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Home My WebLink AboutCOM 0138.000 2008-2010GUYENRIQUES Council Member Council Dislric! 6 Mailing Address: (Former County Building 25 Aupuni Street Hilo, Hawaii 96720 Hawai `i County Council County of Hawai `i February 5, 2009 TO: FROM: SUBJECT J Yoshimoto, Chair And Members of the Hawaii County G. Enriques, Council Member Phone: (808) 961-8536 Fax: (808) 961-89[2 Email: genriques[iz_ilen.hawaii. hi.us Business .Address: 333 Kilauea Avenue, Second P'loor Ben Franklin Building Hilo, Hawaii 96720 ~.~. ~~ ~~ ~ - ~~ n rn ~•-i `;O ca n;: " l r' t ' ~ < :; ~~ -, 3 ~ L,, ": ~ ca A RESOLUTION REQUESTING THE GOVERNOR OF THE STATE OF HAWAII AND STATE LEGISLATURE TO CONTINiJE FiJNDING AND RESTORE FULL FUNDING TO THE HAWAII HEALTHY START PROGRAM OR CONSIDER FUNDING 80"/0 (9.46 MILLION) [F BUDGET CUTS MUST BE MADE. Attached is a proposed resolution requesting Governor Linda Lingle and the State Legislature to continue funding and restore full funding to the Hawaii Healthy Start program. i have also attached a thirteen (I3) page Frequently Asked Questions of supporting statistics explaining why the Hawaii Healthy Start program is a vital expense for cost savings for the future of Hawaii. GE/bdw Att. <R~s.SS-oq~ Comm: No:~~3w _8 . Serving the /nterestc of the People o(Our Island Ref. TOi w f~ N/~lw~~ Hawaii County is an Equal Opportunity Provider and Employer - Ref. Date DEB 6 2009, Hawaii Healthy Start Program Frequently Asked Questions 1-20-09 The Hawaii Healthy Start Program is a statewide, voluntary home visiting program that strengthens families, promotes positive parent-child relationships, and monitors child development in an effort to prevent child abuse. It primarily consists of two major components -Early Identification and Home Visiting. The Early Identification component provides screenings and assessments to identify prenatal and post-partum women and families at-risk for sub-optimal health, developmental delay, and maltreatment. The Home Visiting component provides support services within the family's natural environment to reduce the likelihood of child maltreatment by reducing parental or environmental stressors. There is an emphasis on assuring that the children are enrolled and utilize pediatric services and are developmentally age appropriate. Home Visiting services are offered until the child reaches three years of age. How many families and children are served by the Healthy Start Program? TnTel er.TIVF FNRt71_LMENT FY1995 TO FY2008 YEAR ' FAMILIES CHILDREN CARRY-OVER CHILDREN NEWLY ENROLLED CHILDREN FY95 2,250 1, 893 FY96 2,128 2,024 FY97 2,052 2,102 FY98 2,263 2,441 FY99 2,125 2,360 FY00 2,088 2,330 FY01 2,828 3,013 FY02 4,485 4,648 FY03 4,691 4,845 FY04 4,506 4,802 FY05 4,322 4,632 2,926 1,706 FY06 4,348 4,608 2,832 1,776 FY07 4,308 4,553 2,742 1,811 FY08 4,130 4,411 2,678 1,733 Source: CHEIRS data 7/22/08 Carry-over data for years prior to 2005 is not available or comparable as the database system evolved over the years dependent on program changes for documenting IDEA Part requirements. 2. What are Healthy Start Screens and Assessments? Universal screening and assessment is offered to every civilian birth in all civilian birthing hospitals. The assessment worker enters every hospital room, and with permission begins a "screen" in a conversational "talk story' manner. All screened families regardless of whether they are eligible for the program, receive parenting information and referral for services as needed. Screening services include medical home referrals, medical insurance referrals, housing resources, and/or WIC (Women-Infants-Children nutritional Healthy Start FAQ -1- program) referrals. The program is not intended to serve the families of all newborns, only those determined to be at risk. The screening process covers 15 issues. If the screen results are positive, the worker moves seamlessly into a 10 point assessment. 15 Point Screen: 1. Unmarried 2. Partner unemployed 3. Inadequate income 4. Unstable housing 5. No phone 6. Education under 12 years 7. Inadequate emergency contacts 8. History of substance abuse 9. Inadequate prenatal care 10 History of abortions 11. History of psychiatric care 12. Abortion unsuccessfully sought or attempted 13. Adoption sought or attempted 14. Marital or family problems 15. History of depression Positive Screen: True score on either item numbers 1, 9, 12; two or more true scores, seven or more unknowns. 10 Point Assessment: 1. Childhood history of being abused 2. Substance abuse, mental illness or criminal history 3. Previous or current Child Protective Services involvement 4. Low self-esteem, poor coping ability 5. Multiple life stressors 6. Potential for violent temper outbursts 7. Unrealistic expectations for child's development 8. Harsh punishment of child 9. Perceives child as being difficult or provocative 10. Child unwanted or risk of poor bonding Scoring: O=No problem, S=Mild problem, 10=Severe problem A "positive" assessment of 30 or more for either parent triggers a referral to Healthy Start. Healthy Start FAQ -2- FY08 Kempe n=5206 aza f7 tat%} 5as {10.5 aJ 48g (30;yy _102 59 2 pA"hJ 2G ~ (0.09=a 3 (os%7 ro-2 oy ~J to.os~j Data extract 1/09 Unduplicated child count = 5206 Includes only Hospital and Phone assessments done between 7/1/07 - 6/30/08 Includes only children bom between 7/1/07 and 6/30/08 The Kempe score is the higher score of the parents of the child Families scoring at 30 Kempe points or more receive a referral to the Home Visiting component of the program. (These scores represent administrations of the Kempe to families during this time period.) 3. What percent of families are screened and enrolled in the program? • 87% of all civilian births are screened in the state for risk factors. (13,338 screened/ 15,383 civilian births) • 18% of these families are determined to have risk factors which make them eligible for healthy start services. (2,545 assessed positive/13,338 screened) • 70% of the families determined to be high risk are enrolled in home visitation services. (1,733 enrolled/2,545 assessed positive.) Civilian Births Total Screens Positive Screens Negative Screens Total Assess. Positive Assess. Negative Assess. Number Served (new enrollment Quarter 1 3,934 3,409 1,781 1,628 1,307 612 695 419 Quarter2 3,891 3,317 1,683 1,634 1,259 598 661 442 Quarter 3 3,804 3,295 1,694 1,801 1,309 596 713 415 Quarter4 3,754 3,317 1,707 1,610 1,300 648 652 457 Total FY08: 15,383 13,338 6,865 6,473 5,175 2,454 2,721 1,733 Source: CHEIRS Data as of 722/08 Healthy Start FAQ - 3 - O 5 10 15 70 25 30 35 40 45 50 55 60 65 70 75 80 85 4. What services are provided through home visitation services? The Hawaii Healthy Start program is an early childhood promotion prevention program. It promotes the health and safety of children. Families are provided the supports they need to assure that their child(ren) have a medical home, are fully immunized, are developmentally on target, and not neglected or abused. As the program grew, Child Development Specialists were added to the program to assist with the child development screening and anticipatory guidance. Clinical Specialists were added to address high end issues related to domestic violence, substance abuse, and mental health issues. Specific program activities are described: Familv Training and Consultation: A scheduled or unscheduled home visit with eligible children and family in their natural environment (ideally should be in the home). Activities include parenting education, crisis intervention, family strengthening activities, transition activities/discussion, intake, care coordination, and IFSP meetings. Child Development Screening and Referral: Home Visit time may also include time used to administer developmental screening scales, developmental assessments, pre- and post-tests, etc. Consultation to family may be provided by a child development specialist; if the child is found to have a documented delay then the child will be referred into the Early Intervention Services program for further assessment and therapeutic intervention. Care coordination: Activities to identify child and family's needs and coordinate services; this includes home visits, consultations and correspondence with other professionals within and outside of the program, and phone calls with family members and other interested persons as appropriate. Care coordination also includes transition activities. Transition or transfer includes activities to support the transition of a child out of the Healthy Start program to another EI program, DOE, or a community preschool program. Child Team Meeting: Scheduled meeting for substantive discussion regarding a family's and child's progress or lack of progress. These would also include Ohana conferencing and/or CWS multi disciplinary meetings. Groups: Group activities to support the child's or family's goals on their IFSP. Transportation: This is the time necessary for a service provider to transport a consumer to and from services identified on Section VI of the IFSP. Outreach Services: which included supportive, consistent contact with families who for various reasons do not keep their home visitation appointments was always a key element of the program. Reaching out to isolated and needy populations is an important intervention for at-risk families, however following the budget restriction in September, 2008, outreach services were discontinued. Families who had 2 "no shows" for their home visitation appointments were discharged from the program. Additionally, the Healthy Start Program assists families with referrals to other community services for mental health, domestic violence, and substance abuse issues. Healthy Start FAQ -4- 5. How long do families stay/participate in the program? • 50% of the children remain in the program longer than a year. • 20% stay longer than 2 years. Hawaii's retention rates are consistent with other national models. Wagner and Clayton' reported an average attrition rate of 57% by 2 years for 3 Teen Parents as Teachers demonstrations and Baker et a12 reported about a 30% attrition rate within the first few months of family assignment in the HIPPY program. Even under carefully controlled conditions of the Elmira and Memphis trials of the Nurse Home Visitation Model, Olds et al s found that families completed only about half of the postnatal visits called for in that model. The following table illustrates the numbers and percentages of children enrolled in the program for each fiscal year and their length of stay in the program. Although the program is available to families until their child is 3 years old, most families leave the program earlier to fulfill economic and employment obligations. 0-12 mo 12-18 mo 18-24 mo +24 mo Total FY # % # % # % # % Children 2005 2,013 43 517 11 408 9 1,701 37 4,639 2006 2,135 46 545 12 368 8 1,560 34 4,608 2007 2,231 49 615 14 481 11 1,226 27 4,553 2008 2,195 50 834 11 482 19 900 20 4,411 Data extract 12/08 6. Who are the participants in the Healthy Start Program? Basic demographics for the program: Parent Data: Caregiver's Age at Time Child Enters Program Data extract 12/08 ~ Wagner M. Clayton. The Parents as Teacher Program: results from two demonstrations. Future Child 1999:1: 91-115 Z Baker A, Piotrkowski C, Brooks-Gunn J. The Home Instruction Program for Preschool Youngters (HIPPY). Future Child. 1999; /: ]16-133 s Olds D, Henderson C, Kitzman H, Eckenrode J, Cold R, Tatelbaum R. Prenatal and infancy home visitation by nurses: recent findings. Future Child. 1999;1:44-65 Healthy Start FAQ -5- Parent's marital status FY08: FY08 Marital Status of Mother n=3818 1605 {4294°10) 1460 {38.24 h} ~e a~ yc~ ~~e ~a o` ~~c ~~c ~tia a'O `or 4ea ~a tiea ,ea ,~c O` o~ yao~ ¢ ~~x a<< pro ~ Q Cr Jc Data extract 12/08 Ethnicity of Children FY08: Ethnicit # Asian 457 10.4 Other Asian or Pacific Islander 307 7.0 Pacific Islander 896 20.3 Black/African American 51 1.1 Hawaiian/Part Hawaiian 2,263 51.3 Native American/American Indian/Alaska Indian 17 0.4 His anic 159 3.6 White/Caucasian 255 5.8 Unknown 6 0.1 Total: 4,411 100 Data extract 12/08 Healthy Stag FAQ -6- Native AmcricanjAmerican IndianJAlaska Indian, 17 10.4%) FY08 Ethnicity n=4411 c 'oo :- z A typical client profile: (based on pilot project for Nurturing Parenting curriculum, conducted in Hilo and Maui) 1. Primarily female 2. Pacific Islanders the single largest racial group 3. High School graduate 4. Unmarried 5. 1-2 children 6. Annual income: $15,000.00 or less 7. Parent was abused or neglected as a child Healthy Start FAQ -7- 7. What percent of families is Medicaid/Quest eligible? Medical Insurance: FY2008 FY2007 FY2006 FY2005 # % # % # % $~ Number of children enrolled 4,411 4,553 4,608 4,632 Number of children with QUEST insurance 2,749 - 3,019 - 3,096 - 3,012 - Number of children with Medicaid 41 - 37 - 25 - 20 - Total children with QUEST/Medicaid 2,790 63% 3,056 67% 3,121 68% 3,032 66% Data extract 12/08 8. What are the measurable outcomes for the Healthy Start Program? Ob ective FY05 FY06 FY07 FY08 1. One hundred percent (100%) of all at-risk children and their families enrolled in the program for at least twelve (12) months shall not have a 99% 99.65% 94.01 % 99% confirmed report of Child Abuse and/or Neglect CAN . 2. One hundred percent (100%) of enrolled women with a subsequent pregnancy shall receive 75% 95.91 % 95.21 % 90% prenatal care within 30 days after the pregnancy is made known. 3. One hundred percent (100%) of target children and their families enrolled in the program 6 or 97% 95.93% 95.18% 95% more months shall have an identified medical home for well and sick care. 4. One hundred percent (100%) of all enrolled target children at 2 years of age shall be fully 74% 75.75% 69.71 % 61 immunized. 5. One hundred percent (100%) of program families promoted to Level 4 (family has been promoted to less than weekly visits and has demonstrated stability and positive nurturing 95% 96.25% 98.78% 100% behavior), shall have malleable risk factors reduced (coping ability, life stressors, violent outbursts, harsh unishment . 6. One hundred percent (100%) of target children shall receive developmental screenings at ages 4 1 r 85% 1 r 81 % 1 r 78% months, 12 months, 16 months, 24 months, 30 ° 90% 36 months (Ages and Stages months 2 r 82% 2 r 82% 2 r 78% . , Questionnaire) *FY05 data was collected as an a re ate. 3 r 80% 3 r 72% 3 r 67% Program Variance reports FY05-FY08 Healthy Start FAQ -8- 9. How are the contractors monitored? The contractors are reimbursed on a unit cost basis; payment is made for only the units of services rendered. In addition to programmatic monitoring, in person fiscal monitoring is conducted by the DOH staff annually. Routinely invoices are checked against the department's billing data system for potential discrepancies; periodically the program will run ad hoc reports to identify any outliers and reconciliation are made with the agency. The Department conducts regular program monitoring for all 6 providers. Monitoring not only includes validation for the outcomes reported, but record review, staff interviews, and shadowing home visitors into consumer homes. 10. Do you measure/confirm abuse? The Healthy Start pars professional home visitor is the eyes and ears in the home. Any reports made to CWS for suspected child abuse and neglect are made because there is another advocate in the home supporting parents and observing nurturing principles for healthy families. We have currently engaged in a new curriculum that provides a pre and post test for nurturing parenting. The field of prevention continues to grow and develop better interventions and strategies for measuring outcomes. Any program engaging in prevention is challenged in how to demonstrate effectiveness. How do you provide evidence that something bad has not occurred? The outcome measurements provided above (see #8) are what the program has developed so far. This annual Variance report is limited because of the self reporting nature of the report by each contracted provider. Currently, contracted providers are required to report on a quarterly basis the cases that are referred to CWS for suspected abuse or neglect. The outcome of the CWS investigation is not consistently known by the Healthy Start worker due to confidentiality issues. If the child has been removed from the home, programs generally assume that CWS confirmed the allegation. However, it is expected that reports to CWS for allegations of suspected abuse or neglect will occur because of the close relationship and observational opportunities afforded the home visitor. Healthy Start FAQ -9- Numher of families rennrted to CWS FY 08: A enc 1s uarter 2" uarter 3` quarter 4 uarter Total Catholic Charities 3 2 0 1 6 Child & Famil Service: Oahu Leeward 1 2 1 1 5 Oahu Central 1 2 2 1 6 Oahu Waianae 0 1 0 3 4 Kauai 2 0 0 1 3 Maui Famil Su ort Services: Maui 2 1 1 1 5 Molokai 0 0 0 0 0 Famil Su ort Services of West Hawaii 1 0 4 1 6 Parents and Children Together (West Honolulu, Windward 3 3 3 3 12 YWCA of Hawaii Island 1 0 1 0 2 Total 14 11 12 12 49 FY08 Program Quarterly Reports 49 families were referred to CWS for allegations of abuse/neglect. The outcome of the CWS investigation may not have confirmed the allegation -only those cases confirmed are reported in the measurable outcomes for the program (see item #8), however 49 referrals illustrates the strength this program exercises in assuming the supportive and protective role it plays in the community. Efforts to cross-walk Healthy Start data to Child Welfare Services data for any subsequent CWS involvement have been difficult to complete due to HIPAA rules which require consent from each family. Confirmed CWS reports could only be ascertained for families providing signed informed consent for matching Healthy Start files with the Department of Human Services files. This seriously compromised the validity of findings regarding child maltreatment. Only 10% of families provide signed informed consent for matching. The Department of Health and Department of Human Services should adopt a policy which would allow for the sharing of this information without written approval to validate the effectiveness of the program, However, Johns Hopkins research which followed a cohort of all families screened: low risk families, high risk and not enrolled in the program, and high risk enrolled families indicated that 13°/" of children identified to be at high risk for child maltreatment will be confirmed for child abuse and neglect by the age of nine years if they do not receive home visiting intervention." Applying this information from FY 2008 data alone translates to 573 children who would have been confirmed for child maltreatment if Healthy Start had not intervened. a McFarlane, E; Burrell, L; Leaf, P; Fuddy L; Sia, C; Derauf, DC; 8 Duggan, A (2008b, May). Maternal relationship security as a moderator of home visiting impact. Presented at the annual meeting of the Pediatric Academic Societies, Honolulu, HI. Healthy Start FAQ - 10 - 11. Who are the Healthy Stall providers? Fnr Fiscal Year 2009 the current contracted providers are: Pro ram -Sites Census Tracts CATHOLIC CHARITIES: East Honolulu 1-12 Queen Emma 35-43 North Shore 90-95, 99-100 CHILD AND FAMILY SERVICE: Central Oahu 83-86 Leeward Oahu 87-89 Waianae 96-98 Kauai 401-416 PARENTS AND CHILDREN TOGETHER: Diamond Head 13-34, 78-82 West Honolulu 44-77 Windward 101-113 FAMILY SUPPORT SERVICES OF WEST HAWAII 212-218 MAUI FAMILY SUPPORT SERVICES: Maui 301-315 Lanai 316 Molokai 317-318 YWCA: Hilo 201-209, 219-221 Puna 210-211 In addition to these 6 Contractors for Early Identification and Home Visiting; The Institute for Family Enrichment (TIFFE) is also contracted to provide the training and technical assistance required for both pars professional home visitors and professional level clinicians (Child Development Specialists and Clinical Specialists, Clinical Supervisors). TIFFE provides training to all contractors statewide. The following table illustrates the amount of direct service staff currently employed for the Healthy Start Program. This amount represents the numbers of direct service staff persons left after the initial staff lay-offs that occurred in September, 2008 following the budget restriction. These current staffing numbers do not represent the other non direct service staff supporting the Healthy Start program (directors, data entry staff, clerical staff) Healthy Start FAQ - 11 - A enc Direct Service___S_taff Catholic Charities 16 Child and Famil Service 44 Famil Su ort Services of West Hawaii 17 Maui Famil Su ort Services 29 Parents and Children To ether 51 YWCA of Hawaii Island 18 Total 175 As of 11/08 12. How is the Healthy Start Budget distributed? Service ASO Lo # Provider FY 09 Contract Allocation Amt Trainin 06-116 The Institute for Famil Enrichment 226,697 06-117 Catholic Charities Hawaii 1,162,621 06-118 Child and Famil Service 85,837 Early 06-119 Famil Su ort Services of West Hawaii 127,185 Identification 06-120 Maui Famil Su ort Services Inc. 243,171 (EID) 06-122 YWCA of Hawaii Island 137,567 Home 09-001 Catholic Charities Hawaii 849,126 Visiting/Child 09-002 Child and Famil Service 3,303,397 Development 09-003 Famil Su ort Services of West Hawaii 649,116 Specialist/ 09-004 Maui Famil Su ort Services Inc. 1,120,263 Clinical 09-005 Parents and Children To ether 3,068,032 Specialist HV/CDS/CS 09-006 YWCA of Hawaii Island 884,898 Coachin 08-192 Johns Ho kins Universit Total 11,857,910 Note -This contract is utilizing $81,036 of FY OS general funds for the period May 16, 2008 to June 30, 2009 to provide: coaching to home visitor staff to promote their adherence to using the Hawaii Family Thriving Protocol (HFTP) and consultation to supervisors to promote their ability to enable and reinforce home visitor staff in using the HFTP. 13. What is the per child cost by type of service? Fiscal Year Earl Identification Home Visitin Child Dev. S ecialist Clinical S ecialist FY2007 $147.27 $2 347.43 N/A N/A FYI 2008 ~ $14612 $2165.55 $569.89 $501.65 As of 7/22/08 Healthy Start FAQ - 12 - 14. What has been the funding history of Healthy Start? Fiscal Year Allocation Total A -General Funds B -Early Intervention S cl. Funds B -Tobacco Settlement S ecial Funds U - DHSITANF Funds FY 2000 6,089,435 6,089,435 FY 2001 12,095,070 11,107,936 897,737 89,397 FY 2002 18,983,080 17,638,492 1,344,588 FY 2003 23,804,893 21,179,878 959,000 1,666,015 FY 2004 18,204,878 12,868,855 5,336,023 FY 2005 15,487,360 10,739,693 4,747,667 FY 2006 14,339,693 11,339,693 3,000,000 FY 2007 13,793,813 11,339,693 2,454,120 FY 2008 15,600,102 11,339,693 2,600,000 1,660,409 FY 2009 11,857,910 9,396,750 1,000,000 1,461,160 Healthy Start FAQ - 13 - J YOSHIMOTO Chair & Presiding O(ticer PETE HUFFMANN Vice Chair GUY ENRIQUES BRENDA FORD DONALDIKEDA EMILY L NAEOLE DENNIS FRESH ONISHI DOMINIC YAGONG HAWAII COUNTY COUNCIL County of Hawai `i Hawa `ii County BuildFng 25 fl upuni Street /'/i/q Hawai `i 96720 J Yoshimoto, Chair Hawaii County Council 25 Aupuni Street Hilo, Hawaii 96720 RE: Resolution No. 55-09 : A RESOLUTION REQUESTING THE GOVERNOR OF THE STATE OF HAWAII AND STATE LEGISLATURE TO CONTINUE FUNDING AND RESTORE FULL FUNDING TO THE HAWAII HEALTHY START PROGRAM OR CONSIDER FUNDING 80% (9.46 MILLION) IF BUDGET CUTS MUST BE MADE Pursuant to Section 2(g) of Rule 4 of the Rules of Procedure of the Council of the County of Hawaii, this written request is submitted with my approval that the above-referenced matter be waived from the. Committee on Finance to the full Council for immediate action. In reviewing this matter, timely approval is crucial. It is therefore advantageous that approval is granted and the matter placed onto the next Council agenda for review. However, in the event this request is denied, for whatever reason, I understand the matter shall be referred to the Committee on Finance for placement on its future agenda. Sinc ely, ~"`, 0.. Dominic Yagong, Chair ~ Committee on Finance Approv e/Waive to Council: Disapproved/Date/Refer to FC: J Yoshimoto, Chair J Yoshimoto, Chair Hawaii County Council Hawaii County Council liawai`i County 7s An EquulOpportmtity Provider And Employer