Child welfare advocates are rallying to save the remnants of Healthy Start, a nationally recognized child-abuse prevention program whose state funding shrank from $15 million two years ago to $1.3 million this fiscal year and which is now in danger of being eliminated altogether.

Legislators said this week there is no funding for Healthy Start in draft budgets under consideration for fiscal year 2011, which starts July 1, because the money probably wouldn't be released given the state's ongoing budget crisis. This fiscal year, about $3 million from the tobacco settlement fund was diverted from the Healthy Start program to help balance the budget.

That left the program with about $1.3 million.

The loss of the settlement funds forced the state Health Department to limit the program — which had been offered statewide — to East Hawai'i and Leeward O'ahu. Today, about 100 families are in the Healthy Start program, advocates say, compared with more than 4,000 in fiscal year 2008.

The latest discouraging news for Healthy Start, once considered a key point in Hawai'i's child welfare safety net, comes at a time when advocates say they're seeing more families in need of support to deal with the stresses of job losses and pay cuts. Child abuse cases, they say, often rise during tough times. And figures show the number of Child Protective Services cases is up slightly.

In fiscal year 2009, there were 6,021 active CPS cases statewide, an increase of about 25 cases from the previous fiscal year, the state said. In the first three quarters of fiscal year 2010, there were 5,575 cases, which puts Hawai'i on track for another increase in CPS cases this fiscal year.

Healthy Start, which started as a pilot program in Hawai'i 25 years ago, links up with at-risk families after the birth of a child to offer regular home visits, parenting lessons and other support to prevent child abuse. The model has been exported to more than 37 states and several countries.

NEED IS GREAT

Advocates say Healthy Start is the only state-funded program of its kind in the Islands.

"We need to keep this program alive. This program is needed," said Gail Breakey, executive director of the Hawaii Family Support Institute at the University of Hawai'i School of Social Work.

Breakey said the elimination of Healthy Start could also cost the state millions in promised federal dollars for child-abuse prevention home visiting programs. Provisions in recently-approved health care reform legislation authorize $1.5 billion nationwide over five years for such programs.

It's unclear when those funds would start flowing in or how much Hawai'i could get.

But Breakey warns that if Healthy Start is eliminated before the money is available, the state could lose a chance to restore the program to previous levels and expand it statewide again.

The elimination of Healthy Start could also mean the loss of about $750,000 in federal grant money awarded to Hawai'i to improve implementation of the program. The funds were part of a five-year grant awarded in 2008, said Liz McFarlane, assistant director of early childhood research at Johns Hopkins University's Hawai'i projects office, which has studied Healthy Start for 17 years.

PROVEN SUCCESSES

McFarlane said research shows Healthy Start has proven successful for many families.

Overall, the program has mixed results, but is very effective in several subgroups, she said.

"In terms of child abuse and neglect prevention, home visiting is an effective strategy," McFarlane said. "But there are still lessons to learn." That's why it is so essential to keep Healthy Start up and running, especially in tough economic times when the need is higher, she added.

McFarlane also said similar programs on the Mainland are also being downsized or eliminated.

"It's a sad day when prevention is cut," she said. "The tragedy is that we've had one hardship after another (with Healthy Start). Now there's the risk that there will no funding" for the program.

State Sen. Suzanne Chun Oakland, D-13th (Kalihi, Nu'uanu), the Senate Human Services Committee chairwoman, said she is discouraged funds for Healthy Start aren't in draft budgets before lawmakers, but is hopeful money will be set aside for the program before the session ends.

"Hawai'i has been a leader in the nation with regards to this home visiting model," she said.

Participants in Healthy Start are also urging the state to keep the program alive.

Iroquois Point resident Amy Grima, 25, said that Healthy Start has helped her and her fiance better deal with the difficulties of being first-time parents. Their daughter is almost 2. "Before your child can speak, I feel Healthy Start is a voice for them," she said. "I would hate to see it go away."

SCREENED FOR RISK

Under the voluntary program, women who give birth are screened for child-abuse risk factors.

Those with multiple risk factors are offered support services, classes and home visits until their child turns 3. During home visits, providers are trained to spot other risk factors and offer suggestions about parenting, along with reminders on immunizations and education.

The state Health Department has said about half of mothers drop out of Healthy Start within their first year in the program. But providers point out that of those who stay in the program longer than a year, 99 percent have no reports of child abuse and many find the extra support beneficial.

Carla Masaniai, 33, enrolled in Healthy Start after the birth of her fourth child.

She said the program has helped her be a better parent to her youngest, who will turn 2 in October, but has also improved how she and her husband parent their other children, who range in age from 4 to 14.

"They teach you how to put yourself in time out, and different methods when you feel the stress building up," she said, adding the program is partly about breaking bad habits.

"I wasn't physically abused, but if we answer back, we get slapped. That's how I grew up."

Masaniai said she never slapped her children, but threatened to a few times.

Now, she said, she doesn't do that, either.

She said the program has even improved her marriage, and taught her how fighting between parents affects children. And it was because of the support she got in the program that Masaniai decided to go back to school. She's set to start classes at Leeward Community College this summer.

"It's sad if it (Healthy Start) closes because it helped us," she said.

"We're in a better place."