1. Spark NH Vision “All New Hampshire children and their families are healthy, learning, and...

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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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New Hampshire’s 135,894 Children Age 0 – 8 years

Public_Health_Networks

Towns

Census Tracts1 Dot = 25

Children 0-8

ManchesterManchester

BedfordBedford

GoffstownGoffstown

NashuaNashua

HudsonHudson

Source: 2006-2010 ACS

• 10 counties• 15 public health regions• 170 school districts• 259 towns• 292 populated census tracts

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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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• Early childhood mental health is the social/emotional well-being 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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• 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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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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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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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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• 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% %

Percent of children aged 2-17 years who have one or more emotional, behavioral, or developmental conditions*

12.6 11.3

Prevalence by Age

Age 6-11 years 10.8 12.1

Age 12-17 years 17.8 14.9

Prevalence by Sex

Male 15.5 14.5

Female 9.6 7.9

Prevalence by poverty level

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

The Mental and Emotional Well-Being of Children

Source: Endowment for Health

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2007 National Survey of Children’s Health

New Hampshire Nationwide% %

Prevalence by Insurance Type

Public 29.5 17.5

Private 8.3 9.0

Percent of Children age 2-17 with emotional, behavioral, or developmental conditions: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

Source: Endowment for Health

The Mental and Emotional Well-Being of Children

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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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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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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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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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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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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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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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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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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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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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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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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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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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• 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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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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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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Year

Coverage of vaccine series*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

NIS estimated vaccine coverage among children aged 19-35 months in NH 2007-2010

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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)

NIS estimated coverage of vaccinations among children aged 19-35 months in NH 2007-2010

Source: NIS 2010; and the New Hampshire Immunization Data 2011

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Year Program Enrollment Up to date ReligiousExemption

MedicalExemption

2011-12 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%)

2010-11 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%)

NH School Immunization Survey 2010-11 and 2011-12

Source: Dionne-Odom J. State of the State. NH Immunization Conference, March 2012

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Characteristics Vaccine coverage

LanguageEnglish 74.9 (72.1-77.7)

Spanish 66.5 (42.0-91.0)

Mother Education<12 years 70.1 (58.7-81.5)

College 77.8 (74.5-81.1)

Race/ethnicity White 74.9 (72.0-77.9)

Black 65.1 (34.4-95.8)

Geographic locations

Manchester city 80.7 (71.2-90.2)

Nashua city 81.5 (73.0-90.0)

Non-MSA 72.0 (67.2-76.8)

Source: NIS 2002-2006 Combined Data-New Hampshire

Estimated vaccine series coverage by selected characteristics for NH- 2002-2006

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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 Non-Hispanic black (65.1%).

• Children living in Manchester and Nashua cities had higher vaccine coverage 80.7-81.5%) than children living in Non-MSA areas (72.0%).

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Selected characteristics

Estimated Vaccination Coverage (% 95%CI)

Series* 4+ DTaP 3+Polio 1+MMR 3+HepB 1+Varicella

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±2.3 95.5±3.3 95.6±2.8 94.9±3.0

Others NA NA NA NA NA NA

NIS estimated coverage of vaccinations among children aged 19-35 months by selected characteristics in NH 2010

Source: NIS 2010 data

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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)

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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.

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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

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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

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MeasureHighest 20%

Lowest 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 28% 0.0%

Disparities: New Hampshire Examples

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Public_Health_Networks

Towns

Census Tracts

All-Flags

0

1-2

3-4

5

6

7

8-16


BedfordBedford

GoffstownGoffstown

NashuaNashua

HudsonHudson

Family Strength

• Screening for communities with multiple risk factors.

• For each measure flag 10% of the census tracts with the highest need.

Dimension Measures

Household family relationship

6

Income security 11

Education 3

Housing 2

Disability 2

Minority/Language 4

28

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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

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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

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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.

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Manchester:


BedfordBedford

GoffstownGoffstown

16

Center city Manchester14/28 Measures Flagged > 90th

percentileVulnerabilities Poverty Unemployment Single parents Mothers without high school Low English proficiency Minority, Foreign born Low home ownership Children 5-17 with disability

Census Tract 16, Manchester city, Manchester city, Hillsborough County, New HampshireTract NH Census Tracts

Category Description NH nominal 001600Most needy quintile

Least needy quintile

General: (58) (58)Population children age 0 - 8 135,894 752 815 1812010 Census total population 1,316,470 4,010 6974 2338

Household family relationship:Percent population age 8 and younger 10.66% 16.3% 14.61% 6.63%Percent single parents ( children age 0 - 5 ) 22.71% 67.8% 54.97% 0.60%Percent teen births 4.25% 0.0% 28.41% 0.00%Percent large families ( 5 or more children ) 0.89% 2.6% 4.38% 0.00%Percent foster children 0.19% 0.0% 0.98% 0.00%Percent living with Grandparent (children age 0 - 10 ) 5.12% 11.0% 14.97% 0.00%

Income security:Median household income ( householder age 25 - 44 ) 73,734$ 33,281$ 41,837 111,948 Percent children receiving public assistance income 12.35% 54.8% 36.31% 1.16%Percent of young children age 0 - 5 in poverty 33.19% 92.6% 96.23% 0.00%Percent of elementary school children age 6 - 11 in poverty 11.59% 51.6% 37.61% 0.00%Percent families with young children age 0 - 4 below 184% of poverty 8.77% 54.0% 30.95% 0.00%Percent new mothers below 200% of poverty level 25.58% 89.2% 63.84% 0.66%Percent mothers unemployed ( looking for work with children under 6 ) 4.91% 0.0% 19.72% 0.00%Percent of families with children parents not employed 6.83% 26.1% 20.74% 0.14%Percent young children age 0 - 5 uninsured 4.17% 2.0% 8.35% 1.08%Percent children age 6 - 17 uninsured 5.21% 6.0% 10.38% 2.34%Percent adults age 24 - 34 uninsured 20.99% 21.6% 27.88% 15.69%

Education:Percent new mothers with less tha high school degree or GED 8.09% 36.8% 45.30% 0.00%Percent preschool children age 3 - 4 enrolled in school 50.28% 56.1% 16.66% 86.57%Percent young children age 5 - 9 enrolled in school 95.42% 100.0% 85.19% 100.00%

Housing:Percent children in subfamilies 3.52% 6.0% 9.83% 0.00%Percent households with children age 0 - 5 that rent 31.55% 95.3% 76.55% 1.47%

Disability:Percent of children age 0 - 4 with a disability 0.61% 0.6% 1.66% 0.00%Percent children age 5 - 17 with a disability 5.86% 8.4% 9.90% 3.38%

Minority / LanguagePercent children in households with limited English 1.39% 22.3% 7.70% 0.00%Percent children age 0 - 9 of race other than white alone 9.64% 28.9% 27.87% 0.00%Percent population Hispanic or Lation race White alone 1.82% 12.1% 5.77% 0.03%Percent children that are foreign born 1.95% 10.2% 7.09% 0.00%

Source: 2006-2010 , 2008-2010 ACS

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Winchester:

Winchester11/28 Measures Flagged > 90th

percentileVulnerabilities Poverty Unemployment Mothers without high school Grandparent householder Children in subfamilies

WinchesterWinchester

SwanzeySwanzey

HinsdaleHinsdale

RichmondRichmond

ChesterfieldChesterfield

9717

Census Tract 9717, Winchester CDP, Winchester town, Cheshire County, New HampshireTract NH Census Tracts










Source: 2006-2010 , 2008-2010 ACS

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Claremont:

Smallest of 3 tracts in Claremont8/28 Measures Flagged > 90th

percentileVulnerabilities Poverty % population age 8 and younger Teen births High uninsured

ClaremontClaremont

UnityUnity

CornishCornish

NewportNewport

CharlestownCharlestown

CroydonCroydon

9759.02Census Tract 9759.02, Claremont city, Claremont city, Sullivan County, New Hampshire

Tract NH Census Tracts










Source: 2006-2010 , 2008-2010 ACS

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Berlin:

Smallest of 3 tracts in Berlin13/28 Measures Flagged > 90th

percentileVulnerabilities Poverty Unemployment Single parents Teen births Mothers without high school Large families Children 6-17 uninsured Grandparent householder Children with disability

BerlinBerlin

MilanMilan

RandolphRandolph GorhamGorham

StarkStark

KilkennyKilkenny

SuccessSuccess

JeffersonJefferson

9508Census Tract 9508, Berlin city, Berlin city, Coos County, New Hampshire

Tract NH Census Tracts










Source: 2006-2010 , 2008-2010 ACS

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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.

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211 New Hampshire Call Analysis (211-NH) • State wide call referral system database of over 1,800 providers• In 2011 provided 58,565 referrals

Need CategoryTotal

ReferralsORGANIZATIONAL/COMMUNITY SERVICES 17,046 BASIC NEEDS 15,399 INCOME SUPPORT AND EMPLOYMENT 5,697 CONSUMER SERVICES 4,947 CRIMINAL JUSTICE AND LEGAL SERVICES 4,096 HEALTH CARE 3,882 INDIVIDUAL AND FAMILY LIFE 3,802 MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES 2,619 EDUCATION 452 ENVIRONMENTAL/ PUBLIC HEALTH/ PUBLIC SAFETY 369 REFERRALS TO SERVICES NOT IN 2-1-1 DATABASE 256

TOTAL NUMBER OF REFERRALS 58,565

Rate per

County (1000 pop)Merrimack County 68.35Hillsborough County 49.26Belknap County 44.93Strafford County 41.78New Hampshire 40.89Coos County 34.19Carroll County 33.59Rockingham County 27.35Grafton County 26.35Cheshire County 26.04Sullivan County 24.58

• Call volume by county by month does not appear to be seasonal

Source: 211-NH

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Data Categories:•Conditions / Need (Surveillance; Disparities; Needs Assessment)

•Support / Providers (Social capital inventory; Maps)

•Access / Needs Met (Requests; Referrals; % qualified; Served)

•Quality / Efficacy (Needs met; Satisfaction; Cost)

Greatest need for improved data:•Access / Needs Met•Quality / Efficacy

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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)

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Strong Families: Home Visiting

Indicator #4:

• All families with young children can access home visiting, family support and parent education.

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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 basedSource: PEW Home Visiting Inventory

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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

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State Supported ProgramsPrograms Age Eligibility

Criteria Numbers Served

Services Provided

Early Head Start

0-3 Income based 102 Home visits, prenatal education, parent education and support, developmental screening and assessment, mental health consultation, center-based socialization

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

Home Visiting NH (18 sites in the states)

Prenatal -1

Medicaid eligible

700 Health assessment & education, parent education, family support, family planning, child development, smoking cessation, depression, access to reproductive health care

59

Early Head Start/Head Locations in New Hampshire

Source: Early Childhood Learning & Knowledge Center (ECLKC)

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HVNH Performance MeasurementsFiscal 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 screening95/141 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%

Source: HVNH Data Calculation, Deidre Dunn

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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?

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Early Learning: Access

Indicator #5:

• All families in need of quality early learning programs and services for their young children can access such services

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• “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.

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• “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

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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.

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• 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:sTITLE 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.htmNew Hampshire Department of Education. (2012). Attendance and Enrollment Reports. Retrieved from http://www.education.nh.gov/data/attendance.htm.

http://www.gencourt.state.nh.us/rsa/html/xv/193-e/193-e-mrg.htm

http://www.education.nh.gov/data/attendance.htm

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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=5109New 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

http://datacenter.kidscount.org/data/acrossstates/Rankings.aspx?ind=5109

http://www.nhfv.org/files/dcyf_headstart.pdf

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Early Learning:Public preschool Attendance

Source: NH Dept. Education Attendance and Enrollment reports: http://www.education.nh.gov/data/attendance.htm

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2001-2002

2002-2003

2003-2004

2004-2005

2005-2006

2006-2007

2007-2008

2008-2009

2009-2010

2010-2011

2011-2012

0 500 1,000 1,500 2,000 2,500 3,000 3,500

1,830

1,923

2,221

2,360

2,525

2,531

2,614

2,834

2,987

3,095

3,165

Public Pre-K Enrollment


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2001-2002

2002-2003

2003-2004

2004-2005

2005-2006

2006-2007

2007-2008

2008-2009

2009-2010

2010-2011

2011-2012

0 2,000 4,000 6,000 8,000 10,000 12,000 14,000

9,599

9,757

9,989

10,116

10,360

10,375

10,489

10,968

11,969

11,922

11,904

Public Early Learning Enrollment

Kindergarten PreK

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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

National Institute for Early Education Research: The State of Preschool 2011. State Preschool Yearbook

http://nieer.org/node/660

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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

National Institute for Early Education Research: The State of Preschool 2011. State Preschool Yearbook

http://nieer.org/node/660

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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

http://www.dhhs.nh.gov/dcyf/cdb/documents/marketrate2009.pdf

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Early Learning: Success

Indicator #6:

• All children, birth through grade 3, are on track to succeed when they enter school and beyond.

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Data sources:

• Test Scores:– NECAP (New England Common Assessment Program)– NAEP (National Assessment of Educational Progress)

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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.

http://www.education.nh.gov/instruction/assessment/naep/index.htm

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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)


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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)


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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.

Source: National Center for Education Statistics. National Household Education Survey Program (NHES) 2007: http://nces.ed.gov/nhes/

http://nces.ed.gov/nhes/

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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 HampshireMaster of Public Health Program

Fengxiang Gao- [email protected] Holt- [email protected] Langille- [email protected] Sammy - [email protected]

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