Minutes of the Twelfth Meeting

of the 1998-99 Interim



Minutes of the Tenth Meeting

of the 1998-99 Interim

May 19, 1999

The twelfth meeting of the Interim Joint Committee on Health and Welfare and the tenth meeting of the Interim Joint Committee on Education was held on Wednesday, May 19, 1999 at 1:00 PM, in Room 149 of the Capitol Annex. Representative Tom Burch, Co-Chair, called the meeting to order at 1:12 PM, and the secretary called the roll.

Present were:

Health and Welfare Committee Members: Senator Julie Rose, Co-Chair; Representative Tom Burch, Co-Chair; Senators Charlie Borders, Tom Buford, Paul Herron, Ed Miller, Joey Pendleton, Dick Roeding, Katie Stine, and Jack Westwood; and Representatives Bo Ausmus, John Bowling, Brian Crall, Bob Damron, Bob DeWeese, Jim Gooch, Bob Heleringer, Susan Johns, Eleanor Jordan, Mary Lou Marzian, Steve Nunn, Jon David Reinhardt, Arnold Simpson, Kathy Stein, and Susan Westrom.

Education Committee Members: Senator Lindy Casebier, Co-Chair; Representative Frank Rasche, Co-Chair; Senators Benny Ray Bailey, Alice Forgy Kerr, Vernon McGaha, Dale Shrout, Robert Stivers, and Jack Westwood; and Representatives Larry Belcher, Robert Buckingham, Mike Cherry, Hubert Collins, Barbara Colter, Jon Draud, Tim Feeley, Gippy Graham, Tom Kerr, Mary Lou Marzian, Harry Moberly, Jr., Tom Riner, Charles Siler, Arnold Simpson, Dottie Sims, Kathy Stein, Gary Tapp, Jim Thompson, Mark Treesh, and Charles Walton.

Guest Legislators: Senators Dan Seum and Ritchie Sanders; and Representatives Hoby Anderson, Adrian Arnold, Eddie Ballard, Perry Clark, Howard Cornett, Ron Crimm, Porter Hatcher, Jodie Haydon, Charlie Hoffman, Joni Jenkins, Jimmie Lee, Fred Nesler, Marie Rader, William Scott, Jim Stewart, Johnnie Turner, and Mike Weaver.

Guests Appearing Before the Committee: Craig T. Ramey, Ph.D., Director of the University of Alabama at Birmingham Civitan International Research Center; Dr. Frank Newman, President, Education Commission of the States; and Dr. Ed Ford, Deputy Secretary, Governor's Executive Branch.

Guests: Kurt Walker, Headstart State Collaboration, Frankfort; Linda Locke, 4-C, Lexington; Linda Bratton and Joan B. Tackett, Division of Child Care, Lexington; Ralph Von Derau, Office of Inspector General, Cabinet for Health Services; Debbie Green, Department for Medicaid Services, Cabinet for Health Services; Thelma Cornett Paula Salsman, Roseanne Barkley, Cookie Whitehouse, and Sandra Rolland, Cabinet for Families and Children; , Dee Swain, Zaida Belendez, and Linda F. Burke, Department for Public Health, Cabinet for Health Services; Mary Louise Hemmeter, University of Kentucky, Lexington; A. Rooney French and Terry Vance, Kentucky Department of Education; Rusty MacSwords, PAC, Kentucky Academy of Physician Assistants; Paul Saxton, Policy Development; Phyllis Hall, Anderson County RTC, Lawrenceburg; Kay Wright Elling, Eastern Kentucky University, Richmond; Carol Baughman, Libraries and Archives, Frankfort; Libby Marshall, Kentucky School Boards; Cathy Allgood Murphy, Center for Accessible Living, Louisville; Sandra Kestner, Workforce Development Cabinet; Karen Hacker, Family Care Center, Lexington; Jean Sabbarhal, Lexington; June Widman, EKCCC, Berea; Marty White, Kentucky Medical Association, Louisville; Sean Cutter, MMCK, Lexington; Donna G. Brown, Kentucky Association for Health Care Facilities, Louisville; Bob Barnett, Kentucky Pharmacists Association, Frankfort; Steve Shannon, KARP, Lexington; Bart Baldwin, Children's Alliance, Frankfort; H. Wayne Riddle, CHA Health, Lexington; B. Chambers HCC, Louisville; Judith Gambill, Kentucky Education Association; Mike Ridenour, Kentucky Chamber of Commerce, Frankfort; Anne Joseph, Kentucky Task Force on Hunger, Lexington; Rebeckeh Freeman, Kentucky Farm Bureau; Kathi Marshall, Thomas A. Marshall, Attorney at Law, Frankfort; Wayne Young, Kentucky Association of School Administrators, Frankfort; Clyde Caudill, Jefferson County Public Schools, Louisville; Bill Doll, Kentucky Medical Association; Alice Hobson, LRC Program Review and Investigations Committee; and Sheila Schuster, Kentucky Psychological Association, Inc., Louisville.

LRC Staff: Robert Jenkins, CSA; Barbara Baker, Alisha Miller, DeeAnn Wenk, Murray Wood, Gina Rigsby and Cindy Smith.

Approval of Minutes:

A motion to approve the April 21, 1999 minutes of the Interim Joint Committee on Health and Welfare meeting was made by Senator Herron, seconded by Representative Nunn, and approved by voice vote.

Reports from Interim Subcommittee Chairs:

Representative Burch, Co-Chair, Subcommittee on Families and Children, reported the Subcommittee met and heard testimony regarding 1) the Kentucky Impact Program, a state-funded system of local coordination of services for emotionally disturbed children; 2) the IMPACT PLUS program, a similar model funded by Medicaid/EPSDT dollars; 3) the progress of implementing Kentucky Access, the behavioral health managed care program; and 4) First Steps, the Early Intervention System for infants and toddlers with developmental disabilities.

Senator Westwood, Co-Chair, Subcommittee on Long-Term Care, met and heard testimony from Family Care Homes operators and the Nursing Home Ombudsman Agency of the Bluegrass.

Representative Nunn, Vice-Chair, Subcommittee on Welfare Reform, met and heard testimony 1) from the Cabinet for Families and Children about plans for spending excess welfare dollars created by declining caseloads; 2) from Dawn Jenkins, Kentucky Youth Advocates, who made several recommendations on how to continue to strengthen welfare reform in Kentucky; and 3) from Dr. Craig Ramey on the importance of early brain research and the importance of early intervention for ending the cycle of poverty.

Briefing on Developing Strong Early Childhood Programs:

Dr. Ford, Deputy Secretary, Governor's Executive Cabinet, introduced Craig T. Ramey, Ph.D., Director of the University of Alabama at Birmingham Civitan International Research Center, and Dr. Frank Newman, President, Education Commission of the States.

Dr. Newman said a couple of years ago new research being done on how the brain develops, particularly in infants, was going to be potentially powerful in terms of policies states would make about education and child development. The brain develops, not only so someone can speak or read and handle mathematics, but that you can have self control and operate effectively. A brain is equipped to develop but development depends on the environment a person is in. The development of the brain can be damaged in infancy, pregnancy, and early stages of childhood depending on the environment. How a parent interacts with an infant is very important to their development. Child care is an important issue in the development of a child. Qualified child care workers should be taking care of children. There is a lot of turnover in child care workers because they are underpaid. Research has helped people learn about language development.

Dr. Ramey said it is clear that what happens long before a child arrives in kindergarten is going to have a big bearing on how well the child does. All experiences of a child, in all of its forms such as parent education, day care, care in homes by relatives, is a child's early education. High-quality education and preventive health care will improve the chances that children, even children from high-risk families, will become successful students, productive members of society, and will be contributors not detractors from the social well being. Although all children can learn when exposed to good teaching, extremely low levels of academic readiness among children from low resource families will not change without vigorous investment in their early experiences. Early experience is the interplay between the child and the environment that is registered in the brain and other neurotissue and is the result of what the child actually encounters. Visual perception is strongly influenced by the kinds of experiences someone has. Although the brain is highly genetically determined in its structure, experience plays a very powerful role as well. By the time a child is 3 years of age, they have approximately 90% of the adult brain formed and functioning. The ability to learn is not lost after this time but not done as rapidly. The exposure to speech allows a child to understand the phonics for basic building blocks of language. There is a connection between the quality and quantity of speech a child is exposed to from birth and how well a child will read. Children who are frequently spoken to by age 2 have vocabularies of approximately 800 words. Those who are rarely spoken to by age 2 have vocabularies of approximately 500 words. Special education costs at least twice as much as regular education. Early childhood intervention will benefit children. Dropout rates for special education students is higher than regular education. Girls drop out more frequently because of pregnancy and boys because of behavior. Children whose mothers have low IQs are at the greatest risk.

Dr. Ramey gave the following recommendations: 1) Establish powerful coalitions to support school readiness, student well-being and academic excellence; 2) Increase public awareness of the role of early experience in brain development; 3) Emphasize the importance of language and reading as child and family activities; 4) Develop, analyze, and periodically report Integrated Data Bases for the state and organize by county and local education agency; 5) Seek legislative backing for an early childhood initiative - birth to age 8; 6) Build upon and coordinate existing educational, child care, health, and other supportive resources; 7) Encourage innovation and recognition that there is no one "best" program or strategy for all children and families; 8) Encourage local ownership and leadership in Program Development; 9) Support programs that are inclusive and non-discriminatory; 10) Provide higher levels of supports and services to those children in greatest need; 11) Create a strong, adequately funded technical assistance and continuous quality assurance program that is responsive to the needs of providers and programs, especially those serving young children and families in greatest need; 12) Adopt statewide standards for quality child care, consistent with national standards; 13) Strengthen the current system of child protection and advocacy, as well as foster care and adoption; 14) Incorporate basic information about the importance of the first eight years of life into the public school curriculum; 15) Develop and sustain model programs throughout the state that can serve as local training and technical assistance centers; 16) Create effective transition to School Programs; 17) Expand the availability of high-quality after-school and summer programs for "at-risk" children; and 18) Affirmation of choice, equity, and quality.

Representative Treesh asked if any early childhood intervention studies had been done on children who were not at-risk. Dr. Ramey said no studies had been done for which there are no biological risk factors. Representative Treesh said the more direct, loving interaction a child has in its early life, the better off the child will be and asked if the best situation would be for the child to have a loving caregiver providing full-time care. Dr. Ramey said the quality of care a child receives in the home is extremely important. A high quality preschool program adds value in terms of the child's social and emotional function. Representative Treesh said the legislature does not need to draw the conclusion that the state needs to be more involved in children's lives at an earlier age. Dr. Ramey said research shows it is possible to positively alter the course of development for young children who are at-risk. Dr. Newman said while states fund parental training programs, it is up to parents to volunteer to participate.

Representative Draud asked what the status was on The Early Trust Fund Act which provides $10 billion to states to support a wide range of early learning opportunities. Representative Burch said the bill had just been introduced and had not been acted upon.

Senator Westwood asked what were some risk factors. Dr. Ramey said the single most powerful risk factor for a child not doing well in school is to have parents who are cognitively poorly prepared themselves and do not have reading and literacy skills. Low birth weight and prematurity are risk factors. There are approximately 40 factors known to be linked systematically to risk for poor school performance in addition to medical risks. Dr. Newman said much is related to poverty.

Dr. Ramey explained to Representative Nesler that his recommendation to encourage local ownership and leadership in program development meant a "one size fits all program" is unlikely to have the kind of vibrancy and innovativeness that programs can have when they are organized within local communities where people play major leadership roles and have access to information that allow them to make their programs better. Dr. Ramey said states should adopt statewide standards for quality child care consistent with national standards to improve the chances of a child's development.

Representative Nunn said the Kids Count Book stated Kentucky has identified 163,000 at-risk children and asked how to help them while focusing on the early childhood initiatives for 0-3 year olds. Dr. Ramey said Kentucky emphasizes family literacy, provide incentives, provide resources, have incentives for the development of effective programs, and provide quality assurance programs. Dr. Newman said good early childhood education does not eliminate the need for better schools. Kentucky has good standards and assessments for schools. All programs need to be evaluated to see if they work. Kentucky needs to improve the coordination of social services. Dr. Ford said Kentucky has one of the highest uneducated adult population of any other state. Family Resource Centers in schools coordinate social services and intervene with families who are having problems. Dr. Ramey said integrated databases need to be developed. A lot of information is collected but it is rarely analyzed.

Representative Jordan asked what studies have shown about children who have an inconsistency in caregivers. Dr. Ramey said there is very low turnover when someone is paid a fair wage. High turnover leads to increased levels of insecurity in young children.

Representative Colter asked if Alabama had PACE programs. Dr. Ramey said they have parent and child centers. Representative Colter asked if statistics had proven these centers were good places to work with mothers and children. Dr. Ramey said this was an important resource to have and build upon. Representative Colter said parents need to be educated before they can help their children.

Representative Cherry asked what should be Kentucky's primary education target program. Dr. Ramey said states need to do a better job with subsidized child care. Dr. Newman said there should be funding to prevent risk to newborns educate children in middle school about things such as smoking, pregnancy, STDs, alcohol, and others and improve child care programs.

Senator Roeding was concerned that Kentucky went from 34th to 48th in the drop-out rate.

Representative Westrom asked what services were provided for individual families that had increased progress in his studies. Dr. Ramey said those families received health care according to the American Academy of Pediatrics recommendations. The children received unlimited iron-fortified formula from birth. Family support social services assistance to help families meet their goals were provided-housing, clothing, food, continued education, access to transportation, and anything else to help someone live in the mainstream of society. Representative Westrom asked when the families became involved in the study. Dr. Ramey said families were entered into the program during the last trimester of the mother's pregnancy. Representative Westrom asked if the preschool program was ages 0-3 or 0-5 and Dr. Ramey said 0-5.

Representative Feeley asked if proper nutrition versus improper nutrition was looked at during the studies. He also asked about the effect of television on children. Dr. Ramey said they monitored nutrition by drawing blood samples to see if there was any indication of undernutrition. There was no indication that any of the children in the studies were malnourished or undernourished. There has been research done that indicates a strong correlation between watching a lot of television and doing poorly.

Representative Burch asked what role public health departments play in a child's early childhood program. Dr. Ramey said public health plays an enormous role in the delivery of high quality health care to the indigent population. Public health can be used to be a link that brings the whole health care medical profession together. Dr. Ramey agreed with Representative Burch that the health departments should be an intricate part of any plan developed for early childhood programs. Representative Burch asked what had been learned about early brain development on emotions, social skills, and violence. Dr. Newman said if an infant does not get the kind of emotional connection early, parts of the brain do not develop. Representative Burch asked if religion played a part in the studies. Dr. Ramey said parents were interviewed and one of the areas discussed was religion. Families who reported going to church more tended to be more intact and to have more advantages broadly than those who did not. Whether this is because these families were already prone to have these advantages associated with church or whether church conveyed those advantages cannot be determined.

Representative Tapp asked what kind of information would be put into an integrated database system and who would be asked to supply this information. Dr. Ramey said some states have linked the public health information, mental health/mental retardation information, education, rehabilitation services, and human resources information. An agreement was signed that would keep the data confidential and there would be anonymity for participants. Representative Tapp asked if any data was collected from the parents. Dr. Ramey said human resources agencies collect tremendous amounts of data.

Representative Burch announced the next meeting of the Interim Joint Committee on Health and Welfare would be held June 16, 1999 at the University of Kentucky.

Consideration of Referred Administrative Regulations:

No action was taken on the administrative regulations.


There being no further business a motion to adjourn at 3:40 p.m. was made by Representative Damron, seconded by Senator Herron, and approved by voice vote.