Agency Performance Oversight Hearing, Fiscal Year 2015, Department of Health

Last week, we testified during the FY16 Performance Oversight Hearing for the Department of Health on the importance of evidence-base home visiting in the early care and education landscape. Read our full remarks below.

 

Testimony of HyeSook Chung, Executive Director

DC Action for Children

Agency Performance Oversight Hearing

Fiscal Year 2015

Department of Health

Before the Committee on Health and Human Services

Council of the District of Columbia

February 19, 2016

 

Good afternoon 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 performance of the Department of Health for Fiscal Year 2015. My name is HyeSook Chung, and 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 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.

 

The Department of Health is tasked with many responsibilities, and we are grateful for the agency’s dedication to improving the health and quality of life for all District residents including the youngest and most vulnerable ones. The population of young children under the age of three increased by more than 35 percent between 2004 and 2014.[1] Of those approximately 26,500 children, nearly 40 percent live in low-income families[2] and over half live in homes headed by single parents. The agency provides numerous resources to mothers and infants through the Perinatal and Infant Health Bureau within the Community Health Administration.

 

My testimony today will focus primarily on one type of beneficial service -- the evidence-based home visiting programs for expectant mothers and families with young children. These programs provide hundreds of parents and children with critical education, resources and support that help to improve child outcomes related to health, safety and school readiness.

 

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 evidence-based home visiting services throughout the District by identifying best practice, providing technical assistance and monitoring outcomes data.[3]  We are grateful for the leadership and partnership of the Department of Health’s staff on the Home Visiting Council and their commitment to promoting child and family health through evidence-based home visiting services.

 

Through the federal Maternal, Infant and Early Childhood Home Visiting (MIECHV) grant program, the Department of Health funds three evidence-based models in the District: Healthy Families America (HFA)[4], Parents as Teachers (PAT)[5] and Home Instruction for Parents of Preschool Youngsters (HIPPY)[6]. While these programs vary slightly in their target populations and some services provided, they are all grounded in decades of research and demonstrate positive outcomes for participating families.

 

The difference between home visiting as a strategy and evidence-based home visiting programs

There are a variety of agencies across the city, including the school system, Human Services and Child and Family Services Agency, which use home visits as a way to engage with children and families and connect them with important services and resources. It is important to distinguish the Community Health Administration’s evidence-based home visiting program from other home visits, including ones that CHA funds through DC Healthy Start, because the evidence-based programs are intense and have rigorous standards that providers must meet in order to maintain fidelity to the program. In other words, providers of evidence-based home visiting must adhere to a strict set of guidelines in order to implement these programs.[i]   

 

Similarly, participants must meet specific criteria to enroll and have to complete sessions according to prescribed timelines. These timelines are often long-term (about 3 years) and require a significant time commitment from the families that often face challenges that could affect their ability to fully participate. For example, the data from Oversight Question 11 indicate that 71% of mothers participating in an evidence-based program do not work and 88% live below the poverty level. Families could face potential challenges with stable housing, adequate nutrition and accessing regular medical and behavioral health care. Despite the potential benefits to children and families, we see that only 8% of families have completed a program to date.[7]

 

Evidence-based home visiting programs face challenges but also provide a tremendous opportunity.

Evidence-based home visiting is an effective strategy for promoting children’s health, wellness and safety. As DC’s independent voice for children, we are glad that services with demonstrated value and positive outcomes are available. We recognize that our funding and capacity is limited, so we must make full use of our resources.

 

According to the Community Health Administration’s oversight responses, the MIECHV grant program provides funding to serve a total of 350 families; this includes 150 slots for HFA, 80 slots for PAT and 120 slots for HIPPY.[8] However, the community-based providers only have capacity to serve 275. While DC KIDS COUNT data can clearly demonstrate a need, the program enrollment data indicate that the demand for evidence-based home visiting may not align with this need since the programs are under-enrolled and recruitment and retention of families remains challenging.

 

As a city, we must think more broadly about how we serve families with young children. This includes a systematic approach to service delivery that addresses immediate needs while focusing on long-term child and family outcomes. Evidence-based home visiting is an important strategy in this more comprehensive approach by connecting families with children aged birth to three with services and resources that support healthy growth and development and foster positive connections between children and parents. While evidence-based home visiting may not be suitable for every family, we know that these programs are an integral piece of a comprehensive early childhood system that supports children to ensure they have a healthy start and are ready to learn.

 

DOH and providers have invested heavily in building these programs and it is critical that we do all that we can to reach parents with these resources. Collectively, we must think about the opportunities we have to link families with evidence-based home visiting. To address recruitment and retention challenges of families and staff, we must think about how families obtain services: Where are the entry points? How do we make connections? How do we follow-up? How do we determine if we are giving families the most appropriate resource? These are systems-level questions and cannot and should not be limited to single programs at single agencies.  

 

Sustainability for Home Visiting

Home visiting services have been available in the District for many years. Currently, federal grants are the primary source of the DOH home visiting funding. The MIECHV grants have two parts — a formula grant and a competitive grant. At the end of FY16, the MIECHV Development grant will end, and the number of available slots will decrease from 350 to 170 families.[9]

 

Last year we testified that we have an opportunity to think creatively and innovatively about financing home visiting services. We are happy to report that the Department of Health has joined with the Department of Health Care Finance to participate in a national learning collaborative focused on Medicaid funding for home visiting. DHCF is the lead organization on this initiative, and they have included other partners including a provider representative and DC Action as the advocate representative. Additionally, the Medicaid managed care organizations (MCO’s) have attended Home Visiting Council meetings to learn more about evidence-based home visiting. We have heard reports that MCO’s are now referring families to evidence-based home visiting programs. This kind of coordination and partnership is a necessary part of a comprehensive system that supports linkage to care and connects children and families with ongoing support.

 

Thank you for the opportunity to testify today. I am happy to answer any questions that you may have.

 

 

[1] Data via DC KIDS COUNT; Child Population by Age Group; Source: US Census Bureau. Accessed at: http://datacenter.kidscount.org/data/tables/101-child-population-by-age-group?loc=10&loct=3#detailed/3/any/false/869,36,15,14/6…

[2]U.S. Census Bureau, 2014 American Community Survey 1-Year Estimates; Age by Ratio of Income to Poverty Level in the Past 12 Months Accessed at: http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_14_1YR_B17024&prodType=table

[7] Community Health Administration, DC Department of Health. (2016). Department of Healthy FY 2015 Performance Oversight Responses, Question 11.

[8] Community Health Administration, DC Department of Health. (2016). Department of Healthy FY 2015 Performance Oversight Responses, Question 11.

[9] Community Health Administration, DC Department of Health. (2016). Department of Healthy FY 2015 Performance Oversight Responses, Question 11.

 

[i]  While providers can make some adaptations to accommodate certain family needs, an evidence-based home visiting looks very similar across the country.

 

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