Appropriation; Health Start

Appropriates $          to the Health Start program. (SD1)

THE SENATE                              S.B. NO.           S.D. 1
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            

                   A  BILL  FOR  AN  ACT



 1      SECTION 1.  The legislature authorized piloting of the
 2 Healthy Start program in 1984 in response to concerns related to
 3 the increasing cost of remedial programs for social problems,
 4 such as mental health, remedial education, and delinquency and
 5 crime.  Healthy Start was developed with the capacity to identify
 6 children at risk at birth, those born into overburdened families
 7 with multiple stresses and risk factors, such as domestic
 8 violence, substance abuse, mental retardation and mental illness,
 9 and single and teen parents without support systems.  Families in
10 need of extra support are enrolled in home visiting services on a
11 voluntary basis.  Home visitors seek to reduce the stresses that
12 typically precipitate abuse and neglect, foster positive
13 parenting skills and positive parent-child relationships, and
14 strengthen self-sufficiency of parents to provide safe and caring
15 homes for their children.
16      Healthy Start has proved to be successful.  There were no
17 cases of abuse and only four cases of mild neglect among two
18 hundred forty-one high-risk families served by the pilot project.
19 With expansion to twelve communities across the State since 1988,

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 1 there has been no abuse for ninety-nine per cent and no neglect
 2 for ninety-eight per cent among the thousands of families served.
 3 Other positive outcomes have included:  a ninety per cent
 4 immunization rate, a ninety-five per cent rate for children
 5 having a consistent medical care provider, developmental
 6 screening of all children with referrals for developmental
 7 delays, improved child-parent relationships, and decreased family
 8 risk factors.  A study of children hospitalized for abuse and
 9 neglect at Kapiolani Medical Center from 1991 to 1994 showed that
10 nearly all of the children had been under age five and half were
11 under age three.  Furthermore, five and a half times more high-
12 risk, non-served children were hospitalized than those served by
13 Healthy Start.
14      A recent study by Survey Marketing Services showed that
15 Healthy Start is considered the most effective of the current
16 child welfare reform efforts in Hawaii and to be the most
17 promising service to reduce child abuse in the future.  The
18 Blueprints for Change conducted a cost benefit study which showed
19 prevention of child abuse through the Healthy Start program to
20 have a cost benefit ratio of nearly three-to-one over treatment
21 services.  This study considered short-term savings for child
22 protective services, foster care, and children's mental health.
23 This study was conducted before mental health service costs

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 1 increased dramatically.
 2      Healthy Start has become an internationally-acclaimed model
 3 program for family support and prevention of child abuse.  The
 4 Healthy Families America initiative across the United States, and
 5 similar programs in Canada, the Philippines, and New Zealand have
 6 been developed with consultation from Hawaii.
 7      The foresight of the legislature in establishing early
 8 intervention services in 1984 is strongly supported by
 9 contemporary research.  New early brain research informs us that
10 the formative years from conception to age three literally wire
11 the young brain for emotions and learning and that the foundation
12 for basic personality and capabilities are established during
13 this period.  There are specific periods for development of
14 emotional security and resilience, capacity for positive social
15 behavior, and for language which close by the end of the second
16 year.  Trauma and neglect during this period have been shown to
17 have a lasting impact, with extremely detrimental effects upon
18 emotional and cognitive development.  The child who arrives at
19 school with emotional and behavioral problems and lacking basic
20 language skills will require much remedial support to perform
21 well in school.  If the child does not read by the third grade,
22 that child will become a prime candidate for school failure.
23      Hospitalization data strongly suggest that statewide

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 1 services to all newborns at risk could reasonably reduce serious
 2 abuse to children under age five by more than seventy-five per
 3 cent.  Because early trauma is a major factor in so many social
 4 and health problems, the short- and long-term benefits would be
 5 significant to the State.
 6      Mental health services for children currently cost over
 7 $100,000,000 and this continues to rise.  Early trauma is now
 8 clearly recognized by the National Association on Mental Health
 9 as a leading cause of emotional disturbances of children and
10 long-term mental illness of adults.
11      Compensatory and remedial education budgets totaled
12 $150,000,000 in 1997.  The 1978 National Incidence Study on Child
13 Abuse and Neglect concluded that children who experience
14 psychological abuse or severe violence are more than twice as
15 likely to have failing grades in school.  These children were
16 also more likely to use drugs and be arrested.
17      The state budget for adult and juvenile courts and
18 corrections was about $114,000,000 in 1997.  Many new studies now
19 document the relationship between early trauma and later crime.
20 The National Institute of Juvenile Justice recognizes child abuse
21 to be a major causal factor in delinquency and crime and
22 recommends prevention systems beginning with home visiting for
23 families of young children at risk.

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 1      A 1998 study at the Kaiser Permanente Clinic in San Diego
 2 showed high correlations between a number of chronic illnesses
 3 and early abuse or adverse life experiences.  The chronic
 4 conditions included lung disease, heart disease, cancer, severe
 5 depression, as well as abuse of tobacco, alcohol, and drugs.
 6      The legislature recognizes that there is much that can and
 7 should be done as investments in assuring that Hawaii's children
 8 get a safe start in life and arrive in school healthy and ready
 9 to learn.  Healthy Start is a foundation for these efforts and
10 must be maintained in state funding, with the intention of
11 expansion to all families of infants at risk.
12      SECTION 2.  There is appropriated out of the general
13 revenues of the State of Hawaii the sum of $         , or so much
14 thereof as may be necessary for fiscal year 2000-2001, to fund
15 the Healthy Start program; provided that this sum shall be
16 matched by private sources, Medicaid, and other federal funding
17 sources for the purpose for which this sum is appropriated.
18      SECTION 3.  The sum appropriated shall be expended by the
19 department of health for the purposes of this Act.
20      SECTION 4.  This Act shall take effect on July 1, 2000.