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Chapter 2:Chapter 2:Chapter 2:Chapter 2: ChildrenChildrenChildrenChildren’s Health, Safety s Health, Safety s Health, Safety s Health, Safety
and Educationand Educationand Educationand Education
Children’s Health, Safety and Education
Page 69
Quality Health Care Quality Health Care Quality Health Care Quality Health Care
The early years of a child’s life are characterized by highly dynamic
processes with far reaching implications for health, emotions and,
ultimately, the ability to learn. Physiologic systems such as the nervous,
immune, neuro-endocrine and musculoskeletal systems undergo rapid
changes that can impact healthy functioning for the remainder of a
person’s life. Positive interactions between the child and parent
contribute to the ability of the child to establish healthy relationships.
Appropriate stimulation through reading, sounds, and exposure to shapes
and colors lay the foundation for a child’s ability to learn. All of these
factors contribute to the healthy growth and development from infancy
through adulthood.
Recognizing the critical nature of the early years of a
child’s life, it becomes apparent that access to quality
health care beginning before the birth of the child is
vital. Prenatal care, well-baby checkups, timely
immunizations, and proper nutrition are as important
as the love and care given to a child by a parent.
Information that is presented in the sections that
follow stresses the importance of a mother seeking medical care as early
in the pregnancy as possible. Prenatal care that begins early and follows
a schedule recommended by health care professionals offers the best
chance for a healthy pregnancy and childbirth. Ultimately, this translates
into healthy development giving the young child the best chance to grow
physically, emotionally and intellectually.
During the early years, with the rapid development of the immune
system, well-baby checkups and immunizations that follow the
recommended timetable, enables the immune system to mature to its
ultimate capacity. The series of immunizations that are required and
recommended challenge the maturing immune system in ways that
eventually give each of us the ability to ward off disease.
The early years of a child’s life
are characterized by highly
dynamic processes with far
reaching implications for health,
emotions and, ultimately, the
ability to learn.
Children’s Health, Safety and Education
Page 70
In addition to medical check-ups and immunizations, health care for
young children can offer support to parents, providing information about
developmental concerns and the health problems of the children. Caught
early, many serious complications that result in long-term health concerns
can be avoided.
Pediatricians can also offer guidance about behaviors that are common in
the early years. Parents can learn about appropriate and positive
parenting skills, emphasizing the importance of positive, development-
promoting activities, such as reading to their child regularly. Discussing
parental concerns is also important for identifying issues concerning the
child or the family as early as possible.
In the mid 1990’s, a group of scientists in California began a study that
investigated the impact of early childhood events. Their groundbreaking
work has raised the awareness of professionals and parents alike to the
importance of quality experiences between a child and significant adult
figures in his or her life. The information developed in that study, coupled
with the work of researchers and clinicians around the world, speaks to
the relevance of early experiences and the need for quality, consistent
healthcare which supports the family and promotes the best chances for
the child to be healthy, happy and well-adjusted.
Children’s Health, Safety and Education
Page 71
Reproductive Health Influences upon early childhood growth and development
begin before the birth of the child and continue into
adolescence. Prenatal care, the age of the mother at the
child’s birth, maternal health including prenatal carei, and
social factors that include abuse and violenceii, poverty,
race/ethnicity of the mother, age of the mother at birth, pre‐
and antenatal care are factors that have the potential to
impact the child for many years. Many of these factors will be
discussed in this section and throughout this report.
Many women are facing a confluence of conditions that can
characterize a single pregnancy. Ultimately, the impact is most
deeply felt by the child and can be manifest in a broad range
of physical, emotional, behavioral and learning outcomes that
can impact the child throughout his or her lifetime.
Professionals are increasingly aware of the problems
associated with complications arising during a pregnancy and
are becoming engaged in efforts to address these concerns.
For example, the National Institute for Health & Clinical
Excellence (NICE) in Great Britainiii is currently examining the
role that social factors play in the quality of a pregnancy as
well as the outcomes.
Since 2003, approximately 17,000 live births in McLennan
County have been reported to the Texas Department of State
Health Services (detailed in table 2.1.1). Each year, the
number of reported live births in McLennan County has
increased through 2007 when 3,503 live births were recorded.
Table 2.1.1 details the number of births recorded for each zip
code reported at the time of birth. Six zip codes recoded more
than 1,000 live births during the five year (03‐07) period.
These zip codes are also the most populous areas in the
County.
Section 2 . 1
Repr
oduc
tive
Heal
th
Children’s Health, Safety and Education
Page 72
Zip Code
‘03 ‘04 ‘05 ‘06 ‘07 Total 03‐07
76705 489 468 489 468 452 236676706 433 405 439 422 454 2153 76708 404 383 388 452 452 2079 76707 386 381 392 424 397 1980 76710 332 319 318 352 355 167676712 205 226 241 230 269 117176643 166 172 202 196 202 93876711 164 162 148 163 169 806 76704 141 151 145 123 147 707 76657 115 91 98 125 150 579 76655 67 72 85 60 81 36576691 77 76 73 60 56 34276557 48 58 57 61 44 26876633 50 54 49 58 50 261 76664 51 33 43 44 32 203 76640 42 25 43 37 42 189 76524 31 22 34 35 27 14976624 17 33 32 29 23 13476638 21 27 23 28 25 12476701 21 20 33 22 26 122 76682 25 22 26 27 17 117 76630 25 16 20 21 21 103 76703 12 3 3 4 3 2576702 6 7 NR 2 3 1876715 7 6 2 NR 1 1676654 1 1 4 3 4 13 76714 4 5 1 NR NR 10 76798 3 2 NR NR 1 6
Total 3343 3240 3388 3446 3503 16920
Table 2.1.1 McLennan County: Live Births (2003‐2007) Source: Texas Department of State Health Services
2003 2004 2005 2006 2007
Texas births 377374 381441 385537 ND ND
Birth rates 16.51 16.69 16.87 NA NA
McLennan births 3343 3240 3388 3446 3503
Birth rates 15.04 14.57 15.24 15.50 15.76
Table 2.1.2 Birth Rates Sate of Texas, McLennan County (2003‐2007) Source: Texas Department of State Health Services
Using the most recent data available for
the state of Texas and McLennan County,
birth rates for the five years beginning in
2003 were calculated. The birth rate,
defined as the number of live births
divided by the average population (or the
population at midyear)iv has been used as
the standard for measuring changes in the
population for decades. This analysis
showed that the birth rate for the state
ranged from 16.51 to 16.87 while
McLennan County recorded rates ranging
from 15.04 to 15.76, 8.9% to 12.7% below
the rate of birth for the state.
A key predictor of birth outcomes and
child growth and development is the
prenatal care that is received during the
pregnancy. Early and regular prenatal
care is the most effective means of
promoting a healthy pregnancy giving the
expectant mother and her doctor an
opportunity to discuss diet, healthy
pregnancy, parental immunization needs
and expectations for the pregnancyv. Key
to this evaluation is an examination of the
number of visits, as well as the starting
Children’s Health, Safety and Education
Page 73
trimester for the care as measures to assess the quality of
prenatal care received by an expectant mother.
A recommended schedule of prenatal carevi includes:
Weeks 4 – 28: 1 visit per month (every 4 weeks)
Weeks 28 – 36: 2 visits per month (every 2 weeks)
Weeks 36 to birth: 1 visit per week
High risk pregnancies may require additional care during the
pregnancy.
The Kessner Index,vii,viii an established scale for
determining the quality of prenatal care based upon
the start date of the pregnancy, the number of
prenatal visits and the length of gestation, was used
to assess the adequacy of prenatal care for residents
of McLennan County. The analysis results indicated
if the care was adequate, inadequate or
intermediate for pregnancies reported between the
years 2003 and 2007.
Table 2.1.3 details the results of the analysis of the
adequacy of prenatal care received by mothers of
McLennan County. Using aggregate birth data for
the years 2003‐2007, the analysis examined the
percentage of mothers who received inadequate
prenatal care during their pregnancy. The results
were then compared against the average for
McLennan County. The results indicate that, on
average, 10.81% of the women giving birth in
McLennan County over the five year period (03‐07)
received inadequate prenatal care. Further, six zip
codes had higher percentages of inadequate care
than the 10.81% average value for the county with
the values ranging from 12.02% to 16.85%.
The analysis of pregnancy data from McLennan
County continued with an examination of the
average number of prenatal visits made during the course of a
Zip Code Adeq Inad Inter %
Inad 76704 384 117 206 16.55%
76701 77 19 26 15.57%
76705 1496 316 554 13.36%
76664 128 26 49 12.81%
76657 387 73 119 12.61%
76707 1138 238 604 12.02% McLennan County
11167 1827 3905 10.81%
76624 98 14 22 10.45%
76706 1366 220 567 10.22%
76524 108 15 26 10.07%
76710 1150 165 361 9.84%
76711 500 78 228 9.68%
76638 96 12 16 9.68%
76708 1368 199 512 9.57%
76655 278 34 53 9.32%
76712 882 109 180 9.31%
76643 707 86 145 9.17%
76640 128 17 44 8.99%
76630 78 9 16 8.74%
76633 200 21 40 8.05%
76557 210 20 38 7.46%
76691 256 25 61 7.31%
76682 86 8 23 0.07
Table 2.1.3 McLennan County: Inadequate Prenatal Care (2003 – 2007) Source: Texas Department of State Health Services
Children’s Health, Safety and Education
Page 74
pregnancy between 2003 and 2007. The results showed that, on
average, a mother received 9.5 (2005) to 9.97 (2003) prenatal
visits during the course of their pregnancy.
The next indicator examined during this analysis of McLennan
County pregnancies was the length of gestation. Pre‐term
delivery is defined as delivery prior to 37 weeks gestation.
Children born preterm are at risk for problems associated with
growth, development and academic progress. Reports indicate
that children born pre‐term exhibit more behavioral and
emotional problems, developmental challenges and cognitive
delays that can impact academic successix. Table 2.1.5 details the
results of the analysis that was performed to examine the average
length of pregnancy for each zip code in each of the five years for
which data was available. Subsequently, the zip codes were
ranked from lowest (37.1 weeks) to highest (40.0 weeks) for the
most recent year (2007).
The results of the analysis revealed that the average length of
pregnancy for each zip code was above the threshold for positive
Figure 2.1.4 Annual Average Number of Prenatal Visits for McLennan County (2003‐2007) Source: Texas Department of State Health Services
9.97
9.62
9.5
9.68
9.8
9 9.5 10 10.5
2003
2004
2005
2006
2007
Average # Prenatal Visits
Average # Prenatal Visits
Year n
2003 3274
2004 3074
2005 3228
2006 3429
2007 3476
Children’s Health, Safety and Education
Page 75
classification as a preterm delivery (Table 2.1.5). However, for
2007, three zip codes reported average
pregnancies of 37.8 to 37.1 weeks in duration;
gestation periods that border on classification as
preterm. Further, only twice in the five year time
frame did any zip code report an average below 37
weeks; both in 2006.
Birth outcomes can play a significant role in the
growth, development and general well‐being of a
child. The length of gestation and the birth weight
are recognized predictors of academic success,
general and socio‐emotional health,x,xi and,
ultimately, the survival of the child.xii
In the state of Texas, natality statistics for 2003
through 2006 reveal that, on average,
approximately 13.8% of all live births were
preterm. In comparison, approximately 12.6% of
U.S. births were preterm. Analysis of the birth
records (detailed in 2.1.6) received from the Texas
Department of State Health Services (DSHS) for
2003 through 2007 identified the total numbers of
pre‐term deliveries recorded between 2003 and
2007. From the analysis, it was determined that
an average of 12.22% of the births for McLennan
County were classified as pre‐term, approximately
0.4% lower than the US average and 1.6% lower
than the Texas averages.
Zip Code
2003 2004 2005 2006 2007
76630 39.7 39.3 38.7 38.5 37.1
76702 38.8 38.6 ND 34.5 37.3
76704 38.4 39.0 38.5 37.9 37.8
76643 38.7 38.8 38.4 38.5 38.1
76654 ND 37.0 39.0 39.3 38.3
76707 38.6 38.7 38.5 38.6 38.4
76640 38.6 40.2 38.4 39.0 38.4
76712 39.0 38.4 38.4 38.5 38.4
76691 39.0 39.1 38.4 38.7 38.5
76708 38.7 39.0 38.5 38.4 38.5
76655 38.6 38.8 38.8 38.0 38.5
76710 38.7 38.9 38.5 38.6 38.6
76557 38.3 38.0 38.4 38.7 38.6
76657 38.9 39.3 38.8 38.1 38.6
76706 39.0 38.6 38.5 38.3 38.6
76638 38.5 38.7 38.5 37.9 38.7
76705 38.8 38.8 38.7 38.7 38.8
76624 38.9 38.6 38.7 38.9 38.9
76711 38.6 38.8 38.4 38.4 38.9
76701 40.8 38.0 38.8 38.7 39.0
76524 38.3 38.3 39.1 38.8 39.0
76664 37.5 38.2 39.3 38.9 39.2
76682 39.1 38.4 38.6 38.5 39.4
76633 38.9 39.1 38.7 38.2 39.4
76703 38.2 39.0 39.0 36.3 40.0
76714 39.8 39.7 40.0 ND ND
76795 ND ND ND 40.0 ND
Table 2.1.5 McLennan County: Average Length of Pregnancy (weeks) by Zip Code (2003 – 2007) Source: Texas Department of State Health Services
Children’s Health, Safety and Education
Page 76
Zip Code Total Pre‐
term Total births
PT/Total ratio
76557 45 268 16.79%76704 107 707 15.13% 76711 116 806 14.39% 76707 273 1980 13.79% 76640 26 189 13.76%76630 14 103 13.59%76708 264 2079 12.70%76701 15 122 12.30% 76643 115 938 12.26%
(McLennan County)
2067 16920 12.22%
76706 260 2153 12.08%76657 67 579 11.57%76710 193 1676 11.52% 76705 268 2366 11.33% 76638 14 124 11.29%76655 41 365 11.23%76682 13 117 11.11%76691 38 342 11.11%76664 22 203 10.84% 76712 118 1171 10.08% 76624 13 134 9.70%76633 25 261 9.58%76524 14 149 9.40%
However, nine zip codes reported numbers
of pre‐term deliveries (as a percentage of
the total live births) that exceeded the
county average (Table 2.1.6). Four of the
nine equaled or exceeded the state average
for the 03‐07 time period. Overall, the
differences between the county average
and the individual zip codes ranged from
23.1% below the county average (76524) to
37.4% above the county average (76557).
Note: Two zip codes were eliminated from
the table because of the limited number of
live births (<100) over the five year time
period. The 76702 zip code recorded 18 live
births (4 pre‐term) and 76703 zip code with
25 recorded live births (2 pre‐term) during
the five year time frame.
Continuing the analysis of the birth data for
McLennan County, reported birth weights
were examined and classified as healthy,
low birth weight (<2,500 grams (5.5 lbs);
LBW) or very low birth weight (<1,500 grams
(3.3 lbs); VLBW). The U.S. average of
LBW/VLBW births for 03 – 06 was
approximately 8.1% of all live births,
comparable to the Texas average of 8.2%.
Table 2.1.7 details the analysis of reported birth weights for the
live births recorded during 2003 through 2007. During the five
year span, mothers in McLennan County gave birth to 1118
(6.61%) low birth weight and 278 (1.64%) very low birth weight
children, matching the state average of approximately 8.2%.
Again, a number of zip codes were eliminated from the reporting
because these areas recorded less than 100 live births during the
five years examined.
Table 2.1.6 McLennan County: Preterm Deliveries as Percentage of Total Live Births by Zip Code (2003 – 2007) Source: Texas Department of State Health Services
Children’s Health, Safety and Education
Page 77
Table 2.1.7 McLennan County Low Birth Weight and Very Low Birth Weight Deliveries (2003‐2007) Source: Texas Department of State Health Services
Still, the analysis revealed 9 zip codes in McLennan County with
percentages of low birth weight and very low birth weight
deliveries that exceeded the county averages of 6.61% and 1.64%
respectively. In a limited number of zip codes, the ratios of
LBW/VLBW to live births were approximately double the county
average. McLennan County was similarly compared against other
Texas counties with similar population and demographic
characteristics. Low birth weight data (2005) from four counties,
Bell, Brazos, Lubbock and Smith,
was compared against McLennan
County. Three of the four had LBW
percentages comparable to
McLennan County. Bell, Brazos,
and Smith Counties reported
annual LBW percentages of 8.0%,
7.7%, and 8.3% respectively while
Lubbock County reported 10.5%
LBW deliveries for the same time
period.
Finally, birth weight averages were
calculated for the live births
reported in each zip code in
McLennan County. Table 2.1.8
details the results of the analysis
and ranks the average birth weight
for each zip code from lowest to
highest. As evidenced by the
results, there exists an
approximately 400 gram (14.1 oz)
difference in average birth weight
between the zip codes with the
highest (76712) and lowest
(76704) averages. The results of
this component of the analysis are
supported by the results of the
low birth weight and pre‐term
delivery analysis.
Zip Code LBW VLBW <2500 g Combined VLBW/LBW
Live births
% of live births
76704 71 25 96 707 13.6%
76557 33 2 35 268 13.1%
76701 9 4 13 122 10.7%
76657 45 12 57 579 9.8%
76664 18 1 19 203 9.4%
76707 147 37 184 1980 9.3%
76708 144 33 177 2079 8.5%
76640 14 2 16 189 8.5%
(McLennan County)
1115 276 1391 16858 8.3%
76705 160 36 196 2366 8.3%
76711 52 14 66 806 8.2%
76710 109 26 135 1676 8.1%
76706 133 40 173 2153 8.0%
76630 4 4 8 103 7.8%
76638 7 2 9 124 7.3%
76655 20 6 26 365 7.1%
76643 48 16 64 938 6.8%
76633 14 2 16 261 6.1%
76682 6 1 7 117 6.0%
76712 55 13 68 1171 5.8%
76624 6 0 6 134 4.5%
76691 15 0 15 342 4.4%
76524 4 0 4 149 2.7%
Children’s Health, Safety and Education
Page 78
Zip Code
Year Total
2003 2004 2005 2006 2007 2003‐2007
76704 3101.4 3250.8 3258.8 2970.3 3132.4 3142.7
76702 3170.5 3260.4 3355 2509 3430.3 3145.0
76557 3265.6 3159 3383.3 3245.4 3033.5 3217.4
76707 3287.9 3231.3 3293 3202.2 3224.3 3247.7
76708 3209.5 3294.9 3246.8 3249.1 3309 3261.9
76706 3343 3243.1 3253.2 3231.9 3264.4 3267.1
76657 3321.4 3364.6 3248.5 3147.9 3258.8 3268.2
76664 3359.1 3197.6 3362.1 3097.5 3334.7 3270.2
76630 3414.6 2989.1 3288.8 3505.2 3175.1 3274.6
76710 3284.3 3419.4 3296.3 3271.9 3243.7 3303.1
76705 3336.9 3308.2 3262.4 3318.6 3315.2 3308.3
76711 3446.4 3254.7 3367.3 3191.2 3312.9 3314.5
76701 3456 3526.4 3212.4 3162.4 3283.2 3328.1
76640 3311.6 3719.1 3136 3386.7 3198.4 3350.4
76643 3361.7 3424.8 3368.4 3297.2 3315.9 3353.6
76703 2998.1 3779.7 3100.5 3749.5 3189 3363.4
76655 3470.2 3447.3 3383 3265.8 3386.5 3390.6
76633 3424.2 3446.7 3393.4 3265.2 3429.7 3391.8
76682 3558.4 3140.6 3366.7 3388.6 3548.8 3400.6
76524 3509 3371 3355.5 3339.3 3447.4 3404.4
76624 3428.7 3364.3 3487.9 3339.4 3486.3 3421.3
76638 3557.3 3374.8 3400.4 3318.6 3499 3430.0
76691 3425.2 3469.8 3416.8 3551.7 3318.5 3436.4
76714 3763.3 3152.6 ND 3515 ND 3477.0
76712 3405.2 3405.1 3969 3282.4 3365.2 3485.4
76654 3515 3799 3501.3 3657.3 3090.3 3512.6
A troubling social concern facing families and communities across
the country is teen pregnancy; births to mothers under 20 years
of age. A Center for Disease Control and Prevention (CDC) report
entitled “Estimated Pregnancy Rates by Outcome in the United
States, 1990‐2004” reported that approximately 15% of all live
births in 1990 were to mothers under age 20.xiii A decade and a
half later, teen pregnancies accounted for only 12% of all live
births. The most recent numbers indicate that only 10.20% of all
pregnancies are to teen mothers, despite a short lived spike that
occurred in 2006.
Table 2.1.8 Average Recorded Birth Weights for Identified Zip Codes in McLennan County (2003 – 2007) Source: Texas Department of State Health Services
Children’s Health, Safety and Education
Page 79
In the state of Texas, the most recent rankings
from the Centers for Disease Control and
Prevention (2006) ranks Texas third highest
(63.1/1000 women ages 15‐19) among the 50
states (Figure 2.1.9) for the rate of births to
women ages 15‐19. Texas ranks behind
Mississippi and New Mexico. Locally, a
comparison of Dallas County, McLennan County
and the state of Texas (Figure 2.1.10) reveals that
between 2001 and 2006 the number of births to
teen mothers, as a percentage of all births for
each year, was higher in McLennan County than
the percentages for Dallas County and the state
of Texas. However, as the graph indicates, the
percentage of teen births has declined from a
high of 8.0% in 2001, yet remains higher than the
state of Texas and Dallas County.
Figure 2.1.9 National Ranking of State Teen Birth Rates per 1000 Live Births to Women Ages 15‐19 (2006). Source: National Center for Health Statistics, Centers for Disease
Control and Prevention.
18.7
20.8
21.3
23.5
24.9
25.7
25.8
26.5
27.8
27.9
30.9
31
32.9
33.4
33.4
33.6
33.8
34
35.2
35.7
39.2
39.5
39.6
39.9
40
40.2
40.5
41.9
41.9
42
43.5
43.8
44.3
44.9
45.2
45.7
47.3
48.4
49.7
53
53.5
53.9
54.2
54.6
54.7
55.8
59.6
62
62.3
63.1
64.1
68.4
0 50 100
New Hampshire
Vermont
Massachusetts
Connecticut
New Jersey
New York
Maine
North Dakota
Rhode Island
Minnesota
Wisconsin
Pennsylvania
Iowa
Nebraska
Washington
Maryland
Michigan
Utah
Virginia
Oregon
Idaho
Illinois
Montana
California
Ohio
South Dakota
Hawaii
United States
Delaware
Kansas
Indiana
Colorado
Alaska
West Virginia
Florida
Missouri
Wyoming
DC
North Carolina
South Carolina
Alabama
Louisiana
Georgia
Kentucky
Tennessee
Nevada
Oklahoma
Arizona
Arkansas
Texas
New Mexico
Mississippi
Figure 2.1.10 Comparison of Teen Births for McLennan and Dallas Counties and the State of Texas (2001‐2005). Percentages are Births to Mothers Ages 13‐17 / All Births Source: Texas Department of State Health Services
4.0
5.0
6.0
7.0
8.0
9.0
2001 2002 2003 2004 2005 2006
Texas Dallas McLennan
Percent
Children’s Health, Safety and Education
Page 80
Zip Code
Total Live Births
% U17 % U20
76704 707 5.80% 26.03%
76707 1980 4.70% 24.70%
76711 806 4.59% 24.07%
76524 149 2.68% 22.15%
76706 2153 3.95% 20.58%
76682 117 3.42% 19.66%
76640 189 4.23% 19.58%
76624 134 0.00% 19.40%
76708 2079 3.08% 18.90%
76630 103 1.94% 18.45%
76705 2366 3.80% 18.34%
76664 203 5.42% 17.24%
76701 122 1.64% 17.21%
MC 16920 3.02% 17.20%
76657 579 1.04% 16.06%
76557 268 1.49% 14.18%
76710 1676 1.79% 13.19%
76691 342 0.58% 13.16%
76633 261 1.15% 7.28%
76655 365 0.55% 7.12%
76638 124 0.81% 6.45%
76712 1171 0.94% 5.89%
76643 938 1.17% 5.54%
Table 2.1.11 Teen Births (U17 and U20) by Zip Code. Teen Births as a Percentage of all Live Births (2003‐2007). Source: Texas Department of State Health Services
In McLennan County between 2003 and 2007, 16,920 live births
were recorded (Section 2.2 of this report). During that same time
period, 2,910 births (17.2%) were to mothers under age 20,
with the youngest births to two mothers 13 years of agexiv.
Table 2.1.11 below details the results of an analysis of data
received from the Texas Department of State Health
Services. The table lists, by zip code, the total number of
births and the percentage of all births to mothers under the
age of 17 (U17) and 20 (U20). The analysis also calculated
the mean value for McLennan County (17.20%). The analysis
revealed that thirteen McLennan County zip codes (Table
2.1.11) had teen birth percentages above the average
(17.20%) for the entire county.
The results of the childbirth data analysis demonstrate the
need to address prenatal and childbirth health care services
in specific zip codes within McLennan County. Further, the
children that are born preterm and/or low birth weight are at
risk for a broad range of health, safety and development
concerns beginning immediately after birth.
Children’s Health, Safety and Education
Page 81
Key Points to Consider Prenatal care, the age of the mother at the child’s birth, maternal health, and
social factors have the potential to impact the child for many years.
Texas ranks fifth among the 50 states in the number of teenage pregnancies.
The number of births to teen mothers was higher in McLennan County than the percentages for Dallas County and the state of Texas.
The average length of pregnancy for each zip code was above the threshold
for positive classification as a preterm delivery.
The Department of State Health Services is responsible for maintaining birth records for the state of Texas.
The birth rate for the state of Texas (2003‐2005) ranged from 16.51 to 16.87
births per 1,000 residents.
The birth rate for McLennan County during the same time period ranged from 15.04 to 15.24 live births per 1,000 residents.
Six zip codes recorded 67.5% of all live births in McLennan County between
the years 2003 and 2007.
The average percentage of preterm deliveries for McLennan County was 12.22% during the 2003‐2007 time period.
On average, 8.3% of all live births between 2003 and 2007 in McLennan
County were either Low Birth Weight or Very Low Birth Weight.
Children’s Health, Safety and Education
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i Lu MC, R Bragonier, ER Silver, R Bemis-Heys. (2000). Where it All Begins: The Impact of Preconceptional
and Prenatal Care on Early Childhood Development, in N Halfon, E Shulman, M Hochstein and M Shannon, eds., Building Community Systems for Young Children, UCLA Center for Healthier Children, Families and Communities.
ii Chambliss, LR. (2008). Intimate partner violence and its implication for pregnancy. Clin Obstet Gynecol. 51(2):385-97.
iii National Institute for Health and Clinical Excellence. (2008). Pregnancy and complex social factors: scope. Available at http://www.nice.org.uk/guidance/index.jsp?action=download&o=42412
iv Webster’s New World Medical Dictionary. http://www.medterms.com/script/main/art.asp?articlekey=2469. v National Institutes of Health, National Institute for Child Health & Human Development. “Care Before and
During Pregnancy - - Prenatal Care” Available at http://www.ncihd.nih.gov/womenshealth/research/pregbirth/prenatal_care.cfm
vi National Institutes of Health. Prenatal Care. Available at Medline Plus. http://www.nlm.nih.gov/medlineplus/prenatalcare.html
vii Texas Department of State Health Services. (2008). Kessner Index definition from the glossary of terms and definitions. Available at http://www.dshs.state.tx.us/chs/vstats/latest/glossary.shtm
viii Kessner, D. (1973). Institute of Medicine, Contrasts in Health Status – Vol. 1, “Infant Death: An analysis of Maternal Risk and Health Care”. National Academy of Sciences, Washington, DC. pp 58-60.
ix McCormick, MC. (2004). Preterm Delivery and Its Impact on Psychosocial and Emotional Development in Children. Available at http://www.enfant-encyclopedia.com/pages/PDF/McCormickxp.pdf
x Grunau, RE, MF Whitfield, and TB Fay. (2004). Psychosocial and Academic Characteristics of Extremely Low Birth Weight (<800g) Adolescents Who Are Free of Major Impairment Compared With Term-Born Control Subjects. Pediatrics. 114(6):725.
xi Whitaker, AG., JF Feldman, JM Lorenz, S Shen, F McNicholas, M Nieto, D McCullough, JA Pinto-Martin, and N Paneth. (2006). Motor and Cognitive Outcomes in Nondisabled Low-Birth-Weight Adolescents. Arch Pediatr Adolesc Med. 160:1040.
xii Stevenson, DK, LL Wright, JA Lemons, W Oh, SB Korones, LA Papile, CR Bauer, BJ Stoll, JE Tyson, S Shakaran, AA Afnarov, EF Donovan, RS Ehrenkrantz, and J Verter. (1998). Very low birth weight outcomes of the National Institute of Child Health & Human Development Neonatal Research Network, January 1993 through December 1994. Am J Obstetrics Gynec. 179:1632.
xiii Ventura SJ, Abma JC, Mosher WD, Henshaw SK. (2008). Estimated pregnancy rates by outcome for the United States, 1990–2004. National vital statistics reports; 56(15). Hyattsville, MD: National Center for Health Statistics.
xiv Data received from Texas Department of State Health Services. (2009).
Children’s Health, Safety and Education
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Figure 2.2.1 Infant Death Rates and Fetal Death Rates from DSHS 2005 Mortality Report at http://www.dshs.state.tx.us/CHS/VSTAT/latest/nmortal.shtm
Fetal Deaths The Centers for Disease Control and Prevention (CDC)
definition of "fetal death", which is based upon the definition
advanced by the World Health Organization (WHO) in 1950,
reads as follows:
Fetal death is “Death before the complete expulsion or
extraction from its mother of a product of conception,
irrespective of the duration of pregnancy; the death is
indicated by the fact that after such separation, the
fetus does not breathe or show any other evidence of
life, such as beating of the heart, pulsation of the
umbilical cord, or definite movement of voluntary
muscles.”i
Or, more simply stated as:
“The death of a fetus, after the 8th week until birth.”
In the United States, the Centers for Disease Control and
Prevention collect statistical information on "live births, fetal
deaths, and induced termination of pregnancy" from 57
Section 2 . 2
Feta
l Dea
ths
Children’s Health, Safety and Education
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reporting areas in the United States. While the technical
definition of the World Health Organization indicates that fetal
death occurs after the 8th week of gestation, guidelines
recommend the reporting of those fetal deaths whose birth
weight is over 350g or those more than 20 weeks gestationii.
Fetal death records in Texas are maintained by the Department of
State Health Services (DSHS) in Austin. Reporting guidelines are
established by DSHS and are described in Vital Statistics Annual
Report Technical Appendixiii . Briefly, a fetal death certificate
must be filed for any fetus weighing 350 grams or more, or if the
weight is unknown, a fetus aged twenty weeks or more. Further,
the certificate must be filed with the local registrar within five
days of the date of fetal death by the institution or person who is
responsible for the final care of the fetal remains.iv
The causes of fetal death, it is generally held, are largely unknown
in 25‐60% of all deaths.v However, fetal deaths can be attributed
to a variety of maternal or fetal conditions as well as function and
physiology related to the placenta. Included in the conditions are
the following:
Maternal Prolonged pregnancy (>42 wk) Diabetes (poorly controlled) Systemic lupus erythematosus Antiphospholipid syndrome Infection Hypertension Preeclampsia Eclampsia Hemoglobinopathy Advanced maternal age Rh disease Uterine rupture Maternal trauma or death Inherited thrombophilias
Fetal Multiple gestations Intrauterine growth restriction
Children’s Health, Safety and Education
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Zip Code Live Births
Fetal Dth/1000 live births
Fetal Deaths
76682 117 17.09 2
76701 122 16.39 2
76705 2366 11.83 28
76704 707 11.32 8
76708 2079 11.06 23
76706 2153 10.68 23
76657 579 10.36 6
76711 806 9.93 8
76630 103 9.71 1
76691 342 8.77 3
McLennan County
15737 8.39 132
76624 134 7.46 1
Texas NA 6.00** NA
76712 1171 5.12 6
76664 203 4.93 1
76643 938 4.26 4
76710 1676 4.18 7
76633 261 3.83 1
76707 1980 3.54 7
76689 ND ND 1
Table 2.2.2 Fetal Deaths in McLennan County (2003‐2007) ** Approximation Based upon DSHS Summary of Vital Statistics for 2005 Source: Texas Department State Health Services
Congenital abnormality Genetic abnormality Infection (i.e., parvovirus B19, CMV, Listeria) Hydrops
Placental Cord accident Abruption Premature rupture of membranes Vasa previa Fetomaternal hemorrhage Placental insufficiency
The incidence of fetal deaths in the United
States has seen a decline in recent years to a
current level of 6.22 per 1,000 live births
(2005).vi However, a distinct disparity exists
between the fetal mortality rate for non‐
Hispanic black women (11.25) and non‐Hispanic
white (4.98), American Indian/Alaska Native
(5.84), Asian/Pacific Islander (4.77), and Hispanic
women (5.43).vii In Texas, the fetal mortality
rate has seen a similar decline as the US rate
(Figure 2.3.1) until arriving at the current rate of
6.0 deaths/1,000 live births.viii
Fetal death rates (FDR) for McLennan County, as
an aggregate of the years 2003‐2007, were
calculated during this analysis. Between 2003
and 2007, 15,737 live births were recorded from
the 18 zip codes listed with reported FDRs.
These 18 zip codes reported 132 fetal deaths
during that time frame. Using the aggregate
totals of fetal deaths and live births, a mean rate
of fetal deaths for the 18 zip codes was
calculated. From the analysis, a mean fetal
death rate for the 5 years was established at
8.39 deaths/1,000 live births, 39.8% higher that
the FDR for Texas in 2005 (approximately 6.00
deaths per 1,000 live births). Further, using the
total number of live births for McLennan County
Children’s Health, Safety and Education
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(16,920 births) for the 03‐07 time period, the FDR drops to 7.80
fetal deaths per 1,000 live births.
The analysis that has been conducted on this data examined the
fetal death rate for the individual zip codes in McLennan County
and ranked the rates from highest to lowest. 10 zip codes were
identified with FDRs that exceeded the mean value for McLennan
County (4.5% (76691) to 103.7% (76682) above the calculated
mean for the county). In addition, 7 zip codes fell below the mean
for the county (11.1% (76624) to 56.7% (76707) below the mean).
The FDR for one zip code (76689) was not calculated because of a
lack of data about the number of live births recorded during the
five year time span.
Public health officials have made great strides to reduce the fetal
death rate. In areas where the rate exceeds the national
averages, efforts are being made to address the factors associated
with the elevated rates. In many cases, health care disparities,
economics and social and environmental factors contribute to the
elevated rates. For many women living in these conditions, the
risk to sibling children, both short term and long term, is
significant. In these conditions, there is great potential to
negatively impact the growth and development of the child.
Page 87
Key Points to Consider A wide range of factors can contribute to the death of a fetus.
The Fetal Death Rate (FDR) for the state of Texas is 6.0 deaths per 1,000 live
births (2005).
The Fetal Death Rate for McLennan County for the years 2003‐2007 is 7.80 deaths per 1,000 live births.
10 zip codes in McLennan County had Fetal Death Rates that exceeded the
county average.
Page 88
i National Center for Health Statistics. 2004. Data Definition. Fetal Death. Centers for Disease Control and
Prevention. At: http://www.cdc.gov/nchs/datawh/nchsdefs/fetaldeath.htm ii Centers for Disease Control and Prevention (PDF). State Definitions and Reporting Requirements (1997
Revision ed.). National Center for Health Statistics. http://www.cdc.gov/nchs/data/misc/itop97.pdf. iii Texas Department of State Health Services. (2008). Vital Statistics Annual Report: Technical Appendix.
Available at http://www.dshs.state.tx.us/chs/vstat/latest/tech_app.shtm iv Ibid v Lindsey, JL. (2008) Evaluation of Fetal Death. eMedicine at WebMD. Available at
http://emedicine.medscape.com/article/259165‐overview vi MacDorman MF, Kirmeyer S. Fetal and perinatal mortality, United States, 2005. National vital statistics
reports; vol. 57 no 8. Hyattsville, MD: National Center for Health Statistics. 2009. vii MacDorman MF, ML. Munson, S. Kirmeyer. (2007). Fetal and perinatal mortality, United States, 2004. Natl
Vital Stat Rep 2007; 56(3). Available at http://www.cdc.gov/nchs/products/pubs/pubd/nvsr/nvsr.htm#vol56. viii Texas Department of State Health Services. (2008). Summary of Vital Statistics for 2005. Available at
http://www.dshs.state.tx.us/CHS/VSTAT/latest/nsumm.shtm
Children’s Health, Safety and Education
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Health Care Accessibility During the early years of a child’s life, the need for adequate medical care is substantial. Yet, for many children, their needs go unmet and often times, overlooked. For decades, concerns about access to health care for children and families have been at the forefront for parents, health care professionals, government agencies and political leaders. A 1997 press release from the Agency for Healthcare Research and Quality (AHRQ) succinctly described the problem in the opening paragraph.
“Nearly 13 million of the roughly 110
million families in the United States – 11.6
percent of all families – experienced difficulties
or delays in obtaining medical care or did not
get the care that they needed during 1996,
according to estimates from the federal Agency
for Health Care Policy and Research (AHCPR).”i
A little over a decade later, concerns regarding healthcare
continues.
“Nearly 46 million Americans, or 18
percent of the population under the age of 65,
were without health insurance in 2007”.ii
Multiple factors have been cited as contributing to the
healthcare access problems facing American children and
families. Lack of healthcare insurance, transportation, low
family income, lack of available specialty services are all
recognizable barriers to access of healthcare services.iii
Parents also cite a lack of available dental care, mental health
services and specialized services as significant barriers to
obtaining adequate health care for themselves and their
children.
A 2008 report in the journal Pediatrics stated that problems
associated with access to healthcare are more prevalent in low
Section 2 . 3
Heal
th C
are
Acce
ssib
ility
Children’s Health, Safety and Education
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income, minority populations.iv,v The 2008 Pediatrics report
further indicated that low income, African American and Hispanic
children are more likely to receive inadequate or no healthcare
services including dental care than Anglo children.
With today’s health care costs, many families are forced to choose
between placing food on the table and seeking routine healthcare
services. Families are unable to pay for health care insurance or
do not work for employers that routinely provide basic health
insurance coverage for the employee and their family. Employers
are electing to drop health care coverage for their employees
because costs have become prohibitive. In the United States,
while a contentious debate rages on about health care reform,
millions of Americans are without health care insurance coverage.
How many is unclear and subject to interpretation. However, the
estimates indicate that as many as 46 million Americans under the
age of 65 are without insurance coverage,vi a number that could
top 52 million by the year 2010.vii Findings from a recent Gallup
poll indicate that 26.9% of Texans are without health care
insurance placing the state at the top of the list of most uninsured
residents.viii Couple these facts with the escalating costs for
medical and dental care, and many families are incapable of
obtaining the needed care, even at a time when the child is
undergoing the most rapid physiologic and developmental
changes they will see during their lifetime.
The Center for Public Policy Priorities, State of Texas Children:
2008 reports that 17,496 McLennan County children ages 0‐18
were enrolled in Texas Medicaid during 2006ix. An additional
2,363 were enrolled in CHIP (Children’s Health Insurance
Program) during that same year.x Statistics for the previous year
(2005) indicate that 10,097 children, approximately 17.3% of the
child population for McLennan County, were completely without
insurance coverage. Three years later, the number of children
without healthcare insurance had risen to 12,698 (2008) an
increase of 25.8% from the previous reported statistics.xi Further,
this data represents the limits of information available about a
Children’s Health, Safety and Education
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Hospitals & Clinics Zip Code Hillcrest Clinic ‐ China Spring 76633McGregor Community Clinic 76657Meyer Center Community Clinic 76701Elm Avenue Community Clinic 76704Bellmead Community Clinic 76705Connally Community Clinic 76705Hillcrest Clinic ‐ Bellmead 76705Bell's Hill Elementary and Community Clinic 76706Tom Oliver South 18th St. Community and Dental Clinic 76706Family Health Center/Family Counseling and Children Services
76707
Waco‐McLennan County Public Health District 76707HealthSouth Waco Surgical Center 76708Hillcrest Health System 76708Hillcrest Clinic ‐ MacArthur/Pediatric Pavilion 76708Women's Health Center 76708Hillcrest Highway 6 & Bosque Clinic 76710US Veterans Medical Center 76711Hillcrest Baptist Medical Center/Women and Children's Hospital
76712
Hillcrest Clinic ‐ Hewitt/Woodway 76712Hillcrest Clinic ‐ Midway 76712Providence Healthcare Network 76712Waco Lung Associates 76712Depaul Center 76712
Women, Infants, and Children (WIC) Program McGregor WIC Clinic 76657Mart Clinic 76664Washington Street WIC Clinic 76701TSTC WIC Clinic 76705Waco Drive Clinic 76707
Mental Health Clinics Avalon Center, Inc. 76524MHMR Center Heart of Texas 76701Heart of Texas Region MHMR Center 76703Waco Center for Youth 76708Twin Oaks Retirement Center 76708Lake Shore Center for Psychological Services 76710Baylor University Health Services 76798
Table 2.3.1 Health Related Facilities in McLennan County Source: Google Maps
vital piece of information related to the accessibility of health care
for children of McLennan
County.
For many families,
accessibility is
dependent upon the
proximity of healthcare
facilities to the location
of the residence.
Families living in
poverty often face
challenges regarding
transportationxii,xiii.
McLennan County is
characterized as a
population with a large
percentage of the
residents living at or
below the federally
established poverty
level. Many of these
residents are
dependent upon public
transportation to
access health care
services. It has become
vital that health care
facilities be readily
accessible to the
neighborhoods that
they serve. McLennan
County has built a
system of care for its
residents with facilities
available throughout the County. Table
2.3.1 lists the healthcare facilities and the
zip code of each facility. Figure 2.3.2, GIS
Children’s Health, Safety and Education
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mapping of the facility locations, provides a graphic depiction of
the facilities listed in 2.3.1. The table further identifies the zip
code associated with specialty services (WIC and mental health
services) available throughout the county.
Figure 2.3.2 Graphic Representation of Health Care Related Facility Locations in McLennan County Source: Google maps
Children’s Health, Safety and Education
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In addition to the need for health care services, pharmaceutical
services are vital to the health and well being of McLennan
County families. The availability of local facilities for prescription
and non‐prescription goods becomes important to a family with
no personal means of transportation who may rely on a family
member or neighbor for assistance when public transportation is
not available. Further, even during the hours that public
transportation is available, time is required to access public
transportation and make one or more transfers to get to a facility
that is many miles away.
Pharmacies Zip Code
West Drug 76691
Heb Grocery #557 76705
HEB Pharmacy 76705
Sam's Club Members Only: Pharmacy 76705
Wal‐Mart: Pharmacy 76705
HEB 76705
Wal‐Mart: Pharmacy 76705
HEB Foods 76706
HEB Foods 76706
HEB: Pharmacy 76708
HEB Foods 76708
CVS/pharmacy 76710
HEB Pharmacy 76710
Target Stores: Pharmacy 76710
Target 76710
Walgreens 76710
Wal‐Mart: Pharmacy 76710
CVS Pharmacy 76710
CVS/pharmacy 76711
HEB: Pharmacy 76711
Walgreens 76711
CVS/pharmacy 76712
HEB: Pharmacy 76712
Walgreens 76712
Wal‐Mart: Pharmacy 76712
Zip Code
76691 1
76705 6
76706 2
76708 2
76710 7
76711 3
76712 4
Table 2.3.3 McLennan County Pharmacy Locations by Zip Code Source: Google maps
Table 2.3.4 McLennan County Pharmacy Locations by Zip Code Summarized Source: Google maps
Children’s Health, Safety and Education
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Figure 2.3.5 GIS Representation of McLennan County Pharmacy Locations (green circles) Source: Google maps
Children’s Health, Safety and Education
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Pharmacy locations for McLennan County, by zip code, are listed
in Table 2.3.3. A graphic representation identifies the location of
the facilities and is detailed in Figure 2.3.5. An examination of the
maps and tables indicates that access to pharmacy services is
limited in some areas of the city of Waco and in McLennan
County. For example, 76704 with the lowest median income, has
no commercial pharmacies. There are facilities that are located at
the border between 76705 and 76704 that are reported to be
within 4 blocks of stops along the dedicated bus routes for the
city.
The concerns about health care accessibility are not unique to
McLennan County. However, they are indicative of a situation that
places the health and safety of the youngest members of society
at risk.
Children’s Health, Safety and Education
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Key Points to Consider Nearly 46 million Americans, 18% of the population under the age of 65,
were without health insurance in 2007.
Problems associated with access to healthcare are more prevalent in low income, minority populations.
For many families, accessibility is dependent upon proximity of the
healthcare to the location of the residence.
Access to pharmacy services is limited in some areas of the city of Waco and McLennan County.
Children’s Health, Safety and Education
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Children’s Health, Safety and Education
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i Millions Face Barriers to Obtaining Medical Care. Press Release, November 26, 1997. Agency for Healthcare
Research and Quality, Rockville, MD. http://www.ahrq.gov/news/press/barriers.htm ii DeNavas‐Walt, C.B. Proctor, and J. Smith. (2008) Income, Poverty, and Health Insurance Coverage in the
United States: 2007. U.S. Census Bureau. iii Agency for Healthcare Research and Quality. (20088 2007 National Healthcare Disparities Report. Rockville,
MD: U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality; February 2008. AHRQ Pub. No. 08‐0041.
iv Flores, G. and SC Tomany‐Korman. 2008. Racial and Ethnic Disparities in Medical and Dental Health, Access to Care, and Use of Services in US Children. Pediatrics. 121:e286‐e298.
v Flores, G., M. Abreu, MA Olivar and B Kastner. 2009. Access Barriers to Health Care for Latino Children. Arch. Pediatric Adolescent Med. 152:1119‐1125.
vi DeNavas‐Walt, C.B. Proctor, and J. Smith. 2008. Income, Poverty, and Health Insurance Coverage in the United States: 2007. U.S. Census Bureau.
vii Gilmer, TP and RC Kronick. 2009. Hard Times and Health Insurance: How Many Americans Will Be Uninsured By 2010? Health Affairs. 28(4):w573‐7.
viii Mendes, E. 2009. Uninsured: Highest Percentage in Texas, Lowest in Mass. Percentage of adults without health insurance is up in several states. Gallup Poll. http://www.gallup.com/poll/122387/uninsured‐highest‐percentage‐texas‐lowest‐mass.aspx?version=print .
ix The Texas Kids Count Project, Center for Public Policy Priorities. 2009. State of Texas Children 2008‐2009.McLennan County. Available at http://www.cppp.org/factbook08/county_profile.php?fipse=48309&nt=1.
x Ibid. xi Ibid. xiixii Criden, M. 2008. The Stranded Poor: Recognizing the Importance of Public transportation for Low‐Income
Households. Report for National Association for State Community Services Programs. Available at http://csbg.commerce.wa.gov/Portals/_CTED/Documents/Issue%20Brief‐%20Benefits%20of%20Rural%20Public%20Transportation.pdf
xiii Shoup, L. 2009. Improving access to healthcare by improving transportation options in Transportation for America. Available at http://t4america.org/blog/2009/07/17/improving‐access‐to‐healthcare‐by‐improving‐transportation‐options/
Children’s Health, Safety and Education
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Maslow’s Hierarchy of Needs
Safety and Security
In his 1943 A Theory of Human Motivationi, Dr. Abraham Maslow (1908‐
1970) described a hierarchy of basic human needs that ranged from the
primitive physiological needs such as food, water, sleep, etc. (Figure 1) to
the more esoteric needs for self‐actualization and achievement of
potential.
One of the more basic ‘instinctoid’ needs described by Maslow was the
need for safety and security. The ability to attain a sense of security can
ultimately serve as the foundation for one to be able to achieve the higher
needs that include belonging, self esteem and self actualization.
Young children are especially vulnerable to their environment and events
that occur around them. The smile of a parent, a calm voice, gentle touch
all contribute to a sense of safety and security that is needed by each
human being. A supportive, positive environment can influence the
healthy development of a young child during the first years of their life.
Children’s Health, Safety and Education
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The interaction between a parent, sibling or other persons can have a
significant impact upon the development of the immune, neuroendocrine,
musculoskeletal and neurological systems of the body in ways that follow
the child throughout their life.
Similarly, acute (single) or chronic (repeated) exposure to traumatic
events can significantly impair the growth, development and general
wellbeing of a young child. A study that began in the mid 1990’s has
examined the impact of early childhood experiences upon later life events
and diseaseii. In this ongoing study, the
authors have found a striking correlation
between early childhood exposure to harmful
events, adult high risk behaviors and serious
disease.
The Adverse Childhood Events study of Felitti
et. al. has shown that persons exposed to eventsiii that include domestic
violence, child abuse, substance abuse, parental mental illness or children
from families with an incarcerated parent (partial listing) also reported
having engaged in high risk behaviors that included substance abuse and
sedentary life styles. Further, the same persons reported higher
incidences of diseases that included diabetes, Chronic Obstructive
Pulmonary Disease (COPD) and canceriv.
For the children of McLennan County, the sense of security and safety felt
by each child are greatly influenced by events that occur at home, school
and in the community. A stable home environment free of injuries and
abuse and neglect can go a long way to creating a sense of security in the
child that can eventually lead to that child’s ability to establish
relationships, be successful at school, and live a healthy life free of
crippling diseases. The benefits of these events can be felt by the children
of McLennan County in the same way that has been described by
professionals around the world. In the coming sections, this report will
examine the conditions of McLennan County as they relate to family
stability and the general safety of the youngest members of this
community.
“When the basic physiological needs are largely taken care of, this second layer of needs comes into play. You will become increasingly interested in finding safe circumstances, stability, protection.”v
Children’s Health, Safety and Education
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i Maslow, A. (1943). A Theory of Human Motivation. Psychological Review, Vol. 50, NO. 4, pp. 370-396. ii Adverse Childhood Experiences Study. http://www.cdc.gov/nccdphp/ACE iii Adverse Childhood Experiences Definitions. http://www.cdc.gov/nccdphp/ACE/prevalence.htm#ACED iv Ibid v. Maslow, A. (1943). A Theory of Human Motivation. Psychological Review, Vol. 50, NO. 4, pp. 370-396.
Children’s Health, Safety and Education
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Children’s Health, Safety and Education
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Infant Mortality “Infant mortality is one of the most important indicators of the
health of a nation, as it is associated with a variety of factors
such as maternal health, quality and access to medical care,
socioeconomic conditions, and public health practices.”i In
Texas, the Department of State Health Services (DSHS)
recognizes that the infant mortality rate is a reflection of a
community’s health.ii
Worldwide, the infant mortality rate is defined by the World
Health Organization and United Nations Children’s Fund as:
“The number of children who die before one
year of age in a given year divided by the
number of live births in the same year. It is
expressed as deaths per 1000 live births.” iii,iv
Nationally, the Centers for Disease Control and Prevention
defines infant mortality rate as:
“Deaths of infants aged under 1 year per 1,000 or 100,000 live births. The infant mortality rate is the sum of the neonatal and post neonatal mortality rates.”v
These same criteria are used for establishing the infant
mortality rate for the state of Texas.
In the United States, the Centers for Disease Control and
Prevention, and National Center for Health Statistics (NCHS)
collects statistical information on infant mortality from
selected locations across the country using established
guidelines for identifying and documenting deaths in neonates
and post neonates up to one year of age.vi
Section 2 . 4
Infa
nt M
orta
lity
Children’s Health, Safety and Education
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Figure 2.4.1 "Fiscal Years 1997 ‐ 2000 Strategic Plan," Texas Department of Health
Infant mortality records in Texas are maintained by the
Department of State Health Services (DSHS) in Austin. Reporting
guidelines established by DSHS follow the criteria established by
the World Health Organization and the Centers for Disease
Control and Prevention, National Center for Health Statistics.
Nationally, the incidence of fetal deaths has seen a decline in
recent years to a current level of 6.86 per 1,000 live births
(2006).vii In Texas, the infant mortality rate has seen a decline
similar to the US rate
(Figure 2.4.1) over the
past five decades.
However, the infant
mortality rate in Texas
currently stands at 6.5
infant deaths per 1,000
live births, up from the
2004 rate of 6.3 infant
deaths/1,000 live
births.viii
Records indicate that a
distinct disparity exists
between the infant
mortality rate of
different races /
ethnicities. Nationally, records indicate that the infant mortality
rates for African American women (13.63) differ from non‐
Hispanic Anglos (5.76), American Indian/Alaska Native (8.06),
Asian/Pacific Islander (4.89), and Hispanic women (5.53).ix
Further, infant mortality records indicate that a similar pattern
exists in the state of Texas. The rate among African American
women (12.4) is nearly double the rates of non‐Hispanic whites
(5.9) and Hispanic women (5.6).x
Infant death rates (IDR) for McLennan County, as an aggregate of
the years 2003‐2006, were calculated during this analysis.
Between 2003 and 2006, 113 infant deaths were reported from
Children’s Health, Safety and Education
Page 105
Zip Code
Total Live Births 03‐06
IDR
76624 0 111 0.00
76630 0 82 0.00
76638 0 99 0.00
76640 0 147 0.00
76682 0 100 0.00
76712 3 902 3.33
76691 1 286 3.50
76643 3 736 4.08
76557 1 224 4.46
76657 2 429 4.66
76633 1 211 4.74
76655 2 284 7.04
76711 5 637 7.85
76524 1 122 8.20
76706 14 1699 8.24
76705 16 1914 8.36
MC 113 13,417 8.42
76708 14 1627 8.60
76710 13 1321 9.84
76701 1 96 10.42
76664 2 171 11.70
76707 20 1583 12.63
76704 13 560 23.21
Table 2.4.2 McLennan County Aggregate Infant Mortality Rates by Zip Code (2003‐2006) ** Approximation based upon DSHS summary of vital statistics for 2005. Source: Department of State Health Services
18 zip codes in McLennan County. These same zip codes reported
12,824 of the 13417 live births for McLennan
Countyxi. The 18 zip codes are detailed in Table 2.4.2
(left). Five additional zip codes reported no infant
deaths during this time period. Using the aggregate
totals of fetal deaths and live births, a mean rate of
fetal deaths for the McLennan County was
calculated; 8.42 deaths/1,000 live births, 29.5%
higher than the IDR for Texas in 2005 (approximately
6.5 deaths per 1,000 live births)xii.
The analysis that was conducted on this data
examined the infant death rate for the individual zip
codes in McLennan County and ranked the rates
from highest to lowest. Six zip codes were identified
with IDRs that exceeded the mean value for
McLennan County. However, 16 zip codes fell below
the mean for the county with 5 reporting no infant
deaths during the 4 year period.
The causes of infant mortality can vary widely.
However, more common causes of death have been
identified. Figure 2.4.3xiii,xiv on page 3 of this section,
details the top five causes of infant death across the
United States during 2005, the latest year for which
information is available. In the United States,
congenital defects were the number one cause of
infant mortality, followed by preterm/low birth
weight deliveries and SIDS (2 and 3 respectively).
Children’s Health, Safety and Education
Page 106
Figure 2.4.3 5 Leading Causes of Infant Mortality in the United States (2005) Source: About.com – Palliative Care. 2006
0 2000 4000 6000
Maternal Complications of Pregnancy
Complications of the umbilical cord, placenta and membranes
Sudden Infant Death Syndrome
Preterm and low birth weight
Congenital defects
Further analysis of the records
received from Texas Department of
State Health Services (DSHS)
identified and ranked the causes of
death for the 113 infant deaths
reported during the years 2003‐
2006 in McLennan County. The
results of the analysis, detailed in
Table 2.4.4, revealed that the top
five causes of death in infants is 1)
SIDS, 2) Extreme immaturity, 3)
Other (preterm infants), 4) Primary
atelectasis of newborn, and 5)
Hypoplasia and dysplasia of lung.
The top five causes were
responsible for 55 of 113 (48.7%)
total infant deaths during the four
year period.
The data analysis that was
conducted has limitations because
of the small sample size. Most of
the zip codes reported single digit
numbers of infant deaths for the
Causes of Death Total SIDS 14Extreme immaturity 12Other preterm infants 8Primary atelectasis of newborn 6 Hypoplasia and dysplasia of lung 5 Other ill‐defined and unspecified causes of mortality 5 Neonatal cardiac failure 4Newborn affected by incompetent cervix 4Assault (homicide) by unspecified means 3Congenital diaphragmatic hernia 3 Myocarditis, unspecified 3 Newborn affected by premature rupture of membranes 3 Accidental suffocation and strangulation in bed 2Anencephaly 2Congenital malformation of the heart, unspecified 2Multiple congenital malformations, not elsewhere classified
2
Newborn affected by chorioamnionitis 2Newborn affected by other forms of placental separation and hemorrhage
2
Other cardiovascular disorders originating in the perinatal period
2
Respiratory distress syndrome of newborn 2Whooping cough, unspecified 2 All other causes of death 25
113
Table 2.4.4 Primary Causes of Infant Death, McLennan County (2003‐2006) Source: Texas Department of State Health Services
Children’s Health, Safety and Education
Page 107
time frame and goes counter to larger studies that exclude
samples with less than 20 records for analysis. This limitation is
noted for this analysis and should be considered when
interpreting the analysis results. Still, the information that has
been derived from this analysis can be used for identification of
areas of concern in McLennan County and the city of Waco.
Children’s Health, Safety and Education
Page 108
Key Points to Consider National Infant Death Rate (IDR) stands at 6.86 deaths / 1,000 live births
(2006).
Texas IDR stands at 6.5 deaths/1,000 live births (2006).
The McLennan County IDR (2003‐2006) stands at 8.42 deaths/1,000 live births.
Six zip codes in McLennan County have IDRs higher than the McLennan
County average.
SIDS and extreme immaturity are the two leading causes of infant mortality for McLennan County.
Children’s Health, Safety and Education
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Children’s Health, Safety and Education
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i MacDorman, MF, and T.J. Mathews. (2008). Centers for Disease Control and Prevention, National Center for
Health Statistics. NCHS Data Brief. Recent Trends in Infant Mortality in the United States. ii "Fiscal Years 1997 - 2000 Strategic Plan," Texas Department of Health. iii World Health Statistics 2006. (2006). Geneva, World Health Organization. iv State of the World’s Children 2006. (2006). New York, United Nation’s Children’s Fund. v Centers for Disease Control and Prevention, NCHS. (2008). Supplemental Analyses of Recent Trends in Infant
Mortality. Available at http://www.cdc.gov/nchs/products/pubs/pubd/hestats/infantmort.htm . vi Ibid. vii MacDorman MF, Kirmeyer S. Fetal and perinatal mortality, United States, 2005. National vital statistics
reports; vol. 57 no 8. Hyattsville, MD: National Center for Health Statistics. 2009. viii Texas Department of State Health Services. (2008). Summary of Vital Statistics for 2005. Available at
http://www.dshs.state.tx.us/CHS/VSTAT/latest/nsumm.shtm . ix MacDorman, MF, and T.J. Mathews. (2008). Centers for Disease Control and Prevention, National Center for
Health Statistics. NCHS Data Brief. Recent Trends in Infant Mortality in the United States. x Matthews, TJ, M.S., et. al. Infant Mortality Statistics from the 2005 Period Linked Birth/Infant Death Data Set.
Division of Vital Statistics. National Vital Statistics Report, Vol 57, No. 2, July 30, 2008. Available at http://www.cdc.gov/nchs/products/pubs/pubd/nvsr/nvsr.htm#vol57.
xi Data request from Texas Department of State Health Services. xii Data received from Texas Department of State Health Services (2009). xiii Morrow, A. Leading causes of infant death. Infant mortality in the United States. About.com. Available at
http://dying.about.com/od/pediatriccare/tp/leading_causes_infant_death.htm. xiv Kung HC, DL. Hoyert, JQ. Xu and SL. Murphy. E-stat deaths: preliminary data for 2005 health E-stats.
Hyattsville, MD: US Department of Health and Human Services, CDC; 2007. Available at http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimdeaths05/prelimdeaths05.htm.
Children’s Health, Safety and Education
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Early Childhood Injuries The Centers for Disease Control and Prevention (CDC) reports that “injury and violence are serious threats to the health and well‐being of children and adolescents in the United States. Children and adolescents are at high risk for many injuries that can lead to death or disability.” i The National Health Interview Survey defines an injury episode as a “traumatic event in which a person was injured one or more times from an external cause (e.g., a fall or a motor vehicle traffic accident).”
ii The World Health
Organization defines
injury as “the physical
damage that results
when a human body is
suddenly subjected to
energy in amounts that
exceed the threshold of
physiological tolerance
– or else the result of a
lack of one or more vital elements, such as oxygen.”iii
Children's surroundings contain many inherent hazards that
contribute to the unintentional injuries responsible for 27.7
million hospitalizations each year.iv Further, it is estimated
that the majority of unintentional injuries could be avoidedv
with appropriate precautions. People of all ages can sustain
life‐threatening unintentional injuries; however, some injuries
pose greater risks for certain age groups. The six leading
causes of injury death among children under age 19 are
transportation related (motor vehicle injuries), fires and burns,
drowning, poisoning, suffocation and falls.vi Parents and
caregivers need to know the greatest risk factors for their
children and to take the appropriate steps to reduce the risk of
unintentional injury and hospitalization.
The CDC reports that “injury and
violence are serious threats to the
health and well‐being of children
and adolescents in the United
States. Children and adolescents are
at high risk for many injuries that
can lead to death or disability.”
Section 2 . 5
Early
Chi
ldho
od In
jurie
s
Children’s Health, Safety and Education
Page 112
Population Characteristics Unintentional
F M
Zip Code Total Pop
Total Pop (0‐4 years)
0‐4 years
76706 29,449 1,869 11 12
76705 27,843 2,138 8 12
76710 22,552 1,413 8 9
76708 21,278 1,582 7 9
76707 17,403 1,710 <5 13
76704 7,560 759 <5 7
76643 11,279 889 6 <5
76657 8,654 630 5 <5
76524 2,434 173 <5 <5
76557 3,232 214 <5 <5
76633 3,579 210 <5 <5
76655 6,228 349 NR <5
76664 3,411 230 NR <5
76682 2,622 161 <5 <5
76691 6,342 417 <5 <5
76701 2,216 74 NR <5
76711 8,619 764 <5 <5
76712 19,233 1,167 <5 <5
76624 2,284 148 <5 NR
76630 1,779 134 <5 NR
76638 2,430 178 <5 NR
76640 3,113 210 <5 NR
Total 184,091 13,550 74 97
Percent 40.9% 53.6%
Table 2.5.1 Non Fatal Unintentional Injuries Requiring Hospitalization in McLennan County (2004‐2007) Source: Department of State Health Services NR – None reported
In the United States, one in four children under four years of age
sustains non fatal injuries.vii Injuries resulting from falls, trauma,
transportation accidents, bites/stings and overexertion are the
five leading causes of unintentional injury in very young
children.viii In addition, unintentional
strangulation/asphyxiation and drowning injuries
are common in this age group.ix Many of these
types of injury are largely preventable with
appropriate education and awareness.
Data received from the Texas Department of
State Health Services (DSHS) for the years 2004
through 2007 examined the incidence of non
fatal injuries that required hospitalization in
children ages 0‐4. Statewide, during the same
time period, 18437 hospital reported
unintentional injuries to children ages 0 through
4 were reported with rates of injury ranging from
2.2 to 2.7 injuries per 1000 children in the age
groupx.
Similarly, the data, in aggregated form for
reasons of confidentiality, was analyzed, by zip
code, for McLennan County. The results, detailed
in table 2.5.1, showed that 171 unintentional
injuries requiring hospitalization of children
under 4 years of age were reported.xi Rates of
unintentional injuries for the county ranged from
2.5 to 3.1 injuries per 1000 children in the 0‐4
age groupxii.
Further, Table 2.5.1 details the results of the
analysis which shows that 89 of the 171 injuries
(52.05%) originated in five zip codes in
McLennan County during the four years queried.
The remaining injuries were distributed between
the remaining 17 zip codes. The identification of
the causes for the hospitalizations was not provided by DSHS.
Children’s Health, Safety and Education
Page 113
INTENTIONAL
Female Male
Zip Code
Total Pop
Total Pop (0‐4 years)
0‐4 years
76706 29,449 1,869 <5
76705 27,843 2,138 <5
76710 22,552 1,413
76708 21,278 1,582
76707 17,403 1,710
76704 7,560 759 <5
76643 11,279 889
76657 8,654 630
76524 2,434 173
76557 3,232 214
76633 3,579 210 <5
76655 6,228 349
76664 3,411 230
76682 2,622 161
76691 6,342 417
76701 2,216 74
76711 8,619 764 <5
76712 19,233 1,167
76624 2,284 148
76630 1,779 134
76638 2,430 178
76640 3,113 210 <5
Total 184,091 13,550 <5 5
Table 2.5.2. Non Fatal Intentional Injuries Requiring Hospitalization in McLennan County (2004‐2007) Source: Department of State Health Services
A second category of injuries
requiring hospitalization of a 0‐4
year old is intentional injuries.
During the four years queried, less
than 10 hospitalizations were
reported for intentional injuries
resulting in hospitalization. The
injuries, which were not identified,
were limited to 6 zip codes in
McLennan County (detailed in
table 2.5.2).
Children’s Health, Safety and Education
Page 114
Key Points to Consider In the United States, one in four children under four years of age sustains
non fatal injuries.
Injuries resulting from falls, trauma, transportation accidents, bites/stings and overexertion are the five leading causes of unintentional injury in very young children in the United States.
In McLennan County, 171 unintentional injuries to children requiring
hospitalization were reported between 2004 and 2007.
In 2007, 2.8 unintentional injuries per 1000 children ages 0‐4 were reported from hospital records. Statewide, the rate of unintentional injuries was slightly higher at 2.7 unintentional injuries per 1000 children ages 0‐4.
In McLennan County, less than 10 intentional injuries to children requiring
hospitalization were reported between 2004 and 2007.
Children’s Health, Safety and Education
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Children’s Health, Safety and Education
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i Center for Disease Control and Prevention web site. http://www.cdc.gov/health/childhood.htm ii United States Department of Health & Human Services, Centers for Disease Control and Prevention (2008).
Injury in the United States: 2007 Chartbook. Available at http://www.cdc.gov/nchs/data/misc/injury2007.pdf iii Baker SP et al., eds. (1992). The injury fact book, 2nd ed. Lexington, MA, Lexington Books. iv Pitts, SR., RW. Niska, J. Xu, and CW. Burt. (2006). National Health Statistics Report. National Hospital
Ambulatory Medical Care Survey: 2006 Emergency Department Summary. Available at http://www.cdc.gov/nchs/data/nhsr/nhsr007.pdf
v Peden, M., K. Oyegbite, J. Ozanne‐Smith, AA. Hyder, C. Branche, F. Rahman, F. Rivara and K. Bartolomeos. (2008) World Health Organization. World report on child injury prevention. Available at http://whqlibdoc.who.int/publications/2008/9789241563574_eng.pdf
vi Borse, NN, J. Gilchrist, AM. Dellinger, RA. Rudd, MF. Ballesteros, and DA. Sleet. (2007). Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. CDC Childhood Injury Report: Patterns of Unintentional Injuries among 0‐19 Year olds in the United States, 2000 – 2006. Available at http://www.cdc.gov/SafeChild/images/CDC‐ChildhoodInjury.pdf
vii ibid viii ibid ix ibid x Texas Department of State Health Services, Center for Health Statistics. 2009. Trauma. Available at
http://soupfin.tdh.state.tx.us/ xi Texas Department of State Health Services, Center for Health Statistics data request. xii Texas Department of State Health Services, Center for Health Statistics. 2009. Trauma. Available at
http://soupfin.tdh.state.tx.us/
Children’s Health, Safety and Education
Page 117
Child Abuse Interpersonal violence has been a significant social issue that
has plagued communities, families and individuals for
centuries. Over the past four decades though, grassroots
movements have made great strides to assist individuals who
have endured violent interpersonal relationships. Child abuse
is one of the forms of violence that has exacted a great price on
our children and the community. It continues to place huge
demands on health care, law enforcement, education, child
care and social service providers. The children are particularly
vulnerable to this violence and are hurt by our inability and/or
inaction to address the problems and the pain caused by the
violence committed at the hands of a trusted friend, parent or
partner.
“The problem of child abuse has become one of the most
significant social problems facing our nation. Recent public
opinion polls rank the problem of child abuse second only to
drug abuse as a national concern.”i Some of the greatest
atrocities committed in our society, both past and present are
against our children. The U.S. Department of Health and
Human Services has called violence toward young children a
public health crisis.
Child abuse and neglect cuts across every ethnic, economic
and geographic boundary. However, the statistics indicate
that children from birth to age 3 are the most vulnerable,
possibly reflecting the child’s lack of capacity to protect
themselves from the
abuse and neglect and
verbally communicate
their needs, fears and
pain.
Child abuse is a tragedy
that affects thousands of
The problem of child abuse
has become one of the most
significant social problems
facing our nation, ranking
second only to drug abuse.
Section 2 . 6
Child
Abu
se
Children’s Health, Safety and Education
Page 118
Figure 2.6.1 Confirmed / Total Investigations of Child Abuse and Neglect for McLennan County (2004‐2008) Source: Texas Department of Family and Protective Services
2115
2441
2065
2422
2194
521
620
474
489
456
0 1000 2000 3000
2004
2005
2006
2007
2008
confirmed investigations
total investigations
American children each year. National statistics show in 2007
that 740,517 children (more than 2000 children per day) were
victims of abuse and neglect with approximately 1 in 3 (31.8%)
under the age of 3. That same year, almost 5 children per day
(1,786) died as a result of the abuse, up from 1,530 the previous
year.
Nationally, 31.9% of all confirmed investigations involve children
from birth to age 3 while the 16‐17 year old victims comprise the
smallest percentage of the victims. Rates of abuse for children
under the age of 1 are 22.2 per 1,000 (boys) and 21.5 per 1,000
(girls) and drops to 5.4 per 1,000 for teenagers (ages 16‐17).ii
Finally, approximately 75.7% of the child abuse fatalities reported
nationally involved children under the age of 4. These sobering
statistics emphasize the vulnerability of this population of children
(ages 0‐3).iii
In Texas, 165,010 investigations of abuse and neglect were
conducted during 2008. Of these investigations, 25.2 percent
were confirmed by Texas Department of Family and Protective
Services (DFPS) workersiv. Further, records indicate that 228
(12.7%) child abuse related fatalities were reported in 2007, down
from 257 (16.8%) in 2006.
Each year since
2004, more than
2,000 reports
(approximately 4
reports for every
100 children) of
abuse and neglect
have been filed in
McLennan County
(Figure 2.6.1). In
2008, the most
recent year for
which data is
available, 2,194
Children’s Health, Safety and Education
Page 119
Zip Code Abuse events
Rate of abuse (2008)
% change from the mean
76707 57 12.62 48.30
76682 7 10.77 26.56
76705 74 10.6 24.56
76708 49 9.7 13.98
76701 4 9.55 12.22
76711 19 9.42 10.69
76704 19 9.04 6.23
76664 8 8.7 2.23
MC 456 8.51 0.00
76710 34 7.67 9.87
76643 13 7.11 16.45
76633 6 6.53 23.27 State of Texas
41,591 6.46 NA
76706 52 5.28 37.96
76691 8 4.93 42.07
76638 2 4.78 43.83
76640 4 4.23 50.29
76712 16 4.19 50.76
76657 7 3.73 56.17
76624 2 2.89 66.04
76524 1 1.96 76.97
76630 1 1.69 80.14
76655 3 1.51 82.26
76557 2 1.35 84.14
reports of abuse and neglect were filed; 456 (20.8%) were
confirmedv (Table 2.6.1). These reports of abuse involved 701
children of which 289 were under 4 years of agevi (Table 2.6.2).
Data received from the Texas Department of Family
and Protective Services for 2004 through 2008 was
analyzed. From the data, the rates of confirmed
investigations (Table 2.6.2 above) as well as the
mean values for the 5 year time frame for each zip
code in McLennan County (Table 2.6.3, left) were
calculated. The analysis revealed that the average
rate of abuse for McLennan County ranged from a
high of 11.28 confirmed investigations per 1,000
children (2005) to a low of 8.51 confirmed
investigations per 1,000 children (2008) (Figure
2.6.2). In comparison, the rate of confirmed abuse
for the state of Texas in 2008 was reported to be
6.46 confirmed incidents per 1000 childrenvii.
8.51
8.96
8.62
11.28
9.45
0 5 10 15
2008
2007
2006
2005
2004
Figure 2.6.2 McLennan County Average Rates of Confirmed Abuse / Neglect per 1000 Children (2004‐2008) Source: Texas Department of Family and Protective Services
Table 2.6.3 Rate of Confirmed Child Abuse for McLennan County Zip Codes (2008) Source: Texas Department of Family and Protective Services
Children’s Health, Safety and Education
Page 120
An analysis at the zip code level of the confirmed cases of abuse
and neglect was conducted for each of the five years dating back
to 2004. Table 2.6.3 details the results of the analysis for the year
2008. The average rate for McLennan County for 2008 was
calculated to be 8.51 confirmed abuse events per 1000 children.
Figure 2.6.4 Spatial Representation of Rates of Confirmed Child Abuse/1000 Children in McLennan County (2008). Source: Texas Department of Family and Protective Services
Inset detail
Children’s Health, Safety and Education
Page 121
The analysis identified eight zip codes with rates of abuse that
exceeded the average rate of abuse for McLennan County during
2008. The rates of abuse for the eight zip codes ranged in value
from 2.23% (76664) to 48.30% (76707) above the county average.
In addition, thirteen zip codes fell below the county average.
Finally, a review of the analysis revealed three zip codes with
rates of abuse that exceeded the average for McLennan County
for each of the five years examined (76704, 76705, and 76707).
Figure 2.6.4 and the inset offer a spatial representation of the
rates of abuse for each zip code in McLennan County during 2008.
During this same time period (2004‐2008), 10
childhood deaths related to abuse and
neglect were reported. While the specific
cause of death in each of these deaths is not
clear, the means of death typically involved
in child abuse related deaths is shaken baby
syndrome, blunt force, head trauma,
drowning, and strangulation.
The number of victims for each year did not
always match the number of confirmed
incidents of abuse. In some confirmed cases,
multiple victims are identified by the
investigation. It counts as a single
investigation, but not a single victim. For
2008, detailed in Table 2.6.5 (left) 701
victims of abuse were identified by the Texas
Department of Family and Protective
Services. Of the 711 victims, 289 (40.6%) of
the victims were in the 0‐3 age group,
approximately 8.7% above the national
average for the age group. When 4 and 5
year olds are factored into this analysis, the
percentage of all victims 5 years of age or
less jumps to 55.6%.
Zip Code
Ages 0 ‐ 3
Ages 4 ‐5
Ages 6 ‐ 17
Total
76524 1 0 0 1
76557 1 1 1 3
76624 1 0 1 2
76630 1 0 0 1
76633 1 3 6 10
76638 1 0 1 2
76640 1 0 4 5
76643 7 3 12 22
76655 0 1 2 3
76657 3 2 4 9
76664 3 2 7 12
76682 4 1 5 10
76691 4 4 12 20
76701 3 2 2 7
76704 14 1 11 26
76705 47 21 55 123
76706 34 7 28 69
76707 42 13 30 85
76708 31 16 33 80
76710 21 6 24 51
76711 14 4 14 32
76712 7 3 12 22
Valid 241 90 264 595
Missing zip code
48 11 47 106
Total 289 101 311 701
Figure 2.6.5 McLennan County Confirmed Victims by Zip Code (2008) Source: Texas Department of Family and Protective Services
Children’s Health, Safety and Education
Page 122
For many of these children, the ultimate result of the
investigation is removal from the home. Table 2.6.6 details the zip
code analysis of the removals for 2008 in McLennan County. In
2008, 146 children were removed from an abusive situation. Of
these children, 76 (52.1%) fell into the 0‐3 age group while
another 21 (14.4%) were either 4 or 5 years of age.
This analysis does not examine the issues
related to children living in homes with
domestic violence, a concern addressed in
Section 3.1. However, both child abuse and
domestic violence are often found to occur
simultaneously in many homes. These co‐
morbid conditions can contribute significantly
to a pattern of behavioral difficulties for
preschoolers and beyond in a young child’s
academic endeavors.
Zip Code Age Group
Total0‐3 4‐5 6‐17
76524 0 0 1 1
76557 0 1 1 2
76630 1 0 1 2
76633 0 1 0 1
76643 3 0 5 8
76655 1 0 0 1
76657 1 0 1 2
76664 1 1 1 3
76682 1 1 0 2
76691 2 1 2 5
76701 2 2 0 4
76704 3 0 1 4
76705 13 6 4 23
76706 12 2 4 18
76707 4 2 2 8
76708 5 1 10 16
76710 2 0 1 3
76711 3 1 2 6
76712 1 1 6 8
Valid 55 20 42 117
Missing zip code 21 1 7 29
Total 76 21 49 146
Figure 2.6.6 McLennan County Removals by Zip Code (2008)
Source: Texas Department of Family and Protective Services
Children’s Health, Safety and Education
Page 123
Key Points to Consider The United States Department of Health & Human Services views violence
against children as a public health crisis.
In 2007, more than 740,000 children were victims of abuse and neglect in the United States.
In Texas, 165,000 investigations of abuse were conducted by the Texas
Department of Family and Protective Services (DFPS) in 2008. One in four investigations of abuse against children was confirmed.
In 2007, 228 Texas children did not survive the abuse.
Between 2004 and 2008, 11,237 investigations were conducted by DFPS in McLennan County. 2,560 (22.8%) of the investigations were confirmed.
In McLennan County, the rate of child abuse and neglect (confirmed
investigations) for 2004 – 2008 ranged from 8.51 to 11.62 confirmed events per 1,000 children.
Ten children have died in McLennan County as a result of abuse and neglect
since 2004.
Multiple zip codes reported rates of abuse and neglect that exceeded the county average for each of the years between 2004 and 2008.
Children’s Health, Safety and Education
Page 124
i Boy Scouts of America. Youth Protection Training. Found at http://riskzone.ppbsa.org/youthprotection/ ii U.S. Department of Health and Human Services, Administration on Children, Youth, and Families. Child
Maltreatment 2007 [online]. Washington (DC): Government Printing Office; 2009. Available from: www.acf.hhs.gov.
iii US. Department of Health and Human Services, Administration on Children, Youth, and Families. Child Maltreatment 2007 [online]. Washington (DC): Government Printing Office; 2009. Available from: www.acf.hhs.gov.
iv Texas Department of Family and Protective Services. 2007 Data Book. Available at http://www.dfps.state.tx.us/Documents/about/Data_Books_and_Annual_Reports/2007/databook/CPS_FY07.pdf
v Data received from Texas Department of Family and Protective Services, Austin, TX. 2009 vi Ibid vii Texas Department of Family and Protective Services. 2008 Data Book. Available at
http://www.dfps.state.tx.us/Documents/about/Data_Books_and_Annual_Reports/2008/databook/CPS_FY08.pdf
Children’s Health, Safety and Education
Quality Quality Quality Quality Child CareChild CareChild CareChild Care
Affordab
search for child care by many parents and grandparents. For many
decision about a child care provider is often a choice of cost at the
sacrifice of quality. Despite this agonizing decision forced on many low
and lower middle income families,
as they
Children’s Health, Safety and Education
Page 125
Child CareChild CareChild CareChild Care Affordability, accessibility and quality are key issues considered
search for child care by many parents and grandparents. For many
decision about a child care provider is often a choice of cost at the
sacrifice of quality. Despite this agonizing decision forced on many low
and lower middle income families, quality remains foremost in their minds
as they search for a child care provider.
Quality care is vital in ensuring
that young children meet a
range of
developmental needs.
care is often associated with
limited class size
teacher student ratio
established curriculums. These
criteria are designed to make
the child ready to learn upon
their entrance to a
kindergarten program.
A growing number of
professional child care
providers and educators
recognize the importance of
quality care and h
impacts the futu
young child. Healthy physical
and emotional development,
socialization, and academic
success often hinge upon the
early care and education
experiences of the child and
the family.
issues considered in the
search for child care by many parents and grandparents. For many, the
decision about a child care provider is often a choice of cost at the
sacrifice of quality. Despite this agonizing decision forced on many low
remains foremost in their minds
Quality care is vital in ensuring
that young children meet a
range of education and
developmental needs. Quality
care is often associated with
limited class size, smaller
teacher student ratios and
established curriculums. These
criteria are designed to make
the child ready to learn upon
their entrance to a
kindergarten program.
A growing number of
professional child care
providers and educators
recognize the importance of
quality care and how this
impacts the future of the
young child. Healthy physical
and emotional development,
socialization, and academic
success often hinge upon the
early care and education
experiences of the child and
the family.
Children’s Health, Safety and Education
Page 126
Rapid growth and development of multiple systems of the body are
characteristics of the very early years of a child’s life. The development of
the immune, neuroendocrine and nervous system can be influenced by
environmental factors. Brain development can be enhanced by
appropriate stimulation including the educational activities of quality
early education programs.
Examples of established programs that are used to
establish quality early education opportunities
include the National Association for the Education
of Young Children (NAEYC) Certification, National
Accreditation Commission (NAC) Accreditation
Program, the Texas Early Education Model (TEEM),
the Texas Rising Star (TRS) program, Texas School
Ready! Certification, and the T.E.A.C.H (Teacher
Education and Compensation Helps) model scheduled for introduction in
Texas in 2010.
The NAEYC certification and TRS program offer certifications to child care
providers who meet specific requirements. This may include extra training
of staff or lower numbers of children per adult. Child care providers
meeting the requirements are then given a certification of higher quality
care. While NAEYC and TRS focus on the inputs of child care, TEEM
focuses on mentoring teachers and improving student outputs. Each
model differs in requirements, but all seek to improve the quality of care
and education offered to young children in child care and early education
settings. The T.E.A.C.H. Early Childhood Project addresses the problems of
poor education, low compensation, and high turnover in the child care
sector by providing early childhood professional development
opportunities for teachers, directors, and family child care providers
Finally, the NAC Accreditation Program of the National Association of
Child Care Professionals offers yet another avenue for early care
education programs to document performance measures that are
indicative of quality early childhood education.
Unfortunately, finding high quality care for infants and toddlers is often
impeded by barriers that are difficult to overcome. For many, quality is
secondary to cost for many low-income families. For others, a lack of
Healthy physical and emotional
development, socialization, and
academic success often hinge upon
the early care and education
experiences of the child and the
family.
Children’s Health, Safety and Education
Page 127
information about available resources prevents families from accessing
quality care. Many low-income families are not familiar with specific
indicators of quality care or with the complex, often inadequate, child
care standards. Finally, infant and toddler care is more expensive to
provide than care for older children, creating a smaller supply of quality
infant and toddler care. When these barriers can be overcome, the
benefits to the child, the family and the community are significant.
Providers are often hindered in their ability to offer quality programs at
an affordable price. The high cost of offering quality child care services
has forced many centers, including subsidized care centers, to carefully
watch their budgets and reduce costs wherever possible. This may affect
the number of children served, the materials available and even the
training of staff. In a statewide Texas Association of Resource and
Referral Agencies (TACCRRA) survey, child care providers shared
information about their budget concernsi. When faced with tight budgets,
almost one quarter of surveyed providers chose to reduce their services
for children. For some child care centers, this meant cutting enrichment
programs, while others cut supplies such as paper towels and soap.
Without basic supplies, providers cannot offer children a rich learning
environment, let alone a safe setting in which to learn. Tight budgets also
restrict participation in quality improvement programs, which incur more
costs.
The care of a child at home by the parents is generally accepted as the
best quality care that a child may receive. However, many parents face
challenges related to employment, education, and other family
responsibilities that place them in a position of need for outside child
care. Many challenges face parents and providers as they struggle to
provide a positive, quality learning environment for young children. The
experiences of these children will factor heavily in their future education.
For many, the quality of care and early education may make the
difference between a successful academic career that leads to post
secondary education and training or a child dropping out of a less than
satisfactory educational experience. Whichever choice is made by the
parents, it is increasingly apparent that the quality of the early care and
education sets the stage for the future of the children of McLennan
County, Texas and the nation.
Children’s Health, Safety and Education
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i Texas Association of Child Care Resource and Referral Agencies and Raising Texas. (2007). Executive Summary:
Findings of Infant/Toddler Care and Education Survey. Available at
http://www.taccrra.net/docs/surveys/Executive.Summary.Survey.Infant.Toddler.Child.Care.pdf
Children’s Health, Safety and Education
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Child Care Capacity The Texas Department of Family and Protective Services has
oversight (regulatory) authority over center based and home
based child care services in the state of Texas. Four main
categories of child care services are recognized in Texas;
Licensed Child Care Centers, Licensed Child Care Homes,
Registered Child Care Homes, and Listed Family Homes. Each
type of child care setting differs in its capacity and
regulations.
Licensed centers are located in facilities outside of the
provider’s home and provide care for seven or more children,
age birth to 13, for less than 24 hours a day. Licensed child
care homes provide care for children aged birth to 13 in the
residence of the provider. Registered child care homes also
provide care for children aged birth to 13 in the home, but are
not licensed by the state.i Child care providers in listed family
homes may not care for more than 3 children, and are not
required to register or be licensed with the state. Unlike
licensed or registered providers, listed homes are unregulated
and not subject to visits or reviews by the state.ii McLennan
County provides child care services in each of the four types
of facilities.
McLennan County is home to approximately 44,000 children
between the ages of 0 and 13.iii With 232 centers or homes,
McLennan County has spaces to accommodate 9,683 children
(detailed in Table 2.7.1).iv Currently, there are 5 children for
each open space in a formal child care setting in McLennan
County. This same ratio exists for the state of Texas.
Section 2 . 7
Child
Car
e Ca
pacit
y
Children’s Health, Safety and Education
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Many low‐income families
qualify for assistance or
special programs of care and
education for their 3 and 4
year old children. In
McLennan County, there are
a limited number of available
slots for this age group of
children. However, the
number of available spaces is
dependent upon funding
received by the administering
agencies. Table 2.7.2 details
the number of children served in McLennan County enrolled in
subsidized care, public school pre‐K or Head Start programs.
Across the state, families who meet or exceed the minimum
criteria for subsidized care eligibility are not guaranteed
immediate access to child care services. Eligible families must find
a child care provider who accepts subsidies and has an available
opening for the child.
Waiting lists exist for both subsidized and non‐subsidized care,
but lists are more easily measured for families receiving child care
subsidies. Local Workforce Development Boards (LWDBs)
maintain records of eligible families and report on the number of
children on child care waiting lists. Many more families searching
Child Care Facilities Number Legal
Capacity Licensed Child Care Centers 96 9,127Licensed Child Care Homes 23 276Registered Child Care Homes 39 455Listed Family Homes (unregulated) 66 198Available Capacity for Children Under age 3 in Centers
NA
Available Capacity for Children age 3‐5 in Centers
NA
Texas Early Education Model (TEEM) classrooms
17
Table 2.7.1 Capacity of Child Care Facilities in McLennan County Source: Texas Association of Child Care Resource and Referral Agencies
Early Care and Education Number
Children (0‐12) in State subsidized child care 2,895Children (3‐4) in public pre‐kindergarten 1,711Children (3‐4) in Head Start program 780
Table 2.7.2 Children Enrolled in Early Care and Education Programs for Low‐income Families Source: Texas Association of Child Care Resource and Referral Agencies
Children’s Health, Safety and Education
Page 131
Figure 2.7.3 Fluctuations in Subsidized Child Care Waiting List for McLennan County (2008)
Source: Workforce Solutions of the Heart of Texas.
‐
20
40
60
80
100
120
140
160
180
Number of Child
ren
for child care services on their own are not tracked, so an exact
number of children waiting for child care is not known.
McLennan County has an average of 60 children on subsidized
care waiting lists at any given time.v Figure 2.7.3 shows the
number of McLennan County children waiting for subsidized child
care in 2008. Similar to the state‐wide waiting list, demand tends
to increase in early fall coinciding with the end of summer and the
start of school.
Child care capacity is not evenly distributed across McLennan
County. With the exception of two areas, Waco enjoys a large
capacity within the city limits. The low capacity areas of Waco
include the 76711 and 76712 zip codes, the neighborhood north
of the IH‐35 and Loop 340 junction, and the 76707 area of Waco,
bordered by the Brazos River, Valley Mills Drive and Franklin
Avenue. Several regions, both East and West of Waco, face low
capacity (small number of spaces compared to the child
population). These include 76638, 76657, 76624 and 76664, or
Children’s Health, Safety and Education
Page 132
McGregor, Crawford, Mart and the surrounding areas. Figure
2.7.4 details the quartile ranking (Q4–highest to Q1‐lowest) of the
child care capacity for all the zip codes in McLennan County.
Figure 2.7.4 Geospatial Analysis of Child Care Facility Capacity in McLennan County Source: Texas Department of Family and Protective Services
Children’s Health, Safety and Education
Page 133
Figure 2.7.5 illustrates the distribution of child care centers and
homes across McLennan County. This graphic representation
includes licensed centers, licensed homes and registered homes.
In McLennan County, there are more child care centers than child
care homes. The centers appear to be concentrated in and
around the population centers of Waco (see inset). A similar
observation has been made regarding licensed homes, which are
Inset detail
Figure 2.7.5 Geospatial Analysis of Licensed Child Care Facilities in McLennan County Source: Texas Department of Family and Protective Services
Children’s Health, Safety and Education
Page 134
primarily located in the western areas of Waco. Few licensed
homes operate outside of the Waco city limits. Further, registered
child care homes, while more evenly distributed across the
county, are fewer in number than licensed centers. Finally, the
map does not include the final form of child care facility, the listed
family homes. These homes are unregulated and have a
maximum capacity of 3 children. McLennan County currently has
80 listed homes in operation.
An examination of the distribution of child care facilities across
the county readily reveals the low capacity areas. For example,
the 76711 area code features only 2 child care centers and 1
licensed home, while dozens of centers and homes are in
operation directly north of the 76711 area. Axtell (76624) has one
child care center, and McGregor (76657) has two. In addition,
Axtell has one listed family home while McGregor has 6, each with
a maximum capacity of 3 children.
The distribution of the limited number of facilities, in conjunction
with a 5:1 child to available spaces ratio in McLennan County,
contributes to parents’ struggle to provide quality care for their
young children. In the next section, we begin to examine the
services and programs that are available for McLennan County
children.
Children’s Health, Safety and Education
Page 135
Key Points to Consider McLennan County is home to approximately 44,000 children between the
ages of 0 and 13.
Across the county, 232 centers can provide services for approximately 9,700 children.
There are 5 children for every child care slot in McLennan County.
An average of 60 children are on the subsidized child care waiting list for any
given month. August is the peak month, coincidental to the start of the public school year and end of summer.
The capacity for child care services varies throughout McLennan County
with the highest capacity located within the city limits of Waco.
Children’s Health, Safety and Education
Page 136
i Workforce Solutions Concho Valley. (2008). Child Care Provider Manual. ii Texas Department of Family and Protective Services. (2009). Child Care Solutions: Exploring Your Options iii Texas Department of Family and Protective Services. (2008). 2008 Data Book iv Texas Department of Family and Protective Services. (2009). About Child Care Licensing. v Workforce Solutions of the Heart of Texas. (2009). Open records request.
Children’s Health, Safety and Education
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Child Care Affordability In addition to capacity, child care affordability is a concern for
many families in McLennan County and across Texas. Child
care costs can reach thousands of dollars a year and many
families cannot afford full time care. This is especially true of
infant care, which is more expensive than child care for
toddlers and school‐age children.
In Texas, a family of four
earning less than
$50,600 annually may
be eligible for
subsidized child care.
This is the maximum
limit, but locally
determined eligibility
limits are typically
lower. Family eligibility,
is based on a federally
determined maximum
amount of income that
equals 85% of the state median income (SMI) per household.i
Table 1 compares the Federal Poverty Level (FPL) for a family
of four to the Texas SMI.
Maximum income limits are set by the state, but Local
Workforce Development Boards (LWDBs) have the latitude to
set subsidy rates and family co‐payments. Funding for
subsidized child care in Texas comes largely from the Child
Care Development Block Grant (CCDBG), a federal subsidy
which is distributed among the 28 LWDBs across the state.
While LWDBs determine reimbursement rates locally, the
highest rates are generally paid to licensed centers caring for
infants.
LWDBs also have the freedom to
pay higher reimbursement rates
Section 2 . 8
Child
Car
e Af
ford
abili
ty
FPL Income SMI
100% = $20,650 = 35%
125% = $25,813 = 43%
150% = $30,975 = 52%
200% = $41,300 = 70%
230% = $47,495 = 80%
245% = $50,593 = 85%
Figure 2.8.1 Comparison of Federal Poverty Level Against State Median Income for Established Income Levels Data Source: US Census.
Children’s Health, Safety and Education
Page 138
to child care providers participating in quality improvement
programs such as the National Association for the Education of
Young Children (NAEYC) certification program, Texas Rising Star
Program, Texas School Ready! Certification or Texas Early
Education Model. Unfortunately, if LWBDs choose to increase
reimbursements for quality improvement, they must do so using
the same money that would otherwise be used to reimburse
other local providers. This limited funding does little to encourage
LWDBs to promote quality improvement. In order to ensure
availability, LWDBs must use limited funds to subsidize as many
children as possible, to the detriment of quality improvement
incentives.
The Workforce Solutions Board for the Heart of Texas is
responsible for setting child care subsidy rates in McLennan
County. In February 2009, the Heart of Texas Board approved
reimbursement rate increases for all three types of regulated
care: licensed centers, licensed homes and registered homes. This
increase helped bring local reimbursement rates closer to the
current market rates charged by local child care providers.
The federal government recommends, but does not mandate,
reimbursement rates be set at the 75th percentile of current
market rates.ii For example, federal recommendations suggest
that a community with a $40.00 per day market rate be
reimbursed up to $30.00 per day. However, LWDB
reimbursements are set below the federal recommendations for
reimbursement. Figure 2.8.2 illustrates the difference between
the new maximum daily rates and the 75th percentile of Heart of
Texas market rates. For all ages of children in McLennan County
child care settings, the new maximum reimbursement rates are
close to the recommended 75th percentile of market rates.
The Heart of Texas Workforce Development Board has set the
daily maximum reimbursement rate at $19.34. In comparison,
the Texas average is $20.50 per day. While LWDBs in Austin, San
Antonio and Fort Worth have set higher maximum rates, these
cities also have higher costs of living and market rates. The Heart
Children’s Health, Safety and Education
Page 139
of Texas LWDB currently has set the maximum reimbursement
rates $3.17 below the 75th percentile. In comparison, the state
average for the maximum reimbursement rate is $8.40 below the
75th percentile. In some areas where higher reimbursement rates
are paid, such as Fort Worth, the difference may be as high as
$18.00. Additionally, of the 28 LWDBs across Texas, only 4 have
set their maximum rates closer to the 75th percentile of local
market rates than the Heart of Texas LWDB.
The inability of low and middle‐income families to afford child
care services creates a situation where the parents must decide to
accept a lower quality, higher risk child care arrangement or stay
at home with their child. This situation propagates the cycle of
poverty because the parent is unable to maintain gainful
employment or pursue education opportunities. This is an
especially difficult situation for families whose income is slightly
above the maximum allowable income for eligibility for assistance
with child care costs.
Figure 2.8.2 Comparison of Heart of Texas Local Workforce Development Board (LWDB) Established Maximum Child Care Subsidy Reimbursement Rates against Federally Suggested Reimbursement Rates (75% of Market Rate) for Licensed Child Care Centers Source: TWC. (2007). Child Care Development and Fund Plan for Texas FFY 2008 – 2009.
$0.00
$5.00
$10.00
$15.00
$20.00
$25.00
Infant Toddler Preschool School Age
Maximum Rates
75th Percentile
Children’s Health, Safety and Education
Page 140
Key Points to Consider
Child care costs for a family can run into thousands of dollars each year, putting child care out of reach for many low and middle income families.
Eligibility for subsidized child care is based upon family income as a percentage of the state median income (SMI).
Each of 28 statewide Local Workforce Development Boards (LWDBs) of the Texas Workforce Commission establishes local subsidy rates.
The federal government recommends that LWDB reimbursements be set at
75% of the local market rate.
i Sabo, J. (2002). The Texas Child Care Experience Since 1996: Implications for Federal and State Policy. ii Schulman, K. (2007). State Child Care Assistance Policies 2007: Some Steps Forward, More Progress Needed.
Children’s Health, Safety and Education
Page 141
Head Start Programs Head Start was authorized by President Lyndon Johnson as
part of the Economic Opportunity Act of 1964.i A single line
item in the act gave broad powers to the Office of Economic
Opportunity, the original home of the program. In 1965 Project
Head Start, an eight‐week summer program, was launched in
an effort to help end poverty. The following year it was
authorized by Congress as a fully‐funded year‐round program.
In 1981, the Head Start Act was passed by Congress.
Today, Head Start is a program within the Administration for
Children and Families (ACF) in the Department of Health and
Human Services. Its companion program, the Early Head Start
program for children from birth to three years of age was
started in 1995.
These programs provide early education services to
economically disadvantaged children and families. The
program’s main goal is to promote school readiness by
teaching families about the critical role parental involvement
plays in a child’s education. Head Start programs also offer
educational, health, nutrition and other services to children
and their families. Early Head Start is a similar program that
serves infants, toddlers, and their families by promoting
healthy prenatal outcomes and family involvement. While
Head Start serves children from birth to age 5, the majority of
children in Head Start (87%) are 3 and 4 years old.ii
Unlike pre‐kindergarten programs, which are predominantly
offered through public schools, Head Start services are offered
through a variety of providers. Local public, non‐profit or for‐
profit agencies apply to the Head Start program for grant funds
to open independent Head Start centers.
Section 2 . 9
Head
Sta
rt P
rogr
ams
Children’s Health, Safety and Education
Page 142
Children in Head Start also receive medical and dental services,
while parents can attend classes on parenting or job training. For
example, one Head Start standard requires that all children
receive a comprehensive medical screening within 45 days of
enrollment. In 2005, 89% of all children enrolled in Head Start
programs across the country received this screening. Head Start
staff are also required to assist parents in accessing continuing
medical and dental services. In the same year, 92% of all Head
Start students had continuing medical and dental services.
In 2007, 67,630 Texas children received Head Start services.iii
McLennan County Head Start providers receive funds for 953
children, including 873 spaces for Head Start and 80 spaces for
Early Head Start.iv The number of McLennan County children
enrolled in Head Start has remained steady since 2002. Currently,
12 local agencies provide Head Start services in McLennan
County, 10 of which are in the city of Waco. Further, because
accessibility to Head Start programs is important to many low
income families for numerous services beyond early care and
education, location and accessibility are critical. Figure 2.9.1
details the locations of all 12 Head Start providers and their
proximity to major roadways and public transportation routes.
The income requirement for Head Start is based on 100% of the
Federal Poverty Level (FPL), or an annual income of $22,050 for a
family of four. It stands to reason, then, that many eligible
families may require public transportation to attend Head Start.
Without reliable transportation, whether personal or public,
families face barriers to the range of vital services offered by Head
Start. In McLennan County, 10 of the 12 Head Start centers are
located in the Waco area, and 9 centers are on or near bus routes.
Head Start program capacity in McLennan County can currently
accommodate less than 1,000 children from low income families.
For these children, this may be the only opportunity for a
structured early childhood educational experience. Other options
exist in McLennan County. However, many factors put access to
the other services out of reach. In the next section, this report
Children’s Health, Safety and Education
Page 143
will look at other early childhood education options and the pre‐
kindergarten services of McLennan County.
Figure 2.9.1 Spatial Representation of Head Start Center Locations in McLennan County Source: US Department of Health and Human Services, Administration for Children and Families.
Children’s Health, Safety and Education
Page 144
Key Points to Consider The Head Start Program was authorized by the Economic Opportunity Act of
1964 and signed into law by President Lyndon Johnson.
Head Start is administered under the United States Department of Health & Human Services, Administration for Children and Families.
Head Start offers educational, health, nutritional and other services to
67,630 Texas residents, primarily ages 3 and 4.
McLennan County receives Head Start funds for 953 children; 873 Head Start (4 yr olds) and 80 Early Head Start (3 yr olds, infants and toddlers).
There are 12 Head Start Centers in McLennan County.
9 of the 12 Head Start facilities are established in proximity to local bus lines of the Waco Transit System.
Eligibility is based upon family income at 100% of the federal poverty level.
i Pub.L. 88-452, 78 Stat. 508, 42 U.S.C. § 2701 ii U.S. Department of Health and Human Services, (2009). Administration of Children and Families. iii Ibid. iv EOAC Head Start & Early Head Start. (2009). Child Development Programs Serving Children and Families.
Children’s Health, Safety and Education
Page 145
Pre Kindergarten In Texas, pre‐kindergarten is offered to children of eligible
families through the public school system on a half‐day basis.
State law mandates that school districts must offer half‐day
pre‐k services when at least 15 eligible children are in need of
services within the district. Eligibility criteria include low‐
income families, homeless children, English Language Learners,
children of active military and those under the care of the
Texas foster care system. While the state offers a minimum of
half‐day services, extra funding is available for selected Texas
districts to offer full‐day programs. School districts may apply
to the Pre‐kindergarten Early Start Grant Program for the extra
funding to expand their pre‐k programs to offer full‐day
services.
Section 2 . 10
Pre
Kind
erga
rten
Children’s Health, Safety and Education
Page 146
Approximately 200,500 Texas students were enrolled in public
school pre‐k programs in 2008‐2009i; approximately 50% of the
eligible four year olds in Texas.ii In McLennan County, 1,675
students were enrolled in public school pre‐k in the 2008‐2009
school year, with 950 (57%) of those students enrolled in Waco
ISD. An additional 146 children in McLennan County, from birth
to age 5, received other early intervention services through the
public school systems. These programs include students between
3 and 5 who have not been placed in pre‐k or Kindergarten.
These children may not qualify for pre‐k, but receive special
education services on a part‐time basis. These services include
the Preschool Program for Children with Disabilities (PPCD), and
other special education services. Head Start, which is federally
funded, is also included in this category.
Of the 18 school districts
in McLennan County, 14
offer pre‐k services to
children of eligible
families. Among the 14
districts offering these
services, 10 provide full‐
day programs; the rest,
half‐day services. Across
the county,
approximately 70% of
pre‐k students are
enrolled in full day
programs, with 30% in
half day pre‐k
programs.iii
Figure 2.10.1 Pre‐Kindergarten Enrollment Percentages of 4 Year Olds in the State of Texas and McLennan County Data source: Annie E. Casey Foundation. Kids Count Data Center. Texas. (2006).
10%
15%
20%
25%
30%
2002 2003 2004 2005 2006McLennan County Pre‐k Enrollment
Texas Average Pre‐k Enrollment
Children’s Health, Safety and Education
Page 147
Figure 2.10.2 Changes in Child Population for McLennan County (2002‐2006)
Source: Annie E. Casey Foundation. Kids Count Data Center. Texas. (2006)
6,000
10,000
14,000
18,000
22,000
2002 2003 2004 2005 2006
Number of Children
Year
Child Population Ages 0‐5 Child Population Ages 6‐11
Child Population Ages 12‐14 Child Population Ages 15‐17
Since 2002, McLennan County has seen an increase in the
percentage of eligible 4 year old enrollments in pre‐Kindergarten
programs (Figure 2.10.1). The increases peaked in 2005 in
McLennan County when enrollments jumped 4.4% between 2004
and 2005. The increase was followed by a 0.6% decrease the
following year (2006).
Between 2002 and 2006, the
number of children ages 0 to 5
has grown in McLennan County.
Figure 2.10.2 details the
changes in the child population
for McLennan County’s multiple
age groups between 2002 and
2006. The 2005 increase in pre‐
k students implies that while
the young population of the
county has grown, the number
of available spaces in pre‐k
programs has also increased,
allowing more eligible children
to receive pre‐k services.
The location of established pre‐
k programs in McLennan County
and the city of Waco are
detailed in figure 2.10.3. The
largest number of programs are
offered within the city limits coinciding with the greatest
population density. Outside of Waco, the remaining programs are
largely located West and Northeast of Waco.
During the 2009‐2010 school year, a new pre‐k program opened
in Hewitt, indicative of the growing 0 to 5 population and demand
for pre‐k services.
Children’s Health, Safety and Education
Page 148
Figure 2.10.3 GIS Representation of Public School Pre‐Kindergarten Programs in McLennan County (2008) Source: Texas Education Agency
Children’s Health, Safety and Education
Page 149
Key Points to Consider
Eligibility for public school pre‐k is available to children from low income and military families, English as a Second Language, homeless and the physically challenged.
200,520 Texas students are enrolled in pre‐k programs representing approximately 50% of the four year old age group.
In McLennan County, 1,675 students were enrolled in public school pre‐k during the 2008‐2009 school year.
950 of the 1,675 pre‐k students were enrolled in Waco ISD.
14 of the 18 school districts In McLennan County offer pre‐k services to children of eligible families.
Since 2004, McLennan County has witnessed a growth in the percentage of
4 year olds enrolled in pre‐k programs.
Children’s Health, Safety and Education
Page 150
i Texas Education Agency, State Enrollment Report 2008‐2009. Available at
http://ritter.tea.state.tx.us/cgi/sas/broker?_service=marykay&_program=adhoc.addispatch.sas&major=st&minor=e&endyear=09&linespg=60&charsln=120&format=W&selsumm=ss&key=TYPE+HERE&grouping=g
ii Annie E. Casey Foundation. (2006). Kids Count Data Center. Texas. iii Region 12 Education Service Center (2009). Open records request.