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94–400 2016

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 THIRTEENTH CONGRESS 

SECOND SESSION 

APRIL 2, 2014 

Serial 113–HR11 

Printed for the use of the Committee on Ways and Means 

( 


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COMMITTEE ON WAYS AND MEANS 

DAVE CAMP, Michigan, Chairman 

SAM JOHNSON, Texas 

KEVIN BRADY, Texas 

PAUL RYAN, Wisconsin 

DEVIN NUNES, California 

PATRICK J. TIBERI, Ohio 

DAVID G. REICHERT, Washington 

CHARLES W. BOUSTANY, JR., Louisiana 

PETER J. ROSKAM, Illinois 

JIM GERLACH, Pennsylvania 

TOM PRICE, Georgia 

VERN BUCHANAN, Florida 

ADRIAN SMITH, Nebraska 

AARON SCHOCK, Illinois 

LYNN JENKINS, Kansas 

ERIK PAULSEN, Minnesota 

KENNY MARCHANT, Texas 

DIANE BLACK, Tennessee 

TOM REED, New York 

TODD YOUNG, Indiana 

MIKE KELLY, Pennsylvania 

TIM GRIFFIN, Arkansas 

JIM RENACCI, Ohio 

SANDER M. LEVIN, Michigan 

CHARLES B. RANGEL, New York 

JIM MCDERMOTT, Washington 

JOHN LEWIS, Georgia 

RICHARD E. NEAL, Massachusetts 

XAVIER BECERRA, California 

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 

ALLYSON SCHWARTZ, Pennsylvania 

DANNY DAVIS, Illinois 

LINDA SA ́ NCHEZ, California 

JENNIFER M. SAFAVIAN, Staff Director and General Counsel 

JANICE MAYS, Minority Chief Counsel 

SUBCOMMITTEE ON HUMAN RESOURCES 

DAVID G. REICHERT, Washington, Chairman 

TODD YOUNG, Indiana 

MIKE KELLY, Pennsylvania 

TIM GRIFFIN, Arkansas 

JIM RENACCI, Ohio 

TOM REED, New York 

CHARLES W. BOUSTANY, JR., Louisiana 

LLOYD DOGGETT, Texas 

JOHN LEWIS, Georgia 

JOSEPH CROWLEY, New York 

DANNY DAVIS, Illinois 


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C O N T E N T S 

Page 

Advisory of April 2, 2014 announcing the hearing ............................................... 2 

WITNESSES 

Crystal Towne, RN, Nurse-Family Partnership Home Visitor, Yakima Valley 

Memorial Hospital, Testimony ............................................................................ 8 

Sherene Sucilla, Former Nurse Family Partnership (NFP) program participant, Testimony .................................................................................................... 16 

Darcy Lowell, CEO, Child First, Testimony .......................................................... 22 

Jon Baron, President, Coalition for Evidence-Based Policy, Testimony ............. 34 

Rebecca Kilburn, Senior Economist, RAND Corporation, Testimony ................. 42 

MEMBER SUBMISSIONS FOR THE RECORD 

Rep. Danny Davis 1 ................................................................................................. 58 

Rep. Danny Davis 2 ................................................................................................. 60 

Rep. Joseph Crowley ................................................................................................ 78 

MEMBER QUESTIONS FOR THE RECORD 

Jon Baron ................................................................................................................. 81 

Jon Baron Response ................................................................................................ 83 

Rebecca Kilburn ....................................................................................................... 86 

Rebecca Kilburn Response ...................................................................................... 88 

PUBLIC SUBMISSION FOR THE RECORD 

Scott Hippert Parents as Teachers ........................................................................ 94 


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MATERNAL, INFANT, AND EARLY CHILDHOOD 

HOME VISITING (MIECHV) PROGRAM 

WEDNESDAY, APRIL 2, 2014 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON WAYS AND MEANS, 

SUBCOMMITTEE ON HUMAN RESOURCES, 

Washington, DC. 

The subcommittee met, pursuant to notice, at 2:10 p.m. in Room 

1100 Longworth House Office Building, the Honorable Dave 

Reichert [chairman of the subcommittee] presiding. 

[The advisory of the hearing follows:] 


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HEARING ADVISORY 

FROM THE COMMITTEE ON WAYS AND MEANS 

Chairman Reichert Announces Hearing on the 

Maternal, Infant, and Early Childhood 

Home Visiting (MIECHV) Program 

1100 Longworth House Office Building at 2:00 PM 

Washington, Mar 26, 2014 

Congressman Dave Reichert (R–WA), Chairman of the Subcommittee on Human 

Resources of the Committee on Ways and Means, today announced that the Subcommittee will hold a hearing on the Federal Maternal, Infant, and Early Childhood 

Home Visiting (MIECHV) program. The hearing will take place at 2:00 p.m. on 

Wednesday, April 2, 2014, in room 1100 of the Longworth House Office 

Building. 

In view of the limited time available to hear from witnesses, oral testimony at 

this hearing will be from invited witnesses only. Witnesses will include practitioners 

involved in providing home visiting services, a former recipient of these services, 

and experts on the effectiveness of home visiting programs. However, any individual 

or organization not scheduled for an oral appearance may submit a written statement for consideration by the Committee and for inclusion in the printed record of 

the hearing. 

In announcing the hearing, Chairman Reichert stated, ‘‘We all know it’s better 

to prevent a problem than to try and correct it after things have gone 

wrong. Yet in many cases, the Federal Government does just that by only 

attempting to treat problems instead of focusing on prevention. One of the 

goals of the new federal home visiting program is to help families and children before problems arise. With the reauthorization of that program pending, it’s time to review whether it is really making that hoped-for difference. I look forward to hearing more about how home visiting programs 

are working, how we can ensure we’re investing in what really works, and 

whether we’re getting the quality results that at-risk children and families 

deserve and taxpayers expect.’’ 

BACKGROUND: 

Home visiting programs have operated for many years, delivering services to expectant and new mothers designed to improve a variety of outcomes and using a 

mix of public and private resources. One of the most successful approaches has involved a trained nurse who visits a parent and child in their home on a frequent 

basis to provide ongoing services to the family. However, many different types of 

home visiting programs exist, and these programs may focus on improving child development, increasing parenting skills, reducing the likelihood of child abuse or neglect, or increasing economic wellbeing. 

Begun in 2010, the Federal Maternal, Infant, and Early Childhood Home Visiting 

program (MIECHV) was designed to strengthen existing maternal and child health 

programs, provide services to improve outcomes for families in at-risk communities, 

and better coordinate services in communities. Under the MIECHV program, at-risk 

communities are identified through statewide assessments examining areas with 

concentrations of poor child health outcomes and other difficulties such as high poverty, crime, or unemployment. States then specify how they will serve these communities using an evidence-based home visiting model, and funding is provided based 

on each state’s proportion of preschool children in families with income below the 

poverty level. While the bulk of program funding must be used to provide services 

through home visiting models with evidence of effectiveness as determined by the 

Department of Health and Human Services (HHS), up to 25 percent of total funding 

can be used to fund promising, but still unproven, approaches. Funding for the 

MIECHV program in FY 2014 is $400 million. The program’s current authorization 


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expires at the end of FY 2014. The Administration’s FY 2015 budget calls for the 

program’s reauthorization as well as a total of $15 billion in funding over the next 

10 years. 

FOCUS OF THE HEARING: 

This hearing will focus on the MIECHV program, including what is known about 

whether services funded by the program have improved outcomes for young children 

and their parents and how Congress can determine whether spending on such services can produce the best results for at-risk families. 

DETAILS FOR SUBMISSION OF WRITTEN COMMENTS: 

Please Note: Any person(s) and/or organization(s) wishing to submit 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 submit, and click on the link entitled, ‘‘Please click here to submit a 

statement or letter 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 April 16, 2014. Finally, please note that due to the change in House mail policy, the U.S. Capitol Police will refuse sealed-package deliveries to all House Office Buildings. For questions, or if you encounter technical problems, please call (202) 225–1721 or (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 supplementary 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 or supplementary item 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. 

1. All submissions and supplementary materials must be provided in Word format and MUST 

NOT exceed a total of 10 pages, including attachments. Witnesses and submitters are advised 

that the Committee relies on electronic submissions for printing the official hearing record. 

2. Copies of whole documents submitted as exhibit material will not be accepted for printing. 

Instead, exhibit material should be referenced and quoted or paraphrased. All exhibit material 

not meeting these specifications will be maintained in the Committee files for review and use 

by the Committee. 

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

behalf the witness appears. A supplemental sheet must accompany each submission listing the 

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

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 TTD/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 online at http:// 

www.waysandmeans.house.gov/. 

f 

Chairman REICHERT. Well, good morning, and welcome to all 

of you, and thank you all for being here to testify, and thank you 


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all for coming to listen, and thank I the Members for being here 

today to participate in today’s hearing. 

So, today’s hearing is on the new federal Maternal, Infant, and 

Early Childhood Home Visiting program. Someone apparently 

thought naming a program MIECHV made sense. 

[Laughter.] 

Chairman REICHERT. But, fortunately, we have the pronunciation of this acronym, and it is relatively simple: MIECHV Program. 

So I am going to stick with that, if you guys don’t mind. 

At its core, this program is designed to improve outcomes for 

children and families who face the greatest risk for abuse and neglect and a host of other problems that place too many kids far behind on the road of life. Small home visiting programs have operated for decades using a mix of federal, state, and private funds. 

But the MIECHV program, when it was created in 2010, marked 

the first time there was dedicated federal funding for this purpose. 

Our purpose today is to review what we know about the effects 

of this program, so we can begin thinking about next steps. Earlier 

this week we got a little more time with the program’s extension 

through March 20 of 2015. But there is a lot to consider here, so 

it is good that we have a head start. 

For instance, we need to review whether the actual outcomes of 

this program are living up to its promise, in terms of producing 

better outcomes for children and families. We also need to think 

about whether the program’s mix of supporting proven and promising approaches continues to make sense. And we should consider 

whether this program should continue to have 100 percent federal 

funding, especially since some of the positive outcomes we hope to 

see will benefit our state partners. 

For my part, I am interested in how we can apply the basic discipline of this program, which uses taxpayer funds to support what 

we know works to help children and families. Two other government programs today can’t say the same thing. Fortunately, we 

have the—a distinguished set of experts to help us sort through 

these questions more thoroughly today, and that list includes a 

service provider and recipient of home visitation services from my 

home state of Washington, so we will have an opportunity to ask 

some real how-does-this-work-at-the-ground-level questions. 

We welcome all of our witnesses today, and we look forward to 

their testimony. 

Chairman REICHERT. Mr. Doggett, would you care to make an 

opening statement? 

Mr. DOGGETT. Thank you very much, Mr. Chairman. And I 

share the objectives that you just outlined. We have heard so much 

over the last several years in this Subcommittee about the extent 

of maltreatment and abuse of children across the country, and the 

need to focus more of our resources not just on responding to that 

abuse after it has occurred, but what can we do to prevent maltreatment. 

The enactment of this federal home visiting program, building on 

the experience of many local and state initiatives that were already 

existing back in 2010 I think was an important step forward. It is 

an investment in prevention and future development of children. I 

believe there is considerable evidence that this is a wise investVerDate Mar 15 2010 02:40 Jun 28, 2016 Jkt 094400 PO 00000 Frm 00008 Fmt 6633 Sfmt 6602 I:\WAYS\OUT\94400.XXX 94400

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ment, though, as some of our witnesses point out, it may be difficult to quantify all aspects of the benefits. And this cannot be a 

one-size-fits-all kind of approach, because these are families with 

children in different kinds of positions, and we need to adapt the 

program and look for the most cost-effective way to reach the largest number of children. 

It is not surprising that a group representing some 5,000 law enforcement officers around the country fight crime, invest in kids, 

has recognized that if you have good home visiting programs, they 

will need to visit, as law enforcement officers, fewer homes and 

other places where violence or crime occurs. 

The decision last week of the House to continue this program on 

a temporary extension of one—another year of funding into next 

spring represents some progress. I think we need a little more certainty than going from year to year, or six months to six months. 

There has been good benefit from this program in the State of 

Texas, in both the City of San Antonio and in the City of Austin 

and the surrounding areas, there have been programs that have 

benefitted from the Nurse Family Partnership, and there has been 

investment from the State of Texas that has been important. Between, really, just over the three years of MIECHV, the State of 

Texas has received about $50 million, a significant amount of 

money, but perhaps not that significant, compared to the needs 

that exist there. The money has not been spent in a vacuum; the 

state has worked to try to build a network of high-quality programs, and to invest some of its own money in these programs. 

The division of monies in MIECHV so that some of it is focused 

on evidence-based—most of it is focused on evidence-based programs, important that we have evidence-based programs, but that 

we also continue to look at a few programs that are new and innovative, so that we can assure that we are pursuing every alternative that would be cost efficient in this area. 

Mr. Chairman, I would explain to the witnesses that at the same 

time this hearing is taking place, the House Budget Committee is 

marking up a resolution that I really think would threaten the continuation of home visiting, child abuse services generally, and a 

wide range of social services. So we will be having recurrent votes 

this afternoon there, and I will be in and out, with no disrespect 

to our very diverse and experienced panel, so that we raise appropriate issues in the course of the budget resolution. 

And I thank you, and yield back. 

Chairman REICHERT. I thank you, Mr. Doggett. And, without 

objection, each Member will have the opportunity to submit a written statement and have it included in the record at this point. 

And I want to remind our witnesses to please try and limit their 

oral testimony to five minutes. All of your testimony will be included in the record. 

Our panel this afternoon is made up of five folks, as everyone 

can see. And our first witness this afternoon is Crystal Towne, RN, 

Nurse-Family Partnership Home Visitor, Yakima Valley Memorial 

Hospital. Welcome. 

Sherene Sucilla, a former Nurse-Family Partnership Program 

participant; Darcy Lowell, CEO, Child First; Jon Baron, president, 


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Coalition for Evidence-Based Policy; and Rebecca Kilburn, senior 

economist, RAND Corporation. Welcome to all of you. 

And, Ms. Towne, you are recognized for five minutes. 

STATEMENT OF CRYSTAL TOWNE, RN, NURSE–FAMILY PARTNERSHIP HOME VISITOR, YAKIMA VALLEY MEMORIAL HOSPITAL 

Ms. TOWNE. Good afternoon, Chairman Reichert, Ranking 

Member Doggett, and Members of the Subcommittee. Thank you 

for this opportunity to testify on behalf of the Nurse-Family Partnership Program in support of evidence-based home visiting. 

I am Crystal Towne, and I am a nurse home visitor for Yakima 

Valley Memorial Hospital in Yakima County, and have been a 

nurse home visitor since 2003. I am here with one of my former 

clients, Sherene Sucilla, who graduated from the Nurse-Family 

Partnership Program two years ago, and is a wonderful example of 

how this innovative program can empower young mothers to succeed. I am here in support of the MIECHV program, which is currently serving 80,000 families nationwide, including our Yakima 

County NFP program. 

In Washington, NFP is one of several home visiting models offered as part of a continuum of services that are supported at the 

state level. A higher percentage of pre-term and low birthweight 

babies, an agriculturally-driven economy, low high school graduation rates, and high gang activity in the area make NFP a critical 

element of the county’s continuum of services. 

As a nurse home visitor, I work with first-time, low-income mothers and their families over the course of a little over two years. I 

visit each client in their homes approximately every other week, 

and I have a caseload of no more than 25 clients at one time. These 

visits begin early in pregnancy, and last until the child’s second 

birthday. Through these, I empower each client to have a healthy 

pregnancy, improve her child’s health and development, and set 

goals to achieve economic self-sufficiency. I do this by meeting the 

mom where she is at at the time, not where I would like her to 

be. In NFP we call this a client-centered approach. 

The NFP curriculum guides us to talk about the right issues at 

the right time, such as how can I stay healthy in pregnancy. What 

do I do when I am stressed out? How can I set goals for my life? 

Breastfeeding and infant attachment. The trust I build with my clients begins the moment I walk through their door for the first 

time. 

Sometimes my initial visit is filled with laughter and joy. But 

often times, when serving a young client especially, it is filled with 

great insecurity. The things that I hear most often are, ‘‘My parents are so angry with me. My boyfriend is no longer there for me. 

My friends don’t understand why I won’t go out to parties any 

more. I am so lonely.’’ I listen to their story for the next two-anda-half years, building on our trusting relationship. I listen to clients who experience mental illness, intimate partner violence, substance abuse, living in poverty, lack of family support, and health 

disparities. 

Sherene is one of hundreds of stories I have had the honor to 

hear. She is a truly amazing woman and I am so proud to have 


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the opportunity to have been her nurse, her counselor, her life 

coach, her confidante, her support system, and, most importantly, 

I am her friend. Every client’s story is unique. But since she is here 

with me today, I would like to share my experience as Sherene’s 

home visiting nurse. 

On May 6, 2010, I knocked on her front door for the first time. 

I did not know much about her, only that she was 10 weeks pregnant, and she had been in several foster care homes throughout 

her youth. During our first encounter, I wanted to ask her several 

questions, but I did not. I listened. I wondered how a young woman 

could appear so happy and speak about her goals for her future 

and her hopes and dreams, but have several scars on her arms. We 

never have talked about those scars. It didn’t need to be said. I recognized that Sherene’s smile didn’t always come easily. But, despite her past and future challenges, Sherene is a truly resilient 

woman who has the hope and the drive to provide a better life for 

her child. 

Since we have ended the program two years later, today Sherene 

has a job she loves. She is self-sufficient. She is living in a wonderful home. And she is actively involved in her son’s life. She has not 

given up on continuing her dream for continuing her education. 

But sometimes being a great parent means postponing some of 

those personal goals. 

In closing, NFP applauds the subcommittee and the larger body 

of Congress for support of the MIECHV program. Thank you again 

for this opportunity to testify before you today. I appreciate it. 

[The prepared statement of Ms. Towne follows:] 


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Chairman REICHERT. Well, thank you, Ms. Towne. And we applaud you for your hard work. And we know that you can’t do this 

work without becoming a friend to those that you help. 

Ms. TOWNE. Yes. 

Chairman REICHERT. And thank you for having the heart of a 

servant. 

Ms. TOWNE. Thank you. 

Chairman REICHERT. You are welcome. Thank you, Ms. Towne. 


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Ms. Sucilla, you are recognized. 

STATEMENT OF SHERENE SUCILLA, FORMER NURSE FAMILY 

PARTNERSHIP (NFP) PROGRAM PARTICIPANT 

Ms. SUCILLA. Good afternoon, Chairman Reichert, Ranking 

Member Doggett, 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 Sherene Sucilla, and I was a client with the NurseFamily Partnership Program delivered by the Yakima Valley Memorial Hospital in Yakima, Washington. And I am the incredibly 

proud mother of my son, Andrew, who is now four years old. 

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

my NFP nurse home visitor, Crystal Towne, starting when I was 

just a couple of months pregnant, through my son’s second birthday. I am here on behalf of the mothers like me, the children like 

my son, Andrew, and families like our own, in support of home visiting. I am honored to be here today, to get to thank you all in person for your commitment to improving the health and well-being of 

children and dedicated funding for evidence home-based visiting 

programs. 

This program has meant so much to me and my family, and I 

know that if every mom could be here today to share their experience with you, they would be, because it really is a changing experience to be here—to be in this program, excuse me. 

I grew up in Yakima, Washington. When I was 12 years old I 

went into foster care and remained there through my 18th birthday. In those six years I attended seven high schools, which made 

it very difficult to graduate on time, because I didn’t go to school 

in the same district, so the credits didn’t transfer properly. But I 

did graduate on time, through a lot of hard work. While being in 

foster care isn’t an experience I would wish on any child growing 

up, I would say that that experience has shaped who I am today. 

When I was younger, my mom wasn’t really a mom. I didn’t really have a role model for parenting. And so, when I found out I was 

pregnant, I didn’t really know what to do. I didn’t have anything 

to go off of, and I was really scared, and I was in this by myself. 

I heard about the Nurse-Family Partnership Program through 

my doctor’s office when I found out I was pregnant. Because I was 

a first-time mom and I met other eligibility requirements, they referred me to the Yakima Valley Memorial Hospital NFP program 

and Crystal, and I was set up with an appointment for Crystal to 

come to my home and talk more about the program. After our first 

meeting, I knew that this was the right program for me, and I 

looked forward to our regular home visits. 

At that point I was new to everything when it came to parenting. 

But Crystal was a huge help to me and my family. She helped me 

build confidence and open doors for me to set goals for my life, for 

myself, and for my family. She helped me find other services I 

needed, such as dental care, and she would take my blood pressure 

when I was pregnant, to make sure that I was doing okay. And 

when I had trouble breastfeeding, Crystal had a breast pump 

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And at one point when I was nursing I was afraid that my son 

wasn’t getting enough to grow at a healthy rate, but Crystal would 

bring a scale, and we would weigh Andrew every week, and she reassured me that he was getting what he needed to grow well and 

according to schedule. That was the first major moment for me, 

where I felt like I was doing a good job, that I was a good mother, 

and that I was getting him what he needed. And now, at four years 

old, I can often say that he is the tallest kid in his class. 

I was also nervous about his development. Like every parent, you 

want to make sure that your baby or child is keeping up with different milestones, and I didn’t know how to assess that. But Crystal would bring in questionnaires called the Ages and Stages Questionnaire, or ASQ, to assess his development at different points in 

time, and we would know that his development was on track. 

I remember throughout the program Crystal would say to me 

that my son Andrew was a very caring person from a very young 

age. He was about 13 months when Crystal first commented on 

how sweet he was. He would give Crystal a hug and actually pat 

her on the back. At the end of each visit she would leave a form 

with lots of different feedback, including highlights from that visit, 

what our next visit would be about, and what I needed to do before 

our next visit. Looking back at one of the forms, Crystal mentioned 

how I was raising such a sweet and loving child that his hugs and 

pats melted her heart. 

Crystal was able to point out to me these different signs he was 

showing of being a very caring human being, even when he was 

just a toddler, and I remember realizing that if I was raising a son 

that loving, I really was doing something right, as a parent. 

When I found out I was pregnant, I worked at a barbecue stand. 

When Crystal and I started talking about my future, she helped me 

look into going back to school. Ultimately, I ended up getting a job 

and a great career through steps I took when Andrew was younger. 

I now work in accounts payable for a local heating and air conditioning company, and I have been there for about a year-and-a-half. 

And I have great job security, as I am the only one in the office 

doing what I do. 

It has been really special and wonderful to look back at all the 

records that I have while in this program. I have a big binder of 

all the work, the pictures, and activities that we did. And it is lovely. I can go back and read all my thoughts and feelings from the 

beginning of my pregnancy to his age of two, when he turned two, 

and that is really special for us, now that he is four, we can go 

back and look at everything. 

I really hope that Congress will continue supporting the 

MIECHV program, which supports great programs like NFP. 

Thank you again for the opportunity to testify today. 

[The prepared statement of Ms. Sucilla follows:] 


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f 

Chairman REICHERT. Great job. Is this your first time testifying in front of Congress? 

Ms. SUCILLA. Yes. 

[Laughter.] 

Chairman REICHERT. You didn’t even come across nervous. 


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Ms. SUCILLA. I am sweating. 

[Laughter.] 

Chairman REICHERT. So are we. Future congresswoman sitting 

there, I think. 

You know, I just have to make this comment. You did a wonderful job, and, Ms. Towne, you did a wonderful job, also. And I know 

it is not easy to come before Congress and testify. But the people 

up here are just regular people, we just happen to be sitting in 

these chairs, elected by the folks that we represent. But we all 

come from backgrounds that you might be surprised to hear about. 

You know, I grew up in a home. Ran away from home and from 

domestic violence. And I never became a foster child—by the way, 

we are working on some foster care legislation that can help kids 

stay in school and have those records follow, and hopefully stay in 

one foster home, and hopefully, more than anything, get adopted 

and have a family they can call their own. So we are working on 

all of that. And I am sorry you had to go through that, but that 

just fits into everything that this Committee is trying to accomplish. And you are an all-star, as far as we are concerned. 

Ms. SUCILLA. Thank you. 

Chairman REICHERT. Yes. Ms. Lowell, you are recognized for 

five minutes. Microphone? 

Ms. LOWELL. Good, okay. Thank you. 

Chairman REICHERT. There you go. 

STATEMENT OF DARCY LOWELL, CEO, CHILD FIRST 

Ms. LOWELL. So, good afternoon. My name is Dr. Darcy Lowell, 

and I am honored to be here to talk to you today. Thank you for 

this opportunity to testify on behalf of Child First home visiting 

and the MIECHV program. And thank you so much for your support of the MIECHV extension; it is so needed. 

I am a developmental and behavioral pediatrician, and the 

founder and CEO of Child First. I also serve as an Associate Clinical Professor at Yale University School of Medicine. 

Early in my career, I saw the struggles of vulnerable children 

and families firsthand, as they tried to cope with trauma and depression, homelessness, and hunger. We needed to think about 

intervention in a very different way, and so Child First began. I 

want to give you a feeling for the kinds of families that we work 

so closely with, and that we serve. And here is a little vignette 

about one of them. 

The Child First mental health clinician met a mother at a pediatric visit for her three-year-old daughter, Maria. The mother was 

severely depressed. She had run from her husband because of ongoing domestic violence. She and her three children lived in an empty 

apartment without beds or a kitchen table. Little Maria was about 

to be expelled from child care for aggressive behavior. Mom worked 

three jobs, but was still way behind in her rent payments, and the 

family was about to be evicted. She was desperately afraid that she 

would lose her children to foster care. 

The care coordinator learned from the family that they had been 

on TANF, but Mom was no longer receiving a check. She, the care 

coordinator, immediately contacted the Department of Social Services and found out that the check was being sent to her husband 


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in prison. In less than a week, the check was redirected to the 

mother. The family situation improved dramatically. Mom now 

only needed to work one daytime job, and was able to focus on her 

children. The clinician worked psychotherapeutically with Mom 

and Maria together, and also consulted in the preschool. Maria’s 

behavior improved markedly. Mom’s depression lifted. The care coordinator coached Mom as she worked out a schedule with the 

landlord to pay back rent. The life course of this family changed 

dramatically. 

What we know is scientific research on early brain development 

has clearly demonstrated that growing up with stresses of poverty, 

violence, depression, substance abuse, and homelessness produce a 

rise in stress hormones and other metabolic chemicals that can severely damage the developing brain and other body systems. This 

may lead to academic failure, serious mental health problems, and 

chronic disease, including heart disease, cancer, and diabetes. 

However, it is now scientifically documented that the presence of 

a secure, safe, nurturing relationship between a parent and a 

young child is actually able to protect the developing brain from 

damage. We must, therefore, provide intensive intervention at the 

earliest possible time. 

Child First works with the most challenged families, targeting 

young children under the age of six who suffer from behavioral and 

developmental problems and abuse and neglect. We take a twopronged approach—based on what we now know, what the scientific literature tells us—with a team of two professionals working 

in the home. 

First, we must decrease the enormous stress in the environment, 

and help stabilize families. Our care coordinators work with our 

parents to connect them to comprehensive, community-based services and supports, like medical services, safe housing, early education, and literacy. Through this process, our care coordinators 

build the capacity of our parents, and help them to build internal 

organizational skills that enable them to be successful as parents 

and workers. 

Second, we build the nurturing, responsive, parent-child relationship, because that is what protects the developing brain, even in 

the face of adversity. Our mental health clinicians use Child-Parent 

Psychotherapy to heal these two generations, while they help parents promote safe environments for their children to grow and develop, which makes them so ready for school. 

To evaluate our model, we conducted a randomized controlled 

trial with strong, positive results in child language, behavior, maternal mental health, and decreased involvement with Child Protective Services; and with replication we actually have been able to 

have even better results, with 89 percent of our families improving 

in at least one major area. 

Child First has only the capacity at this time to serve 1,000 children each year in Connecticut, but we know the need is enormous. 

We have replicated through a public-private partnership with the 

Robert Wood Johnson Foundation, especially, and our Department 

of Children and Families. MIECHV has been instrumental in allowing us to move to eight new cities. This support is so essential. 


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The return on investment is substantial. And though I have no 

time to tell you about it now, I will say that Child First only costs 

about $7,000 a year. And if you have psychiatric hospitalization for 

just three months for one child, it is $130,000. There is major savings in multiple sectors. 

I thank the committee most sincerely for your interest and efforts in support of the MIECHV home visiting program serving vulnerable children and families. Thank you. 

[The prepared statement of Ms. Lowell follows:] 


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Chairman REICHERT. Thank you. Great job. 

Mr. Baron? 


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STATEMENT OF JON BARON, PRESIDENT, COALITION FOR 

EVIDENCE-BASED POLICY 

Mr. BARON. Thank you, Chairman Reichert, Members of the 

Subcommittee. I appreciate the opportunity to testify about 

MIECHV on behalf of the Coalition for Evidence-Based Policy. The 

Coalition is a non-profit, non-partisan organization that has no affiliation with any programs or program models, and we have no financial interest in any of the policy ideas that we support. 

We strongly support reauthorization of MIECHV. MIECHV represents an important new and bipartisan approach to social spending, in that it uses scientific evidence of effectiveness as a central 

factor in determining which activities to fund. As a result of this 

evidence-based approach, MIECHV is funding the large-scale implementation of some home visiting program models that, as I will 

discuss in a moment, have been rigorously demonstrated to produce 

major long-term improvement in the life outcomes of at-risk children and mothers. 

MIECHV’s evidence-based approach is bipartisan in origin. The 

Bush Administration’s 2007 pilot, for example, directed HHS to 

‘‘ensure that states use the funds to support home visiting program 

models that have been shown in well-designed, randomized, controlled trials to produce sizeable, sustained effects on important 

child outcomes, such as abuse and neglect.’’ Randomized trials are 

considered the most rigorous evaluation method. 

Similarly, the full MIECHV program, implemented under the 

Obama Administration, directs HHS to allocate at least 75 percent 

of the program’s funds to ‘‘evidence-based home visiting models,’’ 

and uses a slightly different but still rigorous standard to determine what qualifies as evidence-based. 

Why does this matter? Because rigorous studies have found great 

variation in the effectiveness of different home visiting program 

models. At one end of the spectrum, for example, is the nurse-family partnership, which provides nurse home visitation services to 

low-income, first-time mothers. This model has been shown in 

three well-conducted randomized trials to produce major, long-term 

improvements in participants’ life outcomes, such as a 20 to 50 percent decrease in child maltreatment and hospitalizations, and an 8 

percent higher grade point average through elementary school for 

the most at-risk children. And, in one trial, a $13,000 reduction in 

families’ use of welfare, food stamps, and Medicaid, that more than 

offset the program’s cost. 

At the other end of the effectiveness spectrum, for example, is 

the Comprehensive Child Development Program, which was a 

1990s HHS home visiting program in which trained para-professionals provided home visits to families with young children, designed to teach parenting skills and connect families with community services. This was a well-intentioned and a well-implemented 

program. But when evaluated in a rigorous, randomized trial, it 

unfortunately was found to produce no effects on any of the hopedfor outcomes, including children’s cognitive and social development, 

child health, and parents’ economic self-sufficiency. 

More generally, two recent, impartial reviews that examined 

which home visiting models had rigorous evidence of policy-important impacts on child maltreatment and other key outcomes found 


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several models to be effective or promising, including the two that 

we have heard from today, but a larger number to produce no 

meaningful effects. That pattern is not unique to home visitation. 

In almost every field in which rigorous trials are conducted, including medicine, business, and K–12 education, the effective interventions are almost always found to be outnumbered by interventions 

producing weak or no impacts. 

What this means is that if MIECHV were to allocate funds the 

usual way, without regard to rigorous evidence, it would primarily 

be funding program models that produce no meaningful impacts, 

and might miss the opportunity to scale up the few effective models 

that can improve people’s lives in an important way. As I describe 

in my written testimony, MIECHV’s evidence-based design has succeeded, in part, in focusing funds on the subset of effective models 

and, for example, is funding national implementation of the NurseFamily Partnership, as well as the scale-up of other effective evidence-based models, like Child First. We believe this is a very important achievement. 

We also suggest a modest legislative revision in my written remarks to close a loophole that has allowed some of MIECHV’s 

funding to go toward ineffective models. I would be happy to discuss this further, if of interest. 

[The prepared statement of Mr. Baron follows:] 


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Chairman REICHERT. Thank you, Mr. Baron. 

Ms. Kilburn, you are recognized for five minutes. 


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STATEMENT OF REBECCA KILBURN, SENIOR ECONOMIST, 

RAND CORPORATION 

Ms. KILBURN. Chairman Reichert, Ranking Member Doggett, 

and Members of the Subcommittee, thank you for the opportunity 

to testify today about the MIECHV program. My name is Rebecca 

Kilburn, and I am a senior economist at the RAND Corporation. 

My testimony will draw upon a 15-year program of research performed at RAND by me and my colleagues. 

We are here today to discuss what we know about whether the 

MIECHV program improves outcomes for children and their parents. The Federal Government has sponsored a rigorous study of 

the effects of MIECHV, but initial findings from that study will not 

be available until next year. Absent the results of that study, today 

I will describe currently available research that informs MIECHV. 

I am going to discuss two ways that existing research findings 

inform MIECHV. First, I am going to describe research related to 

the rationale for MIECHV. And, second, I am going to make recommendations regarding research-supported features of MIECHV 

that raise the likelihood of it achieving its desired objectives. 

First, as you have heard, rigorous evaluations have demonstrated 

that a diverse set of home visiting models can improve a spectrum 

of outcomes for children and parents. Programs have been able to 

improve outcomes in the short run and the long run, and some, but 

not all, evidence-based programs have found that programs generate government savings that more than outweigh the costs. In 

other words, a growing research base has identified evidence-based 

home visiting models, and supports the theory of change underlying MIECHV: that scaling up home visiting to large numbers of 

at-risk families has the potential to improve outcomes for children 

and parents; improve population level outcomes, such as reducing 

rates of low birthweight or child maltreatment; and these, in turn, 

should save government money in the long run. 

The primary contribution of MIECHV is to test the idea that 

broadly scaling up home visiting can transform our approach to 

human services. 

Having a research-supported rationale does not imply that an 

initiative will necessarily be effective. The initiative must be well 

structured and well implemented. I will now discuss design features of MIECHV that research indicates will raise the likelihood 

of improving outcomes for at-risk families. 

Lawmakers should preserve these three existing features of 

MIECHV. First, continuing to concentrate MIECHV funding on evidence-based models will make the chances greater that MIECHV 

funds will have their intended impact. Second, drawbacks to funding exclusively evidence-based models are that it could stifle innovation and prevent us from discovering models that may be effective, but have not been evaluated. 

A second feature to preserve are mechanisms in MIECHV that 

circumvent these drawbacks. One is allowing 25 percent of the 

funding to be used for promising models that are being evaluated, 

and the other is funding the MIECHV competitive development 

grants, which allow states to apply for funding, to pilot test, and 

evaluate innovations in home visiting. 


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Third, in order to achieve the best outcomes for children and 

families, it is not only necessary to deliver programs that work, but 

it is also necessary to implement them well. The third feature of 

MIECHV that should be preserved is the implementation supports 

it provides states and other grantees. These include training and 

professional development, plus technical assistance that helps 

states engage in best practices in evidence-based program implementation. These best practices include conducting needs assessments, identifying goals, collecting and reporting outcome data, 

and engaging in continuous quality improvement. 

At the same time that the federal home visiting program has expanded, states have also been increasing their funding for home 

visiting. The MIECHV program is partnering with states to build 

state home visiting infrastructure, with the MIECHV program 

leading the drive to integrate best practices into home visiting implementation. 

To conclude, there are also a couple of ways that MIECHV could 

be strengthened to further raise the chances of achieving the best 

outcomes for children and families. One is that while 25 percent of 

MIECHV funds can be used to deliver promising home visiting 

models, MIECHV currently does not support a path by which potentially effective models could undergo evaluation that would lead 

them to be designated as evidence-based. The types of evaluations 

that the MIECHV evidence standards require often cost upwards 

of $1 million, representing a substantial barrier to discovering the 

next evidence-based model. 

Second, MIECHV can better harness the power of performancebased accountability, which links performance measures to funding 

or targeted technical assistance. MIECHV currently requires states 

to collect benchmarks related to family outcomes, which is a cutting-edge aspect of the program. While monitoring outcomes is desirable, there may be opportunities to better monitor states’ organizational performance, such as number of families served, and, importantly, for MIECHV to more closely link performance measures 

to consequences or targeted support to generate improvement. 

Thank you for allowing me to appear before you today, and I look 

forward to taking your questions. 

[The prepared statement of Ms. Kilburn follows:] 


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Chairman REICHERT. Well, thank you very much for your testimony, Ms. Kilburn. Thank you all for your testimony. And we are 

going to go into the question phase now. We will just ask a few 

questions. It will be easy, don’t worry about it. 


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[Laughter.] 

Chairman REICHERT. So, I was a police officer for 33 years before I came to Congress. So I just look like I have been here for 

40 years, but I have only been here 9. I received phone calls this 

past week from sheriffs, from police chiefs from Washington State, 

very much supportive of fighting crime, and investing in kids. We 

get it, because we know if we put the money up front, we are going 

to be saving a lot of money at the back end. And that is a hard 

thing, for people who legislate, to really see the long-term, and the 

long-term goal here. You all see it very clearly. 

But we have heard about evidence-based, scientific—I think, Mr. 

Baron, you said scientific evidence and effectiveness to decide 

which programs to fund. And, Ms. Kilburn, you talked about design 

features in three points that you made about evidence-based models and funding for evaluation and implementation of supporting 

programs. And what I want to try and do is to tie together what 

you do with what is happening, where, as cops would say, where 

the rubber meets the road, where Ms. Towne and Ms. Sucilla are. 

And, you know, what—because you may have never heard about 

implementation supports and things like that, where—no, I didn’t 

think so. So you are down here, doing the work. How does—so this 

is for both of you—how does what you are doing and what you are 

going through, how does that get filtered up to the folks that are 

making those decisions and trying to figure out what is working 

and what is not working? What worked and—so, just real quickly, 

what worked in your case? What was the—you know, you touched 

on some of it. 

Ms. SUCILLA. Sorry, I am trying to understand the question, I 

guess. 

Chairman REICHERT. So you are working with Ms. TOWNE. 

Ms. SUCILLA. Yes. 

Chairman REICHERT. And the programs that you got involved 

in that she helped direct you to, what were those programs that 

you saw that really—kind of a light bulb went on as to this really 

is going to work? This program works, or that program. If you got 

sidetracked into a program that you thought, boy, this isn’t going 

to work at all. 

Ms. SUCILLA. [No response.] 

Chairman REICHERT. You can help her, if you want to. 

Ms. TOWNE. Are you asking about perhaps she participated in 

programs in addition to Nurse-Family Partnership? 

Chairman REICHERT. Yes. I mean anything that—so she finally 

comes to you, and you give her places where she is going, and it 

is working. How does that get communicated to the administrators 

who are making some decisions as to, you know, what programs 

work, what programs don’t work? It is evidence-based, right? 

Ms. TOWNE. Correct. 

Chairman REICHERT. So how does that evidence get moved up 

to, filtered up to—— 

Ms. TOWNE. Okay. So you are asking specifically about the 

data. 

Chairman REICHERT. Yes. 

Ms. TOWNE. Is that—okay, thank you. I was—okay. At visits at 

various time periods that are structured by the program. So, for inVerDate Mar 15 2010 02:40 Jun 28, 2016 Jkt 094400 PO 00000 Frm 00059 Fmt 6633 Sfmt 6602 I:\WAYS\OUT\94400.XXX 94400

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stance, in pregnancy, at 36 weeks, at birth, 6 months, 12 months, 

2 years, we collect data from Sherene in the form of various questions that are then submitted to the University of Colorado for research purposes. 

Chairman REICHERT. Okay. 

Ms. TOWNE. Is that what you are—— 

Chairman REICHERT. Yes, yes, sure. 

Ms. Towne [continuing]. Asking? Yes. For—as part of the curriculum and part of the model for Nurse-Family Partnership, they 

have outlined very specific questions and data they are collecting 

at different times throughout that two-and-a-half year period. 

Chairman REICHERT. Okay. 

Ms. TOWNE. And it is handled through the University of Colorado. 

Chairman REICHERT. Do you ever feel like you are working in 

an area where—if a program that is not working, and you are able 

to give feedback data to the—to Denver that this isn’t really working at the—you know, where the rubber meets the road sort of 

a—— 

Ms. TOWNE. [No response.] 

Chairman REICHERT. No? 

Ms. TOWNE. I don’t see that, as a home visitor, because the 

beauty of the Nurse-Family Partnership program, again, is that it 

is client-centered. So it is not necessarily myself dictating what we 

discuss throughout each visit. It is really looking at the guidelines 

of suggested topics, but allowing Sherene to choose what she feels 

would be most helpful. 

Chairman REICHERT. Okay, you just hit on the answer, right 

there. She chooses. 

Ms. TOWNE. She absolutely—— 

Chairman REICHERT. Yes. 

Ms. TOWNE. Every visit—the way it works in my home visiting 

practice is at the end of every visit we look at what options are 

available to discuss at the next visit. And I guess ‘‘available’’ isn’t 

maybe the right word. First, Sherene can choose. Maybe there is 

something on her mind that is really not a part of the guidelines, 

and that is okay. 

Chairman REICHERT. Okay. 

Ms. TOWNE. But she can also look at the guidelines and topics, 

and choose one of those. 

Chairman REICHERT. Great. Thank you for your answer. Mr. 

Davis, you are recognized. 

Mr. DAVIS. Thank you very much, Mr. Chairman. And let me 

thank all of our witnesses. 

I have been tremendously impressed with all of your testimonies 

for a number of reasons. And one is that, for all of my life, I have 

been intimately involved with, associated with, know people personally, who could make use of this program and of these services. 

And since being in Congress for a decade, I have worked with Republican colleagues to advance a strong federal investment in home 

visiting. 

This bipartisan effort drew on research and economic status documenting that investing in our youngest citizens yields high returns in the form of healthier children and families, and taxpayer 


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savings. The voluntary home visiting law was designed as an investment in evidence-based prevention. 

In Illinois, 30 percent of children entering out of home care for 

the first time are under the age of 1, slightly higher than the national rate. In Chicago, roughly half of those babies enter before 

they are three months old. This pattern is generally true, nationwide. These statistics put into context the importance of home visiting, which focuses on strengthening children and families by supporting pregnant women and parents with young children. 

The role of home visiting is particularly important, given the recent study reported in JAMA—that is the Journal of the American 

Medical Association—about an increase in infants’ death, potentially due to the economy. Supporting young children and families 

is critical to preventing harm and strengthening children. 

Mr. Chairman, I have got two documents I would like to submit 

for the record. 

Chairman REICHERT. Without objection. 

[The information follows: Mr. Davis 1, Mr. Davis 2] 

[Member Submissions for the Record follows:] 


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Rep. Danny Davis 1 


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Rep. Danny Davis 2 


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Mr. DAVIS. I also—well, let me ask you, Ms. Kilburn. You mentioned in your testimony that studies—that the Federal Government has studies underway, and the data has not all been collated 

and put together, and so there is not a report yet. But without that 

report, would you say that home visiting is really an effective way 

of helping to strengthen and prepare children and their families 

that ultimately will provide them with healthier lives, and even 

save our taxpayers a great deal of money? 


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Ms. KILBURN. There is a strong research base that supports the 

idea that these individual programs can improve outcomes for children and families. What MIECHV adds to that is allowing us, for 

the first time, to test the concept of scaling that up on a large basis 

in order to see if we can capture those effects that were found in 

individual programs at a community or a city or a state level. 

So, there is a lot of evidence to support the basic idea behind 

MIECHV, and now we are really testing if it can achieve this 

transformation in the way we deliver human services so that instead of treating things after the fact, we prevent them. And so 

there is a large research basis that supports that idea, and we are 

really testing it right now. 

Mr. DAVIS. And I guess the reason I indicated—I said that for 

all of my life I have been associated—I have lived in low-income 

communities all of my life, growing up, and, of course, even today. 

I used to train community health aides, basically, to do home visiting, and basically to make assessments of the health needs of individuals in the community who often times would not come to the 

clinics unless they had been prompted a little bit, prodded a little 

bit. 

And I know that there have been people who have said that 

these programs are unnecessary, that they don’t really work, or, if 

they do, let the local governments and the state governments provide the resources. Are you aware that the Federal Government, 

based upon your research, has been very instrumental in making 

these programs work, and work effectively? 

Ms. KILBURN. I don’t think we have research evidence on 

MIECHV, per se. But what MIECHV is doing is providing the data 

for us to answer that question. We don’t have that right now, but 

the study underway will provide insights into that. 

The reason it is important that the Federal Government does 

this is that, while the individual states have been increasing their 

investments in home visiting, it hasn’t been in a systematic way 

that supports evidence-based programming and that provides infrastructure support to implement programs while also using evidence-based practices in implementation. 

And so, if we allowed the states to do it one by one, we wouldn’t 

really know the answer to that question: Does scaling this up 

transform human services? We just have a patchwork or sprinkling 

of different, smaller experiments. 

Chairman REICHERT. Thank you, Mr. Davis. 

Mr. DAVIS. Thank you very much. Mr. Chairman, let me just 

thank you on assembling one of the most outstanding panels I 

think that I have heard testify on this matter. So thank you all 

very much. 

Chairman REICHERT. Thank you. 

Mr. DAVIS. Thank you, sir. 

Chairman REICHERT. Thank you to the staff. Mr. Kelly, you are 

recognized. 

Mr. KELLY. Thank you, Chairman. And I agree with Mr. Davis; 

this is a good panel to have before us. 

One of the things that I have been wondering about—and, of 

course, it seems to me that home visits are critical if we are going 

to continue to support families. And I think one of the things that 


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we have seen in our cultural that is causing a greater problem is 

the fact that the nuclear family is now not at the same level it used 

to be. 

Now, some of these programs are working, but there is a lot of 

areas that they are not working. What could we do to change that? 

Mr. Baron and Ms. Kilburn, you both had testimony towards 

that. So how do we look at a good return on the investment for the 

American taxpayers that we actually make a difference in these 

peoples’ lives? 

And, Ms. Sucilla, I really applaud you for what you have been 

able to do. But that is an example of the success of it. So, tell me. 

What else could we do? What programs aren’t working? And how 

would we redirect or redeploy those dollars to make sure that there 

is a better return on it, not just for the taxpayers, but also for the 

people that we are spending the time with? 

Mr. BARON. Well, for some of the more effective models, like the 

Nurse-Family Partnership, one of the things that they did was they 

measured long-term impacts for both the people who got the program, the program group, and a control group of families that did 

not get the program. They measured their use of public assistance 

over a 12-year period, and found that the savings in families’ use 

of public assistance more than offset the initial program cost. So, 

at least for that model, there was strong evidence not only of improvement in people’s lives, but savings to the taxpayer. 

But MIECHV funds, as I mentioned, a diversity of home visiting 

models, some of which have been found in rigorous studies not to 

be as effective. One of the things that could be done to shift funds 

within this program to more effectively focus on programs that 

really make a difference in people’s lives is to slightly change the 

evidence standard to make a modest but important revision in the 

evidence standard. 

Right now, the program’s standard for ‘‘evidence-based’’ is that 

the program model produces statistically significant effects. But the 

standard does not ask whether those effects are of policy or practical importance, like reduced use of public assistance or reduced 

child maltreatment rates. That has opened a loophole in the program, a modest loophole, allowing several models to qualify as evidence-based, solely on the basis of statistically significant effects on 

outcomes that may not be particularly important, or effects that 

may be tiny in magnitude. That would be one—— 

Mr. KELLY. Okay, but as you look at this, you have data that 

you can look at across the board on different programs. 

Mr. BARON. Yes. 

Mr. KELLY. You have the ability, then, to look at which ones are 

working and which ones aren’t working. And I would just think 

that, when you look at that, and you are looking for a really good 

return on the investment, we are talking about building a stronger 

society, and you only can do it through building stronger families, 

which will result in stronger communities and a stronger country. 

So, when you look at these, then, how do you separate one from 

the other, say, you know, ‘‘This is one that we see working. These 

other ones aren’t doing what they are supposed to do.’’ Ms. Towne 

and Ms. Sucilla talked about how that one worked for them. And 

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children—two more on the way—I have seen what can happen with 

families that are very supportive, and they get help from the outside. 

So, you have the ability to do this, though. You can actually compare programs and say, ‘‘This one works, this one is not working 

the way it should,’’ and you can redeploy those dollars. That is the 

effort that you are trying to do. Is that not correct? 

Mr. BARON. Yes. A very—a straightforward way to do it, which 

is used in many different areas now, increasingly in social spending 

as well as in medicine. A home visiting program model generally 

does not have enough money to serve every family that qualifies. 

So one thing that is often—that is sometimes done is to do a randomized control trial, where you use a lottery—meaning random 

assignment—to allocate some families to receive the program, and 

other families, an equivalent set who serve as a control group. 

They get access to the usual services in the community. 

And then you track outcomes, important outcomes, over time, 

like rates of child maltreatment for the program group versus the 

control group; families’ use of public assistance in the program 

group versus the control group. And the outcomes there will tell 

you which program—in a scientifically—— 

Mr. KELLY. Are you able to share that information back and 

forth, then, and actually, you know, come up with a change, then, 

and actually look at this as the best—this is the best way to spend 

those dollars? You can only spend a dollar once, so you want to 

make sure it is spent the right way. So, to get the most mileage 

out of it, you can actually share that data and improve these programs. 

Mr. BARON. That can be shared. And, in fact, MIECHV does 

that, it looks at that data, and it allocates—the grants are made 

toward—on the basis of evidence as one of the main selection criteria, that kind of evidence. There are ways in which that evidence 

criterion can be strengthened. But, in general, the program allocates funds naturally, based on that data we were just talking 

about. 

Mr. KELLY. Okay, all right. Thank you. And just to—so we can 

redeploy these dollars the right way after we have looked at this 

evidence that is conclusive. And you say, ‘‘Listen, we don’t need to 

spend money over here. This program is not coming up with the 

results that we need,’’ and we can redeploy. 

That is my main concern, because I think too often we continue 

to spend money on programs that aren’t effective. And we say, 

‘‘Well, why do we do this?’’ It is because we have always done that. 

That is not the answer. The answer is to change it so it benefits 

families more. 

Mr. BARON. I couldn’t agree with you more. That is one of the 

unique features of this program, as opposed to the way social 

spending is often done—social programs are often done—that in 

this case money is allocated on the basis of evidence. So, if new 

findings come in showing a particular model is effective, or a particular model is not effective, the funding is naturally, through the 

grant-making process, allocated toward the more effective models. 

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Chairman REICHERT. Thank you, Mr. Kelly. I think that is the 

question I was asking, too. Mr. Kelly and I, we are going at it at 

different angles, as to how the information is shared, the programs 

are changed, so that they fit what the star of our show today needs. 

So, Mr. Renacci, you are recognized. 

Mr. RENACCI. Thank you. And I want to thank you, Chairman 

Reichert, for holding this hearing, and highlighting the importance 

of using evidence brand models to home visiting programs. And I 

also want to thank the witnesses. This is a great panel of witnesses. 

In my home state of Ohio, an estimated 1.8 million Ohioans are 

living below the poverty line. Poverty has increased by approximately 58 percent over the last decade, despite a stagnant population and a whole host of federal programs created to end the cycle 

of poverty. So I am glad we are here today to discuss policies that 

work. 

Ohio’s rate of infant mortality is also ranked the 11th worst in 

the nation, averaging 7.7 deaths per 1,000 births in the first year 

of life. In fact, according to a study conducted by researchers at 

Case Western Reserve University, infant mortality exceeds some 

third-world countries in certain neighborhood surrounding the university’s circle area in Cleveland. 

While I applaud the efforts of home visiting programs that have 

been proven to improve the safety and well-being of infants and 

children, we as a nation cannot continue to financially support ineffective programs. As a small business owner, when I implemented 

a particular program, I also wanted to ensure that the procedures 

that I created were effective and really meeting certain goals that 

I created for those employees. Businesses—and my business—actually measured our programs and used evidence-based models in 

order to guarantee success. And I think the Federal Government 

should be no different. 

As a Member of Congress, I want to protect taxpayer dollars 

from going toward ineffective programs, and redirect them toward 

programs that do what is intended, and lift individuals out of poverty. I really hope, together with my friends across the aisle, that 

we can determine what works, what doesn’t work, and can make— 

so that government can finally empower individuals to become 

independent and self-sufficient. 

Ms. Towne and Ms. Lowell, both of your programs have been 

shown to increase the safety and well-being of young children. For 

example, I know families who have gone through the Nurse-Family 

Partnership program, have been shown to have fewer child injuries, fewer emergency room visits, and less reported child abuse 

and neglect. Families participating in Child First also are less likely to be involved with Child Protective Services, even after three 

years. Both of your organizations have had some successes. What 

do you think are really some specific factors that have led to these 

outcomes or successes? 

I will start with you, Ms. TOWNE. 

Ms. TOWNE. Could you repeat the last part of your question, 

please? 


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Mr. RENACCI. Yes. What do you think are some of the specific 

factors that have led to these outcomes or successes for both of 

your programs? 

Ms. TOWNE. That is a complex question. I would say that there 

are many factors of the Nurse-Family Partnership model that have 

led to success. From a home visiting point of view, I believe that 

it is the length of time and the intensity of the program that allows 

me to continue to support a family for two-and-a-half years in developing a strong infant bond, a strong family—a stronger family 

unit than when our relationship had started is part of what helps. 

Mr. RENACCI. So you are zeroing in on the two-and-a-half 

years, making sure the program—you feel pretty strongly about the 

two-and-a-half year time frame. 

Ms. TOWNE. I feel pretty strongly that a larger length period of 

time, along with the intensity of the visits—we are looking at approximately two hours per visit every other week—allows quite a 

bit of time for growth. 

Mr. RENACCI. Ms. Lowell, do you have any—— 

Ms. LOWELL. Yes. I think that for us, there are a number of factors. One is the intensity of the training for our staff. We are working with both bachelor’s level care coordinators and master’s licensed clinicians, as our mental health clinicians who go in the 

home. And we have a training period that lasts a year’s time (not 

before they can start; they start after an intensive two-week training). But we both have what is called a Learning Collaborative, 

which lasts a year’s time, and we have our senior clinical consultants working with each new site on a weekly basis. 

So, we are really looking at, ‘‘do you have fidelity to the model, 

do you really understand what the work is about, and are you 

doing it well?’’ And we also look at implementation measures on an 

ongoing way every single month, and we also look at outcomes, at 

baseline six months and at discharge. So we are able to say, ‘‘Do 

we have a problem here? Are the people who are implementing this 

model doing it really well? Are they doing it according to the model 

fidelity,’’ which I think is essential. 

The other really important piece about the work itself is it is 

built on relationships and on building relationships. And I think 

that, at least when you talk about the families that we serve, 

which are the most vulnerable, they are the ones who have had 

abuse and neglect, domestic violence, homelessness, substance use; 

these are really difficult families. They don’t trust easily. And they 

are not very willing to let new people into their lives. And it takes 

time to build that relationship. But when you have built that relationship of trust, you are able to make a real difference. These are 

families who want to do the right thing, they want to do the best 

for their children. They are there. But it is a process. 

And so, if you can build that relationship you can work with both 

the parent or care giver and the child therapeutically, to understand what are the barriers, what are the problems. But it is not 

so simple. We can’t just teach them, because that is not enough. 

They don’t learn that information. It has to be at a deeper level. 

And I think, for us, with our families, we are so successful with 

them because we do go to that deeper level, and make sure our 

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And one other really important thing I have to say is I think 

that, as was said, that our home visiting models are different, and 

they target different outcomes. And it is really important for us to 

be matching the outcome that the family needs and wants with the 

kind of program that they are getting. And I think that we have 

problems when we have a mismatch there, when we have a very 

vulnerable family, a mom who is running from domestic violence, 

who is severely depressed, and someone who is just going to be 

teaching them things when the mom is not available to learn them. 

But, I think that for other moms—that it may be a perfect match 

for them. So we need this continuum of models to work together 

in a system if we are really going to be effective. 

Mr. RENACCI. Thank you, Mr. Chairman. 

Ms. LOWELL. Thank you. 

Chairman REICHERT. Thank you. That was two minutes over 

time, but that was so passionate, there was no way I was going to 

interrupt. 

Ms. LOWELL. Sorry. 

[Laughter.] 

Chairman REICHERT. That was a great answer. Mr. Doggett, 

you are recognized. 

Mr. DOGGETT. Thank you very much. Dr. Lowell, you described 

in your testimony the need here is enormous. What would be the 

impact in your area if the federal funding through MIECHV is not 

continued beyond next spring? 

Ms. LOWELL. Oh, thank you. That is a really important question. We have—with our MIECHV funding, we have five new sites 

and three expansion sites, which cover about a third of our state 

Child First programs. So, if the MIECHV funding is not continued, 

there is very high likelihood that those programs will be closed. 

And all of those children and families in those areas will not be 

served. 

Mr. DOGGETT. And you used in your testimony the comparison between a $7,000 cost and a $30,000 cost for not relying on home 

visiting to intervene in advance. Would you elaborate on that? 

Ms. LOWELL. I think that we are seeing tremendous cost savings—at least we did a preliminary cost benefit analysis in looking 

at our data, and we need to do much more. But we know that, for 

instance, if one of our children, many of our children have very severe behavioral problems and mental health problems if one of 

those children were to be hospitalized for just two months in a psychiatric hospital, it would cost $130,000. We know that we are getting great language outcomes. If one child needs special education, 

it is going to cost $16,600. If one child goes into foster care—and 

I have heard various costs but we are talking about, potentially, 

somewhere between—depending on the numbers I have seen— 

$20,000 and $80,000 for a child for a year in foster care. And many 

of our families have multiple children. 

For example, we just had a family that I just heard about, which 

we started working with, where Mom was going to be evicted. She 

had six children. Our care coordinator got her into a shelter initially, and then got her an apartment with low-income housing, 

and saved six children from going into foster care. And the trauma 

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ficult, especially if it is not because there is abuse and neglect, but 

just because the circumstances can’t support that parent caring for 

the children. 

So, I also see we are getting other outcomes—we have some data 

on hospitalization and ER visits, which is actually—it is very preliminary, but we are talking about a four to sixfold decrease in hospitalization and emergency room visits. 

Mr. DOGGETT. Thank you. 

Ms. LOWELL. Thank you. 

Mr. DOGGETT. Thank you very much, and thank you for what 

you are doing there. 

And, Dr. Kilburn, you have made reference, of course, to this important study that will come out next year, and the blend that is 

already in the Act to both permit some innovation, but to ensure 

that our dollars are well spent with evidence-based programs. Do 

you believe that that study will allow us to focus on more effective 

programs? Or do you think that the study is something that would 

lead to the elimination of the federal program entirely? 

Ms. KILBURN. I think the study will indicate whether this scaling up of the individual programs has been accomplished. So, were 

they able to replicate these programs with fidelity, and can we provide not just the quantity, but also the quality? I think it will also 

indicate whether, when you scale the programs up, you replicate 

the same outcomes. 

So it is one thing when Darcy is overseeing Child First very 

closely; we are pretty confident that we are going to get great results. But when we start having this replicated in other states, and 

Darcy is not directly involved, for example, can we achieve the 

same outcome? So it will provide information of that sort. 

Mr. DOGGETT. You believe in the value of home visiting as a 

way of preventing abuse and cost. It is a question more of how to 

do it, rather than whether to do it. 

Ms. KILBURN. That is right. 

Mr. DOGGETT. Is that correct? 

Ms. KILBURN. That is correct. 

Mr. DOGGETT. And, Ms. Towne, I am very impressed by both 

your testimony. But what would be the effect in your area if you 

lose federal funding? 

Ms. TOWNE. Unfortunately, as a home visitor, I am not sure 

that I could really testify to the answer to that, as far as funding 

resources go. I believe it would have a significant impact to our 

families in Yakima County. 

Mr. DOGGETT. I think your testimony—and yours, as well— 

really did bring a human, very human dimension to the statistics 

that we frequently throw around here about how this program, this 

intervention, can really help make a difference in lives. And I look 

forward to your continued involvement, and report to the committee on how we can achieve the very most in using home visiting 

as a way to prevent abuse and other costs. 

Thank you so much for the testimony each of you gave. 

Ms. TOWNE. Thank you. 

Chairman REICHERT. Thank you, Mr. Doggett. Mr. Griffin, you 

are recognized. 


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Mr. GRIFFIN. Thank you, Mr. Chairman. Thank you all for 

being here today. Mr. Baron, I wanted to focus a little bit on 

HIPPY USA, which is—although it serves many folks across the 

country, it is based in Little Rock, which is my district, second congressional district in Central Arkansas. And HIPPY stands for 

Home Instruction for Parents of Preschool Youngsters, HIPPY 

USA. 

So, they are operating both in rural and urban areas, and I 

wanted to ask you, Mr. Baron, when you are reviewing your models 

for effectiveness, are you seeing any differences between the outcomes in rural areas versus urban areas? And, if so, what do you 

attribute those differences to? 

Mr. BARON. It is interesting that there have been evaluations 

of—scientific evaluations of home visiting, randomized trials that 

have been done in both rural and urban areas. One of the NurseFamily Partnership studies was done in Upstate New York, in a 

rural, primarily white population, and that study found very large 

effects, as long as 15 years after the study began, for the treatment 

compared to the control group. Big decreases for the children of the 

mothers, for instance, in rates of criminal activity and rates of 

child maltreatment, and so on. 

But some of the other studies have been done, other good studies—another Nurse-Family Partnership randomized trial was done 

in Memphis, Tennessee, an urban setting. This study also found 

large effects, but different. The effects may vary for a variety of 

reasons. It might be the women in Upstate New York, there was 

a larger population of smokers than in Memphis. And then the 

third trial was also urban—that was done in Denver. 

What was most impressive about those sets of studies was that 

sizable effects were found across different ethnicities, rural versus 

urban. There were different effects across the different studies, but 

all showed important improvement in people’s lives. The differing 

effects could have been because the populations were different. 

Mr. GRIFFIN. I think—Ms. Lowell, I think you referred to the 

fact that different programs or different methods are used to reach 

different outcomes. Different families have different needs. And I 

was wondering—and either you, Ms. Lowell, or Mr. Baron—when 

you look at these different programs, are there some programs or 

methods that work in certain areas—urban areas, for example— 

that don’t work as well in rural? Have you seen anything that 

would indicate that, or different parts of the country? 

Ms. LOWELL. I think that, first of all, it has to do with the 

uniqueness of each family; and that if you really do a good assessment, and you really understand what the needs of that family are, 

you are going to be the most successful, because you are going to 

be able to target your intervention specifically to the needs of the 

family. 

As you described so beautifully, it is about what that family 

needs. Now—— 

Mr. GRIFFIN. And just to interrupt there, because—so with each 

of the different models or programs or methodologies, that flexibility exists. They—with each of them they try to take the particular family’s circumstances into account, and there is a certain 

flexibility there? 


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Ms. LOWELL. I think that each model does it in their own way. 

But I think that different models have different capabilities. 

And, for instance, in Connecticut we work in partnership with 

other home visiting. We have another big home visiting program. 

And so, we often get referrals from that other home visiting program, because they have a para-professional model. They know, if 

they are working with a mom who is really depressed, or one who 

has, let’s say, domestic violence, that they are not really the right 

model to work with that family. So they will refer them to us. And 

we will do a very close transfer, so that we will then take that family, or take a family with a child who is having major behavior 

problems. 

I think that each of us has the same idea, that these are very 

family-focused kinds of interventions. And, in that sense, I think 

that everyone is trying to do that, really trying to understand who 

their families are. 

Mr. GRIFFIN. So there is some degree of nimbleness, if you will, 

to allow for tweaks and changes if—it sounds like, through transfers, or what have you—if things aren’t working exactly as maybe 

one thought. 

And I am out of time. Thank you, Mr. Chairman. 

Chairman REICHERT. Thank you, Mr. Griffin. Mr. Crowley, you 

are recognized. 

Mr. CROWLEY. Ms. Kilburn, did you want to respond very 

quickly to that? 

Ms. KILBURN. Sure. I just wanted to raise one issue that hasn’t 

come up today that I think is relevant, and that is that a constraint for implementing these models is the local workforce, and 

this is particularly relevant for rural areas. 

So, if you have a program that needs to deploy mental health clinicians, or registered nurses, it is the case that many rural areas 

are designated as health professional shortage areas, and you 

might have selected one of these great programs, and have the will 

to do it, and even have the funding, but you don’t have the trained 

personnel to be able to pull it off. 

So, I think particularly in our rural areas, we are observing that 

some of these programs have not been selected, and that may be 

a contributing factor. 

Mr. CROWLEY. I appreciate that. Thank you, Ms. Kilburn. 

Mr. Chairman, reclaiming my time, I am very pleased we are 

having this hearing here today on an effective, evidence-based program that has tremendous social benefits down the road. Being 

from New York, I have seen the great work of the Nurse-Family 

Partnership and what it does, and I have been so impressed with 

the results this program has shown over the years. 

New York City Nurse-Family Partnership is the largest urban 

program of its kind in the country. It has served more than 10,500 

clients since its creation in 2003, and currently serving more than 

1,700 clients across all 5 boroughs. These dedicated professionals 

like Ms. Towne are working with New York City families to make 

sure they have the education, information, and assistance they 

need to raise their children and become stronger families. And the 

long-term results are so impressive, even beyond what you would 

expect from the immediate assistance provided. 


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Mr. Chairman, I would like to, if I could, offer into the record the 

state profile of the Nurse-Family Partnership of New York, if I 

could. 

Chairman REICHERT. Without objection. 

[The information follows: Mr. Crowley] 


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Rep. Joseph Crowley 


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Mr. CROWLEY. Reductions in child abuse and neglect, better 

educational outcomes for children, a greater likelihood of economic 

stability for the mother, these results are not just good for the participants, but also are good for society, as a whole. 

Mr. Baron, I know you were here at a previous hearing this Subcommittee held, and we discussed the ripple effect we would see 

from cutting or eliminating funding for these types of programs. 

Our budget should focus on long-term priorities, not just short-term 

impacts. That is why I was so pleased that the Affordable Care Act 

started this federal investment and home visitation programs, and 


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it is, in fact, an investment in the future health and well-being of 

all families in our country. 

Your testimony references some of the research and evidencebased home visiting programs that shows they can lead to reductions in child abuse and injuries, improvements in educational outcomes for children, and even a reduction in needs-tested assistance 

over the long term for mothers. It is, therefore, reasonable to suggest that investment in strong home visiting programs will not only 

protect and help children, but also yield major benefits to society, 

and ultimately to taxpayers. Is that not correct? 

Mr. BARON. Yes, that is right. Often there is a claim that a social program is so effective that you can improve people’s lives and 

save money. Very often, when a rigorous evaluation is done, the effects are not quite so promising. The claim doesn’t pan out. 

But this is a case where, at least for some of the program models, 

like the Nurse-Family Partnership, and perhaps for Child First as 

well, the more effective models, it really does look like the evidence 

shows you can have your cake and eat it, too. You can improve people’s lives in a very important way, over a long period of time, and 

reduce their use of public assistance, so that the government and 

taxpayer benefits, as well. 

Mr. CROWLEY. Win-win. I appreciate that. It is clear that this 

program is making a difference, and we need to maintain that federal support. 

I was pleased to see the President and his Administration have 

proposed a long-term extension expansion of this program. That is 

the kind of investment we should be making. Congress recently 

passed a short-term extension of this program, but it is clear that 

more must be done to build upon the success so far. 

I look forward to working with my colleagues on both sides. I 

want to commend the chairman for a very bipartisan approach to 

this issue, as well. I really do appreciate that. I hope that my colleagues on both sides of the aisle on this Committee will work with 

us to support this program. And, once again, Mr. Chairman, thank 

you for holding the hearing today. 

Chairman REICHERT. Thank you, Mr. Crowley. And, as you can 

see, and as Mr. Crowley said, this is really, truly a partnership up 

here, with Republicans and Democrats all appearing to be on the 

same page, wanting to help those that are most vulnerable. And I 

really—as an old cop—I know I mention this quite often, but I am 

proud to be, you know, an old law enforcement officer. But the evidence-based stuff is very critical, and you guys are doing an awesome job with that. 

So, congratulations. Congratulations to you, Ms. Sucilla, and 

your success. And, thank you, Ms. Towne, for your hard work that 

you do each and every day. So, we are going to see each other 

again. We will visit again, and continue to work together. 

If Members have additional questions for the witnesses, they will 

submit them to you in writing. And we would appreciate receiving 

your responses for the record within two weeks. The committee 

stands adjourned. 

[Whereupon, at 3:30 p.m., the subcommittee was adjourned.] 

[Member Questions for the Record follows:] 

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Jon Baron 


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Jon Baron Response 


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Rebecca Kilburn 


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Rebecca Kilburn Response 


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[Public Submission for the Record follows:] 


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Scott Hippert Parents as Teachers 


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