Healthy Start clients include the Covington family in Salt Lake. Dad Robert Covington holds Jacob on the couch as mom Ngaire changes Josiah's diaper. Program officials understand that raising kids in today's socioeconomic environment can be difficult. See below for their experience with the program.
Program to fight
child abuse refocuses
its outreach efforts
Hawaii's Healthy Start Program, designed to strengthen families and prevent child abuse and neglect, is changing to address more complex problems facing today's families.
A study by the Johns Hopkins Children's Center found that home visits and services provided by Healthy Start paraprofessionals developed family trust but did not prevent child abuse or reduce risk factors.
Home visitors known as paraprofessionals are not required to have degrees, but must have 30 hours of basic training, shadow senior home visitors at the beginning and receive periodic training throughout the year.
Loretta Fuddy, who oversees Healthy Start as chief of the state Health Department's Family Health Services Division, said the "very rigorous" Hopkins study used a higher definition of child abuse, such as harsh discipline.
"Our families did not show up on rolls of child welfare, which was very positive. But what we looked at more carefully was how families discipline children," she said. "We need to have more positive parenting and less discipline.
"We're looking at the whole child development piece, the total child and parent. It is very tough raising children in today's society."
Paraprofessionals visiting about 3,000 families statewide who are getting help from Healthy Start are seeing more substance abuse, she said. "We need to make better identification and referral to treatment."
In 1991, Hawaii's Healthy Start Program was acclaimed by the U.S. Advisory Board on Child Abuse and Neglect as a model for child abuse prevention. Many other states have adopted it.
Dr. Calvin Sia, a Honolulu pediatrician and nationally known child advocate who founded the programs that evolved into Healthy Start, said economic and social changes have resulted in funding cuts for services that led to more troubled families.
Supporting positive child development and preventing abuse and neglect have become much more challenging, he said, requiring more professional staff and linking services to often scarce community resources.
"Everyone has been working, so to speak, in silos," he said. Mental health support for children in schools has increased, he said, but there has been a lack of social and political support to fight "continued substance abuse and psychosocial problems faced by these at-risk families with children."
Fuddy said the Johns Hopkins study began six or seven years ago. Results were published in the June issue of the journal Child Abuse & Neglect, she said.
Researchers went mostly to poor Oahu households -- about 20 percent of Hawaii's childbearing population -- that were participating in Healthy Start.
Fuddy said state health officials welcomed the evaluation and have been working with the Hopkins researchers and participating agencies to address concerns.
The study cited deficiencies in training home visitors, inexperienced supervisors in some cases and lack of coordination of home visit programs with community resource organizations.
To make a lasting impact on child health and development, parental behavioral and mental health programs must be addressed, as well as difficulties related to poverty, reported Dr. Anne Duggan, Hopkins professor of pediatrics and health policy management.
But with some revisions, she said home visiting programs "have great potential."
Fuddy said clinical and child development specialists have been added to the home visit teams, paraprofessional training has been increased and standards are being raised.
She said the state has applied for funding for another study by Johns Hopkins to look at the impact of program changes.
The Health Department also is working with the Department of Human Services to see how child welfare and Healthy Start can collaborate to better serve families, she said.
Providing Healthy Start services on Oahu are Child and Family Service, Parents and Children Together, and Catholic Charities.
Child and Family Service also runs the Early Identification Program on Oahu and Kauai. Workers go to all civilian hospitals to do assessments and offer Healthy Start services to mothers who could benefit.
Robin Hodges, director of the identification program, said Healthy Start services can be offered up to 90 days after a baby is born. Families can receive services until a child is 3.
Fuddy said the Health Department and participating agencies took a hard look at the program to make needed changes, which "takes great courage. ... We should hold our head up high to say our primary concern was what was best for families."
Johns Hopkins Children's Center
www.hopkinschildrens.org Child Abuse & Neglect
authors.elsevier.com/JournalDetail.html?PubID=586&Precis=DESC
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Salt Lake family
welcomes help from
Healthy Start aide
After the birth of her third son 1 1/2 years ago, a home visitor changed Ngaire Covington's family life.
An assessment worker from the Child and Family Service's Early Identification Program called on her at the hospital after the baby's birth, asking if she'd like Healthy Start services, said Covington, 30, of Salt Lake.
"They told me they offered a wide variety of things; they took care of child care services, development and nutrition and all," she said.
A Healthy Start worker from Parents and Children Together's Hana Like (Working Together) Program began weekly visits to her home, and now comes once a month.
The program has been "a huge asset" for her and her husband, Robert, 32, she said. "They've just been a very active part of our lives and a very strong support system and resource system as well.
"Nobody should ever not take advantage of the opportunities they give us. It's all free -- grants to buy a computer, Pampers, and the list goes on and on."
The Covingtons' three children are Josiah, the youngest; Jacob, 3; and Kainoa Pakele, 12, Ngaire's son by a former relationship.
Covington said her home visitor, Michelle B., is "like a sister. I call her up and she is always very supportive. She was my counselor quite a while, too, and offered me therapy. ... She is always persistent and consistent because she calls to remind me about things, to double-check on things, to make sure I follow through.
"She still follows through with my son's developmental process. They've helped me with so many different things, Legal Aid and QUEST (health) insurance for my kids."
Covington received a grant through PACT's Economic Development Center to buy into a cleaning service and was the only one of 23 people to survive a class to prepare for the business, she said. She worked at it for a year, then gave the position back to the program for another needy mother.
She has worked full time since February as a youth counselor for the Honolulu Community Action Program, using her business experience. "I love my job," she said.
Her husband manages an auto detailing company. He also worked previously at an evening valet service "just to get us by," she said.
"Today, I'm in a very good position with everything through the help," she said. "Michelle said I'm ready to be released ... but I told her I'm not willing to let her go yet. She can always be a positive asset for my family. I will wait until Josiah is 3 and have to be kicked out of the program."
