Support
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
