PRINTER'S NO. 370
No. 357 Session of 2003
INTRODUCED BY DENT, O'PAKE, ORIE, CORMAN, MUSTO, COSTA, KITCHEN,
HELFRICK, TARTAGLIONE, HUGHES, KUKOVICH, SCHWARTZ AND
RHOADES, MARCH 3, 2003
REFERRED TO AGING AND YOUTH, MARCH 3, 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-
20 being is critical to a child's health and development, that
21 parenting is a difficult responsibility and that most of the
22 assistance available to Pennsylvania families occurs after there
1 is a problem and often provides too little, too late. Research
2 shows that comprehensive early home visitation programs prevent
3 child abuse, help develop positive parent-child interactions,
4 help brain development of the child, have a long-term savings in
5 both public and private health care costs and help avoid future
6 social problems. In addition to addressing child abuse, such
7 programs help to ensure that families' social and medical needs
8 are met and that children are ready for success in school. The
9 General Assembly finds that Pennsylvania needs broad
10 implementation of a program to provide support for families
11 which need and desire assistance in establishing healthy
12 relationships and environments for their children.
13 (b) Intent.--It is the intent of the General Assembly to
14 establish the Ounce of Prevention Act as a collaborative effort
15 that builds on existing community-based home visiting and family
16 support resources and will not duplicate the existing services.
17 It is further the intent of the General Assembly to provide the
18 needed intensity and duration of services extending beyond those
19 available through Head Start and Early Head Start programs, thus
20 filling a major gap in the existing continuum of early childhood
21 prevention and assistance services.
22 Section 3. Ounce of Prevention Act.
23 (a) Establishment.--The Ounce of Prevention Act is hereby
24 established as a voluntary home visiting grant program for
25 expectant mothers and newborn children and their families.
26 (b) Purpose.--The purpose of the act is to strengthen
27 families; promote early childhood growth and development;
28 improve childhood immunization rates and well-child care;
29 improve child health outcomes; improve school readiness;
30 increase family self-sufficiency; increase the involvement of
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1 both parents with their children; and reduce the incidence of
2 child abuse and neglect through a primary prevention approach
3 that offers home visits and linkages to family supports for
4 families and their newborn children and continues until the
5 children reach five years of age or begin the Head Start
6 Program.
7 Section 4. Delivery of services.
8 Service delivery under this act shall be community-based and
9 collaborative. Services shall be integrated and coordinated with
10 other services provided under Head Start and Early Head Start
11 programs and by local school districts, as well as with other
12 home visiting and family support service delivery systems
13 currently in place in communities throughout this Commonwealth.
14 Services shall be offered with the intensity and duration
15 required to prevent child abuse and neglect, improve child
16 development and child health outcomes and to promote child
17 school-readiness and educational development.
18 Section 5. Program requirements.
19 The program created under this act shall provide for
20 intensive home visits and include the following critical home
21 visiting elements:
22 (1) Initiation of services. This element provides for:
23 (i) Initiation of services prenatally or at the
24 birth of the first child.
25 (ii) Use of a standardized assessment tool to
26 systematically identify those at-risk families most in
27 need of services. The home visitor shall inform any
28 potential participant that the assessment or
29 participation in the program is purely voluntary.
30 (iii) Offering services on a purely voluntary basis
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1 and use of positive, persistent outreach efforts to build
2 family trust.
3 (iv) Working with family members to identify
4 strengths and resources that can be mobilized to help
5 resolve identified family concerns.
6 (2) Service content. This element provides for:
7 (i) Offering services over the long term and
8 intensively, with well-defined criteria for increasing or
9 decreasing the intensity of the service.
10 (ii) Providing services that focus on supporting
11 first-time at-risk expectant parents and families,
12 encouraging the interaction of both parents with their
13 child, and enhancing the development of the child,
14 including school readiness and educational development.
15 (iii) Linking at-risk families to medical providers
16 to ensure optimal health and development of the child,
17 timely childhood immunizations, well-child care that
18 provides for developmental assessment and is consistent
19 with the standards and periodicity schedules of Medicaid
20 and the American Academy of Pediatrics and additional
21 services, as needed.
22 (iv) Ensuring confidentiality and privacy for
23 families.
24 (v) Having periodic evaluations of program
25 effectiveness.
26 (vi) Having established mechanisms in place to refer
27 first-time at-risk expectant parents and families for
28 other intervention services available in the community.
29 (3) Qualifications and training of home visitors. This
30 element provides for:
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1 (i) Ensuring that home visitors have basic training
2 in areas, including, but not limited to, substance abuse,
3 child abuse, domestic violence, drug-exposed infants and
4 parents, child development, services available in the
5 community, infant care and early childhood development,
6 school readiness and parenting.
7 (ii) Ensuring that home visitors conducting home
8 visits are certified registered nurses or are qualified
9 home visitors under 45 CFR Pt. 1304.52(e) (relating to
10 home visitor qualifications under the Head Start and
11 Early Head Start Programs).
12 (iii) Ensuring that home visitors have preservice
13 and ongoing training that is specific to their job
14 requirements.
15 (iv) Ensuring that home visit providers receive
16 ongoing reviews and direct and intensive supervision.
17 (v) Ensuring that home visitors are qualified
18 community-based private, not-for-profit or public
19 organizations that have strong community support and the
20 social and fiscal capacity to provide the service.
21 Section 6. Ounce of Prevention Board.
22 (a) Establishment and membership.--The Ounce of Prevention
23 Board is established within the Department of Health, with
24 membership as follows:
25 (1) The Secretary of Health or a designee.
26 (2) The Secretary of Education or a designee.
27 (3) The Secretary of Public Welfare or a designee.
28 (4) Four members of the General Assembly, one appointed
29 by the President pro tempore of the Senate, one appointed by
30 the Minority Leader of the Senate, one appointed by the
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1 Speaker of the House of Representatives and one appointed by
2 the Minority Leader of the House of Representatives.
3 (5) Seven nongovernmental members who have expertise in
4 at least one of the following areas: substance abuse, child
5 abuse, domestic violence, drug-exposed infants and parents,
6 child development, services available in communities, infant
7 care and early childhood development, school readiness,
8 parenting and prevention research with families and young
9 children.
10 (b) Nongovernmental members.--
11 (1) The Governor shall appoint the nongovernmental
12 members of the board in a manner that provides for regional
13 representation of this Commonwealth.
14 (2) Except as otherwise provided, the nongovernmental
15 board members shall serve a four-year term.
16 (3) Of the seven initial appointments, two shall be
17 appointed for a term of two years, two for a term of three
18 years and three for a term of four years.
19 (4) The Governor may reappoint nongovernmental board
20 members for successive terms.
21 (5) Nongovernmental members of the board shall remain in
22 office until a successor is appointed and qualified.
23 (6) If vacancies occur prior to completion of a term,
24 the Governor shall appoint another nongovernmental member in
25 accordance with this subsection to fill the unexpired terms.
26 (c) Powers and duties.--The board shall have the following
27 powers and duties:
28 (1) To develop measurable outcomes consistent with
29 established home visiting programs operating in this
30 Commonwealth.
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1 (2) To establish assessment and credentialing standards
2 for home visitation programs receiving grant funding under
3 this act.
4 (3) To review grant applications and award grants for
5 home visiting programs no nongovernmental member may:
6 (i) Review grant applications or vote to award
7 grants to entities by which they are employed or with
8 which they are directly affiliated.
9 (ii) Be a lobbyist.
10 (4) Grants for home visiting programs shall be awarded
11 on a three-year basis. The board may rescind a portion of the
12 grant not yet allocated if it determines through outcome,
13 expenditure and performance data submitted by the grantees
14 under section 7 that the funds are not being properly
15 utilized.
16 (5) Develop an assessment tool to identify at-risk
17 families who are eligible for home visiting grants under this
18 act. The assessment tool shall be a mechanism to identify
19 risk factors that may lead to child abuse or neglect or other
20 poor childhood outcomes.
21 (6) Establish policies for the development,
22 implementation and administration of this program.
23 (d) Board operation.--
24 (1) The Secretary of Health shall be the president of
25 the board.
26 (2) The Secretary of Health, the Secretary of Public
27 Welfare and the Secretary of Education shall be nonvoting
28 members of the board.
29 (3) The board shall meet at least biannually to review
30 progress of home visiting programs in this Commonwealth,
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1 establish priorities for grant funding, award grants and
2 advise the Department of Health on matters relating to
3 administration of the program.
4 (4) The Department of Health shall reimburse all
5 nongovernmental members of the board for all necessary and
6 reasonable travel and other expenses incurred in the
7 performance of their duties under this section.
8 Section 7. Implementation.
9 The Ounce of Prevention Board shall:
10 (1) Implement a community-based home visiting program
11 for first-time at-risk expectant parents and families in this
12 Commonwealth using the criteria set forth in this section.
13 (2) Develop a grant application and award grants under
14 this program in accordance with the following requirements:
15 (i) Grants must be awarded in accordance with
16 weighted criteria based on population demographics,
17 factors associated with child abuse and neglect and other
18 appropriate criteria developed by the board.
19 (ii) Cash or in-kind matching funds in the amount of
20 25% of the total program cost shall be required.
21 (iii) If a program is not able to meet the 25% match
22 requirement, justification must be included in the grant
23 application providing a detailed explanation of the
24 reasons why this match cannot be met and the percentage
25 of the match that can be met. A determination will be
26 made by the board, without recourse, as to the merit of
27 the justification.
28 (3) Develop a plan of implementation to equitably
29 distribute funds throughout this Commonwealth.
30 (4) Require that, in addition to the program
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1 requirements outlined in section 5, the following criteria be
2 used in selecting recipients of grant funds:
3 (i) Preference for grant awards must be given to
4 community-based entities that have broad representation
5 and have the fiscal and administrative capacity to
6 successfully implement the program.
7 (ii) Home visiting programs that receive grants
8 should collaborate with other home visiting and family
9 support programs in the community to avoid duplication
10 and complement and integrate with existing services.
11 (iii) Each applicant must use the standardized
12 assessment tool developed by the board under section 6.
13 (iv) Each applicant must provide outcome,
14 expenditure and performance data in the format and the
15 frequency specified by the board.
16 (v) Each applicant must identify local resources
17 available for implementation.
18 (vi) Implementation design must include service
19 delivery strategies that, when appropriate, involve both
20 parents if they have shared parental responsibility,
21 regardless of residential custody arrangements.
22 (5) Evaluate and approve grant applications and local
23 implementation plans for service delivery.
24 (6) Encourage applicants to coordinate service delivery
25 with Head Start, Early Head Start, Parents as Teachers,
26 family centers, school districts and other existing home
27 visiting programs operating in communities in the various
28 regions of this Commonwealth.
29 (7) Identify qualified trainers and training
30 opportunities that will assure adequate opportunities for
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1 grantees and their communities to provide preservice and in-
2 service training. Funds for training may be incorporated into
3 the grants.
4 (8) Develop and implement a quality assurance and
5 improvement process for the program.
6 (9) Identify and seek Federal matching funding for this
7 program.
8 (10) Identify existing State funding streams that could
9 be used to fund home visiting programs in this Commonwealth.
10 (11) Provide for an annual independent review that
11 evaluates both the progress and effectiveness of community
12 programs receiving grants and the overall progress and
13 achievement of the designated outcomes of the programs. The
14 Ounce of Prevention Board shall provide the review to the
15 Governor, the Senate and the House of Representatives on an
16 annual basis.
17 Section 8. Responsibilities of Department of Health.
18 The Department of Health shall allocate the staff and
19 financial resources necessary to assist the Ounce of Prevention
20 Board in the implementation and administration of this grant
21 program.
22 Section 9. Appropriation.
23 The sum of $10,000,000 is hereby appropriated to the
24 Department of Health for the fiscal year July 1, 2003, through
25 June 30, 2004, to implement the Ounce of Prevention grant
26 program established under this act. An amount not to exceed 2%
27 of this appropriation may be used by the department to cover the
28 administrative costs of implementing and administering the
29 program.
30 Section 10. Effective date.
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1 This act shall take effect immediately.
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