Agency Budget Hearing, Fiscal Year 2016, 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 children’s access to health services in schools.
Testimony of Shana Bartley, Senior Policy Analyst
DC Action for Children
Agency Budget Hearing, Fiscal Year 2016
Department of Health
Before the Committee on Health and Human Services
Council of the District of Columbia
April 22, 2015
Good morning Councilmember Alexander and members of the Committee on Health and Human Services. Thank you for the opportunity to address the Council as it reviews the proposed Fiscal Year 2016 budget for the Department of Health. My name is Shana Bartley, and I am a senior policy analyst at 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 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 primarily on the Community Health Administration’s Home Visiting Programs for expectant mothers and families with young children. I will also highlight some other DOH programs that we are following closely as they impact children. We are grateful for the Department of Health and the work they do to improve health outcomes for the District’s children and families.
The proposed FY16 budget for the Community Health Administration is about $70.6 million; this represents a 7.3% decrease from the approved fiscal year 2015 budget. The largest change occurred in the Child, Adolescent and School Health Division that is responsible for overseeing the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program and the school nursing contract. Both of these programs provide essential services that promote health and well-being for District children.
1. We must maintain support for Evidence-based Home Visiting so we do not lose momentum.
DC Action for Children serves on the Home Visiting Council with other advocates, community-based providers and agency leaders. This council works to strengthen the implementation of home visiting services throughout the District by identifying best practice, providing technical assistance and monitoring outcomes data. DC Action supports home visiting as an effective strategy for supporting early growth and development, positive parenting and strengthening families to improve outcomes for children.
As we previously testified during oversight, the Department of Health funds three evidence-based models in the District: Healthy Families America (HFA), Parents as Teachers (PAT) and Home Instruction for Parents of Preschool Youngsters (HIPPY) through the federal Maternal, Infant and Early Childhood Home Visiting (MIECHV) grant program. Implementation of these programs requires significant investment of time and resources from providers and oversight and data collection from the agency. Even though implementation of these programs did not initially go as planned, we know that the providers have worked tirelessly to get these programs staffed and prepared; they are now serving hundreds of families across the District. We are grateful to DOH and the community-based organizations working to ensure that quality, evidence-based home visiting services are available in our city.
These programs have demonstrated positive impact on critical outcomes for child well-being. Some of these outcomes include areas where the District continues to face challenges:
- Infant Mortality— two of these programs (PAT and HFA) can impact infant mortality. They emphasize linkages to prenatal care and work with expectant mothers to prepare for their babies. The most recent infant mortality report shows that infant deaths are increasing with growing racial disparities in the District. High quality home visiting services can address these gaps.
- Child abuse and neglect—all three programs promote positive parenting by working on communication and attachment techniques. While we have positive strides in reducing child abuse and neglect, the District’s victimization rate is one of the highest in the country at 18.4 substantiated reports per 1,000 children. By strengthening parent-child relationships through evidence-based home visiting, we can reduce rate of child victimization rates.
- Educational outcomes—all three programs promote school readiness for young children and provide parents with tangible tools to support children’s development and learning. In DC, less than half of third graders tested proficient in reading on the 2014 DC-CAS. Home visiting works with parents to establish a solid foundation, helping to ensure that children enter school ready to learn.
It is vital that we maintain stable funding for home visiting. While the budget narrative highlights a proposed increase in local funding for home visitation services, there is a subsequent $1.7 million decrease in federal grants. We recognize that our city faces a shortfall and the agencies must be responsive to the city’s fiscal needs. However, preventive services through home visiting have proven cost effective and save money in the long term. At this time, we understand that funding is not available to expand services, but we ask that the Committee work to preserve the current proposed funding level in order to maintain the home visiting programs. This is a critical and smart investment in the District’s children and families.
Long-term Sustainability for Home Visiting Services
Federal funds continue to be the primary source of funding for home visiting. Maintaining this funding is challenging and leaves little opportunity to potentially expand services. The MIECHV grants decreased this year by $1.7 million, and funding through Healthy Start, which also provided some home visiting services, decreased by over $600,000. With fewer consistent federal grants, we must think about long-term financing and sustainability.
In previous testimonies to the Committee, we discussed a potential path for funding home visiting 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. Managed care organizations would not have to manage home visiting services; instead current home visiting programs could potentially bill for case management and health screenings 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.
This strategy would require significant inter-agency cooperation. We hope that Deputy Mayor for Health and Human Services Brenda Donald can work with DOH Director Dr. Nesbitt, DHCF Director Turnage and the Home Visiting Council to investigate this option and develop a plan to move forward. We believe this will lead to greater efficiencies in service delivery and improved outcomes for children and families.
2. We must ensure adequate support for school nursing.
Enrollment in our traditional public and public charter schools continues to increase annually; enrollment has climbed by over 17% since 2009. This year, more than 85,000 children and youth receive their education from our public school system. Recognizing that children’s health is inherently tied to their ability to learn and thrive, we are grateful for the partnership amongst DCPS, PCSB, DOH and Children’s National Medical Center to implement a school nursing program that serves children, especially those with complex medical needs, where they spend much of their time—at school. DC Action feels strongly that this is an essential service that promotes well-being and educational outcomes.
With increased school enrollment comes a greater need for school-based health services. According to the proposed budget, there is a $6.8 million decrease in the Child, Adolescent and School Health Bureau (8514) within the Community Health Administration. According to the narrative, $3 million of this decrease is made in part to align “the budget for school nurses with anticipated need.”  We know that finite resources and a limited number of qualified health professionals make it difficult to have full-time nurses available in all schools. However, we hope that this decrease does not negatively impact services for children or further exacerbate gaps in coverage.
We have heard that many factors receive consideration when determining school nursing coverage; however many parents and advocates do not fully understand the process. Given these proposed changes in funding, we hope this Committee will encourage the agency to provide clarity about how coverage aligns with needs.
Thank you for the opportunity to testify today. I am happy to answer any questions that you may have.
 District of Columbia Department of Health . (2014). 2012 Infant Mortality Report http://doh.dc.gov/sites/default/files/dc/sites/doh/release_content/attachments/2012%20Infant%20Mortality%20Report.pdf
 Data via National KIDS COUNT http://datacenter.kidscount.org/data/tables/6221-children-who-are-confirmed-by-child-protective-services-as-victims-of-maltreatment?loc=1&loct=1#detailed/2/2-52/false/868/any/12942
 OSSE. (2014). 2014 DC-CAS Results Presentation. http://osse.dc.gov/sites/default/files/dc/sites/osse/publication/attachments/2014%20DC%20CAS%20Result%20July%2031%202014...FINAL_.pdf
 District of Columbia Proposed Fiscal Year 2016 Operating Budget, page E-66
 District of Columbia Proposed Fiscal Year 2016 Operating Budget, page E-67
 Based on 2014-2015 School Year Enrollment data from OSSE http://osse.dc.gov/release/district-releases-final-2014-2015-student-enrollment-audit ; 2009-2010 school year enrollment data via DC KIDS COUNT http://datacenter.kidscount.org/data/tables/4773-public-school-enrollment?loc=10&loct=3#detailed/3/any/false/1249,1120,1024,937,809/894,897,1857,898/11141
 District of Columbia Proposed Fiscal Year 2016 Operating Budget, page E-68