Evidence-based Practice and Community Metrics Jan Figart, MS, RN Community Service Council.
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Transcript of Evidence-based Practice and Community Metrics Jan Figart, MS, RN Community Service Council.
Evidence-based Practice and Community Metrics
Jan Figart, MS, RNCommunity Service Council
Home Visitation Model
The Adverse Childhood Experiences (ACE) Study
• Major American research project that poses the question of whether and how childhood experiences affect adult health decades later
• Provides compelling evidence that:– Adverse childhood experiences are surprisingly common– ACE’s happen even in “the best of families”– ACE’s have long-term, damaging consequences
• Findings reveal powerful relationships between emotional experiences as children and physical and mental health as adults
Source: The Adverse Childhood Experiences Study website: www.acestudy.org, “About the Adverse Childhood Experiences Study.”
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The Adverse Childhood Experiences (ACE) Study Pyramid
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Conception
Death
Mechanisms by which Adverse Childhood Experiences Influence Health and Well-being throughout the Lifespan
Source: The Adverse Childhood Experiences Study website: www.acestudy.org, “About the Adverse Childhood Experiences Study.”
Adverse Childhood Experiences…
• Recurrent physical abuse• Recurrent emotional
abuse• Sexual abuse• An alcohol or drug abuser• An incarcerated
household member
• Someone who is chronically depressed, suicidal, institutionalized or mentally ill
• Mother being treated violently
• One or no parents• Emotional or physical
neglect
Source: The Adverse Childhood Experiences Study website: www.acestudy.org, “What are Adverse Childhood Experieinces (ACE’s).”
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…Lead to Health-Risk Behaviors…
• Smoking• Overeating• Physical inactivity• Heavy alcohol use• Drug use• Promiscuity
Source: The Adverse Childhood Experiences Study website: www.acestudy.org
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…Which Cause Disease, Disability and Social Problems in Adulthood
• Heart disease• Cancer• Chronic lung and liver
disease• Stroke • Diabetes• Sexually transmitted
diseases
• Nicotine addiction• Alcoholism• Drug addiction• Obesity• Depression• Suicide• Injuries• Unintentional pregnancy
Source: Felitti, Vincent J., “The Relationship of Adverse Childhood Experiences to Adult Health: Turning gold into lead;” CDC Media Relations, May 14, 1998, “Adult Health Problems Linked to Traumatic Childhood Experiences.”
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Prepared by the Community Service Council of Greater Tulsa
Age of Children of Confirmed Abuse and NeglectOklahoma, FY 2011
Source: Oklahoma Dept. of Human Services, Children & Family Services Division.
1,274
1,399
2,252
1,869
1,316
(15.7%)
(17.3%)
(27.8%)
(23.0%)
(16.2%)
Under 1 1-2 3-6 7-11 12 & older
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Prepared by the Community Service Council of Greater Tulsa
Average Daily Membership and Percentage of Children Enrolled in Special Education, by School District
Tulsa County County, School Year 2010-11
Source: Oklahoma State Department of Education, Education Oversight Board, Office of Accountability, Profiles 2011 Reports.
Berryhill Bixby BrokenArrow
Collinsville Glenpool Jenks Keystone Liberty Owasso SandSprings
Skiatook Sperry Tulsa Union0
10,000
20,000
30,000
40,000
50,000ADM
0%
10%
20%
30%
40%
50%Percent in Special Education
ADM % Spec. Ed.
ADM 1,208.9 5,013.216,675.5 2,652.6 2,384.6 10,044 384.6 596.4 9,107.5 5,102.3 2,541.8 1,219.840,808.214,835.1
% Spec. Ed. 9% 14.2% 14.5% 12.9% 12.6% 14.8% 14.9% 16.2% 10.4% 12.7% 12.7% 12.5% 14.6% 10.2%
Tulsa County total ADM = 112,575; percentage in special education = 13.4%
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Juvenile Arrests, by Type of CrimeTulsa County, 2001 through 2011
Source: Oklahoma State Bureau of Investigation, Uniform Crime Reports.
Index crimes Drug related Alcohol related Other crimes0
500
1,000
1,500
2,000
2,500
3,000
3,500Number of arrests
2001 2002 2003 2004 2005 2006
2007 2008 2009 2010 2011
A total of 2,852 juvenile arrests were made in Tulsa County in 2011, for a rate of 85.2 per 1,000 juveniles age 10-17, down from 5,954 arrests for a
rate of 91.9 in 2001.
Includes murder, rape, robbery aggravated
assault, burglary, larceny, and motor vehicle theft.
Includes sale/manufacturing
and possession of drugs.
Includes driving under the influence, liquor law violations, and drunkenness.
Includes other assaults, disorderly conduct, curfew & loitering, runaway and all other non-traffic offenses
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Prepared by the Community Service Council of Greater Tulsa
Source: Centers for Disease Control, Youth Risk Behavior Surveillance System; Oklahoma State Department of Health, OK2SHARE.
47.8%
22%
9.9%
22.2%
26.5%
17.5%
30.6%
40.5%
18.7%
7.1%
18.4%
28.6%
12.3%
25.8%
43.1%
15.9%
5.5%
19.1%
23.2%
13.3%
26.8%
39%
17.2%
4.8%
16.8%
22.6%
11%
23.1%
38.3%
19.1%
4.2%
17.2%
22.7%
7.2%
19.7%
38.7%
23.1%
3.8%
25.6%
18.1%
8.2%
24.1%
Alcohol
Marijuana
Methamphetamine
Offered/sold/givenillegal drugs at school
Smoked cigarettesduring past month
Drove after drinkingalcohol in past month
Rode with drinkingdriver in past month
0%10%20%30%40%50%60%
2003 Oklahoma
2005 Oklahoma
2007 Oklahoma
2009 Oklahoma
2011 Oklahoma
2011 US
Youth Risk Behavior Survey:Summary of Alcohol, Other Drug & Tobacco Use
High School Students, Oklahoma, 2003 through 2011, and U.S. 2011
Used once or more during past 30 days...
Ever used...
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Prepared by the Community Service Council of Greater Tulsa
Source: Centers for Disease Control, Youth Risk Behavior Surveillance System; Oklahoma State Department of Health, OK2SHARE.
50%
5.8%
64.3%
17.7%
7%
14.2%
49.3%
6.5%
61.7%
16.4%
7.9%
15.9%
38.2%
50.9%
5.8%
59.6%
16.7%
5.9%
15.2%
49.6%
51.1%
4.7%
56.7%
22.7%
7%
16.4%
47.4%
50.5%
5%
57.1%
20.5%
6.3%
16.3%
50.8%
47.4%
6.2%
60.2%
18%
7.8%
15.2%
49.5%
Ever hadsexual intercourse
Had sex before age 13
Used condom last time
Used birth controlpills last time
Attempted suicidein past year
Overweight(according to BMI)
Physical activity for60 min/day 5 of past 7 days
0% 20% 40% 60% 80%
2003 Oklahoma
2005 Oklahoma
2007 Oklahoma
2009 Oklahoma
2011 Oklahoma
2011 US
Youth Risk Behavior Survey:Summary of Sexual Behaviors, Suicide & Physical Health
High School Students, Oklahoma, 2003 through 2011, and U.S. 2011
na
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Prepared by the Community Service Council of Greater Tulsa
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
2005
2010
2011
0
5,000
10,000
15,000
20,000
25,000
30,000Prison population
Oklahoma’s Prison PopulationFiscal Years 1950 - 2011
Source: Oklahoma Department of Corrections.
US incarceration rates (2011): Male: 938 per 100,000 people Female: 67 per 100, 000 people Total: 497 per 100,000 people
Oklahoma incarceration rates (2011): Male: 1,244 per 100,000 people Female: 142 per 100,000 people Total: 686 per 100,000 people
Cri
me
& I
ncar
cera
tion
Oklahoma's Rankings in Health Determinants, 2012 (part 1)According to United Health Foundation's State Health Rankings
Note: Missing data values represent years in which variables were not measured/ranked.
Source: United Health Foundation, “America’s Health Rankings.“
#47
#12
#45
#25
#39
#42
#11
#24
#29
Personal Behaviors
Prevalence of smoking
Prevalence of Binge Drinking
Prevalence of obesity
Community & Environment
High school graduation
Violent crime
Occupational fatalities
Infectious disease
Children in poverty
Air pollution
#0 #10 #20 #30 #40 #50
1992 2002 2012
Ranking: 1=best, 50=worst
Oklahoma's Rankings in Health Determinants, 2012 (part 2)According to United Health Foundation's State Health Rankings
Notes: Missing data values represent years in which variables were not measured/ranked. Updated data for “early prenatal care” were not available. Shown results are for 1991, 2001, & 2011.
Source: United Health Foundation, “America’s Health Rankings.“
#35
#15
#20
#47
#49
#45
#42
Public & Health Policies
Lack of health insurance
Public health funding (per capita)
Immunization coverage
Clinical Care
Early prenatal care
Primary Care Physicians
Preventable Hospitalizations
All Determinants
#0 #10 #20 #30 #40 #50
1992 2002 2012
Ranking: 1=best, 50=worst
Oklahoma's Rankings in Health Outcomes, 2012According to United Health Foundation's State Health Rankings
Note: Missing data values represent years in which variables were not measured/ranked.
Source: United Health Foundation, “America’s Health Rankings.“
#46
#40
#20
#39
#48
#42
#46
#44
Poor mental health days
Poor physical health days
Geographic disparity
Infant mortality
Cardiovascular deaths
Cancer deaths
Premature death
All Health Outcomes
#0 #10 #20 #30 #40 #50
1992 2002 2012
Ranking: 1=best, 50=worst
Oklahoma’s overall health ranking for 2012 is # 43
Home Visitation Model
Social Determinant Model
Prepared by the Community Service Council of Greater Tulsa
Dem
og
rap
hic
sRace Comparison for Total Population and Children under 5
Oklahoma and Tulsa County, 2010
Source: US Census Bureau, 2010 Census.
59.3%
8.2%11.0%
1.6%
19.8%54.9%
12.6%
7.3%
2.5%
22.8%
72.2%
7.4%
8.6%
1.7%
10.1%
69.2%
10.7%
6.0%
2.3%
11.7%
White Black American Indian Asian Other/2+ races
Oklahoma Tulsa County
Under 5
Total Population
N = 591,982
N = 48,035N = 266,547
N = 3,642,361
Hispanic16.8%
Hispanic20.6%
Hispanic8.9%
Hispanic11.0%
Prepared by the Community Service Council of Greater Tulsa
Population Trends and Projections by Age GroupTulsa County, 1970 - 2030
Source: US Census Bureau, 1970, 1980, 1990, 2000, & 2010 Censuses; US Census Bureau, Population Estimates Division, Population Projections, 2000 - 2030.
6.3
6.6
7.4
7.4
7.7
7.7
8.5
16.6
17.1
18.2
18.9
18.4
19.8
25.9
9.2
9.7
9.7
10
10.1
13.5
10.7
47.8
50.5
52.6
51.9
52.2
49.1
46.2
17.5
14.1
10.4
10.4
10.4
9
8.1
2030
2020
2010
2000
1990
1980
1970
0% 20% 40% 60% 80% 100%
Percent of population
0-4 5-17 18-24 25-64 65-84 85+
1.9
1.4
1.2
.9
.6
Pro
ject
ions 2.5
2.1
Dem
ogra
phic
s
Prepared by the Community Service Council of Greater Tulsa
Living Arrangements of Related Children Under 18Tulsa County, 1970, 1980, 1990, 2000 & 2009-11 Estimates
Source: US Census Bureau, 1970, 1980, 1990, and 2000 Censuses; US Census Bureau, American Community Survey 2009-11.
Married Couple Male-headed Female-headed Other relatives0%
20%
40%
60%
80%
100% 1970 1980 1990 2000 2009-11 est.
1970 82% 1% 11% 4%
1980 74% 2% 16% 6%
1990 71% 3% 18% 5%
2000 65% 5% 21% 7%
2009-11 est. 60% 6% 24% 8%
Children living with 1 or both parents
Dem
ogra
phic
s
Ratio of Income to Poverty LevelPercentage of Total Population and Children
Tulsa County, 2007-11
Source: US Census Bureau, 2007-11 American Community Survey.
Total population Under 18 Under 6 6-170%
25%
50%
75%
Percentage of population
Below 100% Below 185% Below 200%
Below 100% 15.1% 22.6% 27% 20.2%
Below 185% 32.4% 43.7% 50.1% 40.2%
Below 200% 35.2% 46.8% 53.1% 43.4%
Family of Three, Tulsa County, 2012*
Source: Oklahoma Association of Community Action Agencies and the Oklahoma Asset Building Coalition, December 2009, The Self-Sufficiency Standard for Oklahoma 2009; 2012 HHS Poverty Guidelines, Federal Register, Vol. 77, No. 17, January 26, 2012, pp. 4034-4035; Oklahoma State Dept. of Human Services; U.S. Census Bureau, 2009-11 American Community Survey.
$75,495
$58,854
$38,277
$10,309$15,312
$19,090
$35,317
$21,410
WelfareWage
MinimumWage
PovertyWage
185% PovertyWage
Median FamilyIncome
(2006-08 ACS)
$0
$20,000
$40,000
$60,000
$80,000Annual Wage
Self-Sufficiency Wage = $39,978 ($18.93/hr)
Comparison of Wages: Self-Sufficiency, Welfare, Minimum, Poverty, 185% of Poverty, and Median Family Income
($4.88/hr) ($7.25/hr) ($9.04/hr) ($16.72/hr)
Notes: For the self-sufficiency wage, family of three consists of one adult, one preschooler and one schoolage child. Hourly wages given assume full-time, year-round employment. The 2009 poverty guidelines are being used until at least March 1, 2010. Welfare wage is the combined value of TANF, SNAP, & WIC.
Married-couple families w/ children <18($35.75/hr)
All families w/ children <18
Male-headed families w/ children <18
Female-headed families w/ children <18
($18.12/hr)
($27.87/hr)
($10.14/hr)
Eco
nom
ics
& E
mp
loym
en
t
Participation in Public Assistance ProgramsNumber of Participants and Percentage of Population Participating
Tulsa County, 2012
Source: Oklahoma Dept. of Human Services, Statistical Bulletin, September 2012; Oklahoma State Dept. of Education, Low Income Report for 2011-12; US Census Bureau, 2010 Census; Oklahoma State Department of Health-WIC Service, Caseload Report, October 2012; Oklahoma Health Care Authority, Monthly Enrollment Fast Facts November 2012.
121,054
79,699
3,974
8,854
3,485
85,722
2,581
35,153
6,116
19.8%
51.2%
17.4%
18.1%
10.1%
13.9%
1.7%
53.1%
9.2%
Soonercare Total (185%/100%)
Soonercare <19 (185%)
WIC Infants (185%)
WIC age 1-5 (185%)
Child Care Subsidy <5 (185%)
SNAP Total (130%)
TANF <18 (50%)
Elem. School Free Lunch (130%)
Elem. School Reduced Lunch (185%)
050,000100,000150,000
Number of Participants
0% 20% 40% 60%
Percent of Population
Econ
omic
s &
Em
ploy
men
t
Prepared by the Community Service Council of Greater Tulsa
Educational Attainment for Persons Age 25 & OlderTulsa County, 2009-11 Estimates
Source: US Census Bureau, American Community Survey 2009-11.
11.5%
26.2%
24.7%
8.2%
20.1%
6.3%
2.1%
0.9%
Less than high school
High school graduate
Some college
Associate degree
Bachelor's degree
Master's degree
Professional school degree
Doctorate degree
0% 5% 10% 15% 20% 25% 30%
Percent of persons 25+
Econ
omic
s &
Em
ploy
men
t