Council Testimony: DC Health Performance Oversight Hearing, FY 2018-2019
Testimony of Ruqiyyah Abu-Anbar
Director of Early Childhood Policy and Programs
DC Action for Children
Agency Performance Oversight Hearing
Fiscal Year 2018-2019
Department of Health
Before the Committee on Health
Council of the District of Columbia
February 8, 2019
Good morning, Councilmember Gray and members of the Committee on Health. Thank you for the opportunity to address the Council as it reviews the Department of Health’s performance in the past year. My name is Ruqiyyah Abu-Anbar, and I am Director of Early Childhood Policy and Programs 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 part of the Birth-to-Three Policy Alliance which is committed to transforming how DC invests in infants, toddlers, and families starting prenatally through age three. Alongside our Policy Alliance partners, we applauded the Council’s unanimous passage of the Birth-to-Three for All Act last year and look forward to working with you to ensure full funding for that program.
DC Action for Children also serves on the DC Home Visiting 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 leadership and partnership of the Department of Health’s (DC Health) staff on the Home Visiting Council and their commitment to promoting maternal, child and family health through evidence-based home visiting services.
This is an important time for DC’s young children, pregnant women and their families. DC is growing rapidly, and more and more young children are calling DC home: currently, 45,000 children under age five live in the District. In 2016, the District saw 9,858 births across the city. With such a large and growing population of children, it is crucial that DC is an excellent place to parent and a great place to be a kid. The research is clear 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.
In DC in FY 2018, 12 organizations implemented 15 home visiting programs that, in total, had the capacity to serve about 850 children and families. Almost one quarter of these families were served by DC Health home visiting programs. During this time, DC Health supported two evidence-based Healthy Families America and Parents as Teachers programs using federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program funding. DC Health also used local home visiting funding to support expansions of these programs, to fill gaps in MIECHV funding, and to support place-based initiatives.
My testimony today will focus on DC Health’s efforts to support pregnant women, young children and their families, with particular attention to three key points:
- Home visiting is a powerful strategy that can provide unparalleled support to pregnant people and the families of young children
- DC Health is carrying out commendable, collaborative work with the HV Council to strengthen home visiting in DC
- The newly released HV Council 2018 Annual Report identifies several opportunities home visiting stakeholders, including DC Health, should consider as they continue to implement and develop home visiting programs
Home visiting is an important strategy to support DC’s growing number of young children and their families.
Early childhood home visiting is a unique family support strategy that provides education, parenting techniques and resources to pregnant women and families with young children ages 0 to 5, primarily in the home. In these evidence-based programs, trained home visitors work 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. These programs are especially valuable because they allow providers to establish trusting relationships with participants that enable them to better understand and address family needs.
We applaud DC Health for its leadership and collaboration on the DC Home Visiting Council.
As a key agency implementing home visiting programs in the District, DC Health is a critical member of the Home Visiting Council. We are pleased that DC Health is working collaboratively with other Home Visiting Council members to carry out portions of Birth-to-Three for All DC. The HV Council’s c-intake subcommittee, which includes DC Health, is engaged in a thoughtful and intensive process of developing a centralized, coordinated intake system for home visiting through Help Me Grow, as mandated by the law. The intention of this process is to better meet families’ needs by improving their access to home visiting services across the District; helping them identify their best fit program, if home visiting is right for them; reducing the burden of enrolling in programming; and making it easier for programs to make referrals to home visiting and other appropriate services. At the conclusion of the collaborative development process for this system, DC Health will launch a pilot intake system. The HV Council will work with DC Health to assess the effectiveness of this pilot in meeting its goals and identify improvements, as needed.
This collaboration is an example of how DC agencies can work with community stakeholders to develop thoughtful programs and services centered on the needs of families. We look forward to sharing the results of this work as it continues.
The DC Home Visiting Council’s 2018 Annual Report highlights critical opportunities for the District as it continues to develop and implement home visiting programs.
This week, the HV Council released its 2018 Annual Report. This report:
- Provides updates on the landscape of home visiting, including data collected from home visiting programs and analysis of policy and funding changes;
- Highlights challenges to implementing and coordinating home visiting in the District, opportunities for improvement, and system strengths; and
- Presents the current work of the HV Council to address the collective needs of home visiting programs, the providers who staff them, and the families who could most benefit from them.
The report identifies three key opportunities for DC home visiting stakeholders, including government agencies:
- Develop a coordinated, District-wide approach to supporting families through home visiting.
A shared vision and a coordinated plan for family-centered implementation would strengthen home visiting services and improve the sustainability of home visiting as a strategy within the District’s early childhood system. The District invests in a diverse array of programs to support young children and their families. Three agencies - CFSA, DC Health, and OSSE – have developed guiding documents to serve as frameworks for meeting the needs of DC children and families based on their priorities. These are the District of Columbia Early Childhood Systems Approach, developed by OSSE and DC’s State Early Childhood Development Coordinating Council (SECDCC); DC Health’s Perinatal Health Framework; and CFSA’s Four Pillars.,, While each guiding document is unique, home visiting is relevant to all of them. Collaboration around home visiting is an opportunity to coordinate these frameworks and their implementation to best serve families according to need and preference.
Specifically, DC agencies are well-positioned to develop a shared home visiting implementation approach based on this vision. This approach might include shared data elements and performance metrics, and 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.” The c-intake subcommittee of the HV Council, which includes DC Health, CFSA, the Department of Health Care Finance, the Department of Behavioral Health, and other non-governmental members, is currently doing a portion of the latter piece of this work. To best serve families, agencies should build on this collaboration to fully develop a District-wide approach to home visiting.
- Identify opportunities to strengthen and support the home visiting workforce
Home visitors are a talented workforce of individuals who must demonstrate a diverse set of skills and aptitudes to best serve families. However, home visiting programs continue to experience high rates of staff turnover that can negatively impact family retention. While high turnover is common in human services jobs, we must better understand the unique factors that contribute to these rates amongst home visitors. B-3 for All DC requires DC Health to conduct a home visitor workforce study to inform efforts to retain these critical family support workers. We look forward to the results of this study. Additionally, the HV Council recently completed a survey of providers to better understand their experiences and best advocate for their needs. The HV Council will share the results of this survey, along with findings from upcoming home visitor focus groups, in a report to be released in Summer 2019.
- Center the needs and preferences of families
No one better understands the needs of DC families than families themselves. To achieve the results we seek, the District must develop strategies to source this knowledge, and use it to guide program development, implementation, and referrals.
We are grateful for the Department of Health’s partnership and consistent dedication to reducing disparities and improving the health and quality of life of all DC residents, including pregnant women, children and their families. We look forward to the agency’s work to implement Birth-to-Three for All DC in upcoming years. Thank you again for the opportunity to testify. I am happy to answer any questions you may have.
 Population Division, U.S. Census Bureau. Retrieved from https://datacenter.kidscount.org/data/tables/101-child-population-by-age-group?loc=10&loct=3#detailed/3/any/false/871,870,573,8…
 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…
 Testimony of Natalie Craver, Program Manager of Community Partnerships, DC Child and Family Services Agency, at the DC Council Public Roundtable: The Status of Home Visiting in the District (November 2018). http://lims.dccouncil.us/ Download/41468/HR22-0163-HearingRecord.pdf
 District of Columbia Department of Health Perinatal Health and Infant Mortality Report, April,2018. Retrieved from https:// dchealth.dc.gov/sites/default/files/dc/sites/doh/service_content/attachments/DC%20Health%20Perinatal%20Health%20 %26%20Infant%20Mortality%20Report_FINAL.PDF