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.