Testimony of Shana Bartley, DOH Performance Oversight Hearing, FY 2016-2017

Testimony of Shana Bartley, Acting Executive Director

DC Action for Children

 

Agency Performance Oversight Hearing

Fiscal Year 2016-2017

Department of Health 

Before the Committee on Health

Council of the District of Columbia

February 17, 2017

 

Good afternoon, 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 Shana Bartley, and I am Acting Executive Director at DC Action for Children (DC Action).

 

DC Action provides data-based analysis and policy leadership on critical issues facing DC children and youth. We are also the home of DC KIDS COUNT, an online resource accessible to policymakers and community members alike that tracks key indicators of child well-being in the District.

 

DC Action for Children also 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. We are grateful for the leadership and partnership of the Department of Health’s (DOH) staff on the Home Visiting Council and their commitment to promoting child and family health through evidence-based home visiting services.

 

My testimony today will focus on DOH’s efforts to support young children and their families through early childhood home visiting, calling attention to three key points:

 

  1. Home visiting is an important strategy to support DC’s growing number of young children and their families;
  2.  

Federal home visiting funding structures have evolved and could be vulnerable in the future; and

  1.  

A coordinated early childhood data system would propel DC’s integrated systems to better serve young children and their families.

 

#1: Home visiting is an important strategy to support DC’s growing number of young children and their families.

 

When thinking about the future of our city, we must think about investments in our youngest residents. Not only is DC growing rapidly, it is also trending younger: 47,300 children under the age of 6 call DC home.[1] In 2014, this included 9,500 births across the city.[2] It is well-established that children reach crucial developmental milestones between birth and age 5, milestones that are influenced dramatically by a family’s access to resources. In a city where over 23% of children under 5 live below the poverty level, home visiting and other family supports are especially relevant to reducing disparities.[3]

 

As a family support strategy, early childhood home visiting provides education, parenting techniques and resources to families with young children. 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. From an economic perspective, home visiting is especially noteworthy because, as an upstream early intervention, engagement with home visiting programs can preempt the need for costlier, more intensive remedial services such as special education and child protective services that a child may otherwise require later in life. Research also indicates that home visiting can also be linked to reduced crime and health care costs.[4] In addition to being cost-effective, home visiting programs facilitate early access to families who are traditionally difficult to reach and establish strong rapport with.

 

#2: Federal home visiting funding structures have evolved and could be vulnerable in the future.

 

As an agency, DOH directs funding towards home visiting programs that focus specifically on improving maternal and child health outcomes. As such, it has historically funded the Parents as Teachers (PAT), Healthy Families America (HFA) and Home Instruction for Parents of Preschool Youngsters (HIPPY) program models. To support this work, DOH receives federal funding from Health Resources and Services Administration (HRSA) through the Maternal and Infant Early Childhood Home Visiting (MIECHV) program, a federal program that supports evidence-based early childhood home visiting programs and promising new approaches nation-wide. DOH began receiving MIECHV funding in fiscal year 2010 and is currently receiving a grant award of $1,624,146 to provide program funding over two and a half years through September 2018. However, it is unclear if and how MIECHV funding might change under the new administration.[5]

 

DOH also receives federal funding for Healthy Start, a maternal and child health program that provides case management and home visiting to improve perinatal and infant mortality disparities. It is important to note that DOH transformed the District’s Healthy Start program for fiscal year 2016 from a direct service model implemented by the agency to one that community-based model that contracted out. In addition to this change in model, the new iteration of Healthy Start no longer uses federal funds to implement home visiting services. Instead, local dollars are currently being leveraged so that Healthy Start providers can integrate home visiting into their programs. As such, it is worthwhile to consider alternative approaches to funding home visiting through Healthy Start that are more sustainable moving forward.

 

Additional funding flags should be examined when interpreting home visiting as an integrated piece of a District-wide early childhood system, including a national cut of the MIECHV development grant, with funding terminated at the end of fiscal year 2016. DOH responded by narrowing its home visiting target population focus to infants and toddlers specifically. Though this was a well-reasoned and appropriate response to such a funding cut given that the District has universal pre-K for 3 and 4 year olds, the funding shift is not without repercussions. HIPPY, a home visiting program model that serves young children ages 3-5 and their transition into the school environment, lost all public funding sources. In order to fulfill the District’s commitment to strengthening the early care and education system so that children are prepared to succeed in school and beyond, it is important to support families at each transitional stage of early childhood.

 

#3: A coordinated early childhood data system would propel DC’s integrated systems to better serve young children and their families.

 

Though DC Action supports a wide array of programs that seek to affect positive change across a diverse set of outcomes, stakeholders must remember that no child exists in a vacuum, and as such neither should the programs that serve them. Rather, their ability to grow up healthy and ready to learn is affected by their family and community environment and resources. To be most effective as a District-wide family-support strategy, we must be intentional so that home visiting programs are accessible to families with children demonstrating a wide variety of risk. Outreach and recruitment is a crucial component necessary to achieve this accessibility. We are pleased to see that DOH has invested in the Help Me Grow model. We would like to hear more from the agency about how it will use this tool to link families to critical supports including early childhood home visiting.

 

The integration and coordination-minded work should not stop at Help Me Grow; rather, we ask DOH and other agencies working to support all DC children to consider the benefits of a coordinated early childhood data system that tracks child-level data pertaining to early care and education, health and developmental screenings and home visiting. When working at a systems level to most impactfully and sustainably serve young children and their families, a common language made possible by a coordinated data system will allow those working in government, advocacy, research, school systems, healthcare, home visiting, and early care and education alike to track progress and communicate. Out of such data-driven communication, stakeholders will be best equipped with the knowledge to understand DC children and family’s needs and the capacity the city has to serve them. Ultimately, a coordinated early childhood data system has the potential to promote a stronger early childhood program quality and improve child outcomes.[6]

 

We urge this Committee on Health and the Committees on Education and Human Services to consider building upon the work that has already been established with the Student Longitudinal Data System (SLED) that tracks student-level education data, PreK-12, by integrating a coordinated early childhood data system. In establishing a coordinated early childhood data system, DC would join the company of states such as Illinois, Washington, Pennsylvania, Vermont, Iowa and Utah, among others.[7] We believe that the system should be placed where it is easily accessible for all of the agencies and programs serving young children. The data system should build upon cross-agency data-sharing agreements and ultimately link to SLED with unique identifiers for individual children.

 

­­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 young children and their families. Thank you again for the opportunity to testify. I am happy to answer any questions you may have.

 

[1] U.S. Census Bureau. (2016). Children Characteristics, 2011-2015 American Community Survey 5-Year Estimates: District of Columbia. Retrieved from https://factfinder.census.gov/bkmk/table/1.0/en/ACS/15_5YR/S0901/0400000US11.

[3] U.S. Census Bureau. (2016). Children Characteristics, 2011-2015 American Community Survey 5-Year Estimates: District of Columbia. Retrieved from https://factfinder.census.gov/bkmk/table/1.0/en/ACS/15_5YR/S0901/0400000US11.

[4] Karoly, L, et al. (2005). Early Childhood Interventions: Proven Results, Future Promise. RAND Corporation. Santa Monica, California. Retrieved from http://www.rand.org/pubs/monographs/MG341.html

[5] FY16 CHA Oversight Responses

[7] Zero to Three: Data Systems in Early Childhood Systems. Accessed at: https://www.zerotothree.org/resources/1638-data-systems-in-early-childhood-systems

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