Testimony to the DC Council on Home Visiting Programs by Nisa Hussain, Early Childhood Program Associate
DC Action supports maintaining level funding in the FY 2021 budget for DC Health and the Department of Behavioral Health’s (DBH) critical early childhood health, mental health, and home visiting programs at this important time in the District’s history. While the country navigates the health and financial impacts of the COVID-19 pandemic and reaches a key moment of reckoning with our country’s racist history, policies, and structures, we must ensure that family supports retain the funding that allows them to serve families.
1. Home visiting is an important support for DC families
Home visiting programs comprehensively support families to meet their goals, help them address the urgent needs emerging in the wake of the pandemic, and work with them to navigate the gaps in our current structures. As the District and the nation navigate a public health emergency and the legacy of anti-Black racism, home visiting programs are an opportunity for the District to provide families with support navigating the structures that are built to exclude Black and brown families.
Home visiting is an effective, evidence-based strategy for supporting families from pregnancy through the first few years of a child’s life. These early years are critical for a child’s cognitive, emotional, and social development. Home visiting programs help families create a nurturing foundation for children. Studies continue to show that these programs can lead to an improvement in birth outcomes, child health and development, school readiness, and reduced rates of child neglect and abuse.
Home visiting benefits not only the child, but also the entire family. Home visitors work with parents to help them to reach their goals for their family and develop their parenting skills. It is essential for parents to feel confident in their ability to care for their children, particularly during these moments of crisis. Having a trusted home visitor on their side, with whom a long-term relationship has been established, parents are able to build that confidence.
Home visiting is an integral part of the early childhood system and an opportunity to weave together the coexisting health, early education, and child welfare systems that impact the lives of DC’s families. The District’s goals to eliminate health inequities and improve poor health outcomes align well with the preventative strategy implemented by most evidence-based home visiting models. Home visiting is uniquely positioned to connect families with the important health systems - with an emphasis on positive family, maternal, and child health outcomes - that might otherwise face challenges reaching them.
DC Health-funded programs support the families most likely to experience a wide range of challenges and barriers, including those described above. While most home visiting models are flexible in their approach, some programs are structured to meet the needs of populations with specific challenges, experiences, or concerns. For example, Georgetown University’s Parenting Support Program is the primary home visiting program that supports caretakers with intellectual or associated disabilities. Similarly, programs like those implemented by Mamatoto Village, Community of Hope, and Mary’s Center are tailored to reach families with particular needs and experiences. This dedicated focus on the populations that benefit from tailored support must continue. We look forward to the release of Georgetown University Center for Child and Human Development’s updated needs assessment for the District, which DC Health commissioned in compliance with federal Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) requirements. This report, due to be released in October, will help DC Health and other agencies more deeply understand the populations that could best be served by home visiting programs in the District.
2. Home visitors are a lifeline for families during COVID-19
The public health emergency has exposed families all over the District to a range of financial, physical, and mental health challenges. As in-person services have become less accessible, home visitors are playing a critical role in connecting families with community resources such as student meal sites, food pantries, diaper banks, child care, and health services. Home visitors are also exceeding their duties to safely deliver basic and urgent supplies like food, diapers, and cleaning supplies to families and some programs are using emergency funds to provide these deliveries.
Beyond meeting the basic needs of families navigating this public health emergency, home visitors can help manage the compounded stress that parents, expecting parents, and their children may experience during this time. They have quickly adapted to virtual visits to continue serving their families. By continuing to focus on the parent-child relationship, providers support the parents to meet the child’s needs around education, health, and development. While some attention during these visits are shifted to the urgent needs of the family, some visits may focus on the regular needs of the family too. During this pandemic, there are still parents expecting and children that need to be cared for, and home visitors make sure they are not forgotten.
While the pandemic has impacted all District residents, some families are dealing with heightened levels of stress. As a result, more parents are likely to need and want additional support now and as the impact of the pandemic reverberates in their lives in the time ahead. Fortunately, home visiting providers are well-positioned to help families cope with these changes and are trained to manage moments of crisis. The challenges families are facing now, either caused or exacerbated by the pandemic, are urgent. Home visitors have the expertise and experience to support families in working through a variety of challenges, from domestic violence to the impacts of social isolation to food insecurity.
More than ever, families need the extra support of a home visitor on their side. Programs must remain funded so these critical services can continue during this already challenging time for DC families.
3. Home visiting programs support the families excluded by racist systems
From housing to education to policing, our current systems are not built to support all families’ ability to be safe, prepare their children for school, and achieve economic stability. When these systems fail, they drive gaps in economic advancement and other outcomes based on race. As we work to restructure these systems to serve all residents justly, programs like home visiting are an important strategy for ensuring families are able to navigate the existing supports to meet their needs. These programs, which in DC primarily serve Black and Brown families, empower families to navigate critical services for their own success.
Systemic racism creates barriers in access to health care, affordable housing, environmental and neighborhood safety, and food security, and has consequences for the health outcomes of Black and Brown residents. Home visiting is one of the many needed investments in eliminating racial maternal and child health disparities. Studies find that home visiting is an intervention that can help to reduce maternal and infant mortality and shows positive maternal mental and physical health behaviors. While it is not a stand-alone solution to systemic racism, home visiting offers meaningful, strength-based support for families facing disproportionate barriers to positive health outcomes.
To best meet the needs of families, home visiting must be part of a strong, coordinated system of health, mental health, safety, education, and economic supports for families, including the valuable programs that DC Health and the Department of Behavioral Health implement. We must preserve these programs in the FY 2021 budget, so that families can continue to receive the assistance they need to achieve their goals and help their children thrive. These include:
Help Me Grow, a free information and referral helpline operated by DC Health, links callers to services and resources for expecting parents and families with children ages five and under. This program helps families locate services such as prenatal and child development screenings, and links families to evidence-based services like home visiting. Especially now, families in the District rely on services they can use at a safe distance to gain access to the crucial supports they need. This program reduces the burden for parents navigating the network of resources and offers a well-organized system families can access. We ask for maintained funding for Help Me Grow to continue assisting families and expecting parents access important health services.
Healthy Futures, an evidence-based, early childhood mental health consultation program of the Department of Behavioral, provides in-classroom support to childcare providers. Healthy Futures mental health consultants then work with families to identify when their child might be at risk of — or display signs and symptoms of — social, emotional, or other mental health problems. This program helps improve classroom climate, enhance teacher-classroom management skills, reduce child behavioral problems, and lower expulsion rates. Healthy Futures currently operates in 61 child development centers and family child care homes. It is critical--as child care operators emphasize the need for mental health supports for families and teachers alike in the wake of COVID-19--that this program continues to support families.
Healthy Steps, an evidence-based program that promotes the health, well-being, and school readiness of infants and toddlers, integrates an early childhood specialist into every child’s care team to support families at well visits. Well-child visits are an important opportunity to ensure that families are equipped to address children’s needs. Developmental specialists can help families work through common and complex concerns that physicians often do not have time to address, such as feeding, behavior, sleep, attachment, and social determinants of health. This specialist provides resources, referrals, screenings and guidance to support the child’s health and development, and to help mothers experiencing postpartum anxiety or depression. There are currently two Healthy Steps sites in DC, both located in Ward 8, which have served more than 1,700 children and families since the program launched in 2017. We urge the Council to continue funding these programs in FY 2021.
In addition to early childhood home visiting and health programs, we urge the District to take action to correct structures that disadvantage and exclude and oppress Black and Brown families, including housing, policing, food insecurity, and more. My testimony is focused on specific early childhood supports, but it is critical to understand these programs sit within the broader context of structural racism’s impact on DC families.
Now is the time for the District to responsibly use more of our rainy day funds, and to raise revenue from our wealthiest residents and most successful businesses that have benefited from significant federal tax breaks in recent years. Particularly in a recession, every drop of revenue is precious, and we shouldn’t leave needed resources on the table when doing so could help create a more just and resilient future for the city. That is why we support the revenue strategies being proposed by the Fair Budget Coalition in a community sign on letter.
Any cuts to DC Health and DBH’s important early childhood services would be detrimental to the many families who rely on them. These programs are an integral part of DC’s early childhood system and contribute to a District-wide strategy for improving early childhood outcomes and ensuring that families’ basic needs are met.