According to Hawaii's Department of Human Services, the leading causes of child maltreatment are the inability to cope with parenting problems, substance abuse, inadequate income, and inadequate housing. Approximately 2,800 families are assessed as "at risk" for maltreatment in Hawaii each year.
Hawaii's Healthy Start (HHS) is a program of the Department of Health (DOH), which is concerned with the health, development, and overall well-being of children less than five years of age. HHS reduces child abuse and neglect by ensuring improved family functioning and enhancing child health and development.
HHS utilizes a proactive screening process around the birth of a newborn in order to determine which families are at risk of child maltreatment. This screening process involves an evaluation of families' personal and situational factors. If identified as at-risk, the family is offered home visitation services from paraprofessionals. HHS' paraprofessionals often live in the same community as their client families, making them more aware of cultural factors. Sensitivity to Hawaii's multicultural population is vital to developing trusting relationships.
These in-home visits provide an opportunity for the complete assessment of the child's environment and the modeling of appropriate parent-child interaction in a non-threatening manner. The frequency of these home visits gradually decreases from weekly to monthly and quarterly visits as families gain skills and functioning. This pace is determined by the Individual Family Support Plan, an assessment that is completed every six months.
The HHS model focuses on both health and social dynamics within families, as it acknowledges that these interrelated conditions must be addressed in order to affect long-term change. According to DOH's outcome data, 90 percent of HHS two year-olds were fully immunized and 95 percent of the children had an identified medical facility, as compared to former levels of 60 percent. HHS' methodologies of cultural sensitivity and specified courses of action are proving effective.