DC Action's Testimony at the Public Hearing on the Home Visiting Services Pilot Program Establishment Act of 2017

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Testimony of Shana Bartley, Acting Executive Director

DC Action for Children

Committee on Health Hearing on

B22-350 – Home Visiting Services Pilot Program Establishment Act of 2017

Before the Committee on Health and Human Services

Council of the District of Columbia

September 18, 2017


Good morning, Chairperson Gray and members of the Committee on Health. Thank you for the opportunity to address the Council as it considers the Home Visiting Pilot Program Establishment Act of 2017. My name is Shana Bartley, and I am acting executive director at DC Action for Children.

DC Action provides data-based analysis and policy leadership on critical issues facing DC children and youth. We are the home of DC KIDS COUNT, an online resource that tracks key indicators of child well-being in the District.

DC Action for Children also serves on the Home Visiting Council along with other advocates, community-based providers and agency leaders. This council works to strengthen the infrastructure for and the implementation of evidence-based home visiting services throughout the District. The HV Council approaches this work by promoting best practices, planning and coordinating program support, and conducting strategic research and advocacy for home visiting. Earlier this year, DC Action also completed the Status Report on Home Visiting for the Office of the DC Auditor, which lays out the landscape of home visiting in the District and serves as the single most comprehensive document on home visiting in the District to date.

When envisioning the future of our city, we must think critically about investments in our youngest residents. Approximately 43,000 children under the age of 5 call DC home.[1] It is well-established that children reach crucial developmental milestones between birth and age 5, milestones that are influenced dramatically by a family’s access to resources. In a city where over 23% of children under 5 live below the poverty level, home visiting and other family supports are especially relevant to reducing disparities.[2]

I am here today to testify in support of the Home Visiting Pilot Program Establishment Act of 2017- I am grateful to Councilmember Nadeau for her support of home visiting and her efforts to strengthen the infrastructure for home visiting through this bill. Early childhood home visiting is a valuable family support strategy that provides education, parenting techniques and resources to families with young children. In these evidence-based programs, trained home visitors work collaboratively with families who are expecting or who already have young children to achieve improved outcomes in school readiness, child welfare, and/or child health and development. These improved outcomes confer significant economic savings to the public by preempting the need for costlier, more intensive remedial services such as special education and child protective services that a child may otherwise require later in life. Research also indicates that home visiting can be linked to reduced crime and health care costs.[3]

The Home Visiting Pilot Program Establishment Act of 2017 would strengthen DC’s home visiting system in three main ways. These strengths of the bill align with the needs we identified in the Status Report on Home Visiting and the priorities of the HV Council. Specifically, this bill would:

  1. Provide much-needed support for capacity building in home visiting provider organizations

Home visiting programs deliver a range of coordinated services through home visitors who must possess a diverse and nimble skillset to be effective. In doing so, however, providers are challenged by a limited pool of home visitors, limited resources for specialized professional development for home visitors, high turnover among home visitors and limited access to technical assistance to support program infrastructure, among others.


If passed, the capacity building grants established in this bill would allow home visiting providers to address these challenges and strengthen their ability to serve families. Additionally, these grants could be used to support system-level efforts to strengthen home visiting in DC, such as shared trainings and home visitor workforce development initiatives. We believe that this capacity fund represents an excellent step toward achieving the strongest possible home visiting system in DC. We urge the Council to support this component of the bill.


  1. Potentially diversify funding opportunities for home visiting

We are encouraged to see that District leadership recognizes the need for diversified funding for home visiting. A key finding of the Status Report on Home Visiting and our work with home visiting providers and funders is that the District lacks sustainable and diverse funding for home visiting. Such a funding landscape can result in instability and potential loss of service for families.


Currently, public funding for home visiting comes through Head Start, the Maternal, Infant and Early Childhood Home Visiting program (MIECHV), administered by DOH, Community-Based Child Abuse Prevention (CBCAP), administered by CFSA, and supplementary local dollars from DOH and CFSA. Over the years, home visiting providers have been subject to funding cuts at the national level, including cuts to MIECHV’s development grant in FY 2016, and the local level, including the resultant defunding of the Home Instruction for Parents of Preschool Youngsters (HIPPY) program and last year’s reallocation of Title IV-E dollars from home visiting to other strategies. These cuts often link to larger agency budget challenges and illustrate the instability of home visiting funding. Each cut resulted in a loss of services for families and inflicted significant operational challenges for home visiting providers.


In order to fulfill the District’s commitment to strengthening the early care and education system so that children are prepared to succeed in school and beyond, it is important to support families at each transitional stage of early childhood- a strength of home visiting programs. Although pay-for-success is a new funding strategy in early childhood, we look forward to the opportunity to explore this and other opportunities to ensure that home visiting funding is sustainably and diversely funded. Further, we urge the Council and DC agencies to continue to explore options for increased sustainability in home visiting funding in this bill and beyond.


  1. Expand understanding of home visiting in DC

Through our work, we have found that there is a limited amount of research and data on local home visiting upon which to base decisions about targeting programs, expanding the number of home visiting slots and conducting quality improvement efforts. While the HVSR was a first step in better understanding the landscape of home visiting in the District, we join with our partners in calling for additional research. This could help us more thoroughly understand the role of home visiting in DC’s early childhood system so that we many better support its strategic development.


This bill calls for a feasibility study to assess the appropriateness of pay-for-success as a financing model for home visiting in DC. We view this as a prudent and necessary precursor to implementing a pay-for-success program for home visiting. We also believe that there is much to learn about home visiting in DC through such a study. Other states and communities that have conducted similar feasibility studies have reported discovering the a great deal about their home visiting infrastructure, including: expansion of knowledge about the strengths and gaps of their systems, a better understanding of the ideal target populations for home visiting services and a clearer idea of the potential local return on investment for implementing home visiting services.[4] Such information would support continued strategic development of a home visiting infrastructure in DC, whether or not pay-for-success is deemed to be a viable option for home visiting.


As the committee considers this bill, I would like to leave you with two final points for consideration:

1) The Home Visiting Council is a valuable resource.

As a body of individuals and organizations who are deeply invested in home visiting as a family support integrated into DC’s early childhood system, and who comprise nearly all home visiting providers and local government funders of home visiting, the HV Council possesses unique expertise. As currently drafted, this bill does not call upon this expertise in the development of the home visiting support mechanisms it mandates. I encourage the DC Council to leverage the HV Council as it considers and amends this bill. This body’s experience and knowledge of home visiting is unparalleled in the District, and a strengthened version of this bill would:

  1. Require that the DMHHS consult the Home Visiting Council in conducting a feasibility study for the Home Visiting Pilot Program and
  2. Call for Home Visiting Council representation on the evaluator panel for the Pilot Program.

2) Home Visiting is an integral part of a well-coordinated early childhood system.

We are pleased that this bill specifically seeks to strengthen home visiting. To bolster the District’s efforts to achieve the best outcomes for families, home visiting must exist within a well-coordinated early childhood system. Such a system would understand the needs of children and families, provide services that address those needs, make it easy for families to find those services and support families’ seamless movement through the system as they grow. We know that some of you have already begun this work and we urge members of this committee, members of the Council, DC agencies and our fellow advocates to continue supporting home visiting and the District’s youngest children by collaborating to put such a system into place. We at DC Action look forward to working with you to make it happen.


We are grateful to see the Council’s consistent dedication to reducing disparities and improving the health and quality of life of all DC residents, including young children and their families. Thank you again for the opportunity to testify. I am happy to answer any questions you may have.


[1] U.S. Census Bureau. (2017). Child population by single age, 2016 American Community Survey 1-Year Estimates: District of Columbia. Retrieved from http://datacenter.kidscount.org/data/tables/100-child-population-by-single-age?loc=10&loct=3#detailed/3/any/false/870,573,869,3….

[2] U.S. Census Bureau. (2016). Children Characteristics, 2011-2015 American Community Survey 5-Year Estimates: District of Columbia. Retrieved from https://factfinder.census.gov/bkmk/table/1.0/en/ACS/15_5YR/S0901/0400000US11.

[3] Karoly, L, et al. (2005). Early Childhood Interventions: Proven Results, Future Promise. RAND Corporation. Santa Monica, California. Retrieved from http://www.rand.org/pubs/monographs/MG341.html

[4] Findings from Pay for Success Feasibility Studies. Retrieved September 12, 2017, from https://www.instituteforchildsuccess.org/findings-pay-success-feasibility-studies/