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Evaluation of outcomes has always been an important aspect of the work of First 5 San Bernardino. Understanding who we are serving and to what degree is a vital practice that informs decision making and how best to invest our funds in San Bernardino County. Measuring and sharing impact allows us to demonstrate that the funds are truly making a difference in the community and changing the lives of children for the better! In the early years of the Children and Families Act (Proposition 10 1998), evaluation focused on aggregate data. Tracking and reporting were limited to how much First 5 San Bernardino invested, which agencies were funded and how many children and caregivers were “served”. Reports were completed as requested by the State Commission (First 5 California) and shared locally. Narratives described the impacts to a certain degree, however, lacked actual formal data analysis. In Fiscal Year 2005-2006, a major shift occurred when First 5 San Bernardino (F5SB) contracted with Harder and Company Community Research (Harder + Co.) for evaluation services. Harder + Co. developed every aspect of evaluation from data collection frameworks to technical support for contracted agencies and F5SB staff. Every year, an evaluation report representing the work of F5SB was presented to the Commission. While data was prepared and submitted to First 5 California each year, the reports were not shared with the public. The report created by Harder + Co. contained actual outcome changes occurring for children and families as a result of Commission investments. Evaluation was an ongoing activity, however, the results were only shared once a year through this annual report as mandated by First 5 California. As the years went on, data reporting became more robust. Harder + Co. included data tables, narratives, qualitative (non-numeric such as interview or survey results) data and graphic design to make the reports more attractive. Beginning in Fiscal Year 2010-2011, the reports were condensed to eight to twelve pages of highlights from each of our focus areas (Family Support, Health and Early Learning). The raw data previously included in the reports were catalogued in an internal “data book” which was available to anyone for their review. The focus was on outcomes of the Commission’s initiatives and investments. Today, the report remains the same size but the data book is now an interactive “dashboard” available for review. The name of the report changed to “Local Outcomes Report”. Much of the content of the report is prepared by Harder + Co. with several aspects completed by F5SB staff including the entirety of the graphic design. Another noticeable change in recent reports is an additional focus area known as “Systems”. In the future, reports will focus on F5SB’s work towards systems change and collective impact. We look forward to you joining the Commission and First 5 staff as we endeavor to make a positive impact on the county! Please sign our yearbook and enjoy this “walk through history” of our evaluation, data and outcomes since our first 2001-2002 report to date. In addition, see what our community and partners have to say about the impact First 5 San Bernardino has had over the past 20 years!

- The Commission and First 5 Staff


“

First 5 San Bernardino has grown tremendously over the past 20 years as have many county commissions. San Bernardino’s Children and Families Commission has been a model for many throughout the state on how to develop strong systems that lead to remarkable impacts while remaining open and transparent with the community. -Funded Agency

2018


20 YEARS OF FIRST 5 SAN BERNARDINO

SAN BERNARDINO

COUNTY

At First 5 San Bernardino, we support kids to be healthy, active learners who grow up in families and communities that nurture them. In 20 years, we invested more than $400 million in services and systems for 895,000+ families with children ages 0 to 5 countywide. With our partners, we are seeing results:

18%

60% 83%

of young kids are read to every day

of kids 2–11 have not visited a dentist in the past year

of mothers receive early prenatal care

715,736

resources and referrals through 2-1-1

$650 M $510M

$460M $355M

2010

HOME VISITING, utilizing AmeriCorps Volunteers who provide support to young parents and their children. PROFESSIONAL DEVELOPMENT and resources for EARLY CARE & EDUCATION PROVIDERS to support high-quality care through Quality Start San Bernardino. NURTURING PARENTING PROGRAMS and soon to launch HELP ME GROW, which identifies kids at risk for developmental concerns and helps families connect to services.

Yet, the needs of San Bernardino County kids are still great.

27%

of kids live in poverty

81%

of families need licensed child care but it is unavailable

47%

Across the state, First 5 county programs are not at scale and funding keeps declining… from $261 to $135 per child statewide.

2000

FIRST 5 SAN BERNARDINO SUPPORTS FAMILIES THROUGH PROGRAMS AND SYSTEMS LIKE:

2015

2018

$337M

of kids 3–5 are not enrolled in preschool or kindergarten

10%

of kids ages 1–2 are reported as victims of abuse or neglect

64%

of third graders do not read at grade level

Let’s put California’s money where our heart is. Prioritize funding for early childhood, so all of California’s kids can thrive.

2020

COMBINED FIRST 5 COUNTY REVENUES FOR CHILDREN'S SERVICES

2018

Source: KidsData.org, San Bernardino County Indicators Report 2017, First 5 San Bernardino Local Outcomes Report 2015-2016, First 5 San Bernardino Strategic Plan 2015-2020, First 5 San Bernardino Budget Book 2017-2018

www.first5sanbernardino.org


“

First 5 San Bernardino seems to get more strategic and streamlined in very passing year. The commitment to families and children, by supporting high performing organizations and expecting excellence from those working to improve lives of children. -Funded Agency

2017


2016-2017

Local Outcomes Report


Convener, Collaborator, Contributor: Building Systems to Achieve Impact Since its inception in 1998, First 5 San Bernardino (F5SB) has sought to secure better outcomes for children age 0 to 5 and their families by funding programs to provide concrete services with immediate outcomes, such as access to health care, high quality early care and education, and family supports. While this approach has succeeded in reaching thousands of children and families across the county, a changing fiscal landscape1 required strategic thinking about how to maximize its resources to create lasting effect. In order to build sustainable services and achieve long-term impact,

F5SB has adopted a systems approach2. The shift to systems was reflected in the Children and Families Commission’s 2015-2020 Strategic Plan in Strategic Priority Area 2, but it really began to take shape in Fiscal year 2016-2017. F5SB’s systems approach moves beyond funding programs and signals that F5SB aims to be a significant leader in the system of care surrounding Early Care and Education, Child Health and Family Resiliency - not only as a financial resource but as a backbone organization working to strengthen systems through collaboration and collective impact.

As the 20th anniversary of the passage of proposition 10 approaches in 2018, First 5 San Bernardino is embracing their leadership role in efforts to strengthen, coordinate and improve systems of care for the youngest residents of San Bernardino County and their families.

Our Investments with a Systems Component SART/EIIS Autism Assessment Center of Excellence Children’s Network Children’s Fund 2-1-1 B.O.N.U.S (Lactation Support) Oral Health Action Coalition-Inland Empire Family and Community Support Programs (Parenting Education and Case Management)

Funders that commit 25% or more of their funding to systems change strategies have the highest impact. -National Committee for Responsive Philanthropy

Career Online High School Quality Start San Bernardino

(Early Care and Education Quality Improvement System)

2016-2017 marked the most robust year of intentional systems work in F5SB’s history. This Brief reflects this shift, devoting substantial space to two of F5SB’s most substantial systems initiatives: Oral Health Action Coalition Inland Empire and Quality Start San Bernardino – and framing their programmatic work in a systems lens. 1 2

1

Proposition 10 funds are decreasing at a rate of about 3% per year due to reduced use of tobacco products Putnam-Walkerly, Kris. (2017). The Role of Philanthropy in Systems Change. Findings and Lesson from a Field Scan of Systems Change and Policy Advocacy in the Philanthropic Field. Retrieved from https://www.issuelab.org/resource/the-role-of-philanthropy-in-systems-change.html November 2017.


Systems Contributor First 5 San Bernardino is working with multiple partners to strengthen linkages, connections, infrastructure and intervention scale. The systems investments highlighted here involve multiple partners working across sectors for countywide and regional impact.

Oral Health Action Coalition Led by the Center for Oral Health, the Oral Health Action Coalition – Inland Empire (OHAC-IE) launched in October 2014 as an effort to mobilize and organize local resources to improve oral health of vulnerable populations in the Inland Empire. It is composed of 30 organizations representing a wide array of diverse oral

health stakeholders – including dental and health care providers, hospitals and medical centers, universities, nonprofit organizations, and government agencies. The coalition convenes regularly for peer-to-peer learning and to leverage resources to collectively impact oral health programs and policies in the region.

San Bernardino County families and children face significant barriers in accessing affordable dental care.3, 4

68%

of pregnant women did not have a dental visit or receive a dental service during pregnancy. Lower than state percentage of 58%.

Nearly 50%

19.3%

of all 0-3-year-old Denti-Cal beneficiaries in the region received a preventive dental visit.

of parents with 0-3 year-old children thought that their child was not old enough for a dental visit.

2016-2017 OHAC-IE Accomplishments Status of Oral Health in Inland Empire, 2016-2017 Comprehensive baseline analysis of the status of oral health in Inland Empire.

Provider webinar, led by Dr. Susan Fisher-Owens, on the importance of oral health in pediatric age and incorporating the use of oral health screening into the primary care practice.

Data will be used to develop policy briefs, fact sheets and infographics; disseminate information to policy makers and communities through town hall meetings; and facilitate the establishment of a stakeholder-driven oral health surveillance system for the region.

This webinar was attended by approximately: attendees Attendees included dental providers, primary care providers, and healthcare administrators.

30

Quality Start San Bernardino

40

In 2016-2017, First 5 San Bernardino launched the implementation of the county’s first formal Quality Rating and Improvement System (QRIS); Quality Start San Bernardino. This collaborative effort is charged with strengthening the quality of the early childhood education system county wide. Partners include Child Care Resource Center, California State University San Bernardino, San Bernardino County Superintendent of Schools, and San Bernardino County Preschool Services Department. Together, QSSB leaders accessed funding from four different grants offered by First 5 California and The California Department of Education totaling $5,581,115 for fiscal year 2016-2017.

30

3 4

Sites Rated in Quality Start San Bernardino, 2016-2017

37

Number of Sites

35

Center-based

25

Family Child Care

20

13

15 10

8

8

5 0

Rising Quality

Quality

6 Quality Plus

4 Highest Quality

QSSB providers, who are rated, receive a rating of 1 (Emerging Quality) to 5 (Highest Quality). Sites that are not rated receive quality improvement services until such time that they can be rated. In 2017, there were 117sites participating in QRIS in San Bernardino County. Of those, 76 sites received a quality rating and another 39 received quality improvement services. Participating sites are rated every two years and receive support and incentives to gain and maintain the highest ratings.

Center for Oral Health (2017). Status of Oral Health in the Inland Empire, 2016-17. Center for Oral Health, Oral Health Action Coalition: Inland Empire. (2015). Current Oral Health Landscape in San Bernardino County, 2015.

2


Impactful Programs to Strengthen Systems High quality programs are important systems components, and First 5 San Bernardino continues its history of financial support to nonprofit and public agency partners to develop and scale highperforming programs and services.

In 2016-2017 First 5 San Bernardino-funded initiatives served:

29% 74% 86%

6,211

children ages 0 to 5

2,025

parents

did not have a high school diploma have incomes that fall below the federal poverty guideline have extremely low incomes5

Perinatal Substance Abuse Services Statewide, 2.5% of women reported smoking in the last three months of pregnancy and 1 in 5 (20.9%) women reported drinking alcohol during the first or third trimester6. Prenatal substance abuse results in harmful consequences for both the mother and baby, including miscarriage, stillbirth and infant mortality, physical birth defects, problems with delivery, and neurological damage7. With support from First 5 San Bernardino, Nurses from the Department of Public Health partner with local obstetricians to ensure all pregnant women in San Bernardino County are screened for drug, alcohol, and tobacco use. Women who are identified as needing treatment are provided with a referral to appropriate services depending on the severity of use, including supportive counseling, outpatient/inpatient treatment programs, and home visits from public health nurses. In 2016-2017, healthcare providers in the county screened:

7,294

...and delivered intensive case management services for:

women

291

at-risk expectant mothers

Program Outcomes: Out of the 122 women who reported smoking cigarettes, 72 reduced the number of cigarettes they smoked or stopped smoking entirely.

122

72

out of

women who reported consuming alcohol stopped drinking entirely.

31

28

Out of the 20 women who reported using hard drugs, 17 stopped using hard drugs entirely.

20

17

Estimated using self-reported income and family size against San Bernardino County Area Median Income (AMI) guidelines http://www.hcd.ca.gov/grants-funding/in come-limits/state-and-federal-income-limits/docs/inc2k17.pdf 6 California Health Care Foundation (June 2016). California Health Care Almanac, Maternity Care in California: Delivering the Data. http://www.chcf.org/~/media/MEDIA%20 LIBRARY%20Files/PDF/PDF%20M/PDF%20MaternityCareCalifornia2016.pdf 7 Forray, A. (2016). Substance use during pregnancy. F1000Research, 5, F1000 Faculty Rev–887. http://doi.org/10.12688/f1000research.7645.1 5

3

16 / 16

Out of the 31 women who reported using marijuana, 28 stopped using marijuana entirely.


Screening, Assessment, Referral and Treatment (SART) & Early Identification and Intervention Services (EIIS)

SART and EIIS comprise DBH’s 0-5 Comprehensive Treatment Services. SART centers serve children experiencing social, physical, cognitive, behavioral, developmental, and/or psychological issues. It is an intensive program that includes screening, assessment, referral, and treatment by clinicians, pediatricians, public health nurses, occupational therapists, speech and language therapists, and pediatric neuropsychologists. EIIS provides specialty mental health and attachment enrichment services to children at risk for manifesting social, cognitive, emotional, behavioral, and/or developmental problems. These programs were primarily funded by Medi-Cal and Early Periodic Screening Diagnosis & Treat dollars but were supported by First 5 San Bernardino to fund elements that are not billable to those funding streams such as speech and language and occupational therapies, among others.

In 2016-20178, a total of

3,039

887

children children were served through SART were served through EIIS

A 24% increase from the previous year

The impacts of these programs on the three most common issues (identified using the Child and Adolescent Needs and Strengths (CANS) Comprehensive Assessment Children) are displayed in Exhibit 1 and Exhibit 29: Exhibit 1. SART Number* of Children Experiencing Specific Issues at Intake and Discharge Issue Areas At Intake At Discharge Affect Dysregulation (ability to regulate emotional expression, such as calming down after getting upset)

2,055

831

Social Functioning (social relationships)

1,886

731

Regulatory Problems (irritability, sleep habits, predictability of sucking/feeding, activity level/intensity)

1,870

815

*numbers estimated from percentages and total number of children served provided by DBH

Exhibit 2. EIIS Number* of Children Experiencing Specific Issues at Intake and Discharge Issue Areas

At Intake At Discharge

Affect Dysregulation (ability to regulate emotional expression, such as calming down after getting upset)

642

259

Anger Control (manage anger and frustration tolerance)

514

235

Social Functioning (social relationships)

505

242

*numbers estimated from percentages and total number of children served provided by DBH Per San Bernardino County Department of Behavioral Health Fiscal Year 2016-2017 Report-0-5 Comprehensive Treatment Services CANS is a standardized assessment tool implemented countywide. It organizes clinical information collected during a behavioral health assessment in a consistent manner to improve communication among those involved in planning care for a child.

8

9

4


Family and Community Support and Partnerships First 5 San Bernardino invests in critical parent education services to ensure families are safe, healthy, and nurturing. Parents who completed the Nurturing Parenting Program, coupled with case management using the Family Development Matrix (FDM) showed a statistically significant increase in knowledge and behaviors related to positive parenting practices that help protect against abuse and neglect. The overall objective of this initiative is to build, over a five year period, an evidence based system of care that can be replicated for access to all parents in San Bernardino County.

Case Management

In 2016-17, the five most frequent needs reported by families using case management services included: 10

Families showed substantial progress throughout their participation in case management. Families who entered case management unable to meet needs in these domains were far better equipped to meet these same needs by the end of the program. While the percent of families meeting adult education goals was relatively smaller, making progress on this goal required adults to enroll in coursework and/ or to have completed a GED or high school diploma, which will contribute to the long-term financial stability of these families.

In 2016-2017...

340

scored in the high risk range on one or more of the five subscales (also known as constructs) of the Adult Adolescent Parenting Inventory (AAPI 2.0 and AAPI 2.1) at program entry 11.

338

...moved from high to moderate or low risk on one or more of the five AAPI subscales, thereby reducing their children’s likelihood of experiencing maltreatment by the end of the program.

parents

Parenting Education Exhibit 4 shows the number and percent of parents who showed decreased risk. For example, all 120 parents who entered the program with highest levels of increased their understanding of ageappropriate child behaviors. 12

= =

parents

= =

= =

=

Needs were identified by considering the percent of families that scored 1 or 2 at program entry. Each item on the FDM is rated on a 1-4 scale where a score of 1 or 2 indicates a client is ‘in crisis’ or ‘at risk’ and a score of 3 or 4 indicates they are ‘stable’ or ‘self-sufficient’ 11 https://www.assessingparenting.com/assessment/aapi 12 Adult-Adolescent Parenting Inventory 2.0 and 2.1 10

5

=


Developmental Screening (ASQ-3) Screening children for developmental delays with tools Therefore, the American Academy of Pediatrics like the Ages and Stages Questionnaire (ASQ-3) can recommends that all infants and young children are help parents, caregivers, physicians, and educators screened for developmental delays13. The ASQ-3 allows understand their child’s needs and create plans for caregivers and providers to assess children in the areas intervention, if needed. Such screening is especially of Communication, Fine Motor Skills, Gross Motor Skills, crucial early in life when risks of delay can be identified Personal-Social Interactions, and Problem Solving and before major developmental milestones are missed. to identify children at-risk of delay. First 5 San Bernardino-funded organizations conducted: Overall

753

developmental screenings of children aged 0 to 5 using the ASQ-3

13.9%

,

--------- or ---------

105 children

of those screened – were identified as at risk of developmental delay, including 45 at risk in more than one domain.

Longitudinal studies have demonstrated long-term benefits of early intervention for children showing signs of delay at a young age, including an increased likelihood to graduate from high school, maintain employment, and live independently.

Combining academic, social, and economic benefits, $30,000 to $100,000 two years of early intervention before a child starts 13 kindergarten is estimated to save society between: per child

Asthma Education and Management There are 96,550 new cases of children with asthma reported each year in California and 17% of all San Bernardino County children have an asthma diagnosis15. The annual total costs associated with childhood asthma are $693 million.16 Serious and costly asthma outcomes (e.g. emergency room [ER] visits, hospitalizations, and even death) are preventable with access to care, medication and parent education.17 Asthma-related hospitalization for children remains higher in San Bernardino County than neighboring counties. Exhibit 4. Asthma-related Hospitalization Rates by County

County

Asthma-related Hospitalizations

per 10,000 infants /children: San Bernardino Los Angeles San Diego Riverside Orange

20.3 20.0 19.7 14.4 13.8

First 5 San Bernardino supports asthma treatment and education to help ensure families are equipped to manage their children’s asthma and reduce asthma-related hospitalizations. Funded services include a mobile asthma clinic (Arrowhead Regional Medical Center’s Breathmobile) and a home visitation program (American Lung Association).

Among participants: 66 families developed an action plan for their home 55 parents were able to gain control over their child’s asthma On average, children served gained almost six symptom-free days per month Children visited Urgent Care or the ER 47 fewer times after being

served than they did in the six months before service Children admitted overnight to the hospital in the previous six months decreased from:

7 to 1

----- or -----

86%

This represents an estimated:16,17

$202,494 cost avoidance

American Academy of Pediatrics, Committee on Children with Disabilities (2001). Developmental Surveillance and Screening of Infants and Young Children. http://pediatrics.aappublications.org/content/108/1/192.full Glasgoe FP (2000) Early Detection of Developmental and Behavioral Problems. Pediatrics in Review, 21(8):272-280. 15 Kidsdata.org. (2017). Asthma Diagnoses. http://www.kidsdata.org/topic/238/asthma/table 16 The average cost per asthma hospitalization in 2010 was $33,749. 17 CaliforniaBreathing.org. (2014) Asthma’s Impact on California Fact sheet. 13

14

6


First 5 San Bernardino Commission Maxwell Ohikhuare, M.D., Chair Public Health Officer County of San Bernardino Elliot Weinstein, M.D., Vice Chair Physician/Pediatrician James Ramos Third District Supervisor County of San Bernardino CaSonya Thomas Assistant Executive Officer Human Services County of San Bernardino Margaret Hill, D.Ed. School Board Member San Bernardino Unified School District J. Paul Vargas School Board and Founding Member Oxford Preparatory Academy Charter Schools Alan H. Garrett President & CEO St. Mary Medical Center

Executive Director Karen E. Scott


“

First 5 has learned to listen to the community and expand its knowledge of the community, taking into consideration its diversity and the assets of the community. -Funded Agency

2016


2015 2016

Local Outcomes Report


Demographics In 2015-2016 First 5 San Bernardino funded initiatives served:

Geographics 1,000+

8,738 children ages 0-5

10%

of parents did not have a High School diploma

79% parents have incomes that fall below the federal poverty guidelines

83% of parents have extremely low incomes based on San Bernardino County Area Median Income (AMI) guidelines

1,899

San Bernardino Fontana Victorville

600+

Ontario Rialto

400+

Chino Hesperia

300+

Barstow Colton

200+

Adelanto Highland Rancho Cucamonga Redlands Upland

100+

Yucca Valley Crestline Bloomington Twentynine Palms Big Bear City Yucaipa Montclair

parents

62 San Bernardino County cities & unincorporated areas served


Family and Community Support and Partnerships Child abuse and neglect can have deep and long lasting effects on physical and emotional health throughout a person’s lifetime. The Center for Disease Control estimates that the total lifetime financial costs associated with just one year of confirmed cases of child maltreatment in the United States is estimated to be $124 billion, and that the lifetime estimated cost for each surviving victim of child maltreatment is $210,012.

395

Parents entered the parent education program scoring in the high risk range on one or more of the five subscales of the AAPI assessment.

First 5 San Bernardino invests in critical parent education services to ensure families are safe, healthy, and nurturing. Parents who completed the Nurturing Parents parenting program showed a statistically significant increase in knowledge and behaviors related to positive parenting practices that help protect against abuse and neglect.

382

96.5% Empathy towards children’s needs 221/229

Out of 395 parents moved from high to moderate or low risk on one or more constructs of the AAPI assessment by the end of the program, thereby reducing their children’s likelihood of experiencing maltreatment.

Number and % of Parents who Moved from High Risk to Medium or Low Risk by AAPI Domain

220

95.3%

210

94.9% Number of parents

Expectations of Children 130/137

130 120

92.6% 96.3%

Child’s power and independence 141/148

Parent-child role responsibilities 126/136

Use of corporal punishment as a means of discipline 104/108

110

2


Nurturing Parenting Program In 2015-16, to complement the Nurturing Parenting program, First 5 San Bernardino invested in capacity strengthening of funded agencies to provide focused, strengths-based skills building support and case management by implementing the Family Development Matrix (FDM). The FDM provides insights into families’ needs that support case planning and can be used to assess progress towards goals. Principally, the goal of the FDM is to strengthen case management systems countywide.

The five most frequent needs reported by families using case management services included 1: Community Resources Knowledge

317

41 at entrance

at exit

Employment

63 at exit

238 at entrance

Social Interactions

3

206

at exit

at entrance

Adult Education

70 at exit

187 at entrance

Basic Household Necessities

28 at exit

169 at entrance

When asked about their knowledge and use of community programs, 317 parents said they either had no knowledge of community resources or had only some knowledge of community resources. Upon entrance, 238 parents said they were either unemployed and have difficulty getting a job or they experience difficulty keeping a job once hired. When asked about their social interactions with family, friends, and neighbors, 206 said either their family does not have social ties with other people (including family) or their family has some social ties with others (mostly with family). Of all parents responding at baseline, 187 either did not have a high school diploma/GED and did not plan on obtaining one or did not have a high school diploma/GED but were planning on obtaining one. When asked about their ability to provide for their family’s basic needs, 169 said they were either not able to maintain basic needs for their family or they had limited ability to maintain basic needs for their family, even with public assistance.

Families showed substantial progress throughout their participation in case management. On average, most families who entered case management unable to meet needs in these domains were far better equipped to meet these same needs by the end of the program. While the percent of families meeting adult education goals was relatively smaller, making progress on this goal required adults to enroll in coursework and/or to have completed a GED or high school diploma, which will contribute to the long-term financial stability of these families.

Needs were identified by considering the percent of families that scored 1 or 2 at program entry. Each item on the FDM is rated on a 1-4 scale where a score of 1 or 2 indicates a client is ‘in crisis’ or ‘at risk’ and a score of 3 or 4 indicates they are ‘stable’ or ‘self-sufficient’

1

3


Early Learning Preschool and Pre-K Children’s school readiness is a strong predictor of future academic and life success. Children with higher levels of school readiness are more successful in grade school, less likely to drop out of high school, and earn higher incomes as adults.2 Access to high-quality educational opportunities, such as preschool and Pre-K academies, ensure young children enter school ready to learn. First 5 San Bernardino addressed this need through quality preschool opportunities to ensure children entered school ready to learn.

Full Day Preschools

318

children were provided with a full day, year-round preschool education.

On average, each child attended

147

days

Pre-K Academies

596

children were provided with a yearround preschool experience who otherwise would not have received any preschool education before entering kindergarten. Collective days of preschool experienced by children in First 5 San Bernardino funded programs:

On average, each child attended

113

days

113,919 days

Outlook

36%

of San Bernardino County 3-and 4-year olds attended preschools.3

52%

of Los Angeles County 3-and 4-year olds attended preschools.

50%

of Orange County 3-and 4-year olds attended preschools.

47%

of Californian 3-and 4-year olds attended preschools.

2 Duncan, G., Ziol‐Guest, K., & Kalil, A. (2010). Early‐Childhood Poverty and Adult Attainment, Behavior, and Health. Child development, 81(1), 306-325. 3 CH1LDREN NOW (2016). 2016-17 California County Scorecard.

4


Parent Enrichment Parents play a critical role in preparing children for school. Research shows that parents do a better job of supporting their children when they understand the process of child development and know which activities prepare children for school.4 First 5 San Bernardinofunded preschool programs provided enrichment sessions for parents alongside the preschool experiences for children. These sessions were designed to increase parents’ knowledge of child development and awareness of activities that will support their child’s success. Pre-and post-program assessments show that parents increased their knowledge of child development, feel more confident about their ability to support their child’s development and more frequently engaged in activities shown to support school readiness as a result of participating in parent enrichment programs.

Parents who reported an increase in the following behaviors: 235

192

234

312 312 /537

328

269

170

Take child to a library

Take child to activities outside the home

Child played with same-age children

Read aloud to child

Tell child stories

Practice alphabet

Ask child what is in picture

/560

/295

/255

/517

/419

/327

234

68

141

56

234

332

Play games with child

Eat with child

Follow bedtime routine

Hold or cuddle child

Practice counting numbers

Play rhyming games

/88

/391

/186

/65

/364

/533

187

187

364

220

105

198

Discuss book topic with child

Track words with finger as read to child

Practice name writing

Sing songs with child

Hold book upright in child’s view

Point out letters and/or words

/331

/331

/539

/332

/164

/400

Number of parents who reported an increase in their assessment of their own skills:

5

4

235

235

249

163

185

143

143

151

79

Knowledge of how child is growing and developing

Knowing of what behavior is typical at this age

Knowledge of how child’s brain is growing and developing

Confidence in self as parent

Confidence in setting limits for child

Confidence to help child learn at this age

Ability to identify what child needs

Ability to respond effectively when child is upset

Ability to keep child safe and healthy

Ackerman, D., & Barnett, W. (2011). Prepared for Kindergarten: What does “readiness” mean?. National Institute for Early Education Research, Preschool Policy Facts.


Family Literacy Literacy and language development are also critical to school readiness. Children who are read to regularly have improved early literacy skills, are better readers in elementary school, and are more likely to succeed in school.5 Early literacy is a strong predictor of children’s reading abilities through grade school and beyond.

First 5 San Bernardino’s Family Literacy programs aimed to increase awareness of the importance of developing literacy skills at an early age by implementing curriculums throughout the county to encourage and enhance family literacy development. As a result parents more frequently engaged the following literacy activities.

Number of books read

149

Number of books in the home

85

Participate in reading activities outside the home

176

Buy/rent books for children

146

Read together

143

Followed a reading routine

139

Practiced the alphabet

159

Sang songs

121

Played rhyming games/recited rhymes

196

Hold the book upright in child’s view

89

Track words with finger, reading from left to right

155

Point out letters and/or words

178

Make up stories based on pictures of the book

185

Ask their child to tell them what’s going on in the picture

150

Ask their child questions when reading

164

Discuss the topic of the book with their child

174

Child’s overall interest in books Child’s overall interest in reading Number of parents who, due to their participation in the program, indicated an increase in their/ their child’s interest, knowledge, ability, or confidence in the following activities:

Parent’s involvement in helping their child to read Parent’s ability to be a reading role model Parent’s ability to become story tellers Parent’s ability to develop a reading routine Child’s overall interest in the alphabet Parent’s ability to pick an age appropriate book for their children Parent’s involvement in helping their child to write Parent’s knowledge of where to buy/rent books for their children

5

Rhode Island KIDS COUNT (2005). Getting Ready: Findings from the National School Readiness Indicators Initiative, a 17 State Partnership.

368 366 364 361 358 351 351 348 346 317


Health Developmental Screening Early identification and intervention of developmental delays has demonstrated cost savings to health care and education systems and increases children’s success. First 5 San Bernardino provides training and support to their funded contractors to conduct developmental screenings with their clients to increase detection of delays and increase opportunities for early intervention. Outlook California ranks 30th in the nation for the rate of developmental screenings conducted with young children 30% of children are at moderateto high-risk for developmental delay

40% of parents with children under the age of 6 have concerns about their child’s development6

The ASQ-3 allows caregivers and service providers to identify children at risk for developmental delays by observing their everyday activities, such as playing, drawing and throwing a ball.

In 2015-2016

First 5 funded contractors conducted

2,329

ASQ-3 developmental screenings of children ages 0-5

ASQ-3’s identify children at risk of delay and includes assessments of 5 developmental domains: Communication Gross Motor Skills Fine Motor Skills Problem Solving Personal-Social Interactions

First 5 Association of CA. A Healthy Beginning for Young California Kids: Universal Developmental & Behavioral Screenings. Retrieved from: https://www.childrennow.org/files/9314/2912/4344/ dev-screening-infographic.pdf 11/23/16.

6

7


Out of 2,329 screenings

432

18% of 2,329

children were identified at risk

162

children were at-risk with more than one domain

If 75% of 432 children (n=324) had not received a screening elsewhere, it would have cost between $9.72 - $32.4 million7 If 50% of 432 children (n=216) had not received a screening elsewhere, it would have cost between $6.48 - $21.6 million7

75% 50% 25%

If 25% of 432 children (n=108) had not received a screening elsewhere, it would have cost between $3.24 - $10.8 million7

Pinto-Martin JA, Dunkle M, Earls M, Fliedner D, Landes C (2005) Developmental Stages of Developmental Screening: Steps to Implementation of a Successful Program. American Journal of Public Health, 95(11):1928-1932.

7


Perinatal Screening, Assessment, Referral, and Treatment (PSART) With support from First 5 San Bernardino, the Department of Public Health partners with local obstetricians to ensure all pregnant women in San Bernardino County are screened for drug, alcohol, and tobacco use. Women who are identified as needing treatment are provided with a referral to appropriate services depending on the severity of use, including supportive counseling, home visits from public health nurses, outpatient and inpatient treatment programs.

In 2015-2016

health care providers screened

the number of women reported consuming hard drugs in the last month:

18

22 stopped using hard drugs entirely

8,439 women

the number of women reported using marijuana in the last month:

19

21

stopped using marijuana entirely

and delivered intensive services for... the number of women reported drinking alcohol in the last month:

20

219

21 stopped drinking entirely

at-risk expectant mothers.

71

reported smoking tobacco in the last month

19

11

stopped smoking entirely

reduced the number of cigarettes they smoked

While the number of women impacted by these services may appear small, the potential savings— in terms of life, quality of life, and cost avoidance to society—are potentially very large. Use of illicit drugs during pregnancy can lead to premature births, low birth weight, externalizing behavioral problems (aggression, attention-deficit/hyperactivity disorder, and oppositional defiant disorder), risk-taking behaviors, visualmotor impairments, memory and perceptual problems.8

The lifetime cost associated with caring for a child with a complex medical history due to prenatal exposure to drugs ranges from:

$750,000 to $1.4 million9

Tobacco use during pregnancy has been associated with an increased risk of premature delivery, low birth weight, and sudden infant death syndrome (SIDS).13 It is estimated that 23.2%–33.6% of SIDS death can be attributed to prenatal smoking.14 Applying the above mentioned estimate to the number of women who stopped smoking entirely:

Prenatal alcohol consumption has been associated with fetal alcohol syndrome (FAS), spontaneous abortion, premature births, and low birth weight.10 The estimated total cost attributed to drinking while pregnant was $5.2 billion in 2006, with 95.3% of this cost being related to FAS.11 FAS is 100% preventable if a woman does not drink alcohol during her pregnancy. 12

$2.9 million

For every FAS case prevented, there is a potential total lifetime (in 2002 dollars) cost saving of:

PSART Screening and referral to appropriate services potentially prevented

4 to 6 SIDS deaths


Asthma Outlook 96,550 new cases of asthma reported each year in California15 San Bernardino ranks second highest of Southern California counties for asthmarelated hospitalizations for children ages 0-416 and sixth in the state for the rate of emergency department visits17 Approximately 129,000 children with current asthma in California miss school or day care because of their asthma resulting in 1.2 million days of school/ day care missed per year.18

Asthma is not only harmful to children’s health, but also costly: the average cost per asthma hospitalization in 2010 was

First 5 San Bernardino supports asthma treatment and education to help ensure families are equipped to manage their children’s asthma and reduce asthmarelated hospitalizations. Funded services include a mobile asthma clinic (ARMC’s Breathmobile) and home visitation through the American Lung Association. Among children and parents participants:

36

4

$33,749

Ross EJ, Graham DL, Money KM, and Stanwood GD (2015) Developmental consequences of fetal exposure to drugs: what we know and what we still must learn. Neuropsychopharmacology, 40:61–87. 9 Kalotra, C. J. (2002, March). Estimated costs related to the birth of a drug and/ or alcohol exposed baby. Washington, DC: Office of Justice Programs Drug Court Clearinghouse and Technical Assistance Project. 10 Bouchery, E., Harwood, H., Sacks, J., et al. (2006). Economic costs of excessive alcohol consumption in the U.S. American Journal of Preventive Medicine, 41(5):516–524. 11 NIH (2013). Fetal Alcohol Exposure Factsheet. 12 HHS (2009). A call to action: advancing essential services and research on fetal spectrum disorders.

10

fewer parents missed one or more days of work

symptom-free days were gained for children

Children admitted overnight to the hospital in the previous 4-6 months decreased by 50% (from 12 to 6) among children served by First 5 San Bernardino asthma programs. The estimated cost avoidance based on 2010 data is:

$202,494

19

8

parents gained control of their child’s asthma

Pollack, H., Lantz, P.M., & Frohna, J.G. (2000) Maternal smoking and adverse birth outcomes among singletons and twins. American Journal of Public Health, 90(3), 395-400. 14 Dietz, P.M., England, L.J., Shapiro-Mendoza, C.K., et al (2010). Infant morbidity and mortality attributable to prenatal smoking. U.S. American Journal of Preventive Medicine,39, 45–52. 15 Kidsdata.org. (2014) Asthma Hospitalizations, by Age Group. 16 CaliforniaBreathing.org. (2014). Asthma ED Visits, Children, 2014. 17 CaliforniaBreathing.org. (2014). Asthma ED Visits, Children, 2014. 19 CaliforniaBreathing.org. (2014) Asthma’s Impact on California Fact sheet. 13

10


Systems and Networks Oral Health Action Coalition Led by the Center for Oral Health, the Oral Health Action Coalition – Inland Empire (OHAC-IE) launched in October 2014 as an effort to mobilize and organize local resources to increase access to oral health care and improve oral health outcomes. The coalition has grown to include over 45 organizations,

representing a wide array of diverse oral health stakeholders including clinic consortia, hygiene and dental providers, dental schools, children’s organizations, hospitals and medical centers, public health departments, children’s dental programs, and advocacy organizations.

San Bernardino county residents face 3 significant barriers in accessing affordable dental care: A shortage of dental providers

Low rates of dental care utilization

25%

18.6%

of children aged 2-11 in San Bernardino County have not visited a dentist, dental hygienist or dental clinic within the past year.

of residents compared to

18.5%

in California.20

1

of children aged 2-11

793

compared to

30.5% in California.

25%

21

of adults 18 & older

licensed dentists

1,900 people statewide

21 1

of the licensed dentists in San Bernardino County accept Denti-Cal22

Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System, 2006-2010. 21 Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System, 2006-2010. 22 Center for Oral Health, Oral Health Action Coalition: Inland Empire (2015). Current

11

dentist for every

In San Bernardino County there are only

Limited access to affordable dental care

20

1

dentist for every

2,643 people countywide

35.7%

of adults 18 & older in San Bernardino County have not visited a dentist, dental hygienist or dental clinic within the past year.

live in Dental Health Professional Shortage Area (HPSA), which is an area with too few health professionals to meet the needs of the population.23

of which are

pediatric dentists

24

pediatric dentist for every

27,547 children

Oral Health Landscape in San Bernardino County, 2015. U.S. Department of Health & Human Services (2016). Health Resources and Services Administration (HRSA), 2016. 24 Center for Oral Health, Oral Health Action Coalition: Inland Empire. (2015). Current Oral Health Landscape in San Bernardino County, 2015. 23


Timeline March 2016 OHAC-IE Launches

July 2015 First Coalition Meetings

November 2014 First 5 Supports the coalition

October 2014 OHAC-IE hosts statewide Share and Learn Symposium Over 70 representatives from oral health coalitions from across the state gathered to discuss access to oral health resources, workforce development, and systems integration Health care providers, policy makers, and stakeholders shared best practices and resources. Representatives from local oral health coalitions included Los Angeles, the Inland Empire, San Diego, Santa Barbara-Ventura, San Luis Obispo, Alameda County, and Sonoma. The coalition has four sub-committees aiming to address these challenges at a systems level. The sub-committees are working on the following focus areas:

Advocacy Public Awareness and Communications Direct Services Data and Surveillance


Screening Assessment Referral and Treatment and Early Identification and Intervention Services First 5 San Bernardino has provided financial support to the Department of Behavioral Health since 2013 to provide comprehensive Screen, Assessment, Referral, and Treatment (SART) along with less intensive Early Identification and Intervention Services (EIIS) in partnership with community-based providers to ensure all children have access to appropriate early intervention services for children in San Bernardino County. This is a prime example of how First 5 San Bernardino is taking a systems change approach by leveraging resources with other county departments and service providers in order to pull down additional federal funding, scale best practices and implement innovative solutions across the county.

SART SART centers serve children (many of whom have been exposed to abuse, neglect, and/or substances in utero) experiencing social, physical, cognitive, behavioral, developmental, and/or psychological issues. It is an intensive program that includes screening, assessment, referral, and treatment by clinicians, pediatricians, public health nurses, occupational therapists, speech and language therapists, and pediatric neuropsychologists.

2,443

children

were served through SART in FY15-16

SART provides intensive treatment, on average

2.7 5.8 201

hours per week for the initial 12 weeks days between treatment services days in program

EIIS EIIS serves a similar, but less severe population than the SART population. It focuses on providing specialty mental health and attachment enrichment services to children at risk for manifesting social, cognitive, emotional, behavioral, and/or developmental problems.

889

children

were served through EIIS in FY15-16

13

EIIS provides intensive treatment, on average

2.0 6.4 110

hours per week for the initial 12 weeks days between treatment services days in program


The majority of children served through SART and EIIS need support related to their everyday functioning (for example motor skills, communication, family, Medical, Sleep) or experiences (e.g., Maternal Availability, Empathy for Child). The impacts on the five most common issues (identified using the Child and Adolescent Needs and Strengths (CANS) Comprehensive Assessment Children) are displayed below:25

SART Issue Areas

# At Intake

# At Discharge

Affect Dysregulation

(ability to regulate emotional expression, such calming down after getting upset)

1,637

562

1,515

611

1,344

489

1,075

366

1,075

708

Regulatory Problems

(irritability, sleep habits, predictability of sucking/feeding, activity level/intensity)

Adjustment to Trauma

(reaction to any of a variety of traumatic experiences, such as emotional, physical, or sexual abuse, separation from family members, witnessing violence, etc.)

Anger Control

(manage anger and frustration tolerance)

Communication (verbal and non-verbal)

EIIS Issue Areas

# At Intake

# At Discharge

Affect Dysregulation

(ability to regulate emotional expression, such calming down after getting upset)

560

222

462

160

453

240

400

142

356

204

Anger Control

(manage anger and frustration tolerance)

Regulatory Problems

(irritability, sleep habits, predictability of sucking/feeding, activity level/intensity)

Oppositional

(defiance toward authority figures)

Impulsivity/Hyperactivity

(impulsive, distractible, or hyperactive behavior that interferes with the child’s ability to function)

*numbers estimated from percentages and total number of children served provided by DBH

CANS is standardized assessment tool implemented countywide. It organizes clinical information collected during a behavioral health assessment in a consistent manner to improve communication among those involved in planning care for a child. 26


First 5 San Bernardino Commission Linda Haugan, Chair Assistant Executive Officer Human Services County of San Bernardino Maxwell Ohikhuare, M.D., Vice Chair Public Health Officer County of San Bernardino Josie Gonzales Fifth District Supervisor County of San Bernardino Elliot Weinstein, M.D. Physician/Pediatrician Margaret Hill, D.Ed. School Board Member San Bernardino Unified School District J. Paul Vargas School Board and Founding Member Oxford Preparatory Academy Charter Schools Stacy Iverson President & Chief Executive Officer Children’s Fund Executive Director Karen E. Scott


“

We’ve noticed growth in the systems approach to collaboration with other childserving agencies from First 5 San Bernardino. The success of seamless evolving systems and collaboration supports families with children in our county. -Collaborative Partner

2015


2014 2015

Local Outcomes Report


Demographics in 2014-2015

8,136

children ages 0-5 were served

3,590

parents were served

26% 64% did not have a high school diploma

parent characteristics:

have incomes that fall below the poverty line

Children and families served mostly lived in... 1000+ 600+ 500+

400+

San Bernardino Ontario Victorville Fontana Rialto Chino Bloomington Redlands

200+

Barstow Colton Rancho Cucamonga Montclair Needles Yucca Valley 100+ Apple Valley Highland

Number of clients served in ranges of 100 to 1,000 in descending order

Upland Hesperia Adelanto Big Bear City Chino Hills Crestline 29 Palms


Family Resource Center and Case Management San Bernardino County is showing signs of recovery from the 2008 Great Recession. Employment and wages have steadily increased, housing values are on the rise, and foreclosures and underwater mortgages continue to decline1. Despite these signs of recovery, high levels of need still exist, especially among families with young children.

San Bernardino County

Relative to surrounding counties, San Bernardino continues to experience higher unemployment (11.2%) and higher poverty rates among families with children. Among families with children, 23.6% live below the poverty line and 29.1% of children 0-5 live below the poverty line (29.1%)2. In response to these needs, First 5 San Bernardino supports resource centers and case management services that help families develop and maintain long-term self-sufficiency. In 2014-15, resource centers delivered ongoing case management services to 1,144 parents.

At entry, here is what parents needed the most: Access to Supportive Services Education & Employment Relationships with Children Relationships with Family and Friends

1 2

The Community Foundation (2015). San Bernardino County 2014 Community Indicators Report. 2014 American Community Survey (1-year estimates).

797 768 761 756


What happened during case management?

On average, parents were enrolled in case management for 16 weeks and received between four and five case management sessions.

413

336

significantly improved their ability to identify and access supportive resources

increased their understanding of their child’s development

136

who were previously unemployed were able to secure employment

27

enrolled in school to work toward their GED or High School Diploma

246 developed more nurturing relationships with their children

13

secured a GED or High School Diploma

Nurturing Parenting Program

718

parents completed the Nurturing Parenting Program

394

parents entered the parent education program scoring in the high risk range on one or more of the five subscales of the AAPI-25 3

4 5

352

Child abuse and neglect can have deep and long lasting effects on physical and emotional health throughout a person’s lifetime3. The Center for Disease Control estimates that the total lifetime financial costs associated with just one year of confirmed cases of child maltreatment in the United States is estimated to be $124 billion, and that the lifetime estimated cost for each surviving victim of child maltreatment is $210,012 (the costs of each death due to child maltreatment are even higher)4. First 5 San Bernardino invests in critical parent education services to ensure families are safe, healthy, and nurturing. Parents who completed the Nurturing Parents parenting program showed a statistically significant increase in knowledge and behaviors related to positive parenting that help protect against abuse and neglect.

parents moved from high to moderate or low risk on one or more subscales of the AAPI-2 by the end of the program, thereby reducing their children’s likelihood of experiencing maltreatment.

Felitti, V. J., & Anda, R. (2009). The relationship of adverse childhood experiences to adult medical disease, psychiatric disorders, and sexual behavior: Implications for healthcare. In R. Lanius, E. Vermetten, & C. Pain (Eds.), The Hidden Epidemic: The impact of early life trauma on health and disease. This estimate includes the costs of child health care, adult medical bills, productivity losses, and child welfare and criminal justice system involvement The AAPI-2 is an inventory designed to assess the parenting and child rearing attitudes of adolescents and adult parents. Responses to the inventory provide an index of risk for practicing behaviors known to be attributable to child abuse and neglect.


Education

Children’s school readiness is a strong predictor of future academic and life success. Children with higher levels of school readiness are more successful in grade school, less likely to drop out of high school, and earn higher incomes as adults6. Access to high-quality educational opportunities, such as preschool and Pre-K academies, ensure young children enter school ready to learn. San Bernardino County 3 + 4 year olds attending preschool7 in comparison:

49%

Orange County

53%

Los Angeles County

351

Statewide

37%

San Bernardino County

On average, each child attended

children were provided with a full day, year-round preschool education

Preschool

681 Pre-K Academy

47%

children who otherwise would have not received any preschool education before entering kindergarten were provided a year-round preschool experience through Pre-K Academies

107,836

149

days of schooling On average, each child attended

82

days of schooling

collective days of preschool experienced by children in First 5 San Bernardino funded programs

Improving school readiness by supporting parents Parents play a critical role in preparing children for school by shaping their social-emotional development, self-control, and cognition8. In 2012, First 5 San Bernardino launched the Pre-K Academy initiative to increase kindergarten readiness. Parent enrichment is an important part of this program. Enrichment sessions helped parents learn how to engage their children in developmentally appropriate school readiness activities shown to increase children’s school readiness. For example, 218 parents reported an increase in the number of times per week they read aloud with their child, one of strongest predictors of kindergarten readiness. Duncan, G., Ziol‐Guest, K., & Kalil, A. (2010). Early‐Childhood Poverty and Adult Attainment, Behavior, and Health. Child development, 81(1), 306-325. CH1LDREN NOW (2014). 2014- 15 California County Scorecard: San Bernardino County. 8 Ackerman, D., & Barnett, W. (2011). Prepared for Kindergarten: What does “readiness” mean?. National Institute for Early Education Research, Preschool Policy Facts. 6 7


Parents reported an increase in the number of days per week:

their child played with other children his/her age

289

they read aloud to their child

218

they told their child stories

213 they played games with their child

154

they ate with their child

they followed a bedtime routine

72

46

they held or cuddled their child

they practice counting

they practiced the alphabet

they practiced name writing

they played rhyming games

233

192

174

they sang songs with their child

168

146

33

Family Literacy

Literacy and language development are also critical to school readiness. Children who are read to regularly have improved early literacy skills, are better readers in elementary school, and are more likely to succeed in school9. Early literacy is also a strong predictor of children’s reading abilities through grade school and beyond. Third grade reading levels by comparison 10:

52%

Orange County

46%

45%

Statewide

Los Angeles County

39%

San Bernardino County

9 10

ed

rea s are nts

the number of times they participated in reading activities with their child

Rhode Island KIDS COUNT (2005). Getting Ready: Findings from the National School Readiness Indicators Initiative, a 17 State Partnership. CH1LDREN NOW (2014). 2014- 15 California County Scorecard

10

5p

ren ts pa

154

the number of books read with their child on a weekly basis

inc

rea s inc

cre s in ren t pa

168

As a result of family literacy programs:

ed

ase d

First 5 San Bernardino’s Family Literacy programs aim to increase awareness of the importance of developing literacy skills at an early age by implementing curricula throughout the county to encourage and enhance family literacy development.

their inventory of children’s books at home


cre ase d

165

ase d

asking their child to tell them what is in the picture

cre s in

s in

112

pa

ren t

ren t pa

142

discuss the topic of the book with their child

pa ren ts i n

pa ren ts i ncr e

179

make up stories based on the pictures of the book

ase d cre

cre s in ren t pa

159

ask their child questions when reading

ase d

ase d pa ren ts i ncr e

stop reading and point out letters and/or words

ase d

161

track words with finger, reading from left to right

160

pa ren ts i n

cre

ase d

Number of parents who noted an increase in how often they now practice the following positive reading activities with their child or children11:

holding the book upright in child’s view

Number of parents who, by the end of the program, were practicing the following literacy activities with their children: 345

330

ced

cti

0 33

pra

bet

ha

alp

er eth

ing

8

d rea

2

tog

33

a ed

e

tin rou

Some parents showed no increases as they were already practicing each of these “always�.

the

34

d rea

ow

l fol

11

315

300


Health

Developmental Screenings Developmental screenings for children 0-5 are critical for early identification of and intervention for developmental delays. Early interventions can improve developmental outcomes, strengthen parent-child interactions, and improve the child's home environment12. According to the California Health Interview Survey (CHIS) impacting the lives of of children ages 0-5 in

15.4%

San Bernardino County are at high risk for developmental delay

this rate is lower than rates for

28,436 Los Angeles County

Statewide

children and their families13

The majority of screenings were administered in the more population dense regions of the west and central regions of the county14. From 2014-2015, First 5 San Bernardino’s investment in early developmental screening reached a total of

4,724

children

Developmental screenings identified 955 children at risk for developmental delays.

Based on published cost-avoidance estimates, the potential savings from early identification of developmental delay for those 995 children identified as at risk by the F5SB screening efforts could result in cost savings ranging from $30,000 to $100,000 per child15. The table below includes cost avoidance estimates based on the extent to which those children would have received a screening elsewhere.

Potential Cost Avoidance of ASQ Screening

Majnemer, A. (1998) Benefits of early intervention for children with developmental disabilities. Seminars in Pediatric Neurology, 5(1):62-9. California Health Interview Survey. CHIS 2009 Child Public Use File. Risk of Developmental Delays (PEDS). Los Angeles, CA: UCLA Center for Health Policy Research, November 2015. Respondents were asked a series of questions about concerns related to their child’s developmental status. The items are drawn from the survey edition of Parents’ Evaluation of Developmental Status (PEDS) and do not have an immediate clinical application. For more information, see http://pedstest.com/ 14 U.S. Census Bureau, 2009-2013 5-Year American Community Survey. POVERTY STATUS IN THE PAST 12 MONTHS OF RELATED CHILDREN UNDER 18 YEARS BY FAMILY TYPE BY AGE OF RELATED CHILDREN UNDER 18 YEARS. 15 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449461/ 12 13


Oral Health First 5 San Bernardino dental programs work with over 40 providers throughout San Bernardino County to provide children 0 to 5 with screenings and treatment. Cavities (tooth decay) are the most common chronic health condition for children. If tooth decay is left untreated, it can impair activities such as eating, speaking, playing, and learning.

San Bernardino County

In 2014, 2,000 San Bernardino County children under the age 6 years missed 2 or more days of school due to dental problems. 16

Top 3 Services for Oral Health

7,757

61

children ages 0-5 received services

pregnant women received services

2

1 Fillings 1,555

3 Tooth Decay/ Pulpotomies17 795

Crowns 1,076

Perinatal Screening, Assessment, Referral & Treatment (PSART)

Of the at-risk expectant mothers that were referred to services:

With support from First 5 San Bernardino, the Department of Public Health partners with local obstetricians to ensure all pregnant women in San Bernardino County are screened for drug, alcohol, and tobacco use. Women are provided supports needed to address their substance use via services ranging from home visits from public health nurses to inpatient treatment programs, depending on the severity of use.

In 2014-15, healthcare providers screened

Tobacco Use During Pregnancy can increase risk of:

Drug Abuse During Pregnancy may cause*:

Alcohol Consumption During Pregnancy can develop*:

stillbirth, infant mortality, sudden infant death syndrome (SIDS), preterm birth. respiratory problems, slowed fetal growth, low birth weight

Neonatal Abstinence Syndrome (NAS) which can result in higher risk of low birth weight,seizures, respiratory problems, feeding difficulties and death18

Fetal Alcohol Spectrum Disorders (FASD) which can result in low birth weight and long-term cognitive & behavioral problems

8,571

women

233

...and at-risk delivered intensive expectant services for mothers

41 reduced the number of cigarettes they smoked or stopped smoking entirely

13 25 18 reduced the number of days they drank or stopped drinking entirely

reduced the reduced the number of number of days they used days their marijuana usage of hard or stopped drugs entirely

2014 California Health Interview Survey (CHIS) A pulpotomy is partial removal of soft tissue from the crown of a tooth that contains nerves and blood vessels. Only tissue from the crown of the tooth is removed during a pulpotomy. A pulpotomy happens when an infection of the pulp occurs, usually due to tooth decay. 18 National Institute on Drug Abuse and Centers for Disease Control and Prevention 16 17


Screening, Assessment, Referral & Treatment (SART)

2,589 children were served through SART in fiscal year 2014-15

903

more an increase of 53.6% children over fiscal year 2013-2014

641

children were served through EIIS in fiscal year 2014-15

361

more an increase of 56.3% children over fiscal year 2013-2014 19 20

SART is administered by the Department of Behavioral Health in partnership with four community-based providers to ensure all children have access to appropriate early intervention services for children (0 -5 years of age) in San Bernardino County. SART centers provide comprehensive care for children at risk for developmental, emotional, or behavioral problems due to exposure to alcohol and other drugs, child abuse and neglect, and/or other environmental or developmental factors. While SART serves all children, there is a special emphasis on serving children from the child welfare system. SART provides intensive treatment, on average:

The majority of children seen at SART need support in the areas of social and emotional functioning. Some of the most common needs of 2014-15 SART participants included19:

2.3

hours per week

for the initial 12 weeks

1 2 3 4 5 6

6.2

days between treatment services

197

days in program

Difficulty Managing Emotions (61.8%) Adjustment to Trauma (58.4%) Communication (45.8%) Anger Control (43.8%) Anxiety (37.8%) Substance Exposure (32.5%)

SART is inclusive of the Early Identification and Intervention Services (EIIS) which provides a less intensive service to this population and expands service to the population to include more children who do not qualify for Medi-Cal services.

Early Identification and Intervention Services (EIIS) EIIS provides intensive treatment, on average:

The majority of children seen at EIIS need support in the areas of social and emotional functioning. Some of the most common needs of 2014-15 EIIS participants included20:

2.0

hours per week

for the initial 12 weeks

1 2 3 4 5 6

6.1

days between treatment services

133.5

days in program

Anger Control (47.0%) Affect Dysregulation (45.3%) Oppositional Behavior (42.7%) Impulsivity/Hyperactivity (30.3%) Regulatory Problems (27.4%) Anxiety (26.0%)

Based on the Child and Adolescent Needs and Strengths inventory (CANS) San Bernardino County Behavioral Health-Children and Youth Collaborative Services (CVS), 2014-2015 Fiscal Year Report – 0-5 Comprehensive Treatment Services.


Resolution of an identified need data is recorded from parents who, at intake, identified needing help with an issue with their child, but at discharge indicated they no longer needed assistance.

SART - Resolution of an Identified Need Living Situation

75%

Anxiety

67%

Family Conflicts

65% 64%

Adjustment to Trauma Sleep

63%

Attachment

62% 0%

10%

20%

30%

40%

50%

60%

70%

80%

EIIS - Resolution of an Identified Need 63%

Attachment 58%

Affect Dysregulation

57%

Anger Control

63%

Oppositional

70%

Living Situation 62%

Family 0%

10%

20%

30%

40%

50%

60%

See the full outcomes report from County of San Bernardino Department of Behavioral Health at www.first5sanbernardino.org

70%

80%


First 5 San Bernardino Commission Linda Haugan, Chairwoman Assistant Executive Officer, Human Services, County of San Bernardino Maxwell Ohikhuare, M.D., Vice Chair Public Health Officer, County of San Bernardino Josie Gonzales Fifth District Supervisor, County of San Bernardino Elliot Weinstein, M.D. Physician/Pediatrician Margaret Hill, D.Ed. School Board Member, San Bernardino Unified School District J. Paul Vargas School Board and Founding Member, Oxford Preparatory Academy Charter Schools Ron Powell, Ph.D. Special Education Consultant, Early Childhood Mental Health Advocate Executive Director Karen E. Scott


“

Specific funding has helped families overcome the seemingly insurmountable issues of learning how to appropriately care for and further the development and educational achievements for thousands of children and their families. -Collaborative Stakeholder

2014


Local Outcomes Brief 2013-2014


In 2013-14

FAMILY CHARACTERISTICS

9,084

children 0-5 were served, a 56% increase from 2012-13

36%

of parents did not have a high school diploma

61%

have incomes that fall below the Federal Poverty guideline

4,448

parents were served, a 45% increase from 2012-13

NUMBER OF PARENTS SERVED IN SAN BERNARDINO COUNTY BY ZIP CODE

#

PARENTS SERVED 1-30

31-82 83-139

140-248

1

ZIP CODES

92366 92322 92333 91759 92332

92364 92242 92318 92327 92386

92305 92280 92382 92339 92398

92321 92285 92341 92347 92352

93562 92365 92358 92397 92256

92401 92325 92315 92317 92391

92372 92356 92363 92342 92359

92252 91708 92313 92314 92310

92371 91737 91784 92408 92377

92354 92284 92344 92373 91701

92307 92405 92316 92277 92411

91739 92374 92308 92311 91763

92337 92394 92301 92399 91786

92395 92346 91761 91709 91762

91730 92392 91764 92407 92324

92410 91710 92404 92345 92336

92376 92335 92323 92304 92268


FAMILY

San Bernardino County families face a host of challenges to stability and self-sufficiency, ranging from job loss and high foreclosure rates to a general lack of economic, social, and material resources. Currently, 18.7% of County residents live below the poverty line, of those children under 5 make up 29%1. First 5 San Bernardino supports resource centers and case management services, which help families develop and maintain longterm self-sufficiency, as well as critical parent education services to ensure families are safe, healthy, and nurturing.

Parents entering resource centers and case management services showed the highest needs in:

756

Access to Supportive Services

491

Parenting Support

493

Education and Employment

Parents who completed the Nurturing Parents parenting program showed a statistically significant increase in knowledge and behaviors related to positive parenting that help protect against abuse and neglect.

In total

1,403 parents received a total of

12,268

Nurturing Parenting Sessions.

418

parents entered the parent education program scoring in the high risk range on one or more of the five subscales of the AAPI-22.

High risk scores are related to higher rates of child abuse and neglect than low or moderate risk.

389

parents moved from high to moderate or low risk on one or more subscales of the AAPI-2 by the end of the program, thereby reducing their children’s likelihood of experiencing maltreatment.

2013 American Community Survey (5-year estimates). The AAPI-2 is an inventory designed to assess the parenting and child rearing attitudes of adolescents and adult parents. Responses to the inventory provide an index of risk for practicing behaviors known to be attributable to child abuse and neglect. 1 2

2


EDUCATION

Early care and education are essential to children’s long term success in school. First 5 San Bernardino recognized the need for such an experience as only 39% of 3- and 4-year-olds in the County attend preschool, compared to 49% statewide3. Lack of preschool attendance puts children at a disadvantage as they enter kindergarten. First 5 San Bernardino addresses this need through programs targeting providers, children and parents to ensure every child enters kindergarten ready to learn. Full day preschools provided 341 children with a full day, year round preschool education. On average, each child attended 138 days of schooling. Pre K-Academies provided a short-term preschool experience to over 1,000 children who otherwise would not have received any preschool education before entering kindergarten.

Children are ready for kindergarten

In 2012, First 5 San Bernardino launched the Pre-K Academy initiative. Pre-K Academies provide children a short term preschool experience to increase school readiness. Along with full-day and half-day preschool, Pre-K Academies are an important part of First 5 San Bernardino’s early education strategy.

117,905

collective days of preschool experienced by children

Number of parents who saw an increase in the number of days per week4,5: their child played with other children his/her age they read aloud to their child they told their child stories they played games with their child they ate with their child they followed a bedtime routine they held or cuddled their child they practice counting they practiced the alphabet they played rhyming games they practiced name writing they sang songs with their child

3

172 109 102 77 13 40 15 79 107 126 170 80

CH1LDREN NOW (2012). 2012-13 California County Scorecard of Children’s Well-Being. A total of 235 parents completed the Pre K Academy Parent Survey, of those the number shown here noted positive change 5 Some parents showed no change as they were already practicing each of these everyday 3

4


FAMILY LITERACY

In 2013, First 5 San Bernardino launched their Family Literacy programs. Family Literacy programs aim to increase awareness of the importance of literacy activities starting at birth by implementing curriculums throughout the county to encourage and enhance family literacy development.

As a result:

116

The number of parents who increased their inventory of children’s books at home.

The number of parents who increased the number of times they take their child to a library, book mobile or another place to participate in a reading activity.

120

The number of parents who noted an increase in how often they now practice at least one of the following positive reading activities with their child or children6:

“What do you think will happen next?”

AM

PL

E:

“Where is letter A?”

FO

R

EX

// Hold the book upright in child’s view // Track words with finger, reading from left to right // Stop reading and point out letters and/or words // Make up story based on the pictures of the book // Ask their child to tell them what is in a picture // Ask their child questions when reading // Discuss the topic of the book with their child

258

Number of parents who, by the end of the program, were practicing the following literacy activities with their children:

233

PRACTICED THE ALPHABET

FOLLOWED A READING ROUTINE

218

READ TOGETHER 6

Some parents showed no change as they were already practicing each of these “always”.

250 4


HEALTH & SYSTEMS First 5 San Bernardino’s 2013-14 health and systems initiatives aimed to ensure that young children and their families are healthy and safe. Health initiatives target access to health care, early screening, and intervention; they also assist parents/caregivers in navigating and receiving appropriate services from health providers. Systems efforts target building healthy cities and communities and ensuring systems in the county make it possible for young children and their families to be safe and healthy.

5,023

children received developmental screenings

A FOCUS ON EARLY SCREENING: Early screenings help identify children who are at risk for delays in physical, cognitive, and social development. From this, appropriate referrals are provided, ultimately helping ensure that all children achieve their full potential.

ASTHMA PREVENTION & INTERVENTION Young children in San Bernardino County experience asthma at a 64% higher rate than their peers statewide. In 2012, 23% of children under 11 had asthma compared to 14.2% statewide. Asthma is not only harmful to children’s health, but also costly7. First 5 San Bernardino funded programs aim to reduce asthma-related hospitalizations and equip families to manage their child’s asthma

34

parents felt confident in controlling and managing their child’s asthma (compared to 23 at the beginning of the program)

39

parents in the program were taught how to recognize early signs/symptoms of an asthma episode

41 5

7

parents in the program developed an asthma care plan for their child/ren

The average asthma hospitalization cost was $23,953 in 2005. California Department of Health Services (2007). The Burden of Asthma in California A Surveillance Report.


PERINATAL SART

Exposure to drugs, alcohol and tobacco during pregnancy can lead to poor birth outcomes and serious health and development problems for children. Prenatal Screening, Assessment, Referral and Treatment (PSART) providers educate and link expectant mothers to services to ensure every baby is born healthy. In 2013-14, healthcare providers delivered intensive services for more than 300 expectant mothers.

46

Risky behaviors such as smoking, drinking and using drugs decreased significantly by the expectant mother’s second follow up8.

28

40

MOTHERS

MOTHERS

MOTHERS

MOTHERS

Decreased the number of cigarettes they smoked or stopped smoking entirely

Decreased the number of days they drank or stopped drinking entirely

Decreased the number of days used marijuana or stopped using marijuana entirely

Stopped using drugs entirely (e.g. cocaine, heroin or meth)

A FOCUS ON HEALTHY CITIES AND COMMUNITIES

Healthy Cities and Communities (HCC) is a systems change effort that acknowledges that a community’s health is highly impacted by the complex interplay of individual behaviors, the physical and social environments, biological and genetic factors and health systems. HCC initiatives aim to improve the health and quality of life of all residents. First 5 San Bernardino began investing in Healthy Cities and Communities initiatives in 2011 and is currently investing in eight HCC initiatives throughout the County.

3

8

22

1) 2) 3) 4) 5) 6) 7) 8)

Healthy Adelanto Healthy Apple Valley Healthy High Desert Healthy Montclair Healthy Muscoy Healthy Rancho Cucamonga Healthy Rialto Healthy San Bernardino

The number of areas Healthy Cities and Communities have made significant strides in to ensure that children and families thrive in safe and healthy communities.

Built Environments

• Access to healthy food options through Farmers’ Markets and fruit parks. • Encourage physical activity through recreation facilities and new bike lanes

Policies

• Internal policies that model healthy behaviors, such as breastfeeding and lactation accommodation policies for city employees • Public education on health-related policy issues through policy briefs and needs assessments • Public policy changes to curb harmful behaviors, such as smoking and drug use, and increase access to healthy food, such as healthy vending machine policies

Integrated Systems

• • • •

Health programs and services for children and families Resident capacity building for civic engagement Increased collaboration between local service providers and institutions Leveraging of resources to sustain programs and initiatives

Data was available for 190 expectant mothers who noted using at least one substance in the moth prior to the screening – most of those only used on substance.

6


First 5 San Bernardino Commission Linda Haugan, Chairwoman Assistant Executive Officer, Human Services, County of San Bernardino Maxwell Ohikhuare, M.D., Vice Chair Public Health Officer, County of San Bernardino James Ramos Third District Supervisor, County of San Bernardino Elliot Weinstein, M.D. Physician/Pediatrician Margaret Hill, D.Ed. School Board Member, San Bernardino Unified School District Leslie Egge Senior Companion Director, Lanterman Developmental Center Vacant Commissioner Seat Executive Director Karen E. Scott


“

A few programs stand out including BabyFriendly Hospitals, Early Smiles, and Help Me Grow. These programs lay out a foundation for the success of our county’s future. These are critical investments that have a life-long impact in our children. -Funded Agency

2013


MAKING A DIFFERENCE


FAMILY

Self-sustaining families can access the resources necessary to meet their family’s social, emotional and economic needs.

 

  


Annually,

1 out of 58 children in the U.S. experience abuse and/or neglect.


EDUCATION

CHILDREN ARE READY FOR KINDERGARTEN

PARENTS: A CHILD’S FIRST TEACHER


CHILDREN ARE READY FOR KINDERGARTEN

A FOCUS ON PRE-K ACADEMY


HEALTH A FOCUS ON EARLY SCREENING AND INTERVENTION


ASTHMA PREVENTION AND INTERVENTION

 

HEALTH CARE ACCESS


First 5 San Bernardino Commission Â

Linda Haugan, Chairwoman Assistant Executive Officer, Human Services, San Bernardino County Maxwell Ohikhuare, M.D, Vice Chair Public Health Officer, San Bernardino County James Ramos Third District Supervisor, County of San Bernardino Leslie Egge Director of Quality Assurance, Lanterman Developmental Center Elliot Weinstein, M.D. Physician/Pediatrician Mark A. Daniels Licensed Clinical Social Worker Margaret Hill, D.Ed. School Board Member, San Bernardino Unified School District

Executive Director Karen E. Scott Â

/first5sb

/f5sb

www.first5sanbernardino.org

735 E. Carnegie Drive, Suite 150 San Bernardino CA 92408 (909) 386-7706


“

From our place in the community we have seen First 5 mature, become more strategic, and thoughtful in its investments. Staff has grown in size and wisdom and its presence and prestige in the community has also grown over time. -Funded Agency

2012


“

The First 5 commission is a proven model or platform for community investments...The process is fair, there is great accountability, and outcomes are measured carefully. The platform demonstrates that First 5 is a prudent steward of public funds. -Funded Agency

2011


“

Thousands of young children and their families are better off because of the work of First 5 over the past two decades. Kids who were born 20 years ago are now becoming adults - and my hope is they are better prepared for life as a result of First 5’s investments in San Bernardino County. -Collaborative Partner

2010


“

First 5 San Bernardino has a better understanding of what is needed for and by young children and their families, impacting the way many organizations now serve that population on a daily basis. -Collaborative Partner

2009


“

First 5 San Bernardino has risen to a level to be greatly valued as a leader in fiscal stewardship, creating lasting change on behalf of some of the most vulnerable in our communities. -Funded Agency

2008


“

We’ve worked with First 5 San Bernardino since the beginning, and to see where it is at 20 years is wonderful. -Funded Agency

2007


“

In the beginning, there were many challenges as with any start up organization. What we see now is a mature organization with strong leadership and a vision for the future. -Funded Agency

2006


“

First 5 San Bernardino has a willingness to look outside the box and explore new ways to collaborate and diversify their reach for children. -Collaborative Partner

2005


“

First 5 San Bernardino has grown from an organization that was known for simply providing funding to projects, to becoming an agency that demonstrates excellence in how it selects, monitors, and helps develop the projects they have invested in. -Funded Agency

2004


“

I’m excited to see First 5 San Bernardino utilize their developed expertise to influence change on a greater level. -Collaborative Partner

2003


Thank you funded agencies and collaborative partners! Here are just a few of our many collaborative partners & funded agencies over the years...

San Bernardino County

FSA FAMILY Service Association

San Bernardino

County

Rim Family Services

Superintendent of

Schools

Transforming lives through education


Meet the Staff 2018 YEARBOOK

Karen

Most Popular

George

Best Candy

Ann

Most Likely to be a Rock Star

Renee

Biggest Self-Starter

Crystal

Best Networker

Cindy

Most Friendly

James

Best Laugh

Leslie

Most Creative

Wendy

Best Educated

Ivon

Most Feisty

Debora

Most Frugal

Staci

Most Crafty

Gilbert

Most Energetic

Andrew

Most Calm

Jessica

Most Shy

Scott

Walid

Class Clown

Most Flexible

Ronnie

LuCretia

Most Positive

Tania

Best Partner

Ashley

Most Helpful

Kelsi

Most Fun

Most Spirited

Tammy

Most Outgoing

Divina

Most Studious

Michelle

Most Outspoken

Will

Most Likely to Succeed

Wilmar Furthest Traveled

Greg

Class Brain

Bricia

Most Trustworthy


Meet the Commissioners 2018 YEARBOOK

Dr. Maxwell C. Ohikhuare Chair Public Health Officer Department of Public Health

CaSonya Thomas

Assistant Executive OfficerHuman Services County of San Bernardino

Dr. Elliot Weinstein, M.D. Vice Chair Pediatrician

Dr. Margaret Hill

School Board Member San Bernardino City Unified School District

Alan H. Garrett

President & CEO St. Mary’s Medical Center

Supervisor James C. Ramos

San Bernardino County Supervisor, Third District

J. Paul Vargas

School Board and Founding Member Oxford Preparatory Academy


Profile for First 5 San Bernardino

20th Anniversary Yearbook  

20th Anniversary Yearbook  

Profile for first5sb
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