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

April 10, 2024
Person Testifying: Mary Katherine West
Title: Home Visiting Program Manager, DC Action
Testimony Heard By: Committee on Health
Type of Hearing: Budget Hearing

Good afternoon Chairperson Henderson and members of the Committee on Health. Thank you for the opportunity to address the Committee as it conducts this budget oversight hearing for DC Health. Thank you Chairperson Henderson for your ongoing support for families in the District. My name is Mary Katherine West, and I am the Chair of the DC Home Visiting Council and a Program Manager for Early Childhood 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. 

In this tight FY25 budget year, we are thankful that the mayor has not cut funding for the DC Health home visiting program. We ask the council to maintain this funding at its $1.5 million budget allocation. 

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. 

I look forward to testifying in more depth about the impacts of the Home Visiting Services Reimbursement Act at the Department of Health Care Finance Hearing. 

Home visiting is a prevention and early intervention service that is free and voluntary for families, and primarily serves low-income Black and brown families living in Wards 4, 5, 7 and 8. Home visiting works to support families in a whole-person, whole-family approach, which results in improved maternal and infant health. In fact, DC Health cited home visiting as an essential component in its strategy to improve maternal and child health in the District. 

DC is facing a maternal health crisis, which disproportionately impacts Black and brown mothers and pregnant people. 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. 

Inadequate access to health care for Black families and racism in health care drive these disparities. For example, in 2022 just over half of District births to Black and Latinx parents involved prenatal care in the first trimester, compared to 81% of births to white parents. Home visitors can help parents initiate prenatal care and support them in getting to all of their appointments.

However, despite committing to supporting and improving the sector and its workers, investment from the District in DC Health’s home visiting program grants has consistently declined over the last several years, diminishing programs already limited spending power. Insufficient and unreliable budgets create a stressful work environment for home visitors through inadequate pay, high administrative burden, high stress, and job instability.

Home visitors in the District are highly skilled, educated, and care deeply about the people they work with and the services they provide. They deserve support and stability from their workplace. Through their work they serve as a reliable and personal resource for a family from pregnancy through their child’s first years of life. Although all families can use additional support, home visiting in DC serves families that face barriers to resources and opportunities because of factors such as economic discrimination, racism, and immigration and disability status. With home visiting support, families are able to access resources and learn to advocate for themselves and their children and create a strong foundation for their families.

Budget cuts and lack of support for home visitors will likely cause more home visitors to leave the field, resulting in the breaking of promises and severing of relationships that families can depend on to help them meet their goals. Many parents and families view their home visitor as a central person in their support network. When parents have questions about pregnancy or postpartum experiences, they call their home visitor. When parents complete an educational milestone, land a new job, or get a promotion, they call their home visitor. When parents need to renew their child’s insurance, enroll in the child care subsidy program, or apply for rental assistance, they call their home visitor. When a child is sick or takes their first steps, parents call their home visitor. Home visitors are there for families through the most stressful and overwhelming moments of parenthood to offer guidance and support and are there to celebrate the successes and joys raising a child and learning to be the best parent they can. 

However, inadequate compensation, high stress, and administrative burden have led to high turnover in the sector for years. Additional cuts will only exacerbate these issues, and families that rely on home visitors as a central part of their support system will be cut off from a critical resource. These families cannot afford to lose this resource and have the promise of this support broken. 

We are hopeful that if funded and implemented, the Home Visiting Services Reimbursement Act will be a path for increased and sustained investments for home visiting programs, including several under DC Health’s administration. 

Home visiting is a proven strategy to improve short and long term outcomes in health, education, and economic self-sufficiency, for both parents and children. As a two-generation solution, home visiting is an investment in the safety and prosperity of DC’s residents who are the most vulnerable to the impacts of racism, economic instability, and crime in the District. 

Thank you for the opportunity to testify today and I am open to any questions.