SB925 SD2.DOC

SECTION 1. Hawaii has long been a leader in early childhood services, reflecting an understanding of the importance of early childhood development. This has resulted in proactive legislation to ensure the safety and well-being of infants, toddlers, and pre-schoolers. Unfortunately, many of these services have been eliminated or drastically cut over the past two years. Hawaii's healthy start program is one of the services that has been affected.

The healthy start program was designed to prevent child abuse and neglect and promote child development among high-risk infants and toddlers. Although healthy start was deployed statewide in 2001, cuts to the program have resulted in elimination of assessment capacity and home visiting services for most of the State. Restoration of these critical services is the first step towards establishment of an effective, coordinated continuum of early childhood services.

Research has shown that a combination of factors, such as abuse of the parent in childhood, social isolation, lack of social supports and life skills, substance abuse, domestic violence, and mental health problems place parents at risk for abuse and neglect of their children. Poverty and unemployment can also be major contributing factors. The healthy start approach uses research-based interview procedures to reach out to parents who may be at risk. Intensive home visits, which seek to strengthen protective factors and reduce risk, promote child and family development, and avert abuse and neglect, are also provided. Restoration of universal screening and home visitation services is a vital step in offering culturally responsive, evidence-based services to address different levels of family needs and risks and ensuring the State meets its public health responsibility of surveillance for needs assessment.

A recent renaissance in research and national-level policy on early childhood underscores the foresight of the legislature in focusing on early childhood issues. 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). Composed 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) Brain architecture is built from the bottom up, with simple circuits and skills providing the scaffolding for more advanced circuits and skill over time;

(2) 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;

(3) Policy initiatives that promote safe, supportive relationships and rich learning opportunities for children create a strong foundation for later learning, followed by greater productivity in the workplace and solid citizenship in the community;

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

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

(6) Responsible investment is needed to produce results; it is not profitable to utilize interventions that may be less costly but fail to produce needed results; and

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

Given the foregoing findings, the legislature finds it prudent to reinstate hospital-based assessments and intensive home visiting for families at highest risk, along with referrals of other families to existing home visiting services. The legislature further finds that utilizing moneys from the Hawaii tobacco settlement special fund and temporary assistance for needy families funds is appropriate and necessary to ensure that the public health interests of the health and safety of at-risk children in Hawaii are met.

The purpose of this Act is to reinstate hospital-based assessments and to target improved intensive home visiting services to the highest risk families of newborns in communities across the State of Hawaii. An additional purpose of this Act is to appropriate moneys from the Hawaii tobacco settlement special fund and temporary assistance for needy families funds and to increase the appropriations ceiling of the Hawaii tobacco settlement special fund to allow expenditures from that fund for the purposes of this Act.

SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§321‑ Assessment and home visitation program; established. (a) There is established within the department of health a hospital-based screening and assessment and intensive home visitation program. This program shall follow the guidelines of the department's improved healthy start program.

(b) Hospital-based screening and assessment pursuant to this section shall:

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

(2) Make intensive home visits available on a voluntary basis for families assessed to be at the highest risk; and

(3) Make referrals for families with lower or no-risk scores, based on the needs of the family, to a range of evidence-based home visiting services.

(1) Maintain critical elements developed by the improved healthy start program, especially related to caseloads, staff ratios, training, and the multi-disciplined team approach;

(2) Utilize a relationship-based approach with families, mother-infant dyads, and supervisor and family support worker relationships;

(3) Focus strongly on caregiver and infant attachment and social and emotional development, following principles of infant mental health;

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

(5) Integrate model enhancements established and proven throughout the federally funded Hawaii evidence based home visitation project, such as:

(A) Initiatives developed for supervision and training;

(B) Initiatives developed for identifying families for services; and

(C) The development of sound infrastructure to support home visitation, which includes data management support, continuous quality improvement, and evaluation,

to ensure that outcomes can be tracked, measured, and yield optimal results for families before taking home visitation to scale;

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

(7) Evaluate outcomes such as risk reduction, child development, family resilience, and confirmed cases of abuse and neglect.

Services may continue until the child reaches three years of age, or until the child reaches five years of age if the child has a younger sibling. Services shall be initiated on an incremental basis, with geographic priority to be determined by the department's needs assessment and to be implemented as funding becomes available."

SECTION 3. There is appropriated out of the Hawaii tobacco settlement special fund, established pursuant to section 328L-2, Hawaii Revised Statutes, the sum of $ or so much thereof as may be necessary for fiscal year 2011-2012 and the same sum or so much thereof as may be necessary for fiscal year 2012-2013 for hospital-based assessment and screening and intensive home visiting services.

The sums appropriated shall be expended by the department of health for the purposes of this Act.

SECTION 4. The Hawaii tobacco settlement special fund appropriation ceiling shall be increased to $53,154,866 for fiscal year 2011-2012 and $53,154,866 for fiscal year 2012-2013.

SECTION 5. Of the federal fund appropriation for the department of human services, there is appropriated temporary assistance for needy families funds in the sum of $ or so much thereof as may be necessary for fiscal year 2011-2012 and the same sum or so much thereof as may be necessary for fiscal year 2012-2013 for intensive home visiting services.

The sums appropriated shall be transferred from the department of human services by interdepartmental transfer (U fund) to the department of health, to be expended by the department of health for the purposes of this Act.

SECTION 6. New statutory material is underscored.

SECTION 7. This Act shall take effect on July 1, 2050.

THE SENATE	S.B. NO.	925
TWENTY-SIXTH LEGISLATURE, 2011		S.D. 2
STATE OF HAWAII