▶ 0:03:53international trade and fair taxation. Continuing to pursue business and philanthropic interests until his passing, he endowed his alma mater, Dartmouth College School.
▶ 0:04:32It's okay. It's working though.
▶ 0:04:36When it's red, it's working.
▶ 0:15:24The committee will come to order. Want to welcome everyone to our work and welfare subcommittee hearing on maternal infant and early childhood home visiting program known as MCV. Um, and early support, lifelong impact is the title of today. And so I want to welcome everybody for being here today. Um, and look forward to a fruitful hearing. Um, and obviously want to thank our witnesses for being here today.
▶ 0:15:50And I particularly want to reference one of my constituents, Miss Mendy Smith from Breitpoint in Bloomington, Illinois on today's panel. Mendy, thank you for being here today. I'm Congressman Darren Lehood, proud to chair the work and welfare subcommittee uh with my counterpart uh Danny Davis. And uh my district covers much of central and northwestern Illinois. And um I'm very very uh proud to have the members here today for this important hearing.
▶ 0:16:17MCV provides voluntary evidence-based home visiting services to expectant and parenting families that are at risk for adverse outcomes. Federal funding for home visiting services was first proposed by President George W. Bush in 2008 and was later authorized by Congress as the MCV program in 2010.
▶ 0:16:39According to the Health Resources and Services Administration, in fiscal year 2025, nearly 79,000 households were with more than 1 million home visits. In my district, in 2025, Breitpoint provided MCV home visiting services to more than 500 families across 17 counties, many of them rural. By supporting families prenatally until age five, a critical period for ear early childhood development.
▶ 0:17:09MCVY is a preventative program. MCVY is a program that gets results. The program builds upon decades of research, improves home visits, um, improves home visits by a nurse, social worker, or other trained professional during pregnancy, and in the first years of the child's life, help prevent child abuse and neglect, support obviously, positive parenting, improve maternal and child health, and promote child development and school
▶ 0:17:39readiness. What makes MCV unique is that funding is tied to evidence. Unlike most federal programs, we know what outcomes taxpayers can expect from our investments. For a home visiting model to earn taxpayer support, an evaluation must prove the program has demonstrated significant positive outcomes on targeted measures of family well-being.
▶ 0:18:02Furthermore, support for the program has had broad bipartisan support, including during reauthorizations in 2018 and 2022. Our late friend and former colleague, then ranking member of the work and welfare subcommittee, Jackie Worski of Indiana, was a steadfast champion for children and the MCV program.
▶ 0:18:22Through the leadership of my friend and ranking member Danny Davis and Jackie Worski, Congress passed the Jackie Worski Maternal and Child Home Visiting Reauthorization Act in 2022. This act reauthorized MCV for fiscal year 2023 through 2027 and increased federal investments in the program including establishment of state match Since passage of that act, the percentage of families receiving services and
▶ 0:18:52screenings has increased and there has been continued improvement in key outcome areas. For instance, 81% of mothers received depression screenings within three months of giving birth, up from 75% in 2020 20 in 2017. 77% of children with developmental delays receive timely services, up from 69% in 2017.
▶ 0:19:17McVeyy's authorization expires in October of 2027, and congressional action will be required to continue the program. At today's hearing, we hope to hear more from the perspective of parents, home visitors, tribal communities, local agencies, and state administrators about implementation of that 2022 reauthorization.
▶ 0:19:40I hope to continue building bipartisan support for this program and better understand how we can strengthen MCV's impact on families. But make no mistake about it, the evidence is clear. MCV's MC MCVY provides early support and lifelong impact for families and children. Unlike other welfare programs, MCVY is grounded in rigorous evaluations and American taxpayers can expect measurable outcomes with these federal investments.
▶ 0:20:08I look forward to our hearing today with our expert witnesses. And uh at this time, I will yield to ranking member Danny Davis for his opening statement.
▶ 0:20:18Thank you, Mr. chairman and I thank you for holding this hearing about the maternal infant and early childhood home visiting program or MCV which is one of our most important tools to strengthen families and help babies and children.
▶ 0:20:38When talking about home visiting, I often invoke Frederick Douglas who said, and I quote, "It is easier to build strong children than to repair broken men." End of quotation. Home visiting has a kind of magic in helping children thrive.
▶ 0:21:02In particular, participants site the powerful partnership fostered by the way home visitors respect parents and guide them with resources and tools to raise healthy, happy children. Home visiting has a special place in my heart.
▶ 0:21:24I introduced my first bill to provide dedicated support for home visiting with Senator Kit Bond and Representatives Tom Osbbor and Todd Plattz in 2005. Later, both Senator Bun and Representative Platt helped enact MCV.
▶ 0:21:47In the 117th Congress, I had the honor of partnering with Representative Jackie to craft a historic 5-year expansion of home visiting. The good news that our witnesses bring today is an important part of my legacy and that of my friend Jackie, who was taken from us far too soon.
▶ 0:22:16Thanks to this committee's action in more parents are choosing home visiting and MCV improves outcomes for them while also making children safer, healthier, and ready to start school.
▶ 0:22:36We're now halfway to our goal of doubling funding for home visiting, and we'll reach it in Already evidence-based home visiting has spread to more than half of US counties with the majority of these counties supported by MACV funding in addition to directly helping families.
▶ 0:23:02MACV funding has improved broader state home visiting efforts, driving other home visiting sites to coordinate intake, shift to evidence-based approaches, and more rigorously track outcomes. MCV now funds 14 different models so states can choose the right approach for their families and communities.
▶ 0:23:31And we've already doubled the number of tribal MECV grants with more to come over the next year. I'd like to ask unanimous consent to insert an article into the record on the role home visiting can play in addressing developmental delays in tribal communities which was co-authored by Dr. follow the netz into the hearing record
▶ 0:24:01without objection.
▶ 0:24:02Thank you, Mr. Chairman. The chairman and I are fortunate that our home state of Illinois has led the way in serving mothers and fathers. MCV helps our state provide home visiting to a thousand additional families including vulnerable like expectant and parent and foster youth and makes it easier and easier for families to connect
▶ 0:24:32with home visiting programs. Our state has used new funding provided in the reauthorization to expand and you will pardon me a second there. MCV helps our state provide home visiting to a thousand additional including vulnerable populations like expectant and parent and foster youth.
▶ 0:24:59makes it easier and easier for families to connect with home visiting programs. Our state has used new funding provided in the reauthorization to expand services and increase wages for home visitors and our program outcomes consistently exceed MCV targets.
▶ 0:25:21As funding to states and tribes grow over the next two years, so will the number of Illinois families able to give their children the best possible start. Home visiting's magic doesn't happen on its own. It takes dedicated home visitors and administrators like the people on our panel today.
▶ 0:25:44It takes parents who love their children and who embrace the resources and developmental knowledge shared by home visitors. And it takes all of us on the Ways and Means Committee working together and fighting to get parents and evidencebased home visiting programs in our communities the support that they need.
▶ 0:26:09Today's stories reflect the successes that grew out of our work in 2022. And I look forward to watching how members of this committee will build on McVy's strong foundation in the next reauthorization. So, I thank you, Mr. Chairman, and you back the balance of my
▶ 0:26:33Thank you, Mr. Davis, for your opening statement. Uh, with that, I'm pleased to recognize and welcome our full committee chairman, Jason Smith, the gentleman from Missouri, and he's recognized for an opening statement.
▶ 0:26:44Thank you, Chairman Lehood, Ranking Member Davis, um, for hosting today's hearing. The maternal infant and early childhood home visiting program provides critical evidence-based services to parents and kids to improve the health and well-being.
▶ 0:27:00As important as the services offered in this manner in which MCV delivers them, by meeting families where they live, where they are raising their kids, it can ensure a more successful, more accountable program, and one that can reach more people in need.
▶ 0:27:20MCV has a long history, long history of strong bipartisan support, including the 2022 reauthorization of the program that was named in honor of our late colleague, Miss Jackie Warski. Jackie was a truly compassionate and tireless advocate on behalf of our most vulnerable families.
▶ 0:27:44Her tremendous leadership ensured that we made improvements to the MCV program that have had a clear and sizable impact. The reforms that were made made to make our state partners more engaged in the success of the program and more accountable has led to an increase in the number of families served, including a 20% increase in those in rural communities.
▶ 0:28:13Again, this is about reaching folks where they live and where they most need our help. I also want to thank our colleagues, Representative Yakam and Davis, who have led the charge to further incorporate the MCV program into the historic effort this committee has embarked on to enact reforms to our foster youth program.
▶ 0:28:38policies they have championed were included in the Fostering the Future Act that was recently approved by the House with unanimous support alongside the leadership of the first lady Melania Trump. They will help connect expectant and parenting foster youth with the maternal and early childhood services provided by MCV.
▶ 0:29:02Representative Yakam is building directly upon the great work of his predecessor, Representative Olarski, leveraging existing programs and resources to help young adults aging out of foster care build healthier, more stable families of their own.
▶ 0:29:26As my colleagues know, this is the essence This program is only authorized only authorized through the fiscal year 2027. And should Congress fail to reauthorize it, these services do not just continue on autopilot, our current funding levers levels. They stop. That is why we have to act.
▶ 0:29:54And that is why we're doing the work now to be prepared for the expiration next year, next Congress. Families who need our help will lose access to support that has a track record of success in improving lives. I'm hopeful given the bipartisan nature of this program that we can act to make meaningful reforms and reauthorize MCV in a very timely manner.
▶ 0:30:22To that end, I want to thank each and every one of the witnesses um for being here today, taking time out of your busy schedule and talking to a bunch of politicians. So, uh we appreciate you you being here. It does make an impact and a huge difference. Um strong families make strong communities.
▶ 0:30:44This is about helping the individual mom and that young child have a more positive environment in which to live and grow. But it is also about helping our communities, including our rural, underserved, and hardto-reach communities see the benefits of a healthier, more thriving I want to thank you again, Chairman Lehood, Ranking Member Davis, and I yield back
▶ 0:31:14the balance of my time.
▶ 0:31:16Thank you, Chairman Smith, for your statement there. And now, we'll move to introduce uh our witnesses on the panel today. And we'll start from my left to right here. First is Miss Mendy Smith, who is the vice president of early childhood services at Breitpoint based in Bloomington, Illinois. Next we have Shamaya Wilson uh who is the parent ambassador at Changent based in Columbus, Ohio.
▶ 0:31:41Next we have Shawn Lagoria is the program director for parents as teachers at Community Health Corps based in Long View, Texas. Next, Miss PJ West is the MCV program director for the state of Iowa Department of Health and Human Services based in Kettleton, Iowa.
▶ 0:32:01And lastly, Paula Surell Senise is the director at the department of dine education for Navajo Nation, growing beauty based in the Navajo Nation. Welcome to all of you. Uh I'll first turn to you, Miss Smith. Uh you're now recognized for your opening statement of five minutes.
▶ 0:32:21Thank you. Um, Chairman Lehood, Ranking Member Davis, and distinguished members of the subcommittee, thank you for holding today's hearing on the maternal, infant, and early childhood home visiting program or MCV. On behalf of Breitpoint and the families we serve across Illinois, thank you for the opportunity to testify about this critical bipartisan program. My name is Mindy Smith and I serve as a vice president of early childhood services at Breitpoint.
▶ 0:32:46Over my 27 years at Breitpoint, I have served as a home visitor, a program manager for healthy families and parents as teachers, and a leader of programs focused on doula services, early childhood programs, parent support, and fatherhood engagement. Breitpoint is a community-based child and family service organization serving more than 37,000 children and families annually annually across 70 Illinois counties. We work in rural, suburban, and urban communities, each with different needs and access challenges.
▶ 0:33:15Home visiting is the cornerstone of our prevention approach. I'm inspired by mothers like Sierra who lives in my hometown of Bloomington, Illinois. Three years ago, Sierra gave birth to twins. While she was already raising a one and nine-year-old, she was recently a single mother without child care or family support, experiencing severe postpartum depression. She described the emotional weight at the time as unbearable. Home visiting was the life-changing for her and for her children. As Sierra recently told us, we stood out.
▶ 0:33:45What stood out most to me was that my home visitor never treated us like a case number or a financial obligation. She treated us like family. And when you're going through a season where you feel completely alone, this kind of support is indescribable. Through home visiting, families receive voluntary relationshipbased services right there in their homes. Home visitors help parents understand that child's development, provide education, connect families to healthcare and community resources.
▶ 0:34:12At Breitpoint, we use two primary home visiting models, Healthy Families America and Parents as Teachers, which serve families with children from birth to five and birth to three years old. These models focus on strengthening that parent child relationship, preventing child maltreatment, and increasing school readiness. Across these models, the relationship between the home visitor and the family is central. Families are more likely to stay engaged and make progress when they have that same trusted person walking alongside them over time.
▶ 0:34:42I began my career as a home visitor and I remember what the field looked like before McVy. Home visiting existed but there was never enough of it and it was more fragmented. Programs were doing important work but there was not the same shared framework of quality benchmarking and coordination that we're going to talk about today. MCV helped change that. Coordinated intake is a perfect example in Illinois. MCV fund funding supports coordinated intake systems that connect families to an appropriate home visiting program while with available capacity.
▶ 0:35:12Instead of families having to connect multiple programs on their own, coordinated intake determines the family needs, identifies the appropriate model, and makes a direct connection to services. This helps families access support more quickly and helps providers use available home visiting slots more effectively. MCV has fostered innovation for families with more complex needs.
▶ 0:35:32In 2016, Breitpoint helped establish the Illinois Pregnant and Parenting Youth and Care Home Visiting Project, a coordinated intake system that connects pregnant and parenting youth in foster care to home visiting services right there in their communities. Research shows that foster care involvement can be intergenerational. Children who parents were in foster care have a substantially higher likelihood. Estimates range depending on the study and region from 30 to 50% of entering foster care themselves.
▶ 0:35:59For these young parents, home visiting can provide a trusted adult that helps them navigate parenting as well as their own transition into adulthood. MCV has also supported the integration of doula services with home visiting, creating a more complete continuum of support from pregnancy through early childhood. Doulas provide support during pregnancy, birth, the postpartum period, and newborn care, while home visitors provide the longerterm support in parenting, child development, family goals, and resource navigation.
▶ 0:36:27Through my own career, I have seen the difference it makes when a parent has someone in their corner. During pregnancy, birth, and through the early years of a child's life, parents let us into their home. They love their children, and they do the work. Continued reauthorization and investment in MCV are necessary to preserve this progress, reach more families with this effective tool, especially in those rural communities, underserved areas and families involved with the child welfare system.
▶ 0:36:54Congress should also continue supporting the home visitors and staff who build the trusted relationships with families and make this work possible every day. Breitpoint looks forward to working with Congress to strengthen and reauthorize MCV, expand access to underserved families, and ensure that more children and parents have the support they need to thrive. Thank you, and I look forward to your questions.
▶ 0:37:15Thank you, Miss Smith. We now recognize Miss Wilson for your opening statement.
▶ 0:37:21Thank you.
▶ 0:37:23Good afternoon, Chairman Le Hood, Ranking Member Davis, and members of the Thank you for the opportunity to testifi testify about my experience with nurse family partnership an evidence-based home visiting model funded by maternal infant and early childhood home visiting program or mcv. My name is Shmaya Wilson. I am a licensed social worker, community advocate and a proud mother from Columbus, Ohio.
▶ 0:37:51I am here today because McVy did more than help me deliver a healthy baby. It changed the trajectory of my life. To understand the impact of MVI, you need to understand the generational cycle I was trying to break. I am the oldest of 17 children. Growing up, my family navigated homelessness, a devastating houseire, and a life in unsafe neighborhoods.
▶ 0:38:18My mother became a mom at 14 when she was pregnant with me, and was absent by the time I turned 13. When my father was incarcerated, my young brothers were left alone to fight hunger and abandonment, and I had to step in as a caregiver once they moved In my neighborhood, poverty and trauma trapped families in cycles of forcing children to take on adult responsibilities while many adults worked endlessly to survive and turn to drugs and alcohol to
▶ 0:38:48cope. I watched members of my family struggle with poverty, trauma, violence, and instability. My sister became a teen mother with little support. One m one one of my brothers survived a gunshot wound while a cousin died beside him. Another brother was later murdered. But I was determined to build a different life. I became the first in my generation to graduate college.
▶ 0:39:16But when I became a parent or pregnant in 2022, the trauma of my past caught up to me. I entered the nurse family partnership program during my first trimester overwhelmed by fear and anxiety after a previous miscarriage and she and hearing from family members throughout my life that I was only meant to be an aunt and never a mother myself. I was convinced something would go wrong.
▶ 0:39:43I experienced frequent panic attacks and questioned whether I could become a mother that I wanted to be. But everything changed when my nurse walked through my door. My nurse became a trusted partner during the most vulnerable period of my life. She provided medical guidance, emotional support, and practical tools that helped me navigate pregnancy and parenting with confidence. I was terrified of sudden infant death syndrome or SIDS.
▶ 0:40:09But my nurse helped me learn a safe sleep practice and trust and to trust myself as a parent. When I wanted to breastfeed but doubted whether I could, she taught me to advocate for myself in the hospital and helped me to reach my goal. She didn't tell me what to do. She taught me how to speak up and make informed decisions for me and my baby.
▶ 0:40:31My nurse also taught me how to access the right medical care at the right time, reducing unnecessary emergency room visits and saving both my family and the health care system money. In 2023, my brother was murdered in front of his children. The grief was overwhelming. I completely broke down and I wanted to drop out of my M's program. But my nurse met me where I was. She came to my home and sat with me as I sat in a dark, paralyzed.
▶ 0:41:00She gently reminded me that continuing my education wasn't about me. It was about creating opportunities for my son. Because of her continuous emotional coaching during my home visits, I earned my masters in social work. Later, when I faced financial challenges during a career transition, my nurse connected me to short-term resources that helped me stay on track professionally.
▶ 0:41:25Today, I work full-time as a therapist, helping others navigate trauma and adversity while raising a thriving son who's excelling in preschool. I also lead mentorship programs in my community since every woman deserves the support that helped me change my life. The NFP nurses who supported me continue to live inside of me and shape how I parent, serve as a therapist and advocate and being mindful of joy and the chaos.
▶ 0:41:54We grow through praying, learning to hold multiple emotions at once. It is a vulnerable and honest way to live. My story is a reminder that resilience alone is not enough. Families possess incredible strength, determination, and love for their children. What they need is stable foundations that allow those strengths to flourish.
▶ 0:42:15McVy and everyone who supported this life-changing program gave me the resources to turn my myself from an anxious, traumatized pregnant woman into a licensed professional, community advocate, and thriving mother. The investment made in me, my son, my family, and my community will continue to pay dividends. That is the power of MCV. I urge Congress to please continue to provide robust funding for home visiting and reauthorize MCV well before its expiration.
▶ 0:42:45By investing in parents during one of the most important periods of our lives, you are investing in healthier children, stronger families, communities, and brighter futures. I am living proof that this investment works. Thank you for the opportunity to share my story.
▶ 0:43:00Thank you, Miss Wilson. Appreciate that. Uh we'll next recognize Miss Loria for your five minutes.
▶ 0:43:07Good afternoon, Chairman Le Hood, Ranking Member Davis, and members of the subcommittee. My name is Sha Longoria. I'm the parents as teachers program director of Community Healthcore in Long View, Texas, where I have worked over 20 years. Community Healthcore provides mental, emotional, behavioral health services to residents in 23 counties across East Texas. Our professionals deliver treatment, prevention, and outreach to more than 16,000 individuals each year.
▶ 0:43:38We help children build resilience, adults live independently, and families grow healthier. Community Healthcore received one of the first MCV grants that brought parents as teachers to Greg County in 2012. I oversaw that program startup and development and have since expanded to Harrison, Smith, and Buouie counties. We currently employ 12 parent educators who can partner with 240 families across the four counties.
▶ 0:44:06This number will expand to 260 when we hire for our current Prior to the availability of the MCV supported services, East Texas families had no access to this type of evidence-based support. It's exciting to report in 2026 that our parents as teachers program along with two other MCV home visiting programs work collaboratively to ensure families are connected to the model that best supports their needs.
▶ 0:44:35We selected the parents as teachers model for East Texas because it serves a broad population of families. Eligibility is linked to families having a child prenatal through kindergarten entry that can enroll at any point during that age span. Our parent educators partner with and support primary caregivers and welcome other family members to participate. We find there is no typical family. We have worked with mothers, fathers, stepparents, grandparents, foster parents, and more.
▶ 0:45:05Ideally, our goal is to partner with a family for at least two years. The PIT model has four interrelated parts. First, personal visits from parent educators focus on supporting child development and family interactions, which are designed to strengthen resilience, identify stressors, and find community resources if needed.
▶ 0:45:26Second, health and developmental screenings, provide an opportunity for families to get real-time data about their child development, including strengths, areas for growth, and any specific concerns. Third, resource referrals connect families, community organizations, and other programs in East Texas. It can these can include food banks, shelter, mental health services, early intervention services for children with disabilities, veteran services, and more.
▶ 0:45:53Fourth, group connections, which is help which helps families to connect with each other and build, expand, and strengthen their social supports in the community. An example of how these interrelate is a mother we enrolled who was living in one room of somebody else's house with her two children. She had no job, no car, and no driver's license.
▶ 0:46:15What she did have was She was biking her children in a cart to daycare so she could go bike around and look for a job. When she enrolled with us, we learned that she was a veteran and we connected her to our veteran services and other Armed with these, she moved forward in her goals.
▶ 0:46:37By the time she completed our program, she had a driver's license, a car, a stable job, her own apartment, and her children were kindergarten The mom knew what she wanted. She just needed support and direction. We served as her compass. This is the program at its core. We build on family strengths to support their abilities to serve their own children and achieve their own goals. I'd like to share one more example to highlight how the model serves all types of families.
▶ 0:47:07We connected with a family who received news that their new baby was born with a brain malf for. They were told not to expect the child to live past six months. We enrolled them in starting provided ser and started providing services as we knew the family would need support regardless of the outcome. We connected them with our early childhood intervention program and other resources. This child not only survived past the six-month part mark, but she met milestones her parents were told she would never meet.
▶ 0:47:38She will celebrate her eighth birthday this summer. In her last parent satisfaction survey, mom wrote, "This program has been a unique experience for our family. My child has grown and developed her skills even though she's a little girl with a brain condition. Despite her limitations, she has blossomed with the help of pat. Thank you for everything you did for our family. We love you all and we're going to be forever grateful we found you.
▶ 0:48:08In conclusion, I hope my testimony has demonstrated that McVy is a gamecher for families and children in East Texas. When families enroll in the program, parents and other caregivers strengthen their parenting skills, foster closer bonds with their children, and achieve tangible life goals. Their children are ha healthier and stronger developmentally, less likely to experience abuse and neglect, and are ready for kindergarten. If there's anything I would ask Congress, it is keep this vital program going.
▶ 0:48:37I want to leave you with a parent comment from a recent parent survey that embodies PAT. My parent educator is such a joy to work with. She makes you feel special as a parent. She gives you the confidence to conquer the world. Thank you again for inviting me to speak before you. I look forward to your questions.
▶ 0:48:56Thank you, Miss Loria. Next, we'll recognize Miss West for five minutes.
▶ 0:49:01Chairman Le Hood, Ranking Member Davis, and all members of the subcommittee. Thank you for the opportunity to speak to you today. My name is PJ West and I serve as the MCVY program director for the Iowa Department of Health and Human Services. I oversee Iowa's portfolio including statewide workforce initiatives and quality supports that strengthen home visiting services across our state.
▶ 0:49:26I've worked in home visiting for nearly 30 years, beginning as a home visitor myself. I will never forget walking up to a family's door, knocking, and having them let me into their home. Those early years sitting with families in their living rooms, on the floor with their children, shaped everything I understand about this work.
▶ 0:49:51Those experiences combined with my current role supporting programs statewide have given me a full view of what families need and what home visiting makes possible. Before MCV was created, Iowa had committed family support programs, but that system lacked stability, statewide training, and strong evidence-based models. MCV changed that.
▶ 0:50:17It provided the funding, the structure, and the accountability needed to build a modern, cohesive home visiting system in Iowa. Today, MCV funded programs serve families in the communities with the highest needs. Last year, they served more than 850 households and provided over 12,000 home visits. Over 90% of the families we serve are lowincome and may face multiple risk factors affecting health development and long-term well-being.
▶ 0:50:48Mickvy reaches families who otherwise struggle to access consistent supports. But I want to focus today on something just as important as those outcomes. Iowa's innovations. Many of them made possible only because of MCV. First, the PACES program performance and education yield success. Pays is an educationalbased salary supplement program for inhome family support professionals.
▶ 0:51:16It provides a quarterly award based on education and performance benchmarks. It improves data accuracy, strengthens reflective practice, and supports retention without penalizing staff. In PACE sites, we're seeing higher data quality and lower staff turnover. It is one of Iowa's most effective tools for building a stable, skilled home visiting workforce. Second, Iowa has made major investments in comprehensive workforce supports.
▶ 0:51:46Through Mickvy, we helped create and fully use the Institute for the Advancement of Family Support a resource providing free professional development, a national competency framework, and certification pathways. We also invest in reflective supervision, mental health consultation for family support professionals, peer support, crisis supports, and the teach family support initiative.
▶ 0:52:12A supported workforce means better supported Third, Iowa is working to reduce administrative burden for local agencies through streamlined reporting and fewer duplicative requirements. Home visitors spend more time with families and less time on paperwork. This directly improves job satisfaction and family engagement.
▶ 0:52:37Finally, Iowa strengthened guidance on virtual visits by requiring that most visits occur in the family's home. This maintains quality while still supporting rural families and those facing transportation or health barriers. We closely monitor visit types to ensure quality stays high.
▶ 0:52:57These innovations, pays, workforce investments, and reduced administrative burden show how Iowa has used MCV not just to maintain programs, but to elevate them. As someone who has walked alongside families, supervised home visitors, and now oversees the system at a statewide level, I can say with confidence, MCV works. It changes trajectories, and it is irreplaceable for Iowa's families.
▶ 0:53:26Thank you for the opportunity to share Iowa's experience and innovations. I look forward to answering your questions and working with you to ensure this critical program continues to provide stability, health, and opportunity for families across
▶ 0:53:42Thank you, Miss West. Now recognize Dr.
▶ 0:53:47Good afternoon, Chairman Lehood, Re Ranking Member Davis, and members of the subcommittee. Thank you for this opportunity and greetings on behalf of the Navajo Nation. A stunning. My name is Paulus Recas and I just recognize a strong extended family who I represent.
▶ 0:54:18For 20 years, I have worked to support Navajo children and families, including developing our program on the Navajo Nation called Hjongo Jin or Growing a Beauty Home Visiting Program. Growing in Beauty serves hard-to-reach parts of Arizona, New Mexico, and Utah. The Navajo Nation or Nikit the Nebaya spans over 27,000 square miles.
▶ 0:54:49Of the 10,700 miles of roadway, roughly 85% are dirt roads and 15% are paved. Our home visitors drive hundreds of miles per week to visit families and provide them with early childhood education, activities, and support. We build on successes with families like the Beay family and their three children ages three, four, and one.
▶ 0:55:19Upon enrollment and developing a parent relationship with with Mrs. Beay, um she expressed significant concerns about her toddler's tantrums and speech delays. She felt overwhelmed balancing the needs of all three children.
▶ 0:55:36With her home visitor, the Beay family planned daily routines with engaging developmentally appropriate learning It wasn't easy, but over six months of effort and support, things have improved for the entire family. The children experience fewer tantrums. They are thriving and eager to help with with daily activities and chores.
▶ 0:56:00They count in the Navajo language and can identify several um animals in their community in na in the Navajo language. They are beginning to speak in complete sentences and enjoy singing songs and rhythms and rhyming activities in the Navajo Our community carries the weight of historical trauma and poverty.
▶ 0:56:24designated as a medically underserved The people's life expectancy is 5.5 years shorter than the US average and our infant mortality rate is 30% higher. Compared to the rest of Arizona, twice as many Navajos, Navajo third graders fall far below the state learning standards.
▶ 0:56:45Growing in beauty helps secure the health and well-being of our people by delivering home visiting using the evidence-based model parents as Activities integrate enhance um activities from the DA culture, the Navajo culture and customs that support family strengths and builds resilience. Home visitors help to build parental knowledge, prevent child abuse and neglect, and increase school readiness and success.
▶ 0:57:15Children and caregivers are screened for health, dental, vision, and hearing, as well as developmental delays, maternal and and substance use. And families are connected to the services that they As a result of growing a beauty between 2016 and 2023, of enrolled children had documented wellchild visits with primary care.
▶ 0:57:4524% of enrolled children were identified with risk for delay. 73% were referred to early intervention. 34% of caregivers were identified as having risk for depression, domestic violence, substance use, and/or the need for general social services. Home visiting is making a difference, but some families still don't receive the support that they need to thrive.
▶ 0:58:13The Navajo Nation is a is proud to be a tribal MCV grantee and thanks you for helping to expand home visiting to more tribal nations. In the last reauthorization, you quadruple tribal home visiting funds. Today, there are 53 tribal MCB grantees, up from 23 in fiscal year 2022.
▶ 0:58:38By the end of fiscal year 2027, approximately 11% of eligible eligible tribes will receive tribal MC MCV to serve Native American and Alaskan Native families as the Navajo Nation does. Thank you again for being champions of home visiting and McVy and I look forward to answering any questions you may have.
▶ 0:59:01Thank you Dr. Senise for that and let me just thank all of our witnesses uh for your valuable and insightful testimony here today. We will now turn to the question and answer session with the members of Congress. And I'll begin by recognizing myself Miss Smith.
▶ 0:59:16Um we're blessed to have Breitpoint um in Illinois and covering much of my district and obviously the program has supported hundreds of families across uh my district in central Illinois particularly in rural communities um through the parents as teachers and healthy families America home visiting services. Um you talked a little bit about this in your testimony, but can you describe some of the outcomes and impacts on families who who you serve um who voluntarily receive McVey services?
▶ 0:59:47Yes, thank you. Um for for us, I mean, the hardest part about serving rural families is getting there. And so find and informing them about what home visiting is. So what MCV allowed us to do is to get to those those communities, hire staff from those communities, actually knowing who and where things are to so that we can get the outcomes that we're going to talk about today.
▶ 1:00:08We've seen increases in breastfeeding initiation, in domestic violence screenings, in connecting families to resources for jobs and housing that um and creating those partnerships through community partners was how we got there. The home visitors are just the connector. The families are the ones that are doing the work. I want to um give one example of a family that I get to work with that um that I did get to work with back in the day. And um she talked about she was so excited to show me the first home that she ever put her name on a on a lease.
▶ 1:00:36And I I got to go there with her and she walked to every room and wanted to show me every single thing there. And I got back to the living room and on the wall there was a picture of her and her child and a picture of a piece of paper and a frame of something that she completed in her home visiting time. and she said, "That's the first thing that I've ever completed in my life. Home visiting did that for me." And I just thought about we we Xerox copies. We give these to families. We talk about these things. And how proud she was to show that.
▶ 1:01:03And I'm even more happy to say two years after when she graduated, that wall was full of not only pictures, but accomplishments. She lived in a very rural community, had no idea that she could ever finish high school, ever have her name on a lease, ever be able to be a mother to her child, to find quality child care. and the home visitors that worked with her were able to provide
▶ 1:01:23Excellent. Thank you, Miss Smith. I'll now turn to you, Miss Wilson. Um, first of all, let me just acknowledge your um your story. Thank you for sharing that here today. Uh, remarkable uh uh describing where you came from with your family and what you've achieved and just how commendable your resilience and determination on getting your degree and being here today as an advocate. We're really grateful to have you here today and have you share that.
▶ 1:01:50Um, you talked about in your testimony how the nurse home visitor taught you how to advocate for yourself and gave you confidence to pursue your goals. Can you describe what a typical home visit was like and the role you you have seen um, home visiting services play in your son's developmental journey? Yes. Thank you.
▶ 1:02:13Um, so when the nurse first came to visit, she came in and she had like a bunch of blood pressure cups and like weighing scales and she had a lot it looked like a doctor's office in my house and that's when I was pregnant. And she did that again as he was growing as well. Um, and she would test his weight every week. So that was pretty nice.
▶ 1:02:37But the other thing that they would do um the other thing that she would do when she came is she would screen like provide screenings for him um that tested his child development as well as like give us family goals that we have for ourel that we have for our child and then provide referrals. One of those referrals um after I mentioned him having a speech delay was to a program that was a early intervention program.
▶ 1:03:03um that early intervention program that she referred us to had evaluated him and noticed that he did qualify for the program. They stayed with us for 3 years and when he turned three, he was able to get evaluated again and he received an IEP and went to preschool at the age of three. After only 6 months, my son is doing so much better with his speech.
▶ 1:03:29I mean, he has this creative way of telling me to mind my own business, like telling me, "Mommy, go take a shower." And sometimes he tells me he's busy, too. He'll just tell me, "Mommy, I'm busy." So, [laughter] he's definitely has achieved so much of that language and is feeling really confident to speak his mind and be emotionally safe and speaking for himself. So, he even tells me when he's angry and happy.
▶ 1:03:56Great. Thank you for sharing that. U Miss Longoria, in your testimony, you discussed how parents as teachers helps families build group connections and con and contribute to the family social capital. You also highlighted how the model brings bridges to other resources such as local organizations and faith-based communities. Can you provide an example of a group connection activity and explain how this has strengthened the outcomes of families who participated?
▶ 1:04:24Thank you for your question. Um, an example of a group connection that we have had was partnering with our local library. Um, so families were able to participate during story time. Um, they were able to go to the library and um, participate during that time, also learn about the programs that the library had to offer that were free to them. Um, they learned about getting a library card.
▶ 1:04:46there walked about uh the library so they knew the structure and they also were able to uh make social connections with the library staff and also the other families that attended.
▶ 1:04:58Excellent. Thank you for that. Uh Miss West, as part of the Jackie Warski Maternal and Child Home Visiting Reauthorization Act of 2022, Congress increased the the federal investments in MCV program as we've talked about and added a state match requirement. And in fiscal year 2027, states will see the largest amount of MCV funding uh in its history. How is the increased federal investment from the 2022 reauthorization act strengthen the quality of MCV services in the state of Iowa?
▶ 1:05:28Excellent question. Thank you. In Iowa, the increased federal investment from the the last reauthorization have funded new matching grants, encouraging state contribution, and dramatically strengthening program quality through enhanced coordination, workforce development, and data systems.
▶ 1:05:49These additional resources have really enabled strategic initiatives like pays that I mentioned earlier, reflective supervision, certification through the institute for the advancement of family support professionals, all in which help us uh improve retention skill and consistency among among home visitors. So truly supporting home visitors in in the work that they do.
▶ 1:06:14The funding also allowed for Iowa to streamline those recording reporting requirements, freeing up home visitors to fully engage families and improve that service delivery. Uh we also bolstered guidance and funding for virtual home visits um which ensures quality and access uh particularly beneficial for rural uh areas of Iowa in which I live uh while maintaining fidelity to that evidence-based model.
▶ 1:06:44Thank you for that. And lastly, uh Dr. Senise, um in your testimony, you discussed challenges in serving remote tribal communities such as the lower rate of referrals to community resources due to long waiting lists and extreme distances that must be traveled to receive these services. Um what strategies have home visitors deployed to overcome some of these challenges in tribal communities and what can be done to reduce these barriers?
▶ 1:07:14Thank you for that question. The um as mentioned earlier, there's uh unpaved roads within on the Navajo Nation. Um very few um passable roads. So our home visitors do travel directly to um the homes to address the developmental needs um where families don't have necessarily reliable transportation.
▶ 1:07:38and they connect um they they are the bridge to providing the direct services for the physical divide of bridging developmental screening um health education and parent resources directly to the families.
▶ 1:07:53Um it also we also address the gap that parents have the inability to access valuable resources by developing a a broadbased um resource mapping that collects the data for resources for families where we can connect families to those resources as well. So we also connect uh service resources to those families. Thank you for that question. Thank
▶ 1:08:20that concludes my questions. I recognize Mr. Davis for his questions. Thank you, Mr. Chairman, and let me thank each one of you for your very impactful As a matter of fact, you reinforced for me having taken a job in 1970 working with the visiting nurses association at a community health center in Chicago where I first learned some of the principles
▶ 1:08:50and practices of what home visiting really is about. Dr. as you were instrumental in bringing home visiting to the Navajo Nation and adopting the parents and teachers model to incorporated into the Navajo culture.
▶ 1:09:12Could you tell us more about some of the that that home visiting filled for this population group? Thank you for that question. Um, as I mentioned um earlier, we do provide the direct uh visits to the families. So that definitely fills the gap of families not having to come to us for services.
▶ 1:09:41The um incorporating um the Navajo culture and language into our program also um builds that child family relationship. We've adapted the parents um parents as teachers model to incorporate Navajo culture and values which is allowed in the parents as teachers model. So that fills that gap of developing uh curriculum and and services directly for the family's needs.
▶ 1:10:10Um, we work with families to um connect them to resources such as um home insecurity, I'm sorry, food insecurity resources and other resources for developmental screenings. We connect them to early intervention. Um, children are often identified through our early intervention program um and referred for home visiting to provide the direct services for for the families.
▶ 1:10:38Thank you. Thank you very much. Um, Miss Smith, I was very interested in the comments that you made relative to work with males in the program. Could you share with us a bit about that work?
▶ 1:10:56Of course. Um, what we try to do is we're engaging fathers from every every stage of home visiting. If it's during recruitment, during um enrollment and throughout the service um um with a with a home visitor, we're engaging them to be invited in the in the service in the home visited home visiting actually, you know, um their their sessions as well as um having parent support groups just for dads.
▶ 1:11:21What we have found is um I talked to um a father a couple weeks ago that was going through a graduation ceremony and he stated that this was the first program that first invited him to participate, engaged him to participate, had resources that were geared more towards dads and also provided a peer support group of dads that are able to talk like dads. He said, "I finally was respected as a father. Someone actually listened." And so, you know, being in human service a long time, we know that not everything um has been set up to do that.
▶ 1:11:51So, I think partnering with fathers, hearing how they like to be engaged, how they like to um show up is really important. In Breitpoint, we spend a lot of time talking to dads to get that input. So, it's it's a partnership and um the children um have loved it. Um we have found in our doula program, if we get fathers involved in the prenatal program, they're more likely to stay throughout the the time of the program.
▶ 1:12:14And what you know, research shows that if a father's involved in the prenatal time, they're more likely to stay in the child's life long term whether or not the you know um the parents stay together. So it's really important.
▶ 1:12:26And Miss Miss Wilson, I'm very familiar with the type of communities that you described in your testimony. I've lived in those kind of communities. I've been a part of those kind of communities. How how how helpful was the inspiration that you received from your case worker, your worker?
▶ 1:12:55Thank you for that question. Um, she was very helpful. I mean, even going back to what you were talking about about, you know, involving fathers. Um, my fiance, he's now my fiance. Um, but at the time he was my boyfriend and we had our child together. And one of the things that she would do is definitely involve him in the parenting process of it. And it wasn't hard because he's always been very much involved in it.
▶ 1:13:23But even just teaching him some of the tools and making sure that he's a part of the conversations that we were having. um when I had questions about sleepovers or you know letting him go over people's houses and you know how to fight the how to create those boundaries with where he can go and where he cannot.
▶ 1:13:42She was very helpful in helping me like realize that I'm allowed to have those boundaries and how to safely establish those and that I didn't have to be mean about it, but just keeping him close and it made me feel really good um and confident about raising him, knowing that I have that option to say, you know, I don't feel so safe with put my son here, he has to stay there. Um when I was showing her the places that I wanted to move to, um we came up with a gated community, so I was really excited about that.
▶ 1:14:12um she provided safety just when she came and visited the home, making sure that um she didn't make us feel unsafe. I know for me, I was always scrabbling around and trying to clean up before she got there, but she just stepped in and she's like, "It's fine. It's fine." So, it's like that confidence that allows you to feel okay in your house. It's hard to open those doors to people and feel like you might be judged. So,
▶ 1:14:36thank you, M. Thank you very much. And I yield back, Mr. Chairman.
▶ 1:14:40Thank you, Mr. Davis recognized Mr. Kerry of Ohio.
▶ 1:14:43Want to thank Chairman Lehood and thank the ranking member uh Davis for covering this hearing today and I want to thank all the witnesses for being here but obviously Miss Wilson is from the Buckeye State. So most of my question is going to be spent on you. Um and you know and and that description of having that person come over to the house and trying to clean up real quickly before they got there. And you know that kind of reminds me when my wife's out and I've got the two kids at the house. I try to do the same thing every time she's gone.
▶ 1:15:12But um I noticed from your testimony you you went to Youngstown State. Am I correct with that?
▶ 1:15:18Yes, that's correct.
▶ 1:15:18Now, are you from the Mohoning Valley originally or did you go to school there? How did you how did you wind up in Youngstown?
▶ 1:15:24So, I actually am from Columbus, Ohio.
▶ 1:15:27Um I was going to go to Akran University. It was really hard to make that decision to go to Youngsttown State University because I knew I would be leaving my siblings wherever I went. But um I was talking to someone at my school from the I know I can uh [clears throat]
▶ 1:15:42organization and I did my fast all the way wrong. [laughter]
▶ 1:15:47And so she had helped me go through it and she was like my son's going to Youngstown. Have you considered that? And I'm like no. So
▶ 1:15:54well the only reason I asked is I looked at your I looked at your resume and one of our former colleagues uh Bill Johnson is the president of Youngstown State. So I sent him your resume. Wow.
▶ 1:16:07And I said, "Is there anything you want me to say?" Because one of your graduates is testifying before the Ways and Means Committee and he said, "Say go
▶ 1:16:16Okay. So, I I I just had to do that.
▶ 1:16:20A penguin.
▶ 1:16:21That's right. And and my time is a little bit. And you're on the east side of Columbus. So,
▶ 1:16:25for those of you who don't know Columbus, I I always define myself as the member from Columbus who is not Joyce Batty. Okay? And anybody who knows Joyce knows why I'm saying that. But uh Joyce and I have a very good relationship and I know you're one of her constituents and you're well represented by Joyce. But I just want to take a few a few minutes. I and I don't have a lot of time but one of the things that I I was looking through this and I because your experience talking about you know coming from were you from the east side originally of town?
▶ 1:16:55I've lived all over Columbus. Um, I believe that I was born maybe on the south side, but I spent a lot of time on the north side.
▶ 1:17:04And spent the rest of my teen years on the east side and in between that, the west side.
▶ 1:17:09Okay. So, you you've been all over central Ohio. But, so I just wanted to just kind of, you know, because I know there's going to be a lot of people in our region, you know, um, that that are going to be watching this. And so can you kind of explain for others that may be in the same situation that you were, how uh Franklin County um how the nurse family partnership model specifically and McVy Services as a whole, how you found out about them, how you got referred to them, and maybe go into a
▶ 1:17:39little bit of detail because if somebody has five minutes and they're seeing somebody from Columbus, a Youngsttown Tate graduate, how did they do it? Where did they get the information? So, I actually got the information from attending a um event that we had at my job at the time. And my boss, she told me, "Go over there and talk to them. You're pregnant." So, I went over there and I talked to them. It was another program and they said I was over income. So, after that, they told me that they would still refer me to another program, which was the nurse family partnership program.
▶ 1:18:09Um, so that was one way that I got connected personally was that they gave them my information. Um, there are other programs that can send referrals. I know that there's a website called RISE for mothers who have their children or um families that have their children's in child care and that website also provides referral services if they need them as well. So there it's basically a referral program. Um you can also get onto the website changeent and access it there.
▶ 1:18:37um it'll take you straight to our state and you can email the person um and let them know that you're interested in the program
▶ 1:18:44and and you're an ambassador for that program now. Am I correct with that?
▶ 1:18:48Yes, I am a parent ambassador for change
▶ 1:18:50And how and how does that work? What do what do you do in that role? What do you advocate for? How do you do it? We don't have a lot of time, but
▶ 1:18:56um so real quick, uh parent ambassador is probably one of the best situations I could get myself into. Um it's amazing. Um, what this program does is provide us the tools to be able to do exactly what I'm here doing today. And that's advocating for not only myself, but the people in the program and it also supports us in other ways with our professional development and helping us network and find opportunities with others and the things that we're most interested in. So, if you're a nurse, um, you can do that, too.
▶ 1:19:24And they have also something that is called um I don't know the name right now. It's not clicking to me. But when you're a person that graduates, you have access to this program and it provides career building skills too. So it doesn't just stop at nurse family partnership.
▶ 1:19:41Miss Wilson, my time is out, but as a Buckeye, I have to say oh
▶ 1:19:46I owe.
▶ 1:19:47There we go. With that, Mr. Chairman, I
▶ 1:19:50Had to do that for you, brother.
▶ 1:19:52Thank you, Mr. Kerry. I will now uh turn to Miss Chu of California.
▶ 1:19:56Well, I want to thank all of the witnesses for sharing your experiences and doing such a great job at it. Um the evidence could not be clear that home visiting delivers such strong positive outcomes for children and families. Four years ago, I was proud that this committee worked in a bipartisan matter manner to pass a MCV reauthorization bill named after our incredible colleague Jackie Worski.
▶ 1:20:21In that law, we doubled over overall MCV funding and also doubled the set aside for tribal home visiting. As a result, Miss Cenas, you testified that by the end of 2027, we expected to have as many as 70 tribes receive MCV grants, which is about triple the number that we had in 2022. But even with that dramatic increase, 70 would have still represented only about 11% of all eligible tribes.
▶ 1:20:51You also mentioned that tribes have to compete against one another for grants while states get mandatory funding. Can you talk about the challenges tribes face when competing for funding? How would tribal home visiting programs and the families they serve be impacted if Congress were to increase funding for tribal MCV so that tribes don't have to compete for such limited funds? Thank you for that question.
▶ 1:21:20There are challenges in competing for the funds and um because of the high competitiveness of these grants, it can can provide some challenges. Um oftent times tribes are um being operated by small administrative staff um where the a single employee may um like myself wear different hats um to to so there are administrative and capacity um constraints when applying for a highly competitive federal
▶ 1:21:50grant. Also, some tribes may not know that the evidence-based models that are here today are being able to be adapted. Um, and so oftent times um while these models are important um they have not been evaluated um or validated in some um American Indian Alaskan Native communities. So um being able to uh look at those adaptations are important when a tribe is applying for for funding.
▶ 1:22:20Um so shifting the competitive um scarcity of funding uh shifting it to more equitable, sustainable um funding that respects tribal sovereignty and fulfills the responsibility for ensuring that Native American children do receive the home visiting supports that they need.
▶ 1:22:41Um, expanding the funding for home visiting would definitely increase the services in tribal communities, especially in Alaskan Native uh, villages where they have to um, they can't get to homes without, you know, uh, boat flight or um, and so it would definitely increase the um, number of families being served in tribal communities. Thank you for that
▶ 1:23:05Thank you. And I'd like to address this question to both uh, Miss Longoria and uh, Dr. Cenis. and it's about the uh fact that there's a big challenge that we've heard about recruitment and retention for the workforce due to issues like low pay and overwhelming case loads. So, um Miss Langori, you were a former uh home visitor now supervisor. What challenges do you see with those issues? And Dr.
▶ 1:23:32Cena, can you talk about the unique challenges that tribal MCV programs face in hiring and retaining home visitors? Thank you for that question. Um I can tell you reflective supervision uh provides an immense support um to our home visitors which is a integrated part of the PAT model. Um it provides them a safe space to feel supported, heard and reflect and uh be able to reflect which is what they provide to families.
▶ 1:24:01So um thank you for asking about the investments we need. um that I spent time maneuvering budgets and making decisions for our staff uh and resources every day. My first recommendation is to uh do all you can to increase MCVY funding. I mentioned in my written testimony, we struggle to pay parent educators what they are really
▶ 1:24:23We have we're having a difficulty hiring for our vacant parent educator position as applicants are declining due to low
▶ 1:24:30Yeah, sorry. I want to make sure that Dr. Cenus has a chance to respond to She thank you for that question. Um our home visitors are um members of tribal communities. So oftent times they're approached at grocery stores and other functions and so they're never off the clock. So this may mean also burnout when they have to serve their communities. So reflective supervision does provide a lot of that support.
▶ 1:24:56In addition, um we um pay is is another example of of what it what we are challenged with. And finally, um to to find professionals qualifications and the deep cultural and language backgrounds, it is necessary to increase the pay and um really support these home visitors through reflective supervision.
▶ 1:25:20Thank you for that Now recognize Miss Yakam, Mr. Yakam of Indiana. Please.
▶ 1:25:31Thank you, Chairman Lehood, and to our witnesses for all being here today. The Maternal Infant and Early Childhood Education Visiting Program or Mickvy is a top priority for me. It has a long history in Indiana's second district as my predecessor Jackie Worski was a longtime champion. She worked tirelessly with her friend at the time and now mine, ranking member Davis, on the last reauthorization, and it was named in honor of her after her tragic passing.
▶ 1:25:58I'd like to give a special thanks to Chairman Smith, Chairman Le Hood, and my colleagues for recognizing Jackie and the great work that she did on behalf of this program. You know, my grandfather used to say, "When you have children, they don't come with an instruction manual. You just have to figure it out yourself." I'm a proud father of three kids over the age of 10, but I still remember preparing for the first arrival of our daughter L. Those early days as a parent, certainly for any parent, can bring a lot of anxiety.
▶ 1:26:25I remember leaving the hospital and thinking, I can't believe they're letting me take this child home. You agonize oftentimes over the the little things, you know, the cries. Is that a hungry cry? Is that a tired cry? Or is one of us on diaper duty? You just have to figure it out. Yeah, often your mind often wonders to the more existential questions like, "How do I raise this child to be a good person and ensure they're a productive member of society?" You're making it up as you go and you learn from a lot of trial and error.
▶ 1:26:54But a strong support system of family and friends can lead that can lend a hand or sometimes advice is a differencemaker. But unfortunately, not everyone has that. That's where a program like Mikvy comes in. It brings trained professionals alongside at risk families to coach parents on valuable skills and lead to better child development, decrease instances of domestic violence and child neglect, and improve economic self-sufficiency. What sets Mickvy apart from other programs is that it's evidence-based.
▶ 1:27:24That means that the methods and approaches have been researched and tested. That gives us confidence at as legislators that our taxpayer dollars are getting results, not just counting the numbers served. I want to share the story of Katherine, a constituent who is facing pregnancy with twins as a single mother. I spoke with Katherine this morning and she shared with me how she searched for resources and found the nurse family partnership or NFP through Goodwill Michigan.
▶ 1:27:51Her NFP nurse Tasha became a steady presence that helped her prepare for motherhood. It also provided a vital resources and more importantly trusted support. During early motherhood, Tasha noticed that Catherine was struggling with severe postpartum depression. And Tasha connected her with a therapist to help her navigate and manage her depression. While talking with Catherine, she shared that the NFP saved her life and that she wouldn't be here without Tasha because Tasha helped her take control of her postpartum depression.
▶ 1:28:22NFP gave Catherine important resources and supportive relationships to help her and her sons thrive. This is just one example of the incredible work that Mickvy programs do in our community and across this country. Indiana is proud to have a strong Mikvy program that exceeds the national threshold for 10 out of the 19 performance measures. Since 2011, nearly 16,000 Hoosiers have provided almost 400,000 home visits.
▶ 1:28:48Miss Smith, could you speak about the landscape of home visiting before and after the 2022 reauthorization of the MCVY program and why program outcome measures are so important?
▶ 1:28:58Yeah, thank you. Um, not just the doubling of slots, which are, you know, were extremely important, the doubling the money for slots and and seeing more families, but that emphasis on the rural communities. I come from Illinois and the same type of how we get to families um was was was critical. that emphasis on spreading the these this critical resource that you talked about having that support system was was really important.
▶ 1:29:22The other piece was the training the training component of the national institute um which some of my staff have have proudly been a part of and we've seen that that that increase of retention for staff that um the quality increasing and how they provide the home visits and it also professionalized the the the job of a home visitor. people know what it is, what it does, and why it's so important to pay the the to put in that development dollars and to pay um a salary, which we were some of my colleagues were talking about today.
▶ 1:29:50Thank you.
▶ 1:29:51Two of the main focuses of the last MCV reauthorization was to reduce the program's administrative burden and better support the home visiting workforce. To date, HERSA has reduced that burden by at least 37% and developed the national strategy for the home visiting workforce. Miss West, in your experience, how has a reduction administrative burden burden benefited home visitors while maintaining program
▶ 1:30:15That's an excellent question and something that we consider all of the time in Iowa. Uh the reduction in administrative burden has been felt strongly at the state level and we felt really strongly about assuring that that was passed down to our local implementing agencies and in turn to our home visitors so that they could spend more time with families and less time on paperwork. Yes, the data is important.
▶ 1:30:42uh proving results is important, but we want our home visitors spending time with families and supporting them in all of the ways that you've heard here today. Uh it is a priority of ours, not just through this reauthorization, but in the future to try to maintain and keep those administrative burden levels
▶ 1:31:03Thank you to all of our witnesses again for being here. Mr. Chairman, I yield
▶ 1:31:06Thank you, Mr. Yakam. Now turn to Miss Moore of Wisconsin. Thank you so much, Mr. Chairman and ranking members. Uh, I have listened uh with delight at all the testimony that we've had here today from all of you and I've uh and instead of all the questions and inquiries from my colleagues causing me to say all the questions have been answered, I got more questions.
▶ 1:31:36But I I've enjoyed this dialogue with all of you. I want to start maybe with uh with Dr. Cinez. Um I noticed that in the Navajo community something like 36% poverty rate.
▶ 1:31:56I I guess that speaks volumes about our notions here that resilience is really an important tool to try to navigate things, but resilience is temporary and it it doesn't help if you don't actually get the support that you need. I think Miss Wilson, you may you're just holding on by your fingernails until that help comes along. And so, um, and you also talked Dr.
▶ 1:32:22seen as about uh some of your navigators um seeing people working 24/7. They see people in the grocery store. They're never really off. How we we have on this committee really come to some conclusion that poverty is not And so, so how do you how do you train people through MCVY and these other programs when they do the home visiting to make a distinction between somebody who needs some resources
▶ 1:32:53and they're just poor uh and somebody who's neglecting their kids? If you go in a house and there's no food, is it that they're, you know, is it they're neglecting their kids or they just need food? How do you how do you train for Thank you for that question. When we um hire our home visitors, we definitely make sure that they are from the community because they are very familiar with the vast Navajo Nation.
▶ 1:33:20We make sure that they are they do come from those communities and um training them about parent child interactions um and developing those relationships building trust and parents as teachers um through their curriculum has a basic foundation or a very good foundation for building that trust. So
▶ 1:33:40yeah. Yeah, that's is important. Miss Wilson, you know, you really mentioned, you know, the fear of someone coming in and seeing your house dirty and judging you. I know my kids would have been taken from me a lot of times if that had been the standard of of care. Um, so cultural competence is important and I mean I'm so glad you're a real social worker, not just a case worker, but a real educated social Congratulations on your journey. We ought to clone you.
▶ 1:34:10Um, but Miss Wilson, uh, Miss Smith, I want to ask you a question related to what she is is saying. You you have uh you use doulas uh in your program to help people navigate uh up to what three years old or 18 months old. What what is the timeline
▶ 1:34:34Yeah. So the doula um usually comes in around the beginning of the third trimester and then stays about 8 to 12 weeks after the child's born in partnering with the home visitor that would stay until 3 to 5 years.
▶ 1:34:44Gotcha. How has do you can you give this committee some insight into how doulas uh have saved lives or prevented SIDS that Miss Wilson was terrified of or you know stop you know she sounded like she was terrified during her pregnancy. I was too. I I I had my first child at 18
▶ 1:35:08um I just looked up the history of Pampers, which I couldn't afford in 1970 anyway, but the visiting nurse taught me how to put a diaper on after I stuck my baby several times. Um how has how have doulas changed the landscape for for women and children outcomes?
▶ 1:35:25Yeah, we have found when we are able to partner doulas and let them be the prenatal prenatal experts and let the home visitors do the longer term the parenting the the life goals that it provides a higher level of of of relief of knowledge of what that's going to be like and be able to advocate for your own birth understanding what what that that entails to be
▶ 1:35:46how important is cultural competence you know like Miss Wilson like you not being judged or like Dr. CZ said, "Not being judged by
▶ 1:35:55by someone, you know, it's important to
▶ 1:35:58people who speak the language you,
▶ 1:36:01you know, Muslim. They're not going to fix you a pot of gumbo with shrimp and pork in it."
▶ 1:36:06Exactly. Yes. And we actually, you know, hire former participants as well that actually can talk the, like you said, talk the talk and be able to really tell how this is going to feel and how they can support to advocate and support that
▶ 1:36:18Mr. Chairman, thank you so much. This has been a delightful hearing and I I do love this subcommittee.
▶ 1:36:26Thank you, Miss Moore. We'll get you on the record for that. Thank you. We appreciate it. Um we'll now recognize uh Mr. Bean from Florida.
▶ 1:36:39I'm in. Thank you so much, Mr. Chairman, and a very good afternoon to you, to committee members, and especially our witnesses. Let me tell you one thing you'll always have for the rest of your life. You get to say that time I testified before Congress. How about that? Not everybody can say that. Uh Mr. Chairman, I know what you're thinking. You're thinking I'm I look way too young to be a grandfather.
▶ 1:37:09How about that? Uh but it is true. And uh I am blessed with the cutest, most intelligent little toddler grandbaby uh there is. Uh we think up excuses to take dinner to uh to our kids just to see the grandbaby. We will uh help them with appointments. And my staff knows that if it says uh uh the congressman is babysitting uh that cannot be overridden.
▶ 1:37:38I will uh we will babysit anytime that we get a chance. So the support that we give our kids and our grandchild is uh is I think uh we'll do anything we can for them. And you know what it's what our parents did for us I guess when I had a kid and and uh uh explained he didn't know what he's doing. I didn't know what I was doing either. But there we are. Uh that we give that support. So I can't imagine when you don't have that level of uh of support.
▶ 1:38:07By the way uh Pop Pop is my uh code name. pop and BB. That's uh that's that's where we are. So, not to have that support, but enter uh the MCV program. The maternal infant and early childhood home visiting program created in 2010. Uh provides funding for lots of groups that can access this funding to provide evidence-based visits in the home right where it needs to be.
▶ 1:38:37uh to give uh parents who were facing an uphill battle and we know if we don't help them, they're most likely to get in trouble health and whatever wise uh to give there in Northeast Florida. I'm going to recognize the Magnolia Project and the Northeast Florida Healthy Start Coalition that have accessed this program and I visited with them many times. I was in the state senate before and uh we utilize this program and want to continue it.
▶ 1:39:03I know uh it has a sunset feature or at least it's going to it's going to run out unless Congress acts. So, we need to act. So, here's a tossup question for the panel. What happens if this program goes away? Anybody want to jump in? You got to be short and brief, but uh what is it? Uh Miss Wilson, you uh you buzzed in first.
▶ 1:39:24So, I would say what happens if this program does not continue is that there will still be a whole lot of violence. Um, by having this program, we decrease the violence in the neighborhoods, giving those parents those opportunities to really think about and have access to someone who can coach them through those emotions and those hard parts of
▶ 1:39:45Nice. Nice. No, Miss Wilson, well done. You're on the board. Anybody else want to jump in? Miss West, you're
▶ 1:39:50I'll I'll go. I If MCVY funding went away, it would have a huge impact in Iowa. I know it's a two-year grant period. We spend all of our money in year one and if MCV went away over 800 families would go unserved and not have those supports and people to help them understand what parenting is like. Uh I oftenimes say we parent the way we are parented unless we learn a different way or if we have a parent who helps us through that. And so that's home
▶ 1:40:19Miss West, you're on the board too. Okay, here we go. We hear about this uh evidence-based and for those that say this is just another throwaway program. Who can tell me uh what evidence are we basing it on? Who can cite something that I can say see there? This is how we save money by uh by heading off the pass and preventing these bad outcomes. Who wants to jump in?
▶ 1:40:44Miss Smith, you're recognized.
▶ 1:40:46Yeah, thank you. Um well I mean the the the the point of like with the youth in in care that we're working with we're providing home visiting you're looking at 30 to 50% chance of those children going into foster care without this additional help of home visiting. So your first question what happens if we get rid of home visiting child welfare numbers will will go up child uh foster care as well as mental health service
▶ 1:41:07Thank you. Thank you so much. Let me uh say this. Uh there's lots of headlines out there. Don't hold your breath that the headline on whatever newspaper you want to talk about that Congress comes together and agrees that the MCV program should uh should continue. That's something that we both uh both sides of the aisle agree with. So hopefully uh we can get it done. Mr. Chairman, I'm on board to make it happen as I think everybody on the committee. So with that, Pop Pop yields back, Mr. Chairman.
▶ 1:41:38Well, thank you, Mr. Beam. Bean, I'm not sure we actually needed to turn on your mic. I think you would have been fine on your own. [laughter] Um, our last uh member to ask questions today will be Mr. Miller of Ohio. You're
▶ 1:41:53Thank you, Mr. Chairman. It's uh it's going to be really hard for me to compete with uh my colleague Aaron. So, but thank you for being here uh this afternoon. It is a pleasure and thank you to the chairman for doing this. I represent northeast Ohio, a region home to thriving cities, small towns, and rural communities, many of which face significant challenges accessing quality health care and family support services. That's why today's hearing matters so much to me and as you can hear to everyone, right, as well as the Congressman Gary and Chairman of the Hood, as well as everyone on the other side.
▶ 1:42:23Um, so in fiscal year 25, Ohio's MCV program served more than 2,300 adults, 2,200 children, and conducted nearly 24,000 home visits across 26 counties, 16 of which are rural. These are real families and real communities getting the support they need before a challenge becomes a crisis. Mickvy works because it meets families where they are, literally.
▶ 1:42:47Trained professionals go into homes, build trust, screen for development delays, connect parents to resources, and help families get on a path towards stability. And the data backs this up. Since 2017, the share of mothers receiving postpartum depression screenings has risen from 75 to 81% nationally. Children with developmental delays receiving timely services has risen from 69 to 77%. These are not small numbers. These are children and families whose trajectories have been changed forever.
▶ 1:43:17The 2022 Jackie Walorski Reauthorization Act expanded MCV's reach by 15% nationwide, including a 20% increase in the number of rural communities that it served. That is meaningful progress and showcases the effectiveness of this preventative program. I look forward to hearing from our witnesses today about what this program has meant for families and how it is working. And once again, thank you all for being here today. It's a pleasure listening to you and hearing your stories. I know I haven't been present but in committee, but listening in the back.
▶ 1:43:46So, thank you very much, Miss Smith. Breitpoint serves families across Illinois using a coordinated intake system to connect them with the right home visiting program. Can you just walk us through how Breitpoint spreads the word about Mickvy services in the communities you serve and how coordinated intake process makes it easier for easier for families to get
▶ 1:44:06Absolutely. Um, being someone that's been in the field for three decades, I remember the days of just handing out flyers, agencies competing on trying to get slots filled. So before McVy and what coordinated intake has been able to do is to not only coordinate those services but to help navigate families through that there's one place where you can go what's home visiting and which one do I apply for it reduces time it gets families in home visiting earlier which is important sometimes for model for the model itself but also we know that the if we can get in that prenatal the earlier the better
▶ 1:44:36um it also has um increased just the quality of the referral they know what it is they're engaged they want to participate that voluntary nature and getting them involved is a critical component of home visiting and we feel that coordinated inkake does that in a way that that makes parents understand what they're signing up for before that knock at the
▶ 1:44:53Yeah, thank you very much. Yeah, just like everything in life and I know people say it all the time, but it's familiarizing yourself with the process or whether it's education, one of the two, however people would like to frame it or talk about it is incredibly important and thank you and your organization for getting that done and and educating those parents um so that they know. Miss Wilson, I I know you're from Ohio. I saw Mr. Carrie go oh io. So I need one as well. Okay. So oh
▶ 1:45:20All right. Thank you. It wasn't as good, but I understand. I'm I'm piggybacking off. So [laughter] your testimony describes how your nurse family partnership orers helped you work through real fears about your son's safety as a new mom, including concerns about SIDS. And I know you've talked about it earlier a little bit, but can you share what support looked like and how it gave you the confidence, you know, to care for your son and to get through those times?
▶ 1:45:45Yes. So, um, in my history, I have two siblings that passed away from SIDS, um, as early as like two or three months. But, so I've known all along about ABCs and the risk of that, like making sure that they're alone on their back in a crib. But it's really different when you're a parent and all you can do is keep falling asleep because you know the oxytocin is releasing.
▶ 1:46:06Um but what my person what my nurse has done for me was letting me know the strengths that I already had that was fighting against SIDS and that was nursing. Um when you lack that when you're nursing your child that can prevent SIDS. She also taught me um that I'm staining from drugs so that also keeps him alive as well as checking on the baby throughout the night and throughout the day. and where he should not be sleeping and then also preventing secondhand smoke in the home.
▶ 1:46:34So, knowing that I was doing all of those things gave me the confidence to know that my son was going to be okay even in those moments where I really couldn't believe it. You know, just wanting to fight and keep my son alive was the goal.
▶ 1:46:48Thank you for sharing that. And I I truly believe it's important for people back home and all of our communities to hear your story and you know the things that Americans go through and just thank you for staying strong and getting through the program and thank you for being who you are. Uh Mr. Chairman, I yield back.
▶ 1:47:03Thank you, Mr. Miller. Um that concludes our questions and answers today. Um and I just want to again in closing want to thank each and every one of you for taking the time and effort to be here, for contributing to this conversation. the dialogue, the discussion helps all of us as we look at the reauthorization of MCV and suggestions and things that we ought to be thinking about, but also thinking about how valuable the resources are in what they do and affecting children and families and people's lives on a daily basis.
▶ 1:47:33So, we commend all of you for the work you do back home. We look forward to working with you along with all the colleagues here in a bipartisan way as we work towards a reauthorization of MCV. With that, please be advised that members have two weeks to submit written questions to be answered later in writing. Those questions and your answers will be ma made part of the formal hearing record. And with that, the committee stands adjourned. Thank