PRINTER'S NO. 238
No. 209 Session of 2003
INTRODUCED BY MUNDY, BROWNE, BEBKO-JONES, BELARDI, BELFANTI, BISHOP, BLAUM, BUXTON, CAWLEY, CORRIGAN, COSTA, COY, CRUZ, DALLY, DeWEESE, EACHUS, FLICK, FRANKEL, FREEMAN, GORDNER, GRUITZA, HARHAI, HORSEY, JAMES, LAUGHLIN, MACKERETH, LEACH, LEVDANSKY, MANN, McCALL, MELIO, NAILOR, PRESTON, ROSS, SAINATO, SANTONI, SEMMEL, SOLOBAY, STABACK, STURLA, TANGRETTI, THOMAS, TIGUE, WALKO, WANSACZ, YOUNGBLOOD AND YUDICHAK, FEBRUARY 11, 2003
REFERRED TO COMMITTEE ON CHILDREN AND YOUTH, FEBRUARY 11, 2003
AN ACT 1 Providing for the strengthening and enrichment of children and 2 families by promoting safe, healthy and nurturing home 3 environments, for the educational and supportive services of 4 home visiting programs in this Commonwealth, for the Ounce of 5 Prevention grant program and for integrated community-based 6 delivery of services; specifying program requirements; 7 establishing the Ounce of Prevention Board; providing for 8 responsibilities of the board and the Department of Health; 9 specifying criteria for community program grant funding; 10 requiring training and an independent evaluation process; 11 providing for quality assurance; and making an appropriation. 12 The General Assembly of the Commonwealth of Pennsylvania 13 hereby enacts as follows: 14 Section 1. Short title. 15 This act shall be known and may be cited as the Ounce of 16 Prevention Act. 17 Section 2. Legislative intent. 18 The General Assembly finds and declares as follows: 19 (a) Funding.--The General Assembly finds that family well-
1 being is critical to a child's health and development, that 2 parenting is a difficult responsibility and that most of the 3 assistance available to Pennsylvania families occurs after there 4 is a problem and often provides too little, too late. Research 5 shows that comprehensive early home visitation programs prevent 6 child abuse, help develop positive parent-child interactions, 7 help brain development of the child, have a long-term savings in 8 both public and private health care costs and help avoid future 9 social problems. In addition to addressing child abuse, such 10 programs help to ensure that families' social and medical needs 11 are met and that children are ready for success in school. The 12 General Assembly finds that Pennsylvania needs broad 13 implementation of a program to provide support for families 14 which need and desire assistance in establishing healthy 15 relationships and environments for their children. 16 (b) Intent.--It is the intent of the General Assembly to 17 establish the Ounce of Prevention Act as a collaborative effort 18 that builds on existing community-based home visiting and family 19 support resources and will not duplicate the existing services. 20 It is further the intent of the General Assembly to provide the 21 needed intensity and duration of services extending beyond those 22 available through Head Start and Early Head Start programs, thus 23 filling a major gap in the existing continuum of early childhood 24 prevention and assistance services. 25 Section 3. Ounce of Prevention Act. 26 (a) Establishment.--The Ounce of Prevention Act is hereby 27 established as a voluntary home visiting grant program for 28 expectant mothers and newborn children and their families. 29 (b) Purpose.--The purpose of the act is to strengthen 30 families; promote early childhood growth and development; 20030H0209B0238 - 2 -
1 improve childhood immunization rates and well-child care; 2 improve child health outcomes; improve school readiness; 3 increase family self-sufficiency; increase the involvement of 4 both parents with their children; and reduce the incidence of 5 child abuse and neglect through a primary prevention approach 6 that offers home visits and linkages to family supports for 7 families and their newborn children and continues until the 8 children reach five years of age or begin the Head Start 9 Program. 10 Section 4. Delivery of services. 11 Service delivery under this act shall be community-based and 12 collaborative. Services shall be integrated and coordinated with 13 other services provided under Head Start and Early Head Start 14 programs and by local school districts, as well as with other 15 home visiting and family support service delivery systems 16 currently in place in communities throughout this Commonwealth. 17 Services shall be offered with the intensity and duration 18 required to prevent child abuse and neglect, improve child 19 development and child health outcomes and to promote child 20 school-readiness and educational development. 21 Section 5. Program requirements. 22 The program created under this act shall provide for 23 intensive home visits and include the following critical home 24 visiting elements: 25 (1) Initiation of services. This element provides for: 26 (i) Initiation of services prenatally or at the 27 birth of the first child. 28 (ii) Use of a standardized assessment tool to 29 systematically identify those at-risk families most in 30 need of services. The home visitor shall inform any 20030H0209B0238 - 3 -
1 potential participant that the assessment or 2 participation in the program is purely voluntary. 3 (iii) Offering services on a purely voluntary basis 4 and use of positive, persistent outreach efforts to build 5 family trust. 6 (iv) Working with family members to identify 7 strengths and resources that can be mobilized to help 8 resolve identified family concerns. 9 (2) Service content. This element provides for: 10 (i) Offering services over the long term and 11 intensively, with well-defined criteria for increasing or 12 decreasing the intensity of the service. 13 (ii) Providing services that focus on supporting 14 first-time at-risk expectant parents and families, 15 encouraging the interaction of both parents with their 16 child, and enhancing the development of the child, 17 including school readiness and educational development. 18 (iii) Linking at-risk families to medical providers 19 to ensure optimal health and development of the child, 20 timely childhood immunizations, well-child care that 21 provides for developmental assessment and is consistent 22 with the standards and periodicity schedules of Medicaid 23 and the American Academy of Pediatrics and additional 24 services, as needed. 25 (iv) Ensuring confidentiality and privacy for 26 families. 27 (v) Having periodic evaluations of program 28 effectiveness. 29 (vi) Having established mechanisms in place to refer 30 first-time at-risk expectant parents and families for 20030H0209B0238 - 4 -
1 other intervention services available in the community. 2 (3) Qualifications and training of home visitors. This 3 element provides for: 4 (i) Ensuring that home visitors have basic training 5 in areas, including, but not limited to, substance abuse, 6 child abuse, domestic violence, drug-exposed infants and 7 parents, child development, services available in the 8 community, infant care and early childhood development, 9 school readiness and parenting. 10 (ii) Ensuring that home visitors conducting home 11 visits are certified registered nurses or are qualified 12 home visitors under 45 Code of Federal Regulations Part 13 1304.52(e) (relating to home visitor qualifications under 14 the Head Start and Early Head Start Programs). 15 (iii) Ensuring that home visitors have preservice 16 and ongoing training that is specific to their job 17 requirements. 18 (iv) Ensuring that home visit providers receive 19 ongoing reviews and direct and intensive supervision. 20 (v) Ensuring that home visitors are qualified 21 community-based private, not-for-profit or public 22 organizations that have strong community support and the 23 social and fiscal capacity to provide the service. 24 Section 6. Ounce of Prevention Board. 25 (a) Establishment and membership.--The Ounce of Prevention 26 Board is established within the Department of Health, with 27 membership as follows: 28 (1) The Secretary of Health or a designee. 29 (2) The Secretary of Education or a designee. 30 (3) The Secretary of Public Welfare or a designee. 20030H0209B0238 - 5 -
1 (4) Four members of the General Assembly, one appointed 2 by the President pro tempore of the Senate, one appointed by 3 the Minority Leader of the Senate, one appointed by the 4 Speaker of the House of Representatives and one appointed by 5 the Minority Leader of the House of Representatives. 6 (5) Seven nongovernmental members who have expertise in 7 at least one of the following areas: substance abuse, child 8 abuse, domestic violence, drug-exposed infants and parents, 9 child development, services available in communities, infant 10 care and early childhood development, school readiness, 11 parenting and prevention research with families and young 12 children. 13 (b) Nongovernmental members.-- 14 (1) The Governor shall appoint the nongovernmental 15 members of the board in a manner that provides for regional 16 representation of this Commonwealth. 17 (2) Except as otherwise provided, the nongovernmental 18 board members shall serve a four-year term. 19 (3) Of the seven initial appointments, two shall be 20 appointed for a term of two years, two for a term of three 21 years and three for a term of four years. 22 (4) The Governor may reappoint nongovernmental board 23 members for successive terms. 24 (5) Nongovernmental members of the board shall remain in 25 office until a successor is appointed and qualified. 26 (6) If vacancies occur prior to completion of a term, 27 the Governor shall appoint another nongovernmental member in 28 accordance with this subsection to fill the unexpired terms. 29 (c) Powers and duties.--The board shall have the following 30 powers and duties: 20030H0209B0238 - 6 -
1 (1) To develop measurable outcomes consistent with 2 established home visiting programs operating in this 3 Commonwealth. 4 (2) To establish assessment and credentialing standards 5 for home visitation programs receiving grant funding under 6 this act. 7 (3) To review grant applications and award grants for 8 home visiting programs. No nongovernmental member may: 9 (i) Review grant applications or vote to award 10 grants to entities by which they are employed or with 11 which they are directly affiliated. 12 (ii) Be a lobbyist as defined under 65 Pa.C.S. Ch. 13 13 (relating to lobby regulations and disclosure). 14 (4) Grants for home visiting programs shall be awarded 15 on a three-year basis. The board may rescind a portion of the 16 grant not yet allocated if it determines through outcome, 17 expenditure and performance data submitted by the grantees 18 under section 7 that the funds are not being properly 19 utilized. 20 (5) Develop an assessment tool to identify at-risk 21 families who are eligible for home visiting grants under this 22 act. The assessment tool shall be a mechanism to identify 23 risk factors that may lead to child abuse or neglect or other 24 poor childhood outcomes. 25 (6) Establish policies for the development, 26 implementation and administration of this program. 27 (d) Board operation.-- 28 (1) The Secretary of Health shall be the president of 29 the board. 30 (2) The Secretary of Health, the Secretary of Public 20030H0209B0238 - 7 -
1 Welfare and the Secretary of Education shall be nonvoting 2 members of the board. 3 (3) The board shall meet at least biannually to review 4 progress of home visiting programs in this Commonwealth, 5 establish priorities for grant funding, award grants and 6 advise the Department of Health on matters relating to 7 administration of the program. 8 (4) The Department of Health shall reimburse all 9 nongovernmental members of the board for all necessary and 10 reasonable travel and other expenses incurred in the 11 performance of their duties under this section. 12 Section 7. Implementation. 13 The Ounce of Prevention Board shall: 14 (1) Implement a community-based home visiting program 15 for first-time at-risk expectant parents and families in this 16 Commonwealth using the criteria set forth in this section. 17 (2) Develop a grant application and award grants under 18 this program in accordance with the following requirements: 19 (i) Grants must be awarded in accordance with 20 weighted criteria based on population demographics, 21 factors associated with child abuse and neglect and other 22 appropriate criteria developed by the board. 23 (ii) Cash or in-kind matching funds in the amount of 24 25% of the total program cost shall be required. 25 (iii) If a program is not able to meet the 25% match 26 requirement, justification must be included in the grant 27 application providing a detailed explanation of the 28 reasons why this match cannot be met and the percentage 29 of the match that can be met. A determination will be 30 made by the board, without recourse, as to the merit of 20030H0209B0238 - 8 -
1 the justification. 2 (3) Develop a plan of implementation to equitably 3 distribute funds throughout this Commonwealth. 4 (4) Require that, in addition to the program 5 requirements outlined in section 5, the following criteria be 6 used in selecting recipients of grant funds: 7 (i) Preference for grant awards must be given to 8 community-based entities that have broad representation 9 and have the fiscal and administrative capacity to 10 successfully implement the program. 11 (ii) Home visiting programs that receive grants 12 should collaborate with other home visiting and family 13 support programs in the community to avoid duplication 14 and complement and integrate with existing services. 15 (iii) Each applicant must use the standardized 16 assessment tool developed by the board under section 6. 17 (iv) Each applicant must provide outcome, 18 expenditure and performance data in the format and the 19 frequency specified by the board. 20 (v) Each applicant must identify local resources 21 available for implementation. 22 (vi) Implementation design must include service 23 delivery strategies that, when appropriate, involve both 24 parents if they have shared parental responsibility, 25 regardless of residential custody arrangements. 26 (5) Evaluate and approve grant applications and local 27 implementation plans for service delivery. 28 (6) Encourage applicants to coordinate service delivery 29 with Head Start, Early Head Start, Parents as Teachers, 30 family centers, school districts and other existing home 20030H0209B0238 - 9 -
1 visiting programs operating in communities in the various 2 regions of this Commonwealth. 3 (7) Identify qualified trainers and training 4 opportunities that will assure adequate opportunities for 5 grantees and their communities to provide preservice and in- 6 service training. Funds for training may be incorporated into 7 the grants. 8 (8) Develop and implement a quality assurance and 9 improvement process for the program. 10 (9) Identify and seek Federal matching funding for this 11 program. 12 (10) Identify existing State funding streams that could 13 be used to fund home visiting programs in this Commonwealth. 14 (11) Provide for an annual independent review that 15 evaluates both the progress and effectiveness of community 16 programs receiving grants and the overall progress and 17 achievement of the designated outcomes of the programs. The 18 Ounce of Prevention Board shall provide the review to the 19 Governor, the Senate and the House of Representatives on an 20 annual basis. 21 Section 8. Responsibilities of Department of Health. 22 The Department of Health shall allocate the staff and 23 financial resources necessary to assist the Ounce of Prevention 24 Board in the implementation and administration of this grant 25 program. 26 Section 9. Appropriation. 27 The sum of $10,000,000 is hereby appropriated to the 28 Department of Health for the fiscal year July 1, 2003, through 29 June 30, 2004, to implement the Ounce of Prevention grant 30 program established under this act. An amount not to exceed two 20030H0209B0238 - 10 -
1 percent of this appropriation may be used by the department to 2 cover the administrative costs of implementing and administering 3 the program. 4 Section 10. Effective date. 5 This act shall take effect immediately. A6L35MSP/20030H0209B0238 - 11 -