Testimony of Dr. Melissa Delia, Pediatric Resident/Intern before the Committee on Health

March 24, 2022
Person Testifying: Dr. Melissa Delia
Title: Pediatric Resident/Intern,
Testimony Heard By: Committee on Human Services

Thank you, Councilmember Nadeau and the members of the Committee on Human Services, for the opportunity to speak today. My name is Dr. Melissa Delia, and I am a pediatric resident in DC. Throughout my training, I have worked in a variety of settings, including newborn care, inpatient medicine and critical care, and general outpatient clinics.  In these settings, I care for children and young adults either hospitalized or seeking medical care. Today, I am testifying in support of CFSA’s home visiting programs to provide much needed support to our most vulnerable families.

Recently, I had a patient that was admitted to the general medical floor for an asthma exacerbation. He was a cute and playful 2.5-year-old boy who needed continuous albuterol and steroids, and improved as expected with treatment. However, when looking through his chart, we found that this was his 7th admission to our hospital (including 2 ICU stays) in his short life – all for asthma or related respiratory illnesses. We saw that he had been prescribed daily medications during his last few admissions, but the frequency of his admissions led us to believe that they were not being given appropriately, or at all. Given that this patient has a well-known illness and straightforward treatment plan that was not being followed, we were concerned that something abnormal was happening in the home.

After discussions with his aunt who brought him in, I learned that his mother has been suffering with mental health illnesses and has been in and out of his life over the last 2 years. His father has multiple medical conditions himself and was admitted to another adult hospital while our patient was here. Ultimately, the decision was made to file a CPS report; not because of purposeful neglect, but we could see that this family has multiple misfortunes that are preventing them from caring for the child as needed.

Unfortunately, the story isn’t uncommon for us in pediatrics. Over the last two years, we have seen increasing amounts of physical abuse, sexual abuse, and neglect cases that have gone unnoticed, and some have had fatal consequences. Routine home visits with this family could have picked up these changes in the family structure, added stressors, asthma triggers in the home (such as smoke or mold), or family’s difficulty with administering medications, which may have prevented many of his hospitalizations.

In healthcare, we have a very limited period with our patients. In a short clinic visit, we must discuss their medical concerns, nutrition, behavior and developmental staging, and many other topics, in addition to performing a physical exam, completing health forms, sending referrals, and refilling/starting medications. It’s hard to hit everything with such limited time. Even if we had an hour to see each patient, we can’t see where the child and family lives, sleeps, and eats. Home visiting is a support tool that we use to ensure that our families and patients are safe and well-cared for. Home visiting staff are trained to provide culturally competent and friendly support to our families, thereby reducing language and cultural barriers. They are equipped to be fully in tune to what the family wants and needs, whether it be diaper supplies or food distribution. They can connect families with head start, early intervention, additional healthcare or mental health services to address the social inequities we see every day. For these reasons and many others, I am in support of a 15% increase to CFSA’s home visiting budget to adequately support these essential staff members and provide programs with additional resources they may need. Thank you for your time, and I welcome any questions you may have.