Testimony of Nisa Hussain
Early Childhood Program Manager at DC Action
Department of Health
Committee on Health: Agency Performance Oversight Hearing
Fiscal Year 2023
Council of the District of Columbia
March 2, 2023
Good afternoon, Chairperson Henderson and members of the Committee on Health. Thank you for the opportunity to address the Committee as it reviews DC Health’s performance and thank you Chairperson Henderson for your ongoing support for DC families. I am Nisa Hussain, Early Childhood Program Manager for DC Action, chair of the DC Home Visiting Council, member of the Under 3 DC 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. We are also the home of DC KIDS COUNT, an online resource that tracks key indicators of child and youth well-being.
DC Action and the Home Visiting Council appreciate the DC Council’s past support for home visiting programs. We are also grateful for DC Health’s partnership in the Home Visiting Council this past year. DC Health has led the Home Visiting Council’s work to develop a coordinated, centralized intake system for home visiting through Help Me Grow. This has been a collaborative process and we look forward to continuing this shared effort.
Today, my remarks will focus on the critical role of the Department of Health’s early childhood home visiting programs, which the agency both funds directly and through MIECHV funding. For context, DC Health directly funds the following programs:
- Mary’s Center’s Nurse-Family Partnership Program
- Mary’s Center’s Healthy Families America Program
- Georgetown University’s Parenting Support Program
- Community of Hope’s Parents as Teachers Program
- Mamatoto Village: Perinatal Health Worker Training Program.
DC Health also receives transferred funding from CFSA to administer Mary’s Center’s Parents as Teachers program.
My testimony focuses on the lasting impacts home visiting programs have on District families and the need for increased funding to these services, so that programs can perform at their optimal level for families.
Home visiting is an effective public health approach to supporting the health and well-being of children, expectant parents, and families.
Home visiting is a valuable, evidence-based strategy that has long been used to improve the health and well-being of young children under five, expectant parents, and families, especially families with lower incomes or multiple risk factors. Home visiting programs work with families to connect them to resources, evaluate their strengths and needs, and guide them towards their individual goals. Studies have shown home visiting can lead to positive maternal and child health outcomes like improvements in school readiness, healthy birth outcomes, reductions in child maltreatment, and family economic security.
These services also support families during an extremely critical time, since participants are expectant parents and families with children 5 and under. A child’s brain develops rapidly during the first five years of life and the positive or negative experiences in those years determine the child’s cognitive, emotional, and physical development as an adult. Home visiting supports the caregiver in providing their child with positive experiences (e.g., using positive parenting practices, nurturing the child’s access to books and play, and creating a safe environment) and minimizing negative experiences (e.g., unstable housing, stressors that lead to child abuse and neglect, exposure to domestic violence). This approach prioritizes prevention and ensures DC’s youngest residents are set up for a thriving future.
Home visiting uses a two-generation approach of addressing the needs of parents and children simultaneously to ensure the whole family benefits and succeeds. When a parent is less stressed and more confident in their parenting skills, their children can receive the care they need to meet their highest potential and healthiest outcomes. Home visitors are the extra support in the parent’s corner, cheering them on towards their goals and helping them alleviate the challenges that come their way in the parenting journey.
All parents need that extra support during the parenting journey, but some families face additional barriers that make caregiving even more challenging. DC home visiting programs serve primarily Black and brown families who must navigate the consequences of systemic racism and the barriers it creates around affordable housing, access to health care, and more. DC Health-funded programs also serve populations with specific needs, such as immigrant families seeking Spanish-speaking services or families experiencing homelessness. For example, Georgetown University’s Parenting Support Program is the primary home visiting program that supports caretakers with intellectual or developmental disabilities. Mary’s Center, Community of Hope, and Mamatoto Village all administer programs that provide individualized support to families facing their own specific challenges and were able to serve __ families total in 2022.
As home visiting clearly plays a critical role in the District’s early childhood strategy, home visiting programs face several challenges that can be addressed with increased investment. Our primary challenges include the low pay that is driving home visitors out of the workforce and the stagnant funding that hasn't increased in years. We are seeking a $700,000 increase to local home visiting grants in FY24 to resolve these current issues. We are also seeking to reduce the high administrative burden that home visitors face in their roles.
We recommend increasing home visitor salaries to reduce turnover, avoid interrupted services to families, and lessen the burden on programs operating without full staff.
Home visitors are educated, committed, and passionate about the role they play in families’ lives. Similar to child care teachers, home visitors are some of the most dedicated, yet underpaid, professionals working with DC’s families and children. As highlighted in the Voices from the Field Report, home visitors also report an emotional toll dealing with difficult scenarios with families and face a heavy workload. Despite the important role they play in the community and the challenges that come with it, home visitors' salaries do not reflect this valuable work and as a result, are leaving the workforce in pursuit of higher paying jobs. In 2021, the Home Visiting Council’s survey data revealed the average salary for a DC home visitor was around $44,000. In 2022, the majority of programs reported experiencing challenges retaining and hiring staff. Not only is it a glaring issue that some home visitors cannot afford to live in the DC communities they work in, but it also has real impacts on the families they work with. As mentioned, home visiting relies on long-term relationships with families to achieve success. When a home visitor leaves their role, this disrupts the services for the families they work with and have built trust with over time. This also leads to a stressful scenario for the remaining home visitors in the program to fill in the gaps of care to families in the meantime as they wait for those roles to be filled after the hiring and training process. Increasing investments so programs can increase home visitor compensation will preserve the workforce and avoid these consequential challenges for the workers and the families alike. The Home Visiting Council released a Policy Recommendations Brief that further outlines several approaches to raise wages for the workforce.
Additionally, we recommend that DC Health collaborates with the Home Visiting Council’s programs to streamline data reporting requirements and collectively identify a way to reduce the administrative burden on home visitors. Home visitors have expressed frustration with the inordinate time spent submitting duplicative data into multiple database systems that takes away the time spent on relationship building with families. Addressing this issue can alleviate some stressors for the home visitor’s workload and ensure families still receive meaningful, high-quality visits with their home visitor.
We also recommend an overall increase to local home visiting programs to adjust for inflation and stagnant grant amounts, enabling programs to support the higher demand for services and supplies from families during this pandemic and economic recovery.
The COVID-19 pandemic continues to impact families. Despite the District’s focus on adjusting to this new normal after nearly three difficult years, home visiting programs have seen a consistent increase in families’ demand and urgency for services, supplies, and resources. In the Home Visiting Council’s recent annual report, programs observed more families seeking mental health and domestic violence resources, asking for basic supplies like diapers and food, and requesting rental assistance. This is during a time where all families, excluding the highest-earning District residents, are feeling the financial squeeze of rising costs of living, groceries, and basic supplies with high rates of inflation. This will only worsen in combination with federal pandemic food assistance and benefits that expire this year. Family supports, like home visiting, as well as HealthySteps and Healthy Futures, are available at little to no cost for families and can be a critical lifeline for them to cope with the stressors of surviving an economic crisis. Despite all of the challenges that come with rising inflation and impacts of the pandemic, home visiting grants have remained flat for several years. Home visiting programs need deeper and sustained investments to adjust for the higher urgency and support families navigating these difficult times.
To address this low pay, inflation, and flat funding of grants, we are seeking a $1 million increase to local home visiting grants in FY24. This is specifically a $700,000 increase to DC Health funding for home visiting programs. Additionally, we request that the $500,000 for DC Health home visiting programs that were recently cut in the FY2023 budget from an existing program continue to be invested into home visiting services in the District.
We implore the DC Council to recognize home visiting as a critical early childhood investment that aligns with DC Health’s efforts to improve the health and well-being of DC families.
Thank you for the opportunity to testify and I welcome any questions.