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;
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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
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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
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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.
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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:
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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
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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
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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
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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
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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.
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