The 2nd meeting of the Poverty Task Force was held on Monday, October 26, 2009, at 1:00 PM, in Room 154 of the Capitol Annex. Senator Brandon Smith, Co-Chair, called the meeting to order at 1:06 PM, and the secretary called the roll.
Present were:
Members: Senator Brandon Smith, Co-Chair; Representative Greg Stumbo, Co-Chair; Senators Dan "Malano" Seum, Robert Stivers II, Elizabeth Tori, and Johnny Ray Turner; Representatives Linda Belcher, Dwight D. Butler, Leslie Combs, C. B. Embry Jr., Jim Glenn, Keith Hall, Richard Henderson, Melvin B. Henley, Martha Jane King, Mary Lou Marzian, Reginald Meeks, Fred Nesler, Kevin Sinnette, Kent Stevens, Ken Upchurch, Alecia Webb-Edgington, and Addia Wuchner.
Guests: Steve Davis, MD, Senior Deputy State Health Office, Cabinet for Health and Family Services; Dr. James P. Ziliak, Director, Center for Poverty Research, Gatton Endowed Chair in Microeconomics, University of Kentucky; Annette Bridges, Office of Early Childhood Development; Department of Education, Education Cabinet; Brenda English, Department for Public Health, Cabinet for Health and Family Services; Anne Joseph, Covering Kentucky Kids and Families, and Melissa Fry Katy, MACED.
LRC Staff: DeeAnn Mansfield; Lou DiBiase, Amanda Dunn, Mustapha Jammeh, Gina Rigsby, and John Scott.
A motion to approve the minutes of the September 21, 2009 meeting was made by Representative Nesler, seconded by Representative Stumbo, and approved by voice vote.
Steve Davis, MD, Senior Deputy Health Office, Cabinet for Health and Family Services, discussed the Access for Babies and Children to Dentistry (ABCD) Initiative. Dr. Davis stated that untreated cavities can cause pain, dysfunction, absence from school, low weight, and poor appearance, which are all problems that can greatly reduce a child’s capacity to succeed in school and in life. Tooth decay affects one-fourth of the children in the United States between the ages of two and five, but in Kentucky it affects nearly half of the children in that age group. Barriers to oral health for children include an insufficient number of dentists, a reluctance of dentists to treat children, and a lack of dentists in rural areas. The three-year ABCD initiative received three federal grants totaling approximately $2 million. One was from the Health Resources and Services Administration (HRSA) and two were from the Appalachian Regional Commission. The initiative has a three step approach: (1) pediatric training for general dentists to foster more comfort in treating children; (2) local oral health coalitions in 40 counties to define gaps in treatment; and (3) portable equipment to bring access to Appalachia. The partners are the Department for Local Government, the Appalachian Regional Commission, the Cabinet for Health and Family Services, the University Dental Schools, the Kentucky Dental Association, and Kentucky’s local health departments.
Representative Wuchner said that even though there are an adequate number pediatric dentistry resources in the main areas of Northern Kentucky, a number of children are not accessing the resources because you find that a large number of children have not even had their first encounter with the dentist before they are 18 years of age. She asked if there is a way to improve the dental reimbursement structure in KCHIP and Medicaid so when there are dental providers available, people take advantage of these services. Dr. Davis said that within the past two years the Department for Medicaid Services has raised the reimbursement for practitioners who see children by approximately 30 percent. The new reimbursement rates and training programs should bring more practitioners into the Medicaid program allowing more children to be seen.
Representative Glenn asked if there are programs that could be put in place that are budget neutral or cost very little that would help the healthcare of children. Dr. Davis said that more can be done through the entire healthcare system to educate families about the importance of oral healthcare in their children. Representative Glenn asked if the dental schools still offer free or reduced cost visits so dental students could get practice in their trade. Dr. Davis said that the Department for Public Health has a partnership with the University of Kentucky Dental School where dental students are taken across eastern and western Kentucky in mobile vans to schools to get experience but also help the children.
Representative Stumbo asked Dr. Davis if funds were available, what would be his recommendations be on what it would cost to adequately address the problems to help these children. Dr. Davis said that he would get some information together and send it to the task force.
Senator Stivers asked about the mobile dental unit in Bell and Knox County. Dr. Davis said that the state dental director, Dr. Julie McKey, has been in contact with them. The mobile dental unit will be involved in a dental workforce committee that will be formed.
Brenda English, Department for Public Health, Cabinet for Health and Family Services, discussed Kentucky’s Health Access Nurturing Development Services (HANDS) Program. Jessica Lopez and Nahibi Valazquez were present to testify about their experiences with the HANDS Program.
Ms. Lopez said she is from Franklin County and just gave birth to triplets who are four-months old now.
Ms. Valazquez said that she is from Mexico and has a three-year old who is in a literacy program at the Thornhill Learning Center in Frankfort called the Families Learning through Interaction Program (FLIP). FLIP is specifically designed for parents earning their GED.
Ms. English stated that HANDS is a voluntary, intensive home visitation program for first-time moms and dads regardless of income. The program is from prenatal to two years of age and is designed to improve both health and social outcomes. The HANDS program was created in House Bill 706, Early Childhood Development Act, of the 2000 Regular Session and regulated under 902 KAR 4:120. The goals of the program are positive pregnancy outcomes, optimal child growth and development, children living in health and safe homes, and family self-sufficiency. There are approximately 11,000 HANDS families served per year. Of the 11,000, 41 percent have less than a high school education, 34 percent have a high school education, 80 percent are female-headed, 10 percent are African Americans, 10 percent are Hispanic, and 88 percent receive Medicaid. Families are screened by a nationally proven tool that examines at-risk factors, then families are assessed by professionals in ten focus areas, and then they begin home visitation. Home visitations focus on medical homes, immunizations, well child checks, child safety checklists, and developmental screens. There is a parent-child interactive curriculum called Growing Great Kids that focuses on basic care, child development, nurturing parent-child relationships, and strengthens base support to families. As of June, 2009, the total number of counties with HANDS was 120; the number of families receiving services was 47,237; the number of assessments made was 48,318; the number of professional or paraprofessional home visits was 1,066,759, and the total number of services provided was 1,115,077. Over 35,000 referrals have been made to local agencies in Fiscal Year 2009. Brain, cognitive, and behavioral development are linked to both educational and health outcomes later in life. Outcomes for the HANDS program include decreased child abuse, decreased emergency room visits, decreased hospital days, less special education requirements, fewer school dropouts, less risky behaviors in adolescence, fewer arrests as teens, higher rates of high school graduation, increased employment, and increased home ownership.
The rate of prematurity among HANDS mothers with six or more prenatal home visits was 30 percent less than the rate of prematurity among HANDS mothers with no prenatal visits. The rate of low birth weight births among HANDS mothers with six or more prenatal home visits was 33 percent less than the rate of low birth weight births among HANDS mothers with no prenatal visits. The rate of very low birth weight births among HANDS mothers with six or more prenatal home visits was 55 percent less than the rate of very low birth weight births among HANDS mothers with no prenatal visits. The infant mortality rates for families served by the HANDS program are 70 percent less, emergency room visits is are 50 percent lower, child abuse and neglect is 29 to 40 percent lower, and there are fewer developmental delays than among non-HANDS families. HANDS families are showing progress in education and employment.
The HANDS program is making a difference in short-term goals and long-term outcomes are expected. In 2009, Kentucky received $12 million federal Medicaid dollars under case management service. The state required match was $5.2 million and $3.3 million was needed to serve non-Medicaid families. If the program is expanded to serve families with multiple children in Fiscal Year 2011, approximately 13,541 additional Medicaid families could benefit from the HANDS program and Kentucky could receive an additional $21 million in federal Medicaid dollars, an additional $7 million state match would be required.
Senator Smith asked where the $12 million was coming from to fund the program. Dr. Davis stated the $12 million in federal Medicaid dollars is matched with tobacco settlement funds and these funds are used to leverage the 70/30 federal Medicaid match. Senator Smith asked about R.E.A.C.H. of Louisville, Inc. Ms. English stated that it is an independent evaluator selected through a Request for Proposal (RFP).
Representative Glenn asked what is being done to reduce child abuse. Ms. English stated that in weekly home visitations they help educate parents on how to deal with stress, how to communicate with their children, and that they can and should seek other supports. Ms. English said that information is given that helps show how to raise a child and what to expect at different developmental stages in a child’s life.
Representative Hall asked how someone would find out about the HANDS program. Ms. English said information is available in all the local health departments, department for community based services offices, from school counselors, and that any agency that deals with families should know about the program. He asked if 80 percent of the mothers were single, and she said yes. Representative Hall asked how long the program had been in existence. Ms. English stated the pilot program began in 1999.
Senator Smith asked Dr. Davis if there are things that need to be explored, actions taken, or legislation that may not cost money that the legislature can help tackle or push out of the way that can help. He asked if there is anything that can be done to help make a dent and help the cabinet move forward with programs already implemented. He asked that recommendations for legislation be sent so the task force could review them to see how it could possibly help the cabinet achieve its goal.
Representative King asked if information is made available to people with high risk pregnancies. Ms. English stated because of limited resources, information is provided only if they are in the HANDS program. She said that they work with the hospitals and obstetrician offices.
Representative Henderson stated that even if the $21 million dollars is leveraged, you cannot put a number on the economical benefits for employees and the benefits for the future generations by knowledge, treatment, and prevention. Ms. English stated that the cabinet had received letters and calls from moms who are not first-time moms who want and need the services of the program.
Dr. James P. Ziliak, Director, Center for Poverty Research, Gatton Endowed Chair in Microeconomics, University of Kentucky discussed children in poverty and programs that work. Dr. Ziliak stated that there is a growing gap between high school graduates and dropouts, and between college graduates and high school graduates. Dropout rates are high, especially among African Americans and Hispanics in urban areas, but also high among whites in parts of rural American such as Appalachia. The rate of return to additional schooling beyond high school is nearly ten percent, and higher if you include social returns from better health, lower crime, and higher marital stability. The cost of intervention is lower for children and has a longer return on investment. GED recipient scores are comparable to high school graduates on cognitive tests, yet they earn 20 percent less on average in the labor market which points to a big role for noncognitive skills.
The Head Start program serves over 900,000 children nationwide with approximately 16,000 from Kentucky. The program provides comprehensive services including literacy, dental, vaccinations, and parent education. It has been shown to have positive effects on academic performance in the short run. Participants in Head Start acquire better non-cognitive skills than similarly situated non-participants and thus are less likely to drop out of school and less likely to be arrested. In 2008, there were about 285,000 children under age five living in Kentucky with 79,000 living in poverty. Approximately 40 percent or 31,600 of these children were ages three and four. This implies that Head Start in Kentucky serves only about half of the eligible population of children.
There is an ongoing debate whether pre-K type programs should be targeted to the disadvantaged or be universal. Many favor targeting the disadvantaged because of cost-effectiveness and evidence that children from low-income families face severe deficits in both cognitive and noncognitive skills. A recent National Association of Manufacturers study found that 69 percent of businesses cite inadequate basic employability skills such as attendance, timeliness, and work ethic as the most common reason for rejecting jobs applicants. This proves that these skills matter.
Representative Glenn said that the middle class is shrinking and the lower income population is increasing, and he asked if this had been factored in targeting low income people versus offering something universal to a group of people. Dr. Ziliak said that many states extend eligibility to people who are eligible for free or reduced school lunch. The main reason for starting here is for cost effectiveness reasons. In the short run, children from these families face the greatest risks throughout their lifetimes. If there are additional dollars to invest, you would see a higher return investing in families under 200 percent of the federal poverty level (FPL) than families at 400 percent of the FPL.
Representative Belcher asked why Head Start only serves half the eligible population. Dr. Ziliak stated that Head Start is not an entitlement program and has restricted resources. She asked the cost per child in Head Start. Dr. Ziliak stated it differs across the nation based on services offered, but approximately $7,000 to $9,000 per child.
Representative Meeks asked how much of the proposed $8 billion to $9 billion in the Obama budget bill will come to Kentucky. Dr. Ziliak said that states would have to compete for the money. Representative Meeks asked if this is how it has normally been done in the past, and Dr. Ziliak said no. Representative Meeks asked how the federal government will spell out the terms of the competition. Dr. Ziliak stated that because it is still part of the budget bill, the terms have not been spelled out at the present time.
Representative Henley said universities get a lot of general fund money and a lot of bond money to build edifices and purchase equipment, conduct renovations, and they should be required to help first-generation college students with a poor background to face and overcome insurmountable fears and go on to finish college. Dr. Ziliak stated that the University of Kentucky knows that their economics depend on students remaining in school and have a number of initiatives to retain students.
Annette Bridges, Office of Early Childhood Development, Department of Education, Education Cabinet, discussed preschool and Head Start programs in Kentucky. Ms. Bridges stated that the Kentucky Invests in Developing Success (KIDS) NOW vision is that all young children in Kentucky are healthy and safe, possess the foundation that will enable school and personal success, and live in strong families that are supported and strengthened within their communities.
In response to the Kentucky Education Reform Act (KERA) of 1990, the Kentucky Preschool Program was established. All of the state’s four-year olds and three-year olds with disabilities are eligible to participate in the program. Currently, 24,000 children are being served. Of these children, 55 percent have disabilities and 45 percent are at risk. Children who do not meet these eligibility requirements may also participate, but are funded by the district or tuition rather than the state. Eligibility was extended to additional children beginning with the 2006-2007 school year when income eligibility was raised from 130 percent of the federal poverty level (FPL) to 150 percent of the FPL. The Kentucky Student Intervention, the state’s version of Response Intervention, which includes preschool, is a result of legislation passed by the 2009 General Assembly. The new administrative regulations require programs to implement relevant, research-based instruction and interventions by qualified personnel. She said that Head Start is a federal program and does not fall under the Department of Education like the preschool program.
The University of Kentucky conducted a nine-year longitudinal study of the KERA preschool program, and there were some very good outcomes. Although the study ended in 1998, the outcomes are still relevant. The gains persisted through fifth grade. The National Institute for Early Education and Research (NIEER) Report looked at ten indicators of quality and ranks states, and Kentucky met eight of them. Kentucky did not have an on-site monitoring process or require teacher assistants in state-funded preschool programs to have a child development associate, so we did not rank as high as we could have.
Two pilot collaboration projects in Fayette County and Anderson County have received $50,000 from the KIDS NOW Authority for two years, but they have to do a one-to one match. The goal is to serve as many children as possible in a high quality environment. There is not enough space in the schools to serve all children, nor does the state want to put child care programs out of business. According to a study conducted by Hart and Risley in 1995, unless there are maternal health problems or health related issues, children begin development at the same rate. Some things do not matter such as race or ethnicity, gender, or if a child is the born first child, but economic advantage does matter. Virtually all children begin to acquire a vocabulary of words in the second year of life, usually soon after their first birthday.
Evaluations for child care programs began in 2002, and the results show the higher the level of Stars for KIDS NOW Child Care Quality Rating System Standards the child care program has, the higher the child scores and the higher the outcomes are for children. The Stars Quality Rating System Standards is voluntary and 25 percent of child care programs participate. The consistent message is that low income and minority children are in low quality programs, but some programs with a large number of children on subsidy are beating the odds. These state-funded programs are required to have learning centers such as science, math, art, computer, and literacy.
Representative Glenn said he read a report that said the size of the classroom did not matter, but that the teacher focus on making students more dependent on themselves and re-enforcing their self-esteem mattered. Ms. Bridges said that the research is mixed about smaller class sizes. Some research shows that some students do better when the teacher to student ratio is lower, and for others there is no difference.
Representative Belcher said she realized that in order to improve day care centers, they would all need to be at level 4, and asked if it would it be helpful to require them to do two levels and then give them some options to complete the others. Ms. Bridges said that her recommendation was that the licensing standards require the level of Star I and that would be an incentive for programs to go to the next level. This says that the state will not continue to give funds to low-quality programs.
Representative Meeks asked about the number of children served in state-funded preschools. Ms. Bridges said there are 24,000 eligible children and added with Head Start it is about 36,000. Representative Meeks asked if that is close to 100 percent of eligible children, and she said yes. Representative Meeks asked Ms. Bridges to provide the task force with copies of the documents “Building a Strong Foundation for School Success.” She said that she would send the information and an overview. Representative Meeks asked what state the Hart and Risely study was conducted in. Ms. Bridges said she was not sure. Representative Meeks asked if a study had been conducted on Kentucky families. He asked what states have the highest licensing ratings. She said that she would get back to him with that information.
Representative Stevens said as a former principal, he had a Head Start unit in his building, and he saw the good things that came from the program and saw other children that would have benefited that could not get in the program. He said that he was pro-universal preschool.
Representative Wuchner asked about educating parents about choosing child care centers with higher levels of care and putting more pressure on centers to want to earn a higher rating. Ms. Bridges said the Stars Advisory Group advertises and promotes the Stars Quality Rating System Standards.
Senator Smith said there was a study conducted on fifth and sixth graders, and one question asked children what they wanted to be when they grew up. He said that the data showed there were a lot of geographical challenges for children in rural, heavy poverty areas that in their minds they dreamed to be less than what they could be. In a child’s mind they should be able to be anything they want to be, and not limited. Unfortunately, because of their circumstances, these children did not even dare to dream.
Senator Smith said the next meeting would be November 16, 2009 at 1:00 p.m. There being no further business, the meeting was adjourned at 3:12 p.m.