Testimony of Nisa Hussain, Program Manager of Early Childhood before the Committee on Health

April 4, 2022
Person Testifying: Nisa Hussain
Title: Program Manager of Early Childhood, DC Action
Testimony Heard By: Committee on Health
Type of Hearing: Budget Oversight Hearing

Good morning Councilmember Gray and members of the Committee on Health. Thank you for the opportunity to address the Council as it conducts this budget oversight hearing for the Department of Health. My name is Nisa Hussain and I am the Early Childhood Program Manager for DC Action and Chair of the DC Home Visiting Council.

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 empower families and communities. We are also the home of DC KIDS COUNT, an online resource that tracks key indicators of child and youth well-being.

Today, my remarks will focus on the Department of Health’s (DC Health) early childhood home visiting programs, which the agency both funds directly and through MIECHV funding. In particular, DC Health administers the Healthy Families America, Parents as Teachers, and Nurse Family Partnership programs at Mary’s Center, the Mothers Rising program at Mamatoto Village, the Healthy Families America program at Community of Hope, and the Parenting Support Program at Georgetown University. DC Health also receives some funding from CFSA for administration of a Parents as Teachers program, which I have addressed in my testimony at the CFSA budget hearing.

I would like to focus my testimony on the importance of  increasing investments in home visiting programs in the FY23 proposed budget to continue supporting DC’s families. We are asking for a 15% increase to all current home visiting grants at DC Health and CFSA to align with the rising inflation rates, address the home visiting workforce shortages, and enable programs to adapt to the increased demands to their workforce during this pandemic. This 15% increase is a $369,150 enhancement to the existing DC Health home visiting budget.

Chairman Gray, thank you for championing home visiting programs as part of the  early childhood system and the Birth-to-Three law these past years. We are also grateful for DC Health’s continued leadership and partnership on the Home Visiting Council. Lastly, we appreciate the Council’s past support of home visiting programs. It is imperative that these programs receive sufficient funding to continue strengthening and sustaining the long-term relationships that make their work so effective.

Home visiting is an essential early childhood and family support strategy 

Home visiting is a valuable, preventative, and evidence-based strategy that supports the healthy development and well-being of children, expectant parents, and families. These voluntary and free programs pair families with a trained home visiting professional, who builds trusted relationships over time to address family and child needs including kindergarten readiness; healthy birth outcomes; maternal and child social, emotional, and physical health; and family economic security DC’s home visiting programs primarily serve Black and brown families who are among those hit hardest by the health and economic impacts of the COVID-19 pandemic for the last several years.

Home visiting is an essential early childhood strategy that plays a unique role in the early childhood system:  due to their relationship-based approach, home visitors have the ability to guide families towards resources and DC’s broader system of services they may otherwise not have access to. Whereas medical (or other program) interactions may be more brief, home visitors have a more holistic understanding of a family’s circumstances and can refer them to services they need.

Home visitors also coach parents to reach self-sufficiency by learning new skills, addressing their challenges, and working towards their personal goals. Parents that enroll in these programs have the desire to care for their young children with confidence. With the support of a trusted home visitor, they can carry out their parenting journey feeling empowered and capable. As a result, children can benefit from a more stable home environment and receive the care they need to meet their highest potential.

The extra support for caregivers has been especially important for the target populations – selected based on their unique needs – served by DC Health-funded home visiting programs. For example, Georgetown University’s Parenting Support Program is the primary home visiting program that supports caretakers with intellectual or developmental disabilities. The programs administered by Community of Hope, Mamatoto Village, and Mary’s Center all focus on expectant parents or families with children under 3 and are able to offer tailored support based on the family’s situation, such as homelessness,  health care access injustice, and more. Mary’s Center’s new Nurse Family Partnership (NFP) program also supports first-time, low-income mothers and began its three year pilot of the evidence-based NFP home visiting model in DC in FY22.

Home visiting programs continue to support families during COVID-19 

As we enter our third year of the COVID-19 pandemic, DC families continue to overcome endless challenges around financial challenges, child care affordability, and anxieties around the many decisions impacting their children’s safety. These are challenges that are added to the existing hardships that many home visiting families were already experiencing.

As a result of these compounded challenges, families relied on the support of their home visitors. Home visitors quickly adapted to the new guidelines and 100% of programs pivoted to a virtual setting and found new ways to maintain these trusted relationships. Most commonly, home visitors found themselves delivering basic supplies (food, diapers, technology, etc.) to houses or centers, utilizing video or phone calls to conduct their regular visits, and directing participants to relevant resources or services that the District provided for COVID-19 relief. The adaptability of programs allowed an uninterrupted continuity of care to the families who needed it the most.

As reported to the Home Visiting Council, 55% of home visiting families experienced an increased need for mental health and domestic abuse resources in 2021. Programs also reported an increase in basic needs like rent assistance, supplies, and food. These combined challenges, plus the effects of social isolation, can all contribute to amplified levels of stress in the home, increasing the risk for child abuse and neglect. As mentioned, home visiting is an effective tool to prevent these outcomes since home visitors coach parents to cope with these negative stressors and continue positive parenting practices especially during crisis.

While programs have effectively transitioned to a safer virtual setting, they are still facing challenges meeting the needs of families who have been hit disproportionately hard by this public health emergency. Programs reported a struggle to maintain consistent engagement and active participation from families, due to competing priorities. 87% of programs observed challenges around their participants’ experience and access to technology or WiFi during their virtual visits. Programs are also seeing families facing increasingly urgent needs and emergencies, so home visitors are spending more time and resources to address those needs before the usual home visiting curriculum. These new set of challenges for programs have weighed heavily on the home visiting workforce these past two years.

More investment in these programs is needed to provide home visitors the support and any additional resources they may need to continue serving families in such a heightened state.

Increase funding for DC Health home visiting programs to reflect their important work and help them meet the evolving needs of families 

Home visiting grants have not increased for several years, even as caseloads have changed and as inflation has risen rapidly over time. With less room for increased compensation, high cost of living rates, and growing levels of stress for the workforce, it is no surprise that home visitor turnover rates continue to rise alongside these changes.

Additionally, programs have used extra time, resources, and creativity to meet the heightened needs of families during this public health emergency without any funding increases. Programs are seeing more families in crisis than ever before. Home visitors are not only working hard through more urgent situations with families, but also using extra resources to meet these evolving needs. During this hearing, programs will share their perspectives on how difficult operating with flat funding has been, especially during a pandemic, and how additional funding could address their workforce challenges.

A 15% increase to home visiting program grants would catch program grants up with inflation since they were first issued, address the challenges of flat funding, and also enable programs the flexibility to meet the needs of their workforce and their home visiting families. A $369,150 enhancement to the existing DC Health grant amount for home visiting programs would better reflect the hard work of these valuable programs.

Overall, home visiting is a unique and critical strategy that invests in families and as a result, invests in the well-being of the wider community of the families. Now is the opportunity for DC Council and DC Health to reciprocate that investment in their home visiting programs by increasing funding for all home visiting grants.

If the District wants to invest in the well-being of their communities, starting with its youngest residents, increasing funding for preventative programs like home visiting is a worthwhile choice. The Mayor’s proposed decision to enhance MPD’s budget by $30 million while valuable family and youth-serving programs like home visiting stay stagnant is disappointing since we know these family support programs have longer term value to addressing the current challenges in our communities. We hope that the DC Council takes the next steps to revise the FY23 budget to better reflect how we want to support our communities facing the highest barriers.

We implore the Council to prioritize home visiting programs for the DC community and find additional funds to allow these critical programs to continue serving families. This is an important investment in DC Health’s goals to support the health and well-being of expectant parents and families with young children.