A Report to the Community: Invest in Children’s Impact to Date

Rob Fischer, Ph.D.Claudia Coulton, Ph.D.

Overview

• Building an initiative and creating a system for meeting the needs of young children

• Highlights of IIC programming results to date• Creating an integrated child data system as a

community resource to inform policy and practice

The Trajectory of the System

Early Childhood System

Invest in Children Logic Model

Strategies Programs OutputsOutputsIntermediateOutcomes

IntermediateOutcomes

Healthy Start Outreach

Primary Lead Prevention

Number ofchildren and

families reached

Children reachedearly and

with continuity

Familieseffectively

access range of available services

Caregivers effectively engaged

Number ofchildren and

families reached

Children reachedearly and

with continuity

Familieseffectively

access range of available services

Caregivers effectively engaged

Children receive appropriate

care at home and in other settings

Parent and caregivers have

increased knowledge and skills

Medical Home

Children develop

appropriately

Longer-term OutcomesLonger-term Outcomes

Effective Parents and Families

Prenatal to three system

Safe & HealthyChildren

Access & utilization of Preventative health care

Home visiting

Early Literacy and Learning

Early Childhood Mental Health

Children Prepared For School

Early Care and EducationSystem

Community Committed to Children

Family Child Care HomesRegional System

Professional developmentFor Centers

Communications campaign

Community mobilization

Disseminate findings

T.E.A.C.H.

UPK

Community ethic

around our youngest children

Positive movement on

community-level child well-being

indicators

Special Needs Child Care

Early Stages of the Initiative

• Effective Parenting– Welcome Home (Newborn Home Visit)

• Significant gains in parent knowledge of community resources and knowledge relating to their baby’s health/wellness; 39% of visits led to identification of at least one medical concern for the newborn or mother

– Early Start (Ongoing Home Visiting) • Increased sense of parental competence and comfort in

caring for child and reduced risk for physical abuse• High rates of immunization and access to regular doctor

Early Stages of the Initiative

• Healthy Children– Healthy Start/Medicaid Expansion

• the percentage of children enrolling in Medicaid during the first month of life increased from 45% to 62%; insured children under age 6 in Cuyahoga County increased from 90% to 98%

Early Stages of the Initiative

• Quality Child Care– Family Child Care System

• Increasing quality among home based providers and growing number of Gold Seal homes

• Impact greater with more intensive services

– Special Needs Child Care• 93% of children at risk of expulsion remaining in their

child care placement for six months or more• Based on feedback parents now receive summary of

focus of services

Expanding the Initiative

• Early Childhood Mental Health (added 2006)– significant decline in child behavior problems and

significant improvement in parent-child relationships; 65% of treatment goals were met by families at program exit

• Primary Lead Prevention Pilot (2006-2010) – decreased lead dust in the home, increased knowledge of

preventing elevated blood lead levels in target infants, and reduced blood lead levels in children in the home

• Universal Pre-K Pilot (began 2007)– significant gains in UPK site quality and average level of

school readiness significantly exceeds the average readiness of all children entering CMSD

Scope of IIC Services-over 120,000 children served

Type of Service

Total Served 2011

Total Served

through 2011

All service types combined 13,254 120,773

Family Child Care 1,621 14,846

Ongoing Home Visiting 2,520 41,980

Early Childhood Mental Health 351 1,174

Special Needs Child Care 1,228 5,582

Early Intervention 3,497 24,273

Universal Pre-K 1,389 4,456

Newborn Home Visit 1,708 65,783

Data Informing the System

• Program development – Medical Home pilot– Primary Lead Prevention pilot

• Program refinement– Home visiting– Family child care quality enhancement

• Program targeting– Health insurance outreach– Newborn home visiting

The Power of Data – Child Health Example

• Dramatic increase in health insurance coverage for children ages 0-6: Hooray!

• But wait, only 43% of children get all the recommended well-child visits in the first year of life: Oh no,

• But wait, data showed that 49% of these families were involved with IIC services close to birth, so we can use that connection to reach families: Hooray!

• But wait, due to data lags and coordination issues, outreach would happen too late to have an effect: Oh, no,

• But wait, we could use a preventive approach by having dedicated staff at clinics reach out to families…

The Power of Data – Child Health Example

• Result - 2007 Medical Home Pilot with one Patient Advocate each at NEON & Neighborhood Family Practice– 86% of families completed scheduled well-child

visits, double the rate for children born on to Medicaid in Cuyahoga County

Now NFP has integrated the model into care with 9 Patient AdvocatesNow serving the needs of families with infants

Now NFP has integrated the model into care with 9 Patient AdvocatesNow serving the needs of families with infants

The Power of Integrated Data

The ChildHood Integrated Longitudinal Data

(CHILD) System

A Community ResourceCreated with Private Funding

Co-founders: Invest In Children & MSASS, CWRU

The Power of Integrated Data

• Data helps inform our understanding of the early childhood system

• Individuals and families interact with multiple systems and services, so integrated data offers a more complete view of reality [“Big Data”]

• Understanding of how systems work and how to better meet existing needs can be informed by integrated data

• Service models emphasize long term and collective impact, so data needed across services and over time

Multiple Service Use

IIC - Origination of CHILD System

• Began with child registry of all children born in Cuyahoga County since 1992

• Draws on routinely available administrative data to monitor program delivery and outcomes

• Brings together data at the child level for longitudinal analyses

• Now expanding data to reflect experiences throughout childhood

16

CHILD System Data Sources - 400,000 children and counting

• Birth certificates• Maternal health• Low birth weight births

• Death certificates• Infant mortality

• Child welfare• Abuse/neglect

investigations• Placements and services

• Public school data • Attendance• Kindergarten readiness • Proficiency tests• Graduation

• Homeless Services

• Public Assistance Receipt• Medicaid receipt• Food Stamp receipt• TANF receipt• Child care voucher receipt

• IIC program participation• Home visiting services• Special needs child care• Early mental health • Universal pre-k

• Juvenile Justice• Delinquency Filings

• Geo-data• Neighborhood and

environmental conditions

Components of CHILD System

Program Planning

• Federal funding application for housing for children in high risk families

Geographic analyses

Geographic analyses

Answering community questions

• What does the CMSD kindergarten class look like?

Child & Family Well Being Indicators

CMSD

Kindergarten Class 2008-091

Cleveland2

Cuyahoga County3

% Teen Births, mother’s age 10 – 14 <1 <1 <1 % Teen Births, mother’s age 15 – 19 22.4 16.7 9.8 % of Mothers without H.S. diploma 41.7 30.2 15.9 % Low Birth Weight 12.6 11.6 9.4 % Premature Low Weight Births 8.7 8.2 6.7 % Mothers w/ adequate prenatal care (Kessner Index) 63.1 69.4 81.3 % Mothers w/out prenatal care 1.9 1.7 0.9 % Healthy Births (based on information about Apgar, prenatal care, birthweight, gestational age)

56.4 61.5 70.9

% Children with a substantiated or indicated report of abuse/neglect by age 4

12.1 9.6 5.1

% Children referred to ongoing services with Child & Family Services by age 4

19.8 14.7 7.6

% Children with any report of abuse/neglect by age 4, including substantiated and unsubstantiated

35.2 26.7 14.7

% Children in households receiving Food Stamps in 2008 76.9 51.1 28.8 % Children in households receiving Cash Assistance in 2008 19.0 11.3 6.1

Summary

• IIC is a leading example of comprehensive community commitment to young children with demonstrated impact

• IIC is ahead of the curve in effort to understanding the importance of place and the commitment to child development over time

• CHILD system is a community resource available to support policy, research, and practice

What's Next?

• Extend CHILD System to include data from later adolescence (e.g., Juvenile Count involvement, Proficiency test data)

• Undertake study to examine factors that predict 3rd Grade Reading Proficiency (Reading Guarantee)

• Explore mechanisms to make aggregate data from CHILD more available to the community