Budget Hearing Testimony of Nisa Hussain, Program Manager of Early Childhood, before the Committee on Health

Testimony of Nisa Hussain

Program Manager of Early Childhood, DC Action

DC Council Committee on Health: Budget Oversight Hearing

Good morning Chairwoman Henderson and members of the Committee on Health. Thank you for the opportunity to address the Council as it conducts this budget oversight hearing for the Department of Health. My name is Nisa Hussain and I am the Early Childhood Program Manager for DC Action, Chair of the DC Home Visiting Council, member of the Under 3 DC Coalition, member of the Fair Budget Coalition, and Ward 1 resident. 

DC Action uses research, data, and a racial equity lens to break down barriers that stand in the way of all kids reaching their full potential. Our collaborative advocacy initiatives bring the power of young people and all residents to raise their voices to create change. Through our signature coalitions, Under 3 DC and the DC Home Visiting Council, we empower families and communities. We are also the home of DC KIDS COUNT, an online resource that tracks key indicators of child and youth well-being. 

Today, my remarks will focus on home visiting and DC Health’s early childhood home visiting programs, which the agency both funds directly and through MIECHV funding. Specifically, DC Health administers the Healthy Families America, Parents as Teachers, and Nurse Family Partnership programs at Mary’s Center, the Mothers Rising program at Mamatoto Village, the Healthy Families America program at Community of Hope, and the Parenting Support Program at Georgetown University. DC Health also receives some funding from CFSA for the administration of the Parents as Teachers program at Mary’s Center, which I will address in my testimony at the CFSA budget hearing. 

I would like to focus my testimony on the importance of deeper investments in home visiting programs in the FY24 proposed budget and ask for an increase of $1.2 million to the current home visiting grants at DC Health. This $1.2 million accounts for the $700,000 enhancement we are seeking for programs to raise home visitor wages and adjust for inflation, and for the $500,000 we are seeking to restore from the cuts to Mary's Center’s Healthy Families America program funding in FY23. 

We are grateful for Chairperson Henderson’s and the rest of DC Council’s past support of home visiting programs over the years. We are also grateful for DC Health’s continued partnership on the Home Visiting Council. We hope that the DC Council, the Mayor’s administration, and the agencies can all work together to ensure home visiting programs receive sufficient funding to continue upholding these critical programs that support families in the District. 

Home visiting is a preventative, two-generation early childhood strategy. 

Home visiting is an evidence-based service delivery strategy that supports expectant parents, new parents, and families with young children. The service pairs a family with a trained professional or home visitor to assess the family’s needs, guide them towards their goals, and offer resources for a healthy pregnancy or safe environment for a young child’s development. These services use a two-generation model and a holistic, public health approach to support the entire family and ultimately, the rest of the family’s community. Research has shown home visiting to reduce child abuse and neglect, improve maternal and child health outcomes, increase school readiness, and improve family economic self-sufficency. Home visiting programs in DC focus on families with low-incomes and many participants also face several risk factors. 

In particular, DC Health home visiting programs serve populations with specific challenges. For example, Georgetown University’s Parenting Support Programs focuses on caretakers with intellectual disabilities. Mamatoto Village’s Mothers Rising program provides expectant individuals with wraparound care and services during the perinatal period, focusing on Black mothers who are Medicaid-eligible. Mary’s Center’s Healthy Families America program supports pregnant and postpartum families identified with high social or medical risks. Community of Hope’s Parents as Teachers program provides family-well being services and offers referrals for migrant patients in DC who need prenatal care at their center. 

In 2022, DC’s 17 home visiting programs served a total of 1,374 families and out of that total, DC Health-funded health programs served 768 of those families. These are programs that allocate time, attention, and care for families that are navigating challenge after challenge. Home visiting is a unique, effective service that reaches the District’s families that want and need the extra support the most in their parenting journey. 

If the District wants to reach families, connect them to the network of services they may benefit from, and provide them care during the critical years of pregnancy and early childhood, then home visiting is a tried and tested approach to utilize. 

Home visiting programs face the risk of losing a dedicated workforce of home visitors. 

Home visitors work hard to guide expectant parents and families towards self-sufficiency and stability. They take time to get to know the families they work with, build a level of trust, and offer tailored support to the family to reach their goals. Whether it involves delivering basic supplies like diapers or food, walking them through rental assistance and paperwork, providing educational resources for the young children, or coaching them through positive parenting practices–home visitors are committed to the families they work with. 

However, home visitors in DC have been leaving the workforce for higher paying jobs and as a result, services to those families are disrupted. 

The average salary for DC home visitors is $44,000. Despite the fact that the DC home visiting workforce is highly educated, with 80% holding a bachelor's degree or higher, the low pay prevents many home visitors from being able to afford to live in the communities where they work. Some home visitors are forced to take on a second job. As is the case with similar industries, the home visiting workforce is also made up of primarily women and people of color. These roles are often underpaid, despite the critical labor they provide for the community. 

When home visitors are forced to quit their roles to find higher-paying jobs to support their own families, the meaningful relationships they build with participants are cut short. Additionally, when a home visitor leaves, either the program cannot operate at peak capacity without full staff or the remaining home visitors are overburdened with increased workloads to fill in the gaps. 

Home visiting programs need additional funding to raise home visitor salaries to address turnover. Home visitors deserve the recognition and pay for the invaluable services they provide. Without a strong, compensated workforce, programs are unable to serve at the best of their ability and families will be the ones who feel those impacts. 

Long-term investments will stabilize the home visiting field and allow programs to sustainably support families over time 

Home visiting is one of several key strategies to support the District’s efforts to produce positive health outcomes. While home visiting may not be the one single solution for every family, it can be one of many effective approaches within a robust system of care to support families during the perinatal, postpartum, and early childhood period of time. Families, especially families dealing with compounded challenges and risk factors, deserve the option to choose from support that meets them where they are at. Home visiting is uniquely positioned to support families in a holistic and individualized way. And due to the trusted relationships that home visitors build with the families, they are able to successfully connect these families to other vital health services and community-based supports the District offers. 

However, home visiting programs cannot continue to provide the highest quality care and reach as many families as they need to if they are underfunded, short-staffed, and underinvested in.  

Home visiting programs need more funding to address the risk of losing valuable staff and lowering participant retention. Home visitors deserve higher wages to be able to afford to live in the District and continue working in the roles they love to do without needing a second job. Families deserve uninterrupted, quality home visiting services. Additionally, home visiting grants have remained at flat funding since 2019 and need to be adjusted for inflation, which has risen exponentially in recent years. Programs have been working hard since the start of the pandemic to meet the needs and resources of families who have been hit hard over the past three years. An increase of $700,000 would enable programs to raise home visitor salaries and catch up with inflation rates. Additionally, we are seeking $500,000 to restore the local funds that were cut in FY23. This $1.2 million increase will stabilize the local home visiting programs and allow them to address these current workforce challenges. 

Additionally, we would like to ask for continued support for Mary’s Center’s Nurse-Family Partnership program for First-Time Mothers. We would like clarification around the program’s funding in the FY24 budget, since we did not see renewal listed for this grant. If it has been cut, we request the $150,000 to be restored. DC Health’s Perinatal and Infant Health division names home visiting as the primary approach to reducing infant mortality and perinatal health disparities, so we hope that this program can be restored. 

As mentioned at the hearings for the Department of Health Care Finance, we are also seeking support for Medicaid reimbursement as a funding mechanism for home visiting programs. Leveraging Medicaid to fund home visiting programs is a cost-effective, coordinated strategy to support pregnant families who are already enrolled in Medicaid or managed care. If coverage and reimbursement can be established to fund evidence-based home visiting programs, DC has the option to ensure home visiting programs have sustained funding for the long-term. 

With deeper investments in the FY24 budget and the possibility to expand streams of funding by leveraging Medicaid dollars, DC has the option to stabilize the home visiting field and create a stronger, more sustainable funding structure. 

Despite the demonstrated positive outcomes of home visiting, the workforce continues to struggle to receive adequate investments in their programs. The yearly effort to tirelessly advocate for modest funding increases takes time and effort from the dedicated home visiting teams, programs, and families who share their experiences at public hearings. We are hopeful that in this budget season, the District will prioritize these critical services as they examine the bigger picture and what it means to support our families and youngest residents to thrive. If we want to see positive family outcomes, we need to invest for the long-term. With a stronger, stabilized home visiting workforce and industry, the District has a chance to work towards that vision.