Testimony of Nisa Hussain, Program Manager, Early Childhood at Performance Oversight Hearing before the Committee on Health

March 11, 2021
Person Testifying: Nisa Hussain
Title: Program Manager of Early Childhood, DC Action
Testimony Heard By: Before the Committee on Health
Type of Hearing: Agency Performance Oversight Hearing - Fiscal Year 2021

Good morning, Councilmember Gray and members of the Committee on Health. Thank you for the opportunity to address the Council as it reviews DC Health’s performance. I am Nisa Hussain, Early Childhood Program Manager for DC Action, coordinator of the DC Home Visiting Council, and member of the Under 3 DC Coalition.

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. Through our signature coalitions, Under 3 DC and the DC Home Visiting Council, we organize families , educators, and communities. We are also the home of DC KIDS COUNT, an online resource that tracks key indicators of child and youth well-being.

Chairperson Gray and Councilmember Nadeau, thank you for championing home visiting programs and early childhood efforts over the years. We are also grateful for the DC Council’s ongoing support of the early childhood space as well as DC Health’s active leadership and partnership on the Home Visiting Council. We appreciate the Council’s ongoing support for DC Health to administer these important home visiting models.

My testimony today will focus primarily on DC Health-funded home visiting programs and the agency’s work to support and strengthen families through the strategy of home visiting. DC Health funds Georgetown University’s Parenting Support Program, Community of Hope’s Parents as Teachers program,  Mary’s Center’s Healthy Families America, and Parents as Teachers programs, and Mamatoto Village’s Mothers Rising program. Each of these programs serves a unique and specific population of families using the program model that is most appropriate for those families.

DC is home to 45,040 children under age 5, of whom 27,196 are under age 3. Nearly half of the District’s under 5 population is Black, 17% are Latinx, and 27% are white. Unfortunately, about 1 in 5 DC children under age 6 is in a family that lives below the federal poverty line.

Families in the District are navigating an incredibly difficult time during this public health emergency. Home visiting is a powerful strategy for supporting them now and beyond the pandemic as families face other barriers in the earliest years of their child’s life. The District’s home visiting programs require continued investment to carry out this crucial work for the children and families who need this support in the District the most.

Earlier this year, the Home Visiting Council released a new report, Voices from the Field: Experiences of the District’s Home Visitors. The Home Visiting Council intended to capture the full experience of the important yet undervalued home visiting workforce in the District. To better understand the strengths, challenges, and needs of home visitors, the Home Visiting Council administered a survey to 13 home visiting programs and conducted several focus groups. The report found that home visitors found deep satisfaction from their work and with the trusted relationships they form with families. However, home visitors desired support around the difficult work-life balance, heavy administrative demands, misconceptions of their role, and safety concerns. Low pay and a lack of professional growth are also major factors in low retention rates.

Over the past few years, DC Health has led the Home Visiting Council’s work to develop a coordinated, centralized intake system for home visiting through Help Me Grow. This has been a truly collaborative process that has engaged providers, managed care organizations, and local agencies. We look forward to continuing this active partnership.

Home visiting is an effective support for DC families to prosper 

Home visiting is a valuable, evidence-based strategy that provides individualized support to expectant families and families with young children. Depending on the model, home visiting programs guide expectant parents through prenatal care, support parents in the postpartum period, identify developmental delays in young children, promote child development screenings, teach positive parenting practices, and more. Studies have shown home visiting can lead to improvements in school readiness, healthy birth outcomes, reductions in child maltreatment, and family economic security.

Expectant parents and families have the desire, motivation, and ability to aid their child’s development and do well by their children. However, the period of time during expectancy and the early years of a child’s life are not only critical for a child’s cognitive, emotional, and social development, but can also be overwhelming for parents. All families need extra support during this time, even more so during a global pandemic. Home visiting offers that support and enables families to work toward self-sufficiency.

DC Health-funded programs are built to support a wide range of family needs and types, including populations with specific needs, who may need this extra support the most. Community of Hope’s home visiting program reaches families experiencing high-risk pregnancies, primarily in Wards 5, 7, and 8. Georgetown University’s Parenting Support Program is the primary home visiting program that supports caretakers with intellectual or associated disabilities. The programs administered by Mamatoto Village and Mary’s Center also tailor their services to support families experiencing a range of challenges and barriers. Broadly, home visiting programs in the District primarily serve Black and brown families, reaching households that are dealing with unjust and systemic barriers like the racial wealth gap and health inequities. A unique value of home visiting comes from its ability to support families facing these inequities, which are amplified by the effects of the COVID-19 crisis.

Home visiting programs continue to show up for families during COVID-19

The COVID-19 pandemic uprooted everyone’s lives. Families of young children, in particular, have experienced significant hardship this past year. Not only are families dealing with job losses, financial insecurity, and tragedies, families are also navigating the combined stressors of virtual learning, child care arrangements, and the anxiety of social isolation’s impacts on children’s development and parents’ well-being. Moreover, Black and brown households have been disproportionately overburdened by the impacts of COVID-19.

Home visiting has been a lifeline for families dealing with the stressors of the public health emergency. Home visitors are trained for managing crisis and are uniquely well-positioned to help families continue through the emotional, physical, and financial impacts of this pandemic and beyond. DC home visiting programs began serving families through virtual visits. This ensured a seamless continuity of care for families. Home visitors safely delivered basic supplies like food, household items, and diapers; walked families through the District’s relief services; and connected families to mental health services. Programs tailored their services to meet a new set of needs created by COVID-19. Since clinical care was significantly impacted by COVID-19 restrictions, Mamatoto Village found themselves filling the gaps in care for families. Georgetown University’s program began customizing support for pregnant participants preparing for their births with the new hospital restrictions on family member presence. This type of flexibility is one of home visiting’s unique abilities to center a family’s current and evolving needs.

Home visiting programs are a critical component of DC’s family support infrastructure that will ensure families living in our most vulnerable communities are able to survive the current crisis.

Even if and when the pandemic subsides, the effects of COVID-19 on families will continue and we cannot let DC families down by interrupting services whenever that recovery begins.

More home visiting services and some systems improvements are necessary to meet families’ needs in the District 

Georgetown University Center for Child and Human Development’s (GUCCHD) 2020 needs assessment for the District, commissioned by DC Health in compliance with federal Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) requirements, provided us a deeper understanding of the gaps, strengths, and needs of the home visiting landscape in DC. We appreciate the work required to release this report. GUCCHD’s data reveals that there is a gap of 811 between the number of home visiting slots in the District (1,347) and the number of families eligible for services based on federal criteria (2,592). Given that federal eligibility guidelines are more restrictive than that of most program models, this gap between program availability and potential demand is likely higher.

We echo many of GUCCHD’s recommendations for improving the infrastructure supporting home visiting programs that support families. In particular:

  • Given the diversity of models and programs, a more systematic way to match families’ needs and priorities to specific programs is needed. Building on work currently underway at the Home Visiting Council, the Help Me Grow program could serve as a centralized intake point for families seeking home visiting services.
  • There is also a need for increased guidance, technical assistance, and support for programs seeking to scale up evidence-based models as well as build the evidence base for home grown initiatives. This could be an area where the strong partnership with philanthropy is expanded.
  • DC MIECHV programs are reaching the intended populations of families with high needs, but home visiting services cannot address all of their issues. At the state agency and local program levels, there is a need for more intentional coordination between early education, child welfare, behavioral health, and primary care systems. Managed care organizations could provide or pay for wraparound case management services to supplement what home visiting programs can offer. More coordination and direct referrals are needed from the perinatal care providers and managed care organizations to ensure that women are connected with home visiting services as early as possible.
  • Substance abuse and mental health treatment services as well as domestic violence services are often needed by families receiving home visiting services. Formal mechanisms to make referrals and get feedback on participants’ connection to those services are needed. Home visiting programs are in a unique position to help support clients with substance use disorders to get connected with treatment services. Unfortunately, formal screening for current use of legal and illicit substances is not being done, due to current laws in DC about penalties for using substances prenatally as well as stigma and fear of CFSA involvement.  There is a need to assess the current statutes and regulations to determine how best to support women who may seek SUD treatment while pregnant. If possible, home visiting programs should add a valid SUD screen to their protocols and build partnerships with CSAs who serve perinatal populations. DC MIECHV, as well as other home visiting programs in DC, continues to see staff turnover and families withdrawing before the programs’ end.
  • A centralized place for professional development and training for home visitors should be organized. With additional funding and support, the DC Home Visiting Council is well positioned to take on this role.
  • DC Health should consider the addition of shorter-term home visiting models to the array of MIECHV-funded programs to increase likelihood of program completion. Given turnover, any new models should allow for local capacity-building for training of trainers.
  • Each home visiting program is reporting data in inconsistent ways, making aggregation difficult. There is no consensus on how to assess quality nor how to measure outcomes. The data subcommittee of the Home Visiting Council should help programs develop systems to report the total number of children and families served (point in time and annually) as well as common metrics for quality and outcomes.
  • More exploration is needed to communicate with eligible families not currently enrolled in home visiting about the match between their needs and what evidence-based models can offer.
  • After COVID-19, there is a need to consider the reach and impact of virtual visits through evidence-based and home grown programs.

Streamlined data and reporting requirements are needed to support high quality home visiting services

An opportunity exists to improve program quality and staff retention by reevaluating the data system and reporting requirements for home visiting programs by DC Health and other public and private funders of home visiting. Based on the Home Visiting Council’s Voices from the Field report and the analysis from the recent MIECHV needs assessment report, the administrative work around collecting and inputting data into several, often duplicative, systems burdens home visitors. This time spent on paperwork takes away from a home visitor’s focus on relationship building and supporting families through their everyday challenges, which is the foundation for effective implementation of these services. Requirements vary across programs, but those of local and federal public funding agencies are often layered over, rather than streamlined with  program model requirements. Data collection is important, so we recommend working with funded programs to explore whether a simpler, more efficient and user-friendly data system to meet these requirements is possible.

Home visiting programs, Help Me Grow, and Healthy Steps are integral components of the broader early childhood system 

Home visiting is one of several approaches to supporting families in the early childhood system. As a voluntary service, families have the choice to join and it may not be the perfect fit for every family. But it is important for the District to continue offering this service as an option, as well as a variety of models that meet a diverse number of needs and populations.

Help Me Grow connects expecting parents and families to health resources for children and pregnant people. The program helps families locate services such as prenatal and child developmental screenings and links families to community-based support services. The parental support services provided by Help Me Grow’s phone line are COVID-safe ways to promote healthy child development, making Help Me Grow an especially valuable tool for supporting DC families as they navigate the anxieties caused by the pandemic. However, as the Help Me Grow line seeks to reach more families in need of support, an additional bilingual care coordinator is needed to support families for whom English is not a second language. We are asking to protect and expand this program for an additional $90,000 to add a bilingual care coordinator for Help Me Grow.

Healthy Steps is another key component of the early childhood system that exists alongside home visiting programs and Help Me Grow to support families with young children. As an infant-toddler developmental health program providing services to families during and between pediatric primary care visits, this program benefits the parent, child, and the District’s overall efforts. Families participating in Healthy Steps are more likely to develop positive relationships with their pediatrician, remain engaged in the primary care relationship, and report satisfaction with the services provided.

Moving Forward

It is imperative, now more than ever, that home visiting programs continue to receive the funding and partnership they need to meet families’ needs.

We appreciate the current work of DC Health and its implementation of existing home visiting programs. Moving forward, we hope the agency will consider these recommendations as it assesses its plans for the coming year. Overall, we share the priority to ensure consistent, uninterrupted service delivery of home visiting to families across the District who most need it.

We cannot let our families down by cutting resources from our successful, existing home visiting programs, especially during times of crisis. We urge the Council and DC Health to maintain funding for these home visiting programs, Healthy Steps, and enhance Help Me Grow by $90,000 to ensure these crucial family support services can reliably and effectively continue to serve families.