The5th meeting of the Subcommittee on Families and Children of the Interim Joint Committee on Health and Welfare was held on Wednesday, November 19, 2003, at 10:00 AM, in Room 125 of the Capitol Annex. Senator Katie Stine, Chair, called the meeting to order, and the secretary called the roll.
Guests: Prentice Harvey, Norton Healthcare; Gary Marshall, University of Louisville; and Sean Cutter, McBrayer, McGinnis, Leslie and Kirkland.
LRC Staff: DeeAnn Mansfield, Murray Wood, and Cindy Smith.
The minutes of the October 15, 2003 meeting were approved without objection.
The first item on the agenda was an update on KIDS NOW, by Dr. Kim Townley, Director, Office of Early Childhood Development, Department of Education. Dr. Townley highlighted positive results of programs including the folic acid campaign, which has reduced the number of children born with spinabifida. The HANDS program continues to have good results. Mothers in the HANDS program are delivering fewer pre-term babies, fewer low birth weight babies, and child abuse and neglect is substantially lower for the families participating in the HANDS program. The universal newborn hearing screening coverage remains at 99 percent. The immunization rates have gone up, but their goal is to have 100 percent of all children immunized by the age of 2. She mentioned the Stars for Kids Now program and its importance. She stressed the importance of the Director’s credentials for childcare programs. They have rolled out a director’s credential and two people have received it. They have established a trainer’s credential, and have had over 265 people who have received the training. Over 500 trainers are expected to receive that credential by the early part of the new year.
Senator Stine said asked about a childcare center in her district that cares for children from difficult situations. She asked about childcare subsidies that may be available for those children. Dr. Townley said the children that benefit the most from quality early childhood programs are low income children. Mike Cheek responded regarding the subsidy. He said they are at 150 percent of poverty now and any family below 150 percent of poverty, under protective services, a KTAP case, or transitioning from KTAP can receive a subsidy automatically. Currently, there is a suspension of intake for low income cases and those who are in education and training. There is a waiting list of about 8,900 now. He said there are federally mandated individuals that Kentucky is required to serve and those transitioning for a year from KTAP are required to be served. The funding just is not there to serve more children. They were able to open up 2,000 slots to put additional kids on subsidies in September. They are managing the applications and terminations each month to watch for openings again. Dr. Townley added that that the General Assembly passed a bill relating to the Child Care Fund nine years ago. They have been trying to work with community childhood councils to let them know that is a way to raise money for childcare subsidies in their counties. A county must accumulate $2,000 before they start to draw the money down. The money goes to the Childcare Resource and Referral Agency. They decide how the money is distributed.
Representative Burch asked how much money the fund has generated so far. Mr. Cheek said so far it has generated about $67,000 in the total fund statewide last year.
The next item on the agenda was a presentation on Autism and Immunizations by Dr. Gary Marshall, Pediatric Infectious Diseases Division, Kosair Children’s Hospital, University of Louisville. Dr. Marshall said thimerosal is a preservative that was added to vaccines starting 60 years ago as a preservative. The issue is that thimerosal does contain mercury. The EPA looked at data to figure out the amount of mercury that was safe for a human to be exposed to. The FDA looked at the childhood vaccination schedule and at that time there were vaccines that contained thimerosal. The FDA calculated that children would be exposed to far more than the safe amount proposed by the EPA. It does not exceed the amount by three other agencies that came up with guidelines. On July 9, 1999, the Public Health Service and the American Academy of Pediatrics issued a notice to readers which said that as a precautionary measure, although there is no evidence that the ethyl mercury in thimerosal has hurt any child, they wanted to remove the thimerosal from vaccines. This was a disastrous statement that confused many pediatricians, and many Hepatitis B vaccines were not given and children were infected with Hepatitis B. There was an argument that autism presents at a year or two of life and that is the period of time when children get many vaccines. There were many studies published that claimed to show a relationship between thimerosal and autism. Unfortunately many of those studies were flawed. Over the years people have become more aware of what autism is, the spectrum of autistic diseases has widened and there are better methods at their disposal to diagnose autism and find it in those children who are not progressing like they should. So, there may not be an epidemic of autism, instead it could just be an increased awareness and better case finding. Statistics have shown that in Denmark and Sweden, even after thimerosal was taken out of the vaccines, the cases of autism continued to rise.
The next item on the agenda was a presentation on Kentucky’s response to the Federal Child and Family Service Review initiative. The first presentation was on the Court Improvement Plan by Patrick Yewell, General Manager, Kevin Smally, Assistant General Manager, and John Burgess, Supervisor, Division of Dependent Children’s Services, Department of Juvenile Services, Administrative Office of the Courts. Mr. Yewell said when he came to work at AOC, he wanted to know how many children there were in out-of-home care and how long they had been there. He went to all different agencies and nobody could answer that question. In the last three years children in out-of-home care are spending an average of nine less months in out-of-home care. There are fewer kids in foster care spending less time in foster care. Next, Mr. Burgess discussed the Court Improvement Plan for the next three years. Within the strategic plan they addressed some of the issues with the child and family services review. They mentioned some ideas for court improvement including: (1) training and education; (2) family courts; (3) Foster Care Tracking System and Court Management Information Systems; (4) Reassessment to be conducted over the next 1.5 years; (5) mediation; (6) Dependency Law Clinic; (7) the Cabinet for Families and Children Program Improvement Plan and (8) the Citizen Foster Care Review Board.
Mr. Burgess said the average length of stay for children in foster care has decreased. Just from last year that number has decreased by four months. Last month the average was 36 months, and this year is 32 months. Children are experiencing less time before they are adopted. During fiscal year 2002, 14.7 percent of children exited care to finalized adoption in less than 24 months. In 2003, 16.1 percent of children exited care to finalized adoption in less than 24 months. That is an improvement, but much less than the national standard of 32 percent in less than 24 months. The average length of time for adoption last year was 46 months, and this year it has been decreased to 42 months. The average length of time spent in foster care for children who were returned to their parents was 14.5 months.
Representative Nunn asked how many active cases and inactive cases there are. Mr. Burgess said of the children reviewed in the last fiscal year, 3,124 were released and 4,928 were still in foster care as of August 1, 2003.
The next presentation was a presentation on the Program Improvement Plan by Secretary Viola Miller, Cabinet for Families and Children, and Barbara Carter, Director, Family and Child Safety Branch, Office of Protection and Permanency, Department of Community Based Services, Cabinet for Families and Children. Secretary Miller said the Cabinet’s Program Improvement Plan has been approved, and every quarter the data is beginning to look better. Their plan focuses on five major themes: (1) increase effectiveness of social work intervention; (2) strengthen professional development; (3) continue to enhance continuous quality improvement; (4) expanding and improving community networks; and (5) building partnerships with the courts. The Cabinet will be required to report quarterly to the federal government on progress that is made. The first report is due in March. Ms. Carter said each region has a Program Improvement Plan team that is working on the areas they need to improve on in their specific regions. They have assigned technical assistance from program experts from Frankfort to work with each team as they work through their Program Improvement Plan, so there is a seamless flow of information and support.
The next item on the agenda was a presentation on the Temporary Assistance for Needy Families (TANF) Program by Viola Miller, Secretary, Cabinet for Families and Children. Secretary Miller said there is little known currently about the federal reauthorization, but the public assistance roles in Kentucky are remaining flat. Many families are exiting TANF, but the food stamp roles continue to go up. There is talk that the forty hour work week for TANF recipients may be reduced. Also, some additional child care funds are coming to the state, but probably not enough to meet the need.
The last item on the agenda was a presentation on Child Poverty in Kentucky by Debra Miller, Director, Kentucky Youth Advocates, and Rick Graycarek, Director, State Fiscal Analysis Initiative, Kentucky Youth Advocates. Mr. Graycarek said poverty is taking the amount of income or earnings that a family has and measuring that against some sort of threshold. The federal government establishes that threshold for all states in the country. One important thing is that non cash government benefits like SSI and TANF are excluded from the poverty definition. On the other side taxes are excluded as well. The poverty level is used to determine program eligibility and is used as a well-being measure. In 2003, for a family of three, the poverty level ends at $15,260. For a family of four, the poverty level ends at $18,400. Poverty has significant impacts on children because they result in lost opportunities for children, lost healthcare and even lost education. Data shows that single parents and minorities are more likely to be poor. Single parent fathers have been an increasing number in terms of the poor and also the head of household. Poverty has declined over the last ten years, but it is still about 18 percent for families with children. In Kentucky, there are 429,681 children that live in poverty. Their policy recommendations include: (1) help families stretch incomes, such as tax policy, KCHIP and child care subsidies; (2) help families increase incomes, such as jobs, economic development and increased education; (3) target programs by geography; and (4) other related issues such as mental health, domestic violence, child abuse, and substance abuse.
The meeting was adjourned at 12:10 p.m.