SB2089 SD1.DOC

SECTION 1. Hawaii has long been a leader in early childhood services, reflecting an understanding of the importance of early childhood development and proactive legislation to ensure the safety and well-being of infants, toddlers, and pre-schoolers. As a result, over the past twenty‑five years, many early childhood programs, services, and concepts have been developed and expanded, including the healthy start program, the zero to three program, the early learning council, good beginnings alliance, the concept of universal pre‑school for four year olds, baby safe, keiki play mornings, the parenting hotline, the family center, and others.

A recent renaissance in research and national level policy on early childhood underscores the foresight of these actions. For example, the National Scientific Council on the Developing Child published The Science of Early Childhood Development: Closing the Gap Between What We Know and What We Do (Harvard University, 2007). Comprised of leading neuroscientists, pediatricians, developmental psychologists, and economists, the National Scientific Council on the Developing Child reviewed all current research and literature on early childhood development. Based on this research, the publication presents the following core concepts of development and considers their implications for policy and practice:

(1) Child development is the foundation for community development and economic development; capable children become the foundation for a prosperous, sustainable society;

(2) Brain architecture is built from the bottom up, with simple circuits and skills providing the scaffolding for more advanced circuits and skill over time;

(3) Toxic stress in early childhood is associated with persistent effects on the nervous system and stress hormonal systems that can damage developing brain architecture and lead to lifelong problems in learning, behavior, and mental and physical health;

(4) Policy initiatives that promote supportive relationships and rich learning opportunities for children create a strong foundation for high school achievement followed by greater productivity in the workplace and solid citizenship in the community;

(5) Substantial progress in proper child development can be achieved by assuring growth-promoting experiences through a range of parent education, family support, early childhood education, and early intervention programs;

(6) Later remediation for highly vulnerable children will produce less favorable outcomes and cost more than appropriate early interventions, beginning in the earliest year of life; and

(7) Responsible investment is needed to produce results; it is not profitable to utilize intervention that may be less costly but fails to produce needed results.

Given the foregoing realities, the legislature finds it prudent to move as soon as possible to reinstate early childhood services and continue the work of the early learning council to develop a comprehensive continuum of services, with emphasis and priority given to the most vulnerable children. Abuse and neglect often start early in a child's life. Perinatal child abuse prevention and home visiting services with high-risk families should be re-established on a permanent basis, as it is critical to avert or minimize toxic stresses that cause long‑term damage to children.

As recent events exemplify, in tight economic times, the safety net for vulnerable families is the first to be dismantled. In the longer term, this will increase the cost of services which already are very costly, such as special education, mental health services, drug treatment services, and prison construction. The State will also lose the potential productivity which these affected children should have as adults.

The strategy of establishing permanent services to ensure the safety and optimal development of our children in their earliest years is humane and economically strategic.

The purpose of this Act is to require the department of health to provide perinatal home visitation family support services of infants and toddlers at highest risk to avert abuse and neglect and to promote healthy parent infant attachment and child development.

SECTION 2. Section 321-37, Hawaii Revised Statutes, is amended to read as follows:

"[[]§321-37[]] Child abuse and neglect secondary prevention programs. The department may provide secondary prevention programs which contain a continuum of services starting from before birth and ending in education for the adult parenting responsibility. The types of programs to be provided may include but need not be limited to, prenatal, perinatal bonding, interaction with infants, support for parents of infants in need of extra services, home visitor programs, mutual aid programs, child screening for early identification and remediation of social and health problems, and education for parenthood. The department of health shall provide comprehensive perinatal screening and assessment services for prospective and new parents, and provide intensive family support home visiting services based upon the following critical elements:

(1) Service initiation: using a standardized tool to systematically identify families who are most in need of services;

(2) Service content: offer services intensively (i.e. at least once a week) with well-defined criteria for increasing or decreasing frequency of service and over the long-term (i.e. three to five years.); and

(3) Staff characteristics: service providers should be selected because of their personal characteristics, their willingness to work in or their experience working with culturally diverse communities, and their skills to do the job.

The department shall provide these services for up to three years for families with infants and toddlers at the highest risk, as defined by scores of 40 and over in the Kempe Family Stress Checklist. The checklist consists of ten areas in which the family is evaluated for risk factors. The factors on the checklist include:

(1) Parent beaten or deprived as a child;

(2) Parent with criminal/mental illness/substance abuse;

(3) Parent suspected of abuse in the past;

(4) Low self-esteem, social isolation, depression, no lifelines;

(5) Multiple crises of stresses:

(6) Violent temper outburst;

(7) Rigid and unrealistic expectations of child;

(8) Harsh punishment of child;

(9) Child difficult and/or provocative as received by parents; and

(10) Child unwanted or at risk for poor bonding."

SECTION 3. Chapter 321, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§321‑ Healthy start program; established. (a) There is established the healthy start program, to be placed under the department of health for administrative purposes.

The healthy start program shall include a home visitation program to foster family functioning, promote child health development, and enhance positive parenting skills for families in order to reduce the risk of child maltreatment by addressing malleable environmental risk factors via information, support, and linkages to needed community resources. The home visitation program shall:

(1) Include proactive universal screening and assessment to enroll families at birth or prenatally before any child welfare reports are made;

(2) Make home visit services available for families assessed to be at-risk, with the highest priority given to those with scores of forty and above on the family stress checklist or parent survey;

(3) Maintain critical elements, especially related to caseloads, staff ratios, and training, developed by the Healthy Families America Program;

(4) Focus on a relational approach with families, mother-infant dyads, and supervisor and family support worker relationships;

(5) Focus strongly on caregiver and infant attachment and social and emotional development;

(6) Conduct interventions to strengthen protective factors and reduce risk;

(7) Integrate emerging evidence-based practice, as feasible and appropriate;

(8) Ensure continuous quality improvement by engaging program staff; and

(9) Evaluate outcomes related to child development, risk reduction, and confirmed cases of abuse, neglect, and family resilience.

Acceptance of services by the family shall be voluntary. Services shall continue until the child reaches three years of age, or until the child reaches five years of age if there is a younger sibling.

(b) In addition to public moneys from appropriations, the department of health may receive federal grants and accept private donations for purposes of funding the healthy start program."

SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 5. This Act shall take effect upon its approval.

THE SENATE	S.B. NO.	2089
TWENTY-FIFTH LEGISLATURE, 2010		S.D. 1
STATE OF HAWAII