Agency Budget Hearing, Fiscal Year 2015 Department of Health

DC Action for Children testified at the budget hearing for the Department of Health (DOH). Our testimony focused on the Department of Health Community Health Administration’s Home Visiting Programs for expectant mothers and families with young children, and other important DOH programs to prevent infant mortality and increase children’s access to health services in schools.

Read our remarks below. PDF version available here.

Testimony of HyeSook Chung, Executive Director

DC Action for Children

Agency Budget Hearing, Fiscal Year 2015

Department of Health

Before the Committee on Health

Council of the District of Columbia

May 1, 2014

 

Hello Committee Chairwoman Alexander and members of the Committee on Health. Thank you for the opportunity to address the Council as it reviews the performance of the Department of Health (DOH). My name is HyeSook Chung, I am the executive director of DC Action for Children.  

DC Action for Children (“DC Action”) provides data-based analysis and policy leadership on critical issues facing DC children and youth, to promote policies and actions that optimize child and family well-being.

DC Action is the home of DC KIDS COUNT, which tracks key indicators of child and youth well-being in the DC neighborhoods where children live, learn and grow. We work closely with city agencies, the school system and service providers to share the most accurate and timely data along with clear and accessible analysis. Our advocacy agenda is based on these data.

My testimony today will focus on the Department of Health Community Health Administration’s Home Visiting Programs for expectant mothers and families with young children, and other important DOH programs to prevent infant mortality and increase children’s access to health services in schools.

Home Visiting “Backfill” Is Only the First Step

DC Action is a member of the DC Home Visiting Council, which includes representatives from community agencies that provide home visiting services, advocacy groups such as DC Action, DOH staff and other DC agencies. The Home Visiting Council works to strengthen DC’s implementation of early childhood home visiting as a strategy to support children and families.

Early childhood home visiting programs in DC serve expectant mothers and families with young children at risk of adverse child outcomes due to circumstances like poverty, teen motherhood or substance abuse. These programs are cost-effective and have had proven positive effects in DC and in other jurisdictions, such as reducing incidences of child abuse and neglect, decreasing ER visits for infants and toddlers, improving school readiness and empowering families to connect with other health services.

Early childhood home visitors provide many services to their clients, including discussing and demonstrating effective parenting techniques, screening for physical and behavioral health issues in mothers and children, referring families to health, early education, substance abuse treatment or other services, and educating families about their child’s healthy development.

DC Action has testified to this committee before about the precarious state of federal home visiting Maternal, Infant and Early Childhood Home Visiting (MIECHV) grants. While the formula grant program was recently renewed by Congress, the competitive grant DC received in 2012, which took over two years to be disbursed to community agencies, is expiring in FY15 with little chance of renewal.

We are grateful that DOH, under the direction of Dr. Joxel Garcia, Mayor Gray and the leadership of this Committee heard our concerns, and built $2.5 million into the proposed FY15 budget to backfill the expiring federal grant and ensure that no family goes without home visiting because of bureaucratic delays among DC agencies.

We hope this is only the beginning of DC’s increased investment in home visiting. CFSA is planning to double its support of home visiting programs, and while the number of families CFSA serves is substantially smaller than that of DOH-funded programs, these are all steps in the right direction, which demonstrate that home visiting has a role to play in DC’s health, education and child welfare strategies.

We estimate that bringing home visiting up to a reasonable scale in DC will require more support: Approximately $6 million in addition to current funding levels across various agencies.

How might this be accomplished? At the Agency Performance Oversight Hearing, we discussed with Chairwoman Alexander whether a sustainable path for funding expanded home visiting might be available through the Department of Health Care Finance. We believe it is important for program quality and continuity that community-based agencies continue to deliver these services, thus we would not support MCOs taking over management of home visiting. There may be promising opportunities, however, for current home visiting programs to bill for case management and health screenings services through Medicaid and CHIP. Medicaid funds would likely not cover the entirety of home visiting programs’ services, but it is a much more reliable and sustainable funding stream than current arrangements.   

This would require significant inter-agency cooperation. We recommend Deputy Mayor for Health and Human Services BB Otero work with DOH Director Garcia, DHCF Director Garcia and the Home Visiting Council to set out a plan of action for supporting DOH-funded home visiting programs through Medicaid. As always, the leadership and assistance of the Committee on Health as we work to keep home visiting at the forefront of agency leaders’ minds is invaluable.

Applauding Additional Investments in School Health and Infant Health

In other important developments for children’s health in DOH’s proposed FY15 budget, we were happy to see some critical additional investments in children’s health:

  • $5 million for school nurses in charter schools
  • $600k for anti-infant mortality programs
  • $375k to support existing school health centers

Each of these investments will make a difference in the lives of DC children. First, there will be more nurses for the over 40% of DC children enrolled in public charter schools. Every DC school, whether public charter or DCPS, should have a nurse on-campus, for the safety and health of our children. A small additional investment in existing school health centers will help improve and sustain the health resources we have already instituted in some schools. These school-based health services are important, because for many children from families with difficulty accessing health care, school is the best place to access preventative care and screenings for physical and behavioral health issues.

Anti-infant mortality programs are also an important investment, so that DC can sustain the recent improvements it has seen in infant mortality rates, and help close infant mortality gaps for infants of color and infants living in poverty.

  • For every 1,000 live births in DC in 2011, seven infants died before reaching their first birthday, a 43% improvement from 2007.
  • Racial differences in infant mortality persist: the infant mortality rate among white families was 1.8 in 2001, compared to 11.6 among black families.[i]  

Racial differences in infant mortality are not completely in the control of the infant health team at DOH. More likely, high infant mortality rates are related to racially disparate rates of poverty and all its associated disadvantages. But, until DC as a community is able to end our unacceptably high rates of child and family poverty, supporting the infant health team as they try to improve some of the tragic symptoms of poverty is sadly necessary.

Thank you for the opportunity to testify, I’m happy to answer any questions.

 


[i] Data from the 2011 Infant Mortality Report, DC Department of Health

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