Transcript Spark NH Vision • “All New Hampshire children and their families are healthy, learning, and thriving now and in the future.” Mission • “To provide.

1
Spark NH
Vision
• “All New Hampshire children and their families are healthy,
learning, and thriving now and in the future.”
Mission
• “To provide leadership that promotes a comprehensive,
coordinated, sustainable early childhood system that achieves
positive outcomes for young children and families, investing in a
solid future for the granite state.”
Focus
• Expectant parents and children from birth through grade 3 and
their families.
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Indicators
• Good Health
• Strong Families
• Positive Early Learning Experiences
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Our Goal
Identify and catalog data sources
• Focus on sources that are authoritative and current
Describe young families and children in NH
• Examination and summarization some of the resources
Make recommendations
• Recommendation concerning collection, maintenance, and
use of these sources
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Public_Health_Networks
Towns
Census Tracts
New Hampshire’s
1 Dot = 25
Children 0-8
135,894 Children Age 0 – 8 years
•
•
•
•
•
10 counties
15 public health regions
170 school districts
259 towns
292 populated census tracts
Goffstown
Manchester
Bedford
Hudson
Nashua
Source: 2006-2010 ACS
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Good Health: Social, Emotional, Behavioral
Indicator #1:
• All young children with social-emotional or behavioral issues
and their families have access to trained professionals to
assess, diagnose, and treat them.
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Good Health: Social, Emotional, Behavioral
• Early childhood mental health is the social/emotional wellbeing of children ages birth to age six which promotes the
capacity to:
– Experience, manage and express emotions
– Develop and sustain stable relationships with others
(adults and peers)
– Safely explore the environment to learn
– Demonstrate developmentally appropriate behavior
Source: Susan Covert, Endowment for Health, 2009
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Good Health: Social, Emotional, Behavioral
• Infant and toddler social-emotional wellbeing is linked to
– Social competence
– Ability to maintain healthy relationships
– Self-regulation
• Characteristics combined with positive outcomes are related
to a child’s health, development, and academic performance.
Source: National Center for Children in Poverty, 2009
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Good Health: Social, Emotional, Behavioral
Data Sources
• National Survey of Children’s Health 2007
• Endowment for Health
– NH Association for Infant Mental Health
• Mental Health Services for New Hampshire’s Young Children and
Their Families: Planning to Improve Access and Outcomes, 2009
– NH Center for Public Policy
• Mental Health Services in New Hampshire Schools, 2009
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Good Health: Social, Emotional, Behavioral
National Survey of Children’s Health (NSCH)
• Examines the physical & emotional health of children 0-17
years of age
• Special emphasis is placed on factors such as medical homes,
family interactions, parental health, school and after-school
experiences, and safe neighborhoods
• Conducted every 4 years
• Sponsored by Maternal and Child Health Bureau of the Health
Resources and Services Administration
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Good Health: Social, Emotional, Behavioral
National Survey of Children’s Health (NSCH) 2007
• Sample size
– 91,642 completed child-level interviews
• Sample frame
– U.S. households with one or more resident children ages 0-17 years
• Data collection period
– April 2007- July 2008
• Data collection
– State and Local Area Integrated Telephone Survey (SLAITS)
– Random digit dial approach
– Collected over landline phones
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Good Health: Social, Emotional, Behavioral
National Survey of Children’s Health (NSCH) 2007
• NH population: ages 0-17 years
– 298,439
• Race/Ethnicity
–
–
–
–
–
White- 89.8% (264,184)
Black- 0.7% (2,116)
Hispanic- 3.2% (9,365)
Multi-racial- 3.1% (8,979)
Other- 3.3% (9,583)
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2007 National Survey of Children’s
Health
New
Hampshire
Nationwide
%
%
12.6
11.3
Age 6-11 years
10.8
12.1
Age 12-17 years
17.8
14.9
Male
15.5
14.5
Female
9.6
7.9
0-99% FPL
29.9
15.5
100-199% FPL
15.8
12.7
200-399% FPL
12.1
9.9
400% FPL or more
8.3
9.2
Percent of children aged 2-17 years who
have one or more emotional, behavioral,
or developmental conditions*
Prevalence by Age
The Mental
and Emotional
Well-Being of
Children
Prevalence by Sex
Prevalence by poverty level
Source: Endowment for Health
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2007 National Survey of Children’s
Health
New
Hampshire
Nationwide
%
%
Public
29.5
17.5
Private
8.3
9.0
Who have two or more emotional,
behavioral, or developmental conditions
39.0
40.3
Who receive coordinated, ongoing,
comprehensive care within a medical
home
47.3
40.2
Whose health insurance is adequate to
meet their needs
71.2
70.6
Who received mental health treatment or
counseling in the past year
49.0
45.6
Prevalence by Insurance Type
Percent of Children age 2-17 with
emotional, behavioral, or developmental
conditions:
Source: Endowment for Health
The Mental
and
Emotional
Well-Being of
Children
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Good Health: Social, Emotional, Behavioral
National Survey of Children’s Health (NSCH) 2007
Emotional & Mental Health Indicators
• 31.3% of children (ages 4 months to 5 years) have a physical,
behavioral or social development issue that is of concern to
their parents
– White: 28.9%
– Black: 76.7%
– Hispanic: 58.7%
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Good Health: Social, Emotional, Behavioral
National Survey of Children’s Health (NSCH) 2007
Emotional & Mental Health Indicators
• 6% of children (ages 4 months to 5 years) are at high risk for
developmental, behavioral or social delay
– White: 3.2%
– Hispanic: 33.4%
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Good Health: Social, Emotional, Behavioral
National Survey of Children’s Health (NSCH) 2007
Emotional & Mental Health Indicators
• 27.1% children (ages 1-5) play with other children their age
every day
– White: 25.8%
– Hispanic: 68.6%
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Good Health: Social, Emotional, Behavioral
National Survey of Children’s Health (NSCH) 2007
Health Care Access & Quality Indicator
• 18.1% of children (ages 10 months to 5 years) had received a
developmental screening
– Received health care in the past 12 months
• White: 18.5%
• Black: 10.4%
• Hispanic: 23.1%
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Good Health: Social, Emotional, Behavioral
NH Association for Infant Mental Health (NHAIMH)
• Study on the availability, accessibility, and quality of early
childhood mental health supports and services for New
Hampshire’s youngest children (aged birth to six) and their
families
• Methodology – family and provider specific surveys and focus
groups with families and key stakeholders
• Survey respondents:
– 178 families
– 119 early care and education providers
– 72 health care providers
– 57 mental health providers
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Good Health: Social, Emotional, Behavioral
NH Association for Infant Mental Health (NHAIMH)
Challenges
• State does not have adequate mental health services to meet the
needs of young children and their families
• Early childhood mental health screening and evaluations are not
consistently provided
• There is no approved process for determining eligibility for children 0
to 4 years
• Over 50% of the early care and education providers reported that
there are not enough mental health services to which they can refer
young children
Source: NHAIMH, 2009
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Good Health: Social, Emotional, Behavioral
NH Association for Infant Mental Health (NHAIMH)
Findings
• 1 in 38 children were identified as needing early childhood mental
health services (out of 119 early care & education programs
surveyed)
• Of 173 families surveyed, 46.2% were worried that their child
(under age 6) might have a social emotional or behavioral disorder
• Nearly half of the family respondents said that mental health
screening was not part of their child’s annual physical
• Most common reason for children needed mental health services
was for external social emotional behavior
Source: NHAIMH, 2009
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Good Health: Social, Emotional, Behavioral
NH Association for Infant Mental Health (NHAIMH)
Ability to Access Services
• 80% of families said they had sufficient time to take their children
– Services were not too far way
– Transportation was not a barrier
– They were eligible for all services needed
• However, 28% of respondents indicated that they did not know
where to get services
• 30% reported they did not even know what services were available
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Good Health: Social, Emotional, Behavioral
Mental Health Services in Schools
• 75-80% of all children who receive mental services get them at school
• Lack of communication and/or formal agreements between school
personnel and mental health providers
– Despite being funded by the same program
• NH Center for Public Policy reports
– 80% of schools provide mental health assessments and referrals
– 50% of school provide family support services
– Schools have inadequate mental health resources
• No school-wide screening for behavioral or emotional problems
• No formal training for staff to identify mental health issues
– Third of schools do not collect any data on services being provided
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Good Health: Social, Emotional, Behavioral
Resources
• New Hampshire Early Supports and Services
• 10 regional agencies contract with the NH Bureau of Developmental
Services
• Community Mental Health Centers (CMHC)
– Located in 10 regions of the states
– Contracted with DHHS and Bureau of Behavioral Health to provide publicly
funded mental health services to individuals and families
• Watch Me Grow
– Developmental screening & referral system
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Good Health: Social, Emotional, Behavioral
Resources
• Child development clinics
• Private practices
• Preschool special education
• Early head start/head start
• Primary care physicians
• Community home visiting
programs
• Private non-profit mental
health
• Preschool Technical Assistance
Network (PTAN)
• Division of children, youth,
and families
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Good Health: Social, Emotional, Behavioral
Improving Access & Availability of Services
Emphasis placed on:
• Increasing public awareness
• Increasing training programs in early childhood mental health
• More trained professionals in the field
• Effective coordination & integration of services
Source: NHAIMH, 2009
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Good Health: Social, Emotional, Behavioral
Family Feedback: Paper Survey
• Target population
– Families
•
Target Locations
– Schools, early head start/head start facilities, early childcare providers and
educators, community mental health centers, doctor’s office
• Sample Questions: Focus on child welfare, service availability &
accessibility
– Are you worried that your child might have a social, emotional, or
behavioral issue?
– Do you know what types of early childhood mental health services are
available to your family?
– Do you know where to get screening or information about screening?
– Are services too far or located in an inconvenient area?
– Do you think your primary care physician is knowledgeable childhood
mental health?
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Good Health: Immunizations
Indicator #2:
• All children receive immunizations appropriate to their age,
development, and mental status.
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Good Health: Immunizations
• Vaccination is the most effective way to prevent the spread of many of
infectious diseases.
• New Hampshire is committed to universal immunization coverage of all
children 18 years of age and younger regardless of insurance status and
provides vaccines, funded by health insurers and the federal and state
governments, to every child in the State.
• NH School Immunization Requirements*:
– 4+ DTP/DT/DTaP
– 3+ polio vaccine
– 1+ MMR
– 3+ hepatitis B vaccine
– 1+ varicella vaccine
– 4+ HIB vaccine required for preschool students 3-5 years old
* Source: http://www.dhhs.nh.gov/dphs/immunization/documents/school12-13.pdf
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Good Health: Immunizations
Data Sources:
• National Immunization Survey (NIS)
– Conducted annually by the National Immunization Program and
the National Center for Health Statistics, Centers for Disease
Control and Prevention.
– Random digit dialing (RDD) telephone survey, with
immunization provider record check (PRC) verification.
– Assess immunization coverage among children aged 19-35
months in the United States and monitor the need for
immunization in geographically defined areas.
Source: http://www.cdc.gov/nchs/nis.htm
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Good Health: Immunizations
Data Sources (continued):
• New Hampshire Immunization Data 2011
– A collection of data from various sources including the NIS,
BRFSS and NH School Vaccination Survey mostly in the time
period between 2006 and 2009
• National Immunization Survey 2002-2006 Combined Data- NH
– Combined data from the NIS between 2002-2006 to access
vaccination coverage in NH
• School Immunization Survey
– This survey focused on Kindergarteners and 7th graders
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Good Health: Immunizations
NIS estimated vaccine coverage among children aged 19-35 months
in NH 2007-2010
Coverage of vaccine series*
Year
NH
US
NH Ranking
2010
84.1 (78.0-90.2)
77.8 (76.6-78.9)
6th
2009
78.7 (72.8-84.6)
77.5 (76.4-78.6)
11th
2008
81.0 (75.8-86.2)
78.7 (77.6-79.8)
4th
2007
90.6 (86.3-94.9)
78.3 (77.2-79.4)
2nd
* Vaccine series include 4+ DTP/DT/DTaP, 3+ polio vaccine, 1+ MMR, 3+
hepatitis B vaccine, and 1+ varicella vaccine
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Good Health: Immunizations
NIS estimated coverage of vaccinations among children aged 19-35 months
in NH 2007-2010
Year
Estimated Vaccination coverage (% 95%CI)
4+ DTaP
3+Polio
1+MMR
3+HepB
1+Varicella
2010
92.0
(86.9-97.1)
97.8
(95.8-99.8)
95.8
(92.8-98.8)
97.2
(95.4-99.0)
92.8
(88.3-97.3)
2009
87.5
(82.9-92.1)
93.0
(89.6-96.4)
92.0
(88.2-95.8)
94.8
(91.9-97.7)
89.0
(84.2-93.8)
2008
90.0
(85.9-94.1)
95.0
(92.1-97.9)
94.8
(91.8-97.8)
94.9
(92.1-97.7)
91.3
(87.8-94.8)
2007
94.4
(90.9-97.9)
97.6
(95.4-99.8)
96.6
(94.0-99.2)
98.6
(97.1-100.0)
91.3
(87.8-94.8)
Source: NIS 2010; and the New Hampshire Immunization Data 2011
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Good Health: Immunizations
NH School Immunization Survey 2010-11 and 2011-12
Year
2011-12
2010-11
Program
Enrollment
Up to date
Private Kinder
1,047
897
(85.7%)
57
(5.4%)
4
(0.4%)
Public Kinder
11,134
10,393
(93.3%)
194
(1.7%)
30
(0.3%)
Total
12,181
11,290
(92.7%)
251
(2.1%)
34
(0.3%)
Private Kinder
1,102
975
(88.5%)
61
(5.5%)
3
(0.3%)
Public Kinder
11,029
10,119
(91.7%)
166
(1.5%)
40
(0.4%)
Total
12,131
11,049
(91.5%)
227
(1.9%)
43
(0.4%)
Source: Dionne-Odom J. State of the State. NH Immunization Conference, March 2012
Religious
Exemption
Medical
Exemption
34
Good Health: Immunizations
Estimated vaccine series coverage by selected characteristics
for NH- 2002-2006
Characteristics
Language
Mother Education
Race/ethnicity
Geographic locations
Source: NIS 2002-2006 Combined Data-New Hampshire
Vaccine coverage
English
74.9 (72.1-77.7)
Spanish
66.5 (42.0-91.0)
<12 years
70.1 (58.7-81.5)
College
77.8 (74.5-81.1)
White
74.9 (72.0-77.9)
Black
65.1 (34.4-95.8)
Manchester city
80.7 (71.2-90.2)
Nashua city
81.5 (73.0-90.0)
Non-MSA
72.0 (67.2-76.8)
35
Good Health: Immunizations
Disparities: (2002-2006 data)
• Children with parents speaking English at interview had
higher coverage (74.9%) than children with parents speaking
Spanish (66.5%).
• Non-Hispanic white had higher coverage (74.9%) than NonHispanic black (65.1%).
• Children living in Manchester and Nashua cities had higher
vaccine coverage 80.7-81.5%) than children living in NonMSA areas (72.0%).
36
Good Health: Immunizations
NIS estimated coverage of vaccinations among children aged 19-35 months
by selected characteristics in NH 2010
Estimated Vaccination Coverage (% 95%CI)
Selected
characteristics
Series*
MSA
81.4±8.7
90.2±7.3
98.7±1.7
93.9±5.0
97.2±2.8
94.7±3.8
Non MSA
89.0±6.9
96.7±3.3
98.1±2.6
97.0±4.3
96.6±3.4
92.8±6.1
WIC
NA
99.0±2.0*
97.9±2.9
94.1±6.9
96.8±3.7
93.7±6.5
No WIC
85.9±6.6
99.8±0.5*
97.7±2.6
96.5±2.9
97.5±2.1
92.4±5.8
White
NA
94.3±4.0
97.4±2.
95.5±3.3
95.6±2.8
94.9±3.0
NA
NA
NA
4+ DTaP
3+Polio
1+MMR
3+HepB
1+Varicella
3
Others
Source: NIS 2010 data
NA
NA
NA
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Good Health: Immunizations
Areas with Incomplete Data and Recommendations:
• Information about Religious Exemption is incomplete. Although
parents or guardians are not required to name a religion or provide
religion related information, the public health professionals could
include religious related questions in the NH School Survey. Parents
or guardians can provide such information voluntarily.
• NH Immunization Data 2011 is a comprehensive report. But it does
not include information about vaccination coverage by social
economic characteristics. We recommend to include these data in
the future updates of combined NH vaccination coverage.
• Implementation of the immunization information system (IIS)
38
Strong Families: Multiple risk factors
Indicator #3:
• All families with young children who face multiple-risk factors
(such as very low income, homelessness, and family violence)
can access programs and services that work together to
support them.
39
Strong Families: Multiple risk factors
Data Sources:
• American Community Survey (ACS)
• 2010 Census
• 211 New Hampshire
Characteristics:
• Credible
• State wide, preferable town level data
• Reliable yearly up-date of key sources & reports
40
Strong Families: Multiple risk factors
Data Sources:
American Community Survey (ACS)
• Continuous survey by US Census Bureau of about 10,000 NH
households per year since 2006. Earlier surveys had a smaller
sample size. The survey contains about 78 questions some
answered for each person in the household. The responses are
compiled into over 1600 tables in 29 subject areas.
• Data is reported annually with estimates based on 1yr, 3yr, and 5yr
aggregated data. Estimates from the 5yr summary are available at
the census tract level of geographic resolution.
• Identifying vulnerable communities: 6 domains; 28 measures
41
Strong Families: Multiple risk factors
Disparities: New Hampshire Examples
Measure
Highest Lowest
20%
20%
% single parent families, children age 0-5
55%
0.6%
% Young children age 0-5 in poverty
38%
0.0%
% of families with children, parents not employed
21%
0.1%
% new mothers with less than high school degree or GED 45%
0.0%
% Children 0-9 of race other than white alone
0.0%
28%
42
Family Strength
Public_Health_Networks
Towns
Census Tracts
All-Flags
Dimension
Measures
0
1-2
3-4
Household family
relationship
6
Income security
11
Education
3
Housing
2
Disability
2
Minority/Language
4
5
6
7
8-16
Goffstown
Manchester
Bedford
Hudson
28
Nashua
• Screening for communities with
multiple risk factors.
• For each measure flag 10% of the
census tracts with the highest
need.
43
Strong Families: Multiple risk factors
Household family relationship:
•
•
•
•
•
•
% population age 8 and younger
% single parent families, children age 0-5
% Teen births
% Large families, 5 or more children
% Foster children
% Living with grandparent, children age 0-10
Income security:
•
•
•
•
•
•
•
•
•
Median household income, householder 25-44
% Children receiving public assistance income
% Young children age 0-5 in poverty
% Elementary school children 6-11 in poverty
% Families with young children age 0-4 below 184% of poverty
% new mothers below 200% of poverty
% mothers unemployed, looking for work with children 0-5
% of families with children, parents not employed
% uninsured: under 6, 6-17, 24-34
44
Strong Families: Multiple risk factors
Education:
• % new mothers with less than high school degree or GED
• % preschool children 3-4 in school
• % elementary school children 5-9 in school
Housing:
• % Children in subfamilies
• % Households with children under 0-5 that rent
Disability:
• % Children 0-4 with a disability
• % Children 5-17 with a disability
Minority/Language:
•
•
•
•
% Children in households with limited English
% Children 0-9 of race other than white alone
% population Hispanic or Latino race
% children 0-17 that are foreign born
45
Strong Families: Multiple risk factors
Caveats:
• This analysis is an exercise to explore the usefulness of population
characteristics.
– These results should not be used to infer conclusions about a
community.
– These measures are selected because they may be useful in
understanding, reaching, and supporting young families.
• This screening is best used as the starting point for discussion.
• These measures are not a substitute for qualitative experts
especially those familiar with local areas and populations.
46
Manchester:
Goffstown
Manchester 16
Census Tract 16, Manchester city, Manchester city, Hillsborough County, New Hampshire
NH Census Tracts
Most needy Least needy
quintile
quintile
Tract
Category
Description
NH nominal
001600
(58)
General:
Population children age 0 - 8
2010 Census total population
Bedford
(58)
815
6974
181
2338
16.3%
67.8%
0.0%
2.6%
0.0%
11.0%
14.61%
54.97%
28.41%
4.38%
0.98%
14.97%
6.63%
0.60%
0.00%
0.00%
0.00%
0.00%
33,281
54.8%
92.6%
51.6%
41,837
36.31%
96.23%
37.61%
111,948
1.16%
0.00%
0.00%
8.77%
25.58%
54.0%
89.2%
30.95%
63.84%
0.00%
0.66%
4.91%
6.83%
4.17%
5.21%
20.99%
0.0%
26.1%
2.0%
6.0%
21.6%
19.72%
20.74%
8.35%
10.38%
27.88%
0.00%
0.14%
1.08%
2.34%
15.69%
Percent new mothers with less tha high school degree or GED
Percent preschool children age 3 - 4 enrolled in school
Percent young children age 5 - 9 enrolled in school
8.09%
50.28%
95.42%
36.8%
56.1%
100.0%
45.30%
16.66%
85.19%
0.00%
86.57%
100.00%
Percent children in subfamilies
Percent households with children age 0 - 5 that rent
3.52%
31.55%
6.0%
95.3%
9.83%
76.55%
0.00%
1.47%
0.61%
5.86%
0.6%
8.4%
1.66%
9.90%
0.00%
3.38%
1.39%
9.64%
1.82%
1.95%
22.3%
28.9%
12.1%
10.2%
7.70%
27.87%
5.77%
7.09%
0.00%
0.00%
0.03%
0.00%
135,894
1,316,470
752
4,010
Household family relationship:
Center city Manchester
14/28 Measures Flagged > 90th
percentile
Vulnerabilities
Poverty
Unemployment
Single parents
Mothers without high school
Low English proficiency
Minority, Foreign born
Low home ownership
Children 5-17 with disability
Percent
Percent
Percent
Percent
Percent
Percent
population age 8 and younger
single parents ( children age 0 - 5 )
teen births
large families ( 5 or more children )
foster children
living with Grandparent (children age 0 - 10 )
10.66%
22.71%
4.25%
0.89%
0.19%
5.12%
Income security:
Median household income ( householder age 25 - 44 )
Percent children receiving public assistance income
Percent of young children age 0 - 5 in poverty
Percent of elementary school children age 6 - 11 in poverty
Percent families with young children age 0 - 4 below 184% of
poverty
Percent new mothers below 200% of poverty level
Percent mothers unemployed ( looking for work with children
under 6 )
Percent of families with children parents not employed
Percent young children age 0 - 5 uninsured
Percent children age 6 - 17 uninsured
Percent adults age 24 - 34 uninsured
$
73,734 $
12.35%
33.19%
11.59%
Education:
Housing:
Disability:
Percent of children age 0 - 4 with a disability
Percent children age 5 - 17 with a disability
Minority / Language
Percent
Percent
Percent
Percent
Source: 2006-2010 , 2008-2010 ACS
children in households with limited English
children age 0 - 9 of race other than white alone
population Hispanic or Lation race White alone
children that are foreign born
47
Chesterfield
Swanzey
Winchester:
Hinsdale
Census Tract 9717, Winchester CDP, Winchester town, Cheshire County, New Hampshire
Winchester
9717
Tract
Richmond
Category
Description
NH nominal
NH Census Tracts
Most needy Least needy
quintile
quintile
971700
(58)
General:
Population children age 0 - 8
2010 Census total population
135,894
1,316,470
550
4,341
(58)
815
6974
181
2338
12.6%
34.1%
0.0%
0.0%
0.0%
14.4%
14.61%
54.97%
28.41%
4.38%
0.98%
14.97%
6.63%
0.60%
0.00%
0.00%
0.00%
0.00%
37,985
57.7%
100.0%
42.8%
41,837
36.31%
96.23%
37.61%
111,948
1.16%
0.00%
0.00%
8.77%
25.58%
44.4%
84.8%
30.95%
63.84%
0.00%
0.66%
4.91%
6.83%
4.17%
5.21%
20.99%
32.6%
23.1%
1.6%
9.6%
24.6%
19.72%
20.74%
8.35%
10.38%
27.88%
0.00%
0.14%
1.08%
2.34%
15.69%
Percent new mothers with less tha high school degree or GED
Percent preschool children age 3 - 4 enrolled in school
Percent young children age 5 - 9 enrolled in school
8.09%
50.28%
95.42%
55.3%
77.7%
96.0%
45.30%
16.66%
85.19%
0.00%
86.57%
100.00%
Percent children in subfamilies
Percent households with children age 0 - 5 that rent
3.52%
31.55%
9.3%
56.3%
9.83%
76.55%
0.00%
1.47%
0.61%
5.86%
0.2%
7.5%
1.66%
9.90%
0.00%
3.38%
1.39%
9.64%
1.82%
1.95%
0.0%
1.4%
0.0%
1.8%
7.70%
27.87%
5.77%
7.09%
0.00%
0.00%
0.03%
0.00%
Household family relationship:
Winchester
11/28 Measures Flagged > 90th
percentile
Vulnerabilities
Poverty
Unemployment
Mothers without high school
Grandparent householder
Children in subfamilies
Percent
Percent
Percent
Percent
Percent
Percent
population age 8 and younger
single parents ( children age 0 - 5 )
teen births
large families ( 5 or more children )
foster children
living with Grandparent (children age 0 - 10 )
10.66%
22.71%
4.25%
0.89%
0.19%
5.12%
Income security:
Median household income ( householder age 25 - 44 )
Percent children receiving public assistance income
Percent of young children age 0 - 5 in poverty
Percent of elementary school children age 6 - 11 in poverty
Percent families with young children age 0 - 4 below 184% of
poverty
Percent new mothers below 200% of poverty level
Percent mothers unemployed ( looking for work with children
under 6 )
Percent of families with children parents not employed
Percent young children age 0 - 5 uninsured
Percent children age 6 - 17 uninsured
Percent adults age 24 - 34 uninsured
$
73,734 $
12.35%
33.19%
11.59%
Education:
Housing:
Disability:
Percent of children age 0 - 4 with a disability
Percent children age 5 - 17 with a disability
Minority / Language
Percent
Percent
Percent
Percent
Source: 2006-2010 , 2008-2010 ACS
children in households with limited English
children age 0 - 9 of race other than white alone
population Hispanic or Lation race White alone
children that are foreign born
48
Cornish Croydon
Claremont
Claremont:
Newport
Census Tract 9759.02, Claremont city, Claremont city, Sullivan County, New Hampshire
Tract
9759.02
Category
Description
NH nominal
NH Census Tracts
Most needy Least needy
quintile
quintile
975902
(58)
General:
Charlestown
Population children age 0 - 8
2010 Census total population
Unity
135,894
1,316,470
241
3,948
(58)
815
6974
181
2338
Household family relationship:
Smallest of 3 tracts in Claremont
8/28 Measures Flagged > 90th
percentile
Vulnerabilities
Poverty
% population age 8 and younger
Teen births
High uninsured
Percent
Percent
Percent
Percent
Percent
Percent
population age 8 and younger
single parents ( children age 0 - 5 )
teen births
large families ( 5 or more children )
foster children
living with Grandparent (children age 0 - 10 )
10.66%
22.71%
4.25%
0.89%
0.19%
5.12%
6.9%
52.6%
100.0%
0.0%
0.0%
5.3%
14.61%
54.97%
28.41%
4.38%
0.98%
14.97%
6.63%
0.60%
0.00%
0.00%
0.00%
0.00%
73,734 $
12.35%
33.19%
11.59%
52,137
44.6%
100.0%
35.5%
41,837
36.31%
96.23%
37.61%
111,948
1.16%
0.00%
0.00%
8.77%
25.58%
21.2%
74.2%
30.95%
63.84%
0.00%
0.66%
4.91%
6.83%
4.17%
5.21%
20.99%
0.0%
9.4%
11.5%
11.9%
28.5%
19.72%
20.74%
8.35%
10.38%
27.88%
0.00%
0.14%
1.08%
2.34%
15.69%
Percent new mothers with less tha high school degree or GED
Percent preschool children age 3 - 4 enrolled in school
Percent young children age 5 - 9 enrolled in school
8.09%
50.28%
95.42%
20.0%
25.7%
95.2%
45.30%
16.66%
85.19%
0.00%
86.57%
100.00%
Percent children in subfamilies
Percent households with children age 0 - 5 that rent
3.52%
31.55%
1.7%
75.3%
9.83%
76.55%
0.00%
1.47%
0.61%
5.86%
0.9%
8.3%
1.66%
9.90%
0.00%
3.38%
1.39%
9.64%
1.82%
1.95%
0.0%
1.8%
1.2%
0.0%
7.70%
27.87%
5.77%
7.09%
0.00%
0.00%
0.03%
0.00%
Income security:
Median household income ( householder age 25 - 44 )
Percent children receiving public assistance income
Percent of young children age 0 - 5 in poverty
Percent of elementary school children age 6 - 11 in poverty
Percent families with young children age 0 - 4 below 184% of
poverty
Percent new mothers below 200% of poverty level
Percent mothers unemployed ( looking for work with children
under 6 )
Percent of families with children parents not employed
Percent young children age 0 - 5 uninsured
Percent children age 6 - 17 uninsured
Percent adults age 24 - 34 uninsured
$
Education:
Housing:
Disability:
Percent of children age 0 - 4 with a disability
Percent children age 5 - 17 with a disability
Minority / Language
Percent
Percent
Percent
Percent
Source: 2006-2010 , 2008-2010 ACS
children in households with limited English
children age 0 - 9 of race other than white alone
population Hispanic or Lation race White alone
children that are foreign born
49
Berlin:
Stark
Milan
Kilkenny
Berlin
Success
9508
Census Tract 9508, Berlin city, Berlin city, Coos County, New Hampshire
Tract
Category
Description
NH nominal
NH Census Tracts
Most needy Least needy
quintile
quintile
950800
(58)
General:
Randolph
Jefferson
Population children age 0 - 8
2010 Census total population
Gorham
Smallest of 3 tracts in Berlin
13/28 Measures Flagged > 90th
percentile
Vulnerabilities
Poverty
Unemployment
Single parents
Teen births
Mothers without high school
Large families
Children 6-17 uninsured
Grandparent householder
Children with disability
135,894
1,316,470
242
2,517
(58)
815
6974
181
2338
10.2%
71.6%
36.8%
5.4%
0.0%
13.5%
14.61%
54.97%
28.41%
4.38%
0.98%
14.97%
6.63%
0.60%
0.00%
0.00%
0.00%
0.00%
38,021
53.9%
63.2%
48.2%
41,837
36.31%
96.23%
37.61%
111,948
1.16%
0.00%
0.00%
8.77%
25.58%
66.7%
56.1%
30.95%
63.84%
0.00%
0.66%
4.91%
6.83%
4.17%
5.21%
20.99%
28.6%
8.9%
5.5%
15.2%
21.7%
19.72%
20.74%
8.35%
10.38%
27.88%
0.00%
0.14%
1.08%
2.34%
15.69%
Percent new mothers with less tha high school degree or GED
Percent preschool children age 3 - 4 enrolled in school
Percent young children age 5 - 9 enrolled in school
8.09%
50.28%
95.42%
36.8%
28.6%
100.0%
45.30%
16.66%
85.19%
0.00%
86.57%
100.00%
Percent children in subfamilies
Percent households with children age 0 - 5 that rent
3.52%
31.55%
3.5%
34.9%
9.83%
76.55%
0.00%
1.47%
0.61%
5.86%
2.9%
14.6%
1.66%
9.90%
0.00%
3.38%
1.39%
9.64%
1.82%
1.95%
0.0%
0.0%
0.0%
0.0%
7.70%
27.87%
5.77%
7.09%
0.00%
0.00%
0.03%
0.00%
Household family relationship:
Percent
Percent
Percent
Percent
Percent
Percent
population age 8 and younger
single parents ( children age 0 - 5 )
teen births
large families ( 5 or more children )
foster children
living with Grandparent (children age 0 - 10 )
10.66%
22.71%
4.25%
0.89%
0.19%
5.12%
Income security:
Median household income ( householder age 25 - 44 )
Percent children receiving public assistance income
Percent of young children age 0 - 5 in poverty
Percent of elementary school children age 6 - 11 in poverty
Percent families with young children age 0 - 4 below 184% of
poverty
Percent new mothers below 200% of poverty level
Percent mothers unemployed ( looking for work with children
under 6 )
Percent of families with children parents not employed
Percent young children age 0 - 5 uninsured
Percent children age 6 - 17 uninsured
Percent adults age 24 - 34 uninsured
$
73,734 $
12.35%
33.19%
11.59%
Education:
Housing:
Disability:
Percent of children age 0 - 4 with a disability
Percent children age 5 - 17 with a disability
Minority / Language
Percent
Percent
Percent
Percent
Source: 2006-2010 , 2008-2010 ACS
children in households with limited English
children age 0 - 9 of race other than white alone
population Hispanic or Lation race White alone
children that are foreign born
50
Strong Families: Multiple risk factors
Limitations:
• The selection of indicators needs to be revisited. Others who understand
Spark NH's needs should examine this work for measures that should be
added.
• We did not include measures of households having moved in the past year
because this data was not broken out by the presence of children.
• Education attainment of the young parent age group may also be useful.
• Some measures are small percentages of the community and the margin
of error needs to be taken into account.
• Weighting of these measures needs to be determined. Different
weightings may be needed for different analysis objectives.
• Mapping information in this way identifies areas where the population has
unusually higher vulnerability characteristics. However, this is not an
indication of where the largest number of vulnerable families are located.
51
Strong Families: Multiple risk factors
211 New Hampshire Call Analysis (211-NH)
• State wide call referral system database of over 1,800 providers
• In 2011 provided 58,565 referrals
Rate per
County
(1000 pop)
Merrimack County
68.35
Hillsborough County
49.26
Belknap County
44.93
Strafford County
41.78
New Hampshire
40.89
Coos County
34.19
Carroll County
33.59
Rockingham County
27.35
Grafton County
26.35
Cheshire County
26.04
Sullivan County
24.58
Need Category
Total
Referrals
17,046
ORGANIZATIONAL/COMMUNITY SERVICES
BASIC NEEDS
15,399
5,697
INCOME SUPPORT AND EMPLOYMENT
4,947
CONSUMER SERVICES
4,096
CRIMINAL JUSTICE AND LEGAL SERVICES
3,882
HEALTH CARE
3,802
INDIVIDUAL AND FAMILY LIFE
MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES 2,619
452
EDUCATION
369
ENVIRONMENTAL/ PUBLIC HEALTH/ PUBLIC SAFETY
256
REFERRALS TO SERVICES NOT IN 2-1-1 DATABASE
TOTAL NUMBER OF REFERRALS
58,565
• Call volume by county by month does not appear to be seasonal
Source: 211-NH
52
Strong Families: Multiple risk factors
Data Categories:
•
•
•
•
Conditions / Need
Support / Providers
Access / Needs Met
Quality / Efficacy
(Surveillance; Disparities; Needs Assessment)
(Social capital inventory; Maps)
(Requests; Referrals; % qualified; Served)
(Needs met; Satisfaction; Cost)
Greatest need for improved data:
• Access / Needs Met
• Quality / Efficacy
53
Strong Families: Multiple risk factors
Recommendations:
• Coordinate and build on the needs assessments and data collected by State
agencies and NH United Way organizations
• Collect consistent data on access to and satisfaction with services
(e.g. questions on access to services and satisfaction with services modeled on
current 211-NH and United Way questions)
• Establish consistent data collection criteria to facilitate use of combined
measures (e.g. common age-range, definitions, questions, and geography)
• Establish a library of data sources and derived indicators
• Maintain a database of metadata on these sources and indicators
• Assure periodic up-date to key reports & measures
(e.g. request a report on unmet needs from 211-NH)
54
Strong Families: Home Visiting
Indicator #4:
• All families with young children can access home visiting,
family support and parent education.
55
Strong Families: Home Visiting
Home visiting, family support, & parent education
• These services are designed to foster the healthy development of
young children and their families
• Home visits:
– Voluntary sustained effort that pairs new or expectant families
with visitors who provide support during pregnancy and
throughout early childhood, parenting information, and
connection to community-based services
– Effective way to improve the health and well-being of children
and their families
– Predominately delivered in family’s home
– Evidence based
Source: PEW Home Visiting Inventory
56
Strong Families: Home Visiting
Benefits of Home Visits, family support, & parent education
programs
• Reduce incidence of preterm and low birth weight babies
– 50% reduction as compared to women who did not partake in programs
• Mothers reported being less stress and more sensitive and support in
interactions with their children
– 30-month reduction in welfare use
– 82% increase in the number of months they were employed
– 46% increase in the father's presence in the household
• Children who participated in programs 35% less likely to end up in the ER
–
–
–
–
40% less likely to need treatment for injuries and accidents (ages 2-4 years)
Higher cognitive and vocabulary scores than control group by age 6
Higher math and reading test scores by third grade
Improved school readiness
Source: The Pew Center on the States
57
State Supported Programs
Programs
Age
Numbers
Served
102
Services Provided
0-3
Eligibility
Criteria
Income based
Early Head
Start
Head Start
3-5
Income based
1,100
Educational, center-based, parent education
and support (in group), screening, enriched
child care, mental health consultation,
nutritional, dental, and medical issues
700
Health assessment & education, parent
education, family support, family planning,
child development, smoking cessation,
depression, access to reproductive health care
Home Visiting Prenatal - Medicaid
NH
1
eligible
(18 sites in the
states)
Home visits, prenatal education, parent
education and support, developmental
screening and assessment, mental health
consultation, center-based socialization
58
Early Head Start/Head Locations in New Hampshire
Source: Early Childhood Learning & Knowledge Center (ECLKC)
59
HVNH Performance Measurements
Fiscal Year 2011
Indicators
Total Numbers
Percentages
Pregnant women who quit smoking by the birth of
the baby
113/208
54%
Children who were not exposed to environmental
tobacco smoke in their homes
341/414
82%
Women who received further evaluation/treatment
for depression
217/247
88%
Children served, after being determined to be at risk
for developmental delays from a formal, validated
developmental screening
95/141
67%
Postnatal women served who are not pregnant at the
exit of the program
296/400
74%
Families who develop resiliency skills in daily family
life management and economic self-sufficiency
446/481
93%
60
Source: HVNH Data Calculation, Deidre Dunn
Strong Families: Home Visiting
Family Feedback: Paper/Phone Survey
• Meeting the needs of targeted populations
• Target Population
– Families who are Medicaid eligible, utilizes family support and parent
education services, under poverty level
• Target Locations
– Distribute surveys at family support and education sites (I.E. home visiting),
community centers,
– Phones: when reapply for assistance
• Can target people who need services but are not currently receiving them
• Sample Questions:
–
–
–
–
Do you have access to family support and parent education services in your community?
Do you think you have a nurturing and healthy relationship with your child?
Have you ever participated in a home visiting program?
What services did you receive while you were pregnant?
61
Early Learning: Access
Indicator #5:
• All families in need of quality early learning programs and
services for their young children can access such services
62
Early Learning: Access
• “Education is one of the strongest predictors of health: The
more schooling people have, the better their health is likely to
be.”
• Investments in education outweigh those in medical care
• The Robert Wood Johnson Foundation:
– Increased knowledge
– Additional opportunity
– Elevated self-efficacy
Sources:
Freudenberg, N., & Ruglis, J. (2007). Reframing school dropout as a public health issue. Centers for Disease Control and Prevention.
Auster, R., Leveson, I., & Sarachek, D. (1969). The production of health, an exploratory study. Journal of Human Resources, 4(4), 411-436.
Egerter, S., Braveman, P., Sadegh-Nobari, T., Grossman-Kahn, R., & Dekker, M. (2009). Commission to build a healthier America: Education and health. No. 6. Robert Wood Johnson Foundation.
63
Early Learning: Access
• “How parents define child care varies according to individual
family need, but the need for affordable, quality child care is
great and growing! Studies by the American Academy of
Pediatrics have confirmed that a child’s brain structure is
influenced significantly by their environment and experiences
during the first few years of life.”
• Ensuring quality early education in New Hampshire will allow
our state to continue to develop healthy citizens who are able
to contribute to the greater community.
Source:
Easter Seals: http://www.easterseals.com/site/PageServer?pagename=ntl_cdc_main
64
Early Learning: Access
Data sources:
• NH Department of Education
– Pre-school and kindergarten enrollment and attendance
• Head Start Data (2006-7)
• Annual Market Rate Survey for Early Care and Education
(UNH) (2010)
• Annie E. Casey Kids Count Data Center
• National Institute for Early Education Research: The State of
Preschool 2011. State Preschool Yearbook.
65
Early Learning: Access
• Early childhood education puts kids on the right track to
succeed.
• Legislation approved in 2007 expanded public education to
include kindergarten in New Hampshire, the last state to do
so.
• Now we have attendance rates of 90%+ in every kindergarten
district.
Source:s
TITLE XV EDUCATION, CHAPTER 193-E: ADEQUATE PUBLIC EDUCATION, (2007). Retrieved from http://www.gencourt.state.nh.us/rsa/html/xv/193-e/193-e-mrg.htm
New Hampshire Department of Education. (2012). Attendance and Enrollment Reports. Retrieved from http://www.education.nh.gov/data/attendance.htm.
66
Early Learning: Access
Kids COUNT
• Children ages 3 to 5 not enrolled in nursery school, preschool or
kindergarten in 2010 in NH- 36%.
– Higher enrollment in Rockingham and Hillsborough counties
Head Start Data (2006-2007)
• NH funded to serve 1,632 children (2,001 actual- about 18% of eligible)
• 34% 3-year-olds, 49% 4-year-olds
• 84% white, 89% English as primary language
Sources:
Annie E. Casey. (2010). Kids Count Data Center. Data Across States. Retrieved from
http://datacenter.kidscount.org/data/acrossstates/Rankings.aspx?ind=5109
New Hampshire Department of Health and Human Services Division for Children, Youth & Families. (2008). Growing and Learning in New Hampshire Head
Start. Retrieved from http://www.nhfv.org/files/dcyf_headstart.pdf
67
Early Learning:
Public preschool
Attendance
Source: NH Dept. Education Attendance and Enrollment reports:
http://www.education.nh.gov/data/attendance.htm
68
Early Learning: Access
Public Pre-K Enrollment
2011-2012
3,165
2010-2011
3,095
2009-2010
2,987
2008-2009
2,834
2007-2008
2,614
2006-2007
2,531
2005-2006
2,525
2004-2005
2,360
2003-2004
2,221
2002-2003
1,923
2001-2002
1,830
0
500
1,000
1,500
Source:
NH Dept. Education Attendance and Enrollment reports: http://www.education.nh.gov/data/attendance.htm
2,000
2,500
3,000
3,500
69
Early Learning: Access
Public Early Learning Enrollment
2011-2012
11,904
2010-2011
11,922
2009-2010
11,969
10,968
2008-2009
10,489
2007-2008
2006-2007
10,375
2005-2006
10,360
Kindergarten
PreK
10,116
2004-2005
9,989
2003-2004
9,757
2002-2003
9,599
2001-2002
0
2,000
4,000
6,000
8,000
Source: NH Dept. Education Attendance and Enrollment reports: http://www.education.nh.gov/data/attendance.htm
10,000
12,000
14,000
70
Early Learning: Access
National Institute for Early Education Research:
The State of Preschool 2011. State Preschool Yearbook
Source:
National Institute for Early Education Research. (2012). Annual State Pre-K reports: The State of Preschool 2011. Retrieved from http://nieer.org/node/660
71
Early Learning: Access
National Institute for Early Education Research:
The State of Preschool 2011. State Preschool Yearbook
Source:
National Institute for Early Education Research. (2012). Annual State Pre-K reports: The State of Preschool 2011. Retrieved from http://nieer.org/node/660
72
Early Learning: Access
Annual Market Rate Survey for Early Care and Education (UNH)
(923 Licensed programs provided data)
• Average capacity of state’s individual child care centers has
risen from 38% to 45% in 10 years.
• Number of licensed child care programs has fallen 12% in ten
years.
• “Slightly more than three out of five licensed programs
(62.17%) have an arrangement with DHHS to receive
scholarships for enrolled children, a 10.88% increase since
2007 (51.29%). It was 53.3% in 2001“.
Source:
University of New Hampshire. (2009). Annual Market Rate Survey for Early Care and Education. Retrieved from http://www.dhhs.nh.gov/dcyf/cdb/documents/marketrate2009.pdf
73
Early Learning: Success
Indicator #6:
• All children, birth through grade 3, are on track to succeed
when they enter school and beyond.
74
Early Learning: Success
Data sources:
• Test Scores:
– NECAP (New England Common Assessment Program)
– NAEP (National Assessment of Educational Progress)
75
Early Learning: Success
NECAP (New England Common Assessment Program)
• 3rd grade NH students performing at or above proficient
– Mathematics: 73% (2007), 76% (2010), NH Rank: #1
– Reading: 77% (2007), 80% (2010), NH Rank: #1
NAEP (National Assessment of Educational Progress)
• 4th grade NH students performing at or above proficient
– Mathematics: 43% (2003), 57% (2011), NH Rank: #2
– Reading: 40% (2003), 43% (2011), NH Rank: #3
Source:
New Hampshire Department of Education. (2011). National Assessment of Educational Progress. Retrieved from http://www.education.nh.gov/instruction/assessment/naep/index.htm.
76
Early Learning: Success
NAEP (National Assessment of Educational Progress)
MATH- 2011
• 4th grade NH students performing at or above proficient
•
•
•
•
•
•
Male - 58% (NH rank: #3)
Female - 56% (NH rank: #2)
White - 59% (NH rank: #9)
Non-White - 44% (NH rank: #1)
Black – 27% (NH rank: #3)
Hispanic – 30% (NH rank: #10)
•
•
•
•
•
•
Disability- 25% (NH rank: #6)
No Disability- 63% (NH rank: #2)
Free Lunch - 39% (NH rank: #1)
No Free Lunch - 64% (NH rank: #4)
ELL– 19% (NH rank: #10)
Non-ELL– 58% (NH rank: #2)
Source:
New Hampshire Department of Education. (2011). National Assessment of Educational Progress. Retrieved from http://www.education.nh.gov/instruction/assessment/naep/index.htm.
77
Early Learning: Success
NAEP (National Assessment of Educational Progress)
READING- 2011
• 4th grade NH students performing at or above proficient
•
•
•
•
•
•
Male - 38% (NH rank: #6)
Female - 50% (NH rank: #2)
White - 44% (NH rank: #15)
Non-White - 33% (NH rank: #2)
Black – No 2011 data
Hispanic – 26% (NH rank: #5)
•
•
•
•
•
•
Disability- 20% (NH rank: #11)
No Disability- 49% (NH rank: #2)
Free Lunch - 25% (NH rank: #2)
No Free Lunch - 50% (NH rank: #13)
ELL– 14% (NH rank: #6)
Non-ELL– 44% (NH rank: #5)
Source:
New Hampshire Department of Education. (2011). National Assessment of Educational Progress. Retrieved from http://www.education.nh.gov/instruction/assessment/naep/index.htm.
78
Early Learning
Other resources:
• New Hampshire Child Care Resource and Referral Network
• NH DHHS Child Development Bureau
• NH Public Libraries
• NECAP can be evaluated at the local level by school
Areas with incomplete data:
• Evaluation of all NH Early Learning programs (public/private) by a
single set of standards.
• Criteria for readiness in NH (before school entry-kindergarten)
• NH Measurements of child success after kindergarten, before grade 3.
• Age ranges are different for many of the resources, which makes
comparison difficult.
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Early Learning Opportunities
Survey Recommendation:
• National Center for Education Statistics: National Household
Education Survey Program (NHES) 2007
– Parent and Family Involvement in Education & School Readiness
– Other surveys: Early Childhood Program Participation, Library use
• New Hampshire application of an adaptation of this survey
would provide a rich picture of the children in our state are on
track to succeed when they enter school and perception of
available resources by families with young children.
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Source: National Center for Education Statistics. National Household Education Survey Program (NHES) 2007: http://nces.ed.gov/nhes/
Conclusions
Common improvement opportunity themes
• Data sharing
• Implementation of common standards
• Data comparability (age ranges)
• Gaps for individuals that don’t qualify
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Conclusions
• After researching the state of children and young families in
New Hampshire, the resources available show that our state is
strong and healthy.
• Despite this overall health, there are disparities that have
been outlined in every category.
• We hope that our recommendations will be taken under
advisement during the next phase of Spark NH’s work for all
the children of our state and their families.
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Acknowledgements
• Laura Milliken
– Spark NH Director
• Patricia Tilley, M.S. E.d.
– Title V Administrator, Maternal and Child Health Section DHHS
• David LaFlamme, Ph.D., M.P.H.
– Maternal and Child Health Section DHHS
• Ludmilla Anderson, M.D., M.P.H.
– NH DHHS, UNH
• John Seavey, Ph.D., M.A., M.P.H.
– College of Health and Human Services, UNH
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May 7, 2012
Project Group:
University of New Hampshire
Master of Public Health Program
Fengxiang Gao- [email protected]
Dennis Holt- [email protected]
Erin Langille- [email protected]
Fatima Sammy - [email protected]
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