[House Hearing, 110 Congress]
[From the U.S. Government Publishing Office]
H.R. 2343: THE EDUCATION BEGINS AT HOME ACT
=======================================================================
HEARING
before the
COMMITTEE ON
EDUCATION AND LABOR
U.S. House of Representatives
ONE HUNDRED TENTH CONGRESS
SECOND SESSION
__________
HEARING HELD IN WASHINGTON, DC, JUNE 11, 2008
__________
Serial No. 110-95
__________
Printed for the use of the Committee on Education and Labor
Available on the Internet:
http://www.gpoaccess.gov/congress/house/education/index.html
----------
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COMMITTEE ON EDUCATION AND LABOR
GEORGE MILLER, California, Chairman
Dale E. Kildee, Michigan, Vice Howard P. ``Buck'' McKeon,
Chairman California,
Donald M. Payne, New Jersey Senior Republican Member
Robert E. Andrews, New Jersey Thomas E. Petri, Wisconsin
Robert C. ``Bobby'' Scott, Virginia Peter Hoekstra, Michigan
Lynn C. Woolsey, California Michael N. Castle, Delaware
Ruben Hinojosa, Texas Mark E. Souder, Indiana
Carolyn McCarthy, New York Vernon J. Ehlers, Michigan
John F. Tierney, Massachusetts Judy Biggert, Illinois
Dennis J. Kucinich, Ohio Todd Russell Platts, Pennsylvania
David Wu, Oregon Ric Keller, Florida
Rush D. Holt, New Jersey Joe Wilson, South Carolina
Susan A. Davis, California John Kline, Minnesota
Danny K. Davis, Illinois Cathy McMorris Rodgers, Washington
Raul M. Grijalva, Arizona Kenny Marchant, Texas
Timothy H. Bishop, New York Tom Price, Georgia
Linda T. Sanchez, California Luis G. Fortuno, Puerto Rico
John P. Sarbanes, Maryland Charles W. Boustany, Jr.,
Joe Sestak, Pennsylvania Louisiana
David Loebsack, Iowa Virginia Foxx, North Carolina
Mazie Hirono, Hawaii John R. ``Randy'' Kuhl, Jr., New
Jason Altmire, Pennsylvania York
John A. Yarmuth, Kentucky Rob Bishop, Utah
Phil Hare, Illinois David Davis, Tennessee
Yvette D. Clarke, New York Timothy Walberg, Michigan
Joe Courtney, Connecticut [Vacancy]
Carol Shea-Porter, New Hampshire
Mark Zuckerman, Staff Director
Vic Klatt, Minority Staff Director
C O N T E N T S
----------
Page
Hearing held on June 11, 2008.................................... 1
Statement of Members:
Davis, Hon. Danny K., a Representative in Congress from the
State of Illinois, submissions for the record:
Prepared statement of the Home Visiting Coalition........ 64
Prepared statement of the Child Welfare League of America 78
Letter from the Military Impacted Schools Association,
dated June 10, 2008.................................... 81
Prepared statement of Prevent Child Abuse America........ 81
Prepared statement of the American Psychological
Association............................................ 84
Article: ``The Parents as Teachers Program and School
Success: A Replication and Extension,'' Journal of
Primary Prevention, March 2008, Internet address....... 85
McKeon, Hon. Howard P. ``Buck,'' Senior Republican Member,
Committee on Education and Labor........................... 5
Prepared statement of.................................... 6
Miller, Hon. George, Chairman, Committee on Education and
Labor...................................................... 1
Prepared statement of.................................... 4
Additional submissions:
Report: ``Breaking the Cycle of Child Abuse and
Reducing Crime in Pennsylvania: Coaching Parents
Through Intensive Home Visiting,'' Internet address 61
Report: ``The Economic Return on PCCD's Investment in
Research-based Programs: A Cost-Benefit Assessment
of Delinquency Prevention in Pennsylvania,''
Internet address................................... 61
Tierney, Hon. John F., a Representative in Congress from the
State of Massachusetts, submission for the record:
Prepared statement of Sarah E. Walzer, executive
director, the Parent-Child Home Program................ 61
Woolsey, Hon. Lynn C., a Representative in Congress from the
State of California, prepared statement of................. 61
Statement of Witnesses:
Ditka, Laura A., deputy district attorney, Allegheny County,
PA, on behalf of Fight Crime: Invest in Kids............... 26
Prepared statement of.................................... 27
Estrada, William A., Esq., director of federal relations,
Home School Legal Defense Association...................... 30
Prepared statement of.................................... 32
Fenley, Julie, Parents as Teachers program participant....... 17
Prepared statement of.................................... 19
London, Makeda, Healthy Families program manager............. 20
Prepared statement of.................................... 21
Smart, Jeanne, director of Nurse-Family Partnership, Los
Angeles County............................................. 32
Prepared statement of.................................... 34
Weiss, Heather, Ed.D., founder and director, Harvard Family
Research Project, Harvard University Graduate School of
Education.................................................. 7
Prepared statement of.................................... 9
H.R. 2343: THE EDUCATION
BEGINS AT HOME ACT
----------
Wednesday, June 11, 2008
U.S. House of Representatives
Committee on Education and Labor
Washington, DC
----------
The committee met, pursuant to call, at 10:06 a.m., in Room
2175, Rayburn House Office Building, Hon. George Miller
[chairman of the committee] presiding.
Present: Representatives Miller, Kildee, Payne, Woolsey,
Hinojosa, Tierney, Kucinich, Wu, Holt, Davis of California,
Davis of Illinois, Sarbanes, Hirono, Altmire, Clarke, Courtney,
Shea-Porter, McKeon, Ehlers, Platts, Kline, Foxx, and Davis of
Tennessee.
Staff present: Tylease Alli, Hearing Clerk; Alfred Amado,
Legislative Fellow for Education; Ruth Friedman, Senior
Education Policy Advisor (Early Childhood); David Hartzler,
Systems Administrator; Lloyd Horwich, Policy Advisor,
Subcommittee on Early Childhood, Elementary and Secretary
Education; Fred Jones, Staff Assistant, Education; Danielle
Lee, Press/Outreach Assistant; Stephanie Moore, General
Counsel; Alex Nock, Deputy Staff Director; Joe Novotny, Chief
Clerk; Rachel Racusen, Deputy Communications Director; Meredith
Regine, Junior Legislative, Labor; Daniel Weiss, Special
Assistant to the Chairman; Margaret Young, Staff Assistant,
Education; Mark Zuckerman, Staff Director; Stephanie Arras,
Minority Legislative Assistant; James Bergeron, Minority Deputy
Director of Education and Human Service Policy; Cameron
Coursen, Minority Assistant Communications Director; Kirsten
Duncan, Minority Professional Staff Member; Alexa Marrero,
Minority Communications Director; Susan Ross, Minority Director
of Education and Human Services Policy; and Linda Stevens,
Minority Chief Clerk/Assistant to the General Counsel.
Chairman Miller [presiding]. The Committee on Education and
Labor will come to order. A quorum being present, the committee
will conduct a hearing on HR 2343, the Education Begins At Home
Act.
Good morning. I want to welcome all of you to today's
hearing.
We will examine the bipartisan legislation that will help
strengthen America's families by expanding early childhood home
visitation programs for parents and children.
Throughout this Congress, we have explored how we can help
every child arrive at kindergarten ready to learn. Last year we
took important steps towards that goal by enacting legislation
to reinvigorate our nation's Head Start program. This is just
the beginning of our efforts. We know that investing in our
youngest children is essential to boosting our nation's
competitiveness.
We must make long-term commitment to promoting positive
growth and development in our children and in those who play
the most significant role in their early years, their parents.
Research tells us the relationships that form between
parent and child during the first 3 years of life, when 85
percent of the brain growth occurs, are especially influential
on a child's cognitive and behavioral development. Early
childhood home visitation programs provide parents with
education and supportive services to help them better
understand the learning and developmental needs of their
children and build long-lasting parent-child bonds.
Each year, hundreds of thousands of families benefit from
these supportive services, which range from prenatal medical
care to health services to family literacy programs. For many
parents, the most valued support these programs provide has
been emotional. For military families who often face unique
parenting circumstances, home visits can make the world of
difference when one parent is deployed or returning from
overseas duty.
The Parents As Teachers Program at the Ft. Bragg military
base in North Carolina helped one mother going through an
especially hard time during her husband's multiple deployments
when her young son began acting out aggressively in child care,
refusing to talk to his father on the phone during his
rotations. Parents As Teachers staff helped the mother find
ways to develop a closer bond and better communications between
her husband and son.
As several of our experts will explain today, early
childhood home visitation programs provide far-reaching
benefits, helping to increase student achievement, improve
access to preventative medical care, reduce high school dropout
rates and decrease maternal depression.
For example, according to an evaluation of the parent-child
home program in South Carolina, 93 percent of the program
participants who were eligible for free lunch passed the
state's first grade skills assessment in contrast to only 74
percent of the free lunch eligible students overall.
As Joan Ohl of the Bush administration's Commission on
Children, Youth and Families recently highlighted, home visits
are an effective approach to preventing child abuse by helping
parents deal with the stresses of raising children. Yet for far
too long the federal government has not invested enough in
programs to support families and children during these first
years of life.
The Education Begins At Home Act would create for the first
time a federal funding framework for home visitation programs,
ensuring that the federal government plays a role in helping
communities better plan for and provide quality services for
families. It would authorize $400 million in grants to states,
tribal organizations and territories over 3 years. The bill
would also create competitive grant programs to expand access
to home visitation services for military families and families
with limited English proficiency.
In addition, the bill would help states create partnerships
between programs and related community services. Preparing
children for success in school and in life begins at home. This
legislation is about strengthening and supporting families, an
investment that is in the best interest of our children, our
communities and our future.
I would like to welcome again all of our witnesses and
thank them for joining us today. And I would especially like to
thank Congressman Danny Davis and Congressman Todd Platts for
introducing this bill, as well as Senator Kit Bond, who has
introduced companion legislation in the Senate.
Our senior Republican, Mr. McKeon, is on his way, and we
will recognize him when he comes in for the purposes of making
an opening statement.
With that, I would like to recognize our panel and
introduce them to the committee.
Dr. Heather Weiss is the founder and director of the
Harvard Family Research Project and is a senior research
associate and lecturer at Harvard Graduate School of Education.
Dr. Weiss received her Doctorate of Education and Social Policy
from Harvard Graduate School of Education and she was
postdoctoral research fellow at the Yale Bush Center in Child
Development and Social Policy. Her latest publications include
several articles reporting on her longitudinal study on ways in
which family involvement in children's learning promotes
development and school success.
Julie Fenley, our next witness, and her husband, Victor
Fenley, are originally from Conroe, Texas. In early 2007, he
was relocated to Virginia Beach, Virginia, when Mr. Fenley
enlisted in the U.S. Navy. Mr. and Mrs. Fenley participate in
Parents As Teachers Program, which is based in Norfolk Naval
Station, and have two children, Zane, who is 2 years old, and
Megan, who is 7 years old. Mr. Fenley is an aviation structural
mechanical airman apprentice at Norfolk Naval Station and Mrs.
Fenley is a full-time parent and supportive Navy spouse.
And I want to thank you very much for joining us today. We
are going to hear a lot of testimony about different families
that are impacted by the benefits of these programs, and later
we are going to ask you some questions about the universality
of these programs, because stress with children cut across all
families. And so we thank you very much for being here.
Mr. Davis, Congressman Davis, is going to introduce our
next witness, Makeda London.
Mr. Davis of Illinois. Thank you very much, Mr. Chairman.
And I, too want to welcome all of our panelists.
I take great pride in introducing Ms. Makeda London, who
works in my congressional district.
Ms. London has devoted more than 30 years to helping
Chicago as a social service provider, be it a faculty member, a
substitute teacher, a leader in the public health community or
a director of a community learning center. It is her 14 years
of service as the director of the Healthy Families Home
Visitation Program at the Near North Health Services
Corporation located in the Winfield Moody Health Center that
gives us the honor of hearing her today.
Ms. London serves families from the Cabrini Green Public
Housing Development. In an area known for its crime and
difficulties, she has brought invaluable support and resources
to thousands of Chicagoans. Her experiences will surely help
increase our understanding of home visiting and how the
Education Begins At Home Act can promote family well-being.
So we certainly thank her and welcome her here today.
Chairman Miller. Thank you very much.
Mr. Altmire, I believe, is going to introduce our next
witness, Laura Ditka.
Mr. Altmire. Thank you, Chairman Miller, for allowing me
the honor of introducing Laura Ditka, who is a constituent and
a friend of mine from western Pennsylvania, a long-time friend.
Ms. Ditka received her Bachelor's degree from Ohio
University and her law degree from Duquesne University School
of Law. She is an Allegheny County deputy district attorney and
the founder of Alleghany County Child Abuse Unit. In this
capacity, as head of that unit, Ms. Ditka is the lead attorney
responsible for cases dealing with child abuse and homicide in
Allegheny County.
Her experience includes 130 jury trials and more than 20
homicide trials. Additionally, Ms. Ditka is an adjunct
professor at the Community College of Allegheny County and the
chairwoman of the Allegheny County Arbitration Division.
Today Ms. Ditka will be testifying on behalf of Fight
Crime, Invest in Kids, an organization of more than 4,000
police chiefs, sheriffs, prosecutors and victims of violence.
I look forward to hearing her testimony and highly
recommend her to the committee.
Chairman Miller. Welcome to the committee.
William Estrada is an attorney and the director of federal
relations for the Home School Legal Defense Association, where
he has served as the director of federal relations for 2 years.
During this time, he has worked on numerous federal issues that
are of interest to the home school community in the United
States.
Jeanne Smart is a registered nurse who is the director of
the Nurse-Family Partnership Program for Los Angeles County
Department of Public Health, where she directs all nurse home
visiting programs within the Department's Maternal, Child and
Adolescent Health Programs. She also represents the Department
of Interagency Operations Group for senior level managers from
the County's Health and Human Services Agency. She has worked
as a community-based public health nurse in some of the highest
risk areas of LA County and also been a public health nursing
instructor at California State in Los Angeles and California
State Long Beach. Welcome.
With that, I would like to turn to the senior Republican on
the committee, Mr. McKeon, for his opening statement, and then
we will begin with your testimony and we will begin with you,
Dr. Weiss, when Mr. McKeon is done.
Thank you.
The gentleman is recognized.
Prepared Statement of Hon. George Miller, Chairman, Committee on
Education and Labor
Good morning. Welcome to today's hearing on ``H.R. 2343: The
Education Begins At Home Act.'' Today we will examine bipartisan
legislation that will help strengthen American families by expanding
early childhood home visitation programs for parents and children.
Throughout this Congress, we have explored how we can help every
child arrive at kindergarten ready to learn.
Last year, we took important steps towards this goal by enacting
legislation to reinvigorate our nation's Head Start program.
This is just the beginning of our efforts. We know that investing
in our youngest children is essential to boosting our nation's
competitiveness.
We must make a long-term commitment to promoting positive growth
and development in our children--and in those who play the most
significant role in their early years: Parents.
Research tells us that the relationships that form between a parent
and a child during the first three years of life--when 85 percent of
brain growth occurs--are especially influential on a child's cognitive
and behavioral development.
Early childhood home visitation programs provide parents with
education and supportive services to help them better understand the
learning and developmental needs of their children and build long-
lasting parent-child bonds.
Each year, hundreds of thousands of families benefit from these
support services, which range from pre-natal medical care and health
services to family literacy programs.
For many parents, the most valuable support these programs have
provided has been emotional.
For military families, who often face unique parenting
circumstances, home visits can make a world of difference when one
parent is deployed or returning from overseas duty.
The Parents as Teachers program at the Fort Bragg military base in
North Carolina, helped one mother going through an especially hard time
during her husband's multiple deployments.
When her young son began acting out aggressively in child care and
refusing to talk to his father on the phone during his rotations, the
Parents as Teachers staff helped the mother find ways to develop a
closer bond and better communication between her husband and son.
As several of our experts will explain today, early childhood home
visitation programs provide far-reaching benefits: Helping to increase
student achievement, improve access to preventative medical care,
reduce high school dropout rates, and decrease maternal depression.
For example, according to an evaluation of the Parent-Child Home
program in South Carolina, 93 percent of program participants who were
eligible for free lunch passed the state's first grade skills
assessment, in contrast to only 74 percent of free-lunch-eligible
students overall.
And as Joan Ohl, the Bush administration's Commissioner for
Children, Youth and Families recently highlighted, home visits are an
effective approach to preventing child abuse by helping parents deal
with the stresses of raising children.
Yet for too long, the federal government has not invested enough in
programs that support families and children during these first years of
life.
The Education Begins at Home Act would create, for the first time,
a federal funding framework for home visitation programs, ensuring that
the federal government plays a role in helping communities better plan
for and provide quality services to families.
It would authorize $400 million in grants to states, tribal
organizations, and territories over three years.
The bill would also create competitive grant programs to expand
access to home visitation services for military families and families
with limited-English proficiency.
In addition, the bill would help states create partnerships between
programs and related community services.
Preparing children for success in school and in life begins in the
home. This legislation is about strengthening and supporting families--
an investment that is in the best interests of our children, our
communities, and our future.
I'd like to welcome all of our witnesses and thank them for joining
us today.
I'd especially like to thank Congressmen Danny Davis and Todd
Platts, for introducing this bill, as well as Senator Kit Bond, who has
introduced companion legislation in the Senate.
Thank you.
______
Mr. McKeon. Thank you, Chairman Miller. Good morning. I
apologize for being late.
We are here today to examine the Education Begins At Home
Act, a bill that authorizes approximately half a billion
dollars to establish or provide programs that provide home
visitation services for families.
I appreciate that we are here for a legislative hearing,
particularly given the significant size and scope of this
proposal. Today's hearing gives us an important opportunity to
consider not only the broad concept of home visitations, which
are generally intended to improve child development, child
health and wellness and parenting practices, but also to look
at the specific details of the legislation that has been
proposed.
In recent years, our committee has focused on authorizing
and funding programs with proven results. We know that programs
backed by sound scientific research can help ensure more
meaningful results for children, a goal we all share whether we
are talking about effective reading and mathematics instruction
or Head Start reform or any number of other programs.
To that end, I am anxious to hear more today about the
research surrounding home visitation programs. What effects
have been demonstrated when it comes to cognitive development,
school preparedness and parenting skills? Have some programs
been shown to be more effective than others? Are home visits
helpful in their own right, or only when paired with other
services?
I am also interested in a discussion about how best to
target federal resources. Traditionally, federal intervention
in this area has focused on disadvantaged children. Take the
Early Head Start program, for example. In that program, we have
explored the use of home visits to strengthen parenting skills
and cognitive development in a way that compliments the
services provided through Early Head Start. This approach
ensures that we are reaching the children most likely to
require additional support in order to start school on par with
their more advantaged peers.
Today's hearing will allow us to explore these and many
other questions about the Education Begins At Home Act. I want
to thank our distinguished panel of witnesses for joining us,
sharing their views and allowing us to benefit from their
varied areas of expertise. There are a range of perspectives on
this issue, each of which will be valuable in our
deliberations.
I intend to focus today on the questions I just posed,
including whether there are proven strategies for success in
this field and how best to target resources to those most in
need.
Once again, I thank the chairman for holding this hearing
and I yield back the balance of my time.
[The statement of Mr. McKeon follows:]
Prepared Statement of Hon. Howard P. ``Buck'' McKeon, Senior Republican
Member, Committee on Education and Labor
Thank you Chairman Miller, and good morning. We're here today to
examine the Education Begins at Home Act, a bill that authorizes
approximately half a billion dollars to establish or expand programs
that provide home visitation services for families.
I appreciate that we're here for a legislative hearing,
particularly given the significant size and scope of this proposal.
Today's hearing gives us an important opportunity to consider not only
the broad concept of home visitations--which are generally intended to
improve child development, child health and wellness, and parenting
practices--but also to look at the specific details of the legislation
that has been proposed.
In recent years, our committee has focused on authorizing and
funding programs with proven results. We know that programs backed by
sound scientific research can help ensure more meaningful results for
children, a goal we all share whether we're talking about effective
reading and mathematics instruction or Head Start reform or any number
of other programs.
To that end, I'm anxious to hear more today about the research
surrounding home visitation programs. What effects have been
demonstrated when it comes to cognitive development, school
preparedness, and parenting skills? Have some programs been shown to be
more effective than others? Are home visits helpful in their own right,
or only when paired with other services?
I'm also interested in a discussion about how best to target
federal resources. Traditionally, federal intervention in this area has
focused on disadvantaged children.
Take the Early Head Start program, for example. In that program, we
have explored the use of home visits to strengthen parenting skills and
cognitive development in a way that complements the services provided
through Early Head Start. This approach ensures that we're reaching the
children most likely to require additional support in order to start
school on par with their more advantaged peers.
Today's hearing will allow us to explore these and many other
questions about the Education Begins at Home Act. I want to thank our
distinguished panel of witnesses for joining us, sharing their views,
and allowing us to benefit from their varied areas of expertise.
There are a range of perspectives on this issue, each of which will
be valuable in our deliberations. I intend to focus today on the
questions I just posed, including whether there are proven strategies
for success in this field and how best to target resources to those
most in need.
Once again, I thank the chairman for holding this hearing, and I
yield back the balance of my time.
______
Chairman Miller. Thank the gentleman.
We are going to begin with your testimony. When you begin,
in front of you a green light will go on that tells you that
you have 5 minutes for your testimony. Obviously, you can't say
everything you want to say in 5 minutes, but do the best you
can. And at 4 minutes, an orange light will come on and that
tells you that you have a minute to sort of try to wrap up. We
want you to complete your thoughts, coherent sentences and all
the rest of that, but we are in session now, so at some point
there may be votes and we want to make sure that everybody gets
an opportunity to be heard.
So, Dr. Weiss, we will begin with you.
And your written statements, of course, are all part of the
formal record, and so we want you to know that also.
Dr. Weiss?
STATEMENT OF HEATHER B. WEISS, ED.D., FOUNDER AND DIRECTOR,
HARVARD FAMILY RESEARCH PROJECT, SENIOR RESEARCH ASSOCIATE AND
LECTURER, HARVARD GRADUATE SCHOOL OF EDUCATION
Ms. Weiss. Thank you very much for the privilege of
testifying before you this morning.
I want my remarks to sort of talk about some of the
research evidence that then frames what you are going to hear
from other very important members of this panel, and that is
families and people who provide home visit services.
I have a long-term interest in home visitation because of
its capacity to help parents get the knowledge and skills and
support they need to help their children succeed. I am here
because as a researcher who created the Harvard Family Research
Project, I know the 40 years of research that shows that
parenting and family processes are one of if not the strongest
predictor of kids' development and school and life success.
They are the strongest predictors, I think, of cognitive,
social and emotional development and, therefore, a very
powerful source of improving outcomes for kids.
I know from recent reviews that I have done with colleagues
that children and youth with involved and supportive and
nurturing parents from birth to adolescence are likely to
succeed in school. They are going to be ready for school,
succeed in school. They are more likely to get better grades.
They are more likely to graduate from high school. And also
they are more likely to go to college or have some kind of
post-secondary success.
So what potentially home visits in the early years do is
set a pathway of parent involvement that begins at birth and
continues through school, and when you create that pathway, you
increase the likelihood of the long-term benefits we want for
kids, and that is high school graduation with the skills they
need to succeed in college or post-secondary education and then
in the global economy and the world.
So this sounds great. What do we know from research about
whether or not voluntary early childhood home visitation is a
good public policy investment? I look at this through the lens
of three questions: What is the evidence that home visiting
creates positive changes in parenting that results in better
outcomes for children and families? What is the evidence that
the home visiting field is ready to scale up and it will
produce these positive outcomes at scale? This is a big public
policy investment. What does the research tell us about whether
or not we are going to get payback at scale? And finally, what
legislation and policy provisions are likely to support
successful scale up so you get the substantial returns on
investment?
And as a researcher, I of course look closely at
legislation and say does this legislation incorporate what I
think research tells us that increases the likelihood of
getting benefits at scale. So I want to address these
questions. I address them, actually, in my written testimony in
detail. I am going to talk about them kind of in a Cliff notes
version today, and then I am happy to answer questions.
I am really here to strongly support the Education Begins
At Home Act, because there is a strong and growing knowledge
base of evaluation evidence that high quality, voluntary early
childhood home visit programs pay off on a variety of outcomes.
They develop parenting skills and knowledge and understanding
of the key roles that parents play in kids' learning and
development.
There is a lot of short-term evidence to this effect, which
I have summarized in gruesome detail and probably put many
people to sleep with, and I am happy to talk about it, believe
me, but I think you can make a strong evidence-based case that
investment in high quality programs pays off across an array of
outcomes.
A thing that is of particular interest to me is the fact
that we are now getting longitudinal evidence that shows that
these programs have the potential to increase parent
involvement into elementary school, meaning that parents are
more likely to go to parent-teacher conferences, initiate
contact with their teachers about how the child is doing, and
as somebody who knows the parent involvement in school and
learning at home literature, if you can create that kind of
changed parenting behavior that endures through elementary and
into high school and beyond, you have got a real recipe for
long-term positive outcomes for kids.
The evidence also tells us a great deal about how to
develop and implement high quality programs. And this knowledge
I would argue is critical for the success of investment at
scale. We know a great deal about what it takes to get high
quality home visit programs, and I want to talk about that in a
minute.
So when I think about it, there is bottom line potential,
great bottom line potential for home visits to return very
important, positive outcomes in the early years and well into
elementary school and perhaps beyond. These outcomes are things
like increased school readiness and school success, prevention
of costly problems from maltreatment to teenage substance
abuse, delinquency, those kinds of problems. We are beginning
to have some evidence of those kinds of benefits with
longitudinal research.
So I support EBAH because of the way, finally, the key
features about what we know about what we need to produce and
implement high quality programs maps directly onto key
provisions of the legislation.
The research tells us that high quality home visit programs
are necessary but not sufficient. They need to be part of a
broader set of early childhood services, including center-based
early care and education, and they need to be connected to
other supports and resources in the community. The legislation
provides for training, curriculum development and I think
incredibly importantly for external evaluation and ongoing
performance management. It requires that states and programs
report yearly on key indicators. They can then use the
information they get from their performance management to
increase their performance.
So when I think about what makes for high quality
investments in public policy, EBAH has strong research behind
it, research that helps us understand how to deliver quality
programs, and the capacity to track our performance and see if
we are getting a return on investment.
Thank you.
[The statement of Ms. Weiss follows:]
Prepared Statement of Heather Weiss, Ed.D., Founder and Director,
Harvard Family Research Project, Harvard University Graduate School of
Education
Chairman Miller and Members of the Committee: Thank you for the
opportunity to provide testimony at this important hearing on the
Education Begins at Home act. My name is Heather Weiss and I am the
Founder and Director of the Harvard Family Research Project at the
Harvard University Graduate School of Education. I have spent the past
thirty years of my work devoted to building the knowledge base for
programs and policies that strengthen and support families, schools and
communities as settings for child development. We regularly compile and
synthesize research and evaluation studies to guide policy, practice
and evaluations, and to provide programs with tools and information to
guide their evaluations. My colleagues and I at the Harvard Family
Research Project are known for our work building the research base for
complementary learning supports which we define as a systemic approach
that intentionally integrates school and non-school supports such as
home visitation and afterschool programs with schools to promote
educational and life success. Complementary learning builds on a long
history of theory and research about the many contextual influences on
children's development and on the research-based understanding that
neither schools nor families nor communities alone can ensure learning
and educational achievement. I sit on numerous advisory boards, advise
on and evaluate major foundation grantmaking initiatives for children
and families, and recently served on the National Academy of Sciences
Institute of Medicine Committee evaluating the implementation of PEPFAR
with particular attention to its effects on orphans and vulnerable
children.
Let me start with a useful and undeniable fact: The evidence from
over forty years' research into the factors that affect children's
education is both consistent and substantial. Family involvement in a
child's learning at home, at school, and in the community is one of the
strongest predictors of social, emotional and academic development.\1\
Nurturing and responsive parenting is a critical factor in ensuring
that children are ready to enter and to exit from school with the
skills they need to succeed in higher education and in the global
workforce. Children and youth with involved and supportive parents from
birth through adolescence do better in many ways. They are more ready
to succeed in school, and they get better grades, have higher
graduation rates, and are more likely to go to college.\2\
The Education Begins At Home Act (EBAH), providing funding for
states to develop, deliver and evaluate home visitation as a core
component of early childhood services, is a key piece of the national
effort to insure that all children succeed for several reasons. It is
the first dedicated federal funding stream providing information and
support for parents to help them enhance their children's early
development. Beginning at birth, home visitation establishes the
critical importance of parent involvement in learning and helps parents
and schools understand and reinforce its continued importance through
the child's entire school career. Evaluations of home visit programs
indicate that when they are delivered with sufficient frequency and
quality, they help parents, particularly economically and otherwise
disadvantaged ones, get what they need to help their children succeed.
The evaluations suggest that these programs can increase school
readiness, increase parents' understanding of their role in child
development, strengthen parenting practices, improve maternal and child
health, and help to reduce child maltreatment. The provisions of the
EBAH Act draw from the most recent research and evaluations laying out
what it takes to develop effective home visit services and this
increases the likelihood of strong returns on investments in these
early parent support and education services.\3\
My review of the home visit research and evaluation literature
addresses three central questions:
1. What is the evidence that early childhood home visit programs
create positive changes in parenting and parent involvement in learning
that lead to better outcomes for children?
2. What is the evidence that the home visit field is ready to scale
up and that it can produce these positive outcomes at greater scale
within states?
3. How does the EBAH legislation incorporate the lessons from past
evaluations and leaders in the home visit field, thereby increasing the
likelihood of returning positive results at greater scale?
This testimony and research review draw from several areas in my
research and professional experience: individual evaluations of
national home visit program models; several literature reviews of home
visitation conducted over the past fifteen years;\4\ a recent meta-
analysis of 60 programs employing home visitation as the primary
service delivery strategy;\5\ and interviews with leaders from six
well-established national home visit program models and selected home
visit researchers and evaluators.\6\ Several national home visit models
have conducted rigorous experimental or quasi-experimental evaluations
of their programs at one or more sites in the past twenty years; by
2004, there were enough peer-reviewed studies by these and other
programs to warrant meta-analysis.
I also draw on my on-the-ground experience with The Home Visit
Forum, a consortium of six national voluntary home visit programs which
operated from 1999 to December 2005. The consortium was organized by
the Harvard Family Research Project, in conjunction with Deborah Daro
of Chapin Hall and Barbara Wasik of Johns Hopkins University, to
strengthen the research and evaluation and continuous improvement
capacity of the home visit field and to build its knowledge base.\7\
The Forum members included representatives from Early Head Start,
Healthy Families America, Home Instruction for Parents of Pre-School
Youngsters (HIPPY), the Nurse-Family Partnership, Parents As Teachers
(PAT) and the Parent Child Home Program. Each of these are home
visitation models serving children during the course of the first five
years of life and emphasizing different aspects of parenting and child
development. Early Head Start is the early years component of the Head
Start program and it includes both home visitation and a center-based
component. Healthy Families America is a program that begins in the
first year of life and specifically targets families considered to be
at risk for abuse and neglect. HIPPY serves 3-5 year olds with a
parent-child literacy emphasis. The Nurse-Family Partnership works with
first-time teen mothers beginning in the third trimester of pregnancy
and continuing through the second year of life and provides a series of
maternal and child health and early parenting supports. Parents As
Teachers works with families with children in the first two years of
life and provides an array of parenting services. The Parent Child Home
Program focuses on family literacy for children from ages 3--5. Each of
the models is national in scope and coverage and has been providing
services for at least twenty years.
Overview of Early Home Visitation
Voluntary home visiting programs provide parenting education and
support at home or other locations chosen with families. Different
program models target different kinds of families, ranging from first-
time teen mothers to all families with children in their requisite age
group, and they typically provide services anywhere from a two- to a
five-year period. As the table below with information from six of the
national models shows, programs differ in their goals and the types of
families they serve, and as a result, they focus on achieving
different--although sometimes overlapping--outcomes.
----------------------------------------------------------------------------------------------------------------
Population Served Program Goals
----------------------------------------------------------------------------------------------------------------
Early Head Start Low-income pregnant women with Promote healthy prenatal outcomes, enhance development
infants and toddlers of young children, promote healthy family functioning----------------------------------------------------------------------------------------------------------------
Healthy Families Parents of all income levels Promote positive parenting, prevent child abuse and
America identified as at-risk for neglect
abuse and neglect----------------------------------------------------------------------------------------------------------------
The Home Instruction Families, many low-income but Empower parents as their children's educators, enhance
Program for Preschool no restricted income children's early school success
Youngsters (HIPPY) guidelines----------------------------------------------------------------------------------------------------------------
The Nurse-Family Low-income, first-time mothers Improve pregnancy outcomes, child health and
Partnership development, family economic self-sufficiency----------------------------------------------------------------------------------------------------------------
The Parent-Child Home Low-income families Develop children's language and literacy skills and
Program prepare them for academic success, empower parents and
enhance parenting skills----------------------------------------------------------------------------------------------------------------
Parents as Teachers Parents of all income levels Empower parents and increase their knowledge of child
development, prepare children for school success
----------------------------------------------------------------------------------------------------------------
Most programs also connect families with other community resources
to support families, including health, mental health, social and other
services.\8\ As of 2001, at least 37 states had home visiting systems
in place, and the number is no doubt higher now.\9\ Many are
experimenting with targeted vs. universal services, targeting
particular models to particular groups, combining models for coverage
from birth through preschool, and combining home visitation with
center-based early care and education.
Early childhood home visitation programs are viewed as a promising
strategy for helping parents and thereby promoting the growth,
development and school readiness of young children because, as
developmental research consistently confirms, young children are most
likely to reach their full potential when they have nurturing,
stimulating and supportive relationships with their caregivers.\10\
Home visit programs focus on building such relationships.
As Hart and Risley's (2002) path-breaking study of the role of
families in early development indicated, children's early language and
literacy development, as well as their understanding of their capacity
to learn, are shaped in the everyday interactions they have at home
with their parents in the first few years.\11\
This study, as well as other research on early development,
indicates that economically disadvantaged children are less likely to
have rich home literacy environments or frequent positive interactions
and experiences with their economically-stressed parents. This in turn
puts them at a disadvantage when they begin school.\12\ Child
development research affirms the importance of parenting practices and
involvement for early childhood development. Home visitation programs
are one way to reach busy parents and offer them regular information
and support with potential benefits for both the children and the
family.
Question 1: What is the evidence that early childhood home
visitation programs create positive changes in parenting and parent
involvement in learning that lead to better outcomes for children?
Most of the narrative reviews over the past fifteen years, as well
as the recent meta-analysis, conclude that home visitation programs can
produce positive changes across an array of child and parent outcomes
when the conditions for high quality services are met. Sweet and
Appelbaum 's meta-analysis examined five parent and five child outcomes
and found home visiting was associated with improved parenting
attitudes and behaviors; mothers returning to school; children with
better social, emotional and cognitive abilities; and less potential
for child abuse based on emergency room visits, injuries and accidents.
They, like most other reviewers, concluded that home visit programs are
a promising but not yet proven strategy. Such programs create modest
but potentially important positive changes, for, as Sweet and Appelbaum
note, ``all effect sizes fall in the small category * * * statistical
significance, however, does not necessarily indicate practical
significance and whether or not the magnitude of observed effects is
meaningful and important remains to be determined'' (1435-1456). As
will be noted below, several of the national models have studies
indicating longitudinal benefits of early home visitation for children
and for families.
At the same time, twenty-five years of investments in evaluation
are paying off in a clearer understanding of the characteristics of
high quality programs, and of the circumstances necessary for home
visitation to produce these and other benefits as they go to greater
scale around the country. Expectations for home visitation must be
realistic. Home visits are ``necessary but not sufficient,'' \13\ and
to be effective, they should be embedded in a comprehensive system of
early childhood services, especially when they serve highly stressed or
economically or otherwise disadvantaged families. Evaluations of
several of the major home visit models also suggest that home
visitation in conjunction with high quality early childhood education
and/or preschool is more likely to result in positive gains.
The comprehensive evaluation of Early Head Start's (EHS) home
visiting, center-based and mixed home visit and center models showed
that the mixed approach had the broadest range of significant impacts,
including on children's language, social-emotional development, and on
parents in terms of reading more to their children, being more
supportive during play, and using less physical punishment, supporting
the case for a mixed home and center approach. Similarly, a non-
experimental evaluation of the Parents As Teachers Program (PAT) found
the best outcomes when home visitation was combined with center-based
care or preschool. Minority and non-minority children and those in
high- and low-poverty schools who participated in PAT and preschool
scored higher on kindergarten readiness assessments, as did EHS
children who also participated in PAT and preschool. Children cared for
only at home but participating in PAT scored higher than those whose
parents did not participate. The combination of home visitation and
center-based early childhood programs can enhance literacy, math and
behavioral readiness for school, all key to early school success.
Several of the national models target early literacy, and their
evaluations suggest promising results with respect to language and
literacy development. In a study of kindergarten readiness, The Parent
Child Home Program (PCHP) found significant increases in school
readiness for participating at-risk children.\14\ HIPPY USA has
promising results in the second year of a three-year study of HIPPY
AmeriCorps programs with respect to an array of parent literacy-related
behaviors and practices and indicators of children's language and
literacy.
There are a few studies which suggest long-term educational and
societal benefits from early home visitation, and fewer still which
examine cost analyses. However, several of the national home visit
models have longitudinal research underway and there are calls for new
cost-benefit studies. In addition to positive results from the
longitudinal research on the Nurse-Family Partnership (noted in the
textbox above), the Parent Child Home Program (PCHP) has followed up
and compared results for at-risk children who completed the program and
a control group. PCHP children had significantly higher rates of
graduation. Several of the national program models target reduced
costly child maltreatment as a key program goal and outcome, including
the Nurse-Family Partnership and Healthy Families America. These
programs show some promising results, particularly for mothers with the
fewest resources to draw on, those who are younger, economically
disadvantaged and first-time mothers.\15\ The two available cost-
benefit analyses suggest that benefits can outweigh the costs, but they
are preliminary, suffer from insufficient information--particularly
across and within the major models--and serve primarily as an incentive
to do further cost-benefit studies with better information.\16\
Twenty five years of evaluation of voluntary home visit programs
indicates that it is critically important to keep expectations of what
they can achieve reasonable and realistic, and to embed home visitation
within a system of early childhood services. It is also important to
insure that there are means to connect families with other accessible
family support services and supports. Programs with theories of change
that carefully link program inputs and processes to desired outcomes,
that continually measure their performance and that use the results as
well as other research for continuous improvement and innovation, are
more likely to provide the quality necessary to get the desired child
and family outcomes. There are a number of examples of this. The Nurse-
Family Partnership has been experimenting with a new curriculum which
has shown promise in reducing domestic violence. PAT has redone its
curriculum in accord with the latest research on child growth and
development from neuroscience. Evaluations also suggest the importance
of sufficient resources to hire competent staff, provide ongoing and
high-quality training and supervision, insure strong organizational
capacity, and allow attention to outreach and program engagement in
order to build the family-visitor relationship and insure sufficient
dosage to get results. When these quality indicators are not in place,
there is much less likelihood that investments in voluntary home
visitation will pay off in better results for children and families.
When they are, home visitation can provide information and support to
families that set them on a path to nurturing and responsive parenting
and continued involvement with the child's learning into and through
the school career.
Question 2: What is the evidence that the home visit field is ready
to scale-up and that it can produce positive outcomes at a greater
scale within states?
Voluntary home visitation has been provided to families with young
children from at least the nineteenth century through to today. The
current major national home visit models date from the 1970's, and a
number of them have been gradually going to greater scale in
communities and now states around the country. Spurred by the national
movement to results-based accountability, as well as by sometimes mixed
evaluation results, national home visit models have been building their
national training and technical assistance capacities, partnering with
each other, and working to build their capacity to evaluate, track and
improve their performance and to be accountable for the results they
seek to obtain. The leaders of these national models, as well as those
creating state early childhood systems, are very aware that in the
current and future policy environment, even experimental evidence that
a program works in one place is insufficient to warrant scale-up and
sustained funding. They understand that in current and future policy
environments, there are now two key questions that must be addressed:
Is there experimental evidence that voluntary home visitation
``works?'' and ``Does the field have the understanding of and capacity
to provide what it takes to go to, and return results at, scale?''
In 2006, Weiss and Klein reviewed the evidence on home visitation
to address the question of readiness to scale. They concluded, given
the current state of knowledge and appropriate demands for
demonstration of returns on investment, that voluntary home visiting is
a wise bet so long as four conditions around home visitation capacity
and infrastructure are met as expansion occurs:
1. First, given the substantial and growing body of evidence about
home visiting, new and continued funders and their funding should
ensure that there is national and state support so that providers have
the commitment and capacity to incorporate lessons from their own and
each others' research and evaluation for program improvement as they go
to and operate at greater scale.
2. Recent meta-analyses suggest that looking across as well as
within programs provides information about the specific capacities,
characteristics and activities that contribute to more positive
outcomes for children and families. Therefore, a second condition is
that home visiting programs must regularly collect and report
information on their progress and outcomes to determine if their
hypothesized outcomes are being achieved.
3. The third condition is that national models and others doing
research, evaluation and performance monitoring share their information
and results to build the collective knowledge base and inform public
policy on home visitation.
4. Finally, because recent evaluations have shown that home
visiting can be more effective for economically and otherwise
disadvantaged families when it is paired with center-based early
childhood and/or prekindergarten programs, the fourth condition is that
there be support for and encouragement of trails of these and other
combinations to better understand how home visitation fits with and
contributes to a comprehensive system of early childhood child and
family supports.
Weiss and Klein also interviewed representatives of the national
models and selected researchers and evaluators knowledgeable about home
visitation to get their perspectives and recommendations about
investments in knowledge development and system and capacity building
that would support efforts to scale high quality and effective home
visitation programs. There followed six recommendations about what is
necessary to deliver quality services at scale:
1. Develop mechanisms to test and report on the extent to which
quality home visiting at scale improves outcomes for young children and
parents.
2. To increase the likelihood of achieving results at scale, and to
support learning and continuous improvement efforts, programs should
use a management information system for tracking and monitoring
activities.
3. Identify what capacity is needed to maintain quality at scale in
areas including training, supervision, technical assistance, research,
communication, and advocacy, and feed this information back in to
support capacity building in each of these areas.
4. Invest in research to better monitor and understand what happens
in visits that leads to improved outcomes and to support training and
supervision efforts.
5. Invest in research to better match program goals, activities,
and intensity with family circumstances, home visitors, and supports to
get the best outcomes for young children and parents. This information
is essential for decisions about targeted vs. universal services,
allocation of families to particular models, and for decisions about
how to integrate home visitation into other early childhood services.
6. Identify realistic expectations for what home visiting can
accomplish and hold programs accountable for achieving those outcomes.
The interviews with the national model representatives indicated
that they are implementing these recommendations now, and that they are
working with a number of state government and nonprofit organizations
in their efforts to do so. The details of their work are described in
Weiss and Klein, 2006. Continuation of these efforts is important as
home visitation moves from individual model-led national expansion to
expansion within a state-led system of home visitation services
integrated into a larger comprehensive system of early childhood child
and family supports. There is much to be learned from the efforts of
the six models as states scale home visitation services. There are also
key decisions to be made about a national research and evaluation
agenda for home visitation and how state program expansion will fit
with and benefit from national or cross state evaluation, performance
management, continuous improvement and accountability efforts.
Several of the recommendations above may be most efficiently
managed at the national level with states contributing data and
experiences, while others might best be handled at the state level with
a commitment to cross-state and national information sharing and
synthesis. So, for example, states should oversee the development of
management information systems but they can learn from the national
models and from each other as they do so. Program expansion arguably
should be tied to a transparent and effective system for collecting
indicators of performance and evidence of use for program improvement
purposes. Research on what happens in home visits--with resulting
implications for targeting, training and supervision, on the other
hand--might best be part of a state-informed but nationally developed
and funded research and evaluation agenda, again committed to
dissemination of results to support continuous improvement efforts. As
home visiting moves to scale, it will also be important for states to
suggest other questions for a nationally-funded research and evaluation
agenda that would in turn inform their work and quality improvement
efforts. Coordinated national and state efforts will be necessary to
address recommendation five, research and evaluations to answer key
policy questions about what types of home visitation, in combination
with what other supports and early childhood services, work when and
how for what types of families in order to promote school readiness and
other valued outcomes.
In sum, the promising evidence on home visit effectiveness and the
field's growing understanding of what it takes to develop and implement
high quality services lead many to conclude they are worthy of
investments to scale-up, so long as all the conditions noted above,
particularly their integration into a comprehensive system of services,
are met.
Question 3: How does the EBAH legislation incorporate the lessons
from past evaluations, and thereby increase the likelihood of returning
positive results at greater scale?
The Education Begins at Home Act--with three years' funding for
states to expand access to early childhood home visitation services
with related supports and provisions for quality implementation and
evaluation--draws from and is consistent with the lessons and
recommendations that are emerging from the home visit field. The Act
wisely builds in key provisions, including national peer review of
state applications, 10% set aside for training and technical
assistance, and 3% set aside for evaluation with requirements for
yearly performance tracking and reporting on key indicators and an
ongoing independent national evaluation. These provisions for
continuous improvement both increase the chances of successful
implementation and will determine if home visiting is in fact achieving
its intended short term outcomes.
As a quick look at the response to question 2 above shows (what it
will take for home visitation to be ready for scale), the proposed
requirements for state plans and use of funds all map onto the emerging
consensus about what it will take to implement high quality voluntary
early childhood home visit programs that offer a genuine and lasting
return on investment. Those requirements include a needs and resource
assessment, collaboration among home visit models and with other early
childhood services, specification of outcome areas to be assessed and
reported yearly, incentive to build in rigorous research designs,
outreach to fathers and other caregivers, attention to staff training
and supervision and organizational capacity for implementation, and the
earmarked resources to strengthen Early Head Start home visitation. All
of these help build programs that can enhance parenting and thus school
readiness, and sustained family involvement in learning and
development.
I respectfully propose several other considerations for this Bill
to the Committee. First, my research and experience suggests that both
the national models and many state administrators are ready to get and
use their own and others' data and research to support an ongoing
process of learning, evaluation, performance management, continuous
improvement, and accountability. They are ready to become what David
Garvin at Harvard Business School calls ``learning organizations.''
\17\ The legislation now provides for substantial national as well as
state level data collection and evaluation, but it does not specify how
these data will be used to enhance implementation, learn from failures,
benchmark, or share proven practices, in order to improve
implementation as well as to inform policy-making. Consideration should
be given to how to get the maximum from the legislation's substantial
investments in performance management and evaluation. Leadership at the
national as well as state level, and provisions to support this
learning process, are key, and perhaps could be specified as part of
the legislation.
A second consideration involves a requirement for and specification
of ways to link early childhood home visitation and other early
childhood services to school such that both children and families are
involved in a successful transition to kindergarten and elementary
school. Evidence continues to grow that it is important to get parents
as well as children ready for school, and that parental readiness
offers academic benefits for children.\18\ Early childhood home visit
programs are designed to enhance parent and family involvement in
children's learning and development, and many of them reinforce the
importance of continued involvement through the child's school career.
There is also a substantial research base about the academic payoff of
continued family involvement and increasing recognition of this amongst
school administrators and teachers.\19\ However, the legislation as
currently drafted does not include provisions for links with districts
and schools in order to support and include both parents and children
in the transition. Nor does the legislation as currently drafted
consider how to work with schools to continue family involvement into
and through elementary school.
Sustained family involvement with the academic payoffs it can bring
is one of the longer-term outcomes from early childhood home visitation
but it will depend on building bridges to school and working with
educators to help sustain this involvement.
At the outset, I mentioned that my colleagues and I are working to
build the knowledge base for complementary learning. Complementary
learning involves linking school and non-school supports for children's
learning and development from birth through high school and thereby
creating pathways into and out of school. Initiatives such as the
Harlem Children's Zone and Omaha's Building Bright Beginnings are
examples of community-based complementary learning approaches and both
emphasize the importance of support for parenting and family
involvement. There is a strong research-based case that nurturing
parenting and continued family involvement throughout a child's school
career are necessary components of these complementary learning
pathways. While increasing evidence suggests that no one support alone,
whether it is a good prekindergarten, school or early childhood home
visitation program, is enough to get children into and graduating from
school, high quality early childhood home visitation holds much promise
for launching both parent and child on a pathway to graduation, to
postsecondary education, and to success in a global society and
economy. The Education Begins at Home Act is structured to provide a
great opportunity to offer a key component in this pathway hypothesis.
endnotes
\1\ Bouffard, S., Weiss, H., Gordon, E. and Bridglall, B. (2008).
Family involvement and Educational Equity. Equity Matters series from
the Campaign for Educational Equity, Teachers' College, Columbia
University; Belsky, J. et al, and the NICHD Early Child Care Research
Network (2007), Are there long-term effects of early child care? Child
Development, 78(2), 681--701.
\2\ Harvard Family Research Project, Family Involvement Makes a
Difference series of 3 research briefs at
\3\ Weiss, H.B. and Klein, L. (2006). Changing the Conversation
About Home Visitation: Scaling Up With Quality.
\4\ Weiss, H.B. (Winter, 1993), Home visits: Necessary but not
sufficient, The Future of Children, 3(3) 113--28; Gomby, D.S. (January
2003), Building school readiness through home visitation, Paper
commissioned for First Five California Children and Families
Commission. Available at: http://www.ccfc.ca.gov/SchoolReady.htm; Daro,
D. (September 2006) Home Visitation: Assessing Progress, Managing
Expectations, Written Testimony for House Subcommittee on Education
Reform, Committee on Education and the Workforce. Available at:
www.chapinhall.org; Raikes, H., Green, B., Atwater, J., Kisker, E.,
Constantine, J., & Chazan-Cohen, R. (2006), Involvement in Early Head
Start home visiting services: Demographic predictors and relations to
child and parent outcomes, Early Childhood Research Quarterly, 21, 2-
24; Weiss & Klein (2006).
\5\ Sweet, M.A. & Appelbaum, M.I. (2004), Is home visiting an
effective strategy? A meta-analytic review of home visiting programs
for families with young children, Child Development, 75(5):1435-1456.
\6\ Weiss and Klein (2006).
\7\ Weiss, H.B. (2006) Lessons from a Community of Practice: The
Home Visit Forum 1999--2005 and After. Available at www.hfrp.org.
\8\ Wasik, B.H. & Bryant, D.M. (2001), Home Visiting, Thousand
Oaks, CA: Sage.
\9\ Johnson, K.A. (May 2001), No place like home: State home
visiting policies and programs, Johnson Group Consulting, Inc., Report
commissioned by The Commonwealth Fund. Available at www.cmwf.org.
\10\ Bronfenbrenner, U. (974), Is early intervention effective?
Teachers College Record, 76(2), 279-303; Shonkoff, J. & Phillips, D.
(2002), From Neurons to Neighborhoods: The Science of Early Childhood
Development, Washington, DC: National Academy Press; Harvard Family
Research Project (2007), Family Involvement in Early Childhood
Education from Family Involvement Makes a Difference series of 3
research briefs at
\11\ Hart, B. & Risley, T.R. (2002), Meaningful Differences in the
Everyday Experience of Young American Children, Washington, DC:
Brookes.
\12\ Bouffard, Weiss, Gordon and Bridglall (2008).
\13\ Weiss & Klein (2006).
\14\ Levenstein, P., Levenstein, S., & Oliver, D. (2002), First
grade school readiness of former child participants in a South Carolina
replication of the Parent Child Home Program, Journal of Applied
Developmental Psychology, 23 (3) 331-353.
\15\ DuMont, K., Mitchell-Herzfeld, S., Greene, R., Lee, E.,
Lowenfels, A., & Rodriguez, M. (June 2006), Healthy Families New York
Randomized Trial: Impacts on Parenting After the First Two Years, New
York State Office of Children and Family Services, Working Paper
Series: Evaluating Healthy Families New York. Available at:
www.ocfs.state.ny..us/main/prevention/assets/
HFNYRandomizedtrialworkingpaper.pdf; Olds, D. (2006), The Nurse-Family
Partnership: An evidence-based preventive intervention, Infant Mental
Health Journal, 27 (1), 5-25.
\16\ Weiss and Klein (2006); Gomby (2003).
\17\ Garvin, D.A., Edmondson, A.C., & Gino, F. (2008), Is Yours a
Learning Organization? Harvard Business Review, 86(3):109-116.
\18\ Kraft-Sayre, M. E., & Pianta, R. C. (2000), Enhancing the
transition to kindergarten: Linking children, families, and schools.
Charlottesville, VA: University of Virginia, National Center for Early
Development & Learning; Kreider, H. (2002), Getting parents ``ready''
for kindergarten: The role of early childhood education, Cambridge, MA:
Harvard Family Research Project; Schulting, A. B., Malone, P.S., &
Dodge, K. A. (2005), The effect of school-based kindergarten transition
policies and practices on child academic outcomes. Developmental
Psychology, 41(6), 860--871; Schulting, A. (2008), Promoting Parent--
School Relationships During the Transition to Kindergarten, The
Evaluation Exchange, 14(1 &2): 8. Cambridge, MA: Harvard Family
Research Project.
\19\ Harvard Family Research Project (2008). The Evaluation
Exchange: Building the Future of Family Involvement, 14(1 &2): 8.
Cambridge, MA: Author.
______
Chairman Miller. Thank you.
Julie, we are going to turn to you. Your husband is Victor?
Ms. Fenley. Yes, that is correct.
Chairman Miller. He is more than welcome, if you and Zane
want to sit at the table and you want to let him color over
there at the table, or if you want to walk around with him, do
whatever you want. This is supposed to be a child-friendly
committee, you know.
Ms. Fenley. He is a handful, as you can see.
Chairman Miller. So if Zane and Megan want to hang out at
the staff table, the press table, whatever, they are welcome
to. Whatever makes it easy on you.
Ms. Fenley. Thank you so much.
Chairman Miller. Julie, welcome to the committee. We look
forward to your testimony. This is the same Zane and Megan that
are in your testimony, right?
STATEMENT OF JULIE FENLEY, PARTICIPANT, PARENTS AS TEACHERS
HOME VISITATION PROGRAM
Ms. Fenley. That is correct.
Thank you for having me, first of all. It is a pleasure to
be here.
My name is Julie Fenley, and I am a participant in the
Parents As Teachers Program in Norfolk, Virginia.
My husband, Victor Fenley, is an aviation structural
mechanic, an airman apprentice, as mentioned. We have two
beautiful children who are both with us today, Megan, who is 7,
and Zane, the handful, who is 2.
Our dream of being a military family started quite some
time ago, but we officially started our Navy career in February
2007. It has changed our lives in many ways. We were both
raised in very small towns in Southeast Texas. We moved to
Virginia Beach, and I was terrified.
I noticed immediately it was very different from life in
Texas, with our extended family there to support us. It has
taken some time, but I am so proud to call Virginia my home
now.
I have taken on the mentality that home is not where you
are raised but indeed where the Navy sends you.
Zane and I joined the Parents As Teachers Program shortly
after we arrived in Virginia Beach. During our first couple of
visits with Ms. Terrilyn Williams, who is our parent educator,
Zane was timid and shy. But now when she comes through the
door, he is always excited to see her. He knows this is a
special playtime with Mommy and Miss Terri, which is his name
for her.
During each meeting, Zane gets to experience a new activity
and I get to learn a new parenting skill. For me, it is the
perfect opportunity to get inside his tiny, little mind and
really understand the reasons he does some of the silly, little
things he does. Or what is behind those challenging behaviors
for us as parents.
The past couple of visits have been very special for Zane
and myself because my husband was able to participate in the
home visit. We have really enjoyed our visits with Ms. Terrilyn
as a family.
When Zane was born, he had a serious medical condition
called PPHN, also known as pulmonary hypertension in newborns.
The physicians told me that he could possibly suffer from
neurodevelopmental issues.
After doing a little research, I made a discovery that the
number one side effect for children who survive the illness is
sudden hearing loss and speech delay. I was terrified and so
worried that this could be the reason that Zane wasn't talking
as well as he should be.
The in-home developmental screening that Ms. Terrilyn
conducted confirmed that Zane had potential delays. She calmly
talked to me about my concerns and referred me to local
resources that could do further testing on Zane. The testing
showed me that he was approximately 3 months behind on his
speech, but they suggested that we wait a few months and see
how he progresses on his own.
Zane is now learning new words almost daily, and if it
weren't for Ms. Terrilyn, I would not have found those
resources on my own.
Terrilyn was also very helpful to help us find some other
resources in the community that helped us through some
difficult financial times, especially around the holidays. She
just seems to know how to get things done in our community and
how to help us connect with community resources that I didn't
know about. I really wish that I would have had this program
when Megan was Zane's age. I think it could have taught me some
wonderful parenting techniques right from the start, rather
than learning from trial and error.
It has been very beneficial for both me and my husband.
Before he left for training, he was the one who took care of
most behavioral issues. But when he left, it was my job to do
everything, including discipline. This was a very stressful
time for me. By the time we reunited 8 months later, he and I
developed completely different approaches on parenting and
discipline.
I asked Ms. Williams about the problem we were having, and
she explained to me some things we could do and she gave me
some very helpful literature. It really helped my husband and I
to get on the same page and work together as a team.
Megan and Zane are wonderful children and we are so blessed
to have them in our lives. They deserve the best this world has
to offer, including my husband and I being the best parents as
possible.
I feel in my heart Parents As Teachers is just what we were
needing in our lives. It helps me be a better parent every day.
I think every military family could benefit from Parents As
Teachers. We are blessed to have such a wonderful program at
Norfolk, but there is a waiting list and so many families
aren't able to participate. I respectfully encourage the
committee to support the Education Begins At Home Act, which
has provided me much help in my life, and it would be great to
get the funding for so many more families that could really
benefit from the program.
I would like to say in closing a special thank you to Ms.
Terrilyn Williams for making such an impact in our lives. Not
only as a parent educator, but as a friend. Thank you for your
dedication to the program and for all your encouraging words
and your knowledge. I feel so validated as a parent each time
Ms. Terrilyn visits. Once she leaves, it is great for me. I
feel so rewarded as a parent. Once again, thank you for
teaching me how to be my children's best and most important
teacher.
Thank you.
[The statement of Ms. Fenley follows:]
Prepared Statement of Julie Fenley, Parents as Teachers Program
Participant
Thank you Mr. Chairman and Committee members for this opportunity
to speak to you today. My name is Mrs. Julie Fenley and I participate
in the Parents as Teachers program in Norfolk, Virginia. My husband,
Victor Fenley, is an Aviation Structural Mechanic Airman Apprentice
with the US Navy. We have 2 children who are both with us today--Meghan
who is 7 years old and Zane who is two years old.
Our dream of being a military family started quite some time ago,
but we officially started our Navy career in February of 2007. It has
changed our lives in many ways. We were both raised in very small towns
in south east Texas. When we moved to Virginia Beach I was terrified. I
noticed immediately it was very different from life in Texas with our
extended family there to support us. It has taken some time but I am so
proud to call Virginia my home now. I have taken on the mentality that
home is not where you are raised, but where the Navy sends you.
Zane and I joined the Parents as Teachers Program shortly after we
arrived in Virginia Beach. During our first couple visits with Mrs.
Terrilyn Williams, our parent educator, Zane was timid and shy but now
when she comes through the door he is always excited to see her. He
knows this is special play time with mommy and Miss Terri, which is
Zane's name for her. During each meeting, Zane gets to experience a new
activity and I get to learn a new parenting skill. For me it is the
perfect opportunity to get inside his tiny little mind and really
understand the reasons he does some of the silly little things he does
or what is behind those behaviors that challenging for us as parents.
The past couple visits have very special for Zane and myself because my
husband was able to participate in the home visits. We have really
enjoyed our visits as a family with Terrilyn.
When Zane was born he had a serious medical condition called PPHN
also known as pulmonary hypertension in newborns. The physicians told
me he could possibly suffer from neurodevelopment issues. After doing a
little research, I made the discovery that the number one side effects
for children who survive this illness is sudden hearing loss and speech
delay. I was terrified and so worried that this could be the reason why
Zane wasn't talking all that well. The in-home developmental screening
that Terrilyn conducted confirmed that Zane had potential delays.
Terrilyn calmly talked with me about my concerns and referred me to
local resource professionals that could do further testing on Zane. The
testing showed that he was approximately three months behind on his
speech, but they suggested we wait a few months and see how he
progresses on his own. Zane is now learning new words almost daily. If
it weren't for Terrilyn I would not have found those resources on my
own.
Terrilyn was also very helpful to us in finding other resources in
the community that helped us through some difficult financial times,
especially around the holidays. Terrilyn just seems to know how to get
things done in our community and helped us connect with community
resources that I didn't know about on my own.
I really wish I would have had this program when my daughter Meghan
was Zane's age. I think this could have taught me some wonderful
parenting techniques right from the start, rather than learning from
trial and error. It has been very beneficial for both me and my
husband. Before he left for training he was the one who took care of
most behavioral issues. But, when he left for eight months it was my
job to take care of everything, including discipline. This was a very
stressful time for me. By the time we reunited eight months later, he
and I had developed completely different approaches to parenting and
discipline.
I asked Terrilyn about the problem we were having and she explained
to me some things we could do and she gave me some helpful literature.
It really helped my husband and me to really work together. Meagan and
Zane are wonderful children and we are so blessed to have them in our
lives. They deserve the best this world has to offer, including my
husband and I being the best possible parents. I feel in my heart that
Parents as Teachers is just what we were need in our life. It helps me
to be a better parent. I think every military family could benefit from
Parents as Teachers. We are blessed to have such a wonderful program at
Norfolk, but there is a waiting list so many families aren't able to
participate. I respectfully encourage the Committee to support the
Education Begins at Home Act, which would provide much needed funding
so more families can benefit from home visiting programs like Parents
as Teachers.
I would like to say in closing a special thank you to Mrs.
Terrylinn Williams for making such an impact in our lives not only as a
parent educator but as a friend. Thank you for your dedication to this
program and for all your encouraging words and knowledge. I feel so
validated as a parent each time Terrilyn visits. Once again thank you
for teaching me how to be my children's best and most important
teacher.
______
Chairman Miller. Thank you very much.
Would Ms. Terrilyn like to stand up? [Applause.]
Thank you. Nice to have you here. Thank you for what you
are doing.
Ms. London?
STATEMENT OF MAKEDA LONDON, PROGRAM MANAGER AND FAMILY SUPPORT
SERVICES COORDINATOR, HEALTHY FAMILIES--NEAR NORTH HEALTH
SERVICE CORP.
Ms. London. Chairman Miller and Congressman Davis and the
other distinguished committee members, thank you for inviting
me here to provide testimony on my experience with home
visitation services in Chicago, Illinois.
I am a Healthy Families program manager and family support
services coordinator for Near North Health Service Corporation.
Today I share with you the benefit of my experience about the
characteristics of a successful home visitation program and the
benefit of a federal investment in such services for our
families and our young children.
The Healthy Families program at Winfield Moody Health
Center presently serves 41 families in the Near North
community. Our intensive home visitation services are offered
to new parents, pregnant and parenting women, and children up
to age three. Since the inception of the program 14 years ago,
our home visitors have successfully completed 14,000 home
visits.
The Near North community where our Healthy Families program
is located 14 years ago has certainly changed. The high-rise
building and row houses that make up the Cabrini Green Housing
Development for many years are daily being demolished,
literally being torn down as we meet here today. This infamous
community better known for its crimes, its gangs and blight has
been a backdrop of the home visitation services of the Healthy
Families program. It has been among this unsafe environment
that home visitors of our program have been more like a
battlefield, where the assessment workers and the home visitors
have reported for duty, armed only with their prenatal and
their parenting curriculum, development screenings and safety
materials, their smiles and their love for the community, and
their passion for their work.
This kind of commitment to work has forged trusting
relationships with our participants that often last a long time
after the children have graduated from our program at age
three.
Within this challenging environment, we have been able to
make great strides with our program participants, leading to a
better early childhood development outcome for our children.
The Near North Healthy Families program, who is part of the
Healthy Families Illinois Network and the large-scale
longitudinal evaluation that examines the programs' impact on
parents' and children's outcomes.
Among the many benefits of participating in this program,
the evaluation found that parents involved in Healthy Families'
services demonstrated significantly greater improvement skills
that foster their child's growth during the infant's first 6
months of life. At 2 years, the families receiving Healthy
Families' services compared to those receiving other usual
services offered their children a wider array of materials to
stimulate the cognitive development.
Every day I see the tremendous impact that quality early
childhood home visitation has on families in my community.
Parents who lack parenting skills graduating from parenting
classes; parents who had little knowledge of their child's
development stages anticipate visits from home visitors so they
can complete their child's age appropriate Ages and Stages
developmental screening. Parent-child interaction has changed
from mere television watching with their children to
interactive play between parents and children at the children's
museum. Parents who were among the many others who believed
that the only time you took your child to the doctor was when
your child was sick, now see the benefit of preventive and
regularly bringing their children to the doctor for well child
visits and immunizations.
Two of our parents, Laquisha and Pam--Laquisha came in and
she has been a member and a participant in the program for 5
years. Today Laquisha is an entrepreneur, a massage therapist.
She was trained following the resources of her home visitor as
a breastfeeding peer counselor, was employed and is very, very
motivated. She has two beautiful children today.
Another participant, Pam, who is a single mother of seven
children, is battling now relocation from Cabrini Green
housing. She has a mother who is ill and blind and not only the
relocation and the housing being an issue with her, working
with her home visitor, we know that she will be relocated to
better housing from the work with the home visitor. But Pam now
serves as our advisory consult chairperson.
What I would like to summarize is the benefits that we see
coming from the Education Begins at Home Act, the training and
the supervision, the community collaboration, the evaluation.
All three are requirements of the bill. In order to assure
quality of home visits, our home visitors receive training. The
training increases the home visitors' knowledge, it develops
their skills to meet the challenges that the program
participants face and the home visitors, in achieving these
outcomes with families.
The initial training that they get, the core training, is
added to that ongoing training. Effective supervision is a part
of it. The Healthy Families program is a program, a home
visitation program, that is important to us, and it is a part
of a community health center, which is the basis of our
participants coming into the program.
I urge today that this committee begin and move this
legislation toward enactment.
Thank you, chairperson, thank you, Danny Davis, and our
executive director, Dr. Bernice Mills Thomas, thanks you very
much for this participation in this committee.
[The statement of Ms. London follows:]
Prepared Statement of Makeda London, Healthy Families Program Manager
Good morning Mr. Chairman and distinguished members of the
committee. Thank you for inviting me to provide testimony of my
experience with home visitation services in Chicago, Illinois.
My name is Makeda London, and I am the Healthy Families Program
Manager & Family Support Services Coordinator for Near North Health
Service Corporation (NNHSC). I have served in the position as Healthy
Families Program Manager for 14 years. When I started in this position
in May 1994, I was responsible for implementing this intensive home
visitation program at our community based health care facility--
Winfield-Moody Health Center, located on the Near North side in
Chicago. I am now responsible for overseeing the supervision of the
home visiting staff and assuring that the program meets its goals, of
which the overall goal is the prevention of child abuse and neglect.
My undergraduate work in social science and graduate work in
education administration uniquely prepared me for this role. Prior to
coming to NNHSC, for 12 years I was the Director of an alternative high
school, Lumumba-Jackson Community Learning Center. This was a private,
nonprofit alternative school that was a member of the Alternative
Schools Network. The school was located in the same community area as
our present Healthy Families program. Over these 14 years, many of the
Healthy Families participants have been relatives and friends of former
students of the high school. Little did I know that my work in the
school was planting a seed in the community that would germinate in the
Healthy Families program today.
Today I share with you the benefits of my experience about the
characteristics of a successful home visitation program and the benefit
of a federal investment in such services for families and young
children.
Home visitation overview
Home visitation provides guidance to parents and increases their
knowledge of their child's growth and development from birth through
kindergarten entry. Services are delivered to the participants by well-
trained, respected home visitors who are responsive to the presenting
and changing needs of parents.
The Healthy Families program at Winfield-Moody Health Center
presently serves 41 families in the Near North Community Area 08. Our
intensive home visitation services are offered to new parents. Since
the inception of the program 14 years ago, this community has
drastically changed. The high rise buildings and row houses that made
up the Cabrini-Green public housing development for many years, are
daily being demolished, literally being torn down as I speak. Families
are being moved around and relocated to other communities and this
relocation often makes it difficult to locate those most in need of our
services.
This infamous community better known for its crime, gangs, and
blight has been the back drop of the home visitation services of the
Healthy Families program. It has been among this 'unsafe' environment,
that often has been more like a 'battlefield,' that assessment workers
and home visitors have reported for duty for the past 14 years armed
only with their prenatal and parenting curriculums, developmental
screenings, safety materials, smiles, love for the community and
passion for their work. This kind of commitment to work has forged
trusting relationships with participants that often lasts well beyond
the child's graduation from our program at age three.
In these 14 years, these community soldiers have delivered more
than 14,000 home visits. These visits are made to participants who are
screened and assessed on a number of factors, including substance
abuse, DCFS involvement, lack of parenting skills, domestic violence,
and no social support; no lifelines. What this indicates to home
visitors, is that a parent assessed with these risks, when he/she
becomes overwhelmed or stressed, has the potential to become abusive or
neglectful to their child. So, at our program, we seek to develop
relationships with the mother while she is pregnant.
While I represent the Healthy Families America program, nationally,
there are a number of effective, evidence-based home visitation
programs that would benefit from the Education Begins at Home Act,
including Home Instruction for Parents of Preschool Youngsters (HIPPY
USA), the Nurse-Family Partnership, The Parent-Child Home Program, and
Parents as Teachers. While the goals and target populations of these
programs vary, they all offer similar core services. All programs offer
home visits which are voluntary and at no cost to participants. All
provide parent education, especially emphasizing early childhood
development. Many home visitation programs work with families on
language, literacy and reading skills, while others focus on baby care
and health services.
Ensuring quality and effectiveness
I have been asked today to share with you what my fourteen years
with the Healthy Families program have taught me about what makes a
home visitation program successful. While there are number of
components for successfully implementing a home visitation program, I
will highlight three specific characteristics that have tremendous
impact on program quality and effectiveness:
Training and Supervision;
Community Collaboration; and
Evaluation linked to program goals.
Training and Supervision:
Staff development and training is one of the 12 research-based
Critical Elements (or Best Practices) that guide the Healthy Families
program. In order to insure the quality of the home visit, the home
visitor must receive intensive formal training (i.e. initial core
training for their specific job function and ongoing wraparound
training). The training increases their knowledge, develops skills to
meet the challenges faced by program participants and assists home
visitors in achieving outcomes with families. Program supervisors and
managers also receive training, support and professional development
opportunities. In my community, the training and professional
development is provided by the Ounce of Prevention Training Institute.
Training is an integral part of the fabric of NNHSC; embedded in
our Mission. Each month, our facilities are closed for a half day for
staff training and development. Some of the training topics each year
are: Age-Specific Competencies; Cultural Diversity; and Child Abuse
Recognition. The Healthy Families program adds to that with regular in-
service trainings for staff.
Effective supervision is an integral part also of the Critical
Elements of the Healthy Families program. Program supervision occurs
weekly with home visitors. During supervision, participant cases are
discussed, home visit content and frequency reviewed. Through
reflective supervision, home visitors are able to discuss challenges
they face and together with the supervisor decide on solutions. They
are able to discuss their own professional development.
In my role as program manager, I supervise the project supervisor
who in turn supervises the home visitors. Together, we evaluate the
performance of home visitors through observation/shadowing and data and
file reviews. Feedback is provided to improve performance, and ensure
the critical elements and standards are followed and goals are
achieved.
Benefits of high quality supervision include:
Promoting both staff and program accountability;
Encouraging home visitor's personal and professional
development;
Reducing staff burnout and turnover by providing home
visitors with much needed support; and most importantly,
Enhancing the quality of services families receive.
The Education Begins at Home Act recognizes the importance of
training and supervision by setting aside 10 percent of a state's grant
for training and technical assistance, and by requiring that states
only fund programs that ``employ well-trained and competent staff'' and
``maintain high quality supervision to establish home visitor
competencies.''
Community Collaboration:
Home visitation is not an island in the sea of early childhood
development programs. Families require an array of services to provide
a safe, abuse-free home environment that produces a healthy child.
The Healthy Families program in Near North Chicago is uniquely
housed in a community health center that offers primary health care
services and a wide range of social support services. A majority of the
Healthy Families participants are patients of the health center. As
such, their medical providers (OB/Gyne doctors and pediatricians) are
within walking distance from their homes and easily accessible to them.
The program participants, medical providers and home visitors have
forged together as an effective team in the positive growth and
development of the child. Some of the other services accessible to
program participants are, case management, domestic violence services,
mental health services (individual and group counseling by licensed
clinical social workers), intensive outpatient substance abuse
treatment, perinatal depression screening and treatment, nutrition
counseling, WIC (Women, Infants and Children) services, dental
services, ophthalmology, parenting classes, consumer support groups,
and client group education.
Our home visitors are trained to link program participants to
available services through a range of state, city and community
partners. The Health Center's community partnerships and affiliations
include the Chicago Department of Public Health, Illinois Department of
Human Services, Children's Memorial Hospital, Northwestern Memorial
Hospital, John Stroger Cook County Hospital and United Way.
In fiscal year 2007, home visitors were instrumental in
facilitating the 14,306 clinical visits made by patients to Winfield-
Moody Health Center and the 10,636 non-clinical (social support
service) visits to all five community health centers of the
corporation.
The Education Begins at Home Act supports the role that home
visitation programs play in linking participants to additional services
in two primary ways:
1. State-level Early Childhood Coordinating Body. EBAH requires
that states ensure collaboration among a broad range of child-serving
programs by creating or utilizing an existing state-level early
childhood coordinating body. This coordinating body would meet
regularly to address policy and implementation issues that will improve
the coordination of a range of services for children and families,
especially those receiving home visitation services. The coordinating
body would include representatives from early childhood home visitation
programs, early care and education programs, child abuse prevention and
treatment programs, health care programs, nutrition programs, and
workforce development programs, to name just a few.
2. Information and Referral. The legislation requires that home
visitation programs funded by EBAH provide referrals for eligible
families to additional resources available in the community, such as
child care, family literacy programs, employment agencies, and other
social services.
Quality Assurance & Evaluation:
We could not state that ours is a successful home visitation
program had we not built in effective quality assurance measures. As
program manager, I sit on our agency's multidisciplinary Quality
Improvement Committee that monthly reviews clinical, program and
support parameters. Our Healthy Families program also has its own
Quality Assurance Committee that quarterly reviews program service
delivery parameters and other critical element standards. Home visitors
are among the reporters on this committee.
Additionally, there are external audits and reviews of program data
inputted by home visitors into the state's human services monitoring
and tracking system called Cornerstone. Also, our program proudly
displays our Credentialing Plaque, just outside my office at Winfield-
Moody. The program was credentialed in June 2007 after a very thorough,
intensive, external review of records, systems, policy, procedures and
service delivery by our national accrediting body, Healthy Families
America.
In fiscal year 2007, 1149 home visits were conducted by home
visitors of our Healthy Families program with a successful completion
rate of 86%. This among program participants with some of the highest
and most numerous challenges for risk of abuse.
Evaluation
Home visitation as a field has a history of being committed to
evaluation and program improvements. The Healthy Families America
program alone has been subject to 34 studies in 25 states involving
over 230 HFA programs.\1\ Healthy Families Illinois--of which my
program is a part--recently underwent a large scale, longitudinal
evaluation that examined the program's impact on parent and child
outcomes. The evaluation, conducted by Northern Illinois University,
identified the following key findings: 2
---------------------------------------------------------------------------
\1\ Study designs include 8 randomized control trials and 8
comparison group studies. More information on the studies can be found
in the Healthy Families America Table of Evaluations at
www.healthyfamiliesamerica.org/research/index.shtml.
\2\ Illinois Department of Health and Human Services. ``Healthy
Families Illinois: Evaluation Findings Executive Summary.'' September
2006.
---------------------------------------------------------------------------
At six months:
Parent-child interactions improved significantly across
time in families receiving HFI services. No such improvements were
noted in families receiving all other usual services.
Parents involved in HFI services demonstrated
significantly greater improvements in their growth fostering skills
during their infant's first six months of life relative to comparison
parents, who received all other usual services.
At one year:
Parents receiving HFI services, relative to parents
receiving all other usual services, displayed higher levels of
acceptance of challenging behaviors.
At two years:
Families receiving HFI services, compared to those
receiving all other usual services, offered their children a wider
array of materials to stimulate their cognitive development.
Parents with highest risk for problems in parenting showed
the greatest improvements, including lower levels of distress, fewer
rigid beliefs, fewer problems with others and greater ego.
The Education Begins at Home Act places a strong emphasis on
evaluation. On an annual basis, states must report on outcomes
consistent with program goals, including parent knowledge of early
learning and development; child development indicators; child
maltreatment indicators; school readiness indicators; and links to
community services. At the federal level, EBAH requires an independent
evaluation at the end of the second year of implementation to assess
outcomes consistent with program goals.
Conclusion
Everyday, I see the tremendous impact that quality early childhood
home visitation has on the families in my community. Parents who lacked
positive parenting skills have graduated from parenting classes.
Parents who had little knowledge of their child's developmental stages
anticipate visits from home visitors so they can complete their child's
age appropriate Ages & State developmental screening.
Parent-child interaction has changed from television watching with
your child to interactive play of between parents and children at the
Children's Museum. Parents who were among many others who believed the
only time you took your child to the doctor was when that child was
sick now see the benefit of prevention and regularly bring their
children to the doctor for well child visits and immunizations. Most
importantly, when I review the child abuse statistics in my community
that indicate there were 52 indicated victims of child abuse--none of
them were participant children of the healthy families program!
I've said enough, though. Two of our Healthy Families participants,
whose success stories are featured in our agency's 2007 Annual Report,
tell the success of home visitation better than I could ever tell it.
The first, Lakisha, was enrolled in our program for five years. She
started the program as a young pregnant woman and today has two
beautiful daughters, both of whom she breastfed, which is a program
outcome. Not only did she breastfeed her daughters, but she became a
Breastfeeding Peer Counselor. Her home visitor referred her to a
Chicago breastfeeding training program, which she attended and
completed. She was employed for a period of time as a Breastfeeding
Peer Counselor at a local hospital. Today, Lakisha has completed
another training program (massage therapy), and is now an entrepreneur.
The second young woman, Pam, a single mother of seven children
enrolled in the Healthy Families program when she was pregnant two
years ago. Pam experienced some complications during her pregnancy and
was placed on bed rest. She gave birth to a beautiful daughter in June
2006. (Incidentally, one of our home visitors also makes hospital
visits to patients and program participants who deliver to give support
to the mother after delivery and welcome the newborn). One of the IFSP
(Individual Family Support Goals) that Pam works together with her home
visitor on is suitable housing.
Pam lives in the Cabrini-Green housing development. Housing
relocation for Pam is very challenging. Not only because of Pam's large
family, but because Pam lives with and is taking care of her mother who
is ill and visually impaired. Pam has faced this and other challenges
and came out smiling. Today she has a son who graduated from elementary
school and a daughter who is a freshman at a local college. Pam's self
esteem has improved since enrollment in the program and she is now the
Chairperson of our Healthy Families Advisory Committee.
In a time of limited resources, the federal government has the
responsibility to make wise investments in services that have been
tested and found to be effective. The Education Begins at Home Act
honors this responsibility by supporting the highest-quality home
visitation services. I urge every member of this committee to support
the Education Begins at Home Act and to move this important legislation
towards enactment this year.
Thank you, Mr. Chairman and distinguished members of the committee,
for allowing me the opportunity to share this testimony with you today.
And thank you Congressman Davis for your leadership on the Education
Begins at Home Act. The Healthy Families participants in the Near North
neighborhood of Chicago are fortunate to be represented by such an
ardent champion for children.
______
Chairman Miller. Ms. Ditka?
STATEMENT OF LAURA A. DITKA, DEPUTY DISTRICT ATTORNEY AND CHIEF
OF CHILD ABUSE UNIT
Ms. Ditka. Thank you, Mr. Chairman, Ranking Member McKeon,
Congressman Altmire and members of this committee. First let me
thank you for the opportunity to speak before you today.
I hope to give you some anecdotal evidence about what
results when there is not home visitation and when there is not
early intervention in children's lives, particularly at-risk
children in our communities.
As a prosecutor for 20 years, there was such a need in
Allegheny County that I was able to start the Child Abuse Unit.
There are four lawyers in our small county that do nothing but
child abuse all day, every day, resulting from sexual abuse,
physical abuse and neglect.
And I am not here today to vilify parents. Certainly there
are cases that come before me where people act with villainous
intent. But in many, many of the cases that we see, there are
parents that just do not have the skills, the resources or the
knowledge necessary to care for their children in an
appropriate way that will help them thrive later in society and
as individuals.
I would like to give you a couple of examples. Last month,
I sentenced two young women in their twenties, between the two
of them they had seven children. They had been life-long
friends since grade school. Those women decided that they
needed to blow off some steam and went out for a night on the
town. They left their seven children home alone. The oldest of
the children were two 8-year-olds.
The 8-year-olds began playing with matches. They burned
down the house. They were unable to get their siblings out and
five of them perished.
The sentencing was an emotional and gut-wrenching event.
These mothers loved their children. They did not wish to harm
their children. But nobody had taught them the dangers that
might befall leaving children of such a young age at home and
the consequences were grave.
On that same street in this at-risk neighborhood, I
currently have a case, a mother, again very young, with a
special needs child, who is somewhat ill-equipped to deal with
the needs of her child, has turned to drugs and alcohol. In her
home, faulty wiring started a fire. She was so intoxicated that
she was unable to tell the police and firefighters that arrived
at the scene how many children she had, and her oldest child,
who was 6, perished in that fire.
Again, not a mother that had any ill intent towards her
child, any sort of malice or malicious will, just ill-equipped
to deal with what was put before her. And at home visiting and
this bill, Education Begins At Home, would greatly improve
those skills that are needed for these parents.
There is not only a component with children that are
harmed, that type of abuse, but one of the stories that will
stay with me throughout my career and, in fact, until the end
of my days, a case that I did. A number of young mothers from
the inner city didn't know what to do with their children. A
gentleman came along with some means and some education and
suggested to these mothers that he could watch their children
and give them a better life, and these mothers essentially gave
this man their children.
I prosecuted him for abusing 11 of the children that were
in his home, ranging from the age of 14 to the age of 2, and
what stuck with me was a young man who was 11 years old. He
told me, ``Ms. Laura, I know he did bad things, but he was the
best dad I ever had. He made me go to school, he cared about my
homework, he took me to church, he had me play baseball.'' And
that young man was then removed from this abusive home and put
back to a home with a mother who still had no skills and 2
years ago I was testifying before a judge asking for leniency,
because that young man had now reached 18 and was turning to a
life of crime and selling drugs to help support he and his wife
and his young infant child.
This program has such positive outcomes. Let me just give
you some good examples of what can happen from this.
In houses where there have been--and in Allegheny County we
use the Nurse-Family Partnership--in houses where they has been
visitation, 60 percent of the mothers and 60 percent of the
children no longer are arrested because of that early
intervention. Test scores have gone up; 43 percent of the
children have scored above the 50th percentile in cognitive
ability, making them better prepared for school, better
prepared for high school and hopefully on to college and a
productive societal ethic.
There are $103 billion spent each year on child abuse. The
cost-benefit analysis shows that these programs for each dollar
spent reduces that cost by making people productive members of
society. I have two empirical data that I would ask the
committee to accept, one from the PCCD in Pennsylvania on the
economic returns of home visiting, and one from Fight Crime,
Invest in Kids, on breaking the cycle of child abuse.
In summation, I would like to encourage you if at all
possible to reduce my workload, to give me less people to
prosecute, to give people more ability to care for their
children so we can have a brighter future tomorrow and in the
future.
Thank you very much.
[The statement of Ms. Ditka follows:]
Prepared Statement of Laura A. Ditka, Deputy District Attorney,
Allegheny County, PA, on Behalf of Fight Crime: Invest in Kids
Chairman Miller, Ranking Member McKeon, and Members of the
Committee: Thank you for the opportunity to testify before you today.
My name is Laura Ditka. I am a graduate of the Duquesne University
School of Law and a 20-year employee of the Allegheny County District
Attorney's Office. I am also a member of FIGHT CRIME: INVEST IN KIDS,
an organization of more than 4,000 police chiefs, sheriffs,
prosecutors, and victims of violence, who have come together to take a
hard-nosed look at the research on what can keep kids from becoming
criminals.
As a Deputy District Attorney, my day-to-day job is to prosecute
offenders and see that justice is done. However, I know that we can't
arrest and prosecute our way out of the crime problem. We must also
invest in proven approaches that reach kids and their families before
they begin offending. When teens are having children, and there's no
role model available of good parenting practices, we can't be surprised
when some of those kids don't grow up to become successful adults. It
is really ironic to me that everyone has to pass a test and get a
license to drive, and even to get a license to fish, but there's no
opportunity for at-risk new moms and dads to learn about effective
parenting practices. Beginning at the beginning means offering services
to new parents, even before their kids are born, and preventing child
abuse and neglect--that's one of our strongest weapons in the fight
against crime.
The Allegheny County Child Abuse Unit that I founded and now direct
investigates and prosecutes hundreds of cases of child abuse and
neglect each year. For example, on any given day the four attorneys
that I supervise are in court with cases of horrific sexual abuse and
cases of physical abuse and neglect of children. One particular case
comes to mind involving a mentally challenged mother who saw her
husband touching her child in a sexual manner. The mother did not have
the parenting skills necessary to stop the abuse caused by her husband.
This child endured this sexual abuse for over one year until she was
seriously harmed and both parents were prosecuted. This is the type of
family in need of quality home visiting and help.
In many of the cases I prosecute, the perpetrator didn't set out to
be a bad parent and hurt their kids. They just didn't realize they
shouldn't leave their child unattended, for example. I have just
finished the prosecution of two young mothers who left 7 children, ages
8 and under, home alone while they went out for the night. One of the
children was autistic. The 8-year-old ``babysitters'' were playing with
matches and started a fire that destroyed the home and killed the five
younger children. On that same street in Allegheny County, a case is
pending of a young mother who was so intoxicated while at home with her
three young children that when her house caught fire--she could not
tell police and fire fighters how many children were in the house. This
resulted in her oldest child dying in the fire.
It is important to note that in Pennsylvania many suspected
instances of child abuse and neglect do not rise to the level of
criminality, so the problem is far greater than the hundreds of cases
my office prosecutes. Last year, there were 4,162 instances of
confirmed abuse or neglect in Pennsylvania. Even though the majority of
children who survive abuse or neglect are able to overcome their
maltreatment and become productive adults, too many victims of abuse
and neglect cannot. Not only are they more likely to abuse or neglect
their own children, they are also more likely to become violent
criminals. The best available research indicates that, of the 4,162
children who had confirmed incidents of abuse or neglect in one year in
Pennsylvania, 160 will become violent criminals as adults who otherwise
would have avoided such crimes if not for the abuse and neglect they
endured. Research also shows that, nationally, based on confirmed cases
of abuse and neglect in just one year, an additional 35,000 violent
criminals and more than 250 murderers will emerge as adults--people who
would never have become violent criminals if not for the abuse or
neglect they endured as kids.
Fortunately, voluntary home visiting programs can help stop this
cycle. These programs offer frequent, voluntary home visits by trained
individuals to help new parents get the information, skills and support
they need to raise healthy and safe kids. There are many models of home
visiting that help young children get off to a good start in life. They
serve slightly different populations and have somewhat different, but
complementary goals--improving outcomes in a wide range of areas
including health, academic achievement, employment and criminality.
The Nurse-Family Partnership (NFP) model of home visiting has the
strongest evidence on crime reduction,and I'd like to note that our
former governor's wife, Michelle Ridge, an active member of the NFP
national board, testified in support of this legislation in a hearing
held by Representative Castle two years ago. NFP provides home visits
by nurses to interested at-risk young mothers starting before they give
birth and continuing until their first child is age two. Rigorous
research, originally published in the Journal of the American Medical
Association, shows the program cut abuse and neglect among at-risk
children in half. In addition, by the time the children in NFP had
reached age 15, mothers in the program had 61 percent fewerarrests than
mothers left out of the program, and their children had 59 percent
fewer arrests than the kids leftout. The Nurse-Family Partnership has
been recognized as an evidence-based model by numerous agenciesand
Administration officials in recent years, including the Office of
Juvenile Justice and Delinquency Prevention, the National Institute of
Justice, the Centers for Disease Control, and the Substance Abuse and
Mental Health Services Administration. I'd like to ask if you would
enter into the record our recent FIGHT CRIME: INVEST IN KIDS
PENNSYLVANIA report, ``Breaking the Cycle of Child Abuse and Reducing
Crime in Pennsylvania: Coaching Parents Through Intensive Home
Visiting.''
As of last year, the Nurse-Family Partnership enrolled roughly 274
mothers in Allegheny County, Pennsylvania--specifically in the City of
Pittsburgh and communities down the Mon Valley. Upon entering the
program, 39% of these women completed high school or received their
GED, 98% were unmarried, 79%were unemployed, and 60% were on Medicaid.
Outcomes of the Allegheny County Nurse-Family Partnership have mirrored
national outcomes and included a 43% reduction in the mothers
experiencing violence during pregnancy and a 100% reduction in mothers
fearing their partners. Of those who entered the program without a high
school diploma, 61% completed their diploma or GED by program
completion and 32% were continuing their education beyond high school.
The Nurse-Family Partnership in Allegheny County has many success
stories. I'd like to briefly share one of them. In 2005, a woman, lets
call her Jane, was referred to the Allegheny County NFP program
fromanother county in Pennsylvania. Jane was a recovering heroin addict
who was herself a victim of emotional,physical and sexual abuse from
the time she was a toddler. Jane's experience in the program did not
start off without some trouble. She would often scream at the nurses
and appear very controlling of their home visit time. But soon, Jane
and her Nurse Home Visitor developed a close bond. The Nurse Home
Visitor helped Jane heal from all of the hurt she had suffered through
the years both physically through drug abuse and emotionally. Jane's
baby was born healthy and developed into a bright toddler under Jane's
nurturing.While in the program, Jane finished her GED and went on to
study medical records at the community college where she is expected to
graduate this spring. She is also planning to be married this fall.
With the help of the Nurse Family Partnership, Jane avoided a prolonged
life of drug abuse, child abuse and criminalbehavior. And we can bet
her child, and society, will reap significant benefits from this
transformation ofJane's life.
Research on other models of home visiting has also found numerous
positive results. For example, a randomized control trial of the
Parents as Teachers model found that treatment for an injury in the
prior year--a possible sign of abuse--was 3% among the children served
compared to the 13% of children not served (at the time of a second
year assessment). A study of Healthy Families New York (HFNY) found
that, at Year 1, compared to mothers in the control group, mothers in
the HFNY intervention group reported having engaged in significantly
fewer acts of very serious physical abuse (e.g., hitting child with
fist, kicking child, slapping on face). At Year 2, HFNY parents
reported having committed, on average, one-third fewer acts of serious
physical abuse in the past year than the control group.
Home visiting's benefits go far beyond child abuse prevention and
crime prevention. Home Instruction for Parents of Preschool Youngsters
(HIPPY) found that cognitive skills at the end of the program were
significantly higher for children in the program compared to those not
receiving HIPPY. A randomized control study of the Parent-Child Home
Program found that 84% of the children finishing the program graduated
from high school compared to 54% of those who did not receive the
intervention. Separate studies have concluded that improving graduation
rates reduces crime, making this finding of particular interest to me
and my law enforcement colleagues.
Preventing child abuse and neglect is not only the right thing to
do, it is also the fiscally sound thing to do. In a study commissioned
by the United States Justice Department, the Children's Safety Network
Economic Insurance Resource Center analyzed the direct and indirect
costs of child abuse and neglect to taxpayers and all those individuals
impacted by abuse or neglect. It concluded that child abuse and
neglects costs Americans $83 billion a year. Analysts with the Federal
Reserve Bank of Minneapolis concluded that NFP produced an average of
five dollars in savings for every dollar invested, and produced more
than $28,000 in net savings for every high-risk family enrolled in the
program. New data from a report commissioned by the Pennsylvania
Commission on Crime and Delinquency estimates that once the costs of
the program are subtracted, Pennsylvania's Nurse Family Partnership
sites average $37,367 in benefits per person served.
By waiting until the problems cannot be avoided, taxpayers are
paying huge sums to cover the costs of holding children back in school,
providing special education services, paying for welfare, and
especially paying for arresting, prosecuting, and imprisoning
criminals. The Pennsylvania Commission on Crime and Delinquency report
also estimates that it currently costs roughly $142,000 per year to
place a juvenile in a Youth Detention Center. Preventing only 5% of
out-of-home youth placements each year in Pennsylvania would produce an
annual savings of over $9 million. Further, Pennsylvania's prisons were
already operating at 115% of their inmate capacity by the end of 2006.
Even if the General Assembly approves the $700 million for Fiscal Year
2008-2009 requested by the Pennsylvania Department of Corrections' for
prison construction, Pennsylvania prisons will still be overcrowded. In
fact, at the projected rate of prison population growth, Pennsylvania's
prisons will be even more overcrowded in five years at 118% of
capacity. As an investment strategy, this is short-sighted. It ignores
the opportunity to act when the interventions are less expensive and
more likely to succeed.
I'd like to ask if you would also enter into the record the recent
report commissioned by the Pennsylvania Commission on Crime and
Delinquency (PCCD), ``The Economic Return on PCCD's Investment in
Research-based Programs: A Cost-Benefit Assessment of Delinquency
Prevention in Pennsylvania.''
An evidence-based approach with proven results and significant
potential savings like home visiting should be more widely replicated
across the nation to ensure that home visiting programs are offered to
all at-risk parents of young children. Yet, due to lack of funding,
hundreds of thousands of at-risk families receive do not receive
quality home visiting. Currently, NFP in Pennsylvania has 134 nurses
working in 41 of the Commonwealth's 67 counties. They have slots to
serve 3,237 families. Since its inception in Pennsylvania, over 10,000
new mothers have been served. Yet, the Nurse-Family Partnership Program
serves only 23% of eligible mothers in Pennsylvania each year. In
Allegheny County, that number shrinks to only 17% of eligible mothers.
While there are a few federal funding sources that can potentially be
used for home visiting, none are specifically designated for this
purpose. These funding sources are designed to provide money to a wide
variety of programs and home visiting efforts are only able to capture
a minimal amount of funding from any single source. The bipartisan
Education Begins at Home Act (H.R. 2343), first written and introduced
by Senator Bond (a Republican from Missouri), would authorize $500
million over three years to expand the reach of voluntary, research-
based home visiting and authorize a parent and public education
campaign about caring for infants and toddlers. The Committee, in
moving the bill forward, could even add language to ensure targeting of
services to jurisdictions with the greatest unmet need.
My colleagues and I see the fatal consequences every day of failing
to invest in quality home visiting programs to get kids off to a good
start in life. That is why the law enforcement leaders of FIGHT CRIME:
INVEST IN KIDS are eager to work with all of you to achieve enactment
of the Education Begins at Home Act. We know that a modest investment
now will cut child abuse and neglect, improve children's school
readiness and reap dividends down the road by reducing crime and saving
lives and money. Thank you for this opportunity to testify, and I would
be happy to answer any questions that you may have.
______
Chairman Miller. Thank you.
Mr. Estrada?
STATEMENT OF WILLIAM A. ESTRADA, DIRECTOR OF FEDERAL RELATIONS,
HOME SCHOOL LEGAL DEFENSE ASSOCIATION
Mr. Estrada. Good morning, Chairman Miller, honorable
members of this committee.
My name is William A. Estrada, and I am an attorney and the
director of federal relations for the Home School Legal Defense
Association.
Thank you for the opportunity to testify today regarding HR
2343, the Education Begins At Home Act.
Since 1983, HSLDA has represented the interests of our
homeschooling member families in all 50 states. We currently
have a membership of over 80,000 member families who are
homeschooling their children.
While there are provisions in the Education Begins At Home
Act that are very helpful, such as in Sections 4, 6 and 7 with
targeted grants, we also have serious concerns with some of the
provisions in this act. My testimony today will focus on
Section 9 of the bill. We believe that the provisions in
Section 9 will harm family integrity and parental rights.
Section 9 is entitled Supporting New Parents Through
Hospital Education. It requires the Secretary of Health and
Human Services to create a public awareness campaign to inform
the public and new parents about the importance of proper care
for infants and children under 5 years of age. The secretary
will ensure that every hospital, military hospital and birthing
center request that families coming through its doors
participate in a parenting class that is approved by the
secretary. The hospital must then request that the family sign
a form indicating whether or not they chose to take this class.
Section 9 is not clear if hospitals, military hospitals and
birthing centers may refuse to offer these materials on
parenting classes. Because of this vagueness, there is no
assurance that religious hospitals or birth centers could
reject materials or parenting classes that violated their
fundamental values.
Section 9 is also not clear about who will design these
parenting classes. There is no guidance offered to HHS, so the
secretary may decide to only approve classes that are designed
by experts, without the input of actual parents.
Parents have numerous parenting philosophies that may
differ from a one-size-fits-all government parenting class.
This could lead to limits on parental choice and parental
rights, because parents will feel pressured to take these
classes and to conform to whatever parenting philosophy is
taught.
Furthermore, the provision that the classes teach
``strategies for caring for infants' social, emotional and
physical needs'' is vague enough to include many conformist
philosophies that could concern many families, particularly
homeschooling families. For example, despite plentiful research
to the contrary, there are still some experts who believe that
home education and homeschooling is not best for a child's
emotional, social or physical needs. One need only look at the
recent California Court of Appeals decision, In re Rachel L.,
where the Court made a blanket ruling that California parents
do not have the right to educate their children at home unless
they are certified teachers. This would have the effect of
needlessly discouraging many families from homeschooling.
Although the parenting classes are optional, Section 9
could lead to needless social worker referrals. There are valid
cases of child abuse, no one is denying that, but we do not
want to see needless referrals of families to social services.
Since the hospitals and birthing centers must request a
signature showing that families participated in or refused a
class, a referral could be made to the child welfare department
alleging neglect simply because the family refused these
parenting classes. In reality, it is very possible that some
families may have chosen to decline participation because of
disagreement with the class' parenting philosophy. At HSLDA, we
have sadly dealt with cases such as this, and they are not
farfetched.
To avoid these and other problems that infringe on parental
rights, we ask that Section 9 be removed from this bill or that
it be modified to a targeted grant-based system where public-
private entities could offer these classes to parents who
desire them.
In closing, there are many good reports of how these
programs, these home visiting programs, have helped many
families. However, on the whole these are classes at the local
level and we believe that having a federal program such as this
could lead to the problems that I have outlined.
Thank you very much, and I yield back the balance of my
time.
[The statement of Mr. Estrada follows:]
Prepared Statement of William A. Estrada, Esq., Director of Federal
Relations, Home School Legal Defense Association
Good morning, Chairman Miller, Ranking Member McKeon, and honorable
members of the committee. My name is William A. Estrada, and I am an
attorney and the director of federal relations for the Home School
Legal Defense Association. Thank you for the opportunity to testify
regarding H.R. 2343, the Education Begins at Home Act.
Since 1983, HSLDA has represented the interests of our
homeschooling member families in all 50 states. We currently have a
membership of over 80,000 families. We have serious concerns with H.R.
2343.
My testimony today will focus on section 9 of the bill. We believe
that the provisions in section 9 will harm family integrity and
parental rights.
Section 9, ``Supporting New Parents Through Hospital Education,''
requires the Secretary of Health and Human Services to create a public
awareness campaign to inform the public and new parents about the
importance of proper care for infants and children under 5 years of
age. The Secretary will ensure that every hospital, military hospital,
and birthing center request that families coming through its doors
participate in a parenting class that is approved by the Secretary. The
hospital must then request that the family sign a form indicating
whether or not they chose to take this class.
Section 9 is not clear if hospitals, military hospitals, and
birthing centers may refuse to offer these materials and parenting
classes. Because of this vagueness, there is no assurance that
religious hospitals or birthing centers could reject materials or
parenting classes that violated their fundamental values.
Section 9 is also not clear about who will design these parenting
classes. There is no guidance offered to HHS, so the Secretary may
decide to only approve classes that are designed by ``experts'' without
any involvement from actual parents. We don't need a ``big mother''
supervising parenting. Parents have numerous parenting philosophies
that may differ from a one-size-fits-all government parenting class.
This could lead to limits on parental choice and parental rights,
because parents will feel pressured to take these classes and conform
to whatever parenting philosophy is taught.
Furthermore, the provision that the classes teach ``* * *
strategies for caring for infants' social, emotional, and physical
needs'' is vague enough to include many conformist philosophies that
would concern many families, particularly homeschooling families. For
example, despite plentiful research to the contrary, there are experts
who do not believe that homeschooling is good for children's social,
emotional, and physical needs. One need only look at the recent
California Court of Appeal decision, In re Rachel L., where the Court
made a blanket ruling that California parents do not have the right to
homeschool their children unless they are certified teachers. This
would have the effect of needlessly discouraging many families from
homeschooling.
Although the parenting classes are optional, Section 9 would likely
lead to needless social worker referrals. Since the hospitals and
birthing centers must request a signature showing that families
participated in or refused the class, a referral could be given to the
child welfare department alleging neglect because the family refused
these parenting classes. In reality, the family may have chosen to
decline participation because of disagreements with the classes'
parenting philosophy.
To avoid these and other problems that infringe on parental rights,
we ask that section 9 be removed from this bill.
Thank you very much and I yield back the balance of my time.
______
Chairman Miller. Thank you.
Ms. Smart?
STATEMENT OF JEANNE SMART, DIRECTOR, NURSE-FAMILY PARTNERSHIP--
LOS ANGELES
Ms. Smart. Thank you, Chairman Miller.
My name is Jeanne Smart. I am a public health nurse, a
registered nurse, and I started a program which I am
representing today, the Nurse-Family Partnership, in Los
Angeles County.
I have had 34 years of experience in home visitation. I
started a home visitation program as a respiratory therapist to
stop people from becoming sick and coming back into the
hospital because of the use of contaminated equipment. It has
come a long way since then, and the Nurse-Family Partnership
program that is utilized in Los Angeles County addresses a
whole different problem, and that is the problem of our future.
It is an evidence-based program that has over 30 years of
empirical research behind it and I am sure you have all been
made familiar with it. When you look at over 650,000 children
in the nation being abused and neglected, and as Ms. Ditka
indicated, some of them are truly heart-wrenching, and we have
our share in Los Angeles County, where over 42,000 children are
in protective services, and this is truly unacceptable.
In Los Angeles in 1996 we brought NFP, which is the
abbreviation for Nurse-Family Partnership, as a pilot project.
It was funded through juvenile justice. In 1997, in November
1997, the LA Times printed an article called ``Orphans of
Addiction,'' and the pictures in that article were truly what
most people don't see. A 3-year-old being held by a drug-
addicted mom, who was so loaded on heroin she couldn't even
focus.
Because of that, a task force was called and decided that
the Nurse-Family Partnership, along with several other
community-based organizational home visiting programs, needed
to be rolled out, and in the year 2000 we received funding from
the welfare reform dollars and we started a full county rollout
of the Nurse-Family Partnership. To date, we have served over
2,000 teenagers and some of these have truly been the most
difficult cases that I have ever seen in my 34-year nursing
career. Our youngest case is 12 years old. She delivered at age
12 years old.
The NFP model is something that I never had in practicing
as a public health nurse. I never had the guidance, I never had
the instruction, I never had the standardized protocol to
follow. Many times, I was at a loss for what to do with these
families that were so impacted by drugs and crime and gangs,
that there was really nothing that I could do that was
significant in my book. I had never gotten this training in
nursing.
The NFP model brings theory and science to actual practice,
of which I am a science freak, so it really was something I
advocated for in 1996 when I helped bring the program to Los
Angeles. It is theory based. It is based on the theories you
all heard today, the attachment theory, the bonding, the care
of the whole family in the care of the child, change theory,
brain development. All of this is brought into this model.
The model has structured activities so the nurse knows at
each and every visit what needs to be done, and during those
visits we talk to the families, we talk to the father of the
families and we collect data so that we can bring that data
back and look at what we are doing and see if we are doing an
effective job at meeting the goals that we would like to
accomplish.
It is really relationship-based, and there is not a program
sitting in this room that is not relationship-based, because
when you are talking about young, at-risk, pregnant teenagers,
you are talking about establishing trust, of which they have
none usually, and establishing some type of respect so you can
work together as a team to promote healthy families.
Over 64 visits the nurses take during this 2\1/2\-year
program with these families, the trust builds up. And,
interestingly, we don't even find out sometimes the problems in
the family for the first 6 months. It is not until that trust
is developed.
We have nurse training. The nurses receive over 60 hours of
training. That is minimal and just the model protocol. And they
carry 25 clients through just three goals: to improve the
pregnancy outcome, to improve the child health and
developmental outcome, and improve the family self-sufficiency,
so that they can learn how to provide for their families and
not use welfare dollars to do so.
Part of what Dr. Olds, Dr. David Olds, who is the model
developer, and he is currently with the director of the
Prevention Research Center for Family and Child Health at the
University of Colorado Denver, he really put in a huge data
element. At every visit we collect data that goes into the
child information system. And through that data, we can provide
excellent quality improvement, quality insurance. I can go over
every single one of my staff, look at their caseload, look at
their outcomes, and through that I have to say that programs,
whatever the program, if it is delivered poorly it will not
consistently achieve good outcome. And I think that is what we
have to keep in mind when we are funding some of these
programs.
With the Nurse-Family Partnership nationwide and through
three very, very strict, randomized control trials that Dr.
Olds has performed in Elmira, New York and throughout the
nation, we have decreased child abuse by 48 percent; 59 percent
reduced in child arrest of that child when it reaches age 15.
We have reduced maternal arrest, for drug use usually, or other
types of crimes. We have increased the involvement of fathers
by 46 percent, and as the Fenley family demonstrates, how
valuable it is to have the father involved on the same target
as the mother is involved in helping develop the family.
We get the children ready for school much quicker by
reducing language delays by 50 percent and behavioral problems
by 67 percent. And again, these are randomized control groups
that are studies done by Dr. Olds. These are pretty validated
percentages, so apply them to your own districts and think
about the cost savings to you by reducing these issues in your
communities.
There is a demonstrated cost savings to government that we
need to look at. When you look at the cost effectiveness,
Washington State Institute for Public Policy, the Rand
Corporation, the Office of Juvenile Justice, all have supported
what we have done here with the Nurse-Family Partnership.
So I thank you again for listening to me as a
representative of the Nurse-Family Partnership and NFP National
urges Congress to direct policy to these models that have the
highest level of evidentiary standards. Thank you again,
Chairman.
[The statement of Ms. Smart follows:]
Prepared Statement of Jeanne Smart, Director of Nurse-Family
Partnership, Los Angeles County
Good morning Mr. Chairman and thank you for the opportunity to
testify on behalf of the Nurse-Family Partnership (NFP) program
regarding the Education Begins at Home Act.
I am Jeanne Smart, Director of the Nurse-Family Partnership program
serving high-risk young mothers who give birth within Los Angeles
(L.A.) County. My testimony is that of a technical consultant for the
NFP, and I am here to support this Bill that will promote evidence-
based programs for at risk mothers. Every year, approximately 650,000
first time low income mothers become pregnant with their first child,
and in L.A. County there are over 7,000 births each year that fit the
intake requirement for NFP, that is: 1) young girl/woman; 2) pregnant
for the first time; and, 3) living in poverty. L.A. County began this
evidence-based program in 1995-96 as a pilot project that was partially
funded by Juvenile Justice because of its proven record of excellent
results in reducing crime by both the mother and the child when he/she
reaches the age of 15 years old. NFP was expanded countywide in 1997
primarily due to the achievement of excellent short-term outcomes seen
in the Pilot and the growing number of headlines about the dismal
outcomes for children born to at risk families who were unprepared,
unable or unwilling to care for them. NFP-LA has now served over 2064
women since December 31, 2007; the median age is 17 years old, 89% are
unmarried, 86% unemployed and 75% were Medicaid recipients. Nationwide,
the NFP program model has served over 14,000 first-time mothers and
their children on any given day and reaches over 22,000 families
annually in 315 counties across 25 states.
NFP is a voluntary program that provides nurse home visitation
services to low-income, first-time mothers by highly trained,
registered nurses beginning early in pregnancy and continuing through
the child's second year of life. NFP nurses and their clients make a
2\1/2\ year commitment to one another, and develop a strong
relationship over the course of 64 planned visits that focus on the
strengths of the young mother and on her personal health, quality of
care giving, and life course development. NFP nurses undergo more than
60 hours of training prior to receiving their caseload of no more than
25 families. Their partnership with families is designed to help them
achieve three major goals: 1) improved pregnancy outcomes; 2) improved
child health and development; and 3) improved parents' economic self-
sufficiency. By achieving these program objectives, many of the major
risks for poor health and social outcomes can be significantly reduced.
NFP is an evidence-based program with multi-generational outcomes
that have been demonstrated in three randomized controlled trials that
were conducted in urban and rural locations with diverse populations. A
randomized controlled trial is the most rigorous research method for
measuring the effectiveness of an intervention because it uses a
``control group'' of individuals with whom to compare outcomes to the
group who received a specified intervention. NFP has been tested this
way for over 30 years through a series of rigorous research,
development, and evaluation activities conducted by Dr. David L. Olds,
program founder and Director of the Prevention Research Center for
Family and Child Health (PRC) at the University of Colorado in Denver.
Dr. Olds has conducted three randomized, controlled trials with
three diverse populations in Elmira, NY (1977), Memphis, TN (1987), and
Denver, CO (1993). Evidence from one or more of these trials
demonstrate powerful outcomes, including the following:
48% reduction in child abuse and neglect (Elmira, 15 year
follow-up)
59% reduction in child arrests (Elmira, 15 year follow-up)
61% fewer arrests for the mother (Elmira, 15 year follow-
up)
72% fewer convictions for the mother (Elmira, 15 year
follow-up)
46% increase in father presence in the household (Memphis,
year 5)
NFP has shown a reduction in high-risk pregnancies by:
32% (Elmira, 15 year follow-up)
23% (Memphis, year 2)
fewer subsequent pregnancies, and 31% fewer closely spaced
(<6 months) subsequent pregnancies (Memphis, year 5)
Improvement in elementary school readiness as demonstrated by a:
50% reduction in language delays at child age 21 months
(Denver)
67% reduction in behavioral/intellectual problems at child
age 6 (Memphis)
Improvements in cognitive development at child age 6
(Memphis)
Improvements in language development at child age 4 and 6
(Memphis)
Improvements in child executive functioning at age 4
(Denver)
As the NFP program model has moved from science to practice, great
emphasis has been placed on building the necessary infrastructure to
ensure quality and fidelity to the research model during the
replication process nationwide. In addition to intensive education and
planned activities for nurses to conduct in the home, NFP has a unique
data collection and program management system called the Clinical
Information System (CIS) that helps NFP monitor program implementation
and outcomes achieved. It also provides continuous quality improvement
data that can help guide local practices and monitor staff performance.
CIS was designed specifically to record family characteristics, needs,
services provided, and progress towards accomplishing NFP program
goals.
In addition to California, NFP has statewide implementations in
Colorado, Louisiana, Pennsylvania, Oklahoma, and Washington; and many
other states are seeking to expand local NFP programs into statewide
initiatives. NFP's replication plan reflects a proactive, state-based
growth strategy that maximizes fidelity to the program model and
ensures consistent program outcomes. NFP urges Congress to direct
policy toward home visit models that maintain the highest level of
evidentiary standards in order to ensure the largest possible economic
return on investment.
The success and cost-effectiveness of NFP has been proven through
several independent evaluations (Washington State Institute for Public
Policy, 2004 & 2008; 3 RAND Corporation studies 1998, 2005, 2008;
Blueprints for Violence Prevention, Office of Juvenile Justice and
Delinquency Prevention). Blueprints identified NFP as 1 of 11
prevention and intervention programs out of 650 evaluated nationwide
that met the highest standard of program effectiveness in reducing
adolescent violent crime, aggression, delinquency, and substance abuse.
The RAND and Washington State reports weighed the costs and benefits of
NFP and concluded that the program produces significant benefits for
children and their parents, and demonstrated a savings to government in
lower costs for health care, child protection, education, criminal
justice, mental health, government assistance and higher taxes paid by
employed parents. More recent analyses indicate that the costs of NFP
compared to other home visitation programs fluctuates by region, and
even though the NFP model is more intensive than other programs, it is
not always more expensive.
The Nurse-Family Partnership supports the Education Begins at Home
Act as introduced by the House of Representatives. This Act proposes
intelligent solutions to core problems facing new families nationwide.
We encourage the Committee to target these scarce resources provided to
States through this legislation to those communities that are most at-
risk and struggling with the challenges of poverty. This bill provides
consolidated funding to support the important work of home visitation
programs including NFP.
I'd like to thank Congressman McKeon for inviting me to testify on
behalf of Nurse-Family Partnership and also I am grateful to
Congressmen Davis and Platts for their leadership on behalf of this
legislation. Thank you again, Chairman Miller, Congressman McKeon, and
Members of the Committee, for the opportunity to testify before you
today.
______
Chairman Miller. Thank you very much, and again thank you
to all of you for being here today.
Ms. Fenley, do you talk to other families that participate
in the Parents As Teachers Program?
Ms. Fenley. Actually, I haven't had the honor of really
speaking to anybody else who is on the program, because I am
one of the few and the proud. I do have a friend who is waiting
to get in the program, but I haven't been to any of the
playgroups that they offer to discuss any of the other issues
with other parents.
Chairman Miller. Have you discussed your participation with
your friends?
Ms. Fenley. Absolutely. I encourage it to all my friends
who have children, you know, that are eligible to participate.
And they are hoping to extend the program for children who are,
like, ages three to five. So I am hoping that we get to do that
so Zane can continue to be in the program.
Chairman Miller. We have heard here this morning,
obviously, different programs that dealt with parents in
different situations and circumstances that have brought about
the inability to cope or the stress or whatever, however it
manifests itself. As we sit here with the war in Iraq and as we
continue to try to review in our own districts and elsewhere
what is happening with military families, you know, you meet
more and more families who are really multitasking, trying to
just handle the stress points, either multiple deployments,
multiple relocations, comings and goings and reuniting and
separation and all these things that one of them by itself is
traumatic for a family.
And so when you talk to your friends about Parents As
Teachers, what do they think? Would they like to have someone
to lean on?
Ms. Fenley. Yes. Absolutely. Like the friend I just
referred to, she is actually the one friend I do have who has a
child Zane's age. She is, you know, really ready to get into
the program. Her daughter has some developmental issues, some
emotional issues, and I think it would be great for her to
really get in there. She has five other children, two of which
are adopted, and these are the ones who have the emotional
issues that she really needs to get addressed, and I think it
would really help her children to do that.
Yeah, she is really ready to get started, actually.
Chairman Miller. How long did it take you and Ms. Terrilyn
to hit it off?
Ms. Fenley. Immediately.
Chairman Miller. I saw Ms. Terrilyn shaking her head back
there when Ms. Smart was testifying about it takes time--
sometimes, she said, you didn't find out problems in the family
for 6 months because you have to build trust, and I saw Ms.
Terrilyn, I was watching you, you were shaking your head, that
that is right. So it doesn't always happen right off the bat.
Ms. Fenley. No, not off the bat. I think it was easier for
me to connect with Ms. Williams because she was one of the very
first people I met when I got to Virginia Beach. She was
actually, yeah, like within the first week. So I was needing--
and she is also a Navy spouse herself--so I was needing to know
my resources, what I could really do to really become grounded
in that area and that aspect of my life. So that is probably
why it was so easy to reach out to her, because she was one of
the first people I knew.
Chairman Miller. Thank you.
Ms. Ditka, I was surprised how adamant--I am from the San
Francisco Bay area--how adamant law enforcement and the
district attorneys were about this program. Basically, what
they are saying, we just can't keep up if we are going to have
this continued growth in child-related problems, whether it is
early child abuse or whether it is later in schools or on the
streets later on, and we think that the evidence is compelling
that this program will reduce our caseload. It doesn't cure the
common cold and it doesn't fix every family, but they were just
adamant in their sense that where we see this taking place,
those law enforcement officials get a benefit of a reduced
caseload.
I don't know if you would like to speak to that.
Ms. Ditka. Congressman, I couldn't agree more. In Allegheny
County, only 17 percent of eligible parents are being served.
The examples I gave you, there could be six children that are
still alive with just some basic skills. We do hundreds of
cases every year, and that doesn't include the cases where we
have tried in minor instances to put people in parenting
classes and to attach them to the resources so a parent doesn't
then get strapped with a criminal record and the children
aren't permanent members of the system instead of a family.
We can't keep up. We need more lawyers, we need more staff,
just to do the cases that we have. And as I tried to stress,
there are parents that are villains in the true sense. But the
vast majority of them are just people that didn't have role
models, that weren't given good examples. You know, I have been
blessed. I have a parent that traveled with me today. I had a
good role model. Hopefully I will be one for my child. But
many, many people don't have that. Many people don't have the
ability to wake up in the morning and see their parent doing
something and being productive and actively working in the
family.
And this model will keep people out of my system. And
especially if it reduces delinquency, it will give children an
opportunity to become productive members of society.
Chairman Miller. Thank you.
My time has expired. Hopefully we will have a second round,
because I would like to go back to Ms. Smart and Ms. Weiss on
the data component of this, which I think is very important.
But right now, let me recognize Mr. Ehlers. The gentleman
is recognized for 5 minutes.
Mr. Ehlers. Thank you, Mr. Chairman. And thank you for
holding this hearing.
I am fascinated with it for two reasons. First of all, I
was homeschooled. Actually, I am old enough that I was
homeschooled before there was homeschooling. I was a sickly
child, so I just stayed home and did all my schoolwork at home,
which is a great way to learn.
But also I am interested because in my experience in local
and state government, as a county commissioner, which I had
charge of the juvenile detention facility and so forth and
seeing the kids and working with the kids, and there is nothing
quite as heartbreaking as seeing a 13-year-old girl brought in
for her fourth arrest for prostitution. It was an education
that I received which I would just as soon not have received.
But also at the state level, dealing with the products in
our penal system of those children who grew up without a proper
home, without proper training, and ended up spending most of
their life in prison.
We were fortunate in Michigan, particularly in my
community, quite a religious community, and we had established
a number of different homes for children for various
denominations. And it is not that the children were restricted
to those denominations, but the contributions came from those
denominations. And they did a fantastic job in our community.
But when I reached the state level, I realized that not every
community had that.
The reason I mention this, I am trying to see where the
federal government fits in this, because obviously some states
are doing quite a good job. Other states a middling job. And
some not doing a job at all. What is the picture overall and
what is the need for federal involvement in this? Is it a
matter that we need uniformity? Is it a matter that we need the
same funding in every state, or what? I would appreciate any
comments any witness might wish to make on that.
Ms. Smart. The funding that we don't have, when you think
of the numbers, in L.A. alone there are 7,000 young girls,
teenagers, our median age is 17, that fit the intake criteria
for NFP. We started with 39 nurses in the year 2000. We are
down to 15 nurses now because of the funding constraints. There
is no funding available that fully funds this type of work.
What we are using now are funds that are meant for
outreach, to get people into services, Medicaid eligible, those
that are living in poverty. That is insufficient, because what
we do goes far beyond simple outreach. It is outreach,
education, support, nurturing. All of that is not covered, but
that is all part of the picture. It is all part of the recipe.
So it is very difficult. I think the role of federal
government is to allow there to be funding that could fully
support programs that meet the needs of those most at need,
especially. I wish we had the dollars to do these programs for
everybody, because everybody truly does need some support when
they are a new parent. But when we don't have those dollars, I
really believe we need to target those most at risk, the young,
the pregnant for the first time and those who are living in
poverty, because by far they have the worst birth outcomes,
social outcomes and every other category that you can think of
outcomes.
So I would direct the dollars, if I were in charge.
Mr. Ehlers. This is still a problem. I am interested in the
federal versus the state. Everyone thinks we have more money.
That is just because we borrow it every year. But what about
the states? What is their contribution? And why can't they, you
know, step up to the plate more?
Ms. Weiss. Can I respond to this?
Mr. Ehlers. Yes.
Ms. Weiss. I led the [INAUDIBLE] which was the [INAUDIBLE]
major national models for 6 years until recently, and I know
that there are I think over 40 states now that have made a
commitment to some kind of state capacity to provide home
visitation.
I was in Michigan in December with Judy Samuelson, who runs
your Early Childhood Commission, to talk with them about how to
begin to create a state system of early home visitation that
would be part of their effort to create a comprehensive early
childhood system of services.
Wisconsin has a state standing task force working on
creating a system of state-based early childhood services,
including early childhood home visitation. That group of
people, representing all kinds of different models from all
kinds of places around the state, came together a couple of
years ago and said we need to develop a standard set of
indicators and outcomes across our programs as part of our
tracking and capacity-building to support home visitation in
the state of Wisconsin.
Pennsylvania has done some very interesting sort of
experimenting with a combination of the Nurse-Family
Partnership and the Maternal Child Home Program. As you have
heard, there is a partnership, 2\1/2\ years, third trimester of
pregnancy--year two with highly stressed families. They have
now paired that with the Maternal Child Home Program, which
focuses on literacy and school readiness. And they do use some
of their welfare reform dollars to do this. And they are
tracking it, and we will know the benefit of that kind of
combination of home visitation services focused on prevention
of maternal and child difficulties, child maltreatment, as well
as school readiness.
I think we are seeing a lot of states making a commitment,
not just to little programs here and there, but to building
state capacity, to develop and fund them, and increase the
likelihood of return on investment from those dollars. There is
not a state I think that any of us in this room know of that
isn't struggling to meet the need for more financial resources
for home visitation.
That is why I think EBAH can contribute. It is never going
to be enough to pay for direct service for everybody who needs
it, but it pays for some key expansion and some key capacity
building, and then some of the other resources perhaps can be
provided, you know, by local dollars and state dollars.
Mr. Ehlers. My time is expired, but thank you very much for
the insight you have given me.
Thank you.
Chairman Miller. Thank you.
Mr. Davis, author of the bill. Well, one of the authors of
the bill.
Mr. Davis of Illinois. Thank you very much, Mr. Chairman.
Let me thank you for holding this hearing.
As a long-time advocate for home visiting and for parenting
programs, I also want to express my appreciation to Mr. Platts
for his co-sponsorship as well as his leadership and indicate
that it is a real pleasure working with him, and I appreciate
what we have been able to come up with.
As I listen to the testimony of the witnesses, I was
thinking, Ms. Fenley, that I could listen to you testify all
day, for lots of reasons. But the question that I wanted to
ask, what aspect of the program do you think has been most
helpful to you and your family?
Ms. Fenley. I can only choose one? Just one?
Honestly, to encourage my children, daily, to never let
them lay their head on a pillow at night and let them know how
proud I am of them. From the smallest thing to the biggest
thing they do, just to encourage them and validate them as my
child and let you know, hey, you did so good today. And that
has taught me that, Parents As Teachers has taught me that.
And also to validate my husband as a parent himself, to let
him know, hey, you are a great dad, you know. Forge on. Keep
going. It is, you know, that has been my favorite thing about
the program. That is the one thing I could probably choose out
of everything.
Mr. Davis of Illinois. Thank you very much.
Attorney Ditka, let me ask you, have any of the cases that
you have come into contact with been individuals that you would
not necessarily describe as being disadvantaged?
Ms. Ditka. Child abuse, Congressman, as this panel probably
knows, crosses all socioeconomic, religious, racial, ethnic
borders. So I see lots of examples of abuse in every aspect of
society.
Where this need I see the greatest is in disadvantaged
families, because they just don't have the resources. They
don't have the ability to go to a parenting class that they are
paying for. They don't have the ability to go to Gymboree with
their children or to a school-based after school program or get
them in a sports program at the Y. That is why I believe this
bill is so important.
But I don't mean to say here in any way that child abuse is
limited to underprivileged inner-city families, because it
crosses all social and economic and racial and ethnic divides,
and some of the most horrific cases come from the wealthiest
and most affluent neighborhoods nationwide.
Mr. Davis of Illinois. So there are many different types of
families in different categories and different groupings of
individuals who can in fact benefit and do in fact benefit.
Ms. Ditka. Absolutely. Absolutely.
Mr. Davis of Illinois. Thank you.
Ms. London, let me ask you, because of the fact that you
have been in the same location over an extended period of time
and have worked with the Near North Corporation, do you see
families as they continue to grow and develop where you can
sort of evaluate the impact of the program after the children
have begun to grow up?
Ms. London. Yes. Absolutely.
In my testimony I shared that the relationships that the
home visitors have with participants after they graduate is
well beyond when the child reaches age 3. Our parents have no
problem after graduation with meeting us at the grocery store,
at church, in the community, wherever it is that they are. Just
because the child has graduated to age 3 does not end the
relationship there.
And so they still come back to the home visitor, to the
health center, asking for advice, and we are open to do that.
Mr. Davis of Illinois. Thank you very much.
And lastly, Dr. Weiss, let me ask you, there are
individuals who believe that evidence-based research which
demonstrates the effectiveness of program activities is what
you really need in order to make a decision or determination
about the value of programs. In your work and research, have
you seen the kind of information that would suggest the value
of this program activity that we are talking about?
Ms. Weiss. Yes, and I think we have 30 years of work,
including clinical trials, either completed or underway, by
most of the major models, that meet a high standard of evidence
that suggest more positive outcomes across an array of things,
from parenting skills to school readiness to reductions in
child maltreatment.
What I find fascinating is the willingness and capacity of
the models and I think the people within the states that are
providing home visit services to learn from that evidence and
improve their programs. So David Olds, Nurse-Family
Partnership, David and I were at graduate school together at
Cornell in the 1970s when David was starting this program. He
did his first clinical trial in Memphis, or in Elmira, New
York.
He learned a great deal from the evidence and from the
pattern that resulted from that. He modified the program when
he did his clinical trial in Memphis, learned from that and
modified the trial when he did it in Colorado.
I watch these models, and have for a long time, do exactly
what David has done, and also do what my colleague down here at
the end of the panel mentioned, which is now develop capacity
at the national office. And I think also the states are
beginning to do that, to track performance of regular programs.
It is one thing to get success in a clinical trial. If you are
going to do a clinical trial, you are going to put all your
best into it and hope you get the best results. The trick I
think is then getting those results in the everyday program,
the everyday Parents As Teachers Program, the everyday Nurse-
Family Partnership.
And what the legislation does is say that every year they
are going to need to report on some performance indicators, and
use that data to support improvement.
Chairman Miller. I am going to have to cut you off. Thank
you very much.
Mr. Davis of Illinois. Thank you, Mr. Chairman.
Chairman Miller. Mr. Platts, who is a primary sponsor of
the bill?
Thank you.
Mr. Platts. Thank you, Mr. Chairman, and I want to add my
words of thanks to you for holding this hearing on the very
important issue and echo my colleague, Mr. Davis', comments and
what a privilege it has been to work with him in advancing this
legislation.
I think Ronald Reagan once said if we want to do something
for our nation's future, we need to do something for our
nation's children, because they are our future. And that is
what this hearing and this legislation is about.
I want to thank all of our panelists for your testimony and
for your work in your daily lives for the benefit of children.
And we are grateful to each and every one of you.
And Ms. Fenley, I especially want to thank you for being
here, but especially for you and your husband's service to our
nation. We are a blessed nation because of military families
such as yours. I love what I do, and I am proud of what I do,
but what I do pales in comparison to what your husband and your
family do on behalf of our nation. So thank you for your
service.
I want to first just reference, I know there is concern and
when we hear $500 million it sounds like--well, not sounds
like--it is a lot of money. But I think it is important to
emphasize, and Ms. Ditka, I think in your testimony you talked
about the Nurse-Family Partnership study that shows $5 saved
for every dollar spent. So we hear $500 million spend, a lot of
money. $2.5 billion saved, a lot more money.
And it is something that I think is important that we keep
in perspective here, that one of the challenges in Washington
is that when we talk about allocating money, the way we factor
the cost of everything is we don't factor in savings, and this
is an example of where we need to. And not just in dollars, but
in human lives and quality of life for families and especially
children.
So I appreciate, Ms. Ditka, you highlighting that aspect in
well-documented studies, not just something over a year or 2
but over many years.
Ms. Ditka, you talked about Nurse-Family Partnership, you
know, one of the many programs that are doing great work out
there. What would you highlight as the strongest aspect of the
Nurse-Family Partnership program that you think makes it such a
good model with others for us to look at, to help emulate
across the country?
Ms. Ditka. Well, Congressman, what we have seen in
Allegheny County, one of the strongest aspects is it is a
holistic approach that looks at the whole family unit. One of
the best success stories is a woman who was drug addicted in
her second trimester of pregnancy. She got off drugs. Her child
was born healthy and now is a thriving toddler going to Head
Start. This woman has got a GED. She is going to community
college and is graduating or may have already graduated this
spring so she could go work in the medical records field. So
now both she and her child will be thriving members of society.
I think that holistic approach, you are helping not only
the child but you are helping the parent, and if that parent
has future children, you are helping future children in that
family. So you are setting a strong and secure base for these
people to move on. I think it is extraordinarily important to
have children school ready, education ready, and it is
important for a number of aspects, not only for educational
purposes and for their future growth, but also to be able to
express to people they come into contact with if they are in
harms way and what is happening to them.
So I think that model that sort of surrounds the whole
family with the knowledge and a hope for a better future is
what works best.
Mr. Platts. And I think Ms. Fenley kind of highlighted the
importance of that holistic approach when, Ms. Fenley, you were
talking about you and your husband getting on the same page,
and the benefit of the family to being together.
I have got a 9-year-old and a 12-year-old and my wife and I
are always working at making sure we are on the same page
together. We are much better as parents in doing so.
Ms. Smart, in focusing specifically on the Nurse-Family
Partnership, you target first-time mothers, more impoverished
individuals. Do you want to maybe expand on why you as an
organization focus on that category versus a broader approach
to who participates?
Ms. Smart. Sure. Yes. We focus on that target population
because that is the target population that this model was
actually tested on, and it was tested on this target population
because those who are young, who are pregnant for the first
time and who are living in poverty have the worst outcomes of
poor birth, premature birth, low birth weight births. They have
poor socioeconomic development on the part of the mother as she
goes on in her life, maybe having multiple children after the
first one.
So we follow the model. We have fidelity to the model. So
that is the target population and that is actually why we do
serve them.
Mr. Platts. And your testimony highlights when we talk
about the benefits, again not specifically dollars but quality
of life for the participants and society in general, whether it
be crime reduction, child abuse reduction, school readiness. I
mean, your studies highlight why this investment is so
important and----
Ms. Smart. And we have been able to demonstrate that at the
local level, too, by the data we keep, so that there is no
doubt about the fact that we do positively impact these
families who are most at risk, who load our hospitals and our
social system.
Mr. Platts. Thank you.
Thank you, Mr. Chairman.
Mr. Kildee. Thank you, Mr. Chairman, and thank you for
having this hearing.
Dr. Weiss, first of all I am happy to hear that you are at
work with Judy Samuelson from Michigan, who is a really great
advocate for children.
You testified to the importance of practitioners and
researchers sharing information to build a knowledge base and
to inform public policy on home visitation. To what extent is
that happening, and what can Congress do to ensure that those
best practices are widely known?
Ms. Weiss. I think it is happening. I think it has been
happening for a long time. The major models share information
with each other about how to improve home visit services. They
individually and collectively learn from the research. Parents
As Teachers redid its curriculum based on the neuroscience
evidence. I mentioned David Olds has redone his curriculum.
So each of them shows an individual and a collective
capacity to getting information to improve home visitation, so
it gives us a strong base, both in terms of their willingness
to do that and also the ways in which they are then feeding it
into improve home visit services.
I am very impressed with the provisions of the EBAH
legislation, particularly around an independent assessment of
the results of the EBAH legislation, a national study, with I
think some very carefully laid out questions that that study
would address. And also with the set-aside and expectation that
each state will track the performance of home visit services.
And my assumption is that with that they will on a yearly basis
learn what is working and not working and celebrate and expand
what is working and learn from what isn't and figure out how to
improve it, very much like the Nurse-Family Partnership does.
And I know Parents As Teachers and a number of the other
national models are building that capacity. And in the state of
Michigan, Judy is helping to build that capacity. By that
capacity, I mean to get and use data to figure out what you are
doing well, what you need to do better and continue to improve
the program. I think that is how you get return on investment
from these kinds of services.
Mr. Kildee. Thank you.
Ms. Fenley, as you testified for your family, home is where
the Navy sends you. I can understand that a bit. I have two
sons who have served in the Army, and that is the case with
them also.
Can you discuss how home visitation programs can best
ensure that military families who may have to move frequently
are aware of their options? When you move from one place to
another, is there some type of network where you can find out
where similar programs exist that you can tap into?
Ms. Fenley. As far as, like, getting here and starting him
in the program, are you wanting to know, like, if we move
somewhere else and not having----
Mr. Kildee. Yes. Would you be able to find out if there is
a similar program at the new base that you were able to
utilize, like at the previous base?
Ms. Fenley. This is our first year in the military at all,
so I have never actually got to participate in another program
like this.
Mr. Kildee. Okay.
Ms. Fenley. But leaving Virginia Beach, I would definitely
seek out another program to get my son in, absolutely. I would
want to find a program to get him in, similar to what we are in
now.
Mr. Kildee. Who would you turn to? What agency would you
turn to at the new base? Is there a----
Ms. Fenley. Like on base? Like as far as, like, military-
wise, who would I try to seek out a new program?
Mr. Kildee. Yes.
Ms. Fenley. There are several resources that you could find
programs for your children, and one is, you know, the child
placement program on base that they have for Navy people. And
you could--there are a few others--and Terri, also, I mean, I
would be looking for a parent educator, a parent educator with
the child placement program.
Mr. Kildee. Okay. Very good.
You know, I really was impressed by what you said was the
most important thing you got from the program, is when you put
your children in bed at night you praise them for what they
have done that day.
Ms. Fenley. Absolutely.
Mr. Kildee. And I probably went overboard a bit in that,
because when my first child, David, was born, about 38 years
ago, I would tell my wife, now, we have to make sure that he
has a good feeling about himself and we have to make sure. I
was in Lansing, the state capital, I was a member of the state
legislature, and she was several miles away, and I kept
emphasizing he has to have a good feeling. And one day I called
her, I said, ``How is David today?'' And she said, ``He has a
very good feeling about himself today.'' So you probably hit
the right balance there.
Thank you very much, Mr. Chairman.
Chairman Miller. Thank you.
Ms. Hirono?
Let me get this straight. When the Navy transfers you,
Terrilyn is going with you? Is that what you said?
Ms. Fenley. I would love that. I am inviting her now.
Chairman Miller. I hadn't heard about these rights of
military families.
Ms. Hirono?
Ms. Hirono. I think my mike is off so I am going to lean
over.
I think it is really important to focus on a comprehensive
system of early childhood services, so Ms. Weiss I was very
intrigued by your testimony, where you indicate that
evaluations of several of the major home visit models suggest
that home visitation in conjunction with high quality early
childhood education and/or preschool is more likely to result
in positive gains.
Could you talk a little bit more about the importance of
this continuum kind of services?
Ms. Weiss. Let me tell you quickly the two sides to it. One
is a study of Early Head Start and that study done by Helen
Raikes and her colleagues shows that when you combine home
visiting, Early Head Start home visiting, and center-based
care, you get more positive results than either of those two
interventions separately, so that mixed home visit and center-
based care is important.
There was a recent study done by Ed Zigler and colleagues
of the Parents As Teachers Program that shows Parents As
Teachers parents were more likely to enroll their children in
early childhood services and also more likely to be reading to
their child at home, and that combination of things measurably
increased their readiness for kindergarten and some of the
early school success.
So we have got several studies now that are pointing
towards the importance of first of all not overpromising what
we can deliver with home visit services, but then the value
added of combining it with other services that are directed to
the child and that continue on from birth through a longer
period of time.
Ms. Hirono. I know that there have been quite a number of
studies that show how important quality early education is to a
child's success, so your testimony that says combining the home
visits with these kinds of high quality programs, that you
really get more bang for the buck, basically. I think that is a
very important point to make.
Also, I would imagine that there are home visitation
programs out there that may not meet the kind of quality test
that we would like these programs to have, because I think one
of the people testifying said that if it is not of quality,
then you are practically wasting your resources.
So what would be the indicators of a high quality home
visitation program? And how does this bill promote quality
programs?
Ms. Weiss. Do you want me to speak to that?
Ms. Hirono. Well, any of the panelists can weigh in.
Ms. Weiss. I think what we know is training, supervision,
high quality curriculum, getting and using data to track your
performance, are all critical. And one of the interesting
things about the legislation, from my point of view, is that it
sets aside and makes provisions for all of those indicators of
quality.
Ms. Hirono. So you mean that this bill focuses enough to
ensure that what we are funding would be the quality programs?
Ms. Weiss. It contributes in a big way to delivering
quality, yes, with set-asides and provisions.
Ms. Smart. I think it is very important that the programs
that are funded have clear-cut goals and objectives that are
measurable, that their activities actually address what their
goals are and that the outcomes that they evaluate are
addressed in the goals and objectives, so that it is just a
complete package, so that what they are doing matches what they
are trying to do and then they assess to see if they have done
it.
And in so many of the programs that we have now are
starting to do that, we are lucky that we are in Nurse-Family
Partnership that this was practically--well, it was already
done for us, and we got all the data systems, we have got the
computerized system, we have got the theory that guides our
work, the activities that are structured. At each visit the
nurse gives, we have structured guidelines of what we are
supposed to do so we are hopefully not that distracted by all
the things going on in the environment, the gang shootings, the
drugs in the back room, and, you know, things like that.
So it is very important to have that structure, and then
the ability to monitor that structure so that your workers--you
can assess the product being delivered in the home through the
outcomes that you achieve.
Ms. Hirono. Thank you. I have a question----
Ms. London. Excuse me. I would like to respond.
Ms. Hirono. Go ahead.
Ms. London. Our Healthy Families Program has embedded in it
the weekly supervision of our home visitors. The project
supervisor of each Healthy Families Program meets with the home
visitors to look at the quality of their home visits. They are
actually trained before they make their first home visit. And
we have a national accreditation body that looks at the quality
of what it is that we do.
Our programs are credentialed. It is like a mini-joint
commission accreditation. So quality is very, very important in
what we do. In the state of Illinois, a monitoring and tracking
system that our home visitors put data in. There are regular
quality improvement reviews of that data. We look at it, we
analyze it and we apply it to the overall goals.
The program is based on 12 critical elements, which are
very, very unique in terms of looking at the quality of what it
is that we do. We are not simply just making home visits and
chatting with an individual. We are actually educating the mom,
the mom is improving in parenting skills, that child is
becoming ready for school because we know that when we are
finished, when the program is completed and the child is 3
years old, we work with them to move the parent and the child
into the school in that particular community. Quality assurance
is a very important part of the Healthy Families Program.
Ms. Hirono. Thank you. I have a question for Ms. Ditka.
You have a lot of experience in the court system, I take it
family court. Do the judges in your state have the discretion
to require the parents to involve themselves in home visitation
programs?
Chairman Miller. Ms. Ditka is going to give you a very
quick answer.
Ms. Ditka. Yes.
Ms. Hirono. Thank you.
Ms. Ditka. Is that quick enough, Chairman?
Chairman Miller. Ms. Woolsey?
Ms. Woolsey. Thank you, Mr. Chairman.
First of all, I would like to thank Congressman Davis and
Congressman Miller and Congressman Platts for authoring this HR
2343. And giving us an opportunity to carry on the conversation
of how important it is that our children get the best start in
life and to talk about needing to do whatever we can to ensure
that they are given every opportunity. Quality education,
health care, support services for parents are such important
programs. They need to be expanded and every child and every
parent needs to have access so that we can ensure that every
single one of these little kids that are born in the United
States of America has an opportunity to be successful. And I
think today's hearing has confirmed all of that once again.
Now, Mr. Estrada, you have had, like, a vacation here. We
have not asked you a question, so I think that that is what I
need to be doing.
You have concerns with Title 9 of HR 2343, and I believe
your concern is that individuals have to sign a release of
whether they will or will not take a particular training.
Now, first of all, don't you think that signature, because
these are funded programs, that signature is just proof to the
funders that indeed the offer has been made? Do you have any
examples of where that has been used and held against an
individual or a family that chose not to be part of the
training?
Mr. Estrada. Congresswoman, our concern is that this could
lead to that. We have dealt with examples, because of the fact
that they are confidential I don't have them with me right now,
but I could get them, and we will get those examples to you.
But we have dealt with many situations, unfortunately, where a
medical nurse or a doctor has seen a family and advised them a
course of treatment in a hospital or something like that, or
parenting classes or something like that, and the family has
said, well, we are going to use our own medical provider, for
example, if they go to an emergency room, if they----
Ms. Woolsey. But this isn't the same thing. This isn't
medical provision. This is signing off to say, yes, this has
been offered to me, I chose to or not to. Is it mandatory, the
training?
Mr. Estrada. The training is not mandatory, no.
Ms. Woolsey. All right. Well, I would like to ask the other
members of the panel, have you ever seen this offer used
against a client, or used for them?
Ms. London?
Ms. London. The Healthy Families Program is a voluntary
program. The home visitation program is voluntary. We are
educating parents to be informed individuals. They make a
choice as to whether they want to participate.
Ms. Woolsey. Ms. Ditka?
Ms. Ditka. The whole tenor of the bill is that it is a
voluntary program, and in my experience we have never used
failure to participate in a voluntary program as a basis to
prosecute someone or in any way get them involved in the social
service system.
Ms. Woolsey. So, Mr. Estrada, would your concerns about
Section 9 then say you and your organization are against--would
vote against--if you were us--vote against the bill in its
entirety?
Mr. Estrada. Well, Congresswoman, two issues about just
Section 9 about these concerns. The first one is, many families
could be pressured to take these classes----
Ms. Woolsey. No, but they aren't.
Mr. Estrada. Okay.
Ms. Woolsey. So what could happen is also many families
could end up without an education for the family and their
children that have prepared those children and those adults to
be good parents and good, successful individuals once they get
into school. So all of this if ``ifs''.
But, okay, the second if?
Mr. Estrada. And the second if, Congresswoman, is actually
following up with what Ms. Ditka said. We are very grateful
that families are not prosecuted. But even an anonymous tip
sometimes from a nurse, for example, who says, well, why did
the family not choose these parenting classes, could lead to
that.
Our concern is it is not clear in Section 9 if hospitals
are required to offer these parenting classes, or if it could
lead to a situation where families are basically strongly
pressured and----
Ms. Woolsey. Okay. Well, then, I would suggest we can--Mr.
Davis will look at the language to make sure it is clear.
Mr. Estrada. Thank you.
Ms. Woolsey. There is no question that it needs to be
clear.
Ms. Smart, have you ever known of a nurse that has used
such evidence?
Ms. Smart. No, I have never known of a nurse to do that,
although we have had referrals from probation officers that
strongly recommended their clients enroll in NFP. When we get
any indication at all that the client is forced to do it, we do
not enroll them, unless they really want to do it. But we
don't.
Ms. Woolsey. It is voluntary.
Thank you, Mr. Chairman.
Ms. Clarke. Thank you, Mr. Chairman.
My question is for you, Ms. Ditka, because just reflecting
that this Sunday is Father's Day, and as I reviewed your
testimony it struck me that many of the statistics you cited
concerning program success relate to women, namely young
mothers in the program. Here is my question: Where are the
fathers? Actually, does the program in your country incorporate
and assist the fathers?
Ms. Ditka. Yes. If the fathers are involved, the Nurse-
Family Partnership in Allegheny County does incorporate the
fathers. And in fact, in the success story I gave you, not only
did the woman become educated and get clean, she was also
getting married. So it is the whole package.
But if the fathers are willing and involved, they are
encouraged to participate. And if they are willing to do so,
they are included in the program.
Ms. Clarke. Can anyone else on the panel speak to their
experience with--when we say parental, there seems to be such a
heavy emphasis on the mothers--what type of success we are
having in incorporating fathers in this process?
Ms. Smart. I can speak to that. We do have great success
when the father of the baby or the boyfriend to the mother, who
may not be the father, is involved in the home environment.
Where we have a problem is when the father is incarcerated.
But the techniques that we use in the home, even the simple
thing of the father walking in the room when the nurse is
there, dads generally don't like to be involved in this, but to
include him, when a father walks in the room and start talking,
the nurse will say, ``Oh, look, the baby just turned its head
to look at you, it already knows you,'' and the father is
astounded. What do you mean the baby knows me? That, right
there, starts the bond. And that starts our work.
And then we see the dad slowly becoming more and more--they
will hang out in the kitchen and listen and they will come into
the room. But it is a process of becoming involved, it is not
just simply--many fathers don't want to sit down and be that
involved right away.
Ms. Clarke. Ms. London?
Ms. London. In our Healthy Families Program in Near North
Chicago, we encourage fathers to participate from the very
beginning, when we are assessing just the eligibility to
participate in the program.
In fact, one of the home visitors is in fact a father, and
he is able to engage the fathers more at each home visit, and
we encourage them even to accompany the moms to the health
center for the prenatal visits, and we have had fathers who
have participated and graduated from our group parenting
classes.
Ms. Clarke. Wonderful.
Ms. Ditka, I wanted to ask you another question. I am from
New York City and we recently had a very tragic occurrence in
our child welfare safety net where a 3-year-old child died as
the result of torture in the care of his foster care mother,
who was deemed unfit for custody of her own children in another
state.
Have you seen models of success in partnering of NFP with
the child protective services and foster care agencies? There
seems to be some sort of hole there if someone who is becoming
a foster care parent doesn't have the parenting skills either.
And that is a huge part of our social network and fabric in our
communities.
Ms. Ditka. I have a similar case pending now, where the
family came from a different state, their children were taken
away, they have new children here and those children have lived
in horrific conditions.
Again, the programs that we are talking about are
voluntary, so these people that are signing up for these foster
care that have already had children removed are not going to
voluntarily participate in a program like this. And this is a
voluntary program.
I think the issue that you raise takes us sort of in a far-
reaching direction with some of our social service problems
that exist not only in New York and Pennsylvania, but I think
in every state across the nation.
Ms. Clarke. I am even wondering whether they are even
offered it.
Ms. Ditka. I can't address that. I am sure Ms. Smart can.
Ms. Smart. I can address that. In Los Angeles County, when
we did try to determine first of all how many girls who were
under protective services got pregnant while they were
receiving protective services, we couldn't find that number,
nor can we find it statewide. That data simply is not kept.
We do offer this program generically to every woman or girl
who fits the intake criteria, first time pregnant, living in
poverty and we try to get them before their 18th week of
pregnancy. But the protective services system is one we really
need to crack into. It should be offered to every single child.
They are the most very, very at high risk of the girls who get
pregnant in our county. Their outcomes are abysmal.
Ms. Clarke. Thank you very much, Mr. Chairman. I yield
back.
Mrs. Davis of California. I was going to yield to Mr. Holt,
right?
Thank you very much.
Thank you, Mr. Chairman, and to the sponsors of the bill.
I remember back in the state legislature, let's see, that
was back in about 1994, and we were beginning to have
discussions about this. The HIPPY Program was involved in
California. So I am actually delighted to see how far this has
come and that is great.
A few quick questions. One, the self-selecting process of
parents choosing to be involved. And I understand this always
has been a voluntary program. But does that hamper in any way
your ability to evaluate the extent to which the programs are
bringing something of great value into the family that perhaps
they might not have received in a different way?
One of the concerns we often have even with charter schools
is that parents who are selecting that their child go to that
school may have different tools available and to make that a
successful opportunity for that child.
Could you comment briefly on that? And are there some ways
of dealing with how perhaps there is additional outreach,
especially for groups of individuals that may tend to decline
the services? Does anybody have any comments?
Dr. Weiss, or whoever would like to respond.
Ms. Weiss. I am happy to respond.
I think that the issue of selection bias is real because
participation is voluntary. So you are always going to have
selection bias, and I think that is true of any of the
programs. You are going to have selection bias based on it
being voluntary.
Having said that, I think each of these programs in my
knowledge goes to special efforts to do outreach to stressed,
vulnerable families that could benefit from the service. Some
of them target those families directly. Some of them do extra
outreach to try to make sure they enroll the families that the
evidence suggests can benefit a great deal from participation.
And in fact, when one does analyses of who participates and
looks specifically at the most high risk groups, there is some
evidence that suggests for example with Early Head Start that
it is the high risk groups that benefit the most, which
validates the extra effort to try to include, you know, perhaps
the most highly stressed families.
So I think we can make claims that these benefit high risk
families, and I think we also have to make sure that we are
doing outreach to get them into the program.
Mrs. Davis of California. Where--and again, if anybody
wants to respond--where is the greatest gap in terms of
outreach providing the trainers, the personnel, to participate
in this program? Are we reaching the individuals who in fact
really can relate best to the families that they might be
serving? Is there a gap in being able to identify outreach
having, you know, the individuals come forward and participate
and any men who participate as well? I mean, have we looked at
that statistic?
Ms. Smart. That is a difficult question, actually, to
answer, because we have dealt with being nurses, and I get this
a lot in Los Angeles, well, you are nurses, how can you
possibly know about the families that live in poverty. So the
cultural differences are something that is always brought up.
And I always have to bring up, well, nurses live somewhere, and
many of us were raised in poverty.
The gaps in Los Angeles County are such mostly with the
bilingual issues. We have so many languages, mostly Spanish
speaking, and so we have made great efforts to make sure our
staff is bilingual. That I think--and then in outreach,
outreaching through churches has been very beneficial, schools
and the Women, Infants and Children Program is one of our main
resources for outreach.
Mrs. Davis of California. Do you see--I know my time is
running out--do you see that as an important part of the
evaluation? And should the bill be more specific in being able
to assess the extent to which the program mirrors the
population in the community that it serves?
Ms. Smart. Absolutely. And we do keep that data in the Dr.
Olds Nurse-Family Partnership model, so that we do know. And it
is very interesting, because our population in NFP Los Angeles
mirrors exactly the population that we have, including a couple
of Cambodian and Vietnamese mothers.
Mrs. Davis of California. Thank you.
And just quickly, other challenges in terms of training.
Wages? Is that an issue that should be addressed? Are people
able to afford being part of this program?
Ms. London. The Healthy Families Program, being a part of
the social service arena, always you hear about the salaries of
the individuals. But as I said in my testimony, our workers
have a passion and a commitment for the families that they work
with, and the families can really see that.
Right here, Ms. Fenley, who has testified, they have
developed a trusting relationship. And so that seems to go
beyond the salary which they may receive, which some may not
feel is competitive.
I wanted to go back to the outreach question of----
Chairman Miller. I am going to ask you to quickly summarize
what you want to say.
Go ahead, Ms. London, just finish your thought.
Ms. London. That issue dealing with the salary, it is their
commitment to the work more than the salary.
Chairman Miller. Thank you.
Mr. Holt?
Mr. Holt. Thank you, Mr. Chairman.
I thank the sponsors of this bill and the chairman for
doing this.
Ms. Fenley, since you are into--since you spoke about
encouragement and validation and praise, let me lay a little
praise on you. I can't imagine a better national spokesperson
for this sort of thing than you, and your testimony about, you
know, understanding the reasons that little Zane does what he
does and finding resources that you would not have found on
your own and connecting with community, learning parenting
techniques, approaches to discipline, working with both you and
your husband in childrearing, it makes it so clear the value of
programs like this.
And, you know, we in New Jersey have seen this. I have seen
it at Family and Children Services, Children Home Society, they
have a program with English language learners, Parents As
Teachers in New Jersey, quite active and quite successful. And
if there is some way we can make this broader and more
effective through legislation such as that of Mr. Davis and Mr.
Platts, I am all for it.
I have a couple of questions. One is, if this becomes too
formalized and appears to be coming from the state and is
connected with child protective services somehow in people's
minds, how do we guard against the participants putting up a
defense, saying, you know, this is an inspection service, it is
intrusive, rather than as obviously I think it was Terrilyn who
worked with Ms. Fenley.
How do we build into this program an inviting aspect? I am
not sure whom I should ask this to. Anyone who has any comment
on that----
Mr. Estrada. I think that is a good point, and I would not,
and I don't think anyone here, even if we have concerns with
the bill, would be against many of the things in this bill.
Something that we have looked at at HSLDA, we have looked
at if the parenting classes, if the materials, instead of
coming from the Secretary of Health and Human Services and
instead of coming maybe so closely linked to the state child
welfare services, if it was in the example of, let's say,
grants that were given to public private entities that could
then offer these parenting classes, maybe that would even get
these classes into the hands of more people and still give very
good education to parents, teachers who could help the parents,
and it would also do away with some of the concerns that HSLDA
has.
I know that----
Mr. Holt. Thank you.
I think maybe Ms. London would be the best to answer this
next question. How do we build into this program a longevity, a
long enough relationship with the family and the visitor? A lot
of these families, of course, are not particularly stable. They
may have to move a lot, particularly if they are military
families. They have changing jobs and life situations. Are
there things that we have learned about how to build in a long
enough contact to get the most benefit out of the program?
Ms. London. Yes. I would say we started with the trusting
relationship that we build with the mom while she is pregnant,
so that is 9 months. And then we work with the children and
families until the child is 3 years old. So that is 3-plus
years. And we continue working with them even beyond that.
If our families are relocated and when they move, they can
voluntarily continue to agree to participate, and the home
visitor will follow them wherever they move within the City of
Chicago limits.
Mr. Holt. Again, I think this is fine legislation and I
thank Mr. Davis and Mr. Platts.
And thank you, Mr. Chairman.
Chairman Miller. Mr. Payne?
Mr. Payne. Thank you very much.
I am sorry that I missed the testimony. But are any of you
associated with CASA, the Court Appointed Special Advocate?
Well, we are very fortunate in our county, I happened to go
to be called for jury duty. The only way I got out is that I
was assigned to a murder case that was going to take 6 weeks,
so I couldn't be chosen because I can't stay in the court for 6
weeks.
But while I was there, they had a presentation, actually,
to all the jurors, must have been a thousand, where they went
over a court appointed--what is it called--court appointed
special advocate. In our county, the abuse in foster care is so
high that the state can't handle it and so they are asking for
volunteers that have to go through training to actually be
assigned to a foster child to make sure that the foster child
is getting proper treatment in foster care. It is a very unique
program and we have almost a thousand volunteers that are in
it.
You know, I usually don't kind of discuss dirty linens in
public, but we have a very serious problem in our county.
Unbelievable. We have more, nearly 25 times, the average U.S.
rate of children in foster care in four cities in my county,
and we have challenges in this little area. Twenty-one percent
of the violent crime occurs right in these four cities for the
entire county. The statistics are really unbelievable of some
of the problems that we have. Fourteen percent of the children
are born low birth weight. Twenty-five percent spend at least
one night in the hospital in their first year. Twenty-seven
percent have asthma. Twenty-one percent were overweight at age
3. Sixty-two percent were below the 15th percentile in verbal
skills.
And so we really have a concentration of poverty that is
probably even more severe than in your Cabrini Green area in
Chicago. And so I am interested in trying to gather from your
testimony, which I missed, but I might ask you, Ms. London,
about the--I understand in your testimony you speak of families
that are being displaced in the Cabrini Green housing area. We
have had the same problem of bringing down public housing, and
people sort of are dispersed.
But could you sort of share with me how your program has
helped these families and how have you impacted on the overall
welfare of the children in these families that have been
dispersed?
Ms. London. Yes, I can. The home visitor works very closely
with families. One of the goals on our IFSP, which is our
individual family support plan, is whatever the parents want us
to work with them on, that particular goal, for a 6-month
period. And we update it and review it every 6 months. So
housing in that area is an integral goal.
The home visitor works together with case managers and with
other agencies to actually move and relocate the families. And
as I said, we are able--if the family wants to continue in the
program, to actually continue home visits wherever it is that
they move within the City of Chicago, and give services, offer
services, to them.
Our program is a part of the Community Health Center, so
many of our participants are also patients of the health
center, and they continue to come into the health center even
after the child has aged out at age 3. And so we are able to
continue interacting with them in terms of school enrollment,
immunizations, well child visits or whatever it is that the
parents need.
Mr. Payne. Do you have Section 8 housing in your portfolio,
or is that out of the Housing Authority, you know, which
Section 8 says 30 percent of the income is spent for housing
and the rest is paid by the federal government.
Ms. London. That would be more case management. But the
home visitors do work very closely with case managers.
Mr. Payne. Okay. Well, it looks like my time is expired.
Thank you very much.
Mr. Hinojosa. Thank you, Mr. Chairman.
I want to say thank you for calling this hearing and I want
to express my support for the parental involvement and family
involvement as we try to teach children the art of learning.
And I say that without a successful program in parental
involvement and family involvement, that I think that we are
missing one of the most important components that Chinese
families--Chinese leaders have taught us, who have visited
China, inquiring how is it that they can be so successful in
having large percentages of their children graduating from high
school and going on to college and beating the socks off of us
when we compete with them in international scholastic
competition.
So my questions are going to be many and I ask you for
short answers so I can ask as many questions as I can during
the short time they are giving me.
My first question is to Ms. London, from Illinois. How does
your program provide support, training and supervision to
ensure that the home visitors are effective in working with
families who do not speak English?
Ms. London. Presently, our program is 100 percent African
American English speaking individuals.
Mr. Hinojosa. Maybe, Ms. Fenley, what do you all do--is it
Mrs. Fenley--can someone else answer my question? Those who are
English limited families who can't speak. I can certainly tell
you that I am very interested in this because I come from a
family of 11 and my mother didn't speak English, so if we had
anybody come visit, she couldn't speak to them.
Ms. Smart. I can speak a little bit to it. In Los Angeles
we have the top 11 languages that we have to deal with. We do
recruit nurses specifically sometimes for the languages they
speak and the culture that they are.
I think all of us struggle with meeting the needs of our
populations we serve, especially the multicultural, multiethnic
groups. But it is very important that what you look at also
statistically--and I did this analysis when we first started--I
found out that oftentimes it is main family language we don't
speak, but the young child who is pregnant--and I say young
child, again, 17--is bilingual, although maybe not good. And
the outcomes are similar and the same to the outcomes of those
with the same cultural mix of the nurse to the client.
That also included we had need to look at the African
American population served by the Latina nurse. Their outcomes
were the same as any other person we served. Again, it goes
back to the relationship, and sometimes there are a million
things you can do without ever saying a word.
Mr. Hinojosa. So would you say that we need to address,
then, the lack of communication wherever we are not able to
have those visitors to the homes with a language the parents
can understand?
Ms. Smart. Absolutely.
Mr. Hinojosa. Maybe taking college students who can speak
that language, be it whatever the language is.
My next question then goes to Ms. Weiss from Harvard Family
Research. What does the research show to be the core components
of an effective home visit program that strengthens family
literacy and helps parents support their children's learning?
Ms. Weiss. I think we talked a little bit about some of
those key components. Well-trained staff. The Nurse-Family
Partnership woman mentioned a program that aligns the goals,
what you do in the home and the measurement to make sure that
they are all consistent with the outcomes that you are trying
to get. Well-trained staff with supervision is critical.
And I think all of these models that I am familiar with
also stress the importance of the parent working with the child
around literacy development in the home.
Mr. Hinojosa. Would your research confirm that those
mothers who work with children at early ages of 1 through 3 or
4, teaching--letting the children listen to somebody reading to
them, to get them to learn to love books and reading? Does that
work?
Ms. Weiss. There is a lot of support--there is a lot of
research evidence that supports that conclusion, a huge amount
of it.
Mr. Hinojosa. Excellent.
The next question goes to Ms. Smart, director of Nurse-
Family training. In many communities across the country,
Hispanic families live in a climate of fear because of the
current policy of indiscriminate immigration raids and local
policies aimed at newcomers to feel unwelcome. How do you build
trust in the communities you serve?
Ms. Smart. I guess we build it by being there and showing
over time that we can be trusted. We don't report to
immigration. The only thing we do report routinely is child
abuse when we see it in the home.
But, no, we have established a reputation and respect and a
lot of our referrals, as mentioned earlier, come from the girls
who are pregnant and their friends get pregnant. They come to
us that way.
I think it is very important, and again it helps to have
multicultural nurses onboard so that they can see we are
supportive. And again, nurses are one of the most respected
professions, and that helps too.
Mr. Hinojosa. Thank you.
I yield back.
Chairman Miller. Thank the gentleman.
Mr. Tierney, do you have any questions?
Mr. Tierney. Just maybe one or two, Mr. Chairman. Thank
you.
Dr. Weiss, I came a little late. I apologize. I have
another committee going at the same time. But I know in your
written remarks you talked about the Parent Child Home Program,
which we have in some of the communities in my district. Have
you explained that already on the record, the specifics of the
program and its measures of success?
Ms. Weiss. I have not.
Mr. Tierney. Would you do that for me, please?
Ms. Weiss. Yes. The Maternal Child Home Program provides
home-based support for language and literacy development from
about age 3 to age 5. It has several studies, experimental
studies, that suggest the value of doing that around children's
language and literacy development and early school readiness.
They also have studies that show that parents who belong to and
the kids that experience the program are more likely to be
involved with their kids' development into elementary school.
So it leverages early parent involvement to support sustained
parent involvement. So it has an array of very important
outcomes. It is a very strong model.
Mr. Tierney. I am curious on that, because I know Brandon
Walsh, when he was head of Title 1 in Salem, started the
program in that community and has a waiting list now. Most of
the communities that do it in fact have a waiting list, and
most of the parents that go through it--not most of them, but
many of them, then become people instructing on the program.
All of the indicators that we have from the local metrics
on that are that it is successful and progressing, and you are
now confirming that on a broader perspective it also seems to
be a good program.
Ms. Weiss. Yes.
Mr. Tierney. Thank you very much.
I have no further questions, Mr. Chairman. Thank you.
Chairman Miller. Mr. Platts?
Mr. Platts. Thank you, Mr. Chairman.
Kind of a follow up to the discussion earlier about the
different programs and who is targeted for inclusion, whether
it be Healthy Families, Nurse-Family Partnership or some of the
others. One issue we haven't really mentioned is the issue of
means testing. And I would be interested in any of the
panelists, and maybe especially Ms. London with Healthy
Families. I know you don't have means testing, but you do kind
of target by at risk of, you know, abuse, not means testing.
And then, Ms. Ditka, in your testimony earlier you were
talking about how abuse does run the gamut of all socioeconomic
groups, which would seem to argue against any kind of means
testing.
So I would be interested in especially the two of you, but
any of the other panelists also, whether there should be any
mandatory means testing included in the legislation as part of
any programs participating.
Ms. London. Ours is a strength-base program. And the way
that we bring in our families is to assess for particular
potential for child abuse and neglect, is what it is that we
are looking for.
Mr. Platts. Regardless of income level, right?
Ms. London. There is no income, no ethnic differentiation
or anything. It is universal assessment and screening.
Mr. Platts. Okay.
Ms. Ditka. In Allegheny County, the Nurse-Family
Partnership that works in Allegheny County does do some needs
assessment. So it is impoverished, primarily teenage mothers,
in their second trimester.
But I think my response was in response to Mr. Davis'
question, and that is that any family, regardless of need
economically could use this program. It is just merely at risk
parents. You don't have to be impoverished to not have good
parenting skills. Anybody can be afflicted with that problem.
Mr. Platts. Thank you.
Anyone else want to comment? Yes?
Ms. Weiss. Programs like Missouri's Parents As Teachers
have evidence of benefits for everybody who participates,
regardless of income. They have also been good, as have other
programs that serve a general population, of providing more
intensive and frequent home visit services to families that may
need more help.
So there are a number of models of universal programs that
then provide more intense, frequent services to more high-need
families.
One of the things I like about the legislation is that it
leaves to the state and perhaps the local community decisions
about how they are going to use their resources. Having said
that, I think there is a research-based case that says more
highly stressed families need more intensive and frequent
services within a universal model when people chose to go in
that direction.
Mr. Platts. It is perhaps allowing that to be an option,
but not mandated for the state and local participation. And I
think that is something to emphasize here, that this is for a
federal program to help fund state and local efforts, not to
create a federal program, but provide the funding for such a
program.
Ms. Weiss. It is also not age-specific programs that you
are mandating, and you are leaving a lot of choice within
reason to states about the kinds of programs they are going to
provide.
Mr. Platts. Thank you.
Mr. Estrada, your testimony focused on Section 9 and the
concerns there, and to follow up my colleague and try to get
into that a little further with you. Is it safe to say that, in
Section 9, if it was retained as far as trying to ensure
parents are made aware of this program, if the requirement was
eliminated as far as a parent having to sign saying yes, I
participated or no, I chose not to participate, that
requirement, because it seemed like that is where your focus
was, that having to sign something would make them feel
pressured to participate. So if that signature requirement was
eliminated, would that go a long way towards eliminating your
organization's concerns?
Mr. Estrada. That would definitely help, Congressman.
If the materials were just in the hospital as something
that is offered by the way to parents, this is something that
would be very helpful, we encourage you to take it, that would
take away a lot of our concerns.
Our concern also, however, is that if the curriculum is
going to be developed by the Secretary of HHS and there are no
guidelines for how the curriculum is going to be developed,
what happens if it is open to politics being played with it as
different administrations come, maybe one side doing it this
way and one side doing it the other way? What if down the road
it ended up something that different religious hospitals or
cultural birthing centers, they disagreed with the materials? I
was uncertain. The bill seems to be a bit vague. Can a hospital
refuse these materials?
Mr. Platts. I think sometimes we can start to imagine all
sorts of things that could be, and you can never write a
legislation to guard against every possibility, but I
appreciate the concern that it is voluntary participation and
no consequences for not.
And I will quickly--I see my time is out--just emphasize
with your organization, in the findings of the legislation, I
really see this as supportive of parents who choose to
homeschool, because in the findings we reflect that the first
and most important teacher for any child is the parent. And
that is exactly what homeschoolers believe, and with the very
large homeschool population in my district that are very
engaged with their children and their education. So we are
trying to, I think, compliment what your organization is about.
A final comment, just again, Ms. Fenley, and this really
goes to Mr. Kildee reflected it as well, all the testimony has
been exceptional and very helpful. Your testimony about the
most important thing you have gotten out of your participation
hit home.
I was telling my 9-year-old last night as he was getting
tucked in and we were recounting the days--yesterday was the
first day of summer vacation, and we were recounting his third
grade year and how proud we are of how hard he worked and how
well he has done, and how I end every day with that hand on the
chest when they are asleep and they don't know it, just that
all is well. I can go to sleep because my kids are sleeping.
Your testimony about that lesson of instilling self-esteem
in our children is a powerful statement, and if you are not
already doing so back home, you are a great advocate for
espousing the importance for families of the parents
participating in your program in Virginia and, really, thank
you for being here today.
Thank you, Mr. Chairman. I yield back.
Chairman Miller. Further questions?
Mr. Davis of Illinois. Mr. Chairman, thank you very much.
I just want to assure Mr. Estrada that we hear him in terms
of the concern that he expressed relative to privacy and the
whole question of possible coercion, and we will review the
language and take a look at that and try to make sure that
there are no loopholes whatsoever.
Mr. Estrada. Thank you, Congressman.
Mr. Davis of Illinois. I consider myself a practicing civil
libertarian, that individuals must have the right to do what
they want to do and when they want to do it and the way they
want to do it.
And Mr. Chairman, again, I want to thank you for holding
this hearing.
And I would just reemphasize, you know, Mr. Holt indicated,
Ms. Fenley, that if we had a national spokesperson for this
issue, it ought to be you, and I would certainly agree with
him. Maybe we will have to figure out a way to create that.
So thank you very much, Mr. Chairman, and I yield back.
Chairman Miller. I feel a Section 10 coming on. [Laughter.]
Let me thank you all. If I just might take a couple of
minutes here.
One, Mr. Platts has made the point and I think it is very,
very important with respect to this legislation that we are
trying to create a federal stream of funding, not a federal
program, and I think that is important. I feel a little bit
like, you know, you will have been running this startup company
for a while and now you are asking to go to scale. And as we
know in dealing with human services, it is the most difficult
thing we can do, and we don't have a great track record.
And on that point, I am most intrigued by these programs as
I have been involved with them and watched them over several
years, that they have--the attempts that have been made to
maintain the integrity and to use the data and the information
for program improvement. And I would just ask you once again to
look at this bill, because I think it is absolutely critical so
that we can say with confidence that we are investing in a
program of success here, a program of record and a program of
sort of constant improvement.
And then I think that allows us to stay out of the way in
the kinds of--so that you can continue to use the discretion
and the history and the background that you have of the program
to make the choices and decisions that you do.
That is a big test in our relationship here. We hand out--
you know, if we are fortunate enough to get a half a billion
dollars, a lot of people start thinking we should start driving
the horses here. That is not a very successful model, either.
So I would just ask you--and Dr. Weiss, as you review the
studies over the last 25 years, you make it very clear that
where these quality indicators are not in place, we are just
kidding ourselves. And I think a couple of the witnesses said
if you don't do it right, if they don't want to volunteer, if
they don't want to participate, it is just not going to work.
And I think that is what would be my priority here with
respect to this legislation. I think Mr. Davis and Mr. Platts
have done a great job of drafting this legislation, but I want
to know that if we are going to scale, we could be back here 5
years from now and 10 years from now and see a program that has
continued to improve without us creating a lot of regulations
and hurdles for people to jump that just eat up the resources.
So there is that part of it. If we could call on you again
to sort of scour the bill, because you have very extensive
experience with this. I think the bill has been drafted with
all of that in mind, but I just want to reiterate that point.
And finally, thank you to Zane and Megan for coming today
to join us. Megan, thank you very much for being here and
brining your brother. We enjoyed you both. So thank you.
And Ms. Ditka, are you going to introduce mom? You brought
her all the way down here, you are going to make her drive
home, come on.
Ms. Ditka. My mother, Joyce Ann and my daughter, Claire.
Chairman Miller. Thank you. And you are welcome, too. Thank
you for being here.
With that, the committee will stand adjourned, and thank
you again so much for your time and your expertise. And we will
leave the record open for further submissions if something
comes to you or members of the audience and members of the
committee.
[The statement of Ms. Woolsey follows:]
Prepared Statement of Hon. Lynn C. Woolsey, a Representative in
Congress From the State of California
Chairman Miller, thank you for holding this hearing today. Thank
you Representatives Danny Davis and Platts for introducing H.R. 2343,
the Education Begins at Home Act. This is an important topic and I look
forward to more conversations about how we can help give every child
the best possible start in life.
Home visitation programs have been shown to reduce child abuse,
improve parent and child bonding, increase literacy, and even reduce
crime. These important programs are already helping many families in
communities all over the United States, but there are long waiting
lists and many more families could benefit from these services
provided. That's why it's so important that the federal government
provide funding to serve more families and so more communities can have
access to home visitation services.
However, we can't stop there. Home visitation programs should be
better utilized along with a host of other services for children and
families, such as early childhood education, affordable, quality child
care, and work schedules that allow parents to more fully participate
in their child's lives. In two-thirds of all American families, one or
both parents work and they are trying to balance work and family
responsibilities. These parents are doing the best they can for their
children and we need to help them by ensuring that they have access to
home visitation, early childhood education, and other programs and
flexible enough work schedules that allow them to utilize these
programs.
Chairman Miller, thank you again for holding this hearing. I look
forward to continuing this dialogue with my colleagues to find more
ways to help parents give their children the best possible start. Thank
you.
______
[Additional materials submitted by Mr. Miller follow:]
[The report, ``Breaking the Cycle of Child Abuse and
Reducing Crime in Pennsylvania: Coaching Parents Through
Intensive Home Visiting,'' may be accessed at the following
Internet address:]
http://www.fightcrime.org/reports/PACAN2.pdf
------
[The report, ``The Economic Return on PCCD's Investment in
Research-based Programs: A Cost-Benefit Assessment of
Delinquency Prevention in Pennsylvania,'' may be accessed at
the following Internet address:]
http://prevention.psu.edu/pubs/docs/PCCD--Report2.pdf
------
[Additional statement submitted by Mr. Tierney follows:]
Prepared Statement of Sarah E. Walzer, Executive Director, the Parent-
Child Home Program
The Parent-Child Home Program is pleased to submit this testimony
in support of the Education Begins at Home Act, H.R. 2343. We thank the
Committee for holding this important hearing on legislation that will
make a tremendous difference in the lives of children and families
across the country. We are pleased to be part of a national coalition
of home visiting organizations and advocates for early childhood and
family support services that has been supporting the passage of the
Education Begins at Home Act.
As a nation, we cannot really begin to talk about ``No Child Left
Behind'' until we have successfully ensured that ``No Child Starts
Behind''. Today, too many children in the United States enter school
never having seen or held a book, without the basic literacy and
language skills they need to participate successfully in the classroom.
As a result their teachers in pre-kindergarten or kindergarten have to
slow or stop the curriculum they had planned, to help these children
catch up. Unfortunately, the data shows us that most children who start
behind will never catch up. Children who do not know their letters when
they enter kindergarten are behind in reading at the end of
kindergarten, at the end of first grade, and are still having trouble
reading at the end of fourth grade.\1\
---------------------------------------------------------------------------
\1\ ``A policy Primer: Quality Pre-Kindergarten,'' Trust for Early
Education, Fall 2004.
---------------------------------------------------------------------------
We also know that preschool is not the sole solution to this lack
of readiness. Children arrive in pre-kindergarten not ready just as
they have been arriving in kindergarten not ready. Children are more
likely to be ready at any age when they have a family that knows what
it needs to do to help them get ready. All families want their children
to be successful, to do well in school, but many families do not know
how to prepare their children to be successful in school. If you are
not educated yourself, did not grow up in the American education
system, and/or do not have the means to purchase books and educational
toys, you may need some guidance to help you get your child ready for
school. The Education Begins at Home Act (EBAH) is designed to do just
that by ensuring that families receive the supports they need to
prepare their children to enter school ready to be successful students
and to go on to graduate from high school.
The Parent-Child Home Program is a research-based, research-
validated early literacy, school readiness, and parenting education
home visiting program developed in 1965. For over 40 years, the Program
has been serving families challenged by poverty, limited education,
language and literacy barriers, and other obstacles to school readiness
and educational success. The Parent-Child Home Program currently serves
over 6,500 families through more than 150 local sites in 14 states.
Many more families could be served in each of these communities, as all
of our sites have waiting lists at least equal to the number of
families they are currently serving. And many more families remain in
need of these services in communities that have not been able to
develop funding streams for this critical early childhood service.
The Parent-Child Home Program works with a broad range of families
whose children are at risk of entering school unprepared: teen parent
families, single parent families, homeless families, immigrant and non-
native English-speaking families, and grandparents raising
grandchildren. Working with parents and children in their own homes
helps families create language-rich home environments and lays the
foundation for school readiness and parent involvement as their
children enter school. Parents are able to continue to build their
children's language and literacy skills after the Program finishes and
their children enter school ready to succeed. The Program erases the
``preparation gap'' and prevents the ``achievement gap.''
The funding that would be provided by EBAH is critical to ensuring
that home visiting programs like these can reach families in need of
services and enable children to enter school ready to be successful
students. The families reached by home visiting are families who are
not accessing center-based early childhood or school readiness
services, including the library, play groups or parenting workshops.
They do not have transportation or access to transportation to get to
these services; the services are not open or available when the parents
are available to attend; they have language or literacy barriers; and/
or they have no money to pay for programs.
I would like to provide you with some background on The Parent-
Child Home Program to highlight the extent of its evaluation and
validation and the depth of the Program's experience working with
families across the country. For over 40 years, we have been preparing
young children and their families to enter school ready to learn. As a
result, four decades of research and evaluation demonstrates that
Parent-Child Home Program participants in communities throughout the
country enter school ready to learn and go on to succeed in school. In
fact, peer-reviewed research demonstrates that program participants go
on to graduate from high school at the rates of middle-class children
nationally, a 20% higher graduation rate than their socio-economic
peers nationally and a 30% higher rate than the control group in the
study. From the first day of school, Program participants perform as
well or better than their classmates regardless of income level. This
research, published in peer-reviewed journals, demonstrates not only
the immediate, but also the very long-term impacts of home visiting.
Not only do child participants perform better in school, but their
parents also become actively involved in their education, as noted by
principals and teachers at the schools they attend. In addition, the
parents go on to make changes in their own lives as well, obtaining
their GEDs, returning to school, and improving their employment
situations. At least 30% of our Home Visitors across the country are
parents who were in the Program as parents; for many of them, this is
an entry into the workforce. All of these changes have significant
ramifications for their children's futures. The Parent-Child Home
Program proves that when programs are available to support parents and
children from an early age, delivering services in a way that is
accessible and meaningful to them, we can ensure that economically and
educationally disadvantaged children will enter school ready to learn,
never experience the achievement gap, and attain high levels of
academic success.
The Program's primary goal is to ensure that all parents have the
opportunity to be their children's first and most important teacher and
to prepare their children to enter school ready to succeed. The
Program's hallmark is its combination of intensiveness and light touch.
Each family receives two home visits a week from a trained home visitor
from their community who models verbal interaction and learning through
reading and play. The families receive a carefully-chosen book or
educational toy each week so that they may continue quality play and
interaction between home visits and long after they have completed the
Program. Often the books are the first books in the home, not just the
first children's books, and the toys are the first puzzles, games or
blocks that the child has ever experienced. The materials are the tools
the parents use to work with their children. The materials ensure that
when these children enter pre-kindergarten or kindergarten they have
experience with the materials that teachers expect all children to
know.
Most importantly, the Program is fun for families, demonstrating
for parents both the joy and the educational value of reading, playing,
and talking with their children. Children's language and early literacy
skills progress rapidly, and parents find an enormous sense of
satisfaction in the progress that comes from their work with their
children. This combination of fun and the dramatic changes families see
in their children are the reason that on average 85% of the families
who start in the Program complete the 2 years. The majority of families
who do not complete the Program fail to do so because they move to a
community where it is not available.
We know The Parent-Child Home Program is successful because of the
changes we see in the families and the success the children have when
they enter school. We also know it is successful because of the
positive responses from the local community sponsors, including school
districts, family resource centers, community health clinics, and many
community-based organizations, and from the way the Program is
continuing to expand across the country. We see that home visiting is a
service delivery method that is able to reach families whose children
would otherwise show up in pre-K or kindergarten never having held a
book, been read a story, engaged in a conversation, been encouraged to
use their imagination, played a game that involves taking turns, or put
together a puzzle.
I would just like to share with you one brief anecdote
demonstrating the long-term impact of the Program on the families who
participate. As I mentioned earlier, we have followed program
participants through high school graduation and beyond and have
collected many wonderful examples of the Program's impact on children's
lives. I think the long-term success of the Program is most clearly
depicted by an interview that was conducted recently with a program
graduate from one of our sites in New York, which has been implementing
the Program for over 35 years. The son of immigrants from Columbia, he
noted that of the 40 native Spanish-speaking students in his grade,
only 3 went on to college. He observes that all these children went
through the same schools and participated in the same activities, the
only difference was The Parent-Child Home Program. He says it got him
on the right track early; he entered school ready to learn and has
soared ever since. He still has vivid memories of how confident he felt
when he started kindergarten, how the books and toys were familiar and
how he was the only native-Spanish-speaking child who knew the words to
London Bridge is Falling Down. For him, the Program was a critical
bridge to the rest of his education and for his mother it was
empowering. She went back to school herself, and he noted she regularly
would call his teachers to tell them to give him more homework because
what they had given him was too easy. This young man is now a lawyer at
a major New York City law firm, and he is the first Program graduate to
become a member of The Parent-Child Home Program's national board of
directors. His story is both extraordinary and typical of the kinds of
success parents and children can achieve when home visiting is
available to reach them where they are most comfortable and help them
build the language and literacy skills they need to enter school ready
to learn.
Thank you for holding this hearing and considering the Education
Begins at Home Act, which will provide funding to support vital
services for children who would otherwise enter school unprepared and
be unsuccessful. Thank you for helping to ensure that all parents
struggling to help their children succeed receive the support they need
to bring the joy of reading, playing, learning, and school success into
their children's lives. We hope that you will move forward with this
legislation to enable states to provide families with high quality,
research-validated home visiting services that are a critical component
of successful school readiness, early childhood education, and parent
support efforts. It is truly a cost-effective way to ensure that all
children have the opportunity to enter school ready to succeed.
______
[Additional materials submitted by Mr. Davis of Illinois
follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
------
Prepared Statement of the Child Welfare League of America
Chairman Miller, Representative McKeon and members of the
Committee, the Child Welfare League of America submits this statement
in support of HR. 2343, the Education Begins At Home Act. We thank the
original sponsors of this legislation, Representatives Danny Davis and
Todd Platts and all the bipartisan cosponsors who have joined them.
CWLA represents hundreds of state and local direct service
organizations including both public and private, and faith-based
agencies. Our members provide a range of child welfare services from
prevention to placement services including adoptions, foster care,
kinship placements, and services provided in a residential setting.
CWLA's vision is that every child will grow up in a safe, loving, and
stable family and that we will lead the nation in building public will
to realize this vision.
As we have stated in other Congressional settings, CWLA believes
the best way to ensure children are safe from all forms of maltreatment
is to provide comprehensive, community-based approaches to protecting
children and supporting and strengthening families. Public and private
agencies, in collaboration with individual citizens and community
entities, can prevent and remedy child maltreatment, achieve child
safety, and promote child and family well being. There is no solution
to addressing child abuse in our society short of a comprehensive
approach that begins with preventive efforts and assures that we have a
safe and permanent place for children who are the victims of abuse and
neglect.
Home Visiting Models
Home visitation programs refer to different model programs that
provide in-home visits to targeted vulnerable or new families. Home
visitation programs--either stand-alone programs or center-based
programs--serve at least 400,000 children annually between the ages of
0 and 5 \1\ but there is a need for us to do much more. The eligible
families in these home visitation programs may receive services as
early as the prenatal stage. Because a child's early years are the most
critical for optimal development and provide the foundation necessary
for success in school and life, home visiting can make a lifetime of
difference./2/ Nurses and other trained members of the community
conduct home visits on a weekly, bimonthly, or monthly basis. Program
goals include an increase in positive parenting practices, improvement
in the health of the entire family, increase in the family's ability to
be self-sufficient, and enhanced school readiness for the children.
Prevention
Although we speak in support of HR 2343 because we feel home
visitation can provide an important component in a continuum of care
that we need in the child welfare field, we also know that these
programs can assist in improving education and health outcomes for
children. Home visitation can show improved outcomes in the areas of
prenatal care, access to health care and improved rates of
immunizations.
Whenever we engage in discussions in regard to our nation's child
welfare system one of the first great challenges and debates is over
how we can prevent abuse and neglect from taking place. All of us would
prefer a system that can help a family before they ever become part of
the more than 3.3 million reports of abuse and neglect filed annually
and certainly before they become one of the more than 900,000 children
who are substantiated as neglected and or abused each year. Research
has shown that home visitation programs reduce abuse and neglect and
juvenile delinquency, and ultimately save taxpayers over $50 billion
annually.\3\
We recognize the value both in human and economic terms, and the
great benefits to our nation and to vulnerable families and children by
enacting policies that prevent the need for ever placing a child in
foster care. There is no simple model for prevention of child abuse and
in fact we believe that a commitment to preventing child abuse will
involve multiple efforts and strategies. Greater investment and support
for home visitation is a critical part of such a strategy.
Currently home visitation programs rely on a range of federal,
state and local funds. Unfortunately these funding sources can be
unreliable, even for programs that are demonstrating effectiveness in a
range of areas. In recent years states have utilized funding sources
such as and including the Social Services Block Grant (SSBG), Title IV-
B part 1, Child Welfare Services, Title IV-B part 2, Promoting Safe and
Stable Families (PSSF), the Child Abuse Prevent and Treatment Act
(CAPTA) state grants and Community-Based Family Resource and support
grants. All of these funding sources are used to fund a range of other
services, and all have been subject to reductions or proposed
reductions in each of the last five budgets. This highlights the need
for specific funding for home visiting programs to strengthen and
stabilize the funding.
All families benefit from information, guidance, and help in
connecting with resources as they meet the challenges of parenthood and
family life. For families with limited resources, or those that face
additional challenges, the need for support and assistance is even
greater.
Families are central to child safety and well-being. Children
develop the ability to lead productive, satisfying and independent
lives in the context of their families. Family ties especially those
between parent and child are extremely important in the development of
a child's identity. Through interaction with parents and other
significant family members, children learn and come to subscribe to
their most cherished personal and cultural values and beliefs. They
learn right from wrong, and gain competence and confidence. Family
relationships must be nurtured and maintained to meet the needs of
children for continuity and stability, which support healthy
development.
Evidence shows that children who experience maltreatment are at
greater risk for adverse health effects and risky health behaviors when
they reach adulthood. Many parents involved in the child welfare system
do not intentionally harm their children; rather their lack of
knowledge, skills, or resources has led them to harm their children.\4\
Quality early childhood home visitation programs lead to several
positive outcomes for children and families, including a reduction in
child maltreatment. Annual data indicates that 40% of the more than
900,000 children who are substantiated as abused and neglected, but not
removed from the home, never receive follow-up services.\5\ There can
be a number of reasons for these consistent statistics from year to
year but one clear reason is that in some states follow-up services may
not come until after a family has been placed on a wait list for
services. More widely available and implemented home visitation could
help address this drastic shortcoming. More serious is the fact that of
the estimated 1,460 child deaths in 2005, 76.6% were younger than age
4. Another 13.4% were between the ages of 4 and 7.\6\ Of the
perpetrators of child maltreatment, 76.6% were parents.\7\
Evidence For Home Visitation Models
Home visitation services stabilize at-risk families by
significantly affecting factors directly linked to future abuse and
neglect. Research shows that families who receive at least 15 home
visits have less perceived stress and maternal depression, while also
expressing higher levels of paternal competence.\8\ Home visitation
programs may also reduce the disproportionality or overrepresentation
of children and families of color in the child welfare system, while
improving outcomes for these families. Research shows that
participating children have improved rates of early literacy, language
development, problem-solving, and social awareness. These children also
demonstrate higher rates of school attendance and scores on achievement
and standardized tests.\9\ Studies show that families who receive home
visiting are more likely to have health insurance, seek prenatal and
wellness care, and have their children immunized.\10\
A study of the Missouri-based Parents As Teachers home visiting
program examined the children enrolled in the program and found that by
age 3, they were significantly more advanced in language, problem-
solving, and intellectual and social abilities than children in
comparable groups.\11\ A study of the Nurse-Family Partnership showed a
79% reduction in child maltreatment among at-risk families compared to
other families in a control group. That same study also indicated a
number of other benefits in the areas of health, employment, and
behavior.\12\ Healthy Families America exists in more than 450
communities; Home Instruction for Parents of Preschool Youngsters is in
167 sites in 26 states; the Parent-Child Home Program has 137 sites
nationally and 10 sites internationally; Early Head Start serves more
than 62,000 children in 7,000 sites; and Parents as Teachers is located
in all 50 states and serves more than 400,000 children.\13\
Conclusion
Under the legislation, each governor would designate a lead state
agency to oversee and implement the state program. The states can use
their grants to supplement--but not replace--current state funding. The
legislation does not dictate which, or how many, home visiting models
may be used. If a state currently lacks a home visitation program, the
funds can be used to develop a program. A state's grant funding award
would be based on the number of children age 5 and younger living in
the state. Applying states would submit a plan outlining their efforts
to collaborate and coordinate among existing and new programs.
CWLA commends the Committee for its hearing today on home
visiting--highlighting its successful outcomes for children and their
families. Such successful outcomes of home visiting contributing to
familial continuity, educational enrichment, as well as physical and
mental health will be expanded by increased federal support. CWLA hopes
that this hearing today is merely the next step building on the hearing
from the last Congress and that the next steps taken by Congress will
be to further home visitation initiatives nationally by passage of the
legislation before you. This commitment will make the benefits of in-
home visiting services accessible to many more families and improve
outcomes for many more children.
endnotes
\1\ Chapin Hall Center for Children at the University of Chicago.
(2006). Challenges to building and sustaining effective home visitation
programs: Lessons learned from states. Available online at http://
chapinhall.webex.com/seminar/251028/play/335933617/PPT--
presentations.pdf. Chicago: Author.
\2\ Daro, D., Howard, E., Tobin, J., & Hardin, A. (2005). Welcome
home and early start: An assessment of program quality and outcomes.
Available online at http://www.chapinhall.org/article--
abstract.aspx?ar=1365. Chicago: Chapin Hall Center for Children at the
University of Chicago.
\3\ Fight Crime: Invest in Kids. (2003). New hope for preventing
child abuse and neglect: Proven solution to save lives and to prevent
future crime. Washington, DC: Author.
\4\ Child Welfare League of America. (2005). Research Roundup:
Parenting. Washington, DC: Author
\5\ Administration on Children Youth and Families. (2008). Child
maltreatment 2006. Washington, DC:, US Government Printing Office.
\6\ Administration on Children Youth and Families. (2008). Child
maltreatment 2006. Washington, DC: U.S. Government Printing Office.
\7\ Ibid.
\8\ Daro, D., Howard, E., Tobin, J., & Hardin, A. (2005). Welcome
home and early start: an assessment of program quality and outcomes.
Available online. Chicago, IL: Chapin Hall Center for Children at the
University of Chicago. back
\9\ Administration for Children and Families. (2003). Research to
practice: Early Head Start home-based services. Washington, DC: Author.
\10\ Berkenes, J.P. (2001). HOPES healthy families Iowa FY 2001
services report. Great Falls, VA: Klagholz & Associates.
\11\ Pfannenstiel, J., & Setlzer, D. (1985). Evaluation report: New
parents as teachers project. Overland Park, KS: Research and Training
Associates.
\12\ Nurse-Family Partnership. (2005) Factsheet. Available online.
Denver, CO: Author.
\13\ Prevent Child Abuse America. (2006). Early Childhood Home
Visiting Programs. Chicago, IL: Author.
______
Military Impacted Schools Association,
June 10, 2008.
Hon. Danny Davis,
Rayburn House Office Building, Washington, DC.
Dear Congressman Davis: I am writing on behalf of the Military
Impacted Schools Association (MISA) to encourage the passage of
H.R.2343 to expand early childhood support programs for American
Families.
MISA represents school districts that provide for the education of
military children throughout the United States. Our military children
have unique challenges that they deal with regularly. One area that we
as educators are trying to address is the tremendous stress that our
children are under as a result of their parents' deployments. The
United States has been at war for over five years. We are seeing young
children going through many stages from withdrawing, to acting out, to
contemplating suicide.
It is a very difficult time for our military children as they watch
the war play out on television, observe the stress of the parent/adult
that is caring for them, and worry about whether their parents will be
home for their birthday, Christmas, graduation, or even at all. School
districts are doing everything they can with the resources they have to
provide support for our military children. This is not a quick, short
term fix. We need additional programs to assist our military children,
keep them connected with their schools and families, and to help them
through this very difficult time.
The proposed legislation will allow school districts that serve
military children the opportunity to secure funding to specifically
address the needs in their school districts. The Military Impacted
Schools Association respectfully requests your support for this
important legislation. If you have questions, don't hesitate to call
me.
Sincerely,
John F. Deegan, Ed.D.,
MISA Executive Director.
______
Prepared Statement of Prevent Child Abuse America
Prevent Child Abuse America and its network of 44 state chapters
and over 400 Healthy Families America program sites in 41 states thanks
the Chairman and the other distinguished members of the U.S. House
Committee on Education and Labor for this opportunity to provide the
organization's perspective on the Education Begins at Home Act (EBAH,
HR 2343). Through this testimony, our organization, including our
National Board of Directors, intends to identify the value of home
visiting and the outcomes that EBAH can achieve to enhance our nation's
ability to promote healthy early childhood experiences.
About Prevent Child Abuse America
Prevent Child Abuse America was founded in 1972 and is the first
organization in the United States whose sole mission is ``to prevent
the abuse and neglect of our nation's children.'' We undertake our
mission by providing testimony such as this, to legislative as well as
executive policy makers about the importance of a full range of
services needed to promote healthy child development and provide
parents regardless of wealth with the information they need to be the
kind of parents they want to be. Based in Chicago, the National Office
and our networks manage over 350 different locally-based strategies to
meet the mission of the organization, including 2900 home visitation
workers, supervisors and program managers oversee and implement Healthy
Families America, a voluntary home visitation service.
The Importance of Development
Our nation is recognized for meeting any challenges brought before
us, our communities, and our workforce, but our continued position of
leadership is greatly impacted by how we raise our children today.
Healthy child development is a foundation for community development and
economic development, as capable children become the foundation of a
thriving society. The basic architecture of the brain is constructed
through an ongoing process that begins before birth and continues into
adulthood. Extreme and sustained stressful environments for children,
also known as ``toxic stress,'' damages the developing brain and
adversely affects an individual's learning and behavior, as well as
increases susceptibility to physical and mental illness. When
considering that the ability to change behavior decreases over time, it
makes sense (and cents) to ``get it right'' early when it is more
beneficial to society than trying to ``fix it'' later. This why Prevent
Child Abuse America promotes the prevention of child abuse and neglect
before it ever occurs. This is why early childhood home visitation
services, as contemplated in the legislation, are so important to
families, communities and our nation.
Role of Early Childhood Home Visitation
All expectant parents and parents of newborns have common questions
about their child's development. Early childhood home visitation
provides a voluntary and direct service in which home visitors can help
parents understand, recognize and promote age appropriate developmental
activities for children; meet the emotional and practical needs of
families; and improve the manner in which parents achieve better
outcomes for their children.
Research has shown that voluntary home visitation is an effective
and cost-efficient strategy for supporting new parents and connecting
them to helpful community resources. Quality early childhood home
visitation programs lead to proven, positive outcomes for children and
families, including improved child health and development, improved
parenting practices, improved school readiness, and reductions in child
abuse and neglect.
Healthy Families America
Healthy Families America is Prevent Child Abuse America's
nationally recognized, signature home visitation program. Through
Healthy Families America, well-respected, extensively-trained
assessment workers and home visitors provide valuable guidance,
information and support to help parents be the best parents they can
be. Healthy Families America focuses on three equally important goals
to: 1) promote positive parenting; 2) encourage child health and
development; and 3) prevent child abuse and neglect.
A review of 34 studies in 25 states, involving over 230 Healthy
Families America programs allows me to say with confidence and
conviction that the benefits of Healthy Families America are proven,
significant, and impact a wide range of child and family outcomes.\1\
In particular, Healthy Families America:
---------------------------------------------------------------------------
\1\ Study designs include 8 randomized control trials and 8
comparison group studies. More information on the studies can be found
in the Healthy Families America Table of Evaluations at
www.healthyfamiliesamerica.org/research/index.shtml.
---------------------------------------------------------------------------
Improves Parenting Attitudes. Healthy Families America
families show positive changes in their perspectives on parenting roles
and responsibilities.
Increases Knowledge of Child Development. Healthy Families
America parents learn about infant care and development; including
child care, nutrition, and effective positive discipline.
Supports a Quality Home Environment. Healthy Families
America parents read to their children at early ages, provide
appropriate learning materials, and are more involved in their child's
activities, all factors associated with positive child development.
Promotes Positive Parent-Child Interaction. Healthy
Families America parents demonstrate better communication with, and
responsiveness to, their children. This interaction is an important
factor in social and emotional readiness to enter school.
Improves Family Health. Healthy Families America improves
parents' access to medical services, leading to high rates of well-baby
visits and high immunization rates. Healthy Families America also helps
increase breast feeding, which is linked to many benefits for both
babies and moms.
Prevents Child Abuse and Neglect. Healthy Families America
has a significant impact on preventing child maltreatment, particularly
demonstrated in recent randomized control trials.
In addition to our stewardship of Healthy Families America, Prevent
Child Abuse America partners with other effective home visiting models
working in communities across the country to create nurturing
environments for children. Our national home visiting partners include
Home Instruction for Parents of Preschool Youngsters (HIPPY USA), the
Nurse-Family Partnership, The Parent-Child Home Program, and Parents as
Teachers.
Together, we have accepted the responsibility to improve the home
visitation field. Together, we share research findings and best
practices, work together towards common goals, and create areas for
cross program cooperation and learning that strengthen the home visit
field as a whole, as well as enhance individual programs. At the local
level, Healthy Families programs partner with other home visiting
models to reach a broader population of families, to ensure that
families are receiving the home visiting service model best suited to
their needs, and to maximize limited resources.
The Need for Reliable Funding and a Coordinated Approach
Across the country, home visitation services struggle with
unreliable and unsustainable funding. Federal programs that have
traditionally provided significant support to home visitation, such as
Temporary Assistance for Needy Families (TANF) and Promoting Safe and
Stable Families (PSSF), have been subject to recent statutory changes
and funding cuts that hamper states' abilities to invest in home
visitation. The current patchwork of funding results in a home
visitation system that serves only a small percentage of families. By
one estimate, approximately 400,000 children and families participate
in home visitation services each year.\2\ As a reference point, there
were 4.1 million live births in the U.S. in 2004.\3\
---------------------------------------------------------------------------
\2\ Gomby, D. (2005). Home Visitation in 2005: Outcomes for
Children and Parents. Invest in Kids Working Paper No. 7. Committee for
Economic Development: Invest in Kids Working Group. Available at
www.ced.org/projects/kids.shtml.
\3\ Martin JA, Hamilton BE, Sutton PD, et al. Births: Final data
for 2004. National vital statistics reports; vol 55 no 1. Hyattsville,
MD: National Center for Health Statistics. 2006.
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The Education Begins at Home Act (EBAH, HR 3628) introduced by
Representatives Danny Davis and Todd Platts will address the current
home visiting funding crisis by establishing the first, dedicated
federal funding stream to support parents with newborns and young
children through quality, voluntary home visitation at the state and
local levels.
EBAH authorizes $500 million over three years to help states
establish or expand quality early childhood home visitation programs.
Of this funding, $400 million will be divided among states to provide
eligible families with voluntary quality early childhood home
visitation on at least a monthly basis. The remaining $100 million will
be equally divided between two competitive grant programs designed to
address the specific needs of military families and families with
English language learners.
EBAH dollars will enable programs to reach thousands more families
with young children. Strict quality controls established in the bill
will ensure that only the highest quality programs are funded with the
new money. In order to be eligible, home visitation programs will need
to use a model with a strong evidence base and must show that they can
adequately monitor their program for quality assurance. Additionally,
there will be standards for staff training and referral networks, and
programs will be independently evaluated.
The legislation empowers states to develop statewide plans for home
visitation that best suit the needs of their communities. In order to
draw down EBAH funds, states will have to assess the reach and scope of
existing early childhood home visitation efforts and identify gaps in
services. Taking this intentional approach to implementation will lead
to: greater coordination among the various models of early childhood
home visitation and the broader child-serving community; a more
efficient use of resources; and a greater assurance that families are
receiving the most appropriate and effective home visiting services to
meet their needs. This model allows for a clear outcome driven national
public policy that promotes consistent results and allows states to
manage the services in accordance with their specific existing service
delivery systems, on-going best practices and existing public-private
partnerships.
Conclusion
Home visitation is an effective, evidence-based, and cost-efficient
way to bring families and resources together, and help families to make
choices that will give their children the chance to grow up healthy and
ready to learn. Making quality home visitation programs more widely
available in all communities is one of Prevent Child Abuse America's
top priorities, and I assure you that our national network is mobilized
in support of this legislation. Research also is clear that failing to
prevent abuse and neglect from occurring costs the America taxpayers
over $103 billion per year.\4\ EBAH does not represent an expenditure
but rather an investment in our children and families. It also
contributes to more productive adult members of our society that
promote stronger families, but also can be more productive in the
workplace. This naturally contributes to our competitiveness in an
expanding global economy.
---------------------------------------------------------------------------
\4\ Wang, C & Holton, J. (2008). Total estimated cost of child
abuse and neglect in the United States: Statistical evidence. Chicago,
IL: Prevent Child Abuse America.
---------------------------------------------------------------------------
While no one piece of legislation can prevent child abuse and
neglect, I believe that EBAH is an important step towards ensuring that
all children have the opportunity to grow up in a safe, healthy, and
nurturing environment. I look forward to working with members of this
Committee to make the well-being of our nation's children a priority. I
hope that this legislation will help to turn our country's priorities
and choices toward more comprehensive and effective ways for
communities and systems to care for children and families.
______
Prepared Statement of the American Psychological Association
On behalf of the 148,000 members and affiliates of the American
Psychological Association (APA), we thank you for holding this
important hearing to discuss the critical role of early home visitation
programs in promoting child development.
The APA is a scientific and professional organization that works to
advance psychology as a science, a profession, and as a means of
promoting health, education, and human welfare. Psychologists play a
vital role in assessing the effectiveness of and making recommendations
regarding programs of importance to children and families, such as
those that provide early childhood home visitation. As such, we
appreciate the opportunity to share our thoughts regarding these
critically important programs with members of this Committee.
``Home visitation'' is defined as a program that includes
visitation of parents and children in their home by trained personnel
who convey information about child health, development, and care; offer
support; provide training; or deliver any combination of these
services. While visits must occur during at least part of a child's
first two years of life, they can also begin during pregnancy.
Individuals providing these services include nurses, social workers,
paraprofessionals, and community peers.
Home visitation programs have generally been offered to specific
population groups, such as those who are first-time mothers; low-income
or young parents; parents suffering from substance use problems;
children at risk of abuse or neglect; and those who have low birth
weight, a disability, or are premature. Visitation programs often
address problems and create interventions of mutual benefit to parents
and children, such as training of parents on prenatal and infant care;
developmental interaction with infants and toddlers; family planning
assistance; educational and work opportunities; and connection with
community services.
Research indicates important benefits of home visitation programs.
Home visitation often leads to the enhancement of parents' sense of
self-efficacy which, in turn, strengthens their role as parents. Home
visitors encourage and facilitate successful, achievable modifications
in parents' lives, teaching effective parenting, working to strengthen
the support of family members and friends, and strengthening the
capacities of parents to access the social resources available to them.
In addition, research suggests that the impact of home visitation may
positively influence social environment--including social networks,
neighborhoods, communities, and cultures--on child development.
A study conducted at New Mexico State University examined the
outcomes of a home visitation program that provided services to first-
born children and their parents. Home visitation workers conducted
pretest and posttest assessments for prenatal and postpartum periods.
Clients participating in the First-Born Program displayed significantly
higher posttest scores on measures of family resiliency. Specifically,
clients demonstrated improved scores in operationalized measures of
resilience, including social support, caregiver characteristics, family
interaction measures, and a reduction in personal problems affecting
parenting. The results of this study are promising, as participants
were observed to make positive improvements in specific areas related
to family resiliency.
Of paramount importance is the potential of home visitation
programs to prevent child maltreatment. Various studies have assessed
the effectiveness of home visitation programs in this area. One such
study, conducted by the nonfederal Task Force on Community Preventative
Services, looked at the effectiveness of early childhood home
visitation in preventing violence. The study concluded that these
programs are effective in the prevention of child maltreatment and
reduce reported maltreatment by approximately 39 percent.
Strong evidence indicates that early home visitation is especially
effective in preventing child maltreatment in populations that have
been shown to be at elevated risk of maltreatment. The study also found
that programs delivered by professional visitors (i.e., nurses or
mental health professionals) seemed to yield greater effects than those
delivered by paraprofessionals.
Staggering numbers of children and families impacted by child abuse
and neglect demonstrate that the need for these programs is urgent. In
2006, an estimated 3.6 million reports of possible child abuse or
neglect were made to child protective agencies. Of those reports,
905,000 were substantiated, yet 40 percent of the victims received no
services following the substantiation. Approximately 1,500 children die
of abuse or neglect each year. These data reveal a public health crisis
warranting concerted national attention and an increased focus on
prevention.
Given the proven success of these programs, especially in
preventing child abuse and neglect, enactment of the Education Begins
at Home Act (H.R. 2343) is critically important. H.R. 2343 dedicates a
funding stream to support parents with young children through home
visitation at the state and local level. The legislation provides $400
million over three years to states, tribes, and territories to expand
access to parent education and family support services. This
legislation additionally targets English language learners and military
families for assistance, since these groups often lack natural support
systems. The APA strongly supports this legislation and urges its
support by the Committee.
In closing, the American Psychological Association would like to
thank you for the opportunity to share our comments on early childhood
home visitation programs. We appreciate the Committee's ongoing
commitment to the positive development of children and look forward to
serving as a resource and partner as you work on this and other
important issues affecting children and their families.
______
[The article, ``The Parents as Teachers Program and School
Success: A Replication and Extension,'' published in the March
2008 Journal of Primary Prevention, may be accessed at the
following Internet address:]
http://www.springerlink.com/content/88h76474r2563455/
?p=10d59e48429641028898aa132cd29e5c&pi=1
______
[Whereupon, at 12:19 p.m., the committee was adjourned.]