Testimony of Shana Bartley, DC Council Committees on Human Services & Education Public Oversight Roundtable on the Status of Home Visiting Services in the District
Testimony of Shana Bartley, Executive Director
DC Action for Children
Public Oversight Roundtable
The Status of Home Visiting Services in the District
Before the Committees on Human Services and Education
Council of the District of Columbia
November 28, 2018
Good morning, Councilmember Nadeau, Councilmember Grosso and members of the Committees on Human Services and Education. Thank you for the opportunity to address the Council as it reviews the status of home visiting services in the District of Columbia. My name is Shana Bartley, and I am executive director at DC Action for Children (DC Action).
DC Action provides data analysis and policy leadership on critical issues facing DC children and youth. We envision a District of Columbia where all children, regardless of their race/ethnicity, family’s income or zip code, have the opportunity to reach their full potential. We are also the home of DC KIDS COUNT, an online resource that tracks key indicators of child well-being in the District. DC Action is a member of the Birth-to-Three Policy Alliance, a collection of community-based organizations working to ensure that the District has a quality, comprehensive system of care and support for infants, toddlers, and their families.
DC Action for Children also serves on the DC Home Visiting Council (HV Council) with other advocates, community-based providers and agency leaders. This council works to strengthen home visiting in the District by building a cross-sector network of support for programs, advocating for resources and funding for their stability and growth and collaborating to address system-wide challenges to the implementation of home visiting services. My colleague, Ruqiyyah Abu-Anbar, will share more about the work of the HV Council during her testimony.
This public roundtable is timely as many recent events highlight the critical role of early childhood home visiting in the District. My testimony today will include three major points:
- Home visiting is a valuable strategy to support DC’s expectant women, young children and their families to navigate various systems;
- Increased diversity among funding sources improves the sustainability of services;
- To create a child- and family-centered system, District agencies and providers must coordinate their efforts to best meet the needs and preferences of families.
1) Home visiting is a needed and valuable strategy to support DC’s expectant women, young children and their families.
The population of young children under age 5 continues to grow with an estimated 44,500 currently living in the District. In 2016, the District saw 9,854 births across the city. Given increases in both the number of births and growth in this specific population of children, it is crucial that DC is a place where caregivers have the supports they need to parent and children have the resources needed to thrive. Research indicates that children reach significant developmental milestones between birth and age 5 and that those milestones are influenced dramatically by a family’s access to resources. In a city where almost 20% of children under 5 live below the poverty level, home visiting and other resources within a coordinated system of care and support are especially relevant to reducing disparities.
Home visiting is a key strategy for supporting pregnant women, young children, and their families, because it provides education, coaching, parenting techniques and resources. 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 and/or child health and development and prevent child abuse and neglect. These programs also provide much-needed social support and serve to connect participants to other families, as well as to community resources that promote positive health, developmental and well-being outcomes for children and families. Additionally, these programs are especially valuable in facilitating engagement with expectant women and families who are traditionally difficult to reach and establish strong rapport with, as these families are often at the greatest risk for negative outcomes.
2) Changes to the funding landscape have increased diversity among funding sources; local investment improves the sustainability of services.
In recent years, the District has seen fluctuations in public funding for home visiting. However, new investments at the local and federal level provide opportunities to sustain and grow the number of slots available in the District.
Through a combination of federal and local dollars, the Department of Health is the largest funder of home visiting programs in the District. DC Health’s programs are evidence-based, rigorously implemented, and are a fixture amongst DC’s early childhood programs and services. However, until this summer, nearly all of DC Health’s funding for home visiting came from the federal Health Resources and Services Administration (HRSA) through the Maternal and Infant Early Childhood Home Visiting (MIECHV) program, which supports evidence-based early childhood home visiting programs and promising new approaches nation-wide. DC Health began receiving MIECHV funding in fiscal year 2010 and is currently receiving a grant award of $1,624,146 to provide program funding over two and a half years through September 2018.
Historically, DC’s MIECHV funding has fluctuated subject to changes in federal programs and funding availability, highlighting the need for increased funding stability for home visiting programs and the families that benefit from them. In 2016, national discontinuation of the MIECHV development grant resulted in a loss of funding to some DC providers, who were forced to reduce their program caseloads and scramble for private funding as a result. At the beginning of FY18, we were once again reminded of the tenuousness of federal funding sources: federal MIECHV authorization expired in September 2017 and was not renewed until February 2018, despite concentrated advocacy on the part of federal and state partners and promises of reauthorization by Congressional staff. Although MIECHV was ultimately reauthorized, the length of time between its expiration and its renewal, as well as the uncertainty about whether it would be reauthorized at all is a reminder a majority of publicly funded home visiting in the District is subject to Congress and HRSA.
DC Health was not the only agency to use federal dollars to support home visiting. During FY18, CFSA also used federal funding through the Community-based Child Abuse Prevention Program (CBCAP) for early childhood home visiting. However, we learned through FY19 Budget Oversight hearings that CFSA was unable to commit to funding through FY19 since CBCAP dollars were ending and limited funds were available. Councilmember Nadeau, we are grateful that you and your staff worked with the HV Council and CFSA to clarify the situation. While current contracts are slated to end in December, it is our understanding that CFSA is working to ensure that there are no disruptions in services for families. They are also working to release the remaining CBCAP dollars which amount to approximately $440,000.
A new opportunity through the federal Family First Prevention Services Act will allow CFSA to invest additional federal dollars into services for families at risk of entering the child welfare system next fiscal year (these families are defined as “candidates for foster care”). This federal funding supports three types of interventions: mental health treatment, substance abuse prevention and treatment, and in-home parenting support. The federal government will develop a clearinghouse of approved model therapies and services; home visiting models are likely to appear on this clearinghouse allowing CFSA to deepen home visiting investments as the strategy contributes to the prevention of child abuse and neglect. In order to take advantage of this opportunity, states are required to create prevention plans that outline who they will serve. We are grateful that DC Action has been invited to participate on CFSA’s Families First Working Group. Over the last few months, the agency has thoughtfully engaged District agency and Collaborative partners. The process to develop the plan is ongoing; states are still awaiting additional guidance from the federal government to complete development of their plans.
While we hope that District agencies will always take full advantage of federal funding opportunities, we know that federal funding alone is not enough to sustain programs and prevent gaps in service delivery. These federal funding sources are often tenuous and often require agencies to select target populations that can restrict access; they also have stringent implementation guidelines and burdensome data collection requirements that are not always family-centered. DC families with young children rely on home visiting programs to achieve positive outcomes and we owe it to these families and to the programs that support them to ensure that funding is secure. For years, the HV Council Advocacy Committee educated DC Council about the necessity of a local funding for home visiting. We are pleased that this ongoing local investment appears in Birth-to-Three for All DC (B-3 DC); it will ensure sustainable implementation of home visiting programs as well as the strengthening of the home visiting system in DC. B-3 DC, when fully-funded, requires both DC Health and the Office of the State Superintendent of Education (OSSE) to administer dollars for home visiting. This will provide more families with access to vital home visiting services according to their preferences and needs. A combination of federal and local dollars will necessary to ensure ongoing implementation of high quality services; having three agencies investing home visiting creates a wider net and additional entry points for families to link to services and resources that could benefit them.
3) To create a child- and family-centered system, District agencies and providers must coordinate their efforts to best meet the needs and preferences of families.
The District invests in a variety of programs to address the needs of young children and their families. We know that CFSA, DC Health, and OSSE are actively working to achieve results. Those results are laid out in a set of guiding documents that we hope will assist the agencies and their partners in meeting the needs of DC children and families. While each agency’s guiding documents are unique, we believe home visiting can serve as a thread to sew them together and think about how to best serve families according to needs and preferences.
For example, DC Health implements programs aligned with their Perinatal Health Framework. Home visiting contributes to their goals of supporting parents and promoting early childhood development. Earlier this year, the State Early Childhood Development Coordinating Council (SECDCC) adopted the Early Childhood Systems Approach. It outlines the results that stakeholders across the District’s early childhood system seek to achieve as well as the collective actions everyone must take to be successful. Home visitors are considered to be a part of this broad system as they often function as system navigators and connectors for families. The systems approach includes healthy births, school readiness, and positive social-emotional development as key results—all outcomes associated with home visiting programs. CFSA already implements their Four Pillars strategy, and that will continue to inform their work as they develop their statewide prevention plan for Family First.
Although the guiding documents highlight the specific outcomes that individual agencies work to achieve based on their area of focus, we know that home visiting is a cross-cutting strategy that can support families to achieve positive outcomes in many across domains. DC Action is grateful for the partnership and leadership of each agency in working to build a comprehensive early childhood system that centers the needs of children and families. The Home Visiting Council would like to work with the agencies to coordinate home visiting services by developing a shared implementation approach and to think about shared data elements and performance metrics. This will include clear guidance on how to determine which home visiting programs, based on model, funding guidelines, and desired outcomes, are available to families when they walk through any “door.”
Thank you for the opportunity to testify today. DC Action is happy to serve as a resource and answer any questions that you may have.
 Population Division, U.S. Census Bureau. Retrieved from http://datacenter.kidscount.org/data/tables/101-child-population-by-age-group?loc=10&loct=3#detailed/3/any/false/870,573,869,36….
 DC Department of Health. (2018). Perinatal Health Report 2018. Retrieved from:
 Population Reference Bureau, analysis of data from the U.S. Census Bureau, Census 2000 Supplementary Survey, 2001 Supplementary Survey, 2002 through 2016 American Community Survey. Retrieved from http://datacenter.kidscount.org/data/tables/5650-children-in-poverty-by-age-group?loc=10&loct=3#detailed/3/any/false/870,573,86…
 FY16 CHA Oversight Responses
 Included in the 2018 Perinatal Health Report: https://dchealth.dc.gov/sites/default/files/dc/sites/doh/service_content/attachments/Perinatal%20Health%20Report%202018_FINAL.p…
 Available from OSSE-Division of Early Learning