U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800

Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001

42–728 PDF 2008

H.R. 2343: THE EDUCATION

BEGINS AT HOME ACT

HEARING

BEFORE THE

COMMITTEE ON 

EDUCATION AND LABOR

U.S. HOUSE OF REPRESENTATIVES

ONE HUNDRED TENTH CONGRESS

SECOND SESSION

HEARING HELD IN WASHINGTON, DC, JUNE 11, 2008

Serial No. 110–95

Printed for the use of the Committee on Education and Labor

(

Available on the Internet: 

http://www.gpoaccess.gov/congress/house/education/index.html 

(II)

COMMITTEE ON EDUCATION AND LABOR 

GEORGE MILLER, California, Chairman

Dale E. Kildee, Michigan, Vice Chairman 

Donald M. Payne, New Jersey 

Robert E. Andrews, New Jersey 

Robert C. ‘‘Bobby’’ Scott, Virginia 

Lynn C. Woolsey, California 

Rube ́n Hinojosa, Texas 

Carolyn McCarthy, New York 

John F. Tierney, Massachusetts 

Dennis J. Kucinich, Ohio 

David Wu, Oregon 

Rush D. Holt, New Jersey 

Susan A. Davis, California 

Danny K. Davis, Illinois 

Rau ́l M. Grijalva, Arizona 

Timothy H. Bishop, New York 

Linda T. Sa ́nchez, California 

John P. Sarbanes, Maryland 

Joe Sestak, Pennsylvania 

David Loebsack, Iowa 

Mazie Hirono, Hawaii 

Jason Altmire, Pennsylvania 

John A. Yarmuth, Kentucky 

Phil Hare, Illinois 

Yvette D. Clarke, New York 

Joe Courtney, Connecticut 

Carol Shea-Porter, New Hampshire 

Howard P. ‘‘Buck’’ McKeon, California, 

Senior Republican Member 

Thomas E. Petri, Wisconsin 

Peter Hoekstra, Michigan 

Michael N. Castle, Delaware 

Mark E. Souder, Indiana 

Vernon J. Ehlers, Michigan 

Judy Biggert, Illinois 

Todd Russell Platts, Pennsylvania 

Ric Keller, Florida 

Joe Wilson, South Carolina 

John Kline, Minnesota 

Cathy McMorris Rodgers, Washington 

Kenny Marchant, Texas 

Tom Price, Georgia 

Luis G. Fortun ̃ o, Puerto Rico 

Charles W. Boustany, Jr., Louisiana 

Virginia Foxx, North Carolina 

John R. ‘‘Randy’’ Kuhl, Jr., New York 

Rob Bishop, Utah 

David Davis, Tennessee 

Timothy Walberg, Michigan 

[Vacancy]

Mark Zuckerman, Staff Director 

Vic Klatt, Minority Staff Director 

(III)

C O N T E N T S 

Page

Hearing held on June 11, 2008 ............................................................................... 1

Statement of Members: 

Davis, Hon. Danny K., a Representative in Congress from the State 

of Illinois, submissions for the record: 

Prepared statement of the Home Visiting Coalition .............................. 64

Prepared statement of the Child Welfare League of America ............... 78

Letter from the Military Impacted Schools Association, dated June 

10, 2008 .................................................................................................. 81

Prepared statement of Prevent Child Abuse America ........................... 81

Prepared statement of the American Psychological Association ........... 84

Article: ‘‘The Parents as Teachers Program and School Success: A 

Replication and Extension,’’ Journal of Primary Prevention, March 

2008, Internet address .......................................................................... 85

McKeon, Hon. Howard P. ‘‘Buck,’’ Senior Republican Member, Committee 

on Education and Labor ............................................................................... 5

Prepared statement of ............................................................................... 6

Miller, Hon. George, Chairman, Committee on Education and Labor ......... 1

Prepared statement of ............................................................................... 4

Additional submissions: 

Report: ‘‘Breaking the Cycle of Child Abuse and Reducing Crime 

in Pennsylvania: Coaching Parents Through Intensive Home 

Visiting,’’ Internet address ............................................................. 61

Report: ‘‘The Economic Return on PCCD’s Investment in Research-based Programs: A Cost-Benefit Assessment of Delinquency Prevention in Pennsylvania,’’ Internet address .............. 61

Tierney, Hon. John F., a Representative in Congress from the State 

of Massachusetts, submission for the record: 

Prepared statement of Sarah E. Walzer, executive director, the Parent-Child Home Program ...................................................................... 61

Woolsey, Hon. Lynn C., a Representative in Congress from the State 

of California, prepared statement of ........................................................... 61

Statement of Witnesses: 

Ditka, Laura A., deputy district attorney, Allegheny County, PA, on behalf of Fight Crime: Invest in Kids ............................................................. 26

Prepared statement of ............................................................................... 27

Estrada, William A., Esq., director of federal relations, Home School 

Legal Defense Association ............................................................................ 30

Prepared statement of ............................................................................... 32

Fenley, Julie, Parents as Teachers program participant .............................. 17

Prepared statement of ............................................................................... 19

London, Makeda, Healthy Families program manager ................................. 20

Prepared statement of ............................................................................... 21

Smart, Jeanne, director of Nurse-Family Partnership, Los Angeles County .................................................................................................................... 32

Prepared statement of ............................................................................... 34

Weiss, Heather, Ed.D., founder and director, Harvard Family Research 

Project, Harvard University Graduate School of Education ..................... 7

Prepared statement of ............................................................................... 9

(1)

H.R. 2343: THE EDUCATION

BEGINS AT HOME ACT 

Wednesday, June 11, 2008

U.S. House of Representatives 

Committee on Education and Labor 

Washington, DC

The committee met, pursuant to call, at 10:06 a.m., in Room 

2175, Rayburn House Office Building, Hon. George Miller [chairman of the committee] presiding. 

Present: Representatives Miller, Kildee, Payne, Woolsey, 

Hinojosa, Tierney, Kucinich, Wu, Holt, Davis of California, Davis 

of Illinois, Sarbanes, Hirono, Altmire, Clarke, Courtney, Shea-Porter, McKeon, Ehlers, Platts, Kline, Foxx, and Davis of Tennessee. 

Staff present: Tylease Alli, Hearing Clerk; Alfred Amado, Legislative Fellow for Education; Ruth Friedman, Senior Education Policy Advisor (Early Childhood); David Hartzler, Systems Administrator; Lloyd Horwich, Policy Advisor, Subcommittee on Early 

Childhood, Elementary and Secretary Education; Fred Jones, Staff 

Assistant, Education; Danielle Lee, Press/Outreach Assistant; 

Stephanie Moore, General Counsel; Alex Nock, Deputy Staff Director; Joe Novotny, Chief Clerk; Rachel Racusen, Deputy Communications Director; Meredith Regine, Junior Legislative, Labor; 

Daniel Weiss, Special Assistant to the Chairman; Margaret Young, 

Staff Assistant, Education; Mark Zuckerman, Staff Director; Stephanie Arras, Minority Legislative Assistant; James Bergeron, Minority Deputy Director of Education and Human Service Policy; Cameron Coursen, Minority Assistant Communications Director; 

Kirsten Duncan, Minority Professional Staff Member; Alexa 

Marrero, Minority Communications Director; Susan Ross, Minority 

Director of Education and Human Services Policy; and Linda Stevens, Minority Chief Clerk/Assistant to the General Counsel. 

Chairman MILLER [presiding]. The Committee on Education and 

Labor will come to order. A quorum being present, the committee 

will conduct a hearing on HR 2343, the Education Begins At Home 

Act. 

Good morning. I want to welcome all of you to today’s hearing. 

We will examine the bipartisan legislation that will help 

strengthen America’s families by expanding early childhood home 

visitation programs for parents and children. 

Throughout this Congress, we have explored how we can help 

every child arrive at kindergarten ready to learn. Last year we took 

important steps towards that goal by enacting legislation to reinVerDate 0ct 09 2002 09:17 Aug 27, 2008 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 G:\DOCS\110TH\FC\110-95\42728.TXT HBUD1 PsN: DICK
2

vigorate our nation’s Head Start program. This is just the beginning of our efforts. We know that investing in our youngest children is essential to boosting our nation’s competitiveness. 

We must make long-term commitment to promoting positive 

growth and development in our children and in those who play the 

most significant role in their early years, their parents. 

Research tells us the relationships that form between parent and 

child during the first 3 years of life, when 85 percent of the brain 

growth occurs, are especially influential on a child’s cognitive and 

behavioral development. Early childhood home visitation programs 

provide parents with education and supportive services to help 

them better understand the learning and developmental needs of 

their children and build long-lasting parent-child bonds. 

Each year, hundreds of thousands of families benefit from these 

supportive services, which range from prenatal medical care to 

health services to family literacy programs. For many parents, the 

most valued support these programs provide has been emotional. 

For military families who often face unique parenting circumstances, home visits can make the world of difference when one 

parent is deployed or returning from overseas duty. 

The Parents As Teachers Program at the Ft. Bragg military base 

in North Carolina helped one mother going through an especially 

hard time during her husband’s multiple deployments when her 

young son began acting out aggressively in child care, refusing to 

talk to his father on the phone during his rotations. Parents As 

Teachers staff helped the mother find ways to develop a closer 

bond and better communications between her husband and son. 

As several of our experts will explain today, early childhood 

home visitation programs provide far-reaching benefits, helping to 

increase student achievement, improve access to preventative medical care, reduce high school dropout rates and decrease maternal 

depression. 

For example, according to an evaluation of the parent-child home 

program in South Carolina, 93 percent of the program participants 

who were eligible for free lunch passed the state’s first grade skills 

assessment in contrast to only 74 percent of the free lunch eligible 

students overall. 

As Joan Ohl of the Bush administration’s Commission on Children, Youth and Families recently highlighted, home visits are an 

effective approach to preventing child abuse by helping parents 

deal with the stresses of raising children. Yet for far too long the 

federal government has not invested enough in programs to support families and children during these first years of life. 

The Education Begins At Home Act would create for the first 

time a federal funding framework for home visitation programs, ensuring that the federal government plays a role in helping communities better plan for and provide quality services for families. It 

would authorize $400 million in grants to states, tribal organizations and territories over 3 years. The bill would also create competitive grant programs to expand access to home visitation services for military families and families with limited English proficiency. 

In addition, the bill would help states create partnerships between programs and related community services. Preparing chilVerDate 0ct 09 2002 09:17 Aug 27, 2008 Jkt 000000 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 G:\DOCS\110TH\FC\110-95\42728.TXT HBUD1 PsN: DICK
3

dren for success in school and in life begins at home. This legislation is about strengthening and supporting families, an investment 

that is in the best interest of our children, our communities and 

our future. 

I would like to welcome again all of our witnesses and thank 

them for joining us today. And I would especially like to thank 

Congressman Danny Davis and Congressman Todd Platts for introducing this bill, as well as Senator Kit Bond, who has introduced 

companion legislation in the Senate. 

Our senior Republican, Mr. McKeon, is on his way, and we will 

recognize him when he comes in for the purposes of making an 

opening statement. 

With that, I would like to recognize our panel and introduce 

them to the committee. 

Dr. Heather Weiss is the founder and director of the Harvard 

Family Research Project and is a senior research associate and lecturer at Harvard Graduate School of Education. Dr. Weiss received 

her Doctorate of Education and Social Policy from Harvard Graduate School of Education and she was postdoctoral research fellow 

at the Yale Bush Center in Child Development and Social Policy. 

Her latest publications include several articles reporting on her 

longitudinal study on ways in which family involvement in children’s learning promotes development and school success. 

Julie Fenley, our next witness, and her husband, Victor Fenley, 

are originally from Conroe, Texas. In early 2007, he was relocated 

to Virginia Beach, Virginia, when Mr. Fenley enlisted in the U.S. 

Navy. Mr. and Mrs. Fenley participate in Parents As Teachers Program, which is based in Norfolk Naval Station, and have two children, Zane, who is 2 years old, and Megan, who is 7 years old. Mr. 

Fenley is an aviation structural mechanical airman apprentice at 

Norfolk Naval Station and Mrs. Fenley is a full-time parent and 

supportive Navy spouse. 

And I want to thank you very much for joining us today. We are 

going to hear a lot of testimony about different families that are 

impacted by the benefits of these programs, and later we are going 

to ask you some questions about the universality of these programs, because stress with children cut across all families. And so 

we thank you very much for being here. 

Mr. Davis, Congressman Davis, is going to introduce our next 

witness, Makeda London. 

Mr. DAVIS OF ILLINOIS. Thank you very much, Mr. Chairman. 

And I, too want to welcome all of our panelists. 

I take great pride in introducing Ms. Makeda London, who works 

in my congressional district. 

Ms. London has devoted more than 30 years to helping Chicago 

as a social service provider, be it a faculty member, a substitute 

teacher, a leader in the public health community or a director of 

a community learning center. It is her 14 years of service as the 

director of the Healthy Families Home Visitation Program at the 

Near North Health Services Corporation located in the Winfield 

Moody Health Center that gives us the honor of hearing her today. 

Ms. London serves families from the Cabrini Green Public Housing Development. In an area known for its crime and difficulties, 

she has brought invaluable support and resources to thousands of 

4

Chicagoans. Her experiences will surely help increase our understanding of home visiting and how the Education Begins At Home 

Act can promote family well-being. 

So we certainly thank her and welcome her here today. 

Chairman MILLER. Thank you very much. 

Mr. Altmire, I believe, is going to introduce our next witness, 

Laura Ditka. 

Mr. ALTMIRE. Thank you, Chairman Miller, for allowing me the 

honor of introducing Laura Ditka, who is a constituent and a friend 

of mine from western Pennsylvania, a long-time friend. 

Ms. Ditka received her Bachelor’s degree from Ohio University 

and her law degree from Duquesne University School of Law. She 

is an Allegheny County deputy district attorney and the founder of 

Alleghany County Child Abuse Unit. In this capacity, as head of 

that unit, Ms. Ditka is the lead attorney responsible for cases dealing with child abuse and homicide in Allegheny County. 

Her experience includes 130 jury trials and more than 20 homicide trials. Additionally, Ms. Ditka is an adjunct professor at the 

Community College of Allegheny County and the chairwoman of 

the Allegheny County Arbitration Division. 

Today Ms. Ditka will be testifying on behalf of Fight Crime, Invest in Kids, an organization of more than 4,000 police chiefs, sheriffs, prosecutors and victims of violence. 

I look forward to hearing her testimony and highly recommend 

her to the committee. 

Chairman MILLER. Welcome to the committee. 

William Estrada is an attorney and the director of federal relations for the Home School Legal Defense Association, where he has 

served as the director of federal relations for 2 years. During this 

time, he has worked on numerous federal issues that are of interest 

to the home school community in the United States. 

Jeanne Smart is a registered nurse who is the director of the 

Nurse-Family Partnership Program for Los Angeles County Department of Public Health, where she directs all nurse home visiting programs within the Department’s Maternal, Child and Adolescent Health Programs. She also represents the Department of 

Interagency Operations Group for senior level managers from the 

County’s Health and Human Services Agency. She has worked as 

a community-based public health nurse in some of the highest risk 

areas of LA County and also been a public health nursing instructor at California State in Los Angeles and California State Long 

Beach. Welcome. 

With that, I would like to turn to the senior Republican on the 

committee, Mr. McKeon, for his opening statement, and then we 

will begin with your testimony and we will begin with you, Dr. 

Weiss, when Mr. McKeon is done. 

Thank you. 

The gentleman is recognized.

Prepared Statement of Hon. George Miller, Chairman, Committee on 

Education and Labor 

Good morning. Welcome to today’s hearing on ‘‘H.R. 2343: The Education Begins 

At Home Act.’’ Today we will examine bipartisan legislation that will help strengthen American families by expanding early childhood home visitation programs for 

parents and children. 

5

Throughout this Congress, we have explored how we can help every child arrive 

at kindergarten ready to learn. 

Last year, we took important steps towards this goal by enacting legislation to 

reinvigorate our nation’s Head Start program. 

This is just the beginning of our efforts. We know that investing in our youngest 

children is essential to boosting our nation’s competitiveness. 

We must make a long-term commitment to promoting positive growth and development in our children—and in those who play the most significant role in their 

early years: Parents. 

Research tells us that the relationships that form between a parent and a child 

during the first three years of life—when 85 percent of brain growth occurs—are 

especially influential on a child’s cognitive and behavioral development. 

Early childhood home visitation programs provide parents with education and 

supportive services to help them better understand the learning and developmental 

needs of their children and build long-lasting parent-child bonds. 

Each year, hundreds of thousands of families benefit from these support services, 

which range from pre-natal medical care and health services to family literacy programs. 

For many parents, the most valuable support these programs have provided has 

been emotional. 

For military families, who often face unique parenting circumstances, home visits 

can make a world of difference when one parent is deployed or returning from overseas duty. 

The Parents as Teachers program at the Fort Bragg military base in North Carolina, helped one mother going through an especially hard time during her husband’s 

multiple deployments. 

When her young son began acting out aggressively in child care and refusing to 

talk to his father on the phone during his rotations, the Parents as Teachers staff 

helped the mother find ways to develop a closer bond and better communication between her husband and son. 

As several of our experts will explain today, early childhood home visitation programs provide far-reaching benefits: Helping to increase student achievement, improve access to preventative medical care, reduce high school dropout rates, and decrease maternal depression. 

For example, according to an evaluation of the Parent-Child Home program in 

South Carolina, 93 percent of program participants who were eligible for free lunch 

passed the state’s first grade skills assessment, in contrast to only 74 percent of 

free-lunch-eligible students overall. 

And as Joan Ohl, the Bush administration’s Commissioner for Children, Youth 

and Families recently highlighted, home visits are an effective approach to preventing child abuse by helping parents deal with the stresses of raising children. 

Yet for too long, the federal government has not invested enough in programs that 

support families and children during these first years of life. 

The Education Begins at Home Act would create, for the first time, a federal funding framework for home visitation programs, ensuring that the federal government 

plays a role in helping communities better plan for and provide quality services to 

families. 

It would authorize $400 million in grants to states, tribal organizations, and territories over three years. 

The bill would also create competitive grant programs to expand access to home 

visitation services for military families and families with limited-English proficiency. 

In addition, the bill would help states create partnerships between programs and 

related community services. 

Preparing children for success in school and in life begins in the home. This legislation is about strengthening and supporting families—an investment that is in the 

best interests of our children, our communities, and our future. 

I’d like to welcome all of our witnesses and thank them for joining us today. 

I’d especially like to thank Congressmen Danny Davis and Todd Platts, for introducing this bill, as well as Senator Kit Bond, who has introduced companion legislation in the Senate. 

Thank you. 

Mr. MCKEON. Thank you, Chairman Miller. Good morning. I 

apologize for being late. 

6

We are here today to examine the Education Begins At Home 

Act, a bill that authorizes approximately half a billion dollars to establish or provide programs that provide home visitation services 

for families. 

I appreciate that we are here for a legislative hearing, particularly given the significant size and scope of this proposal. Today’s 

hearing gives us an important opportunity to consider not only the 

broad concept of home visitations, which are generally intended to 

improve child development, child health and wellness and parenting practices, but also to look at the specific details of the legislation that has been proposed. 

In recent years, our committee has focused on authorizing and 

funding programs with proven results. We know that programs 

backed by sound scientific research can help ensure more meaningful results for children, a goal we all share whether we are talking 

about effective reading and mathematics instruction or Head Start 

reform or any number of other programs. 

To that end, I am anxious to hear more today about the research 

surrounding home visitation programs. What effects have been 

demonstrated when it comes to cognitive development, school preparedness and parenting skills? Have some programs been shown 

to be more effective than others? Are home visits helpful in their 

own right, or only when paired with other services? 

I am also interested in a discussion about how best to target federal resources. Traditionally, federal intervention in this area has 

focused on disadvantaged children. Take the Early Head Start program, for example. In that program, we have explored the use of 

home visits to strengthen parenting skills and cognitive development in a way that compliments the services provided through 

Early Head Start. This approach ensures that we are reaching the 

children most likely to require additional support in order to start 

school on par with their more advantaged peers. 

Today’s hearing will allow us to explore these and many other 

questions about the Education Begins At Home Act. I want to 

thank our distinguished panel of witnesses for joining us, sharing 

their views and allowing us to benefit from their varied areas of 

expertise. There are a range of perspectives on this issue, each of 

which will be valuable in our deliberations. 

I intend to focus today on the questions I just posed, including 

whether there are proven strategies for success in this field and 

how best to target resources to those most in need. 

Once again, I thank the chairman for holding this hearing and 

I yield back the balance of my time. 

[The statement of Mr. McKeon follows:]

Prepared Statement of Hon. Howard P. ‘‘Buck’’ McKeon, Senior Republican 

Member, Committee on Education and Labor 

Thank you Chairman Miller, and good morning. We’re here today to examine the 

Education Begins at Home Act, a bill that authorizes approximately half a billion 

dollars to establish or expand programs that provide home visitation services for 

families. 

I appreciate that we’re here for a legislative hearing, particularly given the significant size and scope of this proposal. Today’s hearing gives us an important opportunity to consider not only the broad concept of home visitations—which are generally intended to improve child development, child health and wellness, and parVerDate 0ct 09 2002 09:17 Aug 27, 2008 Jkt 000000 PO 00000 Frm 00010 Fmt 6633 Sfmt 6621 G:\DOCS\110TH\FC\110-95\42728.TXT HBUD1 PsN: DICK
7

enting practices—but also to look at the specific details of the legislation that has 

been proposed. 

In recent years, our committee has focused on authorizing and funding programs 

with proven results. We know that programs backed by sound scientific research 

can help ensure more meaningful results for children, a goal we all share whether 

we’re talking about effective reading and mathematics instruction or Head Start reform or any number of other programs. 

To that end, I’m anxious to hear more today about the research surrounding home 

visitation programs. What effects have been demonstrated when it comes to cognitive development, school preparedness, and parenting skills? Have some programs 

been shown to be more effective than others? Are home visits helpful in their own 

right, or only when paired with other services? 

I’m also interested in a discussion about how best to target federal resources. Traditionally, federal intervention in this area has focused on disadvantaged children. 

Take the Early Head Start program, for example. In that program, we have explored the use of home visits to strengthen parenting skills and cognitive development in a way that complements the services provided through Early Head Start. 

This approach ensures that we’re reaching the children most likely to require additional support in order to start school on par with their more advantaged peers. 

Today’s hearing will allow us to explore these and many other questions about 

the Education Begins at Home Act. I want to thank our distinguished panel of witnesses for joining us, sharing their views, and allowing us to benefit from their varied areas of expertise. 

There are a range of perspectives on this issue, each of which will be valuable 

in our deliberations. I intend to focus today on the questions I just posed, including 

whether there are proven strategies for success in this field and how best to target 

resources to those most in need. 

Once again, I thank the chairman for holding this hearing, and I yield back the 

balance of my time. 

Chairman MILLER. Thank the gentleman. 

We are going to begin with your testimony. When you begin, in 

front of you a green light will go on that tells you that you have 

5 minutes for your testimony. Obviously, you can’t say everything 

you want to say in 5 minutes, but do the best you can. And at 4 

minutes, an orange light will come on and that tells you that you 

have a minute to sort of try to wrap up. We want you to complete 

your thoughts, coherent sentences and all the rest of that, but we 

are in session now, so at some point there may be votes and we 

want to make sure that everybody gets an opportunity to be heard. 

So, Dr. Weiss, we will begin with you. 

And your written statements, of course, are all part of the formal 

record, and so we want you to know that also. 

Dr. Weiss? 

STATEMENT OF HEATHER B. WEISS, ED.D., FOUNDER AND DIRECTOR, HARVARD FAMILY RESEARCH PROJECT, SENIOR 

RESEARCH ASSOCIATE AND LECTURER, HARVARD GRADUATE SCHOOL OF EDUCATION 

Ms. WEISS. Thank you very much for the privilege of testifying 

before you this morning. 

I want my remarks to sort of talk about some of the research evidence that then frames what you are going to hear from other very 

important members of this panel, and that is families and people 

who provide home visit services. 

I have a long-term interest in home visitation because of its capacity to help parents get the knowledge and skills and support 

they need to help their children succeed. I am here because as a 

researcher who created the Harvard Family Research Project, I 

know the 40 years of research that shows that parenting and famVerDate 0ct 09 2002 09:17 Aug 27, 2008 Jkt 000000 PO 00000 Frm 00011 Fmt 6633 Sfmt 6602 G:\DOCS\110TH\FC\110-95\42728.TXT HBUD1 PsN: DICK
8

ily processes are one of if not the strongest predictor of kids’ development and school and life success. 

They are the strongest predictors, I think, of cognitive, social and 

emotional development and, therefore, a very powerful source of 

improving outcomes for kids. 

I know from recent reviews that I have done with colleagues that 

children and youth with involved and supportive and nurturing 

parents from birth to adolescence are likely to succeed in school. 

They are going to be ready for school, succeed in school. They are 

more likely to get better grades. They are more likely to graduate 

from high school. And also they are more likely to go to college or 

have some kind of post-secondary success. 

So what potentially home visits in the early years do is set a 

pathway of parent involvement that begins at birth and continues 

through school, and when you create that pathway, you increase 

the likelihood of the long-term benefits we want for kids, and that 

is high school graduation with the skills they need to succeed in 

college or post-secondary education and then in the global economy 

and the world. 

So this sounds great. What do we know from research about 

whether or not voluntary early childhood home visitation is a good 

public policy investment? I look at this through the lens of three 

questions: What is the evidence that home visiting creates positive 

changes in parenting that results in better outcomes for children 

and families? What is the evidence that the home visiting field is 

ready to scale up and it will produce these positive outcomes at 

scale? This is a big public policy investment. What does the research tell us about whether or not we are going to get payback 

at scale? And finally, what legislation and policy provisions are 

likely to support successful scale up so you get the substantial returns on investment? 

And as a researcher, I of course look closely at legislation and 

say does this legislation incorporate what I think research tells us 

that increases the likelihood of getting benefits at scale. So I want 

to address these questions. I address them, actually, in my written 

testimony in detail. I am going to talk about them kind of in a Cliff 

notes version today, and then I am happy to answer questions. 

I am really here to strongly support the Education Begins At 

Home Act, because there is a strong and growing knowledge base 

of evaluation evidence that high quality, voluntary early childhood 

home visit programs pay off on a variety of outcomes. They develop 

parenting skills and knowledge and understanding of the key roles 

that parents play in kids’ learning and development. 

There is a lot of short-term evidence to this effect, which I have 

summarized in gruesome detail and probably put many people to 

sleep with, and I am happy to talk about it, believe me, but I think 

you can make a strong evidence-based case that investment in high 

quality programs pays off across an array of outcomes. 

A thing that is of particular interest to me is the fact that we 

are now getting longitudinal evidence that shows that these programs have the potential to increase parent involvement into elementary school, meaning that parents are more likely to go to parent-teacher conferences, initiate contact with their teachers about 

how the child is doing, and as somebody who knows the parent inVerDate 0ct 09 2002 09:17 Aug 27, 2008 Jkt 000000 PO 00000 Frm 00012 Fmt 6633 Sfmt 6602 G:\DOCS\110TH\FC\110-95\42728.TXT HBUD1 PsN: DICK
9

volvement in school and learning at home literature, if you can create that kind of changed parenting behavior that endures through 

elementary and into high school and beyond, you have got a real 

recipe for long-term positive outcomes for kids. 

The evidence also tells us a great deal about how to develop and 

implement high quality programs. And this knowledge I would 

argue is critical for the success of investment at scale. We know a 

great deal about what it takes to get high quality home visit programs, and I want to talk about that in a minute. 

So when I think about it, there is bottom line potential, great 

bottom line potential for home visits to return very important, positive outcomes in the early years and well into elementary school 

and perhaps beyond. These outcomes are things like increased 

school readiness and school success, prevention of costly problems 

from maltreatment to teenage substance abuse, delinquency, those 

kinds of problems. We are beginning to have some evidence of 

those kinds of benefits with longitudinal research. 

So I support EBAH because of the way, finally, the key features 

about what we know about what we need to produce and implement high quality programs maps directly onto key provisions of 

the legislation. 

The research tells us that high quality home visit programs are 

necessary but not sufficient. They need to be part of a broader set 

of early childhood services, including center-based early care and 

education, and they need to be connected to other supports and resources in the community. The legislation provides for training, 

curriculum development and I think incredibly importantly for external evaluation and ongoing performance management. It requires that states and programs report yearly on key indicators. 

They can then use the information they get from their performance 

management to increase their performance. 

So when I think about what makes for high quality investments 

in public policy, EBAH has strong research behind it, research that 

helps us understand how to deliver quality programs, and the capacity to track our performance and see if we are getting a return 

on investment. 

Thank you. 

[The statement of Ms. Weiss follows:]

Prepared Statement of Heather Weiss, Ed.D., Founder and Director, Harvard Family Research Project, Harvard University Graduate School of 

Education 

Chairman Miller and Members of the Committee: Thank you for the opportunity 

to provide testimony at this important hearing on the Education Begins at Home 

act. My name is Heather Weiss and I am the Founder and Director of the Harvard 

Family Research Project at the Harvard University Graduate School of Education. 

I have spent the past thirty years of my work devoted to building the knowledge 

base for programs and policies that strengthen and support families, schools and 

communities as settings for child development. We regularly compile and synthesize 

research and evaluation studies to guide policy, practice and evaluations, and to 

provide programs with tools and information to guide their evaluations. My colleagues and I at the Harvard Family Research Project are known for our work 

building the research base for complementary learning supports which we define as 

a systemic approach that intentionally integrates school and non-school supports 

such as home visitation and afterschool programs with schools to promote educational and life success. Complementary learning builds on a long history of theory 

and research about the many contextual influences on children’s development and 

on the research-based understanding that neither schools nor families nor commuVerDate 0ct 09 2002 09:17 Aug 27, 2008 Jkt 000000 PO 00000 Frm 00013 Fmt 6633 Sfmt 6621 G:\DOCS\110TH\FC\110-95\42728.TXT HBUD1 PsN: DICK
10

nities alone can ensure learning and educational achievement. I sit on numerous advisory boards, advise on and evaluate major foundation grantmaking initiatives for 

children and families, and recently served on the National Academy of Sciences Institute of Medicine Committee evaluating the implementation of PEPFAR with particular attention to its effects on orphans and vulnerable children. 

Let me start with a useful and undeniable fact: The evidence from over forty 

years’ research into the factors that affect children’s education is both consistent 

and substantial. Family involvement in a child’s learning at home, at school, and 

in the community is one of the strongest predictors of social, emotional and academic development.1 Nurturing and responsive parenting is a critical factor in ensuring that children are ready to enter and to exit from school with the skills they 

need to succeed in higher education and in the global workforce. Children and youth 

with involved and supportive parents from birth through adolescence do better in 

many ways. They are more ready to succeed in school, and they get better grades, 

have higher graduation rates, and are more likely to go to college.2

The Education Begins At Home Act (EBAH), providing funding for states to develop, deliver and evaluate home visitation as a core component of early childhood 

services, is a key piece of the national effort to insure that all children succeed for 

several reasons. It is the first dedicated federal funding stream providing information and support for parents to help them enhance their children’s early development. Beginning at birth, home visitation establishes the critical importance of parent involvement in learning and helps parents and schools understand and reinforce 

its continued importance through the child’s entire school career. Evaluations of 

home visit programs indicate that when they are delivered with sufficient frequency 

and quality, they help parents, particularly economically and otherwise disadvantaged ones, get what they need to help their children succeed. The evaluations suggest that these programs can increase school readiness, increase parents’ understanding of their role in child development, strengthen parenting practices, improve 

maternal and child health, and help to reduce child maltreatment. The provisions 

of the EBAH Act draw from the most recent research and evaluations laying out 

what it takes to develop effective home visit services and this increases the likelihood of strong returns on investments in these early parent support and education 

services.3

My review of the home visit research and evaluation literature addresses three 

central questions: 

1. What is the evidence that early childhood home visit programs create positive 

changes in parenting and parent involvement in learning that lead to better outcomes for children? 

2. What is the evidence that the home visit field is ready to scale up and that 

it can produce these positive outcomes at greater scale within states? 

3. How does the EBAH legislation incorporate the lessons from past evaluations 

and leaders in the home visit field, thereby increasing the likelihood of returning 

positive results at greater scale? 

This testimony and research review draw from several areas in my research and 

professional experience: individual evaluations of national home visit program models; several literature reviews of home visitation conducted over the past fifteen 

years;4 a recent meta-analysis of 60 programs employing home visitation as the primary service delivery strategy;5 and interviews with leaders from six well-established national home visit program models and selected home visit researchers and 

evaluators.6 Several national home visit models have conducted rigorous experimental or quasi-experimental evaluations of their programs at one or more sites in 

the past twenty years; by 2004, there were enough peer-reviewed studies by these 

and other programs to warrant meta-analysis. 

I also draw on my on-the-ground experience with The Home Visit Forum, a consortium of six national voluntary home visit programs which operated from 1999 to 

December 2005. The consortium was organized by the Harvard Family Research 

Project, in conjunction with Deborah Daro of Chapin Hall and Barbara Wasik of 

Johns Hopkins University, to strengthen the research and evaluation and continuous improvement capacity of the home visit field and to build its knowledge base.7

The Forum members included representatives from Early Head Start, Healthy Families America, Home Instruction for Parents of Pre-School Youngsters (HIPPY), the 

Nurse-Family Partnership, Parents As Teachers (PAT) and the Parent Child Home 

Program. Each of these are home visitation models serving children during the 

course of the first five years of life and emphasizing different aspects of parenting 

and child development. Early Head Start is the early years component of the Head 

Start program and it includes both home visitation and a center-based component. 

Healthy Families America is a program that begins in the first year of life and specifically targets families considered to be at risk for abuse and neglect. HIPPY 

11

serves 3-5 year olds with a parent-child literacy emphasis. The Nurse-Family Partnership works with first-time teen mothers beginning in the third trimester of pregnancy and continuing through the second year of life and provides a series of maternal and child health and early parenting supports. Parents As Teachers works with 

families with children in the first two years of life and provides an array of parenting services. The Parent Child Home Program focuses on family literacy for children from ages 3—5. Each of the models is national in scope and coverage and has 

been providing services for at least twenty years. 

Overview of Early Home Visitation 

Voluntary home visiting programs provide parenting education and support at 

home or other locations chosen with families. Different program models target different kinds of families, ranging from first-time teen mothers to all families with 

children in their requisite age group, and they typically provide services anywhere 

from a two- to a five-year period. As the table below with information from six of 

the national models shows, programs differ in their goals and the types of families 

they serve, and as a result, they focus on achieving different—although sometimes 

overlapping—outcomes.

Population Served Program Goals 

Early Head Start Low-income pregnant women 

with infants and toddlers 

Promote healthy prenatal outcomes, enhance development of 

young children, promote healthy family functioning

Healthy Families 

America 

Parents of all income levels 

identified as at-risk for 

abuse and neglect 

Promote positive parenting, prevent child abuse and neglect

The Home Instruction 

Program for Preschool Youngsters 

(HIPPY) 

Families, many low-income but 

no restricted income guidelines 

Empower parents as their children’s educators, enhance children’s early school success

The Nurse-Family 

Partnership 

Low-income, first-time mothers Improve pregnancy outcomes, child health and development, 

family economic self-sufficiency

The Parent-Child 

Home Program 

Low-income families Develop children’s language and literacy skills and prepare 

them for academic success, empower parents and enhance 

parenting skills

Parents as Teachers Parents of all income levels Empower parents and increase their knowledge of child development, prepare children for school success 

Most programs also connect families with other community resources to support 

families, including health, mental health, social and other services.8 As of 2001, at 

least 37 states had home visiting systems in place, and the number is no doubt 

higher now.9 Many are experimenting with targeted vs. universal services, targeting 

particular models to particular groups, combining models for coverage from birth 

through preschool, and combining home visitation with center-based early care and 

education. 

Early childhood home visitation programs are viewed as a promising strategy for 

helping parents and thereby promoting the growth, development and school readiness of young children because, as developmental research consistently confirms, 

young children are most likely to reach their full potential when they have nurturing, stimulating and supportive relationships with their caregivers.10 Home visit 

programs focus on building such relationships. 

As Hart and Risley’s (2002) path-breaking study of the role of families in early 

development indicated, children’s early language and literacy development, as well 

as their understanding of their capacity to learn, are shaped in the everyday interactions they have at home with their parents in the first few years.11

This study, as well as other research on early development, indicates that economically disadvantaged children are less likely to have rich home literacy environments or frequent positive interactions and experiences with their economicallystressed parents. This in turn puts them at a disadvantage when they begin 

school.12 Child development research affirms the importance of parenting practices 

and involvement for early childhood development. Home visitation programs are one 

12

way to reach busy parents and offer them regular information and support with potential benefits for both the children and the family.

Question 1: What is the evidence that early childhood home visitation programs 

create positive changes in parenting and parent involvement in learning that lead 

to better outcomes for children?

Most of the narrative reviews over the past fifteen years, as well as the recent 

meta-analysis, conclude that home visitation programs can produce positive changes 

across an array of child and parent outcomes when the conditions for high quality 

services are met. Sweet and Appelbaum ’s meta-analysis examined five parent and 

five child outcomes and found home visiting was associated with improved parenting 

attitudes and behaviors; mothers returning to school; children with better social, 

emotional and cognitive abilities; and less potential for child abuse based on emergency room visits, injuries and accidents. They, like most other reviewers, concluded 

that home visit programs are a promising but not yet proven strategy. Such programs create modest but potentially important positive changes, for, as Sweet and 

Appelbaum note, ‘‘all effect sizes fall in the small category * * * statistical significance, however, does not necessarily indicate practical significance and whether or 

not the magnitude of observed effects is meaningful and important remains to be 

determined’’ (1435-1456). As will be noted below, several of the national models 

have studies indicating longitudinal benefits of early home visitation for children 

and for families. 

At the same time, twenty-five years of investments in evaluation are paying off 

in a clearer understanding of the characteristics of high quality programs, and of 

the circumstances necessary for home visitation to produce these and other benefits 

as they go to greater scale around the country. Expectations for home visitation 

must be realistic. Home visits are ‘‘necessary but not sufficient,’’ 13 and to be effective, they should be embedded in a comprehensive system of early childhood services, especially when they serve highly stressed or economically or otherwise disadvantaged families. Evaluations of several of the major home visit models also suggest that home visitation in conjunction with high quality early childhood education 

and/or preschool is more likely to result in positive gains. 

The comprehensive evaluation of Early Head Start’s (EHS) home visiting, centerbased and mixed home visit and center models showed that the mixed approach had 

the broadest range of significant impacts, including on children’s language, socialemotional development, and on parents in terms of reading more to their children, 

being more supportive during play, and using less physical punishment, supporting 

the case for a mixed home and center approach. Similarly, a non- experimental evaluation of the Parents As Teachers Program (PAT) found the best outcomes when 

home visitation was combined with center-based care or preschool. Minority and 

non-minority children and those in high- and low-poverty schools who participated 

in PAT and preschool scored higher on kindergarten readiness assessments, as did 

EHS children who also participated in PAT and preschool. Children cared for only 

at home but participating in PAT scored higher than those whose parents did not 

participate. The combination of home visitation and center-based early childhood 

programs can enhance literacy, math and behavioral readiness for school, all key 

to early school success. 

Several of the national models target early literacy, and their evaluations suggest 

promising results with respect to language and literacy development. In a study of 

kindergarten readiness, The Parent Child Home Program (PCHP) found significant 

increases in school readiness for participating at-risk children.14 HIPPY USA has 

promising results in the second year of a three-year study of HIPPY AmeriCorps 

programs with respect to an array of parent literacy-related behaviors and practices 

and indicators of children’s language and literacy. 

There are a few studies which suggest long-term educational and societal benefits 

from early home visitation, and fewer still which examine cost analyses. However, 

several of the national home visit models have longitudinal research underway and 

there are calls for new cost-benefit studies. In addition to positive results from the 

longitudinal research on the Nurse-Family Partnership (noted in the textbox above), 

the Parent Child Home Program (PCHP) has followed up and compared results for 

at-risk children who completed the program and a control group. PCHP children 

had significantly higher rates of graduation. Several of the national program models 

target reduced costly child maltreatment as a key program goal and outcome, including the Nurse-Family Partnership and Healthy Families America. These programs show some promising results, particularly for mothers with the fewest resources to draw on, those who are younger, economically disadvantaged and firsttime mothers.15 The two available cost-benefit analyses suggest that benefits can 

outweigh the costs, but they are preliminary, suffer from insufficient information—

13

particularly across and within the major models—and serve primarily as an incentive to do further cost-benefit studies with better information.16

Twenty five years of evaluation of voluntary home visit programs indicates that 

it is critically important to keep expectations of what they can achieve reasonable 

and realistic, and to embed home visitation within a system of early childhood services. It is also important to insure that there are means to connect families with 

other accessible family support services and supports. Programs with theories of 

change that carefully link program inputs and processes to desired outcomes, that 

continually measure their performance and that use the results as well as other research for continuous improvement and innovation, are more likely to provide the 

quality necessary to get the desired child and family outcomes. There are a number 

of examples of this. The Nurse-Family Partnership has been experimenting with a 

new curriculum which has shown promise in reducing domestic violence. PAT has 

redone its curriculum in accord with the latest research on child growth and development from neuroscience. Evaluations also suggest the importance of sufficient resources to hire competent staff, provide ongoing and high-quality training and supervision, insure strong organizational capacity, and allow attention to outreach and 

program engagement in order to build the family-visitor relationship and insure sufficient dosage to get results. When these quality indicators are not in place, there 

is much less likelihood that investments in voluntary home visitation will pay off 

in better results for children and families. When they are, home visitation can provide information and support to families that set them on a path to nurturing and 

responsive parenting and continued involvement with the child’s learning into and 

through the school career.

Question 2: What is the evidence that the home visit field is ready to scale-up and 

that it can produce positive outcomes at a greater scale within states?

Voluntary home visitation has been provided to families with young children from 

at least the nineteenth century through to today. The current major national home 

visit models date from the 1970’s, and a number of them have been gradually going 

to greater scale in communities and now states around the country. Spurred by the 

national movement to results-based accountability, as well as by sometimes mixed 

evaluation results, national home visit models have been building their national 

training and technical assistance capacities, partnering with each other, and working to build their capacity to evaluate, track and improve their performance and to 

be accountable for the results they seek to obtain. The leaders of these national 

models, as well as those creating state early childhood systems, are very aware that 

in the current and future policy environment, even experimental evidence that a 

program works in one place is insufficient to warrant scale-up and sustained funding. They understand that in current and future policy environments, there are now 

two key questions that must be addressed: Is there experimental evidence that voluntary home visitation ‘‘works?’’ and ‘‘Does the field have the understanding of and 

capacity to provide what it takes to go to, and return results at, scale?’’

In 2006, Weiss and Klein reviewed the evidence on home visitation to address the 

question of readiness to scale. They concluded, given the current state of knowledge 

and appropriate demands for demonstration of returns on investment, that voluntary home visiting is a wise bet so long as four conditions around home visitation 

capacity and infrastructure are met as expansion occurs: 

1. First, given the substantial and growing body of evidence about home visiting, 

new and continued funders and their funding should ensure that there is national 

and state support so that providers have the commitment and capacity to incorporate lessons from their own and each others’ research and evaluation for program 

improvement as they go to and operate at greater scale. 

2. Recent meta-analyses suggest that looking across as well as within programs 

provides information about the specific capacities, characteristics and activities that 

contribute to more positive outcomes for children and families. Therefore, a second 

condition is that home visiting programs must regularly collect and report information on their progress and outcomes to determine if their hypothesized outcomes are 

being achieved. 

3. The third condition is that national models and others doing research, evaluation and performance monitoring share their information and results to build the 

collective knowledge base and inform public policy on home visitation. 

4. Finally, because recent evaluations have shown that home visiting can be more 

effective for economically and otherwise disadvantaged families when it is paired 

with center-based early childhood and/or prekindergarten programs, the fourth condition is that there be support for and encouragement of trails of these and other 

combinations to better understand how home visitation fits with and contributes to 

a comprehensive system of early childhood child and family supports. 

14

Weiss and Klein also interviewed representatives of the national models and selected researchers and evaluators knowledgeable about home visitation to get their 

perspectives and recommendations about investments in knowledge development 

and system and capacity building that would support efforts to scale high quality 

and effective home visitation programs. There followed six recommendations about 

what is necessary to deliver quality services at scale: 

1. Develop mechanisms to test and report on the extent to which quality home 

visiting at scale improves outcomes for young children and parents. 

2. To increase the likelihood of achieving results at scale, and to support learning 

and continuous improvement efforts, programs should use a management information system for tracking and monitoring activities. 

3. Identify what capacity is needed to maintain quality at scale in areas including 

training, supervision, technical assistance, research, communication, and advocacy, 

and feed this information back in to support capacity building in each of these 

areas. 

4. Invest in research to better monitor and understand what happens in visits 

that leads to improved outcomes and to support training and supervision efforts. 

5. Invest in research to better match program goals, activities, and intensity with 

family circumstances, home visitors, and supports to get the best outcomes for 

young children and parents. This information is essential for decisions about targeted vs. universal services, allocation of families to particular models, and for decisions about how to integrate home visitation into other early childhood services. 

6. Identify realistic expectations for what home visiting can accomplish and hold 

programs accountable for achieving those outcomes. 

The interviews with the national model representatives indicated that they are 

implementing these recommendations now, and that they are working with a number of state government and nonprofit organizations in their efforts to do so. The 

details of their work are described in Weiss and Klein, 2006. Continuation of these 

efforts is important as home visitation moves from individual model-led national expansion to expansion within a state-led system of home visitation services integrated into a larger comprehensive system of early childhood child and family supports. There is much to be learned from the efforts of the six models as states scale 

home visitation services. There are also key decisions to be made about a national 

research and evaluation agenda for home visitation and how state program expansion will fit with and benefit from national or cross state evaluation, performance 

management, continuous improvement and accountability efforts. 

Several of the recommendations above may be most efficiently managed at the national level with states contributing data and experiences, while others might best 

be handled at the state level with a commitment to cross-state and national information sharing and synthesis. So, for example, states should oversee the development of management information systems but they can learn from the national 

models and from each other as they do so. Program expansion arguably should be 

tied to a transparent and effective system for collecting indicators of performance 

and evidence of use for program improvement purposes. Research on what happens 

in home visits—with resulting implications for targeting, training and supervision, 

on the other hand—might best be part of a state-informed but nationally developed 

and funded research and evaluation agenda, again committed to dissemination of 

results to support continuous improvement efforts. As home visiting moves to scale, 

it will also be important for states to suggest other questions for a nationally-funded 

research and evaluation agenda that would in turn inform their work and quality 

improvement efforts. Coordinated national and state efforts will be necessary to address recommendation five, research and evaluations to answer key policy questions 

about what types of home visitation, in combination with what other supports and 

early childhood services, work when and how for what types of families in order to 

promote school readiness and other valued outcomes. 

In sum, the promising evidence on home visit effectiveness and the field’s growing 

understanding of what it takes to develop and implement high quality services lead 

many to conclude they are worthy of investments to scale-up, so long as all the conditions noted above, particularly their integration into a comprehensive system of 

services, are met.

Question 3: How does the EBAH legislation incorporate the lessons from past evaluations, and thereby increase the likelihood of returning positive results at greater 

scale?

The Education Begins at Home Act—with three years’ funding for states to expand access to early childhood home visitation services with related supports and 

provisions for quality implementation and evaluation—draws from and is consistent 

with the lessons and recommendations that are emerging from the home visit field. 

15

The Act wisely builds in key provisions, including national peer review of state applications, 10% set aside for training and technical assistance, and 3% set aside for 

evaluation with requirements for yearly performance tracking and reporting on key 

indicators and an ongoing independent national evaluation. These provisions for 

continuous improvement both increase the chances of successful implementation 

and will determine if home visiting is in fact achieving its intended short term outcomes. 

As a quick look at the response to question 2 above shows (what it will take for 

home visitation to be ready for scale), the proposed requirements for state plans and 

use of funds all map onto the emerging consensus about what it will take to implement high quality voluntary early childhood home visit programs that offer a genuine and lasting return on investment. Those requirements include a needs and resource assessment, collaboration among home visit models and with other early 

childhood services, specification of outcome areas to be assessed and reported yearly, 

incentive to build in rigorous research designs, outreach to fathers and other caregivers, attention to staff training and supervision and organizational capacity for 

implementation, and the earmarked resources to strengthen Early Head Start home 

visitation. All of these help build programs that can enhance parenting and thus 

school readiness, and sustained family involvement in learning and development. 

I respectfully propose several other considerations for this Bill to the Committee. 

First, my research and experience suggests that both the national models and many 

state administrators are ready to get and use their own and others’ data and research to support an ongoing process of learning, evaluation, performance management, continuous improvement, and accountability. They are ready to become what 

David Garvin at Harvard Business School calls ‘‘learning organizations.’’ 17 The legislation now provides for substantial national as well as state level data collection 

and evaluation, but it does not specify how these data will be used to enhance implementation, learn from failures, benchmark, or share proven practices, in order to 

improve implementation as well as to inform policy-making. Consideration should 

be given to how to get the maximum from the legislation’s substantial investments 

in performance management and evaluation. Leadership at the national as well as 

state level, and provisions to support this learning process, are key, and perhaps 

could be specified as part of the legislation. 

A second consideration involves a requirement for and specification of ways to link 

early childhood home visitation and other early childhood services to school such 

that both children and families are involved in a successful transition to kindergarten and elementary school. Evidence continues to grow that it is important to 

get parents as well as children ready for school, and that parental readiness offers 

academic benefits for children.18 Early childhood home visit programs are designed 

to enhance parent and family involvement in children’s learning and development, 

and many of them reinforce the importance of continued involvement through the 

child’s school career. There is also a substantial research base about the academic 

payoff of continued family involvement and increasing recognition of this amongst 

school administrators and teachers.19 However, the legislation as currently drafted 

does not include provisions for links with districts and schools in order to support 

and include both parents and children in the transition. Nor does the legislation as 

currently drafted consider how to work with schools to continue family involvement 

into and through elementary school. 

Sustained family involvement with the academic payoffs it can bring is one of the 

longer-term outcomes from early childhood home visitation but it will depend on 

building bridges to school and working with educators to help sustain this involvement. 

At the outset, I mentioned that my colleagues and I are working to build the 

knowledge base for complementary learning. Complementary learning involves linking school and non-school supports for children’s learning and development from 

birth through high school and thereby creating pathways into and out of school. Initiatives such as the Harlem Children’s Zone and Omaha’s Building Bright Beginnings are examples of community-based complementary learning approaches and 

both emphasize the importance of support for parenting and family involvement. 

There is a strong research-based case that nurturing parenting and continued family involvement throughout a child’s school career are necessary components of these 

complementary learning pathways. While increasing evidence suggests that no one 

support alone, whether it is a good prekindergarten, school or early childhood home 

visitation program, is enough to get children into and graduating from school, high 

quality early childhood home visitation holds much promise for launching both parent and child on a pathway to graduation, to postsecondary education, and to success in a global society and economy. The Education Begins at Home Act is strucVerDate 0ct 09 2002 09:17 Aug 27, 2008 Jkt 000000 PO 00000 Frm 00019 Fmt 6633 Sfmt 6621 G:\DOCS\110TH\FC\110-95\42728.TXT HBUD1 PsN: DICK
16

tured to provide a great opportunity to offer a key component in this pathway hypothesis. 

ENDNOTES

1 Bouffard, S., Weiss, H., Gordon, E. and Bridglall, B. (2008). Family involvement and Educational Equity. Equity Matters series from the Campaign for Educational Equity, Teachers’ 

College, Columbia University; Belsky, J. et al, and the NICHD Early Child Care Research Network (2007), Are there long-term effects of early child care? Child Development, 78(2), 681—

701. 2 Harvard Family Research Project, Family Involvement Makes a Difference series of 3 research briefs at <http://www.hfrp.org/publications-resources/publications-series/family-involvement-makes-a-difference> 3Weiss, H.B. and Klein, L. (2006). Changing the Conversation About Home Visitation: Scaling 

Up With Quality. <http://www.hfrp.org/publications-resources/browse-our-publications/changing-the-conversation-about-home-visiting-scaling-up-with-quality> 4Weiss, H.B. (Winter, 1993), Home visits: Necessary but not sufficient, The Future of Children, 3(3) 113—28; Gomby, D.S. (January 2003), Building school readiness through home visitation, Paper commissioned for First Five California Children and Families Commission. Available 

at: http://www.ccfc.ca.gov/SchoolReady.htm; Daro, D. (September 2006) Home Visitation: Assessing Progress, Managing Expectations, Written Testimony for House Subcommittee on Education Reform, Committee on Education and the Workforce. Available at: www.chapinhall.org; 

Raikes, H., Green, B., Atwater, J., Kisker, E., Constantine, J., & Chazan-Cohen, R. (2006), Involvement in Early Head Start home visiting services: Demographic predictors and relations to 

child and parent outcomes, Early Childhood Research Quarterly, 21, 2-24; Weiss & Klein (2006). 5Sweet, M.A. & Appelbaum, M.I. (2004), Is home visiting an effective strategy? A meta-analytic review of home visiting programs for families with young children, Child Development, 

75(5):1435-1456. 6Weiss and Klein (2006). 

7Weiss, H.B. (2006) Lessons from a Community of Practice: The Home Visit Forum 1999—

2005 and After. Available at www.hfrp.org. 8Wasik, B.H. & Bryant, D.M. (2001), Home Visiting, Thousand Oaks, CA: Sage. 

9 Johnson, K.A. (May 2001), No place like home: State home visiting policies and programs, 

Johnson Group Consulting, Inc., Report commissioned by The Commonwealth Fund. Available 

at www.cmwf.org. 

10 Bronfenbrenner, U. (974), Is early intervention effective? Teachers College Record, 76(2), 

279-303; Shonkoff, J. & Phillips, D. (2002), From Neurons to Neighborhoods: The Science of 

Early Childhood Development, Washington, DC: National Academy Press; Harvard Family Research Project (2007), Family Involvement in Early Childhood Education from Family Involvement Makes a Difference series of 3 research briefs at <http://www.hfrp.org/publications-resources/publications-series/family-involvement-makes-a-difference> 11 Hart, B. & Risley, T.R. (2002), Meaningful Differences in the Everyday Experience of Young 

American Children, Washington, DC: Brookes. 12 Bouffard, Weiss, Gordon and Bridglall (2008). 13Weiss & Klein (2006). 14Levenstein, P., Levenstein, S., & Oliver, D. (2002), First grade school readiness of former 

child participants in a South Carolina replication of the Parent Child Home Program, Journal 

of Applied Developmental Psychology, 23 (3) 331-353. 15DuMont, K., Mitchell-Herzfeld, S., Greene, R., Lee, E., Lowenfels, A., & Rodriguez, M. (June 

2006), Healthy Families New York Randomized Trial: Impacts on Parenting After the First Two 

Years, New York State Office of Children and Family Services, Working Paper Series: Evaluating Healthy Families New York. Available at: www.ocfs.state.ny..us/main/prevention/assets/

HFNYRandomizedtrialworkingpaper.pdf; Olds, D. (2006), The Nurse-Family Partnership: An 

evidence-based preventive intervention, Infant Mental Health Journal, 27 (1), 5-25. 16Weiss and Klein (2006); Gomby (2003). 17Garvin, D.A., Edmondson, A.C., & Gino, F. (2008), Is Yours a Learning Organization? Harvard Business Review, 86(3):109-116. 18Kraft-Sayre, M. E., & Pianta, R. C. (2000), Enhancing the transition to kindergarten: Linking children, families, and schools. Charlottesville, VA: University of Virginia, National Center 

for Early Development & Learning; Kreider, H. (2002), Getting parents ‘‘ready’’ for kindergarten: 

The role of early childhood education, Cambridge, MA: Harvard Family Research Project; 

Schulting, A. B., Malone, P.S., & Dodge, K. A. (2005), The effect of school-based kindergarten 

transition policies and practices on child academic outcomes. Developmental Psychology, 41(6), 

860—871; Schulting, A. (2008), Promoting Parent—School Relationships During the Transition 

to Kindergarten, The Evaluation Exchange, 14(1 &2): 8. Cambridge, MA: Harvard Family Research Project. 19 Harvard Family Research Project (2008). The Evaluation Exchange: Building the Future of 

Family Involvement, 14(1 &2): 8. Cambridge, MA: Author. 

Chairman MILLER. Thank you. 

Julie, we are going to turn to you. Your husband is Victor? 

Ms. FENLEY. Yes, that is correct. 

Chairman MILLER. He is more than welcome, if you and Zane 

want to sit at the table and you want to let him color over there 

17

at the table, or if you want to walk around with him, do whatever 

you want. This is supposed to be a child-friendly committee, you 

know. 

Ms. FENLEY. He is a handful, as you can see. 

Chairman MILLER. So if Zane and Megan want to hang out at 

the staff table, the press table, whatever, they are welcome to. 

Whatever makes it easy on you. 

Ms. FENLEY. Thank you so much. 

Chairman MILLER. Julie, welcome to the committee. We look forward to your testimony. This is the same Zane and Megan that are 

in your testimony, right? 

STATEMENT OF JULIE FENLEY, PARTICIPANT, PARENTS AS 

TEACHERS HOME VISITATION PROGRAM 

Ms. FENLEY. That is correct. 

Thank you for having me, first of all. It is a pleasure to be here. 

My name is Julie Fenley, and I am a participant in the Parents 

As Teachers Program in Norfolk, Virginia. 

My husband, Victor Fenley, is an aviation structural mechanic, 

an airman apprentice, as mentioned. We have two beautiful children who are both with us today, Megan, who is 7, and Zane, the 

handful, who is 2. 

Our dream of being a military family started quite some time 

ago, but we officially started our Navy career in February 2007. It 

has changed our lives in many ways. We were both raised in very 

small towns in Southeast Texas. We moved to Virginia Beach, and 

I was terrified. 

I noticed immediately it was very different from life in Texas, 

with our extended family there to support us. It has taken some 

time, but I am so proud to call Virginia my home now. 

I have taken on the mentality that home is not where you are 

raised but indeed where the Navy sends you. 

Zane and I joined the Parents As Teachers Program shortly after 

we arrived in Virginia Beach. During our first couple of visits with 

Ms. Terrilyn Williams, who is our parent educator, Zane was timid 

and shy. But now when she comes through the door, he is always 

excited to see her. He knows this is a special playtime with 

Mommy and Miss Terri, which is his name for her. 

During each meeting, Zane gets to experience a new activity and 

I get to learn a new parenting skill. For me, it is the perfect opportunity to get inside his tiny, little mind and really understand the 

reasons he does some of the silly, little things he does. Or what is 

behind those challenging behaviors for us as parents. 

The past couple of visits have been very special for Zane and myself because my husband was able to participate in the home visit. 

We have really enjoyed our visits with Ms. Terrilyn as a family. 

When Zane was born, he had a serious medical condition called 

PPHN, also known as pulmonary hypertension in newborns. The 

physicians told me that he could possibly suffer from neurodevelopmental issues. 

After doing a little research, I made a discovery that the number 

one side effect for children who survive the illness is sudden hearing loss and speech delay. I was terrified and so worried that this 

18

could be the reason that Zane wasn’t talking as well as he should 

be. 

The in-home developmental screening that Ms. Terrilyn conducted confirmed that Zane had potential delays. She calmly talked 

to me about my concerns and referred me to local resources that 

could do further testing on Zane. The testing showed me that he 

was approximately 3 months behind on his speech, but they suggested that we wait a few months and see how he progresses on 

his own. 

Zane is now learning new words almost daily, and if it weren’t 

for Ms. Terrilyn, I would not have found those resources on my 

own. 

Terrilyn was also very helpful to help us find some other resources in the community that helped us through some difficult financial times, especially around the holidays. She just seems to 

know how to get things done in our community and how to help 

us connect with community resources that I didn’t know about. I 

really wish that I would have had this program when Megan was 

Zane’s age. I think it could have taught me some wonderful parenting techniques right from the start, rather than learning from 

trial and error. 

It has been very beneficial for both me and my husband. Before 

he left for training, he was the one who took care of most behavioral issues. But when he left, it was my job to do everything, including discipline. This was a very stressful time for me. By the 

time we reunited 8 months later, he and I developed completely different approaches on parenting and discipline. 

I asked Ms. Williams about the problem we were having, and she 

explained to me some things we could do and she gave me some 

very helpful literature. It really helped my husband and I to get 

on the same page and work together as a team. 

Megan and Zane are wonderful children and we are so blessed 

to have them in our lives. They deserve the best this world has to 

offer, including my husband and I being the best parents as possible. 

I feel in my heart Parents As Teachers is just what we were 

needing in our lives. It helps me be a better parent every day. I 

think every military family could benefit from Parents As Teachers. 

We are blessed to have such a wonderful program at Norfolk, but 

there is a waiting list and so many families aren’t able to participate. I respectfully encourage the committee to support the Education Begins At Home Act, which has provided me much help in 

my life, and it would be great to get the funding for so many more 

families that could really benefit from the program. 

I would like to say in closing a special thank you to Ms. Terrilyn 

Williams for making such an impact in our lives. Not only as a parent educator, but as a friend. Thank you for your dedication to the 

program and for all your encouraging words and your knowledge. 

I feel so validated as a parent each time Ms. Terrilyn visits. Once 

she leaves, it is great for me. I feel so rewarded as a parent. Once 

again, thank you for teaching me how to be my children’s best and 

most important teacher. 

Thank you. 

[The statement of Ms. Fenley follows:]

19

Prepared Statement of Julie Fenley, Parents as Teachers Program 

Participant 

Thank you Mr. Chairman and Committee members for this opportunity to speak 

to you today. My name is Mrs. Julie Fenley and I participate in the Parents as 

Teachers program in Norfolk, Virginia. My husband, Victor Fenley, is an Aviation 

Structural Mechanic Airman Apprentice with the US Navy. We have 2 children who 

are both with us today—Meghan who is 7 years old and Zane who is two years old. 

Our dream of being a military family started quite some time ago, but we officially started our Navy career in February of 2007. It has changed our lives in many 

ways. We were both raised in very small towns in south east Texas. When we 

moved to Virginia Beach I was terrified. I noticed immediately it was very different 

from life in Texas with our extended family there to support us. It has taken some 

time but I am so proud to call Virginia my home now. I have taken on the mentality 

that home is not where you are raised, but where the Navy sends you. 

Zane and I joined the Parents as Teachers Program shortly after we arrived in 

Virginia Beach. During our first couple visits with Mrs. Terrilyn Williams, our parent educator, Zane was timid and shy but now when she comes through the door 

he is always excited to see her. He knows this is special play time with mommy 

and Miss Terri, which is Zane’s name for her. During each meeting, Zane gets to 

experience a new activity and I get to learn a new parenting skill. For me it is the 

perfect opportunity to get inside his tiny little mind and really understand the reasons he does some of the silly little things he does or what is behind those behaviors 

that challenging for us as parents. The past couple visits have very special for Zane 

and myself because my husband was able to participate in the home visits. We have 

really enjoyed our visits as a family with Terrilyn. 

When Zane was born he had a serious medical condition called PPHN also known 

as pulmonary hypertension in newborns. The physicians told me he could possibly 

suffer from neurodevelopment issues. After doing a little research, I made the discovery that the number one side effects for children who survive this illness is sudden hearing loss and speech delay. I was terrified and so worried that this could 

be the reason why Zane wasn’t talking all that well. The in-home developmental 

screening that Terrilyn conducted confirmed that Zane had potential delays. 

Terrilyn calmly talked with me about my concerns and referred me to local resource 

professionals that could do further testing on Zane. The testing showed that he was 

approximately three months behind on his speech, but they suggested we wait a few 

months and see how he progresses on his own. Zane is now learning new words almost daily. If it weren’t for Terrilyn I would not have found those resources on my 

own. 

Terrilyn was also very helpful to us in finding other resources in the community 

that helped us through some difficult financial times, especially around the holidays. 

Terrilyn just seems to know how to get things done in our community and helped 

us connect with community resources that I didn’t know about on my own. 

I really wish I would have had this program when my daughter Meghan was 

Zane’s age. I think this could have taught me some wonderful parenting techniques 

right from the start, rather than learning from trial and error. It has been very beneficial for both me and my husband. Before he left for training he was the one who 

took care of most behavioral issues. But, when he left for eight months it was my 

job to take care of everything, including discipline. This was a very stressful time 

for me. By the time we reunited eight months later, he and I had developed completely different approaches to parenting and discipline. 

I asked Terrilyn about the problem we were having and she explained to me some 

things we could do and she gave me some helpful literature. It really helped my 

husband and me to really work together. Meagan and Zane are wonderful children 

and we are so blessed to have them in our lives. They deserve the best this world 

has to offer, including my husband and I being the best possible parents. I feel in 

my heart that Parents as Teachers is just what we were need in our life. It helps 

me to be a better parent. I think every military family could benefit from Parents 

as Teachers. We are blessed to have such a wonderful program at Norfolk, but there 

is a waiting list so many families aren’t able to participate. I respectfully encourage 

the Committee to support the Education Begins at Home Act, which would provide 

much needed funding so more families can benefit from home visiting programs like 

Parents as Teachers. 

I would like to say in closing a special thank you to Mrs. Terrylinn Williams for 

making such an impact in our lives not only as a parent educator but as a friend. 

Thank you for your dedication to this program and for all your encouraging words 

and knowledge. I feel so validated as a parent each time Terrilyn visits. Once again 

thank you for teaching me how to be my children’s best and most important teacher. 

20

Chairman MILLER. Thank you very much. 

Would Ms. Terrilyn like to stand up? [Applause.] 

Thank you. Nice to have you here. Thank you for what you are 

doing. 

Ms. London? 

STATEMENT OF MAKEDA LONDON, PROGRAM MANAGER AND 

FAMILY SUPPORT SERVICES COORDINATOR, HEALTHY FAMILIES—NEAR NORTH HEALTH SERVICE CORP. 

Ms. LONDON. Chairman Miller and Congressman Davis and the 

other distinguished committee members, thank you for inviting me 

here to provide testimony on my experience with home visitation 

services in Chicago, Illinois. 

I am a Healthy Families program manager and family support 

services coordinator for Near North Health Service Corporation. 

Today I share with you the benefit of my experience about the 

characteristics of a successful home visitation program and the 

benefit of a federal investment in such services for our families and 

our young children. 

The Healthy Families program at Winfield Moody Health Center 

presently serves 41 families in the Near North community. Our intensive home visitation services are offered to new parents, pregnant and parenting women, and children up to age three. Since the 

inception of the program 14 years ago, our home visitors have successfully completed 14,000 home visits. 

The Near North community where our Healthy Families program 

is located 14 years ago has certainly changed. The high-rise building and row houses that make up the Cabrini Green Housing Development for many years are daily being demolished, literally 

being torn down as we meet here today. This infamous community 

better known for its crimes, its gangs and blight has been a backdrop of the home visitation services of the Healthy Families program. It has been among this unsafe environment that home visitors of our program have been more like a battlefield, where the 

assessment workers and the home visitors have reported for duty, 

armed only with their prenatal and their parenting curriculum, development screenings and safety materials, their smiles and their 

love for the community, and their passion for their work. 

This kind of commitment to work has forged trusting relationships with our participants that often last a long time after the 

children have graduated from our program at age three. 

Within this challenging environment, we have been able to make 

great strides with our program participants, leading to a better 

early childhood development outcome for our children. The Near 

North Healthy Families program, who is part of the Healthy Families Illinois Network and the large-scale longitudinal evaluation 

that examines the programs’ impact on parents’ and children’s outcomes. 

Among the many benefits of participating in this program, the 

evaluation found that parents involved in Healthy Families’ services demonstrated significantly greater improvement skills that foster their child’s growth during the infant’s first 6 months of life. 

At 2 years, the families receiving Healthy Families’ services comVerDate 0ct 09 2002 09:17 Aug 27, 2008 Jkt 000000 PO 00000 Frm 00024 Fmt 6633 Sfmt 6602 G:\DOCS\110TH\FC\110-95\42728.TXT HBUD1 PsN: DICK
21

pared to those receiving other usual services offered their children 

a wider array of materials to stimulate the cognitive development. 

Every day I see the tremendous impact that quality early childhood home visitation has on families in my community. Parents 

who lack parenting skills graduating from parenting classes; parents who had little knowledge of their child’s development stages 

anticipate visits from home visitors so they can complete their 

child’s age appropriate Ages and Stages developmental screening. 

Parent-child interaction has changed from mere television watching 

with their children to interactive play between parents and children at the children’s museum. Parents who were among the many 

others who believed that the only time you took your child to the 

doctor was when your child was sick, now see the benefit of preventive and regularly bringing their children to the doctor for well 

child visits and immunizations. 

Two of our parents, Laquisha and Pam—Laquisha came in and 

she has been a member and a participant in the program for 5 

years. Today Laquisha is an entrepreneur, a massage therapist. 

She was trained following the resources of her home visitor as a 

breastfeeding peer counselor, was employed and is very, very motivated. She has two beautiful children today. 

Another participant, Pam, who is a single mother of seven children, is battling now relocation from Cabrini Green housing. She 

has a mother who is ill and blind and not only the relocation and 

the housing being an issue with her, working with her home visitor, we know that she will be relocated to better housing from the 

work with the home visitor. But Pam now serves as our advisory 

consult chairperson. 

What I would like to summarize is the benefits that we see coming from the Education Begins at Home Act, the training and the 

supervision, the community collaboration, the evaluation. All three 

are requirements of the bill. In order to assure quality of home visits, our home visitors receive training. The training increases the 

home visitors’ knowledge, it develops their skills to meet the challenges that the program participants face and the home visitors, in 

achieving these outcomes with families. 

The initial training that they get, the core training, is added to 

that ongoing training. Effective supervision is a part of it. The 

Healthy Families program is a program, a home visitation program, that is important to us, and it is a part of a community 

health center, which is the basis of our participants coming into the 

program. 

I urge today that this committee begin and move this legislation 

toward enactment. 

Thank you, chairperson, thank you, Danny Davis, and our executive director, Dr. Bernice Mills Thomas, thanks you very much for 

this participation in this committee. 

[The statement of Ms. London follows:]

Prepared Statement of Makeda London, Healthy Families Program 

Manager 

Good morning Mr. Chairman and distinguished members of the committee. Thank 

you for inviting me to provide testimony of my experience with home visitation services in Chicago, Illinois. 

22

My name is Makeda London, and I am the Healthy Families Program Manager 

& Family Support Services Coordinator for Near North Health Service Corporation 

(NNHSC). I have served in the position as Healthy Families Program Manager for 

14 years. When I started in this position in May 1994, I was responsible for implementing this intensive home visitation program at our community based health care 

facility—Winfield-Moody Health Center, located on the Near North side in Chicago. 

I am now responsible for overseeing the supervision of the home visiting staff and 

assuring that the program meets its goals, of which the overall goal is the prevention of child abuse and neglect. 

My undergraduate work in social science and graduate work in education administration uniquely prepared me for this role. Prior to coming to NNHSC, for 12 years 

I was the Director of an alternative high school, Lumumba-Jackson Community 

Learning Center. This was a private, nonprofit alternative school that was a member of the Alternative Schools Network. The school was located in the same community area as our present Healthy Families program. Over these 14 years, many of 

the Healthy Families participants have been relatives and friends of former students of the high school. Little did I know that my work in the school was planting 

a seed in the community that would germinate in the Healthy Families program 

today. 

Today I share with you the benefits of my experience about the characteristics of 

a successful home visitation program and the benefit of a federal investment in such 

services for families and young children. 

Home visitation overview 

Home visitation provides guidance to parents and increases their knowledge of 

their child’s growth and development from birth through kindergarten entry. Services are delivered to the participants by well-trained, respected home visitors who 

are responsive to the presenting and changing needs of parents. 

The Healthy Families program at Winfield-Moody Health Center presently serves 

41 families in the Near North Community Area 08. Our intensive home visitation 

services are offered to new parents. Since the inception of the program 14 years ago, 

this community has drastically changed. The high rise buildings and row houses 

that made up the Cabrini-Green public housing development for many years, are 

daily being demolished, literally being torn down as I speak. Families are being 

moved around and relocated to other communities and this relocation often makes 

it difficult to locate those most in need of our services. 

This infamous community better known for its crime, gangs, and blight has been 

the back drop of the home visitation services of the Healthy Families program. It 

has been among this ’unsafe’ environment, that often has been more like a ’battlefield,’ that assessment workers and home visitors have reported for duty for the past 

14 years armed only with their prenatal and parenting curriculums, developmental 

screenings, safety materials, smiles, love for the community and passion for their 

work. This kind of commitment to work has forged trusting relationships with participants that often lasts well beyond the child’s graduation from our program at 

age three. 

In these 14 years, these community soldiers have delivered more than 14,000 

home visits. These visits are made to participants who are screened and assessed 

on a number of factors, including substance abuse, DCFS involvement, lack of parenting skills, domestic violence, and no social support; no lifelines. What this indicates to home visitors, is that a parent assessed with these risks, when he/she becomes overwhelmed or stressed, has the potential to become abusive or neglectful 

to their child. So, at our program, we seek to develop relationships with the mother 

while she is pregnant. 

While I represent the Healthy Families America program, nationally, there are 

a number of effective, evidence-based home visitation programs that would benefit 

from the Education Begins at Home Act, including Home Instruction for Parents of 

Preschool Youngsters (HIPPY USA), the Nurse-Family Partnership, The ParentChild Home Program, and Parents as Teachers. While the goals and target populations of these programs vary, they all offer similar core services. All programs 

offer home visits which are voluntary and at no cost to participants. All provide parent education, especially emphasizing early childhood development. Many home visitation programs work with families on language, literacy and reading skills, while 

others focus on baby care and health services. 

Ensuring quality and effectiveness 

I have been asked today to share with you what my fourteen years with the 

Healthy Families program have taught me about what makes a home visitation program successful. While there are number of components for successfully impleVerDate 0ct 09 2002 09:17 Aug 27, 2008 Jkt 000000 PO 00000 Frm 00026 Fmt 6633 Sfmt 6621 G:\DOCS\110TH\FC\110-95\42728.TXT HBUD1 PsN: DICK
23

menting a home visitation program, I will highlight three specific characteristics 

that have tremendous impact on program quality and effectiveness: 

• Training and Supervision; 

• Community Collaboration; and 

• Evaluation linked to program goals. 

Training and Supervision: 

Staff development and training is one of the 12 research-based Critical Elements 

(or Best Practices) that guide the Healthy Families program. In order to insure the 

quality of the home visit, the home visitor must receive intensive formal training 

(i.e. initial core training for their specific job function and ongoing wraparound 

training). The training increases their knowledge, develops skills to meet the challenges faced by program participants and assists home visitors in achieving outcomes with families. Program supervisors and managers also receive training, support and professional development opportunities. In my community, the training 

and professional development is provided by the Ounce of Prevention Training Institute. 

Training is an integral part of the fabric of NNHSC; embedded in our Mission. 

Each month, our facilities are closed for a half day for staff training and development. Some of the training topics each year are: Age-Specific Competencies; Cultural Diversity; and Child Abuse Recognition. The Healthy Families program adds 

to that with regular in-service trainings for staff. 

Effective supervision is an integral part also of the Critical Elements of the 

Healthy Families program. Program supervision occurs weekly with home visitors. 

During supervision, participant cases are discussed, home visit content and frequency reviewed. Through reflective supervision, home visitors are able to discuss 

challenges they face and together with the supervisor decide on solutions. They are 

able to discuss their own professional development. 

In my role as program manager, I supervise the project supervisor who in turn 

supervises the home visitors. Together, we evaluate the performance of home visitors through observation/shadowing and data and file reviews. Feedback is provided 

to improve performance, and ensure the critical elements and standards are followed and goals are achieved. 

Benefits of high quality supervision include: 

• Promoting both staff and program accountability; 

• Encouraging home visitor’s personal and professional development; 

• Reducing staff burnout and turnover by providing home visitors with much 

needed support; and most importantly, 

• Enhancing the quality of services families receive. 

The Education Begins at Home Act recognizes the importance of training and supervision by setting aside 10 percent of a state’s grant for training and technical 

assistance, and by requiring that states only fund programs that ‘‘employ welltrained and competent staff’’ and ‘‘maintain high quality supervision to establish 

home visitor competencies.’’

Community Collaboration: 

Home visitation is not an island in the sea of early childhood development programs. Families require an array of services to provide a safe, abuse-free home environment that produces a healthy child. 

The Healthy Families program in Near North Chicago is uniquely housed in a 

community health center that offers primary health care services and a wide range 

of social support services. A majority of the Healthy Families participants are patients of the health center. As such, their medical providers (OB/Gyne doctors and 

pediatricians) are within walking distance from their homes and easily accessible 

to them. The program participants, medical providers and home visitors have forged 

together as an effective team in the positive growth and development of the child. 

Some of the other services accessible to program participants are, case management, 

domestic violence services, mental health services (individual and group counseling 

by licensed clinical social workers), intensive outpatient substance abuse treatment, 

perinatal depression screening and treatment, nutrition counseling, WIC (Women, 

Infants and Children) services, dental services, ophthalmology, parenting classes, 

consumer support groups, and client group education. 

Our home visitors are trained to link program participants to available services 

through a range of state, city and community partners. The Health Center’s community partnerships and affiliations include the Chicago Department of Public Health, 

Illinois Department of Human Services, Children’s Memorial Hospital, Northwestern Memorial Hospital, John Stroger Cook County Hospital and United Way. 

24

1Study designs include 8 randomized control trials and 8 comparison group studies. More information on the studies can be found in the Healthy Families America Table of Evaluations 

at www.healthyfamiliesamerica.org/research/index.shtml. 

2 Illinois Department of Health and Human Services. ‘‘Healthy Families Illinois: Evaluation 

Findings Executive Summary.’’ September 2006. 

In fiscal year 2007, home visitors were instrumental in facilitating the 14,306 clinical visits made by patients to Winfield-Moody Health Center and the 10,636 nonclinical (social support service) visits to all five community health centers of the corporation. 

The Education Begins at Home Act supports the role that home visitation programs play in linking participants to additional services in two primary ways: 

1. State-level Early Childhood Coordinating Body. EBAH requires that states ensure collaboration among a broad range of child-serving programs by creating or utilizing an existing state-level early childhood coordinating body. This coordinating 

body would meet regularly to address policy and implementation issues that will improve the coordination of a range of services for children and families, especially 

those receiving home visitation services. The coordinating body would include representatives from early childhood home visitation programs, early care and education programs, child abuse prevention and treatment programs, health care programs, nutrition programs, and workforce development programs, to name just a 

few. 

2. Information and Referral. The legislation requires that home visitation programs funded by EBAH provide referrals for eligible families to additional resources 

available in the community, such as child care, family literacy programs, employment agencies, and other social services. 

Quality Assurance & Evaluation: 

We could not state that ours is a successful home visitation program had we not 

built in effective quality assurance measures. As program manager, I sit on our 

agency’s multidisciplinary Quality Improvement Committee that monthly reviews 

clinical, program and support parameters. Our Healthy Families program also has 

its own Quality Assurance Committee that quarterly reviews program service delivery parameters and other critical element standards. Home visitors are among the 

reporters on this committee. 

Additionally, there are external audits and reviews of program data inputted by 

home visitors into the state’s human services monitoring and tracking system called 

Cornerstone. Also, our program proudly displays our Credentialing Plaque, just outside my office at Winfield-Moody. The program was credentialed in June 2007 after 

a very thorough, intensive, external review of records, systems, policy, procedures 

and service delivery by our national accrediting body, Healthy Families America. 

In fiscal year 2007, 1149 home visits were conducted by home visitors of our 

Healthy Families program with a successful completion rate of 86%. This among 

program participants with some of the highest and most numerous challenges for 

risk of abuse. 

Evaluation 

Home visitation as a field has a history of being committed to evaluation and program improvements. The Healthy Families America program alone has been subject 

to 34 studies in 25 states involving over 230 HFA programs.1 Healthy Families Illinois—of which my program is a part—recently underwent a large scale, longitudinal 

evaluation that examined the program’s impact on parent and child outcomes. The 

evaluation, conducted by Northern Illinois University, identified the following key 

findings: 2 

At six months: 

• Parent-child interactions improved significantly across time in families receiving HFI services. No such improvements were noted in families receiving all other 

usual services. 

• Parents involved in HFI services demonstrated significantly greater improvements in their growth fostering skills during their infant’s first six months of life 

relative to comparison parents, who received all other usual services. 

At one year: 

• Parents receiving HFI services, relative to parents receiving all other usual 

services, displayed higher levels of acceptance of challenging behaviors. 

25

At two years: 

• Families receiving HFI services, compared to those receiving all other usual 

services, offered their children a wider array of materials to stimulate their cognitive development. • Parents with highest risk for problems in parenting showed the greatest improvements, including lower levels of distress, fewer rigid beliefs, fewer problems 

with others and greater ego. 

The Education Begins at Home Act places a strong emphasis on evaluation. On 

an annual basis, states must report on outcomes consistent with program goals, including parent knowledge of early learning and development; child development indicators; child maltreatment indicators; school readiness indicators; and links to 

community services. At the federal level, EBAH requires an independent evaluation 

at the end of the second year of implementation to assess outcomes consistent with 

program goals. 

Conclusion 

Everyday, I see the tremendous impact that quality early childhood home visitation has on the families in my community. Parents who lacked positive parenting 

skills have graduated from parenting classes. Parents who had little knowledge of 

their child’s developmental stages anticipate visits from home visitors so they can 

complete their child’s age appropriate Ages & State developmental screening. 

Parent-child interaction has changed from television watching with your child to 

interactive play of between parents and children at the Children’s Museum. Parents 

who were among many others who believed the only time you took your child to the 

doctor was when that child was sick now see the benefit of prevention and regularly 

bring their children to the doctor for well child visits and immunizations. Most importantly, when I review the child abuse statistics in my community that indicate 

there were 52 indicated victims of child abuse—none of them were participant children of the healthy families program! 

I’ve said enough, though. Two of our Healthy Families participants, whose success 

stories are featured in our agency’s 2007 Annual Report, tell the success of home 

visitation better than I could ever tell it. The first, Lakisha, was enrolled in our program for five years. She started the program as a young pregnant woman and today 

has two beautiful daughters, both of whom she breastfed, which is a program outcome. Not only did she breastfeed her daughters, but she became a Breastfeeding 

Peer Counselor. Her home visitor referred her to a Chicago breastfeeding training 

program, which she attended and completed. She was employed for a period of time 

as a Breastfeeding Peer Counselor at a local hospital. Today, Lakisha has completed 

another training program (massage therapy), and is now an entrepreneur. 

The second young woman, Pam, a single mother of seven children enrolled in the 

Healthy Families program when she was pregnant two years ago. Pam experienced 

some complications during her pregnancy and was placed on bed rest. She gave 

birth to a beautiful daughter in June 2006. (Incidentally, one of our home visitors 

also makes hospital visits to patients and program participants who deliver to give 

support to the mother after delivery and welcome the newborn). One of the IFSP 

(Individual Family Support Goals) that Pam works together with her home visitor 

on is suitable housing. 

Pam lives in the Cabrini-Green housing development. Housing relocation for Pam 

is very challenging. Not only because of Pam’s large family, but because Pam lives 

with and is taking care of her mother who is ill and visually impaired. Pam has 

faced this and other challenges and came out smiling. Today she has a son who 

graduated from elementary school and a daughter who is a freshman at a local college. Pam’s self esteem has improved since enrollment in the program and she is 

now the Chairperson of our Healthy Families Advisory Committee. 

In a time of limited resources, the federal government has the responsibility to 

make wise investments in services that have been tested and found to be effective. 

The Education Begins at Home Act honors this responsibility by supporting the 

highest-quality home visitation services. I urge every member of this committee to 

support the Education Begins at Home Act and to move this important legislation 

towards enactment this year. 

Thank you, Mr. Chairman and distinguished members of the committee, for allowing me the opportunity to share this testimony with you today. And thank you Congressman Davis for your leadership on the Education Begins at Home Act. The 

Healthy Families participants in the Near North neighborhood of Chicago are fortunate to be represented by such an ardent champion for children. 

Chairman MILLER. Ms. Ditka? 

26

STATEMENT OF LAURA A. DITKA, DEPUTY DISTRICT 

ATTORNEY AND CHIEF OF CHILD ABUSE UNIT 

Ms. DITKA. Thank you, Mr. Chairman, Ranking Member 

McKeon, Congressman Altmire and members of this committee. 

First let me thank you for the opportunity to speak before you 

today. 

I hope to give you some anecdotal evidence about what results 

when there is not home visitation and when there is not early 

intervention in children’s lives, particularly at-risk children in our 

communities. 

As a prosecutor for 20 years, there was such a need in Allegheny 

County that I was able to start the Child Abuse Unit. There are 

four lawyers in our small county that do nothing but child abuse 

all day, every day, resulting from sexual abuse, physical abuse and 

neglect. 

And I am not here today to vilify parents. Certainly there are 

cases that come before me where people act with villainous intent. 

But in many, many of the cases that we see, there are parents that 

just do not have the skills, the resources or the knowledge necessary to care for their children in an appropriate way that will 

help them thrive later in society and as individuals. 

I would like to give you a couple of examples. Last month, I sentenced two young women in their twenties, between the two of 

them they had seven children. They had been life-long friends since 

grade school. Those women decided that they needed to blow off 

some steam and went out for a night on the town. They left their 

seven children home alone. The oldest of the children were two 8-

year-olds. 

The 8-year-olds began playing with matches. They burned down 

the house. They were unable to get their siblings out and five of 

them perished. 

The sentencing was an emotional and gut-wrenching event. 

These mothers loved their children. They did not wish to harm 

their children. But nobody had taught them the dangers that might 

befall leaving children of such a young age at home and the consequences were grave. 

On that same street in this at-risk neighborhood, I currently 

have a case, a mother, again very young, with a special needs child, 

who is somewhat ill-equipped to deal with the needs of her child, 

has turned to drugs and alcohol. In her home, faulty wiring started 

a fire. She was so intoxicated that she was unable to tell the police 

and firefighters that arrived at the scene how many children she 

had, and her oldest child, who was 6, perished in that fire. 

Again, not a mother that had any ill intent towards her child, 

any sort of malice or malicious will, just ill-equipped to deal with 

what was put before her. And at home visiting and this bill, Education Begins At Home, would greatly improve those skills that are 

needed for these parents. 

There is not only a component with children that are harmed, 

that type of abuse, but one of the stories that will stay with me 

throughout my career and, in fact, until the end of my days, a case 

that I did. A number of young mothers from the inner city didn’t 

know what to do with their children. A gentleman came along with 

some means and some education and suggested to these mothers 

27

that he could watch their children and give them a better life, and 

these mothers essentially gave this man their children. 

I prosecuted him for abusing 11 of the children that were in his 

home, ranging from the age of 14 to the age of 2, and what stuck 

with me was a young man who was 11 years old. He told me, ‘‘Ms. 

Laura, I know he did bad things, but he was the best dad I ever 

had. He made me go to school, he cared about my homework, he 

took me to church, he had me play baseball.’’ And that young man 

was then removed from this abusive home and put back to a home 

with a mother who still had no skills and 2 years ago I was testifying before a judge asking for leniency, because that young man 

had now reached 18 and was turning to a life of crime and selling 

drugs to help support he and his wife and his young infant child. 

This program has such positive outcomes. Let me just give you 

some good examples of what can happen from this. 

In houses where there have been—and in Allegheny County we 

use the Nurse-Family Partnership—in houses where they has been 

visitation, 60 percent of the mothers and 60 percent of the children 

no longer are arrested because of that early intervention. Test 

scores have gone up; 43 percent of the children have scored above 

the 50th percentile in cognitive ability, making them better prepared for school, better prepared for high school and hopefully on 

to college and a productive societal ethic. 

There are $103 billion spent each year on child abuse. The costbenefit analysis shows that these programs for each dollar spent 

reduces that cost by making people productive members of society. 

I have two empirical data that I would ask the committee to accept, 

one from the PCCD in Pennsylvania on the economic returns of 

home visiting, and one from Fight Crime, Invest in Kids, on breaking the cycle of child abuse. 

In summation, I would like to encourage you if at all possible to 

reduce my workload, to give me less people to prosecute, to give 

people more ability to care for their children so we can have a 

brighter future tomorrow and in the future. 

Thank you very much. 

[The statement of Ms. Ditka follows:]

Prepared Statement of Laura A. Ditka, Deputy District Attorney, Allegheny 

County, PA, on Behalf of Fight Crime: Invest in Kids 

Chairman Miller, Ranking Member McKeon, and Members of the Committee: 

Thank you for the opportunity to testify before you today. My name is Laura Ditka. 

I am a graduate of the Duquesne University School of Law and a 20-year employee 

of the Allegheny County District Attorney’s Office. I am also a member of FIGHT 

CRIME: INVEST IN KIDS, an organization of more than 4,000 police chiefs, sheriffs, prosecutors, and victims of violence, who have come together to take a hardnosed look at the research on what can keep kids from becoming criminals. 

As a Deputy District Attorney, my day-to-day job is to prosecute offenders and see 

that justice is done. However, I know that we can’t arrest and prosecute our way 

out of the crime problem. We must also invest in proven approaches that reach kids 

and their families before they begin offending. When teens are having children, and 

there’s no role model available of good parenting practices, we can’t be surprised 

when some of those kids don’t grow up to become successful adults. It is really ironic 

to me that everyone has to pass a test and get a license to drive, and even to get 

a license to fish, but there’s no opportunity for at-risk new moms and dads to learn 

about effective parenting practices. Beginning at the beginning means offering services to new parents, even before their kids are born, and preventing child abuse and 

neglect—that’s one of our strongest weapons in the fight against crime. 

28

The Allegheny County Child Abuse Unit that I founded and now direct investigates and prosecutes hundreds of cases of child abuse and neglect each year. For 

example, on any given day the four attorneys that I supervise are in court with 

cases of horrific sexual abuse and cases of physical abuse and neglect of children. 

One particular case comes to mind involving a mentally challenged mother who saw 

her husband touching her child in a sexual manner. The mother did not have the 

parenting skills necessary to stop the abuse caused by her husband. This child endured this sexual abuse for over one year until she was seriously harmed and both 

parents were prosecuted. This is the type of family in need of quality home visiting 

and help. 

In many of the cases I prosecute, the perpetrator didn’t set out to be a bad parent 

and hurt their kids. They just didn’t realize they shouldn’t leave their child unattended, for example. I have just finished the prosecution of two young mothers who 

left 7 children, ages 8 and under, home alone while they went out for the night. 

One of the children was autistic. The 8-year-old ‘‘babysitters’’ were playing with 

matches and started a fire that destroyed the home and killed the five younger children. On that same street in Allegheny County, a case is pending of a young mother 

who was so intoxicated while at home with her three young children that when her 

house caught fire—she could not tell police and fire fighters how many children 

were in the house. This resulted in her oldest child dying in the fire. 

It is important to note that in Pennsylvania many suspected instances of child 

abuse and neglect do not rise to the level of criminality, so the problem is far greater than the hundreds of cases my office prosecutes. Last year, there were 4,162 instances of confirmed abuse or neglect in Pennsylvania. Even though the majority 

of children who survive abuse or neglect are able to overcome their maltreatment 

and become productive adults, too many victims of abuse and neglect cannot. Not 

only are they more likely to abuse or neglect their own children, they are also more 

likely to become violent criminals. The best available research indicates that, of the 

4,162 children who had confirmed incidents of abuse or neglect in one year in Pennsylvania, 160 will become violent criminals as adults who otherwise would have 

avoided such crimes if not for the abuse and neglect they endured. Research also 

shows that, nationally, based on confirmed cases of abuse and neglect in just one 

year, an additional 35,000 violent criminals and more than 250 murderers will 

emerge as adults—people who would never have become violent criminals if not for 

the abuse or neglect they endured as kids. 

Fortunately, voluntary home visiting programs can help stop this cycle. These programs offer frequent, voluntary home visits by trained individuals to help new parents get the information, skills and support they need to raise healthy and safe kids. 

There are many models of home visiting that help young children get off to a good 

start in life. They serve slightly different populations and have somewhat different, 

but complementary goals—improving outcomes in a wide range of areas including 

health, academic achievement, employment and criminality. 

The Nurse-Family Partnership (NFP) model of home visiting has the strongest 

evidence on crime reduction,and I’d like to note that our former governor’s wife, 

Michelle Ridge, an active member of the NFP national board, testified in support 

of this legislation in a hearing held by Representative Castle two years ago. NFP 

provides home visits by nurses to interested at-risk young mothers starting before 

they give birth and continuing until their first child is age two. Rigorous research, 

originally published in the Journal of the American Medical Association, shows the 

program cut abuse and neglect among at-risk children in half. In addition, by the 

time the children in NFP had reached age 15, mothers in the program had 61 percent fewerarrests than mothers left out of the program, and their children had 59 

percent fewer arrests than the kids leftout. The Nurse-Family Partnership has been 

recognized as an evidence-based model by numerous agenciesand Administration officials in recent years, including the Office of Juvenile Justice and Delinquency Prevention, the National Institute of Justice, the Centers for Disease Control, and the 

Substance Abuse and Mental Health Services Administration. I’d like to ask if you 

would enter into the record our recent FIGHT CRIME: INVEST IN KIDS PENNSYLVANIA report, ‘‘Breaking the Cycle of Child Abuse and Reducing Crime in 

Pennsylvania: Coaching Parents Through Intensive Home Visiting.’’

As of last year, the Nurse-Family Partnership enrolled roughly 274 mothers in Allegheny County, Pennsylvania—specifically in the City of Pittsburgh and communities down the Mon Valley. Upon entering the program, 39% of these women completed high school or received their GED, 98% were unmarried, 79%were unemployed, and 60% were on Medicaid. Outcomes of the Allegheny County Nurse-Family Partnership have mirrored national outcomes and included a 43% reduction in 

the mothers experiencing violence during pregnancy and a 100% reduction in mothers fearing their partners. Of those who entered the program without a high school 

29

diploma, 61% completed their diploma or GED by program completion and 32% 

were continuing their education beyond high school. 

The Nurse-Family Partnership in Allegheny County has many success stories. I’d 

like to briefly share one of them. In 2005, a woman, lets call her Jane, was referred 

to the Allegheny County NFP program fromanother county in Pennsylvania. Jane 

was a recovering heroin addict who was herself a victim of emotional,physical and 

sexual abuse from the time she was a toddler. Jane’s experience in the program did 

not start off without some trouble. She would often scream at the nurses and appear 

very controlling of their home visit time. But soon, Jane and her Nurse Home Visitor developed a close bond. The Nurse Home Visitor helped Jane heal from all of 

the hurt she had suffered through the years both physically through drug abuse and 

emotionally. Jane’s baby was born healthy and developed into a bright toddler under 

Jane’s nurturing.While in the program, Jane finished her GED and went on to 

study medical records at the community college where she is expected to graduate 

this spring. She is also planning to be married this fall. With the help of the Nurse 

Family Partnership, Jane avoided a prolonged life of drug abuse, child abuse and 

criminalbehavior. And we can bet her child, and society, will reap significant benefits from this transformation ofJane’s life. 

Research on other models of home visiting has also found numerous positive results. For example, a randomized control trial of the Parents as Teachers model 

found that treatment for an injury in the prior year—a possible sign of abuse—was 

3% among the children served compared to the 13% of children not served (at the 

time of a second year assessment). A study of Healthy Families New York (HFNY) 

found that, at Year 1, compared to mothers in the control group, mothers in the 

HFNY intervention group reported having engaged in significantly fewer acts of 

very serious physical abuse (e.g., hitting child with fist, kicking child, slapping on 

face). At Year 2, HFNY parents reported having committed, on average, one-third 

fewer acts of serious physical abuse in the past year than the control group. 

Home visiting’s benefits go far beyond child abuse prevention and crime prevention. Home Instruction for Parents of Preschool Youngsters (HIPPY) found that cognitive skills at the end of the program were significantly higher for children in the 

program compared to those not receiving HIPPY. A randomized control study of the 

Parent-Child Home Program found that 84% of the children finishing the program 

graduated from high school compared to 54% of those who did not receive the intervention. Separate studies have concluded that improving graduation rates reduces 

crime, making this finding of particular interest to me and my law enforcement colleagues. 

Preventing child abuse and neglect is not only the right thing to do, it is also the 

fiscally sound thing to do. In a study commissioned by the United States Justice 

Department, the Children’s Safety Network Economic Insurance Resource Center 

analyzed the direct and indirect costs of child abuse and neglect to taxpayers and 

all those individuals impacted by abuse or neglect. It concluded that child abuse and 

neglects costs Americans $83 billion a year. Analysts with the Federal Reserve Bank 

of Minneapolis concluded that NFP produced an average of five dollars in savings 

for every dollar invested, and produced more than $28,000 in net savings for every 

high-risk family enrolled in the program. New data from a report commissioned by 

the Pennsylvania Commission on Crime and Delinquency estimates that once the 

costs of the program are subtracted, Pennsylvania’s Nurse Family Partnership sites 

average $37,367 in benefits per person served. 

By waiting until the problems cannot be avoided, taxpayers are paying huge sums 

to cover the costs of holding children back in school, providing special education 

services, paying for welfare, and especially paying for arresting, prosecuting, and 

imprisoning criminals. The Pennsylvania Commission on Crime and Delinquency report also estimates that it currently costs roughly $142,000 per year to place a juvenile in a Youth Detention Center. Preventing only 5% of out-of-home youth placements each year in Pennsylvania would produce an annual savings of over $9 million. Further, Pennsylvania’s prisons were already operating at 115% of their inmate capacity by the end of 2006. Even if the General Assembly approves the $700 

million for Fiscal Year 2008-2009 requested by the Pennsylvania Department of 

Corrections’ for prison construction, Pennsylvania prisons will still be overcrowded. 

In fact, at the projected rate of prison population growth, Pennsylvania’s prisons 

will be even more overcrowded in five years at 118% of capacity. As an investment 

strategy, this is short-sighted. It ignores the opportunity to act when the interventions are less expensive and more likely to succeed. 

I’d like to ask if you would also enter into the record the recent report commissioned by the Pennsylvania Commission on Crime and Delinquency (PCCD), ‘‘The 

Economic Return on PCCD’s Investment in Research-based Programs: A Cost-Benefit Assessment of Delinquency Prevention in Pennsylvania.’’

30

An evidence-based approach with proven results and significant potential savings 

like home visiting should be more widely replicated across the nation to ensure that 

home visiting programs are offered to all at-risk parents of young children. Yet, due 

to lack of funding, hundreds of thousands of at-risk families receive do not receive 

quality home visiting. Currently, NFP in Pennsylvania has 134 nurses working in 

41 of the Commonwealth’s 67 counties. They have slots to serve 3,237 families. 

Since its inception in Pennsylvania, over 10,000 new mothers have been served. Yet, 

the Nurse-Family Partnership Program serves only 23% of eligible mothers in Pennsylvania each year. In Allegheny County, that number shrinks to only 17% of eligible mothers. While there are a few federal funding sources that can potentially be 

used for home visiting, none are specifically designated for this purpose. These funding sources are designed to provide money to a wide variety of programs and home 

visiting efforts are only able to capture a minimal amount of funding from any single source. The bipartisan Education Begins at Home Act (H.R. 2343), first written 

and introduced by Senator Bond (a Republican from Missouri), would authorize 

$500 million over three years to expand the reach of voluntary, research-based home 

visiting and authorize a parent and public education campaign about caring for infants and toddlers. The Committee, in moving the bill forward, could even add language to ensure targeting of services to jurisdictions with the greatest unmet need. 

My colleagues and I see the fatal consequences every day of failing to invest in 

quality home visiting programs to get kids off to a good start in life. That is why 

the law enforcement leaders of FIGHT CRIME: INVEST IN KIDS are eager to work 

with all of you to achieve enactment of the Education Begins at Home Act. We know 

that a modest investment now will cut child abuse and neglect, improve children’s 

school readiness and reap dividends down the road by reducing crime and saving 

lives and money. Thank you for this opportunity to testify, and I would be happy 

to answer any questions that you may have. 

Chairman MILLER. Thank you. 

Mr. Estrada? 

STATEMENT OF WILLIAM A. ESTRADA, DIRECTOR OF FEDERAL RELATIONS, HOME SCHOOL LEGAL DEFENSE ASSOCIATION 

Mr. ESTRADA. Good morning, Chairman Miller, honorable members of this committee. 

My name is William A. Estrada, and I am an attorney and the 

director of federal relations for the Home School Legal Defense Association. 

Thank you for the opportunity to testify today regarding HR 

2343, the Education Begins At Home Act. 

Since 1983, HSLDA has represented the interests of our homeschooling member families in all 50 states. We currently have a 

membership of over 80,000 member families who are homeschooling their children. 

While there are provisions in the Education Begins At Home Act 

that are very helpful, such as in Sections 4, 6 and 7 with targeted 

grants, we also have serious concerns with some of the provisions 

in this act. My testimony today will focus on Section 9 of the bill. 

We believe that the provisions in Section 9 will harm family integrity and parental rights. 

Section 9 is entitled Supporting New Parents Through Hospital 

Education. It requires the Secretary of Health and Human Services 

to create a public awareness campaign to inform the public and 

new parents about the importance of proper care for infants and 

children under 5 years of age. The secretary will ensure that every 

hospital, military hospital and birthing center request that families 

coming through its doors participate in a parenting class that is approved by the secretary. The hospital must then request that the 

31

family sign a form indicating whether or not they chose to take this 

class. 

Section 9 is not clear if hospitals, military hospitals and birthing 

centers may refuse to offer these materials on parenting classes. 

Because of this vagueness, there is no assurance that religious hospitals or birth centers could reject materials or parenting classes 

that violated their fundamental values. 

Section 9 is also not clear about who will design these parenting 

classes. There is no guidance offered to HHS, so the secretary may 

decide to only approve classes that are designed by experts, without the input of actual parents. 

Parents have numerous parenting philosophies that may differ 

from a one-size-fits-all government parenting class. This could lead 

to limits on parental choice and parental rights, because parents 

will feel pressured to take these classes and to conform to whatever 

parenting philosophy is taught. 

Furthermore, the provision that the classes teach ‘‘strategies for 

caring for infants’ social, emotional and physical needs’’ is vague 

enough to include many conformist philosophies that could concern 

many families, particularly homeschooling families. For example, 

despite plentiful research to the contrary, there are still some experts who believe that home education and homeschooling is not 

best for a child’s emotional, social or physical needs. One need only 

look at the recent California Court of Appeals decision, In re Rachel L., where the Court made a blanket ruling that California parents do not have the right to educate their children at home unless 

they are certified teachers. This would have the effect of needlessly 

discouraging many families from homeschooling. 

Although the parenting classes are optional, Section 9 could lead 

to needless social worker referrals. There are valid cases of child 

abuse, no one is denying that, but we do not want to see needless 

referrals of families to social services. Since the hospitals and 

birthing centers must request a signature showing that families 

participated in or refused a class, a referral could be made to the 

child welfare department alleging neglect simply because the family refused these parenting classes. In reality, it is very possible 

that some families may have chosen to decline participation because of disagreement with the class’ parenting philosophy. At 

HSLDA, we have sadly dealt with cases such as this, and they are 

not farfetched. 

To avoid these and other problems that infringe on parental 

rights, we ask that Section 9 be removed from this bill or that it 

be modified to a targeted grant-based system where public-private 

entities could offer these classes to parents who desire them. 

In closing, there are many good reports of how these programs, 

these home visiting programs, have helped many families. However, on the whole these are classes at the local level and we believe that having a federal program such as this could lead to the 

problems that I have outlined. 

Thank you very much, and I yield back the balance of my time. 

[The statement of Mr. Estrada follows:]

32

Prepared Statement of William A. Estrada, Esq., Director of Federal 

Relations, Home School Legal Defense Association 

Good morning, Chairman Miller, Ranking Member McKeon, and honorable members of the committee. My name is William A. Estrada, and I am an attorney and 

the director of federal relations for the Home School Legal Defense Association. 

Thank you for the opportunity to testify regarding H.R. 2343, the Education Begins 

at Home Act. 

Since 1983, HSLDA has represented the interests of our homeschooling member 

families in all 50 states. We currently have a membership of over 80,000 families. 

We have serious concerns with H.R. 2343. 

My testimony today will focus on section 9 of the bill. We believe that the provisions in section 9 will harm family integrity and parental rights. 

Section 9, ‘‘Supporting New Parents Through Hospital Education,’’ requires the 

Secretary of Health and Human Services to create a public awareness campaign to 

inform the public and new parents about the importance of proper care for infants 

and children under 5 years of age. The Secretary will ensure that every hospital, 

military hospital, and birthing center request that families coming through its doors 

participate in a parenting class that is approved by the Secretary. The hospital must 

then request that the family sign a form indicating whether or not they chose to 

take this class. 

Section 9 is not clear if hospitals, military hospitals, and birthing centers may 

refuse to offer these materials and parenting classes. Because of this vagueness, 

there is no assurance that religious hospitals or birthing centers could reject materials or parenting classes that violated their fundamental values. 

Section 9 is also not clear about who will design these parenting classes. There 

is no guidance offered to HHS, so the Secretary may decide to only approve classes 

that are designed by ‘‘experts’’ without any involvement from actual parents. We 

don’t need a ‘‘big mother’’ supervising parenting. Parents have numerous parenting 

philosophies that may differ from a one-size-fits-all government parenting class. 

This could lead to limits on parental choice and parental rights, because parents 

will feel pressured to take these classes and conform to whatever parenting philosophy is taught. 

Furthermore, the provision that the classes teach ‘‘* * * strategies for caring for 

infants’ social, emotional, and physical needs’’ is vague enough to include many conformist philosophies that would concern many families, particularly homeschooling 

families. For example, despite plentiful research to the contrary, there are experts 

who do not believe that homeschooling is good for children’s social, emotional, and 

physical needs. One need only look at the recent California Court of Appeal decision, 

In re Rachel L., where the Court made a blanket ruling that California parents do 

not have the right to homeschool their children unless they are certified teachers. 

This would have the effect of needlessly discouraging many families from homeschooling. 

Although the parenting classes are optional, Section 9 would likely lead to needless social worker referrals. Since the hospitals and birthing centers must request 

a signature showing that families participated in or refused the class, a referral 

could be given to the child welfare department alleging neglect because the family 

refused these parenting classes. In reality, the family may have chosen to decline 

participation because of disagreements with the classes’ parenting philosophy. 

To avoid these and other problems that infringe on parental rights, we ask that 

section 9 be removed from this bill. 

Thank you very much and I yield back the balance of my time. 

Chairman MILLER. Thank you. 

Ms. Smart? 

STATEMENT OF JEANNE SMART, DIRECTOR, NURSE–FAMILY 

PARTNERSHIP—LOS ANGELES 

Ms. SMART. Thank you, Chairman Miller. 

My name is Jeanne Smart. I am a public health nurse, a registered nurse, and I started a program which I am representing 

today, the Nurse-Family Partnership, in Los Angeles County. 

I have had 34 years of experience in home visitation. I started 

a home visitation program as a respiratory therapist to stop people 

33

from becoming sick and coming back into the hospital because of 

the use of contaminated equipment. It has come a long way since 

then, and the Nurse-Family Partnership program that is utilized in 

Los Angeles County addresses a whole different problem, and that 

is the problem of our future. 

It is an evidence-based program that has over 30 years of empirical research behind it and I am sure you have all been made familiar with it. When you look at over 650,000 children in the nation being abused and neglected, and as Ms. Ditka indicated, some 

of them are truly heart-wrenching, and we have our share in Los 

Angeles County, where over 42,000 children are in protective services, and this is truly unacceptable. 

In Los Angeles in 1996 we brought NFP, which is the abbreviation for Nurse-Family Partnership, as a pilot project. It was funded 

through juvenile justice. In 1997, in November 1997, the LA Times 

printed an article called ‘‘Orphans of Addiction,’’ and the pictures 

in that article were truly what most people don’t see. A 3-year-old 

being held by a drug-addicted mom, who was so loaded on heroin 

she couldn’t even focus. 

Because of that, a task force was called and decided that the 

Nurse-Family Partnership, along with several other communitybased organizational home visiting programs, needed to be rolled 

out, and in the year 2000 we received funding from the welfare reform dollars and we started a full county rollout of the Nurse-Family Partnership. To date, we have served over 2,000 teenagers and 

some of these have truly been the most difficult cases that I have 

ever seen in my 34-year nursing career. Our youngest case is 12 

years old. She delivered at age 12 years old. 

The NFP model is something that I never had in practicing as 

a public health nurse. I never had the guidance, I never had the 

instruction, I never had the standardized protocol to follow. Many 

times, I was at a loss for what to do with these families that were 

so impacted by drugs and crime and gangs, that there was really 

nothing that I could do that was significant in my book. I had 

never gotten this training in nursing. 

The NFP model brings theory and science to actual practice, of 

which I am a science freak, so it really was something I advocated 

for in 1996 when I helped bring the program to Los Angeles. It is 

theory based. It is based on the theories you all heard today, the 

attachment theory, the bonding, the care of the whole family in the 

care of the child, change theory, brain development. All of this is 

brought into this model. 

The model has structured activities so the nurse knows at each 

and every visit what needs to be done, and during those visits we 

talk to the families, we talk to the father of the families and we 

collect data so that we can bring that data back and look at what 

we are doing and see if we are doing an effective job at meeting 

the goals that we would like to accomplish. 

It is really relationship-based, and there is not a program sitting 

in this room that is not relationship-based, because when you are 

talking about young, at-risk, pregnant teenagers, you are talking 

about establishing trust, of which they have none usually, and establishing some type of respect so you can work together as a team 

to promote healthy families. 

34

Over 64 visits the nurses take during this 21⁄2-year program with 

these families, the trust builds up. And, interestingly, we don’t 

even find out sometimes the problems in the family for the first 6 

months. It is not until that trust is developed. 

We have nurse training. The nurses receive over 60 hours of 

training. That is minimal and just the model protocol. And they 

carry 25 clients through just three goals: to improve the pregnancy 

outcome, to improve the child health and developmental outcome, 

and improve the family self-sufficiency, so that they can learn how 

to provide for their families and not use welfare dollars to do so. 

Part of what Dr. Olds, Dr. David Olds, who is the model developer, and he is currently with the director of the Prevention Research Center for Family and Child Health at the University of 

Colorado Denver, he really put in a huge data element. At every 

visit we collect data that goes into the child information system. 

And through that data, we can provide excellent quality improvement, quality insurance. I can go over every single one of my staff, 

look at their caseload, look at their outcomes, and through that I 

have to say that programs, whatever the program, if it is delivered 

poorly it will not consistently achieve good outcome. And I think 

that is what we have to keep in mind when we are funding some 

of these programs. 

With the Nurse-Family Partnership nationwide and through 

three very, very strict, randomized control trials that Dr. Olds has 

performed in Elmira, New York and throughout the nation, we 

have decreased child abuse by 48 percent; 59 percent reduced in 

child arrest of that child when it reaches age 15. We have reduced 

maternal arrest, for drug use usually, or other types of crimes. We 

have increased the involvement of fathers by 46 percent, and as the 

Fenley family demonstrates, how valuable it is to have the father 

involved on the same target as the mother is involved in helping 

develop the family. 

We get the children ready for school much quicker by reducing 

language delays by 50 percent and behavioral problems by 67 percent. And again, these are randomized control groups that are 

studies done by Dr. Olds. These are pretty validated percentages, 

so apply them to your own districts and think about the cost savings to you by reducing these issues in your communities. 

There is a demonstrated cost savings to government that we 

need to look at. When you look at the cost effectiveness, Washington State Institute for Public Policy, the Rand Corporation, the 

Office of Juvenile Justice, all have supported what we have done 

here with the Nurse-Family Partnership. 

So I thank you again for listening to me as a representative of 

the Nurse-Family Partnership and NFP National urges Congress to 

direct policy to these models that have the highest level of evidentiary standards. Thank you again, Chairman. 

[The statement of Ms. Smart follows:]

Prepared Statement of Jeanne Smart, Director of Nurse-Family 

Partnership, Los Angeles County 

Good morning Mr. Chairman and thank you for the opportunity to testify on behalf of the Nurse-Family Partnership (NFP) program regarding the Education Begins at Home Act. 

35

I am Jeanne Smart, Director of the Nurse-Family Partnership program serving 

high-risk young mothers who give birth within Los Angeles (L.A.) County. My testimony is that of a technical consultant for the NFP, and I am here to support this 

Bill that will promote evidence-based programs for at risk mothers. Every year, approximately 650,000 first time low income mothers become pregnant with their first 

child, and in L.A. County there are over 7,000 births each year that fit the intake 

requirement for NFP, that is: 1) young girl/woman; 2) pregnant for the first time; 

and, 3) living in poverty. L.A. County began this evidence-based program in 1995-

96 as a pilot project that was partially funded by Juvenile Justice because of its 

proven record of excellent results in reducing crime by both the mother and the 

child when he/she reaches the age of 15 years old. NFP was expanded countywide 

in 1997 primarily due to the achievement of excellent short-term outcomes seen in 

the Pilot and the growing number of headlines about the dismal outcomes for children born to at risk families who were unprepared, unable or unwilling to care for 

them. NFP-LA has now served over 2064 women since December 31, 2007; the median age is 17 years old, 89% are unmarried, 86% unemployed and 75% were Medicaid recipients. Nationwide, the NFP program model has served over 14,000 firsttime mothers and their children on any given day and reaches over 22,000 families 

annually in 315 counties across 25 states. 

NFP is a voluntary program that provides nurse home visitation services to lowincome, first-time mothers by highly trained, registered nurses beginning early in 

pregnancy and continuing through the child’s second year of life. NFP nurses and 

their clients make a 21⁄2 year commitment to one another, and develop a strong relationship over the course of 64 planned visits that focus on the strengths of the 

young mother and on her personal health, quality of care giving, and life course development. NFP nurses undergo more than 60 hours of training prior to receiving 

their caseload of no more than 25 families. Their partnership with families is designed to help them achieve three major goals: 1) improved pregnancy outcomes; 2) 

improved child health and development; and 3) improved parents’ economic self-sufficiency. By achieving these program objectives, many of the major risks for poor 

health and social outcomes can be significantly reduced. 

NFP is an evidence-based program with multi-generational outcomes that have 

been demonstrated in three randomized controlled trials that were conducted in 

urban and rural locations with diverse populations. A randomized controlled trial 

is the most rigorous research method for measuring the effectiveness of an intervention because it uses a ‘‘control group’’ of individuals with whom to compare outcomes 

to the group who received a specified intervention. NFP has been tested this way 

for over 30 years through a series of rigorous research, development, and evaluation 

activities conducted by Dr. David L. Olds, program founder and Director of the Prevention Research Center for Family and Child Health (PRC) at the University of 

Colorado in Denver. 

Dr. Olds has conducted three randomized, controlled trials with three diverse populations in Elmira, NY (1977), Memphis, TN (1987), and Denver, CO (1993). Evidence from one or more of these trials demonstrate powerful outcomes, including the 

following: 

• 48% reduction in child abuse and neglect (Elmira, 15 year follow-up) 

• 59% reduction in child arrests (Elmira, 15 year follow-up) 

• 61% fewer arrests for the mother (Elmira, 15 year follow-up) 

• 72% fewer convictions for the mother (Elmira, 15 year follow-up) 

• 46% increase in father presence in the household (Memphis, year 5) 

NFP has shown a reduction in high-risk pregnancies by: 

• 32% (Elmira, 15 year follow-up) 

• 23% (Memphis, year 2) 

• fewer subsequent pregnancies, and 31% fewer closely spaced (<6 months) subsequent pregnancies (Memphis, year 5) 

Improvement in elementary school readiness as demonstrated by a: 

• 50% reduction in language delays at child age 21 months (Denver) 

• 67% reduction in behavioral/intellectual problems at child age 6 (Memphis) 

• Improvements in cognitive development at child age 6 (Memphis) 

• Improvements in language development at child age 4 and 6 (Memphis) 

• Improvements in child executive functioning at age 4 (Denver) 

As the NFP program model has moved from science to practice, great emphasis 

has been placed on building the necessary infrastructure to ensure quality and fidelity to the research model during the replication process nationwide. In addition to 

intensive education and planned activities for nurses to conduct in the home, NFP 

has a unique data collection and program management system called the Clinical 

Information System (CIS) that helps NFP monitor program implementation and 

outcomes achieved. It also provides continuous quality improvement data that can 

36

help guide local practices and monitor staff performance. CIS was designed specifically to record family characteristics, needs, services provided, and progress towards 

accomplishing NFP program goals. 

In addition to California, NFP has statewide implementations in Colorado, Louisiana, Pennsylvania, Oklahoma, and Washington; and many other states are seeking to expand local NFP programs into statewide initiatives. NFP’s replication plan 

reflects a proactive, state-based growth strategy that maximizes fidelity to the program model and ensures consistent program outcomes. NFP urges Congress to direct policy toward home visit models that maintain the highest level of evidentiary 

standards in order to ensure the largest possible economic return on investment. 

The success and cost-effectiveness of NFP has been proven through several independent evaluations (Washington State Institute for Public Policy, 2004 & 2008; 3 

RAND Corporation studies 1998, 2005, 2008; Blueprints for Violence Prevention, Office of Juvenile Justice and Delinquency Prevention). Blueprints identified NFP as 

1 of 11 prevention and intervention programs out of 650 evaluated nationwide that 

met the highest standard of program effectiveness in reducing adolescent violent 

crime, aggression, delinquency, and substance abuse. The RAND and Washington 

State reports weighed the costs and benefits of NFP and concluded that the program 

produces significant benefits for children and their parents, and demonstrated a 

savings to government in lower costs for health care, child protection, education, 

criminal justice, mental health, government assistance and higher taxes paid by employed parents. More recent analyses indicate that the costs of NFP compared to 

other home visitation programs fluctuates by region, and even though the NFP 

model is more intensive than other programs, it is not always more expensive. 

The Nurse-Family Partnership supports the Education Begins at Home Act as introduced by the House of Representatives. This Act proposes intelligent solutions to 

core problems facing new families nationwide. We encourage the Committee to target these scarce resources provided to States through this legislation to those communities that are most at-risk and struggling with the challenges of poverty. This 

bill provides consolidated funding to support the important work of home visitation 

programs including NFP. 

I’d like to thank Congressman McKeon for inviting me to testify on behalf of 

Nurse-Family Partnership and also I am grateful to Congressmen Davis and Platts 

for their leadership on behalf of this legislation. Thank you again, Chairman Miller, 

Congressman McKeon, and Members of the Committee, for the opportunity to testify 

before you today. 

Chairman MILLER. Thank you very much, and again thank you 

to all of you for being here today. 

Ms. Fenley, do you talk to other families that participate in the 

Parents As Teachers Program? 

Ms. FENLEY. Actually, I haven’t had the honor of really speaking 

to anybody else who is on the program, because I am one of the 

few and the proud. I do have a friend who is waiting to get in the 

program, but I haven’t been to any of the playgroups that they 

offer to discuss any of the other issues with other parents. 

Chairman MILLER. Have you discussed your participation with 

your friends? 

Ms. FENLEY. Absolutely. I encourage it to all my friends who 

have children, you know, that are eligible to participate. And they 

are hoping to extend the program for children who are, like, ages 

three to five. So I am hoping that we get to do that so Zane can 

continue to be in the program. 

Chairman MILLER. We have heard here this morning, obviously, 

different programs that dealt with parents in different situations 

and circumstances that have brought about the inability to cope or 

the stress or whatever, however it manifests itself. As we sit here 

with the war in Iraq and as we continue to try to review in our 

own districts and elsewhere what is happening with military families, you know, you meet more and more families who are really 

multitasking, trying to just handle the stress points, either mulVerDate 0ct 09 2002 09:17 Aug 27, 2008 Jkt 000000 PO 00000 Frm 00040 Fmt 6633 Sfmt 6602 G:\DOCS\110TH\FC\110-95\42728.TXT HBUD1 PsN: DICK
37

tiple deployments, multiple relocations, comings and goings and reuniting and separation and all these things that one of them by 

itself is traumatic for a family. 

And so when you talk to your friends about Parents As Teachers, 

what do they think? Would they like to have someone to lean on? 

Ms. FENLEY. Yes. Absolutely. Like the friend I just referred to, 

she is actually the one friend I do have who has a child Zane’s age. 

She is, you know, really ready to get into the program. Her daughter has some developmental issues, some emotional issues, and I 

think it would be great for her to really get in there. She has five 

other children, two of which are adopted, and these are the ones 

who have the emotional issues that she really needs to get addressed, and I think it would really help her children to do that. 

Yeah, she is really ready to get started, actually. 

Chairman MILLER. How long did it take you and Ms. Terrilyn to 

hit it off? 

Ms. FENLEY. Immediately. 

Chairman MILLER. I saw Ms. Terrilyn shaking her head back 

there when Ms. Smart was testifying about it takes time—sometimes, she said, you didn’t find out problems in the family for 6 

months because you have to build trust, and I saw Ms. Terrilyn, 

I was watching you, you were shaking your head, that that is right. 

So it doesn’t always happen right off the bat. 

Ms. FENLEY. No, not off the bat. I think it was easier for me to 

connect with Ms. Williams because she was one of the very first 

people I met when I got to Virginia Beach. She was actually, yeah, 

like within the first week. So I was needing—and she is also a 

Navy spouse herself—so I was needing to know my resources, what 

I could really do to really become grounded in that area and that 

aspect of my life. So that is probably why it was so easy to reach 

out to her, because she was one of the first people I knew. 

Chairman MILLER. Thank you. 

Ms. Ditka, I was surprised how adamant—I am from the San 

Francisco Bay area—how adamant law enforcement and the district attorneys were about this program. Basically, what they are 

saying, we just can’t keep up if we are going to have this continued 

growth in child-related problems, whether it is early child abuse or 

whether it is later in schools or on the streets later on, and we 

think that the evidence is compelling that this program will reduce 

our caseload. It doesn’t cure the common cold and it doesn’t fix 

every family, but they were just adamant in their sense that where 

we see this taking place, those law enforcement officials get a benefit of a reduced caseload. 

I don’t know if you would like to speak to that. 

Ms. DITKA. Congressman, I couldn’t agree more. In Allegheny 

County, only 17 percent of eligible parents are being served. The 

examples I gave you, there could be six children that are still alive 

with just some basic skills. We do hundreds of cases every year, 

and that doesn’t include the cases where we have tried in minor 

instances to put people in parenting classes and to attach them to 

the resources so a parent doesn’t then get strapped with a criminal 

record and the children aren’t permanent members of the system 

instead of a family. 

38

We can’t keep up. We need more lawyers, we need more staff, 

just to do the cases that we have. And as I tried to stress, there 

are parents that are villains in the true sense. But the vast majority of them are just people that didn’t have role models, that 

weren’t given good examples. You know, I have been blessed. I 

have a parent that traveled with me today. I had a good role 

model. Hopefully I will be one for my child. But many, many people 

don’t have that. Many people don’t have the ability to wake up in 

the morning and see their parent doing something and being productive and actively working in the family. 

And this model will keep people out of my system. And especially 

if it reduces delinquency, it will give children an opportunity to become productive members of society. 

Chairman MILLER. Thank you. 

My time has expired. Hopefully we will have a second round, because I would like to go back to Ms. Smart and Ms. Weiss on the 

data component of this, which I think is very important. 

But right now, let me recognize Mr. Ehlers. The gentleman is 

recognized for 5 minutes. 

Mr. EHLERS. Thank you, Mr. Chairman. And thank you for holding this hearing. 

I am fascinated with it for two reasons. First of all, I was homeschooled. Actually, I am old enough that I was homeschooled before 

there was homeschooling. I was a sickly child, so I just stayed 

home and did all my schoolwork at home, which is a great way to 

learn. 

But also I am interested because in my experience in local and 

state government, as a county commissioner, which I had charge 

of the juvenile detention facility and so forth and seeing the kids 

and working with the kids, and there is nothing quite as heartbreaking as seeing a 13-year-old girl brought in for her fourth arrest for prostitution. It was an education that I received which I 

would just as soon not have received. 

But also at the state level, dealing with the products in our penal 

system of those children who grew up without a proper home, without proper training, and ended up spending most of their life in 

prison. 

We were fortunate in Michigan, particularly in my community, 

quite a religious community, and we had established a number of 

different homes for children for various denominations. And it is 

not that the children were restricted to those denominations, but 

the contributions came from those denominations. And they did a 

fantastic job in our community. But when I reached the state level, 

I realized that not every community had that. 

The reason I mention this, I am trying to see where the federal 

government fits in this, because obviously some states are doing 

quite a good job. Other states a middling job. And some not doing 

a job at all. What is the picture overall and what is the need for 

federal involvement in this? Is it a matter that we need uniformity? 

Is it a matter that we need the same funding in every state, or 

what? I would appreciate any comments any witness might wish to 

make on that. 

Ms. SMART. The funding that we don’t have, when you think of 

the numbers, in L.A. alone there are 7,000 young girls, teenagers, 

39

our median age is 17, that fit the intake criteria for NFP. We started with 39 nurses in the year 2000. We are down to 15 nurses now 

because of the funding constraints. There is no funding available 

that fully funds this type of work. 

What we are using now are funds that are meant for outreach, 

to get people into services, Medicaid eligible, those that are living 

in poverty. That is insufficient, because what we do goes far beyond 

simple outreach. It is outreach, education, support, nurturing. All 

of that is not covered, but that is all part of the picture. It is all 

part of the recipe. 

So it is very difficult. I think the role of federal government is 

to allow there to be funding that could fully support programs that 

meet the needs of those most at need, especially. I wish we had the 

dollars to do these programs for everybody, because everybody 

truly does need some support when they are a new parent. But 

when we don’t have those dollars, I really believe we need to target 

those most at risk, the young, the pregnant for the first time and 

those who are living in poverty, because by far they have the worst 

birth outcomes, social outcomes and every other category that you 

can think of outcomes. 

So I would direct the dollars, if I were in charge. 

Mr. EHLERS. This is still a problem. I am interested in the federal versus the state. Everyone thinks we have more money. That 

is just because we borrow it every year. But what about the states? 

What is their contribution? And why can’t they, you know, step up 

to the plate more? 

Ms. WEISS. Can I respond to this? 

Mr. EHLERS. Yes. 

Ms. WEISS. I led the [INAUDIBLE] which was the [INAUDIBLE] 

major national models for 6 years until recently, and I know that 

there are I think over 40 states now that have made a commitment 

to some kind of state capacity to provide home visitation. 

I was in Michigan in December with Judy Samuelson, who runs 

your Early Childhood Commission, to talk with them about how to 

begin to create a state system of early home visitation that would 

be part of their effort to create a comprehensive early childhood 

system of services. 

Wisconsin has a state standing task force working on creating a 

system of state-based early childhood services, including early 

childhood home visitation. That group of people, representing all 

kinds of different models from all kinds of places around the state, 

came together a couple of years ago and said we need to develop 

a standard set of indicators and outcomes across our programs as 

part of our tracking and capacity-building to support home visitation in the state of Wisconsin. 

Pennsylvania has done some very interesting sort of experimenting with a combination of the Nurse-Family Partnership and 

the Maternal Child Home Program. As you have heard, there is a 

partnership, 21⁄2 years, third trimester of pregnancy—year two 

with highly stressed families. They have now paired that with the 

Maternal Child Home Program, which focuses on literacy and 

school readiness. And they do use some of their welfare reform dollars to do this. And they are tracking it, and we will know the benefit of that kind of combination of home visitation services focused 

40

on prevention of maternal and child difficulties, child maltreatment, as well as school readiness. 

I think we are seeing a lot of states making a commitment, not 

just to little programs here and there, but to building state capacity, to develop and fund them, and increase the likelihood of return 

on investment from those dollars. There is not a state I think that 

any of us in this room know of that isn’t struggling to meet the 

need for more financial resources for home visitation. 

That is why I think EBAH can contribute. It is never going to 

be enough to pay for direct service for everybody who needs it, but 

it pays for some key expansion and some key capacity building, and 

then some of the other resources perhaps can be provided, you 

know, by local dollars and state dollars. 

Mr. EHLERS. My time is expired, but thank you very much for 

the insight you have given me. 

Thank you. 

Chairman MILLER. Thank you. 

Mr. Davis, author of the bill. Well, one of the authors of the bill. 

Mr. DAVIS OF ILLINOIS. Thank you very much, Mr. Chairman. 

Let me thank you for holding this hearing. 

As a long-time advocate for home visiting and for parenting programs, I also want to express my appreciation to Mr. Platts for his 

co-sponsorship as well as his leadership and indicate that it is a 

real pleasure working with him, and I appreciate what we have 

been able to come up with. 

As I listen to the testimony of the witnesses, I was thinking, Ms. 

Fenley, that I could listen to you testify all day, for lots of reasons. 

But the question that I wanted to ask, what aspect of the program 

do you think has been most helpful to you and your family? 

Ms. FENLEY. I can only choose one? Just one? 

Honestly, to encourage my children, daily, to never let them lay 

their head on a pillow at night and let them know how proud I am 

of them. From the smallest thing to the biggest thing they do, just 

to encourage them and validate them as my child and let you 

know, hey, you did so good today. And that has taught me that, 

Parents As Teachers has taught me that. 

And also to validate my husband as a parent himself, to let him 

know, hey, you are a great dad, you know. Forge on. Keep going. 

It is, you know, that has been my favorite thing about the program. 

That is the one thing I could probably choose out of everything. 

Mr. DAVIS OF ILLINOIS. Thank you very much. 

Attorney Ditka, let me ask you, have any of the cases that you 

have come into contact with been individuals that you would not 

necessarily describe as being disadvantaged? 

Ms. DITKA. Child abuse, Congressman, as this panel probably 

knows, crosses all socioeconomic, religious, racial, ethnic borders. 

So I see lots of examples of abuse in every aspect of society. 

Where this need I see the greatest is in disadvantaged families, 

because they just don’t have the resources. They don’t have the 

ability to go to a parenting class that they are paying for. They 

don’t have the ability to go to Gymboree with their children or to 

a school-based after school program or get them in a sports program at the Y. That is why I believe this bill is so important. 

41

But I don’t mean to say here in any way that child abuse is limited to underprivileged inner-city families, because it crosses all social and economic and racial and ethnic divides, and some of the 

most horrific cases come from the wealthiest and most affluent 

neighborhoods nationwide. 

Mr. DAVIS OF ILLINOIS. So there are many different types of families in different categories and different groupings of individuals 

who can in fact benefit and do in fact benefit. 

Ms. DITKA. Absolutely. Absolutely. 

Mr. DAVIS OF ILLINOIS. Thank you. 

Ms. London, let me ask you, because of the fact that you have 

been in the same location over an extended period of time and have 

worked with the Near North Corporation, do you see families as 

they continue to grow and develop where you can sort of evaluate 

the impact of the program after the children have begun to grow 

up? 

Ms. LONDON. Yes. Absolutely. 

In my testimony I shared that the relationships that the home 

visitors have with participants after they graduate is well beyond 

when the child reaches age 3. Our parents have no problem after 

graduation with meeting us at the grocery store, at church, in the 

community, wherever it is that they are. Just because the child has 

graduated to age 3 does not end the relationship there. 

And so they still come back to the home visitor, to the health 

center, asking for advice, and we are open to do that. 

Mr. DAVIS OF ILLINOIS. Thank you very much. 

And lastly, Dr. Weiss, let me ask you, there are individuals who 

believe that evidence-based research which demonstrates the effectiveness of program activities is what you really need in order to 

make a decision or determination about the value of programs. In 

your work and research, have you seen the kind of information that 

would suggest the value of this program activity that we are talking about? 

Ms. WEISS. Yes, and I think we have 30 years of work, including 

clinical trials, either completed or underway, by most of the major 

models, that meet a high standard of evidence that suggest more 

positive outcomes across an array of things, from parenting skills 

to school readiness to reductions in child maltreatment. 

What I find fascinating is the willingness and capacity of the 

models and I think the people within the states that are providing 

home visit services to learn from that evidence and improve their 

programs. So David Olds, Nurse-Family Partnership, David and I 

were at graduate school together at Cornell in the 1970s when 

David was starting this program. He did his first clinical trial in 

Memphis, or in Elmira, New York. 

He learned a great deal from the evidence and from the pattern 

that resulted from that. He modified the program when he did his 

clinical trial in Memphis, learned from that and modified the trial 

when he did it in Colorado. 

I watch these models, and have for a long time, do exactly what 

David has done, and also do what my colleague down here at the 

end of the panel mentioned, which is now develop capacity at the 

national office. And I think also the states are beginning to do that, 

to track performance of regular programs. It is one thing to get sucVerDate 0ct 09 2002 09:17 Aug 27, 2008 Jkt 000000 PO 00000 Frm 00045 Fmt 6633 Sfmt 6602 G:\DOCS\110TH\FC\110-95\42728.TXT HBUD1 PsN: DICK
42

cess in a clinical trial. If you are going to do a clinical trial, you 

are going to put all your best into it and hope you get the best results. The trick I think is then getting those results in the everyday 

program, the everyday Parents As Teachers Program, the everyday 

Nurse-Family Partnership. 

And what the legislation does is say that every year they are 

going to need to report on some performance indicators, and use 

that data to support improvement. 

Chairman MILLER. I am going to have to cut you off. Thank you 

very much. 

Mr. DAVIS OF ILLINOIS. Thank you, Mr. Chairman. 

Chairman MILLER. Mr. Platts, who is a primary sponsor of the 

bill? 

Thank you. 

Mr. PLATTS. Thank you, Mr. Chairman, and I want to add my 

words of thanks to you for holding this hearing on the very important issue and echo my colleague, Mr. Davis’, comments and what 

a privilege it has been to work with him in advancing this legislation. 

I think Ronald Reagan once said if we want to do something for 

our nation’s future, we need to do something for our nation’s children, because they are our future. And that is what this hearing 

and this legislation is about. 

I want to thank all of our panelists for your testimony and for 

your work in your daily lives for the benefit of children. And we 

are grateful to each and every one of you. 

And Ms. Fenley, I especially want to thank you for being here, 

but especially for you and your husband’s service to our nation. We 

are a blessed nation because of military families such as yours. I 

love what I do, and I am proud of what I do, but what I do pales 

in comparison to what your husband and your family do on behalf 

of our nation. So thank you for your service. 

I want to first just reference, I know there is concern and when we hear $500 million it sounds like—well, not sounds like—it is a 

lot of money. But I think it is important to emphasize, and Ms. 

Ditka, I think in your testimony you talked about the Nurse-Family Partnership study that shows $5 saved for every dollar spent. 

So we hear $500 million spend, a lot of money. $2.5 billion saved, 

a lot more money. 

And it is something that I think is important that we keep in 

perspective here, that one of the challenges in Washington is that 

when we talk about allocating money, the way we factor the cost 

of everything is we don’t factor in savings, and this is an example 

of where we need to. And not just in dollars, but in human lives 

and quality of life for families and especially children. 

So I appreciate, Ms. Ditka, you highlighting that aspect in welldocumented studies, not just something over a year or 2 but over 

many years. 

Ms. Ditka, you talked about Nurse-Family Partnership, you 

know, one of the many programs that are doing great work out 

there. What would you highlight as the strongest aspect of the 

Nurse-Family Partnership program that you think makes it such 

a good model with others for us to look at, to help emulate across 

the country? 

43

Ms. DITKA. Well, Congressman, what we have seen in Allegheny 

County, one of the strongest aspects is it is a holistic approach that 

looks at the whole family unit. One of the best success stories is 

a woman who was drug addicted in her second trimester of pregnancy. She got off drugs. Her child was born healthy and now is 

a thriving toddler going to Head Start. This woman has got a GED. 

She is going to community college and is graduating or may have 

already graduated this spring so she could go work in the medical 

records field. So now both she and her child will be thriving members of society. 

I think that holistic approach, you are helping not only the child 

but you are helping the parent, and if that parent has future children, you are helping future children in that family. So you are setting a strong and secure base for these people to move on. I think 

it is extraordinarily important to have children school ready, education ready, and it is important for a number of aspects, not only 

for educational purposes and for their future growth, but also to be 

able to express to people they come into contact with if they are 

in harms way and what is happening to them. 

So I think that model that sort of surrounds the whole family 

with the knowledge and a hope for a better future is what works 

best. 

Mr. PLATTS. And I think Ms. Fenley kind of highlighted the importance of that holistic approach when, Ms. Fenley, you were talking about you and your husband getting on the same page, and the 

benefit of the family to being together. 

I have got a 9-year-old and a 12-year-old and my wife and I are 

always working at making sure we are on the same page together. 

We are much better as parents in doing so. 

Ms. Smart, in focusing specifically on the Nurse-Family Partnership, you target first-time mothers, more impoverished individuals. 

Do you want to maybe expand on why you as an organization focus 

on that category versus a broader approach to who participates? 

Ms. SMART. Sure. Yes. We focus on that target population because that is the target population that this model was actually 

tested on, and it was tested on this target population because those 

who are young, who are pregnant for the first time and who are 

living in poverty have the worst outcomes of poor birth, premature 

birth, low birth weight births. They have poor socioeconomic development on the part of the mother as she goes on in her life, maybe 

having multiple children after the first one. 

So we follow the model. We have fidelity to the model. So that 

is the target population and that is actually why we do serve them. 

Mr. PLATTS. And your testimony highlights when we talk about 

the benefits, again not specifically dollars but quality of life for the 

participants and society in general, whether it be crime reduction, 

child abuse reduction, school readiness. I mean, your studies highlight why this investment is so important and——

Ms. SMART. And we have been able to demonstrate that at the 

local level, too, by the data we keep, so that there is no doubt about 

the fact that we do positively impact these families who are most 

at risk, who load our hospitals and our social system. 

Mr. PLATTS. Thank you. 

Thank you, Mr. Chairman. 

44

Mr. KILDEE. Thank you, Mr. Chairman, and thank you for having this hearing. 

Dr. Weiss, first of all I am happy to hear that you are at work 

with Judy Samuelson from Michigan, who is a really great advocate for children. 

You testified to the importance of practitioners and researchers 

sharing information to build a knowledge base and to inform public 

policy on home visitation. To what extent is that happening, and 

what can Congress do to ensure that those best practices are widely known? 

Ms. WEISS. I think it is happening. I think it has been happening 

for a long time. The major models share information with each 

other about how to improve home visit services. They individually 

and collectively learn from the research. Parents As Teachers redid 

its curriculum based on the neuroscience evidence. I mentioned 

David Olds has redone his curriculum. 

So each of them shows an individual and a collective capacity to 

getting information to improve home visitation, so it gives us a 

strong base, both in terms of their willingness to do that and also 

the ways in which they are then feeding it into improve home visit 

services. 

I am very impressed with the provisions of the EBAH legislation, 

particularly around an independent assessment of the results of 

the EBAH legislation, a national study, with I think some very 

carefully laid out questions that that study would address. And 

also with the set-aside and expectation that each state will track 

the performance of home visit services. And my assumption is that 

with that they will on a yearly basis learn what is working and not 

working and celebrate and expand what is working and learn from 

what isn’t and figure out how to improve it, very much like the 

Nurse-Family Partnership does. 

And I know Parents As Teachers and a number of the other national models are building that capacity. And in the state of Michigan, Judy is helping to build that capacity. By that capacity, I 

mean to get and use data to figure out what you are doing well, 

what you need to do better and continue to improve the program. 

I think that is how you get return on investment from these kinds 

of services. 

Mr. KILDEE. Thank you. 

Ms. Fenley, as you testified for your family, home is where the 

Navy sends you. I can understand that a bit. I have two sons who 

have served in the Army, and that is the case with them also. 

Can you discuss how home visitation programs can best ensure 

that military families who may have to move frequently are aware 

of their options? When you move from one place to another, is there 

some type of network where you can find out where similar programs exist that you can tap into? 

Ms. FENLEY. As far as, like, getting here and starting him in the 

program, are you wanting to know, like, if we move somewhere else 

and not having——

Mr. KILDEE. Yes. Would you be able to find out if there is a similar program at the new base that you were able to utilize, like at 

the previous base? 

45

Ms. FENLEY. This is our first year in the military at all, so I have 

never actually got to participate in another program like this. 

Mr. KILDEE. Okay. 

Ms. FENLEY. But leaving Virginia Beach, I would definitely seek 

out another program to get my son in, absolutely. I would want to 

find a program to get him in, similar to what we are in now. 

Mr. KILDEE. Who would you turn to? What agency would you 

turn to at the new base? Is there a——

Ms. FENLEY. Like on base? Like as far as, like, military-wise, 

who would I try to seek out a new program? 

Mr. KILDEE. Yes. 

Ms. FENLEY. There are several resources that you could find programs for your children, and one is, you know, the child placement 

program on base that they have for Navy people. And you could—

there are a few others—and Terri, also, I mean, I would be looking 

for a parent educator, a parent educator with the child placement 

program. 

Mr. KILDEE. Okay. Very good. 

You know, I really was impressed by what you said was the most 

important thing you got from the program, is when you put your 

children in bed at night you praise them for what they have done 

that day. 

Ms. FENLEY. Absolutely. 

Mr. KILDEE. And I probably went overboard a bit in that, because when my first child, David, was born, about 38 years ago, I 

would tell my wife, now, we have to make sure that he has a good 

feeling about himself and we have to make sure. I was in Lansing, 

the state capital, I was a member of the state legislature, and she 

was several miles away, and I kept emphasizing he has to have a 

good feeling. And one day I called her, I said, ‘‘How is David 

today?’’ And she said, ‘‘He has a very good feeling about himself 

today.’’ So you probably hit the right balance there. 

Thank you very much, Mr. Chairman. 

Chairman MILLER. Thank you. 

Ms. Hirono? 

Let me get this straight. When the Navy transfers you, Terrilyn 

is going with you? Is that what you said? 

Ms. FENLEY. I would love that. I am inviting her now. 

Chairman MILLER. I hadn’t heard about these rights of military 

families. 

Ms. Hirono? 

Ms. HIRONO. I think my mike is off so I am going to lean over. 

I think it is really important to focus on a comprehensive system 

of early childhood services, so Ms. Weiss I was very intrigued by 

your testimony, where you indicate that evaluations of several of 

the major home visit models suggest that home visitation in conjunction with high quality early childhood education and/or preschool is more likely to result in positive gains. 

Could you talk a little bit more about the importance of this continuum kind of services? 

Ms. WEISS. Let me tell you quickly the two sides to it. One is a 

study of Early Head Start and that study done by Helen Raikes 

and her colleagues shows that when you combine home visiting, 

Early Head Start home visiting, and center-based care, you get 

46

more positive results than either of those two interventions separately, so that mixed home visit and center-based care is important. 

There was a recent study done by Ed Zigler and colleagues of the 

Parents As Teachers Program that shows Parents As Teachers parents were more likely to enroll their children in early childhood 

services and also more likely to be reading to their child at home, 

and that combination of things measurably increased their readiness for kindergarten and some of the early school success. 

So we have got several studies now that are pointing towards the 

importance of first of all not overpromising what we can deliver 

with home visit services, but then the value added of combining it 

with other services that are directed to the child and that continue 

on from birth through a longer period of time. 

Ms. HIRONO. I know that there have been quite a number of 

studies that show how important quality early education is to a 

child’s success, so your testimony that says combining the home 

visits with these kinds of high quality programs, that you really get 

more bang for the buck, basically. I think that is a very important 

point to make. 

Also, I would imagine that there are home visitation programs 

out there that may not meet the kind of quality test that we would 

like these programs to have, because I think one of the people testifying said that if it is not of quality, then you are practically wasting your resources. 

So what would be the indicators of a high quality home visitation 

program? And how does this bill promote quality programs? 

Ms. WEISS. Do you want me to speak to that? 

Ms. HIRONO. Well, any of the panelists can weigh in. 

Ms. WEISS. I think what we know is training, supervision, high 

quality curriculum, getting and using data to track your performance, are all critical. And one of the interesting things about the 

legislation, from my point of view, is that it sets aside and makes 

provisions for all of those indicators of quality. 

Ms. HIRONO. So you mean that this bill focuses enough to ensure 

that what we are funding would be the quality programs? 

Ms. WEISS. It contributes in a big way to delivering quality, yes, 

with set-asides and provisions. 

Ms. SMART. I think it is very important that the programs that 

are funded have clear-cut goals and objectives that are measurable, 

that their activities actually address what their goals are and that 

the outcomes that they evaluate are addressed in the goals and objectives, so that it is just a complete package, so that what they are 

doing matches what they are trying to do and then they assess to 

see if they have done it. 

And in so many of the programs that we have now are starting 

to do that, we are lucky that we are in Nurse-Family Partnership 

that this was practically—well, it was already done for us, and we 

got all the data systems, we have got the computerized system, we 

have got the theory that guides our work, the activities that are 

structured. At each visit the nurse gives, we have structured guidelines of what we are supposed to do so we are hopefully not that 

distracted by all the things going on in the environment, the gang 

47

shootings, the drugs in the back room, and, you know, things like 

that. 

So it is very important to have that structure, and then the ability to monitor that structure so that your workers—you can assess 

the product being delivered in the home through the outcomes that 

you achieve. 

Ms. HIRONO. Thank you. I have a question——

Ms. LONDON. Excuse me. I would like to respond. 

Ms. HIRONO. Go ahead. 

Ms. LONDON. Our Healthy Families Program has embedded in it 

the weekly supervision of our home visitors. The project supervisor 

of each Healthy Families Program meets with the home visitors to 

look at the quality of their home visits. They are actually trained 

before they make their first home visit. And we have a national accreditation body that looks at the quality of what it is that we do. 

Our programs are credentialed. It is like a mini-joint commission 

accreditation. So quality is very, very important in what we do. In 

the state of Illinois, a monitoring and tracking system that our 

home visitors put data in. There are regular quality improvement 

reviews of that data. We look at it, we analyze it and we apply it 

to the overall goals. 

The program is based on 12 critical elements, which are very, 

very unique in terms of looking at the quality of what it is that we 

do. We are not simply just making home visits and chatting with 

an individual. We are actually educating the mom, the mom is improving in parenting skills, that child is becoming ready for school 

because we know that when we are finished, when the program is 

completed and the child is 3 years old, we work with them to move 

the parent and the child into the school in that particular community. Quality assurance is a very important part of the Healthy 

Families Program. 

Ms. HIRONO. Thank you. I have a question for Ms. Ditka. 

You have a lot of experience in the court system, I take it family 

court. Do the judges in your state have the discretion to require the 

parents to involve themselves in home visitation programs? 

Chairman MILLER. Ms. Ditka is going to give you a very quick 

answer. 

Ms. DITKA. Yes. 

Ms. HIRONO. Thank you. 

Ms. DITKA. Is that quick enough, Chairman? 

Chairman MILLER. Ms. Woolsey? 

Ms. WOOLSEY. Thank you, Mr. Chairman. 

First of all, I would like to thank Congressman Davis and Congressman Miller and Congressman Platts for authoring this HR 

2343. And giving us an opportunity to carry on the conversation of 

how important it is that our children get the best start in life and 

to talk about needing to do whatever we can to ensure that they 

are given every opportunity. Quality education, health care, support services for parents are such important programs. They need 

to be expanded and every child and every parent needs to have access so that we can ensure that every single one of these little kids 

that are born in the United States of America has an opportunity 

to be successful. And I think today’s hearing has confirmed all of 

that once again. 

48

Now, Mr. Estrada, you have had, like, a vacation here. We have 

not asked you a question, so I think that that is what I need to 

be doing. 

You have concerns with Title 9 of HR 2343, and I believe your 

concern is that individuals have to sign a release of whether they 

will or will not take a particular training. 

Now, first of all, don’t you think that signature, because these 

are funded programs, that signature is just proof to the funders 

that indeed the offer has been made? Do you have any examples 

of where that has been used and held against an individual or a 

family that chose not to be part of the training? 

Mr. ESTRADA. Congresswoman, our concern is that this could 

lead to that. We have dealt with examples, because of the fact that 

they are confidential I don’t have them with me right now, but I 

could get them, and we will get those examples to you. But we 

have dealt with many situations, unfortunately, where a medical 

nurse or a doctor has seen a family and advised them a course of 

treatment in a hospital or something like that, or parenting classes 

or something like that, and the family has said, well, we are going 

to use our own medical provider, for example, if they go to an 

emergency room, if they——

Ms. WOOLSEY. But this isn’t the same thing. This isn’t medical 

provision. This is signing off to say, yes, this has been offered to 

me, I chose to or not to. Is it mandatory, the training? 

Mr. ESTRADA. The training is not mandatory, no. 

Ms. WOOLSEY. All right. Well, I would like to ask the other members of the panel, have you ever seen this offer used against a client, or used for them? 

Ms. London? 

Ms. LONDON. The Healthy Families Program is a voluntary program. The home visitation program is voluntary. We are educating 

parents to be informed individuals. They make a choice as to 

whether they want to participate. 

Ms. WOOLSEY. Ms. Ditka? 

Ms. DITKA. The whole tenor of the bill is that it is a voluntary 

program, and in my experience we have never used failure to participate in a voluntary program as a basis to prosecute someone or 

in any way get them involved in the social service system. 

Ms. WOOLSEY. So, Mr. Estrada, would your concerns about Section 9 then say you and your organization are against—would vote 

against—if you were us—vote against the bill in its entirety? 

Mr. ESTRADA. Well, Congresswoman, two issues about just Section 9 about these concerns. The first one is, many families could 

be pressured to take these classes——

Ms. WOOLSEY. No, but they aren’t. 

Mr. ESTRADA. Okay. 

Ms. WOOLSEY. So what could happen is also many families could 

end up without an education for the family and their children that 

have prepared those children and those adults to be good parents 

and good, successful individuals once they get into school. So all of 

this if ‘‘ifs’’. 

But, okay, the second if? 

Mr. ESTRADA. And the second if, Congresswoman, is actually following up with what Ms. Ditka said. We are very grateful that 

49

families are not prosecuted. But even an anonymous tip sometimes 

from a nurse, for example, who says, well, why did the family not 

choose these parenting classes, could lead to that. 

Our concern is it is not clear in Section 9 if hospitals are required to offer these parenting classes, or if it could lead to a situation where families are basically strongly pressured and——

Ms. WOOLSEY. Okay. Well, then, I would suggest we can—Mr. 

Davis will look at the language to make sure it is clear. 

Mr. ESTRADA. Thank you. 

Ms. WOOLSEY. There is no question that it needs to be clear. 

Ms. Smart, have you ever known of a nurse that has used such 

evidence? 

Ms. SMART. No, I have never known of a nurse to do that, although we have had referrals from probation officers that strongly 

recommended their clients enroll in NFP. When we get any indication at all that the client is forced to do it, we do not enroll them, 

unless they really want to do it. But we don’t. 

Ms. WOOLSEY. It is voluntary. 

Thank you, Mr. Chairman. 

Ms. CLARKE. Thank you, Mr. Chairman. 

My question is for you, Ms. Ditka, because just reflecting that 

this Sunday is Father’s Day, and as I reviewed your testimony it 

struck me that many of the statistics you cited concerning program 

success relate to women, namely young mothers in the program. 

Here is my question: Where are the fathers? Actually, does the program in your country incorporate and assist the fathers? 

Ms. DITKA. Yes. If the fathers are involved, the Nurse-Family 

Partnership in Allegheny County does incorporate the fathers. And 

in fact, in the success story I gave you, not only did the woman become educated and get clean, she was also getting married. So it 

is the whole package. 

But if the fathers are willing and involved, they are encouraged 

to participate. And if they are willing to do so, they are included 

in the program. 

Ms. CLARKE. Can anyone else on the panel speak to their experience with—when we say parental, there seems to be such a heavy 

emphasis on the mothers—what type of success we are having in 

incorporating fathers in this process? 

Ms. SMART. I can speak to that. We do have great success when 

the father of the baby or the boyfriend to the mother, who may not 

be the father, is involved in the home environment. Where we have 

a problem is when the father is incarcerated. 

But the techniques that we use in the home, even the simple 

thing of the father walking in the room when the nurse is there, 

dads generally don’t like to be involved in this, but to include him, 

when a father walks in the room and start talking, the nurse will 

say, ‘‘Oh, look, the baby just turned its head to look at you, it already knows you,’’ and the father is astounded. What do you mean 

the baby knows me? That, right there, starts the bond. And that 

starts our work. 

And then we see the dad slowly becoming more and more—they 

will hang out in the kitchen and listen and they will come into the 

room. But it is a process of becoming involved, it is not just simVerDate 0ct 09 2002 09:17 Aug 27, 2008 Jkt 000000 PO 00000 Frm 00053 Fmt 6633 Sfmt 6602 G:\DOCS\110TH\FC\110-95\42728.TXT HBUD1 PsN: DICK
50

ply—many fathers don’t want to sit down and be that involved 

right away. 

Ms. CLARKE. Ms. London? 

Ms. LONDON. In our Healthy Families Program in Near North 

Chicago, we encourage fathers to participate from the very beginning, when we are assessing just the eligibility to participate in the 

program. 

In fact, one of the home visitors is in fact a father, and he is able 

to engage the fathers more at each home visit, and we encourage 

them even to accompany the moms to the health center for the prenatal visits, and we have had fathers who have participated and 

graduated from our group parenting classes. 

Ms. CLARKE. Wonderful. 

Ms. Ditka, I wanted to ask you another question. I am from New 

York City and we recently had a very tragic occurrence in our child 

welfare safety net where a 3-year-old child died as the result of torture in the care of his foster care mother, who was deemed unfit 

for custody of her own children in another state. 

Have you seen models of success in partnering of NFP with the 

child protective services and foster care agencies? There seems to 

be some sort of hole there if someone who is becoming a foster care 

parent doesn’t have the parenting skills either. And that is a huge 

part of our social network and fabric in our communities. 

Ms. DITKA. I have a similar case pending now, where the family 

came from a different state, their children were taken away, they 

have new children here and those children have lived in horrific 

conditions. 

Again, the programs that we are talking about are voluntary, so 

these people that are signing up for these foster care that have already had children removed are not going to voluntarily participate 

in a program like this. And this is a voluntary program. 

I think the issue that you raise takes us sort of in a far-reaching 

direction with some of our social service problems that exist not 

only in New York and Pennsylvania, but I think in every state 

across the nation. 

Ms. CLARKE. I am even wondering whether they are even offered 

it. 

Ms. DITKA. I can’t address that. I am sure Ms. Smart can. 

Ms. SMART. I can address that. In Los Angeles County, when we 

did try to determine first of all how many girls who were under 

protective services got pregnant while they were receiving protective services, we couldn’t find that number, nor can we find it 

statewide. That data simply is not kept. 

We do offer this program generically to every woman or girl who 

fits the intake criteria, first time pregnant, living in poverty and 

we try to get them before their 18th week of pregnancy. But the 

protective services system is one we really need to crack into. It 

should be offered to every single child. They are the most very, 

very at high risk of the girls who get pregnant in our county. Their 

outcomes are abysmal. 

Ms. CLARKE. Thank you very much, Mr. Chairman. I yield back. 

Mrs. DAVIS OF CALIFORNIA. I was going to yield to Mr. Holt, 

right? 

Thank you very much. 

51

Thank you, Mr. Chairman, and to the sponsors of the bill. 

I remember back in the state legislature, let’s see, that was back 

in about 1994, and we were beginning to have discussions about 

this. The HIPPY Program was involved in California. So I am actually delighted to see how far this has come and that is great. 

A few quick questions. One, the self-selecting process of parents 

choosing to be involved. And I understand this always has been a 

voluntary program. But does that hamper in any way your ability 

to evaluate the extent to which the programs are bringing something of great value into the family that perhaps they might not 

have received in a different way? 

One of the concerns we often have even with charter schools is 

that parents who are selecting that their child go to that school 

may have different tools available and to make that a successful 

opportunity for that child. 

Could you comment briefly on that? And are there some ways of 

dealing with how perhaps there is additional outreach, especially 

for groups of individuals that may tend to decline the services? 

Does anybody have any comments? 

Dr. Weiss, or whoever would like to respond. 

Ms. WEISS. I am happy to respond. 

I think that the issue of selection bias is real because participation is voluntary. So you are always going to have selection bias, 

and I think that is true of any of the programs. You are going to 

have selection bias based on it being voluntary. 

Having said that, I think each of these programs in my knowledge goes to special efforts to do outreach to stressed, vulnerable 

families that could benefit from the service. Some of them target 

those families directly. Some of them do extra outreach to try to 

make sure they enroll the families that the evidence suggests can 

benefit a great deal from participation. 

And in fact, when one does analyses of who participates and 

looks specifically at the most high risk groups, there is some evidence that suggests for example with Early Head Start that it is 

the high risk groups that benefit the most, which validates the 

extra effort to try to include, you know, perhaps the most highly 

stressed families. 

So I think we can make claims that these benefit high risk families, and I think we also have to make sure that we are doing outreach to get them into the program. 

Mrs. DAVIS OF CALIFORNIA. Where—and again, if anybody wants 

to respond—where is the greatest gap in terms of outreach providing the trainers, the personnel, to participate in this program? 

Are we reaching the individuals who in fact really can relate best 

to the families that they might be serving? Is there a gap in being 

able to identify outreach having, you know, the individuals come 

forward and participate and any men who participate as well? I 

mean, have we looked at that statistic? 

Ms. SMART. That is a difficult question, actually, to answer, because we have dealt with being nurses, and I get this a lot in Los 

Angeles, well, you are nurses, how can you possibly know about the 

families that live in poverty. So the cultural differences are something that is always brought up. And I always have to bring up, 

52

well, nurses live somewhere, and many of us were raised in poverty. 

The gaps in Los Angeles County are such mostly with the bilingual issues. We have so many languages, mostly Spanish speaking, 

and so we have made great efforts to make sure our staff is bilingual. That I think—and then in outreach, outreaching through 

churches has been very beneficial, schools and the Women, Infants 

and Children Program is one of our main resources for outreach. 

Mrs. DAVIS OF CALIFORNIA. Do you see—I know my time is running out—do you see that as an important part of the evaluation? 

And should the bill be more specific in being able to assess the extent to which the program mirrors the population in the community that it serves? 

Ms. SMART. Absolutely. And we do keep that data in the Dr. Olds 

Nurse-Family Partnership model, so that we do know. And it is 

very interesting, because our population in NFP Los Angeles mirrors exactly the population that we have, including a couple of 

Cambodian and Vietnamese mothers. 

Mrs. DAVIS OF CALIFORNIA. Thank you. 

And just quickly, other challenges in terms of training. Wages? 

Is that an issue that should be addressed? Are people able to afford 

being part of this program? 

Ms. LONDON. The Healthy Families Program, being a part of the 

social service arena, always you hear about the salaries of the individuals. But as I said in my testimony, our workers have a passion 

and a commitment for the families that they work with, and the 

families can really see that. 

Right here, Ms. Fenley, who has testified, they have developed 

a trusting relationship. And so that seems to go beyond the salary 

which they may receive, which some may not feel is competitive. 

I wanted to go back to the outreach question of——

Chairman MILLER. I am going to ask you to quickly summarize 

what you want to say. 

Go ahead, Ms. London, just finish your thought. 

Ms. LONDON. That issue dealing with the salary, it is their commitment to the work more than the salary. 

Chairman MILLER. Thank you. 

Mr. Holt? 

Mr. HOLT. Thank you, Mr. Chairman. 

I thank the sponsors of this bill and the chairman for doing this. 

Ms. Fenley, since you are into—since you spoke about encouragement and validation and praise, let me lay a little praise on you. 

I can’t imagine a better national spokesperson for this sort of thing 

than you, and your testimony about, you know, understanding the 

reasons that little Zane does what he does and finding resources 

that you would not have found on your own and connecting with 

community, learning parenting techniques, approaches to discipline, working with both you and your husband in childrearing, 

it makes it so clear the value of programs like this. 

And, you know, we in New Jersey have seen this. I have seen 

it at Family and Children Services, Children Home Society, they 

have a program with English language learners, Parents As Teachers in New Jersey, quite active and quite successful. And if there 

is some way we can make this broader and more effective through 

53

legislation such as that of Mr. Davis and Mr. Platts, I am all for 

it. 

I have a couple of questions. One is, if this becomes too formalized and appears to be coming from the state and is connected with 

child protective services somehow in people’s minds, how do we 

guard against the participants putting up a defense, saying, you 

know, this is an inspection service, it is intrusive, rather than as 

obviously I think it was Terrilyn who worked with Ms. Fenley. 

How do we build into this program an inviting aspect? I am not 

sure whom I should ask this to. Anyone who has any comment on 

that——

Mr. ESTRADA. I think that is a good point, and I would not, and 

I don’t think anyone here, even if we have concerns with the bill, 

would be against many of the things in this bill. 

Something that we have looked at at HSLDA, we have looked at 

if the parenting classes, if the materials, instead of coming from 

the Secretary of Health and Human Services and instead of coming 

maybe so closely linked to the state child welfare services, if it was 

in the example of, let’s say, grants that were given to public private 

entities that could then offer these parenting classes, maybe that 

would even get these classes into the hands of more people and still 

give very good education to parents, teachers who could help the 

parents, and it would also do away with some of the concerns that 

HSLDA has. 

I know that——

Mr. HOLT. Thank you. 

I think maybe Ms. London would be the best to answer this next 

question. How do we build into this program a longevity, a long 

enough relationship with the family and the visitor? A lot of these 

families, of course, are not particularly stable. They may have to 

move a lot, particularly if they are military families. They have 

changing jobs and life situations. Are there things that we have 

learned about how to build in a long enough contact to get the most 

benefit out of the program? 

Ms. LONDON. Yes. I would say we started with the trusting relationship that we build with the mom while she is pregnant, so that 

is 9 months. And then we work with the children and families until 

the child is 3 years old. So that is 3-plus years. And we continue 

working with them even beyond that. 

If our families are relocated and when they move, they can voluntarily continue to agree to participate, and the home visitor will 

follow them wherever they move within the City of Chicago limits. 

Mr. HOLT. Again, I think this is fine legislation and I thank Mr. 

Davis and Mr. Platts. 

And thank you, Mr. Chairman. 

Chairman MILLER. Mr. Payne? 

Mr. PAYNE. Thank you very much. 

I am sorry that I missed the testimony. But are any of you associated with CASA, the Court Appointed Special Advocate? 

Well, we are very fortunate in our county, I happened to go to 

be called for jury duty. The only way I got out is that I was assigned to a murder case that was going to take 6 weeks, so I 

couldn’t be chosen because I can’t stay in the court for 6 weeks. 

54

But while I was there, they had a presentation, actually, to all 

the jurors, must have been a thousand, where they went over a 

court appointed—what is it called—court appointed special advocate. In our county, the abuse in foster care is so high that the 

state can’t handle it and so they are asking for volunteers that 

have to go through training to actually be assigned to a foster child 

to make sure that the foster child is getting proper treatment in 

foster care. It is a very unique program and we have almost a thousand volunteers that are in it. 

You know, I usually don’t kind of discuss dirty linens in public, 

but we have a very serious problem in our county. Unbelievable. 

We have more, nearly 25 times, the average U.S. rate of children 

in foster care in four cities in my county, and we have challenges 

in this little area. Twenty-one percent of the violent crime occurs 

right in these four cities for the entire county. The statistics are 

really unbelievable of some of the problems that we have. Fourteen 

percent of the children are born low birth weight. Twenty-five percent spend at least one night in the hospital in their first year. 

Twenty-seven percent have asthma. Twenty-one percent were overweight at age 3. Sixty-two percent were below the 15th percentile 

in verbal skills. 

And so we really have a concentration of poverty that is probably 

even more severe than in your Cabrini Green area in Chicago. And 

so I am interested in trying to gather from your testimony, which 

I missed, but I might ask you, Ms. London, about the—I understand in your testimony you speak of families that are being displaced in the Cabrini Green housing area. We have had the same 

problem of bringing down public housing, and people sort of are 

dispersed. 

But could you sort of share with me how your program has 

helped these families and how have you impacted on the overall 

welfare of the children in these families that have been dispersed? 

Ms. LONDON. Yes, I can. The home visitor works very closely 

with families. One of the goals on our IFSP, which is our individual 

family support plan, is whatever the parents want us to work with 

them on, that particular goal, for a 6-month period. And we update 

it and review it every 6 months. So housing in that area is an integral goal. 

The home visitor works together with case managers and with 

other agencies to actually move and relocate the families. And as 

I said, we are able—if the family wants to continue in the program, 

to actually continue home visits wherever it is that they move 

within the City of Chicago, and give services, offer services, to 

them. 

Our program is a part of the Community Health Center, so many 

of our participants are also patients of the health center, and they 

continue to come into the health center even after the child has 

aged out at age 3. And so we are able to continue interacting with 

them in terms of school enrollment, immunizations, well child visits or whatever it is that the parents need. 

Mr. PAYNE. Do you have Section 8 housing in your portfolio, or 

is that out of the Housing Authority, you know, which Section 8 

says 30 percent of the income is spent for housing and the rest is 

paid by the federal government. 

55

Ms. LONDON. That would be more case management. But the 

home visitors do work very closely with case managers. 

Mr. PAYNE. Okay. Well, it looks like my time is expired. 

Thank you very much. 

Mr. HINOJOSA. Thank you, Mr. Chairman. 

I want to say thank you for calling this hearing and I want to 

express my support for the parental involvement and family involvement as we try to teach children the art of learning. And I say 

that without a successful program in parental involvement and 

family involvement, that I think that we are missing one of the 

most important components that Chinese families—Chinese leaders 

have taught us, who have visited China, inquiring how is it that 

they can be so successful in having large percentages of their children graduating from high school and going on to college and beating the socks off of us when we compete with them in international 

scholastic competition. 

So my questions are going to be many and I ask you for short 

answers so I can ask as many questions as I can during the short 

time they are giving me. 

My first question is to Ms. London, from Illinois. How does your 

program provide support, training and supervision to ensure that 

the home visitors are effective in working with families who do not 

speak English? 

Ms. LONDON. Presently, our program is 100 percent African 

American English speaking individuals. 

Mr. HINOJOSA. Maybe, Ms. Fenley, what do you all do—is it Mrs. 

Fenley—can someone else answer my question? Those who are 

English limited families who can’t speak. I can certainly tell you 

that I am very interested in this because I come from a family of 

11 and my mother didn’t speak English, so if we had anybody come 

visit, she couldn’t speak to them. 

Ms. SMART. I can speak a little bit to it. In Los Angeles we have 

the top 11 languages that we have to deal with. We do recruit 

nurses specifically sometimes for the languages they speak and the 

culture that they are. 

I think all of us struggle with meeting the needs of our populations we serve, especially the multicultural, multiethnic groups. 

But it is very important that what you look at also statistically—

and I did this analysis when we first started—I found out that oftentimes it is main family language we don’t speak, but the young 

child who is pregnant—and I say young child, again, 17—is bilingual, although maybe not good. And the outcomes are similar and 

the same to the outcomes of those with the same cultural mix of 

the nurse to the client. 

That also included we had need to look at the African American 

population served by the Latina nurse. Their outcomes were the 

same as any other person we served. Again, it goes back to the relationship, and sometimes there are a million things you can do 

without ever saying a word. 

Mr. HINOJOSA. So would you say that we need to address, then, 

the lack of communication wherever we are not able to have those 

visitors to the homes with a language the parents can understand? 

Ms. SMART. Absolutely. 

56

Mr. HINOJOSA. Maybe taking college students who can speak 

that language, be it whatever the language is. 

My next question then goes to Ms. Weiss from Harvard Family 

Research. What does the research show to be the core components 

of an effective home visit program that strengthens family literacy 

and helps parents support their children’s learning? 

Ms. WEISS. I think we talked a little bit about some of those key 

components. Well-trained staff. The Nurse-Family Partnership 

woman mentioned a program that aligns the goals, what you do in 

the home and the measurement to make sure that they are all consistent with the outcomes that you are trying to get. Well-trained 

staff with supervision is critical. 

And I think all of these models that I am familiar with also 

stress the importance of the parent working with the child around 

literacy development in the home. 

Mr. HINOJOSA. Would your research confirm that those mothers 

who work with children at early ages of 1 through 3 or 4, teaching—letting the children listen to somebody reading to them, to get 

them to learn to love books and reading? Does that work? 

Ms. WEISS. There is a lot of support—there is a lot of research 

evidence that supports that conclusion, a huge amount of it. 

Mr. HINOJOSA. Excellent. 

The next question goes to Ms. Smart, director of Nurse-Family 

training. In many communities across the country, Hispanic families live in a climate of fear because of the current policy of indiscriminate immigration raids and local policies aimed at newcomers 

to feel unwelcome. How do you build trust in the communities you 

serve? 

Ms. SMART. I guess we build it by being there and showing over 

time that we can be trusted. We don’t report to immigration. The 

only thing we do report routinely is child abuse when we see it in 

the home. 

But, no, we have established a reputation and respect and a lot 

of our referrals, as mentioned earlier, come from the girls who are 

pregnant and their friends get pregnant. They come to us that way. 

I think it is very important, and again it helps to have multicultural nurses onboard so that they can see we are supportive. And 

again, nurses are one of the most respected professions, and that 

helps too. 

Mr. HINOJOSA. Thank you. 

I yield back. 

Chairman MILLER. Thank the gentleman. 

Mr. Tierney, do you have any questions? 

Mr. TIERNEY. Just maybe one or two, Mr. Chairman. Thank you. 

Dr. Weiss, I came a little late. I apologize. I have another committee going at the same time. But I know in your written remarks 

you talked about the Parent Child Home Program, which we have 

in some of the communities in my district. Have you explained that 

already on the record, the specifics of the program and its measures of success? 

Ms. WEISS. I have not. 

Mr. TIERNEY. Would you do that for me, please? 

Ms. WEISS. Yes. The Maternal Child Home Program provides 

home-based support for language and literacy development from 

57

about age 3 to age 5. It has several studies, experimental studies, 

that suggest the value of doing that around children’s language 

and literacy development and early school readiness. They also 

have studies that show that parents who belong to and the kids 

that experience the program are more likely to be involved with 

their kids’ development into elementary school. So it leverages 

early parent involvement to support sustained parent involvement. 

So it has an array of very important outcomes. It is a very strong 

model. 

Mr. TIERNEY. I am curious on that, because I know Brandon 

Walsh, when he was head of Title 1 in Salem, started the program 

in that community and has a waiting list now. Most of the communities that do it in fact have a waiting list, and most of the parents 

that go through it—not most of them, but many of them, then become people instructing on the program. 

All of the indicators that we have from the local metrics on that 

are that it is successful and progressing, and you are now confirming that on a broader perspective it also seems to be a good 

program. 

Ms. WEISS. Yes. 

Mr. TIERNEY. Thank you very much. 

I have no further questions, Mr. Chairman. Thank you. 

Chairman MILLER. Mr. Platts? 

Mr. PLATTS. Thank you, Mr. Chairman. 

Kind of a follow up to the discussion earlier about the different 

programs and who is targeted for inclusion, whether it be Healthy 

Families, Nurse-Family Partnership or some of the others. One 

issue we haven’t really mentioned is the issue of means testing. 

And I would be interested in any of the panelists, and maybe especially Ms. London with Healthy Families. I know you don’t have 

means testing, but you do kind of target by at risk of, you know, 

abuse, not means testing. 

And then, Ms. Ditka, in your testimony earlier you were talking 

about how abuse does run the gamut of all socioeconomic groups, 

which would seem to argue against any kind of means testing. 

So I would be interested in especially the two of you, but any of 

the other panelists also, whether there should be any mandatory 

means testing included in the legislation as part of any programs 

participating. 

Ms. LONDON. Ours is a strength-base program. And the way that 

we bring in our families is to assess for particular potential for 

child abuse and neglect, is what it is that we are looking for. 

Mr. PLATTS. Regardless of income level, right? 

Ms. LONDON. There is no income, no ethnic differentiation or 

anything. It is universal assessment and screening. 

Mr. PLATTS. Okay. 

Ms. DITKA. In Allegheny County, the Nurse-Family Partnership 

that works in Allegheny County does do some needs assessment. So 

it is impoverished, primarily teenage mothers, in their second trimester. 

But I think my response was in response to Mr. Davis’ question, 

and that is that any family, regardless of need economically could 

use this program. It is just merely at risk parents. You don’t have 

58

to be impoverished to not have good parenting skills. Anybody can 

be afflicted with that problem. 

Mr. PLATTS. Thank you. 

Anyone else want to comment? Yes? 

Ms. WEISS. Programs like Missouri’s Parents As Teachers have 

evidence of benefits for everybody who participates, regardless of 

income. They have also been good, as have other programs that 

serve a general population, of providing more intensive and frequent home visit services to families that may need more help. 

So there are a number of models of universal programs that then 

provide more intense, frequent services to more high-need families. 

One of the things I like about the legislation is that it leaves to 

the state and perhaps the local community decisions about how 

they are going to use their resources. Having said that, I think 

there is a research-based case that says more highly stressed families need more intensive and frequent services within a universal 

model when people chose to go in that direction. 

Mr. PLATTS. It is perhaps allowing that to be an option, but not 

mandated for the state and local participation. And I think that is 

something to emphasize here, that this is for a federal program to 

help fund state and local efforts, not to create a federal program, 

but provide the funding for such a program. 

Ms. WEISS. It is also not age-specific programs that you are mandating, and you are leaving a lot of choice within reason to states 

about the kinds of programs they are going to provide. 

Mr. PLATTS. Thank you. 

Mr. Estrada, your testimony focused on Section 9 and the concerns there, and to follow up my colleague and try to get into that 

a little further with you. Is it safe to say that, in Section 9, if it 

was retained as far as trying to ensure parents are made aware of 

this program, if the requirement was eliminated as far as a parent 

having to sign saying yes, I participated or no, I chose not to participate, that requirement, because it seemed like that is where 

your focus was, that having to sign something would make them 

feel pressured to participate. So if that signature requirement was 

eliminated, would that go a long way towards eliminating your organization’s concerns? 

Mr. ESTRADA. That would definitely help, Congressman. 

If the materials were just in the hospital as something that is offered by the way to parents, this is something that would be very 

helpful, we encourage you to take it, that would take away a lot 

of our concerns. 

Our concern also, however, is that if the curriculum is going to 

be developed by the Secretary of HHS and there are no guidelines 

for how the curriculum is going to be developed, what happens if 

it is open to politics being played with it as different administrations come, maybe one side doing it this way and one side doing 

it the other way? What if down the road it ended up something 

that different religious hospitals or cultural birthing centers, they 

disagreed with the materials? I was uncertain. The bill seems to 

be a bit vague. Can a hospital refuse these materials? 

Mr. PLATTS. I think sometimes we can start to imagine all sorts 

of things that could be, and you can never write a legislation to 

59

guard against every possibility, but I appreciate the concern that 

it is voluntary participation and no consequences for not. 

And I will quickly—I see my time is out—just emphasize with 

your organization, in the findings of the legislation, I really see this 

as supportive of parents who choose to homeschool, because in the 

findings we reflect that the first and most important teacher for 

any child is the parent. And that is exactly what homeschoolers believe, and with the very large homeschool population in my district 

that are very engaged with their children and their education. So 

we are trying to, I think, compliment what your organization is 

about. 

A final comment, just again, Ms. Fenley, and this really goes to 

Mr. Kildee reflected it as well, all the testimony has been exceptional and very helpful. Your testimony about the most important 

thing you have gotten out of your participation hit home. 

I was telling my 9-year-old last night as he was getting tucked 

in and we were recounting the days—yesterday was the first day 

of summer vacation, and we were recounting his third grade year 

and how proud we are of how hard he worked and how well he has 

done, and how I end every day with that hand on the chest when 

they are asleep and they don’t know it, just that all is well. I can 

go to sleep because my kids are sleeping. 

Your testimony about that lesson of instilling self-esteem in our 

children is a powerful statement, and if you are not already doing 

so back home, you are a great advocate for espousing the importance for families of the parents participating in your program in 

Virginia and, really, thank you for being here today. 

Thank you, Mr. Chairman. I yield back. 

Chairman MILLER. Further questions? 

Mr. DAVIS OF ILLINOIS. Mr. Chairman, thank you very much. 

I just want to assure Mr. Estrada that we hear him in terms of 

the concern that he expressed relative to privacy and the whole 

question of possible coercion, and we will review the language and 

take a look at that and try to make sure that there are no loopholes whatsoever. 

Mr. ESTRADA. Thank you, Congressman. 

Mr. DAVIS OF ILLINOIS. I consider myself a practicing civil libertarian, that individuals must have the right to do what they want 

to do and when they want to do it and the way they want to do 

it. 

And Mr. Chairman, again, I want to thank you for holding this 

hearing. 

And I would just reemphasize, you know, Mr. Holt indicated, Ms. 

Fenley, that if we had a national spokesperson for this issue, it 

ought to be you, and I would certainly agree with him. Maybe we 

will have to figure out a way to create that. 

So thank you very much, Mr. Chairman, and I yield back. 

Chairman MILLER. I feel a Section 10 coming on. [Laughter.] 

Let me thank you all. If I just might take a couple of minutes 

here. 

One, Mr. Platts has made the point and I think it is very, very 

important with respect to this legislation that we are trying to create a federal stream of funding, not a federal program, and I think 

that is important. I feel a little bit like, you know, you will have 

60

been running this startup company for a while and now you are 

asking to go to scale. And as we know in dealing with human services, it is the most difficult thing we can do, and we don’t have a 

great track record. 

And on that point, I am most intrigued by these programs as I 

have been involved with them and watched them over several 

years, that they have—the attempts that have been made to maintain the integrity and to use the data and the information for program improvement. And I would just ask you once again to look 

at this bill, because I think it is absolutely critical so that we can 

say with confidence that we are investing in a program of success 

here, a program of record and a program of sort of constant improvement. 

And then I think that allows us to stay out of the way in the 

kinds of—so that you can continue to use the discretion and the 

history and the background that you have of the program to make 

the choices and decisions that you do. 

That is a big test in our relationship here. We hand out—you 

know, if we are fortunate enough to get a half a billion dollars, a 

lot of people start thinking we should start driving the horses here. 

That is not a very successful model, either. 

So I would just ask you—and Dr. Weiss, as you review the studies over the last 25 years, you make it very clear that where these 

quality indicators are not in place, we are just kidding ourselves. 

And I think a couple of the witnesses said if you don’t do it right, 

if they don’t want to volunteer, if they don’t want to participate, 

it is just not going to work. 

And I think that is what would be my priority here with respect 

to this legislation. I think Mr. Davis and Mr. Platts have done a 

great job of drafting this legislation, but I want to know that if we 

are going to scale, we could be back here 5 years from now and 10 

years from now and see a program that has continued to improve 

without us creating a lot of regulations and hurdles for people to 

jump that just eat up the resources. 

So there is that part of it. If we could call on you again to sort 

of scour the bill, because you have very extensive experience with 

this. I think the bill has been drafted with all of that in mind, but 

I just want to reiterate that point. 

And finally, thank you to Zane and Megan for coming today to 

join us. Megan, thank you very much for being here and brining 

your brother. We enjoyed you both. So thank you. 

And Ms. Ditka, are you going to introduce mom? You brought her 

all the way down here, you are going to make her drive home, come 

on. 

Ms. DITKA. My mother, Joyce Ann and my daughter, Claire. 

Chairman MILLER. Thank you. And you are welcome, too. Thank 

you for being here. 

With that, the committee will stand adjourned, and thank you 

again so much for your time and your expertise. And we will leave 

the record open for further submissions if something comes to you 

or members of the audience and members of the committee. 

[The statement of Ms. Woolsey follows:]

61

Prepared Statement of Hon. Lynn C. Woolsey, a Representative in Congress 

From the State of California 

Chairman Miller, thank you for holding this hearing today. Thank you Representatives Danny Davis and Platts for introducing H.R. 2343, the Education Begins at 

Home Act. This is an important topic and I look forward to more conversations 

about how we can help give every child the best possible start in life. 

Home visitation programs have been shown to reduce child abuse, improve parent 

and child bonding, increase literacy, and even reduce crime. These important programs are already helping many families in communities all over the United States, 

but there are long waiting lists and many more families could benefit from these 

services provided. That’s why it’s so important that the federal government provide 

funding to serve more families and so more communities can have access to home 

visitation services. 

However, we can’t stop there. Home visitation programs should be better utilized 

along with a host of other services for children and families, such as early childhood 

education, affordable, quality child care, and work schedules that allow parents to 

more fully participate in their child’s lives. In two-thirds of all American families, 

one or both parents work and they are trying to balance work and family responsibilities. These parents are doing the best they can for their children and we need 

to help them by ensuring that they have access to home visitation, early childhood 

education, and other programs and flexible enough work schedules that allow them 

to utilize these programs. 

Chairman Miller, thank you again for holding this hearing. I look forward to continuing this dialogue with my colleagues to find more ways to help parents give 

their children the best possible start. Thank you. 

[Additional materials submitted by Mr. Miller follow:] 

[The report, ‘‘Breaking the Cycle of Child Abuse and Reducing 

Crime in Pennsylvania: Coaching Parents Through Intensive Home 

Visiting,’’ may be accessed at the following Internet address:] 

http://www.fightcrime.org/reports/PACAN2.pdf 

[The report, ‘‘The Economic Return on PCCD’s Investment in Research-based Programs: A Cost-Benefit Assessment of Delinquency 

Prevention in Pennsylvania,’’ may be accessed at the following 

Internet address:] 

http://prevention.psu.edu/pubs/docs/PCCD—Report2.pdf 

[Additional statement submitted by Mr. Tierney follows:]

Prepared Statement of Sarah E. Walzer, Executive Director, the ParentChild Home Program 

The Parent-Child Home Program is pleased to submit this testimony in support 

of the Education Begins at Home Act, H.R. 2343. We thank the Committee for holding this important hearing on legislation that will make a tremendous difference in 

the lives of children and families across the country. We are pleased to be part of 

a national coalition of home visiting organizations and advocates for early childhood 

and family support services that has been supporting the passage of the Education 

Begins at Home Act. 

As a nation, we cannot really begin to talk about ‘‘No Child Left Behind’’ until 

we have successfully ensured that ‘‘No Child Starts Behind’’. Today, too many children in the United States enter school never having seen or held a book, without 

the basic literacy and language skills they need to participate successfully in the 

classroom. As a result their teachers in pre-kindergarten or kindergarten have to 

slow or stop the curriculum they had planned, to help these children catch up. Unfortunately, the data shows us that most children who start behind will never catch 

up. Children who do not know their letters when they enter kindergarten are beVerDate 0ct 09 2002 09:17 Aug 27, 2008 Jkt 000000 PO 00000 Frm 00065 Fmt 6633 Sfmt 6621 G:\DOCS\110TH\FC\110-95\42728.TXT HBUD1 PsN: DICK
62

1 ‘‘A policy Primer: Quality Pre-Kindergarten,’’ Trust for Early Education, Fall 2004. 

hind in reading at the end of kindergarten, at the end of first grade, and are still 

having trouble reading at the end of fourth grade.1

We also know that preschool is not the sole solution to this lack of readiness. Children arrive in pre-kindergarten not ready just as they have been arriving in kindergarten not ready. Children are more likely to be ready at any age when they have 

a family that knows what it needs to do to help them get ready. All families want 

their children to be successful, to do well in school, but many families do not know 

how to prepare their children to be successful in school. If you are not educated 

yourself, did not grow up in the American education system, and/or do not have the 

means to purchase books and educational toys, you may need some guidance to help 

you get your child ready for school. The Education Begins at Home Act (EBAH) is 

designed to do just that by ensuring that families receive the supports they need 

to prepare their children to enter school ready to be successful students and to go 

on to graduate from high school. 

The Parent-Child Home Program is a research-based, research-validated early literacy, school readiness, and parenting education home visiting program developed 

in 1965. For over 40 years, the Program has been serving families challenged by 

poverty, limited education, language and literacy barriers, and other obstacles to 

school readiness and educational success. The Parent-Child Home Program currently serves over 6,500 families through more than 150 local sites in 14 states. 

Many more families could be served in each of these communities, as all of our sites 

have waiting lists at least equal to the number of families they are currently serving. And many more families remain in need of these services in communities that 

have not been able to develop funding streams for this critical early childhood service. 

The Parent-Child Home Program works with a broad range of families whose children are at risk of entering school unprepared: teen parent families, single parent 

families, homeless families, immigrant and non-native English-speaking families, 

and grandparents raising grandchildren. Working with parents and children in their 

own homes helps families create language-rich home environments and lays the 

foundation for school readiness and parent involvement as their children enter 

school. Parents are able to continue to build their children’s language and literacy 

skills after the Program finishes and their children enter school ready to succeed. 

The Program erases the ‘‘preparation gap’’ and prevents the ‘‘achievement gap.’’

The funding that would be provided by EBAH is critical to ensuring that home 

visiting programs like these can reach families in need of services and enable children to enter school ready to be successful students. The families reached by home 

visiting are families who are not accessing center-based early childhood or school 

readiness services, including the library, play groups or parenting workshops. They 

do not have transportation or access to transportation to get to these services; the 

services are not open or available when the parents are available to attend; they 

have language or literacy barriers; and/or they have no money to pay for programs. 

I would like to provide you with some background on The Parent-Child Home Program to highlight the extent of its evaluation and validation and the depth of the 

Program’s experience working with families across the country. For over 40 years, 

we have been preparing young children and their families to enter school ready to 

learn. As a result, four decades of research and evaluation demonstrates that Parent-Child Home Program participants in communities throughout the country enter 

school ready to learn and go on to succeed in school. In fact, peer-reviewed research 

demonstrates that program participants go on to graduate from high school at the 

rates of middle-class children nationally, a 20% higher graduation rate than their 

socio-economic peers nationally and a 30% higher rate than the control group in the 

study. From the first day of school, Program participants perform as well or better 

than their classmates regardless of income level. This research, published in peerreviewed journals, demonstrates not only the immediate, but also the very long-term 

impacts of home visiting. 

Not only do child participants perform better in school, but their parents also become actively involved in their education, as noted by principals and teachers at the 

schools they attend. In addition, the parents go on to make changes in their own 

lives as well, obtaining their GEDs, returning to school, and improving their employment situations. At least 30% of our Home Visitors across the country are parents who were in the Program as parents; for many of them, this is an entry into 

the workforce. All of these changes have significant ramifications for their children’s 

futures. The Parent-Child Home Program proves that when programs are available 

to support parents and children from an early age, delivering services in a way that 

is accessible and meaningful to them, we can ensure that economically and educaVerDate 0ct 09 2002 09:17 Aug 27, 2008 Jkt 000000 PO 00000 Frm 00066 Fmt 6633 Sfmt 6621 G:\DOCS\110TH\FC\110-95\42728.TXT HBUD1 PsN: DICK
63

tionally disadvantaged children will enter school ready to learn, never experience 

the achievement gap, and attain high levels of academic success. 

The Program’s primary goal is to ensure that all parents have the opportunity to 

be their children’s first and most important teacher and to prepare their children 

to enter school ready to succeed. The Program’s hallmark is its combination of intensiveness and light touch. Each family receives two home visits a week from a 

trained home visitor from their community who models verbal interaction and learning through reading and play. The families receive a carefully-chosen book or educational toy each week so that they may continue quality play and interaction between home visits and long after they have completed the Program. Often the books 

are the first books in the home, not just the first children’s books, and the toys are 

the first puzzles, games or blocks that the child has ever experienced. The materials 

are the tools the parents use to work with their children. The materials ensure that 

when these children enter pre-kindergarten or kindergarten they have experience 

with the materials that teachers expect all children to know. 

Most importantly, the Program is fun for families, demonstrating for parents both 

the joy and the educational value of reading, playing, and talking with their children. Children’s language and early literacy skills progress rapidly, and parents find 

an enormous sense of satisfaction in the progress that comes from their work with 

their children. This combination of fun and the dramatic changes families see in 

their children are the reason that on average 85% of the families who start in the 

Program complete the 2 years. The majority of families who do not complete the 

Program fail to do so because they move to a community where it is not available. 

We know The Parent-Child Home Program is successful because of the changes 

we see in the families and the success the children have when they enter school. 

We also know it is successful because of the positive responses from the local community sponsors, including school districts, family resource centers, community 

health clinics, and many community-based organizations, and from the way the Program is continuing to expand across the country. We see that home visiting is a 

service delivery method that is able to reach families whose children would otherwise show up in pre-K or kindergarten never having held a book, been read a story, 

engaged in a conversation, been encouraged to use their imagination, played a game 

that involves taking turns, or put together a puzzle. 

I would just like to share with you one brief anecdote demonstrating the longterm impact of the Program on the families who participate. As I mentioned earlier, 

we have followed program participants through high school graduation and beyond 

and have collected many wonderful examples of the Program’s impact on children’s 

lives. I think the long-term success of the Program is most clearly depicted by an 

interview that was conducted recently with a program graduate from one of our 

sites in New York, which has been implementing the Program for over 35 years. 

The son of immigrants from Columbia, he noted that of the 40 native Spanishspeaking students in his grade, only 3 went on to college. He observes that all these 

children went through the same schools and participated in the same activities, the 

only difference was The Parent-Child Home Program. He says it got him on the 

right track early; he entered school ready to learn and has soared ever since. He 

still has vivid memories of how confident he felt when he started kindergarten, how 

the books and toys were familiar and how he was the only native-Spanish-speaking 

child who knew the words to London Bridge is Falling Down. For him, the Program 

was a critical bridge to the rest of his education and for his mother it was empowering. She went back to school herself, and he noted she regularly would call his 

teachers to tell them to give him more homework because what they had given him 

was too easy. This young man is now a lawyer at a major New York City law firm, 

and he is the first Program graduate to become a member of The Parent-Child 

Home Program’s national board of directors. His story is both extraordinary and 

typical of the kinds of success parents and children can achieve when home visiting 

is available to reach them where they are most comfortable and help them build 

the language and literacy skills they need to enter school ready to learn. 

Thank you for holding this hearing and considering the Education Begins at 

Home Act, which will provide funding to support vital services for children who 

would otherwise enter school unprepared and be unsuccessful. Thank you for helping to ensure that all parents struggling to help their children succeed receive the 

support they need to bring the joy of reading, playing, learning, and school success 

into their children’s lives. We hope that you will move forward with this legislation 

to enable states to provide families with high quality, research-validated home visiting services that are a critical component of successful school readiness, early 

childhood education, and parent support efforts. It is truly a cost-effective way to 

ensure that all children have the opportunity to enter school ready to succeed. 

64

[Additional materials submitted by Mr. Davis of Illinois follow:]


hvc-1.eps
65


hvc-2.eps
66


hvc-3.eps
67


hvc-4.eps
68


hvc-5.eps
69


hvc-6.eps
70


hvc-7.eps
71


hvc-8.eps
72


hvc-9.eps
73


hvc-10.eps
74


hvc-11.eps
75


hvc-12.eps
76


hvc-13.eps
77


hvc-14.eps
78

Prepared Statement of the Child Welfare League of America 

Chairman Miller, Representative McKeon and members of the Committee, the 

Child Welfare League of America submits this statement in support of HR. 2343, 

the Education Begins At Home Act. We thank the original sponsors of this legislation, Representatives Danny Davis and Todd Platts and all the bipartisan cosponsors who have joined them. 


hvc-15.eps
79

CWLA represents hundreds of state and local direct service organizations including both public and private, and faith-based agencies. Our members provide a range 

of child welfare services from prevention to placement services including adoptions, 

foster care, kinship placements, and services provided in a residential setting. 

CWLA’s vision is that every child will grow up in a safe, loving, and stable family 

and that we will lead the nation in building public will to realize this vision. 

As we have stated in other Congressional settings, CWLA believes the best way 

to ensure children are safe from all forms of maltreatment is to provide comprehensive, community-based approaches to protecting children and supporting and 

strengthening families. Public and private agencies, in collaboration with individual 

citizens and community entities, can prevent and remedy child maltreatment, 

achieve child safety, and promote child and family well being. There is no solution 

to addressing child abuse in our society short of a comprehensive approach that begins with preventive efforts and assures that we have a safe and permanent place 

for children who are the victims of abuse and neglect. 

Home Visiting Models 

Home visitation programs refer to different model programs that provide in-home 

visits to targeted vulnerable or new families. Home visitation programs—either 

stand-alone programs or center-based programs—serve at least 400,000 children annually between the ages of 0 and 5 1 but there is a need for us to do much more. 

The eligible families in these home visitation programs may receive services as early 

as the prenatal stage. Because a child’s early years are the most critical for optimal 

development and provide the foundation necessary for success in school and life, 

home visiting can make a lifetime of difference./2/ Nurses and other trained members of the community conduct home visits on a weekly, bimonthly, or monthly 

basis. Program goals include an increase in positive parenting practices, improvement in the health of the entire family, increase in the family’s ability to be selfsufficient, and enhanced school readiness for the children. 

Prevention 

Although we speak in support of HR 2343 because we feel home visitation can 

provide an important component in a continuum of care that we need in the child 

welfare field, we also know that these programs can assist in improving education 

and health outcomes for children. Home visitation can show improved outcomes in 

the areas of prenatal care, access to health care and improved rates of immunizations. 

Whenever we engage in discussions in regard to our nation’s child welfare system 

one of the first great challenges and debates is over how we can prevent abuse and 

neglect from taking place. All of us would prefer a system that can help a family 

before they ever become part of the more than 3.3 million reports of abuse and neglect filed annually and certainly before they become one of the more than 900,000 

children who are substantiated as neglected and or abused each year. Research has 

shown that home visitation programs reduce abuse and neglect and juvenile delinquency, and ultimately save taxpayers over $50 billion annually.3

We recognize the value both in human and economic terms, and the great benefits 

to our nation and to vulnerable families and children by enacting policies that prevent the need for ever placing a child in foster care. There is no simple model for 

prevention of child abuse and in fact we believe that a commitment to preventing 

child abuse will involve multiple efforts and strategies. Greater investment and support for home visitation is a critical part of such a strategy. 

Currently home visitation programs rely on a range of federal, state and local 

funds. Unfortunately these funding sources can be unreliable, even for programs 

that are demonstrating effectiveness in a range of areas. In recent years states have 

utilized funding sources such as and including the Social Services Block Grant 

(SSBG), Title IV-B part 1, Child Welfare Services, Title IV-B part 2, Promoting Safe 

and Stable Families (PSSF), the Child Abuse Prevent and Treatment Act (CAPTA) 

state grants and Community-Based Family Resource and support grants. All of 

these funding sources are used to fund a range of other services, and all have been 

subject to reductions or proposed reductions in each of the last five budgets. This 

highlights the need for specific funding for home visiting programs to strengthen 

and stabilize the funding. 

All families benefit from information, guidance, and help in connecting with resources as they meet the challenges of parenthood and family life. For families with 

limited resources, or those that face additional challenges, the need for support and 

assistance is even greater. 

Families are central to child safety and well-being. Children develop the ability 

to lead productive, satisfying and independent lives in the context of their families. 

80

Family ties especially those between parent and child are extremely important in 

the development of a child’s identity. Through interaction with parents and other 

significant family members, children learn and come to subscribe to their most cherished personal and cultural values and beliefs. They learn right from wrong, and 

gain competence and confidence. Family relationships must be nurtured and maintained to meet the needs of children for continuity and stability, which support 

healthy development. 

Evidence shows that children who experience maltreatment are at greater risk for 

adverse health effects and risky health behaviors when they reach adulthood. Many 

parents involved in the child welfare system do not intentionally harm their children; rather their lack of knowledge, skills, or resources has led them to harm their 

children.4

Quality early childhood home visitation programs lead to several positive outcomes for children and families, including a reduction in child maltreatment. Annual data indicates that 40% of the more than 900,000 children who are substantiated as abused and neglected, but not removed from the home, never receive follow-up services.5 There can be a number of reasons for these consistent statistics 

from year to year but one clear reason is that in some states follow-up services may 

not come until after a family has been placed on a wait list for services. More widely 

available and implemented home visitation could help address this drastic shortcoming. More serious is the fact that of the estimated 1,460 child deaths in 2005, 

76.6% were younger than age 4. Another 13.4% were between the ages of 4 and 7.6

Of the perpetrators of child maltreatment, 76.6% were parents.7

Evidence For Home Visitation Models 

Home visitation services stabilize at-risk families by significantly affecting factors 

directly linked to future abuse and neglect. Research shows that families who receive at least 15 home visits have less perceived stress and maternal depression, 

while also expressing higher levels of paternal competence.8 Home visitation programs may also reduce the disproportionality or overrepresentation of children and 

families of color in the child welfare system, while improving outcomes for these 

families. Research shows that participating children have improved rates of early 

literacy, language development, problem-solving, and social awareness. These children also demonstrate higher rates of school attendance and scores on achievement 

and standardized tests.9 Studies show that families who receive home visiting are 

more likely to have health insurance, seek prenatal and wellness care, and have 

their children immunized.10

A study of the Missouri-based Parents As Teachers home visiting program examined the children enrolled in the program and found that by age 3, they were significantly more advanced in language, problem-solving, and intellectual and social abilities than children in comparable groups.11 A study of the Nurse-Family Partnership 

showed a 79% reduction in child maltreatment among at-risk families compared to 

other families in a control group. That same study also indicated a number of other 

benefits in the areas of health, employment, and behavior.12 Healthy Families 

America exists in more than 450 communities; Home Instruction for Parents of Preschool Youngsters is in 167 sites in 26 states; the Parent-Child Home Program has 

137 sites nationally and 10 sites internationally; Early Head Start serves more than 

62,000 children in 7,000 sites; and Parents as Teachers is located in all 50 states 

and serves more than 400,000 children.13

Conclusion 

Under the legislation, each governor would designate a lead state agency to oversee and implement the state program. The states can use their grants to supplement—but not replace—current state funding. The legislation does not dictate 

which, or how many, home visiting models may be used. If a state currently lacks 

a home visitation program, the funds can be used to develop a program. A state’s 

grant funding award would be based on the number of children age 5 and younger 

living in the state. Applying states would submit a plan outlining their efforts to 

collaborate and coordinate among existing and new programs. 

CWLA commends the Committee for its hearing today on home visiting—highlighting its successful outcomes for children and their families. Such successful outcomes of home visiting contributing to familial continuity, educational enrichment, 

as well as physical and mental health will be expanded by increased federal support. CWLA hopes that this hearing today is merely the next step building on the 

hearing from the last Congress and that the next steps taken by Congress will be 

to further home visitation initiatives nationally by passage of the legislation before 

you. This commitment will make the benefits of in-home visiting services accessible 

to many more families and improve outcomes for many more children. 

81

ENDNOTES

1 Chapin Hall Center for Children at the University of Chicago. (2006). Challenges to building 

and sustaining effective home visitation programs: Lessons learned from states. Available online 

at http://chapinhall.webex.com/seminar/251028/play/335933617/PPT—presentations.pdf. Chicago: Author. 2Daro, D., Howard, E., Tobin, J., & Hardin, A. (2005). Welcome home and early start: An assessment of program quality and outcomes. Available online at http://www.chapinhall.org/article—abstract.aspx?ar=1365. Chicago: Chapin Hall Center for Children at the University of Chicago. 3Fight Crime: Invest in Kids. (2003). New hope for preventing child abuse and neglect: Proven 

solution to save lives and to prevent future crime. Washington, DC: Author. 4 Child Welfare League of America. (2005). Research Roundup: Parenting. Washington, DC: 

Author 5 Administration on Children Youth and Families. (2008). Child maltreatment 2006. Washington, DC:, US Government Printing Office. 6 Administration on Children Youth and Families. (2008). Child maltreatment 2006. Washington, DC: U.S. Government Printing Office. 7 Ibid. 

8Daro, D., Howard, E., Tobin, J., & Hardin, A. (2005). Welcome home and early start: an assessment of program quality and outcomes. Available online. Chicago, IL: Chapin Hall Center 

for Children at the University of Chicago. back 9 Administration for Children and Families. (2003). Research to practice: Early Head Start 

home-based services. Washington, DC: Author. 10 Berkenes, J.P. (2001). HOPES healthy families Iowa FY 2001 services report. Great Falls, 

VA: Klagholz & Associates. 11Pfannenstiel, J., & Setlzer, D. (1985). Evaluation report: New parents as teachers project. 

Overland Park, KS: Research and Training Associates. 12 Nurse-Family Partnership. (2005) Factsheet. Available online. Denver, CO: Author. 13Prevent Child Abuse America. (2006). Early Childhood Home Visiting Programs. Chicago, 

IL: Author. 

MILITARY IMPACTED SCHOOLS ASSOCIATION, 

June 10, 2008. 

Hon. DANNY DAVIS, 

Rayburn House Office Building, Washington, DC. 

DEAR CONGRESSMAN DAVIS: I am writing on behalf of the Military Impacted 

Schools Association (MISA) to encourage the passage of H.R.2343 to expand early 

childhood support programs for American Families. 

MISA represents school districts that provide for the education of military children throughout the United States. Our military children have unique challenges 

that they deal with regularly. One area that we as educators are trying to address 

is the tremendous stress that our children are under as a result of their parents’ 

deployments. The United States has been at war for over five years. We are seeing 

young children going through many stages from withdrawing, to acting out, to contemplating suicide. 

It is a very difficult time for our military children as they watch the war play 

out on television, observe the stress of the parent/adult that is caring for them, and 

worry about whether their parents will be home for their birthday, Christmas, graduation, or even at all. School districts are doing everything they can with the resources they have to provide support for our military children. This is not a quick, 

short term fix. We need additional programs to assist our military children, keep 

them connected with their schools and families, and to help them through this very 

difficult time. 

The proposed legislation will allow school districts that serve military children the 

opportunity to secure funding to specifically address the needs in their school districts. The Military Impacted Schools Association respectfully requests your support 

for this important legislation. If you have questions, don’t hesitate to call me. 

Sincerely, 

JOHN F. DEEGAN, ED.D., 

MISA Executive Director. 

Prepared Statement of Prevent Child Abuse America 

Prevent Child Abuse America and its network of 44 state chapters and over 400 

Healthy Families America program sites in 41 states thanks the Chairman and the 

other distinguished members of the U.S. House Committee on Education and Labor 

for this opportunity to provide the organization’s perspective on the Education Begins at Home Act (EBAH, HR 2343). Through this testimony, our organization, inVerDate 0ct 09 2002 09:17 Aug 27, 2008 Jkt 000000 PO 00000 Frm 00085 Fmt 6633 Sfmt 6621 G:\DOCS\110TH\FC\110-95\42728.TXT HBUD1 PsN: DICK
82

1Study designs include 8 randomized control trials and 8 comparison group studies. More information on the studies can be found in the Healthy Families America Table of Evaluations 

at www.healthyfamiliesamerica.org/research/index.shtml. 

cluding our National Board of Directors, intends to identify the value of home visiting and the outcomes that EBAH can achieve to enhance our nation’s ability to 

promote healthy early childhood experiences. 

About Prevent Child Abuse America 

Prevent Child Abuse America was founded in 1972 and is the first organization 

in the United States whose sole mission is ‘‘to prevent the abuse and neglect of our 

nation’s children.’’ We undertake our mission by providing testimony such as this, 

to legislative as well as executive policy makers about the importance of a full range 

of services needed to promote healthy child development and provide parents regardless of wealth with the information they need to be the kind of parents they 

want to be. Based in Chicago, the National Office and our networks manage over 

350 different locally-based strategies to meet the mission of the organization, including 2900 home visitation workers, supervisors and program managers oversee and 

implement Healthy Families America, a voluntary home visitation service. 

The Importance of Development 

Our nation is recognized for meeting any challenges brought before us, our communities, and our workforce, but our continued position of leadership is greatly impacted by how we raise our children today. Healthy child development is a foundation for community development and economic development, as capable children become the foundation of a thriving society. The basic architecture of the brain is constructed through an ongoing process that begins before birth and continues into 

adulthood. Extreme and sustained stressful environments for children, also known 

as ‘‘toxic stress,’’ damages the developing brain and adversely affects an individual’s 

learning and behavior, as well as increases susceptibility to physical and mental illness. When considering that the ability to change behavior decreases over time, it 

makes sense (and cents) to ‘‘get it right’’ early when it is more beneficial to society 

than trying to ‘‘fix it’’ later. This why Prevent Child Abuse America promotes the 

prevention of child abuse and neglect before it ever occurs. This is why early childhood home visitation services, as contemplated in the legislation, are so important 

to families, communities and our nation. 

Role of Early Childhood Home Visitation 

All expectant parents and parents of newborns have common questions about 

their child’s development. Early childhood home visitation provides a voluntary and 

direct service in which home visitors can help parents understand, recognize and 

promote age appropriate developmental activities for children; meet the emotional 

and practical needs of families; and improve the manner in which parents achieve 

better outcomes for their children. 

Research has shown that voluntary home visitation is an effective and cost-efficient strategy for supporting new parents and connecting them to helpful community resources. Quality early childhood home visitation programs lead to proven, 

positive outcomes for children and families, including improved child health and development, improved parenting practices, improved school readiness, and reductions 

in child abuse and neglect. 

Healthy Families America 

Healthy Families America is Prevent Child Abuse America’s nationally recognized, signature home visitation program. Through Healthy Families America, wellrespected, extensively-trained assessment workers and home visitors provide valuable guidance, information and support to help parents be the best parents they can 

be. Healthy Families America focuses on three equally important goals to: 1) promote positive parenting; 2) encourage child health and development; and 3) prevent 

child abuse and neglect. 

A review of 34 studies in 25 states, involving over 230 Healthy Families America 

programs allows me to say with confidence and conviction that the benefits of 

Healthy Families America are proven, significant, and impact a wide range of child 

and family outcomes.1 In particular, Healthy Families America: 

• Improves Parenting Attitudes. Healthy Families America families show positive 

changes in their perspectives on parenting roles and responsibilities. 

• Increases Knowledge of Child Development. Healthy Families America parents 

learn about infant care and development; including child care, nutrition, and effective positive discipline. 

83

2Gomby, D. (2005). Home Visitation in 2005: Outcomes for Children and Parents. Invest in 

Kids Working Paper No. 7. Committee for Economic Development: Invest in Kids Working 

Group. Available at www.ced.org/projects/kids.shtml. 3Martin JA, Hamilton BE, Sutton PD, et al. Births: Final data for 2004. National vital statistics reports; vol 55 no 1. Hyattsville, MD: National Center for Health Statistics. 2006. 

• Supports a Quality Home Environment. Healthy Families America parents read 

to their children at early ages, provide appropriate learning materials, and are more 

involved in their child’s activities, all factors associated with positive child development. • Promotes Positive Parent-Child Interaction. Healthy Families America parents 

demonstrate better communication with, and responsiveness to, their children. This 

interaction is an important factor in social and emotional readiness to enter school. • Improves Family Health. Healthy Families America improves parents’ access to 

medical services, leading to high rates of well-baby visits and high immunization 

rates. Healthy Families America also helps increase breast feeding, which is linked 

to many benefits for both babies and moms. • Prevents Child Abuse and Neglect. Healthy Families America has a significant 

impact on preventing child maltreatment, particularly demonstrated in recent randomized control trials. 

In addition to our stewardship of Healthy Families America, Prevent Child Abuse 

America partners with other effective home visiting models working in communities 

across the country to create nurturing environments for children. Our national home 

visiting partners include Home Instruction for Parents of Preschool Youngsters 

(HIPPY USA), the Nurse-Family Partnership, The Parent-Child Home Program, and 

Parents as Teachers. 

Together, we have accepted the responsibility to improve the home visitation field. 

Together, we share research findings and best practices, work together towards common goals, and create areas for cross program cooperation and learning that 

strengthen the home visit field as a whole, as well as enhance individual programs. 

At the local level, Healthy Families programs partner with other home visiting models to reach a broader population of families, to ensure that families are receiving 

the home visiting service model best suited to their needs, and to maximize limited 

resources. 

The Need for Reliable Funding and a Coordinated Approach 

Across the country, home visitation services struggle with unreliable and 

unsustainable funding. Federal programs that have traditionally provided significant support to home visitation, such as Temporary Assistance for Needy Families 

(TANF) and Promoting Safe and Stable Families (PSSF), have been subject to recent 

statutory changes and funding cuts that hamper states’ abilities to invest in home 

visitation. The current patchwork of funding results in a home visitation system 

that serves only a small percentage of families. By one estimate, approximately 

400,000 children and families participate in home visitation services each year.2 As 

a reference point, there were 4.1 million live births in the U.S. in 2004.3

The Education Begins at Home Act (EBAH, HR 3628) introduced by Representatives Danny Davis and Todd Platts will address the current home visiting funding 

crisis by establishing the first, dedicated federal funding stream to support parents 

with newborns and young children through quality, voluntary home visitation at the 

state and local levels. 

EBAH authorizes $500 million over three years to help states establish or expand 

quality early childhood home visitation programs. Of this funding, $400 million will 

be divided among states to provide eligible families with voluntary quality early 

childhood home visitation on at least a monthly basis. The remaining $100 million 

will be equally divided between two competitive grant programs designed to address 

the specific needs of military families and families with English language learners. 

EBAH dollars will enable programs to reach thousands more families with young 

children. Strict quality controls established in the bill will ensure that only the 

highest quality programs are funded with the new money. In order to be eligible, 

home visitation programs will need to use a model with a strong evidence base and 

must show that they can adequately monitor their program for quality assurance. 

Additionally, there will be standards for staff training and referral networks, and 

programs will be independently evaluated. 

The legislation empowers states to develop statewide plans for home visitation 

that best suit the needs of their communities. In order to draw down EBAH funds, 

states will have to assess the reach and scope of existing early childhood home visitation efforts and identify gaps in services. Taking this intentional approach to implementation will lead to: greater coordination among the various models of early 

84

4Wang, C & Holton, J. (2008). Total estimated cost of child abuse and neglect in the United 

States: Statistical evidence. Chicago, IL: Prevent Child Abuse America. 

childhood home visitation and the broader child-serving community; a more efficient 

use of resources; and a greater assurance that families are receiving the most appropriate and effective home visiting services to meet their needs. This model allows 

for a clear outcome driven national public policy that promotes consistent results 

and allows states to manage the services in accordance with their specific existing 

service delivery systems, on-going best practices and existing public-private partnerships. 

Conclusion 

Home visitation is an effective, evidence-based, and cost-efficient way to bring 

families and resources together, and help families to make choices that will give 

their children the chance to grow up healthy and ready to learn. Making quality 

home visitation programs more widely available in all communities is one of Prevent 

Child Abuse America’s top priorities, and I assure you that our national network 

is mobilized in support of this legislation. Research also is clear that failing to prevent abuse and neglect from occurring costs the America taxpayers over $103 billion 

per year.4 EBAH does not represent an expenditure but rather an investment in our 

children and families. It also contributes to more productive adult members of our 

society that promote stronger families, but also can be more productive in the workplace. This naturally contributes to our competitiveness in an expanding global 

economy. 

While no one piece of legislation can prevent child abuse and neglect, I believe 

that EBAH is an important step towards ensuring that all children have the opportunity to grow up in a safe, healthy, and nurturing environment. I look forward to 

working with members of this Committee to make the well-being of our nation’s 

children a priority. I hope that this legislation will help to turn our country’s priorities and choices toward more comprehensive and effective ways for communities 

and systems to care for children and families. 

Prepared Statement of the American Psychological Association 

On behalf of the 148,000 members and affiliates of the American Psychological Association (APA), we thank you for holding this important hearing to discuss the critical role of early home visitation programs in promoting child development. 

The APA is a scientific and professional organization that works to advance psychology as a science, a profession, and as a means of promoting health, education, 

and human welfare. Psychologists play a vital role in assessing the effectiveness of 

and making recommendations regarding programs of importance to children and 

families, such as those that provide early childhood home visitation. As such, we appreciate the opportunity to share our thoughts regarding these critically important 

programs with members of this Committee. 

‘‘Home visitation’’ is defined as a program that includes visitation of parents and 

children in their home by trained personnel who convey information about child 

health, development, and care; offer support; provide training; or deliver any combination of these services. While visits must occur during at least part of a child’s 

first two years of life, they can also begin during pregnancy. Individuals providing 

these services include nurses, social workers, paraprofessionals, and community 

peers. 

Home visitation programs have generally been offered to specific population 

groups, such as those who are first-time mothers; low-income or young parents; parents suffering from substance use problems; children at risk of abuse or neglect; and 

those who have low birth weight, a disability, or are premature. Visitation programs 

often address problems and create interventions of mutual benefit to parents and 

children, such as training of parents on prenatal and infant care; developmental 

interaction with infants and toddlers; family planning assistance; educational and 

work opportunities; and connection with community services. 

Research indicates important benefits of home visitation programs. Home visitation often leads to the enhancement of parents’ sense of self-efficacy which, in turn, 

strengthens their role as parents. Home visitors encourage and facilitate successful, 

achievable modifications in parents’ lives, teaching effective parenting, working to 

strengthen the support of family members and friends, and strengthening the capacities of parents to access the social resources available to them. In addition, research 

suggests that the impact of home visitation may positively influence social environVerDate 0ct 09 2002 09:17 Aug 27, 2008 Jkt 000000 PO 00000 Frm 00088 Fmt 6633 Sfmt 6621 G:\DOCS\110TH\FC\110-95\42728.TXT HBUD1 PsN: DICK
85

ment—including social networks, neighborhoods, communities, and cultures—on 

child development. 

A study conducted at New Mexico State University examined the outcomes of a 

home visitation program that provided services to first-born children and their parents. Home visitation workers conducted pretest and posttest assessments for prenatal and postpartum periods. Clients participating in the First-Born Program displayed significantly higher posttest scores on measures of family resiliency. Specifically, clients demonstrated improved scores in operationalized measures of resilience, including social support, caregiver characteristics, family interaction measures, and a reduction in personal problems affecting parenting. The results of this 

study are promising, as participants were observed to make positive improvements 

in specific areas related to family resiliency. 

Of paramount importance is the potential of home visitation programs to prevent 

child maltreatment. Various studies have assessed the effectiveness of home visitation programs in this area. One such study, conducted by the nonfederal Task Force 

on Community Preventative Services, looked at the effectiveness of early childhood 

home visitation in preventing violence. The study concluded that these programs are 

effective in the prevention of child maltreatment and reduce reported maltreatment 

by approximately 39 percent. 

Strong evidence indicates that early home visitation is especially effective in preventing child maltreatment in populations that have been shown to be at elevated 

risk of maltreatment. The study also found that programs delivered by professional 

visitors (i.e., nurses or mental health professionals) seemed to yield greater effects 

than those delivered by paraprofessionals. 

Staggering numbers of children and families impacted by child abuse and neglect 

demonstrate that the need for these programs is urgent. In 2006, an estimated 3.6 

million reports of possible child abuse or neglect were made to child protective agencies. Of those reports, 905,000 were substantiated, yet 40 percent of the victims received no services following the substantiation. Approximately 1,500 children die of 

abuse or neglect each year. These data reveal a public health crisis warranting concerted national attention and an increased focus on prevention. 

Given the proven success of these programs, especially in preventing child abuse 

and neglect, enactment of the Education Begins at Home Act (H.R. 2343) is critically important. H.R. 2343 dedicates a funding stream to support parents with 

young children through home visitation at the state and local level. The legislation 

provides $400 million over three years to states, tribes, and territories to expand 

access to parent education and family support services. This legislation additionally 

targets English language learners and military families for assistance, since these 

groups often lack natural support systems. The APA strongly supports this legislation and urges its support by the Committee. 

In closing, the American Psychological Association would like to thank you for the 

opportunity to share our comments on early childhood home visitation programs. We 

appreciate the Committee’s ongoing commitment to the positive development of children and look forward to serving as a resource and partner as you work on this and 

other important issues affecting children and their families. 

[The article, ‘‘The Parents as Teachers Program and School Success: A Replication and Extension,’’ published in the March 2008 

Journal of Primary Prevention, may be accessed at the following 

Internet address:]

http://www.springerlink.com/content/88h76474r2563455/?p=10d59e48429641028898aa132cd29e5c&pi=1

[Whereupon, at 12:19 p.m., the committee was adjourned.]

Æ