The Committee on Health and Human Services was called to order at 1:30 p.m., on Wednesday, April 9, 1997. Chairman Vivian Freeman presided in Room 3143 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Guest List.

COMMITTEE MEMBERS PRESENT:

Mrs. Vivian Freeman, Chairman

Mr. Mark Manendo, Vice Chairman

Mr. Mark Amodei

Ms. Merle Berman

Ms. Barbara Buckley

Mr. Dario Herrera

Mr. Pat Hickey

Mrs. Saundra (Sandi) Krenzer

Ms. Kathleen (Kathy) Von Tobel

Mr. Wendell Williams

GUEST LEGISLATORS PRESENT:

Assemblyman Jack Close, Assembly District 15

STAFF MEMBERS PRESENT:

OTHERS PRESENT:

Sheila Ward, representing Carson/Douglas Christian Coalition

Lezlie Porter, private citizen

Stephen Shaw, Deputy Director, Department of Human Resources

Following roll call, Chairman Freeman opened the work session on A.B. 155.

Chairman Freeman asked Ms. McDade to explain the proposed amendments to A.B. 155 (Exhibit C). Ms. McDade, for the record, introduced herself as the Policy Analyst for the Health and Human Services Committee. She noted the subcommittee reviewed the key issues addressed by the bill and described the 16 issues they had considered (Exhibit C).

Assemblyman Close, for the record, identified himself as the Assemblyman representing District 15. Mr. Close explained, regarding item 5 of Exhibit C, the individual who would sign the forms to become the licensee would be the individual who would be subject to fingerprinting. He noted the entire board of directors or the president of a company could not be required to be fingerprinted. However, Mr. Close stated he believed the Legal Division of the Legislative Counsel Bureau interpreted this item to mean the person responsible for the license would need to be fingerprinted along with the administrator of the facility. Mr. Close also pointed out, though, any of those individuals who were already required by their license to be fingerprinted would be exempt from having to be fingerprinted again by the bill (see page 1, second bullet, in
Exhibit C).

Mr. Close commended the subcommittee for their work in producing a version of A.B. 155 that he hoped would create something worthwhile for the industry. He stated he had received further communication (Exhibit D) from the industry affected by A.B. 155. The Adult Care Association of Nevada requested the fingerprinting of an employee take place within the first 30 days of employment. Mr. Close noted this proposal was important to put in the record. He said, "This criminal background check should only be a condition of employment, not application for employment." There was concern, Mr. Close noted, that certain administrators might require all applicants to go through the process, yet might never offer them a job. He thought this was a worthwhile proposal to consider, if the committee agreed. The Adult Care Association of Nevada also questioned the limits placed on the disqualifying crimes (see item 11, Exhibit C). Mr. Close noted he had no objection if the committee wanted to lessen the limits to
6 or 7 years. In addition, item (8) of item 11 in Exhibit C, was seen as too much of a penalty against an individual who committed those crimes by the Adult Care Association of Nevada. Mr. Close said he would agree to add a time limitation to that set of crimes, if the committee agreed as well.

Mr. Close then mentioned he received a letter from Larry Fry, Marketing Manager of Dayton Parkview Adult Residence. Mr. Fry had requested an amendment stating the employee should be 100 percent responsible for the application fee. However, Mr. Close did not agree with Mr. Fry. Mr. Close stated he believed the fee should be a shared responsibility and allowing the employer to recoup 50 percent of the cost over time was a reasonable solution. Mr. Fry also suggested an amendment relating to limiting the liability of the employer and Mr. Close noted the proposed amendments mentioned in Exhibit C covered his concern.

Mr. Close noted, despite the many changes proposed to the bill so far, many people still supported the bill. He suggested, once the legal wording for the amendments was drafted, he would appreciate a chance to review the language before finalizing the bill.

Chairman Freeman asked Mr. Close how he would deal with those people in facilities who were under the age of 60 (see item (7) in item 11 of Exhibit C). Mr. Close answered the bill addressed concerns for a specific population that seemed to be exploited. However, he noted he would have no objection, if the committee wished, to strike the age limitation and have item (7) in item 11 of Exhibit C say ‘abuse, neglect or exploitation of a person.’ Mrs. Freeman said she wanted to make sure those other populations be protected as well as those over the age of 60.

Chairman Freeman then asked Mr. Close whether he had an estimate of cost of the background check (she referred to item 12 of Exhibit C). Mr. Close responded the testimony received so far indicated a cost of approximately $50. However, he noted there were other alternatives presented in the subcommittee meetings that offered a more rapid background check than the Federal Bureau of Investigations could provide but these alternatives would more than double the estimated $50 cost.

Assemblywoman Krenzer asked Mr. Close which group facilities it was his intent to include in the bill (see section 2, line 17). Mrs. Krenzer noted this wording could be interpreted to include a group home facility for foster care children. Mr. Close responded the Nevada Revised Statute (NRS) included in the bill referred to the definition of ‘group facilities.’ Mrs. Krenzer asked whether the NRS language referred to just senior citizens. Mr. Close responded the language referred to other populations as well. Mrs. Krenzer wondered how broad the language was.

Ms. McDade would find the reference to the definition of ‘group facilities’ in NRS and would report back to the committee.

Mrs. Krenzer continued and asked Mr. Close whether it was his intent to have the disqualifying crimes include misdemeanors as well as felonies (see item (6) of item 11 in Exhibit C). Mr. Close answered the intent of the change was to deal with the difficulty of defining the term ‘moral turpitude.’ Mrs. Krenzer, to clarify, asked Mr. Close whether this list would cover any conviction, even if it was a misdemeanor or gross misdemeanor. Mr. Close responded he believed that it would.

Regarding item 16 of Exhibit C, Mrs. Krenzer asked Mr. Close why employees of alcohol and drug abuse facilities would be exempted from A.B. 155. Mr. Close answered the administrators of such facilities had testified the bill would be discriminatory towards them since they often employed recovering alcoholics and drug-offenders in their rehabilitation programs. Mr. Close noted the requirements of the bill would limit their ability to hire such individuals.

Mrs. Krenzer stated, if the definition of ‘group’ included foster care homes, she would not want the exemption stated in item 16 of Exhibit C because those group care homes might be specifically for teens with drug and alcohol problems.

Chairman Freeman mentioned A.B. 11 also dealt with the subject of background checks for group facilities; however the bill was intended mainly to cover the senior citizen population. She stated if foster care homes were not intended to be included in this bill then protecting that population might be better addressed in a separate bill.

Ms. McDade stated the definition in NRS for facility for intermediate care meant, ‘an establishment operated and maintained to provide 24 hour personal and medical supervision for a person who does not have illness, disease, injury or other condition that would require the degree of care and treatment that a hospital or a facility for skilled nursing is designed to provide.’ A facility for skilled nursing was defined in NRS as, ‘an establishment which provides continuous skilled nursing and related care as prescribed by a physician to a patient in the facility who is not in an acute episode of illness and whose primary need is availability of such care on a continuous basis. It does not include a facility which meets the requirements of a general or any other special hospital.’ A residential facility for groups was defined in NRS as, ‘an establishment that provides food, shelter, assistance and limited supervision to any aged, infirm, mentally retarded, or handicapped person or four or more females during pregnancy or after delivery. The term does not include an establishment which provides care only during the day, a natural person who provides care for no more than two persons in his own home, a natural person who provides care for one or more persons related to him in the third degree of sanguinity or affinity, or a facility funded by the Welfare Division or the Mental Hygiene and Mental Retardation Division of the Department of Human Resources.’

Chairman Freeman asked Mr. Close what populations were intended to be covered in A.B. 155. Mr. Close responded the intent was to deal with those who were incapacitated, senior or otherwise. Mrs. Krenzer stated the NRS definitions Ms. McDade read had satisfied her previous concerns.

Mrs. Krenzer asked whether any conviction, be it a misdemeanor or felony, was intended to be included as a disqualifying crime. Ms. McDade stated the language in Exhibit C, item 11 was taken from the existing child care statutes.

Assemblywoman Buckley asked Mr. Close if the subcommittee had addressed whether a facility would have to post a bond to protect an individual who was robbed of his or her personal belongings, against such a loss. Mr. Close stated he believed the subcommittee had not discussed that concern. Ms. Buckley suggested, if the Health and Human Services Committee was concerned with that issue, a separate bill draft request could be made.

Chairman Freeman asked whether Ms. Buckley could have language ready within a few days regarding her concern. Ms. Buckley responded she would be willing to draft language, with Mr. Close’s permission. She stated if Mr. Close felt the idea diverged from the intent of his bill she would pursue the issue with a separate bill draft request. Mr. Close agreed he would be willing to work with her to see if her proposal could fit into the bill. He suggested the subcommittee should have the opportunity to look over the proposal and then give its recommendation to the Health and Human Services Committee.

Chairman Freeman stated the Health and Human Services Committee would hear the recommendation of the subcommittee on Monday, April 14, 1997, and most likely vote on A.B. 155 for reprinting.

Mrs. Krenzer asked whether the individuals affected by A.B. 155 were required to have a sheriff’s card. Mr. Close stated they were not required to have a sheriff’s card. He stated he had studied the option of requiring a sheriff’s card however the cost for obtaining that, in addition to the FBI check, would be exorbitant. Mrs. Krenzer asked about the current cost of a sheriff’s card
Mr. Close responded there was no control over the expense sheriffs could charge. Presently, some sheriffs were charging $39.

Chairman Freeman stated her hope the issues discussed so far could be resolved during the subcommittee hearing so they could make a recommendation to the full committee. She closed the work session on A.B. 155.

Although it was not on the agenda specifically, Chairman Freeman asked the committee to review A.B. 274 for a vote. Chairman Freeman stated the Health and Human Services Committee had not voted on it previously because the language was possibly going to be changed. However, Mrs. Freeman said her information to this point was that no changes were to be made.

Chairman Freeman called Tim Terry, Director, Medicaid Fraud Control Unit, Senior Deputy Attorney General, Office of the Attorney General, to answer any questions before the committee would vote.

Assemblyman Herrera requested additional time to review the bill before voting. Chairman Freeman asked whether Mr. Herrera would rather postpone the vote to another meeting. Mr. Herrera responded he would feel more comfortable having additional time to review the bill before voting on it.

Mr. Terry stated each member of the Health and Human Services Committee should have the correspondence which he had submitted at the time of his previous testimony on March 26, 1997. This correspondence, he noted, summarized the details of the bill concisely. Mr. Terry offered to discuss any questions the committee members might have while reviewing the bill.

With no further questions from the committee, Chairman Freeman closed the work session on A.B. 274 and opened the hearing to the presentation about the Family to Family Connection program. Mrs. Freeman called Charlotte Crawford, Director, Department of Human Resources to testify.

Dr. Crawford stated her agency’s presentation would cover the motivation, the mission, and the procedures of the Governor’s proposed Family to Family Connection program. She expressed hope the Health and Human Services Committee would share her agency’s excitement about what the program had to offer to Nevada’s children. The Family to Family Connection program, as outlined in Exhibits E to P, would:

• Support and help families to provide the care and nurturing that was essential to allow their very young children to realize their developmental potential;

• Build a network of hospital, home, and neighborhood services to support families, their newborns, and their very young children;

• Be voluntary, with participation optional, and there would be no mandatory component in the program;

• Be made available to all families in Nevada with newborns or very young children with no qualifying criteria or means-tests for receiving services;

• Build a network of services, link together existing services, identify gaps that might exist in services, and attempt to fill those gaps. The program would not duplicate existing services;

• Be locally tailored, crafted, and administered. The program would use local programs that already exist and would invite local services to participate in the development of new programs. It would offer a request for proposal (RFP) as the funding mechanism to support this;

• Be flexible in order for it to fit within each community and within the current array of services available; and

• Promote positive parenting.

In the surveys the DHR completed (pages 5 to 8 of Exhibit E), new families with very young children or newborns had overwhelmingly indicated they wanted additional support services, they would be interested in participating in a program like this, and they would support the development of such a program. Dr. Crawford stated, the most common response heard by DHR was, "It’s about time we did something for the very young children."

Dr. Crawford introduced a video, which she stated would allow the committee to understand some of the scientific information available regarding the importance of early childhood development. Exhibit N was shown, the title was "Family to Family Connection" and the original is on file at the Legislative Counsel Bureau Research Library.

Dr. Crawford introduced Marilyn Walter, Chief, Early Childhood Services Administration, Division of Child and Family Services, Department of Human Resources and stated Ms. Walter would continue the Family to Family Connection program presentation.

Ms. Walter discussed the various materials presented to the committee in Exhibits E through P. She emphasized the program would:

• Be designed to support the child within the family and the family within the local community;

• Create a network that would encourage each child to reach his or her potential;

• Happen at the community level in partnerships with local community, non-profit, private, and public agencies; and

• Be measurable. The program, as designed, would be accountable and it would make data available for the Legislature, the Interim Finance Committee, and other decision makers about the impact of the program (see pages 10 to 14 of Exhibit E).

Ms. Walter said, "We would not want this program to be perceived as another state program coming into family’s lives. This will be truly money that flows out to communities to develop community infrastructure."

Ms. Walter then explained Nevada had some of the highest rates in the areas of child abuse, teen pregnancy, and child poverty in the United States (see page 4 of Exhibit E). The Family to Family Connection program would be designed to prevent such problems, to help support families, and to provide them with the knowledge of how to deal with stresses in their lives. The program would help families, assist them, and connect them to resources within their own neighborhoods.

In Exhibit P Ms. Walter described an example of how the Family to Family Connection program could operate. There were other examples of possible situations that the Family to Family Connection program might encounter listed in Exhibit I. She then concluded her presentation and stated she would be happy to answer any questions from the committee.

Assemblyman Hickey commented Nevada’s children were fortunate they did not enter the world as deprived as the poor Romanian orphans did. While realizing the state had the best intentions in developing this program, he stated his concern the program was trying to accomplish more than what it was capable of doing. Mr. Hickey asked Ms. Walter whether she had an estimate of the number of volunteers or family specialists the Family to Family Connection program would train and where the five Family Support Center sites would be located. Ms. Walter concurred with Mr. Hickey regarding the condition of the Romanian children. She stated, fortunately, conditions here certainly were not as extreme as in Romania. However, she explained the information gathered there had helped to further the understanding of how such deprivation affected children and had indicated how critical the first years of life were in the process of development. To answer Mr. Hickey’s question, Ms. Walter stated the proposed budget for the program was based on a 75 percent participation rate. Her agency had projected that 75 percent of families might want some form of information within a range of activities including receiving a phone call, borrowing a book, or receiving 5 or 6 intensive home visits from a family specialist. Within that 75 percent participation rate, the agency had budgeted for two interventions for every family within that range of services. The family specialists, Ms. Walter explained, would not be volunteers. The program would have paid positions for the basic core coverage of services. The program would want to have and to encourage volunteers from the communities to participate in and expand those services. However, to ensure the success of the program, Ms. Walter explained they wanted to make sure the family specialists were paid and recognized for their expertise just as professionals in other fields were recognized as well.

Mr. Hickey asked Ms. Walter how many family specialists the program planned to hire. Ms. Walter responded there would be an overall total of 47 state classified positions for the program, of which 11 of those would be family specialists. There would also be money, she explained, which would be given to community entities to hire from within their organizational structure an additional 32 family specialists and some support staff.

Mr. Hickey asked where the five Family Support Center sites would be located. Ms. Walter stated they had not identified the sites yet. The sites would be determined by a RFP basis; the site would be placed in a community or neighborhood that had submitted a strong proposal. She indicated there would be one rural site, two in Las Vegas or Southern Nevada, one in Northern Nevada, and one based on where the most need was found.

Mr. Hickey agreed there were grave needs for families in our current society but he wondered if the program was promising more than it could realistically deliver. In addition, he expressed his concern that because the needs were so great, the funding for this program would continue to escalate.

Dr. Crawford acknowledged Mr. Hickey’s concerns as legitimate ones. She said the program was designed to try to meet the needs of all newborns and families of all newborns. A large part of what the program would try to do was to link families with existing and other services when they have specialized needs beyond the scope of the program. The program was not intended to provide all the specialized services or on-going support. A variety of other programs existed to handle those issues, and the intention was to link families to those services.

Dr. Crawford also discussed the extreme case of deprivation suffered by the Romanian children as shown in the video (Exhibit N). However, from those experiences, she stated researchers could show that early childhood experiences did have an impact. The dramatic information coming out of this research was the impact could be seen even at the level of neurons, it could actually be seen on a brain scan. Dr. Crawford stated it had long been known that a child’s early experiences had an impact on his or her life. Now there was evidence of the impact and that the changes could not be removed. Dr. Crawford said, "We cannot fill the void that was left by the lack of a positive experience in these critical periods of development. We can’t compensate tomorrow for what we left undone yesterday. . . . We need to be preventive." She stated the Family to Family Connection program would try to help families deal with life’s stresses, help them understand how critical the experiences, stimulation, and learning of their children was during the early years of life. The program would try to share the awareness of that critical stage of life in order to help families deal with the stress that could frequently lead to abuse or neglect. This would help to ensure each Nevada child could have the opportunity to get through that stage so they could reach their positive developmental potential.

Chairman Freeman commented Dr. Crawford’s point was well taken regarding the critical stage of development and how neglect and deprivation could negatively affect a child’s later outcome in life. She said, "These people very often end up in our prisons, they have no advantages that the rest of us are accustomed to in our lifetime, but somehow we have to address the children who have no one there to help them."

Assemblywoman Buckley asked either witness to explain the preference indicated in the survey for phone calls after birth as opposed to home visits (page 5 of Exhibit E). Ms. Buckley stated her reaction to that survey result was she thought the need, more often after birth, was to talk to someone and get reassurance. Those types of concerns would seem to be more amenable to a phone call where a new mother could receive advice from someone who had experience and who had been there. Ms. Walter responded the survey was administered statewide to both individuals who were in the hospital after giving birth and to those mothers who had been discharged up to 8 weeks after giving birth. The families they surveyed had children no older than 6 months of age. Overwhelmingly people had indicated they wanted the personal connection of a home visit. The respondents knew there were hot lines they could call to get information but what they said they wanted was to develop a relationship and a connection with someone. However, they did not want that person to come from a profession that had been perceived as a part of the social service arena or a state agency. They also conducted four focus groups around the state to determine people’s preferences and the focus group summary stated those respondents also liked the idea of a personal interaction.

Ms. Buckley asked Ms. Walter to what she would attribute the differences in responses to question 4 (page 7 of Exhibit E) between those at home and those in the hospital. Ms. Walter said her interpretation of that result was people in a hospital were often overwhelmed by the flood of information. Whereas the community people were saying, once home, they might want the personal contact. Once they were in their home with their baby many questions could arise that might have been lost in the overload of information received at the hospital.

Assemblywoman Von Tobel asked Dr. Crawford whether her agency had compiled a list of all the current services available to families in all the communities in Nevada so as to be sure the Family to Family Connection program would not be duplicating services. She also hoped the program would recognize the services provided by various religious groups. Ms. Von Tobel stated the program would need to look at all available services, whether they be private or public. She asked Dr. Crawford to provide such a listing for the committee. Dr. Crawford responded the listing of services was a work in progress since each community in Nevada was different. The Family to Family Connection program would identify services in the communities so they could provide referrals within communities. She stated she hoped the program would have adequate sensitivity to the faith community and the services they provided. Dr. Crawford noted her agency had a very long list of services available, however, the list was not exhaustive since services continued to evolve, be created or discontinued.

Ms. Von Tobel asked whether communities in Nevada were being asked whether they wanted the Family to Family Connection program or was it mandated they participate. Ms. Walter answered no community entity would be forced to take part in this program. Participation would be on a request for proposal basis and if there were no proposals that came forward from a community the state would not mandate the community to participate. At this point, Ms. Walter noted, there were no plans to force any neighborhood, community or family to participate in any part of the program. She stated, in her opinion, that would ruin the success and the intent of the program.
Ms. Walter mentioned, to respond to Ms. Von Tobel’s earlier question regarding a list of services, her agency did have a database of the various services available compiled from the 112 completed surveys. She noted the information in the packet provided to the committee was only a summary of the survey results. A more detailed survey had been completed and the agency was continually getting those returned. She noted they were always asking for the most updated information possible.

Assemblywoman Berman asked for clarification of the statement mentioned earlier that people would be unhappy with social workers coming to visit them (see survey results pages 6 and 7 of Exhibit E). She had several concerns:

• How will family specialists differ from social workers in such a way that people would be more accepting of them in their homes?

• Would the family specialists have 4 year college degrees?

• What would become of the social workers not needed by this program?

Ms. Walter answered social workers would still provide a valuable service to communities in other social service agencies. However, the survey results indicated families would prefer to have someone with a different background such as a child development specialist to visit them in their homes.

Ms. Berman described a situation she had read about involving twins - one had died and the other suffered from malnutrition. The article noted a social worker had visited the home and not found anything wrong. Ms. Berman stated most social workers had gone to school for 4 years and most had a Master’s degree. She expressed her concern if a trained social worker could not find anything wrong in the home of those twins, then how would the neighborhood people the program would train, who would have no background in the field of social work, be able to understand and be alerted to potential dangers in a home.
Dr. Crawford responded the Family to Family Connection program would not replace the Child Protective Services program and was not intended to provide that service. It was intended to help families by providing positive parenting skills and supporting families. The Family to Family Connection program would not be investigative in nature. The program was not intended to identify parents at risk of neglecting or abusing their children - the aim of the program was to prevent those situations from happening by supporting families.

Chairman Freeman commented many managed care organizations had testified before the committee regarding the services they offered to their new mothers who were having difficulty nursing their child. She asked Dr. Crawford whether social service agencies were meeting the needs of new mothers regarding nursing difficulties. Dr. Crawford answered she knew of a variety of programs that addressed such concerns. Some were provided to women by their private health insurance. The Family to Family Connection program would not duplicate those. Dr. Crawford noted the results of the survey appeared to indicate there were unmet needs. She explained there were many families who had the need for information who either did not have families of their own to turn to or who were unaware of the availability of services. The Family to Family Connection program would assist in networking those services, connect families to what was available to them, or provide that service when it was not available in the community. Chairman Freeman asked whether it was possible for the program to develop partnerships with some agencies who already provided that service. Dr. Crawford said her agency had met with various managed care organizations and hospitals and those organizations had indicated they would be interested in developing partnerships with the Family to Family Connection program.

Chairman Freeman asked Marti Searcy, Manager of the MOMS program for Medicaid, to come forward to testify. Chairman Freeman asked Ms. Searcy what services Medicaid offered to their new mothers who had problems nursing their newborns. Ms. Searcy explained women case-managed through the MOMS program were women who were at extreme high-risk for poor outcomes after pregnancy. Her program would postpartum home visit those women
60 days following delivery which would include the month in which the sixtieth day fell. The program connected those women with community health nurses, with county extension services, and in Carson City and Reno, with a postpartum home visiting program supplied by home health agencies affiliated with Carson-Tahoe Hospital and Washoe Medical Center. Of the women home visited by her program, many had problems with lactation. She also mentioned there was a hot line in Nevada called the "Warm Line" where women could access services 24 hours a day.

Chairman Freeman asked Ms. Searcy whether she felt there was an unmet need in the community for those types of services. She noted not everyone was on Medicaid or in a managed care organization and able to receive help. She asked whether she felt the Family to Family Connection program would pick up those people who were not covered under a program. Ms. Searcy said many families in Nevada had little means of family support - most had no extended family, most people worked, most did not know their neighbors - and most families definitely needed support.

Assemblywoman Krenzer stated she chaired the Perinatal Substance Abuse Subcommittee for the Maternal and Child Health Board and acknowledged the MOMS program as one of the most successful programs in terms of increasing birth weight of babies, reducing, to the extent possible, drug and alcohol abuse and addiction, and life skills problems. She asked Ms. Searcy whether it was true that the program just could not meet the need that was out there.
Ms. Searcy stated the MOMS program was limited since they could only follow women for 2 months postpartum. In the event the program encountered a family with multiple needs, she stated they were generally successful in connecting the family with other community resources. Whether or not those resources successfully provided for that family, Ms. Searcy could not answer because her program could not follow them after 60 days. She explained several programs in the United States offered initial data which proved that families who were supported during the crucial first year of their child’s life had become more successful, for example their children had lower-drop out rates, and less instances of substance abuse.

Chairman Freeman asked Ms. Searcy whether the current welfare reform with block grants would mean even more people would be unable to access necessary services. Ms. Searcy responded she did not know how welfare reform would effect programs since Medicaid had not been impacted by reforms yet. Her program was still intact and in place. Chairman Freeman asked
Dr. Crawford to address the question of whether welfare reform with block grants would reduce the services available to people currently receiving services. Dr. Crawford responded, at this point, the most dramatic effect seen relative to Aid to Families with Dependent Children (AFDC) was the drop in case loads, which had started before the block grant was imposed. That amounted to a 32 percent drop in cash assistance programs. She noted the MOMS program primarily was offered to those who were AFDC eligible so as the case load continued to drop, the MOMS case load might also be lightened. Dr. Crawford indicated her agency had not seen the same drop in case loads in the children’s programs such as the Child Health Assurance Program (CHAPS) and the Temporary Assistance for Needy Families (TANF); in fact, she noted the case loads continued to climb.

Ms. Searcy stated she had not seen a reduction in referrals to the MOMS program. The program consistently had 7,000 referrals for the last 3 years and, for the first half of fiscal year 1997, had not demonstrated any drop in that number.

Chairman Freeman asked how the Family to Family Connection program would coordinate with the local governments and called May Shelton, Director, Washoe County Social Services, to discuss this issue. Ms. Shelton described a small program called "Healthy Generations," which was designed to help families identified as high-risk. The services were offered through the county’s Health Department on a voluntary basis. This year, Washoe County Social Services had referred 243 cases to the Health Department. Of those cases, 148 had accepted services. Of those accepting services, only one incident of child abuse was reported. However, Ms. Shelton stated, this successful program would probably lose its funding due to welfare reform. She expressed the Family to Family Connection program would be an exciting opportunity to offer prevention services to the entire state, without regard to income or risk-factors. There were so many people who could benefit from this service especially with the population growth in Nevada and the transient nature of our communities where people did not connect to their neighbors, moved a lot, and did not have extended families. Ms. Shelton stated she thought the Family to Family Connection program would be successful because it would be established in the neighborhoods and the workers and the volunteers will be their neighbors.

Ms. Shelton stated prevention worked. It was cost-effective and the results would be fewer drop outs, higher completion rates of high school, fewer child abuse cases, fewer delinquency cases, and ultimately fewer adults in the criminal justice system. She believed the Family to Family Connection program would be a good investment and encouraged the committee to support the program. Ms. Shelton also presented Exhibit Q.

Chairman Freeman called Janine Hansen, State President of the Nevada Eagle Forum, to testify. Ms. Hansen presented Exhibit R. She stated her organization had serious concerns about the Family to Family Connection program, not because they were not concerned about the success, health and future of every family. They had considerable concern because:

• The answer to families’ problems may not necessarily be best answered by the government;

• Last year, in June of 1996, Reader’s Digest stated 50 to 60 percent of a family’s income was now consumed by federal, state and local government taxes, which meant many families were unable to have a full-time parent at home to care for children because both parents had to work to pay for taxes;

• This program would make it the norm for individuals to seek governmental solutions rather than individual and private solutions and it would create a constituency which would seek additional government solutions instead of extending the opportunity for people to become self-sufficient;

• Family privacy needed to be safe-guarded against expanding technology. She wondered how records would be kept private in the Family to Family Connection program. She emphasized the need to ensure families’ personal privacy was protected and safe-guarded; and

• Many programs started as voluntary and over the course of time lost that voluntary nature.

Ms. Hansen stated a reduction in the size and scope of government would allow individual families to experience the wonderful opportunities which were originally afforded to families through the Constitution of the United States. Economic opportunities were now denied to families because the population now had become slaves to government and that interfered with families. She stated there was a philosophical issue at stake here. Ms. Hansen said, "Are people responsible for government as our founding fathers said, or is government now, as in the socialist nations, responsible for people?" She then gave an example of how she believed government, when seeking to solve problems, actually exacerbated them. Ms. Hansen said the welfare system had resulted in many more people having babies out of wedlock, families without fathers in the home, and many attendant problems because government, instead of encouraging people to seek private solutions, began to resolve their problems through government funding. She said, "Now we have a generation of gangs, children with no families, with no fathers, with no stability, that we are seeking again a government remedy to." Ms. Hansen explained her organization considered "this program not to be Family to Family but Government to Family" and stated the money for the funding of this program would be better left in the hands of individuals so they could have the opportunity to make those decisions in their own lives.

Assemblyman Manendo asked Ms. Hansen whether she was saying that teen pregnancy and gangs were a direct result of or the fault of government.
Ms. Hansen stated she believed many of those problems could be directly related to government interference through the welfare system, which instead of allowing those individuals to work out those difficulties on their own, actually provided a means by which they could be supported through government welfare while having children out of wedlock. She stated there were many other government programs that she would suggest had done the same.

Assemblyman Manendo asked Ms. Hansen about the families that were well off, not on any type of government assistance that have children that do get pregnant and families that have problem teenagers that end up in gangs.
Ms. Hansen said, "I certainly do not think there is one single genesis of the problem. I think there are many problems which we have, one of those, of course that we all see, is the acceleration of the divorce rate and other problems which we recognize in our society. All of them cannot be traced to government, but I think, in many cases, the well-meaning and intentioned purposes of government have caused increases in the very problems they sought to resolve. They are not the single source of all of our problems, and I do not wish to imply that."

Chairman Freeman called Robin Hollingshead, private citizen, to testify.
Ms. Hollingshead, a parent and resident of Douglas County, stated she was in opposition to the Family to Family Connection program. She stated she was confused by the long-term outcomes. One outcome was to increase the number of participants, both volunteer and paid, in order to support families. Another outcome was to promote self-sufficiency of families. However, she felt these two outcomes contradicted each other since self-sufficiency should lead to a decrease in the need for services and for employees of the program. This program, in her opinion, would reach out to those who did not need or seek out help and would actually encourage dependency amongst those who would otherwise be self-sufficient. In addition, she felt the program would perpetuate dependency amongst those already relying on the state. Another outcome of the program was to increase the safety and general welfare of infants, which she stated, was certainly desired by all. Many public and private organizations existed that were concerned with safety and health of infants and families.
Ms. Hollingshead stated a network already existed within these agencies to make sure families had access to a variety of resources. For example, Carson Tahoe Hospital gave a packet to new mothers after giving birth, which contained plenty of useful information about the La Leche league (breast feeding), lactation consultants, new mother support groups, and in-home visits. Also, the hospital provided social workers for families identified as needing additional support. Many support services were provided through a hospital, through county support or through private health insurance. Ms. Hollingshead said, "I determined that the purpose of this Family to Family program is to familiarize and encourage all families in the State of Nevada with the opportunity to become dependent upon a social service system and to contribute to increasing their own tax burden." She suggested the state print out a listing of the social services already available, make the listing available to hospitals to give to families with newborn children. Ms. Hollingshead stated this would be a more practical and cost-effective way to let new families know about existing services.

Chairman Freeman then called Peggy John, private citizen, to testify. Ms. John, a mother and grandmother, lived in Minden. She stated she cared very much about families but was opposed to the Family to Family Connection program. Ms. John suggested the government should alter the tax structure to lower taxes so that maybe one parent could be at home with children. She stated, in her opinion, that would take care of a lot of the social problems society currently had. Ms. John stated the program also seemed to contradict the federal government since at the federal level they were trying to get people off welfare. She explained this program, by inviting everyone, would make the part of society that was strong, weak. Ms. John indicated she conducted an informal poll of her own. She had asked approximately 20 friends and acquaintances how they viewed the Family to Family Connection program.
Ms. John stated these people were not for the program, they found it to be frightening and intrusive. They did not want the government micro-managing their families.

Chairman Freeman called Lynn Chapman, private citizen, to testify.
Ms. Chapman, a mother, told the committee how, when she was pregnant with her first child, her husband transferred to Nevada. She stated they did not know anyone and had no family members close by. Ms. Chapman indicated she had to rely on common sense, two books she bought, her mother’s phone number, her best friend’s phone number, and her doctor’s phone number to help her deal with a new baby. She said, "If people use their common sense and use the phone to call mom and doctor and whomever else, they probably won’t need to worry about spending government money, etc. and paying higher taxes for this program." Ms. Chapman stated her concern about the liability of having trained people who were not government workers go into other people’s homes to help them. She felt that was an important concern that needed to be addressed.

Chairman Freeman then called Sheila Ward, representing Carson-Douglas Christian Coalition, to testify. Ms. Ward stated her agency’s opposition to the Family to Family Connection program and echoed her support for the testimony previously given by those against the program.

Chairman Freeman called Lezlie Porter, private citizen, to testify. Ms. Porter stated she was concerned that a quantified and definite need had not been established for this program. She questioned the statistics which were used to justify the program. Ms. Porter indicated the statistics that one-half of
1 percent of infants that died before age of 1 and three-tenths of 1 percent of the population were abused in the first three years of life represented a minute portion of population. She stated she had not seen information on the amount, whether it would be 25 percent or 50 percent, by which the program intended to reduce those statistics. Ms. Porter suggested those statistics were relatively generic and stated no evidence was provided to indicate the infant deaths were caused by people not having the right information or a support system. She suggested the same concept applied to the statistic on abuse since it was known that much abuse was drug and alcohol related. Her concern was how this program was going to try to impact those statistics.

Ms. Porter was also concerned about the program’s evaluation process because it was based on satisfaction and use. She stated those indicators did not necessarily mean a need for services existed. As an example, Ms. Porter said, "My children would be very satisfied with pizza and soda pop at every meal, but that doesn’t necessarily mean that it would appropriately meet their needs." She explained the state should look at what was truly needed and what would best satisfy those needs rather than use satisfaction as an evaluation criteria.

Additionally, Ms. Porter stated she was concerned about the failure to identify, in hard figures, what constituted the gap in services. She noted several different agencies had said there was a gap and they could not meet all the needs of the population. However, the gap was not quantified and the need was not defined. Ms. Porter stated the Governor’s video reminded her of George Orwell’s book, "1984." She noted giving a video to every new mother implied availability of a VCR in every home and perhaps that was overestimating the resources of families. Ms. Porter concluded by stating she was opposed to the Family to Family Connection program. She was a mother of six and families were the most important thing to her. However, she felt the state had neglected to look at resources that already existed and to identify a true need for this program.

Chairman Freeman asked Steven Shaw, Deputy Director for the Department of Human Resources, to testify. Mr. Shaw stated he was excited about the Family to Family Connection program. He stated the tax dollars spent on this program would be pure prevention dollars. Mr. Shaw explained those states which used this model had decreased child abuse and neglect by 27 percent. The program would involve partnering with communities and also with faith communities. It would not be government involved in families lives rather it would be neighborhoods and communities getting involved in families lives. Mr. Shaw asked where did we want to put our money - in prisons or mental health institutions - or into prevention? He asked whether the Family to Family Connection program would be a smarter, better investment? He answered yes since the evidence and research showed programs like this worked. It would be an optional, not mandatory, program and 86 percent of the respondents to their survey (Exhibit E) said they could use that help.

With no further testimony forthcoming, Chairman Freeman adjourned the meeting at 3:43 p.m.

RESPECTFULLY SUBMITTED:

Lori Conforti,

Committee Secretary

APPROVED BY:

Assemblywoman Vivian Freeman, Chairman

DATE: