(a)
Pilot program required—
(1)
In general— The Secretary of Defense shall, acting through the Defense Health Agency, carry out a pilot program on universal nurse home visits designed to provide eligible covered beneficiaries and their families training on safe childcare practices aimed at reducing child abuse and fatalities due to abuse and neglect, assessments of risk factors for child abuse, and connections with community resources to meet identified needs.
(2)
Scope— The pilot program shall be designed to facilitate connections between covered beneficiaries and their families and community services and resources (including services and resources provided by the Department of Defense), and shall not be designed to replace any other resources currently available to covered beneficiaries and their families. The pilot program, including the practices covered by training pursuant to the pilot program, shall conform to evidence-based scientific criteria, including criteria available through publications in peer-reviewed scientific journals.
(3)
Discharge— The pilot program shall be carried out through a contract with an entity selected by the Secretary for purposes of the pilot program from among entities capable of meeting the requirements of the pilot program, including the provision of training for nurses who makes visits under the pilot program on evidence-based practices in connection universal nurse home visits.
(b)
Locations— The pilot program required by this section shall be carried out at military installations selected by the Secretary for purposes of the pilot program as follows:
(1)
Not fewer than five installations that are locations of a military medical treatment facility.
(2)
Such other installations as the Secretary considers appropriate from among installations representing a range of situations, including installations in an urban location and a rural location, installations with a large population and with a small population, installations currently experiencing high incidence of child abuse, neglect, or both and low incidence of child abuse, neglect, or both, installations within the United States and outside the United States, joint installations, and installations serving only one Armed Force.
(c)
Elements— The pilot program shall include the following:
(1)
Between one and three home visits described in subsection (f), and not more than seven other contacts, except in unusual cases (such as deployments), with such home visits by a team led by a licensed nurse to provide screening, community resource referral, and training to eligible covered beneficiaries participating in the pilot program and their families on the following:
(A)
General maternal and infant health.
(B)
Safe sleeping environments.
(D)
Adequate supervision.
(G)
Recognition of post-partum depression, substance abuse, domestic violence in a mother or her partner, and community violence.
(H)
Skills for management of infant crying.
(I)
Other positive parenting skills and practices.
(J)
The importance of participating in ongoing healthcare for an infant and in ongoing healthcare for post-partum depression.
(K)
Finding, qualifying for, and participating in available community resources with respect to infant care, childcare, and parenting support.
(L)
Planning for parenting, co-parenting, or guardianship of children during deployment.
(M)
Such other matters as the Secretary considers appropriate.
(2)
Services and resources on offer or as otherwise available as described in subsection (g).
(3)
An electronic integrated data system as described in subsection (h) relating to—
(A)
availability and use of services and resources under the pilot program;
(B)
tracking of interactions between teams described in paragraph (1) and eligible beneficiaries and their families under the pilot program; and
(C)
evaluation of the effectiveness of the pilot program.
(d)
Medical staff— The Secretary shall ensure that the pilot program is carried out by licensed medical staff of the Department, such as obstetrics or pediatric nursing staff, and not family advocacy staff.
(e)
Mandatory participation—
(1)
In general— Except as provided in paragraph (2), the Secretary shall require all eligible covered beneficiaries at military installations at which the pilot program is carried out to be contacted as described in subsection (c)(1).
(2)
Exception— The Secretary shall encourage participation by both parents of a child in the pilot program, but participation by one parent shall be sufficient to meet the requirement under paragraph (1).
(f)
Home visits—
(1)
In general— The home visits described in subsection (c)(1) shall include the following:
(A)
An initial contact made prenatally (except when not possible, in which case the contact shall occur in the hospital or birthing location as soon after birth as possible) by a team described in subsection (c)(1), which shall include screening for the matters specified in that subsection.
(B)
If a parent is deployed at the time of birth—
(i)
the first home visit pursuant to subparagraph (A) shall, to the extent practicable, incorporate both parents, in person with the local parent and by electronic means (such as Skype or FaceTime) with the deployed parent; and
(ii)
another such home visit shall be conducted at a reasonable time after the return of the parent from deployment (in order to allow for reintegration), and shall include both parents.
(C)
Home visits by a nurse trained in the practices covered by the pilot program at the birth of a child, which visits shall follow a research-based structured clinical protocol.
(2)
Timing of visits— The home first visit under paragraph (1) shall occur between two and five weeks after discharge from hospital or birthing plan, with appropriate follow-up generally accomplished within 2 home visits.
(3)
Duration of visits— Visits under this subsection shall have a duration between 90 minutes and 2 hours.
(4)
Final visit— Not later than 45 days after the last visit conducted by a nurse under paragraph (1) with respect to an eligible covered beneficiary, appropriate staff shall follow-up with the beneficiary and the beneficiary's family to assess if they are using the services available as described in subsection (g).
(g)
Services and resources—
(1)
In general— In carrying out the pilot program under this section, the Secretary shall—
(A)
offer applicable available services and resources of the Department to eligible covered beneficiaries participating in the pilot program and their families based on the particular needs of the beneficiaries and their families; and
(B)
inform beneficiaries and their families of applicable services and resources that are otherwise available in the community concerned in connection with the pilot program.
(2)
Voluntary participation— Participation by an eligible covered beneficiary and family in any service or resource offered or available under paragraph (1) shall be at the election of the beneficiary.
(3)
Needs assessments of eligible covered beneficiaries—
(A)
In general— In offering services and resources under paragraph (1)(A), the Secretary shall conduct, or attempt to conduct, an assessment of every eligible covered beneficiary and beneficiary family participating in the pilot program, regardless of risk factors, to determine which services and resources to offer such beneficiary and family under that paragraph.
(B)
Particular needs— In conducting an assessment of an eligible covered beneficiary and family under subparagraph (A), the Secretary shall assess their needs and eligibility for particular services and resources and connect the beneficiary and family to services and resources for which they have a need and are eligible, either within the Department of Defense or elsewhere.
(h)
Electronic integrated data system— Before commencing the pilot program, the entity with which the Secretary contracts under subsection (a)(3) shall develop and deploy an electronic integrated data system, tailorable to each military installation at which the pilot program is carried out and created in consultation with experts in community resources available in the vicinity of such installation, for purposes of as follows:
(1)
To list all services and resources to be offered under subsection (g)(1)(A) to eligible covered beneficiaries and their families.
(2)
To inform beneficiaries and their families pursuant to subsection (g)(1)(B) of services and resources that are otherwise available in the community concerned in connection with the pilot program.
(3)
To track interactions between teams described in subsection (c)(1) and beneficiaries and their families under the pilot program.
(4)
To track the services and resources used by beneficiaries and their families under the pilot program in order to evaluate the implementation and impact of the program.
(5)
To otherwise track and assess the effectiveness of the pilot program.
(i)
Two-Year assessment— Two years after the commencement of the pilot program, the Secretary conduct an assessment of the effectiveness of the pilot program.
(j)
Reports—
(1)
Initial report— Not later than 180 days after the date of the enactment of this Act, the Secretary shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the pilot program required by this section. The report shall include a comprehensive description of the pilot program, including the following:
(A)
The installations at which the pilot program is being carried out.
(B)
The strategy and metrics for evaluating the effectiveness of the pilot program for purposes of the report under paragraph (2).
(2)
Final report— Not later than 180 days after the completion of the pilot program, the Secretary shall submit to the committees specified in paragraph (1) a report on the pilot programs. The report shall include the following:
(A)
A comprehensive description and assessment of the pilot program, including an assessment of each of the following:
(i)
The electronic integrated data system required by subsection (h).
(ii)
The ability of nurses to contact eligible covered beneficiaries and families eligible for participation in the pilot program.
(iii)
The extent to which families eligible for participation in the pilot program actually participate in the pilot program.
(iv)
The characteristics of families eligible for participation in the pilot program that do not participate in the pilot program, and summaries of the reasons for lack of participation.
(v)
The ability of nurses to adhere to the clinical protocols of the pilot program.
(vi)
The extent to which families participating in the program are being connected to services and resources under the pilot program.
(vii)
The extent to which families participating in the pilot program are using services and resources under the pilot program.
(B)
Such recommendations for legislative or administrative action as the Secretary considers appropriate in light of the pilot program, including expansion or extension of the pilot program.
(k)
Ongoing evaluation—
(1)
In general— Not later than three years after the date of the report required by subsection (j)(2), and every five years thereafter, the Secretary shall conduct a scientifically rigorous evaluation of universal nurse home visits provided in accordance with this section, using administrative records, in order to assess the effectiveness of such visits in—
(A)
reducing incidence of child abuse and neglect and fatalities due to abuse and neglect; and
(B)
reducing emergency health care utilization for child injuries.
(2)
Scope of evaluation— Each evaluation shall include a review of available referrals to the Family Advocacy Program, child hospital administration records, community-wide child protective service investigations, and such other indicators and sources of information as the Secretary considers appropriate.
(l)
Implementation defense-Wide— If the Secretary determines as a result of the pilot program that any element of the pilot program is effective, the Secretary shall take appropriate actions to implement the pilot program as a program throughout and across the military installations of the Department.
(m)
Definitions— In this section:
(1)
The term community, with respect to a military installation, means the catchment area for community services of the installation, including services provided on the installation and services provided by State, county, and local jurisdictions in which the installation is located or in the vicinity of the installation.
(2)
The term eligible covered beneficiary means a covered beneficiary (as that term is defined in
section 1072 of title 10, United States Code) who has a child under the age of five years or is expecting a child.
(n)
Funding—
(1)
Authorization of appropriations— There is hereby authorized to be appropriated for fiscal year 2019 for the Department of Defense $5,000,000 to carry out the pilot program.
(2)
Availability— The amount authorized to be appropriated by paragraph (1) shall remain available until expended.