and service delivery, the Hub celebrates and explores successes while working through challenges by modeling principles of reflective supervision and parallel process.
The Hub offers supports to home visiting programs across all models on topics such as:
- Staff hiring, onboarding, and retention
- Best practice in family engagement
- Data collection to inform decision-making
- Developing referral relationships with community partners
- Family recruitment and enrollment
- Policy and procedure development
- Technical and adaptive skills in staff supervision, reflective practice, and team culture
In addition, contractors implementing Nurse-Family Partnership, Parents as Teachers, and ParentChild+ receive supports on meeting model-specific outcomes and reporting processes.
A contractor’s assigned technical assistance provider will provide support through individual calls and team visits. Technical assistance providers will work with contractors to determine a consistent time and frequency for monthly individual technical assistance calls that help supervisors work toward their team’s goals for home visiting implementation. Team observations occur once per year and may take place virtually or on-site. During team observations, technical assistance providers join home visiting team meetings, answer questions and learn about changes in implementation, and provide follow-up coaching to supervisors.
Because of the volume of contractors implementing NFP, PAT, and ParentChild+ in Washington, these models also host group meetings. Monthly, technical assistance providers for these models will host a group meeting (virtual or in-person) for all model supervisors. While some programmatic components may be discussed, these meetings tend to focus on administrative or business topics and are intended to keep contractors informed and up-to-date. Model leads also hold longer, in-person or virtual supervisory meetings. In contrast to the monthly supervisory connections, these will focus more on practice implications, peer-to-peer sharing, and self-care.
CQI provides a constructive and adaptable framework to promote quality, innovation, and program reflection in order to improve outcomes for families. This process is fundamentally data driven, but also draws on the expertise and invaluable knowledge of front-line home visiting staff and families. A thoughtfully implemented CQI project has the potential to optimize program outcomes, identify and test innovate approaches, disseminate best practices, and enhance program efficiency and effectiveness. The Hub also houses expertise in CQI process and provides specific support to all contractors around implementing improvement cycles to improve their practice. CQI support generally revolves around a contractor’s specific CQI project and includes individual coaching sessions and peer learning opportunities.
The Home Visiting Advisory Committee (HVAC) purpose is to advise the HVSA partnership regarding research and the distribution of funds from the account to eligible programs. The committee provides oversight and strategic direction to Washington State’s home visiting systems building and expansion of services. The HVAC’s role includes:
- Integrating expertise of home visiting models, early learning research and knowledge, and the experience of families and providers to inform how the state supports and expands home visiting services that meet the values and goals of the Home Visiting Advisory Committee.
- Develop strategies and recommendations on how home visiting can be more integrated and accessible with other community resources.
- Review, discuss, and deliberate to shape recommendations on key questions and findings based on data and research.
The HVAC is managed by Start Early Washington and is comprised of 18-26 home visiting experts, government and health department representatives, tribal community liaisons, service providers, and volunteers from the community who reflect Washington State’s diversity. The HVAC provides oversight and recommendations to DCYF, DOH, and Start Early Washington. It does not control HVSA funding sources, though it does provide input on how funding should be used.