Categorized | Health, Opinions

Sen. Espero: Healthy Start in danger

Sen. Will Espero goes to bat for Healthy Start:

Healthy Start is now itself in danger of losing its life.  The governor has deleted the 25 year old program entirely from the state budget.  Without state funding, the program will immediately stop.  Healthy Start serves more than 4,000 families a year at about $3,000 per family.  The cut puts thousands of our youngest, most helpless children at risk of serious physical and emotional injury.  Their well being, whole outlook on life, social skills, and being stable enough to be able to learn and do well in school – so much is at risk. 

For better or worse, early childhood experiences are the foundation for future development.  Healthy Start is the only program in Hawaii that provides help right from the start before the abuse or neglect occurs.  This effort to redirect and create healthy families provides the safety net for the most vulnerable infants and toddlers, and improves the odds that children do not have adverse early experiences and reach school age healthy and ready to learn.  School readiness and success are integral components of emotional well-being and positive development. 

The Healthy Start philosophy is that prevention as early as possible is critical.  Infants and toddlers are the most vulnerable to abuse; 43 percent of all deaths are to children under age one year.  Healthy Start uses a research-validated assessment to triage high risk families, then strategically focuses scarce resources on those most needed to strengthen family capacity, reduce risk of abuse and neglect, and promote child health and development.  A key program feature is the presence of a child advocate in the home to mentor parents, which is critical to enhancing child safety.  The advocate can catch abuse, neglect, and threatened harm in its early stages before incidents escalate or become chronic. 

Research supports the benefits of Healthy Start intervention.  A John Hopkins study on outcomes related to maternal attachment issues showed that mothers who received services showed 60 percent less maltreatment and 54 percent less neglect.  John Hopkins data show that without intervention, 13 percent of high risk children are abused by age 9.  A Kapiolani Medical Center study of high risk families showed that non-served children were hospitalized 8.7 times more frequently than program participants. 

Prevention is cheaper than later intervention, and successful prevention reduces a wide range of very costly social, educational, and physical and emotional health problems.  The federal Department of Health and Human Services recognizes that social and emotional health is the primary indicator of future school readiness.  The Hawaii Department of Human Services estimates that high risk families that do not receive early prevention services cost about $783,888 per family in terms of later intervention, or about $17.7 million per year in short term costs per year overall, which is nearly twice the requested annual DHS budget. 


Many child advocates worked for decades on behalf of society’s youngest, most helpless victims.  Pediatrician Dr. Calvin Sia and social worker Patti Lyons were the pioneers, leading a group to get the mandatory reporting law, HRS 350, on the books in 1968, and to establish the initial Child Protection Center. 

In 1974, Gail Breakey joined their efforts, and they obtained one of the first federal grants to combat child abuse.  The Hawaii Family Support Center, a preventive hospital-based screening program at Kapiolani Medical Center, and the Hana Like Home Visiting program were established.  The program was expanded to open Family Support Services in Hilo, Kona, Maui, Molokai, and Kauai.

In 1984 Healthy Start began when Sen. Mamoru Yamasaki and the state Legislature established a pilot program in Ewa Beach.  The program marked the culmination of a decade long effort of program development, training and advocacy involving many people including Dr.Sia, nurses Barbara Naki and Barbara Yamashita, and Gail Breakey, Betsy Pratt and others involved in service delivery.  Children’s champion, former Sen. Neil Abercrombie, Chair of the Senate Human Services Committee, was instrumental in obtaining funds for the Healthy Start pilot program as well as for the Family Support Programs and other child abuse and neglect prevention, education, and treatment programs.

Healthy Start now

Since then, Healthy Start has expanded statewide to reach all families who need and accept services, and now helps redirect and strengthen 4,000 families a year.  Other agencies currently involved include Child and Family Services, Parents and Children Together, Catholic Charities, West Hawaii Family Support Services, the YWCA of Hawaii, and Maui Family Support Services.  

Budget decisions are seldom easy, especially in a shortfall year, but our priorities should be toward those for whom the consequences are literally life and death, who are the most vulnerable, and who are the most helpless and least able to speak for themselves.  That’s the Healthy Start philosophy.  The Governor would be wise to realize this.

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