A Report to the Community: Invest in Children’s Impact to Date Rob Fischer, Ph.D.

1. A Report to the Community: Invest in Children’s Impact to Date Rob Fischer, Ph.D. Claudia Coulton, Ph.D.

2. Overview Building an initiative and creating a system for meeting the needs of young children Highlights of IIC programming results to date Creating an integrated child data system as a community resource to inform policy and practice

3. The Trajectory of the System

4. Early Childhood System

5. Early Stages of the Initiative • Effective Parenting • Welcome Home (Newborn Home Visit) • Significant gains in parent knowledge of community resources and knowledge relating to their baby’s health/wellness; 39% of visits led to identification of at least one medical concern for the newborn or mother • Early Start (Ongoing Home Visiting) • Increased sense of parental competence and comfort in caring for child and reduced risk for physical abuse • High rates of immunization and access to regular doctor

6. Early Stages of the Initiative • Healthy Children • Healthy Start/Medicaid Expansion • the percentage of children enrolling in Medicaid during the first month of life increased from 45% to 62%; insured children under age 6 in Cuyahoga County increased from 90% to 98%

7. Early Stages of the Initiative • Quality Child Care • Family Child Care System • Increasing quality among home based providers and growing number of Gold Seal homes • Impact greater with more intensive services • Special Needs Child Care • 93% of children at risk of expulsion remaining in their child care placement for six months or more • Based on feedback parents now receive summary of focus of services

8. Expanding the Initiative • Early Childhood Mental Health (added 2006) • significant decline in child behavior problems and significant improvement in parent-child relationships; 65% of treatment goals were met by families at program exit • Primary Lead Prevention Pilot (2006-2010) • decreased lead dust in the home, increased knowledge of preventing elevated blood lead levels in target infants, and reduced blood lead levels in children in the home • Universal Pre-K Pilot (began 2007) • significant gains in UPK site quality and average level of school readiness significantly exceeds the average readiness of all children entering CMSD

9. Scope of IIC Services-over 120,000 children served

10. Data Informing the System • Program development • Medical Home pilot • Primary Lead Prevention pilot • Program refinement • Home visiting • Family child care quality enhancement • Program targeting • Health insurance outreach • Newborn home visiting

11. The Power of Data – Child Health Example • Dramatic increase in health insurance coverage for children ages 0-6: Hooray! • But wait, only 43% of children get all the recommended well-child visits in the first year of life: Oh no,  • But wait, data showed that 49% of these families were involved with IIC services close to birth, so we can use that connection to reach families: Hooray! • But wait, due to data lags and coordination issues, outreach would happen too late to have an effect: Oh, no,  • But wait, we could use a preventive approach by having dedicated staff at clinics reach out to families…

12. The Power of Data – Child Health Example • Result - 2007 Medical Home Pilot with one Patient Advocate each at NEON & Neighborhood Family Practice • 86% of families completed scheduled well-child visits, double the rate for children born on to Medicaid in Cuyahoga County Now NFP has integrated the model into care with 9 Patient Advocates Now serving the needs of families with infants

13. The Power of Integrated Data Co-founders: Invest In Children & MSASS, CWRU The ChildHoodIntegrated Longitudinal Data (CHILD) System A Community Resource Created with Private Funding

14. The Power of Integrated Data Data helps inform our understanding of the early childhood system Individuals and families interact with multiple systems and services, so integrated data offers a more complete view of reality [“Big Data”] Understanding of how systems work and how to better meet existing needs can be informed by integrated data Service models emphasize long term and collective impact, so data needed across services and over time

15. Multiple Service Use

16. IIC - Origination of CHILD System • Began with child registry of all children born in Cuyahoga County since 1992 • Draws on routinely available administrative data to monitor program delivery and outcomes • Brings together data at the child level for longitudinal analyses • Now expanding data to reflect experiences throughout childhood

17. CHILD System Data Sources - 400,000 children and counting • Birth certificates • Maternal health • Low birth weight births • Death certificates • Infant mortality • Child welfare • Abuse/neglect investigations • Placements and services • Public school data • Attendance • Kindergarten readiness • Proficiency tests • Graduation • Homeless Services • Public Assistance Receipt • Medicaid receipt • Food Stamp receipt • TANF receipt • Child care voucher receipt • IIC program participation • Home visiting services • Special needs child care • Early mental health • Universal pre-k • Juvenile Justice • Delinquency Filings • Geo-data • Neighborhood and environmental conditions

18. Components of CHILD System

19. Program Planning • Federal funding application for housing for children in high risk families

20. Geographic analyses

21. Geographic analyses

22. Answering community questions • What does the CMSD kindergarten class look like?

23. Summary IIC is a leading example of comprehensive community commitment to young children with demonstrated impact IIC is ahead of the curve in effort to understanding the importance of place and the commitment to child development over time CHILD system is a community resource available to support policy, research, and practice

24. What's Next? • Extend CHILD System to include data from later adolescence (e.g., Juvenile Count involvement, Proficiency test data) • Undertake study to examine factors that predict 3rd Grade Reading Proficiency (Reading Guarantee) • Explore mechanisms to make aggregate data from CHILD more available to the community