Testimony of Wes Rivers, Health Policy Analyst, At the Public Hearing on the Fiscal Year 2013-2014 Performance Oversight Hearing for the DC Department of Health

Chairwoman Alexander and other members of the committee, thank you for the opportunity to testify today. My name is Wes Rivers, and I am a Health Policy Analyst at the DC Fiscal Policy Institute. DCFPI engages in research and public education on the fiscal and economic health of the District of Columbia, with a particular emphasis on policies that affect low- and moderate-income residents. 

I am here today to support and applaud the Department of Health’s (DOH) efforts to expand evidence-based home visiting programs to at-risk families across the city. DOH is a valuable member of DC’s Home Visiting Council, and their willingness to work and consult with community stakeholders gives me confidence that the District is building a strong foundation for an effective program.  The greatest issue facing these programs is the need for the District to create a sustainable funding strategy that will serve as many eligible families as possible. 

Maternal and child health home visiting is designed to improve early childhood health and development through home-based interventions. Home visiting targets services to expecting parents and families with children under age five. The Home Visiting Council has identified and is in the process of expanding three evidence-based models that are nationally recognized for their effectiveness. These models focus on maternal and child health, early physical and cognitive development, parenting practices, school-readiness and access to community resources and immunizations.   

The need for these services is great in DC. About 1,800 babies born each year — one fifth of all births in the city ‘ are at high risk for health and developmental problems due to factors such as late or no prenatal care, preterm delivery, low parental education, or family history of substance abuse. In addition, nearly one in three DC children lives in poverty, meaning they likely face higher barriers to accessing health care. With about 500 families being served right now, the Home Visiting Council estimates that 3,500 additional children could benefit from services.  

The District is in the process of evaluating the outcomes of home visiting services delivered in the city, and it is too early to gauge the impact of the program. However, we do know that home visiting is expanding access to critical health and developmental services, especially in Wards 5, 7, and 8. Moreover, several national studies on home visiting and early childhood interventions show promising results in health and educational outcomes. A study out of the University of Minnesota found that quality preschool for low-income children under the age of three boosts cognitive development, closes the educational achievement gap between low- and higher-income students, and results in cognitive gains that are preserved over time.[1] Moreover, a RAND meta-analysis of the literature found that evidence-based home visiting had significant marginal effects on test scores, classroom achievement and childhood health rating.[2] 

Evidence-based programs are also cost effective with the potential to generate long-term savings. RAND’s study found that every dollar invested in home visiting saves $5.70 in future costs related to health and academic outcomes. DC could compound savings by implementing home visiting as part of an overall framework of integrated services and prevention, such as the Help Me Grow model. 

While the District has a foundation for a comprehensive home visiting program, the main issues facing DOH and the Home Visiting Council over the next two years are capacity and sustainability. Home visiting providers currently operating have the capacity for about 935 families, meaning that current programming can still reach 435 more families. However, even then, the program will miss the majority of the 3,500 unserved children who could benefit from the service. 

Even maintaining the current capacity for home visiting is in jeopardy, because the federal grant which provides the majority of funds is expiring at the end of 2015. If Congress does not act soon to reauthorize the funds for maternal and infant health programming, DC’s federal allocation could end sooner than that. Local funding will be needed to maintain services at their current levels. Moreover, DOH also needs to coordinate with other agencies to implement a sustainable funding strategy for expansion.  For example, Health Care Finance offers opportunities to tap federal funding through Medicaid, while other agencies offers access to federal funds through a Title IV-E waiver. As political pressures mount over the federal budget, local funds will also be needed to ensure that there are no gaps or delays in services. DC Fiscal Policy Institute estimates that $1.7 million would be a reasonable local base in FY 2015. 

Thanks you for the opportunity to testify, and I would be happy to answer any questions.

[1] Duncan, Greg J. and Aaron J. Sojourner. “Can Intensive Early Childhood Intervention Programs Eliminate Income-Based Cognitive and Achievement Gaps?” Journal of Human Resources. September 21, 2013 48:945-968

[2] Karoly, Lynn A., M. Rebecca Killburn, and Jill S. Cannon. “Early Childhood Interventions: Proven Results, Future Promise.”