Report on Evaluation of Fiscal Year 200708 services

Report on Evaluation of Fiscal Year 2007/08 services Prepared for: First 5 Sacramento Commission 2750 Gateway Oaks Drive, Suite 330 Sacramento, CA 95833 Prepared by: Walter R. McDonald & Associates, Inc. 2720 Gateway Oaks Drive, Suite 250 Sacramento, CA 95833 March 16, 2009   REPORT ON EVALUATION OF FISCAL YEAR 2007/08 SERVICES Prepared for: First 5 Sacramento Commission 2750 Gateway Oaks Drive, Suite 330 Sacramento, CA 95833 Prepared by: Walter R. McDonald & Associates, Inc. 2720 Gateway Oaks Drive, Suite 250 Sacramento, CA 95833 March 16, 2009   TABLE OF CONTENTS EXECUTIVE SUMMARY .......................................................................................................................... 1 CHAPTER 1: OVERVIEW .......................................................................................................................... 4 Introduction to the First 5 Sacramento Evaluation ................................................................................... 6 Organization of Report ............................................................................................................................. 7 CHAPTER 2: NUMBER AND CHARACTERISTICS OF CLIENTS ........................................................ 8 Race/Ethnicity .......................................................................................................................................... 8 Language .................................................................................................................................................. 9 Family Structure ..................................................................................................................................... 10 Education ................................................................................................................................................ 10 Employment ........................................................................................................................................... 11 CHAPTER 3: HEALTH ACCESS RESULT AREA ................................................................................... 12 CHAPTER 4: NUTRITION RESULT AREA ............................................................................................. 17 Breastfeeding Support ............................................................................................................................ 17 Childhood Obesity Prevention................................................................................................................ 18 CHAPTER 5: EFFECTIVE PARENTING RESULT AREA ...................................................................... 23 CHAPTER 6: SCHOOL READINESS RESULT AREA ............................................................................ 34 CHAPTER 7: DENTAL RESULT AREA .................................................................................................. 46 CHAPTER 8: COMMUNITY BUILDING RESULT AREA ...................................................................... 49 CHAPTER 9: EARLY CARE RESULT AREA .......................................................................................... 53 CHAPTER 10: CROSS-CUTTING INDICATORS................................................................................... 60 CONCLUSION ........................................................................................................................................... 71 APPENDICES APPENDIX A: RESULT AREA AND CROSS-CUTTING INDICATORS ........................................... A.1 APPENDIX B: METHODOLOGY .......................................................................................................... B.1 APPENDIX C: MEASURES .................................................................................................................... C.1 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page ii LIST OF TABLES Table 1.1: First 5 Sacramento Commission Priorities, Results, and Result Areas, Funding Cycle 2007/08 to 2009/10 ............................................................................................................................................... 4 Table 2.1: Race/Ethnicity of First 5 Sacramento Children and Parents, Fiscal Year 2007/08 ..................... 8 Table 2.2: Primary Language of First 5 Sacramento Children and Parents, Fiscal Year 2007/08................ 9 Table 2.3: Languages Spoken at Home to First 5 Sacramento Children, Fiscal Year 2007/08 .................... 9 Table 4.1: Nutrition Services, Fiscal Year 2007/08 .................................................................................... 19 Table 5.1: Effective Parenting Services, Fiscal Year 2007/08.................................................................... 25 Table 5.2: Neighborhood Connectedness by Result Area, Fiscal Year 2007/08 ........................................ 30 Table 6.1: School Readiness Services, Fiscal Year 2007/08 ...................................................................... 36 Table 6.2: Children with Hearing, Vision, and Development Screening during Previous Year, Fiscal Year 2007/08 ........................................................................................................................................ 38 Table 6.3: Children from School Readiness Meeting Developmental Milestones, Fiscal Year 2007/08 ... 42 Table 7.1: First 5 Sacramento Funded Water Fluoridation, Fiscal Years 2004/05 to 2007/08 ................... 47 Table 8.1: Neighborhood Connectedness by Community Event Participation, Fiscal Year 2007/08 ........ 50 Table 8.2: Parents with High Neighborhood Cohesion by Community Event Participation, Fiscal Year 2007/08 ................................................................................................................................................. 51 Table 8.3: Parents with Efficacy by Community Event Participation, Fiscal Year 2007/08 ...................... 52 Table 9.1: Child Care Providers’ Ascent on the Professional Matrix, Fiscal Year 2007/08....................... 54 Table 9.2: Number of Licensed and Accredited Child Care Facilities and Spaces for Children Ages 0 to 5 Years by Type and School District Catchment Area, Fiscal Year 2007/08 ............................... 55 Table 9.3: Children with Special Needs Linked to Child Care by Child Action, Fiscal Year 2007/08 ...... 56 Table 9.4: Progress in Obtaining Licensure among Family, Friends, and Neighbor Child Care Providers, Fiscal Year 2007/08.............................................................................................................................. 59 Table 10.1: Parent Reports of Community Services Received, Fiscal Year 2007/08 ................................. 67 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page iii LIST OF FIGURES Figure 1.1: Proportion of First 5 Sacramento Program Expenditures for $14.5 Million by Result Area, Fiscal Year 2007/08................................................................................................................................ 5 Figure 2.1: Family Structure of First 5 Sacramento Families, Fiscal Year 2007/08................................... 10 Figure 2.2: Highest Level of Education First 5 Sacramento Families, Fiscal Year 2007/08 ...................... 11 Figure 2.3: Occupational Status of First 5 Sacramento Parents, Fiscal Year 2007/08 ............................... 11 Figure 3.1: Distribution of 793 First 5 Sacramento Clients Receiving Services from Cover the Kids, Fiscal Year 2007/08.............................................................................................................................. 13 Figure 3.2: Children Receiving Dental Exam by One Year of Age by Result Area, Fiscal Year 2007/08 ................................................................................................................................................. 16 Figure 4.1: Distribution of 5,262 First 5 Sacramento Clients Receiving Nutrition Services, Fiscal Year 2007/08 ................................................................................................................................................. 20 Figure 4.2: Children Exclusively Breastfed Six Months After Delivery by Result Area, Fiscal Year 2007/08 ................................................................................................................................................. 22 Figure 4.3: Children Exclusively Breastfed 12 Months After Delivery by Result Area, Fiscal Year 2007/08 ................................................................................................................................................. 22 Figure 5.1: Distribution of 2,603 First 5 Sacramento Clients Receiving Effective Parenting Services, Fiscal Year 2007/08.............................................................................................................................. 26 Figure 5.2: Families at Risk for Poor Functioning by Result Area, Fiscal Year 2007/08 .......................... 27 Figure 5.3: Parents with High Parental Distress by Result Area, Fiscal Year 2007/08 .............................. 29 Figure 5.4: Parents from Effective Parenting with High Nurturance, Energy, Authoritative, and Authoritarian Parenting Styles, Fiscal Year 2007/08 ........................................................................... 32 Figure 6.1: Distribution of 3,282 First 5 Sacramento Clients Receiving School Readiness Services, Fiscal Year 2007/08.............................................................................................................................. 37 Figure 6.2: Children Ages Three to Five Who Regularly Attended a Nursery School, Preschool, Prekindergarten or Head Start Program by Result Area, Fiscal Year 2007/08.......................................... 41 Figure 6.3: Children with Special Needs Who Participated in Early Childhood Care and Education Programs by Result Area, Fiscal Year 2007/08 ................................................................................... 45 Figure 9.1: Change in Environmental Rating Scales, Fiscal Year 2007/08 ................................................ 58 Figure 10.1: Changes in Percent of Children with Health Insurance, Fiscal Year 2007/08 ....................... 61 Figure 10.2: Children with Complete Immunizations by Race/Ethnicity, Fiscal Year 2007/08................. 62 Figure 10.3: Children Exclusively Breastfed Six Months after Delivery by Race/Ethnicity, Fiscal Year 2007/08 ................................................................................................................................................. 64 Figure 10.4: Recent Dental Care among Children Older Than One Year by Race/Ethnicity, Fiscal Year 2007/08 ................................................................................................................................................. 65 Figure 10.5: Parent Reports of Children Receiving Hearing, Vision, and Developmental/Behavior Tests During Past Year by Race/Ethnicity, Fiscal Year 2007/08 .................................................................. 68 Figure 10.6: Parents with High Authoritative Parenting by Race/Ethnicity, Fiscal Year 2007/08 ............. 70 Figure 10.7: Parents with High Parental Energy by Race/Ethnicity, Fiscal Year 2007/08 ......................... 70 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page iv   EXECUTIVE SUMMARY The First 5 Sacramento Commission expended $14.5 million in 2007/08 for programs to benefit children ages 0 to 5 years and their families in Sacramento County. These programs were supported by the county’s share of the 50-cent tax on all tobacco products sold in California, as approved by voters in 1998 under Proposition 10, the California Children and Families Act. Numerous First 5 Sacramento strategies and events were employed during the year to benefit young children and their families. These included the distribution of over 25,000 “Kits for New Parents” and training nurses and child care providers on “Touchpoints” to encourage parents to become active participants in the development of their children. First 5 Sacramento also sponsored the educational “Children’s Celebration” and provided funding for “2-1-1 Sacramento,” a 24-hour telephone referral service that connects families with employment, training, housing, financial, health care, and other needed services. The majority of services to children and their families during fiscal year 2007/08 were provided by organizations that received funding and were monitored by First 5 Sacramento. These services were funded through the following seven “Result Areas,” which were developed through a comprehensive strategic planning process in 2006. HEALTH ACCESS RESULT AREA The Health Access provider Cover The Kids assisted 445 families with enrolling children in health insurance programs. Cover The Kids periodically contacted these families to verify that children did obtain health insurance and to provide additional assistance as needed. Cover the Kids works closely with Healthy Kids Healthy Future, a regional non-profit organization that administers the Healthy Kids insurance program within Sacramento and surrounding counties. Healthy Kids Healthy Future supports insurance premiums for children who are not eligible for Medi-Cal, Healthy Families, or other health insurance programs. Through Health Access, First 5 Sacramento also partnered with over 50 agencies to offer no-cost dental, hearing, and developmental screenings for children attending “Bright Futures” community fairs. These fairs also provided the opportunity to educate parents about the services available through Cover The Kids. NUTRITION RESULT AREA Nutrition included one-on-one and group lactation support services for expecting and recent mothers. A total of 5,220 families benefits from these services during the fiscal year. In addition, “Baby Friendly” trainings were provided to nurses and other hospital staff on techniques to promote breastfeeding among new mothers and assist hospitals in adopting the “Ten Steps to Successful Breastfeeding.” Nutrition also included interventions to address childhood obesity. EFFECTIVE PARENTING RESULT AREA Effective Parenting services for 1,545 families during 2007/08 consisted of education and crisis intervention services through eight Family Resource Centers; a home visitation program for expecting or new mothers; temporary child care for parents in crisis; and parenting classes and father engagement events. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 1 SCHOOL READINESS RESULT AREA School Readiness services were provided to 2,114 families within schools and at children’s homes through eight school districts. Services included parent workshops, case management, literacy programs, developmental assessments and treatment, kindergarten transition activities, and pre-kindergarten summer camps. These camps provided children who did not attend preschool with some exposure to formal schooling to support their transition into kindergarten. DENTAL RESULT AREA Dental funding to two water companies led to an additional 26,774 connections with fluoridated water in Sacramento County. COMMUNITY BUILDING RESULT AREA Community Building supported 219 informal community events and activities to build social capital and strengthen relationships among families and community members with young children to empower parents, foster support networks, and develop healthier and safer neighborhoods. EARLY CARE RESULT AREA Early Care offered 1,637 providers with information and referrals, technical assistance and training, and professional consultation towards improving child care in the county. EVALUATION DESIGN AND IMPORTANCE OF “CROSS-CUTTING” INDICATORS The evaluation of First 5 Sacramento during fiscal year 2007/08 focused on the services offered through the seven Result Areas described above, and was guided by specific “indicators,” or statements that defined how progress would be monitored. Health Access, Nutrition, Effective Parenting, and School Readiness Result Area indicators were examined with data from a longitudinal survey of a random sample of parents called the Parent Interview. Ten outcomes were identified prior to the start of the evaluation as applicable to all First 5 Sacramento services involving direct contact with families. These 10 “Cross-Cutting” indicators represent an important and unique approach to the evaluation of First 5 services because they recognize that the benefits of services involving direct contact with parents and children extend beyond the specific type of services that families initially intend to receive. For example, the advantages of breastfeeding are recognized and promoted by all direct service providers. A pregnant mother might be counseled on the advantages of breastfeeding, or referred to a Nutrition provider for lactation support services, by staff providing services through the Effective Parenting Result Area. Thus, breastfeeding rates are examined in this report within the Nutrition Result Area and at the Cross-Cutting level, which included Parent Interview responses from mothers receiving services through Health Access, Effective Parenting, and School Readiness providers. Data to address all 10 Cross-Cutting indicators and the Community Building indicators came from the Parent Interview. The Dental and Early Care indicators were examined with information from the service providers funded within these Result Areas. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 2 The findings presented in this report represent the initial (i.e., “baseline”) data for the first year of the current three-year evaluation. Subsequent reports will examine changes over time in outcomes and in relation to types and levels of services provided to First 5 Sacramento children and families. PRIMARY FINDINGS FOR 2007/08 • • Health insurance coverage among First 5 Sacramento children increased from 85.9% to 97.0%, exceeding the national average. 84.2% of two-year olds and 91.7% of five-year olds who received Health Access services were reported by parents to have complete immunizations. Compared to the average for California, a greater percentage of First 5 Sacramento two-year olds were reported to have complete immunizations. A greater percentage of First 5 Sacramento children received all age appropriate wellchild visits than the national average. Specifically, 88.8% of children who received Health Access services had all age appropriate well-child visits. Health Access services were also related to an increase in the proportion of children receiving dental care by 12 months of age. The percentage of First 5 Sacramento mothers following the breastfeeding recommendations of the American Academy of Pediatrics was more than twice the rate found in national surveys. That is, 25.5% of First 5 Sacramento children were exclusively breastfed for six months; the comparable national average is 11.3%. Effective Parenting services were related to a lower risk of poor family functioning (i.e., having the resources for greater self-sufficiency and positive influences on child development). These services were also associated with greater neighborhood connectedness, which has been found to be related to health, social, economic and educational outcomes, and leads to healthy environments for children to develop and prepare for kindergarten. School Readiness services were correlated with increased attendance in a preschool on a regular basis and, among special needs children, enrollment in early childhood care and education programs. In addition, the majority (92.0%) of children participating in School Readiness programs were assessed to be “ready for kindergarten” by their teacher. First 5 Sacramento parents were more connected to their community, had a greater sense of trust and investment in their neighborhoods, and had an increased sense of control over their lives if they participated in a Community Building Initiative (CBI) event or activity. The additional fluoridated water connections funded by First 5 Sacramento raised the percentage of Sacramento County residents receiving fluoridated water from 37.0% to 45.0% at the end of fiscal year 2007/08. Page 3 • • • • • • • First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 CHAPTER 1 OVERVIEW With funds collected from a state-wide, 50-cent tax on all tobacco products, the First 5 Sacramento Commission supports a variety of services to improve the health and education of children ages 0 to 5 years and their families. The services for the current three-year (2007/08 to 2009/10) funding cycle resulted from a comprehensive process that included an assessment of unmet needs within the county and input from service providers and members of the community. Planning for the current funding cycle began in September 2005 and resulted in the release of the “First 5 Sacramento Commission 2006 Strategic Plan Update” in February 2006.1 This document represented the work of the full First 5 Sacramento Commission with input from members of First 5 Sacramento’s Advisory Committee, a needsassessment interview with 445 parents, and the community through the solicitation of public comment. The foundation of the Strategic Plan is a “Strategic Hierarchy” that explicates and logically connects broad Priorities to overall Goals to specific Results. Table 1.1 lists the three Priorities and the 11 Results identified for funding for the fiscal years 2007/08 to 2009/10. The table also includes the “Result Areas” – the brief titles given to the program areas intended to address the related Results. First 5 Sacramento Commission Foundational Statements, 2006 Vision: Sacramento will have strong and inclusive communities, safe and healthy families, and valued children who can realize their potential and enjoy productive and fulfilling lives. Mission: The First 5 Sacramento Commission is committed to supporting the healthy development of children prenatal to age five, the empowerment of families, and the strengthening of communities. Core Components: Services and supports for children prenatal to age five and their families shall be affordable and accessible; culturally competent; community-driven; and responsive to special needs. Table 1.1: First 5 Sacramento Commission Priorities, Results, and Result Areas, Funding Cycle 2007/08 to 2009/10 Priority Result Increase comprehensive health insurance coverage Health Increase use of medical/dental homes Improve nutrition Decrease dental disease Increase use of effective parenting Early Care & Education Increase caregivers’ use of developmentally appropriate practices Increase schools’ readiness for Kindergarten Increase participation in quality early care and education Empowered Families Increase family participation in community activities Increase family and community self-advocacy to make change Result Area Health Access Health Access Nutrition Dental Effective Parenting Effective Parenting School Readiness Early Care Community Building Community Building 1 Available at: www.first5sacramento.net First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 4 In accordance with Proposition 10, passed by California voters in 1998, First 5 Sacramento receives a proportion of the 50-cent tax on tobacco products based on the number of live births in the county.2 In fiscal year 2007/08, the First 5 Sacramento Commission expended $18.3 million. The majority of these dollars – $14.5 million – were for program expenses in support of the Result Areas. Figure 1.1 shows the proportion of program expenditures for each of the seven Result Areas. Figure 1.1: Proportion of First 5 Sacramento Program Expenditures for $14.5 Million by Result Area, Fiscal Year 2007/08 Early Care, 7.5% Health Access, 8.4% Nutrition, 9.8% Dental, 14.2% Community Building, 5.7% Effective Parenting, 26.2% School Readiness, 28.2% Following is a brief introduction to the services provided in the seven Result Areas: Health Access includes assisting parents with enrolling their children in health insurance programs, and supports insurance premiums for children who are not eligible for Medi-Cal, Healthy Families, or other health insurance programs. Through Health Access, First 5 Sacramento partners with over 50 agencies to offer “Bright Futures” community fairs that combine entertaining activities with no-cost dental, hearing, and developmental screenings for children. Nutrition services consist of lactation support for expecting and new mothers and “Baby Friendly” trainings to provide nurses and other hospital staff with the knowledge and skills to promote breastfeeding among new mothers and assist committed hospitals in their quest to adopt the “Ten Steps to Successful Breastfeeding” and receive a “Certificate of Intent” from Baby Friendly USA. Nutrition also includes interventions directed at families to address childhood obesity. Effective Parenting services are designed to improve parenting skills through formal classes and home visits and assist families in crisis. A number of services and supports are available through School Readiness to children, parents, and teachers to better prepare children for kindergarten, such as preschool, workshops for parents, health and development screenings, and summer camps. Community Building provides support for community-driven projects or events that foster and strengthen relationships among families and community members with young children to empower parents, create support networks, and develop healthier and safer neighborhoods for 2 Information on the history of Proposition 10 is available at: ccfc.ca.gov/press/prop.asp First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 5 children. Water fluoridation is funded through the Dental Result Area. Finally, Early Care funds facilitate programs to improve the quality of child care throughout Sacramento County. The First 5 Sacramento Commission also provided $635,000 for selected projects during fiscal year 2007/08. These included “Touchpoints,” a training for nurses and child care providers to encourage parents to become active participants in the development of their children; “Kits for New Parents” distributed to parents throughout Sacramento County, the annual “Children’s Celebration,” an educational event for families with young children ages 0 to 5 years provided at no-charge to parents; and “2-1-1 Sacramento,” a 24-hour telephone referral service that connects families with employment, training, housing, financial, health care, and other needed services. Introduction to the First 5 Sacramento Evaluation The evaluation of First 5 Sacramento services for the 2007/08 to 2009/10 funding cycle is guided by specific “indicators,” or statements that define how progress towards a desired Result will be monitored. Indicators specific to each of the seven Result Areas (i.e., the “Result Area indicators”) were developed by the First 5 Sacramento Evaluation Committee, which includes members of the First 5 Sacramento Commission. The Evaluation Committee recognized that there were certain benefits to all First 5 Sacramento services involving direct contact with families. For example, although breastfeeding is the centerpiece of lactation support services funded through the Nutrition Result Area, the advantages of breastfeeding are recognized and promoted by service providers from the other Result Areas. In total, 10 “Cross-Cutting” indicators were identified as applicable to the population of children and parents receiving direct services through the Health Access, Nutrition, Effective Parenting, and School Readiness Result Areas. This report includes findings for each of the Result Area and Cross-Cutting indicators listed in Appendix A. Descriptive information about individual clients, such as race/ethnicity and services received, were recorded only for families recruited through the direct service Result Areas – Health Access, Nutrition, Effective Parenting, and School Readiness. That is, the nature of the services offered through the direct service providers allowed for parents to be presented with the consent form to participate in the evaluation and to complete a Family Intake Form with demographic information about the parent and their children ages 0 to 5 years. These data were entered by providers into a web-based data system referred to as Persimmony – short for the name of the software provider, Persimmony International Inc. Families with data in Persimmony were subsequently sampled at random and recruited for the longitudinal survey of parents titled the “Parent Interview.” The outcomes presented in this report to address most Result Areas and all Cross-Cutting indicators came from the Parent Interview. Findings provided in this report for the Dental and Early Care indicators came from service providers. Thus, this report is based on a sub-set of families receiving First 5 Sacramento services during 2007/08. Descriptive and outcome data are not available, for example, on the 25,000 families who received “Kits for New Parents,” the 4,368 attendees of Bright Futures events, the 280 hospital staff who attended the two-day Baby Friendly trainings, or the 5,229 attendees of the 2007 Children’s Celebration. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 6 This is the first of three reports to examine the effectiveness of First 5 Sacramento services for the current funding cycle. Most of the data presented here represent the initial or “baseline” information. When appropriate, we compare this baseline information with comparable published data for children or parents from other populations to investigate the potential impact of First 5 Sacramento services. Future reports will highlight changes over time in the Result Area and Cross-Cutting indicators, and will investigate the association between types and levels of First 5 Sacramento services and important outcomes. Organization of Report Chapter 2 of this report presents the number of First 5 Sacramento families, parents, and children who received direct services during the year, and summarizes the characteristics of First 5 Sacramento families. Chapters 3 through 9 review the findings for the Result Areas indicators. Information about the direct-service Result Areas (Health Access, Nutrition, Effective Parenting, and School Readiness) appear in Chapters 3 through 6 and include: types and levels of services, the areas within Sacramento County where clients who received the services live, and outcomes for each indicator associated with the Result Area. Outcomes are compared between the Result Area where the clients initially received services (was recruited for the evaluation) and the other three Result Areas. For example, breastfeeding rates are compared between Nutrition mothers and mothers recruited from the Health Access, Effective Parenting, and School Readiness Result Areas. The justification for these comparisons is that children or parents who received services related to a specific Result Area should demonstrate greater outcomes than those clients from other Result Areas. Only notable differences between Result Areas are presented in these chapters.3 The outcomes for the indicators in each of the three indirect-service Result Areas (Dental, Community Building, and Early Care) are reviewed in Chapters 7 through 9. Chapter 10 presents the findings for the 10 Cross-Cutting indicators, which apply to all First 5 Sacramento clients who received services from the Health Access, Nutrition, Effective Parenting, and School Readiness Result Areas. For each indicator, comparisons were made across the three most common racial/ethnic groups – Latinos, Whites, and African Americans. These comparisons provide information on which racial/ethnic groups may be in most need of certain services. In addition, future reports will be used to determine whether those racial/ethnic groups in greatest need end up benefiting the most from First 5 Sacramento services. Readers interested in the complete methodology to evaluate First 5 Sacramento services should refer to Appendix B. Similarly, Chapters 3 through 10 of this report briefly mention the questions that parents were asked to assess the Result Ares and Cross-Cutting indicators, Appendix C details the specific items and procedures used to measure each indicator. 3 Some clients received services from a provider in Result Areas other than where they first enrolled. Thus, Result Area groups are not mutually exclusive. The criterion for notable differences between Result Areas was selected as a percent difference equal to or greater than 20%. Result Areas were considered similar or equivalent when percent differences were less than 20%. Statistical tests of differences were conducted when comparison groups were mutually exclusive, such as attendance at CBI events and race/ethnicity. Differences are noted in this report when the probability (p) level was equal to or less than 0.05. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 7 CHAPTER 2 NUMBER AND CHARACTERISTICS OF CLIENTS This chapter presents information about families who received services through the Health Access, Nutrition, Effective Parenting, and School Readiness Result Areas. During 2007/08, a total of 9,324 families (9,876 children and 8,079 parents) received services from providers funded through these direct service Result Areas, 4.8% from Health Access, 56.0% from Nutrition, 16.5% from Effective Parenting, and 22.7% from School Readiness providers. The number of children exceeds the number of families because some families had more than one child age 0 to 5 years. The number of parents is fewer than the number of families because not all parents received First 5 Sacramento services (only their children received services). Race/Ethnicity First 5 Sacramento funds services for children and their parents from a number of racial/ethnic groups (Table 2.1). Half (50.5%) of parents receiving direct services were Hispanic/Latino and 16.4% identified as White, non-Hispanic. In addition, 11.2% of children and 6.4% of parents receiving services were Multiracial. The more common Multiracial groups were African American & White, Latino & White, and Latino & African American. Table 2.1: Race/Ethnicity of First 5 Sacramento Children and Parents, Fiscal Year 2007/08 Children, % (n = 9,876) Parents, % (n = 8,079) Latino White, non-Hispanic African American Russian/Ukrainian Other Slavic Hmong Chinese Filipino Vietnamese Asian Indian Other Asian Pacific Islander Alaska Native/American Indian Other Single Race Multiracial African American & White Latino & White Latino & African American Other Multiracial Information Not Provided Source of Data: Persimmony. 48.8 14.7 11.6 3.2 0.2 2.4 0.7 0.8 0.7 1.1 1.4 1.0 0.6 1.1 11.2 1.8 1.2 1.2 7.0 0.6 50.5 16.4 12.0 3.6 0.2 1.7 0.6 1.1 0.8 1.0 1.6 1.2 0.7 0.9 6.4 1.5 0.6 0.7 3.6 1.0 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 8 Language First 5 Sacramento providers successfully deliver direct services by employing staff who can speak a variety of languages. This is extremely important since English was noted as the primary language for just over half of children and parents who received services during the year (Table 2.2). In fact, 37.7% of parents identified languages other than English as spoken in their household (Table 2.3). Table 2.2: Primary Language of First 5 Sacramento Children and Parents, Fiscal Year 2007/08 Children, % (n = 9,876) English Spanish Hmong Russian Ukrainian Vietnamese Lao Mien Tagalog Hindi Korean Chinese-Cantonese Chinese-Mandarin Other Language Information Not Provided Source of Data: Persimmony. Parents, % (n = 8,079) 51.3 39.4 1.3 2.8 0.6 0.5 0.1 0.1 0.3 0.5 < 0.1 0.4 < 0.1 1.3 1.1 51.4 39.0 1.9 2.5 0.6 0.6 0.1 0.1 0.3 0.4 < 0.1 0.5 0.1 1.6 0.9 Table 2.3: Languages Spoken at Home to First 5 Sacramento Children, Fiscal Year 2007/08 % English Only Multiple Languages, Including English Single or Multiple Languages, Not Including English Information Not Provided Source of Data: Persimmony. 37.3 24.4 37.7 0.6 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 9 Family Structure Among First 5 Sacramento families receiving direct services, most children (70.6%) lived in a household with both parents (Figure 2.1). However, over one-fourth (26.8%) of families included only the mother as the head of the household. Figure 2.1: Family Structure of First 5 Sacramento Families, Fiscal Year 2007/08 Father Only , 2.0% Mother Only , 26.8% Neither Parent , 0.7% Mother and Father , 70.6% Education The highest level of education of the mother and/or father was identified to create a family education level. Highest level of education was at or below the 8th grade for 8.9% of First 5 Sacramento families receiving direct services; 17.2% of families had a mother and/or father whose highest level of education was taking high school classes but not graduating from high school (Figure 2.2). However, 25.3% of families receiving direct services had some college education and 17.0% had a college degree. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 10 Figure 2.2: Highest Level of Education First 5 Sacramento Families, Fiscal Year 2007/08 <= 8th Grade, 8.9% >= College Degree, 17.0% Some High School, 17.2% Some College, 25.3% High School or Equivalent, 31.6% Employment Figure 2.3 shows that mothers work on a full-time basis in 20.9% of First 5 Sacramento households. Sixty-three percent of mothers were not employed. Just under half (48.4%) of households included a father who worked full-time. Part-time employment was reported for 11.3% of fathers and 12.6% were not employed. Overall, 6.3% of mothers and 7.8% of fathers were not working and were seeking employment (data not in figure). Figure 2.3: Occupational Status of First 5 Sacramento Parents, Fiscal Year 2007/08 Mothers Mother Not in Household, 2.6% Refused/Not Provided, 0.7% Employed Fulltime, 20.9% Refused/Not Provided, 1.1% Employed Fulltime, 48.4% Fathers Father Not in Household, 26.6% Employed Parttime, 12.9% Not Employed, 63.0% Not Employed, 12.6% Employed Parttime, 11.3% First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 11 CHAPTER 3 HEALTH ACCESS RESULT AREA The Health Access Result Area was established to support First 5 Sacramento’s commitment to comprehensive health insurance coverage for children ages 0 to 5 years, and during 2007/08, the First 5 Sacramento Commission expended $1,226,000 towards this effort. This commitment addresses dental health, mental health, preventive services, and medical care. Parents’ understanding of well-child and preventive health needs, as well as factors such as languages spoken, transportation, and hours of service, often prevent parents from taking full advantage of the health services available with insurance. Bright Futures, Cover the Kids, and Healthy Kids Healthy Future were funded by First 5 Sacramento to address these barriers. Cover the Kids is funded to assist families with applying for children’s health insurance and to verify enrollment and utilization of services. Moreover, Cover the Kids contacts families at 2-3, 8, and 13 months post-application assistance, at which times they provide additional assistance as necessary. Cover the Kids promotes its services primarily by conducting outreach and distributing information to parents through schools, child care providers, and African American faith-based organizations. Additional outreach strategies include: sponsoring enrollment events; developing relationships with business owners to generate referrals; and publicizing services through grassroots advertising campaigns in multiple languages. First 5 Sacramento’s commitment to accessible health services includes requiring all service providers to screen families for health insurance coverage for children and refer those in need to Cover the Kids. Healthy Kids Healthy Future is a regional non-profit organization that administers the Healthy Kids insurance program within Sacramento and surrounding counties (Colusa, El Dorado, Placer, and Yuba). Healthy Kids supports medical, dental, mental health, and vision care for children ages 0 to 18 years in low-income families who are ineligible for Medi-Cal (eligibility rate of 100% or less of the Federal Poverty Level) or Healthy Families (eligibility rate of 101% to 200% Federal Poverty Level). Insurance premiums are covered for children ages 0 to 5 years in Sacramento County by First 5 Sacramento. The Healthy Kids insurance paid by First 5 Sacramento is one health insurance product for which Cover the Kids provides application assistance, they also provide assistance to those who qualify for Medi-Cal and Healthy Families. The remainder of this chapter presents data on the direct services offered through Cover the Kids, and excludes the indirect services provided by Healthy Kids Healthy Future and any outcomes from the dental, hearing, and developmental screenings conducted at the Bright Futures community fares. Cover the Kids provided application assistance for health insurance to 793 clients during fiscal year 2007/08. Figure 3.1 shows the distribution of the clients in Sacramento County served by Cover the Kids; the zip code with the highest number of clients was 95823. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 12 Figure 3.1: Distribution of 793 First 5 Sacramento Clients Receiving Services from Cover the Kids, Fiscal Year 2007/08 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 13 HEALTH ACCESS INDICATOR: PERCENT OF CHILDREN CONTINUOUSLY ENROLLED IN HEALTH INSURANCE AT 4, 8, AND 13 MONTHS FINDING: THE MAJORITY (91.7%) OF PARENTS RECEIVING COVER THE KIDS SERVICES REPORTED THAT THEIR CHILDREN CONTINUED TO HAVE HEALTH INSURANCE AT EIGHT MONTHS FROM APPLICATION ASSISTANCE. Children who do not have continuous health insurance are less likely than those with health insurance to have access to regular and preventive health care. When children have access to regular health care, they are more likely to be healthy, succeed in school, and less likely to rely on emergency rooms for regular health care. Children who do not have health insurance often forgo needed care, impacting their development and quality of life. When a few months have passed after the provision of application assistance, staff from Cover the Kids call parents to verify that their children were enrolled in a health insurance program. Additional telephone calls are placed to parents over a 13-month period to verify continuous enrollment in health insurance and to provide parents with additional assistance as needed. For this report, information on continuous health insurance coverage was available for the period up to eight months after application assistance. During the year, 397 children were able to obtain and retain health insurance coverage for up to eight months due in part to the efforts of Cover the Kids. The finding for this indicator is based on the 433 families who Cover the Kids staff were able to reach by phone about eight months after providing application assistance. HEALTH ACCESS INDICATOR: PERCENT OF CHILDREN WITH COMPLETE IMMUNIZATIONS AT AGES 2 AND 5 YEARS FOR CHILDREN ENROLLED IN HEALTH PLANS OF TWO-YEAR OLDS AND 91.7% OF FIVE-YEAR OLDS WHO RECEIVED SERVICES THROUGH COVER THE KIDS WERE REPORTED TO HAVE HAD COMPLETE IMMUNIZATIONS. FINDINGS: 84.2% Immunizations are important for young children because vaccines prevent many diseases that are more common and lethal in children. Also, immunizations are most effective when given early in life. Required immunizations result in higher school attendance and better physical health among children. Immunizations are also an important public health practice to prevent outbreaks of diseases that can result in long-term severe developmental disabilities, sensory impairments, or death. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 14 To assess immunizations rates, First 5 Sacramento parents were asked, “In your opinion, has [child’s name] received all of the recommended shots for (his/her) age?” Compared to the average for California two-year olds with complete immunizations, a greater percentage of parents of two-year olds receiving services through Cover the Kids had complete immunizations (84.2% for Cover the Kids children versus 78.6% for the state average).4 Comparable state data are not available for five-year olds. HEALTH ACCESS INDICATOR: PERCENT OF CHILDREN WHO HAVE RECEIVED ALL AGE APPROPRIATE WELL-CHILD VISITS FINDING: 88.8% VISITS. OF COVER THE KIDS CHILDREN HAD ALL AGE APPROPRIATE WELL-CHILD Well-child visits are an important practice to ensuring a child’s health. During well-child visits doctors assess the general health, growth and development of children. Early identification and treatment of any delays or disabilities identified can lessen the future impact of the condition on the child and family. Well-child visits are also a time when physicians can promote health behaviors conducive to healthy development, and make sure that the child is up-to-date on immunizations. Parents were asked whether their child was seen by a “medical doctor or other health professional for a check-up, or other routine care” during the previous year. Answers to this question and each child’s age were compared with the American Academy of Pediatrics’ wellchild visits schedule to determine the percent of children with age appropriate well-child visits. A similar percent of First 5 Sacramento children (88.8%) have all age appropriate well-child visits compared with the national average for children under six (85.0%) for the year 2004.5 HEALTH ACCESS INDICATOR: PERCENT OF CHILDREN WHO HAVE SEEN A DENTIST BY ONE YEAR OF AGE OF ONE-YEAR-OLDS RECEIVING SERVICES THROUGH COVER THE KIDS HAD BEEN TO THE DENTIST. HISTORY OF DENTAL CARE BY AGE ONE YEAR WAS GREATER AMONG COVER THE KIDS CHILDREN COMPARED WITH CHILDREN FROM THE NUTRITION, EFFECTIVE PARENTING, AND SCHOOL READINESS RESULT AREAS. FINDINGS: 3.3% National Immunization Survey, 2006-2007. Data for the National Immunization Survey is also based on selfreport. Data available at: www.kff.org. 5 From the National Health Interview Survey. Data available at: www.childtrendsdatabank.org. 4 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 15 Poor oral health has been linked to problems with eating, speaking, and sleeping. In addition, school performance and social relationships can be affected by dental problems. The American Academy of Pediatric Dentistry recommends that all children visit the dentist within six months of the appearance of the first primary tooth and no later than after their first birthday. Unmet dental needs among one-year-old children was determined by the question, “How old in months or years was [child’s name] when (he/she) first visited a dentist?” The difference between the findings for Cover the Kids and the other Result Areas (Figure 3.2) suggests that Cover the Kids may be helping families with young children to visit the dentist by one year of age, by providing dental insurance and by communicating the importance of early dental care with the families they serve. However, the overall prevalence of dental visits at this age remains very low. Figure 3.2: Children Receiving Dental Exam by One Year of Age by Result Area, Fiscal Year 2007/08 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% Cover the Kids Other Result Areas 2.2% 3.3% Percents based on 121 children from Health Access (i.e., Cover the Kids) and 542 from other Results Areas. Source of Data: Parent Interview. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 16 CHAPTER 4 NUTRITION RESULT AREA Two types of Nutrition services received a total of $1,420,000 from the First 5 Sacramento Commission during 2007/08: breastfeeding support and childhood obesity prevention. This chapter only reviews the breastfeeding services from the Enhanced-Community Lactation Assistance Project – those services provided directly to mothers – and does not include findings from the Baby Friendly training of 280 nurses and other hospital staff in strategies to encourage breastfeeding among new mothers. Breastfeeding Support Enhanced-Community Lactation Assistance Project services were provided at 10 sites by the Sacramento County Department of Health and Human Services Women, Infants and Children Program (DHHS WIC); Community Resource Project WIC (CRP WIC); Sutter Medical Center Sacramento (SMCS)6; and the University of California Davis Medical Center (UCDMC). These services are designed to encourage mothers to initiate breastfeeding after delivery and continue to provide only breast milk (exclusive breastfeeding) to the child for at least six months. Services are provided to mothers on a drop-in or call-in basis at DHHS WIC and CRP WIC, and to mothers delivering at SMCS and UCDMC. One-on-one Lactation Consultation breastfeeding services include assessing a baby’s growth and his or her latch and positioning when breastfeeding. Guidance on how to deal with breastfeeding problems (such as engorgement) and general suggestions for different ways to breastfeed are also provided by an International Board Certified Lactation Consultant (IBCLC). Clinic Support services are provided by the Peer Counselor (PC) or Lactation Consultant Assistant (LCA) and include encouraging mothers to continue breastfeeding should they express the desire to quit. Breastfeeding Support Group services provide mothers with a forum to share challenges (e.g., engorgement, pain, exhaustion, or lack of family support), to receive encouragement to continue breastfeeding from other mothers, and to receive education on topics such as introducing solid foods. The Breastfeeding Help Line service is available to mothers to receive immediate assistance over the phone with breastfeeding problems. Phone Contact services involve contacting mothers within 72 hours of discharge from a hospital as well as between 72 hours and 1 year post-discharge. These services are intended to address a mother’s needs, concerns, and questions (e.g., how to properly store breast milk) through providing information and referrals. Back to Work Education services provide mothers with information on ways to continue providing breast milk to their babies after returning to work or school. A total of 5,162 expecting and new mothers received breastfeeding support services during fiscal year 2007/08. Over half (51.8%) of clients receiving Nutrition services were mothers who received a one-on-one Lactation Consultation (Table 4.1). Lactation consultation(s) is the most intensive and personalized breastfeeding support service funded, which is provided by an International Board Certified Lactation Consultant. 6 SMCS elected to terminate its contract with DHHS WIC in October 2007. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 17 Mothers accessed breastfeeding support through a variety of methods. Some may only have needed the assistance from the helpline, while others may have accessed an ongoing service such as that of a support group. Just under half of clients receiving Nutrition services accessed the Breastfeeding Help Line (48.0%) or received Clinic Support (47.5%); the Breastfeeding Help Line service was provided 4,425 times, making it the Nutrition service accessed the most this fiscal year. Mothers who participated in the Breastfeeding Support Groups accounted for 35.0% of clients receiving Nutrition services. Childhood Obesity Prevention Six providers were funded on January 1, 2008 to implement childhood obesity prevention strategies; that is, to improve nutrition and increase physical activity among children and their parents. Community School Solutions of California, Inc. (Community School Solutions) provides culturally relevant services to Spanish-speaking families through access to a community store that sells healthful foods. Community School Solutions uses the MyPyramid guidelines to provide nutrition information to participating parents. They offer parents participation in a Nutrition Workshop and instruction on how to cook healthful meals through cooking classes. Physical activity is encouraged through exercise classes for children and parents, and the distribution of pedometers to parents. Continuing Development Incorporated is contracted to provide family-centered workshops to instruct parents in becoming teachers of nutrition to their children. Workshops in preschools are conducted on topics of healthy eating, active living, and appropriate feeding dynamics. Parents and children together experience hands-on nutritional activities and learn how to extend these practices to their daily lives. The Health Education Council (HEC) is focused on educating teachers and parents in healthy living. HEC provides Head Start teachers with nutrition and physical activity integration training, and implements farms stands at Head Start sites. Nutrition workshops and monthly nutrition newsletters are also provided to parents and children. The Sacramento Mutual Housing Association (SMHA) is contracted to develop urban farm stands, providing low-income housing communities access to fresh, reasonably priced produce. Farm stand customers have access to nutrition information and parents are trained in planning and operating new farm stands to encourage their participation. SMHA also developed nutrition education classes for preschool children and their parents. Los Rios Community College District services target student parents, their children, and early childhood providers. Services include educating parents and children on reading food labels, healthful food choices, and physical activity. A curriculum for parent classes has also been developed to address children’s nutritional needs, health risks and physical activity, and meal planning. Seven community recreation and park districts in Sacramento County were contracted during the fiscal year to build “Tot Lots” or playgrounds to provide children with environments where they can be physically active. The districts are the Carmichael Recreation and Park District, City of First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 18 Sacramento Department of Parks and Recreation, Cordova Recreation and Park District, Cosumnes Community Services District, Fulton-El Camino Recreation and Park District, North Highlands Recreation and Park District, and the Rio Linda Elverta Park and Recreation District. Community School Solutions was the only provider of childhood obesity prevention services to recruit clients during the 2007/08 fiscal year. One hundred clients were recruited and received services that ranged that included participating in Nutrition Workshops or Cooking Classes (Table 4.1). No outcome data (i.e., children’s height and weight) were available during this fiscal year. The next evaluation report will include these data in examination of the effectiveness of the childhood obesity programs. Table 4.1: Nutrition Services, Fiscal Year 2007/08 Clients Receiving Service, % (n = 5,262) Lactation Consultation Phone Contact – IBCLC Phone Contact – PC/LCA Breastfeeding Help Line Home Visit – Lactation Support Clinic Support Breastfeeding Support Group Breast Pump Loan Back to Work Education Community Store Access Cooking Class Nutrition Workshop Exercise Class Pedometers Referral for Health Insurance Referral for Lactation Support Source Data: Persimmony Services Provided (n = 19,216) 4,311 524 1,188 4,425 226 3,607 2,276 797 173 298 113 298 543 5 12 420 51.8 8.2 16.9 48.0 3.1 47.5 35.0 13.8 3.1 0.6 0.3 0.7 0.9 0.1 0.2 7.4 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 19 In fiscal year 2007/08, the largest number of Nutrition clients lived in the 95838, 95823, and 95670 zip codes of Sacramento County (Figure 4.1). Figure 4.1: Distribution of 5,262 First 5 Sacramento Clients Receiving Nutrition Services, Fiscal Year 2007/08 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 20 NUTRITION INDICATOR: PERCENT OF WOMEN WHO ARE EXCLUSIVELY BREASTFEEDING AT 6 MONTHS AND 1 YEAR AFTER DELIVERY FINDINGS: 25.5% OF FIRST 5 SACRAMENTO CHILDREN WERE EXCLUSIVELY BREASTFED FOR SIX MONTHS AND 19.2% WERE BREASTFED FOR 12 MONTHS. SIX- AND 12-MONTH BREASTFEEDING RATES WERE HIGHER FOR CHILDREN WHOSE MOTHERS RECEIVED SERVICES THROUGH NUTRITION COMPARED WITH THE OTHER RESULT AREAS. The nutritional, health, immunological, developmental, and psychological benefits of breastfeeding for infants and children have been well established. Children who were breastfed during their first year of life are less likely to become overweight or obese, and breastfeeding supports bonding between infant and mother. Breastfeeding rates for First 5 Sacramento mothers were measured using questions developed by the Centers for Disease Control and Prevention. Infants receiving only breast milk were considered to be exclusively breastfed. La Leche League and the American Academy of Pediatrics currently recommend that breastfeeding continue for at least the first year with the introduction of solids occurring around the middle of the first year of the child’s life. Twelvemonth breastfeeding rates represent the percent of children with a diet of breast milk plus water, cow’s milk, or solid foods, but no formula until the child’s first birthday. Breastfeeding is a health behavior that is promoted by all First 5 Sacramento service providers. Thus, the differences in rates for breastfeeding by Result Area (Figures 4.2 and 4.3) could be explained by the additional support and services that mothers from the Nutrition Result Area receive (e.g., support groups and breast pumps). The six-month exclusive breastfeeding rate for First 5 Sacramento children of 25.5% is well above the national average of 11.3% as reported for the most recent national survey of breastfeeding.7 7 From National Immunization Survey, 2004. Data available at: www.cdc.gov. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 21 Figure 4.2: Children Exclusively Breastfed Six Months After Delivery by Result Area, Fiscal Year 2007/08 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Nutrition Other Result Areas 29.7% 24.0% Percents based on 155 children from Nutrition and 425 from Other Results Areas. Source of Data: Parent Interview. Figure 4.3: Children Exclusively Breastfed 12 Months After Delivery by Result Area, Fiscal Year 2007/08 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Nutrition Other Result Areas 17.4% 27.7% Percents based on 83 children from Nutrition and 397 from Other Result Areas. Source of Data: Parent Interview. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 22 CHAPTER 5 EFFECTIVE PARENTING RESULT AREA During 2007/08 a total of $3,804,000 was expended for Effective Parenting services provided through the Sacramento County Department of Health and Human Services, Family Support Collaborative, Effective Parenting Initiative and Crisis Intervention programs; the Elk Grove Unified School District, Power of Parenting program; the Sacramento County Department of Health and Human Services, Nurse Family Partnership program; and the Sacramento Crisis Nurseries program of the Sacramento Children’s Home. The Family Support Collaborative provides parent education and support services primarily on a drop-in basis at eight Family Resource Centers (FRCs) throughout Sacramento County. The most appropriate education and support services are determined by FRC staff in conjunction with the family. A Needs Assessment or the Parent Stress Index (PSI) is conducted upon intake to assess and determine the appropriate effective parenting or crisis intervention services for the family. Families begin receiving parenting services as determined with the Needs Assessment conducted by staff at intake. Following the administration of the PSI, a Family Support Plan is developed by a Crisis Intervention Specialist with the parent receiving crisis intervention services. The goal of this plan is to ensure child safety while dealing with the crisis and to provide support for the parent and family. The Family Support Collaborative also uses three parenting education curricula to improve parenting skills, while addressing cultural differences in parenting: Make Parenting a Pleasure (MPAP), Dare to Be You (DTBY), and Strengthening Multi-Ethnic Families and Communities (SMEFC). Home visits conducted by the Family Support Collaborative include discussing parenting concepts and principles with the family. Enhanced Core Services is used to refer to a variety of parent education and support services provided by the Family Support Collaborative including: peer support, alcohol and drug counseling, life skills and advocacy training, and resource/referrals. The Elk Grove Unified School District (EGUSD) offers services through its Power of Parenting program to teach effective parenting skills, promote family literacy, and to engage fathers in the lives of their children. In addition, this program utilizes the Project PLAY model to provide a variety of fitness and leisure activities for children and families to improve family and community relationships, increase self-concept, foster greater independence, and increase the social experiences of participants. The Nurse Family Partnership is a home visitation program conducted by registered nurses who visit first time expecting and new mothers and provides the family with services until the child is two-years old. During home visits the nurse discusses personal and environmental health, life course development, and maternal role, and refers families to resources in the community. The PIPE curriculum, implemented by the Nurse Family Partnership, is specifically designed to focus the parent on the child’s needs and emotional communication with educational material and parent activities. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 23 The Sacramento Children’s Home (SCH) provides a safe haven for children in need of immediate care when parents are in crisis and have no other supports. In addition, SCH provides parenting education and connects parents with other support services within the county. The goal of the services is to prevent families from entering the child protective services system and/or having their children end up in foster care. Respite care is the provision of short-term (day or overnight) temporary care for children, giving parents in crisis a break from caring for their children. Respite care provides a safe place for children while reducing parental depression and increasing parental self-confidence. Daytime respite care is sometimes referred to as “emergency child care,” which parents may access when they have a job interview or legal or doctor appointment. The SCH also provides transportation to ensure that clients can access services such as respite care or can get to a medical appointment, for example A total of 30,475 Effective Parenting services were provided during fiscal year 2007/08 with 34.7% of clients receiving a home visit(s) from either Family Support Collaborative or the Nurse Family Partnership (Table 5.1). A Needs Assessment was conducted at intake for clients seeking the parenting services from Family Support Collaborative; 32.2% of clients from Effective Parenting received this service. In addition, 30.4% received Parenting Education services and 21.1% received Enhanced Core Services. Due to challenges with the PSI, only 28 were administered during the fiscal year. In response to these challenges, the Family Support Collaborative began using the Family Development Matrix tool to assess families in crisis in fiscal year 2008/09. One Effective Parenting program – EGUSD’s Power of Parenting – is unique in that a key component is to increase father engagement. The Father Engagement Parent Events provided through this program reached 11.4% of all clients receiving Effective Parenting services. It is also interesting to note that Respite Care was accessed by only 8.4% of Effective Parenting clients, yet comprises 10.1% of all services provided. This suggests that a relatively small number of clients receive a large number of the Respite Care services, or that the same clients continue to need this service. During fiscal year 2007/08 Respite Care services were only available through the SCH site located in the north area of Sacramento. A key part of the Effective Parenting services is also to connect clients with additional resources throughout the community. Specifically, Case Management and referrals are provided to address the various support needs of families. Case Management services involve the Crisis Nursery Case Manager or Crisis Intervention Specialist establishing a relationship with families to periodically assess their strengths and needs, and ensure the family is connected to needed support services. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 24 Table 5.1: Effective Parenting Services, Fiscal Year 2007/08 Clients Receiving Service % (n = 2,603) Respite Care Home Visits Case Management Family Support Plan Enhanced Core Services Developmental Assessment Parent Stress Index Needs Assessment Post Assessment of Services Parenting Education Father Engagement Event Child Literacy Parent Event Playgroup Transportation Referral to Family Resource Center Referral for Health Insurance Referral for Crisis Services Referral for Respite Care Referral for Infoline Referral for Lactation Support Referral for Parent Education Source Data: Persimmony Services Provided (n = 30,475) 3,085 12,101 701 268 3,141 2 28 1,002 287 5,988 376 339 534 718 53 194 396 188 62 262 750 8.4 34.7 6.6 7.5 21.1 0.0 1.1 32.2 8.5 30.4 11.4 9.3 7.5 4.6 1.9 5.4 8.3 5.2 2.0 8.8 16.2 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 25 Figure 5.1 illustrates the distribution of the clients served by programs in the Effective Parenting Result Area. As the map shows, the highest number of clients served live in the 95823 and 95828 zip codes. Figure 5.1: Distribution of 2,603 First 5 Sacramento Clients Receiving Effective Parenting Services, Fiscal Year 2007/08 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 26 EFFECTIVE PARENTING INDICATOR: IMPROVED FAMILY FUNCTION FINDING: FAMILIES FROM THE EFFECTIVE PARENTING RESULT AREA DEMONSTRATED LOWER OVERALL RISK OF POOR FAMILY FUNCTIONING THAN FAMILIES FROM THE OTHER THREE RESULT AREAS. First 5 Sacramento funding for Effective Parenting supports the principle that families function well through strong, caring relationships that recognize the parent as the primary nurturer, educator, and advocate for their young child. Improved family functioning can also encompass family communication and the use of positive approaches to discipline. Improved family functioning was defined based on family social capital, that is, the resources that families have available for greater self-sufficiency, which positively influence children’s development. A composite measure for family social capital was developed, based on 12 Parent Interview survey items that indicate availability of resources or the presence of risk factors. Questions covered occupational status, parent education, parent age, family structure, and parent involvement in training courses or other education. A higher score on the composite suggests that the family has reduced social capital and hence is at greater risk. A lower score indicates that families have sufficient levels of family social capital. It appears that those who have participated in Effective Parenting services, such as Parenting Education, are at decreased risk compared with parents receiving services in other Result Areas (Figure 5.2). Subsequent reports will determine whether the level of risk among Effective Parenting parents shows consistent decreases over time. Decreased risk means that these families have higher levels of social capital and better family functioning. Figure 5.2: Families at Risk for Poor Functioning by Result Area, Fiscal Year 2007/08 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Effective Parenting Other Result Areas 12.5% 16.5% Percents based on 96 families from Effective Parenting and 363 from Other Result Areas. Source of Data: Parent Interview. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 27 EFFECTIVE PARENTING INDICATOR: PERCENT OF PARENTS WHO IMPROVE KNOWLEDGE OF DEVELOPMENTAL STAGES IN CHILDREN FINDING: 32.3% OF PARENTS FROM KNOWLEDGE OF CHILD DEVELOPMENT. EFFECTIVE PARENTING DEMONSTRATED HIGH Parents who understand the stages of young children’s growth will be better able to nurture and support their children’s healthy development. These parents will be able to understand the developmental challenges children face and thus can provide the appropriate level of guidance and structure geared towards each child’s level and needs. Such knowledge is a core component of effective parenting. Knowledge of child development was measured by 11 statements from the Knowledge of Infant Development (KIDI) Scale. Items included “All infants need the same amount of sleep” and “A baby usually says its first real word by six months of age.” Parents were asked to indicate which of these statements are correct, or whether they believed that incorrect statements applied to younger or older children. The findings for this indicator establish the baseline for participants in Effective Parenting programs. The follow-up interviews with parents from Effective Parenting will give us the information we need to determine the percent of parents who improve in their knowledge of child development. EFFECTIVE PARENTING INDICATOR: PERCENT OF PARENTS WITH DECREASED STRESS FINDING: PARENTS RECRUITED FROM THE RESULT AREAS OTHER PARENTING HAD LOWER LEVELS OF STRESS COMPARED WITH PARENTS EFFECTIVE PARENTING PROGRAMS. THAN EFFECTIVE PARTICIPATING IN Parents can lower their parenting stress by drawing upon resources in the community, such as parenting classes, counseling, opportunities to connect with other parents, and respite and emergency child care. When parents decrease their perceived level of stress as a parent, they can help prevent that stress from negatively impacting their children. This is consistent with the idea that when parents take care of themselves, they are better able to take care of their children. First 5 Sacramento-funded family support services are designed to strengthen families’ resiliency and to address sources of stress for parents. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 28 Agreement with statements such as, “I feel trapped by my responsibilities as a parent” and “There are quite a few things that bother me about my life” was used to determine parents’ levels of stress. These items came from a well-known scale, called the Parenting Stress Index (PSI), and they all belonged to a specific subset of items on this scale that assess “Parental Distress.” Effective Parenting providers specifically target parents with increased levels of stress; thus it makes sense that such parents would report greater stress at baseline compared with those not receiving such services (Figure 5.3). Follow-up interviews will allow for measuring the change in levels of stress for parents who participate in Effective Parenting programs and compare these changes to the levels of stress reported by parents who do not participate in these programs. Figure 5.3: Parents with High Parental Distress by Result Area, Fiscal Year 2007/08 20.0% 19.1% 15.0% 14.4% 10.0% 5.0% 0.0% Effective Parenting Other Result Areas Percents based on 94 parents from Effecting Parenting and 360 from Other Result Areas. Source of Data: Parent Interview. EFFECTIVE PARENTING INDICATOR: PERCENT OF PARENTS WHO REPORT CONNECTEDNESS TO THEIR COMMUNITIES PARENTS REPORTED GREATER NEIGHBORHOOD CONNECTEDNESS THAN PARENTS FROM THE OTHER RESULT AREAS, AND 58.7% OF PARENTS FROM THE EFFECTIVE PARENTING RESULT AREA RESPONDED WITH HIGH SOCIAL COHESION. FINDINGS: EFFECTIVE PARENTING A parent’s approach to parenting is shaped by many factors such as ethnic heritage, cultural practices, friends and family, and community resources. Parents’ connections to their communities can link them to support networks, information sources, safety net resources, and a sense of security, among other potential benefits. This indicator reflects the importance of community in effective parenting. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 29 Connectedness to the community, or involvement with one’s neighborhood, is a complex concept. This evaluation used a series of items drawn from two well-known measures. Parents were first asked about their connection to other people in their neighborhood with questions related to the number of people within their neighborhood whom they know by name, the number of neighbors with whom they visit in each other’s homes, and the number of friends and relatives who live in their neighborhood. In addition, parents were presented with nine statements about their neighborhood such as “People in my neighborhood are willing to help their neighbors” and “My neighborhood is a good place to raise children” to determine their levels of social cohesion. Even though parents receiving Effective Parenting services were more stressed compared to parents from other Result Areas, as noted earlier, they appear to show higher connectedness to their neighborhoods (Table 5.2). Future analyses will determine whether the percent of parents with high social cohesion increases over time, and whether changes over time found for individuals (e.g., knowing more people by name) may be related to the conditions of the larger community (i.e., do neighborhoods become safer places to raise children?). Table 5.2: Neighborhood Connectedness by Result Area, Fiscal Year 2007/08 Average Number of People in Neighborhood Known by Name Effective Parenting Result Area Other Result Areas Number of People Who Visit in Each Other’s Homes Effective Parenting Result Area Other Result Areas Number of Friends and Relatives Who Live in Neighborhood Effective Parenting Result Area Other Result Areas Source of data: Parent Interview. 7.5 5.4 3.9 2.2 3.0 2.2 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 30 EFFECTIVE PARENTING INDICATOR: PERCENT OF PARENTS WHO PRACTICE DEVELOPMENTALLY APPROPRIATE PARENTING SKILLS FINDING: 87.9% OF EFFECTIVE PARENTING “RARELY” SPANK THEIR CHILDREN. PARENTS INDICATED THAT THEY “NEVER” OR When parents make use of parenting skills appropriate to their child’s developmental stage, they are enhancing their relationship with their child and strengthening their family. Gaining knowledge and understanding of appropriate parenting strategies can also create a sense of greater competence and satisfaction with being a parent. This indicator directly addresses the use of developmentally appropriate skills that are at the core of effective parenting. Parents were asked how often they spanked or smacked their child in the last six months. Developmentally appropriate parenting skills were also measured by reading different statements to parents and asking them whether the behavior was “very much like them,” “somewhat like them,” or “nothing like them.” Examples of some of these statements are, “I encourage my child to be curious, to explore, and to question things” and “I believe physical punishment to be the best way of disciplining.” These questions were used to determine the percent of parents with high Nurturance (affection and positive feedback) and Energy (consistency in parenting practices), and also to distinguish Authoritative (encouragement of independence) and Authoritarian (discipline by verbal or physical punishment) parenting styles. The American Academy of Pediatrics discourages parents from using spanking as a form of discipline. The 2000 National Survey of Early Childhood Health found that 26% of parents frequently use spanking to discipline their children.8 Among First 5 Sacramento parents, only 12.1% stated that they “sometimes” or “often” spank or smack their children. In addition, only 12.9% of parents had high Authoritarian parenting behaviors (Figure 5.4). These data establish the baseline levels of these measures as well as Nurturance, Energy, and Authoritative parenting. Follow-up data collected over the course of this evaluation from First 5 Sacramento parents will establish whether parents receiving Effective Parenting services, as well as those in other Result Areas, show positive changes over time in these parenting practices. . Regalado, M., Sareen, H., Inkelas, M., Wissow, L. S., & Halfon, N. (2004, June). Parents' discipline of young children: Results from the National Survey of Early Childhood Health. Pediatrics, 113(6), 1952-1958. 7 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 31 Figure 5.4: Parents from Effective Parenting with High Nurturance, Energy, Authoritative, and Authoritarian Parenting Styles, Fiscal Year 2007/08 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Nurturance Source of Data: Parent Interview. 86.0% 50.0% 51.6% 12.9% Energy Authoritative Authoritarian EFFECTIVE PARENTING INDICATOR: PERCENT OF PARENTS WHO INTERACT WITH THEIR CHILDREN IN A SUPPORTIVE AND POSITIVE MANNER FINDINGS: 33.1% OF CHILDREN ARE READ TO EVERY DAY AND HALF OF EFFECTIVE PARENTING PARENTS HAD HIGH ACTIVITIES WITH CHILD SCORES. Young children grow and change rapidly, learning from the environments and people surrounding them. They depend on their parents to nurture their development, care for their health and safety, and prepare them for new experiences. By using supportive and positive parenting approaches, parents can provide the stimulation and beneficial interactions their children need in order to thrive. The extent to which First 5 Sacramento children live in a positive and supportive household was measured with a number of questions. First, parents of children one year or older were asked how often someone in the family reads to the child. In addition, an “Activities with Child” score was calculated by asking parents of children three years or older how often they conducted each of 15 activities with their child. These activities included, “Played any game or sport together,” “Helped (him/her) learn letters, words, or numbers,” and “Talked with [child’s name] about (his/her) family history or stories about the family”. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 32 At the baseline, the rate for reading every day to First 5 Sacramento children is below the average of 44.6% for children five years and younger across California.9 We will look at change over time by asking the same First 5 Sacramento parents these questions in the one-year followup interviews to determine whether parents who participated in Effective Parenting services increased their frequency of reading to their children, and whether the same changes occurred for parents receiving services in other Result Areas. Russ, S., Perez, V., Garro, N., Klass, P., Kuo, A. A., Gershun, M., Halfon, N., & Zuckerman, B. (2007). Reading Across the Nation: A Chartbook. Reach Out and Read National Center. Boston, MA. 9 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 33 CHAPTER 6 SCHOOL READINESS RESULT AREA With $4,105,000 expended in 2007/08, School Readiness represents the First 5 Sacramento Commission’s largest investment in improving the lives of children ages 0 to 5 years. School Readiness services during the fiscal year were numerous and included preschool and prekindergarten summer camps, parent workshops, health and developmental screenings, and kindergarten transition activities. Eight school districts provided School Readiness services this fiscal year: Del Paso Heights, Elk Grove Unified, Folsom Cordova Unified, North Sacramento, Rio Linda Union, Robla Elementary, Sacramento City Unified, and San Juan Unified, as well as the Sacramento County Office of Education. Seven of these school districts received funding from both First 5 Sacramento and First 5 California (“state matched” programs). The Sacramento City Unified School District program is unique in that it provides both services within schools and at families’ homes. Its case management services include Family Advocates conducting home visits to families with multiple health or social service needs. Among other services, free books are provided to assist in promoting the child’s and parents’ literacy and English language development. Unlike other school districts, Elk Grove Unified School District is funded to provide a Special Needs Mental Health Project in addition to their program focused solely upon School Readiness – Nurturing Success. The Special Needs Mental Health Project increases access to developmental assessments and treatment services, and provides classroom consultation for preschool teachers. Together, these two programs provide most of the “Special Needs Identification and Intervention” services within the School Readiness Result Area: from neurological, psychological, developmental and behavioral assessments, to intervention, treatment, and private consultations. The Sacramento County Office of Education led the implementation of the Preschool Bridging Model pilot program in Elk Grove from 2006 to 2008. In Cycle 2 (fiscal years 2008 to 2012) the pilot program will be expanded to include every elementary school district in Sacramento County, including districts that receive School Readiness funding (listed above) and those that do not (Archoe, Elverta and Center). The Preschool Bridging Model is designed to enhance the quality of child care for children ages 3 to 5 years. This is achieved through workforce development, increased collaboration between public and private agencies, program quality improvement, enhanced learning environments, comprehensive screenings and assessments for children entering kindergarten, and linking parents to schools to facilitate kindergarten transition. Many districts provide Summer Pre-K Camps which vary between two and six weeks in duration. These summer camps provide opportunities for children without any preschool experience to interact with other children within a classroom environment prior to entering kindergarten. School Readiness programs involve parents in early care programs and provide parent workshops and training on the characteristics of quality child care, child development, effective parenting techniques, and techniques that support learning. These workshops use either First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 34 the Parents for Readiness or I Am Going to Kindergarten curricula. Transition Activities involve the distribution of “readiness backpacks,” which include information about kindergarten readiness, school supplies, and books and activities that families can do at home to promote language development and/or literacy. Some School Readiness services specifically address parenting knowledge and practices. Parenting education services include workshops, training, or dissemination of information to address such topics as parent-child interaction, child development, attachment, discipline, and/or healthy nutrition. One workshop utilizes curricula from The Right Question Project to teach and empower parents to ask the “right questions” about their child’s education. Children’s literacy services range from general programs to expose children to books and encourage reading, to a program geared to increase the child’s literacy in his/her primary language in order to strengthen their acquisition of English. Young children (ages 0 to 3 years) are also engaged with their peers through playgroups, and some include opportunities for parents to obtain information on additional resources available in the community. One school district provides a playgroup that specifically seeks to engage children with special needs. Health screenings and assessments address vision, oral, and general health of children. Health education for parents is provided through workshops to ensure parents are educated on general health topics, such as oral health and asthma. Additional effort to connect families with the resources they need is made by providing case management services, such as referrals to WIC for nutrition needs, or to Cover the Kids for health insurance application assistance. Overall, 73,937 services were provided to 3,282 clients across the four targeted areas of School Readiness: Improved Family Functioning, Improved Child Development, Improved Health, and Improved Systems of Care (Table 6.1). Transition Activities reached the highest percentage of clients (28.9%) receiving School Readiness services, followed by Children’s Literacy Programs (26.6%). Clearly, First 5 Sacramento School Readiness services largely reached clients with efforts to increase literacy and language development this fiscal year. Approximately one-fifth of clients receiving School Readiness services this fiscal year either received a health related screening or received parent-geared educational services. That is, Health Screenings and Assessments were provided to 19.4% of clients, while 18.1% received Kindergarten Readiness Education for Parents and 13.4% participated in Parenting Education services. Each day that children participated in Preschool, Playgroups, and Summer Pre-K Camps represents one unit of service in Table 6.1. If five children attended a preschool for three days, for example, 15 services would be reported. Similarly, the Preschool Quality Improvement data in Table 6.1 represent the number of days that children participating in these services. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 35 Table 6.1: School Readiness Services, Fiscal Year 2007/08 Clients Receiving Service, % (n = 3,282) Improved Family Functioning Home Visit Case Management Health Education for Parents Kindergarten Readiness Education for Parents Parenting Education Literacy Training for Parents Improved Child Development Preschool Playgroup Summer Pre-K Camp Transition Activities Children’s Literacy Programs Improved Health Special Needs Identification and Intervention Health Screenings and Assessments Vision and Dental Care Referral for Health Insurance Improved Systems of Care Preschool Quality Improvement Source Data: Persimmony Services Provided (n = 73,937) 1.1 6.1 4.4 18.1 13.4 0.1 13.6 10.2 13.2 28.9 26.6 7.2 19.4 8.7 3.3 5.7 36 1,016 147 1,217 891 4 42,483 4,009 3,185 995 4,282 394 662 323 183 14,110 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 36 The highest number of School Readiness clients lived in the 95817, 95822, 95824, 95823, and 95838 zip codes (Figure 6.1). Figure 6.1: Distribution of 3,282 First 5 Sacramento Clients Receiving School Readiness Services, Fiscal Year 2007/08 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 37 SCHOOL READINESS INDICATOR: PERCENT OF CHILDREN WHO HAVE RECEIVED A COMPREHENSIVE HEALTH AND DEVELOPMENTAL SCREENING IN THE PAST YEAR FINDING: 16.3% OF SCHOOL READINESS CHILDREN DEVELOPMENTAL TEST DURING THE PAST YEAR. HAD A HEARING, VISION, AND Early and comprehensive health and developmental screenings are important services as physical health and motor development are critical to a child’s success and readiness to learn in school. The earlier problems are identified, the more likely they are to be addressed and to have less impact on the child’s overall development. Additionally, parents of children with identified special needs can obtain the support and services to help them cope with and provide for their child’s specific needs. First 5 Sacramento parents were asked whether their children had received a hearing and vision test during the previous year. A separate question asked if, during the past year, the child had been screened for development or behavior problems, explained as a “brief, simple procedure usually done by a professional or medical doctor to identify possible developmental delays or disabilities.” Although relatively few children in the School Readiness Result Area received all three assessments, the majority of the children were screened for hearing and vision during the year (Table 6.2). These results establish the baseline levels of this indicator during the first year of the evaluation. Data collected from families receiving School Readiness services during subsequent years of the evaluation will show whether the percentages of children being assessed, particularly in all three areas, are growing over time. Table 6.2: Children with Hearing, Vision, and Development Screening during Previous Year, Fiscal Year 2007/08 All Three Screenings, % Hearing, % Vision, % Developmental, % School Readiness Result Area Source of data: Parent Interview. 61.9 53.5 26.2 16.3 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 38 SCHOOL READINESS INDICATOR: PERCENT OF PARTICIPANTS REPORTING SATISFACTION WITH THE CONTENT, QUALITY, AND FAMILY CENTEREDNESS OF SERVICES FINDING: 81.0% OF SCHOOL READINESS PARENTS EXPRESSED SATISFACTION. Services for families have more potential to be effective when they are perceived as high quality and relevant. Moreover, parents’ satisfaction is likely to be higher when they feel that their own needs and the needs of their children are being addressed and understood by providers. Levels of satisfaction about the school programs where the child “spends most of (his/her) time” were obtained from First 5 Sacramento parents in seven areas, including “Supporting and respecting your family’s culture and background” and “Preparing [child’s name] to enter kindergarten.” Parent satisfaction in general tends to be relatively high for most services, and thus we would expect the percent of parents who were satisfied with the School Readiness services to be high. The continued evaluation will show whether parent satisfaction levels are even higher in subsequent project years among families participating in the Cycle 2 School Readiness programs that began on July 1, 2008.10 SCHOOL READINESS INDICATOR: PERCENT OF CHILDREN PARTICIPATING IN SCHOOLLINKED TRANSITIONAL PRACTICES FINDING: 69.0% OF FAMILIES WITH CHILDREN AGES 4 OR 5 READINESS SERVICES PARTICIPATED IN TRANSITION ACTIVITIES. YEARS RECEIVING SCHOOL In general, school-linked transitional practices are an important part of learning the formalized routines of kindergarten, how to be independent and responsible, and how to interact with teachers in ways that promote academic progress. A smooth transition to kindergarten can help set children on a trajectory for school success. A total of 978 families with children ages 4 or 5 years participated in school-linked transitional activities this fiscal year. These activities included kits/backpacks with kindergarten readiness information, language development materials, and school supplies, and/or summer prekindergarten camps. 10 The Cycle 2 School Readiness initiative represents an expansion of the Cycle 1 School Readiness initiative that ended June 30, 2008, and is intended to serve more children and families by involving more school districts and adding important infant-toddler components. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 39 Client data from Persimmony show that, of families with a 4 or 5 year old receiving School Readiness services, more than two-thirds participated in transition activities at baseline. While this percentage appears in line with the national survey results, we expect the percentage of families participating in transition activities to increase over subsequent years of the evaluation especially given that School Readiness programs funded for fiscal years 2008 to 2012 (“Cycle 2”) are intentionally incorporating more activities to support families with children transitioning into kindergarten. SCHOOL READINESS INDICATOR: PERCENT OF CHILDREN AGES 3-5 WHO REGULARLY ATTEND A NURSERY SCHOOL, PRESCHOOL, PRE-KINDERGARTEN, OR HEAD START PROGRAM BY THE TIME OF KINDERGARTEN ENTRY FINDING: 71.6% OF SCHOOL READINESS RESULT AREA CHILDREN ATTENDED A PRESCHOOL ON A REGULAR BASIS, COMPARED WITH 46.1% OF CHILDREN FROM OTHER RESULT AREAS, WHO ATTENDED A PRESCHOOL ON A REGULAR BASIS. There is a strong and growing evidence base showing that high-quality pre-kindergarten significantly narrows the achievement gap and allows children to start school on more equitable footing. Longitudinal studies also indicate that children who enter kindergarten at a disadvantage are likely to remain so, whereas participation in high quality early care and education programs can close the gap in achievement and sustain gains into the third grade and beyond. Attendance in primarily center-based preschools, pre-kindergarten programs, or Head Start tends to be split among different populations, along income, education, and racial/ethnicity lines. In general, many parents make choices for alternative child care arrangements, such as more informal child care, either through family child care homes or through care by relatives, or, if income permits, nannies. The data reported here come from the Parent Interview and thus are based solely on the parents’ report of their children’s participation in preschool, nursery, or pre-kindergarten. When looking only at children ages 3 to 4 years, we found that the percentages reported above were similar: 74.4% of children in School Readiness and 47.7% of children in the other Result Areas attended a nursery or preschool. We can compare these percentages with those reported in the 2007 Data Book for Sacramento County, which is derived from the California Health Interview Survey dataset, for only children ages 3 to 4 years. In Sacramento County, 35% of children ages 3 to 4 years attended a preschool or nursery school, which is lower than the state average of 42% and significantly lower than the 47.7% reported here for children from the other Result Areas. Overall, 3 to 4 year old children participating in any First 5 Sacramento direct service program were attending nursery and preschool at much higher rates than in the county as a whole. Children participating in the School Readiness Result Area attended a preschool at a much higher First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 40 level, which is not surprising given that this is a core strategy of this Result Area, and that many of the key School Readiness activities occur in center-based preschools (Figure 6.2). However, even children in other First 5 Sacramento Result Area programs attended preschool or nursery school at a higher level compared with the county average. Over time we would expect these participation rates to increase just as there have been increases over time in the county-level preschool participation rates (for 3 to 4 year olds), from 26.9% in 2003 to 34.6% in 2007.11 Increases in preschool participation could be expected to lead to significant long-term benefits in terms of children’s school readiness as well as families’ involvement in the child’s education. Figure 6.2: Children Ages Three to Five Who Regularly Attended a Nursery School, Preschool, Pre-kindergarten or Head Start Program by Result Area, Fiscal Year 2007/08 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% School Readiness Result Area Other Result Areas 46.1% 71.6% Percents based on 134 children from School Readiness and 167 from other Result Areas. SCHOOL READINESS INDICATOR: PERCENT OF CHILDREN MEETING DEVELOPMENTAL MILESTONES FINDINGS: THE RESULTS SUGGEST THAT MORE THAN THREE-QUARTERS OF CHILDREN ATTENDING SCHOOL READINESS PROGRAMS APPEAR TO BE MEETING DEVELOPMENTAL MILESTONES FOR PHYSICAL AND MOTOR DEVELOPMENT, BUT LESS THAN A THIRD ARE MEETING DEVELOPMENTAL MILESTONES FOR SOCIAL DEVELOPMENT AND LEARNING. 11 California Health Interview Survey. CHIS 2003 and 2007 Child Public Use Files. Release 1 [computer file]. Los Angeles, CA: UCLA Center for Health Policy Research, 2003, 2007. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 41 The National Education Goals Panel defines children’s readiness for school on a number of key developmental domains including cognitive, physical, and social-emotional development as well as language skills and their approaches to learning. By meeting typical milestones for growth in each of these areas, children can arrive in kindergarten with the skills needed to be successful. The Desired Results Developmental Profile Revised Edition (DRDP-R) was administered by teachers of children attending School Readiness programs in some school districts. Scores for meeting developmental milestones are based on teachers rating the child in each developmental domain at the top two levels of the four-level scales for each item within each domain.12 The percentages in Table 6.3 are based on combining all items within a core developmental area, and showing the percentage of children who were rated at the highest two levels on the DRDP-R. It is likely that the source of these relatively low numbers are due to the backgrounds and characteristics of families from lower income, social class and education levels, as the research has shown that family background has a significant impact on variations in children’s development at any given time period. For example, there is substantial evidence that lowincome families provide less intellectual stimulation to their young children compared with higher-income families.13 The findings in Table 6.3 serve as the baseline for children’s development and we would expect that, over time, as participation in School Readiness programs continue, the percentages of children in the sample meeting the key domains of learning and social development will increase. Table 6.3: Children from School Readiness Meeting Developmental Milestones, Fiscal Year 2007/08 n % Personally and Socially Competent (15 items) 102/324 31.5 Effective Learners (18 items) Showing Physical and Motor Competence (3 items) Safe and Healthy (3 items) Source of data: DRDP-R. 76/324 23.5 256/324 79.0 177/324 54.6 12 In the DRDP-R PS (preschool) version, the four developmental levels are Exploring, Developing, Building, and Integrating. There are two additional ratings for each item – “emerging” and “unable to rate” – but these are considered optional and do not contribute to the scores (California Department of Education, Desired Results Developmental Profile-Revised User’s Guide, March 2008). 13 Dickinson, D. K. and Tabors, P. O. (Eds.). 2001. Beginning literacy with language. Baltimore, MD: Brookes: 2001 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 42 SCHOOL READINESS INDICATOR: PERCENT OF CHILDREN ASSESSED TO BE READY FOR KINDERGARTEN AT THE COMPLETION OF A SCHOOL READINESS PROGRAM FINDING: 92.0% OF CHILDREN WERE REPORTED TO BE READY FOR KINDERGARTEN. Assessment for school readiness is important because children whose knowledge and skills are far behind those of their classmates enter school at a disadvantage. Studies show that children who enter kindergarten at a disadvantage remain at a disadvantage throughout adulthood. Children who are not successful in school manifest frustration through inappropriate behavior and are more likely to drop out of school. Children’s readiness for kindergarten was recorded on the “Summer Camp & Preschool Teacher Services/Assessment Form” with the question, “If this child has been assessed for his/her readiness for kindergarten, what was the result?” Response options were: “Ready,” “Not Ready,” “Not Sure,” and “N/A – Not Assessed.” Teachers were requested to complete the form once each quarter, or as the child exited the program. It is noteworthy that such a large percentage of teachers rated the children as being ready for kindergarten, despite the relatively low percentages of children on several key DRDP-R domains who were rated as reaching developmental milestones by their teachers. This discrepancy suggests that the teachers of the children attending these programs applied different standards for defining readiness, depending on whether they were asked globally or for specific developmental areas such as those on a formal instrument like the DRDP-R, where they may have applied a stricter standard for judging the child’s skills in each area. It may also be the case that many preschool teachers want to have their children enter kindergarten, even if some children’s skills are such that they are not ready to do so. The data here seem to be supporting these views and also point to the difficulty of asking teachers directly if a child is ready for entry into kindergarten. This discrepancy could be due to differences between the child populations: those who attended a funded summer camp or preschool (and assessed for readiness for kindergarten) may have come from more at-risk families, compared to the more restricted group of preschool children assessed on the DRDP-R. (Some summer camp recruitment focused on children who did not have prior preschool experience.) Alternatively, the discrepancy could be due to potentially different assessors of kindergarten readiness and administrators of the DRDP-R; the data do not allow for determining if the same teacher completed both assessments. SCHOOL READINESS INDICATOR: DEGREE TO WHICH PLANNING/PILOT SERVICE DELIVERY MODEL OR SYSTEMIC INTERVENTION IS IMPLEMENTED First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 43 During fiscal year 2007/08, the Sacramento County Office of Education piloted the Preschool Bridging Model (PBM) strategy. Preschool teachers and an instructional coach from the Elk Grove Unified School District provided preschool services and connections to school district resources to 15 child care facilities serving children ages three to five years. The objective of the PBM strategy is to promote workforce development and program improvement in private child care settings, promote collaboration between the public and private sectors, link child care to resources available in public sector, and to help early care educators better understand the important role they have in promoting school readiness. During the year, 11 of the 15 PBM classrooms implemented programs consisting of three hours of daily instruction, with three sites offering instruction three days a week and one site offering instruction two days per week. SCHOOL READINESS INDICATOR: PERCENT OF CHILDREN WITH SPECIAL NEEDS WHO PARTICIPATED IN EARLY CHILDHOOD CARE AND EDUCATION PROGRAMS FINDING: THE RATE FOR ENROLLMENT OF SPECIAL NEEDS CHILDREN IN EARLY CHILDHOOD CARE AND EDUCATION PROGRAMS WAS MUCH HIGHER FOR SCHOOL READINESS CHILDREN. Attending a quality early childhood care and education program is particularly important for children with special needs, who already face challenges when entering the formal education system. Longitudinal studies suggest that children who enter kindergarten at a disadvantage are likely to remain so, whereas participation in high quality early childhood care and education programs can close the gap in achievement and sustain gains into the third grade and beyond. For children with special needs, participation in preschool is an important factor in determining their future inclusion in regular schools. In this evaluation, children with special needs were defined according to the parent’s affirmative response on the Parent Interview to the question: “Has a doctor, other health or education professional, or someone from the First 5 contractor ever told you that your child has special needs or disabilities, for example, physical, emotional, language, hearing, learning difficulty, or other special needs?” If the parent answered yes to this question, he/she was then asked whether the child is currently attending a “nursery school, preschool, pre-kindergarten or Head Start program.” In response to the first question, 5.3% of children were said by the parent to have a special need based on the report of a professional. When comparing children participating in the School Readiness Result Area with those children participating in the other Result Areas, more children in the School Readiness Result Area were found to have a special need (7.9% versus 4.1%). This higher percentage may be due to the greater proportion of children screened at School Readiness Result Area programs, indicating an important function of service providers in this Result Area in terms of detecting special needs and reporting the results to the parents. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 44 More special needs children from the School Readiness Result Area attended early childhood care and education programs compared with the attendance rate of special needs children participating in programs from other Result Areas (Figure 6.3). The rate of attendance of special needs children in early childhood care and education programs (Figure 6.3) is high, and much higher than the attendance rate of special needs children who are participating in programs from other Result Areas. The primary goal of School Readiness is early identification and early intervention because it is more effective and less costly. With the focus of the School Readiness programs on early intervention and prevention, this participation rate in early childhood care and education programs suggests that many of these children may receive remedial interventions earlier, with the goal of reducing the chances they will require Individualized Education Plans upon entry into kindergarten. Thus, it appears that School Readiness programs are providing an important service to children with special needs. In addition, the programs in which these children participate are likely to be of higher quality since early intervention and prevention is one indicator of quality in early childhood care and education programs according to well-known measures of quality such as the ECERS-R. Figure 6.3: Children with Special Needs Who Participated in Early Childhood Care and Education Programs by Result Area, Fiscal Year 2007/08 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% School Readiness Other Result Areas 31.6% 81.3% Percents based on 16 special needs children from School Readiness and 19 special needs children from other Result Areas. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 45 CHAPTER 7 DENTAL RESULT AREA From fiscal years 2004/05 through 2007/08, First 5 Sacramento awarded the Sacramento Suburban Water District (SSWD) and California American Water Company (Cal-Am) $4,900,843 of capital improvement funding to expand fluoridation of their water supplies. By December 31, 2007 both water companies completed their First 5 Sacramento funded fluoridation projects. Cal-Am expanded fluoridation to two districts – “Arden” and “Suburban”. SSWD fluoridated its “South” (also known as “Town and Country”) service district. DENTAL INDICATOR: PERCENT OF CHILDREN WHO HAVE FLUORIDATED WATER TO FISCAL YEAR 2006/07, THERE WERE 155,310 SERVICE CONNECTIONS PROVIDING FLUORIDATED WATER TO AN ESTIMATED 507,335 HOMES AND BUSINESSES. BY THE END OF FISCAL YEAR 2007/08, AN ADDITIONAL 26,774 SERVICE CONNECTIONS HAD BEEN ESTABLISHED BRINGING THE TOTAL NUMBER OF SERVICE CONNECTIONS IN SACRAMENTO COUNTY TO 182,084. FINDINGS: PRIOR Untreated dental caries (i.e., tooth decay) can be very painful and can interfere with diet, nutrition, and sleep. When the fluoride concentration in drinking water reaches recommended levels (0.7-1.2 parts per million), the incidence of dental caries can be reduced. The SSWD and Cal-Am funded contractors provided data regarding the new service connections and population estimates in their water districts. Table 7.1 shows the number of additional service connections and the population served in the “Arden,” “Suburban,” and “South” service districts. Based on the estimated population of the water districts and the estimated percentage of children ages 0 to 5 years in each of the water districts, more than 8,000 new children in this age range are estimated to be receiving fluoridated water. In all, an estimated 614,185 people in the county have fluoridated water. These additional connections raised the percentage of Sacramento County residents receiving fluoridated water from 37.0% prior to fiscal year 2006/07 to 45.0% at the end of fiscal year 2007/08. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 46 Table 7.1: First 5 Sacramento Funded Water Fluoridation, Fiscal Years 2004/05 to 2007/08 New Service Connections Established by December 31,2007* Estimated Population of District* Water Company Service Districts Fluoridated Estimated Children 0-5 Years, %** Cal-Am Arden Suburban South (Town and Country) 1,258 10,516 15,000 26,774 4,150 34,700 68,000 106,850 12 9 7 SSWD TOTAL *Service connections and population of district are based on estimates provided by water contractors. ** Based on County population of 1,386,667. Source: U.S. Census Bureau. 2007 Population Estimates. Distributions for service areas based on census tract level data from 2000 U.S. Census. DENTAL INDICATOR: PERCENT OF CHILDREN WITH DENTAL CARIES AT KINDERGARTEN ENTRY FINDINGS: ALMOST HALF (49.7%) OF THESE PRESCHOOL CHILDREN WERE OBSERVED TO HAVE DENTAL CARIES. TWENTY-SEVEN CHILDREN, OR 8.4% OF ALL CHILDREN SCREENED, HAD ORAL HEALTH THAT WAS CLASSIFIED AS “URGENT CARE REQUIRED.” Dental caries affects children in the United States more than any other chronic infectious disease, and are the most common health problem among California’s children, particularly children from low income and racial minority families. Poor dental health can contribute to other health problems, poor self-image, poor concentration, and difficulties in school. Although Smile Keepers is not funded by First 5 Sacramento, the program offers the best available data to assess the dental health of Sacramento’s children. Smile Keepers conducted 320 dental screenings during fiscal year 2007/08 at the following preschools: Cordova Villa, Rancho Cordova, Williamson, Riverview, Noralto, Lichen, Pasadena, Kingswood, Mariposa, Mustard Seed-Montessori, and the California State University Sacramento Extension Preschool. A “Report of Screening” is sent home with each child screened along with a list of dental resources for the parent to access. Based on data from the National Center for Health Statistics, tooth decay among children ages 2 to 5 years increased from 24% to 28% between 1988-1994 and 1999-2004.14 Further, according to the 2007 California Health Interview Survey, 29.8% of children ages 2 and up in Sacramento County had never been to a dentist15 (which corresponds closely with the NCES percentage of 14 15 Data available at: www.cdc.gov. California Health Interview Survey. CHIS 2007 Child Public Use File. Release 1[computer file]. Los Angeles, CA: UCLA Center for Health Policy Research, January 2007. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 47 children with tooth decay) and 58% of children ages 0 to 5 years had visited a dentist in the past year.16 Although it would appear that the oral health of Sacramento preschoolers, as indicated by the 49.7% of children participating in Smile Keepers dental screenings who were found to have dental caries is far worse than the national average, we have to be careful interpreting these findings. Only 8.4% were considered requiring urgent care and we do not know, from the Smile Keepers data, how many of the remaining children were considered to require care. Finally, the schools that are targeted for screening from one year to the next are different, so it is difficult to say whether the percentage reported for these schools this year is higher or lower than for other schools (with different child populations). 16 Children Now, 2007 California Data Book, analysis of data from California Health Interview Survey. From: http://publications.childrennow.org/publications/invest/cdb07/cdb07_sacramento.htm. Accessed March, 2009. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 48 CHAPTER 8 COMMUNITY BUILDING RESULT AREA First 5 Sacramento provides small grants to informal community groups to plan and implement events or activities with the aim of building connections (social capital) between families with children ages 0 to 5 years. The connections built through Community Building Initiative (CBI) funded activities have the potential to make neighborhoods healthier and safer for children and empower parents to improve their lives, based on the support they receive from others and the knowledge they obtain about community resources. Applications for CBI funding are carefully screened by the First 5 Sacramento Advisory Committee and staff to ensure that they meet the objectives of the program. The investment in the Community Building Result Area was $825,000 during 2007/08. A total of 219 CBI events were reported during fiscal year 2007/08. Some events provided the opportunity for families to connect and network during an organized activity, such as regular playgroups with art activities or planting and harvesting a community garden. Many events were designed to also provide educational opportunities for young children or their parents. These included gatherings where parents read to children or collaboratively prepared nutritious meals and promote healthy eating. A random sample of First 5 Sacramento parents from the four direct service Result Areas were asked a series of questions about their attendance at community events during the previous six months. Responses were compared with a master list of CBI events reported during the year to categorize parents into three groups: “Did Not Attend a Community Event,” “Attended a Community Event, Not CBI,” or “Likely or Definitely Attended a CBI Event.” Comparisons were then made across these three groups on the related measures for each indicators associated with the Community Building Result Area. COMMUNITY BUILDING INDICATOR: PERCENT OF PARENTS WHO REPORT CONNECTEDNESS TO THEIR COMMUNITIES FINDINGS: COMMUNITY BUILDING INITIATIVE (CBI) ATTENDEES WERE FOUND TO BE MORE CONNECTED TO THEIR COMMUNITIES THAN PARENTS NOT ATTENDING A CBI EVENT. A feeling of connectedness with one’s community can have a variety of health, social, and economic benefits. These benefits may include a reduction in violence and crime rates, positive health outcomes such as lower rates of infant mortality and teen pregnancy, and improved achievement in elementary school. Greater connectedness allows parents to access formal and informal networks for support and information in times of need and to thereby moderate the effects of stressful life events and other disadvantages, such as poor education or language/cultural barriers. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 49 How connected individuals are to their community is related to the number of people they know and can possibly look to for information, advice, and support. Thus, First 5 Sacramento parents were asked to tell us the number of people in their neighborhood whom they know by name, the number of people who visit each other’s house, and the number of relatives and friends who live in their neighborhood. The relationship between community events and connectedness strongly supports the premise that bringing neighbors together for community events leads to lasting relationships (Table 8.1). Furthermore, the findings strongly suggest that CBI events have greater impact on community connectedness than other types of community events that may not be organized with the specific focus and intent that First 5 Sacramento requires of CBI events. Table 8.1: Neighborhood Connectedness by Community Event Participation, Fiscal Year 2007/08 Average Number of People in Neighborhood Known by Name Did Not Attend a Community Event Attended Community Event, Not CBI Likely or Definitely Attended a CBI Event Number of People Who Visit in Each Other’s Homes Did Not Attend a Community Event Attended Community Event, Not CBI Likely or Definitely Attended a CBI Event Number of Friends and Relatives Who Live in Neighborhood Did Not Attend a Community Event Attended Community Event, Not CBI Likely or Definitely Attended a CBI Event Source of data: Parent Interview. 4.5 6.9 14.4 2.0 2.7 8.5 2.2 2.4 4.5 COMMUNITY BUILDING INDICATOR: PERCENT OF PARENTS WHO REPORT A SENSE OF INVESTMENT AND TRUST IN THEIR NEIGHBORHOOD FINDING: A GREATER PERCENTAGE OF PARENTS WHO HAD ATTENDED A CBI EVENT HAD HIGH NEIGHBORHOOD COHESION COMPARED WITH PARENTS ATTENDING A NON-CBI COMMUNITY EVENT OR NO EVENTS IN THE COMMUNITY DURING THE PREVIOUS SIX MONTHS. Neighborhoods where parents report a lack of investment and trust in the environment have been associated with a variety of child outcomes in those neighborhoods such as infant mortality and low birth weight, juvenile delinquency, high school dropout, and child abuse and neglect. Parents who believe that their neighborhood is unsafe may limit their child's independent play outside, First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 50 which can decrease the child's opportunities for spontaneous play and exploration and possibly limit the child’s relationships with peers. Finally, neighborhoods that are rated unsafe generally have fewer resources to support families and children’s development compared with those that are rated as safe. Nine items were used to measure the sense of investment and trust parents have in their neighborhoods. These items, such as “I live in a close-knit neighborhood” and “People in my neighborhood can be trusted,” were combined into one score to determine levels of “Neighborhood Cohesion.” The findings presented in Tables 8.1 and 8.2 can be interpreted as follows: CBI events are associated with parents connecting with others in their communities in ways that might not otherwise be available. Parents who are more connected to their community have a greater sense of investment and trust in their neighbors. Table 8.2: Parents with High Neighborhood Cohesion by Community Event Participation, Fiscal Year 2007/08 % Did Not Attend a Community Event Attended Community Event, Not CBI Likely or Definitely Attended a CBI Event Source of data: Parent Interview. 50.4 54.5 80.0 COMMUNITY BUILDING INDICATOR: PERCENT OF PARENTS WHO REPORT AN INCREASED UTILIZATION OF FORMAL AND INFORMAL NEIGHBORHOOD RESOURCES FINDING: CBI EVENT PARTICIPANTS ARE JUST AS LIKELY TO TAKE ADVANTAGE OF ONE OF THESE COMMUNITY RESOURCES AS PARENTS NOT ATTENDING A CBI EVENT. The degree to which parents make use of their neighborhood resources tends to lessen parental feelings of isolation and can counteract the negative effects of stress in parents’ lives. Such resources may include babysitting groups, mothers’ clubs, community centers, neighborhood watch groups, family resource centers, and the like. Parents and their children can benefit from the use of resources in their communities Parents were asked if someone in their household was receiving formal or informal community resources, which included training to improve reading and writing skills, English as a second language classes, and job training. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 51 Over time, the information exchanged at CBI events, either through formal presentations, informal discussions, or hand-outs such as brochures, may have helped parents develop an increased interest in or access to resources. Follow-up interviews with parents will confirm this hypothesis and show changes over a one-year period in both CBI participation and the potential benefits to parents. COMMUNITY BUILDING INDICATOR: PERCENT OF PARENTS WITH INCREASED EFFICACY FINDING: EIGHTY PERCENT OF CBI ATTENDEES DEMONSTRATED HIGHER LEVELS OF EFFICACY THAN LEVELS FOR PARENTS ATTENDING A NON-CBI COMMUNITY EVENT (60.0%) OR NO COMMUNITY EVENT (50.4%). Parenting efficacy is the degree to which parents feel they can be in control of their lives, rather than feeling helpless and unable to change what is happening to them, and is related to parents’ sense of self-esteem. With sufficient levels of efficacy, parents can positively impact their children’s behavior and development through positive parenting practices and nurturance, and by reaching out to access personal social networks as well as formal and informal resources to assist them when needed. Efficacy, or the perceived degree of control over life circumstances, was measured by asking parents to express their agreement with nine statements, such as “I have little control over the things that happen to me,” and “I often feel helpless in dealing with the problems of life.” Parents who attended CBI events appear to have an increased sense of control over problems and other challenges (Table 8.3), possibly due to support they receive from being more connected to the community and the actions they may be taking to improve their own and their children’s lives. Table 8.3: Parents with Efficacy by Community Event Participation, Fiscal Year 2007/08 % Did Not Attend a Community Event Attended Community Event, Not CBI Likely or Definitely Attended a CBI Event Source of data: Parent Interview. 50.4 60.0 80.0 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 52 CHAPTER 9 EARLY CARE RESULT AREA The aim of Early Care is to improve child care throughout Sacramento County. The First 5 Sacramento Commission expended $1,093,000 for this Result Area in 2007/08. Addressing this aim is achieved through the Quality Child Care Collaborative (QCCC), as overseen by Child Action, Inc. QCCC is a partnership of community agencies, governmental and educational institutions, and private businesses that work together to help family child care homes and child care centers throughout Sacramento County provide quality care. During fiscal year 2007/08 1,637 providers were served by the QCCC. Key activities of the QCCC include information and referrals, technical assistance and training, and professional consultation. Child Action, Inc. also administers the local CARES (Comprehensive Approaches to Raising Educational Standards) program, a First 5 California-matched program intended to promote child care workforce development. Workforce development activities include providing stipends of varying amounts to child care providers participating in continuing education. Educational activities include, but are not limited to, Early Childhood Education courses and classes towards an Associate or Bachelor degree. EARLY CARE INDICATOR: PERCENT OF PROVIDERS MOVING UP ON THE PROFESSIONAL DEVELOPMENT MATRIX FINDINGS: 450 INDIVIDUALS APPLIED FOR PROFESSIONAL DEVELOPMENT STIPENDS THROUGH 17 THE CARES PROGRAM; 171 WERE AWARDED STIPENDS. 15.2% OF STIPEND AWARDEES ADVANCED ON THE PROFESSIONAL DEVELOPMENT MATRIX DURING THE YEAR. Researchers have found that provider education is associated with the quality of care for children and the degree to which child care environments provide stimulation and learning opportunities for children. While there is some disagreement on whether a B.A. level of qualification is necessary, it is clear that providers with training in early childhood education tend to provide higher quality care. By advancing up the professional development matrix, providers are improving the quality of care available for children. Advancing on the professional development matrix entails obtaining the next level of permit on the Child Development Permit Matrix. The Child Development Permit Matrix has seven levels: Assistant, Associate, Teacher, Master Teacher, Site Supervisor and Director. Advancing to the next level requires a certain combination of Early Childhood Education and General Education coursework. 17 This number excludes 9 Family, Friends and Neighbors who participated in CARES Track 1. CARES Track 1 offers exempt caregivers small stipends and training towards becoming licensed. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 53 Advancement on the professional development matrix is important in improving the quality of early care provided by staff. Although a large number of individuals received the stipends averaging $1,485.38 each, only 15.2% advanced (Table 9.1). An important consideration is that there are a number of barriers to providers taking the coursework required to move up the matrix, most notably, the hours they have to work and needing to take time off to take additional courses. We would expect a higher percentage in subsequent years as these providers have the time to complete the necessary coursework. Table 9.1: Child Care Providers’ Ascent on the Professional Matrix, Fiscal Year 2007/08 n % Providers Advancing on Professional Development Matrix Source of data: Child Action staff on November 14, 2008. 26/171 15.2 EARLY CARE INDICATORS: PERCENT OF LICENSED AND ACCREDITED FAMILY CHILD CARE SPACES PER 100 CHILDREN IN SCHOOL DISTRICT CATCHMENT AREAS & PERCENT OF LICENSED AND ACCREDITED CENTERS PER 100 CHILDREN IN SCHOOL DISTRICT CATCHMENT AREAS FINDINGS: LESS THAN ONE PERCENT OF THE FAMILY- AND CENTER-BASED CHILD CARE SPACES FOR CHILDREN AGES 0 TO 5 YEARS ARE LICENSED AND ACCREDITED. Many children spend a significant amount of time in childcare and preschool environments. The availability of quality early child care has an impact on children’s cognitive, emotional and physical development. Quality early care and education can promote positive relationships and behaviors, and help prepare children for later school success. Licensure tends to be the minimum standard for adequate care, while accreditation tends to be indicative of higher quality child care environments, particularly if the accreditation is from the National Association for the Education of Young Children (NAEYC). Two family-based child care facilities with the capability of serving up to 21 children were licensed and accredited. Twenty-six center-based child care facilities, serving 1,471 children, were licensed and accredited. Although the larger picture shows that relatively few facilities were licensed and accredited in the past year (Table 9.2), we must consider that the processes of licensure and accreditation take a significant period of time. In particular, accreditation, especially if this was done by the NAEYC, can take several years, so we may not see significant changes in this indicator until later in the project. While licensure requires less time and effort compared to accreditation, it First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 54 still takes time, and there may not be sufficient incentive to get licensure over and above the standards already in place and monitored by the school boards. Table 9.2: Number of Licensed and Accredited Child Care Facilities and Spaces for Children Ages 0 to 5 Years by Type and School District Catchment Area, Fiscal Year 2007/08 Sacramento County School Districts with Licensed and Accredited Child Care Spaces Family-based Accredited Center-based Accredited Total number Licensed Center Unified School District Twin Rivers Unified School District San Juan Unified School District Folsom Cordova Unified School District Sacramento City Unified School District Elk Grove Unified School District Natomas Unified School District Total number of child care facilities Total number of child care spaces Percentage of total child care spaces** *Includes 258 spaces pending accreditation as of 10/2/08 Source of data: Child Action staff on November 14, 2008. 0 0 0 1 0 1 Not reported 2 21 <1% 2 1 4 3 2 13 1 26 1,471* <1% 93 345 484 231 494 635 189 2,471 48,790 N/A EARLY CARE INDICATOR: PERCENT OF CHILDREN WITH SPECIAL NEEDS WHO PARTICIPATE IN EARLY CHILDHOOD CARE AND EDUCATION PROGRAMS FINDING: OF THE 110 CHILDREN WITH SPECIAL NEEDS REQUIRING CHILD CARE, CHILD ACTION, INC. WAS ABLE TO LINK 63.6% TO CHILD CARE. Children who receive services for their special needs while in an early care environment are more likely to optimize their development and to participate more fully with their peers. Access to early care environments for special needs children is important given children with special needs are less likely to be in child-care centers, are more likely to begin child care at older ages, and are more likely to be in child care fewer hours than children without special needs. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 55 Child Action, Inc. provides “enhanced referrals” to families of children with special needs. Families of children with special needs include those for whom English is a second language and those with children who have a chronic health condition or disability. It would appear that this is an area in which Child Action, Inc. was successful, insofar as 63.6% of children identified as having special needs were linked to child care (Table 9.3). We would expect Child Action, Inc. to show a higher percentage of special needs children with linkages to child care in the future. Table 9.3: Children with Special Needs Linked to Child Care by Child Action, Fiscal Year 2007/08 n % Linked to Child Care Source of data: Child Action staff on November 14, 2008. 70/110 63.6 EARLY CARE INDICATOR: PERCENT OF CHILD CARE PROVIDERS WHO INCREASE THEIR ENVIRONMENTAL RATING SCALES FINDINGS: POST-TEST SCORES WERE HIGHER THAN PRE-TEST SCORES, INDICATING IMPROVED QUALITY WITHIN THESE CLASSROOMS. Environmental Rating Scales are tools used to measure the quality of early childhood care environments. Among other things, the tools are used to assess a program’s learning activities for children including language and reasoning, as well as interaction and social development. In addition, they may consider issues related to staff, the facility’s space and furnishings, and their health and safety provisions. These assessments can be used to help providers identify specific areas for improvement. Achieving a higher score on a subsequent Environmental Rating Scale assessment indicates that the program has increased in quality. Higher quality of early childhood care has been shown to contribute to children’s increased levels of school readiness. To assess changes in childcare program quality associated with participation in the PBM pilot program, formal pre- and post-assessments were conducted for 15 PBM sites using two Environment Rating Scales (ERS): the Early Childhood Environment Rating Scale- Revised Edition (ECERS-R) for center-based providers, and the Family Child Care Environment Rating Scale-Revised Edition (FCCERS-R) for family child care homes. The average time between the ERS pre- and post-test was 206 days. Overall, the five center-based programs improved from an average of 4.4 at the initial assessment to 4.9 at the follow-up. The 10 family child care homes also improved more than a half point from 4.6 to 5.1 on a 7 point scale (Figure 9.1). While these changes suggest that both centerFirst 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 56 based and family child care homes improved in their quality, we must place several caveats on these findings. First, the two scales cannot be compared, so that a score of 4 on the FCCERS-R may not mean the same as a score of 4 on the ECERS-R. Although the scores suggest that the early care settings have attained a level of quality close to the “good” rating on both scales (a score of 5), we are not sure how the two settings can compare. This is particularly true for the FCCERS-R scores because research shows that generally the quality of family child care homes tends to be lower than the quality of center-based child care.18 However, the average ERS scores are well in line with the scores from national studies, particularly those of Head Start, and are higher than those reported historically for center-based child care using the ECERS-R (historical data are not available for the FCCERS-R since it changed from a prior scale). Studies conducted in Head Start FACES, New Jersey, Georgia, and a six-state prekindergarten program reported average ECERS-R scores ranging from 3.90 to 4.81, well below those reported for First 5 Sacramento funded preschool classrooms.19, 20, 21, 22, 23 18 Whitebook, M., Howes, C., & Phillips, D. (1989). Who Cares? Child care teachers and the quality of care in America (Final report of the National Child Care Staffing Study). Oakland, CA: Child Care Employee Project. 19 Zill, N., Resnick, G., Kim, K., O’Donnell, K., Sorongon, A., McKey, R. H., Pai-Samant, S., Clark, C., O’Brien, R., D’Elio, M. A. (2003). Head Start FACES 2000: A Whole-Child Perspective on Program Performance, Fourth Progress Report. Washington, DC: Administration for Children and Families, U.S. Department of Health and Human Services. Available at: http://www.acf.hhs.gov/programs/opre/hs/faces/reports/faces00_4thprogress/faces00_title.html (Retrieved January, 2006) Resnick, G., McKey, R. H., & Klayman, D. (2001). The evaluation of early childhood education programming in the 30 Abbott School Districts: First-year report on program implementation and descriptions of children and families. (Contract No. A43078). Trenton, NJ: New Jersey Department of Human Services and New Jersey Department of Education. 21 20 Henry, G. T., Henderson, L. W., Bentley, D. P., Gordon, C. S., Mashburn, A. J., & Rickman, D. K. (2003). Report of the Findings From the Early Childhood Study: 2001-02. Atlanta, GA: Georgia State University, Andrew Young School of Policy Studies. 22 Bryant, D., Barbarin, O., Clifford, R., Early, D., & Pianta, R. (2004). The National Center for Early Development and Learning: Multi-state Study of Pre-Kindergarten. Symposium Presentation at the Biennial Head Start Research Conference, Washington, DC. 23 Whitebook, M., Howes, C., & Phillips, D. (1989). Who Cares? Child care teachers and the quality of care in America (Final report of the National Child Care Staffing Study). Oakland, CA: Child Care Employee Project. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 57 Figure 9.1: Change in Environmental Rating Scales, Fiscal Year 2007/08 5.2 5.1 5 4.9 4.8 4.6 4.4 4.2 Center-Based Providers Family Child Care Homes 4.6 4.4 Average pre- and post score for Center-Based Providers (ECERS-R, n=5) and Family Child Care Homes (FCCERS-R, n=10) Source of data: PBM staff on July 15, 2008. EARLY CARE INDICATOR: PERCENT OF FAMILY, FRIENDS, AND NEIGHBORS WHO MAKE PROGRESS OR OBTAIN LICENSURE FINDING: 10 FAMILY, FRIENDS, AND NEIGHBORS PARTICIPATED IN THE PROGRAM. ONE OBTAINED LICENSURE AND FIVE MADE PROGRESS TOWARDS OBTAINING LICENSURE IN THE FISCAL YEAR. Licensed family child care tends to be higher in quality than non-licensed family child care. Family child care providers who are licensed may be more likely to offer sensitive and responsive care as well as more stimulation and learning opportunities for children. Child Action, Inc. administers Sacramento County’s CARES program which is intended to promote workforce development among child care providers. For the past two years the program has targeted family, friends, and neighbors (FFNs) who provide child care. It is significant that in one year, so many of those who participated in the program either obtained or made progress towards licensure (Table 9.4). This is an important indicator because family, friends and neighbors are those providing family child care and informal child care where the quality tends to be lower or at the least, uneven. Licensure enables these providers to meet the minimum standards of care, which is a start towards having high quality program. It could be that, as noted earlier, the school districts impose their own minimum standards on the early care settings under their jurisdiction, and thus there may be less incentive to obtain licensure compared to those offering informal arrangements (family, friends and neighbors). First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 58 However, it is important to note that relatively few individuals participated in the program this year. We look towards next year to see more family, friends or neighbors participating and, of these, similar or higher percentages either obtaining or making progress towards licensure. Table 9.4: Progress in Obtaining Licensure among Family, Friends, and Neighbor Child Care Providers, Fiscal Year 2007/08 n % Licensure Acquisition 1/10 10.0 Progress towards Licensure Acquisition Source of data: Child Action staff on October 2, 2008. 5/10 50.0 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 59 CHAPTER 10 CROSS-CUTTING INDICATORS In the previous chapters we examined the findings for families receiving services in each of the Result Areas. This chapter examines 10 outcomes for all First 5 Sacramento families receiving services from the Health Access, Nutrition, Effective Parenting, and School Readiness Result Areas. To measure these outcomes, “Cross-Cutting” indicators were developed and subsequently examined with data from a representative sample of families from these four direct service Result Areas. Race/ethnicity is an important variable when evaluating health and education programs because access to such programs is not always equivalent across racial/ethnic groups, and all individuals may not benefit similarly from such services. As such, the findings for the 10 Cross-Cutting indicators were examined by the three most common racial/ethnic groups and are presented in this chapter when significant differences were found. CROSS-CUTTING INDICATOR: PERCENT OF CHILDREN ENROLLED IN HEALTH INSURANCE FINDING: HEALTH INSURANCE COVERAGE FOR CHILDREN INCREASED FROM 85.9% TO 97.0%. Children who do not have health insurance often forgo both preventive and acute care, leading to more serious medical conditions that adversely affect growth and development. Despite the availability of the federally-funded SCHIP program, many families without health insurance do not enroll their children. For these reasons, it is important for all providers serving uninsured children ages 0 to 5 years old to encourage families to get assistance with enrollment in health insurance. Children’s health insurance was measured at two points in time: first on the Family Intake Form, when families receiving services from a First 5 Sacramento provider consented to take part in the evaluation, and later during interviews with parents conducted in spring 2008.24 The increase in the percentage of children with health insurance depicted in Figure 10.1 translates into 963 children in Sacramento County obtaining health insurance as First 5 Sacramento clients. Rates for health insurance coverage were similar regardless of a child’s race or ethnicity. 24 The range for the period time between completing the Family Intake Form and participating in the Parent Interview was three weeks to 11 months. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 60 Figure 10.1: Changes in Percent of Children with Health Insurance, Fiscal Year 2007/08 98.0% 96.0% 94.0% 92.0% 90.0% 88.0% 86.0% 84.0% 82.0% 80.0% Family Intake Form Source of Data: Parent Interview. 97.0% 85.9% Parent Interview Parents began to complete the Family Intake Form on July 1, 2007, regardless of when they or their children first received First 5 Sacramento services. Since some of the parents who were First 5 Sacramento clients prior to July 1, 2007 likely had already received application assistance, 963 represents the minimum number of children who obtained health insurance during the year. The percent of First 5 Sacramento children with health insurance is higher than the national averages (89.2% for children under three years and 89.9% for children three to five years).25 CROSS-CUTTING INDICATOR: PERCENT OF CHILDREN WITH COMPLETE IMMUNIZATIONS AT AGE TWO AND AGE FIVE FINDINGS: 89.9% OF TWO-YEAR OLDS AND 95.1% OF FIVE-YEAR OLDS HAD COMPLETE IMMUNIZATIONS, REGARDLESS OF ENROLLMENT IN A HEALTH PLAN. OVERALL, THE MAJORITY (93.4%) OF FIRST 5 SACRAMENTO CHILDREN WERE REPORTED TO HAVE UP-TO-DATE IMMUNIZATIONS. PARENTS OF CHILDREN IDENTIFIED AS WHITE WERE LESS LIKELY TO REPORT COMPLETE IMMUNIZATIONS, COMPARED WITH PARENTS OF LATINO AND AFRICAN AMERICAN CHILDREN. Immunizations are an important public health practice to prevent outbreaks of diseases that are now virtually unknown in the U.S. and can result in long-term severe developmental disabilities, sensory impairments, or death. Further, an important component of a child’s readiness for school 25 U.S. Census Bureau, Current Population Survey, 2008. Data available at: www.census.gov. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 61 is that they have completed all of their immunizations. Throughout activities funded by First 5 Sacramento there are opportunities to inform parents of the timeline for and importance of immunizations. The immunization status of First 5 Sacramento children was based on parent responses to the question, “In your opinion, has [child’s name] received all of the recommended shots for (his/her) age?” Although fewer White children had complete immunizations (Figure 10.2), the rate of 92.1% among Whites exceeds the rate of 80.1% reported for U.S. children.26 Follow-up interviews with First 5 Sacramento parents will determine whether rates for complete immunizations among Whites are increasing over time to meet the same levels as those found for Latinos and African Americans. Figure 10.2: Children with Complete Immunizations by Race/Ethnicity, Fiscal Year 2007/08 98.0% 97.0% 96.0% 95.0% 94.0% 93.0% 92.0% 91.0% 90.0% 89.0% Latinos Whites African-Americans 92.1% 97.0% 96.1% Percents based on 332 Latinos, 89 Whites, and 51 African-Americans. Source of Data: Parent Interview. CROSS-CUTTING INDICATOR: PERCENT OF CHILDREN WHO HAVE RECEIVED ALL AGE APPROPRIATE WELL-CHILD VISITS FINDING: PARENTS REPORTED ADHERING TO THE WELL-CHILD VISITS SCHEDULE FOR 89.2% OF FIRST 5 SACRAMENTO CHILDREN, WITH NO DIFFERENCES FOUND ACROSS THE THREE MOST COMMON RACIAL/ETHNIC GROUPS. 26 National Immunization Survey, 2006-2007. Data for the National Immunization Survey is also based on selfreport. Data available at: www.kff.org. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 62 Well-child visits are an opportunity for physicians to monitor the child’s health and development to ensure the child is within normal ranges and to screen for potential problems. Health and physical development within normal ranges are related to the child’s ability to learn and socialize with peers, and ultimately to the child’s school readiness. Many First 5 Sacramento providers have an opportunity to encourage adherence to the well-child visits schedule recommended by the American Academy of Pediatrics. Children’s age in months and reported recent history of receiving routine check-ups were compared with the American Academy of Pediatrics well-child visits schedule to determine the extent of age appropriate well visits among the First 5 Sacramento population. A slightly higher percentage of First 5 Sacramento children receive all age appropriate well-child visits than the national average of 85.0%.27 CROSS-CUTTING INDICATOR: PERCENT OF WOMEN WITH CHILDREN UNDER THREE WHO WERE EXCLUSIVELY BREASTFEEDING AT 6 MONTHS AND ONE YEAR AFTER DELIVERY FINDINGS: PARENTS REPORTED THAT 27.7% OF FIRST 5 SACRAMENTO CHILDREN WERE EXCLUSIVELY BREASTFED FOR SIX MONTHS AND 19.2% WERE BREASTFED UNTIL ONE YEAR AFTER DELIVERY. RATES FOR EXCLUSIVE BREASTFEEDING FOR 6 MONTHS WERE SIMILAR FOR LATINO AND WHITE CHILDREN, BUT BOTH WERE SIGNIFICANTLY BELOW THE RATE FOR AFRICAN AMERICAN CHILDREN. NO DIFFERENCES FOR 12-MONTH BREASTFEEDING RATES WERE FOUND ACROSS RACIAL/ETHNIC GROUPS. Children who are breastfed during their first year of life experience a variety of nutritional, health, immunological, developmental, and psychological benefits. Breastfeeding also supports bonding between infant and mother, and children who are breastfed are less likely to be overweight or obese later in life. There are differing opinions regarding the appropriateness of exclusive breastfeeding at one year of age, but there is agreement that breastfeeding should be exclusive at least through the first six months, and thereafter in combination with the introduction of solid foods (complementary breastfeeding). The health, nutritional, and effective parenting benefits of breastfeeding make it an important focus of First 5 Sacramento activities. Exclusive breastfeeding for infant 6 months and younger is defined as providing only breast milk to infants. Twelve-month breastfeeding rates are based on children receiving breast milk but no formula until 12 months of age. 27 From the National Health Interview Survey, 2004. Data available at: www.childtrendsdatabank.org. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 63 These findings are quite impressive, both because the rate for exclusive breastfeeding at six months among First 5 Sacramento mothers exceeds the national average of 11.3%, and because African Americans are often found to have the lowest rates of exclusive breastfeeding, 28 but had the highest rates among First 5 Sacramento mothers (Figure 10.3). Figure 10.3: Children Exclusively Breastfed Six Months after Delivery by Race/Ethnicity, Fiscal Year 2007/08 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Latinos Whites African-Americans 22.2% 21.3% 47.6% Percents based on 135 Latinos, 47 Whites, and 21 African-Americans. Source of Data: Parent Interview. CROSS-CUTTING INDICATOR: PERCENT OF CHILDREN WHO HAVE SEEN A DENTIST IN THE PAST YEAR FINDINGS: PARENTS REPORTED THAT 40.8% OF CHILDREN AGES 0 TO 5 HAD BEEN TO THE DENTIST DURING THE PREVIOUS YEAR. RECENT DENTAL CARE AMONG CHILDREN OLDER THAN ONE YEAR WAS 55.9%, AND WAS LESS COMMONLY REPORTED AMONG WHITES, FOLLOWED BY AFRICAN AMERICANS, THEN LATINOS. Children who have not seen a dentist by their first birthday may experience a variety of problems associated with poor oral health. These problems – ranging from eating and speaking difficulties to poor physical growth, cognitive, linguistic and social development – are seen by a variety of First 5 Sacramento service providers. First 5 Sacramento parents were asked, “Has [child’s name] been to a dentist or dental hygienist for dental care in the past year?” On average, First 5 Sacramento children fare better than children in the United States in terms of recent dental care; national data from 2004 show that 47.1% of two through four year olds in the 28 From National Immunization Survey, 2004. Data available at: www.cdc.gov. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 64 U.S. have been to the dentist in the past year.29 Given the importance of dental care as a preventive health measure for all children over age one, many opportunities remain to bring the benefits of community dental screenings, provision of dental insurance for children, and oral health education to families in Sacramento. This is particularly the case for White children (Figure 10.4).30 In fact, parents reported that half (50.7%) of White children had never been to the dentist, while 36.6% of African American and 34.4% of Latino children had never received dental care. Figure 10.4: Recent Dental Care among Children Older Than One Year by Race/Ethnicity, Fiscal Year 2007/08 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Latinos Whites African-Americans 46.4% 64.0% 52.5% Percents based on 247 Latinos, 69 Whites, and 39 African-Americans. Source of Data: Parent Interview. CROSS-CUTTING INDICATOR: PERCENT OF PARENTS WHO REPORT CONNECTEDNESS TO THEIR COMMUNITIES FINDINGS: LATINOS REPORTED KNOWING FEWER NEIGHBORS BY NAME COMPARED WITH WHITES AND AFRICAN AMERICANS. OVER HALF (53.2%) OF PARENTS REPORTED HIGH NEIGHBORHOOD COHESION WITH NO DIFFERENCES FOUND ACROSS THE THREE PRIMARY RACIAL/ETHNIC GROUPS. Parents who feel connected to their communities have resources at their disposal that can serve to bolster the family’s social capital, thereby offsetting or moderating stressful life events or risk factors. Neighborhoods that foster good cohesion and connectedness provide a healthy environment for children to develop and to be ready for school. Health, social, economic and educational outcomes tend to be higher for families who feel connected to their communities. 29 30 From National Center for Health Statistics, 2004. Data available at: www.cdc.gov. Children under 12 months of age were excluded to ensure that racial/ethnic group comparisons included only children who should have been to a dentist First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 65 Responses to items measuring “Neighborhood Networks” and “Neighborhood Cohesion” were examined for all First 5 Sacramento parents. Follow-up interviews will determine whether First 5 Sacramento parents become more connected to their communities through activities funded through the Community Building Initiative (CBI). CROSS-CUTTING INDICATOR: PERCENT OF PARENTS WHO REPORT THAT THE SERVICE PROVIDER HELPED THEM INCREASE KNOWLEDGE AND UTILIZATION OF FORMAL AND INFORMAL RESOURCES IN THE COMMUNITY FINDINGS: EIGHT OUT OF 10 PARENTS REPORTED THEIR FAMILIES WERE UTILIZING AT LEAST ONE OF THE COMMUNITY RESOURCES. THE MOST FREQUENT RESOURCE RECEIVED BY FIRST 5 SACRAMENTO PARENTS WAS FOOD AND NUTRITION ASSISTANCE, REPORTED BY 68.6% OF PARENTS, FOLLOWED BY INCOME ASSISTANCE (26.8%), AND HELP WITH HOUSING OR UTILITIES (17.9%). ALMOST ONE THIRD (31.9%) OF FAMILIES UTILIZING FOOD AND NUTRITION ASSISTANCE, AND 22.0% OF FAMILIES RECEIVING INCOME ASSISTANCE, WERE LINKED TO THESE SERVICES BY FIRST 5 SACRAMENTO PROVIDERS. IN ADDITION, AMONG FAMILIES WHO ACCESSED FAMILY RESOURCE CENTERS AND RESPITE CHILD CARE, FIRST 5 SACRAMENTO PROVIDERS COMMONLY PROVIDED THE CONNECTION TO THESE SERVICES. WHITES WERE SIGNIFICANTLY LESS LIKELY TO REPORT COMMUNITY SERVICE UTILIZATION THAN OTHER RACIAL/ETHNIC GROUPS. HOWEVER, NO DIFFERENCES WERE FOUND ACROSS THESE GROUPS REGARDING WHETHER FIRST 5 SACRAMENTO PROVIDER STAFF LINKED THEM TO THE SERVICES. Formal and informal resources are important components of parents’ engagement with their community. If a community has resources available to support families, outcomes for children can improve. Parents were asked whether anyone in their household was receiving various community services, such as income assistance, food assistance, family literacy classes, or English as a second language training, among others. They were also asked whether their First 5 Sacramento service provider helped connect them to the service. Table 10.1 shows that First 5 Sacramento providers are contributing to ensuring that families are finding the economic, educational, and care resources they need. In the current economic downturn, needs for such resources are likely increasing. Future interviews with parents will demonstrate whether contractors are filling expanded roles in terms of connecting families to vital services. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 66 Table 10.1: Parent Reports of Community Services Received, Fiscal Year 2007/08 Connected to Resource with Help of First 5 Sacramento Provider, % 31.9 22.0 8.5 10.4 17.9 4.2 13.3 50.0 25.0 75.0 0.0 0.0 Families Receiving Service, % Food and nutrition assistance - like Food Stamps or WIC Income assistance--like welfare, TANF or SSI Help with housing or utilities (running water, hot water, heat, telephone service) Prenatal care English as a second language training (ESL classes) Payments for unemployment or disability (disability insurance, or workers compensation – including pregnancy disability) Adult Education (GED, College Selection) Family Resource Centers where parents and children learn and can get connected with services they need Job training Respite child care, where you can get emergency help with child care Legal aid/ Free legal services Family literacy classes, for example, where you or your family learn reading or writing skills Source of Data: Parent Interview. 68.6 26.8 17.9 16.8 12.4 10.5 6.5 5.0 2.6 1.7 0.9 0.7 CROSS-CUTTING INDICATOR: PERCENT OF CHILDREN WHO HAVE RECEIVED A COMPREHENSIVE HEALTH AND DEVELOPMENTAL SCREENING IN THE PAST YEAR FINDINGS: RATES OF COMPREHENSIVE SCREENINGS VARIED CONSIDERABLY BY RACE/ETHNICITY. PARENTS OF WHITE CHILDREN WERE THE LEAST LIKELY TO REPORT A COMPREHENSIVE SCREENING, FOLLOWED BY PARENTS OF AFRICAN AMERICAN AND LATINO CHILDREN, RESPECTIVELY. Early identification of health and developmental problems can be made by comprehensive health and developmental screenings. By identifying children with special needs early, an individualized learning plan can be developed to allow the integration of special needs children with peers and thus full participation in preschool and kindergarten activities. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 67 Parents were asked whether their children had received a hearing and vision test during the previous year. They were also asked if, during the past year, the child had been screened for development or behavior problems, describing the screening as a “brief, simple procedure usually done by a professional or medical doctor to identify possible developmental delays or disabilities.” Children whose parents reported they had hearing, vision, and development tests during the previous year were considered to have had comprehensive health and development screenings. The results show that less than one quarter of any racial/ethnic group among First 5 Sacramento children are receiving all comprehensive screenings, according to their parents (Figure 10.5). Because hearing, vision, and healthy development are all important components to a child’s growth and learning process – and because early intervention in cases of detected problems can provide major benefits – these findings presents an opportunity for First 5 Sacramento providers in the future. Figure 10.5: Parent Reports of Children Receiving Hearing, Vision, and Developmental/Behavior Tests During Past Year by Race/Ethnicity, Fiscal Year 2007/08 25.0% 20.0% 15.0% 11.8% 10.0% 5.0% 0.0% Latinos Whites African-Americans 4.5% 22.6% Percents based on 322 Latinos, 89 Whites, and 51 African-Americans. Source of Data: Parent Interview. CROSS-CUTTING INDICATOR: PERCENT OF PARENTS WITH DECREASED STRESS OF PARENTS WERE DETERMINED TO HAVE ELEVATED LEVELS OF STRESS, WITH NO SIGNIFICANT DIFFERENCES FOUND BY RACE/ETHNICITY. FINDINGS: 15.4% Parents with high levels of stress associated with their parenting role tend to use harsher discipline practices and are less nurturing and warm with their children, thereby affecting the child’s social and emotional development. Resources to reduce parenting stress focus on giving parents the tools necessary to deal with their feelings about being a parent, and to give them skills to become more nurturing and make them more apt to use pro-social discipline techniques. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 68 Parental distress was measured from a widely-used scale called the Parenting Stress Index. Parents were asked about their agreement with statements such as, “I feel trapped by my responsibilities as a parent” and “There are quite a few things that bother me about my life” were used as a measure of their levels of stress in their parenting role. In future years of the evaluation, comparison of parents’ levels of stress over time can be made, along with an examination of relationship to stress levels and services received from First 5 Sacramento service providers. CROSS-CUTTING INDICATOR: PERCENT OF PARENTS WHO PRACTICE DEVELOPMENTALLY APPROPRIATE PARENTING SKILLS FINDINGS: LATINOS WERE MORE LIKELY TO REPORT HIGHER AUTHORITATIVE PARENTING PRACTICES, WHICH MEANS THEY WERE MORE LIKELY TO ENCOURAGE INDEPENDENCE AND PROVIDE POSITIVE FEEDBACK TO THEIR CHILDREN. A GREATER PERCENTAGE OF AFRICAN AMERICAN PARENTS REPORTED CONSISTENCY IN PARENTING PRACTICES. HIGHER AUTHORITARIAN PARENTING WAS FOUND FOR ONLY 14.0% OF FIRST 5 SACRAMENTO PARENTS, AND DID NOT DIFFER BY RACE/ETHNICITY. Parents who use an authoritative parenting style, rather than authoritarian or permissive parenting styles, tend to raise children with strong social skills and self-regulated behavior. Additionally, parents who gain knowledge and understanding of appropriate parenting strategies can develop a sense of competence and satisfaction with being a parent. Making use of parenting skills appropriate to the child’s developmental stage is a way for parents to enhance their relationship with the child and strengthen their family. To assess the percentage of parents who practice developmentally appropriate parenting skills, parents were asked the degree to which their parenting practices matched certain behaviors. Examples of these statements include, “I encourage my child to be curious, to explore, and to question things” and “I believe physical punishment to be the best way of disciplining.” The responses to these questions were used to characterize parents with high Nurturance or Warmth and Energy, and also to distinguish between Authoritative and Authoritarian parenting styles. The degree to which Nurturance, Warmth and Energy, and Authoritative parenting styles increase, and Authoritarian approaches to parenting decrease, from those levels identified at baselines (Figures 10.6 and 10.7), will be assessed across the First 5 Sacramento population in the follow-up surveys of the random sampled of parents. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 69 Figure 10.6: Parents with High Authoritative Parenting by Race/Ethnicity, Fiscal Year 2007/08 70.0% 60.0% 50.0% 40.2% 40.0% 30.0% 20.0% 10.0% 0.0% Latinos Whites African-Americans 59.2% 45.9% Percents based on 220 Latinos, 85 Whites, and 37 African-Americans. Source of Data: Parent Interview. Figure 10.7: Parents with High Parental Energy by Race/Ethnicity, Fiscal Year 2007/08 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Latinos Whites African-Americans 45.5% 54.1% 81.1% Percents based on 228 Latinos, 87 Whites, and 37 African-Americans. Source of Data: Parent Interview. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 70 CONCLUSION Many of the findings presented in this report are noteworthy. Since the measure for health insurance was collected at two points in time (i.e., the Family Intake Form and the subsequent Parent Interview) we can state that rates of health insurance for children increased, from 85.9% to 97.0%. Adopting the same questions and methodology used in national probability-based surveys shows that the rate for exclusive breastfeeding at six months among First 5 Sacramento mothers well surpasses the national average (25.5% versus 11.3%). CBI events attendees were more connected to their community, had a greater sense of trust and investment in their neighborhoods, and had an increased sense of efficacy compared with other randomly selected parents. A high proportion of First 5 Sacramento two-year olds (89.6%) and five-year olds (95.0%) were reported by their parents to have complete immunizations. In addition, 89.2% of children older than two months were up-to-date on well-child visits. The majority (92.0%) of children completing a School Readiness program were considered to be ready for kindergarten. While impressive, these findings should be interpreted with consideration that they are based on parent and teacher reports. In addition, the evaluation design does not allow for attributing the findings solely to First 5 Sacramento services. The comparison of findings by Result Areas offer insight into potential associations between First 5 Sacramento services and outcomes. For example, Effective Parenting parents had better family functioning and higher levels of community connectedness. However, one should also be cautious when drawing conclusions from these comparisons. Parents from Effective Parenting also demonstrated higher levels of stress. This is likely because Effective Parenting providers target parents with increased levels of stress, and thus, it makes sense that such parents would report greater stress than those not receiving such services. Therefore, differences between groups may be due to the types of persons targeted for or attracted to a service, rather than the outcome of that service. The follow-up Parent Interview, scheduled to occur March through June 2009, will provide more robust evaluation findings – within person changes over time in the measures for the Result Area and Cross-Cutting indicators. Follow-up data will allow for testing whether stress for Effective Parenting clients decreases to a level at or below that reported by other parents. Moreover, associations between levels of services received (i.e., dosage) and outcomes will be available in the future. For the most part, this report presents the “baseline” data from which one-year followup changes will be based. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Page 71   APPENDIX A RESULT AREA AND CROSS-CUTTING INDICATORS   Result Area Indicators Health Access Percent of children continuously enrolled in health insurance at 4, 8, and 13 months Percent of children with complete immunizations at ages 2 and 5 years for children enrolled in health plans Percent of children who have received all age appropriate well child visits Percent of children who have seen a dentist by one year of age Nutrition Percent of women who are exclusively breastfeeding at 6 months and 1 year after delivery Effective Parenting Improved family function Percent of parents who improve knowledge of developmental stages in children Percent of parents with decreased stress Percent of parents who report connectedness to their communities Percent of parents who practice developmentally appropriate parenting skills Percent of parents who interact with their children in a supportive and positive manner School Readiness Percent of children who have received a comprehensive health and developmental screening in the past year Percent of participants reporting satisfaction with the content, quality, and family centeredness of services Percent of children participating in school-linked transitional practices Percent of children ages 3-5 who regularly attend a nursery school, preschool, pre-Kindergarten, or Head Start program by the time of Kindergarten entry Percent of children meeting developmental milestones Percent of children assessed to be ready for Kindergarten at the completion of a school readiness program Degree to which planning/pilot service delivery model or systemic intervention is implemented Percent of children with special needs who participated in early childhood care and education programs Dental Percent of children who have fluoridated water Percent of children with dental caries at Kindergarten entry Community Building Percent of parents who report connectedness to their communities Percent of parents who report a sense of investment and trust in their neighborhood Percent of parents who report an increased utilization of formal and informal neighborhood resources Percent of parents with increased efficacy Early Care Percent of providers moving up on the professional development matrix Percent of licensed and accredited family child care spaces per 100 children in school district catchment areas Percent of licensed and accredited centers per 100 children in school district catchment areas Percent of children with special needs who participate in early childhood care and education programs Percent of child care providers who increase their Environmental Rating Scales Percent of family, friends, and neighbors who make progress or obtain licensure First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix A.1 Cross-Cutting Indicators Percent of children enrolled in health insurance Percent of children with complete immunizations at age two and age five Percent of children who have received all age appropriate well child visits Percent of women with children under three who were exclusively breastfeeding at 6 months and one year after delivery Percent of children who have seen a dentist in the past year Percent of parents who report connectedness to their communities Percent of parents who report that the service provider helped them increase knowledge and utilization of formal and informal resources in the community Percent of children who have received a comprehensive health and developmental screening in the past year Percent of parents with decreased stress Percent of parents who practice developmentally appropriate parenting skills First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix A.2 APPENDIX B METHODOLOGY   This section of the report details the methodology for the evaluation of First 5 Sacramento services during fiscal year 2007/2008, as conducted by Walter R. McDonald & Associates, Inc. (WRMA), Westat, and Harder+Company Community Research (the “evaluation team”). Client Consent Procedures and Training Recruitment procedures for the evaluation required service providers to present parents31 with a consent form and Family Intake Form. The consent form was reviewed and approved by the Institutional Review Board of Westat and was also approved by the Sacramento County Counsel. Both forms were available in Hmong, Russian, Spanish, Ukrainian, and Vietnamese, with translation of the English form conducted by certified translators. In addition to the consent form, in situations where the parent was a minor, there was a separate assent form and accompanying “Grandparent” consent form. These forms were not translated. The seven consent and teen assent forms were distributed by the evaluation team to service providers in triplicate copies, allowing the parents and providers to each retain a copy of the signed form, with the original saved for eventual collection by the evaluation team. On-site training by the evaluation team in recruitment and consent procedures included requesting that providers write “Refused” on a consent form when a parent chose not to participate in the evaluation. These trainings often involved discussions with staff on strategies for effectively recruiting clients and when best to introduce the forms during the intake and service delivery procedures occurring at the site. Finally, informational fact sheets summarizing the main components and procedures of the evaluation – one for service providers and one designed for distribution to clients – were given to those staff attending the recruitment and consent trainings. Persimmony Two service providers assisted in a series of pilot testing activities with the web-based data system prior to its release to train staff in the data entry procedures, functions, and security protocols. Two classroom trainings were held in June 2007 at a computer lab at California State University, Sacramento with 95 service provider staff attending. Subsequent one-on-one Persimmony trainings occurred throughout the year, mostly at service providers’ sites, and technical assistance was available throughout the fiscal year from the evaluation team during regular business hours. Data entered into Persimmony included the date of consent and information from the Family Intake Form – demographics about the parents, and child(ren)’s demographics and health and dental insurance status and special needs. Types and duration of services provided to parents and children as funded by First 5 Sacramento were also entered into Persimmony. In addition to the forms for documenting services, the evaluation team developed forms for WIC staff to record the status of breastfeeding among mothers receiving lactation support services, and for school staff to record preschoolers’ readiness for kindergarten. Service providers also entered into Persimmony information about their contracted services to comply with the quarterly reporting requirements of First 5 Sacramento. Evaluation team 31 Parents or adults with legal custody of children under six years could sign the consent form. For this report the term “parent” is used to refer to any adult with legal custody. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix B.1 members worked closely with First 5 Sacramento staff to modify the description of services outlined in providers’ contracts to measurable objectives for the quarterly reporting requirements, and with Persimmony to modify and enhance the data entry screens to address the requirements of the evaluation overall and the needs of service providers. Finally, the evaluation team developed and distributed “Client-Level” and “Milestone and Aggregate” Data Entry Guides for service providers’ reference. These documents included step-by-step instructions for entering data with accompanying screen shots from Persimmony. Communication with Service Providers Cultivating a collaborative relationship with service providers required encouraging responding to their recommendations and concerns, keeping them fully apprised of current forthcoming events, and explaining the rationale behind evaluation-related requirements procedures. In addition to the on-site trainings and technical assistance, forums communication with service providers included a monthly Evaluation Newsletter presentations at Quarterly Contractor Forums facilitated by First 5 Sacramento staff. Evaluation Plan Deliverable The evaluation design was developed and refined by the evaluation team in March and April 2007 in consultation with the Evaluation Committee and the Commission of First 5 Sacramento. The Evaluation Plan deliverable was submitted to and approved (pending minor revisions) by the Evaluation Committee on May 21, 2007, and was presented to the Commission on September 10, 2007. This document delineated the primary components of the evaluation (i.e., Consent Form, Family Intake Form, Persimmony, Parent Interview), the timeline for specific evaluation activities, and mapped the source of data to address each Result Area and Cross-Cutting indicator. Service Providers’ Individual Evaluation Plans The period of time leading up to the initiation of services on July 1, 2007 included a number of meetings with evaluation team members and service providers. These meetings offered the opportunity for the evaluation team to learn more about the agencies and their contracted services.32 Over time, as the evaluation design was being finalized with the knowledge obtained from these site visits, the focus of these meetings shifted to discussions about the details of the forthcoming evaluation and addressing providers’ related questions and concerns. The evaluation team was very receptive to suggestions and provider feedback, and in fact developed or modified a number of aspects of the evaluation as a result of these meetings, as follows: The proposed assessment of parent education classes by pre- and post-tests was dropped in favor of the addition of uniform items on the Parent Interview; the evaluation team agreed to duplicate consent forms on triplicate copies; and, for two providers, entry of data into Persimmony was replaced with submission on a quarterly basis of internal client data files containing demographic information matching the Family Intake Form for import into Persimmony, so as not to burden staff with duplicate data entry. Staff from Harder+Company Community Research – the evaluators of fiscal year 2004-2007 First 5 Sacramento services – were extremely valuable in educating WRMA and Westat staff about the service providers. 32 and and and for and First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix B.2 These meetings produced, for each service provider, a document called the Individual Evaluation Plan (IEP) that detailed each provider’s responsibilities regarding recruiting and consenting clients; the collection and entry or submission of data for Persimmony; and the proper storage of signed consent forms and other data security procedures. Each IEP was signed by the project manager (or staff person in a similar position) at each service provider. Parent Interview Sampling The Commission-approved Evaluation Plan identified a longitudinal survey of a random sample of parents as the key source of data for addressing most Result Area and all Cross-Cutting indicators. Sampling for the Parent Interview was projected to occur in October 2007; however the Evaluation Plan recognized that the start date for sampling was dependent upon a sufficient level of recruitment by service providers. Preparations for sampling included the evaluation team reviewing on an ongoing basis the status of recruitment within Result Areas and by service providers, as well as contacting providers with low recruitment numbers to investigate whether they had a backlog of Family Intake Forms for entry into Persimmony, or were indeed experiencing slower than anticipated levels of recruitment. Due to delays in recruitment, the decision was made to delay the sample selection until March 2008 so that the sample could include all new cases at the service providers through February 2008. The initial sample for the Parent Interview included an equivalent proportion of families selected from the Nutrition, Effective Parenting, and School Readiness Result Areas, with fewer families from Health Access because of the limited number of families in Persimmony by February 2008 (Table 1.1). Parents who identified themselves as Russian/Ukrainian and Hmong on the Family Intake Form were over-sampled so that findings from these clients would be based on sufficiently-large numbers. The Commission-approved Evaluation Plan called for Vietnamese parents to be included in the over-sample; however, by late February there were too few Vietnamese families in Persimmony to constitute an over-sample, so these families were selected at the same rate as other families for each result area. This also increased the size of the Russian/Ukrainian and Hmong over-samples, allowing for greater statistical power in analyses involving these groups. Two months into data collection it was apparent that recruitment for the Parent Interview was falling short of projections, and in mid-May the evaluation team decided to increase the sample size for the Health Access, Effective Parenting, and School Readiness Result Areas, as well as the Racial Sub-Group Over-sample (Table B.1). Overall, 742 families were selected to participate in the Parent Interview. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix B.3 Table B.1: Number of Families Sampled for the Parent Interview by Result Area Families Sampled February 2008 Health Access Nutrition Effective Parenting School Readiness Racial Sub-Groups Over-sample TOTAL 122 150 150 150 64 636 Interviews Completed Mid-May 2008, % 51.0 79.7 45.3 50.0 64.8 Families Sampled Late May 2008 32 0 32 32 10 106 Families Sampled Overall 154 150 182 182 74 742 Developing and Pilot Testing of Survey Instrument Developing a survey instrument for the longitudinal Parent Interview began in July 2007 with the identification of items from existing national studies and known, validated scales that could measure the Result Area and Cross-Cutting indicators. The Parent Interview was initially conceived to include questions about one child in the family and his or her parents. Conceptualizing the administration of the instrument required developing a specific protocol for the selection of the focal child in families with more than one child five years or younger, on which the questions related to breastfeeding, history of medical care, and other topics would be based. Various options were discussed by the evaluation team (with input from the Evaluation Director and the Evaluation Committee) for selecting the focal child, including random sampling, or selecting the youngest or oldest child. It was decided that the most sound approach would be to select up to two focal children in each family, thereby asking the parent the same set of questions about the youngest and the oldest child in the family (zero to five years). There were several reasons for this approach. First, data from two children in the family would reduce the potential bias that could occur if questions were only asked about one child. Second, this increased the likelihood of detecting differences and the potential benefits of First 5 services specific to developmental ages (children from birth to three vs. three to five years of age constitute differentiated developmental groups, each with different service and programmatic needs). Third, it increased the sample size for analyzing child-specific indicators. The potential disadvantage to this decision was the increased time required to complete the interview, hence increasing respondent burden. However, it should also be noted that 54.7% of families only had one child in the birth to five age group, and therefore only answered a single set of questions. By mid-September the evaluation team had developed an instrument with important demographic questions and items to address all indicators, and began to conduct pilot and mock interviews in order to test the time required to complete each section of the instrument and also to obtain feedback from potential respondents about item difficulty and understanding. Many of the items in the survey that operationalized key outcome indicators were derived from national studies with proven psychometric properties, thereby increasing the validity and reliability of the information on the survey. This process underscored the need to trim the instrument, and the focus of a subsequent two-day meeting was to re-evaluate each item (or series of related items) First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix B.4 while considering its overall importance for describing the sample or addressing an indicator. One outcome of this meeting was to cut the items from the Centers for Disease Control and Prevention (CDC) State and Local Area Immunization Coverage and Health Survey (SLICHS), which asks parents the number of times their children have received each of five distinct immunizations. Instead, the evaluation team decided that one question concerning whether the child had received all recommended shots for his or her age would have to suffice. This is one example of the compromises the evaluation team had to make between developing an instrument with items that would best address all the indicators while at the same time trying to minimize respondent burden. In late September 2007 the evaluation team agreed that they had an instrument ready for pilot testing with First 5 Sacramento clients; seven pilot test interviews were conducted in early October 2007 (Table B.2). Before the next round of pilot interviews was conducted on November 5, 2007, the evaluation team met twice to review and critique each item of the instrument, and conduct mock interviews to assess the time required to complete each section. The instrument was subsequently revised and sent to certified translators for Spanish translation. Two pilot tests of the Spanish version of the instrument were conducted on December 11, 2007. These pilot interviews resulted in changes of certain words from the translation of the instrument provided by the certified translators to better fit the cultural background of First 5 Sacramento clients. In addition to providing a means for improving the instrument, the pilot tests ensured that the final version of the instrument was not a burden for parents, both in the amount of time it took to complete and the nature of the questions (e.g., sensitivity of questions). Table B.2: History of the Development of the Parent Interview, 2007 Initial Draft of Instrument Completed by Principal Investigator Drafts Reviewed and Revised by Principal Investigator and Project Director Evaluation Team Reviewed Instrument Independently. Mock Interviews Conducted to Assess Time to Complete Each Section and Overall Evaluation Team Met To Review Instrument Item-by-Item Instrument Revised by Principal Investigator Pilot Test Interviews Conducted with Five Women at CRP WIC Pilot Test Interviews Conducted with Two Women at La Familia Evaluation Team Met To Review Instrument Item-by-Item Instrument Revised by Principal Investigator Evaluation Team Met To Review Instrument Item-by-Item Evaluation Team Reviewed Instrument Independently. Mock Interviews Conducted to Assess Time to Complete Each Section and Overall Pilot Test Interviews Conducted with Four Women at DHHS WIC Instrument Sent for Spanish Translation Spanish Translated Parent Interview Received, Reviewed by Evaluation Team Spanish Pilot Test Interviews Conducted with Two Women at Birth and Beyond Evaluation Team Met To Revised Based on Spanish Pilot Test Interviews October 30 – November 4 November 5 November 14 December 3 December 11 December 17 September 10 – 15 September 17 & 18 September 19 – 28 October 3 October 5 October 15 & 16 October 17 - 19 October 29 July July – August First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix B.5 Field Interviewers for Parent Interview Over 70 applications for field interviewer positions were screened and 10 applicants were interviewed in January 2008. Six field interviewers were initially hired, with four bilingual in the languages most commonly reported (other than English) as primary language spoken on the Family Intake Form – Russian/Ukrainian, Spanish, Hmong, and Vietnamese. Training of the field interviewers occurred on February 27 and 28. During the training, interviewers were given a number of opportunities to conduct mock interviews with evaluation team members and with each other. The second day of training ended with the interviewers pairing off with a member of the evaluation team. During this interview the evaluation team members recorded on a “Certification” form interviewers’ ability to read the instrument verbatim and follow instructions, including the various skip patterns throughout the instrument, and to probe appropriately when required. The Certification process was developed to ensure that interviewers demonstrated professional behaviors and the ability to administer the instrument in a manner that would reduce potential bias. By the end of the Parent Interview, an additional two field interviewers were hired, trained, and certified to interview parents. Training, Reference, and Tracking Documents Preparing for the Parent Interview included the development of the following documents that were reviewed during the field interviewer training and used during parent recruitment and interviewing: • A comprehensive question by question (QxQ) document that provided instructions or additional information for the majority of items on the questionnaire. The document presented this information on the page opposite each page of the Parent Interview for easy reference. A checklist of items to be brought to each interview. A document outlining specific procedures for calling parents to schedule interviews. Interviewing Safety Procedures. Confidentiality Procedures. General Interview Guidelines. A shortened version of the General Interview Guidelines for quick reference. An age calculation sheet to determine the age of the child at the interview based on the present month and the date of child’s birth as recorded on the Family Intake Form. A laminated “Interview in Progress” card to be placed on a door when interviews were conducted at service provider sites. “Show Cards” that interviewers presented to parents at 11 specified points during the interview. The Show Cards depicted in large text the possible response options and allowed the parent to visually review the range of possible answers when deciding which options best represented their circumstances. A Disposition Sheet to record the outcome of each attempt to contact by telephone the parents sampled for the Parent Interview. The Disposition Sheet also ensured that multiple attempts were made at different days and times to contact parents and invite them to participate in the Parent Interview. The document was also used to note when phone numbers from Persimmony were incorrect, and the outcome of attempts to obtain updated information from contractors. Appendix B.6 • • • • • • • • • • First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 • A Phone Screening document that included the script to be read to parents who signed the consent form once they were identified over the phone. The document was used to verify information entered in Persimmony, such as the names and ages of children; identify any additional children under six year who were not in Persimmony; and to record the date and location of the scheduled interview. Recruitment and Data Collection Monitoring Scheduling Parent Interviews occurred over the phone using the telephone numbers parents provided on the Family Intake Form. Initially, field interviewers were tasked with recruiting parents, but a few weeks into the survey it was evident that centralizing most recruitment activities to an evaluation team member was more fruitful. Recruitment calls included verifying information from the Family Intake Form and a request to schedule the interview at the parent’s residence or a nearby location, such as a coffee shop or library. Telephone interviews were presented as an option only when personal interviews were not feasible due to parents’ schedules or preferences. Personal interviews, while more costly than telephone interviews, were recognized as a superior method of data collection since they allow interviewers to develop a better rapport with parents and visually display the response options using the “Show Cards,” thus leading to more truthful and accurate responses. Moreover, receipt of the incentive (i.e., $20 Target gift card) could occur immediately following the interview in face-to-face settings, as opposed to having the incentive mailed to those interviewed by phone. The recruitment protocol required at least eight attempts to reach parents by phone, although some parents were called up to 15 times. The research assistant responsible for coordinating and monitoring recruitment activities carefully screened the disposition sheets used to record the day, time, and outcome of each attempted contact to ensure that calls were dispersed throughout the day and included at least one weekend attempt. As anticipated, many telephone numbers were no longer in service. The following strategies were employed in an attempt to contact those who could not be located (many of the families had moved since completing the Family Intake Form when they initially enrolled in the program): • • • • Service providers where these parents were recruited were contacted and asked for updated contact information; Service providers were sent a list of names for posting on site with a request that they keep on the look out for these parents, and if identified, to let them know that they have been selected for the Parent Interview; Numerous searches were conducted to investigate whether there was updated information in the Persimmony database, or if the parents had been entered by more than one service provider with different contact information; Reverse telephone directories were used to investigate the availability of new phone numbers connected with a given address. Through service providers’ regular contact with parents, updating client entries in Persimmony, and directly providing the evaluation team with new information, many parents with out-of-date contact information were found and interviewed. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix B.7 Weekly evaluation team meetings during the data collection period included reviewing a number of tables of data to assess the status of recruitment and adjust tactics, both in the office and in the field, as required. These data included the average number of hours interviewers were taking to complete one interview (which include recruitment calls, travel, and time to complete and verify paperwork); the average time per interview; the number of interviews completed overall, by Result Area and language, and face-to-face versus over the phone; and the number of parents who refused to participate. Refusals were categorized as “hard” and “soft” based on how ardent the parent was in his or her lack of interest in rejection of participating in the survey. Soft refusals were contacted towards the end of data collection in an attempt to persuade them to participate in the survey. Field interviewers dropped off completed questionnaires to the evaluation team on a weekly basis; each questionnaire was carefully reviewed for skipped questions or other errors. When such cases were discovered, the related items were flagged and parents were contacted by phone to collect additional information or rectify discrepant responses. Outcome of Parent Interview From March 3 through June 27, 459 parents participated in the Parent Interview with information collected for 667 children. Half (49.9%) of interviews were in English, 40.7% in Spanish, 4.8% in Russian, 3.1% in Hmong, 0.9% in Ukrainian, and 0.7% in Vietnamese. Table B.3 displays the final recruitment rates for the four Result Areas and the over-sample of selected racial groups. These rates were based on the exclusion of 17 families deemed ineligible for participation in the survey because they were sampled more than once due to duplicate parent names existing in the Persimmony database; the sampled parent was not legal guardians of the children listed on the consent form or did not speak one of the languages of the consent form; or the only child in the family was over five years old at the time of consent. The overall recruitment rate for the 2008 Parent Interview was 63.3%. Only 132 (28.8%) of the 459 interviews were conducted over the telephone. The majority (85.0%) of face-to-face interviews took place where the parent lived. English interviews took an average of 51 minutes; Spanish interviews were a bit longer at 54 minutes. The longest average time was for interviews conducted in Russian: 71 minutes. The majority (94.3%) of interviews were conducted with the child(ren)’s birth mother, 4.4% involved the father, and 1.3% some other family member with legal custody. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix B.8 Table B.3: Number of Families Sampled and Eligible for the Parent Interview, and Completion Rates by Result Area Number of Parent Interviews Competed 116 116 98 85 44 459 Percent of Parent Interviews Competed, % 78.4 64.8 56.3 56.7 59.5 63.3 Number of Eligible Families Nutrition School Readiness Effective Parenting Health Access Racial Sub-Groups oversample TOTAL 148 179 174 150 74 725 Families in the nutrition area had the highest completion rates, compared to families who participated in the other result areas, and as a result, we did not need to boost the sample size for these families compared to those from the other result areas (as described previously). The lowest completion rates were found for families enrolled in the Effective Parenting and Health Access Result Areas. Differences in completion rates could be due to a host of factors, including the recency of their enrollment in the respective services, and the frequency in which they maintained contact with the service provider. Updated contact information could not be obtained for 89 of the 266 sampled and eligible parents not participating in the Parent Interview (Table B.4). A total of 135 parents could not be reached by phone over the course of the survey; at least eight recruitment attempts were made to contact these parents. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix B.9 Table B.4: Final Recruitment Outcome of 2008 Parent Interview N Sample Ineligible/Duplicates Eligible Parents Refused Unreachable 2 3 4 1 % 2.3 97.7 5.8 12.3 18.6 63.3 742 17 725 42 89 135 459 Not Available Completed Interviews 1. Nine ineligible; eight duplicate parents. Two ineligible parents were not legal guardians of the children listed, six did not speak one of the languages of the consent form, and one parent’s child was age six years at the time of consent. 2. All efforts to find new contact information failed for 87 parents; the survey ended before attempts could be made to find new contact information for two parents. 3. Family members indicated that two parents were not available (moved out of the country or missing). For 133, eight or more calls at various times of day and messages were left, but parents were still not reached. 4. One interview only partially completed. Tables B.5 and B.6 present comparisons by race/ethnicity and primary language for three groups of parents: those recruited for the evaluation, those sampled for the Parent Interview, and those participating in the Parent Interview. Comparisons between the first two columns of data convey the extent to which the Parent Interview sample matched the population of all parents in Persimmony. However, exact similarities are not expected due to the inherent nature of random sampling, and because Russian/Ukrainian and Hmong parents were purposely over-sampled. As seen in Table B.5, Russian/Ukrainian and Hmong constituted 3.6% and 1.7% of parents in Persimmony, respectively, but each group represented 5.0% of the sample for the Parent Interview. There is a remarkable similarity between parents sampled versus interviewed by race/ethnicity, with all racial/ethnic groups represented in the Parent Interview. Comparisons by primary language also reveal agreeable concordance (Table B.6). First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix B.10 Table B.5: Race/Ethnicity of Parents Who Received Services, Sampled for the Parent Interview, and Participated the Parent Interview, March to June 2008 Parents in Persimmony, % (n = 8,079) Hispanic/Latino Black/African American White, non-Hispanic Russian/Ukrainian Other Slavic Hmong Chinese Filipino Vietnamese Asian Indian Other Asian Pacific Islander Alaska Native/American Indian Other Race Multiracial Decline/Don’t Know 50.5 12.0 16.4 3.6 0.2 1.7 0.6 1.1 0.8 1.0 1.6 1.2 0.7 0.9 6.4 1.0 Parents Sampled, % (n = 742) 48.9 8.9 17.8 5.0 0.1 5.0 0.7 0.7 0.9 1.2 1.1 0.7 0.5 1.6 5.1 1.8 Parents Interviewed, % (n = 459) 49.2 7.6 20.0 4.8 0.2 5.0 0.7 0.9 1.3 1.1 0.4 0.7 0.4 0.9 5.7 1.1 Table B.6: Primary Language of Parents Who Received Services, Sampled for the Parent Interview, and Participated the Parent Interview, March to June 2008 Parents in Persimmony, % (n = 8,079) Spanish English Hmong Russian Ukrainian Vietnamese Mien Tagalog Hindi Chinese-Cantonese Chinese-Mandarin Other Language Decline/Don’t Know 39.4 51.3 1.3 2.8 0.6 0.5 0.1 0.1 0.3 0.5 < 0.1 0.4 < 0.1 Parents Sampled, % (n = 742) 39.2 48.4 3.5 4.6 0.2 1.1 0.0 0.2 0.2 0.2 0.2 0.9 1.3 Parents Interviewed, % (n = 459) 37.8 50.5 2.1 3.9 0.7 0.7 1.1 0.0 0.0 0.7 0.0 0.4 2.1 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix B.11 Retention Activities The final section of the Parent Interview requested that parents provide additional information that would allow for locating them for the follow-up interview, scheduled to occur from March through June 2009. Requested information included work phone numbers and contact information for three friends or family members who “we could try to reach if we can’t reach you”. Our ongoing efforts to maintain contact with parents included sending them and their children birthday cards. The cards included a note, translated into the parent’s primary language, thanking them for participating in the Parent Interview, and informing them that a $20 Target gift card will be available for participating in the 2009 interview. The card also requested that parents contact the evaluation team if they plan to change their address or phone numbers. Finally, cards were sent “Return Service Requested, Do Not Forward,” and returned cards indicated that a parent has moved and follow-up phone calls were made to identify and record the new address. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix B.12 APPENDIX C MEASURES   CHAPTER 2 Number of First 5 Sacramento clients Table 2.2: Not all 9,876 children in Persimmony had a record of services. However, all children in Persimmony by June 30, 2008 were considered to have benefited from First 5 Sacramento services either directly or indirectly by the services provided to their parents. Children in Persimmony whose mothers received lactation support, for example, had no record of service, but breastfeeding is known to benefit both mother and child. The number of parents in Table 2.2 represents only those who had a record of services in Persimmony. Parents excluded from Table 2.2 (n = 1,368) are those who never received services (are in Persimmony only because they consented their children to be in the evaluation), or may have received services but they were never recorded and/or entered into Persimmony. CHAPTER 3 Continuously enrolled in health insurance Retention Survey data were entered into Persimmony for 433 children during fiscal year 2007/2008. The majority (69.7%) of children were reported by their parents to have been enrolled in an insurance program two to three months after application assistance (Table C.1). When considering only those parents whom Cover the Kids could reach by telephone, 91.2% of children had reported insurance coverage at two to three months after application assistance. Although a subsequent Retention Survey was intended to be collected eight months after application assistance, the actual point at which the “eight-month” Retention Survey was collected varied considerably, with 52.2% occurring four to seven months after the initial survey. In order to estimate continuous enrollment, we first looked at reports of enrollment from the twothree month surveys completed between July and December 2007, and then looked at eightmonth surveys completed by the same pool of families as of June 30, 2008. This timeframe allowed for at least six months to pass between administration of the two-three month survey and the eight month survey. Based on these data (Table C.1), parents reported having health insurance for 67.1% of children at eight months (94.0% if excluding parents who were not reached), and 62.9% of children were reported to have insurance at both points in time (91.7% if excluding parents who were not reached). First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix C.1 Table C.1: Children Enrolled in Health Insurance at Two-Three and Eight Months Post Application Assistance (n = 433) 2-3 Month Survey 8 Month Survey 8 Month Retention Parents Interviewed, % Enrolled in Health Insurance Yes No Parents Not Reached All Parents, % Parents Interviewed, % All Parents, % Parents Interviewed, % All Parents, % 91.2 8.8 -- 69.7 6.7 23.6 94.0 6.0 -- 67.1 4.3 28.6 91.7 8.3 -- 62.9 5.7 31.4 Immunizations at ages 2 and 5 years for children enrolled in health plans Enrollment in a health plan was determined by affirmative responses to the question, “Is [child’s name] covered by some form of health insurance?” Complete immunizations were estimated based on parents’ responses to the question, “In your opinion, has [child’s name] received all of the recommended shots for (his/her) age?” Age in months was calculated from the difference between date of interview and date of birth, and separate analyses were performed on children aged 24 to 35 months and 60 to 71 months. Age appropriate well child visits Age appropriate well visits were determined by taking each child’s age and the number of times he or she received routine check-ups (“visits to the doctor when (he/she) is not sick, but to get (him/her) checked over, or for vaccinations”) during the past year, and comparing these data with the recommended well child visits schedule. Seeing a dentist by one year of age Analyses to assess the percent of children with a dental visit by age one year were based on the questions, “Has [child’s name] ever been to a dentist or dental hygienist for dental care?” and “How old in months or years was [child’s name] when (he/she) first visited a dentist?” CHAPTER 4 Breastfeeding Breastfeeding items for the Parent Interview were developed by the Centers for Disease Control and Prevention (CDC) and have been used in national surveys such as the 2006 National Immunization Survey (NIS). The length of time that a child was breastfed was measured with the question, “How old was [child’s name] when (he/she) completely stopped breastfeeding or being fed breast milk?” Two subsequent questions were asked of the mother or father to assess the child’s age when something other than breast milk was first introduced into his or her diet to determine if the child was exclusively breastfed for 6 months: • “How old was [child’s name] when (he/she) was first fed formula?” Appendix C.2 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 • “The next question is about the first thing that [child’s name] was given other than breast milk or formula. Please include juice, cow’s milk, sugar water, baby food, or anything else that [child’s name] many have been given, even water. How old was [child’s name] when (he/she) was first fed anything other than breast milk or formula?” The difference between the child’s date of birth and his or her age when first fed something other than breast milk established the number of days that each child was exclusively breastfed. When calculating the percent of children exclusively breastfed for at least 180 days (six months), 71 children who were younger than six months at the time of the interview were excluded. Similarly, the percent of children exclusively breastfed for at least 360 days (one year) excluded the 175 children less than a year old when their father or mother participated in the Parent Interview. Calculations for six months and one year excluded children with incomplete data, eight and two respectively, and both excluded an additional 10 children with data provided by someone other than the child’s birth mother or father. The denominator for both calculations included children who were never breastfed. CHAPTER 5 Improved family function An index variable was created from a number of items on the Parent Interview to assess a family’s risk of functioning as a family and in society. Specifically, a value of 1 was assigned to a family for each of the following conditions: 1. Family occupational status in the lowest quarter of the distribution of all parents participating the Parent Interview; 2. Parents do not speak English to the children; 3. Parent single or neither parent in household; 4. Birth mother was 20 years or younger when oldest child was born; 5. Neither parent works full-time; 6. Either child has not seen at least one birth parent within 182 days; 7. One or both parents did not graduate from high school; 8. One or both parents do not speak English; 9. One or both parents were not born in the United States; and 10. One or both parents were recent immigrants to the United States. Thus, families with a score of 10 are considered at greatest risk of dysfunction. Two items on the Parent Interview were noted to reduce risk, and therefore were subtracted from each family’s risk score. One or both parents taking a class was assigned a -0.5, and -1.0 was given to families where one or both parents was working on a degree. Family’s combined scores were multiplied by 100, for a theoretical range of the risk index of -15 to 100. Families with scores of 60 and above were considered at risk of poor functioning. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix C.3 Knowledge of developmental stages in children Parents’ knowledge of stages of children’s development was assessed by the Knowledge of Infant Development Inventory.33 The KIDI first asks parents to indicate their level of agreement with the following statements: • • • • All infants need the same amount of sleep. A young brother or sister may start wetting the bed or thumb-sucking when a new baby arrives in the family. A child thinks he is speaking correctly even when he says words and sentences in an unusual or different way, like “I goed to town” or “What the dolly have?” Children learn all of their language by copying what they have heard adults say. Next, parents who disagree with any of the following seven statements are asked whether the behavior is more applicable to a younger or an older child: • • • • • • • A one-year-old knows right from wrong. A baby will begin to respond to her name at 10 months. Most infants are ready to be toilet trained by one year of age. A baby of 12 months can remember toys he has watched being hidden. One-year-olds often cooperate and share when they play together. A baby is about 7 months old before she can reach for and grab things. A baby usually says its first real word by six months of age. The standardized procedures for scoring the KIDI results is an average score for knowledge of developmental stages, ranging from 0% to 100%. Parents with scores of 60 and above were considered to have high knowledge of children’s developmental stages. Decrease parent stress The Parenting Stress Index (Short Form)34 asks for level of agreement with the following statements: • • • • • • • I find myself giving up more of my life to meet my children’s needs than I ever expected. I feel trapped by my responsibilities as a parent. Since having a child, I have been unable to do new and different things. Since having a child, I feel that I am almost never able to do things that I like to do. There are quite a few things that bother me about my life. I feel alone and without friends. I don’t enjoy things as I used to. 33 MacPhee, D. (1981). Manual: Knowledge of Infant Development Inventory. Unpublished manuscript, University of North Carolina. Haskett, M.E., Ahern, L.S., Ward, C.S., & Allaire, J.C. (2006). Factor structure and validity of the Parenting Stress Index-Short Form. Journal of Clinical Child & Adolescent Psychology, 35, 302-312. 34 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix C.4 Parental Stress scores ranged from 1 to 5, with scores under 3 considered high. Community Connectedness Community connectedness was also assessed with items from the Social Cohesion Scale35 and the Neighborhood Environment for Children Rating Scale,36 when combined allow for calculating Neighborhood Cohesion scores. The Social Cohesion Scale items are: • • • • • People in my neighborhood are willing to help their neighbors. I live in a close-knit neighborhood. People in my neighborhood do not share the same values as me. People in my neighborhood can be trusted. People in my neighborhood generally don’t get along with each other. And the Neighborhood Environment for Children Rating Scale includes the following items: • • • • My neighborhood is a good place to raise children. Neighbors should mind their own business about their neighbor’s children. I disagree with the way my neighbors discipline their children. Any adult has the right to verbally correct a neighborhood child if the parents are not around. Neighborhood Cohesion scores ranged from 2 to 10, with scores of 6.4 and above considered high. Developmentally appropriate parenting skills Parents were presented with different methods of discipline and asked “How often you have used it in the last 6 months: never, rarely, sometimes, or often?”37 The percent of “never” or “rarely” responses to this question among parents in the Effective Parenting Result Area versus those in other Result Areas is seen in Table 3.16. Twenty six parents indicated that the discipline method did not apply to their child (e.g., the child was too young). Sampson, R.J., Raudenbush, S.W., & Earls, F. (1997). Neighborhoods and violent crime: A multilevel study of collective efficacy. Science, 277, 918-924. 36 Coulton, C. J., Korbin, J. E., & Su, M. (1996) Measuring neighborhood context for young children in an urban area. American Journal of Community Psychology, 24, 5–32. 37 MacPhee, D., & Rattenborg, K. (1991). Parental Discipline Methods scale. 35 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix C.5 Statements from the Parenting Dimensions Inventory38 and Child Rearing Practices Report were used to determine levels of Parental Nurturance, Energy, and Authoritative versus Authoritarian parenting styles. During the Parent Interview, survey participants were presented with each statement and asked if it was “very much like them,” “somewhat like them,” or “nothing like them.” Parental Nurturance, Energy, Authoritative, and Authoritarian scores ranged from 1.0 to 3.0, with scores of 2.5 and above considered high. The following statements were used to determine the Parental Nurturance Score: • • • My child and I have warm intimate/affectionate moments together. I encourage my child to be curious, to explore, and to question things. I make sure my child knows that I appreciate what (he/she) tries to accomplish. Higher levels of Parental Energy were established with the following items: • • • There are times I just don’t have the energy to make my child behave as (he/ she) should. Once I decide how to deal with a misbehavior of my child, I follow through on it. I have little or no difficulty sticking with my rules for my child even when close relatives (including grandparents) are there. Parental Authoritative items consisted of: • • • • I encourage my child to be curious, to explore, and to question things. I am easygoing and relaxed with my child. I make sure my child knows that I appreciate what (he/she) tries to accomplish. I encourage my child to be independent of me. And Parental Authoritarian items included: • • • • I control my child by warning (him/her) about the bad things that can happen to (him/her). I teach my child that misbehavior or breaking the rules will always be punished one way or another. I do not allow my child to get angry with me. I believe physical punishment to be the best way of disciplining. Interact with children in a supportive and positive manner The extent to which parents interacted in a positive and supportive manner was assessed by recording the frequency of participation in certain activities with their children three years of age and older. Parents were first asked how often they engaged in the following activates during the previous week: 38 Slater, M. A., & Power, T. G. (1987). Multidimensional assessment of parenting in single-parent families. In J. P. Vincent (Ed.), Advances in family intervention, assessment, and theory (pp. 197-228). Greenwich, CT: JAI Press. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix C.6 • • • • • • • • • • Played with toys or indoor games Played any game or sport together Sung to or with (him/her) songs or music Told (him/her) a story Helped (him/her) learn letters, words, or numbers Played counting games like singing songs with numbers or reading books with numbers Talked about TV, radio programs, or videos Talked about what happened in preschool, nursery school or early education program Cooked or prepared a meal together Watched a children’s movie together Parents were then asked if they did the following activities within the past month: • • • • • Talked with [child’s name] about (his/her) family history or stories about the family Attended family functions or events such as a quinceañera, a birthday party, a wedding, or a christening Attended an event sponsored by a community or ethnic group Taken [child’s name] to watch sports, or a game such as soccer Attended a religious activity or religious school An “Activities with Child” score was computed with a value of 1 given to parents for every weekly activity they did “3 or more times,” and for every monthly activity. Activities with Child scores ranged from 1 to 15 with scores of 9 and above considered high. CHAPTER 6 Satisfaction with the content, quality, and family centeredness of school programs Parents were asked about their levels of satisfaction (“not satisfied,” “somewhat satisfied,” or “satisfied”) with each of the areas below in the school programs where the child “spends most of (his/her) time.” • • • • • • • Helping [child’s name] to grow and develop Being open to your ideas and participation Supporting and respecting your family’s culture and background Identifying and helping to provide services that help your family—for example, public assistance, transportation, or job training Maintaining a safe program—for example, secure play grounds, clean and tidy classrooms Preparing [child’s name] to enter kindergarten Helping you become more involved in groups that are active in your community First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix C.7 Satisfaction scores ranged from 1 to 100, with scores of 90 and above considered high. Regular attendance at a nursery school, preschool, pre-Kindergarten, or Head Start program Parents were asked, “Is [child’s name] now attending a nursery school, preschool, prekindergarten or Head Start program on a regular basis?” Children meeting developmental milestones Data to assess the developmental milestones of children in the School Readiness Result Area came from the Desired Results Developmental Profile-Revised (DRDP-R), which is scheduled to be administered at the beginning and end of the preschool program by school staff. Pre- and post- DRDP-R data were entered into Persimmony. Due to not all children with a DRDP-R having both the pre- and the post- assessment done, data from the most recent assessment or the only assessment entered into Persimmony (a proxy for the post assessment) were analyzed. Kindergarten readiness at the completion of a school readiness program Children’s readiness for kindergarten was recorded on the “Summer Camp & Preschool Teacher Services/Assessment Form” with the question, “If this child has been assessed for his/her readiness for kindergarten, what was the result?” Response options were: “Ready,” “Not Ready,” “Not Sure,” and “N/A – Not Assessed.” Teachers were requested to complete the form once a quarter, or before the child left the program. Data from the only or most recent assessment were analyzed. Special needs children’s participation in early childhood care and education programs Children’s special needs were determined through parent self-report, as with all items on the Parent Interview, by asking, “Has a doctor, other health or education professional, or someone from [Name of First 5 Sacramento service provider] ever told you that [child’s name] has special needs or disabilities, for example, physical, emotional, language, hearing, learning difficulty, or other special needs?” CHAPTER 8 Community Building Events Attendees are often not fully aware that a CBI activity or event is sponsored by First 5 Sacramento, which posed a challenge in assessing the relationship between attendance and the outcomes reflected in the related Result Area indicators. In other words, we could not expect all Parent Interview participants who attended a CBI event to know that they had attended a CBI event. To address this challenge, the evaluation team developed descriptive summaries of six types of CBI events. After each summary was read to parents they were asked if they had heard about such an event occurring in their neighborhood or community during the past six months. If they had, they were asked whether they attended the event. The six types of events, listed below, were developed from reviewing the CBI events occurring during fiscal year 2006/07. 1. Events that promote a safe neighborhood, such as crime or drug prevention events with local police, or Neighborhood Watch groups or block club meetings. First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix C.8 2. Events that help parents become better parents, such as parent education classes, discussion and support groups, or community resource awareness meetings for parents. 3. Events that encourage literacy and early childhood education, through such activities as neighborhood book clubs, reading programs, or library hours for children. 4. Events that are celebrations and festivals such as neighborhood celebrations, holiday festivals, cultural events, pot-luck dinners, or barbeques. 5. Events that promote children’s creativity, such as with arts and crafts, dance, or music. 6. Events that promote nutrition, health and fitness, such as community bike rides for children, health fairs, or community gardens to teach children nutrition. A series of questions were asked of parents who indicated that they had attended one or more of these events. Field interviewers recorded when the event took place (i.e., month and/or date), the name of the event, and its location (specific address or general location). This information was subsequently compared with the master list of CBI events provided by First 5 Sacramento staff. Evaluation staff developed a set of specific procedures for comparing and identifying potential CBI events derived from the Parent Interview with actual CBI events. These procedures resulted in each parent receiving a code of “Definitely Did Not Attend,” “Likely Did Not Attend,” “Likely Attended,” and “Definitely Attended” for each event they identified. (Some parents identified multiple events, and thus received multiple codes.) Two members of the evaluation team coded a sample of these identified events independently, compared their answers and revised the procedures until agreement was obtained for over 90% of coded events. Ultimately, each parent was coded as “Did Not Attend a Community Event,” “Attended a Community Event, Not CBI,” or “Likely or Definitely Attended a CBI Event.” Analyses were conducted across these three groups on the related measures for each indicators associated with the Community Building Result Area. Increased efficacy Efficacy was assessed on the Parent Interview with the following items from the Pearlin Mastery Scale39: • There is really no way I can solve some of the problems I have. • Sometimes I feel that I am being pushed around in life. • I have little control over the things that happen to me. • I can do just about anything I really set my mind to do. • I often feel helpless in dealing with the problems of life. • What happens to me in the future depends mostly on me. • There is little I can do to change many of the important things in my life. Pearlin, Leonard I.; Lieberman, Morton A.; Menaghan, Elizabeth G.; and Mullan, Joseph T. "The Stress Process." Journal of Health and Social Behavior. 22 (December): 337-353, 1981. 39 First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix C.9 Pearlin Mastery scores ranged from 1 to 4, with scores of 3 and above considered high. CHAPTER 10 Enrolled in health insurance Parents were asked to note on the Family Intake Form whether their children had health insurance. These data were not collected through the Health Access Result Area since those parents go to Cover the Kids specifically to obtain coverage for their uninsured children. Thus, the calculation of the baseline rate for children enrolled in health insurance included in the denominator responses of “no” on the Family Intake Form and all children recruited for the evaluation through Cover the Kids, but excluded all the cases where this question was not answered or was unavailable (n = 925, or 10.0% of all children recruited through service providers other than Cover the Kids). First 5 Sacramento Report on Evaluation of Fiscal Year 2007/08 Services March 16, 2009 Appendix C.10