Revamping, extra
funds for Healthy
Start urged

The abuse prevention program
faces a $5 million budget cut

The Healthy Start Program, a national model for child abuse prevention, is overloaded with state requirements and should be restructured, say leaders of service agencies.

Healthy Start Who: About 5,000 families enrolled. Established: In 1985. Purpose: To prevent child abuse and neglect by providing support for families of newborns and others needing help. Cost: $18 million a year.

Until that's done, they're urging restoration of more than $5 million cut from the program's $17.6 million budget to maintain current services in the next fiscal year.

The budget offered by Gov. Linda Lingle contained $12 million for the program, and the Legislature hasn't increased the amount, said Sen. Suzanne Chun Oakland (D, Alewa Heights-Kalihi-Liliha-Nuuanu-Palama-Puunui), Human Services Committee chairwoman.

She said she's looking into federal sources to offset the shortfall and the Department of Health may tap into an Early Intervention Program special fund for some Healthy Start expenses.

Community agencies that contract with the Health Department to provide Healthy Start services proposed a resolution, pending in the Legislature, to create an advisory board and planning task force to work on restructuring the program.

Healthy Start was established in 1985 to prevent child abuse and neglect by providing support for families of newborns and others needing help.

But families are different from what they were 15 years ago, said Geri Marullo, Child and Family Service chief executive officer. "Issues are more complicated. We're seeing more drug and substance abuse. We're seeing families busier than ever."

Also, the Health Department has added so many requirements to the program that "they have, in my opinion, obscured the original intent," Marullo said.

Chiyome Fukino: Says Department of Health is evaluating program's effectiveness

State Health Director Chiyome Fukino said funds were juggled last year to make up more than $5 million but the funding wasn't available this year.

The Health Department also is also trying to evaluate the effectiveness of Healthy Start, which cost $18 million last year, she said.

Although the funding has shrunk more than $5 million, "it's a good time to take a good hard look at what we're doing, with good performance and outcome measures," Fukino said.

She questioned its success rate, noting 12 percent of families with newborns are referred to Healthy Start, but 57 percent leave within six months and 39 percent more leave in the next six months.

Fukino said child abuse is on the rise, but Marullo said it isn't on the rise with Healthy Start families.

However, Marullo said the original intent "to be there for families who needed support" has been eroded by a Health Department policy "to add more services to Healthy Start, more paperwork, more bureaucracy and a complicated billing system."

Paraprofessionals on home visit teams don't have flexibility to work with families because of state deadlines on how soon things have to be done, she said.

"We have a problem with families staying in the program now because the model is tainted," Marullo said. "There are so many requirements that both the family and workers have to meet that the focus on parenting and prevention of child abuse is really obscured."

Marullo said the providers would like to see a letter of intent from the Health Department to keep services at the current level so they can plan their work force and the number of families they can service.

Gail Breakey, Hawaii Family Support Institute director who was one of the Healthy Start founders and helped launch the Healthy Families America Initiative, said the program has maintained a 99 percent no-abuse rate among its families.

The Health Department "has been so bent on meeting requirements of the Felix consent decree that they've persisted in things that have actually made the program too cumbersome and too bureaucratic," Breakey said.

Providers are frustrated because the Health Department had no discussions with them before the legislative session about a budget cut or retooling the program, she said.

"We've shown what has been expended, what the program is costing. It is difficult not to be getting really clear answers," she added.

Concerns were raised by the Johns Hopkins Children's Center in a study of the program in the 1990s. Evaluators cited a number of deficiencies but praised certain aspects, such as the concept of a "medical home" for every family.

"Overall, it's very positive," said Dr. Calvin Sia, Honolulu pediatrician and one of the Healthy Start pioneers. He said the data "reveals what we need to do, what needs to be corrected, what our problems are."

Breakey, Sia and other Healthy Start leaders in Hawaii provided training and consultation for Healthy Families America, which now has programs in 350 communities in the United States and Canada.