STRENGTH IN DIVERSITY Young Children and Colorados Future: - - PowerPoint PPT Presentation

Charles Bruner BUILD Ini1a1ve and Child and Family Policy Center September 15, 2014

STRENGTH IN DIVERSITY – Young Children and Colorado’s Future: Demographics, Equity, and Family Support

A mother brings her six month-old in for a check-up and it’s clear that the mom is stressed, uncomfortable and feeling out-

• f-place, and not picking up on the child’s cues for a:en;on.

While there isn’t a medical condi;on that requires a:en;on today, the prac;;oner fears that in two years there will be significant indicators of developmental delay and likely social and emo;onal problems. The primary health prac;;oner does not want to wait two years to take ac;on and the mom seems recep;ve to receiving help. At the same ;me, what can the child health prac;;oner do to respond to what are clearly more than and different from medical needs?

The Opportunity

Health and Health Equity Defined

Child health is a state of physical, mental, intellectual, social and emo4onal well-being and not merely the absence of disease or

• infirmity. Healthy children live in families, environments, and

communi4es that provide them with the opportunity to reach their fullest developmental poten4al. – World Health Organiza4on Health equity is achieving the highest level of health for all people. Health equity entails focused societal efforts to address avoidable inequali4es by equalizing the condi4ons for health for all groups, especially for those who have experienced socioeconomic disadvantage or historical injus4ces. – Healthy People 2020

Of all the forms of inequality, injus4ce in health care

is the most shocking and inhumane.

• - Mar4n Luther King

We cannot allow a child’s zip code or color of skin determine the child’s health.

• - Maxine Hayes

THE IMPERATIVE: Equity in Diversity

1. Colorado’s youngest are its most diverse and most in need 2. The first years are the most cri7cal to equitable growth (but where we invest the least) 3. Inequi7es currently exist but are preventable 4. Family strengthening is key 5. Community building is also key 6. We know enough to act

What We Know and Can Do About Health Equity & Young Children

• 1a. Colorado’s Youngest Are Its

Most Diverse

COLORADO Racial/Ethnic Informa6on By Age

Source: United States Census, 2012 American Community Survey

United States: Percent of Popula4on Combined Non-white and Hispanic 0 to 5 years: 49.0%; 6 to 17years: 45.2%; 18 to 64 years: 35.7%; 65 + years: 20%

• 1b. Colorado’s Youngest Are

Its Most in Need

Source: United States Census, 2012 American Community Survey

COLORADO Poverty/Income Level by Age Group

United States: Percentage of Popula5on Below Poverty, By Age: 0-5 years: 24.8%; 6-17 years: 20.0%; 18-64 years: 14.2%; 65 + years: 9.0%

• 1c. Colorado’s Most Diverse

Youngest Are Its Most in Need

Source: United States Census Bureau, 2009-2011 Public Use Microdata Sample

Poverty/Income Level by Race/Ethnicity: 0-5 Year Olds

• 2a. Science Shows the

First Years of Life Most Critical

• Protec've Factors (Strengthening Families)
• Adverse Childhood Experiences (CDC)
• Resiliency (AAP)
• Epigene'cs (Gene'cs)
• Neurobiology (Brain Research)
• Toxic Stress (Center on the Developing Child)
• Social Determinants of Health

(World Health Organiza'on)

Harry T. Chugani, MD, PET Center Director, Chief of Pediatric Neurology and Developmental Pediatrics, Children’s Hospital of Michigan

• 2b. AND Science Spells Out the

Solution

• Protec&ve Factors (Strengthening Families)
• Adverse Childhood Experiences (CDC)
• Resiliency (AAP)
• Epigene&cs (Gene&cs)
• Neurobiology (Brain Research)
• Toxic Stress (Center on the Developing Child)
• Social Determinants of Health

(World Health Organiza&on)

• 2c. Protective Factors and Social

Determinants Points to Same Set of Needs

The Social Gradient. Life expectancy is shorter and most diseases are more common further down the social ladder. [Concrete services and supports in 5mes of need] Early Life. A good start in life means suppor;ng mothers and young children; the health impact of early development and educa;on lasts a life;me. [Knowledge of healthy child development]

• Stress. Stressful circumstances, making people feel worried, anxious and

unable to cope, are damaging to health. [Resiliency] Social Exclusion. By causing hardship and resentment, poverty, social exclusion and discrimina;on cost lives. [Posi5ve and suppor5ve ac5vi5es with children] Social Support. Friendship, good social rela;ons and strong suppor;ve networks improve health at home, at work and in the community. [Social 5es]

• 2d. … But Where We Invest the Least

BUILD Initiative. Early Learning Left Out (2013).

Per Child Expenditure by Age Group as % Per Child (6-18) Expenditure

US CO Per child (0-2) Exp as % Per Child (6-18) 7% 5% Per Child (3-5) Exp as % Per Child (6-18) 25% 13% Per Child (0-5) Exp as % Per Child (6-18) 16% 9%

For the first *me in our country’s history, America’s children overall face the prospect of growing up less healthy, living less long lives, and being less equipped to compete and lead in a world economy – unless we address issues of inequity in health, educa*on, and social

• pportunity (through a family strengthening lens).
• 3a. Child Health and Well-Being is in

Jeopardy

• 3b. This Means Family Strengthening

For a Large Proportion of Children

3c.To Address a Range of Health, Social, and Educational Disparities…

The Fi'y State Chart Book provides detailed informa0on on the indicators listed:

Racial and Ethnic Popula0on of Children in the United States Young Child Poverty Levels by Race and Ethnicity Maternal Educa0on ABainment for Women with Children 0-5 Low Birthweight by Race and Ethnicity Infant Mortality by Race and Ethnicity Late or No Prenatal Care by Race and Ethnicity Health Insurance by Race and Ethnicity Access to Medical Home by Race and Ethnicity Immuniza0on Rates for Children 19-35 Months 10. Percent of Children Having Well-Child Visits 11. Children 10 Months to 5 Years Screened for Developmental, Behavioral and Social Delays 12. Percent in Part C by Race and Ethnicity 13. Foster Care 0-5 by Race and Ethnicity 14. Children Under 6 Years Exposed to Risk Factors 15. Mothers’ Mental Health by Race and Ethnicity 16. Neighborhood Safety by Age and Race and Ethnicity 17. NAEP 4th Grade Reading Proficiency Scores 18. Race for Results composite indicator for children

• 3d. Inequities are Reflected in

Family Demographics

Race/Ethnicity Child Poverty1 25-34 year-olds with Associates Degree or Higher2 Children in Single Parent Families3 Teen Birth Rate (per 1,000)4 Hispanic 31% 16% 32.5% 55 White, non-Hispanic 10% 51% 20.7% 18 Black, non-Hispanic 41% 32% 51.4% 36

Colorado Data: Family Demographics

* = esSmates based on sample sizes too small to meet standards for reliability or precision S = esSmates suppressed when the confidence interval around the percentage is greater than or equal to 10% points 1. hZp://www.childrensdefense.org/child-research-data-publicaSons/state-of-americas-children/ 2. hZp://dashboard.ed.gov/statecomparison.aspx?i=o&id=0&wt=40

• 3e. … and in Family Concerns and

Stressors

Race/Ethnicity Live in an Unsuppor5ve Neighborhood Fair/Poor Maternal Mental Health Parents are Usually or Always Stressed about Paren5ng Hispanic 28% 7%* 17% White, non-Hispanic 13% 3% 7% Black, non-Hispanic 33%* 19%* 13%*

Colorado Data: Family Concerns and Stressors

hOp://www.childhealthdata.org/browse/survey * = es5mates based on sample sizes too small to meet standards for reliability or precision

3f… Resulting in Disparities in Child Outcomes

Race/Ethnicity Concerns About Child’s Development1 Low – Birthweight2 Percent Proficient

• r above on 4th

Grade Reading NAEP Assessment3 Hispanic 46% 9% 23% White, non- Hispanic 36% 8% 52% Black, non- Hispanic 43%* 14% 19%

Colorado Data: Child Outcomes

*= esTmates based on sample sizes too small to meet standards for reliability or precision 1 hWp://www.childhealthdata.org/browse/survey 2 hWp://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf 3 hWp://nces.ed.gov/naTonsreportcard/naepdata/report.aspx

• 3g. …Which Involve BOTH Race/

Ethnicity & Socio-Economic Status

Colorado NAEP 4th Grade Reading Composite Scores ALL Children 227 White Children 237 Not FRM Children 239 Hispanic Children 210 FRM Children 210 Black Children 203 FRM Not FRM White Children 223 242 Hispanic Children 205 228 Black Children 97 n.a.

Note: AKendance Works indicates that a 12 point difference is equivalent to more than one grade

• level. The White/Hispanic/FRM/NotFRM shows differences for FRM/NotFRM of about 20 points

within groups and the difference by White/Hispanic about 16 points within groups. This is to aKribute causality but suggest race/income are intertwined.

• 3h. Colorado is Not Alone Among

States: But Colorado Has Work to Do

‘Race for Results’ Composite Scores Colorado and U.S.

Race forResults/Kids Count Rankings Overall Kids Count 22nd White RaceforResults 8th Hispanic RaceforResults 27th AA RaceforResults 19th Hispanic/White Gap 41st AA/White Gap 35th

• 4a. Affecting the Health Trajectory

Starts in the Earliest Years

Source: BUILD Ini0a0ve and the Child and Family Policy Center (February 2013)

• 4b. There Are Exemplary

Programs (in all Fields)

Health Leads

• 4c. …Which Share Common

Attributes…

• Child Health Prac..oner
• Developmental and social/environmental surveillance and screening
• An.cipatory guidance/advice to family
• Referral for “medically necessary” services
• Referral to care coordina.on
• Care Coordinator/Networker
• Mo.va.onal interviewing and whole child/family approach to

iden.fy further needs/opportuni.es

• Iden.fica.on of available services and supports
• Connec.on to services (referral/scheduling/follow-up/prac..oner

no.fica.on of ac.ons)

• Community Service Maven (Community u.lity)
• Community networker and builder across “medically necessary”

and other community services

• 4d. Which Reflect a Disciplined,

Holistic & Ecological Response

1. Understanding Where the Family Is 2. Connec6ng with the Family in the Context of the Family’s Life, Culture, Language, and Community 3. Engaging and Linking Family into Community Supports (social 6es that foster resiliency and reciprocity) as well as Services (concrete supports in 6mes of need)

• 4e. Within and Across Health,

Education, and Family support

• 5a. Place and Community Matter

Source: Village Building and School Readiness (2007).

COMPARISON ON TEN INDICATORS OF CENSUS TRACTS WITH NO CHILD VULERNABILITY FACTORS WITH TRACTS WITH 6 OR MORE VULNERABILITY FACTORS

Indicators No Vulnerability Factors 6-10 Vulnerability Factors % Single Parent Families 20.5 53.1 % Poor Families with Children 7.2 41.4 % 25+ no High School 13.5 48.0 % 25+ BA or Higher 28.7 7.1 % 16-19 not working/in school 3.0 15.0 % HoH on Public Assistance 4.9 25.5 % HoH with Wage Income 80.6 69.1 % HoH – Int/Div/Rent/Income 42.3 11.0 % 18+ Limited English 1.9 17.5 % Owner-Occupied Housing 71.0 29.6

ImplicaXon: Improving child health in these neighborhoods requires community-building as well as individual child service strategies.

• 5b. .. And Are Critical for Young

Children and Children of Color

While 1.7% of all white, non-Hispanic Americans live in the highest- risk neighborhoods, 20.3% of all African-Americans and 25.3%e of Hispanic/LaEnos live in these highest-risk neighborhoods

Source: Village Building and School Readiness: Closing Opportunity Gaps in a Diverse Society

Breakdown by race/ethnicity of who lives in census tracts with 0 and with 6+ vulnerability factors Racial Composi,on No Vulnerability Factors 6-10 Vulnerability Factors % White Non Hispanic 83.2 17.6 % Black 6.2 38.0 % Asian 3.7 3.3 % Hispanic 6.1 39.4 % American Indian/NaEve Alaskan 0.5 1.2 Child Composi,on % of populaEon that is 0-4 yrs. 6.1 9.2

• 5c. Colorado Has These Neighborhoods

and Communities

Children Living in High Poverty Census Tracts – Colorado and United States Poverty Rate Colorado U.S. Under 20% 79.1% 75.2% 20 to 30% 13.3% 14.2% 30 to 40% 5.9% 6.5% Over 40% 1.7% 4.1% Note: Between 2000 and 2010, the percentage of children living in such neighborhoods grew from 9% to 11% in the United States and from 2% to 8% in Colorado, Kids Count Data Snapshot.

1. Crea%ng Awareness of the Need for and Ability to Change 2. Promo%ng/Incen%vizing New Prac%ce and Inves%ng in Innovators and Innova%on 3. Developing Mainstream Management, Financing, and Accountability Systems to Make Exemplary Prac%ce the Norm

• 6a. We Can Do This

The Iowa Health Experience/Cast of Dozens

• 2003-2006 Iowa ABCD Ini1a1ve (developmental screening and

surveillance/Medicaid changes)

• 2006 state funding for demonstra1on HELP ME GROW/1st FIVE

Ini1a1ve

• 2010 Membership in HMG na1onal network
• 2012 Further coverage of features of 1st Five under Medicaid

(administra1ve claiming)

• 2013 Expansion of State Funding for 1st Five/Links to Child

Health Specialty Clinics

• 2013 Incorpora1on of child health metrics and focus on

children within state SIM grants

• 6b. It’s Not Rocket Science

The mother comes in with her child for the 36-month well-child visit. Her daughter is looking forward to the visit, knowing she will receive a new book and excited to tell the nurse she will be going to Head Start next month with her best friend from the Hispanic Family

• Center. The mother has an ASQ form, completed at her family day-

care home, and a set of quesFons for the pracFFoner about her daughter, who’s already starFng to read but mixing up leHers, and is wondering if there might be dyslexia. The mother is in a mutual assistance group with other parents and wants help from the pracFFoner in geIng more denFsts who will serve children in their community.

Labor

• Top 10 Things We Know about Young Children and Health Equity…

and Three Things We Need to Do with What We Know

• FiAy State Chart Book: Dimensions of Diversity and the Young Child

PopulaJon

• Village Building and School Readiness: Closing Opportunity Gaps in

a Diverse Society

• Equity and Diversity in Early Childhood Systems Building: BUILD

Ini<a<ve Framework, Living Document, and Case Studies

Additional Resources

The Child and Family Policy Center is the research partner with BUILD and works na6onally and in Iowa on developing more comprehensive, community-based systems of services and supports to improve child well-being. The BUILD Ini7a7ve is a na6onal ini6a6ve which supports state early childhood systems building through a comprehensive approach that integrates health, family support, and early childhood educa6on, with a special focus upon developing inclusive and culturally responsive systems. The BUILD Ini6a6ve and the Child and Family Policy Center are collabora6ng to create a Learning Center on Health Equity and Young Children.

About the Child and Family Policy Center, the BUILD Initiative, and the Learning Center on Health Equity and Young Children

Child and Family Policy Center: Charles Bruner, Director www.cfpciowa.org BUILD Ini8a8ve: Susan Hibbard, Director www.buildini;a;ve.org Learning Center for Health Equity and Young Children: Angelica Cardenas-Chaisson, Mary Nelle Trefz, Kelly Perez acardenas@cfpciowa.org mnt@cfpciowa.org; kperez@buildini;a;ve.org

Contact Information