U.S. GOVERNMENT PUBLISHING OFFICE

33–364 WASHINGTON : 2019

THE REAUTHORIZATION OF THE MATERNAL, 

INFANT, AND EARLY CHILDHOOD HOME 

VISITING (MIECHV) PROGRAM 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HUMAN RESOURCES 

OF THE

COMMITTEE ON WAYS AND MEANS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED FIFTEENTH CONGRESS 

FIRST SESSION 

MARCH 15, 2017 

Serial No. 115–HR02 

Printed for the use of the Committee on Ways and Means 

( 

ii 

COMMITTEE ON WAYS AND MEANS 

KEVIN BRADY, Texas, Chairman 

SAM JOHNSON, Texas 

DEVIN NUNES, California 

PATRICK J. TIBERI, Ohio 

DAVID G. REICHERT, Washington 

PETER J. ROSKAM, Illinois 

VERN BUCHANAN, Florida 

ADRIAN SMITH, Nebraska 

LYNN JENKINS, Kansas 

ERIK PAULSEN, Minnesota 

KENNY MARCHANT, Texas 

DIANE BLACK, Tennessee 

TOM REED, New York 

MIKE KELLY, Pennsylvania 

JIM RENACCI, Ohio 

PAT MEEHAN, Pennsylvania 

KRISTI NOEM, South Dakota 

GEORGE HOLDING, North Carolina 

JASON SMITH, Missouri 

TOM RICE, South Carolina 

DAVID SCHWEIKERT, Arizona 

JACKIE WALORSKI, Indiana 

CARLOS CURBELO, Florida 

MIKE BISHOP, Michigan 

RICHARD E. NEAL, Massachusetts 

SANDER M. LEVIN, Michigan 

JOHN LEWIS, Georgia 

LLOYD DOGGETT, Texas 

MIKE THOMPSON, California 

JOHN B. LARSON, Connecticut 

EARL BLUMENAUER, Oregon 

RON KIND, Wisconsin 

BILL PASCRELL, JR., New Jersey 

JOSEPH CROWLEY, New York 

DANNY DAVIS, Illinois 

LINDA SA ́ NCHEZ, California 

BRIAN HIGGINS, New York 

TERRI SEWELL, Alabama 

SUZAN DELBENE, Washington 

JUDY CHU, California 

DAVID STEWART, Staff Director 

BRANDON CASEY, Minority Chief Counsel 

SUBCOMMITTEE ON HUMAN RESOURCES 

ADRIAN SMITH, Nebraska, Chairman 

JASON SMITH, Missouri 

JACKIE WALORSKI, Indiana 

CARLOS CURBELO, Florida 

MIKE BISHOP, Michigan 

DAVID G. REICHERT, Washington 

TOM REED, New York 

DANNY DAVIS, Illinois 

LLOYD DOGGETT, Texas 

TERRI SEWELL, Alabama 

JUDY CHU, California 

iii 

C O N T E N T S 

Page 

Advisory of March 15, 2017, announcing the hearing .......................................... 2 

WITNESSES 

Beth Russell, Nurse Home Visitor, Nurse-Family Partnership, Lancaster General Health/Penn Medicine, Lancaster, Pennsylvania ...................................... 10 

Rosa Valentin, Client, Nurse-Family Partnership, Lancaster General Health/ 

Penn Medicine, Lancaster, Pennsylvania .......................................................... 20 

Eric Bellamy, Home Visiting Manager, Children’s Trust of South Carolina ...... 26 

Diana Mendley Rauner, Ph.D., President, The Ounce of Prevention Fund ....... 36 

QUESTIONS FOR THE RECORD 

Questions submitted by The Honorable Tom Reed of New York to Eric Bellamy, Home Visiting Manager, Children’s Trust of South Carolina ................ 59 

Questions submitted by The Honorable Danny Davis of Illinois to Diana 

Mendley Rauner, Ph.D., President, The Ounce of Prevention Fund ............... 62 

SUBMISSIONS FOR THE RECORD 

Charles Bruner, Ph.D. ............................................................................................. 66 

American Academy of Pediatrics (AAP) ................................................................. 68 

Baby TALK ............................................................................................................... 74 

Child & Family Research Partnership (CFRP) ..................................................... 75 

Children’s Home Society of Washington ................................................................ 83 

Children’s Institute .................................................................................................. 84 

Easterseals, Incorporated ........................................................................................ 86 

Fight Crime: Invest in Kids Council for a Strong America .................................. 89 

Home Nursing Agency ............................................................................................. 91 

Home Visiting Coalition .......................................................................................... 95 

Johns Hopkins Center for American Indian Health (JHCAIH) ........................... 99 

National Nurse-Led Care Consortium (NNCC) ..................................................... 103 

Nurse-Family Partnership ...................................................................................... 108 

Beth Russell .......................................................................................................... 111 

Virginia Sosnowski, RN, BSN ............................................................................. 112 

Parent-Child Home Program (PCHP) .................................................................... 113 

Parents as Teachers National Center (PATNC) .................................................... 116 

Partners in Community Outreach (PiCO) ............................................................. 122 

Pennsylvania Department of Human Services, Office of Child Development 

and Early Learning (OCDEL) ............................................................................. 127 

People’s Emergency Center (PEC) .......................................................................... 137 

Prevent Child Abuse America ................................................................................. 139 

Responsible Fatherhood Roundtable ...................................................................... 145 

Shriver Center, Sargent Shriver National Center on Poverty Law .................... 149 

The Dads Matter Research Team at the University of Chicago School of 

Social Service Administration and the University of Denver School of Social 

Work ...................................................................................................................... 152 

The Florida Association of Healthy Start Coalitions, Incorporated (FAHSC) .... 155 

United Way of Miami-Dade .................................................................................... 163 

Voices for Ohio’s Children ....................................................................................... 164 

Washington State Home Visiting Coalition ........................................................... 171 

(1) 

THE REAUTHORIZATION OF THE MATERNAL, 

INFANT, AND EARLY CHILDHOOD HOME 

VISITING (MIECHV) PROGRAM 

WEDNESDAY, MARCH 15, 2017 

U.S. HOUSE OF REPRESENTATIVES, COMMITTEE ON WAYS AND MEANS, SUBCOMMITTEE ON HUMAN RESOURCES, Washington, DC. 

The Subcommittee met, pursuant to call, at 10:00 a.m., in Room 

1100, Longworth House Office Building, Hon. Adrian Smith [Chairman of the Subcommittee] presiding. 

[The advisory announcing the hearing follows:] 

2 

ADVISORY 

FROM THE COMMITTEE ON WAYS AND MEANS 

SUBCOMMITTEE ON HUMAN RESOURCES 

FOR IMMEDIATE RELEASE CONTACT: (202) 225–1721 

Wednesday, March 15, 2017 

HR–02 

Chairman Smith Announces Human Resources 

Subcommittee Hearing on the Reauthorization 

of the Maternal, Infant, and Early Childhood 

Home Visiting (MIECHV) Program 

House Ways and Means Human Resources Subcommittee Chairman Adrian Smith 

(R–NE), announced today that the Subcommittee will hold a hearing entitled ‘‘Reauthorization of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) 

Program’’ on Wednesday, March 15, at 10:00 a.m. in room 1100 of the Longworth House Office Building. This hearing will examine a range of home visiting 

models, review how States operate and fund programs, and highlight how an evidence-based home visiting program can produce positive outcomes for children and 

families. 

In view of the limited time to hear witnesses, oral testimony at this hearing will 

be from invited witnesses only. However, any individual or organization may submit 

a written statement for consideration by the Committee and for inclusion in the 

printed record of the hearing. 

DETAILS FOR SUBMISSION OF WRITTEN COMMENTS: 

Please Note: Any person(s) and/or organization(s) wishing to submit written comments for the hearing record must follow the appropriate link on the hearing page 

of the Committee website and complete the informational forms. From the Committee homepage, http://waysandmeans.house.gov, select ‘‘Hearings.’’ Select the hearing for which you would like to make a submission, and click on the link entitled, 

‘‘Click here to provide a submission for the record.’’ Once you have followed the online instructions, submit all requested information. ATTACH your submission as a 

Word document, in compliance with the formatting requirements listed below, by 

the close of business on Wednesday, March 29, 2017. For questions, or if you 

encounter technical problems, please call (202) 225–3625. 

FORMATTING REQUIREMENTS: 

The Committee relies on electronic submissions for printing the official hearing record. As always, submissions will be included in the record according to the discretion of the Committee. 

The Committee will not alter the content of your submission, but we reserve the right to format 

it according to our guidelines. Any submission provided to the Committee by a witness, any materials submitted for the printed record, and any written comments in response to a request for 

written comments must conform to the guidelines listed below. Any submission not in compliance with these guidelines will not be printed, but will be maintained in the Committee files 

for review and use by the Committee. 

All submissions and supplementary materials must be submitted in a single document via 

email, provided in Word format and must not exceed a total of 10 pages. Witnesses and submitters are advised that the Committee relies on electronic submissions for printing the official 

hearing record. 

All submissions must include a list of all clients, persons and/or organizations on whose behalf 

the witness appears. The name, company, address, telephone, and fax numbers of each witness 

must be included in the body of the email. Please exclude any personal identifiable information 

in the attached submission. 

3 

Failure to follow the formatting requirements may result in the exclusion of a submission. All 

submissions for the record are final. 

The Committee seeks to make its facilities accessible to persons with disabilities. 

If you are in need of special accommodations, please call 202–225–1721 or 202–226– 

3411 TDD/TTY in advance of the event (four business days notice is requested). 

Questions with regard to special accommodation needs in general (including availability of Committee materials in alternative formats) may be directed to the Committee as noted above. 

Note: All Committee advisories and news releases are available at 

http://www.waysandmeans.house.gov

f 

/ 

Chairman SMITH OF NEBRASKA. The Subcommittee will come 

to order. 

Thank you for joining us here today. Welcome to our Human Resources Subcommittee hearing. Today we are here to discuss the 

Maternal, Infant, and Early Childhood Home Visiting program, 

known as MIECHV, which helps support State and local efforts to 

provide voluntary, evidence-based, outcome-focused home visiting 

services to parents and children at risk of adverse experiences. The 

program’s objectives include promoting school readiness of young 

children, increasing economic self-sufficiency of families, improving 

prenatal health and birth outcomes, and preventing child abuse 

and neglect. 

This hearing will examine a range of home visiting models, review how States operate and fund programs, and highlight how an 

evidence-based home visiting program can produce positive outcomes for children and families. 

Federal funding for home visiting was first proposed in 2004 by 

Republican Senators Chris Bond and Jim Talent, both from Missouri. However, the first Federal funds for evidence-based home 

visiting were provided in fiscal year 2008 after Congress agreed to 

fund President George W. Bush’s proposal to test this approach 

and measure the outcomes. The MIECHV program was fully authorized in fiscal year 2010 to continue these efforts and is now up 

for reauthorization this year. 

I, like other Members of this Subcommittee, have had the opportunity to see firsthand what home visiting looks like in my community. Last Monday, I spent time with the Panhandle Public Health 

District’s Healthy Families America program, which aims to improve the economic success and school readiness of vulnerable children and families in three Nebraska counties: Scotts Bluff, Morrill, 

and Box Butte. Dawn, one participant I met with on Monday, 

shared her experience of working with a home visitor who helped 

her find a stable home and a steady income in order to provide for 

her growing family. These are the types of outcomes we should be 

expecting and receiving from the use of limited taxpayer resources. 

Unfortunately, outcomes like these are the exception rather than 

the rule when we look around at how we help struggling families. 

New Federal social programs have been evaluated to determine 

if they are working, and almost none have conditioned funding on 

evidence of effectiveness. In our Better Way agenda, we proposed 

measuring how well programs are working so we can focus funding 

on programs which produce real results. When we spend limited 

4 

taxpayer dollars to help those in need, we must make sure we are 

spending money on effective programs. To do otherwise is a disservice to both taxpayers as well as beneficiaries. MIECHV is one 

of the only social programs where funding is tied to proving evidence. 

For a home visiting model to be funded, an evaluation must show 

the program has demonstrated significant, positive outcomes in 

areas such as reducing child abuse and neglect, improving maternal and child health, and improving economic self-sufficiency. 

Many of these approved models are now being further studied 

through a rigorous random assignment evaluation to better measure their impact so we know families are receiving real help. States 

have also been held accountable for demonstrating positive outcomes for children and families. If they don’t show improvements 

in four of six areas specified in law, they have to explain how they 

plan to improve their services to get results, which again provide 

real help to struggling families. 

A top priority for this Subcommittee in this Congress continues 

to be ensuring greater opportunity for Americans. Last week, I was 

grateful to learn more about how the Home Visiting program empowers Nebraska parents to provide a better life for their children, 

and I look forward to hearing more about similar efforts across the 

country today as we look forward to MIECHV reauthorization. 

I now yield to the distinguished Ranking Member, Mr. Davis, for 

the purpose of an opening statement. 

Mr. Davis. 

Mr. DAVIS. Thank you very much, Mr. Chairman. And I want 

to thank you for holding this hearing on evidence-based home visiting. I would like to ask unanimous consent to submit a group of 

stories that have—well, not really stories, but experiences that 

have been submitted about families in my district, and I would like 

to submit those for the record. 

Chairman SMITH OF NEBRASKA. Without objection. 

[The submission of Mr. Davis follows:] 

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33364A.001

children's home + a id 

AHLQUIST CENTER 60Jt, 

Policy 1 Practice 1 Innovation 

March 13, 2017 

Examples of the Success of MIECHV -funded Services in Illinois 

Illinois Pregnant and Parenting Youth in Care Pilot funded by MIECHV 

The I Pirk H0111t T / isitingpilol provides bo;ne visiting to nbnsed and neglert J'OIIth in the foster care ryste111 who are 

pregnant orpartnft. Tbe pilot {JJings togttber the child 1n(fort and tllr/y cbildbood tpttlll! to illljNrJut Olltto/JJt.J for 

yonth in fotltr tm~ nnd their childrtJJ. 

Materoal Infant Eany Childhood Home Visiting (MIECHV) funding is supporting an innovative 

pilot program that provides evidence-informed home visiting services to young adults in d1e foster 

care system who are pregnant or who are already parents. The I Pick Home Visiting (IPPYC) pilot 

began in October 2016 atld provides home visiting to eight communities in Illinois with the largest 

concentration of young adults in the foster care systen1 who are parents or who are pregnant. Since 

October, 30 young parents have been referred to the program and eight are currendy recei,,ing 

services, with anolher eight parents ru1d their children soon to be emolled. 

• L~ura* bccrune pregnant dming her first year at lllinois State University (ISU). Originally 

f1·om Chicago ru1d as a youth in foster care, Laura had no suppo1"t in the BloomingtonNormal area. Rather than drop out of school as she was advised to do by her foster care 

caseworker, Laura decided to continue at ISU and was referred to the Healrl1y Frunilies 

horne visiting program supported by l\ITECHV ftmding. Since her case was opened in 

Feb mary of d1is year, Latu-a has been linked wirlt a doula who will assist her at her birth, 

attended \VIC and doctor appointments, and connected to rl1e Bloomington Ctisi.s Nursety 

for postpartum support. The home visitor has also helped Laura to create a postpartum plan 

in concert with he.r professors at ISU to ensure she can continue to attend classes and 

complete assignments. Laura meets regula~ly with her home visitor and has expressed dtat 

she now feds more confident ru1d prepared for rlte birdt of her child. 

Home visiting funded through MIECHV 

TIJtSe exa11plu trJ/1/t jir/J/t tbt MIECHV fmded Henlfi!J Fa111iliu !JOtllt vitili11gprr;gm11t i11 B/oo/Jii11glo11 n11d 

Nomta/, flli11oit ill McLea11 Coltll!)'. 

After becoming pregnant at rlte young age of 16, Sarah* turned to rlte Healthy Fa1nilies 

home visiting program in Normai,IL for suppo1t. Sarah's home visitor provides her widt 

parenting education, encouragetnent, and access to chjld care so that she can tna~n in 

school and complete a Certified Nursing Assistant (CNA) program, all while parentUlg. Not 

only is Sarah at dte top of her class in the CNA progmm, but she also maintains a 4.0 GPA 

in her orl1er high school classes. Sarah has given up her extracurricular activities in order to 

care for her one-year-old son iJl the evening. Sarah says rltat being with her son is better than 

1 
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33364A.002

any other activity she could be doing. Even at 16, this young mom is planning a brighter 

future for herself and her son. 

Erika* always planned to start college at a four-year university after high school, but with the 

bU:th of her son, her plans changed. Erika's home visitor worked with Erika to establish her 

family goals and help her achieve those goals, which include getting a college education. By 

providing young mod1ers with access to basic needs uke clod1ing and diapers, the Heald1y 

Families program allows mod1ers to focus on larger goals railier tl1an worry about where 

they will get the next diaper. This past fall, Erika successfully enrolled at Heardand 

Community College in Bloomington. Over tl1e past few mond1s, she's had near perfect 

attendance and recently passed all of her classes witl1 A's and B's. Aliliough Erika misses her 

son wlli!e she's in class, she knows tl1e sacrifice is for d1e good of her and her family. Erika 

has often has stated that getting an education is important to her because she wants to be a 

good role model for her son. 

• Facing eviction from her Bloomington home, Alicia* mrned to Healthy Families to help 

fight d1e eviction because she thought the eviction reason to be w1true and unfaU:. Alicia's 

home ''isitor helped he.r read d1e lease to understand her rights as a tenant, and also provided 

her with support to let her know she wasn't in the wrong or dese1ving of being treated that 

way. Healthy Families also linked Alicia with free legal cow1sel and d1e agencr's Crisis 

Nursety care to take care of her children while she's in court. Alicia stated she primarily 

wanted to keep her home for her children's sake because she didn't want d1em to be raised 

in a shelter, whicl1 would've been her only other housiJlg optioJl had she been evicted. 

Titrough perseverance, resilience, and consistently seeking connection to resources, Alicia 

won her court case against her landlord and was able to rernain in her ho1ne. Alicia was 

ovetjoyed to have won the case and states how relieved and blessed she is tl1at her family is 

able to remain u1 their home togetl1er. 

The fxo111plu bf!OJJ' nre jil'JIII tbe So11tb Side Enr(y l..Lnmi11g Nflwork (SELN), o MIECH f/ jimdfd t1Jordi11nted 

i11toke n11d dim! st111itu ro/lobomtio11 servi11g /be GIMier Eng!m·ood COI/11/IIIIIi(y 011 Cbicogo's So11tb Side. M11cb of liM G1Mter E11glt1rood ro/11/llllllif.J• is i11 M1: Dovis' 7'' Co11gmsio11ol Difflitt. 

Henry Booth House providts ho111t visiti11g mvices as pod of the So 11th Side Em()• l..L11mi11g Ne111'orkfimdfd 

fo' MIECHV. 

Kyrll and her boyf.riend,Jared, have been participants;,, the home visiting program for 

nead r three years. In 2014, Kyra was a fi.rst:-time tnOnl with no iucon1e, living with her 

mod1er, while Jared lived in an unstable situation. \'i/itl1 home visiting support, Kyro attended 

aU of her prenatal appointments. After her son was born, Kyra wanted to work and was able 

to en.roll in a job readiness program and obtain clli!dcare through one of the HerHy Bood1 

House da yca re centers. When her child turned one year old, Kym started her f:i.rst job as a 

cashier. During home visits, Jared began to see the importance of his role as a father and 

decided to return to school to get his high school diploma. With assistance from the home 

visitor, Jared is currendy employed and a full-time student- Kyra and Jared also both learned 

how to budget and save money, which allowed the family to recently move into d1eir ~irst 

apartment. TI1ey are planning to get married u1 2017. With home visiting support and 

encouragement, Kyra and Jared are stronger parents and a stronger couple. 

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ChiJdServ provider /)()1/Jt visiting seroim ns pnr1 oft he So11th Side Enrly LtnmiJJt, Nttrrork fimdtd h' 

MIECHV. 

When l'vl.:ny Arm enrolled in d1e home visiting program, she was pregnant and living in a 

homeless shelter. After expressing that living in me shelter was causing her stress, ilie home 

visitor went over breathing exercises wid1 Mary ruu1 to help calm her anxiety. Through d1e 

home visiting program, Mary Ann attended aU of her prenatal visits and was provided wim a 

lead for a job and received interview coaching. Today Mat')' Ann is a pham1acy teclmiciatl at 

\'ilalgreens. Wid1 ilie assistance of her home visitor, l\'!at')' Ann is no longer homeless and 

now lives in a one-bedroom apartment, where she continues to attend group meetings ru1d 

hotne v isits. 

Women's Treatment Center providts /)()JJJe visitiNg services tiS pm1 oft he So11th Side End)' Ltnming Network 

fimded o/ MIECHV. 

• A )'Oung moilier to three children, including two in foster care, Jessica was referred to 

Women's Treatmellt Center (\XITC) in 2015. A victim of domestic violence, Jessica was 

referred to a d1e1·apist dlCough \'i!TC to help her recover from d1e tea lunatic e.'<perience of 

being shot by her mod1er's significant od1er. Jessica also received help with her special needs 

children. The home visitor made weekly visits and provided parenting coaching to Jessica. 

Jessica went to corn'! in 2016 for reunification ru1d her children were returned home. TI1e 

judge remarked that he was impressed wid1 d1e home visiting program and was contident 

dtat Jessica would continue to receive parentit~g support duough the program. 

• After her children were placed in foster care due to her alcohol addiction, Kate enrolled in 

the home visiting pcogmm at Women's Treatment Center. \XIith d1e support of her borne 

visitor, Kate was referred to a domestic violence suppot'l group mat helped her separate 

from her abusive husband. Since she began the program, Kate has been dedicated to her 

weekly visits and her parentit1g education curricullUn. Kate will go to court in April for 

retullt'icatioo wi.ili her children, who are expected to be retumed home. At a previous court 

hearing, d1e judge stated d~at he was Vet')' impressed wim the progress that Kate has made. 

Family Focus provider home visili11g st~vicu tiS pm1 of the So11th Side Enr!J Let1mi11t, NthJ'(JI'kjimded h• 

MIECHV. 

• Brittany* enrolled in d1e home visiting program at the age of 16 wiili a one-year-old child. 

Growing up, Brittany experienced multiple, severe forms of tramna and was raised by 

caregivers who faced substance abuse, mental illness and poverty. As a result, Brittany 

stt'llggled to have positive interactions with her baby. She was physically assaulted by her 

adult relatives several titnes while holding her son. As he grew into a toddler and continued 

to be exposed to violence atld conflict in his home, the yotUlg child exhibited developmental 

delays, severe tantrums, aggression towards od1ers and self-hanning behavior. With d1e help 

of a d1erapist, Brittany begru1 to understand how both she and her baby were impacted by 

the violence around d1em. She was able, through therapy and wid1 coacl1ing from the home 

visitor, to start making healthy decisions and to access resources to keep bod1 her and her 

child safe. She grew more able to nurture him and to help him teel safe. Motivated by a 

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33364A.004

desire to give her child~ better childhood than sbe had, and helped along by home visiting 

services, Brittany graduated high school on time and was the fust in her family ever to enroll 

in college. She moved into a supportive housing progrom that provided • s•fe, pe•celi..J 

environment for her and her child, and emolled her child in a high·quality preschool. Wlule 

the family sti.ll faces chillenges, Brittany is employed and looking for.vard to moving into her 

own apartment Brittany's son, who will start kindergarten next year, is helpli.tl, inquisitive 

and playli.tl. Moreover, his preschool teachers have not identified any delays or concems 

regarding his learning or Ius emotional-behavioral fimctioning in school. 

*All lltlll/ts hnut bem clxmged to proltd!ht idmtitits of the illdiuid11nls 

For more infom1ation, please contact Pat.!a Conigan-Halpern, Vice President, Public Policy + 

Stmtegic Initiatives at Children's Home+ Aid, pcoqiganhalpern@childrenshomeandaid.org or 312-

424-6822. 
9 

Mr. DAVIS. Before I came to Congress, I worked in community 

health centers and saw firsthand how home visits by community 

health workers helped engage people to change behaviors and embrace preventative health approaches. I introduced my first bipartisan home visiting bill over a decade ago in 2005. And so I look 

forward to continuing this bipartisan work with you and other 

Members of this Committee. 

Frederick Douglass said, ‘‘It is easier to build strong children 

than to repair broken men.’’ And I agree. Infants are more likely 

to enter foster care than any other age group, twice as likely as 1- 

year-olds and more than five times as likely as 11-year-olds. Several home visiting models, including Healthy Families America, 

which is headquartered in Chicago, have proven that home visiting 

is a tool that can keep these children safe at home. 

Children at risk of foster care are not the only ones who benefit 

from home visiting. In my congressional district, nearly 60 percent 

of children 5 and under live in low-income families. Some of them 

are fortunate to be served by the Home Instruction for Parents of 

Preschool Youngsters, our HIPPY program, which has a long track 

record of working with parents of all backgrounds to prepare children to succeed at school. 

The Federal Maternal, Infant, and Early Childhood Home Visiting program, or MIECHV, did not invent home visiting. My home 

State of Illinois has invested in home visiting for 30 years, and we 

are not alone. MIECHV has played a vital role in strengthening 

these State and local efforts. Where home visiting did not exist, 

MIECHV offered the neediest families this lifeline for the first 

time. In States with home visiting, like Illinois, MIECHV improved 

program coordination, reinforced the emphasis on proven models, 

and expanded availability of services. In my congressional district, 

MIECHV directly provides home visiting services to 219 additional 

families and has supported innovative pilot projects for homeless 

families and parenting foster youths. 

MIECHV is built on a foundation of decades of research. The Department of Health and Human Services has identified 17 different 

models that meet its stringent tests for proven results. States, territories, and tribes can choose from a range of evidence-based models that allow them to target the right help to the right families 

at the right time. Some States even transition families from one 

model to another as children grow. In Illinois, MIECHV funds a 

central intake process to make sure families are directed to the 

most effective models for their needs. 

Although home visiting models focus on different aspects of child 

well-being and use visitors with different qualifications, they have 

important commonalities. Home visitors form positive relationships 

with families to help them find strength in themselves and in their 

communities. They link families with critical supports like transportation assistance, substance abuse, and mental health treatment, child care, and economic support, and they measurably improve outcomes for children. MIECHV has already made a difference for tens of thousands of children and families. And as we 

continue to invest and home visiting models continue to learn from 

rigorous research evaluations, from careful data tracking, from the 

families and communities they serve, and from each other, I believe 

10 

we will be able to do even more to build strong children who grow 

into successful adults. 

So I thank you, Mr. Chairman, and I yield back the balance of 

my time. 

Chairman SMITH OF NEBRASKA. Thank you, Mr. Davis. 

And without objection, other Members’ opening statements will 

be made a part of the record. 

I would like to welcome our witnesses here today. Thank you for 

joining us. This is a conversation that I think can help many folks, 

and so, certainly, it is a conversation that we can benefit from as 

we learn more from you. 

I will introduce the panel we have here today. First, we have Ms. 

Beth Russell, nurse home visitor, Lancaster General/Penn Medicine. And Ms. Rosa Valentin. She is a client with Lancaster General/Penn Medicine. And Mr. Eric Bellamy, home visiting manager, 

Children’s Trust of South Carolina. And Ms. Diana Rauner, president of The Ounce of Prevention Fund in Illinois. 

Witnesses are reminded to limit their oral statements to 5 minutes. You will see the light there. With the yellow light there, you 

can look to perhaps, as they say, bring it in for a landing. And all 

of your written statements will be included in—your full written 

statements will be included in the record. 

Right now, we will begin with Ms. Russell. You may begin when 

you are ready. 

STATEMENT OF BETH RUSSELL, NURSE HOME VISITOR, 

NURSE-FAMILY PARTNERSHIP, LANCASTER GENERAL 

HEALTH/PENN MEDICINE, LANCASTER, PENNSYLVANIA 

Ms. RUSSELL. Good morning, Chairman Smith, Ranking Member Davis, and Members of the Subcommittee. Thank you for the 

opportunity to testify on behalf of Nurse-Family Partnership and 

Lancaster General Health/Penn Medicine in support of evidencebased home visiting and the Maternal, Infant, and Early Childhood 

Home Visiting program. 

I am Beth Russell, and I have worked as an NFP nurse home 

visitor for nearly 5 years. I have the privilege of helping new mothers become the best moms they can be for their babies. As a nurse 

home visitor, I serve a regular caseload of 25 first-time, low-income 

mothers and their families, including my client who is here with 

me today, Rosa Valentin. 

NFP is a voluntary program that provides regular home visits to 

first-time, low-income mothers by registered nurses, beginning 

early in pregnancy and continuing through the child’s second year 

of life. Each woman is partnered with her own free personal nurse, 

a nurse that can be there for her, getting to know her during pregnancy, and building trust with her family to offer critical support 

when it is most needed. 

As a nurse home visitor, I serve many kinds of clients. Truly, you 

never know what you will encounter until you meet with that mom 

for the first time. However, in every instance, I meet the client 

where she is, and hopefully I can be a positive force for good in her 

life amidst often stressful situations. 

When I first met Rosa in early 2015, I met a scared, quiet, 14- 

year-old with little direction other than that she was 4 months into 

11 

an unplanned pregnancy and wanted to do the right thing for her 

baby. She was anxious and unsure if she could be a good mom and 

did not want to give up on her goals to finish high school and further her education. Rosa had her whole life ahead of her and was 

still figuring out who she wanted to be. Unlike many of my clients, 

Rosa had supportive parents who wanted to help her, but Rosa 

sought guidance, health advice, and one-on-one support as she attempted to navigate becoming a parent at such a young age. 

I quickly realized during the first encounter that it would take 

some work to open Rosa up to me, so I took my time to make her 

comfortable. Combine the uncertainty of being pregnant for the 

first time with being a teenager, and Rosa had a lot of anxiety she 

needed to share. ‘‘I needed to vent,’’ Rosa would say. I was there 

to listen at each visit and become the person Rosa could open up 

to. 

I had Rosa make a list of her needs and goals and made several 

referrals to get her the right services that she needed to complement our visits. I referred her to A Woman’s Concern, which is 

a local pregnancy support organization that provides education 

support for parents, and Teen Elect, which helps pregnant and parenting students complete their educational goals. Rosa was already 

attending Cyber School, a program that allows her to complete her 

high school diploma primarily online. While she had a strong desire 

to finish, she needed confidence to continue, given her pregnancy 

and impending motherhood. 

Rosa had a generally healthy pregnancy, but she struggled with 

the fact that the child’s father was not around as much as she 

would have liked and disappointment about not having the type of 

family she would have liked to bring a child into. Additionally, routine screening for depression did show that Rosa had elevated 

scores, which prompted conversations about counseling. NFP’s client-centered approach allowed Rosa to make this decision, and 

while initially she did not want to see a counselor, she eventually 

agreed and now sees how it has helped her. Through lots of individual conversation and reflection, Rosa was able to get past the 

things that were holding her back and focus on the parent that she 

wanted to be for her child. I also know that our conversations 

about health and wellness, prenatally, postnatal, and for her child, 

were important to her and helped her to be reassured when she 

was concerned. 

Now 2 years after our first meeting, Rosa is the proud, confident 

parent of 20-month-old Angelica, who is here with us today. She is 

a junior in high school and on track to graduate next year. She has 

also been accepted into a local vocational-technical program where 

she plans to enroll next year. Initially, she was interested in cosmetology, but has a growing interest in the field of health care. Learning lots of new medical terminology over the course of her pregnancy and being a mom might have had something to do with that. 

In addition, Angelica continues to be a very healthy child, up to 

date on all well-child visits and immunizations, and has excellent 

developmental scores that reinforce Rosa’s positive and responsive 

caregiving. 

In my role as a nurse home visitor, I work with each client to 

help her to establish her education, employment, and life course deVerDate Sep 11 2014 06:25 Feb 25, 2019 Jkt 033364 PO 00000 Frm 00015 Fmt 6633 Sfmt 6602 I:\WAYS\OUT\33364.XXX 33364
12 

velopment goals. While Rosa was initially very unsure about where 

this road would take her, she had the sheer will to try to make the 

best of it, and it is that determination, those glimmers of achievement along the way, that keep me doing the work that I do as a 

nurse home visitor. I am so proud of her progress and her willingness to share her story with you today. 

Rosa’s story is just a glimpse of the impact that Nurse-Family 

Partnership has on low-income, first-time parents. Rosa is one of 

over 250,000 that have been partnered with a registered nurse 

through Nurse-Family Partnership. The program is backed by over 

40 years of evidence, and each visit to a new mom’s home is 

tracked to measure the impact we are making in a young family’s 

life. 

The MIECHV program is a strong and cost-effective Federal policy that is joining States and local agencies to support these valuable services to at-risk moms. Without congressional action, this 

program which funds my work and is helping young mothers like 

Rosa and young children like Angelica will expire this September. 

I hope that Congress takes swift action to reauthorize the MIECHV 

program for at least 5 years with the increased funding that is 

needed to reach more families. 

Thank you again, Chairman Smith, Ranking Member Davis, and 

Members of the Subcommittee for the opportunity to testify today 

and for your support of evidence-based home visiting programs. 

[The prepared statement of Ms. Russell follows:] 

13 


33364A.005

STATEMENT OF 

BETH RUSSELL 

NURSE HOME VISITOR, NURSE-FAMILY PARTNERSHIP 

LANCASTER GENERAL HEATH/PENN MEDICINE 

LANCASTER, PENNSYLVANIA 

BEFORE THE 

HOUSE COMMITTEE ON WAYS & MEANS 

SUBCOMMITTEE ON HUMAN RESOURCES 

MARCH 15, 2017 
14 


33364A.006

Good morning Chairman Smith, Ranking Member Davis, and members of the subconm1ittee. 

Thank you for the opportunity to testify on behalf of Nurse-Family Partnership (NFP) and 

Lancaster General Health/Penn Medicine in support of evidence-based home visiting and the 

Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program to strengthen families 

living in poverty. 

I am Beth Russell and I have worked as an NFP Nurse Home Visitor for nearly five years. I have 

the privilege of helping new mothers become the best moms they can be for their babies. As a 

nurse home visitor, I serve a regular caseload of25 first tinle, low-income mothers and their 

families, including my client who is with me today, Rosa Valentin. 

Every year, 380,000 children are born to first time mothers living below the federal poverty level 

in the United States. Nationwide, the NFP model has served over 253,000 fami lies since 

replication began in 1996, and currently has over 32,000 first-time mothers enrolled in 42 states, 

6 tribes, and l territory (USVI). We believe that the national replication of our program is 

dramatically improving lives of vulnerable families and yielding significant returns to society by 

more stable and productive families. We start at the beginning - where there is the most 

opportunity - during pregnancy -to have the most impact on that baby's life. By starting early, 

Nurse-Family Partnership builds confident parents, strengthens families, prevents tragedies, 

inlproves outcomes for communities, and saves government money. For every 100,000 families 

served by NFP, research demonstrates that 14,000 fewer children will be hospitalized for injuries 

in their first two years of life; 300 fewer infants will die in their first year of life; 11 ,000 fewer 

children will develop language delays by age two; 23,000 fewer children will suffer child abuse 

and neglect in their first 15 years oflife; and 22,000 fewer children will be arrested and enter the 

criminal justice system through their first 15 years of life, among other outcomes. 

NFP currently serves 45 ofPermsylvania's 67 colmties. The first three sites were started in 1999 

through the Pennsylvania Commission on Crime and Delinquency. In 200 I, then- Governor Tom 

Ridge and the Pennsylvania Department of Human Services utilized unspent Temporary 

Assistance for Needy Families (TANF) funds to help expand Nurse-Family Partnership to 20 

additional locations throughout the Commonwealth. In 2012, a significant expansion of NurseFamily Partnership services was made possible through MIECHV, and today, NFP has the 

capacity to serve over 4,000 moms across the state. My implementing agency, Lancaster General 

Health/Penn Medicine, strongly supports implementation of the NFP model, which serves 225 

moms throughout the county. The mission of Lancaster General Health/Penn Medicine is to 

"advance the health and well-being of the communities we serve." The young mothers and 

children that the NFP program serves is an integral part of its long-standing commitment to these 

families and their future. Our clinical, community wellness and community bene tit 

commitments also wrap themselves around these families. A multitude of unfortunate factors in 

the community make Nurse-Family Partnership a critical element of the county's continuum of 

services for prevention and families in need. 

NFP is a voluntary program that provides regular home visits to first time, low-income mothers 

by registered nurses beginning early in pregnancy and continuing through the child's second year 

of life. Each woman is partnered with her own free, personal nurse - a nurse that can be there for 

her, getting to know her during pregnancy, and building trust with her family to offer critical 

support when it is most needed. 
15 


33364A.007

2 

The cbildren and families NFP serves are young, living in poverty, and at tbe highest risk of 

experiencing significant health, educational and employment disparities that have a lasting 

impact on their lives, their families, and communities. The average age of our clients is usually 

around 18- 19 years old, which puts botb the mom and tbe child at risk for a nwnber of 

challenges. For example, studies have shown that only 38% of young women who have a child 

before age 18 complete high school, and their children sc.ore significantly worse on measures of 

school readiness i. NFP nurses help them stay focused on their goals and what they want for 

their baby's future. Nationally, 28 percent of families served by Nurse-Family Partnership are 

Hispanic; 29 percent are African-American; 24 percent are Caucasian; 5 percent are Native 

American or Alaskan Native; and 2 percent are Asian/Pacific Islander (the remainder declined to 

identify). 

NFP nurses and their clients make a 2.5-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. Their 

partnership is designed to help families achieve three major goals: I) improve pregnancy 

outcomes; 2) improve child health and development; and 3) improve parents' economic selfsufficiency. By achieving these program objectives, many of the maj or risks for poor health and 

social outcomes can be significantly reduced. 

In addition to our clinical training as registered nurses, NFP nurses are trained in a variety of 

developmental concepts and assessments. Nurses are able to work one-on-one with each mom to 

improve her child's development and teach her what is valuable at each stage of the baby's life. 

They are also able to answer questions when a new mom thinks something may not be right with 

her child and needs a nurse's expert clinical advice. NFP nurses use Partners in Parenting 

Education (PIPE) lessons to teach clients a variety of concepts such as attachment, bonding, 

early language and the importance of reading and literacy. We also perform continual 

assessments of the child's growth and development and use tools such as the Ages and Stages 

Questionnaire (ASQ) at prescribed times help influence visit content and activities. By 

addressing deficits discovered through regular contact and use of the evaluative tools, nurses are 

able to instruci clients in a variety of ways such as floor play, demos with a doll, videos, 

handouts, and then fmally, if necessary, a referral to early intervention. Lastly, using the NFP 

Strengths and Risks (STAR) framework we regularly access a variety of client risk factors and 

changes in areas such as personal health, home safety, unsafe family/friend network, and 

economic adversity. It helps us serve clients better, maintaining engagement with NFP and the 

visit schedule. 

As a nurse home visitor, I serve many different kinds of clients. Truly, you never know what you 

will encounter until you meet with that mom for the first time. However, in every instance, I 

meet the client where she is and hopefully, I can be a positive force for good in her life amidst 

often stressful situations. 

When I first met Rosa in early 2015, I met a scared, quiet, 14-year old with little direction other 

than that she was four months into an unplanned pregnancy and wanted to do the right thing for 

her baby. She was anxious and unsure if she could be good mom, and did not want to give up on 

her goals to finish high school and further her education. Rosa had her whole life ahead of her 

and was still figuring out who she wanted to be. Unlike many of my clients, Rosa had supportive 
16 


33364A.008

3 

parents who wanted to help her, but Rosa sought guidance, health advice, and one on one support 

as she attempted to navigate becoming a parent at such a young age. 

I quickly realized during that first encounter that it would take some work to open Rosa up to 

me, so I took my time to make her comfortable. Combine the uncertainty of being pregnant for 

the first time with being a teenager, and Rosa had a lot of anxieties she needed to share. "I need 

to vent," Rosa would say. I was there to listen at each visit and became the person Rosa could 

open up to. 

I had Rosa make a list of her needs and goals, and at that first visit made several referrals to get 

her the right services that she needed to complement our visits. I referred her to A Woman's 

Concern, which is a local pregnancy support organization in Lancaster that provides education 

support for parents, and Teen Elect, which helps pregnant and parenting students complete their 

education goals. Rosa was already attending Cyber School, a program that allows you to 

complete your high school diploma primarily online. While she had a strong desire to fmish, she 

needed confidence to continue given her pregnancy and impending motherhood. 

Rosa bad a generally healthy pregnancy, but she struggled with the fact that the child's father 

was not around as much as she would have liked, and disappointment about not having the type 

of family she would have liked to bring a child into. Additionally, routine screening for 

depression did show that Rosa had elevated scores which prompted conversations about 

counseling. NFP's client centered approach allowed Rosa to make this decision, and while 

initially she did not want to sec a counselor, she evenntally agreed and now sees how it helped 

her. Through lots of individual conversation, refle.ction and, to be honest - venting -- she was 

able to get past the things that were holding her back and focus on the parent that she wanted to 

be for her child. I also know that our conversations about health and wellness- prenatally, postnatal, and for her child- were important to her and helped reassure her when she was concerned. 

Now, two years after our first meeting, Rosa is the proud, confident parent of20-month old 

Angelica, who is here with us today. She is a junior in high school, and on track to graduate next 

year. She has also been accepted into a local vocational-technical program where she plans to 

enroll next year. Initially, she was interested in cosmetology, but has a growing interest in the 

field of healthcare. Learning lots of new medical tetminology over the course of her pregnancy 

and being a mom might have bad something to do with that! In addition, Angelica continues to 

be a very healthy child, up-to-date on all well child visits and immunizations, and has excellent 

developmental scores that reinforce Rosa's posicive and responsive caregiving. 

In my role as a nurse home visicor, I work with each client to help her to establish and pursue her 

educalion, employment, and life course development goals. While Rosa was initially very unsure 

about where this road would take her, she had the sheer will to try to make the best of it and it is 

that detennination - those glimmers of achievement along the way- that keep me doing the 

work that I do bas a nurse home visitor. I am so proud of her progress, and her willingness to 

share her story with you today. 

Rosa's story is just a glimpse of the impacl that Nurse-Family Partnership has on low-income, 

first-time parents. Rosa is one of over 250,000 that have been partnered with a registered nurse 

through Nurse-Family Partnership. This program is backed by over 40 years of evidence, and 
17 


33364A.009

4 

each visit to a new mom's home is tracked to measure the impact we are making in a young 

family's life. NFP can help break the cycle of poverty by empowering young mothers to become 

knowledgeable parents who are able to confidently care for their children and guide them along a 

healthy life course. NFP nurses use a client-centered approach, which means the nurse is 

constantly adapting to the needs of the family, ensuring that each visit is relevant and valued by 

the parent(s). These client-centered principles drive our practice with families to create positive, 

lasting change for the family that sustains long after our time as their nurse home visitor has 

ended. These principles include: 

• The client is the expert on her own life. When the client is the expert, you build solutions 

based on information provided by the client on what's relevant and valued to her. 

• Follow the client's heart's desire. The client leads the way and the central focus is on what 

the client wants. Find out what they want to do and help them do it. 

• Focus on strengths. By focusing on capabilities, opportunities and successes, while being 

aware of risk factors, you can support the client through tough simations and encourage 

them to move forward, in tum, helping them to develop this strength within themselves 

that can sustain long after my visits are completed. 

• Focus on solutions. 

• Only a small change is necessary. The experience of one small success builds selfefficacy and causes a ripple effect in other areas of functioning and creates a context for 

bigger changes. 

NFP nurses also continue to monitor the model's progress in the field through data collection, 

which nurses submit to the national database, and receive quarterly and annual reports evaluating 

the local program's ability to achieve sizeable, sustained outcomes. Each NFP implementing 

agency's goal is not only to improve the lives of first-time families, but also replicate the nurse 

home visitation model that was proven to work through rigorous research. 

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 mral 

locations with Caucasian, African-American and Hispanic families. A randomized, cont(QIIed 

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. The NFP model bas been tested for over 40 years 

through ongoing research, development, and evaluation activities conducted by Dr. David L. 

Olds, founder of the NFP model and Director of the Prevention Research Center for Family and 

Child Health (PRC) at the University of Colorado in Denver. 

Dr. Olds and his research team have conducted three randomized, controlled trials with diverse 

populations in Elmira, NY (1977), Memphis, TN (1987), and Denver, CO (1994). Evidence 

from one or more of these trials demonstrates powerful outcomes including the following (in 

connection to each ofNFP's program goals): 
18 


33364A.010

5 

Improved pregnancy outcomes 

• Reductions in high-risk pregnancies as a result of greater intervals between first and 

subsequent births, including a 28-month greater interval between the birth of first and second 

child. 

o 31% fewer closely spaced (<6 months) subsequent pregnancies, 

o 23% reduction in subsequent pregnancies by child age two, and 

o 32% reduction in subsequent pregnancies for the mother at child age 15 (among lowincome, unmarried group) 

• 79% reduction in pretenn delive1y among women who smoked 

• 35% fewer hypertensive disorders during pregnancy 

Improved child health and development 

• 39% fewer injuries among children (among low-resource group) 

• 56% reduction in emergency room visits for accidents and poisonings 

• 48% reduction in child abuse and neglect 

• 50% reduction in language delays of child age 21 months 

• 67% reduction in behavioral and intellectual problems at child age 6 

• 26% improvement in math and reading achievement test scores for grades 1-3 

• 59% reduction in arrests at child age 15 

• 90% reduction in adjudication as PINS (person in need of supervision) for incorrigible 

behavior 

Increased family self-sufficiency 

• 6 1% fewer arrests of mothers at child age 15 

• 72% fewer convictions of mothers at child age 15 

• 20% reduction in welfare use 

• 46% increase in father presence iJl household 

• 83% increase in labor force participation of mothers at child age 4 

As the NFP 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 plallJled activities for 

nurses to conduct in the home, NFP has a unique data collection system called Efforts-toOutcomes (ETO) that helps NFP monitor program implementation and outcomes achieved. It 

also provides continuous quality improvement data that can help guide local practices and 

monitor staff performance. NFP's ETO system was designed specifically to record family 

characteristics, needs, services provided, and progress towards accomplishing NFP program 

goals. 

NFP applauds Congress for their bipartisan, bi-cameral support for the MIECHV program, and in 

particular, this committee for your collective commitment to funding programs proven to work 

through rigorous, scientific evidence and research. The MIECHV program provides critical 

funding to states, territories, tribes and tribal organizations to implement and expand evidencebased home visiting services that have been proven to produce significant health, educational and 

economic outcomes for low-income children and families. MIECHV grantees have established 

benchmark requirements that will measure effectiveness of these programs on reducing poor 
19 

f 


33364A.011

6 

birth outcomes, child abuse, neglect and injuries, cognitive and learning disabilities, dependence 

on public assistance, and juvenile delinquency and crime, among other outcomes. These 

outcomes are saving state and federal government significant resources in reduced health, child 

welfare, foster care, remedial education and criminal justice expenditures. State govemments 

have invested in Nurse-Family Partnership and other evidence-based home visiting programs for 

decades because of the impressive outcomes and cost-savings resulting from improved child and 

family outcomes. The MIECHV program is strong and cost-effective federal policy that is 

joining states and local agencies to support these valuable services to at-risk families. 

Without congressional action, this program, which funds my work and is helping young moms 

like Rosa and young children like Angelica, will expire this September. I hope that Congress 

takes swift action to reauthorize the MIECHV program for at least five years with the increased 

funding that it needs to reach more families. 

Independent evaluations have found that investments in NFP lead to significant retums to society 

and government (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; and Pacific Institute for Research & Evaluation). Blueprints identified 

NFP as I of II 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 ofNFP 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, govemment assistance and higher taxes 

paid by employed parents. Most recently, the Pacific Institute for Research & Evaluation released a study in August 2015, which found significant govemment savings from the NFP model 

in particular, Medicaid and health care cost savings. This study projects that NFP will reduce 

Medicaid spending per child by 8.5% from birth to age 18, leading to $2.2 billion in total savings 

for the 177,517 children served by operational programs from 1996-2013. The study also projects that NFP will reduce estin1ated spending on Temporary Assistance by Needy Families 

(TANF) by $250 million and on food stamps by $540 million (present value in2010 dollars), resulting in $3.0 billion in total govemmental savings. By comparison, NFP costs $1.6 billion to 

serve those children and their families. 

Nurse-Family Partnership thanks the subcommittee for your continued iuterest in hamessing the 

ability of evidence-based programs to improve the daily lives of people who need it most, and 

for your support of the MIECHV program, which has allowed states to implemeut and expand 

evidence-based home visiting services to reach more families in need. I hope that the 

Subcommittee will strongly support reauthorization of the MIECHV program. Thank you again, 

Chairman Smith, Ranking Member Davis, and Members of the Subcommittee, for the 

opportunity to testify today. 

'Ng, A. S., & Kaye, K. (2012). W11y It Matters: Teen Cllildbearing, Education. and Economic Wellbeing. Washington, DC: The 

National Campaig,.> to Prevem Teen and Unplallll<d Preg,.>aney. 
20 

Chairman SMITH OF NEBRASKA. Thank you, Ms. Russell. 

Ms. Valentin, you may begin. 

STATEMENT OF ROSA VALENTIN, CLIENT, NURSE-FAMILY 

PARTNERSHIP, LANCASTER GENERAL HEALTH/PENN MEDICINE, LANCASTER, PENNSYLVANIA 

Ms. VALENTIN. Good morning, Chairman Smith, Ranking Member Davis, and Members of the Subcommittee. Thank you for the 

opportunity to testify on behalf of the Nurse-Family Partnership 

program in support of evidence-based home visiting, and the Maternal, Infant, and Early Childhood Home Visiting program. 

My name is Rosa Valentin, and I am a client with the NurseFamily Partnership program delivered by Lancaster General 

Health in Lancaster, Pennsylvania. I am the incredibly proud 

mother of my daughter, Angelica, who is 20 months old and here 

with me today. 

As a client, I have received regular visits about every other week 

from my NFP nurse home visitor, Beth Russell, starting when I 

was just 4 months pregnant. I am 16 years old and have lived in 

Lancaster my entire life with my mother and father. Two years 

ago, when I was 14 years old, I found out I was pregnant with Angelica. I was in shock. What am I going to tell my mother? Thankfully, my mom was supportive of my decisions to have the baby, 

and from the minute I saw her arms, legs, and fluttering heartbeat, 

I knew that I wanted to protect her from any harm and do what 

was best for her. 

I heard about the NFP program through my doctor’s office. Because I was a first-time mom and met the other eligibility requirements, they referred me to Lancaster General Health’s NFP program and Beth. We set up an appointment for Beth to come to my 

home and talk more about the program. I was shy at first, but 

Beth helped me to start thinking about my goals and programs 

that were available to help me as a teenager. I started to look forward to our visits. Up until the point where I got pregnant, I had 

taken care of my little cousins as babies, but that was about it. 

On June 23, 2015, at 2:39 p.m., my life changed. My baby girl 

was born weighing 6 pounds, 3 ounces, and measuring 191⁄2 inches 

long. She had jet-black hair and black eyes. Now I had a lot to 

learn about taking care of my own baby, not to mention navigating 

my own personal challenges. I had experienced a lot of disrespect 

from my peers about my pregnancy, and although my mom and 

dad have always been there for me, I didn’t have the support of my 

entire family. And although I initially expected Angelica’s father to 

be a part of raising her, and I thought we would be together as a 

family to experience her milestones, ultimately he was not in the 

picture. This was very difficult for me, and I struggled to move past 

that, but I had to take care of my baby and reach my goals. 

Beth helped me do just that. She has been there for me emotionally, sometimes just as a listening ear for venting or to provide suggestions on dealing with stressful situations so that I can get back 

to being the mom I needed and wanted to be. 

Angelica is the love of my life. After I brought my baby girl 

home, it seemed like all I wanted to do was spend time with her, 

and there was so much to learn about taking care of a new baby. 

21 

Beth showed me how to bathe her for the first time and answered 

all of my questions about what was going on with my baby. 

It was difficult to keep up as a new mom. I was still a high 

school student and started to fall behind on my online classes. Beth 

helped me not to lose sight of my goals for school. ‘‘This is what 

you wanted for yourself,’’ she reminds me. She helped me to develop a routine for my daughter and find time for myself to study. 

It was exhausting taking care of a new baby, but Beth helped me 

to stay focused. I will go to college. 

Beth also helped me find programs to support my parenting and 

educational goals and stick with them. When I initially questioned 

how long I could stick with breastfeeding, she encouraged me to set 

goals and do what I felt was right. My initial goal was 6 months, 

and today, I am still nursing my 20-month-old daughter, although 

trying to wean. 

Like every new mom, I had concerns, and Beth has always been 

there to address them. Beth has also been a resource for my mom, 

who is usually involved with our home visits because she helps me 

take care of Angelica. It has meant so much to me to have a nurse 

at my side, someone who I could trust for advice when I was experiencing round ligament pain late in my pregnancy and was concerned about the baby, or had cramping while breastfeeding. Beth 

was also very helpful when I was worried about Angelica’s weight 

because others thought she was too small or if she was learning 

things at the right pace. Beth was always able to reassure me that 

Angelica was growing well and passing her developmental 

screenings. She also helped me understand birth control options 

after pregnancy, and when I was under a lot of stress and needed 

counseling, Beth helped me understand why it was important to 

talk to somebody. 

What I think is important for me to provide for Angelica is consistency. I am trying to follow the four C’s of parenting: clear, calm, 

consequences, and consistency, and use encouraging words to help 

her realize what to do instead of what not to do. These concepts 

are all so important for me as my baby grows into a toddler. Every 

day I am so excited for all the new things she is learning and showing me. Angelica makes me proud every day, and I am so proud 

to see how much she has learned and how much she has grown. 

When I found out I was pregnant, I was a freshman in high 

school. Now here I am with a beautiful blue-eyed, 20-month-old little girl, looking forward to my senior year and the Career and 

Technology Center’s program for cosmetology. After I graduate, I 

would like to go on to college and graduate school and have a career as a prenatal nurse. 

Even though being a mom at times isn’t easy, Angelica is my motivation to do better, finish school, and have a career. I am lucky 

to say that I had the support to help me along the way. I truly 

hope that Congress will continue supporting the Maternal, Infant, 

and Early Childhood Home Visiting program, which supports great 

programs like Nurse-Family Partnership. 

Thank you, Chairman Smith, Ranking Member Davis, and Members of the Subcommittee for the opportunity to testify today. 

[The prepared statement of Ms. Valentin follows:] 

22 


33364A.012

STATEMENT OF 

ROSA VALENTIN 

CLIENT, NURSE-FAMILY PARTNERSHIP 

LANCASTER GENERAL HEALTH/PENN MEDICINE 

BEFORE THE 

HOUSE COMMITTEE ON WAYS & MEANS 

SUBCOMMITTEE ON HUMAN RESOURCES 

MARCH 15, 2017 
23 


33364A.013

Good afternoon Chairman Smith, Ranking Member Davis, and Members of the Subcommittee. 

Thank you for the opportunity to testify on behalf of the Nurse-Family Partnership (NFP) program 

in support of evidence-based home visiting and the Matemal, Infant, and Early Childhood Home 

Visiting (MIECHV) program. 

My name is Rosa Valentin, and I am a client with the Nurse-Family Partnership program 

delivered by Lancaster General Health/Penn Medicine in Lancaster, Petmsylvania. I am the 

incredibly proud mother of my daughter, Angelica, who is 20 months old and here with me 

today. As a client, I have received regular visits about every other week from my NFP Nurse 

Home Visitor, Beth Russell, starting when I was just four months pregnant. 

I am here on behalf of the mothers, children, and families like us that benefit from the Matemal, 

Infant, and Early Childhood Home Visiting (MIECHV) Program. I am honored to be here today 

to thank Chairman Smith and the Members of this Subcommittee in person for their commitment 

to improving the health and well-being of children with dedicated funding for evidence-based 

home visiting programs. This program has meant so much to me and my fatuily, and I know that 

if every Nurse-Family Partnersbip mom could be bere today to talk about tbeir experience, they 

would be, because it is truly a life cbanging experience to be part of this program. 

I am 16-years old I and have lived in Lancaster my entire life with my mother and father. Two 

years ago, when I was 14-years old, I found out I was pregnant with Angelica. I was in shock. I 

was in denial. I was scared, sad, disappointed; all I tbought about was, "What am I going to tell 

my mother?" Thankfully, my mom was supportive of my decisions to have the baby. And from 

the minute I saw her arms, legs, and fluttering heartbeat I knew that I wanted to protect her from 

any ham1 and do what was best for her. 

I heard about the Nurse-Family Partnership program through my doctor's office. Because I was 

a first-time mom and met the other eligibility requirements, they referred me to Lancaster's NFP 

program and Beth. We set up an appointment for Beth to come to my home and talk more about 

the program. I was shy at first, but Beth helped me to start thinking about my goals and programs 

that were available to help me as a teenager. I started to look forward to our visits. 

Up until U1e point where I got pregnant, I had taken care of my little cousins as babies, but that 

was about it. On June 23'd, 20 15 at 2:39p.m., my life changed. My baby girl was born weighing 

61bs, 3oz, and measuring 19 Yz inches long. She had jet-black hair and black eyes. Now I had a 

lot to team about taking care of my own baby, not to mention navigating my own personal 

challenges. I had experienced a lot of disrespect from my peers about my pregnancy and 

although my Mom and Dad have always been there for me, I didn' t have the support of my entire 

family. And although I initially expected Angelica's father to be a part of raising her, and I 

thought we would be together as a family to experience her milestones, ultimately he was not in 

the picture. TI1is was very difficult for me and I needed to move past that in order to take care of 

my baby and reach my goals. 

Beth helped me do just that. She has been there for me emotionally, sometimes just as a 

listening ear for venting, or to provide suggestions on dealing with stress till situations so that I 

can get back to being the mom I needed and wanted to be. 
24 


33364A.014

Angelica is the love of my life. After I brought my baby girl home, it seemed like alii wanted to 

do was spend time with her and there was so much to learn about how to take care of a baby. 

Beth showed me how to bathe her for the first time, and answered all of my questions about what 

was going on with my baby. It was difficult to keep up as a new mom. I was still a student high 

school and started to fall behind on my online classes. Beth helped me not to lose sight of my 

goals for schooL She helped me to develop a routine for my daughter and find time for myself to 

study. It was exhausting taking care of a new baby, but Beth helped me to stay focused. 

I want to go to vocational school next year, and Beth has helped me to always keep that goal in 

sight. "This is what you wanted for yourself," she reminds me. I will go to college. 

Beth also helped me find programs to support my parenting and educational goals- like Teen 

Elect and A Woman's Concern- and stick with them. When I initially questioned how long I 

could stick with breastfceding, she encouraged me to set goals and do what I felt was right. My 

initial goal was six months, and today, I am still nursing my 20-month-old daughter, although 

trying to wean! 

Like every new mom, I have had concerns, and Beth has been there to help me address them. 

Beth has also been a resource for my mom, who usually is involved with our home visits because 

she helps me take care of Angelica, and is helping me achieve my goals. It has meant so much 

to me to have a nurse at my side, someone who l could trust for advice when was experiencing 

round ligament pain late in my pregnancy and was concerned about the baby, or bad cramping 

while breastfeeding. Beth was also very helpful when I was worried about Angelica's weight 

because others thought she was too small or if she was learning things at the right pace. Beth 

was always able to reassure me that Angelica was growing well and passing her developmental 

screenings. She also helped me understand birth control options after pregnancy, and when I 

was under a lot of stress, and needed counseling, Beth helped me understand why it was 

important to talk to someone. 

Beth also encouraged me to think about the type of parent that I wanted to be. I thought about 

people who are parents in my life- some are too strict, some have no rules at all- and thought 

about what I thought was the best approach. I've decided I want both- rules, but not too many. 

What I think is important for me to provide for Angelica is consistency. I am trying to follow the 

"Four C's of parenting" (choices, consequences, consistency, and care) and use encouraging 

words that help her realize what to do instead of what not to do. These concepts are all so 

important for me as my baby grows into a toddler. Every day I am so excited for all the new 

things she is learning and showing me. She loves to look at books and point out things; she loves 

to play and she is very smart. We love to read together, and I know that I am doing the right 

things for her. Angelica makes me happy every day, and l am so proud to see how much she has 

learned and bow much she bas grown. 

When I found out I was pregnant, I was a freshman in high schooL Now, here I am with a 

beautiful blue-eyed 20 month-old little girl, looking forward to my senior year in the Career and 

Technical Center's vocational program for Cosmetology. After I graduate I would like to go on 

to college and graduate school and have a career as a Perinatal Nurse. 

2 
25 

f 


33364A.015

I know that I am a better mom today because of this program and Beth. It's been really special to 

look back at what I have done while 1 have been in the NFP program. 1 feel like so much has 

changed since I first began, and it is encouraging for me to see bow far I have come. NurseFamily Partnership really gave me the opportunity to be a good parent, and tllis gives me a proud 

feeling every day. If it was possible, I would appreciate the program extending to 3 years! Beth 

has been so helpful and I wish she didn't have to go after the 2 years. I don't know what it must 

be like to be a teen mom without this support, and 1 know there are so many more new moms 

just like me who are in need of it. Having a nurse like Beth, who I could tnast with questions 

about my hea lth when I was pregnant, breastfeeding when I was a new mom, child development 

as she grows, and life goals - helped me to be a successful parent. 

Even though being a mom at times isn't easy, Angelica is my motivation to do better, finish 

school, and have a career. I am lucky to say that I had the support to help me along the way. 

would certainly refer a friend to the NFP program because of all the opportunities and benefits 

that come with the program. NFP is the best program that anyone could have; having a nurse by 

your side through every step of the way to reassure you that you are not alone is something that 

every first time mom needs to hear. 

I truly hope that Congress will continue supporting the Maternal, Infant, and Early Childhood 

Home Visiting (MIECHV) program, which supports great programs like Nurse-Family 

Partnership. Thank you, Chainnan Smith, Ranking Member Davis, and the Members of this 

Subcommittee for the opportunity to testify today. 

3 
26 

Chairman SMITH OF NEBRASKA. Thank you, Ms. Valentin. 

Well done. 

Mr. Bellamy, please proceed. 

STATEMENT OF ERIC BELLAMY, HOME VISITING MANAGER, 

CHILDREN’S TRUST OF SOUTH CAROLINA 

Mr. BELLAMY. Good morning. Chairman Smith, Ranking Member Davis, and Members, please let me preface with I apologize for 

bringing this crazy weather from South Carolina to DC. But thank 

you for inviting me to represent South Carolina’s perspective on 

MIECHV. I represent Children’s Trust of South Carolina, the agency designated by the Governor to administer the State’s MIECHV 

funding. 

Thanks to MIECHV, South Carolina serves families in 39 of 46 

counties. We still have a long way to go in reaching all the children 

and families who could benefit from home visiting. But that task 

would be significantly harder without MIECHV funds, specifically 

the direct services and the underpinnings for quality and accountability that MIECHV provides. 

MIECHV funds voluntary, evidence-based home visiting to disadvantaged families with young children. Families receiving home 

visiting saw significant improvements in measures such as birth 

outcomes, child development screenings and referrals, prevention of 

child abuse and neglect, school readiness. These outcomes and the 

program’s broader success are the results of a law that provides 

State and tribal grantees with a firm foundation in evidence-based 

practice and the flexibility to match these practices to individual 

community needs. 

In 2010, Governor Sanford designated Children’s Trust as the 

lead agency to implement and administer the State’s MIECHV 

grant. Like other States, we conducted a needs assessment to determine which communities were most at risk and which proven 

interventions would best be suited to meet their needs. Our needs 

assessment identified counties with significant populations of families at risk for poverty, poor birth outcomes, child abuse and neglect, and low school readiness. Even in a State the size of South 

Carolina, no one approach meets the needs of all children and families. 

We selected four evidence-based models to meet the needs of children and parents: Healthy Steps, Family Check-Up, Healthy Families America, and Nurse-Family Partnership. We have since added 

Parents as Teachers, and in 2013, we expanded from 12 counties 

to 38 counties. To date, over 6,200 South Carolina families have received MIECHV home visits. 

This implementation process illustrates many of the strengths of 

the legislation. States tailor their approach to address statewide 

goals for improving early childhood outcomes. States can choose to 

address prenatal and infant health, child abuse and neglect prevention, and/or school readiness goals. States can also select any combination of approved models to deploy in targeted communities. 

Each State’s home visiting network looks a little different. However, every MIECHV program is supported by the same evidence 

base and is held to the same requirements that document outcomes 

and demonstrate continuous quality improvement. 

27 

South Carolina can say with confidence and evidence that 

MIECHV continues to make important progress in improving the 

health and economic well-being of our vulnerable families. But 

MIECHV does more than fund direct services to children and families. It underpins the statewide foundation on which high-quality 

services depend. South Carolina’s MIECHV grant allowed us to create the data system that collects and reports information on outcomes and provides funding for professional development and training for home visitors. These resources are available to all home 

visitors in the State, regardless of how their programs are funded. 

Another defining strength of MIECHV is the robust and tiered 

evidence base. MIECHV’s rigorous evidence standards give State 

legislators and philanthropies an objective validation for investing 

in home visiting. In South Carolina, we saw a significant increase 

in the philanthropic dollars flowing into existing home visiting programs after MIECHV was signed into law. While private philanthropy provided modest support for home visiting prior to 

MIECHV, in the years since 2011, we have seen an increase in 

support from organizations such as Duke Endowment Foundation, 

the Blue Cross and Blue Shield Foundation, the Boeing Foundation, and other private funders. 

I realize my time is up, though there is much more that I could 

say. If you remember only one thing from South Carolina, I hope 

it is this: MIECHV is evidence-based policy that works to empower 

families, coordinate services, and unify systems. 

I appreciate your time and attention this morning. I will be 

happy to answer any questions you may have. Thank you. 

[The prepared statement of Mr. Bellamy follows:] 

28 


33364A.016

House Ways and Means Subcommittee on Human Resources 

Hearing on Maternal, Infant, and Early Childhood Home 

Visiting (MIECHV) 

March 15, 2017 

Remarks by Eric Bellamy, 

Home Visiting Manager, Children's Trust of South Carolina 

Chairman Smith, Ranking Member Davis, and members, thank you for the privilege of 

testifying before you this morning. My name is Eric Bellamy. I am the at the Children's Trust of 

South Carolina, the agency designated by the Governor of South Carolina to administer the 

state's Maternal, Infant, and Early Childhood Home Visiting {MIECHV) funding. I would like to 

thank you, Mr. Chairman, for inviting me to join this panel to represent a South Carolina 

perspective on home visiting and MIECHV. South Carolina is also a founding member of the 

Association of State and Tribal Home Visiting Initiatives (ASTHVI), an organization created to 

promote best practices, information sharing, and peer assistance among state and tribal 

administrators of home visiting programs. I thank ASTHVI for my colleagues' collective wisdom, 

which I also hope to convey to you today. 

last, but not least, I would be remiss if I did not acknowledge South Carolina' s own 

Congressman Tom Rice, a member of this committee. Thanks to MIECHV funding, South 

Carolina has been able to establish home visiting programs in a majority of counties in the 71

h 

Congressional district; indeed, MIECHV supports home visiting in 39 out of 46 counties in the 

state. While we still have a long way to go in reaching all the children and parents who could 

benefit from home visiting services, that task would be significantly harder without MIECHV 

funds, specifically the direct services and the underpinnings for quality and accountability that 

MIECHV provides. 

The Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) is widely 

pointed to as a model of effective, evidence-based policy. MIECHV funds voluntary, evidencebased services to disadvantaged families with young children in all fifty states, five territories, 

and the District of Columbia. Families receiving home visiting services are documented to show 

significant improvements across a number of key measures including birth outcomes, child 

development screenings and referrals, prevention of abuse and neglect, and school readiness. 

These outcomes, and t he program's broader success, are the result of a law that provides state 

and tribal grantees w ith a firm foundation in evidence-based practices and the flexibility to 

match those practices with individual community needs. 

In 2010, Governor Sanford designated Children's Trust of South Carolina as the lead 

agency to implement and administer the state's MIECHV grant. Like each of the forty-nine 
29 


33364A.017

other states, South Carolina conducted a state-wide needs assessment to determine which 

communities were most at risk, and which proven interventions were best suited to meet their 

needs. One size does not fit all nationally, and even in a state the size of South Carolina, no one 

home visiting model meets the needs of all children and families. From our needs assessment, 

we initially identified five catchments, w ith outreach to twelve counties, with significant 

populations of families at risk for poverty, poor birth outcomes, child abuse & neglect and low 

school-readiness and developed a state plan to respond. Children's Trust determined that four 

of the models meeting HRSA's criteria for evidence-based programs could best meet the needs 

of children and parents in South Carolina's most disadvantaged communities: Healthy Steps, 

Family Check-Up, Healthy Families America, and the Nurse Family Partnership. In 2013, 

Children's Trust wrote for and received an expansion award through MIECHV. This has allowed 

us to now fund five evidenced-based models, including Parents as Teachers, and expand 

services through 16 local implementing agencies. As I mentioned, 39 out of 46 counties in the 

state are served by a MIECHV-funded model, and over 6,200 individual families have received 

MIECHV services to date. 

The implementation process that South Carolina launched in 2011 illustrates many of 

the defining strengths of the MIECHV funding. States enjoy a high degree of flexibility to tailor 

their approach to meet community needs and address state-wide goals for improving early 

childhood outcomes for vulnerable families. Because the law includes multiple purposes, states 

can choose to address prenatal and infant health, child abuse and neglect prevention, and/or 

school readiness goals. States can also select any combination of the seventeen federally· 

approved, evidence-based models to deploy in targeted communities. As a result, each state's 

home visiting network looks different. But every MIECHV program is supported by the same 

evidence base and is held to the same requirements to document outcomes and demonstrate 

continuous quality improvement. 

We can say with confidence- and evidence- that the MIECHV program in South 

Carolina continues to make important progress in improving the health and economic well· 

being of South Carolina's most vulnerable families and the early childhood workforce. 

Children's Trust has contracted with the Rural Health Research Center within the School of 

Public Health at the University of South Carolina to ensure that all supported programs are 

measured against legislative benchmarks and to implement a comprehensive evaluation 

process that assesses family, community, agency, and state-level systems, including workforce 

development. 

6,261 caregivers and children have enrolled in South Carolina MIECHV programs since 

program inception in 2011. In the first reporting year of the program (2011·2012), South 

Carolina MIECHV implementing sites served 297 caregivers and children statewide (Figure 

1). Enabled by expansion funding awarded in 2013, the South Carolina MIECHV programs 

enrolled over 2,900 new parents and children, and served almost 4,500 new or continuing 

caregivers and children in the 2014·2015 reporting year. In the most recent reporting year 

(2015·2016). an additional1,630 new caregivers and children were enrolled and a total of 5,280 

caregivers and children were served. 
30 


33364A.018

Fi~ 1.: 1\bnber at Selah carn1na 

ca reg1ll'e'S a'1d dlildren sen.<ed yecrty bv 

SC MIEOIVpr~ 201.1-2016 

2011-12 •• 2013-14 2015-16 

Number of counties served: Expanded to 39 of 46 South Carolina counties; 

• Performance measures: Improved or maintained 23 out of 34 performance measures 

and improved 78 percent of program benchmarks from 2014-2016; 

Home visit s: 17,549 home visits in 2015-2016 and 48,426 home visits since 2010 

In 2015-2016: 

> 69 percent of families served were 100 percent under the Federal Poverty line; 

> 66 percent of families served were from minority racial groups (52.4 = African 

American; 13.5 = Latino/Other); 

> 75 percent were headed by a single parent; 

}'> 99 percent of parents served received guidance about injury and safety; 

> 94 percent of children completed scheduled well-child visits; 

}'> 93 percent of famil ies with a need at enrollment received and completed a 

referral; 

}'> 84 percent of parents improved positive parenting skills; 

> 99 percent of women had no second pregnancy w ithin 12 months of giving birth; 

> 82 percent of post-partum women were screened for maternal depression. 

Children's Trust elevated and expanded evidence-based home visiting in the state by 

concentrating on the areas of greatest need with strategic home visiting integration into 

primary healthcare and/or medical homes. Target areas and populations include those with the 

greatest need, with specific focus on child maltreatment, maternal and infant health, and 

school readiness. But MIECHV does more than fund direct services to children and families. It 

provides critical funding for the construction and maintenance of a statewide foundation on 

which high quality services depend. In South Carolina, our MIECHV grant allowed us to create 

the data system that collects and reports information on the outcomes our program produces 

for children and families. MIECHV also provides funding for professional development and 

training for home visitors. These resources are available to all home visitors in the state, 

regardless of how their programs are funded. This raises the quality of the entire home visiting 
31 


33364A.019

workforce in the state, and gives us a pool of effective, qualified family support workers to draw 

from as funding and caseloads fluctuate. In year five of program implementation, Children's 

Trust provided effective leadership and guidance for implementing agencies by offering 

multiple individual and collective learning opportunities for home visitors and site staff. These 

opportunities included a year-long continuous quality improvement (CQI) learning collaborative 

that addressed developmental screening and family engagement, and a statewide MIECHV 

retreat for all lead implementing site staff. 

The South Carolina home visiting workforce is experienced and skilled, with the majority 

of home visitors having three or more years of social work experience (57 percent), healthcare 

experience (72 percent), or home visiting experience {62 percent). Home visitors are welleducated, with 95 percent having a college education or higher, and are also racially diverse: 53 

percent-white; 42 percent-African American; 5 percent-"other." We continue to develop the 

skills of our family service workers. In 2015-2016, Children's Trust offered nineteen 

professional and workforce development opportunities for home visitors, including: a statewide 

Home Visiting Summit {289 participants); All-Sites spring meeting; virtual trainings/webinars on 

issues such as cultural competence, oral health, and child development; model trainings; 

reflective supervision training; and other supplemental offerings. 

Another defining strength of the MIECHV legislation is the robust and tiered evidence 

base it has created, and which it continues to build. Each model on the Home Visiting Evidence 

of Effectiveness {Hom VEE) list has met rigorous standards and produced peer-reviewed studies 

documenting their evidence of effectiveness. As the models are implemented in states, 

additional data is continually coll~cted. States r~port data annually on b~nchmarks that 

represent the full scope of the MIECHV Program. This ongoing data collection ensures that 

individual programs across the country are faithfully replicating the model as it was evaluated 

and approved by Hom VEE. The benchmarks also show the impact of MIECHV, holding states 

accountable for the federal investment they are charged with administering. 

Besides ensuring model fidelity and accountability for outcomes, MIECHV's evidence 

base also helps states leverage other sources of funding for home visiting programs. Prior to 

the enactment of MIECHV, home visiting was adopted community-by-community. There was 

no national authority to evaluate model effectiveness and set standards for replicating those 

programs at scale. MIECHV created the first nationally accepted definition of an evidencebased program, and gave state legislatures and philanthropies an objective validation for 

investing in home visiting. Following the enactment of MIECHV, many states introduced 

legislation allowing, and often dedicating, state funds to be spent on evidence-based home 

visiting programs. In South Carolina, we saw a significant increase in the philanthropic dollars 

flowing into existing home visiting programs after MIECHV was signed into law. While private 

philanthropy provided modest support for home visiting prior to MIECHV, in the years since 

2011 we have seen an increase in support from organizations such as the Duke Endowment 

Foundation, the Blue Cross and Blue Shield Foundation, the Boeing Foundation, and other 

private funders. 
32 


33364A.020

I realize my time is up, though there is so much more than I could say. If you remember 

only one thing from this hearing, I hope it is this: MIECHV is evidence-based policy that works; 

to empower families, to coordinate services and unify systems. I appreciate your time and 

attention this morning, and would be happy to answer any questions you may have. 
33 


33364A.021

ASTHVI Member Spring 2017 

SOUTI-I CAROLINA HOME VISITING 

Home visiting in South Carolina is supported by a variety of public and private sources that 

collectively believe in its value. Importantly, one large has served as a for other 

funding sources. 

South Carolina received a total of $8.4 million in 

Maternal, Infant, and Early Childhood Home Visiting 

(MJECHV) formula grants from 2010-2016. The stale 

applied for, and won_ competitive funds of S13.8 million 

in 2013, to expand services and to bring programs and 

practices to scale. 

South 

Carolina is 

using Pay for 

Success, 

which 

combines 

nonprofit 

expertise, 

private 

funding and 

rigorous 

evaluation to 

Fitu"e l: frt.I'TU!rdSo.ltl CWoiN 

Oltq:Mn..Cc:tilchn~~bV 

SCMit'ONp<-l01H016 

transform how government leaders respond to chronic 

social problems. Pay for Success will bring Nurse-Family 

Partnership to an additional3,200 first-time mothers and 

their babies enrolled across the stale over the next four 

years. The project is led by South Carolina Department of 

Health and Human Services in partnership witll NurseFamily Partnership, 0 1ildren's Trust of South Carolina, 

and other supporting entities. 

Additional funding has been awarded by: 

• Duke Endowment Foundation: $14 million (2009-

2015) 

• Blue Cross/Blue Shield Foundation: $7 million (2009-2015) 

• Boeing Foundation $1 million (2014-2016) 

• Other private funders: -52.1 million (since 2010) 
34 


33364A.022

ASTHVJ Member Spring 2017 

Evidence of Success: 

The state contracts with the 

Un.iversity of SouU1 Carolina 

for data collection, impact 

evaluation, and qualitative 

studies of state and local 

programs. In 2015-2016: 

• 66% of families served 

were from minority racial 

groups (52.4 = African 

American; 13.5 = 

Latino/ Other) 

• 69% of families served 

were 100 percent under 

the Federal Poverty Line 

• 75% were headed by a 

single parent 

• 99% of parents served 

received guidance about 

injury and safety 

• 94% of children completed 

scheduled weU-chiJd visits 

• 93% of families, with a need 

at eru·ollment, received •md 

completed a referral 

• 84% of parents improved 

positive parenting skiJJs 

• 99% of women had no 

second pregnancy within 12 

months of giving birth 

• 82% of post-partum women 

were so:eened for n1aternal 

depression 

Overall, the MIECHV program 

in SC continues to make 

important progress in 

improving the heaiU1 and 

economk well-being of South 

Carolina's most vulnerable 

families and the early duldhood 

workforce. 

Contact: 

Eric L. ~llamy 

Home Visiting Manager 

Children's Trust of 

South Carolina 

Phone: 803-744--!057 

Fax: 803-7 +1-4020 

ebellamy@scchildren.org 

Investment: MIECHV -Supported Progr ams 

• c~thySitP$ 

• f~mlly Check Up 

• HurM family Partnen.hlp 

2 

In South Carolina, 39 out of 46 

counties are served by the MIECHV 

program, through 171ocal 

implementing agencies. Participating 

fanu lies are 52.4% African Ametican 

and 13.5% are Latino or oU1e1· 

minorities. 

The models currently funded through 

MIECHVare: 

• Family Check Up 

• Healthy Famjljes America 

• Healthy Steps 

• Nurse Family Partnership 

• Pru-ents as Teachers 
35 

f 


33364A.023

South Carolina 

Maternal, Infant, & Early Childhood Home Visiting 

..... ~ 

Children's Trust OP IOUTII CAitOt..I:"'A 

• 

Year 5 Data Report 

AuJUftt,2()1S • ~~ ber30,2()t6 

Caregive~ Characteristics 

1'."-'r.-. Rvrol HeoJ!.h...!~.!!~ch Center 

. . 

@ I 

I 
36 

Chairman SMITH OF NEBRASKA. Thank you, Mr. Bellamy. 

Ms. Rauner. 

STATEMENT OF DIANA MENDLEY RAUNER, PH.D., PRESIDENT, 

THE OUNCE OF PREVENTION FUND 

Ms. RAUNER. Chairman Smith, Ranking Member Davis, and 

Members of the Subcommittee, thank you for the opportunity to 

testify in connection with your hearing on the reauthorization of 

the Maternal, Infant, and Early Childhood Home Visiting program. 

My name is Diana Rauner and I am here today in my role as the 

President of The Ounce of Prevention Fund, a public-private partnership serving children and families from before birth through age 

5. I am also a developmental psychologist, the Co-chair of the Illinois Home Visiting Task Force, and the First Lady of the State of 

Illinois. 

I began my career in investment banking and private equity investing, so I know something about return on investment. And I 

came to the field of early childhood because of concerns about the 

huge social and economic costs of educational inequities. I chose to 

focus on early childhood development because investments in the 

first years of life are simply the most efficient and effective ways 

to develop human capital. With the right investments, human capital development can provide great economic and social gains for individuals and for society. 

James Heckman, a Nobel Laureate at the University of Chicago, 

recently said, ‘‘The real measure of child poverty isn’t money, it’s 

love.’’ Voluntary home visiting programs that support parents in 

their critical responsibilities to help their children become healthy, 

successful citizens are the most effective human capital investments we can make because they compound the positive behavior 

of parents and children. 

I wish to voice my strong support for the MIECHV program and 

respectfully urge you and your colleagues to reauthorize MIECHV. 

The funding Illinois receives from MIECHV has significantly enhanced our State’s robust early childhood and home visiting systems and is a vital component of our infrastructure. Illinois has 

long valued evidence-based home visiting programs as an effective 

and efficient strategy for strengthening expectant and new vulnerable families, by increasing children’s readiness for school, reducing 

the risk of child abuse and neglect, and improving economic selfsufficiency. 

Over the past three decades, Illinois has developed a cross-sector 

statewide home visiting system, serving over 17,000 families per 

year, making it a nationally recognized model of a State system 

supporting a variety of evidence-based models and innovative practices. Please refer to my written testimony which provides a more 

thorough picture of home visiting in Illinois. 

For today’s purposes, I would like to elaborate a little on what 

MIECHV funding has allowed us to do in Illinois. We have reached 

more at-risk families. Last year, nearly 1,000 additional families 

received more than 12,000 home visits. We have improved our 

home-visiting workforce through infant mental health consultation 

that teams mental health professionals with home visitors, and additional training for home visitors, regardless of funding, to enVerDate Sep 11 2014 06:25 Feb 25, 2019 Jkt 033364 PO 00000 Frm 00040 Fmt 6633 Sfmt 6602 I:\WAYS\OUT\33364.XXX 33364
37 

hance their understanding of critical topics, such as domestic violence, substance abuse, and child abuse prevention. 

MIECHV has increased coordination and collaboration across 

funding streams. For example, MIECHV’s focus on identifying the 

outcomes that help best support families is something that all Illinois funders are now considering in their systems. MIECHV has pioneered coordinated intake, which ensures that families referred to 

home visiting are matched with a program and the model that best 

meets their particular needs and that they have access to other 

services as well. This concept of coordinated intake introduced 

through MIECHV has generated such interest that several communities not funded directly through MIECHV have chosen to develop 

coordinated intake systems with technical assistance from our 

MIECHV team. 

We have been able to test innovations, including projects focused 

on some of our most vulnerable families, such as homeless families 

and pregnant and parenting youth in care, and in randomized control evaluations to examine the effectiveness of doula-enhanced 

home visiting. We hope these innovations will be useful to other 

States as they are proven. 

Decades of research show that high-quality, evidence-based home 

visiting programs produce long-term positive outcomes for children 

and families. Data from Illinois show that home visiting services 

are increasing breastfeeding rates and birth intervals between 

births, particularly among teen parents; improving parenting practices; and ensuring that children are routinely screened for developmental delays. Research demonstrates that these outcomes, 

while measured in the short-term, set children and families on a 

positive trajectory for the long-term. The MIECHV program has increased the focus on these outcomes which is raising the bar for all 

home visiting programs in our State. 

In closing, I would like to reiterate my strong support for the 

MIECHV program. MIECHV undergirds and enhances our entire 

home visiting system and improves the lives of at-risk families and 

children in Illinois. It must continue, and I hope you view me, The 

Ounce, and the First Five Years Fund, our project, as a resource 

in that regard. 

Thank you for your time and consideration of my testimony. I 

will be happy to answer your questions. 

[The prepared statement of Ms. Rauner follows:] 

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33364A.024

Subcommittee on Human Resources 

Committee on Ways and Means 

U.S. House of Representatives 

Washington, D.C. 20515 

March 13, 2017 

Chairman Smith, Ranking Member Davis, and Members of the Subcommittee on Human Resources: 

Thank you for the opportunity to testify before you in connection with your hearing on the reauthorization 

of the Maternal, Infant, and Early Childhood Home Visiting {MIECHV) Program. I am the President of the 

Ounce of Prevention Fund (the "Ounce"), Co-Chair of the Illinois Home Visiting Task Force {HVTF), and the 

First Lady of the State of Illinois (the "State" or "Illinois"), although I testify before you in my capacity as the 

President of t he Ounce. In doing so, I wish to voice my strong support for the M IECHV Program, and 

respectfully urge you and your colleagues to reauthorize MIECHV. The funding Illinois receives from 

M IECHV has significantly enhanced our State's robust early childhood and home visiting systems and is a 

vital component of our infrastructure. 

Since 1982, the Ounce has persistently pursued a single goal: that all children living in America-particularly 

those born into poverty-have quality early childhood experiences in the crucial first five years of life. In 

addition to our work in early childhood center-based services, the Ounce is the leading provider of 

professional development and training for home visitors in the State, and with our community-based 

partners, the Ounce offers voluntary home visiting services to nearly 1,900 families throughout Illinois. 

The HVTF is a standing committee of Illinois' Early Learning Council, which works w ith the Governor's Office 

to provide overall leadership in early childhood systems development. The HVTF is a diverse, collaborative 

group of nearly 200 members drawn from federal, state, and local governments; academia; representatives 

from national home visiting models; service providers; advocates; parents; and others. The HVTF's goals are 

to expand access to evidence-based home visiting programs for all at-risk children; improve the quality of 

home visiting services; and increase coordination between home visiting programs at the state and local 

level, as well as between home visiting and all other publicly-funded services for mothers, infants and 

toddlers. The HVTF also serves as the advisory body for the State's MIECHV grants. Positioning this work 

under the Early Learning Council is one example of how home visiting is connected to the other major early 

childhood services in Illinois such as preschool, child care and Early Intervention Part C services. 

Illinois has long valued evidence-based home visiting programs as an effective and efficient strategy for 

strengthening expectant and new families who are vulnerable to poor health, educational, economic and 

social outcomes by increasing children's readiness for school, reducing the risk for child abuse and neglect, 

and improving economic self-sufficiency. Over the past three decades, Illinois has reflected this value by 

developing a cross-sector statewide home visiting system that provides these essential services to over 

17,000 families per year, making it a nationally-recognized model of a state system supporting a variety of 

evidence-based models and innovative practices. 

Thank you for the opportunity to submit my written testimony. We appreciate the Subcommittee's efforts 

to better understand how M IECHV funding is impacting children and families, including ours in Illinois. In 

order to share Illinois' experience with home visiting and M IECHV, I will focus on four issues: (i) why home 

visiting is effective in Illinois; (ii) why MIECHV is vital to our home visiting system in Illinois; (iii) the need for 
39 


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home visiting services in Illinois; and (iv) the long-term benefits of home visiting in Illinois on a micro and 

macro level. 

The Effectiveness of Home Visiting in Illinois 

In Illinois, home visiting is an effective intervention for children and families due to a number of factors, 

including the following: 

Our statewide approach and philosophy, which welcomes and uses a variety of evidence-based 

models that are selected based upon individual community and family needs; 

Our well-trained home visiting workforce; 

Our ability to direct services to at-risk and vulnerable populations; and 

Our ability to leverage other supports and services. 

The MIECHV program has greatly enhanced the overall home visiting system as well as each of these 

areas and has provided the opportunity for Illinois to better serve young children and their families. 

Statewide Approach and Philosophy. Illinois' home visiting system is both structured and funded in such a 

way as to welcome all evidence-based models to the table, and then allow individual communities and 

programs to select the model(s) best suited to their specific needs. In Illinois, our home visiting system uses 

a range of effective evidence-based models, including Parents As Teachers (PAT), Healthy Families America 

(HFA), and Early Head Start-home based (EHS). These models are funded through our entire home visiting 

system, which includes funding from MIECHV, the Illinois Department of Human Services (IOHS), the Illinois 

State Board of Education (ISBE), and Chicago Public Schools (CPS). It is one of the hallmarks of our Illinois 

system that we allow communities to choose a model based on their needs. 

On the family level, a priority of the Illinois home visit ing system is to ensure that each family is connected 

with the home visiting program that best suits its individual needs. For example, in the initial meeting with 

the family, an eligibility screening tool is used that takes into account the family's current needs and 

geographic considerations. Particularly for our at-risk families, it is important that a good match is made 

right from the start because if we do not, the family may not continue with the services and we may lose 

the opportunity to partner with them during a critical time in their child's development. 

The coordinated intake system introduced to Illinois communities through the MIECHV program has played 

a critical role in ensuring that families referred to home visiting are matched with the program and the 

model that best meets their particular needs and that they have access to myriad other services that will 

help to support them. This concept has generated such great interest that several communities not funded 

directly through MIECHV have chosen to become "voluntary" communities and develop coordinated intake 

systems with t echnical assistance from the M IECHV implementation team. 

Home Visiting Workforce. Home visiting programs are grounded in the belief that young children, families, 

and staff grow and learn best in the context of trusting, supportive relationships. Home visiting staff are 

hired with education and training in early childhood development, as home visiting services are anchored in 

child development and psycho-social support to mother, baby, and extended family. Using a relationshipbased model of intervention, trained home visitors focus on promoting a strong mother-infant attachment 

right from the start. Home visiting programs and funders dedicate considerable resources to supporting 

home visiting staff, through professional development, access to professional consultants, and reflective 

supervision. 
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Through purposeful and systematic efforts, Illinois has a well-trained and diverse home visiting workforce 

with a variety of cultural, linguistic, and educational backgrounds. The State's home visiting system has 

demonstrated a commitment to building a highly-skilled home visiting workforce capable of improving 

outcomes for t he children of Illinois. For example, the Ounce is the recognized training provider for all 

home visitors in core model training (i.e., HFA and PAT programs in Illinois), as well as wraparound trainings 

that help to enhance their practice. Funding for Ounce training is provided through MIECHV, IDHS, ISBE and 

CPS. 

M IECHV funding is also being used to provide supplemental training around specific issues in response to 

stated needs from the field, such as intimate partner violence, child abuse prevention, substance abuse, 

and maternal stress through the Futures without Violence, 4Ps Plus, and Mothers ond Bobies curricula, 

respectively. MIECHV funding is also being used to build the capacity of home visiting staff through Infant 

Mental Health Consultation (IMHC), which is a multi-level preventative intervention that teams mental 

health professionals with home visitors and supervisors. While these specialized trainings and IMHC are 

provided to all MIECHV funded programs in Illinois, they are also available to any home visiting program in 

the State, and they serve as an example of how MIECHV funding helps the entire home visiting system in 

Illinois. 

Directing Services to At-Risk Populations. The latest Illinois MIECHV data show that we are serving families 

who need home visiting services the most and who benefit the most from them. For example, 988 

additional families in federal fiscal year 2016 received home visiting services due to MIECHV funding. These 

families face a variety of risk factors, including pregnancy before age 21, child and maternal emergency 

room visits, child maltreatment, poverty, domestic violence, substance abuse, and educational and 

vocational disadvantage. 

In order to direct services to at-risk populations, all home visiting programs use eligibility screening tools 

and the home visiting system implements the models with fidelity. We continue to try to direct services to 

some of our most vulnerable families, such as homeless families and pregnant and parenting youth in care, 

through the use of pilot and demonstration projects (as described in more detail below under " MIECHV's 

Vital Role in Illinois"). 

Leveraging Other Supports and Services. Home visitors in Illinois play an important role in referring families 

to other services when available. For example, home visitors can serve as a bridge to services for families. 

Because they see families regularly, home visitors are often the first to witness and respond to emerging 

family concerns, such as maternal depression, child development issues, or household needs, all of which 

can negatively affect the developing parent-child relationship. In turn, parents, because of their trust in the 

home visitor, are more likely to share their own concerns and to accept linkages to other services, including 

early intervention and center-based early childhood programs for their children, and education, jobtraining, and counseling programs for themselves. 

In order to help home visitors become more informed with regard to other systems and services in Illinois, 

a series of cross-trainings have been held and continue to be organized to better support cross-system 

collaboration. In addition, as mentioned above, M IECHV-funded communities as well as several nonM IECHV funded communities in Illinois implement coordinated intake, which serves as a hub for home 

visiting to streamline services wit hin each community. 
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MIECHV's Vital Role in Illinois 

Even though Illinois has long valued evidence-based home visiting programs and receives funding from 

sources other than MIECHV, MIECHV funding has allowed Illinois to enhance its existing infrastructure 

through each of the following: 

Reach more at-risk families; 

Make a greater investment in our home visiting workforce; 

Increase coordination and collaboration across funding streams; and, 

Test innovative practices. 

Reach More At-Risk Families. MIECHV funding has enabled Illinois to build on existing state investments in 

home visiting and expand our direct services to families. In federal fiscal year 2016, 988 additional families 

(of which at least 93% were low-income) received a total of 12,296 home visits in English, Spanish and 

Arabic through MIECHV funding. 

Make a Greater Investment in our Home Visiting Workforce. MIECHV funding has allowed Illinois to make 

a greater investment in our home visitors through the use of IMHC and enhanced and additional 

professional development opportunities. See above "The Effectiveness of Home Visiting in Illinois- Home 

Visiting Workforce" for a more detailed overview. 

Increase Coordination and Collaboration across Funding Streams. One of the hallmarks of the Illinois home 

visiting system has always been the collaborative approach that the funding streams take towards ensuring 

the quality of the home visiting system. With the introduction of the MIECHV program in Illinois, this 

coordination and collaboration has increased significantly, in turn enhancing the support of the home 

visiting system. For example, there is an increasing focus on better aligning the data systems used for home 

visiting programs and on identifying the most critical and compelling data elements that should be collected 

and reported. These partnerships, enhanced through MIECHV, are essential in continuing to support the 

home visiting system. 

Test Innovative Practices. Illinois has used M IECHV funds for a variety of innovative projects. MIECHV 

fund ing enables Illinois to create laboratories for researching and testing pilots and demonstration projects, 

as well as valuable trainings, tools and approaches that can be applied more broadly to the entire home 

visiting system as well as other systems, such as child welfare. Showing the beneficial impacts of these 

innovative projects on a smaller scale will build a case for expanding them to more programs across the 

State. 

Each of the following innovative projects receives M IECHV funding. These novel strategies have generated 

significant interest from other states and are already producing results that will be used to drive 

improvements in practice and continue to strengthen the evidence base of home visiting. 

Home Visiting for Homeless Families Demonstration (HVHF} Project - Young children who 

experience homelessness face a host of challenges that threaten their health, development, and 

ability to succeed in school. Unfortunately, many of the homeless services families may be accessing 

do not provide child-centered comprehensive services that address child well-being and parent-child 

attachment. At the same t ime, these families also face barriers to accessing early childhood services 

and supports that can improve outcomes, such as evidence-based home visiting. Through high-quality 

home visiting services, the HVHF Project seeks to improve the developmental trajectories (i.e., 
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improvements in breast feeding rates# developmental screenings, well-child visits, and maternal 

efficacy rates) of children experiencing homelessness in Chicago. The HVHF Project's approach is to 

train homelessness providers on home visiting, hire a home visitor whose caseload is exclusively 

homeless families, and provide training to a shelter on implementing the PAT model. The HVHF 

Project will collect data that will indicate impact and inform future efforts. To date, learnings include 

the importance of using the educational definition of homelessness, and that there is significant 

interest from other parts of the country in doing a similar project. 

11/inois Pregnant ond Parenting Youth in Core Home Visiting (1-PPYC-HV) Pilot Project- Nationally 

and in Illinois, young children ages birth to five comprise nearly half of all child maltreatment cases. 

Research shows that early exposure to abuse and neglect can have negative impacts on development 

and learning. Home visiting has been shown to be an effective intervention in preventing 

maltreatment. The 1-PPYC-HV Project provides pregnant and/or parenting youth in child welfare care 

with access to voluntary home visiting services that are provided by eight programs located in Illinois. 

The 1-PPYC-HV Project will serve 30 young families over a two year period. The goals of the 1-PPYC-HV 

Project are to promote nurturing parent-child relationships and healthy child development, enhance 

family fu nctioning by reducing the risk of abuse and building protective factors, break the 

intergenerational cycle of abuse, neglect and trauma, increase coordination between the child 

welfare and home visiting systems in Illinois, and create a model that can be replicated throughout 

Illinois. 

11/inois Universal Newborn Support System (UNSS)- Based upon the principle that all families need 

some level of support when a baby is born, a pilot project is being launched to create a system that 

would offer all newborns and their parents a home visit to provide them with information, supports, 

and resources to strengthen the capacity of parents to meet their children's needs. Based on an 

individual family's level of need and personal resources, assistance will range from providing 

information on how to care for newborns, to offering assistance with breastfeeding, to finding 

appropriate child care, to referring families to parent support groups, to making referrals to highintensity services such as home visiting. 

Expansion of Doulo Services- Eight home visiting programs in underserved communities are testing 

the impact of incorporating a community doula model into their traditional home visiting services. 

This project helps parents build strong bonds with their babies before the child is born, and 

preliminary findings show an improvement in maternal and child health outcomes. 

"Fussy Baby" Training- The Erikson Institute's Fussy Baby Network (FBN) Enhancement Training 

provides support for families who have concerns about their baby's crying, sleeping, feeding or 

temperament during the first years of life. The training uses a family-centered approach, and 

preliminary findings support that this training helps the home visitor be more attentive and attuned 

to the families they serve and improvements were shown in parental well-being outcomes. The FBN 

evaluation and scale-up aims to strengthen the capacity of multiple program models to improve child 

outcomes and will introduce innovations to the statewide system. 

Developing a Uniform Quality Rating Tool- The Erikson Institute is partnering with over 20 home 

visiting programs to create a home visiting program quality rating tool, which will develop uniform 

indicators of quality across Illinois home visiting agencies and models. This research will offer a crossmodel approach to quality and quality improvement for the State's multiple-model system. 

Randomized Control Trial {RCT) of Doula-Enhanced Home Visiting - This research undertaken by the 

University of Chicago with four well-established home visiting programs uses high-quality research 

methods to examine the effectiveness of doula-enhanced home visiting for improving maternal and 

child health, parenting and child development. The RCT will contribute further to the research base 

5 
43 

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for the doula model, which is being implemented in multiple states as an enhancement to evidencebased home visiting models. Preliminary results of the RCT are promising. 

The Need for Home Visiting Services in Illinois 

In Illinois, we serve approximately less than 10% of eligible families with our home visiting services, based 

solely on income level (i.e., 185% of the federal poverty level). We know, however, that income alone does 

not demonstrate a need for home visiting services. Furthermore, given the complexity of issues and trauma 

that many of our families face, we know there are numerous and complicated risk factors beyond poverty 

and, therefore, an even greater need than we can measure using income levels. While 988 additional 

families in Illinois received home visiting services in federal fiscal year 2016 due to M IECHV funding, we 

know that the need for home visiting services is greater. 

The long-Term Benefits of Home Visiting 

National and Illinois-specific research studies show that high-quality evidence-based home visiting 

programs result in myriad positive outcomes for children and their families, including the following: 

Increasing rates of breastfeeding, immunization, well<hild visit, and developmental screenings; 

Promoting language development and school readiness; 

Improving rates of high school graduation; and 

Increased rates of talking, reading and positive interactions between parent and child. 

In addition to the positive short-term benefits of home visiting programs, there is a host of positive longerterm outcomes associated with these services, including reduced risk of chronic health problems later in life 

(such as obesity, diabetes, heart disease, alcohol consumption, smoking, etc.). 

In Illinois, data have consistently indicated that home visiting services are having a significant impact in 

increasing breastfeeding rates, increasing inter-partum intervals (particularly among teen parents), helping 

families establish medical homes, and ensuring that children are routinely screened for potential 

developmental delays. Specifically, among MIECHV-funded programs in 2016, 100% of families were 

screened for needed services, 93% of children received recommended well-child visits, and 93% of children 

were screened for developmental delay before 12 months of age. These outcomes, while measured in the 

short-term, have critical implications for the healthy long-term trajectory of children and families. The 

MIECHV program has encouraged an increased focus on identifying the outcomes associated with home 

visiting and improving those outcomes for young children and their fami lies, which (as mentioned above), 

has created a focus on the same concept among all funders of home visiting in Illinois. 

In closing, I would like to reiterate my strong support for the MIECHV Program. Not only does MIECHV 

undergird and enhance our entire home visiting system, but the lives of at-risk families and children in 

Illinois have improved directly as a result of our MIECHV funding, and it must continue. Thank you for your 

time and consideration of my testimony. Please do not hesitate to reach out to me if I can provide any 

additional information as you move forward with this process. 

Sincerely, 

Diana Mend ley Rauner, PhD 

President, Ounce of Prevention Fund 
44 

Chairman SMITH OF NEBRASKA. Thank you, Ms. Rauner. 

Thank you to all of our witnesses here today. We appreciate your 

insights. They are important for us. So now we will go through 

questions here from myself and the Members. 

I will begin. Mr. Bellamy, in your testimony, you hit on a very 

important point about the program that I think is sometimes overlooked, and it is a point about how Federal funding programs based 

on evidence can really support States, and even the nonprofit sector, in their efforts to focus on what works. In your testimony, you 

highlight how the MIECHV program itself is important, but also 

that the evidence standard is set up and the signal it sent was just 

as important as it identified the models that were shown to be 

most effective. For example, I know once MIECHV-specified programs must be evidence-based and show results to receive funding, 

Nebraska, my home State, tied their own State funding to a similar 

standard so now all home visiting in Nebraska is evidence-based. 

Can you tell us a bit more about how the evidence standard in 

MIECHV has influenced the State practice in funding home visiting? 

Mr. BELLAMY. Yeah. I think the fact that MIECHV has set a 

level of standardization has really influenced how funders look at 

what they will fund around evidence-based practices. We have 

adopted in our South Carolina MIECHV program that we would 

only fund evidence-based programs. And private funders, as well as 

our State, has looked at that standardization authorization for 

those evidence-based programs to really look at setting a target 

and really being able to identify those practices as we move forward. 

At this point, funding has not moved in our State as far as looking at specific evidence-based practices. We want to build a continuum of services in our State around evidence-based practices, so 

we want to continue to really build a systematic approach to it. 

Chairman SMITH OF NEBRASKA. In your interactions with 

other States perhaps, have you learned what other States have 

done, or could you point to anything like that perhaps? 

Mr. BELLAMY. Tough for me to say. Well, in conversations with 

my peers in other States, there have been States that have identified ways to look at their standardization. They have worked with 

their legislation to really put into action some of their standards 

in evidence-based standardization. It would be difficult for me to 

pinpoint exactly where those States are at this time, but, yes, there 

have been other standardizations looked at in how they have 

adopted those practices. 

Chairman SMITH OF NEBRASKA. Thank you. 

Anyone else on the panel wish to comment? Ms. Rauner. 

Ms. RAUNER. I would just add that one of the ways that 

MIECHV has helped with standardization is in terms of standardization of the workforce, common understanding of what qualities 

are necessary across the models for training and professional development, ongoing professional development, and credentials. And 

that has, again, raised the standards and raised uniformity across 

programs and across funding streams. 

Chairman SMITH OF NEBRASKA. Thank you. 

Anyone else? If not, that is fine. 

45 

I now recognize the Ranking Member, Mr. Davis, for any questions he might have. 

Mr. DAVIS. Thank you very much, Mr. Chairman. And I also 

want to thank all of the witnesses. 

Mr. Bellamy, let me ask you, I don’t run into that many men in 

this line of work. What drew you to it, if you would? 

Mr. BELLAMY. To the work that I do? 

Mr. DAVIS. Yes. 

Mr. BELLAMY. That is a very good question, Mr. Davis. You 

know, years ago, I started out in doing teen pregnancy prevention 

work and worked with adolescents in direct services, and it really 

influenced my passion with working with younger populations. But, 

essentially, what it boils down to is the fact that I thoroughly believe that early intervention is a predictor of some very good things 

in later years, and I think our youngest population is the most vulnerable population, and we need to target those strategies, whether 

it be men, women, whatever the case may be. And I am just passionate about what I do and the work that I do and, hopefully, I 

can bring a different perspective sometimes from where I sit as a 

State lead. 

Mr. DAVIS. Thank you. Thank you very much. 

Dr. Rauner, it is not every day that I run into a First Lady of 

the State who also has a full-time working job and is involved with 

all kinds of other social service entities. 

The Ounce of Prevention is supporting some innovative home visiting programs, especially dealing with pregnant and foster youth. 

How does this work strike you in terms of its benefit to society? 

Ms. RAUNER. Well, I personally believe that the development of 

every child’s potential is the social justice issue of our time. It is 

an economic challenge and a moral challenge for us to ensure that 

every child can participate in the American Dream and in the 

American economy and as a full citizen of our Nation. And, again, 

research is quite clear that the period of the first few years of life 

has the greatest opportunity for setting children on the proper trajectory for development. And, again, because it is an intervention 

that affects both children and their parents, it has the opportunity 

to build and develop two lives, and I think that is one of the most 

powerful pieces of this work for me. It certainly drives the work 

that I have been doing for decades. 

Mr. DAVIS. Thank you very much. 

Ms. Valentin, I think you are, indeed, a role model. As a former 

teacher, youth worker, father, grandfather, great-grandfather, I 

used to counsel teenagers, and I think you represent the best quality of thinking and decisionmaking that I have run into. Could you 

share with us how your experiences have actually assisted you, 

what you may have done even for others? 

Ms. VALENTIN. My experience with this program has been 

amazing. You know, an unplanned pregnancy, a first-time mom, 

any mom, young or older, you know, you just need to have that 

support and need to know certain things. And this program has 

helped me so much with even the littlest things, not so much about 

the child but about me or helping, you know, my family and stuff 

like that. So it has been really helpful, and I hope that everybody— 

46 

I mean, I know if everyone could be here right now, they would 

share their experience, because this is truly amazing. 

Mr. DAVIS. Thank you very much. And I yield back, Mr. Chairman. 

Chairman SMITH OF NEBRASKA. Thank you, Mr. Davis. 

Mr. Smith from Missouri. 

Mr. SMITH OF MISSOURI. Thank you, Mr. Chairman. And 

thank you to the witnesses for making it here today despite the 2- 

inch winter blizzard that we had up here. Clearly not like Missouri 

and Illinois weather. 

I want to thank the Chairman for holding this important hearing 

on the Maternal, Infant, and Early Childhood Home Visiting, or 

MIECHV, program. Many times the Federal Government tries to 

do too much. Our third President, Thomas Jefferson, got it right 

when he said: ‘‘The government closest to the people serves the 

people best.’’ But MIECHV works because it offers States like Missouri the flexibility to administer the program in the way that best 

suits their needs. 

MIECHV’s flexibility allows Missouri’s Governor, Eric Greitens, 

to implement three of his major priorities. He wants to improve 

healthcare access, reduce opiate abuse, and reduce infant mortality. By choosing to run the Nurse-Family Partnership as part of 

the program, Governor Greitens is able to follow through on his 

promise to address the high infant mortality rates in the Bootheel 

of Missouri. For example, in my district in Pemiscot County in the 

Bootheel, we have the worst health outcomes of any county in Missouri. It is 115 of 115. Of course, there are 114 counties in the city 

of St. Louis, that is why it is 115. 

Pemiscot County experiences the highest infant mortality rates 

in all of Missouri. We know that one out of eight mothers don’t 

make it to full term when pregnant, and two-thirds of infant mortality is due to preterm births. We know that we can do a lot better. That is why Missouri’s Department of Health and Senior Services has begun to administer the Nurse-Family Partnership program in Butler, Dunklin, Pemiscot, and Ripley Counties in the 

Bootheel. This targeted approach can help reduce infant mortality 

rates in our most distressed counties. Unfortunately, Pemiscot 

County needs the most help of anywhere in the State, but fortunately, because of the MIECHV and by working with Governor 

Greitens, we can improve health outcomes, save lives, and reduce 

costs. 

As an evidence-based program, we know taxpayer dollars are 

being spent in the right place because the Nurse-Family Partnership program is shown to decrease preterm births and reduce infant mortality. 

Ms. Russell, I would like to learn a little bit more about the nuts 

and bolts of the program. How do you prepare for your first visit 

with a mother? 

Ms. RUSSELL. The Nurse-Family Partnership program is a 

blueprint program, and we do have a curriculum that we follow. 

However, each mom is very different. So, personally, I prepare for 

the first visit by just keeping an open mind, knowing that what I 

walk into in one home might be very different than what I walk 

into in another home. So my priorities across the board are always 

47 

ensuring that she already has prenatal care established, and if she 

does not, ensuring that I can help make referrals to get her prenatal care started. And then from there we look at some of the— 

is she utilizing the appropriate community resources like she 

should be? Are they part of the WIC program? Do they have food 

they can eat? And ensuring that we will refer to those services as 

needed. 

Once I am sure that all of her basic needs are met, we can start 

to learn a little bit more about who she is as a person and what 

is important to her. We have, as nurses, outcomes that we would 

like to see as far as keeping everybody healthy and safe. But it is 

also important, and Nurse-Family Partnership agrees with this as 

well, that it is important that we find out what the client’s heart’s 

desire is and help them reach that as well. 

So the first visit is very much getting to know them, trying to 

be as laid back as possible, and letting them share with us what 

they are willing to share, and then building on from there in each 

visit from that point on. 

Mr. SMITH OF MISSOURI. The Nurse-Family Partnership requires a 2-year commitment. Why such a duration? 

Ms. RUSSELL. As Rosa can attest to, there are many struggles 

that come up in those first 2 years of parenting. Pregnancy in itself 

is a struggle, and there is a lot to learn as far as education to stay 

healthy and have a healthy baby as a result of the pregnancy. And 

then building on that, infancy has its own struggles with learning 

what your baby needs from you and how to respond to those needs 

in an appropriate way, as well as ensuring that the baby is getting 

access to care and immunizations and well-baby visits. And then 

the toddler years also create some more struggles as they are now 

mobile and they are doing different things that their parents aren’t 

sure they are supposed to be doing or are safe for them. 

And then from a clinical aspect, the baby’s brain grows so much 

in those first 2 years and is almost fully grown at that point, so 

we want to have as many positive influences on the baby in those 

first 2 years as possible. 

Mr. SMITH OF MISSOURI. Thank you, Mr. Chairman. I yield 

back. 

Chairman SMITH OF NEBRASKA. Thank you, Mr. Smith. 

Next is Ms. Chu from California. 

Ms. CHU. Thank you, Mr. Chair. 

In Los Angeles County, we utilize both the Healthy Families 

America and the Nurse-Family Partnership models of home visiting. And in 2015, home visitors made over 29,000 home visits to 

around 5,500 parents and children in California. The program in 

my State and in L.A. County has placed an emphasis on connecting 

pregnant women and new mothers with mental health services. 

That is, in my opinion, a fantastic way to leverage existing programs aimed at improving mental health and wellness for children 

and families with the unique methods of the home visiting program. 

So, Ms. Russell, based on your experiences working with the 

Nurse-Family Partnership model in Pennsylvania, can you describe 

a few ways in which you have relied on a broader array of available 

48 

social services, such as mental health evaluation and treatment, to 

carry out your mission, and do you have examples? 

Ms. RUSSELL. Sure. As part of the Nurse-Family Partnership 

program, we do regular incremental screenings for depressive and 

anxiety disorders. So based on those screenings, we can refer as 

necessary. So we do those during pregnancy and then continuing 

through the child’s first 2 years of life, on a schedule. But we can 

also do them as needed. So if we come into a home and we find 

that the mother’s affect and tone are just not quite like they had 

been before, we can screen as needed, which is one thing that is 

great for us as nurses. We have been given those tools in our undergraduate degrees to recognize some of the problems that might 

present if a mother is having trouble with her mood but maybe 

isn’t quite ready to recognize that in herself, just like Rosa had 

been through. So through those routine screenings and through our 

basic assessment skills that we learn in our undergraduate programs, we are able to keep a really close eye on that. 

Unfortunately, in Lancaster, our mental health resources are not 

as strong as we would like them to be. We are able to make referrals, but many times they do have to wait for a couple of weeks 

or a couple of months until they can be seen by a provider. So in 

the meantime, we are able to educate on some coping mechanisms 

that they can use in their own home until they are able to get into 

a more structured environment for counseling services. 

Ms. CHU. And do you think mental health issues are a frequent 

kind of issue that comes up for pregnant women? 

Ms. RUSSELL. I would say yes. I do feel that they are very, very 

prevalent in our population. Nurse-Family Partnership collects 

data that could give you the real percentages as far as that goes, 

but every day I am working with at least one mom who is having 

trouble with her mood at that current time. 

A general day for me is three to four visits with three to four different patients, so that is one a day that is probably having some 

sort of trouble, which is about 25 percent to 50 percent of my caseload. So it is very prevalent, unfortunately. 

Ms. CHU. And how about substance abuse counseling? Is substance abuse an issue that comes up frequently? 

Ms. RUSSELL. Yes. Yes. Substance abuse is also an issue that 

comes up, whether that might be a past history and the mother is 

now no longer using but is working on ways to prevent herself from 

continuing to use, or whether they actually are using a substance 

during their pregnancy. 

So for us as nurses, it is important that we educate on how it 

will not only affect her, but affect her unborn child or if she is already parenting, how that will affect that child’s growth and development as well. 

Ms. CHU. Okay. Ms. Rauner, in placing emphasis on connecting 

pregnant women and new mothers with mental health services, 

States like California try to detect and remediate potential issues 

very early in a child’s life. However, data from the L.A. County 

Health Services underscores the challenges facing many mothers, 

which is that nearly one-third of women who were recently pregnant or had delivered a baby lacked a regular source of health care. 

49 

So how do home visitors help to provide effective early intervention for pregnant women and new mothers who do not have easy 

or regular access to health care? 

Ms. RAUNER. Well, certainly, one of our efforts has been to connect new mothers to all the services that they need. With respect 

to mental health programs, we also have been able to use MIECHV 

funds to build mental health consultation in for our home visitors 

so that they are actually able to be supportive when we don’t have 

access to services. 

But access to early intervention services, to health care services, 

and other connections is a very vital part of what the home visitor 

is doing in any community. And certainly, we make that a high priority for all of the models that are in place in Illinois. 

Ms. CHU. Okay. I yield back. 

Chairman SMITH OF NEBRASKA. Thank you, Ms. Chu. 

We will move on to Mr. Reichert from Washington State. 

Mr. REICHERT. Thank you, Mr. Chairman. 

First of all, I want to thank the witnesses for being here and for 

the time that it took to put your comments and statements together. And I thank the staff. The Democrats and the Republicans 

have people that are sitting back here. They put this whole thing 

together, and I want to congratulate them on bringing some excellent witnesses today to testify. It is important for us to hear, not 

only from people like Rosa—if it is okay if I call you Rosa—and the 

experts in the field that do the work, but it is so critical to hear 

from those who are the recipients and then those who provide the 

work, the services, like Beth. 

So how many of the witnesses have testified before Congress before? 

How many have testified before other members of maybe a city 

council or a county council? 

I knew that Ms. Rauner would raise her hand. She has experience in this world. 

You have all done a great job, but I think we really need to recognize Rosa’s testimony. She is the first 16-year-old to testify—I 

have been here 12 years. I just look like I have been here 40. I 

have been here 12 years, but this is the first 16-year-old witness, 

Mr. Chairman, that we have had, and she did outstanding. I don’t 

know if it is against the rules or not, but we should give her an 

applause. 

[Applause.] 

The heck with the rules sometimes, right? 

So I wanted to ask Rosa, and you don’t have to answer this if 

you don’t want to, but why did you choose Angelica for—I have 

kind of maybe a thought on that, but why did you choose Angelica 

for your daughter’s name? 

Ms. VALENTIN. Angelica was my grandmother’s name, which is 

also my middle name. My middle name is Angelica Marie, so I 

named her Angelica Marie. 

Mr. REICHERT. Okay. I had two choices, but I bet you your 

grandmother was named Angelica and your middle name is Angelica because—— 

Ms. VALENTIN. Of my grandmother, yes. 

50 

Mr. REICHERT [continuing]. Because you are angels. My daughter’s name is Angela, and we weren’t supposed to have children, so 

we chose Angela because she was our little angel. So I am sure you 

think of Angelica that way, right? 

Ms. VALENTIN. Yes. 

Mr. REICHERT. So what I would like to ask Rosa is just—you 

know, we are having a conversation here. It gets a little formal 

sometimes, but, you know, just from your first contact with Beth 

and how this came about—because the courage it took for a 14- 

year-old to decide to go through with the birth of your child, and 

now here you are today, going to school, looking for a nurse’s profession in the future, I think is just an amazing feat, and it shows 

so much maturity, but you couldn’t have done it without Beth and 

your parents. 

Ms. VALENTIN. Yes. 

Mr. REICHERT. Don’t worry about the rest of your family. They 

will get on board eventually. Eric is laughing. I have been there. 

I am the oldest of seven. You know, every now and then, they kind 

of float in and out of your life. 

Just tell me in your own words what the whole thing is all about 

for you. How did it really help you? 

Ms. VALENTIN. I just felt like I needed more support. You 

know, my mom was always there to help me, but she was like, you 

know, this wasn’t planned, but we are going to make the best of 

it, and we are going to get you through this no matter what bumps 

come through the road. Like, we are going to get through it. You 

are going to finish school. You are going to be on track to finish, 

and you are going to be a great mom. 

So this program, you know, at first, I was going to Healthy Beginnings, but Healthy Beginnings wasn’t associated with the hospital I was in, the OB–GYN, so I was referred to Nurse-Family 

Partnership. And I am so glad that I was referred to Nurse-Family 

Partnership because it has been, you know, so great—I am so 

grateful to, you know, have this program, have a nurse by my side 

that, you know, can answer any questions and stuff like that. So 

it has been really helpful. 

Mr. REICHERT. Good. Beth, do you want to add something 

quickly to that? 

Ms. RUSSELL. I am just so proud of Rosa. She does not do public speaking very well, and one of her goals that she set for herself 

was to try to interact with people more because with doing the 

cyber program, she really doesn’t get much interaction with people 

outside of her home, so this is a really huge step for her. 

Mr. REICHERT. I mean, you did awesome. Look, at 16 years old, 

I wouldn’t have been in your seat. I guarantee you that. 

We get a second round of questions, so I am going to come back 

to the others to just ask some technical questions. But I just want 

to really emphasize the courage it took to move forward with your 

life, the courage it took to be here today. I truly would not have 

been doing what you are doing today. I couldn’t have done it. And 

you can’t even vote. You might be a Congresswoman some day. 

I yield back. 

Chairman SMITH OF NEBRASKA. Or perhaps you have higher 

aspirations. 

51 

Mr. REICHERT. We will make that the first female President 

then. 

Chairman SMITH OF NEBRASKA. There you go. Thank you. 

Ms. Sewell. 

Ms. SEWELL. Thank you, Mr. Chairman. 

I wanted to associate myself with the remarks of my colleague. 

I think that your grace and your courage and your maturity is 

something to be marveled at, Rosa, so thank you for being here 

today. 

Before I begin my questions, I wanted to quickly express my desire to make sure that MIECHV is re-funded and reauthorized. In 

my State of Alabama, 5,220 families and 6,280 children receive 

home visiting services. In my district, 12 out of the 14 counties are 

eligible to receive MIECHV funds. Moreover, the MIECHV funding 

programs are primarily—are the primary source of funding for 

home visits in Alabama. The Federal funding is. 

My district also has a wide variety of evidence-based models, including the Parents as Teachers, Nurse-Family Partnership, and 

the Home Instruction for Parents of Preschool Youngsters program. 

In fact, 86 percent of Alabama families receive home visiting services from a model that has been rated as evidence-based by HHS. 

For my constituents, many of whom live in underserved rural 

communities, the home visiting services that MIECHV programs 

fund are essential. And as we have learned from the special relationship between Beth and Rosa, home visitors also provide important emotional support when young parents may feel all alone. In 

Alabama, over 50 percent of the single mothers with children under 

5 live in poverty. These mothers and their children need these 

kinds of programs. 

I want to thank all the panelists for taking the time to be here 

today. 

And my question I wanted to first address to Mr. Bellamy. South 

Carolina, like Alabama, has both urban and rural communities. 

One of the biggest questions or complaints, challenges, that I hear 

a lot from my constituents that live in underserved rural communities is lack of transportation. Can you talk to me about how the 

MIECHV-funded programs are administered in your State in rural 

communities and what are some of the challenges, and how your 

State overcomes those challenges? 

Mr. BELLAMY. Yes, ma’am. Many of the same challenges, Ms. 

Sewell, that we have in South Carolina for sure, transportation 

being one of them. The beauty of MIECHV and home visiting is 

meeting families where they are literally. And also, MIECHV has 

also given us an opportunity to expand services into these rural 

communities that really needed it and target those families that 

were most in need, so the needs assessment that states that we 

could really look at where we needed to target services. In most 

of—in South Carolina, most of our State is a rural State, so we put 

in practices and allow the ability for programs to be able to have 

sufficient funding to do home visits and travel to outlying counties 

and work with contiguous communities that may be rooted in 

really a more resource-richer community. 

Ms. SEWELL. And I noticed that you guys expanded the number 

of counties that were covered, and that expansion is, I would asVerDate Sep 11 2014 06:25 Feb 25, 2019 Jkt 033364 PO 00000 Frm 00055 Fmt 6633 Sfmt 6602 I:\WAYS\OUT\33364.XXX 33364
52 

sume that South Carolina like Alabama, most of the funding for 

MIECHV comes from the Federal Government, and our State 

matches maybe, it is sort of a 2 to 1 match. Talk to me about how 

you guys—it seems to be a capacity problem in my State, that 

there are far more eligible families that could benefit from 

MIECHV than are actually reached. In my home county of Dallas 

County, I grew up in Selma, and Selma has 67 percent of the families with children under 5 in poverty. But yet 2.9 percent are actually covered by the MIECHV funding, so there is a capacity issue. 

I would like to get you involved, Ms. Rauner, if you could talk 

a little bit about how Illinois addresses the capacity issue and making sure that these great programs actually reach more families. 

Ms. RAUNER. Yes, thank you. Well, in Illinois, despite many 

years of investment, both from our State Board of Education and 

our State Department of Human Services as well as of course, 

MIECHV, we are still only serving 10 percent of all eligible children in our State. And Illinois, as well, is an urban and a rural 

State and has—of our 102 counties, most of them are quite rural. 

We have used MIECHV dollars specifically to build community 

collaborations in both urban and in rural States. And we have 

looked through our needs assessment at some of the places that are 

most isolated and, again, have some of the most—the highest infant mortality rates. So the MIECHV program has allowed us to 

create community collaborations in those communities that bring 

together the available resources. 

Ms. SEWELL. So you pool funds? Are you pooling funds? 

Ms. RAUNER. Pooling funds, but also making sure that we are 

effectively using all the resources that the community has. And to 

the extent that we find gaps in resources, being able to advocate 

and reach out to other agencies to support those. 

So we have actually connected our MIECHV programs with our 

infant mortality Title V programs. We have been able to use some 

of our child welfare dollars, again, to identify places where there 

are real gaps in services. 

Ms. SEWELL. Thank you. 

Chairman SMITH OF NEBRASKA. Thank you. And now I will 

begin our second round. Fortunately, we have the time resources 

to deal with this, with the second round. 

Ms. Russell, I would like to focus a little bit on your insight and, 

kind of, frontline involvement there. I mean, the list is quite long 

in terms of what can be achieved with these effective models of 

home visiting. And, you know, from obviously economic self-sufficiency in a very broad way to increased work reduce arrests, less 

welfare dependence in general. Can you, perhaps, highlight or give 

us more specifics on your work in terms of how you might begin 

providing or connecting with a client and what that looks like compared to maybe evolving through and in making adjustments along 

the way and the observations that, perhaps, that you have had 

along the way as well? 

Ms. RUSSELL. So in regards to connecting with her and her 

goals for herself, we start that the first day we meet each other. 

It is a very important part of the Nurse-Family Partnership program to ensure that we are not only with them during these 21⁄2

years but we have given them the information that they need to 

53 

create their own foundation for the future as well. So very early on 

we do meet, and we talk about goals. 

Each time we meet with them, we have an agreement form, and 

they have a little, what we call, a mini goal on there of something 

that they want to accomplish before we see them the next time. 

And sometimes that is a parenting, sometimes that is something 

much larger as far as applying for schooling and enrolling in programs like that. 

So we do discuss goals very early on and remind them of those 

goals every time we see each other. Sometimes they come to us and 

they say, oh, I forgot about that, and then we remind them kindly, 

again, that this is important to them. And they will very much pull 

through with what is important to them. And that is probably the 

most beneficial part of Nurse-Family Partnership is knowing that 

they are accomplishing what is important to them as well as we 

are encouraging them to accomplish what is also important to them 

and other parts of the program, other importance as well as selfsufficiency in the future. 

Chairman SMITH OF NEBRASKA. Okay. And I know that 

sometimes we struggle with wanting accountability in various programs and also allowing enough flexibility to spawn innovation, 

you know, a creative approach and so forth. Are there any times 

when you might feel somewhat confined in—with the services you 

offer because of, perhaps, some restrictions or Federal requirements or even State requirements? 

Ms. RUSSELL. Yeah. I feel like I can say no to that, because the 

beauty of Nurse-Family Partnership is that we can be a little bit 

flexible with when and where we meet our clients. So if it is snowy, 

and I can’t get to her where I need to be—our plowing, unfortunately, is not so great—so we might see each other a couple of days 

later, but we can connect by phone and have a short interaction by 

phone if we need to. 

If I have a patient or a family member who is homeless, we can 

meet at a public library or at a park or a cafe. So coming to them 

makes it very flexible for us to be able to meet our requirements 

with how often we are supposed to visit with our families, because 

we can truly meet them wherever our cars will allow us to go. 

If there is ever a concern with our clients where maybe they are 

having some difficulties, and they can’t physically meet with us, 

again, we are able to have phone encounters as well to still check 

in on them and make sure everything is going the way it needs to 

be, and if they have everything they need before we can physically 

see them again for a true home visit. 

Chairman SMITH OF NEBRASKA. And can you say—I think 

you may have said earlier, but can you say a typical number of clients you see in a day. 

Ms. RUSSELL. In a day, I try for three to four. Sometimes I see 

more than that, just depending on what they need. But if I had 

perfect control of my schedule, I would see about three to four a 

day, and then we just fill in as needed based on what the clients 

are in need of at that time. 

Chairman SMITH OF NEBRASKA. Okay. Thank you. 

Mr. Davis. 

Mr. DAVIS. Thank you. Thank you, Mr. Chairman. 

54 

And, again, I thank the witnesses. 

Dr. Rauner, let me ask you. Sometimes substance abuse is a 

problem in the home. How does the Ounce of Prevention deal with 

substance abuse issues when you run into them? 

Ms. RAUNER. Well, substance abuse is a major challenge for 

many of the families that we are serving, and one of the most important things we can do is train our home visitors to ensure that 

they have the skills necessary to identify, address, and refer patients and clients to appropriate services. 

Now, we know that services are sometimes difficult to come by. 

And one of the important things, again, that collaboratives allow 

us to do is begin to look at where the gaps in services are and how 

we begin to advocate for and push for greater services to address 

particularly substance abuse. We know in our State that, as in 

many, that the opioid crisis has really changed the dynamics for 

many of our communities. We also know there are many patients 

who are suffering from mental health issues that are, of course, associated with substance abuse. And so we are very focused on ensuring that our home visitors are appropriately trained and, also, 

that they are connected to a system that can—to which they can 

refer—they can refer clients. 

Mr. DAVIS. And for each one of you, if you could, how do you 

deal with the challenge of getting male involvement or more male 

involvement in the activities? 

Ms. RAUNER. Well, I would just say that one of the benefits of 

home visiting is that it is an opportunity to coach both mothers and 

fathers in their role even when the parents are not living together 

and may not actually be together anymore as a couple. 

But one of the things—I tell one story of a family actually in, Mr. 

Davis, in your community, that has been benefiting from home visiting services. Again, a mother and a father, young individuals who 

were not together, were not living together. The mom living at 

home and trying to continue with her education and get a job, and 

the dad living in a pretty unstable circumstance. 

Over the course of a couple of years of participation in a home 

visiting program, a Healthy Families program, where the mom and 

dad were able to participate in those programs together. So he 

would come over and spend time with the home visitor when she 

would visit the child. They actually—he actually decided it was important for him to get his life back on track, get back into school 

and become a caretaker for his child. And the couple have decided 

to get married. He is in school. She is employed, and they are getting ready to move into their own home. So I think this is an example of how home visiting can support parents as they are developing, frankly, into adults and making the challenging commitments that they need to make to their children and to each other. 

Mr. DAVIS. Thank you. 

Yes. 

Mr. BELLAMY. I think it is—I think fatherhood and male involvement is essential to the holistic approach to serving families, 

even though, oftentimes, mothers are the focal point and the entry 

point to many of our programs, we really need to continue to look 

at how we are supporting the entire family with our programs. 

55 

You know, oftentimes, as I said, we may have couples or families 

that may be divided and not living together, but we—the beauty 

of MIECHV is that it has allowed for innovation within models to 

really push for the models to look at different ways that they can 

continuously improve the initiatives, improve their programming. 

And fatherhood initiatives has been one that has—is building momentum on a continuum. And I think as we move forward, it is 

something that many States will look at stronger strategies to involve their fatherhood initiatives and local fatherhood initiatives 

within the States to be a part of, again, that holistic approach to 

really bring in the family and being self-sufficient as a family. 

Mr. DAVIS. Thank you very much. 

Mr. Chairman, I yield back. 

Chairman SMITH OF NEBRASKA. Thank you, Mr. Davis. 

Mr. Smith from Missouri. 

Mr. SMITH OF MISSOURI. Thank you, Mr. Chairman. 

Ms. Russell, Nurse-Family Partnership is just one service, but I 

am sure you connect your clients with numerous other needs. How 

do you coordinate with these other programs? 

Ms. RUSSELL. In Lancaster, we are very grateful to be under 

the Lancaster General Health and Penn Medicine umbrella, so this 

allows us opportunities to communicate within that umbrella to 

other services that are available to families. But we also over some 

time really built strong relationships with other community resources, and we tend to have meetings with them on a regular 

basis to remind each other that all of our programs exist and that 

we should be working together as best we can to support our families. 

So we do have as easy as a basic list of resources that are available in the area that we can take out to the families, but we are 

also the ones that are making the phone calls and sending the 

faxes to get all that information across to them. 

So we have built some really great connections in our community 

just by meeting each other at different events, organizing different 

coalitions to bring all the resources together for our families. 

Mr. SMITH OF MISSOURI. So whenever you, like, coordinate 

some of these programs and services to the families, is there a reporting mechanism where they report back to you, or do you check 

back up with them to make sure that those services are following 

through to help assist them, or how does that work? 

Ms. RUSSELL. Yes. If I send a referral somewhere, I do request 

that the referral organization contact me once the client has made 

contact, but then I also will check in with my client when I go to 

the home visit to ensure that they have either called that referral 

source or that they have received a call back that they have gotten 

that service. 

And we do track all of that in our data ETO tracking as well so 

that the main NFP site can see where we are sending referrals and 

what types of referrals we are in most need of. 

Mr. SMITH OF MISSOURI. Thank you. 

And the Nurse-Family Partnership model requires services be 

delivered in a certain way so that they are effective, and the 

MIECHV statute requires programs be operated in the way they 

56 

were designed and studied. What do you do as a nurse visitor to 

ensure fidelity to the model? 

Ms. RUSSELL. So to prepare for each home visit, I will first 

start by reviewing what we had done at our last home visit just 

to see what we had talked about, refresh my memory so I don’t forget as well, and then build on there. 

So we have multiple different facilitators of educational sheets 

and activities, interaction activities, we can do with the family to 

do things hands-on. And, generally, what we try to do is ask the 

client, the next time I see you, is there anything specific you would 

like to talk about, is kind of how we end our visit. And if they are 

unable to name something, we have a choice sheet that they can 

choose from. 

So that gives us the opportunity to deliver what the program is 

asking us to deliver, because the options that we are giving her to 

talk about are part of that blueprint curriculum for Nurse-Family 

Partnership. 

Mr. SMITH OF MISSOURI. Thank you. I would like to speak to 

Rosa. 

As one of the youngest Members in Congress and the youngest 

Member on this Committee, I am very impressed with you being 

here today. My first touch at ever speaking to anyone in government was before my small city council of a town of less than 5,000 

people, and I was about your age and was fortunate enough to be 

able to still serve that city in Congress now. So I can only imagine 

what your future lies ahead if your first venture is to speak before 

what I believe is the most important Committee in Congress. 

I am very impressed, and I look forward to seeing the great 

things that you will accomplish. And I just want to say, I am extremely proud and humble to be part of this. 

And Ms. Rauner, as my neighbor to the east, I was highly impressed whenever I see a first lady that is a working first lady 

other than—just, you know, career and family, it is both a double 

task. But I would encourage you to meet with our first lady, Ms. 

Sheena Greitens, who is also a working first lady, and help mentor 

her as well. I think you would have a lot in common. Thank you 

for being here. 

Chairman SMITH OF NEBRASKA. Thank you. Well said. 

And Mr. Reichert from Washington State. 

Mr. REICHERT. Thank you, Mr. Chairman. 

Even though Mr. Smith is the youngest, we—you know, he has 

a lot of potential unless more senior Members are, you know, trying to work with him. He is coming along nicely. 

You know, I—so I wanted to—so the first question I wanted to 

get to was for Mr. Bellamy. 

Evidence-based, you have all mentioned that. We see that it is 

necessary, you know, from Rosa’s testimony also. You know, as it 

applies to how it is used across the State, I think, my question: 

Doesn’t it become complicated when you are looking at rural versus 

urban, and then you have to evaluate what services to provide? For 

example, you know, nurses or counselors that, sort of, help and 

how you get that—those resources to those different areas needing 

just different types of services and the population is spread out? 

57 

Mr. BELLAMY. Yeah. It can be a little tricky. But, again, I think 

the power in this is being able to identify appropriate programs for 

families and really tailoring those programs and interventions that 

are—that families are going into more specific to that family. 

So when we target areas, we look at—you know, when we talk 

about needs assessment, we talk about areas that we want to go. 

We may look at, you know, specific programs that may work well 

there; however, again, the autonomy lies within those local implementing agencies. And we want to continuously work with them 

and partner with them to make sure that they have that ability to 

identify appropriate services. 

So, again, in South Carolina, we really wanted to build a continuum service, that is why we didn’t look at one specific model 

that we wanted to implement across the State or support across 

the State. We wanted to look at prenatally up to age 3, up to age 

5 and look at the different services that we can implement within 

those communities to help with those services. 

Mr. REICHERT. And that, really, is the important point here I 

think to make is every community is different. And you are in 

those communities, tailor making those services to each community 

is really the key and success. 

I really like what you said, Ms. Rauner, about early childhood, 

the human capital development is absolutely critical. I am a 33- 

year law enforcement career retiree and ending up here in Congress. I was a cop in Seattle for 33 years ending up as a sheriff 

and being in homes and working with young people my entire career. That human capital is so critical. 

Readiness for school, preparing people for the future gives hope 

and opportunity. And that is what is missing in today’s world, that 

hope and opportunity, and ending that cycle of, you know, just coming from families, and getting into situations where it takes away 

hope. And—which goes back to the fatherhood issue. 

You know, if young men don’t have hope, they lose opportunities. 

They kind of disappear, and we have to save those young people. 

The question I have for you—both of you and Ms. Rauner, first, 

was on the substance abuse issue. I think two or three of you mentioned that. What is the most common substance that is abused? 

I know opioids are the biggest problem today, but what are some 

of the others? Alcohol, tobacco, would that be some? Is marijuana 

in that? 

Ms. RAUNER. Yes, I would certainly—I am not sure I have the 

exact data on that. I would certainly say that alcohol, and marijuana, and tobacco are some of the biggest—the most prevalent. 

What we also know is that substance abuse is very likely and very 

often associated with depression and mental health issues. And so, 

again, support for the underlying issues can, in fact, be an important part of both preventing and addressing substance abuse. 

Mr. REICHERT. Yes. Again, I just want to thank all of you for 

being here today and for your testimony. This is such an important 

issue. And you can see from the comments on the dais here, you 

read in the papers and see in the media the lack of cooperation 

that some have described whereas, sort of, the state of, you know, 

separation in some—on some issues. But this is one issue where 

58 

you can see total agreement on this panel for both Democrats and 

Republicans. 

We want to help. We think it is absolutely critical. And I thank 

you all for being here, and especially, again, Rosa. 

And I hope I can see Angelica before—okay—before I leave today. 

I yield back, Mr. Chairman. 

Chairman SMITH OF NEBRASKA. Thank you, Mr. Reichert. 

And, again, thank you to our witnesses. And if you don’t mind, 

colleagues, we might want to grab a quick photo with our witnesses 

here momentarily. 

But, again, thank you, to all of you, for sharing your unique perspectives. And we know that your personal experiences and professional expertise are very helpful. I think we have Angelica visiting 

here right now. Very good. 

Please be advised that Members will have 2 weeks to submit 

written questions to be answered later in writing. Those questions 

and your answers will be made part of the formal hearing record. 

With that, the Subcommittee stands adjourned. 

[Whereupon, at 10:25 a.m., the Subcommittee was adjourned.] 

[Questions for the Record follow:] 

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33364A.030

COMMITTEE ON WAYS AND MEANS 

SUBCOMMITTEE ON HUMAN RESOURCES 

U.S. HOUSE OF REPRESENT ATIVES 

WASHINGTON, D.C. 20515 

Mm·ch 20, 2017 

MEMORANDUM 

Witness: Eric Bellamy 

From: 

Home Visiting Manager 

Children's Trust of South Carolina 

1330 Lady Street, Suite 310 

Columbia, SC 2920 I 

Andrew Rocca, Legislative Assistant 

Subconm1ittee on Human Resources 

Subject: Questions for the Record for the hearing entitled, "The Reauthorization of 

lhe Maternal, Infant, and Ear(J' Childhood Home Visiting (MIECHV) 

Program." 

Tltank you for testifying before the House Ways and Means Subconm1ittee on 

Human Resources during the hearing entitiled, "The Reauthorization oft he Maternal, 

Infant, and Early Childhood Home Visiting (MIECHV) Program." In order to complete 

the record of the hearing, please respond to the attached Questions for the Record 

(QFRs) submitted by Mt·. Reed of New Yot·k. 

Purs uant to the Comm1ttee rules, we ask that resp onses to the QFRs b e retui'Oed 

to the Comorittee by 6:00PM on Monday, April 3, 2017. Please submit your 

responses via e-mail as a Word attachment to Andrew.Rocca@mail.house.gov by that 

date. 

If you have any questions concerning this matter, please feel free to contact me at the 

email above or via phone at (202) 225-1025. 
60 


33364A.031

Rep. Reed QFR for Mr. Eric Bellamy 

I. While the main focus of home visiting programs tends to be health of the mother and 

child, one of the program models that South Carolina uses is Parents as Teachers which 

has a strong educational focus including school readiness and success. Can you speak to 

some of the educational results that you 've seen in your state? 

The MIEHCV initiative has allowed South Carolina to improve in school readiness and 

educarional capacities through several, concerred strategies. 17tese effor/s are rooted in 

the abiliry to provide fimdingfor evidenced based service pervision in local communiries 

with the mosl need. Additionallly, South Carolina, like many other srates has worked 

extremely hard to inlegrate and strategically rm-get such outcomes as education and 

school readiness, by building a continuum of se111ices rhrough several models and 

improving efforts with other early childhood systems. 

A strong foundational knowledge of child development, and engaged parenting behaviors 

are essential precursors to school readiness. In improved scores compared to 2014-2015 

(84%, compared to 76% last), four out of evety five MIECHV-enrolled caregivers 

demonstrated quantifiable improvement in scores reflecting supporr for child learning 

and deve/opmenl, knowledge of child development and the developmenf(J/ progress, and 

parenting behaviors that strengthen parent-child relationships. 

The SC MJECHV programs also works to facilitate the upward mobility of parricipating 

families. This year, more families were idenrifled as having specific needs at enrollment 

(33%, compared to 28%}, and among I hose who were referred for services, 93% received 

those se1vices. This year approximately 52% of families reporred an increase in income 

or related benejirs after 12 months of MIECHV enrollment. Among families who had no 

health insurance at program enrollment, more obrained health insurance during the 

course of their participation in the MIECHV program (56%, compared to 51% lasr yem). 

Furthermore, 24% of mothers improved their level of educational allainment. 

17te early identificarion of and inleJvention for developmental delays is crucial to a 

child's long-tenn well-being and school success. Among lvf.IECHV-enrolled children who 

reached 12 months of age during program enrollment and were identified with possible 

developmental delays in communication, general cognitive skills, gross and fine motor 

skills, social and emotional behaviors pallerns, and positive approaches to learning, the 

majoriry received appropriate and timely referrals. 

2. In my State of New York, only eight counties are served directly by MIECHV- all 

focused on high density areas. What are some of the challenges in serving mral 

populations that are not faced serving urban populations? What ways have you found 

success in reaching poor mral areas? 
61 

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33364A.032

Two of the biggest challenges that we have e:.perienced with se1vingjamilies in rural 

sellings are Transportation needs and access and equity to identified service needs. Many 

of the families that are sen•ed in ow· SC MIECHV program often lack the ability to follow 

up or physically report to senrices, once needs are identified through 1he home visiting 

fi'amework. 

To o.!Jsetthis, we have worked wilh ourjimded sites, 1hrough conliuous quality 

improvement efforts, to strive jot· innovatitive ways to work with and build local 

collaboration to assisl in sen,ing these families. Additionally, we provide supplemental 

training and workforce development efforts 10 contimuously strengthen the capacity and 

compe1ency of I his worl.force. 

From our initial MJECHV plan, we have established a 'hub-and-spoke' approach to 

building our state program. This approach is designed to connect lesser, often more 

rural communities and coumies (e.g the "spokes') with areas that are more established 

or "richer" in resources (e.g. the "hubs'), contiguously. This approach has helped our 

program build partnerships and collabora1ions on both the macro and micro levels. As 

well, there has been a continued culture growth of a unified approach to home visiting 

across the state, systemically and systematically-with MIECHV Jimded programs and 

non-MJECHV programs. This has truly allowed for our families to be be tier connected 

to setvices in a more equititable manner. 

3. In taking a look at what you' ve been able to accomplish in South Carolina, how 

important is analyzing outcomes in detem1ining funding for programs? When we, as the 

Human Resources Conunittee, take a look at aJ1ti-pove1ty programs, would you advise us 

to implement similar evidence-based requirements like those found in MIECHV? 

The SC MIECHV program continues to se1ve some ofSC's most vulnerable families. This 

ye01; almost 70% of enrolled households lived below 100% of the Federal Poverty Level, 

II% of caregivers were under 20 years of age; 58% of caregivers had a high school 

diploma equivalent or less, and 15% of families spoke a primOIJI/anguage other than 

English. 771e ability to build system and data processes that help us track these outcomes 

is imperative to the overall success of programs. Outcomes tel/us two stories--the have, 

and the have not-or what we have done and what we need to do. We need to use 

outcomes, both quatititalive and qualitalive, to contiuously assist in improving our 

programs and targeting those families and areas most in need. 

I believe the continued focus on evidenced based programming and the standardization 

1ha1 if can offer is a key element in tme sys1ema1ic imernvemion and holistically serving 

all families. Another key competent to this is for states, territories and programs to have 

a stronger sense of coni tuned autonomy to building their programs and knowing that 

!here will be a continuity of financial support for their efforts. /1 is e:.·1remely di.fficulltO 

build programs based on short-term support- because these often lead to only short-term 

outcomes. 
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April 6, 2017 

Representative Davis, 

Thank you again for the opportunity to testify before the House Ways and Means Committee 

Subcommittee on Human Resources regarding "The Reauthorization of the Maternal, Infant, and Early 

Childhood Home Visiting (MIECHV) Program" on March 151

•. It was a pleasure to speak with you about 

Illinois' robust home visiting system and the opportunity that MIECHV has provided to enhance that 

system in order to increase the positive impacts of home visiting on the children and families that we 

serve. 

I am writing in response to the following Question for the Record presented by you: "Ounce of 

Prevention is currently supporting innovative home visiting programs targeted at pregnant and 

parenting foster youth, and homeless youth. Can you tell us more about how you tailored the programs 

to focus on those very high-risk groups, how those projects are improving outcomes, and what you think 

might be the long-term benefits?" 

As I mentioned in my oral and written testimonies, MIECHV undergirds and enhances our entire home 

visiting system and improves the lives of at-risk families and children in Illinois. We have always focused 

on identifying better ways to serve the most high-risk young children and their families, and MIECHV has 

provided us with a critical opportunity to further explore this for two key populations: pregnant and 

parenting youth in care, and homeless youth_ Below I have included detailed information on these 

projects in response to your question. 

Home Visiting-Child Welfare Pilot Project 

The Illinois Pregnant and Parenting Youth in Care- Home Visiting (1-PPYC-HV) pilot project is a 

collaboration between state- and local-level stakeholders in both the home visiting and child welfare 

systems. The project was born out of an interest from the state agencies that fund and operate these 

programs to better serve pregnant and parenting youths in the care of the state, recognizing that due to 

the trauma they themselves have endured their children are statistically more likely to enter the child 

welfare system. For example, a study from Chapin Hall at the University of Chicago found that nearly 

40%1 of the children of these mothers entered the child welfare system in Chicago alone2

. To that end, 

the primary long-term goal of this pilot project is to mitigate the intergenerational cycle of child abuse 

and neglect and the resulting trauma that it causes for fam ilies throughout the life course. 

The pi lot project launched in October 2016 with the goal of enrolling thirty families across eight sites in 

home visiting programs implementing the Healthy Families America (HFA) model. As of the writing of 

this response, 27 families have been referred to home visiting programs and nine are already receiving 

services. Outreach and referrals continue between the service providers for the child welfare system 

and the home visiting programs. Additionally, home visitors at all of the sites have received trainings to 

increase their knowledge about the child welfare system and its requirements and approach. Finally, 

1 This statistic is based on the percentage of families with any investigation forchildren under 5. 17% had an 

indicated report, and 11% were placed in foster care. 

'Dworsky, A. (2015). Child welfare services involvement among the children of young parents in foster core. Child 

Abuse ond Neglect, 45, 68-79. 

1 
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33364A.034

through the MIECHV formula grant, a project coordinator has been hired, housed at Children's Home+ 

Aid, in order to ensure that the pilot program runs smoothly and that programs receive the assistance 

that they need to be successful. 

One of the key realizations early on in the development of the pilot project was the difficulty of reaching 

these very high-risk families before the baby turned two weeks old, which would have rendered them 

ineligible for the HFA model. Therefore, we engaged the national HFA office in a conversation about 

extending eligibility for the purposes of this pilot in order to reach these families. The national HFA 

office was excited about this pilot project and agreed to extend eligibility until the baby is one year old, 

which is an important adaptation for us when trying to reach these families. The national HFA office 

remains very engaged in the pilot and is planning to feature it in an upcoming newsletter. Another 

critical component of the project, given the high risk factors associated with the population being 

served, is the provision of infant mental health consultants to work with the home visitors participating 

in the pilot as well as training in the FAN approach. As these youth have likely experienced trauma, 

infant mental health consultants as well as this specialized training can support home visitors in working 

with these youth. 

Chapin Hall at the University of Chicago will conduct an evaluation of the pilot project, which will 

examine whether the pi lot program was effective in mitigating the intergenerational cycle of child abuse 

and neglect by creating a healthy attachment relationship between the mother and her baby. As the 

project is still in its initial stages, there is not yet data available on the short-term outcomes for the 

family. However, Chapin Hall plans to measure the following short- and long-term outcomes: 

Short-term outcomes: 

o Mothers receive postpartum health care and breastfeed for at least three months after 

giving birth (if they were enrolled before giving birth); 

o Parents quit smoking/using tobacco; 

o Mothers are screened for maternal depression and referred for treatment if appropriate; 

o Parents demonstrate more positive parenting and child rearing attitudes; 

o Children receive well-child checks as recommended by the AAP and a developmental 

screening; 

o Chi ldren are achieving general developmental milestones at the expected ages; and, 

o Chi ldren with developmental delays are referred for services. 

Long-term outcomes: 

o Mothers do not experience a subsequent pregnancy prior to emancipation; 

o Parents without a high school credential earn their high school diploma or GED and enroll in 

postsecondary education or training program or become employed; 

o Parents have health insurance coverage and are connected to a medical home following 

emancipation; 

o Parents demonstrate more positive parenting and child rearing attitudes; 

o Children are not the focus of a child maltreatment investigation or an indicated child 

maltreatment report; 

o Children are not placed in the care of the Illinois Department of Children and Family 

Services; 

2 
64 


33364A.035

o Children are achieving general developmental milestones at the expected ages; 

o Children are enrolled in an accredited early learning program or licensed day care by age 3; 

and, 

o Children have health insurance coverage and are connected to a medical home following 

parent's emancipation. 

Home Visiting for Homeless Families Demonstration Project 

Young children who experience homelessness face a host of challenges that threaten their health, 

development, and ability to succeed in school. For example, a brief published in January of this year by 

t he U.S. Department of Health and Human Services and OPRE concluded, among other things, that 

"compared to national norms, young children who have stayed in shelter have higher risk for 

developmental delays and higher rates of behavioral challenges"3

. Unfortunately, many of the homeless 

services families may be accessing do not provide child-centered comprehensive services that address 

child well-being and parent-child attachment. At the same time, these families also face barriers to 

accessing early childhood services and supports that can improve outcomes, such as evidence-based 

home visiting. 

The Home Visiting for Homeless Families Demonstrat ion Project (HVHF) is a project led by the Ounce of 

Prevention Fund that seeks to improve the developmental trajectories of children experiencing 

homelessness in Chicago through high-quality home visiting services. Beginning in the fall of 2013, the 

Ounce recruited local home visiting and homeless service providers to volunteer to pilot three 

approaches to enhance t he abil ity of home visiting programs to engage and serve homeless families: 

1. Adding one new home visitor with specialized training in working with homeless populations to 

a home visiting program, who carries a reduced caseload to accommodate the intensive support 

that homeless families require; 

2. Training all home visitors in participating home visiting programs to provide services to one or 

two homeless families as part of their overall caseload; and, 

3. Training a homeless service agency so that home visiting can be integrated into the current 

services being provided through that agency. 

All approaches include support for increased collaboration between home visitors and homeless service 

providers, additional training and technical assistance on identifying and working with homeless 

families, and an evaluation component to help identify effective approaches that could be replicated 

more broadly. 

Another key feature of the pilot project has been to adapt home visiting models to allow more flexibility, 

with permission from home visiting models and funders. Some of the most common and significant 

barriers for home visitors include lack of training on serving homeless families and awareness of 

homelessness among home visitors; homeless families' tenuous connections to traditional referral 

1 Brown, S.R., Marybeth Shinn, and Jill Khadduri. (2017). Wefi·Being of Young Children Experiencing Homelessness, 

2. 

3 
65 

[Submissions for the Record follow:] 


33364A.036

sources, such as public health departments and medical providers; difficulty in identifying and referring 

homeless families during the prenatal period or early months of infancy; and home visiting model and 

Iunder requirements, such as requirements that visits occur only in the home and restrictions on 

providing services only in a designated service area, which makes it very difficult to stay connected to 

highly mobile families. Accommodations to the models are dependent upon the needs of the family and 

may include: increasing options for the location of the home visits, extending enrollment to children 

who are older than typically permitted, and allowing home visitors to follow homeless families as they 

move outside of the typical service area. Finally, to alleviate programs' concerns that performance 

indicators might decline as a result of serving this higher-risk populat ion, we've communicated to 

programs that we are viewing the pilot as a learning experience and thus we are not establishing 

requirements regarding benchmarks at this point. 

As w ith t he 1-PPYC-HV pilot project, this is a relatively nascent project and so at this point it is difficult to 

definitively measure the short-term impact the intervention has had so far. Anecdot ally, participants in 

the HVHF project have reported that the flexibility afforded to home visiting programs in implementing 

home visiting services has allowed programs to engage and stay connected to homeless families that 

they otherwise would not have been able to work with. In addition, home visitors have been able to play 

a critical role in connecting families to more resources and supports. Furthermore, a focus group 

analysis indicates t hat home visitors find supervision and support critical to serving these families, that it 

is important to have a common understanding of the definition of "homelessness", that the ability to be 

creative and persistent in reaching these families is important, and that there are some challenges in 

implementing the curricula as it is currently due to the unique challenges these families face. We view 

this innovation as an iterative process, and this anecdotal evidence is informing what additional 

supports need to be put in place to better allow home visiting services to be tailored to the needs of 

homeless families. 

Our hypothesized long-term benefit is that the developmental trajectories for children from homeless 

families (chi ldren whom we know to be at-risk of a number of poor developmental outcomes) will be 

improved as a result of access to intensive home visiting services and that we will identify 

recommendations to improve policy and practice. 

In conclusion, we are proud of these initiatives and look forward to seeing their long-term benefits for 

our most vulnerable young children and their families. I would be happy to answer any additional 

questions you may have, and to continue to share any information that would be helpful for you as you 

move forward. 

Sincerely, 

Diana Mend ley Rauner, Ph.D 

President, Ounce of Prevention Fund 

4 
66 


33364A.037

Written Statement to Ways and Means Human Resources Subcommittee Hearing 

On the Geography of Poverty, February 15, 2017 

Charles Bruner, Ph.D. 

The House Ways and Means Human Resources Subcommittee held an important hearing on 

February 15, 2017 on the topic of the geography of poverty. This topic deserves continued 

attention- and additional focus upon issues of age and race within difference geographic areas. 

It also deserves further drilling down not only to a county level, but to a neighborhood and 

census tract level. 

This is needed to correct one statement in the release for that hearing that may be part of the 

perception about poverty but simply is not borne out by a detailed look at the facts: 

The traditional geography of poverty is changing. In recent years, poverty has shifted 

from cities to the suburbs, while poverty rates in rural areas are consistently higher than 

rates in urban communities. 

In fact, Elizabeth Kneebone's testimony from the Brookings Institution at the hearing itself 

showed that, in terms of Americans in poverty, both suburbs and cities have experienced 

steady increases in the numbers of people in poverty from 1970 through 2015, while the 

number of people in poverty in rural areas has declined. Of course, population growth during 

this period has been primarily in metropolitan areas, and this only speaks to the numbers of 

people in poverty and not to their rates. 

The Institute for Research on Poverty at the University of Wisconsin, however, shows poverty 

rates by center city, suburb, and rural/small town America over a similar time period (1967-

2013). While in 1967 the highest poverty rate was in the rural/small town areas (20 percent, 

compared to 15 percent for center cities and 7 percent for suburbs), by 2013 center city rates 

(18.9 percent) had surpassed those in rural/small town areas (16.5 percent), while suburban 

areas had shown the largest percentage increase (to 11.9 percent). 

The figures from both these reports come from United States Census data, which is the source 

for virtually all information about poverty in the United States. 

Further analyses of poverty over this period from the Census also show that there have been 

dramatic reductions in poverty among seniors, while the poverty rate among children has 

increased. Moreover, while 61 percent of seniors in poverty are white and non-Hispanic, 69 

percent of children living in poverty are either non-white or Hispanic. More of the poverty in 

rural areas is in the senior population, while much more of the poverty in the center cities is 

among children, particularly very young children. 
67 

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When analysis is kept at the county level, the differences between center cities and suburbs 

generally are missed, as well as differences within neighborhoods in center cities or types of 

rural areas. When poverty is examined at the census tract level, the tracts with the highest child 

poverty rates (where SO percent of the child population or more is in poverty) mostly are in 

center cities. Higher poverty areas for rural and small towns that do exist almost entirely are in 

the South and Southwest or on reservation land. 

These high poverty tracts, whether in center cities or elsewhere, generally are the most distant 

from job opportunities, educational and recreational supports, and access to good housing and 

transportation. They generally are highly segregated racially and places subject to historical 

discrimination. 

Finally, they are rich in young children. In census tracts with child poverty rates of 10 percent or 

less, S.9 percent of all residents are young children (0-4). In census tracts with child poverty 

rates over SO percent, 8.6 percent of all residents are young children (even with the undercount 

of young children in the census). These census tracts need commensurately more opportunities 

for children to grow and develop- physically, educationally, and socially-into healthy and 

productive adults- but generally have far fewer. 

Part of the subcommittee release was a statement from Chairman Adrian Smith (R-NH), 

that stressed the importance of finding different solutions related to different geographies and 

needs to reach one common goal: 

Our instinct might be to think rural Nebraska and urban Chicago are so vastly different 

they have nothing in common. But what we are charged to do in this subcommittee is to 

find ways for individuals and families to succeed, and those challenges are universal, even 

if they require different solutions ... It's important we realize and respect the differences 

between the constituencies we represent, as too often Congress proposes national, onesize-fits-all solutions when local flexibility is really what's needed. 

As this work proceeds, it is essential to tackle poverty issues with particular attention to 

differences of who is living in poverty across geographies- seniors and young children; white 

non-Hispanic and nonwhite and/or Hispanic persons. 

Further, if America society is to eliminate or dramatically reduce poverty over the long-term, it 

is critical that children growing up today, whether or not their households can escape poverty, 

have the opportunity- particularly health, safety, and education- to themselves grow up to be 

free from poverty as adults and as they raise their own children. While it remains important to 

address the needs of seniors to live in safety and dignity, with their basic needs met, the longterm solutions to poverty ultimately will be determined by to the extent to which children can 

grow into adulthood healthy, educated, and ready to take on responsibilities of work, career, 

and parenthood. 
68 


33364A.039

March 29, 2017 

Statement of 

American Academy 

of Pediatrics 

DEDICATED TO THE HEALTH OF ALL CHI LOREN" 

The America n Academy of Pediatrics 

Testimony for the record to the 

House Ways and Means Subcommittee on Human Resources 

"Hearing on the Reauthorization of the Maternal, Infant, and Early 

Childhood Home Visiting Program" 

American Academy of Pediatrics • Department of Federal Affairs 

601 13th Street NW, Suite 400 North • Washington, DC 20005 

Tel: 800.336.5475 • E-mail: kidslst@aap.org 
69 


33364A.040

American Academy of Pediatrics 

Hearing on the Reauthorization of the Maternal, Infant, and Early Childhood Home Visiting Program 

March XX, 2017 

Chainnan Smith, Ranking Member Davis, and Subcommittee Members: 

The American Academy of Pediatrics (AAP) is a non-profit professional organization of 

66,000 primary care pediatricians, pediatric medical subspecialists, and pediatric s urgical 

specialists dedicated to the health. safety, and well-being of infants, children, adolescents, and 

young adults. We are grateful for the opportunity to provide testimony for the record about the child 

health benefits of the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV). The 

House Ways and Means Committee has a significant opportunity to reauU10rize this successful program 

and increase its resources to expand irs impact, and we look f01ward to workiJig together with Conuniuee 

Members on this effort. 

Tite AAP has long supported home visiting programs for the impact tltey have on children's 

health, development, and wellbeing. 1 Child health and developmental outcomes depend on the 

capabilities of families to provide a nurturing, safe euviroumeut for their infants and young ch.ildren. A 

variety of factors can d.isrupt that capability, including health and educational dispatities, parental trauma, 

poverty, and parental mental health and substance use disorders. Home visiting programs offer a 

mechanism for ensuring that at-risk frunilies have social support, linkages with public and private 

cotllllltmity services, and ongoing hea lth, developmental, and safety education. These programs make a 

major difference in the health and economic trajectories of child beneficiaries and their families, and 

MIECHV is a critical public policy intervention to improve access to these progranJS. As the Ways and 

Means Conunittee considers reauthorization of this impot1ant program. we offer tl1is testimony on bow to 

1 American Academy of Pediatrics Council on Community Pediatrics, 2009. The Role of Pre-School Home Visiting 

Programs in Improving Children's Oevelopmental and Health Outcomes. Pediatrics. 001: 10.1542/peds.2008·3607. 

Available online at http://pedlatrics.aappublications.org/content/pediatrics/123/2/598.full.pdf 
70 


33364A.041

American Academy of Pediatrics 

Hearing on the Reauthorization of the Maternal, Infant, and Early Childhood Home Visiting Program 

March XX, 2017 

best suppon the MIECHV program so that it can continue to make a difference in the health and 

wellbeing of children. 

Benefits of MIECHV-Funded Po·ograms 

!IUECHV has consistently held itself to the highest standards of evidence-based practice. 

MIECHV funds programs focused on a variety of imponant child outcomes, including preventing 

maltreatment, fostering child development, promoting school readiness and improved loug-tenn academic 

outcomes, and supponing the development of educational and work-related skills for parents. Home 

visiting programs provide families with social suppon tltrough the development of a tnosting relationsl1ip 

between the home visitor and parents. These relationships are designed to promote parent effectiveness 

and help engender strong bonds between the adults and children with.in famj]jes. Case nJ.anagement, 

referrals to conununity-based services, skill building for parents, chi.ld development education, and 

improvement in matemal heaiUl are all common components of programs, and help to break down silos 

and leverage other child welfare services. Working together, tltese components can bring about a variety 

of positive matemal and child health omcomes, including: improved parenting skills; improved home 

environment: ameliorated cltild behavioral problems; intproved cltild inteUectual development; enhanced 

maternal life course such as employment and education: reduced frequency of lmintentional injury and the 

presence of home hazards: incre<tsed breast feeding rates; and improved detection and management of 

postpartum depression. 

Home visiting programs also generate substantial cost savings in health, education and social 

services. Home visitiJtg programs are associated with reduced emergency department visits, decreases in 

foster care assignments, fewer hospitalizations, and reduced child protective services interventions, all of 

wltich lead to substantial cost savings. Chi.ldren of fanti lies who participate in evidence-based home 

visiting services are also more likely to have gone for their preventive health care visits and are more 

likely to have all necessary vaccinations. Home visiting for suppot1 and obsen•ation of newboms with 

2 
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American Academy of Pediatrics 

Hearing on the Reauthorization of the Maternal, Infant, and Early Childhood Home Visiting Program 

March XX, 2017 

low birth weight who are sent home early has been shown to be cost-effective. It saves significant costs 

for the heallh insurer wllile improving overa ll health stalus. Home visiting also has good evidence for its 

rerum on investment, which demonstrates the long tenn economic benefits that result from this child 

health program. At its core, quality pediatric care is prevention. Home visiting recognizes tltis crucial 

aspect of children's health and development, generating benefits to children, parents, and society across 

the life span. Home visiting programs not only improve the healtll of children and mothers now, but also 

reduce chronic health needs later in life. 

Evidentiary Standa•·d 

MIECHV is flexible and adaptable, so that states and local commmtities can tailor solutions to the 

needs of their population. What makes this Oexibility work, while still acllieving these important 

outcomes, is the program's rigorous evidemiary standards. Curreotly, 17 home visiting models receive 

federal funding suppo11 t.lu·ough MIECHV. The diverse availability of models to meet population needs is 

a testament to the appropriateness of the current evidentiary standards in the ~UECHV program. 

MIECHV uses rigorous •·equirements while also creating a pipeline for building the evidence base for 

demonstrating program effectiveness. This balance is critical to maintaining quality without 

inappropriately presenting baniers to in1plementation of promising practices. C\urent MIECHV policy 

employs an appropriate evidentiary standard. We urge you to maintain the cunent rigorous evideutiary 

standards in U1ese reauU10rization discussions. 

Mental Health and Substance Abuse 

During the hearing, Subcommittee Members expressed great interest in home visiting's 

role in addressing parental behavioral health, and particularly the effects of the opioid epidemic. 

The public health issue of prenatal drug exposure resulting from maternal substance use is 

3 
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33364A.043

American Academy of Pediatrics 

Hearing on the Reauthorization of the Maternal, Infant, and Early Childhood Home Visiting Program 

March XX, 2017 

significantly affecting children's health and causing family disruption. In 2016, the U.S. 

Oepamn ent of Health and Htunan Services reported that from 2012 to 2015, the percentage of 

child removals where substance use was a contributing factor rose from 28.5 percent to 32.2 

percent.2 Home visiting plays an important role in supporting parental health through screenings 

and linkages to community treatment services, such as postpartum depression screenin gs and 

substance use disorder treatment. In addition, home visitors serve a vital social suppon role to 

parents receiving these services. Parental substance use and its impact on child health and 

wellbe ing is a growing public health crisis, and there is evidence that evidence-based home 

visiting programs can reduce substance use in pregnant women. Home visiting is an important 

pan of the continuum of successful policy responses to this issue. 

Honte VIsiting and the Pediatric Medlc.1l Home 

Home visitors can also have an essential role in augmenting the services oftbc n-aditional 

pediatric medical home. Home visitors can be health care advocates and improve access to providers of 

care. In addition, they can be partners with pediatricians and other clinicians, working in the home setting 

to provide essential education and suppottive services to at-risk children and families and to improve 

adherence to medica l preventive and treatment regimens. Home Visitors can enhance developmeJJtally 

oriented anticipatory guidance with content that meets faJDi lies' individual needs. Home visiting 

programs can work as a complememary service to pediab·icians' care that enhances cltildren's health and 

developmental trajectories. Supporting and facilitating the relationship between families and their 

children's pediatJi cians is a ctitically important aspect of home visiting. Current MIECHV flexibility 

already allows for the strengthetting of these relationships, and tl1ere is a significant opporttulity to expand 

1 Se:e hups://www acf.hhs.soy/media/press/2016·number-of.children-in·foster=eare·jnqeases.for-the·third· 

consecutive-year 

4 
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33364A.044

American Academy of Pediatrics 

Hearing on the Reauthorization of the Maternal, Infant, and Early Childhood Home Visiting Program 

March XX, 2017 

this approach in tbe futt~re. We suggest that Congress and tlte U.S. Health Resotu·ces and Services 

Administration (HRSA) work collaboratively to encourage MIECHV-funded programs tO intentionally 

incorporate collaboration between the home visitor and the child's pediatrician into their approach. 

Increased emphasis on this collaboration can maximize the child health benefits of MIECHV. 

funding 

MIECHV is a successful program that is benefitting children and families across the cotmtry. To 

co111iuue expanding the reach of the program to cover those who would benefit. additional federal 

resources are necessary. The AAP supports increasing annual MlECHV funding from S400 million to 

$800 million to expand tlte program's capacity, support further iunovation iu developing effective 

models, and to address ongoing public health needs, iucluding the impact of the opioid crisis on children 

and families. While this important p•·ogram reaches many families it is ctuTently far below serving all 

eligible families, and t11csc reso ~rces will help expand the program's reach. 

Part of what makes MIECHV successful is the ways iu which home visitiug programs serve as a 

linkage point for families to other CJ'itical commtutity resources. Home visiting has greater impact when a 

community bas tl1e capacity to meet needs that the home visitors identify in tl1e families they serve. Tite 

success of MIECHV is context dependent. so we urge Congress to provide these additional funds without 

reduciug supp011 for other important health and human services programs serving vulnerable children and 

families. 

Conclusion 

Thank you again for tlte opporttutity to provide testimony for the record on the reauthorization of 

MIECHV. Home visiting is an essential child health intervention that makes a difference in the lives of 

children and families. We look forward to continuing to work together on this imponant issue as the 

reauthorization process continues. 

5 
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33364A.045

Baby TALK Board of Directors 

Trlsha Er1ckson, Presi<lent 

Jeff Byrkit, Vice President 

t'e: Gross, Secretary 

Dan McGuire, Treas:urer 

Joel Fletcher, Past Prestdent 

Shauna Ejeh, Exec. Director 

Phoebe Bowers 

March 29, 2017 

Attention: Committee on Ways and Means 

Thank you for this opportunity to submit information In support oft he 

reauthorization of the Maternal, Infant, and Early Childhood Home Visiting 

(MIECHV) Program. In Illinois, MIECHV has been instrumental in moving toward 

cohesion for what was a somewhat misaligned field of practice. 

I represent Baby TALK, an organization that has worked for over 30 years to 

deliver services to famil ies prenatally with children through age five in Macon 

County, Illinois. In addition, Baby TALK has trained practitioners In our evidence· 

based model and relationship-based approach in over 30 states. In Illinois, Baby 

TALK practitioners serve over 5,000 chi ldren and while Baby TALK is not currently 

one of the funded MIECHV models, all home visiting practitioners have had the 

benefit of accessing current and relevant training that supports their 

professional development and the work they do with families. In turn, Baby TALK 

has provided newborn encounter training to MIECHV Coordinated Intake 

wori<ers statewide to support Illinois' efforts towards universal screening for 

families with newborns. 

In addition, In Macon County, the MIECHV community systems component has 

enhanced our Early Childhood Coalition and helped formalize a more structured 

coordinated intake process for all low income families interested in home visiting 

and other early care and education services in the area. It is important to note 

that MIECHV does not only impact the children and families enrolled in 

programming, but the entire home visiting sector. This funding stream has 

enabled Illinois to grow, align and integrate our home visiting system increasing 

positive outcomes for children and families. We hope that this committee will 

see the value of reauthorizing this program which supports the provision of 

meaningful services to vulnerable populations. 

~· auna E)eh &L 

Executive Director 

Baby TALK • 500 E. ll:lkashore Drive • O<!C3turf ltllnois 6254.9 • 217475·2234 

Magan Breheny 

Andy <:ave 

Mepn Comerford 

Cindy Funi< 

Ashley Grayned 

Dianna H~•er 

Anq:uenette H!cb 

Darlene Hoffman 

Mkhae-IICarunas 

Kathy Locke 

Kim Mangan 

Sarah Massey 

Michelle Michael 

Matt Naber 

karen Sctmeller 

Pen Slladc 

Chris S1udyla 

Lucy Smith 

Jenntfer Walker 
75 


33364A.046

CHILD& FAMILY RES EA RC H PARTNERS H IP 

HOUSE WAYS AND MEANS SUBCOMMITTEE ON HUMAN RESOURCES 

HEARING ON MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING (MIECHV) 

REAUTHORIZATION HEARING 

MARCH 15, 2017 

Statement for the Record Submitted by: 

Cynthia Osborne, Ph.D. 

Associate Professor, LBJ School of Public Affairs 

Director, Child and Family Research Partnership 

The University of Texas at Austin 

2315 Red River St. Austin, TX 78713 

512-471-9808 

cosborne@prc.utexas.edu 

March 28, 2017 

Child & Family Research Partnership 

ch•ldandfam•lyresearch org • mfo@ch•ldandfamtlyresearch.org • S12 471.3536 • Toll Free 855.471 CFRP (2377) 

The University of Texas at Aust.in • The tBJ School of Public Affairs • P.O. Box Y,Austin, Texas 78713 
76 


33364A.047

Involved fatherhood is linked to better outcomes on nearly every measure of children's 

wellbeing, from cognitive development and educational achievement to self-esteem and prosocial behavior.' When fathers are committed to the lives of their children, those children are 

also more likely to be healthy, productive, empathetic, and emotionally secure.2 Fathers play a 

crucial role in child development, but historically, social programs aimed at poverty alleviation, 

health, and parenting have been geared almost exclusively toward mothers and children.3 

Programs for fathers, by contrast, have traditionally sought to increase their financial 

contributions to the family, with little attention given to their broader role in the family. 4 

For the last five years, my t eam at the Child and Family Research Partnership {CFRP) and I have 

conducted multiple evaluations of the MIECHV-funded Texas Home Visiting {THV) program 

including two studies focused specifically on father involvement. Findings from these 

evaluations are detailed in the following pages, but are highlighted here: 

Multiple barriers {e.g., work schedules) often prevent fathers from participating in home 

visits, but fathers engage with home visiting programs in other ways including attending 

other program activities, completing homework or practicing lessons with the mother 

and child, or asking mothers about the visit. 

Fathers value home visiting programs and cite their child's improved school readiness 

and health outcomes as being particularly important. 

Program staff can be trained to increase father participation including specifically 

inviting fathers to visits and program events, and being flexible with the timing and 

location of home visits to accommodate fathers' work schedules. 

Father participation in home visiting programs is positively linked to family retention, 

which provides both parents increased opportunity to benefit from the program. 

Families in which fathers have participated in at least one home visit stay in the program 

over six months longer than families in which fathers never participate, controlling for 

family, program, and community factors. 

My team and I also evaluate other federally- and state-funded fatherhood programs that aim to 

increase the quantity and quality of fathers' involvement in their children's lives, improve the 

co-parenting relationship between the child's parents, and support fathers' financial stability. 

Fathers report the connections to other fathers in the class, the class facilitator, and community 

resources, and learning to be patient with their children as the primary value of participating in 

the program. Additional insight to t he value of the program, as reported by fathers, is provided 

in these videos: {https:ljyoutu.be/blwEgSntbQ and https:l/youtu.be/PTfYns3lq04). 

Child & Family Research Partnership 

choldandfamllyresearch.org • lnfo@choldandfamllyresearch.org • 512.471.3536 • Toll Free 8S5.47l.CFRP (2377) 

The University of Texas at Austin • The LSJ School of Public Affairs • P.O. BoxY, Austin, Texas 78713 
77 


33364A.048

CHILD & FAMILY A&S&ARCH PARTNERSHIP 

March 2017 

CFRP 

Engaging Fathers in Home Visiting: Lessons from 

Texas 

Involved fatherhood plays a crucial role in child development, but programs aimed at parenting, 

including home visiting programs are often targeted at mothers. Two evaluations of the 

MIECHV·funded Texas Home Visiting (THV) program demonstrate that fathers engage with 

home visiting programs in many ways, even if they do not attend home visits; program staff can 

increase father participation simply by inviting fathers to participate; and father attendance at 

visits and program events is positively related to family retention. This brief highlights key 

findings from each evaluation. 

Father involvement in children's lives is associated with positive outcomes for children across 

multiple domains, from cognitive development and educational achievement to self-esteem 

and pro-social behavior.s'6 1n response to this growing body of research, policymakers and 

practitioners have become increasingly interested in finding ways to support fathers to be more 

involved with their children. Home visiting programs (HVPs) provide an opportunity to help 

mothers and fathers support their children during a critical time for child development. Despite 

this potential value, HVPs typically only target mothers and little is known about the specific 

strategies that are effective for engaging fathers in programs. 

The Texas Department of Family and Protective Services Prevention and Early Intervention 

(DFPS PEl) division contracted with the Child and Family Research Partnership (CFRP) to conduct 

two evaluations of father participation in home visiting programs. In the first, the goal was to 

develop a better understanding of the strategies that are effective for increasing father 

participation, as well as the family and program characteristics that enhance and limit the 

effectiveness of different father engagement strategies. In the second, the goal was to 

determine whether father participation in home visiting programs is associated with higher 

rates of family retention and whether attrition patterns-including when families leave, which 

families leave, and why families leave-are associated with whether or not fathers participate 

in the program. For both evaluations, CFRP used a mixed-methods approach, analyzing 

childandfamilyresearch.org 1 3 
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33364A.049

administrative and survey data collected from families participating in THV across the state, and 

qualitative data collected through interviews with program staff and focus groups with fathers. 

Findings from both evaluations are highlighted below. 

Father Participation Evaluation 

The Father Participation Evaluation (FPE) was guided by five research questions: 

1. How do fathers participate in home visiting programs? 

2. What are the barriers to father partic.ipation in home visiting programs? 

3. What program strategies are associated with higher levels of father participation in 

home visiting programs? 

4. How do home visitor characteristics enhance and limit the effectiveness of father 

engagement strategies? 

5. How do family characteristics enhance and limit the effectiveness of father 

engagement strategies? 

On average, the MIECHV·funded home visit ing sites in Texas experienced similar levels of father 

participation found in other early childhood programs with a home-based component. There is 

substantial variation, however, in the levels of father participation among the MIECHV-funded 

sites in Texas, and many sites have successfully encouraged relatively high levels of father 

participation among families. Although study design and data limitations prevented CFRP from 

assessing whether the trainings and technical support the state provided had a significant effect 

on home visitors' practices and levels of father participation associated with these practices, 

qualitative analyses of data collected from staff indicate that the trainings encouraged staff to 

prioritize father engagement in a way that they had not done in the past. 

Consistent with prior research, CFRP identified that the main barrier to fathers' participation is 

fathers' work schedules. Some fathers also noted, however, that they did not know they were 

welcome to participate described being hesitant to participate because they perceive the 

program to be more in line with the maternal roles and responsibilities in their family. In 

addition, non-resident fathers and fathers who are not in a relationship with their child's 

mother may face distinct barriers to participation that are not well captured in our study. 

Offering to schedule visits at a time when fathers can attend is the most effective strategy for 

encouraging fathers to attend at least one home visit, which is consistent with parents' reports 

that fathers' work schedules are the largest barrier to father participation. Once a father has 

attended a visit, explaining the benefits of father participation to fathers is the most effective 

approach for increasing the number of visits that he attends. CFRP found that parents' 

relationship is the primary family characteristic that mediates the effect of the father 

engagement strategies, and none of the home visitor characteristics included in this study 

explain the effectiveness of the strategies. 

Based on these analyses, the evaluators recommend that programs interested in encouraging 

father participation use "invite dad" strategies, such as explaining the benefits of father 

participation to parents and offering to schedule visits when fathers can attend. Perhaps the 

childandfamilyresearch.org 1 4 
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33364A.050

simplest strategy that sites can use to increase father participation is for home visitors to 

consistently initiate conversations about engaging fathers with the mothers with whom they 

work. If sites are interested in consistently engaging fathers in home visits they may need to 

make programmatic and policy changes beyond outreach and occasional scheduling 

accommodations, such as adopting more flexible scheduling policies. 

Importantly, the evaluators also learned that the majority of fathers are engaging with the 

home visiting programs in ways that researchers and programs have not traditionally 

measured, suggesting a need to expand measures of father participation in future research to 

more accurately capture the diverse ways fathers are participating in programs. Evidence-based 

home visiting program models should define their measurements based on the curriculum, but 

they may also include measures such as father attendance at program activities, homework 

completed by fathers, lessons mothers re-taught to fathers, or lessons fathers practiced with 

their child or their child's mother. Collecting these more nuanced measures of father 

engagement in the program will be necessary for building a better understanding of the ways 

fathers are participating and for linking father participation to family outcomes. 

Father Participation and Retention Evaluation 

The Father Participation and Retention Evaluation (FPRE) had five research aims: 

1. When do families leave HVPs? 

2. Which families are most likely to leave HVPs before completion? 

3. How do families participate prior to dropping out? 

4. Why do families leave HVPs before completion? 

5. Do these retention patterns vary by father participation? 

To gain a better understanding of attrition in HVPs, CFRP examined when families leave 

HVPs, who leaves, how families participate prior to leaving, and why families leave. Findings 

suggest that higher-risk families, including families with mothers who are poorer and 

younger, receive more visits initially but are more likely to leave prior to one year of 

enrollment and are more likely to leave for undesirable reasons such as home visitors no 

being able to find them. These findings are consistent with prior research on family retention 

in HVPs which found that higher-risk families have greater initial engagement in the 

programs but red uced long-term engagement. 

Finally, CFRP explored the link between father participation and family retention in home visiting. 

Consistent across analyses, father participation, specifically observable participation including 

attendance at home visits or parent/group meetings, was positively linked to family retention. 

The link was still significant even after controll ing for important family characteristics that might 

suggest the link only reflects selection bias-that the families who have engaged fathers have 

certain characteristics that may also make them more likely to participate longer. These findings 

suggest that engaging all family members, particularly fathers, In home visiting programs can 

childandfamilyresearch.org 1 5 
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33364A.051

promote family retention. Although more research is needed, our analysis demonstrates a clear 

association between father participation in HVPs and longer family enrollment. 

Based on these find ings, CFRP developed three recommendations. First, CFRP recommends 

that researchers and practitioners define and measure father participation more broadly 

than simply participation that is visible to HVP staff. Second, CFRP recommends that 

practitioners examine who leaves their program, when, and why in order to develop 

effective and targeted retention strategies for families who may be at the highest risk of 

leaving. Third, CFRP recommends that practitioners focus specifically on engaging fathers in 

home visiting programs as a retention strategy. 

For Additional Information: 

Both mothers and fathers provided important perspectives on father participation In HVPs that 

were collected through surveys and focus groups. Summaries of both perspectives are provided 

here: 

1. lessons from mothers: htte:/{childandfamilyresearch.org/publications/b0010514/ 

2. lessons from fathers: http://www.childandfamilyresearch.org/content/uploads/ 

CFRPBrief B010.0613 HVLessonsFromDadsl.pdf 

C'l (March 2017} Child ond Family Research Partnership, All Rights Reserved. 

The Child and Family Research Partnership (CFRP) ls on Independent, nonportlson research group ot the LBJ School 

of Public A/fairs at The University of Texas at Austin, specializing In issues related to young children, teens, and their 

portf'lts. we engage in rigorous teseorch and evoluorlon work oimed at suengthtt~ing families and enhancing 

public policy. 

childandfamilyresearch.org 1 6 
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33364A.052

Endnotes 

1 Rosenberg, Jeffrey, and Wilcox, w. Bradford. United States Department of Health and Human Services. 

Administration for Children and Families. Child welfare Information Gateway. The Importance ot Fathers in the 

Htolthy Dtvtlopmtnt of Childrtn. Office on Child Abuse and Neglect, U.S. Children's Bureau, 2006. Retrieved from 

https://www.chiJdwelfare.gov/pubs/usermanuals/fatherhood/chaptertwo.cfm; Bronte·Tinkew. Jacinta et al. 

Involvement among Resident Fathers and Links to Infant Cognitive Outcomes. Journal of Family Issues. Volume 29 

Number 9. September, 2008. 1211· 1244.: Cabrera, N. J .. Shannon, J. D .. & Tamis·leMonda, C. (2007). Fathers' 

Influence on Their Children's Cognitive and Emotional Development: From Toddlers to Pre-K. Applied 

DevelopmentoiSCience,ll(4), 208·213: Bla<k, M. M., Oubowitz, H., &Starr, R. H., Jr. (1999). Afri<an Ameri<an 

Fathers In low Income, Urban Families: Development, Behavior, and Home Environment of Their Three·Year·Oid 

Children. Child Development. 70 (4), 967·978.; carlson, Marcia J. and Katherine Magnuson. (2011) Low-Income 

Fathers' Influence on Children. The Annals of the American Academy of Political and Social Science. 635:95. 95· 

116.; carlson, Marcia J .• Sara S. McLanahan, and Jeanne Brooks·Gunn. (2007, September) Fathers' lnvotvement 

and Young Children's Sehavior in Fragile Families. Extended Abstract.: Carlson, Marcia J., Sara s. Mclanahan. (2009, 

May 11) Father1 in Fragile Families. Center for Research on Child wellbeing. Working Paper WP09·14-FF.; Harris, 

Kathleen Mullan, Frank F. Furstenberg, and Jeremy K. Marmer. (1998). Paternal Involvement with Adolescents in 

Intact Families: The Influence of Fathers over the Life Course. Demography. 35 (2), 201·216.: Carlson, M. l. (2006), 

Family Structure, Father Involvement, and Adolescent Behavioral Outcomes. Journal of Marriage and Family, 

68: 137-154. 2 United States Department of Health and Human Services. (2011, July). Promoting Responsible Fatherhood: 

Effective Portntlng. Federal Research Site. Retrieved from http://fatherhood.hhs.gov/Parenting/index.shtml 

) Haskins, R .• & Sawhill, I. (2009). Creating an Opportunity Society. Brookings Institution Press. 191; Solomon-Fears, 

Carmen. (2015). Fatherhood Initiatives: Connecting Fathers to Their Children. (CRS Report No. RL31025). Retrieved 

from Congressional Research Service. https://www.fas.org/sgp/c.rs/misc/RL31025.pdf; Osborne, C .• Workgroup, R. 

F., Austin, J.., Oion, M. R., Oyer, J .• Fagan, J .• & Scott, M. E. Framing the Future of Responsible Fatherhood. 

Evaluation Research for the Fatherhood Research and Practice Network. Responsible Fatherhood Workgroup. 4 1bid. 

' 5arkadi, A., Kristiansson, R., Oberl<laid, F., & Bremberg, S. (2008). Fathers' involvement in children's 

developmental outcomes: a sys:tematic review or longitudinal studies. Acto Poedlotrico, 97, 153·158. 

doi:10.1111/j.1651·2227.2007.00S72.x 

' Rosenberg.. Jeffrey, and Wilcox, w. Bradford. United States Department or Health and Human Services. 

Administration for Children and families. Child Welfare Information Gateway. The Jmpottoflce of Fother$ ifl the 

Healthy Development of Children. Office on Child Abuse and Neglect, U.S. Children's Bureau, 2006. Retrieved from 

https:lfwww.childwelfare.gov/pubs/usermanuals/fatherhood/chaptertwo.cfm; Bronte·Tinkew. Jacinta et at. 

lflvolvemem Amoflg Resideflt Fathers Dfld Liflks to lfi/Dflt Cogflitive Outcomes. Journal of r=amily Issues. Volume 29 

Number 9. September, 2008. 1211·1244.: Cabrera, N. J .. Shannon, J. 0., & Tamis·leMonda, C. (2007). Fathers' 

Influence on Their Children's Cognitive and Emotional Development: From Toddlers to Pre·K. Applied 

Developmental SCience,ll(4), 208·213: Bla<k, M. M., Oubowitz, H., & Starr, R. H., Jr. (1999). African American 

Fathers in Low Income, Urban Families: Development, Behavior, and Home Environment of Their Three·Year-Qid 

Children. Child Development, 70 (4), 967-978.; carlson, Marcia J. and Katherine Magnuson. (2011) Low-Income 

Fathers' Influence on Children. The ANNALS of the American Academy of Political and Social Science. 635:95. 95· 

116.; Carlson, Marcia J., Sara S. Mclanahan. and Jeanne Brooks·Gunn. (2007, September) FatherS"' Involvement 

and Young Children's Behavior in Fragile Families. Extended Abstract.; Carlson, Marcia J., sara S. Mclanahan. 

(2009, May 11) Fathers in Fragile Families. Center for Research on Child Wellbeing. Working Paper WP09·14-FF.: 

Harris, Kathleen Mullan, Frank F. furstenberg, and Jeremy K. Marmer. (1998). Paternal involvement with 

childandfamilyresearch.org 1 7 
82 

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33364A.053

adolescents in intact ramifies: The influence of fathers over the life course. Demography. 35 (2), 201·216.; Carlson, 

M. J. (2006), Family Structure, Father lnvotvement, and Adolescent Behavioral Outcomes. Journal of Marriage and 

Family, 6S: 137-154. 

childandfamilyresea rch.org I 8 
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33364A.054

It 

CHILDREN'S 

HOME SOCIETY o/W4shinttOrl 

OFFKERS 

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"""""' UFETlME TR\ISTEES 

P.-nK•iW 

G..-yf"onti 

t.wta. Sundquist 

March 20,2016 

House \Vays and Means Human Resources Subconunittee 

1102 Longworth HOB 

Washington D.C. 20515 

Dear House Ways and Means Human Resources Subcommittee: 

SEATIU ADMINtSTRATTVE Of'FIUS 

PO 8oX!S19G 

S.#ttllt,WAg(l.us 

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As one of the largest and oldest uouprofi1 children and family service providers in the 

country, Children's Home Socie.tyofWashington is writing in suppo11 of reauthorization 

of the Maternal, l.nfant, and Early Childhood Nome Visiting (MIECHV) Program. We 

bel.ieve that limding for evidence·based home visiting programs is critical to improving 

the Jives or children and their families. 

As leading early teaming provider in the state of Washington. Children's Home Society 

of \Vash.ington offers the MIECHV·funded home visiting model Parents as Teachers, 

which boosts tbe early developmem. learning and heahb of young children by suppo11ing 

and engaging their pa.rents and caregivers. In addition to showing positive outcomes for 

children, Children's Home Society of Washington bas integrated economic mobility 

coaching into Parents as Teachers to help faLnilies move out ofpoverry and reach selfsufficiency. \Ve strongly suppon the reauthoriz.1tion of the M ICCHV program that fimds 

high quality services for children, which are evidence-based, and pro\~ des accotmtability 

in tracking the provision of services and benefits for children. 

We look 

"7\_ s:;' /:).1 forward "7&~-croC~.,...._ __...----. to uOit..t.l' ~ ~~ working 

with you to eosure that MJECHV funding, 

retnaius intact and to continue to explore addjtional illlprovemenrs within MIECHVfhoded programs to etlSIU'e beher outcomes for chiJdren and their families. 11.1a1\k you for 

your contjmaing leadership on behalf of these children. 

Sincerely, 

Sharon Osborne 

President/CEO 

Neal F. Lessenger 

BoardCbair 

cc: Children's Nome Society of Washington Board ofTmstees 

li!Ili CWUI 

·--
84 


33364A.055

Children's 

Institute 

chlldlnst.org 

BOARD OF DIRECTORS 

J•lle Young, Soard Chair 

Chffdren's Advoc.atc 

L~ Hennlon 

Sttlior \Ike Pr0$idcnt · 

ln~Cmettts 

!Mnpq~.ta lnwstments 

Mtrgaret 10t11;patrtck 

Of Counsel 

P"rll t p iG""'p 

Mignon M~lq~~~e 

ChfJdren's AdWc.ntc 

lu u Regenstrttf 

IHR Consultlns. u.c 

GHJCe Rus.seU 

CEO & ProsldOflt 

Gtotgt RU$1011 &AS$otlat>s 

JehnTapogna 

Pte'$ident 

ECOIIOI1llo't$! 

autsTebben 

Principal 

Sapient SoMioM, UC 

Ken Thrasher 

Cbaftmin ol the Board 

CompO 

Natale Vep O'Nel 

Depol)' Vfco ,..,deflt 

&:eaaJ~ Olret:t« 

He•dStart 

Save the Children US 

HlnWalltr 

Pms;dintlo<Jgo 

M"ultnomah Count)' 

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Susan Walda 

fAeart ~e Vb PreJI<IMt 

Tho Campbofl Foundadon 

OaryWitllt" 

&-heVI<o/'rt$ideM 

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EMERilUS BOARD 

Duncan Campbell 

a ... Denhart 

lnfngLeYin 

Altene Schnitzer 

Sw.ttiAdartcar 

Pmldtfflt and C£0 

To: U.S. House Committee on Ways and Means, Human Resources 

Subcommittee 

From: Elena Rivera. Health Policy & Program Advisor, Children's Institute 

Date: March 20, 2017 

Re: In support of ··eauthorizing the Maternal, lnfanr, and Early Childhood 

Home Visiting (MIECHV) program 

Chairman Smith, Ranking Member Davis, and members of the Subcommittee: 

My name is Elena Rivera, and I am the Health Policy & Program Advisor for 

Children's Institute. Children's Institute's mission is to ensure every child in 

Oregon is prepared for school and life. Thank you for the opportunity to 

provide testimony in support of reauthorizing the Maternal, Infant, and Early 

Childhood Home Visiting (MIECHV) program. Children's Institute champions 

early investments in kids and families from prenatal care to age eight to boost 

education and health outcomes for all of Oregon's children. My testimony 

reflects the perspective of a state that has benefited greatly from the M I ECHV 

program and deeply understands the value of voluntary, evidence· based home 

visiting services in driving positive outcomes for kids and families. 

The importance of maternal, infant, and early childhood home visiting 

We know children experience their most profound cognitive, physical, social, 

and emotiona l growth in the first few years of life. Over 80 percent of brain 

development takes place by the time children reach three years old. When 

young children live in stable and healthy environments and have nurturing 

caregivers, they are more likely to be healthy and meet developmental 

milestones. The quality of children's early experiences during this crucia l 

period of growth sets the foundation for all future learning and lifelong health. 

Maternal, infant, and early childhood home visiting is a critical inte1vention for 

vulnerable families. Home visiting promotes healthy child development by 

serving expectant parents and their children through the first few years of life. 

Programs match skilled home visitors with families facing risk for poor 

outcomes to offer parents resources. information, and tools that strengthen 

parent-child relationships, ensure children are getting the health care they 

need, and promote early learning. Home visiting programs intervene early to 

prevent and reduce adverse childhood experiences that could have lifelong 

impacts on health, education, and economic outcomes, thereby saving the 

state millions in costly in terventions later down the road and promoting a 

healthy and productive wor force.~" 

MIECHV home visiting is a critical piece of Oregon's early childhood 

system 

1411 SW Mofrison St. Suite 205 • Portland. Oregon 97205 • 503.219.9034 • into@childi,.torg 
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Children's lnstit\Jte 

Page 2 

Oregon has been awarded MIECHV funding since the initiation of the program 

in 2010. With this federal funding. our state serves vulnerable children and 

families in 13 counties through three evidence-based programs: Healthy 

Families Oregon, Nurse Family Partnership, and Early Head Start. 

In Oregon, MIECHV programs have directly improved maternal and newborn 

health, decreased child injuries, abuse and neglect, decreased emergency room 

visits, increased child school readiness, decreased crime and domestic 

violence, and increased family economi c self-sufficiency.'U 

In addition to these outcomes of direct service provision, the MIECHV program 

has also been instrumental in driving system development work to build a 

comprehensive early childhood system that truly works for children and 

families. Oregon's MIECHV program is working to a lign with other statefunded home visiting programs, building collaboration w ith new regional 

Early Leaming Hubs and Coordinated Care Organizations, and creating a more 

robust home visiting and early childhood data system. The value of this work 

cannot be overstated. 

Reau thorize the MIECHV p rogram 

Oregon has achieved incredible progress in reaching children and families 

with critical and cost-effective home visiting services and in building an 

evolving comprehensive early child hood system. This work would not be 

possible without the MIECHV program. I urge the Subcommittee to strongly 

support reauthorization of the MIECHV program to ensure that progress in 

supporting maternal and child health and success across the country is not 

stalled. 

' Oregon Health Authority. Building Resiliency: Preventing Adverse Childhood 

Experiences. 

bttps·//public health o regon goy/HcalthyPcoplcEarojljcs/DataRcports/Documcnts/0 

reeonACEsReoort.pd[ 

• Nurse Family Partnership. What is Evidence-Based Policy? Using Public Dollars 

Wisely to Support Programs that Work. 

http· //www oyrscrarnjlypartngrshlp OC21Public·Poljcy/Eyidencc·based·oolicy 

111 Health Resources and Services Administration. Horne Visiting Program: Oregon. 

2015. 
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. · ... · . . :::easterseals ... . . .... •. 

STATEMENT TO THE 

U.S. HOUSE WAYS AND MEANS 

HUMAN RESOURCES SUBCOMMITTEE 

ON REAUTHORIZATION OF THE MATERJ.'lAL, INFANT AND EARLY 

CHILDHOOD HOME VISITING (MlECHV) PROGRAM 

BY 

MAYNARD FRIESZ 

ASSISTANT VICE PRESIDENT, GOVERNMENT RELATIONS 

EASTERSEALS, INC. 

MARCH 15, 2017 

Chainnan Smith, Ranking Member Davis, and Members oftbe Snbconunittee: 

I am pleased to share Easterseals' strong support of the Maternal, Infant, and Early Childhood 

Home Visiting (MlECHV) Program and to provide examples of how our community-based 

affiliates are using MIECHV funds to improve the lives of children and families all across the 

coumry. Easterseals appreciates your leadership on the MlECHV reauthorization and 

respectfully asks that you take immediate steps to extend and fully fund the MlECHV Program. 

Eastcrseals is a leading non-profit organization committed to helping individuals with disabilities 

and others reach their potential and thrive in their conuuunities. Easterseals provides lifechanging, community-based services, including home visiting, early childhood and other 

MlECHV-funded supports, to individuals and their families through a national network of75 

affiliates. More than one million people benefit annually from Easterseals services. 

As a leading provider of child development and early intervention services, Easterseals 

understands that the first years of life lay the foundation for a child's long-tenu well-being and 

overall success. As part of our Make The Firs/ Five Coun1 national campaign, Easterseals offers 

a free, comprehensive and confidential online screening tool for parents to track their children's 

growth and development. The tool has helped families understand and cotlllect to available 

c-onununity services to help support their child's development. Research also shows that young 

families with regular and early access to a nurse, social worker or other trained professional 

improves health and child development outcomes and reduces child abuse and neglect.; 

Office of Public Affairs • 1425 K Street NW, Suite 200, Washington, DC 20005 • P 202.347.3066 • f 202.737.7914 

easterseals.com 
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:::: ... ~asterseals . . .· ... •. 

Easterseals Written Testimony in Support ofSCSEP & HVRP 

March 8, 20 I 7 

Pagel 

Congress created MIECHV to help meet the needs of and improve the well-being of low-income, 

expectant families and families with young children through voluntary home visiting and 

counseling services. Through the program, states, territories and tribal entities receive federal 

funding to deploy evidence-based home visiting models and promising approaches to help 

families from at-risk communities with high concentrations of poverty, crime, unemployment, 

substance abuse, high school drop-outs, and infant mortality. More than 9 12,000 home visits 

were made to families across the country as a result of MIECHV funding.;; In addition to 

improved child development, the home visits and counseling were instrumental in helping to 

increase parental eamings and to reduce emergency room visits and need for public benefits.;;; 

States regularly partner with community providers, such as Easterscals, to implement MIECHV 

best practices. Across the country, Easterseals uses MIECHV funding to improve lives and to 

demonstrate a strong return on investment. 

ALABAMA: Easterseals Alabama assists families in western Alabama through two MIECHVfuoded best practice models: Parents as Teachers (PAT) and Nurse-Family Partnership (NFP). 

Easterscals' PAT provides information and support to families in need in an ll·coumy area near 

Tuscaloosa. Easterscals West Alabama specialists help empower parents to recognize and 

support key child development milestones and to prepare their children for school. Easterseals 

West Alabama works with more than 150 families and over 200 children each year through PAT. 

NFP provides maternal and early childhood health support to vulnerable first-time moms in 

Tuscaloosa County. Titrough the program, a specially trained nurse meets with the mothers 

during pregnancy and until the baby tunJs two to help lay the foundation for parental and 

childhood success. Nationwide, NFP has been successful in promoting child health through 

healthy binh weights and immunizations.iv Easterscals West Alabama assists about 75 mothers 

annually through NFP. 

ARIZONA: Easterseals Blake Foundation provides employment, behavior health, and 

supportive and community living supports to individuals with disabilities and others from 

Arizona. Easterseals Blake Foundation provides Parents as Teachers support to families liviJlg in 

Cochise, Pima, Pinal and Yuma counties. In addition, Easterseals family specialists assist firsttime pregnant mothers in Pima County through NFP. Yasmen was one of the mothers who has 

participated in and benefited from Easterseals' supports through the MIECHV·funded NurseFamily Partnership best practice. She was paired with an Easterseals Blake Foundation nurse 

during her pregnancy, wh.ich was a time of great transition and hardship for Yasmeo bavi.ng been 

placed in the care of extended fami ly members. Despite the challenges, Yasmen was coJlllllitted 

to being a great mom. She fully engaged in NFP classes and activities, receiving guidance, parent 

coaching and individualized support. She maintained a healthy, full-tcrrn pregnancy, delivering 

Mario, a beautiful, healthy young boy. Detennined to create a beuer future for her family, 

Yasmen finished high school on-schedule and completed multiple college credits. She earned her 

Early Childhood Studies Certification- which she uses as a child care teacher- and plans to 

pursue further education in her chosen field. Her and Mario are on the road to success as a result 

ofMIECHV investments. 

Office ofl'ubtic Affairs· 1425 K Su-eel NW, Sui1e 200, Washinglon, DC20005 • I' 202.347.3066 • F 202.737.7914 

easterseals.com 
88 

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:::: ... ~asterseals . . .· ... •. 

Easterseals Written Testimony in Support ofSCSEP & HVRP 

March 8, 20 I 7 

Page3 

ILLINOIS: Easterseals Serving Chicagoland & Rockford provides inclusive child care, autism, 

family support, and adult services for individuals with disabilities and families. In lllinois' 

Winnebago County, Easterseals Serving Chicagoland & Rockford promotes health and stable 

families by providing parenting and prenatal education, infant health counseling and home 

visiting to pregnant teenagers and young teen mothers living in Rockford and other Willllebago 

County communities. Administered by the Winnebago County Health Department, the evidence· 

based Teen Family Support Program has helped hundreds of teen parents like Triasia. About to 

give birth, the Rockford teen found it difficult to focus on her school work and felt overwhelmed 

by the responsibility of caring for a child. Easterseals specialists colltlected Triasia to a birth 

support partner and provided counseling and educational resources to prepare her for success in 

motherhood. While taking care of her daughter, Brooklynn, Triasia finished high school and 

today is working and anending college to be an elementary schoolteacher. 

TEXAS: Easterseals Rio Grande Valley located in McAllen, Texas provides a range of services 

for children and adults with disabilities, including child care, early childhood intervention and 

adult therapy services. In addition, Easterseals Rio Grande Valley specializes in providing Texas 

families with the skills, infonnation and supports they need to raise their young children with and 

without disabilities. Easterseals partners with the Texas Depanment of Health and Human 

Services on its Texas Home Visiting program, which uses four evidence-based models to assist 

eligible families. llrrough the program's Parents as Teachers model, Easterseals specialists work 

with parents through one·on·one and group meetings to address needs and provide parenting 

support. Easterseals Rio Grande Valley also helps prepare young children for kindergarten 

through reading, couming and other at-home educational activities. 

Congress last authorized and funded the Maternal, Infant and Early Childhood Home Visiting 

(MIECHV) Program through the Medicare Access and CHIP Reauthorization Act of2015 (P.L. 

114·1 0). Easterseals supported this bipartisan effort and urges the !15th Congress to expand 

access for at-risk families to MIECHV parenting supports and trained professionals. Thank you 

for your support of children and families and for your consideration of Easterseals' views on and 

support of a long-ten11 reauthorization ofMlECHV. 

1 Depar1ment of Health and Human Services. FY 2017 HRSA Budget Justification. 

https·ttwww hrsa.0ov/aboullbudget/budgetjustificalion2017 odf 

" Depar1ment of Health and Human Services. FY 2017 HRSA Budget Justification. 

https:ttwww.hrsa.gov/aboullbudget/budgetjustification2017.odf 

"' Depar1ment of Health and Human Services, FY 2017 HRSA Budget Justification, 

httos:/twww.hrsa.gov/aboullbudget/budgeliustification2017.odf 

lv NFP in Alabama Fact Sheet, 

http:/twww.nursefamilyoartnership.ora/getaltachmentJlocations/Aiabama/AL State Profile.(! l.pdf.aspx 

Office of Public Affairs· 1425 K Su-eel NW, Sui1e 200, Washinglon, DC20005 • I' 202.347.3066 • F 202.737.7914 

easterseals.com 
89 


33364A.060

Statement for the Record: Harvard Police Department Chief John Smith & Gage 

County Sheriff Millard Gustafson, Nebraska 

House Ways & Means Subcommittee on Human Resources 

Hearing on Maternal, Infant, and Early Childhood Home Visiting (MIECHV) 

March 15, 2017 I 10:00 am 

How Home Visiting Increases the Health and Wellness of our Communities 

A police chief and sheriff in Nebraska make the case for reauthorizing the Maternal, 

Infant, and Early Childhood Home Visiting (MIECHV) Program 

Approximately 3,500 children experience abuse or neglect each year in Nebraska. In our 

more than 50 combined years of law enforcement, we have seen many d ifficult 

scenarios involving these children. What is not immediately visible in these situations is 

that there are longer-term repercussions to child abuse and neglect. Children who are 

abused and neglected are twice as likely to become involved in crime later in life. 

However, if we reach out to families early, many child abuse and neglect cases are 

preventable. Guidance and support provided by advisors to parents in the early years of 

a child's life can make all the difference. 

In voluntary home visiting, a coaching relationship between young parents and trained 

experts is developed. A professional who specializes in early childhood issues partners 

with parents to lay a strong foundation for the child's success. In home visiting, new 

moms and dads receive counseling and support on a range of critical parenting skills 

from pregnancy through the first years of the child's life. 

Often times, it is everyday situations that are the greatest stressors of new parents. 

Having knowledge of what action to take when a baby will not stop crying, guidance for 

when a child is teething, proper sleeping positions, how to childproof a home; new 

parents often stumble and need help. Infants do not come with instruction manuals and 

coaching of vital daily skills increases the child's chance of good health and well ness. 

The program, known as the Maternal, Infant, and Early Childhood Home Visiting 

(MIECHV) program, is not only common sense but evidence-based. MIECHV allocates 75 

percent of funding to proven home visit ing programs and 25 percent to promising 

programs undergoing rigorous evaluation. Ways & Means Human Resources 

Subcommittee Chairman Adrian Smith noted the effectiveness of these models in 

improving family outcomes in a hometown site visit with Healthy Families America. 

1212 NtwYor1t Av•nut NW I Suite 300 / Washington. DC 20005 1202.464.7005 

SlrongNation org/FightCrime C FightCrime 0 FightCrimetnvest 
90 

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The benefits are far reaching. extending from family to community, with a demonstrable 

fiscal impact. A study of the Early Head Start program found that mothers who received 

home visits increased their earnings by $3,600 a year, likely because the program helped 

connect them with education and jobs. As a result of crime reductions and other 

outcomes, a cost-benefit analysis by the Nurse-Family Partnership found that highquality home visiting programs achieve average savings of $6,000 for each family 

served, and welfare savings of $14,500 per family over a decade. 

Home visiting is more than just a solution for one family, or one at-risk child. It is a 

solution for communities here in Nebraska, and across the country. This fall, Congress 

must act to reauthorize MIECHV and make decisions about its funding moving forward. 

We urge all representatives to contemplate the value of preventing abuse and neglect, 

preventing crime, and increasing the health and wellness of our communities. It is 

working here in Nebraska. 

John Smith is Chief of the Harvard Police Deportment and Sheriff Millard Gustafson of 

the Gage County Sheriffs Office. They ore both members of the notional anti-crime 

organization, Fight Crime: Invest in Kids. 

StroogNation.orgJFightCrlme 
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33364A.062

UPMC LIFE 

CHANGING 

MEDICINE 

March 27, 2017 

House Ways and Means Committee 

11 02 Longworth HOB 

Washington, DC 20515 

Dear Chairman Smith, Ranking Member Davis, and members of the subcommittee, 

As the Director of Home Nursing Agency's Nurse-Family Partnership Program®, I 

wholeheartedly agree with the House Ways and Means Human Resources 

Subcommittee Chairman Adrian Smith that for a home visiting model to be funded, an 

evaluation must show the program has demonstrated significant, positive 

outcomes in areas such as reducing child abuse and neglect, improving 

maternal and child health, and improving economic self-sufficiency. We 

appreciate the opportunity to share how one central Pennsylvania mother established 

economic self-sufficiency, a healthy and thriving family and who is now "paying it 

forward'' as a result of the mentorship provided by her Nurse Home Visitor. 

Nurse-Family Partnership and Home Nursing Agency Background: NurseFamily Partnership operates in 42 states with goals of healthy pregnancy 

outcomes, healthy child development and a positive life course development. 

During visits, nurses bring information on topics that the mother chooses to 

discuss in a comfortable, conversational style. A national, evidence-based 

program for first-time pregnant mothers that provide home visits and mentorship 

by a registered nurse, the Nurse-Family Partnership program is free for mothers 

and provides support from pregnancy through the child's second birthday. 

Home Nursing Agency has evolved into a trusted leader in the community health 

network with nearly 1,000 employees serving more than 21,500 people throughout 

Page 1 
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UPMC LIFE 

CHANGING 

MEDICINE 

western and central Pennsylvania. Also, the Agency has maintained its unwavering 

pledge to deliver uncompromising patient care despite the challenges and adversities 

on the healthcare front The Agency's ability to serve was strengthened in 2013 when 

the Home Nursing Agency became part of UPMC Community Provider Services, 

which specializes in post-acute services. 

Since Home Nursing Agency began offering Nurse-Family Partnership in 

2002, more than 1,500 families have benefited from this free and voluntary 

program offering nurse home visitation. We serve families in the following 

counties: Blair, Cambria, Centre, Clearfield, Huntingdon and Jefferson. 

Home Nursing Agency's Nurse-Family Partnership® program marks ten years of 

serving first-time mothers in Cambria County in Pennsylvania. In January, the 

program also surpassed the milestone of serving more than 500 Cambria County 

clients. 

"I was so nervous and scared when I found out I was pregnant The first baby I ever 

held was my own," explains Cambria County resident Megan, who praises her Nurse 

Home Visitor Chrissy with helping her through her pregnancy and her daughter 

Dandelion's early days. 

"My husband and I got all of our questions answered." 

Megan credits Chrissy with building her confidence as a mother, which led to 

pursuing a position as breastfeeding peer counselor for Cambria County WIC 

(Women, Infants and Children), where she now empowers other young 

mothers. 

Page 2 
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UPMC LIFE 

CHANGING 

MEDICINE 

In addition to providing reassurance and answering her medical questions, Chrissy 

became a cheerleader and advocate who helped Megan to grow and recognize her 

own potential. 

"NFP gave me more confidence as a mom," she says. "Chrissy would always 

affirm me and tell me what I was doing right, and she gave me a lot of 

confidence. That was part of why I reached out to look for a job." 

While Megan desired to work outside the home to help support her family, she 

knew daycare costs would undercut her efforts. Chrissy shared the option of 

subsidy for eligible parents, and she helped Megan to look for a trustworthy 

daycare for her daughter. 

"When I saw the ad in the paper for a Breastfeeding Peer Counselor for WIC 

[Women, Infants and Children], I thought that was something I can do," Megan 

said. Now she uses the affirmative and supportive techniques she learned 

from NFP to impact the lives of her clients. 

"My role is personal like Chrissy's was with me. As I get to know my clients, they 

open up more to me. My favorite thing is that I can empower women to 

believe in themselves. They just need support to believe that." 

"The key to Nurse-Family Partnership's success is the positive relationship 

that develops between the mother and her nurse," explains Lois Schultz, 

supervisor of Cambria County Nurse-Family Partnership who admitted the first 

client ten years ago. 

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UPMC LIFE 

CHANGING 

MEDICINE 

"The mother and her nurse really get to know each other so the nurse can provide 

information and support that is very helpful for the mother and tailored to her 

needs." 

We know the MIECHV program is an evidence-based program that helps to 

improve the lives of families in at-risk communities. Unlike most federal social 

programs, MIECHV funding is tied to real results like Megan. 

House Republicans have long called for more programs to follow this evidencebased approach to ensure limited taxpayer dollars are actually delivering the 

intended results and helping those most in need. In fact, the House Republican "A 

Better Way to Fight Poverty" agenda specifically calls for more programs to 

replicate MIECHV's approach. 

Thank you for the opportunity to submit testimony and to share Megan's story as 

the committee considers the reauthorization of MIECHV funding. 

Respectfully submitted, 

Lisa Ritchey, BSN, RN 

Director of Nurse-Family Partnership® 

Blair, Huntingdon, Centre, Cambria, Clearfield and Jefferson Counties 

I HOME NURSING AGENCY P~rtoiUPMC 

~ ~\ll'<·family r- \ Partnership .._/ ~ -""'-' '--"· 

500 East Ches1nutAIII!flue, Altoona, PA 16601 

P: 1.1100.315.4358/P: 814-942-1903/ F: 814.505.1100 

lha!loy,@homenursingagency.com www.ho!pevursinqagency.com 

QUAU rY & SAFETY I PIGN• 1Y .l ,f 'LL I CARING 8: USTENING I R£SPONSIBIUTY & FNTEGRI'TY I EXCEu.ENCE& fNNOVA110 N 

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~ .IH'o'Me VISITING 

CC6LIUON' 

Hearing on the Reauthorization of the Maternal, Infant, Early Childhood Home Visiting 

(MIECHV) Program 

Statement for the Record 

Submitted by 

The Home Visiting Coalition 

3/29/2017 

Chairman Smith, Ranking Member Davis, and members of the House of Representatives 

Conmuttee on Ways and Means, Subcommittee on Human Resources: The Home Visiting 

Coalition, a diverse group of nearly 50 organizations working to promote continued federal 

investment in evidence-based home visiting, is honored to subnlit testimony in strong support of 

the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program. 

The investments that we make in our people today will pay dividends in the future. Nowhere is 

that statement truer than with children. Our children are the en1bodiment of our ideals and the 

promise of our nation. Iconic leaders of our nation have always focused on family. President 

Ronald Reagan said "The fami ly has always been the cornerstone of American society. Our 

fanulies nurture, preserve, and pass on to each succeeding generation the values we share and 

cherish, values that are the foundation of our freedoms." In that same vein, President John F. 

Kennedy said "Children are living messages we send to a time we will not see." 

Home visitors help families send positive messages to future generations. By using practices 

proven to work, these talented providers bring to the surface the innate gifts parents possess to 

nurture children to become healthy, well adjusted, and ready to learn. The home visiting 

conmmnity knows that no parent is perfect, but believes that with the appropriate support, each 

parent can be the best parent for their child, and parents are ideally suited to be their baby's first 

and best teacher. 

The Home Visiting Coalition commends you on your conmutment to reauthorizing the MIECHV 

program. Home visiting programs provide support to vulnerable families in the earliest stages of 

their child's life to lay the foundation for the health, education, and social development and 

success of the entire fauilly. The birth of a child introduces new challenges for every fanuly. But 

for fanlilies facing poverty, a lack of education, and isolation from community resources, life can 

begin to feel overwhelming. To help more families achieve stability and to reach more children 

and communities, the Home Visiting Coalition recommends that MIECHV be reauthorized for a 

minimum of 5 years, with incremental increases in funding, over five years, until the program 

reaches $800 million per year. 

1 
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When Congress enacted the MIECHV program, families who may bave felt like they were going 

it alone bad a sense of community restored. MIECHV changed tbe reality in higb needs areas 

around the country, from one of isolation and families doing their best to get by, to a reality 

where there are people ready to help parents to do their best in proven and time honored ways. 

MIECHV supports families through home visitors who respect parent's rights, instincts, and 

traditions. MIECHV puts families first to strengthen co111111unities and improve outcomes for 

kids and their families. 

A cornerstone of evidence-based public policy, MIECHV provides funds for developing and 

implementing voluntary, evidence-based home visiting programs. Programs must meet at least 

four of six evidence-based benchmarks to qualify for use of federal funds. The benchmarks 

include: improving maternal and newborn health; reducing child injuries, abuse, and neglect; 

improving school readiness and achievement; reducing crime or domestic violence; improving 

family economic self-sufficiency; and improving coordination and referral for other community 

resources. According to the Health Resources and Services Administration (HRSA), as of2015, 

83% ofMIECHV grantees demonstrated overaU improven1elll in benchmark areas (HRSA, 

20 16); 81% ofMIECHV grantees demonstrated improvements in maternal and newborn health; 

85% ofMIECHV grantees demonstrated improvements in school readiness and achievement; 

and 85% ofMIECHV grantees demonstrated improvements in family economic self-sufficiency. 

Screenings for developmental delays in young children are twice the national average in 18 states 

with MIECHV progratns. 

In addition, several studies have proven that home visiting programs show a substantial return on 

investment, which may later save on state and federal expenditures. The Nurse Family 

Partnership (NFP) bas a benefit-cost ratio of up to $5.70 per dollar invested (Karoly, Kilburn, & 

Cannon, 2005). The Durham Connects program model bas a community benefit-cost ratio of up 

to 3.01 per dollar invested (Dodge, et al., 2014). Parents as Teachers (PAT) has an estimated 

benefit-cost ratio of3.39 per dollar invested (Washington State Institute for Public Policy, 2015). 

The aforementioned results are just a part of the reason that MIECHV enjoys bipartisan support. 

MIECHV funds 17 scientifically proven models that strengthen families over time, and families' 

participation is fully voluntary. Importantly, state and local grantees detem1ine the best way to 

use MIECHV funding to effectively address the unique needs of their communities. 

More than anything, it is the real people and families that have made this progran1 so strong. 

Parents like Elizabeth Eddings, a mother of three originally from Alabama, are anxiously 

awaiting news that Congress has voted to once again support MIECHV. Ms. Eddings voluntarily 

enrolled in the home visiting program Parents as Teachers. 

Through those regular visits with a trained parent educator, she was able to escape a damaging 

relationship, secure health interventions for her child, and sta11 down the path to economic selfsufficiency. 

2 
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"Thanks to my home visitor, who I understand is supponed through the MIECHV program, my 

son has the help he needs," says Ms. Eddings. "That's why I'm in a position today to share with 

you why this program is so valuable to families and communities." Ms. Eddings, along with 

thousands of other moms and dads across the country, is encouraged to know that the Ways and 

Means Committee's Human Resources Subcommittee has beg11n the work to reauthorize 

MIECHV. 

Without timely reauthorization, the critical services provided by MIECHV -supported home 

visiting programs will be drastically limited for families in need. Home visiting can make all the 

difference in the lives of individual families and, by extension, entire collllllunities, breaking 

generations-long cycles of poveny, addiction, abuse, and despair. Regular visits by caring, 

experienced professionals can help parents tum their good intentions into solid parenting and 

coping skills. We are excited that the Ways and Means Committee is so strongly in favor of the 

MIECHV program and look forward to working with you further to reauthorize this essential 

program. 

Thank you for the opportunity to submit this statement for the record. 

The Home Visiting Coalition: 

Alliance for Early Success 

Alliance for Strong Families and Communities 

American Academy of Pediatrics 

American Psychological Association 

Association of Maternal & Child Health Programs (AMCHP) 

Association of State and Territorial Health Officials (ASTHO) 

Center for Law and Social Policy (CLASP) 

Child Care Aware of America 

Child First 

Children's Defense Fund 

Child Welfare League of America 

Dalton Daley Group (DOG) 

Division for Early Childhood of the Council for Exceptional Children 

Early Intervention Program for Adolescent Mothers 

Easterseals 

Family Check-Up 

Family Spirit 

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First 5 Association of California 

First 5 California 

First 5 LA 

First Five Years Fund (FFYF) 

First Focus 

Futures Without Violence 

Healthy Families America (HFA)/Prevent Child Abuse America (PCA) 

Home Instruction for Parents of Preschool Yotmgsters (HIPPY USA) 

IDEA Infant Toddler Coordinators Association (ITCA) 

Institute for Child Success 

March ofDimes 

National Alliance of Children's Trust & Prevention Funds 

National Association of Counties (NACo) 

National Association of County and City Health Officials (NACCHO) 

National Association of Nurse Practitioners 

National Head Start Association (NHSA) 

Nemours Children's Health System 

Nurse-Family Partnership (NFP) 

Ounce of Prevention Fund 

Parent-Child Home Program 

Parents as Teachers (PAT) 

Partnership for America's Children 

Play & Learning Strategies (PALS) 

SafeCare 

Save the Children 

Save the Children Action Network 

The Children's Partnership 

The National Campaign to Prevent Teen & Unplanned Pregnancy 

United Way Worldwide 

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The Johns Hopkins Center for American Indian Health is grateful to share its perspective on how 

important the MIECHV Program is for all Americans. There is strong evidence that homevisiting works to improve health and well-being for mothers and young children, particularly the 

youngest, poorest single mothers. We hope to share one perspective on how home-visiting is 

critical to breaking intergenerational cycles of substance use risk. 

Background: Johns Hopkins Cente1· for American Indian Health 

The Johns Hopkins Center for American Indian Health ~JHCAIH) is part of the Johns Hopkins 

Bloomberg School of Public Health, celebrating its I OO'' anniversary as the oldest and largest 

school of public health. JHCAIH was founded in 199 1 to work in partnership with American 

Indian and Alaska Native communities to create sustainable solutions to overcome hea lth 

disparities and promote health leadership and autonomy. 

American Indian Youth Behavioral/Mental Health Disparities 

Leading disparities affecting American Indian (AI) youth at the time of MIECHV legislation and 

still today include high rates of teen pregnancy, substance use, suicide, and school dropout. Led 

by substance abuse, these and other behavioral/mental health disparities in reservation-based 

communities lead to a high burden of years of productive life lost. These disparities are 

transferred to futme generations in a cycle of despair that is perpetuated by high rates of teen 

pregnancy and challenging home environments. 

Breaking the Cycle with Home-Visiting 

To break this cycle, Family Spirit was developed in partnership with the White Mountain and 

San Carlos Apache Tribes and Navajo Nation as the first home-visiting intervention designed to 

address behavioral health disparities specifically among Als. There are two important and highly 

effective design features of Family Spirit that were necessitated by working in tribal 

communities: 

I. Family Spirit engages the local workforce capacity by employing paraprofessionals from 

the community to address a shortage of nurses and overcome language barriers. Tribal 

leaders knew that culturally-embedded change agents would be most effective, and, of 

course, many are mothers themselves. 

2. Family Spirit was designed not just to tackle improved parenting but to work across 

generations to be sure mothers' behavioral health issues don't impede their ability to 

parent effectively. 

The resulting Family Spirit Program is highly structured and strengths-based. 

The Family Spirit trials sought to evaluate the intervention's effect on parental competence and 

maternal behavioral problems that impede effective parenting from birth to 36 months 

THE JOHNS HOPKINS SCHOOL OF PUBLIC HEALTH 

415 N. Washington Street. 4th Floor. Baltimore. MD 21231 jhsph.edu/CAtH 1 
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postpartum and early childhood emotional and behavioral outcomes that predict risk for future 

substance use and related behavior problems. Thus, while Family Spirit was built from the 

ground up with rural reservation tribal communities, it has some vital importance to other U.S. 

populations. 

From P1·omising to Evidence-Based Practice: An lte•·ativc Process 

Since evaluation of the Family Spirit Program began, a body of literature has been published to 

support it as an evidence-based program. A summary of publications is provided at the end of 

this statement, along with links to each joumal article. 

It took two decades of iterative work and three randomized controlled trials to design and prove 

Family Spirit. When the MlECHV legislation was passed, Family Spirit was still a "promising" 

but not evidence-based program. However, the third trial, called Cradling Our Furure, which 

took place during the first phase of MlECHV, launched Family Spirit to evidence-based status. 

Family Spirit is now endorsed by both Hom VEE and SAMHSA NREPP as evidence-based, 

which has led to tremendous scaling. 

Family Spi•·it Impact: Pregnancy to Age 3 

Mothers who received the Family Spirit intervention experienced significantly better parenting 

competencies and lower parenting stress. Simultaneously, they had decreased depression, 

substance use and related risk behaviors. And, as we had hoped, their children bad significant! y 

improve child behavior outcomes that predict fewer health disparities across their life span. 

Family Spirit children experienced highly significant and clinically relevant drops in 

developmenta l problems in three key domains (extemalizing- aggression and impulsivity, 

intema lizing- anxiety and depression, and dysregulation- fussy, disordered sleep and eating). 

Family Spirit children also met or fell below national nonns for these behaviors despite living in 

the poorest and most stressed communities in America. 

These early childhood behavior impacts extend across a child's lifespan. We know that children 

with poor extemalizing and intemalizing problems can later experience early onset substance use 

problems; young, risky first sex; poorer academic achievement; risk of suicide; and adolescent 

depression- all linked to the major health disparities affecting AI adolescents today. 

What's Next fo•· Family Spirit 

Family Spirit bas been replicated in over 80 communities across 16 U.S. states, itlcluding two 

non-Native sites- Chicago, Illinois and St. Louis, Missouri. 

New modules are in progress to address other identified disparities, including early childhood 

obesity (RO l funding from NIH to study new module) and early childhood caries (four times 

more prevalent among AIIANs than U.S. general population. 

Further, we aim to digitize Family Spirit. This is includes a pre-screening tool that would allow 

us to tailor the intervention to enrolled families. We also aim to adapt the curriculum for use on a 

digital platfonn. 

THE JOHNS HOPKINS SCHOOL OF PUBLIC HEALTH 

415 N. Washington Street. 4th Floor. Baltimore. MD 21231 

jhsph.edu/CAIH 2 
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33364A.072

~'36. JOHNS H OPKINS 4.AA.A. U CENTER FOR AMERICAN 

INDIAN HEALTH 

The Powe1· of Home-Visiting and the C1·itical Role of MIECHV 

M1ECHV is truly saving lives for generations to come. We k.n at home-visiting works, and 

there is still work to do. C un·ently, n early 20% of Family Spirit affiliate contmcts are 

funded th1·ough the MIECHV Prog•·am. 

Family Spirit's Training and Implementation Manager reflects on the impact she has seen homevisiting have on the lives of families. One of the first mothers that she recruited as a home visitor 

was living in a place where she bad no access to electricity, running water, or reliable 

transportation. She struggled as a single parent and credits her home visitor and the Family Spirit 

Program for learning to love being a mother. She says "Back then, I was ashamed of where I 

came from. As a Native American, we're at the botiom of the list. And now to be able to stand 

up and say 'I am a Native American, and I love being American. That's where I come from. 

That's my land.' This young mother knows that her positive outlook on life and confidence in 

raising her children and following her own dreams is going to impact her children, their children, 

and generations to come. 

Here is a link to the full story of this mother as told by her home visitor: 

https://www.youtube.com/watch?,=uDK 7c990c6c 

Summary of Family Spirit Publications (authors names have been removed to comply with 

submission guidelines) 

OUTCOMES 

These papers describe characteristics of the Family Spirit intervention and its effectiveness in 

improving parenting outcomes and mothers' and children's emotional and behavioral functioning 

from pregnancy to 3 years postpartum. 

I. Home-visiting intervention to improve child care among American Indian adolescent 

mothers: A randomized trial. Arch Pediatr Adolesc Med. 2006; 160(11):1101-1107. 

2. Randomized controlled trial of a paraprofessional-delivered in-home intervention for 

voung reservation-based American Indian mothers. J Am Acad Child Adolesc Psychiatry. 

2009;48(6):591-60 1. 

3. Effect of a Paraprofessional Home-Visiting Intervention on American Indian Teen 

Mothers' and Infants' Behavioral Risks: A Randomi zed Controlled Trial. American 

Journal of Psychiatry 20 13; 170:83- 93. 

4. Paraprofessional Delivered. Home-Visiting Intervention for American Indian Teen 

Mothers and Children: Three-Year Outcomes from a Randomized Controlled 

Trial. American Journal of Psychiatry. 20 15; 172(2): 154-162. doi: 

I 0.1!76/appi.ajp.20 14.14030332. 

METHODS 

This paper describes the rationale, design, methods, and baseline results of the definitive 

randomized controlled trial of the Family Spirit Program. 

THE JOHNS HOPKINS SCHOOL OF PUBLIC HEALTH 

415 N. Washington Street. 4th Floor. Baltimore. MD 21231 jhsph.edu/CAIH 3 
102 

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5. 1l1e Family Spirit trial for American fndian teen mothers and their children: CBPR 

rationale. design. methods and baseline characteristics. Prev Sci. 2012: 13(5}:504-518. 

EXAMII'HNG DRUG USE 

This paper describes correlates of meth use in a sample of pregnant American Indian teens from 

a Family Spirit trial. It focuses on sociodemographic, fami lial, and cultural factors and use of 

other drugs. 

6. Examining correlates of methamphetamine and other drug use in pregnant American 

Indian adolescents. American Indian and Alaska Native Mental Health Researcb.The 

Journal of the National Center. 20 10; 17(1): 1-24. 

EDITORIALS 

The first editorial was written in response to the 2009 Family Spirit outcomes paper. 111e author 

commends Family Spirit researchers for their creative, cost-effective way of addressing the 

mental health needs of American Indian children and their families. He further addresses the 

importance of participatory research. 

7. Participatory Research Brings Knowled!!e and Hope to American Indian 

Communities.Joumal of the American Academy of Child and Adolescent Psychiatry. 

2009; 48(6):585-586. 

The second editorial was published in the same American Journal of Psychiatry issue that the 

2015 Family Spirit outcomes paper appears in as the cover story. The author acknowledges 

Family Spirit's major contribution to the science of early life intervention. 

8. Gelling to the Roots: Earl y Life Intervention and Adult Health. American Journal of 

Psychiatry. 2015; 172(2): 108-110. 

THE JOHNS HOPKINS SCHOOL OF PUBLIC HEALTH 

415 N. Washington Street. 4th Floor, Baltimore. MD 21231 

jhsph.edu/CAIH 4 
103 


33364A.074

NAnONAL 

.......... CAll 

OliiSOIITIUM 

-

March 24, 2017 

The Honorable Kevin Brady 

Chairman 

Committee on Ways and Means 

U.S. House of Representatives 

1011 Longworth HOB 

Washington D.C. 20S15 

Oft(GC)NOfff(( 

U710SE27thA~ 

~.OAt7112 

Submitted online via: waysandmeans.submissions@mail.house.gov 

RE: Reauthorization of the M aternal, Infant, and Early Childhood 

Home Visiting (MIECHV) Program 

Dear Chairman Brady: 

MAINOfft(( 

c.ro.-E>st 

l500 MM'Jcet SUHt 

,....,pt!Ll,MH102 

:ZU.7U 71.4~ PHON1~7Jf.24100 , 

On behalf of the National Nurse-Led Care Consortium (NNCC), I am submitting the following 

written comments regarding the reauthorization of the Maternal, Infant and Early Childhood 

Home Visiting (MIECHV) program, which funds home visiting programs for low-income children 

and families. 

MIECHV funds support evidence-based services that improve birth outcomes, early childhood 

health and development, school readiness, and economic self-sufficiency while reducing child 

abuse, neglect and Injuries, cognitive disabilities, domestic violence, and juvenile delinquency. 

The MIECHV program helps states- including our home state of Pennsylvania - achieve these 

impressive outcomes while also producing a significant return on government investment. 

NNCC's mission is to advance nurse-led health care through policy, consultation, and programs 

to reduce health disparities and meet people's primary care and wellness needs. NNCC's 

signature public health nursing programs are Philadelphia Nurse-Family Partnership 

(Philadelphia NFP) and the Mabel Morris Family Home Visit Program (MM-PAT), evidencebased early childhood initiatives that have served over 4,000 women and children to date. 

Both Philadelphia NFP and MM-PAT are funded via MIECHV dollars administered by the 

Commonwealth of Pennsylvania's Office of Child Development and Early learning. 

Philadelphia NFP and MM-PAT together comprise one of the largest countywide maternal-child 

home visiting programs in Pennsylvania. Our goals include: better pregnancy outcomes; 

improved child health and development; increased school readiness; and greater economic 

self-sufficiency for families. Philadelphia NFP and MM-PAT meet an important need by building 

the strength and capacity of especially vulnerable, hard-to-reach young mothers. By taking a 
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33364A.075

Notional Nurs.e·Led Care Consortium 

Philadelphia Nurse-Family Partnership and Mabel Moms Family Home V1s1t Program 

multi-generational approach, our programs invest in both the short-term and long-term wellbeing of families. 

Program Overview 

Philadelphia NFP implements the Nurse-Family Partnership model to serve low-income firsttime mothers and their babies until age two. MM·PAT complements Philadelphia NFP by 

supporting families with young children from birth until age five, using the Parents as Teachers 

(PAT) model. 

Research has demonstrated both the NFP and PAT program models' proven effectiveness in 

addressing a wide variety of challenges experienced by low-income families. The federal 

HomVEE project' notes that well-designed research has consistently demonstrated the 

following positive impacts associated with each model: 

NFP: Maternal health; Child health; Child development and school readiness; Reductions 

in child maltreatment; Reductions in juvenile delinquency, family violence, and crime; 

Positive parenting practices; Family economic self-sufficiency 

PAT: Child development and school readiness; Reductions in child maltreatment; 

Positive parenting practices; Family economic self-sufficiency 

Research also shows a return on investment of between $3.29 to $5.70 for every $1.00 invested 

in the PAT and NFP programs.2 The exceptional out comes achieved among both mothers and 

babies prove that participation in MIECHV-funded home visiting programs can change the 

entire trajectory of families' lives for the better. 

Both Philadelphia NFP and MM·PAT provide parental education and support through an 

established multi-year curriculum that focuses on topics such as child development, maternalchild health, and positive parenting practices. The total annual caseload for NNCC's home 

visiting programs is 700 unduplicated children. Each participating family receives multiple visits 

from their nurse home visitor, using a schedule linked to child development milestones and 

perinatal health needs. 

Philadelphia NFP and MM-PAT provide home visiting services year-round on a full-time basis. 

Home visitors routinely make visits that are responsive to client needs, and that may include 

evenings and weekends to accommodate the client's school or work schedule. Home visitors 

1 The U.S. Department of Health and Human Services launched the Home Visiting Evidence of Effectiveness 

(Hom VEE) project to usess the evidence underlying maternal-child home visiting program models, including NFP 

and PAT. For more information, see: http://homvee.ad.hhs.gov 1 Nurse-Family Partnership (2016). Benefits and Costs Factsheet. For more information, see: 

http://www.nursefamilypartnership.org/getattachment/about /fact·sheets/NFP Benefit Cost 2016.pdf.aspx; 

Washington State Institute for Public Policy (2016). Parents as Teachers: Benefit-Cost Results. For more 

information, see: http://www.wsipp.wa.gov/BenefitCost/Program/118 
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33364A.076

National Nurse· Led Core Consortium 

Ph1fode/phlo Nurse·Fomlly Partnership ond Mabel Moms Family Home V1s!t Program 

are easily reachable by cell phone and text message, and communication with clients often 

takes place outside of regular business hours. 

Participation in high-quality early learning programs provides children with a foundation for 

school success, and helps close the opportunity gap between children from low-income families 

and more advantaged children. Philadelphia city statistics show lower maternal education 

levels and higher rates of child abuse than statewide averages, indicating that many 

Philadelphia families stand to benefit from the child development, positive parenting and 

school readiness counseling provided through Philadelphia NFP and MM·PAT. The communities 

served by our early childhood home visiting programs have high rates of deep, 

intergenerational poverty, and soc.ial factors play an outsized role in the overall health status of 

women and children in these neighborhoods. Working with their nurse, many young mothers 

break multi-generational patterns of abuse and neglect and set goals for themselves for the 

first time. 

As Philadelphia NFP Team Supervisor Breanne Ward, RN, MSN explains: 

"I think something that's really special is the intimacy of the nurse-client 

relationship. That is what I believe causes the positive changes to occur. 

There is a deep sense of trust that builds between the moms and nurses over 

time. The mom thinks to herself, 'There's a nurse coming into my home who 

really wants the best for me and my family. She believes in me. I can 

change my life, even if it's just one little step at a time."' 

Client Testimonials 

The following quotes shared by Philadelphia NFP and MM-PAT maternal cl ients exemplify how 

public health nurses and evidence-based MIECHV-supported programs contribute to family and 

societal well-being: 

SABRINA: "My nurse was very helpful and assisted in reassuring me that 

things would get better over time. There were many times {as a new 

mother) when I felt beyond stressed. I was always uplifted after speaking 

and meeting with my nurse." 

KALlA: "The part I love most is that my nurse comes to my home and can see 

me at different days every week which is important because my work 

schedule is always changing. I want my kids to be their best and my nurse 

helps me know how to do that for them. I thought the hardest part of being 

a mom was having an infant, but talking to and being patient and fair with 

my four-year-old is a lot harder. My nurse lets me talk about this and points 

out the ways I am [patient and fair] and how I can parent the way I really try 

to." 
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33364A.077

National Nurse· Led Core Consortium 

Ph1fode/phlo Nurse·Fomlly Partnership ond Mabel Moms Family Home V1s!t Program 

STEPHANIE: "I have learned a lot from participating in NFP and I feel that it 

has improved my life, my health, and now my daughter has a better future 

because I con be the best mom to her." 

NINA: "The consistency and commitment of the Nurse-Family Partnership is 

evident because [my nurse] Julie has been working with us for two years. 

We rarely experience this continuity of professional medical providers in the 

primary care and hospital settings." 

DALIE: "/love the program so much that I wont all my friends with kids to be 

in it." 

KELECHI: "Nurse-Family Partnership Is a phenomenal program. This program 

really helps the community. It is like that saying it tokes a village to raise a 

child well. NFP is like my village in a sense." 

Thank you for the opportunity to provide comments on the MIECHV program and its positive 

impact on families. If you or your colleagues would like additional information, or would like to 

visit our offices in Philadelphia, please feel free to contact me at kkinsey@nncc.us or 215·287· 

2114. We would welcome the opportunity to introduce you to the dedicated nurses on our 

staff, and the families we serve. 

Sincerely, 

Katherine K. Kinsey, PhD, RN, FAAN 

Nurse Administrator and Principal Investigator 

Philadelphia Nurse-Family Partnership 

Mabel Morris Family Home Visit Program 

NNCC Home Visiting Program Office: 

4 
107 

f 


33364A.078

National Nurse· Led Core Consortium 

Ph1fode/phlo Nurse·Fomlly Partnership ond Mabel Moms Family Home V1s!t Program 

1080 North Delaware Avenue, Suite 300 D 

Philadelphia, PA 19125 

E·mail: kkinsey@nncc.us 

Phone: 215·287·2114 
108 


33364A.079

Nurse-F~ 9--Q\ Partnership V H•/ping Fint-7ime Pannts Succud& 

Mar·ch 21 ,2017 

Nurse-Family Partnership 

107 South Market Street, Suite 3 

Benvick, PA 18603 

We, the undersigned staff members of the Geisinger Clinic-Nurse-Family Partnership site 

covering Columbia, Montour·, Northumberland, Snyder·, Union and part of Luzerne Counties- are 

writing in support of the re-authorization of the Maternal fnfant Early Childhood Home Visiting 

(MIECHV) Progr·am. The Nurse-Family Partnership is an evidence-based conummity health program 

based on !he work of Dr. David Olds that helps transfonn the lives of vulnerable mothers pregnant with 

their f11st child. Each mother we serve is partnered with a registered nurse early in her pregnancy and 

receives ongoing nurse home visilS that continue through her child's second birthday. Forty-five counties 

in Pennsylvania have Nurse-Family Parmership sites. 

Significant outcomes from this program include: 

48% reduction in child abuse and neglect 

20% reduction in months on welfare 

32% fewer subsequent pregnancies 

35% fewer hypertensive disorders of pregnancy 

56% reduction of emergency room visits for accidents and poisonings 

72% fewer convictions of mothers by the time the children are at age 15 years 

67% reduction in behavioral and intellectual problems in children at age 6 years 

59% reduction in arrest of children at age 15 years. 

Locally, the following outcomes have been replicated during the fiscal ye11r 7/112015-6/30/2016: 

98.1% of Geisinger Nurse-Family Partnership progran1 babies were up-to-date with 

iruunmizations at 24 months as compared to 93% nationally. 

23.5% of Geisinger Nurse-Family Partnership clients bad a second pregnancy at 24 mouths as 

compared to 27.7% nationally. 

68.5% of Geisinger Nurse-Family Partnership clients (18 plus years old at intake) were working 

when the baby turned 24 months as compared to 65.3% nationally. 

9.6% of Geisinger Nurse-Family Partnership clienlS had low birth weight babies (infants born 

weighing < 2,500 grams or 5.5 lbs.) as compared to 10% nationally. 

9.2% of Geisinger Nurse-Family Partnership clienlS bad premat11re births (births which occurred 

at less than 37 week's gestation) as compared to 9.6% nationally. 

52.2% of Geisinger Nurse-Family Partnership mothers were enrolled by the end of 16 weeks' 

gestation as compared to 45% nationally. 
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33364A.080

As Administrator of our site, when I think back over the past 16 years of families served, I remember: 

Women who lack self-esteem aod allow themselves to be victims of abuse become confideot 

enough to say no and leave so they and their babies are safe and have a chance of success. 

Women whose parent(s) have told them all their lives that they \\111 never amount to anything 

have the courage to make changes to better their lives so their child can succeed. (Seek gainful 

employment, return to school, get a driver's license, sober up, enter drug lreatment). 

One woman whose role model was her drug dealiog step-father, found slrength in the nurse home 

visitor's interventions, held a full-time job. moved into her own apartment and became one of our 

best mothers. A remarkable turnaround. 

"From the site's Nurse Supervisor's perspective, "l\'FP is a proven prevention program which saves over 

$7 for every dollar spent. NFP provides the education and guidance needed to assist vulnerable first-tinte 

moms to become self-sufficient, contributing citizens. The lives of their children are forever positively 

impacted by the improved quality of parenting they receive". Deb Forsythe 

I asked each nurse to give a short testimony. These will give you insights from the people who work 

side-by-side with the first-time mothers: 

"The Nurse Family-Partnership program helps the nurse-mother relationsnip build strong and lasting 

farnily bonds". Kara Ferro 

"The positive outcomes of the Nurse-Family Partnership program show that we are dedicated to helping 

some of the most vulnerable children in our cormmmities have a healthier start and brighter future." 

Lisa Foster· 

"Because NFP nurses follow a client for 2 112 years, the nurse fomlS a deep connection with that mother's 

needs and her heart's desire. facilitating real change in the life of the mother & child and extending to that 

mother's farnily and the broader commwlity. The return on investment is evident by the data and statistics 

collected by the National Service Office which confimlS the effectiveness of the program." 

Chl'istine Hayes 

"The Nurse-Family Partnership works, because it is just that, a partnersllip with fust-tirne parents that 

provides them 1vith the tools they need for stellar parenting. This is done by meeting the parents at 

whatever place in their lives they are. Whatever the situation, the nurse provides mentoring, 

advocacy and guidance while allowing them to make their own choices a11d decisions. Excellent 

parenting equips their offspring to ftmction as successful, productive members of society." 

Donna Pauling 

"Nurse-Family Partnership provides support to women during a critical time in their lives. Through 

education and establishing a !rUsting relationship, NFP positively impacts the health and overall wellbeing of both the mother and child." Christine Resele 

"I am a nurse case manager for Nurse-Family Partnership. I have worked in this excellent home evidence 

based home care program for almost 9 years. I believe that continued ti.mding would be necessary to help 

ensure continued interaction and education for some of the area's most at-risk clients. Through our 

program we have helped monlS and babies flourish in areas of job readiness, education, parenting and 

prevention. Knowledge is key: most of these moms do not have that. Education is so imperative to excel 

and many have never had the support and education to go anywhere in life. If we can help these moms 

succeed, then the sky is the limit for their children so that they will not be left behind." Anita Rose 
110 

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33364A.081

"NFP is the art of nursing at its best as the nurse home visitor partners wi1h at risk families to engage 

them in becoming healthier and self-sufficient. My favorite part of the program is facilitating the motherchild bonding process. and seeing the excitement in the mom as the baby develops. As a home visitor, 

I'm encouraged by the statistics that prove the program is valuable not only for our families, but for our 

society as well." Susan Roth 

There are cotmtless other examples of success stories. When these moms/families succeed, you (as 

legislators) succeed too. Less money will be needed to support prisons, welfare programs. etc. 

I nm urging you to vote m to re-authorization of the Maternal Infant Early Childhood Home 

Vi.sitation (MIECHV) Program to support Nurse-Family Partnership. The future of our state and the 

nation depends on the children who are being born today. My staff and I ask that you vote to help us 

continue to help those who are down and out now, but who are motivated to change their circumstances 

so their cltild will have opportunities they never had. We in the Nurse-Family Partnership are working to 

make a difference for a lifetime-breaking the cycle of poverty by utilizing proven methods. The 

outcomes speak for themselves. Independent research proves that communities benefit from this 

relationship--every dollar invested in Nurse-Family Partnership can yield mot·e than five dollars 

and seventy cents in t·eturn. 

Sincerely. 

Loreen Comstock, MSN, RN, GCNS-BC 

Administrator 

Kara Ferro, BSN, RN 

Nurse Home Visitor 

Christine Hayes. BSN. RN 

Nurse Home Visitor 

Christine Resele. BSN, RN 

Nurse Home Visitor 

Susan Roth, BSN, RN 

Nurse Home Visitor 

Deborah Forsythe, BS, RN 

Supervisor 

Lisa Foster, BSN, RN 

Nurse Home Visitor 

Donna Pauling. MSN, RN 

Nurse Home Visitor 

Anita Rose, BSN, RN 

Nurse Home Visitor 
111 

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33364A.082

SUPPLEMENTAL TESTIMONY 

BETH RUSSELL 

NURSE HOME VISITOR, NURSE-FAMILY PARTNERSHIP 

LANCASTER GENERAL HEATH/PENN MEDICINE 

LANCASTER, PENNSYLVANIA 

Involvement of Fathers 

NFP engages fathers in our home visits as well. That person may not be the father of the baby -

maybe it's the mother's new boyfriend. But we try to engage with anybody that is in the home 

and present in the mother's life, or whom the mother would like us to engage with. We have NFP 

specific fac ilitators for fathers and other males that will serve as role models for the child. 

Additionally, our PIPE (Partners in Parenting Education) activities are geared to caregivers that 

may not be the mother. 

Challenges in Implementation 

The committee should be aware that while I have not encountered issues where MIECHV 

prevents me from meeting my client's needs, one broad challenge that prevents us from 

delivering the program to the population that could benefit is that we don't have enough nurses to 

serve all of the mothers in need. We regularly get referrals for NFP that we are not able to enroll 

due to our nurses not having any open slots in their caseload. Additional ftmding would help 

alleviate this challenge, of course. Another challenge is locating the client for the first time. We 

have to get creative and meet them at doctor appointments, school or WlC if we are unable to 

reach tbem by phone, because either tbey don't have one, or they don't respond to our messages 

because they don't really know who we are yet. 
112 

f 


33364A.083

Sent on behalf ofMrECHV Nurse-Family Partnership of Monroe County, PA. 

Virginia Sosnowski, RN, BSN - Nurse-Family Partnership Supervisor/Administrator 

Sent from my iPhone 

Begin forwarded message: 

Ft·om: Date: December 5, 2016 at 11:18:52 PM EST 

To: Subject: Thank you 

When I started Nurse Family Partnership I was 19, 20 something weeks pregnant, living 

on my own, and working 3 jobs to make ends meet. I came from a functionaVdysfunctional 

home. My parents were a mess but also kinda had it together so it made it confusing when I 

thought about bow I would raise my own child. I knew that I wanted to instill some of the same 

values but also knew that I wanted to do a lot better. My now husband (boyfriend at the time) 

was still living with his mom and hadn't even held a permanent job. I was so worried about how 

we would take care of this baby. Then at the doctor's office I saw a sign for nurse family 

partnership and figured why not. 

Jan was my nurse and I'm so grateful for her every day. She did more than prepare us to 

take care of a baby. She instilled goals in us, she forced us to really think about what we wanted 

and to write them down on paper. At every meeting she checked in on our goals and how we 

were working towards them. She educated me on the importance of early literacy, attachment, 

and nursing. I knew I wanted to nurse and Jan stuck by me the whole time to help me accomplish 

that. When Logan was born she checked in frequently and reminded me to keep going and that I 

was doing a great job. Her love and kindness helped make me the mom I am today. 

Today, my husband and I have surpassed our goals. Just a few months after having my 

son I achieved my goal of finishing cosmetology and about a year later my husband joined the 

military. Fast forward to today (5 years later) and I'm almost done with my bachelors in early 

childhood and my husband is now a Sergeant in the Marine Corp. We worked so hard to get here 

and I don't know about my husband but for me, a lot of my accomplishments stem from her 

support, education, and guidance. I encourage every new mom I meet to participate in this 

program. I just hope all of the nurses are as awesome as mine. 
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33364A.084

PARENT-CHILD HOME PROGRAM 

50 YEARS OF PROVEN SUCCESS 

Sonia w. Hamsn Prtsi!Stn1 

Talctlang leny 

FfrltV!e. Preskhont 

JamtS M. Molloy 

Stconcf Vice PrHidtnt 

........... .. !)' .. 

Tmsuttf 

aneC S~r 

S....O.oy 

81alt R.Holflinln 

Mttnbtf brvt 

William F. all ot 

Member-at-large 

Bvry A. Berman 

Oorolhy BoOOattnko 

St.rityW. But!itrf.ass 

Chartos L.8uUa 

8rtnebOf Leo 

Uu fiklmla·AkW 

O¥ild E. F~lak 

HllbryA.frommtr 

Melanie Holland 

Howatdlandsberg 

8obLIVOit 

Otborah VtlezMtdtnica 

Kriltbn M. Whlltn 

Ta-~yalabtn 

Sarah E. Walzer, CEO 

March 28. 2017 

House Ways and Means Human Resources Suhcomminec 

United States House of Representatives 

RE: March 15, 2017 Maternal infant Early Childhood Home Visiting Hearing 

Dear Suhconunittee, 

ll1e Parent-Child Home Program (PCHP) would like to take this opportunity to thank you 

for holding the March 15, 2017 hearing highlighting the critical role home visiting 

programs play in suppon ing parcniS with limited access to other suppons and services to 

nurture healthy babies, prepare school ready children. and strengthen their families. 

For over 50 years, PCHP has been helping families prepare their children for school 

success through intensive home visiting. This evidence-based early literacy, parenting, and 

school readiness model addresses the achievement gap head-on by working with 

underserved, under-resourced families when their children are between 16 and 48 months 

to provide them with the knowledge, skills. and tools they need to build school readiness 

where it begins. the home. 

PCHP's target population is well-defined - low-income families (800/o of PCHP f.~mil es 

have annual incomes of S25.000 or less), challenged by significant obstacles to school 

readiness including poveny, low literacy, limited English. under-educated pareniS, single 

and teen parents, geographic isolation. cultural barriers. and/or homelessness, enter the 

Program when their children are approximately age two. They panicipate in the Progrant 

for two program cycles. and then with the support of Program staff transition to the next 

educational step in their community, most often Head Start or pre-kinderganen. Our goal 

is that those children most at risk of entering school not ready to be successntl studencs, 

receive two cycles of parent-c.hild visits and then a year of quality preschool and enter 

kindergarten ready to succeed in the classroom. Currently, the Program is working in 14 

states (including Washington, California, Florida, Pennsylvania, Massachusetts. and New 

York) and in over 400 local conuuunities. 

PCHP is urtique in employing Early Learning Specialists who are bilingttal in the home 

languages of the families with whom they work (over 30 different langttages), share their 

ethnic/cultural background, and live and/or have worked in the community where the 

families live. Twenty-five percem of PCHP's home visiting staff are fomte.r pareniS in the 

Program who are trained and hired to visit with other fami lies in their communities. By 

building its own cost-effective, cotrnmmity-based workforce, PCHP not only strengthens 

families, it strengthens comrmmities. 

The Early Learning Specialists work one-on-one with families. providing 92, twiceweekly. 30-mimue home visits over a two-year period. Each week, they bring a gift of a 
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book or educationa l toy, often the first in the home; and use the book or toy to model for the 

parent (grandparent/foster parent/primary caregiver) and child, reading, c<>nversation, and play 

activities designed to stimulate parent-child interaction, develop language, literacy, numeracy, 

and social-emotional skill.s, and prepare children for school success. 

This seemingly simple model has been proven to have profound outcomes. Over five decades, 

PCHP has built a record of replicating a model supported by rigorous evidence and consistently 

achieving its predicted outcomes for low-income families. Extensive evaluations have resulted 

in a large body of scientific literature (over 50 studies) published in juricd journals and validated 

by the federal Joint Dissemination Review Panel. In tbe past two years, PCHP has received 

significant positive results from two new independent studies conducted by New York 

University and ORS Impact in the state of Washington. For decades, PCHP's research results 

have consistently supported the value of the Program for strengthening positive parent-child 

imeractiou and reducing risk factors for child abuse and neglect. Parents learn bow to embrace 

their role as their children's first teachers and become ongoing academic advocates for their 

children. In turn, outcomes for child participants are astounding. PCHP graduates: 

1\rc 50% more likely to measure ready for kindergarten compared to their socioeconomic peers 

Outperform the statewide average on third grade state math achievement tests. 

• Score two and a half times higher on social-emotional assessments than control groups. 

Have a 30% higher high school graduation rate tban their socio-economic peers. 

Enter school performing 10 months above their chronological age. 

Are 50% less likely to be referred to special education services by the third grade. 

While the Parent-Child Home Program's research base proves the strength of the model and its 

effective replication in diverse communities, the successes of the children and families who 

participate in tbe Program provide invaluable insight into the in1pact of the Program - bel ping 

parents discover their role as their children's first and most important teachers, assisting them in 

building brighter futures for their fami ly, and preparing children to be successful students. 

Evidence of the Program's success is seen each day i.n chi.ldren discovering the joy of reading 

and learning, and in parents beaming with pride over their children's accomplishments. Below is 

a story that exemplifies the impact of the Parent-Child Home Program. 

It's summertime and Wesley, a single father, and his three-year-old daughter Heaven 

work on a puzzle together. Wesley asks his daughter lots of questions, stimulating 

interaction and conversation with ber, something he learned by participating in ParentChild Home Program funded through the United Way of King County in Washington. 

Many young learners take a break from books and educa tional toys during the school 

break, and experience summer learning loss, but not Haven. She'll conti11ue developing 

her cognitive skills because her father continues to do what his home visitor modeled, 

playing, talking, reading, supporting and sustaining Heaven's learning all year long. 

Veronica Williams, an Early Learning Specialist with Parent-Child Home Program, 

emphasizes that the child is not the only one teaming during the home visits. " I model 

for the parents what to do. It's a guideline and not a must-do. After a while, a lot of 
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parents take the lead, hand the child a book or a toy. The child will take it and the parent 

then takes charge and I think to myself, 'That's exactly what we want to happen."' 

Wesley says that when Veronica modeled educational play for him, a light bulb went otT; 

the home visits were more than mere child's play. "It opened up a lot of leaming for both 

of us, not just for her but for me, especially on how I need to teach her and the things I 

need to develop with her. She's coloring, tracing, all of the things that we worked on. 

She's phenomenal in puzzles and shapes. ll was a big help for me because now I know 

what areas to rea II y work on with her." 

The odds are often stacked against low-income children like Heaven. Low-income 

children are behind their peers when they start kindergarten. The Parent-Child Home 

Program eliminates that preparation gap by supporting parents during the crucial early 

years of their child's development. Nationwide, more than 84% of children who 

complete the Parent-Child Home program graduate ti·om high school, compared to just 

54% of their socioeconomic peers. 

Wesley said, "The Program taught me things that I need to teach my child." Helping 

Heaven succeed is no longer a dream for Wesley. The Parent-Child Home Program bas 

equipped bim and thousands of other parents wbo bave participated in tbe Program, with 

tbe tools tbey need to make tbat happen. 

The Parent-Child Home Program national center joins its home visiting and early childhood 

education partners nationwide in its support of reauthorizing M lECHV with a five-year 

extension including incremental funding increases up to $800 million per year. 

Thank you for bringing attention to the critical work that home visiting does in communities 

across the country. 

Sincerely, 

Sarah E. Walzer 

CEO 
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® Parents as Teachers. 

STATEMENT OF CONSTANCE GULLY, PRESIDENT AND CEO 

PRESENTED ON BEHALF OF THE 

PARENTS AS TEACHERS NATIONAL CENTER 

TO THE HOUSE COMMITIEE ON WAYS & MEANS 

SUBCOMMITIEE ON HUMAN RESOURCES 

SUBMITIED MARCH 29, 2017 

Chairman Smith, Ranking Member Davis, members of the subcommittee, thank you for the opport unity 

to submit written testimony following the March 15, 2017 hearing on the Maternal, Infant, and Early 

Childhood Home Visiting (MIECHV) program. My name is Constance Gully and I am t he President and 

CEO of Parents as Teachers National Center (PATNC). M IECHV helps meet a gaping need in our 

communities and for that, we are sincerely grateful. 

Families in many of our communities are facing extreme stress. last October, PATNC hosted our national 

conference in St. Louis. As a pre-conference session, we invited Parents as Teachers parent educators 

and program coordinators from across t he count ry to meet and talk about the challenges their families 

face. The communities represented were quite diverse, from inner city, to suburban, to rural, to tribal. 

Despite the geographic distances and differences, the obstacles for families were very familiar: 

"We are a community serving rural, low income, low educational attainment, teen parents- an 

area that is saturated with chemical dependencies, single-parent households, and children with 

violent behavior concerns." 

"I currently work with homeless mothers and their children ... with families where one parent is 

incarcerated ... with famil ies that are involved with Child Protective Services." 

"We are located on a tribal reservation and very agricultural area with a large Hispanic 

population ... lots of obstacles for families to overcome such as teen pregnancy, violence, 

substance abuse, etc." 

"In my two (housing) developments this year we have had 3 infant deaths ... as a county we have 

been hit hard w ith the opiate epidemic with 247 overdoses in 20 days, 21 of which resulted in 

death." 

• "We serve an urban community t hat has a history of drug and gang-related violence ... Last 

summer we experienced an influx of murders. People were being murdered in front of t heir 

homes, at local parks, outside of car washes; many times the by-standers were family members 

and young children." 

"One of my centers is in a neighborhood where there have been drive-by shooting deaths." 
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If we know nothing else, we know that learning begins before birth and that, with the rapid brain 

development that occurs, the first three years of life are absolutely critical to health, well-being, and 

success in school, life and work. Toxic stress response can occur when a child experiences strong. 

frequent, and/or prolonged adversity-such as physical or emotional abuse, chronic neglect, caregiver 

substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family 

economic hardship-without adequate adult support'. In addition, we know that by age 3, there is 

already a 30-million word gap" between children from the wealthiest and poorest families, and without 

intervention these children will find it harder, if not impossible, to ever catch up. These early years are 

not only a time of learning to read, count, and understand the world around them, these are the years 

when a strong foundation of executive function and self-regulation skills are built; that is, the mental 

processes that enable us to plan, focus attention, remember instructions, and juggle multiple tasks 

successfully. 

Clearly, there is a critical need for MIECHV. 

Through MIECHV, states and tribal communities have received financial and technical support to scale 

up existing home visiting systems and to support home visiting services to new populations in at-risk 

communities. With a focus on funding what works-evidence-based home visiting- as well as 

'promising practices' that can bring new models to the field, this Federal funding has allowed states to 

present communities with a choice of models that best meet their needs. However, unmet need still far 

outweighs our collective capacity. 

Parents as Teachers (PAT) is a nationally recognized evidenced-based, voluntary early childhood home 

visiting model that promotes the optimal early development, learning and health of children by 

supporting and engaging their parents and caregivers. Parents as Teachers has a core value of working 

with moms and dads, prenatally all the way through their children's first year of Kindergarten, not just 

first time moms, but also families with multiple children. PAT is the most widely replicated home visiting 

model in the country serving families in all 50 states, more than 100 tribal communities, and six other 

countries. In 2015/2016, PAT served 123,468 families with 148,659 children in the United States through 

1.26 million personal visits and 45,500 group meetings. The model meets the evidence-based criteria of 

the federally funded Maternal, Infant, Early Childhood Home Visiting (MIECHV) program and has been 

selected by 35 states to be replicated through MIECHV and in 13 of the 25 tribal communities to be 

implemented through the 3% Tribai-MIECHV set aside. 

Parents as Teachers has more than 30 years of implementation experience. In addition to the evidencebased model, PATNC has developed-and continuously updates-research-based, evidence-informed 

foundational curricula to serve families from pregnancy through kindergarten. Many Early Head Start 

home·based programs, Health Family America model affiliates, and other national and local 

organizations implementing locally designed, home-based programs deliver services using the PAT 

foundational curricula. 

The delivery of Parents as Teachers is straightforwa rd. Trained parent educators, who may be early 

childhood educators, social workers, nurses or other trained professionals recruited from the 

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3 

communities they serve, work through local schools, hospitals, housing authorities, childcare centers, or 

other local implementing agencies to help strengthen and engage families. The model is designed to 

serve families through any agency that engages families with young children, including homeless, foster, 

and military families; families may enroll anywhere along the prenatal through Kindergarten continuum 

with maximum outcomes resulting from a partnership of at least two years. 

The evidence-based model includes four components: 

Personal visits are individualized, strength-based visits where parent educators focus on child 

development and parent-child interaction, and empower parents to interact with their children 

in a way that facilitates healthy development. Visits may take place in the home-which 

removes the barrier of transportation-or in a community setting that is most comfortable to 

the family. Visits include the mother and child, however, fathers and other family members or 

caregivers involved in that child's life are encouraged to participate; in some cases, the primary 

parent served is the father. In families with multiple young children, the parent educator will 

screen and provide age-appropriate activities and guidance for those siblings as well. Visits 

cover issues such as sleep, discipline, good nutrition, health, routines, and child safety. 

Child Screenings. At key intervals, parent educators screen the children for possible 

developmental delays, or any hearing, vision, or physical health problems. The goal is to identify 

any issues or delays early so that children can be referred to appropriate services and therapies. 

Early intervention is less costly and more effective at mitigating issues. 

Community resource referrals. The parent educator, as part of the visit, helps bridge the gap 

between resources available and families' needs. Every personal visit includes a focus on family 

well-being. Parent educators help connect parents to agencies that can help in areas such as 

finding employment, finding health insurance, or getting a better education to help increase 

family self-sufficiency and independence. Parent educators also monitor parents for any signs of 

depression, medical issues, or intimate partner violence and offer community referrals. 

Finally, facilitated group connections allow parents to meet with other parents of young 

children as a support group, allowing them to practice parenting skills and build a strong familycommunity connection. Mothers of young children often experience social isolation and these 

connections serve as an additional, community support. Many programs offer group meetings 

for young fathers, helping provide positive social connections and opportunities for them to 

build healthy, ongoing relationships with other young fathers. 

Researchers and experts have found that the social determinants of health-factors such as social 

support, parental stress, access to insurance, income and poverty status, and environmental 

conditions-affect families and their children. Home visiting programs are an essential intervention and 

prevention program to address these social determinants of health. Children need safe, stable, and 

nurturing relationships and environments to grow up healthy and ready for the world. Which is where 

Parents as Teachers can make a vital difference. PAT parent educators: 

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4 

Understand and respect that parents are their children's first and most infl uential teacher 

Work with families anywhere along the continuum from pregnancy through Ki ndergarten-the 

earlier the better 

Partner with parents to identify and build their parenting strengths 

Focus on family well-being and goal setting 

Identify health issues and developmental delays in children early and refer families to community 

resources that reduce the cost of later remediation 

Build healthy social networks for parents of young children 

Are a trusted, informed resource 

As a result, parents enrolled in Parent'S as Teachers learn to be more self-sufficient and become 

advocates for their children, for life. Some examples include: 

At the age of 21, Sharon and her partner, Marcus, were first time parents of a 2-month-old 

daughter, Alanna. Sharon and her parent educator have met twice a month in Sharon's home for 

the past year. Marcus has also participated when his work schedule allowed. Sharon says, "In the 

past year I have learned so much about Alanna's development and the importance of each 

milestone. The hands on activities, working together one on one with my parent educator has 

helped me build my confidence as a mom. I share everything I've learned with Marcus, and I love it 

when he is able to sit in on the visits too." While in the PAT program, Sharon set personal goals to 

obtain her driver's license and purchase a car. She has achieved both goals. Sharon and Marcus both 

have jobs and use teamwork to split the workday so one parent can stay home with Alanna. They 

credit the PAT program for providing the focus and support they needed to be the best parents they 

can be. 

Amber is a single mom, a veteran who served in Iraq, and suffers from PTSO and depression. She 

was unemployed and fearful of leaving her daughter with anyone. She was very unsure about her 

parenting skills and reported that at times she felt overwhelmed by the constant fear of doing 

something wrong w ith her baby. She was somewhat cautious and reserved in the beginning but, 

with encouragement, she began to follow through w ith suggestions and activities between visit s. 

Her daughter is now developing appropriately and her confidence as a parent and teacher to her 

child continues to flourish. Amber has returned to work. She continues to use w hat she learns from 

PAT to help her daughter prepare for preschool. 

Shelly and Justin enrolled after their son was born. As Shelly was adjusting to being a new mom, she 

was successfully treated for post-partum depression. When Jax was eight months old, the family 

moved to be closer to Shelly's family and left the program. They returned and re-enrolled w hen Jax 

was three. At that time, the program identified what appeared to be developmental regression and 

referred them to their pediatrician who suggested they wait until his next checkup and re-evaluate. 

Shelly did not feel comfortable waiting 6 months; as the program had educated her in advocating for 

her child, she sought a second opinion, w hich resulted in a diagnosis of autism. The program has 

continued to support and educate the family with the day-to-day obstacles of having a child w ith 

autism. Jax is making progress with therapy and services he receives at school. 

The youngest child in the P. family was identified as having a delay in his development of social and 

language skills, and autism spectrum disorder was suspected. Mother set goals to help her child 

improve his development, and she learned skills that helped him transition to preschool. During her 

Parents as Teachers, 2228 Ball Drive, St.louis, MO 63146 ( 314.432.4330 I parentsasteachers.org 
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time in the program, mother became more confident, learned about the system of education, and 

began to advocate for her son. 

At enrollment, one mother had significant depression that affected her parenting. She used 

spanking as discipline, and screamed and criticized her children. Her parent educator supported 

mother's mental health needs and helped her connect to counseling services. She has developed 

coping skills that allow her to parent in a more positive manner. 

Parents as Teachers is a proven and well-researched strategy for reducing the need for remedial 

education, increasing school readiness, reducing instances of child abuse and neglect, promoting family 

economic self-sufficiency, and parent involvement in their children's care and education. Outcomes 

include: 

improved language and literacy for young and school age children 

increased entire family engagement in children's learning and engagement with their schools 

increased school achievement for children 

identification and treatment of developmental delays well before the K-12 years 

improved parenting knowledge and skills 

decreased child maltreatment 

o one randomized trial of Parents a Teachers found that the use of harsh parenting was 

significantly lower in PAT families 

o In New York, a quasi-experimental evaluation showed PAT was associated with lower rates of 

suspected cases of abuse and neglect in a review of DSS and school based records. 

o A PAT program in Maine focusing on families with involvement with Child Protective Services, 

found that once entered into a PAT program 95% of families had no further substantiated 

reports or allegations of child abuse or neglect. 

increased family self-sufficiency 

child health outcomes, such as: 

o increased child immunization rates 

o lower body mass index rates 

o higher birth weights 

o improved family well-being 

o increased family health literacy 

The Parents as Teachers National Center, which developed the evidence-based model, and the research-based 

curricula used by the models, provides training, technical assistance and quality assurance. The national center 

requires its affiliates maintain fidelity to the model and monitors performance. 

Finally, and significantly, home visiting is cost-effective. One state institute for public policy issued to 

policymakers and budget writers a list of evidence-based programs that are well researched and that can with a 

high degree of certainty, lead to better statewide outcomes coupled with a more efficient use of taxpayer 

dollars. Those policy analysts found that Parents as Teachers has a cost benefit ratio of $3.29-it saves taxpayers 

money. m 

Parents as Teachers, 2228 Ball Drive, St.louis, MO 63146 I 314.432.4330 I parentsasteachers.org 
121 

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33364A.092

MIECHV is a success, but we need to reach more families in more communities. Parents as Teachers National 

Center respectfully asks that Congress reauthorize the Maternal, Infant, and Early Childhood Home Visiting 

program for five years, to increase to a year 5 annual level of $800 million. 

Thank you. 

For more information, or if you have questions about Parents as Teachers, please contact me at 

constance.gully@parentsasteachers.org or Alison Gee, VP Government and Community Engagement at 

alison.gee@parentsasteachers.org. 

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• A W111shing1on Slate lnstilute fOI' Publit Poliq (WSIPP) rqxwt entitlccl "Rcturn ou lal\"eStJUenl; £,idct~ Options to hupr<we S.atev.;dc: Out«M.UC$.'' 

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Partners in Community Outreach 

Ecluc<Jrlon Begins ar Home 

March 28, 2017 

Committee on Ways and Means 

U.S. House of Representatives 

1100 Longworth Office Building 

Washington D.C. 20515 

Re: Maternal, Infant, and Early Childhood Home Visiting program (MIECHV) 

Dear Chairman Brady: 

Home Visiting was established in West Virginia nearly 35 years ago. In West Virginia, the 

evidence-based models of Healthy Families America (HFA), Early Head Start (EHS) and Parents 

As Teachers (PAT) are used. The Maternal Infant Health Outreach Worker (MIHOW) model, a 

promising practice is also used. 

In 1999, programs using three of these models agreed to collaborate and form an informal 

coalition which they named Partners in Community Outreach (PiCO). The term In-Home Family 

Education was coined around that time to accurately reflect the important support to families 

provided by these three models. The success accomplished by PiCO in promoting In-Home 

Family Education helped lay the collaborative groundwork for MIECHV funding to come to West 

Virginia in 2010. In fact, West Virginia is often held up as an example of successful collaboration 

for the nation. Our models collaborate well with each other as well as with other early 

childhood and prevention programs in West Virginia. 

In 2016, Home Visiting/In-Home Family Education was provided to some fami lies in all of the 55 

counties in West Virginia with the help of state, federal, local foundation funding and in-kind 

resources. These services are provided by twenty-five agencies, employing over 150 staff and 

serving over 1800 families. The organizations on whose behalf I submit this statement are: 

A.B.L.E. Families 

Brooke Hancock Family Resource Network 

Burlington United Methodist Family Services 

CASE WV Early Head Start 

Charleston Family Resource Center 

Children's Home Society of West Virginia 

Clarksburg Mission 

The Community Crossing 

Clay County Board of Education 
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Cornerstone Family Interventions 

Doddridge County Starting Points 

Lewis County Family Resource Network 

Marshall County Family Resource Network 

Monongalia County Starting Points Center 

Monroe County Board of Education 

New River Health Association 

Nicholas County Empowerment Corporation 

Northern Panhandle Head Start 

Preston County Caring Council 

Rainelle Medical Center 

REACHH Family Resource Center 

Regional Family Resource Network 

TEAM for WV Children 

Tucker County Family Resource Network 

Wetzel County Center for Children and Families 

Data collected by the West Virginia Home Visitation Program for the fiscal year ending 

September 30, 2016 reveals the following about families enrolled in the program: 

Benchmark 1: Maternal & Newborn Health 

• Over 93% of pregnant women began prenatal care within four weeks of enrolling in a 

home visitation program. 

• 83% of women had a visit with their health provider within three months after delivery 

of their baby. 

81% of women were screened for maternal depression. 

• 93% of women reported using birth control to prevent unintended pregnancies. 

• Over 95% of children received at least 50% of the American Academy of Pediatrics 

Bright Futures recommended standard well-child visits by six months of age. 

Benchmark 2: Child Injuries. Abuse. etc. 

• The percentage of families with substantiated child maltreatment cases dropped from 

4.2% in Fiscal Year 2013 to 2.7%. 

• The percentage of families with first time substantiated report for child maltreatment 

cases dropped from 4.2% in Fiscal Year 2013 to .62%. 

Benchmark 3: School Readiness 

Over 99% of children showed developmental progress in communication. 

Over 98% of children showed developmental progress in problem solving cognitive 

skills. 

Benchmark 4: Domestic Violence 

• 93% of pregnant women and mothers were screened for domestic violence. 

In addition to these impressive data, some of the programs listed on pages one and two shared 

the following stories about and quotes from the families they serve. 
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From Rainelle Medical Center, which provides Parents As Teachers to families in Greenbrier & 

Pocahontas Counties: 

Julie*, is a single mom raising her daughter without receiving any child support 

from the father. Relocating to Pocahontas County, West Virginia, she told her 

PAT Parent Educator Rachel that she wanted to get a job, car and work on 

getting her GED. Julie has had difficulty holding down a job due to debilitating 

anxiety and limited work experience. Despite this, she was able to get a car 

through the DHHR and complete SPOKE classes. Through the support of her 

Parent Educator Rachel, Julie continues to work on her GED in between jobs and 

doesn't let her difficulties keep her from working toward her goals. *not her real 

name 

The Early Head Start program at CASE WV in Mercer County shared this story: 

A seventeen-year-old mother of a new born child, who is also a former special education 

student and former resident of a group home, transitioned to her sister's home and 

enrolled in the program. Before the first home visit could be made the young mother 

was asked to leave her sister's home and ultimately became homeless. An uncle allowed 

her to move into his residence which was isolated and physically inaccessible to home 

visitors. Telephone contact was maintained with the mother for the next few weeks to 

offer support through discussions regarding the care, safety and nurturing of the infant. 

The Home Visitor provided guidance regarding developmental milestones, nutrition, 

well child visits, immunizations, strategies for dealing with depression and questions to 

ask the infant's doctor during visits as well as questions for her doctor regarding birth 

control information. A crisis erupted with the uncle and the mother became homeless 

again. With encouragement and support from the Home Visitor, the mother asked her 

mother to keep the child and the mother contacted the homeless shelter in Beckley, 

wv. She was accepted into the facility and during her stay at the shelter she completed 

applications for housing in Bluefield. She is currently living at Tiffany Manor, has her 

child with her, has begun studies to take her GED exam and has moved from t he waiting 

list for home visits to scheduled home visits and participation in the program. 

From Cornerstone Family Interventions, which provides Parents As Teachers to families in 

Boone & Lincoln Counties: 

In Early November 2016, a Lincoln County, West Virginia mother named Cassie 

expressed concern about her nine-month old son Ely's gross motor 

development. Cassie stated that Ely had not started to crawl and did not move 

around much. As a result of these concerns, PAT Parent Educator Christopher 

completed t he Aces & Stages Questionnaire and found that Ely did have a slight 

delay in his gross motor ability. So Cassie and Christopher developed a plan of 

action to improve Ely's gross motor ability. Just two months into the plan, Ely 

made tremendous strides. Cassie stated that Ely was not only crawl ing forward 

and backwards all around the house, but was now pulling himself up and has 
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been able to stand while holding on to things. Cassie stated that Ely had also 

started to hold his grandparents' hands and walk a little. In late January 2017 Ely 

started walking on his own, and during the last developmental screen in 

February, he was right on target with his development. 

Our Maternal Infant Health Outreach Worker program in Ohio County, through Northern 

Panhandle Head Start, sends us this quote from Patty: 

"(My home visitor] gives me confidence as a mom. When the whole world beats 

me down and tells me I can't, she reminds me I can, and already have. Learning 

things about what is healthy for my children helps me feel like I can make a 

positive difference in their lives. Every mom needs to feel like that." 

Nicole, a grandmother in Barbour County, states this about the Al legheny Highlands Parents As 

Teachers program at the Tucker County Family Resource Network: 

"My daughter Sara and 11 month old grandson are participants in Barbour 

County Parents as Teachers. [Parent Educator) Teresa has worked diligently with 

Sara to help her learn parenting skills which include developmentally appropriate 

activities, nutrition, health care, and ways to keep Lennox occupied and 

engaged. This program reaches out to many young parents, helping them to 

bond and interact with their children through learning activities and community 

outreach. 

I myself have participated with lennox and Teresa, when Sara was unavailable. 

Parents as Teachers workers take their time individualizing their programs to 

each child, so that they can succeed and thrive on t heir own developmental 

level. lennox has finger-painted, worked with object permanence, texture 

activities, and material manipulation among many other activities. All these 

skills will help lennox in the future when he attends school. We have learned 

different ways to interact with Lennox that stimulate his mind and help him 

learn. Parents as Teachers also help parents keep track of their children's 

growth and developmental milestones, and since they are engaged with the 

families more often, they are able to assist in early identification of any 

concerns. 

Parents as Teachers also has community events, so that young parents can 

socialize and participate in fun, age-appropriate activities with other families. 

Many young parents feel isolated and depressed, and these events allow them 

to meet other families with kids the same age. 

Parents as Teachers and Teresa have played a vital role in helping Lennox 

become the bright, happy, and adventurous little boy he is. This program has 

played an important role in our family and our community. " 
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As you can see, MIECHV funding has made a difference in the lives of families of young children 

in West Virginia. 

We are confident that future screenings, data and referrals to services will reveal even more 

improvements in the health, safety, educational readiness and well-being of West Virginia's 

youngest children and their families. 

Thank you for the opportunity to share this information with you. 

Michele Baranaskas, LCSW 

Coordinator, Partners in Community Outreach 

TEAM for WV Children, Inc. 

PO Box 1653 

Huntington WV 25717 

304-543-3770 

Michele@wvpartners.org 

www.wvpartners.org 

www.inhomefamilyed.com 
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11J 

pennsylvania 

DEPARTMENT OF HUMAN SERVICES 

OFFICE OF CHILD DEVELOPMENT 

AND EARLY LEARNING 

Ove•·view of the Maternal, Infant, and Early Childhood Home Visiting 

(MIECHV) Awa•·d in Pennsylvania 

The Pennsylvania, Deparhnent of Human Services, Office of Cbild Development and Early 

Leaming (OCDEL) is writing in support oftbe re-authorization of the Matemal, Infant, and 

Early Childhood Home Visiting (MIECHV) Program. 

The MIECHV program, along with Pennsylvania's early childhood programs, are administered 

by OCDEL, an oflice that j oins together programs from both the Pennsylvania Department of 

Human Services and the Pennsylvania Department of Education. Well-positioned to implement 

services through a systems approach, OCDEL administers child care subsidy and licensing; 

Early Intervention; birth to five; and infant-toddler, and pre-kindergarten programs, in addition to 

family suppo•t programs such as evidenced-based home visiting. These services, when managed 

under one umbrella agency, implement MIECHV at the state level and serve Pennsylvania in the 

effort to enhance and expand the early childhood infrastructure, ultimately supporting families' 

positive outcomes. OCDEL assists families and their children, from prenatal through school age, 

by using data, research, and stakeholder guidance to assure high quality services. 

The main goals of OCDEL are to: 

• Work effectively, eollaboratively, creatively, and successfully to ensure that all families 

have access to high-qua lity early care and education programs for their children. 

• Engage stakeholders in actionable ways that provide guidance on programs and policies. 

• Identify and use key data and research to improve policies and practices. 

Through the MIECHV award, Pennsylvania received $11 ,798,665 in fonnula funding for the 

2016 federal fiscal year. This provided the following evidenced-based home visiting services to: 

• Fund 31 Local Implementing Agencies (LIA 's) 

• Provide home visiting services in 46 out of 67 counties 

• Fund four evidenced based models across the state: 

o Early Head Start - Home Based (EHS) 

o Health Families America (HFA) 

o Nurse-Family Partnership (NFP) 

o Parents as Teachers (PAT) 
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In federal fiscal year 2015, home visitors in Pennsylvania: 

• Made 39,027 home visits to 6,208 parents and children in 3,169 families; 

• EnroUed 2,105 new parents and children to the program; and 

• Served families Jiving in communities in 46 counties across the state, of which 21 

counties are rural. 

Through MIECHV, OCDEL established the fo11owing requirements of our LIAs: 

En•·ollment: LIAs are required to report their enrollment on a monthly basis to their designated 

infant toddler specialist and are required to maintain 95 percent enrollment. 

Continuous Quality Improvement: LIAs are required to participate in Continuous Quality 

Improvement (CQI). All LIAs submitted their initial plans for review in April 2016, working on 

a CQJ topic that fell within one of the eight topic areas below: 

• Breastfeeding 

• Cotmlmnity collaboration 

• Data 

• Enrollment/recruitment 

• Family engagement and retention 

• Subsequent pregnancy 

• Screenings 

• Staffmg and professional development 

Throughout the work of the CQ!team, LIAs successfully made enhancements to programs and 

services. The following are examples of agency CQI achievements: 

• ARIN Intermediate Unit 28 identified implementation of the State Home Visitor 

Competencies as their CQitopic. They have successfully created and implemented a 

system of tracking that both identifies the early childhood domains that are in highest 

need of further professional development, and also the trainings that staff are 

participating in that meet that need. The infonnation ensures that staff are getting training 

that is relevant, data-based, and meeting the requirements outlined by OCDEL. 

• Cameron County Family Center wanted to increase family engagement and chose to 

create an updated family survey as their CQI topic. This provided insight into what the 

families hoped to gain from participation in the program. As a result, the center offered 

several new family engagement opportunities, such as a father/daughter dance and 

mother/son game night. These activities were well-received and highly attended, bringing 

fami ly strengthening activities to the community that were reflective of client goals. 

• Community Services of Venango County chose lead screenings as their CQf focus. By 

detecting high lead levels early in children, the potential for developmental delays and 

other complications can be decreased. There is a significant need for screenings in the 

communities of Venango County because few children are screened. At the beginning of 

2 
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33364A.100

the CQI work, 36 percent of children were receiving lead screenings. Establishing a goal 

to increase the amount to 50 percent of all children by December 2016. As ofDecember 

2016, 69 percent of the children enrolled had received a lead screening. 

Coot·dination with Early Intervention (EI): All LIAs are required to coordinate services with 

El agencies to ensure support to those children receiving services or children identified after 

enrollment as needing services. Coordination between home visiting and EI is documented in a 

memorandum of agreement (MOA). LIA staff noted that receiving and providing referrals for EI, 

having more information about the child (e.g. Individual Family Service Plans (ISFP)), and 

working with children on the same goals are all benefits to having a relationship with El. 

As part of home visiting coordination with EI, all home visiting programs within OCD EL were 

moved from the Bureau of Early Learning Services into the Bureau of Early Intervention to 

better coordinate between the two programs. This administrative arrangement is intended to 

create smoother transitions tor children and families between and among services. 

Community Collabou tion: All LIAs must comply with the following community 

collaboration requirements: 

a) Participate in existing local collaborative groups to coordinate home visiting and other 

early childhood initiatives if available; 

b) Work to develop shared resources and refetTal strategies between local home visiting 

agencies and other community service providers to allow for early access to services by 

families; 

c) Actively work with other local community agencies and refer those needing services, if at 

capacity, to other agencies that will meet their needs; 

d) Establish a point of contact from each agency for follow up conversations and planning 

as needed; 

e) Outline protocols to share information and coordinate services as appropriate; 

f) Detem1ine a frequency for the MOA to be reviewed and revised; 

g) Detem1ine other topics as relevant to local programs; and 

h) Obtain signatures on the MOA. 

Program Review: All agencies during the 2015-2016 reporting period received two site visits 

from their designated infant toddler specialist. This is beyond the home visiting models 

monitoring requirement. The infant toddler specialists are professional staff wbo complete tbe 

agencies' review annually to ensure they are meeting all program requirements beyond the home 

visiting models requirements. During this review, a Program Review Instrument (PRJ) is 

completed. The PRI assesses the programs in the following areas: reporting requirements, 

enrollment, confidentiality, home visit completion, staff qualifications, professional 

development, cutTiculum, use of screenings, coordination with EI agencies, transitions, 

community collaboration, and a CQI plan. The highest score that the implementing agency can 

receive on a PRI is 140. The scores are broken down into three areas: exemplary- 95-100 

percent, compliant- 86- 94.9 percent, and deficient- 0- 85.9 percent. Of the 32 MIECHV sites, 

25 received exemplary scores; those who did not score in the exemplary range were placed on 

corrective action plans. 

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33364A.101

Home Visiting Steet·ing Team : The steering team is a group of individuals that meet to discuss 

various topics that affect MIECHV LIAs. Enrollment reports are reviewed monthly. Challenges 

that LIAs are experiencing are considered and supports are provided as needed. The team 

approves and provides feedback regarding policies and procedures, announcements, and data 

collection. All program requests are considered and approved by the team. Additionally, after all 

program reviews are completed, the team evaluates the results and uses the collected infom1ation 

to make infonned decisions. 

Home Visitation Stakeholders Committee: The committee continues to meet on a quarterly 

basis, either in person or via phone. In 2016, the group has expanded to over I 00 representatives 

from across various state agencies, local home visitation service providers, technical assistance 

agencies, and advocacy groups. During the meetings, updates are shared from collaborating 

agencies, as well as successes from the home visiting field, allowing for local innovation and 

collaboration among programs to be fostered. In addition, workgroups are assembled to gather 

feedback on current policies for home visitation, defining the priorities in the home visiting field, 

and identifying needed professional development opportunities. 

2011-2014 MIECHV Statistics 

The following clients received services under Pennsylvania MIECHV awards from 20 II through 

2014: 

l'nd4!t· 18 yeat·s of age 

Race Ethnicit) 

White 

Black 

llispanic 

Other 

Unmarried 

Le~s Than High School 

TANF Recipient 

Food Stamp Recipient 

17% 

Percentage Served 

47% 

21% 

28% 

3oto 

84% 

19% 

44% 

53% 

Clients receiving home visiting services were typically low-income, young, unmarried, and 

possessed less than a high school education. Through these funds, 54 percent ofMIECHV 

families received all of their recommended well-child visits in the first year of life and 30 percent 

of clients who enrolled prenatally were 30 percent more likely to quit smoking in their third 

trimester. 

How Do Clients Benefit from Home Visiting services offered tht•ough MIECHV funding? 

! . Positive Health Outcomes - Clients received valuable information about how to have 

a healthy pregnancy and support their child's health needs. 

4 
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33364A.102

2. Better School Readiness - Clients felt their children were better prepared for entering 

the classroom. 

3. Social Supports - Programs enabled clients to leverage resources and meet personal 

goals such as obtaining jobs, locating housing, accessing education, and connecting to 

community resources. 

How do P•·ograms Benefit from Receiving the MIECHV award? 

Through Collaboration with their local communities: 

Columbia County Family Cente1· (PAT): The Family Center began to collaborate with 

another local agency, The Jaycees. The organization has a newly renovated building with a 

kitchen, updated technology, and plenty of space for classes and group connections to be held. It 

is located a block away from the current Family Center site. Starting in March 2017, all group 

events will be held at this location. The Jaycees also agreed to provide snacks for each event. 

They will also have boxes of food on hand so that if any family is stnaggling fmancially and 

could benefit from receiving food assistance, Family Center staff can provide it to them on the 

spot. 

Family First Health (NFP): Family First Health have been able to build on an initial 

referral relationship with the York County Women, Infants, and Children (WIC) office. They 

have revised the referral fonns specifically to meet the needs of WIC and created a drop-box for 

referrals to be submitted. The fonns are sent out with the intake packets for any WIC applicants 

who are pregnant, the client completes the packets, and stafT is responsible for picking up the 

fom1s on a weekly basis. This has resulted in more than double the number of monthly referrals 

from tlus source in the frrst month. 

G uthrie, Towanda l\1

1emorial Hospital (NFP): In November, tl1e hospital hosted a spa 

day open to all current NFP mothers in coll.aboration with Firefly Massage Seminars, local 

massage therapists. Licensed massage therapists are required to complete continuing education 

credits, and Firefly Massage Seminars can provide those credits. firefly Massage Seminars has a 

six-hour CEU course which includes three hours of instnaction (teaching new techniques), 

followed by three hours of actual practice on volunteers. This is where NFP comes in -

providing the volunteers. This event serves as a teaching tool for the program as well as for the 

licensed massage therapists. Clients learn many lessons, including that self-care can aid in 

attentiveness and happiness as a mother. Not only does this event help mothers learn new 

techniques in self-care, but they also learn life skills including bow to plan, arrange for child care 

and transportation, and how to make appointments. 

Through Family Successes: 

ARIN IU 28 (PAT!EHS): ARJN offers multiple client examples of family success-- a 

yow1g single mom rented a home on her own for the first time with the help of St. Vincent de 

Paul; a young mom completed her first semester at Indiana University ofPennsylvmua; and a 

mom recently paid off all her debts and is now debt free. A new statT member was able to 

increase her case load and new families greatly welcomed her expande-d presence. A single mom 

5 
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33364A.103

completed j ob training and is now an LPN. Several new babies were bom into the program. With 

assistance, one child was finally accepted into the Head Start program in their community. 

Cameron County Family Center (PAT): A local family was struggling to fmd out what 

was causing the delays in their child's development. As a direct result of the developmental 

screening done by their PAT Parent Educator (home visitor), they were able to make a quick 

referral to ET services which lead to medical appointments with specialists. TI1e family has since 

leamed that their child has a rare genetic disorder. In many cases, families may become 

disheartened to hear such news; however this family believes that early detection and the 

ongoing support of both PAT and EI will be assets to their overcoming many of the obstacles 

they face in the future. 

Columbia County Family Cent e.· (PAT): Tn December, a single mom enrolled in PAT 

program graduated from college with a Bachelor's Degree. This mom is one of the original 

MIECHV funded families enrolled when the award was received. She bas been very consistent 

with the programs. This mom has a medically needy child who requires a Bayada nurse. She still 

managed to plug along and finish her education despite this. 

Community Prevention Pat·tnet·sbip of Berks County (NFP): The program has at least 

eight clients who graduated from NFP who either are studying to become a nurse or who have 

obtained a degree in nursing. 

Maternity Care Coalition: During an early fall home visit, Karl, a client, expressed his 

goals and dreams for himself and his family. It was during that home visit, for the first time, Karl 

reported feel ing inspired to challenge himself to get bis GED. At that time, he also expressed life 

fears, being afraid of the unknown and failure. During home visits, Karl's advocate (home 

visitor) provided him with words of encouragement and support to create a goal plan with 

attainable action steps. Together they addressed barriers, concems, and identified tasks. One of 

the first steps was to find a GED program. Karl searched for schools by area, availability, and 

additional trade options. He took the initiative to find a GED program that was prefect for him. 

Matemity Care Coalition is proud to say that Karl enrolled in a GED program and started classes 

in December 2016. He reported that he is forever grateful for his advocate and happy to be 

making steps to better himself and his family. 

By Providing Services to their communities which can have long term effects: 

Susquehanna Home Care and Hospice: In the summer of2015, the NFP program of 

Susquehanna Home Care and Hospice was featured in the Nurse Family Partnership NewsLin.k 

published by the national service office. The article "Not looking back, but always looking 

fonvard," captured the impact of a nurse home visitor in the life of a young mother. TI1e mother 

was 19 years old and uncertain about what the future held when she was enrolled in NFP. Today 

she is a graduate of Dickinson Law School, a wife, and a mother of three. She credits much of 

her success to her nurse home visitor, who was in attendance on her graduation day. 

Central Susqueha nna Community Foundation: This program was highly regarded in 

an article featured in their local newspaper. It was quoted by a local pediatrician that "Nurse 

Family Partnershi p is effective and important." The article goes on to interview a currently 

6 
133 


33364A.104

enrolled mother and her nurse. The mother praising the nurse and the program tor providing her 

with education and support and the nurse describing her devotion to the families that she serves. 

It goes on to state that the relationship between mother and nurse is why the program works. 

"Sometimes tiJ.is is the first trusting relationship that a young mom has," was quoted by the 

nurse. This relationship can make all the difference. 

Allegheny County Health Depu tment: Allegheny County has created a community 

resource titled the Allegheny Link. The mission of the Allegheny Link is to simplify and 

streamline access to services and supports in an effort to help individuals and families maintain 

their independence, dignity and quality of life. Families and providers can visit the website or 

call and be linked to services that fit the unique needs of the individual family. 

http://allesthenylink.org/ 

Notice: 

This report was developed using reports collected from the agencies listed on pages nine and ten. 

Information located within this report was collected as a requirement of the MIECHV award 

within Pennsylvania. ·n1ey did not have any direct input into the report. 

Questions regarding this report can be directed to 

Office of Child Development and Early Leaming 

Attn: Andrew M. Dietz, Family Support Program Manager 

333 Market Street 

6'h Floor 

Harrisburg, PA 17126 

Questions can also be directed via email to anddietz@pa.gov 

Through this report, we have shared a brief summary of all that home visiting can do to bolster 

family resiliency, improve child outcomes, and facilitate positive familial relationships. We ask 

you to strongly consider the re-authorization of the Matemal Infant Early Childhood Home 

Visitation (MIECHV) Program. The future of our commomvealth and the nation depends on the 

success of children who are bom today. We, at the state office, along with all of our LIAs, ask 

that you consider the long-ranging, positive effects home visiting has on families and 

communities, and reference the success stories mentioned above, as well as tbe success of the 

MIECHV program in general. 

We are motivated to help change fami lies' circumstances so that the caregivers and their children 

will have opportunities to move beyond poverty, obtain meaningful employment, gain an 

education, leam the value of giving back to their communities, and become model citizens. 

In addition to Pennsylvania's MIECHV award, Governor Tom Wolf has proposed $9 million iJl 

additional state funding to support evidenced-based home visiting models within the 

commonwealth. The success of MIECHV evidenced-based home visiting programs shine a 

spotlight on what these programs can do for both individual families and communities. 

7 
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33364A.105

We thank you for your consideration in this matter. 

Sincerely, 

Suzann Morris 

Deputy Secretary 

Office of Child Development and Early Learning 

Departments of Education and Human Services 

8 

33364A.106

MIECHV Lora.llmpl<meutlug Phon<# Fox# Address CUy State 

Agencies 

Allegheny County Health 412-247-7954 412-578-8325 807 WaUace Ave, 4tlt Floor, Suite Pittsburg PA 

407 

ARJN !nterwe<liate Unit 28 724-463-5300 724-463-5315 2895 W. Pike Rd. lndiana PA 

cameron County Commissioners 814-486-1810 NIA 20 West Fifth Street EmporiUIIl PA 

Capital Area Head Start 71 7-541-!795 7 I 7-232-4597 3705 Ehnwood Drive Harrisburg PA 

Central Susquehanna Conunuuity 57Q-784-1723 57Q-752-7435 4 10 Glerul Avenue, Suite 200 Bloomsburg PA 

Foundation 

Chester County Health Departlllent 610-334-6459 NIA 601 Westtown Rd., Ste. 290 West Chester PA 

Children's Advocacy Center of 724-658-4688 724-658·8810 1000 S. Mercer St. NewCastle PA 

Lawrence County 

Colnrubia County Family Center 570-387-9086 570-389-5703 I I W. Main Street, PO Box 380 Bloomsburg PA 

Community Preveution Partnership 6 10-376-6988 610- 376-6944 227 Nortlt Fifth Street Reading PA of Berks CowliY. Inc. 

ColllJlluuity Services of Venango 814-678-7766 NIA 206 Seneca St. Oil City PA 

Cotwty 

Health System 610-497-7344 NIA CK NFP, Conummity Hospital, Chester PA 

2600 

W. 9tb Street 

Erie Family Center 814-$74-6995 814-$74.·6994 913 Payne Ave Erie PA 

Family First Healtb 717-$46-6776 NIA I 16 South George Street Yoti< PA 

Fayette County Commwtity Action 724-437-6050 724-437-4418 108 N. Beeson Blvd. Uniontown PA 

AJ<ency 

Guthrie, Towanda MenlOrial S?Q-268·2518 NIA 91 Hospital Drive Towanda PA 

Hospital Home Nursing Agency Conumw.ity 8 14·942-1903 888-271-8190 SOO E. Chestnut Ave Alt00118 PA 

Service 

Infant Development Inc. 570-748-3928 57Q-748-3610 980 East Water Street Lock Haven PA 

..., 
f 


33364A.107

,_. 

0 

Jefferson-Clarion Head Slart Lancasler General Health 

Malemily Care Coalition Monlgoroery County Health 

Departtuenl 

National Nurse-led Care Consortium 

Perry County Family Center 

Pinnacle Health Hospitals Pocono Medical Cenler Ponsto"1l Fantily Cenler 

Sadler Heallh Ce uler CotpOration STEP (Lyconting Clinton) 

SUM Chlld Developmenr 

Susquehanna Home Care aud 

HoSPice Providence) 

The Guidance Center 

814-849-3660 814-849-0128 

717-824-81 24 717-544-5914 

610-278-5117 215-989-3584 

610-278-5117 610-278-5167 

26 7-765-2322 215-731-2400 

711-582-3656 71 7-582-4949 

717-231-8010 717- 782-5507 

570-426-1688 570-422-8249 

610-63Q-2111 610-326-3104 

71 7-96G-4321 717- 218-0671 

5 70-001-9689 800-206-3006 

570-966-2845 570-966-9693 

57Q-326-8912 N/A 

814-73 1-Q613 N/A 

18 \Veslem Ave., Sttile C Brookville PA 

527 Notth Lime Slreel Lancaster PA 

2000 Hamillon Suire 205 Philadelphia PA 

1430 DeKalb Sl., PO Box 311 Norristown PA 1080 N. Delaware Ave Suile 300 Philadelphia PA 

D 

8391 -R Spring Road New Bloomfield PA 

2645 N. 3rd St. Hanisburg PA 206 East Bro1m Street Eas1 Stroudsburg PA 

31 25 Ridge Pike Norristown PA 

100 N. Hanover Slreel Carlisle PA 

21 38 Lincoln Slreel Williamsport PA 

14 South II Slreet !VIiffi.inburg PA 

II 00 Grampian Blvd, fl. 4 Williamsport PA II 0 campus Drive Bradford PA 
137 


33364A.108

PEOPLE'S EMERGENCY CENTER Nurwrlt~g Fnmt/l~s. Strengthe,lng Neighborhoods. Drldng Change. 

United States House of Representatives 

Subcommittee House Ways and Means Human Resources 

Testimony of Kathy Desmond, CEO of People's Emergency Center in Philadelphia, PA 

March 23, 2017 

I am Kathy Desmond, CEO of the People's Emergency Center (PEC) in Philadelphia (PA). PEC provides 

emergency, transitional, and permanent supportive housing to more than 160 families on any given day. In an 

average year, we serve over 100 families with more than 250 children in our Emergency Housing Program. 

Overall, the City of Philadelphia annually serves 1,400 families in emergency housing, and more than 5,000 

ch ildren and youth. 

I urge the Committee to extend the Maternal, Infant, Early Childhood Home Visiting (MIECHV) program and 

urge for the greater use of M IECHV programs to serve children and families who experience homelessness. 

As you are aware, M IECHV supports home visiting programs that minimize potential health risks of children 

and improves school readiness and achievement . These are services that homeless families and children need 

prior to and after they exist emergency or transitional housing. MIECHV can offer homeless families the 

stabilizing force that is needed to keep them in their communities and not re-enter the homeless system, 

services for which the homeless housing system provides in little abundance. 

The federal departments of Health and Human Services, Housing and Urban Development, and Educat ion 

released an interagency policy statement on meeting the needs of families with young children who are at risk 

of or experiencing homelessness. The policy statement recommends M IECHV as a key resource. 

In Philadelphia, the Children's Work Group Early Childhood Committee (CWGEC) has brought together housing 

providers, home visiting program providers, public health experts and academics so that there is a space to talk 

to one another, follow-up, and learn about developing issues and strategies to combat family homelessness 

and barriers to early childhood development. Together, we are working to identify how home visiting programs 

can serve our families and children, and reauthorization of MIECHV would help Philadelphia reach this goal. 

PEC and the CWGEC is working to understand the utilization of home visiting programs by famil ies residing in 

Emergency and Transitional Housing Service providers. The results of a recent survey of providers showed that 

out of eight responders to our survey, seven of them referred families to Early Head Start (EHS) in the past 

year, but only half refer to other home visiting programs. In other words, EHS is a consistent referral but 

providers do not make regular referrals to other home visiting programs. In addition, EHS serves 3-years old. 

This fact suggests to us that the home visiting programs serving infants and toddlers are not a primary 

connection for families by the emergency housing system. 

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33364A.109

PEOPLE'S EMERGENCY CENTER Nurwrlt~g Fnmt/l~s. Strengthe,lng Neighborhoods. Drldng Change. 

PEC then followed-up with intensive interviews with specific home visiting programs in Philadelphia. These 

interviews revealed that these programs work with very traumatized, stressed-out families who are still 

housing insecure. Erin, a Nurse Home Visitor with the Nurse Family Partnership (NFP), reported that "lead 

poisoning, asthma, eczema, and developmental delay ore common issues for our homeless children. If they 

ore in really unsafe condition, they ore not physically allowed to get down and develop motor skills." 

Staying in contact with homeless famil ies is a common barrier represented among the interviews. Joy from 

NFP reports that "I hove a difficult time keeping hold of people who ore homeless and couch surfing. They 

usually hove a very low income and their phone numbers ore changing all the time." Homeless ness makes it 

challenging to retain families in care and continue to provide the services that they desperately need. 

These are just two examples. There are many more showing the needs that our families have after they leave 

an emergency or transitional housing program. 

Overall, our two surveys show that some homeless children and families are benefiting from home visiting 

programs, but certainly not the majority, and yet these families are suffering 

In summary, some families are assisted by MIECHV programs, but not all, even though these families are highly 

traumatized and in need of stabilizing services after they exit from shelter. 

PEC advocates for the continuation of funding for M IECHV and for MIECHV to expand its work with families 

and young children who experience homelessness. 

Thank you for consideration of my comment s. 

References: 

Fantuzzo, J., LeBoeuf, W., Brumley, B., & Perlman, S. (2013). A population-based inquiry of homeless episode 

characteristics and early educational well-being. Children and Youth Services Review, 35, 966-972. 

doi:http://dx.doi.org/10.1016/j.childyouth.2013.02.016 

Solari, C.D., Althoff, S., Bishop, K., Epstein, Z., Morris, S., & Shivji, A. (2015). 2014 Annual homeless assessment 

report. U.S. Department of Housing and Urban Development. 

Masten, A. S., Cutuli, J. J., Herbers, J. E., Hinz, E., Obradovic, J., & Wenzel, A. J. (2014). Academic risk and 

resilience in the context of homelessness. Child Development Perspectives, 8(4), 201-206. 

Office of Supportive Housing, 2016. 

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33364A.110

Testimony for 

The United States House of Representatives Committee on Ways and Means 

Subcommittee on Human Resources 

Hearing on the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program 

March 15, 2017 

Submitted by: 

Prevent Child Abuse America 

228 South Wabash Avenue 

10th Floor 

Chicago, IL 60604 

Contact: Dan Duffy, President and CEO 

312·366·3520, extension 810 

dduffy@preventchildabuse.arg 

Prevent Child Abuse America and its network of 50 state chapters and 588 Healthy Families 

America program sites thanks the Chairman and the other distinguished members of the U.S. 

House Committee on Ways and Means Subcommittee on Human Resources for their hearing on 

the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program on Wednesday, 

March 15. 

The testimony below w ill add detail and nuance to the testimony that the committee has 

already heard and will help illustrate not only the impact of home visiting, but also how 

investing in programs like MIECHV helps bot h the families served by the program, but also the 

taxpayers in communities where home visiting is making a difference. 

About Prevent Child Abuse America 

Founded in 1972, Prevent Child Abuse Ameri ca is a national organization with chapters in all 50 

states and nearly 600 Healthy Families America home visitation sites. We lay the groundwork to 

deliver the great childhoods that all children deserve and we promote servi ces that improve 

child well-being and develop programs that help to prevent all types of abuse and neglect . 

We work towards our mission by advocating for a variety of evidence based services that 

promote healthy child development and create the context for healthy families in thriving 

communities. As an organization, we believe that it is everyone' s responsibility to be good 

stewards of children, not just the federal government. Our signature prevention program is the 

Healthy Families America home visiting model. 

About Healthy Families America 
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2 

Developed in 1992, Healthy Families America (HFA) is Prevent Child Abuse America's nationallyrecognized, signature home visiting program. Rooted in the science of attachment and infant 

mental health, HFA is designed to work with families who have histories of trauma, intimate 

partner violence, and mental health and/or substance abuse issues. HFA services begin 

prenatally or immediately after the birth of a baby and are offered voluntarily, intensively and 

over the long-term depending on the needs and wishes of the fami ly (3 to 5 years after the 

birth of the baby). 

Healthy Families America has a strong research base w hich includes randomized control trials 

and well-designed quasi-experimental research. The model is based on a set of 12 researchbased elements providing benchmarks to measure quality derived from more than 30 years of 

research. These Critical Elements are operationalized through a series of best practice 

standards, requiring a comprehensive and rigorous accreditation process to ensure model 

fidelity. 

To date, research and evaluation indicates impressive outcomes. Reviews of 15 evaluation 

studies of HFA programs in 7 states produced the following outcomes: 

Reduced child maltreatment; 

Decreased low weight babies; 

Improved parent-child interaction; 

Improved success in school measured at age 7; 

Increased parent educational attainment; 

Increased access to primary care medical services; and, 

Increased well-baby visits. 

Why Home Visiting? 

"MIECHV is evidence-based policy that works; to empower families, to coordinate 

services, and to unify systems."· Eric Bellamy, Home Visiting Manager, Remarks at the 

Subcommittee Hearing on MIECHV, 3.15.17 

All parents want what is best for their children. At the same time, not all parents have the same 

knowledge, skills, or resources to understand child development or their role as a parent. Early 

childhood home visiting provides a voluntary and direct service in which home visitors can help 

equip parents with the tools they need to be the best parent possible. 

Evidence-based services such as parent education, parent support programs, and early home 

visiting are effective strategies leading to positive outcomes for children and families. Home 

visitors 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 visiting is an effective and cost-efficient strategy for supporting new parents 
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3 

and connecting them to helpful community resources, helping these new parents give their 

baby the great childhood t hey deserve. 

Who Participates? 

"It's important to keep home visiting because there are young women out there like 

myself that have been through a ton, who have battled though struggles, and who 

need to learn more about their pregnancy, the rights and wrongs, as well as to have 

someone there that understands them and doesn't judge and is there through every 

step of the way."- Rachel, Healthy Families America participant 

According to data from the Human Resources Service Administration, Maternal and Child 

Health Bureau, participants in the federal MIECHV program tend to be living in or at risk of 

poverty, in addition to other risk factors. According to the data: 

• 77% of families who receive home visiting services had household incomes at or below 

100 percent of the federal poverty guidelines ($24, 250 for a family of four) 

• 46% of families were at or below 50% of the federal poverty guidelines 

• 31% of participants had less than a high school education 

35% of participants had only a high school diploma 

• 22% of newly-enrolled households included pregnant teenagers 

• 12% of newly-enrolled households reported substance abuse problems, and 

• 15% of newly-enrolled households reported a history of child abuse and maltreatment 

Simply put, the families and children served by federally-funded home visiting programs are 

among the most vulnerable populations in the country. 

The Problem of Child Abuse and Neglect 

"Infants are more likely to enter foster care than any other age group· twice as likely 

as one-year olds and more than five times as likely as 11-year-olds. Several home 

visiting models, including Healthy Families America, have proven that home visiting is 

a tool that can keep these children safe at home." -Rep. Danny Davis, Remarks at the 

Subcommittee Hearing on MIECHV, 3.15.17 

Abusive or neglectful experiences in early childhood can have long-lasting effects that increase 

the probability of poor developmental outcomes, such as learning, personal behavior, as well as 

physical and mental health problems for children. These negative outcomes manifest later in 

life as increased likelihood of both physical and mental health problems as well as decreased 

work efficiency. 
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4 

These effects can be broken down into real-world costs. Research has shown that child abuse 

and neglect affects over one million children every year and its effects cost our nation $220 

million every day.' 

Fortunately, prevention solutions such as home visiting offer hope. A U.S. Government 

Accountability Office {GAO) study finds that total federal costs of providing initial prevention 

program funding for low-income populations were offset over four years. 2 Another study found 

longer term savings based on the cost reduction of social problems related to abuse. 3 Abused 

children have higher rates of juvenile delinquency and special health care needs than those 

who have not been abused.4 Ultimately, increased early funding surrounding child abuse 

prevention will save taxpayers over the long-term while protecting those children most at risk. 

Research has shown that our country and our families see the greatest benefit when we choose 

to invest in programs that prioritize prevention, such as MIECHV. 

Investing in prevention is less costly to society and individuals than attempting to treat 

problems later. Prevent Child Abuse America estimates that implementing effective policies and 

strategies to prevent child abuse and neglect can save taxpayers $80 billion per year.5 Further, 

the Centers for Disease Control and Prevention determined that the average lifetime cost of 

nonfatal child abuse per victim was over $210,012 in 2010 dollars, including $32,648 in 

childhood health care costs; $10,530 in adult medical costs; $144,360 in productivity losses; 

$7,728 in child welfare costs; $6,747 in criminal justice costs; and $7,999 in special education 

costs.6 In 2008, the total lifetime economic burden from new cases of fatal and nonfatal child 

maltreatment in the United States was approximately $124 billion. In sensitivity analysis, the 

total burden was estimated to be as large as $585 billion. 7 

The cost of the status quo includes direct costs for foster care services, hospitalization, mental 

health treatment, and law enforcement. Indirect costs include loss of productivity, as well as 

expenditures related to chronic health problems, special education, juvenile delinquency and 

the adult criminal justice system.

8 An international study by the United Nations Children's Fund 

{UNICEF) placed the United States next to last on child well-being, among the 21 wealthiest 

1 Gelles, Richard)., & Perlman, Staci (2012). Estimated Annual Cost of Child Abuse and Neglect. Chicago IL: 

Prevent Child Abuse America. 

' U.S. General Accountability Office. ( 1992). Prevention Programs Need Greater Emplwsis. Report to the 

Chairman. Subcommittee on Oversight a[ Government Management Committee on Governmental Affairs. U.S. 

Senate. (GAO Publication No. GAO/HRD-92-99). 

J lbid.,25. 4 1bid.,27. 

s Gelles, Richard )., & Perlman, Staci (2012). Estimated Annual Cost of Child Abuse and Neglect. Chicago IL: 

Prevent Child Abuse America. 

http://www .preventchildabuse.orgji mages/research/ pcaa_cost. report_20 12_gelles_perlma n.pdf 6 Fang. X., et al. (2012). The economic burden of child maltreatment in the United States and implications for 

prevention. Child Abuse & Neglect Volume 36, Issue 2, pages 156- 165. 

' Ibid., 157. 

• Gelles, R., & Perlman, S. (2012) 
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5 

nations in the world.9 Although only one indicator of child well-being, rates of child abuse and 

neglect are ultimately tied to a nation's investment in its children. 

Home Visiting: A Positive ROI for Families and for the Nation 

"Dawn, one participant I met with on Monday, shared her experience of working with 

a home visitor who helped her find a stable home and steady income in order to 

provide for her growing family. These are the types of outcomes we should be 

expecting and receiving from the limited use of taxpayer resources." -Rep. Adrian 

Smith, Remarks at the Subcommittee Hearing an MIECHV, 3.15.17 

Home visiting programs that receive federal funding through M IECHV are held to rigorous 

standards for effectiveness and must demonstrate a positive impact in order to continue 

receiving funds. This approach both supports families while protecting taxpayers by ensuring 

that at-risk families receive the support they need in a way that is both cost-effective and 

solutions-focused. 

Since its inception, there have been over 185 studies on Healthy Families America. The most 

rigorous evidence of the program's efficacy comes from 15 publications of multiple randomized 

control trials, or RCTs. Those trials have consist ently demonstrated positive impacts in all six 

domains required by the MIECHV program (improvements in maternal, newborn, and child 

health; prevention of child injuries, child abuse, neglect or maltreatment and reductions of 

emergency room visits; improvements in school readiness and child academic achievement; 

reductions in crime or domestic violence; improvements in family economic self-sufficiency; and 

improvements in the coordination and referrals for other community resources and supports). 

The majority of these findings were replicated and sustained over time. Some of the most 

compelling recent findings from HFA research include reduction in low birth weight rat es by 

nearly half10, reduction in rapid repeat birth rates by nearly half overall and by two-thirds for 

teen mothersu, and improved parenting attitudes and behaviors demonstrated by numerous 

studies in more than 17 states12. 13 

• UNICEF, Child poverty In perspective: An overview of child well-being In rich countries. Innocenti Report 

Cord 7, 2007. UNICEF Innocenti Research Centre, Florence. 

to Lee, E .. et al., (2009}. Reducing low birth weight through home visitation: A randomized controlled 

trial. American journal of Preventive Medicine. 36(2), 154- 160. 11 Ownbey, M., et al., (2011). The effects of a healthy families home visitation program on rapid and teen 

repeat births. Child & Adolescent Social Work journal, 28(6), 439-458. 

" HFA Impacts on Parents & Families (n.d.} Chicago: Prevent Child Abuse America. 

http:/ fwww.preventchildabuse.org/index.php/research/research-reports 

" Avellar, Sarah, et al., Home Visiting Evidence of Effectiveness Review: Executive Summary, Washington, D.C. 

U.S. Department of Health and Human Services, Office of Policy, Research and Evaluation, September 2013, 

bup·/lhomyeeacthbsgovtHomyEE Executjye Summary 2013 pdf#texec summaey. 
144 

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6 

In addition to the research from individual models, federal evaluations of home visiting models 

have shown similar, positive results. In 2015, research from HRSA showed impressive outcomes 

attributable to MIECHV models. According to their research, of all home visiting models: 

• 83% demonstrated overall improvement in MIECHV benchmark areas, 

• 81% demonstrated improvement in maternal and newborn health, 

• 85% reported improvements in school readiness and achievement, 

• 85% resulted in improvements in family economic self-sufficiency, and 

• Screenings for developmental delays in young children are double that of the national 

average in the 18 states with MIECHV programs. 

Results like these indicate that not only do M IECHV funded programs have a positive effect on 

the families who participate, but that these positive outcomes can reverberate across the 

community. With more parents gainfully employed and more children born healthy and into 

families that understand child development, entire communities will see more children 

excelling in school, fewer parents reliant o n social safety net programs, and more families set to 

succeed. 

Conclusion: Home Visiting Works 

The data provided here, whether told from the tables within a randomized control trial or from 

the mouth of a young mother who has a different future thanks to M IECHV, proves that home 

visiting works. Home visiting is an effective, evidence-based, and cost-efficient solution to the 

problems faced by many new families across the country. In implementing this solution, 

MIECHV provides an example of the kind of federal/state partnership that demonstrates 

positive outcomes for both the families who participate in it and the taxpayers who help fund 

it. 

If we truly want to make a difference for young parents like Rachel and babies like Angelica, 

federally funded home visiting programs must become more widely available in communities 

across our country. To that end, Prevent Child Abuse America and Healthy Families America 

encourage an expansion of MIECHV funding and a long-term reauthorization that will provide 

stability to the programs that have been providing st ability to at-risk families across the United 

States. While no one program can end child abuse and neglect or break the cycle of poverty, 

home visiting is an example of how one program can interface w ith other community programs 

and resources to provide a positive return on investment and to create a holistic system of 

support around at-risk families. 
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House Ways and Means Subcommittee on Human Services 

Hearing on Maternal, Infant, and Early Childhood (MIECHV) 

Home Visiting Reauthorization Hearing 

March 15, 2017 

Statement for the Record Submitted by: 

Debra Pontisso, MPA - Policy Advisor, 

Responsible Fatherhood Roundtable 

(Retired) Program Specialist, Office of Child Support Enforcement, Administration for Children 

and Families, Department of Health and Human Services 

6830 Deer Spring Court, Falls Church, VA 22043 

Phone: 703-241-0163 Email: dpontisso@aol.com 

Distinguished M embers of the Human Resou.rces Subcommittee: 

" Paren ting Our Children: ln the Best interest of the Nation" is an axiom that I believe 

all of us can firmly support and agree upon. And it is in this spirit that I encourage you to give 

serious consideration to including language in the MIECHV reauthorization that would expand 

services andjor provide incentives and resources for Home Visiting Programs to serve fathers as 

well as mothers. 

"Parenting Our Children .. ." is also the title of a 1996 report to Congress and the President that 

emanated from the bi-partisan U.S. Commission on Child and Family Welfare of which I served 

as its Associate Director. In 1990, approximately 28% of all lives births nationwide were to 

unmarried mothers. 

The Commission was created as part of the Child Support Recovery Act of 1992 (P.L. 102-521) to 

study and to advise Congress and the President on issues relating to child custody, parental 

access and visitation, abuse, 'services for children and families, family and juvenile courts and 

the child welfare system. '01e focus of the Commission's attention was based, in large part, on 

the growing concern and consequences offather absence in the lives of children. As a result, the 

Commission held hearings around the country to solicit recommendations for changes in public 

policies that held the promise of increased father involvement--and responsibility (both 

financially and emotionally)- in the lives of their children. 

Today, the changes in fami ly formation and structure are even more pronounced given 

the continued increased in nonmarital child bearing. In 2014. 40% (1.7 million est.) of all 

live births (3.9 million est.) nationwide were to unmarried parents. 

And this percentage is exponentially higher among various racial groups, specifically: 71.5% to 

unmarried births to African-American mothers, 53.2% to Hispanic Mothers; and 29.3% to White 

Debra Pontisso - Statement for the Record March 28, 2017 

Page 11 
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mothers. While there have been improvements in reducing teen pregnancies, over ~ 

mothers between the age of 20 -24 years had children outside of marr a~e 

And to draw this changing demographic closer to home, I have included the nonmarital births 

percentages and numbers for the members oft he Human Resources Subcommittee based on their 

respective states: 

Disease Control al'ld Prcve•'ltion, 

One of many consequences of these changing demographic t1·ends is that as of 23.6% of children 

(•7·4 million) lived in father-absent homes and the poverty rate for these households is 48% --

over four times the rate for children living in married couple fam il ies. 

Father absence also has unintended consequences for a child's emotional and social well-being. 

According to Child Trends, 

Children born to unmarried mothers are more likely to grow up in a single-parent household, 

experience instable living arrangements, live in poverty, and have socio-emotional problems. 

Debra Pontisso - Statement for the Record March 28, 2017 

Page I 2 
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33364A.118

As these children reach adolescence, they are more likely to have low educational 

attainment, engage in sex at a younger age, and have a birth outside of marriage as young 

adults, children born outside of marriage are more likely to be idle (neither in school nor 

employed), have lower occupational status and income, and have more troubled marriages 

and more divorces than those born to married parents 

Our country's social policies have failed to respond to the changes in family formation. It has also 

failed to incorporate a "father factor" into mainstream child and family support programs that 

would create on-ramps to services for fathers who live apart from their children. 

Changes in the MIECHV reauthorization that offer fathers home visiting services similar to those 

provided to mothers could have many positive impacts on family and child well-being. It holds 

the promise of providing an incentive for both mothers and fathers to establish a co-parenting 

partnership, thereby enabling fathers (since mothers are often the "gate keepers") to maintain a 

parenting relationship with their children. 

In a study entitled Promoting Father Involvement in Home Visiting Services for Vulnerable 

Families· Finds from a Pilot Study of Dads Matter by Guterman, N.B., j.L., & Ban man, A. (under 

review - Z017), researchers posited the following: 

Perhaps most fundamentally, the field of home visitation as a whole has largely overlooked 

the key role that fathers play in young children's developmental outcomes and in configuring 

home visiting services to address tl~eir role. It is rather startling to note, for example, that 

none of the home visitation models that have been rigorously evaluated have been designed 

to target fathers as primary service recipients, none were designed to address the array of 

father-related influences on cltildren's well-being, and none have yet included fathers as 

subjects of study, leaving a scant evidence base from which to understand how home visiting 

programs can best address fathers' roles in promoting positive child and family outcomes. 

This is an especially significant oversight: A growing body of evidence has indicated that 

fathers play a central role in the development of young children, influencing a variety of 

critical outcomes for later life. 

Indeed, a growing evidence base has documented a wide variety of fathering roles and an 

array of important developmental outcomes linked with these roles. In addition to 

discernable benefits accruing to cltildren from fathers' economic contributions to the family, 

evidence indicates that gre<lter positive father involvement in early childhood, regardless of 

whether fathers live with mothers, has been/inked witlt improved mother-infant attachment 

quality, greater academic achievement, lower aggression, lower delinquency, lower 

depression, and lower anxiety in children 

Furthermore, father-inclusive services have proven tO contribute to positive outcomes in the areas 

of: 

paternal Involvement During Pregnancy 

Debra Pontisso - Statement for the Record March 28, 2017 

Page I 3 
148 

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Paternal involvement during pregnancy was shown to positively influence health outcomes for 

the mother, child, and father. However, the father's role and level of involvement during the 

p1·egnancy may be limited by the focus on the mother during the prenatal period. New parents 

described how attending ultra ·sound appointments together strengthened their relationship. 

Mothers found the fathCI"s presence soothing and 1·eassuring during the p1·egnancy. Mothers also 

cited the father as the best source of support during the nine months. 

Source: Widarsson, M., Engstrom, G., Tyden, T., Lundberg, P., & Hammar, l. (2015). 

'Paddling upstream': Fathers' involvement during pregnancy as described by expectant 

fathers and mothers. Joumal of Clinical Nursing, 27, 1059·1068. 

Paternal Enga~ement in Child and Family Services 

Research on the engagement of fathers in a variety of child and family interventions and programs 

suggests that fathers' participation in services boost mothers' engagement in the intervention and 

improve service outcomes. 

Sources: Fals-Steward, W., Fincham, F.O., & Kelley, M.l. (2004). Substance-abusing 

parents' attitudes toward allowing their custodial children to participate in treatment: a 

comparison of mothers versus fathers. journal of Family Psychology, 18(4), 666. 

Bagner, D.M., & Eyberg, S.M. (2003). Father involvement in parent training: When does it 

matter? journal of Clinical Child and Adolescent Psychology, 32(4), 599·605. 

Gevan, S., Granic, 1., Solomon, T., Blokland, K., & Ferguson, B. (2012). Paternal 

invoh•emcnt in Multisystemic Therapy: Effects on adolescent outcomes and maternal 

depression. Journal of Adolescence, 35(3), 743-751 

Paternal Engagement in the Perinatal Period 

Involving fathe1·s in the perinatal period, as is targeted by home visiting programs, is linked to 

continued involvement over time. Father involvement among young unmarried parents, on 

average, often declines over the first 2 years of their children's lives, but when fathers participated 

in the birth they were more likely to be positively involved 2 years later across multiple measures, 

i.ncluding contact, direct caregiving, financial contribution, decision making, and contact with 

exttmded family. 

Source: Bellamy, j.L., Thullen, M.j. & Hans, S.L. (2015). The effect of fathers' presence at 

birth on involvement over time. journal of Ma rriage and Family, 77(3), 647·661. 

In closing, I sincerely hope you will give serious consideration to making father-inclusive services 

an impo1tant hallmark of the MIECHV Reauthorization. 

Debra Pontisso • Statement for the Record March 28, 2017 

Page 14 
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• SHRIVER 

CENTER Sa.rg.enl Shriver National Center on P~ucy Law 

March 29, 2017 

Subcommittee on Human Resources 

Committee on Ways and Means 

U.S. House of Representatives 

Washington, D.C. 20515 

I 

SO F.., Wa.~hington St., S.ail¢ SOO 

Chia_gq, lll_inols 60602: 

, .2.263.$830 

www.po'o'("nylaw.org 

Chairman Smith, Ranking Member Davis, and Members of the Subcommittee on 

Human Resources: 

We appreciate the opportunity to submit testimony in support of reauthorization of the 

Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. The mission 

of the Sargent Shriver National Center on Poverty Law is to provide national leadership 

in advancing Jaws and policies that secure justice to improve the lives and opportunities 

of people living in poverty. The Shriver Center develops and advances policies that 

respond directly to the needs of people in poverty, including in the areas of health care, 

education, housing, civil rights, and employment. 

A large body of research links poverty in childhood to poor adult outcomes such as lower 

educational attainment and earnings and higher incarceration rates. Over the last 

decade, researchers have examined the effect of poverty at different stages of childhood. 

What they found is that living in poverty during early childhood is far more damaging to 

a child's long-term prospects than is living in poverty at later ages. The negative effects 

of early childhood poverty can last a lifetime, at significant cost to society as a whole. 

Nationally, 43% of all young children live in low income families with incomes below 

200% of the federal pove rty threshold in the crucial early years of life. Roughly one in 

every ten children under age five live in deep poverty, o r below so% of the feder:tl 

pove1ty level. The sheer number of children living in poverty in our nation gives urgency 

to stemming the harm at an early age. 

Advancing justice and opportunity THtStlltiV£11, CL~ R IS /1. R.t;CIPIE.N'T O F T HE MACMlni\Ht .AWARD FOil. CRL\TIV£AND tFrECTIVE INSTITUTION S 
150 


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.\U£CIIV 

The federal MIECHV program provides a promising means to ameliorate the harsh 

effects of early poverty, building upon decades of scientific research showing that borne 

visits by a nurse, social worker, or early childhood professional during pregnancy and in 

the first years oflife improve the lives of young children and families. The federal 

MIECHV program serves many of the most vulnerable families by promoting key 

elements necessary to improve lifetime outcomes for children born into families lh~ng 

in poverty: universal developmental screening and early intervention services to 

support children's healthy development; parenting education and support se•"Vices; and 

connecting families to medical care, including behavioral health care and infant mental 

health support. In FY 2015, MIECHV repo1ted serving approximately 145,500 young 

children and families. According to the Administration for Children and Families 

(ACF), 77% ofMIECHV participating families had a household income at or below 100% 

of the federal poverty level ($24,350 for a family four), while 46% were living in deep 

pove1ty, with income at or below so% of those guidelines. 

Illinois has long valued evidence-based home visiting programs as an effective strategy 

for strengthening expectant and new fantilies. By developing a cross-sector statewide 

home visiting system, 11linois has provided essential se1"Vices to over 17,000 families, 

making it a nationally-recognized model of a state system supporting a variety of 

evidence-based models and innovative practices. National and Illinois-specific research 

studies show that high-quality evidence-based home visiting programs result in 

numerous positive outcomes for children and their families, including: 

• Increasing rates ofbreastfeeding, immunization, well-child visit, and 

developmental screenings; 

• Promoting language development and school readiness; 

• Improving rates of high school graduation; and 

• Increased rates of talking, reading and positive interactions between parent and 

child. 

In addition to the positive short-term benefits of home visiting programs, there is a host 

of positive longer term outcomes associated with these services, including reduced risk 

of chronic health behaviors and outcomes (such as obesity, diabetes, heart disease, 

alcohol consumption, and smoking. Recent economic literature also demonstrates that 
151 

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~UECII\' 

public investments in high-quality programs for disadvantaged children from birth 

to age five can result in an estimated 13% annual rate of return. 

Among MIECHV-funded programs in 2016, 100% of families were screened for needed 

services, 93% of children received recommended well-child visits, and 93% of children 

were screened for developmental delay before age one. These accomplishments have 

critical implications for the healthy long-term trajectory of low income children and 

families. And yet home visiting programs reach only a small fraction of the children and 

families who would benefit ft·om them. 

In closing, we would like to reiterate our strong support for the reauthorization of the 

MIECHV program. Extending the MIECHV program for an additional five years, and 

doubling the expenditure, would allow many more children and families to overcome 

the ill effects of poverty, and strengthen our nation's promise. 

Respectfully submitted, 

Ann Courter 

Early Childhood Director 

Sargent Shriver National Center on Poverty Law 

so East Washington, Suite soo 

Chicago, IL 60602 

312.757-5105 

anncourter@povertylaw.org 

Sources: 

Duncan, Greg J. and Magnuson, Katherine (2011). The Long Reach of E.trly Childhood Poverty. Pathways 

Magazine. The Stanford Center on Poverty and lltequality. 

bttp·//www stanford edu /gmuu/scsnj/ media/pdf/p;athwys/wjnter 20aa/PatbwaysWjntena Dum;an, 

Garcia, J; Heckman JJ; Leaf OM; Prndos MJ. The life Cycle &nefits of Innuential Early Childhood 

Program (2016). Retrieved from: http:/ j heckmanequation.orgjcontcnt/ re$0urceflifecyclc·bencfits· 

influential·early-dlildhood·program. 
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House Ways and Means Subcommittee on Human Resources 

Hearing on Maternal, Infant, and Early Childhood (MIECHV) 

Home Visiting Reauthorization Hearing 

March 15, 2017 

Statement for the Record Submitted by: 

Jennifer Bellamy, Neil Gutetman, Aaron Bamnan, Sandra Morales-Mirque, Justin Harty 

The Dads Malter Research Team, 

At the University of Chicago School of Social Service Administration, and the 

University of Denver School of Social Work 

969 East 60tll Street, Chicago, II 60637 

(773) 702-1420 

Jemufer.Bellamy@du.edu 

March 28, 2017 
153 


33364A.124

We are pleased to provide our statemenl in support of reauthorization of the Matemal, Infant, and Early 

Childhood Home Visiting (MIECHV) Reauthorization, and wish to urge language in that reauthorization 

that provides incentives and resources for home visiting programs to more fully consider and include 

fathers in the design and delivery of home visiting services to families in need. 

The scientific evidence supporting the benefits of early home visiting for children's development is now 

clear, and MJECHV is thoughtfully designed so that ongoing quality improvements and scientifically 

guided innovation can be achieved that can magnify the positive impact of such services to our most 

vulnerable young children and their families. The Dads Matter research team at the University of 

Chicago and the University of Denver have been designing and testing one such innovation that more 

fully incorporates fathers into the delivery of home visiting services. Why? 

Simply stated, because the successful inclusion of fathers in such services holds significant potential to 

substantially boost the benefits of such services for the developing child, which were originally designed 

to be mother and baby focused. Studies show that although fathers may less commonly play the primary 

caregiver role in very early childhood, they are increasingly playing a direct caregiving role, and their 

positive involvement during the phase in which home visitation services are provided can improve 

mother-infant anachment, lower child abuse and neglect risk, and later lead to improved academic 

achievement, lower aggression, lower delinquency, lower depression, and lower anxiety in children. 

Moreover, studies conducted in other child and family services suggest that the inclusion of fathers can 

also increa.se mothers' engagement in those services and both boost and extend outcomes so that the 

impact of programs is maintained over time. 

A recent survey of home visitors in the state of Jllinois conducted by one of our team members finds that 

almost all workers have access to fathers (98% know they have a father in a caregiving role within 

their caseload); and yet, many fathers are not actively included in services by home visitors, and thus 

often miss a key opportunity to improve outcomes for children and families. 

Our research team has been designing and testing a program enhancement to evidence-based home 

visitation program models supported under MIECHV, called Dads Matter, and our pilot findings suggest 

that fathers can be well engaged by such services, and that this enhancement can increase fathers' 

productive involvement with their children, strengthen the quality of the mother-father relationship, 

reduce parental stress for both parents, and lower risk of both physical child abuse and neglect. While 

these findings are preliminary, they are highly promising, and we are presently subjecting the Dads 

Matter enhancement to a randomized controlled trial sntdy design with over 200 families to evaluate its 

overall effectiveness under "gold standard" scientific conditions. Such an enl1ancement adds nominal 

financial costs to existing home visiting services. 

Given that fathers have traditionally not formed the focus of early home visitation services, and that their 

productive engagement and involvement can promote even greater outcomes for children and families, we· 

recommend that the reauthorization of MIECHV include language that provides incentives and resources 
154 

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for home visiting programs to more fully include fathers in the design and delivery of evidence-based 

home visitation programs. 
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March 21, 2017 

The Honorable Adrian Smith 

Chair, House Ways & Means 

Human Resources Subcommittee 

& 

The Honorable Jason Smith, Jackie Walorski, Carlos Curbelo, Mike Bishop, Dave Reichert, Tom Reed, 

Danny Davis, Lloyd Doggett, Terri Sewell and Judy Chu 

Subcommittee Members 

The Florida Association of Healthy Start Coalitions, Inc. (FAHSC) is pleased to share our experience 

implementing the Mat ernal, Infant and Early Childhood Home Visiting {MIECHV) initiative and its impact 

on families who seek services. 

In Florida, MIECHV is implemented through a public-private partnership. FAHSC is one of three 

non-profit organizations in t he country that serve as the state lead. We coordinate our activities with 

key state agencies, as well as other state and local partners working to improve outcomes for expectant 

and new families. FAHSC represents a statewide network of community-based maternal and child 

health coalitions establ ished in 1991 to reduce infant mortality and promote healthy child development . 

The coalitions are community-driven and governed by volunt eers who live in the service area and are 

knowledgeable about local resources and needs. We work to ensure families are successful and have the 

information, care and support they need to raise children who are healt hy, safe and enter school ready 

to learn. 

Our work in maternal and child health over the last 25 years led us to embrace the opportunity 

offered by MIECHV. Home visiting, particularly in pregnancy and the first two years after birth, is an 

effective and proven strategy for changing the trajectory of parents and the lives of their children. It 

provides education, encouragement, linkage to health care and other resources, and personal support 

to vulnerable families during a critical period of rapid brain development. It levels the playing field for 

low-income families in high-need communities and contributes to their social and economic success, as 

well as the success of t heir children. 

Florida currently receives $10.9 million annually in MIECHV funding and implements three 

evidence-based home visiting models - Nurse Family Partnership, Parents as Teachers and Healthy 

Families Florida- in 28 high-need communit ies. Programs were selected by the communities based on 

local needs and gaps in services. The models are implemented by local Healthy Start Coalitions, 

hospitals, federally-qualified health centers, early learning coalitions, and other community-based 

organizations. MIECHV resources leverage public and private funding that support a continuum of 

Fl Association of Hea l thy Start Coa l i t ions MIECHV Page 1 18 
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community programs, including Florida Healthy Start, Healthy Families Florida, HIPPY, Early Steps and 

Early Head Start. 

During 2015·16,1ocal MIECHV sites in Florida served nearly 1,800 of t he most at-risk families. 

Programs provided more than 17,700 home visits during the year. As shown in the following graphic, 

MIECHV provided our state and communities with the resources to implement evidence-based home 

visiting programs that had a direct and measurable impact on participating families. Noteworthy, nearly 

half of program participants took steps toward economic self-sufficiency by gaining employment or 

enrolling in school. Between 2013 and 2015, the Florida MIECHV initiative achieved required 

improvements in five of the six legislatively mandated benchmark areas (Maternal & Child Health; Child 

Safety; School Readiness; Reducing Violence, and Coordination & Referral). 

Families are the faces behind the data and describe the real impact of home visiting on their 

lives and the future of their children. Below we share a few of the many stories we hear daily: 

Hi my name is Denise M, 

I was a participant in the Nurse Family Partnership (NFP) program in Jacksonville. NFP is o 

program for first time parents where o nurse comes to visit you in your home. This home visitor helps you 

get prepared to be o parent. Your home visitor nurse stays with you until your child is 2 years old. 

While I wos o participant in the NFP 

program I made a choice to breastfeed my 

son. My nurse home visitor Janet McDonald 

gave me information one visit about 

breastfeeding and I knew that I hod to try it. I 

breostfed my son for 12 months ond I hove to 

soy I truly loved it. Although it wasn't easy in 

the beginning I knew that I was giving my san 

the best gift I could ever give him. After my 

experience with breastfeeding I told anyone I 

could about it. I was sa thankful to the NFP 

program and the Coalition that they truly 

became part of my life. I never wanted to leave this program but knew one day that day would come and 

another mom would learn everything that I did. 

Fl Assoc ia t i on of Healthy Start Coa l i t i ons MIECHV Page2 18 
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fLORIDA MATERNAL, INFANT, &._ 

EARLY CHILDHOOD H OME VISITING 

INITIATIVE 

2015-16 HIGHLIGHTS 

1,799 Families Served 

../ 667 Pregnant Women 

../ 1,132 Other Caregivers 

../ 1 ,460 Children 

Race Primary Language 

52% 

Unemployed 

Age 

Our Impact 

94% 

Repotted No 

SuWequent 

Pregnancies Wrthin 

One Year 

" Q 100% 

81% Of Uninsured Women & Chil<lr$0 Gained Health Insurance 

'j

. Sl>owedtmprovement 

in Parent a.havtors & Parent ..Child •• "" Rolationships 

,. 

88% Screened tor MatemaJ 

Oepreuion 

Among the 819 

Families Newly 

Enrolled this Year: 

• 19% p<egnant women underage 21 

• 24% with histooy ol child abuse or neglect 

• 20% with history of 

substanoe abuse 

98% Of Children had No 

Verified Repotts of Manr.atmeot 

93% Sc""'nedfor 

Intimate Partner 

VIOlence 

Fl Assoc ia t i on of Hea l thy Start Coa l i t ions MIECHV Page 318 
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I was very pleased one day to know that I wasn't the only mom that wished the NFP program 

lost longer. The Coalition and the Jacksonville NFP program granted our wish. They allowed us to put 

together a NFP support group. In this group we give all NFP participants (graduates and current) a 

chance to get together and get to know each other. This group is still fairly new but we ore growing and 

we hope to have all participants come to the once a month meetings. We have moms days out and play 

dates with the kids. We ore trying to get a daddy's group together where the graduated dads will mentor 

the new dads in the group. I am very thankful to the Northeast Florida Healthy Coalition for this platform 

that they hove allowed us to hove. 

Recently The Northeast Florida Healthy Start Coalition has given me another amazing 

opportunity. I om now working with the Coalition on a grant to increase breostfeeding initiation ond 

duration through a grant with the Notional Association of City and County Health Officials (NACCHO) as 

a peer breostfeeding counselor. I have been trained as a peer breast feeding counselor and now I have 

breostfeeding support groups for pregnant and breostfeeding moms. This program works hand in hand 

with our NFP program by referring NFP clients at 33 weeks that show interest in Breastfeeding to me for 

breastfeeding support. We are also working on putting pumping stations in two local high schools. I get 

to share my story to so many now and I just hope that I con make a difference in one person's life. NOTE: 

Denise continued to pursue her training and recently passed an exam to receive her certification as a 

Lactation Counselor. 

My PAT+ mentor Alyssa asked me if I wanted to share my story and I was absolutely thrilled to if 

it meant I could somehow inspire one other person ... / hod my son Lucas on May 31" lost year and it wos 

the best day of my life. Just being able to hold this little bundle of love after carrying him for 10 months, 

worrying about if I hod stocked up enough diapers and if he hod enough clothes. It hod all melted away. 

When I brought him home I was so scored. Here I was a 23 yeor old single mother of a beautiful baby 

boy. The first few weeks were very stressful between trying to breast feed getting up at night every 2 

haurs ... running on 0 energy, worried if I was changing his diaper right. Now Lucas is 10 months ald. I am 

enrolled in school full time. I would never have thought I'd be going to school with on infant while being 

a single parent but I wouldn't change a thing. Lucas is the world to me. I don't know what I would do if I 

didn't have Alyssa to listen to me when no one else would. Or bounce ideas off of. Or even email her in 

the middle of the night when things are bothering me. I om so thankful 1 have someone like her in my life. 

She has helped me through so much. I hove a happy healthy little boy that keeps me motivated. I would 

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really suggest this program to anyone like myself or even to o woman that has a happy home life 

because having a child is never easy. And it's always nice to have someone to talk to reassure you that 

you are doing a great job. 

"I don't know what I would have done without you." Those words were spoken by Oneida, a 17 

yeor old, first-time parent who enrolled in the home visiting program at age 16 when she was eight 

weeks pregnant. During eight months of home visits, she was on active and interested participant. Her 

primary goal was to finish her education. During her pregnancy, Oneida and her nurse home visitor 

worked on strategies to keep herself healthy and relaxed by learning more about the pregnancy process 

and ways to reduce stress. In later visits, Oneida learned about developmental milestones and ways to 

calm a baby. At each visit, the nurse assessed her for any physical concerns, discomforts, changes in her 

environment, or coping with the pregnancy. In turn, Oneida followed through on guidance and referrals. 

On October 31, Oneida delivered a healthy, 9/b., 2 oz. baby boy. Since then, she and the nurse hove 

discussed the importance of proper nutrition, sleep position, well-baby visits, immunization schedule and 

family planning. Oneida kept her postpartum appointment and has chosen a method of family planning 

after reviewing several options with the nurse. While on maternity leave with no income, Oneida started 

experiencing some financial difficulties. She shared her financial difficulties with her nurse home visitor, 

who referred her to loco/ financial assistance office. Oneida was planning to return to work but was 

informed that the company thot employed her was closing. Oneida wanted to start looking for job and 

she requested the assistance of the nurse in putting together o resume. The nurse discussed all the 

information needed for a resume and provided guidance and assistance. Oneida utilized the resume and 

successfully found new employment. Oneida is grateful for the opportunity to participate in the home 

visiting program and also for having a nurse home visitor who has always been very helpful. 

One of the mothers we ore working with is 18 years old who has recently received her high 

school diploma. Her child is a one-year-old little girl who is healthy, happy, and active little girl who is 

full of joy. 

When we first met she was very sad after becoming isolated because she was in high school and 

hod a baby. She stated that many of her friends abandoned her when she needed their support the most. 

She felt that she did not have a friend in the world. Her family and the baby's dad was supportive, but 

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they were not with her during the day at school. She wonted to graduate and show the girls that she 

could hove a baby and succeed. 

As a Parent Educator, I focused on family well-being and her education, letting her know that we 

as on agency see her self-worth. Her first goal was to graduate. Once she completed her first goal we 

celebrated her success and talked about how she con do anything that she puts her mind to. 

Since meeting her first goo/ of graduating, she has set new goals and is reaching them one by 

one. One of her goals was to get her driver's license so that she could toke her daughter to her 

appointments oil by herself She was recently successful at getting her license. She is now spending time 

with other moms and no longer feels lonely. 

She in now babysitting to bring in income and has token the TABE test os her first step toward 

enrollment into college. She now has confidence in herself and the decisions that she is making for her 

family. 

On July 24, a Family Support Worker Supervisor (FSWS) met with a determined young lady who 

was unemployed, faced homelessness, hod little support, and was 21 weeks pregnant with her second 

child. The FSWS soon learned that the expectant mother had suffered from mental health complications; 

recently hod her first child removed from her core, and hod o history of using substances. The father of 

the baby was incarcerated. 

After learning about the benefits of Healthy Families, she signed into the program with her 

assigned Family Support Worker {FSW). The FSW began to educate her on maternal health and the 

implications of using tobacco, drugs, and alcohol while pregnant. The participant vowed not to use 

substances such os tobacco, alcohol, and illicit drugs, because she wonted her baby to be healthy. She 

realized that she had to make some serious changes in her life. She learned the importance of living in a 

stable in environment when her baby is born; therefore she decided to move into the paternal 

grandparents' home. As the time got closer to the her baby's due dote, the FSW educated the participant 

on the benefits of breastfeeding, providing o safe place for her baby to sleep, and how to cope with her 

baby's crying. The FSW also went down a checklist to ensure the she hod all the necessities for a sweet, 

newborn baby. 

The participant gave birth in December, and began to breastfeed her baby right away. 

Beneficially, she continues to breostfed the child who is now five months old. Both mom and baby 

continue to live in a stable, nurturing home with the paternal grandparents. The participant has secured 

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child care far her daughter, while she works part-time. Proudly, this mother is able to say that she has 

not used any substances such as alcohol or illicit drugs, and does not smoke or use tobacco. 

We celebrate all the accomplishments she has mode towards self-sufficiency, using activities 

that promote positive parent/child interaction, and ensuring that her baby is up-to-date with 

immunizations and well-baby checks. 

MIECHV not only supports families, but is also raising the bar for all home visiting programs in 

Florida by creating core competencies, managing statewide training, promoting accountability and 

continuous quality improvement, and contributing to systems development at both the state and local 

level. 

Systems development, in particular, is critical for coordinating multiple evidence-based home 

visiting programs and related services, ensuring families get the services that best meet their needs and 

preferences. Florida has invested MIECHV funds in piloting Coordinated Intake & Referral (CI&R) in 10 

communities. Multi-agency teams, led by the local Healthy Start Coalition, worked together over a twoyear period to craft strategies for making home visiting a "hub" of local place-based early childhood 

systems. The goal of CI&R is for families to receive the most appropriate services as well as to minimize 

duplication, ensure effective use of local resources, and collectively track what happens to each family. 

Using Florida's universal prenatal and infant screening, the teams developed service inventories and 

agreements, decision trees to aid in linking eligible families to home visiting and other programs, 

awareness & education material for families, referral tracking systems, and related processes. 

CI&R and other systems work supported by MIECHV further impacts families and communities: 

"Bringing the agencies together while avoiding duplication of services through the CI&R project 

guarantees the best utilization of funds received for direct services. Follow-up with the family is a key 

component through the CI&R process in that it ensures the family receives services that best address 

their individual needs. The BFG Coalition encountered several families that would have gone without 

much needed services, had they not received a follow-up call through the CI&R program."- Sharon 

Owens, Executive Director of the Bay, Franklin, Gulf Healthy Start Coalition. 

"The Coordinated Intake and Referral Learning Collaborative has provided an excellent 

opportunity to improve our systems for linking families in our community to the most appropriate and 

preferred community services. The learning collaborative provided both on opportunity for communities 

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to learn from each other ond the time ond resources to improve the intake ond ref errol system to needed 

community resources. Through this project, our team hos hod the ability to develop o mobile app that 

will be used by bath parents ond social service providers in our area." Brenda Breslow, Director of 

Programs, Hillsborough Healthy Start Coalition. 

Based on the success of the pilot s, the Florida Department of Health, t he st ate's Title V agency, 

is providing funding to replicate CI&R in other communities through Healthy Start. 

The Florida Association of Healthy Start Coalitions, Inc. strongly believes MIECHV is a wise and 

sound investment of tax dollars. Evidence-based home visiting supported by MIECHV sets the standard 

for all early childhood services provided in a state. MIECHV leads the way in demonstrating 

programmatic accountability. 

MIECHV impacts families. It impacts services. It impacts state and local systems of care. 

Thank you for the opportunity to share our experience in implementing the MIECHV program in 

Florida. 

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March 27,2017 

The Honorable Adrian Smith 

Chair, House Ways & Means, Human Resources Subcommittee 

The Honorable Carlos Curbelo 

House Ways & Means Committee, Human Resources Subcommittee 

Dear Mr. Smith and Mr. Curbelo, 

On behalf of the United Way of Miami-Dade, I am pleased to provide this statement of support for the 

Reauthorization of the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program. This 

program aligns with two key United Way priorities - strengthening investment in early childhood and 

supporting economic self-sufficiency for working families. 

Our organization is committed to implementing evidence-based strategies that contribute to healthy 

child development and ensure all children enter school ready to learn. We are impressed with the track 

record of MIECHV and the home visiting programs it funds in Florida in achieving measureable results in 

improving outcomes for vulnerable families and their children. This program supports evidence-based 

home visiting programs that provide education, coaching and support to families who ask for help 

during a critical period of early brain development. Experts, including economist and Novel laureate 

James Heckman, have underscored the importance and wisdom of investing in families during thi s 

period. Home visiting offers proven prevention and early intervention that avoids the need for costly 

remedial services in the future. Evidenced-based home visiting models implemented in Miami-Dade 

t hrough MIECHV and other funders complement and enhance our efforts and investment in quality 

early learning. 

United Way is also leading efforts in Florida to address t he financial challenges faced by low-income, 

working families. With state and local support, we provide t ax filing assistance to ensure these families 

take advantage of the federal Earned Income Tax Credit (EITC) and other programs that contribute to 

their economic self-sufficiency. We have worked with MIECHV in Florida to assist home visitors with 

linking the families they serve to these and other resources. Our collaboration with MIECHV has allowed 

us to reach families who could benefit the most from this assistance. 

Home visiting works. MIECHV is a critical funding source for leveraging both public and private resources 

in Florida. We urge you to support the reauthorization and continued funding of this effective program. 

Thank you. 

Sincerely, 

Jess Scher 

Senior Director, Public Policy 

United Way of Miami-Dade 

3250 SW 3'd Ave. Miami, FL 33129 

Tel: 305·322·6143 

scherj@unitedwaymiami.org 

www.unitedwaymiami.org 
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House Ways and Means Human Resources Subcommittee 

March 15, 2017 

Hearing on the Reauthorization of the Maternal, Infant, and Early Childhood Home Visiting 

(MIECHV) Program 

Written Comments and Statement for the Record of Voices for Ohio's Children 

oo 

tfvoacES FOR 

OHIO'S CHILDREN 

Voices for Ohio's Children 

33 N. Third St., Ste. 420 

Columbus, OH 43215 

614-221-5204 

www.raiseyourvoiceforkids.org 
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March 15, 2017 

Ways and Means Committee Office 

1102 Longworth HOB 

Washington, D.C. 20515 

Re: Hearing on t he Reauthorization of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) 

Program 

Voices for Ohio's Children is pleased to provide a written statement regarding reauthorization of the 

Mat ernal, Infant, and Early Childhood Home Visiting (MIECHV) Program. We hope our comments will 

prove helpful to the House Ways and Means Human Resources Subcommittee as it considers support 

for this important program. 

Organizational Background 

Voices for Ohio's Children is a nonprofit, nonpartisan advocacy organization dedicated to keeping Ohio 

children safe and healthy; educated in quality programs from preschool through high school; connected 

to their families, friends, and communities; and employable by ensuring their access to afterschool 

programming and work opportunities. 

Voices does exactly what it sounds like-we give Ohio kids a voice in the public policy process. We do 

this by providing proactive leadership on our policy priorities-which are based on need, trends, and 

community feedback-and by partnering with national and state advocates, service providers, and 

government offices. Voices is also an experienced convener and facil itator of diverse stakeholder 

groups. 

Voices offers regular public educat ion opport unit ies on a variety of children's issues. Join our Policy 

Team each month for our Public Policy Partner webinar series. You can also get involved in Voices' work 

by becoming a Public Policy Partner. Visit our website at RaiseYourVoiceForKids.org to learn more and to 

sign up for our weekly e-newsletter and upcoming events. 

Home Visit ing Matters 

Home visiting is a powerful tool for families. Research shows that home visits by a nurse, social worker, 

early childhood educator or other trained professional during pregnancy and in the first years of life 

improve maternal and child health, prevent child abuse and neglect, increase positive parenting and 

enhance child development and school readiness.' 

Long-term developmental well-being, safety and early school success of children are important public 

policy and social objectives. These goals are not achieved through a single effort, but through many 

small, consistent efforts that improve a parent's ability to care for a child and themselves. According to 

the PEW Charitable Trusts, " Home visiting is proved to be an excellent spark for initiating such change 

and for placing young fami lies on the right track."" 

Home visiting delivers early education and support to families on t heir terms and in their own homes, 

which eliminates environmental constraints such as transportation and structured hours of operation." 

This allows home visitors to observe family processes in their natural environments.lvThrough stand-
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alone programs, or in partnership with cent er-based services, voluntary home visiting educates families, 

provides resources for health, child development and school readiness . ."Families who participated in 

home visiting services were half as likely to be involved with Child Prot ective Services."' Home visiting 

bridges community resources for participating families in order to build a better future for themselves. 

Home visiting is a tool for reducing Ohio's abysmal infant mortality rate. Ohio's 2015 infant mortality 

rate was 7.2 infant deaths per 1,000 live births, a rate 21 percent higher t han the most recently reported 

national rate. The white infant mortality rate was 5.5 and the black infant mortality rate was 15.1, with 

black babies dying at nearly t hree times the rate as whit e babies."" Studies have found that high-quality 

home visiting programs yielded better birth outcomes. Children whose parents participated in home 

visiting programs are born w ith fewer instances of low birthweight and are more likely to be breastfed."'n 

An Ohio study found infants whose families did not receive home visiting were 2.5 times more likely to 

die in infancy compared to those infants whose families received home visiting services." 

What is home visiting? 

Home visiting is an in-person, evidence-based service t hat provides pregnant women and familiesparticularly t hose considered at-risk- the necessary resources and skills to raise children who are 

physically, socially and emotionally healthy and ready to learn. 

Evidence-based 

In order to receive stat e funds t hrough Help Me Grow or federal funds through MIECHV, t he home 

visiting model must be designated as evidence-based by t he U.S. Department of Health and Human 

Services (DHHS). The Department of Health and Human Services launched the Home Visiting Evidence of 

Effectiveness (Hom VEE) review to conduct a t horough and transparent review of t he home visiting 

research lit erat ure. Hom VEE provides an assessment of t he evidence of effectiveness for home visiting 

program models t hat t arget families with pregnant women and children from birth through age five. 

According to t he PEW Charitable Trusts, " Decades of research show t hat t hese family support programs 

are effective and ultimately save money for t axpayers. When quality programs, carried out in local 

communities, are properly implemented, they lead to increased family self-sufficiency, lower health care 

cost s, and reduced need for remedial education."' 

Home visiting programs must be shown to be effective and consistently improve measurable outcomes 

for Ohio's children and families. Success is measured by demonstrating improvement in six benchmarks: 

1. lm provement in maternal and newborn health; 

2. Reduction in child injuries, abuse, and neglect; 

3. Improved school readiness and achievement; 

4. Reduction in crime or domestic violence; 

5. Improved family economic self-sufficiency; and 

6. Improved coordination and referral for other community resources and supports.'' 

Maternal, Infant, and Early Childhood Home Visiting in Ohio 

The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program is a federal/state 

partnership active in all 50 stat es that funds home visiting models for stat es, t errit ories and tribal 

entities. M IECHV is not a home visiting model or direct service provider, but a name given to the federal 

program that funds federally recognized evidence-based home visiting services across the nation. 
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Jointly administered by the U.S. Department of Health and Human Services' Health Resource 

Administration and the Administration for Children and Families, the Affordable Care Act appropriated 

five years of funding for the program in 2010 and the funding was extended to March 2017 by the 

passage of the Medicare Access and CHIP Reauthori zation Act of 2015. In Federal Fiscal Year 2016 

(FFY16) Ohio received $5,819,100 MIECHV funding resulting in a total program capacity to serve 1,687 

families'". The number of home visits provided will be determined at the end of the FFY closing 

September 30, 2017. 

The U.S. Department of Health and Human Services requires 75 percent of granted MIECHV funds be 

used to implement approved evidence-based home visiting models and up to 25 percent may be used 

on promising approaches rather than approved models. Ohio's M IECHV funds support expanded access 

to home visiting by broadening the eligibility base to encompass additional families who previously 

could not participate in HMG home visiting services funded by the state, as well as systems-building 

initiatives, quality improvement processes, partnership development, targeted outreach and public 

education.'"' 

The Ohio Department of Health is the MIECHV lead agency and is charged with the execution of the 

statutory purposes of the program which include: strengthen and improve the programs and activities 

carried out under Title V of the Social Security Act; improve coordination of services for at-risk 

communities; and identify and provide comprehensive services to improve outcomes for families who 

reside in at-risk communities.''• 

The MIECHV program targets pregnant women under age 21 and families who are: low income; live in 

at-risk communities, have a history of child abuse; potential substance abuse; smokers in the home; 

children demonstrating low achievement; children who have developmental delays; and mothers who 

have served or serve in the armed forces. 

Priority for MIECHV funding is given to families living in at-risk communities as identified by a statewide 

needs assessment. .. Thirty one counties were identified by t he Ohio Department of Health as being atrisk for poor birth or family developmental outcomes in a 2010 needs assessment. Within these counties 

there are communities, neighborhoods, and/or census tracts with individual and clustered risk indicators 

that rate even higher than the county or state averages identified as the most at-risk communities to be 

served with the MIECHV program ... ' 

In FFY16 there were 27 unique Local Implementing Communities receiving MIECHV funding to provide 

services in Ohio. M IECHV was expanded to Cuyahoga County on October 1, 2016. Counties served 

include Adams, Allen, Ashtabula, Clark, Clinton, Columbiana, Coshocton, Crawford, Fayette, Franklin, 

Gallia, Hamilton, Harrison, Jefferson, Lucas, Mahoning, Marion, Meigs, Montgomery, Pike, Ross, Scioto, 

Stark, Summit, Trumbull and Vinton. 

Similar to Help Me Grow, the program gives states flexibility to identify the issues most pressing to their 

communities and select their programs which are locally implemented where t he participating families 

live.""' Currently Ohio's MIECHV funds support implementation of the Nurse Family Partnership• 

(Cuyahoga, Franklin and Montgomery) and Healthy Families America• models. 
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The goals of MIECHV are: 

Improve maternal and child health; 

Prevention of child injuries, child abuse, neglect or maltreatment and reduction of emergency 

department visits; 

Improvement of school readiness and achievement; 

Reduction in crime or domestic violence; 

Improvements in family economic self-sufficiency; and 

Improvements in the coordination and referrals for other community resources and supports."'u; 

Home Visiting Outcomes in Ohio 

Data on Ohio's stat e-funded home visiting program, Help Me Grown, and MIECHV programs are 

collected by the Ohio Department of Health. 

In SFY16, highlights of the outcomes achieved by Ohio's HMG and MIECHV programs were as follows: 

The average length of stay for a child in a home visiting program was 414 days. Forty-two percent of 

families were enrolled in home visiting prenatally and 38.6 percent of those mothers started receiving 

services in her first trimester. Nearly all (99.45 percent) of the mothers who received services in their 

first trimester had one or more pregnancy risks. Seventy one percent of mothers enrolled prenatally 

reported accessing prenatal care. 

Of the moms who enrolled in home visiting in their first trimester and reported smoking, 50 percent of 

those moms quit smoking. The statewide average of pregnant women who quit smoking was only 17.76 

percent. 

Mothers in home visiting programs determined by screening to be at high risk for maternal depression 

was 22.3 percent and 47.2 percent of those moms received a community referral for treatment. 

Child developmental screenings of children in home visiting programs resulted in 13.92 percent 

identified as having a potential developmental delay, 5.09 percent identified as at-risk for social 

emotional delays and 9.32 percent needed connected to Early Intervention services. 

Reauthorize MIECHV before September 2017 for a five-year term, increasing funding from $400 

million to $800 million annually. 

Home visiting programs strengthen child and families today and strengthen our economy tomorrow, but 

they continue to be underfunded and largely unknown across the country. Implementation of evidencebased home visiting programs is made more difficult by short-term funding extensions, as many 

programs are designed to serve families for multiple years. In addition, programs can be reluctant to 

expand their services and challenged to retain trained staff without consistent, stable funding. 

Policymakers should enact a five-year extension of MIECHV and double its funding from $400 million to 

$800 million annually before it expires in September 2017. The reauthorization over five years with 

double funding will enable MIECHV: to serve more children and families in the hardest to reach 

communities, providing them with improved health, educational and workforce outcomes that provide 

greater opportunities to succeed; enable states and the federal government to realize cost-savings in 

reduced expenditures on health conditions, remedial educational costs and costs associated with child 
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abuse and neglect; and promote state innovations in their programs that make state systems and 

services more efficient. 

Thank you for your consideration. By working together, we can ensure a positive future for our families 

and our nation. 

1 Health Resources & Services Administration. (2016, February). Ohio. Retrieved from Federal Home 

Visiting Program: 

https:/ /mchb.hrsa.gov/sites/default/files/mchb/MaternaiChildHealthlnitiatives/HomeVisiting/p 

df/oh.pdf 

The Pew Charitable Trusts. (2015, May 7). Using Doto to Measure Home Visiting Performance. Retrieved 

from Home Visiting Project: http:/ /www.pewtrusts.org/en/research-and-analysis/factsheets/2015/0S/using-data-to-measure-home-visiting-performance 

11 Gill, S. G. (2007). Home Visitor Competence, Burnout, Support, and Client Engagement. Journal of 

Human Behavior in The Social Environment. 

lv Krugman, R. D. (1993). Universal Home Visiting: A Recommendation from the U.S. Advisory Board on 

Child Abuse and Neglect. The Future of Children, 185-191. 

v Lee, E. M.-H. (2009). Reducing low birth weight through home visitation: A randomized controlled trial. 

American Journal of Preventive Medicine, 36(2):154-160. 

~ Lowell, D. C.-G. (2011). A randomized controlled trial of Child FIRST: A comprehensive home-based 

intervention translating research into early childhood practice. Childhood Development, 

82(1):193-208. 

"" Ohio Department of Health. (2016, November 16). Number of Ohio Infant Deaths Rise in 2015; State 

Surging New Resources to Support Local Initiatives. Columbus, Ohio. 

""'U.S. Department of Health & Human Services Administration for Children & Families. (n.d.). Reduction 

in Child Maltreatment. Retrieved from Home Visiting Evidence of Effectiveness: 

http:/ /homvee.acf.hhs.gov/Outcome/2/Reductions-in-Child-Maltreatment/4/1 

" Edward F. Donovan, R. T. (2007, June). Intensive Home Visiting Is Associated With Decreased Risk of 

Infant Death. Pediatrics, 119(6), 1145-51. 

'The PEW Charitable Trusts. (2014, January). Benefits of the Maternal, Infant, and Early Childhood Home 

Visiting Program. Retrieved from Home Visiting Family Support Programs: 

http://www. pewtrusts.org!-/ media/legacy I uploadedfi les/ pes_ assets/2014/home 20visiting20fa 

ctsheet20january202014pdf.pdf?la=en 

"' Ohio Department of Health. (n.d.). For Help Me Grow Professionals. Retrieved from Help Me Grow: 

http://www.helpmegrow.ohio.gov/Professionals/For%20Professionals.aspx 

'" Ohio Department of Health. (2016, September 28). Early Childhood Home Visiting Regional Meeting. 

Columbus, Ohio. 
170 

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•• Center for law and Social Policy and the Center for for American Progress. (2015, February 9). 

Retrieved from CLASP: http:/ /www.clasp.org/in-the-states/ publications/publication1/0H_MIECHV_Profile.pdf 

""' Ohio Department of Health. (2014, September 25). Ohio's Maternal, Infant, and Early Childhood Home 

Visiting Program {MIECHV). Retrieved from Ohio Department of Health: 

http://www.helpmegrow.ohio.gov/Home%20Visiting/Ohio%20MIECHV.aspx 

"' Health Resources & Services Administration. (2016, February). Ohio. Retrieved from Federal Home 

Visiting Program: 

https:/ /mchb.hrsa.gov/sites/default/ files/mchb/MaternaiChildHealthlnitiatives/HomeVisiting/p 

df/oh.pdf 

"" Ohio Department of Health. (2014, September 25). Ohio's Maternal, Infant, and Early Childhood Home 

Visiting Program (MIECHV). Retrieved from Ohio Department of Health: 

http://www.helpmegrow.ohio.gov/Home%20Visiting/Ohio%20MIECHV.aspx 

""'The Pew Charitable Trusts. (2014, february 21). The Maternal, Infant, and Early Childhood Home 

Visiting Program. Retrieved from http://www.pewtrusts.org/en/research-and-analysis/q-anda/2014/02/21/t he-maternal·infant-and-early-childhood-home-visiting-program 

'"n Ohio Department of Health. (2014, Sept ember 25). Ohio's Maternal, Infant, and Early Childhood 

Home Visiting Program (MtECHV). Retrieved from Ohio Department of Health: 

http://www.helpmegrow.ohio.gov/Home%20Visiting/Ohio%20MIECHV.aspx 
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For-Info. 

..--

EIIee Hallock 

e~me 

(509)991·2390 

Lawle Uppolcl 

~Lcom 

(208)718-6853 

WASHINGTON STATE HOME VISITING COALITION 

March 22, 2017 

The Honorable Adrian Smith 

Chair, House Ways and Means Human Resources Subcommittee 

United States House of Representatives 

RE: March 15, 2017 Maternal Infant Early Childhood Home Visiting (MIECHV) Hearing 

Dear Congressman Smith, 

The members of the Washington State Home Visiting Coalition thank you for holding a hearing 

on the Maternal Infant Early Childhood Home Visiting (MIECHV) Program In your House Ways 

and Means Subcommittee on Human Resources on March 15, 2017. This hearing provided a 

unique opportunity for subcommittee members to hear firsthand about the transformative 

power of evidence-based home visiting. 

MIECHV has greatly accelerated the expansion of evidence-based home visiting in Washington 

state. Since 2010, $32.4 million i.n M IECHV funds has supported home visiting in 15 of 

washington's 39 counties. In our state, MIECHV helps support a portfolio of home visiting 

programs, including evidence-based programs such as Nurse Family Partnership and Parents as 

Teachers. 

Rigorous research has tested and proven the benefits of evidence-based home visiting 

programs. While outcomes vary depending upon which home visiting model is used, programs 

may result in: 

Reduced child abuse and neglect and need for child welfare services 

~alth er births 

Increased preschool and kindergarten readiness 

Reduced crime or domestic violence 

Improved family economic self-sufficiency 

Improved coordination and referral for other community resources 

The washington State Home Visiting Coalition joins its colleagues nationwide in its support of 

reauthorizing MIECHV with a 5-year extension including incremental funding increases up to 

$800 million per year. This action would: 

Colf!tlOn Mo~ Amoncan I I'd .an Ht-Mn Q.vnl11l'5oSIOn for W:t:$1'1 ll 1 SU te • 0'1< •n·$~ • CMdrf'n'• 

HOITle ~t)' of Wbl'l•n&!On • F gttt CHI'* Invest 1n KidS WSSI'IIf'l&.t0r1 • \olrS$101\: R~ao ness • Nuf!ot'-fam.ly 

Parti1NS! p • Parerw.-OuldHomeProgr~m • Pafet'ltTrus.tfOI'W~ Cnldf!M\ • Parefltsa:sTMCM-rs • Partners 

lorOwCMdmn • Pall'ltkDunft&A.$50 1 • Ro.ld)N;!O" • I,Hr~todY.JYOfl'l.· ·County • Y.~onChaotm 

A/neftc8 ~ ol POOial!a • \\'BV' rc,tor Stale A,s.'SOCt;l~•on ol Heed Stan •I'd ECEAP 
172 


33364A.143

The Honorable Adrian Smith 

March 22, 2017 

Page 2 

Expand and improve existing evidence-based home vjsiting services 

Enh<lnce our state's ability to reach more vulnerable children and families 

Provide stability for families and administrators by assuring continuity of funding for 

effective programming 

Build infrastructure that benefits not only MIECHV programs but all community 

resources and program coordination 

Improve implementation and evaluation of evidence·based policy that can be replicated 

In future public policy programs 

Create cost-savings for communities and government 

Despite significant federal, state and local investments in home visiting, Washington state serves 

only twenty-five percent of eligible families (8,200 families). More than 28,800 of eligible 

families could be served should additional funds be made available. 

Thank you for bringing attention to this evidence-based program that provides multiple benefits 

to participating families. 

Sincerely, 

American Academy of Pediatrics Washington 

4616 25"' Ave. NE ~594 

Seattle, WA 98105 

(206) 937-1461 

Children's Alliance 

718 6"' AvenueS. 

Seattle, WA 98104 

(206) 324-0340 

Children's Home Society 

PO Box 15190 

Seattle, WA 98115 

(206) 695·3200 

Partners for Our Children 

UW Mailbox 359476 

Seattle, WA 98195·9476 

(206) 221-3100 

Save the Children 

SOl Kings Highway East Suite 400 

Fairfield CT 06825 

(203) 221-4000 

Fight Crime: Invest in Kids Washington 

1224 E. Blackhawk Drive 

Spokane, WA 99208 

(509) 991·2390 

Mi.ssion: Readiness 

ReadyNation 

6746 Division Ave. NW 

Seattle, WA 98117 

(206) 375·6081 

Nurse family Partnership 

1900 Grant St. #400 

Denver, CO 80203 

{206) 715·4035 

Parents as Teachers 

13311 NE 173'" Street A105 

Woodinville, WA 98072 

{360) 481·1572 

Parent Child Home Program 

1415 Kellum Place, Suite 101 

Garden City, New York 11530 

(516) 883·7480 
173 

Æ 


33364A.144

Save the Children Action Network 

4318 Winslow Place N 

Seattle, WA 98103 

(617) 913-8381 

United Way of King County 

7202"' Ave. 

Seattle, WA 98104 

(206) 461-3700 

Thrive Washington 

1111 3'• Ave. #210 

Seattle, WA 98101 

(206) 621-SSSS