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Promote the economic and social well-being

of individuals, families, and communities.

Chapter 4

Strategic Goal 3:

Human Services



cHaPter 4: HUman SerViceS

91HHS Strategic Plan FY 2007-2012

Welare reorm stands as a fagshp acheement n

socal polcy reorm n the md-1990s. Trough welarereorm, many Amercans were helped n breakng

the cycle o dependency and encouraged to pursue

sel-sucency. Snce the reorms were passed n

1996, the employment rates o current and ormer

welare recpents hae rsen and caseloads hae

declned dramatcally. Earnngs or current welare

recpents hae ncreased, as hae earnngs or emale-

headed households n general. In addton, chld

poerty rates hae declned substantally snce the

start o the emporary Assstance or Needy Famles

(ANF) program. States are usng ther feblty to ocus a growng porton o welare dollars on

helpng ndduals retan jobs and adance n ther

employment.

STRATEGIC GOAL 3:

HUMAN SERVICES

Strategic Objective 3.1:

Promote the economc ndependence and socal

well-beng o ndduals and amles across the

lespan.


Protect the saety and oster the well-beng o

chldren and youth.


Encourage the deelopment o strong, healthy,

and supporte communtes.


Address the needs, strengths, and abltes o

ulnerable populatons.




92 HHS Strategic Plan FY 2007-2012

Despte these acheements, sel-sucency remans

eluse or many. Only a thrd o adults n the ANF

caseload are ully meetng work requrements. Te

Dect Reducton Act (DRA) o 2005 (Publc Law 109-171), whch ncludes language reauthorzng ANF

through 2011, challenges and encourages States to

engage the remanng adult ANF recpents n work-

related acttes to moe them up the economc ladder.

Addressng the needs o ulnerable chldren contnues

to be a prorty o HHS. Te most recent annual HHS

Child Maltreatment Report (coerng 2005) ndcated

that each year an estmated 899,000 chldren n the

Unted States are ctms o abuse or neglect. At the

end o FY 2005, there were 513,000 chldren n oster

care; 114,000 o these chldren were watng to be

adopted. Nearly 2 mllon chldren hae a parent n

a Federal or State correctonal aclty, a number that

more than doubled oer the 1990s.

Snce 1996, the percentage o chldren born out

o wedlock to teens has dropped but stll remans

unacceptably hgh. In addton, more adults are

choosng to hae chldren outsde the protecte bonds

o marrage. Research suggests that, all other thngs

beng equal, chldren who grow up n healthy marred,

two-parent amles do better on a host o outcomes;or nstance, they are less lkely to engage n crmnal

actty or abuse drugs and alcohol than those who do

not. HHS’s multcomponent Healthy Marriage Initiative

works to help couples who hae chosen marrage to

gan access to serces where they can acqure the sklls

and knowledge necessary to orm and sustan healthy

marrages. Makng marrage educaton accessble and

approprate or amles s a major component.

Chldren are not alone n ther need or support. As the

Amercan populaton ages, enhanced eorts are needed

to help the growng number o older persons remanacte and healthy. An agng socety means that the

number o persons requrng long-term care serces

wll ncrease. Te aalablty o these serces n the

home and other communty-based settngs wll be

ncreasngly mportant people are to mantan ther

ndependence and qualty o le.

People wth dsabltes, reugees and other mgrants,

and other ulnerable populatons also need assstance

and protecton to achee and sustan economc

ndependence and sel-sucency, as well as socal well-beng.

Strategc Goal 3, Human Services, seeks to protect le,

amly, and human dgnty by promotng the economc

and socal well-beng o ndduals, amles, and

communtes; enhancng the saety and well-beng o

chldren, youth, and other ulnerable populatons;

and strengthenng communtes. Te Admnstraton

or Chldren and Famles (ACF), Admnstraton on

Agng (AoA), Center or Fath-Based and Communty

Intates (CFBCI), Oce on Dsablty (OD), and

Substance Abuse and Mental Health Serces

Admnstraton (SAMHSA) are among the operatng

and sta dsons prmarly responsble or acheng

ths strategc goal. In addton, HHS’s Centers or

Dsease Control and Preenton (CDC), Health

Resources and Serces Admnstraton (HRSA), and

Oce or Cl Rghts (OCR) play mportant roles.

Tere are our broad objectes under Human Services:

Promote the economc ndependence and socal•

well-beng o ndduals and amles across thelespan; Protect the saety and oster the well-beng o •

chldren and youth; Encourage the deelopment o strong, healthy,•

and supporte communtes; and Address the needs, strengths, and abltes o ul-•

nerable populatons.

Below s a descrpton o each strategc objecte,

ollowed by a descrpton o the key programs, serces,

and ntates the Department s undertakng to

accomplsh those objectes. Key partners and

collaborate eorts are ncluded under each releant

objecte. Te perormance ndcators selected or thsstrategc goal are also presented wth baselnes and

targets. Tese measures are organzed by objecte.

Fnally, ths chapter dscusses the major eternal

actors that wll nfuence HHS’s ablty to achee these

objectes, and how the Department s workng to

address those actors.





Strategic Objective 3.1

Promote the economic independence and

social well-being o individuals and amilies

across the liespan.

HHS s commtted to helpng ndduals and amles

achee economc ndependence and socal well-beng,

through nddual eorts o ACF, AoA, OCR, OD, and

SAMHSA, and n concert wth the U.S. Departments o

Justce and Labor, States, terrtores, trbes, and other

nterested stakeholders.

Te ocus s twoold. Frst, HHS wll collaborate wth

States n mong dsadantaged amles to work and

economc sel-sucency, usng ndcators to measure

the moement o ndduals rom welare to work, as

well as ncreases n chld support collecton. Second,

HHS supports nterentons that help ndduals

and amles who are dsadantaged mproe ther

economc and socal well-beng across the lespan;

an ndcator at the end o the chapter measures the

success o serces to ndduals wth deelopmental

dsabltes. Te narrate below descrbes the eorts,

ntates, programs, and collaboratons that the

Department wll mplement n the net 5 years to

address ths strategc objecte. Many o these are

contnuatons and epansons o estng programs.

Work and Economic Sel-Sufciency

Temporary Assistance for Needy Families.

Temporary Assistance or Needy Families (ANF), a

block grant admnstered by ACF’s Oce o Famly

Assstance, prodes temporary assstance and work

opportuntes to needy amles by grantng States

the Federal unds and wde feblty to deelop

and mplement ther own welare programs. ANF

prodes undng annually to States, terrtores, and

elgble trbes or the desgn o create programs to

help amles transton rom welare to sel-sucency.

States hae tremendous feblty n determnng how

to use ther ANF dollars to achee program goals.

Reauthorzaton o ANF n 2006 requres that States

mplement more meanngul work partcpaton rate

requrements n the comng years.





Child Care. o support workng amles, ACF prodes

States, terrtores, and trbes wth drect chld care

assstance payments to low-ncome amles when the

parents work or partcpate n educaton or tranng. Incollaboraton wth the U.S. Department o Educaton,

ACF’s Oce o Head Start, and HRSA, ACF’s Chld

Care Bureau promotes State feblty n deelopng

chld care programs and polces that meet the needs

o chldren and parents wthn each State; supports

research and ealuaton o nnoate chld care subsdy

polces and Web-based access to reports, data, and

other research-related normaton; and helps amles

to achee and mantan sel-sucency by mprong

access to aordable, hgh-qualty chld care.

Assets for Independence. Te Assets or Independence

(AFI) program uses asset-buldng strateges to

assst low-ncome amles n acheng economc

ndependence. Te program helps partcpants

sae earned ncome n specal-purpose, matched

sangs accounts called Individual Development

Accounts (IDAs). Eery dollar n sangs deposted

by partcpants nto an IDA s matched by the AFI

program. Te IDA mechansm promotes sangs and

enables partcpants to acqure a lastng asset ater

sang or a ew years. AFI program amles use ther

IDA sangs, ncludng the matchng unds, to acqure

a rst home, captalze a small busness, or enroll n

postsecondary educaton or tranng. In addton

to helpng partcpants wth ther IDA sangs, all

AFI programs prode basc tranng and supporte

serces related to amly nancal management.

AFI contnues to deelop new partnershps to assst

amles. SCORE, a U.S. Small Busness resource

partner, helps AFI grantees sang or small busness

startups. Moreoer, the 360 IDAs Intate now

helps ncrease the aalablty o IDAs to people wth

dsabltes and ther amles.

Programs of the Administration for Native Americans.

Te Administration or Native Americans (ANA) n

ACF promotes the goal o sel-sucency by prodng

socal and economc deelopment opportuntes.

ANA programs oer tranng, as well as nancal and

techncal assstance, and support a range o projects

or elgble trbes and Nate Amercan organzatons.

ANA supports the creaton o new jobs, deelopment

or epanson o busness enterprses and socal serce

ntates, and ormulaton o enronmental ordnancesand tranng n the use and control o natural resources.

Future grants wll contnue to support socal and

economc deelopment strateges and healthy marrages

to mproe the well-beng o chldren.

Child Support Enforcement. Te Child Support

Enorcement (CSE) program s a jont Federal, State,

and local partnershp that seeks to ensure nancal and

emotonal support or chldren rom both parents by

locatng noncustodal parents, establshng paternty, and

establshng and enorcng chld support orders. Chld

support serces, as mandated n tle IV-D o the Socal

Securty Act o 1935 (Publc Law 74-271), as amended,

are aalable or all amles wth a noncustodal parent,

regardless o welare status. Chld support collectons

play an mportant role or amles transtonng rom

welare to sel-sucency, partcularly n lght o

tme lmts on recept o cash assstance. By securng

support rom noncustodal parents on a consstent and

contnung bass, amles may aod the need or publc

assstance, thus reducng goernment spendng.

Te CSE program contnues to make strong gans nchld support order and paternty establshment, as

well as n collectons o current and back support. Te

Dect Reducton Act (DRA) o 2005 (Publc Law 109-

171) ncludes a seres o prosons to strengthen and

mproe the program. Oerall, DRA prosons wll

both strengthen estng collecton and enorcement

tools and allow States the opton to prode addtonal

support to amles who need t most. Tese prosons

nclude State optons to drect more chld support

collectons to chldren and amles that eer receed

ANF; new eorts to ncrease collectons such asepandng passport denal, mandatory reew and

adjustment o support orders, and mprong medcal

support by requrng States to consder both parents’

access to health nsurance coerage when establshng

chld support orders; and an annual user ee or chld

support cases when enorcement eorts are successul

or amles who hae neer receed ANF assstance.





Well-Being Across the Liespan

Healthy Marriage and Responsible Fatherhood. Te

DRA prodes undng or research and demonstratons

that support healthy marrage. Appromately 125 Federal

grants were awarded to States and communtes to testnew ways to promote and support healthy marred-parent

amles. Grant unds wll be used to test promsng

approaches to encourage healthy marrages and prode

marrage educaton, marrage sklls tranng, publc

adertsng campagns, hgh school educaton on the alue

o marrage, and marrage mentorng programs.

HHS supports seeral other healthy marrage acttes

and research, ncludng Building Strong Families,

Supporting Healthy Marriages, and the Community

Healthy Marriage Initiative. Te purpose o the Building

Strong Families project s to ealuate healthy marrageserces or romantcally noled low-ncome, unwed

parents around the tme o the brth o a chld. Te

purpose o Supporting Healthy Marriages s to norm

program operators and polcymakers o the most

eecte ways to help marred parents to strengthen

and mantan ther marrages. Te Community Healthy

Marriage Initiativeealuates broad-based communty-

leel coaltons that help couples who choose marrage

or themseles to deelop the sklls and knowledge to

orm and sustan healthy marrages. In collaboraton

wth the U.S. Department o State, HHS also promotes

programs and polces at nternatonal organzatons to

strengthen amles and marrages and to promote the

preseraton o human le and dgnty.

Te Promoting Responsible Fatherhood Initiative

promotes responsble atherhood by undng programs

that support healthy marrage acttes, enhance

responsble parentng, and oster economc stablty.

Te ntate wll enable athers to mproe ther

relatonshps and reconnect wth ther chldren. It

wll help athers oercome obstacles and barrers that

oten preent them rom beng the most eecte and

nurturng parent possble. Although the prmary goal o

the ntate s to promote atherhood n all o ts arous

orms, an essental pont s to encourage atherhood

wthn the contet o marrage. Grant unds wll be

allocated to promote noled, commtted, responsble

atherhood through counselng, mentorng, marrage

educaton, enhancng relatonshp sklls, parentng, and

acttes to oster economc stablty.





Family Violence. ACF’s Family Violence Prevention and

Services Program, admnstered by the Famly and Youth

Serces Bureau (FYSB), prodes grants to States and

trbes to preent ncdents o amly olence, prodemmedate shelter and related assstance or ctms

o amly olence, and support preenton serces

or perpetrators. FYSB also supports programs that

oer sae haens and access to serces or ctms o

domestc olence, a natonal toll-ree hotlne to prode

normaton and assstance to ctms o domestc

olence, maternty group home serces, and runaway

and homeless youth shelters.

Seeral collaborate eorts both wthn HHS and n

partnershp wth other departments and stakeholders

support ths eort to preent amly olence. Te

National Advisory Committee on Violence Against

Women s an adsory body cochared by the Attorney

General and the Secretary o HHS. Natonal Adsory

Commttee members meet perodcally to share

ther thoughts, deas, and epertse and to submt

recommendatons on a arety o prorty ssues as the

Federal Goernment deelops ts polces to address

the crmes o domestc olence, seual assault, datng

olence, and stalkng. Te Greenbook ntate, a jont

project o HHS and the U.S. Department o Justce,

supported s demonstraton projects, helpng chld

welare and domestc olence agences and amly

courts work together more eectely to help amles

eperencng olence. Now that the undng cycle

has been completed, HHS wll partner wth the U.S.

Department o Justce and wth the Natonal Councl o

Juenle and Famly Court Judges to prode techncal

assstance and support to communtes nterested n

mplementng the Greenbook’s recommendatons.

Support for Older Adults in Home and Community

Settings. AoA’s Home and Community-Based SupportiveServices program prodes an array o serces to older

adults and ther caregers, ncludng access serces such

as transportaton, case management, and normaton and

reerral; n-home serces such as personal care, chore,

and homemaker assstance; and communty serces such

as adult day care, respte care, and dsease preenton,

health promoton, and physcal tness programs.

ogether, these serces stre to help older adults

mantan ther ndependence and enable them to stay

n ther homes and communtes or as long as possble,

delayng the need or costly nsttutonal care.

New Freedom Initiative and Olmstead Decision

Response. Te HHS Oce on Dsablty (OD) was created

n 2002 as an outcome o Presdent Bush’s New Freedom

Initiative. Te New Freedom Initiative commts the Unted

States to a polcy o communty ntegraton or ndduals

wth dsabltes. OD and OCR are noled n a arety

o eorts to enhance the ndependence and qualty o le

o persons wth dsabltes, ncludng those wth long-

term needs. OD, through the New Freedom Initiative,

ensures a coordnated nteragency and ntergoernmental

approach n support o communty ntegraton to tear

down barrers on behal o ndduals wth dsabltes.

In Olmstead .L.C. (1999), the U.S. Supreme Court held

that States unjustably segregatng qualed persons

wth dsabltes n nsttutons s a orm o dscrmnaton

prohbted by tle II o the Amercans wth Dsabltes

Act o 1990 (Publc Law 101-336). OCR has the authorty

to enorce the Olmstead decson, and has done so

through hundreds o complant nestgatons, oluntary

complance eorts, outreach ntates, and techncal

assstance projects. Trough these eorts, OCR ensures

that, when approprate, States prode ndduals wth

dsabltes access to serces n the communty. OCR

wll contnue ts Olmstead -related eorts, ensurng that

ndduals wth dsabltes return to or reman n ther

communtes wth adequate supports.

Low Income Home Energy Assistance Program. ACF’s

Low Income Home Energy Assistance Program (LIHEAP)

wll contnue to prode home energy assstance

through grants to States, trbes, and terrtores. O the

households receng heatng assstance, about one-thrd

nclude a member 60 years or older; about hal hae atleast one person wth a dsablty; and about one-th

nclude at least one chld 5 years old or younger. xxxii

For the past seeral years, almost 5 mllon households

per year receed LIHEAP assstance to help them

through the wnter months. Te program also prodes

coolng assstance to about 400,000 households and

weatherzaton assstance to about 90,000 more.






Protect the saety and oster the well-being o

children and youth.

HHS s commtted to protectng the saety and

osterng the well-beng o chldren and youth, through

the combned eorts o ACF, SAMHSA, HRSA, and OD,

and n partnershp wth other Federal departments,

such as the U.S. Departments o Educaton and Justce,

the Corporaton or Natonal and Communty Serce

(CNCS), and other nterested stakeholders.

Seeral o the Department’s eorts relate to chld

maltreatment and sae and permanent lng

stuatons or chldren and youth, as represented by the perormance measure at the end o ths chapter, whch

ocuses on the adopton rate or chldren noled

wth the chld welare system. Other programs and

collaboratons ocus on chld care and osterng school

readness, as measured by the percentage o Head Start

programs that hae a poste mpact on erbal and

mathematcal abltes. Addtonal ntates, ncludng

mentorng, abstnence educaton, youth deelopment,

and sucde preenton, oster poste behaor, as

represented n the ndcator ocusng on the lack o

nteracton wth law enorcement. Although many o

these programs are not new, they wll contnue and

wll be strengthened durng the perod coered by ths

Strategic Plan.

Child Maltreatment

Te Child Abuse State Grant Program plays a key

role n the preenton o chld abuse and neglect by

undng postnestgate serces such as nddual

counselng, case management, and parent educaton.

Te Child Welare Services program helps State chld

welare agences mproe ther serces wth the goal o

keepng amles together. Grants also are proded to

deelop and mproe educaton and tranng programs

and resources or chld welare proessonals through

the Child Welare Training program and to preent the

abandonment o nants and young chldren eposed

to HIV/AIDS and drugs through the Abandoned Inants

Assistance Program. Oer the net seeral years, unds

or new regonal partnershp grants wll assst State

and local agences n buldng cooperate eorts

addressng the range o ssues presented by amles whose substance abuse mpars parentng and places

ther chldren at rsk. Te Independent Living Education

and Training Vouchers program prodes up to $5,000

or costs assocated wth college or ocatonal tranng

or youth ages 16 to 21 n oster care.

wo nteragency workgroups ocus on the ssue o chld

abuse and neglect and prode settngs wthn whch

Federal agences coordnate and collaborate. Te rst,

the Federal Interagency Work Group on Child Abuse and

Neglect, led by the Oce on Chld Abuse and Neglect

o ACF/Chldren’s Bureau, engages ACF, CDC, HRSA,IHS, NIH, and SAMHSA, as well as the U.S. Departments

o Agrculture, Deense, Interor, Justce, and Labor,

State sta, and other partners, n ts dscussons on

chld abuse preenton, chld welare, and ndependent

lng support serces. Te group shares normaton,

plans and mplements jont acttes, makes polcy

and programmatc recommendatons, and works





toward establshng complementary agendas n the

areas o tranng, research, legslaton, normaton

dssemnaton, and delery o serces as they relate

to the preenton, nterenton, and treatment o chldabuse and neglect. Te second, NIH Neglect Consortium,

deelops and supports research on chld neglect,

wth support rom ACF and the U.S. Department o

Educaton. ACF/Chldren’s Bureau s workng wth OD

n supportng necessary research to understand the

mpact o chld maltreatment on chldren and youth

wth dsabltes resdng n long-term care acltes and

wth amles (ncludng oster care).

Saety and Permanency

Te Adopton and Sae Famles Act o 1997 (Publc Law

105-89) establshed that a chld’s health and saety must

be o paramount concern n any eorts made by a State

to presere or reuny a chld’s amly. ACF’s Foster Care,

Adoption Assistance, and Independent Living programs

hae demonstrated success n mprong saety,

permanency o lng arrangements, and well-beng

o chldren. Workng wth the States, these programs

mnmze dsruptons to the contnuty o amly

and other relatonshps or chldren n oster care by

decreasng the number o placement settngs per year

or a chld n care. Te programs also met goals to

prode chldren n oster care wth permanency and

stablty n ther lng stuatons by mprong the

tmelness o reuncaton, possble, and promotng

guardanshp or adopton when reuncaton s not

possble. In recent years, the Chldren’s Bureau wthn

ACF has poneered a results-ocused approach to

montorng Federal chld welare programs. Te second

round o these Child and Family Service Reviews began

n 2007 and wll hold States accountable or the saety,

permanency, and well-beng o chldren noled wth

chld welare authortes.

Addtonally, the Promoting Sae and Stable Families

(PSSF) program, a capped enttlement program

authorzed through the Promotng Sae and Stable

Famles Act o 1997 (Publc Law 105-89), asssts

States n coordnatng serces related to chld abuse

preenton and amly preseraton. Tese serces





nclude communty-based amly support, amly

preseraton, tme-lmted reuncaton serces, and

adopton promoton and support serces. Inspred

by research showng that regular caseworker stsare related to the acheement o mportant chld

and amly outcomes or chldren n oster care, new

undng wthn the PSSF program prodes resources

to States to help them ensure that caseworkers st

chldren monthly.

Trough the Adoption Incentives program, States wll

be able to earn bonus payments by ncreasng the

number o adoptons o chldren n oster care oer

preous years. Te Adoption Opportunities program

supports grants that acltate the elmnaton o

barrers to adopton, and the adopton awareness

programs support adopton eorts, ncludng adopton

o chldren wth specal needs, through tranng and

a publc awareness campagn. Adopton ncentes

added n the 2003 reauthorzaton o the Adoption

Incentive Payments Program ocus on adoptons o

chldren age 9 and older who ace partcularly long

wats or adopte homes.

Early Care and Education

ACF’s Head Start and Early Head Start programs are

comprehense chld deelopment programs that

sere chldren rom brth to age 5, pregnant women,

and ther amles. Head Start s desgned to oster

healthy deelopment and school readness n low-

ncome chldren. Head Start programs help ensure that

chldren are ready to succeed at school by supportng

socal and cognte deelopment. Head Start programs

prode comprehense chld deelopment serces,

ncludng educatonal, health, nutrtonal, and socal

serces, prmarly to low-ncome amles. Tey also

engage parents n ther chld’s preschool eperenceby helpng them achee ther own educatonal

and lteracy goals as well as employment goals,

supportng parents’ role n ther chldren’s learnng,

and emphaszng the drect nolement o parents n

the admnstraton o local Head Start programs. Early

Head Start has a trple msson. It promotes healthy

prenatal outcomes, enhances the deelopment o

nants and toddlers, and promotes healthy amly

unctonng. HHS wll contnue to eplore how to

mamze the use o technology to dssemnate

normaton and research n ways that wll mproe programs and perormance. HHS wll nestgate

ways that Head Start and chld care can collaborate

wth other State and local partners, such as State

prekndergarten programs, to ensure that chldren

enter school ready to succeed.

Seeral collaborate eorts between HHS and the U.S.

Department o Educaton support early chldhood

programs and research. TeGood Start, Grow Smart

nteragency workgroup, wth HHS representates rom

ACF/Oce o Head Start, ACF/Chld Care Bureau,

NIH, and ASPE, ocuses on enhancng early chldhood

programs and osters better collaboraton among

agences serng young chldren at rsk. Te Interagency

School Readiness Initiative engages the same operatng

and sta dsons rom HHS and the U.S. Department

o Educaton to ocus on enhancng early chldhood

research. Another nteragency collaboraton, the Early

Childhood Workgroup on English Language Learners,

noles ACF and ASPE n deelopng strateges or

coordnaton o early chldhood programs amed at

Englsh Language Learners.

Mentoring

Research ndcates that chldren wth parents who

are ncarcerated are seen tmes more lkely than the

general populaton to become ncarcerated themseles

and are more lkely to dsplay a arety o behaoral,

emotonal, health, and educatonal problems. Trough

ACF’s Famly and Youth Serces Bureau (FYSB), HHS

supports the Mentoring Children o Prisoners program,

through whch publc and prate organzatons

establsh or epand projects that prode one-on-onementorng or chldren o parents who are ncarcerated

and those recently released rom prson.

OD promotes physcal tness or chldren and youth

wth dsabltes n conjuncton wth the Presdent’s

HealtherUS Intate and the Presdent’s Councl on

Physcal Ftness and Sports awards system, through ts

“I Can Do It, You Can Do It” mentorng program. Ts





program eatures one-on-one mentorng or chldren

and youth wth dsabltes across the Naton to

enhance ther physcal tness, wth the goal o serng 6

mllon chldren wth dsabltes.

HHS also partcpates on the recently ormed Federal

Mentorng Councl, an oshoot o the Coordinating

Council on Juvenile Justice and Delinquency Prevention

(see the secton, Collaborative Eorts to Support Youth,

or more normaton on ths Councl). Conened and

staed by the CNCS, the Councl seeks to mproe

coordnaton and better leerage resources among

all the mentorng programs that est n the Federal

Goernment. Te Councl ncludes representates

rom the U.S. Departments o Deense, Educaton,

Interor, Justce, Labor, and many others. Te Councl

works to denty key ways n whch the Federal

Goernment can adance the goal o nolng 3 mllon

new mentors by 2010, and then act on those ndngs.

Abstinence Education

ACF admnsters two abstnence educaton programs—

the Community-Based Abstinence Education program

and the State Abstinence Education program. ACF’s

abstnence educaton programs prode grants to

communty-based organzatons, ncludng ath-based

organzatons, as well as to States, to deelop and

mplement abstnence programs. Te Community-

Based Abstinence Education program ocuses on

adolescents, ages 12 through 18, and targets the

preenton o teenage pregnancy and premartal seual

actty. Te Community-Based Abstinence Education

program also supports a natonal publc awareness

campagn desgned to help parents communcate wth

ther chldren about health rsks o early seual actty.

Te State Abstinence Education program enables States

to create or augment estng abstnence educaton programs and, where approprate, prode mentorng,

counselng, and adult superson to promote

abstnence rom seual actty, wth a ocus on those

groups most lkely to bear chldren out o wedlock.

ACF epects that all grantees wll present medcally

accurate normaton. ACF s requrng Community

Based Abstinence Education grantees to certy that

currcula are medcally accurate and s conductng

reews or medcal accuracy as part o the grant award

process.

Wthn OPHS, the Adolescent Family Lie Program (AFL)

also supports abstnence educaton acttes. Trough

tle XX o the Publc Health Serce Act (42 U.S.C., 300z

et seq.), AFL authorzes two types o demonstraton

projects: (1) care projects to deelop, mplement, and

ealuate nnoate, comprehense, and ntegrated

approaches to the delery o health care, educaton,

and socal serces or pregnant and parentng

adolescents and ther amles; and (2) preenton

projects to deelop, mplement, and ealuate program

nterentons to promote abstnence rom seual

actty among preadolescents and adolescents.

AFL also places a strong emphass on ensurng that

educatonal materals are medcally accurate.

OPHS, through an nteragency agreement wth

ACF, has launched an ntate that ocuses on the

mportance o parental communcaton. Te Parents

Speak Up National Campaign (PSUNC) s an educatonal

campagn amed at encouragng parents to talk wth

ther chldren early and oten about abstnence. Ts

nteracte campagn wll nclude rado, prnt, and

teleson adertsements to rase awareness. AllPSUNC products drect parents to the 4Parents.go

Web ste or urther normaton and sklls on talkng

early and oten wth ther chldren about se and

abstnence. 4Parents.go prodes concse, helpul

health normaton regardng the mportance o parent-

teen communcaton. Te Web ste also prodes

specc normaton on seually transmtted dseases

and teen pregnancy, benets o abstnence rom seual

nolement, drugs and alcohol, deelopment o

healthy teen relatonshps, and preparaton or uture

marrage and amly.





Collaborative Eorts or Youth

Poste Youth Deelopment s an approach to

youth programmng based on the understandngthat all young people need support, gudance, and

opportuntes durng adolescence, a tme o rapd

growth and change. FYSB’s Positive Youth Development

State and Local Collaboration Demonstration grants

wll contnue to deelop and support nnoate youth

deelopment strateges.

ogether wth nne other Federal agences, HHS also

supports the Frst Lady’s Helping America’s Youthntate,

whch ocuses on the mportance o connectng carng

adults wth youth n order to help youth make better

choces that lead to healther, more successul les.Te Community Guide to Helping America’s Youth helps

communtes buld partnershps and assess ther needs

and resources. It also oers normaton about edence-

based youth program desgns that could be replcated n

ther communty. In the comng years, the Community

Guide wll contnue to be enhanced so that t seres the

needs o local youth-ocused partnershps.

Representates rom seeral operatng and sta

dsons wthn HHS also partcpate wth nne other

Federal agences and eght practtoner members on the

Coordinating Council on Juvenile Justice and Delinquency

Prevention. Te Councl’s prmary unctons are to

coordnate Federal juenle delnquency preenton

programs, Federal programs and acttes that detan or

care or unaccompaned juenles, and Federal programs

relatng to mssng and eploted chldren. Te Councl

works to mplement seeral o the recommendatons

rom the 2003 report o the Whte House ask Force on

Dsadantaged Youth. In the comng years, the Councl

wll conduct an nentory o comprehense communty

ntates and wll nestgate how to support collaboraton

among Federal, State, and local partners, to determne how

best to nest Federal resources to sere youth.

HHS wll contnue to partcpate n the Federal

Goernment delegatons that attend the meetngs o

the Executive Board o the United Nations Children’s

Fund. Te Department also wll promote programs and

polces at nternatonal organzatons to protect the

nterests and well-beng o chldren and ther amles.






Encourage the development o strong, healthy,

and supportive communities.

HHS s commtted to encouragng the deelopment

o strong, healthy, and supporte communtes. ACF,

CDC, OD, OPHS, and SAMHSA und comprehense

communty ntates to help dstressed communtes

address the most ntractable problems. Te Center or

Fath-Based and Communty Intates (CFBCI) works

to deelop the capacty o ath-based and communty-

based organzatons to respond to communty needs.

In the perormance ndcator secton at the end o ths

chapter, the Strategic Plan uses amly coheseness as a proy or the strength o communtes.

Below s a samplng o the Department’s eorts related

to ath-based and communty ntates, capacty

buldng, and comprehense communty ntates.

Faith-Based and Community Initiatives

HHS has made great strdes n mprong current

ath-based and communty partnershps, prodng

opportuntes or new partnershps wth ath-

based and communty organzatons, and remong

estng barrers to the ncluson o these groups n

HHS programs. Trough the HHS CFBCI, techncal

assstance has been proded throughout the country

to ncrease the capacty o ath-based and communty

organzatons workng wth ulnerable and needy

populatons. HHS has reached out and collaborated

wth relgous and neghborhood organzatons that

or decades hae been brngng solutons to bear on

some o the Naton’s most ntractable problems. CFBCI

works wth operatng and sta dsons across the

Department to elmnate barrers to the partcpaton

o ath-based and other communty organzatons;

these barrers nclude regulatons, polces, and

procedures. CFBCI also works wth operatng and sta

dsons to propose the deelopment o nnoate

plot and demonstraton programs. Fnally, HHS sta

hae receed tranng to understand how to reach out

and partner wth these organzatons more eectely.





Capacity-Building Eorts

Te Compasson Captal Fund adances the eorts

o communty and chartable organzatons,ncludng ath-based organzatons, to ncrease ther

eecteness and enhance ther ablty to prode socal

serces where needed. Grants support ntermedary

organzatons that prode tranng and techncal

assstance to grassroots organzatons n accessng

undng sources, admnsterng programs, epandng

serces, and replcatng promsng approaches. In

addton, targeted capacty-buldng mngrants help

grassroots organzatons more eectely deler

serces to the most ulnerable populatons ncludng

youth at rsk, persons eperencng homelessness,amles transtonng rom welare to work, and

prsoners reenterng the communty.

Comprehensive Community Initiatives

SAMHSA unds seeral comprehense communty

mental health serces grants or chldren and youth

wth serous emotonal dsturbances and ther

amles. Grants are used to mplement a “systems o

care” approach to serces, based on the recognton

that the needs o chldren wth serous mental health

challenges can best be met wthn ther home, school,and communty, and that amles and youth should

be the drng orce n the transormaton o ther own

care. Te grants wll be used to prode a ull array o

mental health and support serces organzed on an

nddualzed bass nto a coordnated network n

order to meet the unque clncal and unctonal needs

o each chld and amly.

OD s coordnatng an nteragency and

nterdepartmental 2-year seamless program, the Young

Adult Program. Ts program promotes ntegrated

support systems spannng educaton, health, assste

technology, employment, transportaton, and housng

or young adults 14 to 30 years wth dsabltes n s

demonstraton States through the Natonal Goernors

Assocaton and s documentng outcomes through a

process and mpact ealuaton.






Address the needs, strengths, and abilities o

vulnerable populations.

HHS s commtted to addressng the needs, strengths,

and abltes o ulnerable populatons, ncludng

people wth dsabltes, Amercan Indans and Alaska

Nates, reugees and other entrants, ctms o human

trackng, persons eperencng homelessness, and

people aected by natural or manmade dsasters. ACF,

AoA, CDC, OCR, OD, and SAMHSA hae deeloped

programs and ntates talored or these partcularly

ulnerable populatons. Te two selected perormance

ndcators at the end o ths chapter that ocus on thsssue look at serces proded to homebound older

people and newly arred reugees. Below are a ew o

the Department’s eorts.

People With Disabilities

A number o nteragency collaboratons hae deeloped

to support the economc ndependence and socal

well-beng o people wth physcal, sensory, behaoral,

cognte, and deelopmental dsabltes. One s the

jont plannng eort between AoA, CMS, HRSA, IHS,

NIH, OCR, OD, SAMHSA, and non-Federal organzatons,ncludng State deelopmental dsablty agences, long-

term care proders, trbal goernments, State and local

agences on agng, and State and local Medcad agences.

Tese agences and organzatons work to ncrease

the ndependence and qualty o le o persons wth

dsabltes, ncludng those wth long-term care needs.

Another collaboraton, the Committee or Employees

with Disabilities, wth representaton rom 14 HHS

operatng and sta dsons, represents the ssues

and needs o the Department’s employees wth

dsabltes; prodes proacte adce, gudance,

and recommendatons to the Secretary n plannng,

mplementng, montorng, and ealuatng the

Department’s armate acton program on

employment o ndduals wth dsabltes; and seres

as a ocal pont or the concerns o employees wth

dsabltes on matters aectng ther employment to

help resole Departmentwde problems n ths area.





American Indians and Alaska Natives

Te Admnstraton or Nate Amercans (ANA) promotes

economc and socal sel-sucency or Amercan Indans, Alaska Nates, Nate Hawaans, and other Nate Pacc

Islanders by prodng undng or communty-based short-

term projects through three compette dscretonary

grant programs to elgble trbes and nonprot Nate

Amercan organzatons. Te three program areas are

Social and Economic Development Strategies or Native

Americans; Native Language Preservation and Maintenance;

andEnvironmental Regulatory Enhancement, whch ocuses

on buldng the capacty to denty, plan, and deelop

enronmental programs consstent wth Nate culture.

Coordnaton wth HHS s ostered by the Intradepartmental Council on Native American Aairs, cochared by the

Drector o IHS and the Commssoner or the ANA. Te

purposes o the Councl are to deelop and promote

polces to prode greater access and qualty serces or

Amercan Indans and Alaska Nates; denty and deelop

legslate, admnstrate, and regulatory proposals that

promote eecte polcy; deelop a comprehense strategy

that promotes sel-sucency and sel-determnaton;

promote the trbal/Federal Goernment-to-goernment

relatonshps on a Departmentwde bass; and ensure that

the HHS polcy on trbal consultaton s mplemented by all HHS dsons and oces. Wthn HHS, all operatng

dsons and many sta dsons are engaged n ths

mportant collaborate eort.

People Aected by Disasters

For ctms o natural dsasters, mmedate prortes are

access to water, ood, shelter, medcal care, and securty. As

ndduals attempt to recoer and rebuld ther les, they

must also contend wth stressors on ther mental health,

whch can lnger or weeks or months. Almost eeryone

who les through dsastrous eents eperences eelngs

o sadness and depresson. Dependng on the nddual,

these eelngs can ary n ntensty and duraton. Ts s true

not only or the resdents o the ctes and towns deastated

by natural dsasters, but also or the thousands o rescue

workers, emergency medcal personnel, and dsaster

recoery eperts engaged n search-and-rescue operatons.

SAMHSA s ocused on prodng resources to ad n

the recoery process, to assst both the people n areas

damaged by natural dsasters and the workers who

are takng care o them. SAMHSA’s Disaster Technical Assistance Center helps ensure that our Naton s

prepared and able to respond rapdly when eents

ncrease the need or trauma-related mental health and

substance abuse serces.

AoA oers a comprehense set o techncal assstance

materals to help prepare and plan or the management

o major emergences or dsaster eents. AoA has

deeloped a techncal assstance gude, whch ncludes

many tools to assst those wth the responsblty or

the saety and contnued ndependence o the Naton’s

older populaton. Te gude helps State agences and

local proders work through the ntrcate plannng and

collaborate eorts needed n an emergency. Usng

ths gude, emergency teams wll be ready to begn work

mmedately should a dsaster or emergency occur.

Te Oce on Dsablty, n conjuncton wth ASPR and

ACF’s Admnstraton on Deelopmental Dsabltes,

has mplemented and montored the use o a dsablty-

based toolkt, shelter assessment tool, and publc health

sta tranng modules. ogether wth the HIPAA Pracy

decson tool or emergency preparedness plannng, createdby OCR, these resources ensure that the needs o persons

wth dsabltes are understood by rst responders and

other emergency response proders at the Federal, State,

and local leels durng all emergency stuatons.

Interruptons n chld care serces durng an nfuenza

pandemc may cause confcts or workng parents

that could result n hgh absenteesm n workplaces.

Some o that absenteesm could be epected to aect

personnel and workplaces that are crtcal to the

emergency response system. A checklst created by

CDC wll help chld care and preschool programs prepare or the eects o a fu pandemc and wll help

them protect the health o ther sta and the chldren

and amles they sere. Many o these steps can also

help n other types o emergences.

For more normaton on ths topc, see In the Spotlight:

Emergency Preparedness, Prevention, and Response.





Reugees and Other Entrants

Te Oce o Reugee Resettlement (ORR) n ACF oers

a arety o serces to support reugees, mgrants, andother entrants, ncludng ctms o human trackng.

Assstance to reugees ncludes transtonal cash

assstance, health benets, and a wde arety o socal

serces, proded through ORR grants. Te prmary

ocus s employment serces such as sklls tranng,

job deelopment, orentaton to the workplace, and job

counselng. Te prorty s to nd employment early

ater arral, because t not only leads to early economc

sel-sucency or the amly, but also adds greatly to the

ntegrty o amles who seek to establsh themseles n a

new country and prode or ther own needs.In addton to economc assstance to adults, ORR

supports the Unaccompanied Reugee Minors program,

whch delers chld welare serces n a culturally

senste manner. Speccally, the program asssts

reugee and entrant youth younger than 18 who are

wthout a responsble adult n deelopng approprate

sklls to enter adulthood and to achee economc

and socal sel-sucency. Te Unaccompanied Alien

Children program prodes a sae and approprate

enronment or mnors durng the nterm perod

between the mnor’s transer nto a shelter care aclty and the mnor’s release rom custody by ORR or

remoal rom the Unted States.

Victims o Human Trafcking

Te rackng Vctms Protecton Act o 2000 (Publc

Law 106-386), as amended, desgnates HHS as the

Federal Agency responsble or helpng ctms o

human trackng become elgble to recee benets

and serces so that they may rebuld ther les saely

n ths country. As part o ths eort, HHS has ntated

the Rescue & Restore Victims o Human Trafcking

campagn to help denty and assst ctms o human

trackng n the Unted States. Te ntent o the

campagn s to ncrease the number o dented

trackng ctms and to help those ctms recee the

benets and serces needed to le saely n the Unted

States. By ntally educatng health care proders,

socal serce organzatons, and the law enorcement





communty about the ssue o human trackng, HHS

wll encourage these ntermedares to look beneath

the surace by recognzng clues and askng the rght

questons because they mght be the only outsders wth the chance to reach out and help ctms. A

crtcal component o the campagn s the creaton o

the Trafcking Inormation and Reerral Hotline, whch

connects ctms o trackng to nongoernmental

organzatons that can help ctms n ther local areas.

Te hotlne helps ntermedares determne whether

they hae encountered a ctm o human trackng,

helps connect ctms to resources, and coordnates

wth local socal serce organzatons to protect and

sere ctms o trackng.

People Experiencing Homelessness

Te delery o treatment and serces to persons

eperencng homelessness s ncluded n the acttes

o the Department, both n 5 programs speccally

targeted to such ndduals and n 12 nontargeted, or

manstream, serce delery programs. o mproe

the response o HHS programs to homelessness, a

crosscuttng Departmental workgroup, the Secretary’s

Work Group on Ending Chronic Homelessness,

meets quarterly to deelop, lead, and coordnate a

comprehense Departmental approach to addressng

homelessness. Te group also supports the Secretary

n hs role as a statutory member o the United

States Interagency Council on Homelessness (USICH).

Te USICH coordnates the Federal response to

homelessness across 20 Federal departments and

agences and prodes leadershp or acttes desgned

to assst amles and ndduals who are eperencng

homelessness wth the goal o preentng and endng t

n the Naton. Te Secretary chars the USICH n 2007.

HHS coordnates etensely wth ts Federal partners

n deelopng research and program ntates that wll

mproe access to housng and treatment resources

and contrbute to endng homelessness.

SAMHSA’s Projects or Assistance in Transition rom

Homelessness (PAH) program s a ormula grant

program that unds the 50 States, Dstrct o Columba,

Puerto Rco, and 4 terrtores to support serce

delery to ndduals wth serous mental l lnesses,

as well as ndduals wth co-occurrng substance

use dsorders or other dsabltes, who are homeless

or at rsk o becomng homeless. SAMHSA prodestechncal assstance to States and local proders

unded by the PAH program , ncludng onste

consultaton, collecton o annual reportng data,

deelopment o an annual report to the U.S. Congress,

holdng o bannual meetngs o PAH program

contacts, and dentcaton and dssemnaton o best

practces rom the program.

HRSA’s program, Health Care or the Homeless centers,

prodes ndduals and amles eperencng

homelessness wth access to comprehense preente

and prmary care serces, ncludng oral health, mental

health, and substance abuse serces. Tese serces

are proded n a arety o settngs that promote

access, ncludng homeless shelters and moble clncs.

Te program currently seres as the source o care or

appromately 600,000 people per year.





Perormance Indicators

Most Recent ResultFY 2012

TargetStrategic Objective 3.1

Promote the economic independence and social well-being o individuals and amilies across the liespan.

3.1.1Increase the percentage o adult ANF recpents who become

newly employed.

34.3% 39%

3.1.2

Increase the percentage o ndduals wth deelopmental

dsabltes reached by State Councls on Deelopmental

Dsabltes who are ndependent, sel-sucent, and ntegrated

nto the communty.

11.27% 11.34%

3.1.3 Increase the chld support collecton rate or current support orders. 60% 63%


Protect the saety and oster the well-being o children and youth.

3.2.1Increase the adopton rate or chldren noled n the Chld

Welare System.

10.06% 10.40%

3.2.2

Increase the percentage o Head Start programs that achee

aerage all to sprng gans o

a) At least 12 months n word knowledge (Peabody Pcture

Vocabulary est); and

a) 52%; and a) 66%;

and

b) At least our countng tems. b) 84.6%. b) 86%.

3.2.3

Increase the percentage o chldren receng Chldren’s Mental

Health Serces who hae no nteracton wth law enorcement n

the 6 months ater they begn receng serces.

69.3% 70%


Encourage the development o strong, healthy, and supportive communities.

3.3.1Increase the number o chldren lng n marred couple households

as a percentage o all chldren lng n households.

69% 72%


Address the needs, strengths, and abilities o vulnerable populations.

3.4.1Increase the number o older persons wth seere dsabltes who

recee home-delered meals.

313,362 500,000

3.4.2Increase the percentage o reugees enterng employment through

reugee employment serces unded by ACF.

53.49% 60%

Note: Addtonal normaton about perormance ndcators s ncluded n Append B.





Meeting External Challenges Wthn the human serce goal, changes n economc

condtons, speccally downturns, hae been shown tobe the most nfuental eternal actor nfuencng how

successul HHS’s strateges are n accomplshng ts

stated objectes.

Hstorcally, when negate economc condtons occur,

welare recpents, low-ncome people, and persons

wth dsabltes are more ulnerable to unemployment;

and ewer local resources and saety nets est or these

populatons. Decreases n State and local reenue could

result n a reducton n undng or home and communty-

based placements or ndduals wth dsabltes. Famly

stress s greater as economc stuatons deterorate,leadng to ncreased potental or olence and amly

breakup. Noncustodal parents may lose jobs or ncome

resultng n fuctuatons n ncome support ablty.

o mtgate these eects, HHS works at the State leel

to enhance States’ capacty to coordnate a broad range

o serces, conducts research, prodes techncal

assstance, and dentes best practces that ocus on

elmnaton o barrers or the hard-to-employ and cost-

eecte serce delery. Addtonally, HHS can assst

communty acton agences, communty deelopment

corporatons, and other communty groups n

leeragng Federal, State, local, and phlanthropc

resources to strengthen neghborhoods; buld socal

captal by deelopng communty leadershp and

strengthenng communty-based organzatons; and

support asset deelopment projects or resdents o

dstressed communtes. On the nddual leel, HHS

prodes normaton and support or consumers and

ther caregers and ensures ndduals and amles

are connected to saety net programs or whch they

are elgble through outreach and reerral. HHS also

prodes support or chld care serces, workng toconnect amles wth the most approprate chld

care settng (also called parental choce) and helpng

amles mong nto work to reman connected to

other saety net programs or whch they are elgble.

Chld support enorcement acttes can also be

coordnated wth opportuntes or job tranng and

supported work acttes.





populaton ncreases, more serces wll be requred

or the treatment and management o chronc and

acute health condtons and dsabltes. Te aerage

75 year old has three chronc condtons and uses

e derent prescrpton drugs. xxxiv oday’s health

care workorce lacks much o the tranng requred to

prode approprate care to today’s older adults and

s thus unprepared or the projected ncrease n the

number o older Amercans oer the net 20 years.

Equally mportant, the health care workorce s older

than n the past.

Across the country, long-term care proders are

acng a shortage o qualed and commtted drect

care workers—those certed nursng assstants,

home health ades, and personal care workers who

prode hands-on care to mllons o older adults and

ndduals wth dsabltes. Oer the net 10 years,

the country wll need an estmated 874,000 addtonal

drect care workers to meet growng demand. At the

same tme, the supply o workers tradtonally reled

upon to ll these postons—mddle-aged women— wll

all by about hal by 2030. xxxv

Older Amercans also hae behaoral health and

human serce needs. Some older adults eperence

late onset o mental and addcte llnesses; others

hae eperenced them throughout ther les. Older

adults may eperence depresson and anety as they

ace physcal declne, death o amly members and

other loed ones, and ncreased lmtatons n normal

daly acttes. In leu o seekng treatment, some

older adults—as wth other populatons—may “sel-

medcate” wth alcohol. Further, older adults may

msuse prescrpton or oer-the-counter medcatons,

oten nadertently.

Te scence o agng ndcates that chronc dsease

and dsablty are not netable. As a result, health

promoton and dsease preenton acttes and

programs are an ncreasng prorty or older adults,

ther amles, and the health care system.

Demographic Changes and Teir

Impact on Health and Well-Being

Eorts to mproe the health and well-beng o

Amercans oer the net 5 years wll be shaped by

mportant changes n demographcs. Our Naton

s growng older and becomng more racally and

ethncally derse.

Aging Population

More Amercans are lng longer, and the proporton

o the Naton’s populaton that s age 65 or older s

growng rapdly. A baby born n 2006 can epect

to le to age 78. Ts age epectancy represents

a gan o more than 10 years snce 1965, when the

Older Amercans Act o 1965 (Publc Law 89-73) rst

authorzed Medcare and Medcad. From 1950 to

2006, the total resdent populaton o the Unted States

doubled rom 150 mllon to more than 300 mllon.

Durng ths same perod, the populaton 65 years o age

and oer grew twce as rapdly, ncreasng rom 12 to 36

mllon. Accordng to projectons rom the U.S. Census

Bureau, ater the rst Baby Boomers turn 65 n 2011,

the number o older people wll substantally ncrease.

In 2030, the older populaton s antcpated to be twce

as large as n 2000, and wll represent nearly 20 percent

o the total U.S. populaton. xxxiii

Te agng o the populaton has mportant

mplcatons or health care, publc health, and

human serce systems. As the older racton o the




Racial/Ethnic Diversity

Dersty has long been a characterstc o the Naton’s

populaton, but the racal and ethnc composton haschanged oer tme. In recent decades, the percent

o the populaton that s o Hspanc or Asan orgn

has more than doubled. In 2000, 19 percent o the

populaton dented themseles as Black or Arcan-

Amercan, Asan, Amercan Indan or Alaska Nate,

Nate Hawaan or Other Pacc Islander, or o more

than one race; 12.6 percent o the total U.S. populaton

dented themseles as o Hspanc orgn. Te U.S.

Census Bureau projects that by 2010, 20.7 percent o the

total U.S. populaton wll denty themseles as Black

or Arcan-Amercan, Asan, Amercan Indan or Alaska

Nate, Nate Hawaan or Other Pacc Islander, or

o more than one race; and 15.5 percent wll denty

themseles as o Hspanc orgn. xxxvi

Te U.S. Census Bureau also reports that nearly one

n e people, or 47 mllon U.S. resdents age 5 and

older, spoke a language other than Englsh at home

n 2000—an ncrease o 15 mllon people snce 1990.

Accordng to the report, Spansh speakers ncreased

rom 17.3 mllon n 1990 to 28.1 mllon n 2000, a 62

percent rse. Only 55 percent o the people who speak alanguage other than Englsh at home report they speak

Englsh “ery well.” xxxvii

Tese changes n the racal and ethnc composton

o the populaton hae mportant consequences or

the Naton’s health because many o the measures o

dsease and dsablty der sgncantly by race and

ethncty. Tese shts n the racal and ethnc makeup

o the Unted States requre health proessonals and

organzatons to achee cultural competence and

to ensure that they utlze approprate and talored

approaches n workng wth these populaton groups.

Health and Human Services: hhsplanc4

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