Hawaii-2011-HB614-Amended

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 the elimination of assessment capacity and home visiting services for most of the State. Restoration of these critical services is the first step toward the 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 support 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, 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.

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 sources, including 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 use 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 realities, the legislature finds it prudent to reinstate hospital-based screening and assessments and intensive home visiting for families at highest risk, along with referrals of other families to existing home visiting services.

The purpose of this Act is to reinstate hospital-based screening and assessments and to target improved intensive home visiting services to the highest-risk families of newborns in communities across the State, while offering other families a range of evidence-based home visiting services based on their identified needs.

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 multidisciplinary teams, as determined by the department.

(b) The hospital-based screening and assessment component of the hospital-based screening and assessment and intensive home visiting program 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, with the highest priority given to those with scores of forty and above on the family stress checklist or parent survey; 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.

(c) The intensive home visiting component of the hospital-based screening services and assessment and intensive home visiting program shall:

(1) Maintain critical elements developed by multidisciplinary teams as determined by the department, especially related to caseloads, staff ratios, and training;

(2) Use 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) Use the clinical specialist approaches of enhanced healthy start in working with very high-risk families;

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

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

(7) Ensure continuous improvements in quality by engaging program staff;

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

(9) Continue to evaluate the impact of intensive home visitation services and make program improvements as needed.

Services shall 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."

SECTION 3. The Hawaii tobacco settlement special fund ceiling appropriation shall be increased to $ for fiscal year 2011-2012 and $ for fiscal year 2012-2013.

SECTION 4. 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 screening and assessment and intensive home visiting services.

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

SECTION 5. There is appropriated out of the temporary assistance for needy families fund 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 by 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, 2030.

HOUSE OF REPRESENTATIVES	H.B. NO.	614
TWENTY-SIXTH LEGISLATURE, 2011		H.D. 2
STATE OF HAWAII