Identifying at-risk communities: Alabama's methods and findings from the maternal, infant and early childhood home visiting program needs assessment

As part of the Affordable Care Act, states were required to conduct a home visitation needs assessment to identify at-risk communities. The Alabama (AL) Departments of Children's Affairs and Public Health, and the University of AL at Birmingham partnered to conduct AL's needs assessment to determine availability of home visitation and other resources within communities, defined as counties. Six criteria were used to assess AL's 67 counties: family and social environment, economic circumstances, physical environment and safety, health behavior, education, and health and health care. “At-risk” was measured using a series of indicators, including population characteristics; health outcomes; health factors, such as health care utilization; health behaviors; socioeconomic factors; and educational factors. Identification of “communities” with at-risk profiles utilized secondary data from the AL Center for Vital Statistics, U.S. Census Bureau, Centers for Disease Control and Prevention, and other sources. Weighted scores for each indicator were calculated and each county's at-risk status was ranked based on its composite risk score. Mapping with ArcGIS showed the distribution of home visitation resources throughout Alabama and where gaps in resources exist. We identified 13 AL counties as being most “at-risk”. Four nationally recognized Home visitation models operate within Alabama. However, mapping revealed that five of the thirteen at-risk communities have no home visitation services, and the others only have one program that serves small proportions of the populations in need. The communities that are in the “gap areas” are those that the State will focus on for development of future home visiting programs.