Legislature(1995 - 1996)
04/10/1995 09:10 AM House HES
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* first hearing in first committee of referral
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= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
JOINT HOUSE AND SENATE HEALTH, EDUCATION
AND SOCIAL SERVICES STANDING COMMITTEES
April 10, 1995
9:10 a.m.
SENATE MEMBERS PRESENT
Senator Lyda Green, Chairman
Senator Loren Leman, Vice-Chairman
Senator Mike Miller
Senator Johnny Ellis
Senator Judy Salo
SENATE MEMBERS ABSENT
All members present
HOUSE MEMBERS PRESENT
Representative Con Bunde, Co-Chair
Representative Cynthia Toohey, Co-Chair
Representative Caren Robinson
HOUSES MEMBERS ABSENT
Representative Al Vezey
Representative Gary Davis
Representative Norman Rokeberg
Representative Tom Brice
COMMITTEE CALENDAR
Presentation by Rebecca Rufner, Arizona State Coordinator, National
Committee for the Prevention of Child Abuse.
WITNESS REGISTER
REBECCA RUFNER, Arizona State Coordinator
National Committee for the Prevention
of Child Abuse
POSITION STATEMENT: Gave presentation
SHERRIE GOLL, Lobbyist
P.O. Box 22156
Juneau, Alaska 99802
Telephone: (907) 463-6744
POSITION STATEMENT: Answered funding questions regarding
Ms. Rufner's presentation
ACTION NARRATIVE
TAPE 95-29, SIDE A
CHAIRMAN LYDA GREEN called the Joint House and Senate Health,
Education and Social Services (HESS) Committee to order at 9:10
a.m. She invited Rebecca Rufner to come forward to give her
presentation.
Number 028
REBECCA RUFNER, Arizona State Coordinator of the National Committee
for the Prevention of Child Abuse, informed the committee that she
would be speaking about her experience in Arizona and the national
progress of the Healthy Families Program. She commented that today
social problems threaten the future of our country, families and
communities. She explained that she is a National Site Visitor for
Healthy Families which is a neo-natal home visitation program aimed
at child health and development, family functioning, and prevention
of child abuse and neglect. Child abuse is believed to be the root
of many of the social problems facing us today. She informed the
committee that persons in maximum security prisons have all been
severely abused and neglected as young children. This common link
of severe abuse and neglect of young children can also be found in
juvenile delinquents, the mentally ill, high school dropouts, teen
runaways, pregnant teens, and alcohol and drug abusers as well as
long-term welfare dependents.
MS. RUFNER stated that child abuse is costing the state of Alaska
millions of dollars a year in child welfare investigations and
treatment, foster care, special education, and residential care.
She noted that in Arizona the cost of opening an investigation of
a child abuse case totals approximately $10,000 not to mention the
hundreds of thousands spent in treatment. The long-term can barely
be estimated. She informed the committee that approximately 80
percent of severe abuse affects children under the age of five.
Forty-three percent of the children who die from abuse and neglect
have not reached their first birthday. She expressed the need to
solve the social problems facing the country in order to decrease
the costs of social programs while increasing their effectiveness
and outcome. She pointed out that Human Services is under much
scrutiny and pressure to become more accountable, more outcome
based and more cost effective with all of its programs. There is
a tremendous amount of fragmentation in their service delivery
systems.
Number 117
MS. RUFNER said Healthy Families Alaska is under way and has much
interest across the state. She noted that currently, there are
three programs that are funded and operating. All 50 states are in
various stages of planning, implementing and securing state funding
for this program on a pilot basis. Arizona has $4.7 million in
state funds which funds approximately 16 sites. She informed the
committee of the goals of the Healthy Families Program: Child
health and development; the enhancement of family functioning; and
the prevention of child abuse and neglect. Those people who are
most likely to have poor parenting outcomes in the first few years
face great burdens during the birth of their children. The burdens
of those people can be identified as poverty, substance abuse,
criminal history, domestic violence and a history of abuse or
neglect as a child themselves.
MS. RUFNER explained that the Healthy Families Program provides
home visitation to those families soon after they return from the
hospital. Ms. Rufner pointed out that in Arizona, there has been
a 95 percent acceptance rate of the families with major stressors.
The family can refuse services at any time. The home visitor helps
the family identify their goals as parents, their family
aspirations as well as assisting the family in moving forward in
those issues. Ms. Rufner looked forward to positive outcomes in
the programs in Alaska. The states who have done outcome
evaluations of this program, have seen a 95 percent immunization
rate in children in the program and all program children receiving
preventive and primary health care. She explained that preventive
and primary health care is very important in order to avoid the
treatment of basic health problems in emergency rooms and acute
care settings where the costs are higher.
MS. RUFNER stated that there is good outcome information about
child development scores. Children with developmental delay risks
have been identified early and placed them in services addressing
that problem. Again, this early intervention would decrease costs
of special education and later intervention programs. There have
been positive scores in family functioning. Ms. Rufner pointed out
that the home visitors in Arizona are from the community and they
share the culture and values of the community. There has been a 95
percent success rate in the prevention of abuse and neglect in this
high risk parent group. She expressed pleasure in Arizona's
outcomes and predicted that Alaska could expect the same. The cost
effectiveness of this program is very exciting. She estimated the
cost to be $3,000 per year per family as compared to the $10,000
cost in merely opening a case for an investigation of child abuse
in Arizona. In conclusion, Ms. Rufner stated that the Healthy
Families Program is an exciting and promising approach with regards
to long-term solutions to these costly problems.
Number 217
REPRESENTATIVE CYNTHIA TOOHEY asked Ms. Rufner if she thought the
cost in Alaska would be $3,000 or would it be a little higher. MS.
RUFNER said that there may be a percentage higher cost per family
in Alaska which would also mean that investigation and treatment
costs would also be higher. The average cost in Arizona is
approximately $3,000 in the first year while the cost dropped to
approximately $2,250 in the second year. Visits after the first
year are less frequent and the family becomes more self-sufficient
in the second year.
In response to Representative Toohey, MS. RUFNER clarified that the
family needs assessment person works in the hospital directly with
OB and pediatrician and hospital staff. The family needs
assessment person has a BA or above; that person needs good skills
with face to face interviews as well as the ability to discuss
problems with new mothers. Ms. Rufner explained that the home
visitor in Arizona is a non degreed woman. Program supervisors
should be Masters level people.
REPRESENTATIVE CON BUNDE inquired as to what a home visit would
consist. MS. RUFNER explained that the early focus of the home
visit is building a trusting relationship with the parent. Often
overburdened families lack trust in traditional services. As the
parent and home visitor build trust the focus of the visit turns to
the needs of the infant. Child health is another important focus
of the visit. The visit also focuses on personal issues of the
family. Ms. Rufner specified that the issues addressed in the home
visits are issues that have been identified by the family as their
needs and wants. The family is in control. After a few months in
the program, family stress levels decline which affords the family
more opportunity to focus on the children.
Number 277
REPRESENTATIVE BUNDE stated that this program seemed to provide a
state supported conscious for these people who supports the notion
that it takes a village to raise a child as opposed to the past
years of encouragement of privacy. Representative Bunde felt that
Ms. Rufner's use of the word "burden" indicated that the families
plight was imposed on them. He preferred to say that the families
were making poor choices.
SENATOR JOHNNY ELLIS asked the House members what had happened with
the Governor's funding proposal for this program. Senator Ellis
asked if Ms. Rufner could then give an estimate as to the level of
program possible with regards to the funding. REPRESENTATIVE
TOOHEY hoped that it was the same, but was unsure. REPRESENTATIVE
CAREN ROBINSON specified that funding had been requested for three
programs while only the program in Juneau received funding.
Number 308
SHERRI GOLL, Lobbyist, Alaska Women's Lobby, clarified that the
House passed a budget that included $200,000 more for one
additional project than existed last year. The Governor had
requested $600,000 additional money, beyond last year's
appropriations in order to open new sites for Healthy Start. The
House included $200,000 more for one additional site, which would
be in addition to the Juneau program that was funded last year.
CHAIRMAN GREEN inquired as to the net funding. SHERRI GOLL
explained that last year was the first year of the program which
had an appropriation of $200,000. Now there is a total of $400,000
appropriated for Healthy Start.
MS. RUFNER believed that the best way to build these programs on a
state level is team by team, community by community. The three
sites in Juneau, Kenai, and Anchorage are a good start. Ms. Rufner
informed the committee that there are more than 11,000 births a
year; approximately a quarter of the population that is high risk
would be served.
SENATOR JUDY SALO noted that overcoming substance abuse even with
help is difficult, however, Ms. Rufner had presented overwhelmingly
positive and successful statistics. Senator Salo asked if there
was any particular manner in which substance abuse problems are
treated.
MS. RUFNER said that there are no particular ways in which to deal
with substance abuse families. Perhaps the most positive aspect of
this program is that when home visitors recognize substance abuse
in families with new babies, someone is watching out for the health
and safety of the infant. A good percentage of the program's new
mothers have entered substance recovery programs. She explained
that birth is a time of emotional focus for the parent. She
pointed out that in Arizona there is a shortage of effective and
available treatment programs. Child care becomes a problem for
parents seeking residential treatment. She emphasized that the
availability and awareness of help early on is important. She
mentioned that approximately 60 to 70 percent of the child abuse
referrals involve substance abuse. That would seem to be the case
in Alaska or even higher. She indicated that a large number of
infant and child fatalities could be involved in substance abuse.
Ms. Rufner reiterated that the program has served very substance
abusing high risk families with no fatalities and no severe abuse.
Number 380
CHAIRMAN GREEN inquired as to the responsibility of these programs
with regard to confidentiality. MS. RUFNER agreed that was
difficult, but it is manageable with respect to the confidentiality
aspect and the ethical perspective of the home visitor. Home
visitors are mandated to report child abuse and neglect; that is a
federal and state law. Ms. Rufner noted that the families are
notified of this law, furthermore, the family signs an informed
consent when they begin the program. The family can decide at any
time to leave the program. There is no punitive follow up unless
the child was in imminent harm of abuse or neglect in the opinion
of the home visitor. Ms. Rufner informed the committee that public
opinion polling by the National Committee to Prevent Child Abuse
found that 86 percent of Americans polled feel that providing a
home visitor to new parents is positive. All other industrialized
countries provide public health home visitation to new parents.
America did this in the past through public health nursing, but we
switched over to clinic based services which was believed to be
more cost effective. The preventive capacity has been lost when
new parents are not supported when they leave the hospital.
CHAIRMAN GREEN asked if any of the sites in Arizona were considered
rural. MS. RUFNER replied yes and explained that the home visitors
spend a lot of time in transit. Families are widely spaced from
one another. The costs are about the same.
REPRESENTATIVE TOOHEY inquired as to the number of single parents
in these programs. MS. RUFNER explained that in Arizona the
program serves a higher percentage of single parents than in Hawaii
due to Arizona's higher divorce rate and teen birth rate. In the
Tucson program, of the unemployed families enrolled in the program
at the time the babies were born, 75 percent of those families had
an employed parent within one year. That is strongly encouraged by
the home visitor.
REPRESENTATIVE ROBINSON understood that the home visitor helps the
family set goals. Often young families do not have the skills.
Representative Robinson asked if the family needed transportation
to a health care facility, would the home visitor provide that.
MS. RUFNER replied yes and explained that the home visitor attempts
to help the family identify the needs of the family and the child.
Then the home visitor helps the parent feel competent to solve
their problems; the home visitor does not solve the family's
problems. The solutions are generated as part of the relationship
between the parent and the home visitor.
Number 446
REPRESENTATIVE ROBINSON inquired as to how these programs were
funded in Arizona. Representative Robinson also asked if Arizona
had a Children's Trust Fund. MS. RUFNER pointed out that Arizona's
Children's Trust Fund was the original funding source of the first
two pilot sites. That trust fund is funded by marriage decrees and
divorce dissolutions and $1 from death certificates. Last year the
Healthy Families Program was expanded with a combination of funding
from the Children's Trust Fund, state dollars as well as community
foundations and dollars.
REPRESENTATIVE ROBINSON asked if Ms. Rufner had found an average
age level of those served. MS. RUFNER did not know the median age
of the parents served, however, most of the parents served are
under the age of 25. A number of parents in the program are having
there third or fourth child.
SENATOR SALO asked how long the family would be served after the
birth of the baby. MS. RUFNER specified that the home visitor can
visit up to five years. The goal of the program is to ensure that
the children enter school safe, healthy, and ready to succeed in
school. Ms. Rufner commented that a universal transition to Head
Start for a child at age three is an exciting aspect of this
program. A way to save money in the state's system is to develop
a seamless transition from the home visitation program into Head
Start at age three.
There being no further questions, Chairman Green thanked Ms. Rufner
for her presentation. Chairman Green called a brief at ease from
9:45 a.m. to 9:50 a.m. so that the House members may leave the
meeting room.
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