HUMAN SERVICES RESTRUCTURING TASK FORCE

Program Duplication and Resource Utilization Subcommittee
MINUTES

November 24, 1997 - Third Meeting of Three

MEMBERS PRESENT

MEETING IN BRIEF

Minutes prepared and organization staffing by Patty Funaro, Sr. Legal Counsel

  1. Summary -- Procedural Business.
  2. Governor's Commission on Educational Excellence and Early Childhood Education.
  3. Division of Criminal and Juvenile Justice Planning.
  4. Optimal Development in Children.
  5. Evaluation Proposal.
  6. Office of the Auditor of State.
  7. Recommendations.
  8. Next Meeting Cancelled.

SUBCOMMITTEE BUSINESS

1. Summary -- Procedural Business.
The third meeting of the Program Duplication and Resource Utilization Subcommittee of the Human Services Restructuring Task Force was held on November 24, 1997, in the Supreme Court Chamber, State Capitol. The meeting convened at 10:25 a.m. and adjourned at 5 p.m.
2. Governor's Commission on Educational Excellence and Early Childhood Education.
Ms. Gail Sullivan, Chief of Policy Planning, Department of Education, reviewed the portions of "The Governor's Commission on Educational Excellence for the 21st Century" report relevant to early childhood education. Ms. Sullivan began by reviewing the Commission's vision which includes a statement that "...education consists of a continuum of services from early care and preschool education to lifelong learning and adult education." This includes schools working closely with the child, family, and community agencies to ensure that every child enters school ready to learn; providing parental support and education programs for children 0-3 years of age and their families; providing the opportunity for at-risk 4-year-olds to attend preschool; and providing full-day, five-day-a-week kindergarten. Ms. Sullivan noted that the vision also includes using schools as active learning centers which offer an array of learning opportunities for the entire community, with schools acting as the "hub" of the community.
Ms. Sullivan summarized the recommendations of the report which relate to early childhood education. They include:
The Subcommittee members discussed using the variety of existing models around the state to make schools year-round education centers and noted that expansion of preschool to four-year-olds is limited to those at risk only due to funding limitations and that child development advisory committees are good models to use in getting the community to unite because these committees, which were once required in the Iowa Code but only exist today on a voluntary basis, provide for assessment of the community needs and resources.
Regarding the length of the school day, the members discussed the need to extend the school day, but also to improve the curriculum to provide more depth rather than only more breadth of subject matter. Students should receive in-depth instruction in core subject matters and should additionally participate in courses that develop the whole child, through extension of the school day. Additionally, there should not be such a discrepancy across the state in the length of the school day even though this is a matter of local control. Subcommittee members expressed concerns that many of Iowa's school buildings are not structurally equipped to provide for year-round activities and that the cost of providing year-round activities would be great.
Ms. Donna Eggleston, Early Childhood Education Consultant, Department of Education, discussed the Child Development Coordinating Council (CDCC), a multi-agency group charged with advocating for children and administering model child development programs for children at-risk. Efforts include the development of comprehensive programs which provide services to assist families in being self-sufficient and productive. Services include components to provide staff development, health and wellness for children and families, child care, and developmentally appropriate activities for children.
Current programs include:
3. Division of Criminal and Juvenile Justice Planning.
Mr. Dick Moore, Administrator, Division of Criminal and Juvenile Justice Planning, Department of Human Rights, provided the Division's perspective on what should be done for children ages 0-5 and their families to reduce their involvement in the juvenile and criminal justice systems. Mr. Moore began by noting that the Division administers two grant programs and provides staff support to two advisory councils. Mr. Moore reviewed a document entitled "Risk Factors for Juvenile Crime Model," which addresses community, family, school, and individual/peer group risk factors which research has demonstrated can all lead to a child's involvement in juvenile crime. He also discussed another model which focuses on 40 developmental assets developed by the Search Institute through its own research. The asset model is divided into external and internal assets that a child must have to be successful. The more of each asset that a child has, and the more assets that a child has that are specifically needed in that child's environment, the more likely the child is to overcome problems. Mr. Moore then discussed the comprehensive strategy for at-risk and delinquent youth. Six counties in Iowa are currently receiving federal funding for technical assistance in this area to develop a collaborative, comprehensive strategy in addressing at-risk and delinquent youth. Finally, Mr. Moore discussed a study that categorized research in crime prevention according to the ecological context (e.g., home, preschool, school, etc). The researchers concluded that more research should be done and that the effectiveness of crime prevention efforts is contingent upon all sectors being successful, that success is interdependent. The researchers also concluded that long-term frequent home visitation combined with preschool prevents later delinquency; that weekly home visitation of families with infants reduces child abuse and injury; and recommended that family therapy be provided by clinical professionals for delinquent and predelinquent youth. The researchers concluded that home visits by police officers following an incident of domestic abuse did not work, but that battered women's shelters when women were also taking other steps to improve their lives and protective orders for battered women were showing promise. Mr. Moore noted that the community grants total $1.8 million, including both federal and state funding, and are awarded annually.
4. Optimal Development in Children.
Dr. Edward Schor, Iowa Department of Public Health, provided information regarding the importance of certain factors, including brain stimulation, in early childhood. He enumerated factors which are obstacles to children having opportunities to interact with parents and others, including that mothers in the majority of cases are working outside of the home during a child's early years in contrast to 20 years ago when mothers often remained at home after the birth of a child and until the child was grown; that mothers are returning to work soon after the birth of a child thereby requiring child care for infants which is hard to find and expensive; and that there are many single parent families (in Iowa 20 percent of the families are headed by a single parent). Dr. Schor noted that children today have the same basic needs that they have had for thousands of years, but that the current society is not meeting these needs. Today, families are stressed, which leads to use of a dogmatic, autocratic parenting style and a less nurturing environment. Families are increasingly isolated from social groups due to lack of time and other factors and so are dependent upon their own members, which reduces opportunity for interaction and may enhance the opportunity for child abuse. Children are less supervised or are "supervised" by the television and as a result are less likely to develop interactive skills, explore their environment, or read.
From a biological perspective, Dr. Schor described the development of a brain, both intrauterine and during early childhood, noting the importance of early stimulation of the brain to reach optimum potential. He noted that the human brain is not fully developed when a baby is born and that its shape and the way that it operates is determined by its environment.
Dr. Schor described the intrauterine development of brain cells, noting that by the 17th week of gestation, all brain cells have been formed, and that this is happening at a time when many women have just learned they are pregnant. He stated that this is one reason for women to always be in good health and to plan their pregnancies. Dr. Schor continued by stating that as brain cells develop, they migrate to the "right place" in the brain, based upon their need, and if they are in the wrong place they will either die or other developments might occur such as mental retardation. Additionally, the brain is affected by the environment of the placenta, and if a mother is stressed or is not in good health, these factors will also have an effect on brain development.
Dr. Schor described how neurons communicate with one another through synapses and noted that neurons are stimulated through sensation such as touch, taste, or smell and that if they are not stimulated, the synapses do not become stronger but are weakened and pruned away. He noted that by the age of 14, the way that we process incidences of stimulation is largely predetermined. He provided examples of orphans who do not interact with humans and described their brains as being 25 percent smaller than those who are provided human interaction. He noted that wolves who are raised in the wild and utilize their full range of potential skills through hunting, survival, etc., have larger brains than wolves raised in a zoo who are less stimulated to develop to their full potential. Dr. Schor stated that the brain is programmed for two types of learning, one for learning expected things such as vision, and one for learning new things and problem solving, such as learning a language. He provided the example of kittens who have one eye covered for a period of time at birth and never develop sight in that eye. He noted that babies who are exposed to words and stimulation will have as much as a 20 percent increase in their vocabulary. Additionally, if a child learns a language early in life, before the age of 10, the child will not have an accent and will be able to learn more quickly because the synapses are not fully formed and the way the information is processed is not totally predetermined. He said that stimulation from a television will not lead to optimal development because of the lack of two-way stimulation. He also provided the example of "smart" rats and "dumb" rats who were marked as such, the "smart" rats being provided more love, encouragement, and stimulation than the "dumb" rats. The "smart" rats were able to learn a maze more quickly than the "dumb" rats even though the rats were genetically the same and the only variable was the amount of stimulation provided.
Dr. Schor related that in the area of mental retardation, the Centers for Disease Control concluded that mental retardation which is borderline usually has a social origin and is rarely biological in origin. The study followed high-risk children for 12 years, providing one group with intensive education, home visits, and other assistance. At age three, the group which had the extra stimulation had an average IQ of 105 while the IQ of the control group was 85. At age 12, those provided the extra stimulation had increased grade retention and had repeated fewer grades. Of those in the stimulated group, only 13 percent had an IQ in the 70-85 percent range while of those in the control group, 44 percent were in this range. When the control group members entered school, they were provided with tutoring and family assistance. However, this was not helpful because their potential to achieve had already been limited.
Regarding problem solving and learning new things, Dr. Schor stated that these abilities develop from the ground up, through early experiences. He provided the example of how differently socialized people will view attending school. For a person whose parent provided love and affection, learned to feel safe in his environment, learned to be able to depend on parents and others, attending school is welcomed, the environment is an extension of the safe, dependable environment, and the child feels that he or she can succeed. For a child who might not have always been provided with love and affection, and who did not develop a sense of safety and being able to depend on someone, entering school is an extension of a potentially dangerous place, where no one can be trusted, where people are critical of him or her, and he or she may develop an "attitude" and feel stressed.
Dr. Schor emphasized that the first few years are critical and that a child must be provided with a home environment and experiences to achieve his full potential. Additionally, families are under a great deal of stress, and they need a social system of support.
Dr. Schor suggested that the principles for child rearing include that humans need each other, children take time, everyone loves their children, intuition is not enough, parents are powerful and are unaware of their power, parenting starts by responding and reading cues, parents need to talk, read, and listen, and parenting is making choices. The implications for society are that society pays now or pays later; people should plan, want, and prepare for pregnancies; only a family can raise a child (this can include a dependable adult if a family member is not available); social policy is making choices; there must be social support for families; and communities must be built and social capital developed.
During discussion Dr. Schor emphasized that all parts of the community must be involved in promoting optimal growth of a child, there must be family planning and support programs, and there must be nonstigmatizing parental education for everyone. Dr. Schor noted that the medical community must increase its sensitivity to the needs of children and families and that there should be a consistent form of public health intake.
Dr. Schor suggested that if the walls between disciplines cannot be eliminated (such as those between education and health), at least a number of doors between them should be provided. He suggested that the role of state government is to help organize the system, to provide assistance to local communities when asked, to provide more public education for everyone not just the "human services" population, and to provide a standard for a decent quality of services. He suggested that in order to overcome the fear of schools in taking on all of the social aspects of the child, communities could meet several times annually to discuss social issues thereby providing the opportunity for the community to decide how to deal with these issues. Dr. Schor noted that in Europe, women are provided incentives to remain at home with their children. He also noted that it is difficult to find the right time to provide parenting education, but that the best way to teach a child to be a good parent is for the parent to provide a good example to that child early in life. Other possibilities for providing parental education include utilizing child care workers to teach parenting to parents as well as providing good child care, and by churches, the workplace, and others emphasizing through information and policies the importance of parenting. In response to a suggestion that brain development instruction and the effects on a child be taught in biology classes, Dr. Schor noted that teachers need to have this information too. There was discussion that a good place to start teaching parenting is with the first baby rather than using the first baby to "practice" parenting, and Dr. Schor suggested developing a standard way of assessing assets of all children and their families at birth, such as in the hospital prior to discharge.
5. Evaluation Proposal.
Representative Wayne Ford shared his experiences and proposals for improving evaluation of programs. With regard to a grant recipient evaluation, Representative Ford suggested establishing time limits on the receipt of funding of a new project prior to evaluation; requiring evaluation of all current programs in the fifth year of operation and beyond; requiring third-party evaluation commissioned by the grant recipient or the granting authority, or paid with funding provided for administrative costs; using a results-based evaluation format; auditing invoice and expenditure records; and evaluating the total amount of funds expended by the grant recipient. Representative Ford also suggested applying consistent evaluation standards to the state and to nonprofit grantees, ensuring that the data upon which a report is premised is good data, and noting that the duration of terms of the persons who make decisions about the letting of grants might influence project funding.
With regard to state program evaluation, Representative Ford suggested that the programs should be linked to state policy goals, that they should have a results-based evaluation format, that time limits should be established for pilots or that an automatic sunset be imposed on a pilot if it does not demonstrate efficacy, and that similar programs should be considered together.
With regard to decategorization county evaluations, Representative Ford suggested that these should also be linked to state policy goals, should be in a results-based format, and that an audit of invoice and expenditure records should be performed to validate the process.
6. Office of the Auditor of State.
Mr. Warren Jenkins, Office of the Auditor of State, provided suggestions for improving the evaluation and auditing of human services programs. Mr. Jenkins stated that he agreed with the suggestions made by Representative Ford. Mr. Jenkins emphasized the need for accountability because it is the means by which each party demonstrates that it has fulfilled its part of an agreement. He noted that it is important to establish goals for programs before letting grants or contracts and that a means to measure should be established to be able to determine success. By stating the goals and the performance measures before a grant or contract is entered into, all parties have the same expectations. He noted that timely monitoring of programs and their results is important and is especially important for human services programs due to the volume of programs.
From the financial side, Mr. Jenkins suggested that human services programs be subject to pre-award surveys, which provide a prospective review of potential contracting entities, applicable to program costs of $150,000 or more. Pre-award surveys are currently required for contracts under every other state department. Mr. Jenkins stated that prior to 1992, this requirement was also applicable to human services programs, but legislation was enacted to provide an exception for programs under the Department of Human Services due to budget troubles. The legislation was to have provided an exception for only one year but was enacted in a way which provided for a permanent exception. Mr. Jenkins suggested that with a pre-award survey at least there is an initial review of the potential of the program to succeed and a check that all data and procedural safeguards are in place. Accountability should begin at the beginning of the cycle and then be subsequently assessed by monitoring and periodic financial and performance audits by the Office of the Auditor of State, the Legislative Fiscal Bureau, the federal government, and others. Mr. Jenkins estimated that pre-award surveys would cost approximately $450 each to perform.
Mr. Jenkins stated that absolute accountability is very costly and that a balanced approach, in which all parties agree on the goals, have a good working relationship, and in which the program is well-run, is preferred. There must be a balance between the costs of accountability and the benefits of accountability. Mr. Jenkins suggested that to get beyond "self-validation" the parties should agree up front as to the results to be achieved so that there is a basis for unbiased measurement.
In response to a reference to nursing home evaluation complaints which focus on micromanaging in evaluating and reporting, Mr. Jenkins suggested that what should be measured is what is most important to measure rather than what might be the easiest to measure. He also suggested that the time-frame for measuring must be meaningful to the type of program.
In response to a question regarding state policy goals, Mr. Jenkins noted that there should be a global goal and then the goal can be broken down into specific results that are desired and specific measurements.
Mr. Jenkins suggested that local control and accountability are not mutually exclusive and that because local governing entities are currently required to ensure accountability of their current programs, they should extend this requirement if programs and funding are devolved.
Mr. Jenkins suggested reviewing current programs to determine if they are successful in meeting the established result and then prioritizing funding based upon the result of this review.
Mr. Jenkins agreed that 28E agreements and other existing laws and rules, which include auditing provisions, could be used with nonprofit as well as state relationships to provide for consistency in evaluation and auditing. He suggested that if the law provided for this and funding was provided for these additional activities, that the Office of the Auditor of State could perform these as well.
7. Recommendations.
Following discussion of the state policy objectives and of a mission statement proposed by Chairperson Tinsman, the Subcommittee approved the following recommendation to the full Task Force:
That the following mission statement, which includes five objectives for the state as a whole to achieve in reference to children 0-5 years of age and their families, be approved by the General Assembly:
"A child of Iowa should possess a healthy body; be part of a loving family and a caring community, beyond the family, that listens, emotionally supports, teaches, and advocates for the child; live in a safe home; have a self-sufficient family; and be ready to learn by receiving brain stimulation through early education."
The Subcommittee discussed using the mission statement as a basis for implementing planning, programming, budgeting, and devolution.
The Subcommittee decided to discuss the remaining portions of the document of proposed recommendations at its final meeting. These issues relate to the process of implementing the mission statement; the roles of the state, local, public, and private sectors; accountability and evaluation; interdisciplinary collaboration; and local governance.
8. Next Meeting Cancelled.
The Human Services Restructuring Task Force met on November 25, 1997. A progress report from the Subcommittee was submitted to the full Task Force, and following discussion, the members of the Subcommittee agreed that the remaining issues to be discussed by the Subcommittee related not only to the work of the Subcommittee, but also, and more appropriately, to the work of the entire Task Force. Therefore, the final meeting of the Subcommittee scheduled for December 2, 1997, was cancelled. Instead, the members of the Subcommittee are being invited to attend the final meeting of the full Task Force on December 18, 1997, to share their knowledge and to participate in the discussion of recommendations. The Subcommittee will also receive a listing of proposed recommendations of the Subcommittee prior to the meeting of the Task Force for their review and response.

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