Agency Budget Oversight Hearing, Fiscal Year 2019, Department of Health, Perinatal and School Health

Testimony of Shana Bartley, Acting Executive Director

DC Action for Children

 

Agency Budget Hearing

Fiscal Year 2019

Department of Health

 

Before the Committee on Health

Council of the District of Columbia

 

April 9, 2018

 

Good morning, Councilmember Gray and members of the Committee on Health. Thank you for the opportunity to address the Council as it reviews the proposed Fiscal Year 2019 budget for the Department of Health (DC Health). My name is Shana Bartley, and I am Acting 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.

My testimony today focuses on similar themes to the ones included in my testimony for DC Health’s performance oversight hearing in February:

  1. Women and children in the District must be supported by a strong maternal and child health system;
  2. Home visiting is an important strategy to support young children and their families, and it needs sustainable and secure local funding; and
  3. DC leads in providing school health services

We are glad to see that the proposed DC Health budget for fiscal year 2019 includes funding for programs that address these key areas. It is vital that these important supports receive adequate investment.

  1. Women and children in the District must be supported by a strong maternal and child health system

Over the last several months, we have seen increasing media attention about the plight pregnant women face when seeking maternal health care, particularly on the East End of the city. This attention highlights ongoing challenges women and their children have faced for decades in the District. Tremendous disparities persist between women of color and their peers regarding entry to prenatal care, pre-term birth, and infant mortality. For example, in 2016, there were 9,854 births across the city.[1] Of those births, 70 infants died during their first year of life resulting in an infant mortality rate of 7.1 deaths per 1,000 live births. When we disaggregate the data by race/ethnicity, we see that the mortality rate for non-Hispanic, Black infants is 11.3 deaths per 1,000 live births. While Black babies accounted for 49% of live births in 2016, they represented 79% of infant deaths. The numbers may be jarring, but they represent an ongoing reality that requires deeper cross-sector engagement and more action as access to maternal health care grows scarcer in certain parts of the District.

We applaud DC Health’s focus on perinatal health outcomes in FY 2019.[2]  The Department continues to administer valuable and diverse maternal and child health programs, including home visiting programs, Healthy Start, place-based initiatives, school-based health centers, Help Me Grow and other supportive programs. We also support new efforts included in the proposed FY19 budget, as well as the others outlined in Mayor Bowser’s B22-0758, Better Access for Babies to Integrated Equitable Services Act of 2018 (B.A.B.I.E.S. Bill).

New investments that include a pilot program to reduce pre-term births and implementation of new standards of care are needed and timely.  Looking at combined data for 2015 and 2016, the percentage of pre-term births for non-Hispanic, Black mothers was double the percentage for non-Hispanic, White mothers. Additionally, the percentage of pre-term births were highest among mothers living in Wards 7 & 8.[3] Pilot programs are useful to study effective strategies for addressing complex problems, testing new services, and identifying scalable solutions. We hope this pilot will build on our collective knowledge of what works for women, children and families in the District and translate into effective programs and supports for them.

Although this pilot is an important step to tackle pre-term births, it will not be able to reach all expectant women that could potentially benefit. Therefore, the District must invest in and expand other maternal and child health resources and supports. We believe B22-0203, Birth-to-Three for All DC Bill achieves this by providing a path for the District to strengthen the maternal and child health system of care in a variety of ways:

  1. Establishing recurring local funding for home visiting-- I discuss the importance of this in the next section of this testimony.
  2. Strengthening Help Me Grow (HMG) by increasing community involvement —Help Me Grow is a promising city-wide resource for pregnant women and families with young children under age 5. According to DC Health’s FY17 Performance Oversight Responses, “Help Me Grow is a comprehensive, coordinated system of early identification and referral for children at risk for developmental and behavioral delays. Help Me Grow DC is the District’s hub for all questions and inquiries concerning maternal support services and early childhood development and behavioral services.”[4] B22-0203 proposes that DC Health regularly produce a HMG implementation report and an annual development health surveillance report and share it with relevant stakeholders. These reports are key to building community-wide understanding of the needs of pregnant women and young children as well as the gaps in services and barriers to accessing care. These reports are necessary to inform future efforts to build and sustain a coordinated system of care.
  3. Expanding Healthy Steps—We know that other colleagues will speak about the importance of this evidence-informed model, and we support expanding this resource based on the experience of the Early Childhood Innovation Network’s pilot in Children’s National Community Health Centers.

 

As a member of the Birth-to-Three Policy Alliance, DC Action is grateful for the leadership of Councilmember Gray and other members of this committee to ensure this legislation builds on the strengths and evidence of existing programs and creates the foundation for a coordinated system of care.

  1. Home visiting is an important strategy to support families with young children; DC needs a recurring local investment.

As mentioned during our FY17 Performance Oversight testimony,

“Maternal and early childhood home visiting is one key strategy for supporting pregnant women and the families of young children. As a family support strategy, early childhood home visiting provides education, parenting techniques and resources to pregnant women and families with young children ages 0 to 5. 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. Importantly in our current landscape, where a coordinated maternal and child health system is absent, these programs are a source of 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.” [5]

DC Action for Children 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. We are grateful for the partnership of the DC Health staff on the Home Visiting Council and their commitment to promoting maternal, child and family health through evidence-based home visiting services.

Over the last few years, the District’s investments in home visiting have changed significantly. With other agencies like Child and Family Services Agency and the Office of the State Superintendent of Education reducing or eliminating funding for programs, DC Health now administers most of the dollars supporting evidence-based home visiting. However, the federal funding DC receives through the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program is insufficient to meet the needs, and DC Health uses local funds to supplement. Annually, members of the DC Home Visiting Council request an additional $2 million in local dollars to augment federal funding. While DC Health uses some of these local dollars to support evidence-based home visiting, the Department also leverages funding for other perinatal health programs including their place-based initiatives. While we support DC Health exploring other promising strategies to improve perinatal health outcomes, DC Action believes the District needs to invest a full $2 million of local funds in home visiting. The MIECHV program follows federal guidelines and restricts services to specific wards (5, 7 & 8) of the city. A local commitment provides flexibility and allows DC Health to expand home visiting to other parts of the city where there are high numbers of births (Wards 1 and 4) and families could benefit from these services. Other colleagues and program participants will share further about the value of and need for home visiting today, so my testimony serves to echo and support their calls for a local investment.

  1. DC’s leads in providing school health services

Lastly, I would like to express DC Action’s support for increased school-based health services funding. The additional $4.4 million included in the Community Health Administration—Family Health Bureau’s budget will ensure that children and youth attending DC public and public charter schools have access to 40 hours of nursing coverage in approved health suites. This investment is necessary to ensure that DC Health can support the required staffing to meet this goal. In 2015, DC Action for Children conducted the School Health Needs Assessment (SHNA) that found that students attending DC Public Schools and public charter schools experience both chronic conditions and common childhood ailments that can affect their ability to be present in the classroom, and that the model for school health implemented at the time was not successfully addressing students’ needs.[6] We also learned through research on school health programs in other states that most school districts do not have the resources needed to supply all schools with full-time nursing coverage. The District leads in this area, and we hope that continued implementation of the Whole School, Whole Community, Whole Child Model will yield positive results for DC’s children and youth.

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

 

[1] DC Department of Health. (2018). DC Health Perinatal and Infant Mortality Report 2018. Retrieved from https://dchealth.dc.gov/perinatal

[2] DC Department of Health. (2018). FY2017 Performance Oversight Questions and Responses—Question 33.  Retrieved from: http://dccouncil.us/budget/2019/health

[3] DC Department of Health. (2018). DC Health Perinatal and Infant Mortality Report 2018. Retrieved from https://dchealth.dc.gov/perinatal

[4] DC Department of Health. (2018). FY2017 Performance Oversight Questions and Responses—Question 33.  Retrieved from: http://dccouncil.us/budget/2019/health

[5] Bartley, S. (2018). Testimony, DOH Performance Oversight Hearing, FY 2017-2018. Retrieved from: https://www.dcactionforchildren.org/blog/testimony-doh-performance-oversight-hearing-fy-2017-2018

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