Testimony of Mary Katherine West, Home Visiting Program Coordinator, before the Committee on Health

January 18, 2024
Testimony
Person Testifying: Mary Katherine West
Title: Home Visiting Program Coordinator, DC Action
Testimony Heard By: Committee on Health
Type of Hearing: Oversight Hearing

Good morning Chairperson Henderson and members of the Committee on Health. Thank you for the opportunity to address the Committee as it reviews DC Health’s performance.  Thank you Chairperson Henderson for your ongoing support for families in the District. My name is Mary Katherine West, and I am the Program Coordinator for the DC Home Visiting Council at DC Action. I am a member of the Under 3 DC Coalition, and a Ward 1 resident.

DC Action uses research, data, and a racial equity lens to break down barriers that stand in the way of all kids reaching their full potential. Our collaborative advocacy initiatives bring the power of young people and all residents to raise their voices to create change. We are also the home of DC KIDS COUNT, an online resource that tracks key indicators of child and youth well-being. 

DC Action and the Home Visiting Council appreciate the DC Council’s past support for home visiting programs, including the recent passage of the Home Visiting Services Reimbursement Act. We are also grateful for DC Health’s partnership in the Home Visiting Council this past year. DC Health has led the Home Visiting Council’s work to develop a coordinated, centralized intake system for home visiting through Help Me Grow. DC Health has also been a key contributor to our work to improve our data collection practices and processes. We look forward to continuing this collaboration. 

My testimony focuses on the critical role of the Department of Health’s early childhood home visiting programs, which the agency both funds directly and through MIECHV funding. For context, DC Health directly funds the following programs: 

  • Community of Hope’s Parents as Teachers Program
  • Georgetown University’s Parenting Support Program
  • Mary’s Center’s Healthy Families America Program
  • Mary’s Center’s Parents as Teachers Program

In FY23 DC Health funded the Mary’s Center Nurse Family Partnership home visiting program, but the administration of NFP will move under the Department of Health Care Finance in FY24. DC Health also directly funds the evaluation for Mamatoto’s Village home visiting program. Finally, DC Health receives funding transferred from CFSA to administer Mary’s Center’s Parents as Teachers program. 

Home Visiting is an effective intervention to support the District’s families. Home visiting is an individualized service that connects expectant families and families with children 5 and under with a trained professional to create a safe and stable environment for child development and for parents to reach their parenting goals. The DC Health home visiting programs all use evidence-based curricula that structure the educational content of the home visits over the course of the months to years a family is enrolled in the program. 

Rapid brain development occurs during the first five years of life and the positive or negative experiences in those years influence a child’s cognitive, emotional, and physical development as an adult. Home visiting supports the caregiver to provide their child with positive experiences (e.g., using positive parenting practices, nurturing the child’s access to books and play, and creating a safe environment) and minimize negative experiences (e.g., unstable housing, stressors that lead to child abuse and neglect, exposure to domestic violence). This approach prioritizes prevention and ensures DC’s youngest residents are set up to thrive.  

By assessing family needs, educating and supporting parents, and referring families to community resources, home visitors support the needs of both parents and childrenData and studies show that home visiting improves school readiness, healthy birth outcomes, and family economic security and reduces child abuse and neglect. 

The 17 locally, federally, and privately funded home visiting programs served 2,628 parents and children across the District, delivering 22,799 home visits in FY23. Home visitors most often helped families navigate income, employment, or financial stress; finding safe, stable or affordable housing; food insecurity; mental health; immigration; and domestic violence.

All parents need support during the parenting journey, but many DC families face additional barriers that make caregiving even more challenging. DC home visiting programs primarily serve primarily Black and brown families who must navigate the consequences of systemic racism and the barriers it creates around affordable housing, access to health care, and more. Data from DC Health confirm that low-income, Black women in DC continue to experience disproportionately high rates of adverse birth outcomes including high rates of maternal morbidity and mortality and infant mortality. By centering and supporting these families, home visiting works to reduce these disparities and prevent devastating outcomes. 

In the upcoming budget year, the District must protect investments in the District’s families. There have been rumblings of midyear budget constraints in the health and human services sector and I strongly caution against any cuts to home visiting programs, this year or next. By contrast, home visiting needs more public investment either from federal or local sources to maximize its full potential to reduce Black maternal health disparities, prevent adverse childhood experiences, and pursue meaningful improvements to administrative processes and staff retention goals. Budget cuts – and even threats of budget cuts – destabilize programs and disrupt family continuity in these vital programs.

Home visiting plays a critical role in the District’s early childhood strategy.  At the Committee on Health’s December 2023 Maternal Health Roundtable, DC Health representatives cited home visiting services as a prong in their strategy to improve maternal and child health in the District. Specifically, home visiting supports the goal of Early Entry into Quality Prenatal Care. In their testimony, DC Health testified that improvements to the home visiting system were necessary, and committed to improving programs, workforce recruitment and retention and reimbursement for services. 

However, this testimony does not align with DC Health’s investment in home visiting over the last several years. In the 2023 Home Visiting Annual Report, DC Health reported that there was a $343,746 cut across home visiting grants between FY22 and FY23. In FY24, DC reported an additional reduction of $35,456 in DC Health home visiting investments. This brings the reduction in home visiting funds to a total of $379,202 over the past two fiscal years. 

The District must follow through on the commitments to improvement for programs and in workforce recruitment and retention, because ultimately, families bear the consequences. Losing a home visitor creates instability in a family’s support system and a potential gap in access to critical resources.

Inadequate wages are a key component to  workforce challenges in the home visiting sector.  In 2023, the majority of programs reported continuing challenges retaining and hiring staff. Home visitors are highly trained, educated, and passionate about their work and role in their community. With data from the Home Visiting Annual Report survey, we calculated that the average salary for a home visitor in a DC Health funded program will be $48,125 in FY24. This is compared to the average salary for all home visitors in the District of $53,000. These salaries are not competitive to related fields of social work or early childhood education. This salary is also inadequate to support living in DC which faces high housing costs and other costs to live. The average rent price in DC is $2,202 which is over 50% of a DC Health home visitor’s salary, resulting in home visitors not being able to afford to live in the communities they work in.

Last year, the home visiting council released the Home Visitor Compensation and Workforce Brief, which detailed workforce trends and outlined recommendations from the Home Visiting Council. I look forward to bringing you a follow up resource that outlines updates to these data points and recommendations in further detail in the coming months. Funding programs to support workers and maintain a full staff will reduce turnover, reduce burden on understaffed programs, and prevent unnecessary service interruptions to families.

When home visitors leave, programs struggle to hire new staff at a rate equal to attrition. Some programs report reductions in their grants when positions that they are trying to fill remain vacant. Here, instead of fueling recruitment, programs face disinvestment from DC Health. DC Health should work to improve administration and communication with programs about the status of upcoming grants so that programs are able to plan for funding changes. 

Furthermore, DC Health should increase transparency and continue to leverage federal investments in home visiting.  In 2023, HRSA granted over 1.85 million dollars to the District of Columbia for the MIECHV programs. However, MIECHV home visiting programs themselves only received 1.1 million dollars. There is a lack of transparency about how the remainder of that funding is spent to support maternal and child outcomes through home visiting. 

In FY24, DC Health will have increased opportunity to leverage federal funding. In FY24, federal matching grants  for MIECHV are available subject to a rate of 75% federal funds and 25% non federal funds (i.e., $3 in federal funds for every $1 contributed in qualifying non federal funds, up to certain limits). So, there is opportunity for DC Health to draw down more MIECHV dollars to support home visiting programs in the District. 

Furthermore, with the Home Visiting Services Reimbursement Amendment Act recently passed by the DC Council, home visiting programs hope to soon have the opportunity to receive reimbursement through Medicaid. We are excited about these opportunities for further federal investment, these opportunities must be braided along with local funds to meaningfully support home visiting programs.

As these new funding streams are integrated into program budgets, DC Health must continue to support programs through this process of introducing new funding streams and braiding funding to ensure stability and continuity of services. 

Family supports, including home visiting, HealthySteps and Healthy Futures, are available at little to no cost for families and help them navigate critical transitions so that parents, children, and their communities thrive. We implore the DC Council and DC Health to act on their recognition of home visiting as a critical and effective investment for the health and wellbeing of parents and young children in the District. 

Thank you for the opportunity to testify and I welcome any questions.