Testimony of Mary Katherine West, Home Visiting Program Manager, before the Committee of the Whole

May 3, 2024
Testimony
Person Testifying: Mary Katherine West
Title: Home Visiting Program Manager, DC Action
Testimony Heard By: Committee of the Whole
Type of Hearing: Budget Hearing

Good morning Chairman Mendelson, Council, and Council staff. Thank you for the opportunity to address the Committee as it conducts this budget hearing. My name is Mary Katherine West, and I am the Chair of the DC Home Visiting Council and Program Manager for Early Childhood at DC Action. I am a member of the Under 3 DC Coalition and a Ward 1 resident.

​The DC Home Visiting Council is a body of home visiting providers, local government agency representatives, early childhood advocates, managed care organizations, and other partners that works to strengthen the understanding, implementation, and sustainability of home visiting as a strategy to support positive child and family outcomes in the District of Columbia.

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. 

Today my testimony will focus on home visiting as a critical service to support DC families and the District’s role to invest and sustain in the sector in the FY25 Budget. 

Home visiting is an individualized service that connects expectant families and families with children five and under with a trained professional to create a safe and stable environment for child development and for parents to reach their parenting goals.

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.

Home visiting has the potential to support families to improve priority outcomes for many of the District’s agencies that serve children, including DC Health, the Child and Family Services Agency, and DC’s education agencies. 

  • Health: At the Committee on Health’s December 2023 Maternal Health Roundtable, DC Health representatives cited home visiting services as a key facet 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. 
  • Child welfare: CFSA sees home visiting as an important strategy in advancing their prevention strategy of keeping families together, improving parent-child relationships, and reducing harm to children.
  • Education: Several of the District’s home visiting programs help families to prepare their children for school, including Early Head Start, Parents as Teachers, and HIPPY programs.

Supporting positive health outcomes is vital as the District works to combat maternal and infant health disparities, especially in the context of high adverse birth outcomes for Black women and their babies, as compared to other demographics. DC Health data show that over the past six years, severe maternal morbidity, defined as the “outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health,” has increased across all demographics. Black women in DC continue to experience severe maternal morbidity at almost double the rate of all other races. A failure of our health systems, inadequate access to health care for Black families, and racism in health care drive these disparities. 

To best illustrate the impact of home visiting, I will share the words of Ms. Jocelyn, a home visiting program participant. She shared, “My experience with home visiting has been better than any other program I have been in when it comes to casework and working with me and my baby.

My favorite part has been truly being heard by my home visitor and having a person to have a conversation with over my concerns about my health. I feel as though it has been a lot easier to have home visits than having to go to an office for things I need help with- as far as resources and supplies, they’re coming to my doorstep instead of me having to figure it out alone. I have seen changes in myself because I am able to talk about certain things and I have somebody to talk with about topics like breastfeeding, how to put up the bassinet, and resources about my birth certificate and my ID. 

I do not understand why the District would not protect funding for home visiting. There are a lot of moms and parents in general, especially low income parents, who need programs like this to help them get resources because not everyone has the direction for help.”

Eight of the 17 home visiting programs that serve DC residents receive funding or administration from the District. Funding and administration for home visiting programs spans across two committees: the Facilities and Family Services committee and the Committee on Health, and reside within three agencies: the Child and Family Services Agency, DC Health, and the Department of Health Care Finance. 

In FY25, we asked the Council to preserve home visiting funding in DC Health, to restore the $300K FY24 recurring grant that was not included in the CFSA home visiting Budget, and to include one-time funding in DHCF for the NFP program and to fund an updated FIS for and implement the Medicaid Reimbursement Act.

CFSA Home Visiting

CFSA directly funds three home visiting programs: the Parent Support and Home Visitation program at Community Family Life Services (CFLS), Mary’s Center’s Father-Child Attachment Program, and the Family Place’s HIPPY Home Visiting Program, which served a combined total of 209 families in FY23. In addition, CFSA provides funding to DC Health to support evidence-based home visiting services to 192 caregivers and 241 children through Healthy Families America and Parents as Teachers, and administers the federal Community Based Child Abuse and Prevention Grant to the HIPPY Home Visiting Program through Creative Soultions for Communities.

In FY25, we ask the Council restore home visiting funding to FY24 levels at $770,471. In FY24, Councilmember Lewis George increased CFSA home visiting grants by $300K in home visiting. This investment followed a one-time increase to CFSA home visiting in FY23 of $70,500. 

Councilmember Lewis George intended the FY24 dollars to be a recurring, long-term investment to support home visiting programs and their workers and the families they serve. However, at the CFSA Budget Engagement Forum, CFSA shared that the $300K recurring increase was not in the FY25 budget. This reduction, along with a loss of $70K, would set home visiting programs back to FY22 funding levels. If set back to FY22 funding levels, CFLS and the Father Child Attachment program both would face budget reductions of approximately 40%.

The home visiting programs under CFSA predominantly rely on local funding and some federal funding, and these changes have the potential to result in staff cuts and reductions in services for families. 

DC Health Home Visiting 

DC Health supports four home visiting programs and two home visiting program evaluations. In FY23, DC Health performance oversight responses report these programs served 885 caregivers and 381 children in the District. To learn more about DC Health home visiting programs, please refer to my performance oversight testimony. 

Home visiting is a critical component of DC’s early childhood strategy. Home visitors, participants, and advocates have shared for years that the four DC Health home visiting programs have endured stagnant or diminishing grant funding. Failure to align funding levels over the past several years with the cost of the program has caused programs to struggle to support their staff and maintain consistent service delivery for families. 

While home visiting programs would benefit from increased investment to support these aims, we ask that minimally the Council maintain the current level of investment this year. Home visitors and participants in these programs cannot afford cuts

We are hopeful that if funded and implemented, the Home Visiting Services Reimbursement Act will be a sustainable funding source that increases investments through the federal match for home visiting programs in the future. 

Department of Health Care Finance 

The Nurse-Family Partnership Fills Critical Gaps

The Nurse Family Partnership is the only home visiting program administered through the Department of Healthcare Finance. NFP program is an evidence-based home visiting model that is over 50 years old. NFP programs create an alternative pathway for families to access quality health care by matching expecting parents with registered nurses. Families enroll in the program prenatally and their nurse delivers high-quality visits and interactions through the child’s second birthday. To learn more about NFP’s evidence base, refer to my performance oversight testimony.

With support from the District, the Nurse Family Partnership began in the District in 2021 and has been operating successfully as a pilot program over the last three years. In this time, the program worked with 146 families, including 105 children. As we approach the end of the pilot, funding for NFP is expected to lapse. While we are thankful for the Council’s allocation of a $225,000 grant to support home visiting in DHCF, this is not sufficient to support the program for an entire year. We ask the Council to invest one-time funding of $475,000 to sustain the program for FY25.

For the $475,000 investment to be a one-time investment in the program, the Council must begin the implementation of the Medicaid Reimbursement Bill to provide a pathway for sustainable funding for NFP and other home visiting programs. 

Without additional funding, the District is at risk of losing the program entirely, or the majority of the nurses in the program. The District is currently experiencing a nurse shortage, and without guaranteed funding, nurse home visitors may worry about supporting their own families, and can easily find work elsewhere. 

Losing nurse home visitors will be detrimental to families in the program and costly for the program to replace and rebuild the program in the out-years. As Black women and children continue to be disproportionately harmed by our health system’s failures and racism, we cannot afford to lose one of the few services meant to ensure that they are safe, healthy, and supported.

Medicaid Reimbursement for Home Visiting is an Opportunity

The Home Visiting Services Reimbursement Act represents an exciting opportunity for the District to stretch the impact of its investment of local funds in home visiting and gain additional federal support. 

With consistent, long-term investments, the District can maximize impacts for families and create a path to achieving long-term stability for home visiting program budgets so that they can best serve families. We believe that the Office of the Chief Financial Officer has overestimated the cost of this program. 

We believe the current fiscal impact statement fails to account for other federal program dollars that support home visiting, overestimates the cost of covering Alliance beneficiaries, expects significantly higher growth rate of programs than historical growth patterns support, and includes an incorrect number of eligible programs. In addition, the Council could delay the implementation of the State Plan to Q4 of FY25 to provide time to establish reimbursement and support program take-up, which would reduce the number of quarters the funding would need to cover in FY25. 

To support the critical services that home visiting programs provide to District families, we ask the Council to fund the Nurse Family Partnership’s $475K funding gap in the FY25 budget, and to update the program’s FIS, and fund the Home Visiting Services Reimbursement Act of 2023 Medicaid Reimbursement for home visiting based on corrected cost estimates. 

Conclusion

We urge you to make the needed investments in home visiting programs for FY25 so they can continue to provide high quality services to current participants, and so future generations of District families can access this critical resource. 

Cutting budgets for early childhood and family health supports including home visiting will disproportionately harm Black and brown residents – and there is an alternative. Raising revenue by taxing wealth would afford DC additional resources to invest in our communities while also helping to correct the racist harm in the tax system. 

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