Bill would eliminate Children First program in Oklahoma

BY WAYNE GREENE World Senior Writer
Saturday, February 16, 2013
2/16/13 at 5:32 PM

Correction
The original version of this story incorrectly reported an enrollment requirement for women in the Children First program. The story has been corrected.

A Sapulpa legislator wants to eliminate a program that sends public health nurses into the homes of poor, first-time mothers.

The Children First program uses an obsolete model, isn't a prudent use of tax money and needs to be replaced, says Rep. Mark McCullough, R-Sapulpa.

His House Bill 1063 would disband the program, return Affordable Care Act funding it receives to the federal government and suspend three smaller home visitation programs until they can be audited.

"Very few programs or agencies will actually work to reform themselves or improve their quality of service," McCullough said in a press release. "There are some that do, but the service provided by Children First has steadily declined.

"We are using an Obamacare grant to expand an obsolete program languishing in mediocrity when we could be funding a better home visitation program."

The state Health Department official who oversees the program says the program saves lives and public money.

"We have some fabulous outcomes related to infant mortality, prevention of child maltreatment, immunization - you name it," said Annette Jacobi, chief of the Health Department's Family Support and Prevention Service. "I don't know anyone in the field who would argue that it is not evidence-based. If it is not the premier model, it is one of the premier models in the country."

The program - funded with local, state and federal tax money - sends public health nurses into the homes of high-risk, first-pregnancy mothers starting before their 29th week of pregnancy and lasting until the child turns 2. To be eligible, women must live in a household earning no more than 185 percent of the federal poverty level, which is $28,693 for a family of two.

In the home, the nurses work on a wide variety of things, including health issues for the mother and child, jobs, education opportunities, nutrition and child-development education, Jacobi said.

McCullough said he is a proponent of home visitation, when done right.

"Home visitation is an increasingly significant part of the social services the state provides," he said. "However, we must be good stewards of the dollars we spend on these programs. This is not a witch hunt. I am not angry with anyone. I am just trying to be a responsible steward of tax dollars and an advocate for the true mission of home visitation programs.

"If relatives fail to help an at-risk family and the church fails to help, then the government must. It is in our best interest to intervene early," McCullough said. "And if we're going to do it, let's do it right."

During a legislative hearing on the proposal earlier this month, McCullough said he didn't have a replacement program for Children First, but he saw many good things in a Connecticut program that sends paraprofessionals instead of nurses.

McCullough said the number of individuals served by the program has fallen drastically, and the qualitative results of those served is marginal. Despite receiving 11 percent less in funding than in 2001, the agency now serves 56 percent fewer people.

Father involvement in the families served by the program decreases by 10 percent over a six-month period while other qualitative measures, at best, show small improvement over the control group, McCullough said.

"For the price tag of $14 million, plus another $9 million in Affordable Health Care Act funding, we get little improvement, and in some cases, worse results," McCullough said. "I was amazed to see father involvement decline in the group served by the program."

The program costs about $4,000 per client, he said. While it was serving about 8,000 patients in 2001, it served about 3,500 last year, he said.

McCullough said that in the past two years he tried to work with the program to make changes, but his bills died in the legislative process likely due to lobbying by those associated with the program. His latest bill passed the House Public Health Committee on an 8-3 vote earlier this month.

Rep. Jeannie McDaniel, D-Tulsa, was one of three members of the committee to vote against McCullough's proposal in committee.

"I don't think we can afford to turn these funds back without having a plan and evaluate how we can do better," she said.

Jacobi said the number of women served by the program has gone down because the program has had a hard time attracting and retaining nurses.

A Health Department fact sheet on the program says the average cost is $3,464 per family served. The program made 33,460 visits to 3,547 families in fiscal year 2012, according to the program's annual report. In Tulsa County, the program made 7,810 visits to 701 families, more than any other county in the state.

The report shows that:

81 percent of the mothers in the program initiated breastfeeding, compared to 67 percent of the mothers in the state's general population.
88 percent of the mothers received all recommended immunizations at 24 months compared to 78 percent of the state's general population.
88 percent of the mothers received prenatal care in their first trimester, compared to 76 percent in the state's general population.

"I have no understanding why he can come to the conclusion that the program is obsolete," Jacobi said. "I think it's just absolutely contrary of that. Most states have picked up the model and are expanding it as rapidly as they can afford because they see the return on investment to be valid and that families do well in this program."

If the program is eliminated, it would mean families teetering on failure might fall in, Jacobi said.

"Our job is to keep these families from moving from the front porch across the threshold into Child Welfare," she said. "We know that the families we serve have risk factors associated with child abuse and neglect, and our job is to keep them from being part of that system. I think that would be a tremendous impact on that system, and they're not ready for it."

About Children First mothers

To be eligible, a woman must enroll prior to the 29th week of her first pregnancy and earn no more than 185 percent of the federal poverty level.

75 percent are single, never married.
40 percent are younger than 19 years old.
32 percent have less than a high school education.
51 percent have an annual household income of $15,000 or less.
15 percent smoke when they begin the program.
48 percent are white.
17 percent are black.
16 percent are Hispanic.
16 percent are American Indian.
21 percent report a history of depression.
90 percent of the children are born with normal birth weights.
89 percent of the children are born with normal gestational ages.
89 percent had adequate prenatal care.
86 percent initiated breastfeeding.
87 percent reported placing their baby on its back to sleep at 2 months of age.
77 percent have daily contact with the child's father.
76 percent were in the workforce a year after giving birth.
80 percent did not have a subsequent pregnancy within 18 months of giving birth.

Source: Oklahoma State Department of Health

Original Print Headline: Bill would ax program

Wayne Greene 918-581-8308
wayne.greene@tulsaworld.com

Associated Images:

Catherine Ndhlovu, public health nurse with the Children First program, holds 5-month-old Jasmine on Thursday at her home in Jenks. Rep. Mark McCullough, R-Sapulpa, says the program uses an obsolete model. MIKE SIMONS/Tulsa World

Natalie Smith, 16, holds her 5-month-old baby, Jasmine, at their home in Jenks on Thursday. Smith is part of the Children First program. MIKE SIMONS/Tulsa World

Catherine Ndhlovu, public health nurse with the Children First program, visits Natalie Smith, 16, and her 5-month-old baby, Jasmine, on Thursday at their home in Jenks. MIKE SIMONS/Tulsa World

McCullough