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					     2007-08 Annual Evaluation Report
           Investing in our most precious resource
                         … our children




January 2009
Founded in 1986, Harder+Company Community Research is a comprehensive
social research and planning organization located in San Diego, Los Angeles, San
Francisco, and Davis, California. The focus of the company’s work is in broad-
based community development and human services. Its staff conducts needs
assessments, program evaluation, planning studies, and training for a wide range
of clients across the country.
Acknowledgements


H     arder+Company Community Research would like to thank and acknowledge the valuable input of
      various individuals and agencies that contributed to the evaluation design and the FY 2007-08 local
      evaluation report. In particular, we would like to thank the following people:

        The Commissioners of First 5 San Bernardino for their commitment to positively affect the lives
        of children ages 0-5 and for their continued interest, support and commitment to evaluation of
        these efforts: Josie Gonzales (Chair), Cheryl Brown (Vice-Chair), Mark A. Daniels, Leslie Egge,
        Linda Haugan, Jim Lindley, and Dr. Guillermo Valenzuela.

        The First 5 San Bernardino management team, including Karen Scott (Executive Director), Cindy
        Faulkner (Interim Operations Manager and former Community Engagement Manager), Stacy
        Iverson (former Program Manager), Hilda Alexander-Ragin (Interim Program and Evaluation
        Supervisor), and David Ramos (Interim Community Engagement Supervisor).

        The First 5 San Bernardino Program, Community Engagement, and Administrative staff.

        Members of the First 5 San Bernardino Advisory and Evaluation Committee for their expertise,
        dedication, and guidance.

        The First 5 San Bernardino partner agencies that participated in focus groups, case studies and
        participatory photography, as well as administered hundreds of client intakes and surveys.

        The First 5 San Bernardino data system contractor, Michael Kogus of Persimmony, for his
        expertise and support in accessing useful data to inform this report.

        The community stakeholders who openly shared their Commission opinions, perceptions and
        recommendations with the evaluation team.




Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                              January 2009
Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                     January 2009
Table of Contents


Executive Summary…………………………………………………………………………..                          i

Chapter 1: Introduction to Evaluation……………………………………………………….             1

Chapter 2: Health and Well-Being…………………………………. ……………………….                9

Chapter 3: Early Care and Education………………………………………………………...             43

Chapter 4: Family Support…………………………………………………………………..                    85

Chapter 5: System Integration and Community Engagement……………………………..    121

Appendix A: Partner Agency Directory……………………………………………………....           143

Appendix B: Further Notes about the Methodology……………………………………….        161

Appendix C: Evaluation Framework Logic Model…………………………………………...        173




Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                     January 2009
Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                     January 2009
  Executive Summary:
  2007-08 Evaluation Report




F   irst 5 San Bernardino supports programs, activities, and services that help ensure that children are ready to
    learn and thrive. During FY 2007-08, First 5 San Bernardino invested in approximately 197 programs,
    sponsorships, and other activities for a total of nearly $30 million.

The Commission is committed to systematically and continually assessing its efforts and using data to
strengthen programs, inform decision-making, measure outcomes, and document the collective impact of
activities funded by First 5 San Bernardino. Evaluation results are prepared for multiple audiences at both the
local and state level. In addition to reporting results to the San Bernardino County community, the
Commission is also required to report outcomes to the First 5 California Commission and the California State
Legislature.

In FY 2007-08, First 5 San Bernardino and its partner agencies provided critical services to children 0-5 and
their families. Together they also continued to strengthen the infrastructure and systems that serve children
and families and increase awareness among parents and members of the community. Main highlights and
findings are presented in this Executive Summary and are organized by the five Clusters identified in the
Commission’s Strategic Plan:

        Health and Well-Being
                                                “[First 5 San Bernardino] has really created
        Early Care and Education                recognition in the county that this 0-5 age
        Family Support                          group is at risk and that this is the age group
        System Integration                      that we need to pay close attention to… for
                                                successful students and eventually a successful
        Community Engagement
                                                workforce.”
                                                                                            – Stakeholder
The full evaluation report provides
more detailed information about the
successes and challenges in each Strategy area, as well as recommendations for future consideration. For a full
copy of the 2007-08 Annual Evaluation Report, please visit the Commission’s website at
www.first5sanbernardino.org (available in January 2009).




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Annual Evaluation Report FY 2007-08                                                   January 2009                i
Health and Well-Being
First 5 San Bernardino made health and well-being issues a priority during 2007-08 by investing over $11
million to assist in improving health outcomes for children ages 0-5 and their families. This year, the Health
and Well-Being Cluster included 32 funded agencies providing an array of healthcare assistance throughout
the County. Specifically, the Health and Well-Being Cluster included programs focused on health insurance
enrollment and retention, primary health care for children, oral health, perinatal health, and comprehensive
screening, assessment and treatment.


Fiscal Year 2007-08
Cluster      Strategies               Key Findings and Recommendations

                                            Best Practices: Agencies in the Children’s SART and Perinatal
                                            SART programs are implementing best practices and utilizing
                                            standardized assessment tools. The use of these instruments
                                            demonstrates a continued commitment to provide a high level of
                                            screening for the children and adults.


                                            Diverse Clients: Demographic data demonstrated that programs
                                            are serving people from diverse backgrounds but remain
                                            committed to the target population of low-income families, low
                                            levels of formal educational attainment, and isolated communities.

                  Child and Family
                  Assessment                High Need Children: Results of the children’s developmental and
                                            behavioral screenings suggest a high need for further services
                                            beginning with the completion of a more thorough assessment. As
  Health and                                SART partners continue to screen high risk children, the
  Well-Being                                relationships between screener and service providers must continue
                                            to strengthen in order to meet the needs of parents who are already
                                            struggling in many cases.
                  Health Care
                  Access
                                            Access to Care: A substantial number of First 5 funded providers
                                            continued to make a wide variety of health care services and dental
                                            screening available in every region of the County. An estimated
                                            12,000 clients received general health services, while over 35,000
                                            clients accessed dental services through First 5 HCA partners.


                                            Outcome Measurement and Data Collection: This year presented
                                            many challenges for data collection in the Health and Well-Being
                                            Cluster. It is recommended that the evaluation designs and
                                            reporting activities be reviewed and revised as part of the new
                                            Strategic Plan to ensure that the Commission can adequately
                                            represent the results of its investments.




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Annual Evaluation Report FY 2007-08                                                   January 2009                ii
Early Care and Education
For FY 2007-08, the Early Care and Education Cluster was awarded nearly $9.5 million for 29 programs and
activities throughout the County. The Early Care and Education Cluster aims to increase opportunities for
children to access quality early education, as well as improve early care environments in order to facilitate
children’s readiness for school. This section highlights key findings and recommendations for the School
Readiness and Child Care Strategies.

Fiscal Year 2007-08
Cluster      Strategies                Key Findings and Recommendations

                                            High Need Clients: The School Readiness programs served
                                            approximately 23,000 children and families during FY 2007-08.
                                            Many of the children and families had a high level of need (i.e.,
                                            uninsured and low socio-economic status families).

                                            Children’s Developmental Progress: Children showed positive
                                            developmental progress on all of the established domains of the
                                            DRDP-R as a result of participating in a School Readiness program.
                  School Readiness
                                            The largest increases in scores were found in effective learning, and
                                            personal and social competence.

                                            Parenting Skills: Parents who participated in a parenting class
                  Child Care Quality
                                            through School Readiness programs demonstrated increases in each
                  Standards
                                            of the parenting practice areas (knowledge, confidence, behaviors).


                                            Complementary Health Screenings: School Readiness programs
  Early Care      Child Care                provided opportunities for over 2,000 clients to receive screenings
  and             Capacity                  and assessments related to dental, vision, and hearing.
  Education
                                            ECE Provider Trainings: Over 6,000 providers enrolled in classes
                                            or trainings to enhance their knowledge and skills about child
                  Child Care Access         development, potentially benefiting their care center or practice.

                                            ECE Provider Impact: Over three-quarters of ECE providers who
                                            participated in a survey reported an increase in providing positive
                  Child Care                reinforcement, providing physical activities for children, and
                  Advocacy                  encouraging parents to read to their children, as a result of
                                            participation in training programs.

                                            Outcome Data Quantity: Despite the increase in reported outcome
                                            data, there were a number of clients who did not have data at pre
                  Play Spaces for
                                            and post, and therefore were not used. Additionally, for those
                  Children
                                            surveys completed only once (including SR and ECE Provider
                                            Surveys) the response rates were not as high as they could have
                                            been. Commission staff should continue to work with these
                                            programs to emphasize the importance of their participation in
                                            data collection.

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Annual Evaluation Report FY 2007-08                                                    January 2009               iii
Family Support
In FY 2007-08, over $7 million was invested in 24 programs that support parents and families. These services
were provided through Resource Centers and Parenting Education programs. The purpose of the Family
Support Cluster is to link parents to services in order to meet all needs, as well as provide parents resources to
enhance their parenting skills and improve their parent-child relationships.


Fiscal Year 2007-08
Cluster      Strategies               Key Findings and Recommendations
                                            Data Quality: Improved data collection and quality allowed for a
                                            more accurate description of the clients served by the Family
                                            Support Cluster. This provides much better information for
                                            evaluation as well as providers who seek data to guide their
                                            programming decisions.

                                            High Need Clients: The population of core clients served by the
                                            Family Support programs continues to reflect low-income clients
                                            with a high level of need. The percentage of clients who reported
                                            incomes of less than $10,000 annual income increased substantially
                                            over the previous fiscal year.

                                            Regional Reach: All of San Bernardino County’s regions had a First
                                            5-funded Resource Center. These programs provided parents with
                                            referral and linkage services in their own communities. Over this
                                            last program year, Resource Centers have also increased the
                  Resource Center           provision of case management services for clients.

                                            Parental Knowledge: Using data from the Survey of Parenting
  Family
  Support                                   Practice, analysis showed an increase on all items related to parental
                                            knowledge.

                                            Parent Life Skills: For clients who stayed in services long enough to
                  Parenting
                                            complete a Time 2 Life Skills Progression instrument,
                  Education
                                            improvements were seen on 23 of the 35 scales. The greatest change
                                            was seen on the Relationship scales where clients were asked about
                                            relationships with family, friends, their children and service
                                            providers.

                                            Resource Center Data Challenges: Data available for matched
                                            cases showed a decrease of almost 50% of clients from Intake to
                                            Time 2. The RC partners may benefit from a program level analysis
                                            of the data in order to develop and implement retention strategies
                                            for their individualized programs.

                                            Support Collaboration: Many parents identified gaps in services
                                            which may be linkage challenges. Many of these could begin to be
                                            addressed through increased collaboration both among First 5 San
                                            Bernardino funded partners and between First 5 funded agencies
                                            and other community organizations.



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Annual Evaluation Report FY 2007-08                                                     January 2009                 iv
System Integration and Community Engagement
First 5 San Bernardino continues to strengthen its partnerships and role as an advocate for young children and
their families. In addition to its efforts to increase awareness and engagement among parents and members of
the community, First 5 San Bernardino has been a key player in coordinating countywide efforts to integrate
systems and create a continuum of care. In FY 2007-08, 112 projects and activities were conducted in the
System Integration and Community Engagement Clusters, with a combined awarded amount of $1.4 million.
Key activities included building partnerships and coordinating countywide efforts, as well as projects designed
to improve community awareness of the importance of the first five years of life.

Fiscal Year 2007-08
Clusters      Strategies              Key Findings and Recommendations
                                            Awareness: Although the Commission has increased the awareness
                                            of the needs of the 0-5 population, 2008 Family Survey findings
                                            suggest a need for continued effort to raise awareness, as nearly half
                    Information             (45%) of participants were still unaware of First 5 San Bernardino.
                    Sharing
                                            Strategic Messaging: While the Commission has made considerable
                                            strides to raise awareness, there are still high need populations that
                                            appear to be unaware of First 5 issues and resources. This might
                                            necessitate more strategic media and marketing efforts to specific
  System            System                  geographic areas and target populations.
  Integration       Integration
                    Advocacy                Sustainability: Sustainability continues to be a central concern for
                                            most First 5 funded partners, and will likely become more critical
                                            given the economic downturn. First 5 San Bernardino should
                                            continue to expand its efforts around sustainability to include the
                    System Access           development and implementation of sustainability efforts.

                                            Accountability: Stakeholders mentioned the Commission’s
                                            leadership and commitment to promoting outcomes and
                    Community               accountability, noting that programs are becoming stronger, as First
                    Education               5 San Bernardino funds programs that are “tried and true.”
                                            Continuous Quality Improvement: The Commission and its
                                            funded partners continue to demonstrate their commitment to
  Community
  Engagement                                continuous quality improvement by using data and client feedback
                    Technical               to enhance and modify their programs and services delivery. There
                    Assistance              is still interest among funded partners in discussing how to better
                                            use data for program improvement.

                                            Culture of Learning: First 5 funded partners and stakeholders have
                    Community               expressed the importance of the Commission as a leader and
                    Engagement              convener in the County. First 5 San Bernardino should consider
                                            implementing a quarterly convening series (“learning
                                            communities”) for funded partners to discuss strategies, lessons
                                            learned and solutions to common challenges.


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Annual Evaluation Report FY 2007-08                                                     January 2009                 v
Conclusion
First 5 San Bernardino continued to support many programs providing vital services to young children and
families throughout San Bernardino County during FY 2007-08. The evaluation results revealed continued
positive outcomes for parents and children participating in services through the partner agencies. Feedback
from providers and stakeholders also revealed a continued respect for First 5 San Bernardino as a “learning
organization” that is committed to strengthening the infrastructure and systems that support young children
and their families.

In FY 2007-08, the Commission also reviewed and refined its Strategic Plan to ensure its continued
responsiveness and relevance to the changing needs of the community. The revised plan will help guide the
Commission’s strategic use of resources in the coming years with a renewed emphasis on capacity building,
sustainability, and deepening the impact of First 5 funds in the region.




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      Chapter 1                    Introduction to Evaluation




Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                     January 2009   1
    Introduction to Evaluation


I  n 1998, Proposition 10 was passed to authorize the use of a tobacco tax to fund services for children ages 0-5
   and their families. This unprecedented decision to support early childhood programs created the Children
   and Families Commission of San Bernardino County (First 5 San Bernardino or the Commission) and gave
   this Commission the flexibility to determine its structure, approach, and focus in response to local
community needs. Now, a decade later, First 5 San Bernardino (F5SB) has evolved as an influential leader and a
key funder of services for young children and their families. Its influence as an agent of change will continue to
expand as San Bernardino County grows. The largest county
in the contiguous United States, San Bernardino was among
the top five metro areas experiencing the greatest increase in         “I’m impressed with the
population from 2000 to 2006. 1 San Bernardino County's                diversity in the
population was about 2 million as of 2007 and by 2050 it's             organizations that they fund
expected to nearly double to an estimated 3.7 million, 8-9% of         and also with how they are
                                          2
which will be children under the age of 6. The diversity,              going about trying to meet
geographic breadth, and numbers of families and children 0-5           the needs of an enormous
pose both opportunities and challenges for the Commission              county.”
as it seeks to support its mission to promote, support, and
enhance the early development of children prenatal through
                                                                                             – Stakeholder
age 5.

On an annual basis, Harder+Company Community Research (the Commission’s external evaluator) produces
a comprehensive report that documents the results of the Commission activities and strategic funding efforts.
The Commission uses this information to reflect on the successes and challenges and to make informed
decisions about future funding opportunities and priorities. The Commission is committed to systematically
collecting information that helps strengthen programs, improve outcomes and document the collective impact
of their investments.

The purpose of this report is to document the overall impact of F5SB’s work from July 2007 through June 2008.
It is an impact evaluation report, which seeks to address the successes and challenges of the Commission’s
initiatives and activities on the children and families who access the services, the collective programs it funds
and the health, education and family systems in this community.

The Purpose of Evaluation

The evaluation approach not only captures how funds are used, but how F5SB investments contribute to
improving outcomes for children 0-5 and their families. Using a mixed methods approach, the evaluation also


1
  U.S. Census. Accessed 8 November 2007.
<http://www.census.gov/Press-Release/www/releases/archives/population/009865.html>.
2
  State of California, Department of Finance. Race/Ethnic Population with Age and Sex Detail, 2000–2050. Sacramento, CA, July
2007.

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Annual Evaluation Report FY 2007-08                                                              January 2009                   2
seeks to go beyond the quantitative measurement of client and program achievement to capture the personal
stories and experiences of those who participate in programs and services that are funded by F5SB.

Evaluation is a critical part of the information loop as illustrated in the diagram below (Exhibit 1.1). As part of
the Commission’s outcomes-based approach, evaluation findings help the Commission, partner agencies, and
community stakeholders better understand the results of F5SB investments and make informed decisions
about funding priorities and allocations.



                                    Exhibit 1.1 The Evaluation Loop:
                    Assessing, Planning, Implementing, Analyzing & Reporting Results




Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                      January 2009                 3
Evaluation and the Strategic Plan

The First 5 San Bernardino Strategic Plan is a critical guiding document that is reviewed annually and modified
periodically to ensure that it reflects new state initiatives, evolving trends, emerging needs, and demographic
shifts. 3 The Strategic Plan utilized during FY 2007-08 was approved and disseminated beginning July 2006 and
thus marks the second year of its utilization. 4 First 5 San Bernardino’s Strategic Plan for FY 2007-08 was based
on five Desired Result Areas (i.e., long-term goals):


          Children are safe and healthy
          Children are ready to enter and succeed in school
          Families are safe, healthy, nurturing, and self-sustaining
          Systems are responsive to the needs of children, families, and communities
          Communities are engaged and empowered to meet the needs of children and families


To achieve these results, the Commission has
invested in a variety of programs that it believes                   Utilizing Evaluation Findings:
will ultimately contribute to positive outcomes
                                                                      2007-08 Strategic Analysis
for young children and families. Programs are
classified into specific programmatic Strategies,
                                                                In FY 2007-08, First 5 San Bernardino formed
which are assigned to an umbrella Cluster.                      an advisory committee to conduct an analysis
There are five Cluster areas that correspond to                 of their Strategic Plan. The committee
the above Desired Results Areas. They include:                  reviewed previous evaluation findings to
           Health and Well-Being                                refine and strengthen their established goals
                                                                and defined Cluster/Strategy areas. Without a
           Early Care and Education                             systematic approach to reviewing
           Family Support                                       Commission-supported activities and
                                                                outcomes, critical activities such as the
           System Integration                                   strategic analysis would be executed without
           Community Engagement                                 context to inform the process.



In FY 2007-08, F5SB funded approximately 197 programs, sponsorships, and other activities with an allocation
of $29,927,843 to address the local needs of children 0-5 and their families. The pie chart in Exhibit 1.2 reflects
the distribution of funds by Cluster in FY 2007-08. Each chapter that follows in this report includes evaluation
findings related to each Cluster and its corresponding Desired Results.




3
 See First 5 San Bernardino’s website for the Strategic Plan in its entirety. Available at: http://www.first5sanbernardino.org
4
 The Strategic Plan was analyzed and refined during FY 2007-08 and a new version will begin implementation in FY 2008-09.
This annual report is based on the version approved in 2006. For more information about the Strategic Analysis process, see
Chapter 5. System Integration and Community Engagement.

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Annual Evaluation Report FY 2007-08                                                                 January 2009                 4
         Exhibit 1.2 2007-08 Actual Budget Allocation by Cluster (Total Awards = $29,927,843)


                                                                System
                                     Family Support,       Integration, 1.1%
                                         24.1%

                                                                             Community
                                                                            Engagement,
                                                                               3.7%




                  Early Care &
                Education, 31.7%

                                                                        Health & Well-
                                                                        Being, 39.4%




To assess progress and measure results, F5SB’s funded partner agencies are required to establish Performance
Targets (PTs) for each program activity. PTs are program-level benchmarks or progress indicators that specify
verifiable participant gains or condition changes as a result of the program activities. Achievement of these PTs
represents success for the program.

Performance Targets link directly to Performance Target Areas (PTAs) which represent collective
Commission-Level Outcomes (CLOs). Achievement of CLOs/PTAs represents success for F5SB.

Logic models are used by the Commission and evaluation team to help chart progress towards interim and
long-term outcomes. The First 5 San Bernardino Evaluation Framework Logic Model (see Appendix C) serves
as a roadmap that shows the connections between short-term, intermediate, and long-term outcomes for each
Desired Result Area.



Evaluation Approach and Methods

First 5 San Bernardino’s evaluation is a collaborative, mixed methods approach designed to gather meaningful
data that can be used to improve programs, policies, practices and decision-making. The Evaluation
Framework serves as a roadmap for how results will be collected and reported to the community and
stakeholders. The First 5 San Bernardino Evaluation Framework defines an approach that is characterized by
the following hallmarks: multi-level, collaborative and utilization focused, impact oriented, and mixed
methods. A brief description of each hallmark is below.

Multi-Level
With a focus on outcomes, information is collected from multiple sources and at multiple levels to assess how


Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                      January 2009           5
F5SB funding affects individuals, agencies, systems and communities throughout the County. The multiple
levels include:
        Client level: Client-level data provide information about how programs or services affect individuals.
        Examples of client-level outcomes might include improved parent communication skills or
        demonstrated developmental gains for a child.
        Program level: At the program level, the evaluation assesses how funding impacts the provider
        agencies. Examples might include improved interagency partnerships or increased capacity to provide
        services to the target population.
        Systems and community level: The evaluation also examines systems and community outcomes such
        as increased service integration and community awareness of the importance of the child’s first five
        years.


Collaborative and Utilization Focused
The evaluation approach works collaboratively with F5SB partner agencies, Commission staff, and the
Commission’s advisory bodies. The evaluation loop, noted in Exhibit 1.1, relies upon the participation of
multiple stakeholders throughout all stages in the process; from assessing needs, to collecting data, and
utilizing results. First 5 San Bernardino and the evaluation team strive to design an evaluation that is
meaningful, feasible, and timely for use in planning, policy and other decision-making.

Impact Oriented
Understanding the individual and collective impact of programs funded by F5SB requires understanding the
actual outcomes of the partner agencies, as well as the process of service delivery.

Mixed Methods
In an effort to capture both the stories and the numbers, the evaluation is designed to document outcomes and
better understand the ingredients of effective program implementation. Given the ambitious evaluation plan,
the approach includes an array of quantitative and qualitative methods ranging from more rigorous surveys
and assessments of behavior change to qualitative approaches that include focus groups, case studies, and
stakeholder interviews. Sources and data collection methods for FY 2007-08 are presented in Exhibit 1.3. For
more specific information about each evaluation component, see the expanded methodology in Appendix B.




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Annual Evaluation Report FY 2007-08                                                   January 2009           6
                             Exhibit 1.3 2007-08 Evaluation Methods and Data Sources*

                              Sources                                          Description

                                                   Quarterly reports provided numbers representing clients served for
                     Funded Partner Quarterly
                                                   each type of service and the number of clients progressing in each
                             Reports
                                                   program throughout the year.

                                                   Program surveys provided “pre and post” self-reported client data on
                             Program
                                                   various topics pertaining to Commission-Level Outcomes under the
                        Intake/Exit Surveys
                                                   Desired Results within the Strategic Plan.
     Quantitative




                                                   In 2008, 1,227 random digital dial phone interviews were conducted
                                                   throughout the County by the Institute of Applied Research and
                       First 5 San Bernardino      Policy Analysis at Cal State San Bernardino. The survey collected data
                        2008 Family Survey         relevant to the F5SB target population and provides valuable
                                                   community context data that can be compared to the 2006 survey
                                                   findings and the F5SB clients.

                                                   Community indicators provide measurements that can be used to
                                                   compare evaluation findings and track changes in community
                       Community Indicators        conditions over time. Indicators in this report include those collected
                                                   by large institutions, such as the State of California and UCLA
                                                   California Health Interview Survey (CHIS).

                                                 The goal of the Community Storybook was to understand the impact
                                                 of a sample of seven F5SB partner agencies. Case studies were
                    Case Studies & Participatory
                                                 conducted with providers and families participating in services to
                           Photography
                                                 understand perceived impact. Participating parents were also
                      (Community Storybook
                                                 trained in participatory photography techniques to capture visual
                              Project)
                                                 representations of the issues and effects of services on the child, the
                                                 family, and the community.
     Qualitative




                                                   Focus groups provided an opportunity to hear from parents involved
                           Focus Groups            in First 5 services and programs. Four focus groups were conducted
                                                   in FY 2007-08.

                                                   F5SB funded partners participated in a voluntary annual survey that
                      Funded Partner Survey        reveals the many ways in which partners contribute to the
                                                   Commission’s systems-level goals and objectives. (n=43/57.3%)

                                                   Interviews were conducted with 20 community stakeholders who
                                                   provided insight, perspective, and recommendations about the role
                      Stakeholder Interviews
                                                   of F5SB as a funding agency, leader, and advocate for children and
                                                   families.
*For more information, see Appendix B.




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Annual Evaluation Report FY 2007-08                                                            January 2009              7
Limitations of Evaluation

Like every research project, this evaluation has limitations. In general, it is important to recognize that a
Commission-level evaluation cannot address multiple levels of impact to the fullest extent that may be desired
by all stakeholders. The purpose of this evaluation is to measure the broad impact of the Commission,
describing trends in outcomes and the impact of groups of similar programs, in order to assist F5SB in
understanding its impact on the community and its progress toward meeting its Desired Results.
Consequently, the nuances of discrete programs are not addressed in this report and are left to F5SB’s contract
monitoring process.

Specific evaluation challenges and limitations during FY 2007-08 included the following:

        This year marked the first full year of the utilization of a new data system designed to capture First 5
        activities and outcomes. Although tremendous improvements were made to the system, there
        continued to be challenges. Specifically:
             o   The process of quarterly report data entry is set up in a way in which new clients are not
                 always being accurately captured.
             o   Quantitative data analyzed by Harder+Company and presented in this annual evaluation
                 report are based on the collection and entry of data by F5SB partner agencies. Although
                 efforts are made to review the data for errors, errors in data collection and reporting may exist
                 and readers should use caution in interpretation.


        The partner agencies were funded under specific Strategies, but often each pursued different activities
        necessitating program-level evaluation measurement tools and methods. For example, in the Health
        Care Access Strategy, partner agencies focus on different aspects of health promotion, such as
        breastfeeding, insurance enrollment, and direct health care services to children. Thus, it is not possible
        to succinctly report on countywide impact given that most partners do not pursue common
        Commission-Level Outcomes or utilize common evaluation tools.




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Annual Evaluation Report FY 2007-08                                                     January 2009               8
          Chapter 2 Health and Well-Being

Key Findings
    During FY 2007-08, the Child and Family Assessment Strategy provided services to approximately 15,674
    clients. This is a significant increase over the numbers of clients reported last year. Much of the increase is
    due to improvement and expansion of the screening component of the Perinatal SART model. Of those
    served, 95.5% of the participants were parents and a much smaller percentage (4.3%) were children.
    Agencies in the Children’s SART and Perinatal SART programs are implementing best practices and
    utilizing standardized assessment tools. The use of these instruments demonstrates a continued
    commitment to provide a high level of screening for the children and adults.
    Screenings completed by Children’s SART partners reveal that partner agencies are serving a high risk
    population of children. They also suggest a high need for further services beginning with the completion
    of a more thorough assessment. The relationships between screener and service providers must continue
    to strengthen in order to meet the needs of these children and their families.
    Demographic data demonstrated that programs are serving people from diverse backgrounds but remain
    committed to the target population of low-income families, low levels of formal educational attainment,
    and isolated communities.
    First 5 funded community based providers continued to make available a wide variety of health care
    services and dental screening in every region of the County. The ability of F5SB to support efforts by
    community based organizations across a very disparate and large county has increased the reach of
    services for San Bernardino families.
    An estimated 12,000 clients received general health services, while over 35,000 clients accessed dental
    services through First 5 HCA partners.

Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                     January 2009              9
    Introduction to Health and Well-Being


H      ealth and well-being is a broad and complex subject matter. It includes the physical and social-emotional
       health of the child, as well as that of pregnant women and the parents who care for young children. San
       Bernardino County children and families continue to face many challenges in this area. Consider the
       following statistics:
     14% of children in San Bernardino County do not have regular access to a doctor, compared to 12% for the
     State of California. 1
     Fewer San Bernardino County children 0-5 have dental insurance compared to those across the State
     (80.4% and 81.4%, respectively). 2 Furthermore, between 40-49% of children 0-5 in San Bernardino
     County have never visited a dentist. 3
     Approximately 83% of San Bernardino mothers receive early prenatal care, 4 compared to 97% of mothers
     throughout California. 5
     Approximately 30% of pregnant women in San Bernardino County screened for alcohol or illegal drug use
     were positive during 2006. The County spends over $6 million per month for children who, as a result of
     neonatal drug exposure, exhibit emotional and
     behavioral problems in their teens that require
     institutional care. 6                                 “First 5 has done a lot across the
                                                                       spectrum on the medical end –
Funds to address these issues have become scarcer at
                                                                       with health insurance being made
the State and Federal level, while the needs within San
Bernardino County have increased. First 5 San                          available to children who need
Bernardino made these issues a priority during 2007-08                 it…and making a significant
by setting aside $9.7 million for the Health and Well-                 contribution to oral health. Also, I
Being Cluster to assist in improving health outcomes                   think they have made an
for children ages 0-5 and their families. The                          important investment in early
Commission focuses on two key Strategies to positively                 interventions both with Perinatal
impact children’s health and well-being:                               and Children’s SART.”
                                                                                                        – Stakeholder
     Child and Family Assessment (CFA) Strategy:
     Perinatal and Children’s Screening, Assessment,
     Referral and Treatment (SART) programs and support for parents with children with special needs
     comprise this strategy.
     Health Care Access (HCA) Strategy: This Strategy includes a variety of programs that provide access to
     health insurance and health care services and promote prenatal/perinatal care and infant health.


1
  Children Now. (2007). 2007 California County Data Book. <http://www.childrennow.org>
2
  Ibid.
3
  Center for Health Policy Research, University of California, Los Angeles. California Health Interview Survey. 2007. Accessed 10
November 2008 <http://www.chis.ucla.edu/>
4
  Children Now. (2007). 2007 California County Data Book. <http://www.childrennow.org>
5
  Children Now. (2007). California Report Card 2006-07: The State of the State’s Children. <http://www.childrennow.org>
6
  Children’s Network of San Bernardino County, 2006 Annual Report.
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Annual Evaluation Report FY 2007-08                                                                January 2009                10
During FY 2007-08, the Health and Well-being Cluster was comprised of 32 partner agencies. The amount
allocated through contracts and expended for the year can be seen in Exhibit 2.1. The allocation awarded
exceeded the planned allocation due to the implementation of the Community Investments funding stream in
winter 2007, aimed at increasing First 5 San Bernardino’s (F5SB) collaboration with community based
organizations in all regions of the County. Many of these community investments were awarded to support
children with special needs and improve perinatal and infant services. 7



                        Exhibit 2.1 2007-08 Health & Well-Being Cluster Investments
                                                                                                              % of Total
                                                                                          % of Award
    Total Allocation    Contract Awards          % Awarded            Expenditures                            Allocation
                                                                                          Expended
                                                                                                              Expended
       $9,750,000           $11,778,834             121.0%              $9,561,648            81.2%             98.1%




Linkages to the Strategic Plan
                                                                          “I think mental health and well
As seen in Exhibit 2.2, the Health and Well-being Cluster
                                                                          being is not something that had
connects to the first three Desired Result areas in the First 5
San Bernardino Strategic Plan. The Commission-Level
                                                                          been previously embraced. First
Outcomes (CLOs) listed below are the most common                          5 has been diligent at
outcomes that the Cluster’s Strategies work towards;                      expanding mental health…they
however not every partner agency within the Cluster links                 have been on the forefront.”
to each indicator. 8                                                                                  – Stakeholder




7
    For more information about the Community Investments awarded in 2007, see the 2006-07 Annual Evaluation Report.
8
    For a list of all F5SB Desired Result Areas, Objective and Commission Level Outcomes, see Appendix C.
Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                            January 2009                11
                 Exhibit 2.2 2007-08 Health & Well-Being Cluster Linkages to Strategic Plan
                                                                                                              Strategy
         Objective                                 Commission-Level Outcome
                                                                                                               Area(s)
                                 Desired Result 1: Children are Safe and Healthy
                                     1.1 Increased utilization of prenatal care                                 HCA
1. Children are born healthy         1.2 Reduced number/percent of pregnant women abusing
                                                                                                                CFA
                                     substances
                                     2.1 Increased number/percent of children with health insurance
                                                                                                                HCA
                                     and ongoing relationship with health provider
                                     2.2 Increased number/percent of children receiving annual dental
2. Children are healthy, well                                                                                   HCA
                                     screenings and appropriate follow-up care
nourished and physically fit
                                     2.3 Increased number/percent of mothers breastfeeding                      HCA

                                     2.4 Improved nutrition among children                                      HCA
                                     2.5 Improved physical fitness among children                               HCA
                                                                                                                CFA
                                     3.1 Reduced number/percent of parents abusing substances
                                                                                                                HCA
                                     3.2 Increased number of parents trained in child related safety
3. Children are raised in safe                                                                                  HCA
                                     and put this knowledge into practice
and nurturing environments           3.3 Decreased number/percent of families with reoccurrence of
                                     identified child or domestic abuse (repeated 10.3)
                                                                                                                CFA

                                     3.4 Increased parent-child bonding attachment                              CFA

                   Desired Result 2: Children are Ready to Enter and Succeed in School
5. Children receive early
                                     5.1 Improved screening, assessment, referral and treatment of
screening & intervention for                                                                                    CFA
                                     children for special needs identification and intervention
special needs
                                     7.1 Increased number/percent of children exhibiting age-
                                                                                                                CFA
7. Children develop within           appropriate development
normal ranges in all domains         7.2 Increased number/percent of children exhibiting healthy
                                                                                                                CFA
                                     cognitive and social-emotional behavior

              Desired Result 3: Families are Safe, Healthy, Nurturing and Self-Sustaining
                                     8.2 Increased coping skills among parents to improve parenting
8. Parents are mentally and          behavior (attitudinal domains such as anger management, stress             CFA
physically fit                       relief)
                                     8.3 Improved nutrition and physical fitness among parents                  HCA
9. Parents practice                  9.1 Increased number/percent of parents understanding
developmentally appropriate          developmental milestones and practicing parenting skills that re           CFA
parenting skills                     developmentally appropriate for their child
10. Children are free from any       10.1 Increased number/percent of parents practicing positive
                                                                                                                CFA
form of abuse                        disciplinary skills
                                     11.1 Improved parental ability to access and coordinate needed             CFA
11. Families are stable and
                                     services for their children                                                HCA
have the capacity to meet the
needs of their children              11.2 Improved parental ability to meet the basic needs of their            CFA
                                     families                                                                   HCA




Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                            January 2009           12
    Child and Family Assessment

First 5 San Bernardino has invested in numerous programs that focus on the early identification of
developmental delays and disabilities in children 0-5. Early identification helps ensure that children receive
assistance and interventions and enter school ready to learn. According to the Centers for Disease Control and
Prevention, 17% of children ages 0-17 have developmental or behavioral disabilities and even more have delays
in language or other areas. Yet, less than 50% of these children are identified as having a delay prior to entering
school, by which time the delay may become more significant and opportunities for treatment are missed. 9

Through the Child and Family Assessment (CFA) strategy, nine agencies received a total of $2,702,574 during
FY 2007-08. The CFA Strategy includes supporting a countywide initiative to increase screening, assessment,
referral and treatment of pregnant women and children who are at risk of developmental delays, behavioral
problems due to social-emotional factors, and drug exposure in utero. Known as the Children’s SART and
Perinatal SART projects, (Screening, Assessment, Referral, and Treatment) these projects involve blended
funding from multiple public and private sources.

In addition to these projects, F5SB funds programs that provide education and assistance for parents of
children with special needs. The agencies and their program focus are described in Appendix A.

Key Elements and Activities
                                                                              “The way that First 5 has
This section highlights the key elements and activities of four               supported the growth of the
primary service areas:                                                        SART programs and the
     Children’s SART                                                          capacity building efforts has
     Perinatal SART
                                                                              allowed the programs to be
                                                                              successful.”
     Children with Special Needs
                                                                                                      – Stakeholder
     Parent Education and Support


Children’s SART and Perinatal SART

One of the primary goals of the CFA Strategy is to implement approaches that increase collaboration and
streamline the processes by which children and parents move from screening to treatment. Based on the SART
model developed by Dr. Ira Chasnoff’s (Children’s Research Triangle), 10 the San Bernardino SART initiative
seeks to provide a comprehensive continuum of screening, assessment, referral, treatment and prevention
services for children and their families in San Bernardino County. The collaborative nature of SART has
impressed community stakeholders with one stating, “On a systems level, [First 5] has been allowed the
opportunity to build partnerships with county and community partners that were not in existence before, with

9
  U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center on Birth Defects
and Developmental Disabilities. Accessed 28 September 2007. <http://www.cdc.gov/ncbddd/child/devtool.htm>
10
   http://www.childstudy.org/
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Annual Evaluation Report FY 2007-08                                                            January 2009               13
child servicing county systems. These partnerships are an important direction for them to be going.”

Young children, ages 0-5, and pregnant women are screened, assessed, and referred for treatment through a
regional collaborative and standardized process that strengthens and builds on existing programs in the
community. First 5 San Bernardino is one of many funders who support Children’s SART and Perinatal SART.
SART has been implemented in stages as partner agencies work to build the capacity necessary to bring the
initiative to scale. The ultimate goals include:
           Babies are born free of exposure to alcohol, tobacco and other drugs
           Children are raised in a safe and nurturing home
           Children and families achieve optimal health and development

Children’s SART is being implementing in stages and includes
the development of three regional assessment centers: one in
the High Desert (opened in October 2005), a second in the             “[My daughter] is able to be
Central Valley region (opened in October 2006), and a third in        herself and share her
the West End which opened to the community this fiscal year.          emotions with me and feel
SART partners have made the strategic decision to start with          secure.”
the most vulnerable children in the child welfare system,
                                                                              – Children’s SART Focus
particularly those in foster care, and then expand to other target
populations such as those in Head Start.
                                                                                    Group Participant

Perinatal SART is similar to Children’s SART, but focuses on pregnant women. The primary service provider
for Perinatal SART is the Partnership for Healthy Babies (PHB). The role of PHB is to recruit and train
obstetric and other prenatal care providers about the importance of screening pregnant women for substance
use. One of PHB’s goals is to implement standardized screening countywide. Once onboard with the PHB
protocol, medical providers screen pregnant women using a standardized methodology as part of the initial
assessment of drug, alcohol, and tobacco use during pregnancy, followed by a referral to appropriate treatment
programs.

On the following two pages are diagrams (Exhibit 2.3 and 2.4) of each SART system of care, including how
clients pass through the systems, as well as the F5SB funded partners that collaborate and provide services
along each continuum.




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Annual Evaluation Report FY 2007-08                                                  January 2009             14
                       Exhibit 2.3 Continuum of Care for Children’s SART Model

                                                        Services                        Providers
  Provider Training                                                          Children’s Fund/Network
                                          Training:                          Cal State San Bernardino
                                             • Ongoing provider training     Desert Mountain SELPA
                                               in evidence-based practices   West End Family Counseling
                                                                             Services
    Screening                             Screening:
                                                                             Cal State San Bernardino
                                                                             Desert Mountain SELPA
                                             • ASQ and ASQ-SE
                                                                             West End Family Counseling
                                                                             Services
                                                                             Other partners
   Assessment                             Assessments may include:           Cal State San Bernardino
                                            • Physical assessment            Desert Mountain SELPA
                                            • Psychological assessment       Christian Counseling Service
                                            • Occupational therapy           West End Family Counseling
                                            • Speech and language            Services

    Referral                                                                 Cal State San Bernardino
                                          Referrals to treatment:            Desert Mountain SELPA
                                            • SART partners                  Christian Counseling Service
                                              (subcontracts)                 West End Family Counseling
                                            • Outside agencies               Services
                                                                             Treatment Sites/Subcontractors
   Treatment                              Evidence-based treatment           Cal State San Bernardino
                                          may include:                       Desert Mountain SELPA
                                             • Family therapy                West End Family Counseling
                                             • Individual therapy            Services
                                             • PCIT                          Christian Counseling Service
                                             • Occupational therapy          Treatment Sites/Subcontractors




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Annual Evaluation Report FY 2007-08                                                   January 2009            15
                        Exhibit 2.4 Continuum of Care for Perinatal SART Model

                                                        Services                        Providers
 Provider Training
                                          Training:
                                                                             Partnership for Healthy Babies
                                             • Recruitment and training of
                                               providers

    Screening
                                          Screening:
                                                                             Physicians/Providers
                                             • 4 P’s Plus

                                          Selective prevention:
                                             • Smoking cessation
                                               materials
                                                                             Physicians/Providers
                                             • “I am Concerned” –
                                               pretreatment educational
                                               book
    Assessment
                                          Assessment:
                                            • Field assessment
                                                                             Physicians/Providers
                                              conducted after positive
                                              screen

     Referral                             Referrals to treatment:
                                            • Perinatal SART
                                                                             Treatment Sites/Subcontractors
                                              subcontractors
                                            • Outside agencies

    Treatment                             Treatment may include:
                                             • Recovery center
                                             • Intensive outpatient care
                                                                             Treatment Sites/Subcontractors
                                             • Residential treatment
                                             • Other programs (for less
                                               intensive intervention)




Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                   January 2009            16
Children with Special Needs and Parent Education and Support

First 5 San Bernardino recognizes the unique challenges faced by parents of children with special needs. For
many parents, navigating the service system, understanding and assisting their child, and finding the emotional
support can be daunting and overwhelming. F5SB recognizes these challenges and provides support through
Community Investment partner agencies. Four agencies were funded by F5SB in 2007-08 to provide support
and education for parents raising children diagnosed with specific developmental delays and disabilities. These
include the following:
           A Special Place Children’s Museum - “Parent-to-Parent Support Group for Special Needs Children”
           Blindness Support Services - “A Tactile Approach to Learning”
           Mountain Special Needs Network
           Samaritan Counseling Center - “BEAMS”



Summing It Up: Child and Family Assessment

During FY 2007-08, the Child and Family Assessment Strategy provided services to approximately 15,674
clients. This is a significant increase over the numbers of clients reported last year. Much of the increase is due
to improvement and expansion of the screening component of the Perinatal SART model. Of those served,
95.5% of the participants were parents and a much smaller percentage (4.3%) were children.

Demographic data was much more thorough during FY 2007-08 than the previous FY. Race/ethnicity data was
available for 89.7% of CFA clients as compared with last year where data was available for fewer than half
(45.6%). Of the clients who reported an ethnicity, 55.1% identified as Hispanic/Latino and 28.5% identified as
White. This year language data was available for 91.5% of clients as compared to last year where it was
available for only 47% of clients. Of those who reported primary language, 72.3% of clients reported English as
a primary language. This is illustrated in the graphs on the following page (Exhibits 2.5 and 2.6).



Making a Difference: Child and Family Assessment in Action

This section highlights the outcomes from the Child and Family
Assessment Strategy for FY 2007-08. In FY 2007-08, providers
                                                                        “Now, she looks forwards to
in the CFA Strategy were providing services in all regions of San
                                                                        me teaching her. She didn’t
Bernardino County. Reaching underserved populations in all
                                                                        like it before. She didn’t
regions of the County continues to be a priority for F5SB and its
funded partners. In addition to regular progress reports and
                                                                        want to know her ABC’s
screening results submitted to F5SB by the partners, a focus            because I was so stern.”
group was conducted with clients from Christian Counseling                       – Children’s SART Focus
Service and a case study was completed with a client enrolled at                       Group Participant
the High Desert Assessment Center through Desert-Mountain
SELPA.


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Annual Evaluation Report FY 2007-08                                                     January 2009             17
        Exhibit 2.5 2007-08 CFA Participants:                             Exhibit 2.6 2007-08 CFA Participants:
                   Race/Ethnicity                                                   Primary Language
          (Aggregate and Core n=14,062)*                                    (Aggregate and Core n=14,341)*

                  African
                 American                Other,                                             Spanish,
                  , 12.1%                4.1%                                                27.1%
                                                                                                                 Other,
                                                                                                                 0.7%
     White,
     28.5%




                                             Latino,
                                             55.1%                                       English,
                                                                                          72.3%


*Total client n=15,674, excluded 1,612 records with declined or    *Total client n=15,674, excluded 1,333 records with declined or
missing ethnicity data                                             missing language data



Children’s SART Model

Community Context
According to the First 5 San Bernardino Family Survey, children continue to be identified with special needs
and/or disabilities throughout the County. When asked if their child had ever been diagnosed by a health care
professional as having disabilities or special needs, 10.8% of respondents were affirmative in 2006, while 7.4%
agreed in 2008 (Exhibit 2.7). 11 Of those parents who responded “yes” to having had a health care professional
diagnose one of their children as having a special need or disability, speech impairment was the most common
diagnosis in both survey years.

While children continue to show need in terms of development, the rate of parents indicating that their child
has been screened continued to be high, according to the 2008 Family Survey. Over seventy five percent of
parents who participated in the Family Survey both years reported having had their child checked by a
professional to make sure he/she was developing both motor and social skills at the appropriate rate according
to their age (Exhibit 2.7). 12




11
   Bockmann, S., Sirotnik, B., Aldana, L. Brief Report, Phase 1: 2006 First 5 Family Survey; & 2008 First 5 San Bernardino Family
Survey. Institute of Applied Research and Policy Analysis, California State University, San Bernardino. 2006 & 2008.
12
   Ibid.
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Annual Evaluation Report FY 2007-08                                                                 January 2009                18
     Exhibit 2.7 Family Survey: Children Showing Developmental Need and Receiving Developmental
                                            Screening by Year

                                                                            75.8%             76.9%




                                                                                                                      2006
                                                                                                                      2008


                      10.8%
                                         7.4%


                       Have Special Need                                    Received Screening




First 5’s Impact
San Bernardino County faces many challenges in service provision ranging from the geographic expanse of the
County to the limited number of providers available in more remote regions. With a focus on the regions and
populations with the highest and most immediate needs, the Children’s SART Centers are providing screening,
assessment and treatment services to at-risk children in the child welfare system.

In FY 2007-08, Children’s SART programs served an
estimated 600 children with targeted intensive
                                                                                “I wanted my daughter to
interventions for developmental/behavioral issues, as well
                                                                                secure the attachment with me. I
as those with determined special needs.
                                                                                wanted to completely embrace
As a starting point to serve these children, the Children’s                     motherhood and enjoy it
SART Centers utilize two screening tools: the Ages and                          because I wasn’t.”
Stages Questionnaire (ASQ) and the Ages and Stages                                  – Children’s SART Focus Group
Questionnaire: Social Emotional (ASQ-SE). The results of
                                                                                                       Participant
these two tools are summarized below.

ASQ
The ASQ instrument was developed as a screener for early identification of developmental delays in young
children. It is utilized to screen for various disorders or needs that can be diagnosed in early childhood and
which can benefit from early intervention. 13 The ASQ produces scores on five developmental domains:
communication, gross motor, fine motor, problem solving, and personal-social. Analysis of the ASQ compares

13
  The ASQ has two main purposes. First, the tool is used to screen large groups of infants and young children. The questionnaire
also can be used to monitor the development of children that are at risk for developmental delays resulting from medical factors
such as low birth weight, prematurity, or from environmental factors such as poverty, parents with mental impairments, history
of abuse and/or neglect in home, or teenage parents. The ASQ intervals are 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 27, 30, 33, 36, 42,
48, 54 and 60 months; each with age-appropriate questions and tailored cut-off scores. Source: Squires, J., Potter, L., and Bricker,
D. The ASQ User’s Guide, 2nd Ed, Baltimore, MD: Paul H. Brooks Publishing, 1995. 3-5.
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the individual scores of each child in each developmental area with the scientifically set cut-off scores for each
of the ASQ’s age-specific instruments. This helps preserve the design of the tool while comparing children’s
status “above” or “below” the age-specified cut-off score at each point in time. 14 “Above” the cut-off score
indicates the child is at or above the skills expected for their age; “below” the cut-off score indicates the child
may be behind for their age. Following the SART model utilized in San Bernardino County, a child who was
screened and whose results in any of the domains was below the cut-off should be referred for further
assessment.

During FY 2007-08, the three SART Centers reported baseline ASQ data representing 304 children ages 4
months to 5 years. 15 This is very similar to the number available for the previous FY (n=318). One possible
explanation for the similarity in number is that the third SART center came on-line later in the fiscal year and
only recently began seeing clients. Exhibit 2.8 below shows the percentage of children below cut-off on the
ASQ for both FY 2006-07 and FY 2007-08. During FY 2007-08, there was an increase in the percentage of
children screened who reported at below cut-off on each of the five developmental domains. While there was
no change in the identified target population, the level of need among the children screened seems to have
increased. Particularly on the Communication domain, 45.1% of all clients screened were below the cut-off.
This suggests an increased need within the population being served by the SART centers, as well as an
increased need for further assessment. It is through this assessment that specific needs are identified and
children are referred to appropriate service providers within the community.


     Exhibit 2.8 Percent of Children Below Cutoff at Baseline in Each ASQ Developmental Area by Year


                                                                                          2006-07 (n=318)
                                                                                          2007-08 (n=304)
                45.1%
                                                             39.5%
         34.0%                                          33.6%                  32.1%33.9%
                                                                                                            29.6%
                                                                                                       25.5%
                                        23.0%

                                 17.6%




       Communication            Gross Motor             Fine Motor          Problem-Solving          Personal-Social




14
   In this analysis, the cut-off scores used are specific to each instrument used for the screening. Using the “above” or “below” cut-
off allows for accurate analysis, regardless of instrument used during the screening.
15
   Due to a very small number of follow-up items (n=31), it was not possible to complete analysis comparing intake and post data.
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                       SART Treatment from the Parent’s Perspective
   Christian Counseling Service (CCS) is a First 5 funded partner agency that provides treatment to a
   number of the children screened by the SART centers. It is an interfaith, non-profit organization that
   provides Parent-Child Interaction Therapy (PCIT), an evidence-based practice shown to help parents
   by reducing their child's stressful behaviors and increasing parent’s skills in working with the child
   that participates in therapy with the parent. Over the last FY, clients from Christian Counseling
   Service participated in a focus group facilitated by Harder+Company staff. During the focus group,
   parents answered questions about their experience with both the services and their child. The group
   of parents who volunteered to participate represented clients who had been in PCIT for varying
   amounts of time, from recently begun to almost a year into services.

   There were several reasons that brought the parents and their children to services at CCS. For one
   client, CPS involvement was the motivating factor, and for another, her son had been “kicked out” of
   so many preschools that she was not sure what else to do. It was at the last preschool that staff told
   her about CCS and the help they could provide to her and her son. While all the cases had different
   motivating factors for seeking services, all clients reported that the treatment with CCS helped and
   positively impacted their relationships, both with children and co-parents. One mother commented,
   “He knows he has a structure and has the same set of rules here, at home and at school… it’s really,
   really helping.”

   All parents reported that they were attending PCIT treatment once a week, and then continued at
   home practicing the skills taught to them in the sessions. When asked to describe the skills learned,
   one parent replied, “There are lots of different skills. (For example) when a certain behavior is
   problematic they get a feedback sheet . . . with different techniques for the behavior.” Another
   theme that was frequently mentioned by the parents was the strengthening of the bond with their
   child. One parent, reflecting on how he was raised, wanted to develop a strong bond with his child
   and found that PCIT helped him with this. “I think we are all creatures of habit. I think that the way
   that we were raised and some of what we experienced, we do not want to project it to our
   children…the way you talk positive instead of a negative tone and it makes them want to do better.”

   Another commonality expressed by the parents in
   the group was a feeling of being overwhelmed and          “They teach you how. That’s
   wanting to give up on being a good parent. One            what I love. . . I don’t have the
   parent stated, “I was tired, drained, upset, depressed,
                                                             experience and this is where I
   whatever. I just wanted someone to take [him] off my
    hands, it was too much for me.” Several talked about learned how to be a more
   being single parents with little support and              productive, effective parent.”
   struggling to keep their jobs while responding to all
   the preschool or day care concerns about their                 - Children’s SART Focus Group
   children. For many of the parents, the need to have
   their child’s behavior improve had much to do with                                    Participant
   the parent’s need to go to work and the family’s
   economic needs. “When I came in here, I’m like just fix him” was a sentiment shared by the parents.
   However, through their participation in PCIT they realized their own role in the behavior, as well as
   the skills they need to manage the behaviors they see in their children.




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ASQ:SE
The ASQ:SE screening instrument was developed in response to requests from early child care providers
looking for assistance in screening young children for social and behavioral problems. 16 The ASQ:SE assesses
several areas related to the personal-social domain (self-regulation, compliance, communication, adaptive
functioning, autonomy, affect, and interaction with people) and has demonstrated validity and reliability in 8
intervals with children ages 6 months – 60 months. 17

During FY 2007-08, Children’s SART partners continued
to use the ASQ:SE for screenings and reported baseline            “[The children] know that you
data. This year’s sample size (n=302) was very similar to         are their supporter and they
last year’s (n=269) and the percentage of children over the       know you are not there to be
cut-off was very similar, again demonstrating a high need         negative, they want to do their
for children in the 0-5 population. Much like last year, over
                                                                  best for you and they enjoy the
two-thirds of children (66.8%) who received an ASQ:SE
                                                                  praise that is offered to them.”
screening were 3 years of age or older. Also, much like the
ASQ discussed above, the percentage of children screened              – Children’s SART Focus Group
who needed further assessment was higher this fiscal year                                     Participant
(See Exhibit 2.9). 18 Unlike the ASQ, a child is referred for
further assessment if he/she is above the cut-off on the ASQ:SE. This would denote that the behavior is either
more frequent or more intense than the comparison scores for the age-appropriate cut-off scores.


                 Exhibit 2.9 Percent of Children Above Cutoff at Baseline on ASQ:SE by Year



                                                                   68.5%
                                           59.9%                                          2006-07 (n=269)
                                                                                          2007-08 (n=302)




                                                  Above Cut-off




16
   Squiers, J., Brocker, D. and Twombly, E. The ASQ:SE User’s Guide, Paul H. Brookes Publishing, Baltimore, Maryland, 2003.
17
   Investigated with over 3,000 children across the age intervals and their families. Reliability is 94%; validity is between 75% and
89%. Ibid.
18
   Due to a very small number of follow-up items , it was not possible to complete analysis comparing intake and post data.
Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                                    January 2009                 22
                 Providing Comprehensive Support for Families in Need:
                               Desert Mountain SELPA

  Valarie is a wise, resilient and compassionate woman with much to share about the trials and
  tribulations of life. As she reflects on her experiences, her eyes well with tears and she expresses what
  most parents hope for their children – a happy and fulfilling life. “The type of life I lived,” she says
  reflectively, “I didn’t want them to live that life.”

  Valarie’s niece is addicted to drugs and after being arrested, Valarie knew she needed to intervene or
  her niece’s children would end-up in the “system.” Valarie could not let that happen. She became the
  legal guardian of three children - 4 year old twins, and a two and a half year old boy. She instantly
  became responsible for meeting the special needs of these children, including helping one of the
  twins, Michael, who was diagnosed with autism.

  Michael was non-verbal when he entered her custody. His only form of communication was to head
  butt and due to sensory limitations, he would often stuff his mouth full of food, posing a potential
  choking hazard. Michael constantly fought with his brother and sister and soon Valarie’s house, quiet
  for so many years, was filled with an overwhelming amount of energy. Valarie knew nothing about
  autism at the time and was already struggling to provide the basic needs of food and shelter. Valarie
  decided she needed help and fast!

  Before becoming the primary caregiver for three children, Valarie worked in a group home and was
  familiar with the services provided by Desert Mountain SELPA. Desert Mountain SELPA offers a wide
  variety of treatments including but not limited to: Lay Therapy; Theraplay techniques; Parent Child
  Interaction Therapy; Cognitive Therapy; and Behavioral Therapy. They also house the Screening,
  Assessment, Referral and Treatment (SART) team for the mountain and desert regions of San
  Bernardino County. The agency screened Michael, identified areas for growth, developed treatment
  goals and immediately began treatment.

  Equipped with the understanding and          “Michael’s something else with his siblings.
  tools to help autistic children, the agency He shows his love and affection.
  was able to provide Michael with the
                                               Grandparents, uncles…he loves (them) to
  teaching, support, knowledge and
  practices that he needed to properly         death. Within the last couple months he
  communicate. Through the use of a            started saying grandma and grandpa. He’d
  variety of therapies, all of the children    run up to them and say ‘Hey Grandma! Hey
  began to adjust to their new home and        Grandpa!’ ”
  find a sense of safety, security, and                                         - Valarie, First 5 Parent
  stability in Valarie’s care. In a matter of
  months, Michael began to listen to others
  and respond appropriately when spoken to. He gradually developed the skills necessary to sit at a
  table and eat his food, and to watch TV without the irresistible urge to sit on his head. He learned how
  to hug people he cares about and most remarkably, has begun to call Grandpa and Grandma by their
  names.




Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                  January 2009             23
      Because of the sudden nature of Valarie’s guardianship, some basic needs, like a bed to sleep in, or a
      dresser for their clothes were not readily available. Desert Mountain SELPA made house visits,
      assessed the needs of the children and provided reliable referrals if they could not meet those
      needs. Staff from Desert Mountain SELPA went with Valarie to purchase bunk beds for the kids,
      helped Valarie provide gifts for the children at Christmas, and assisted in finding food and clothes.
      SELPA has stayed true to their motto: “The Relentless Pursuit of Whatever Works in the Life of a
      Child.”

      When creating a healthy and safe environment for children to thrive and grow, the needs of parents
      and guardians can be as important as the needs of the children. Valarie’s life changed drastically
      when she became the guardian of her niece’s children. Understanding that a sudden “life change”
      brings emotional challenges for adults, as well as children, SELPA provided counseling to Valarie as
      part of their parent/child services. They also went beyond the “call of duty” by contacting the elders
      at Valarie’s church and rallying other community members to provide support and assistance. Over
      time, Valarie has come to enjoy her new role as a caregiver, with all of its challenges and pressures. In
      talking about Michael’s struggle with autism, she recalls, “I never dealt with anything like that. He
      taught me things that nobody has ever taught me… He taught me how to be more patient and how
      to look from another vision - another set of eyes on how we take everything and everybody for
      granted. I learned how to stop doing that…(I learned) to step back, to listen to a person, to observe a
      person, to be patient with a person, to help a person… as much as I possibly can. I’m there to help.”

      Valarie has learned a lot in the last 2 ½ years that she and Michael have been in the SELPA SART
      program. Desert Mountain SELPA has taught her how to ground Michael using pressure points when
      he is feeling irritable. They have taught her how to set boundaries with the children, and how to
      create space by having a specialized and structured routine to meet all of their needs.


           “They helped in every aspect there is. Everything - mentally, spiritually,
           physically. And if they can’t help me they will find someone who can.”

                                                                                 - Valarie, First 5 Parent



Perinatal SART
                                                                        “There are more doctors screening
Community Context                                                       and educating women about drugs.
As noted at the beginning of this chapter, San                          We also have places to send
Bernardino County continues to have high rates of                       children whose behaviors suggest
substance abusing pregnant women (estimated at 30%                      they were exposed to drugs and
in 2006). 19 The effects of alcohol and drugs on the                    they are getting better…and this
developing fetus are detrimental, and therefore First 5                 positively affects school
San Bernardino continued to support the tremendous
                                                                        readiness.”
effort of the Perinatal SART partners during FY 2007-
08.                                                                                             – Stakeholder


19
     Children’s Network of San Bernardino County, 2006 Annual Report.
Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                       January 2009            24
First 5’s Impact                                                                From Recovery to Discovery:
In 2007-08, the Perinatal SART program continued to
                                                                               Learning to Live in a New Way
focus on increasing the screening of pregnant women for
substance use/abuse. One aspect in which Perinatal SART
                                                                                   through New House
attempts to intervene and improve services for pregnant
women is at the first prenatal visit. The number of                       Monica, a mother of four young children, was
screenings completed at the first prenatal visit increased                “sick and tired of being sick and tired.” She
6% from 9,660 in FY 2006-07 to 10,273 in FY 2007-08.                      was addicted to meth, homeless, had lost both
The screening (using the 4 P’s Plus 20 ) serves as an initial             her car and her job, and had already turned
baseline for the client and allows for medical staff to                   three of her four children over to relatives
maintain follow-up as the pregnancy progresses. As
                                                                          because she couldn’t care for them. In
                                                                          addition to all that, she was pregnant with
identified last year, this follow-up continues to be among
                                                                          twins, and had a rambunctious toddler in tow.
the greatest challenges faced by the service providers.
Often times they note that they are not able to contact the               Monica knew she needed to get help
clients for follow-up and therefore frequently are not able               immediately or she would eventually lose her
to document services and field assessments in the later                   daughter and unborn children. After a brief
months of the pregnancy.                                                  and unsatisfactory stay with another
                                                                          rehabilitation facility, she was ready to try
The Perinatal SART program has also improved its                          again to get clean. She called New House. “I
visibility in the community. As reported by staff, “It is                 came voluntarily. I needed a new outlook on
gratifying to see the steady climb in referrals as DCS                    life.” After placing herself on the waitlist,
workers become more aware of and confident towards                        Monica called everyday for several weeks until
the ADCs (Alcohol and Drug Counselors) working this                       she, and her daughter, were admitted. Initially
project.”                                                                 apprehensive about the strict schedules and
                                                                          incessant check-ins with doctors, she
                                                                          immediately recognized the importance of
This year, Perinatal SART was able to identify several
                                                                          following the rules and how that dedication
solutions they are proposing for implementation in order
                                                                          could ultimately result in getting her life back.
to address some of their most common challenges.
Some of these include:                                                    Once settled in, a tailored plan was
     Linking clients to smoking cessation programs has                    implemented to ensure that her unborn
     not been as successful as staff would like particularly              babies were regularly monitored by doctors.
     because many clients seem eager to pursue this                       New House set up three prenatal
     service when they initially hear about it.                           appointments a week for Monica. The babies’
                                                                          exposure to meth in the first trimester left
       o    Proposed Solution: The SART team has                          them susceptible to complications so New
            decided to train several of the staff members in
                                                                          House stepped in to provide Monica with
            smoking cessation techniques. By providing
                                                                          assistance with transportation to every single
            the training to staff, clients will be able to
                                                                          prenatal appointment. Along with a need for
            receive support and tips from staff with whom
                                                                          diligent prenatal support, New House staff
            they already have a relationship.




20
  The 4P’s represent screening for substance abuse history by asking about the woman’s parents, partners and herself, in the past
and during the present pregnancy.
Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                                January 2009                25
 recognized that Monica’s troubled childhood coupled with her drug abuse, left her with an
 inability to bond with her children.

 Reflecting on her relationship with her youngest daughter, Monica said, “In my addiction I would
 give her what ever she wanted just so that she would leave me alone and not cry. She didn’t have
 any type of discipline not just because of my addiction but because of the way I was brought up - I
 was abused.” New House offered Monica daily classes and therapy to help her get clean. They also
 helped her develop the skills and gain access to resources that would allow her to properly care for
 her children and gain more control of her life as a parent.

 Monica was soon on her way to being sober, but more importantly, becoming better equipped to
 be an attentive parent to her children. Every single service offered to Monica would result in her
 children being healthy and happy. They offered transportation to Monica’s doctor’s
 appointments, shelter, individual therapy for her, anger management classes, and parenting
 classes which helped her gain a better understanding of how children develop. She also took
 meditation and “women’s issues” classes. With a full week of classes, Monica felt she was learning
 what life could be like without her addiction. She began to learn more about herself and was on
 her way to becoming the mother she wanted to be.

 Upon graduation from the program, New House offered Monica a room in their transitional facility.
 Three days after moving into her new apartment, Monica gave birth to her twins. She is currently
 living in the transitional facility and attending school full time. She is making concerted efforts to
 stay clean and implement the techniques she learned at New House. Reflecting on her experience,
 Monica stated, “I had an awesome experience. I begged to stay when I was here…coming here
 was one of the best decisions I ever made.” Her motivation to change is driven by the desire to
 reverse some of the negative effects her drug use has had on her young children.

 Monica’s case manager at New House believes that,

 “For Monica it’s more discovery, I mean, the word recovery means to get something back and I
 don’t think that Monica, from childhood on, has anything she wants to get back. She’s
 discovering a whole new way…”



    Some quarters demonstrated a substantial decrease in clients screened and re-screened as appropriate.
             o   Proposed Solution: Staff will follow-up with providers more frequently and monitor the data
                 more closely to be able to intervene with a provider as soon as possible.


There were other challenges identified by staff that will continue with the program as they are challenges faced
by many people n the field of substance use. These include mothers committing but not following through
with receiving treatment and maintaining contact with many of these mothers for follow-up. While these
challenges do not have easy resolutions, the plan of increasing staff, may help with the strengthening of
relationships between clients and staff, allowing for the provision of increased support from staff.




Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                   January 2009             26
 Health Care Access
Access to adequate, quality healthcare is a critical component of children being ready for school. First 5 San
Bernardino’s Health Care Access (HCA) Strategy addresses the need for insurance, regular medical and dental
care, and promotion of child and family health and wellness through funding a wide range of partners that
focus on a variety of health concerns. Similar to last fiscal year, HCA funded partners reported serving a large
number of clients (estimated at over 56,000 countywide during 2007-08), demonstrating the scope and reach of
these partner agencies. While the thrust of service delivery is focused on providing access to health insurance
and medical care in a variety of settings, First 5 San Bernardino has also provided funding for programs that
target specific high-need populations including pregnant women with substance abuse problems, and children
with special needs and their parents. Many of the HCA partner agencies offer services that complement CFA
Strategy efforts to identify and treat women of child bearing age at risk of abusing substances, as well as
children at risk for developmental delays or disabilities early in life. Other HCA partners offer services that
intersect with those of Resource Centers, offering assistance or referrals to services for families with multiple
needs.

First 5 San Bernardino’s HCA Strategy involves four primary focus areas that organize this Strategy’s diverse
programs:
         Health insurance, access to healthcare and medical home
         Prenatal/perinatal care and infant health
         Oral health
         Safety and nutrition

Twenty-three partner agencies were funded within these focus areas (see Exhibit 2.10) for a total awarded
amount of $9,076,260 and expended approximately $7,508,693 (82.7%).


                 Exhibit 2.10 2007-08 Health Care Access Partners and Service Areas

                                                                       Service Areas
HCA Partners                                      Health
                                                               Prenatal care                          Safety &
                                               insurance &                       Oral health
                                                              & infant health                         nutrition
                                                healthcare
American Lung Association of CA                                                                          X

Asian-American Resource Center,
                                                                                                         X
Traffic Safety Awareness
Chino Valley Unified School District,
                                                                                                         X
Monte Vista Healthy Options
County of San Bernardino,
                                                                                       X
ARMC Dental Program
High Desert Youth Center,
                                                                                                         X
First 5 Safety and Wellness Program


Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                    January 2009               27
                 Exhibit 2.10 2007-08 Health Care Access Partners and Service Areas

                                                                       Service Areas
HCA Partners                                      Health
                                                              Prenatal care                           Safety &
                                               insurance &                      Oral health
                                                             & infant health                          nutrition
                                                healthcare
Inland Counties Health Systems Agency               X

Inland Empire Health Plan, Healthy Kids             X

Kids Come First Community Clinic                    X

Latino Health Collaborative                         X              X
Loma Linda University Medical Center,
                                                                   X
Perinatal Services Network
Loma Linda University Medical Center,
                                                                   X
Comprehensive Tobacco Treatment
Morongo Basin Mental Health Services,
                                                                   X
Prenatal Services
Moses House Ministries                                             X
Mountains Community Hospital ,
                                                                                       X
Rural Health Clinic Dental Program
New House Inc..,
                                                                   X
Clean and Sober Moms
Pregnancy Support Centers                                          X
Reach Out West End,
                                                                   X
Reach Out to Parents
Rialto Unified School District,
                                                                                       X
Health Services Dental Program
SAC Health System,
                                                    X                                  X
Good to Grow
San Antonio Community Hospital,
                                                                   X
Healthy Beginnings
Veronica’s Home of Mercy                                           X

Victor Valley Community Dental Program                                                 X

Water of Life Mobile Medical Clinic                 X




Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                    January 2009               28
Key Elements and Activities

As noted above, services within First 5 San Bernardino’s Health Care Access Strategy primarily encompass one
of four elements. The types of services addressed by the 23 funded partners within each element are listed
below.

Health insurance, access to healthcare and medical home
    Health care through community clinics
    Health insurance enrollment and payment of insurance premiums for uninsured children
    Community based health care through mobile units and community health screening sites
    Home visiting to undernourished children

Prenatal/perinatal care and infant health
    Increasing the number of hospitals achieving the U.S. Baby Friendly Award that requires hospitals to
    promote rooming-in after delivery, skin-to-skin contact and breastfeeding
    Screening pregnant women for substances (drugs, alcohol, tobacco), referring for treatment, and providing
    parent education about the effects of the drug of choice on child development
    Access to and utilization of prenatal care
    Health and developmental assessments for infants
    Parent education about a variety of parent/child topics including infant bonding, child development,
    parenting skills, and breastfeeding

Oral health
    Dental care through community clinics
    Community-based dental care and screening through mobile units and community health screening sites
    Parent education about dental care for young children
    Trainings for pediatric physicians and residents on dental care of very young children

Safety and nutrition
    Parent education about a variety of health issues including the effects of secondhand smoke, asthma and
    improved home environment, nutrition, and traffic and car seat safety




Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                  January 2009             29
Summing It Up: Health Care Access

During FY 2007-08, providers funded under the HCA Strategy provided services to approximately 56,244
clients. 21 When looking at the demographics of clients, nearly three-quarters (74.3%) of the clients who
reported an ethnicity identified as Hispanic/Latino and about half (51.9%) reported Spanish as a primary
language. This is illustrated in the graphs below (Exhibits 2.11 and 2.12).

      Exhibit 2.11 2007-08 HCA Participants:                            Exhibit 2.12 2007-08 HCA Participants:
                  Race/Ethnicity                                                  Primary Language
         (Aggregate and Core n=52,253)*                                    (Aggregate and Core n=52,878)*


                   African
                  American              Other,
                                                                          Spanish,                              Other,
           White, , 12.1%               6.7%
                                                                           51.9%                                0.9%
           12.3%




                                                                                                             English,
                                                                                                              47.2%
                            Latino,
                            74.3%


*Total client n=56,244, excluded 3,991 records with declined or   *Total client n=56,244, excluded 3,366 records with declined or
missing ethnicity data                                            missing language data




Making a Difference: Health Care Access in Action

Each of the four HCA Strategy topic areas is described further with examples of partner efforts during FY
2007-08. Included in these examples are client success stories, as well a focus group summary based on a group
of women receiving services from Moses House Ministries.




21
  Number may include duplicate counts as clients may have received services through multiple service providers. Also, number
includes parents, children and other family members.
Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                                January 2009                30
Health Care Access and Utilization

Community Context
According to the First 5 San Bernardino 2008 Family Survey, 5.4% of children ages 0-5 in San Bernardino
County had no insurance coverage, which indicates a slight decrease in uninsured from the Family Survey
conducted in 2006 (6.3%). 22 In 2007, the California Health Interview Survey (CHIS) reported that 6.5% of San
Bernardino County households did not have medical insurance for their children ages 0-5 (compared to only
4.3% for the State). 23 These statistics seem to indicate a
relatively static percentage of children in the County
without health coverage (5-6%) in the past 3 years.                HCA Evaluation Limitations

                                                                               The HCA Strategy has been comprised
Also according to the 2008 Family Survey, Medi-Cal was
                                                                               of four substantial programs since 2004,
the primary source of health insurance for children 0-5 in
                                                                               aimed at countywide and system level
San Bernardino County, followed by employment-based
                                                                               impact on health care. In 2006-07, F5SB
insurance. The percentage of children whose source of
                                                                               funded many additional smaller
insurance was Medi-Cal rose by 3.3% since 2006, as seen
                                                                               programs with more narrow health foci
in Exhibit 2.13. Healthy Families coverage also increased
                                                                               and various service modalities and
by 4.5%. 24
                                                                               outcomes.
Beyond access to health insurance, one key indicator of                        Due to the variability of the programs
child health and utilization of services is the                                assigned to the HCA Strategy, no
identification of a medical home, and regular source of                        standardized evaluation framework or
care. In reviewing the F5SB Family Survey data over time,                      data collection has been implemented at
the percentage of families who reported that their                             this time. Instead partners were
children received regular care from a doctor, nurse                            responsible for tracking their program
practitioner or clinic increased by 11.3% from 2006 to                         progress and results for the purposes of
2008. Additionally, there was a 2.8% decrease in                               contract monitoring.
emergency room and 2.2% decrease in urgent care facility
                                                                               As F5SB revised the Strategic Plan set to
utilization as primary care in the same time period (see
                                                                               phase in by 2011, the HCA Strategy will
Exhibit 2.14). 25
                                                                               be much more focused and specific in
                                                                               its service and evaluation goals.




22
   Bockmann, S., Sirotnik, B., Aldana, L. Brief Report, Phase 1: 2006 First 5 Family Survey; & 2008 First 5 San Bernardino Family
Survey. Institute of Applied Research and Policy Analysis, California State University, San Bernardino. 2006 & 2008.
23
   Center for Health Policy Research, University of California, Los Angeles. California Health Interview Survey. 2007. Accessed 10
November 2008. <http://www.chis.ucla.edu/>
24
  Bockmann, S., Sirotnik, B., Aldana, L. Brief Report, Phase 1: 2006 First 5 Family Survey; & 2008 First 5 San Bernardino Family
Survey. Institute of Applied Research and Policy Analysis, California State University, San Bernardino. 2006 & 2008.
25
   Ibid.
Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                                January 2009                31
                                       Exhibit 2.13 F5SB Family Survey:
                                        Child Insurance Source by Year
                                                         2008 Family Survey   2006 Family Survey

             Medi-Cal                                          34.7%                31.4%

             Insurance from place of employment                28.9%                24.9%

             Private insurance purchased for child             14.4%                16.4%

             Healthy Families                                  8.9%                 4.3%

             Other private insurance or military               12.8%                23.0%



                                      Exhibit 2.14 F5SB Family Survey:
                                     Child Medical Home Source by Year
                                                         2008 Family Survey   2006 Family Survey

             Doctor, nurse practitioner or clinic              96.6%                85.3%

             Emergency room                                     0.8%                3.6%

             Urgent care                                        0.5%                2.7%

             Other                                              0.4%                1.9%

             No regular care                                    1.7%                6.5%



First 5’s Impact
While the percent of uninsured children 0-5 has
decreased only a small amount, appropriate medical              “[F5SB] has helped to ensure that
home has increased tremendously in the last few years.          children who need health
F5SB contributes to these positive outcomes by funding a        insurance have gotten it. They
variety of programs to provide health insurance                 have been funding and
enrollment, health insurance costs, as well as primary          supporting children in enrollment
health care services to children 0-5 and their families.        and have been key supporters for
                                                                the Healthy Kids program. When
In 2007-08, more than 12,000 clients received services          kids are ill they can get into care
related to health access, primary care services, and            because of First 5 funds.”
resources and referrals for health needs.
                                                                                            – Stakeholder
One of F5SB’s key partners assisting with these health
services is the Inland Empire Health Plan (IEHP). IEHP received funding from not only First 5, but also the
California HealthCare Foundation, Blue Shield of California Foundation, California Wellness Foundation, and
The California Endowment, to bring health coverage to San Bernardino County children who do not qualify
for existing public programs. Inland Empire Health Plan (IEHP) was designated as the health plan called
“Healthy Kids” – handling enrollment, marketing, and grant acquisition, as well as program management.

Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                  January 2009           32
IEHP works with over 30 community-based organizations that meet quarterly to discuss outreach and
enrollment. This informal coalition includes school districts, churches, health providers, and many others.
IEHP provided health insurance for over 4,000 children in 2007-08.




                           Providing a Wrap-Around Health System
   Silvia is a married mother of two boys, ages 1 and 9, who enrolled in the SAC Health System
   Good2Grow (G2G) program, a First 5 San Bernardino funded agency. SAC Health System is a three-
   clinic system that provides low-cost primary care and rehabilitative services for thousands of
   patients annually. The G2G program is specifically for families with children under age 6 and
   provides a variety of health assessments for children. To create a more comprehensive wrap-around
   approach to the health program, G2G also provides community services and health education for
   the families of these young children, knowing that children’s health is dependent on a healthy and
   stable family environment.

   While Silvia primarily attended the G2G program to access the child health assessments, she was
   approached by a staff member who talked to her about the various services offered by the agency.
   At the time, Silvia was going through some financial problems due to the fact that her husband had
   just lost his job. Within a week, Silvia received a call from the agency and she met with a staff
   member specifically to address her needs. During her meeting, she mentioned her need for a job
   due to her financial situation and they immediately provided her with some resources, including
   some agencies where she could go to obtain a job. Silvia was also in need of groceries and other
   basic needs. G2G gave her a gift card to a local grocery store, which is an incentive of the program,
   along with a bag of groceries.

   Silvia was so grateful to G2G that she asked for program flyers to take to her support group in order
   to promote the program to her friends. She really enjoyed the fact that they provided her with a lot
   of resources even though she was originally there for medical and dental services for her child. Silvia
   states that she, “can rely on the agency at any time she is in need.”




Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                   January 2009            33
Perinatal and Infant Health

Community Context
Access to prenatal care impacts both a mother and child’s health, and is associated with premature births and
the exacerbation of medical conditions that may be treated or diagnosed. In 2005, the large majority of
mother’s who gave birth in San Bernardino received prenatal care in the first trimester (82.7%), however this
percentage was 3.1% lower than the State of California (85.8%). 26

Based on a three year average (2003-2005) of breastfeeding initiation during early postpartum, San Bernardino
ranked 56th out of all 58 counties. San Bernardino’s average of 79.5% was above the Healthy People 2010
National Objective of 75.0%, but lower than the State average of 86.0%. 27

First 5’s Impact
As noted earlier, F5SB supported a variety of programs to
improve access to prenatal care, as well as improve outcomes
for new mothers and their babies. In FY 2007-08, over 6,ooo                   “First 5 has been the direct
clients received maternal child health care and/or education                  funding source for our
related service.                                                              prenatal program, which has
                                                                              allowed us to reach mothers
One of the key First 5 partners working to improve maternal                   that are pregnant, especially
child health outcomes is Loma Linda University Medical                        those mothers that are at-
Center, Perinatal Services Network (PSN). In 2007-08, PSN                     risk or are currently addicted
continued to promote mother-child bonding and breastfeeding                   to substances.”
by offering technical support to hospitals to adopt the standards
associated with the U.S. Baby Friendly Award. These standards
                                                                                          – F5SB Partner Agency
include an emphasis on three key baby-friendly elements:
     Skin-to-skin contact
     Rooming-in
     Exclusive breastfeeding after delivery


Ten hospitals in San Bernardino County have undertaken the intensive process of working toward achieving
this designation. By providing training and resources, PSN has helped hospitals move towards U.S. Baby
Friendly standards. Through their advocacy work, they have been able to promote the policy changes within
these hospitals. PSN reported, “The National Baby-Friendly office in Massachusetts noted that all San
Bernardino hospitals that had been visited by the national review team had passed following the first visit. This
is not usually the case. We at PSN believe that the mock visits [at the hospitals by PSN staff] have helped to
prepare these hospitals to complete the official visit during 2008-09.”




26
  State of California, Department of Health Services, Birth Records.
27
  California Department of Public Health: Genetic Disease Branch; Maternal, Child and Adolescent Health/Office of Family
Planning Branch, 2007.
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In addition to improving systems of care for maternal child health, First 5 San Bernardino supported many
programs that assisted pregnant women in need. Some of these programs linked with the Perinatal SART
model, as seen earlier in the chapter with the story of Monica who received help through New House, a HCA
partner helping women of child bearing age with addictions. Below is also a summary of a focus group
conducted with mothers being served through Moses House Ministries.




       Promoting Healthy Moms and Infants in the High Desert Community
   The Health Care Access Strategy includes many programs that focus on increasing access to services
   that will help families lead healthier lives. One such program, a community investment partner, is
   Moses House Ministries, located in the High Desert region of San Bernardino County. Moses House
   Ministries provides more than access to health care. They offer services that help mothers with safe
   and healthy deliveries and are also available to address the many emergency stressors that often
   overwhelm young mothers.

   In this past fiscal year, clients of Moses House Ministries participated in a focus group where they
   responded to questions about the services they received as well as how the services has helped
   them as parents. Many of the clients had heard of Moses House Ministries through Moses House’s
   outreach process – whether at a domestic violence shelter, a presentation at a local school or
   through a pamphlet that staff had distributed. Many of the women who called for services were
   struggling financially and emotionally when they made the call. One mother reported that she called
   Moses House because her child was in the Intensive Care Unit at the local hospital and she did not
   have transportation to get there which limited the amount of time she was able to spend with her
   newborn. She recalls “It was a really big transportation issue. Trying to get to St. Mary’s to see my
   daughter, when they said she could be dead or in a vegetative state.” Another young mother
   commented that she found out because her doctor was concerned that she had been walking
   almost 2 miles each way to the bus stop and was risking pre-term labor. These are just two examples
   of women who had health coverage but were struggling with a way to access the healthcare. Both
   benefited from transportation services as well as emotional support provided by the program staff.

   When looking at the effectiveness of community based programs, we are often looking for
   measurable outcomes and sustained change. When talking with the women involved in this
   program, it was clear that one of the greatest outcomes was one that is difficult to measure – the
   sense of support and community created by the staff and clients of Moses House Ministries. When
   sitting in the room with the clients, it was evident that one of the lessons learned had been to
   provide support for one another. When one of the young mothers was telling her story, recalling her
   own pregnancy and the shock of being pregnant at 15, another of the mothers began talking with
   her about the services available both through Moses House and outside of Moses House. Still
   another client began talking about the series of classes provided internally by Moses House and how
   these topics often come up in the classes.




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   Another important piece of the Moses House Ministries program is their ability to help parents meet
   basic needs. For parents struggling with basic needs, often times health and medical needs go
   unmet or can be ignored. For many of these parents, this includes examples such as prioritizing the
   need for diapers over their own follow-up medical care or complicated planning to figure out how to
   get to a well child check-up.

   One parent mentioned the desire to have transportation        “I am disabled and live in
   services extend at least to cover well-child check ups and    Adelanto. It takes me three
   immunizations. She was already concerned with how to          buses just to get my child to a
   get herself and her child to the pediatrician. Other parents  well-child check-up.”
   reported that staff has helped with food, diapers and as
   mentioned above, transportation. However, one mother
   was in tears as she described the role Moses House                          - Focus Group Parent
   Ministries has played in her life. She was a volunteer who
   later became a client of Moses House. When she was a client of the agency, her daughter had a
   wetting accident at school and she had no extra clothes and no transportation due to her car
   recently breaking down. She was devastated and upset both for herself and her daughter who did
   not have extra clothes to change into. Staff from Moses House Ministries responded by giving her
   clothes from their boutique and taking her to her daughter’s school.

   Throughout the focus group, the clients reflected on how Moses House Ministries and the staff had
   helped them access the health care they needed – whether for prenatal care, well baby check-ups or
   tranportation to the hospital to be with a very ill child. Several mothers stated that without the
   transportation services provided by Moses House, they would have stopped going to their prenatal
   appointments or would not have gone as regularly.
   As one mother stated “Sometimes I didn’t have a car
   and other days it was so cold. When is was cold it          “I was diabetic during pregnancy. I
   was hard on my baby when walking.” Moses House              had to go twice a week to do stress
   Ministries not only assisted parents with medical care tests and to the doctor almost
   but also supported and prepared mothers for the             everyday. There is no way that I
   role of mother by assisting with other areas of basic
                                                               would have been able to do it my
   needs.
                                                          self.”
                                                                             - Focus Group Parent




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Oral Health

Community Context
Oral health is very important for young children’s overall physical wellbeing. Failing to address the oral health
needs of children can have great implications, such as related health problems, school absences, difficulties in
eating and speaking, as well decreased self esteem and social interaction.

According to a recent report by Children Now, 80% of children 0-5 in San Bernardino County have dental
insurance, 28 while previous figures from the California Health Interview Survey (CHIS) were somewhat higher
(88.0%). 29

Timeliness of dentist visits is also important in maintaining good oral health. While clinical guidelines for
pediatric care recommend children have a dental exam every six months, Healthy People 2010 sets the more
modest goal of annual dental visits, aiming for 56% of children and adults to have visited the dentist within the
past year. 30, 31 Exhibit 2.15 below reflects San Bernardino County data for children’s last dental visit, comparing
2005 and 2007 findings. 32 While many children had never been to the dentist, there was an increase in the
percent of children 0-5 who had seen the dentist in the last 6 months in the most recent survey (from 26.2% to
39.2%).

        Exhibit 2.15 Time since last dental visit for children 0-5 in San Bernardino County by Year
                                                                                                            49.6%
       Never been to dentist
                                                                                               41.1%

          Less than 6 months                                              26.2%
                  ago                                                                        39.2%

                                                                     22.9%
       6 months up to 1 year
                                                           16.1%                                          2005
                                                                                                          2007
                                      1.4%
     1 year up to 2 years ago
                                         3.5%




28
   Children Now. “2007 California County Data Book.” 13 June 2008.
<http://publications.childrennow.org/publications/invest/cdb07/cdb07_sanbernardino.htm.>
29
   Center for Health Policy Research, University of California, Los Angeles. California Health Interview Survey. 2003. Accessed 10
November 2008 <http://www.chis.ucla.edu/>
30
   Both the American Academy of Pediatric Dentistry and the American Academy of Pediatrics recommend children begin
annual dental exams by their first birthday. Therefore, by age two, a child should have had an exam within the past year.
31
   Office of Disease Prevention and Health Promotion. “With Understanding and Improving Health and Objectives for Improving
Health.” Healthy People 2010: Volume II. Washington, DC: U.S. Department of Health and Human Services, 2000. Accessed 13
July 2006. <www.healthypeople.gov>
32
  Center for Health Policy Research, University of California, Los Angeles. California Health Interview Survey. 2007 & 2005.
Accessed 10 November 2008 <http://www.chis.ucla.edu/>
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First 5’s Impact
First 5 San Bernardino continued to support programs throughout the County to increase the number of
children and families with access to both preventive dental health and treatment services, as well as increasing
the capacity of dentists to serve young children. In FY 2007-08, over 35,000 clients were estimated to have
received services related to dental health and education, equaling the highest number of clients receiving any
specific type of First 5 funded service during the year.

Of note, F5SB continued to fund one its largest programs, the County of San Bernardino, Arrowhead Regional
Medical Center (ARMC) Dental Program, responsible for providing dental screening and follow-up services to
thousands of children in child care centers all over the County. In addition to the numerous screenings
provided, ARMC reported referring and treating over 100 children more during FY 2007-08 than the previous
fiscal year.

ARMC also works with a variety of dentists to assist in treating children with Medi-Cal (Denti-Cal). Though
the Medi-Cal program made a 10% cut in what providers would be reimbursed if they accepted Medi-Cal
patients beginning in March 2008, ARMC was able to cover that 10% cut in order to maintain partners.
Providers partnering with ARMC are also encouraged to provide some pro-bono dental treatment each year as
part of meeting community need. While it has been a challenge, ARMC reported a story about one such
provider’s willingness:

        “Karen, a 2 year old Latina from the Central Valley, was in dire need of dental treatment. The mother
        had heard of our program and decided to give us a call. We referred her to one of our providers,
        because they accepted her insurance. As it turned out, the patient’s dental coverage had run out and
        the mother did not have money to pay for the needed treatment. This child needed not only general
        anesthesia, but also lots of dental work that totaled over $1,500. We told the provider that we had run
        out of treatment funds and that we would send her to a community clinic where she could hopefully
        pay a reduced rate. This particular office refused to send her out and instead completed all of the
        dental work at no charge, as a courtesy to our program. The mother was so happy that Karen was out
        of pain and smiling again.”


Safety and Nutrition

Community Context
There are several factors that can prevent a child from growing up into a healthy adult. According to the
Centers for Disease Control, the leading cause of death for young children is unintentional injuries, including
motor vehicle accidents and other accidents at home due to hazards. Along with preventing injuries, children
must also be protected against environmental risk factors, like air quality, that may impinge on their
development. Similarly, appropriate nutrition is critical to child development.

Some relevant statistics showing the importance of safety and nutrition include:




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     In 2006, among children under the age of 5 in the United States, an estimated 425 lives were saved by
     appropriate car and booster seat use. 33
     In the U.S, a $46 child safety seat generates approximately $1,900 in benefits to society. 34
     In 2004, approximately 2,300 children in the U.S, ages 0-14, died from unintentional injuries that occurred
     in the home. Nearly 80% of the deaths were among children ages 0-4. 35
     Low income families are less likely to have safety devices due to a lack of control over housing conditions,
     lack of money to purchase them, and lack of transportation. 36
     Among California children with active asthma, 43% of those exposed to secondhand smoke at home suffer
     from monthly symptoms, compared to 33% of those in smoke-free homes. 37
     The EPA reports that San Bernardino County ranked third in the State for the highest number of
     unhealthy air quality days for children in 2007. 38
     13.5% of children under 5 in San Bernardino County suffer from asthma symptom prevalence. 39
     2007 CHIS data reveal that 38.8% of children 2-5 in San Bernardino County do not eat the suggested daily
     intake of fruits and vegetables, and 14.6% of these children ate fast food at least three times in the last
     week. 40


First 5’s Impact
Four programs funded by F5SB focus on various topics related to car and home safety, as well as nutrition.
About 2,000 parents and/or children benefited from these services during FY 2007-08.

One partner agency example is the American Lung Association, who provided home visits to families with
children suffering from asthma. As part of the home visit, the program assessed the home, educated the family
on asthma and medications, and created an action plan to reduce environmental triggers. One success story
included, “We had one family who has a child with asthma and the mom didn’t know much about it. She
treated the child as if he was disabled. The child was not allowed to play sports, run around, or even eat ice
cream. After explaining to the mom what asthma was, and the difference in medications, she has completely
changed the way she treats the child.”

Another example includes the High Desert Youth Center, First 5 Safety and Wellness Program. This program
offered car seat classes for 388 participants, surpassing their 2007-08 target. As part of the classes, parents
learned about car seat safety and successfully demonstrated appropriate child safety practices through proper
car seat installation. Car seats were also given to families who did not have the resources to purchase their own.


33
   Centers for Disease Control. “Child Passenger Safety: Fact Sheet.” <http://www.cdc.gov/ncipc/factsheets.childpas.htm.>
34
   Safe Kids USA. “Motor Vehicle Safety Factsheet”. <http://www.usa.safekids.org>.
35
   Safe Kids USA. “Home Safety Factsheet.”<http://www.usa.safekids.org>.
36
   Ibid.
37
  UCLA Center for Health Policy Research, Pets and Smoking in the Home Associated with Asthma Symptoms and Asthma-Like
Breathing Problems (Los Angeles: UCLA Center for Health Policy Research, 2007).
38
   Environmental Protection Agency. <http://www.epa.gov/aircompare/>
39
   Center for Health Policy Research, University of California, Los Angeles. California Health Interview Survey. 2007. Accessed 10
November 2008 <http://www.chis.ucla.edu/>
40
   Ibid.
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  Conclusions and Recommendations
First 5 San Bernardino continued to fund many partner agencies in the Health and Well-Being Cluster during
the 2007-08 fiscal year. A diverse range of countywide and community based programs provided access to
child development and behavioral services, health insurance, primary and dental health care services, as well as
health education to thousands of clients. Some of the primary conclusions of the Health and Well-being
Cluster include:

F5SB partners continued to implement best practice models and instruments.
    Agencies in the Children’s SART and Perinatal SART programs are implementing best practices and
    utilizing standardized assessment tools. The use of these instruments demonstrates a continued
    commitment to provide a high level of screening for the children and adults. Examples include the 4 P’s
    Plus utilized with the Perinatal SART funded partners and the ASQ and ASQ:SE among the Children’s
    SART partners.
    The Perinatal Services Network continued to assist local hospitals with modification of perinatal practices
    in order to qualify for U.S. Baby Friendly status.

F5SB Children’s SART partners continued to screen a high risk population of
children.
    Results of the ASQ and ASQ:SE screenings provided baseline data that suggests a high need for further
    services beginning with the completion of a more thorough assessment. As SART partners continue to
    screen high risk children, the relationships between screener and service providers must continue to
    strengthen in order to meet the needs of parents who are already struggling in many cases.

F5SB partners provided access to much needed health care and dental care
through hospitals, community based clinics and mobile units.
    A substantial number of First 5 funded community based providers continued to make a wide variety of
    health care services and dental screening available in every region of the County. The ability of F5SB to
    support efforts by community based organizations across a very disparate and large county has increased
    the reach of services for San Bernardino families.
    An estimated 12,000 clients received general health services, while over 35,000 clients accessed dental
    services through First 5 HCA partners.

F5SB partners continued to reach a diverse population.
    Demographic data demonstrated that programs are serving people from diverse backgrounds but remain
    committed to the target population of low-income families, low levels of formal educational attainment,
    and isolated communities. This demonstrates not only the Commission’s effort to make services accessible
    to the entire community but also to the partner agencies who implement diverse and innovative programs
    to meet the needs of this population.


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Challenges
While the Health and Well-Being Cluster succeeded in many ways over the fiscal year, it also faced many
challenges. First 5 San Bernardino remains committed to using these challenges as learning opportunities and
is working to integrate these into program modifications.

    Challenges with collecting data and details regarding data collection. As the agencies move
    towards the use of standardized testing instruments and best practice models, it is more important that
    they have developed a thorough and detailed plan for their own data collection. When agencies collect
    their own data, it is important that they also document their steps to allow for further assessment and
    determination of change or success. This becomes more important as programs are being required to
    demonstrate change in the field of health and mental health.

    Challenges with collecting exit data. As the Children’s SART partner agencies have moved towards an
    increased use and implementation of standardized instrument for evaluation, one of the principal goals has
    been to collect data from when clients exit the programs. However, the collection of this Time 2 (mid or
    post) has proven to be very difficult due in part to the needs and challenges of the clients. The number of
    clients lost to services suggests that agencies examine their retention strategies and perhaps consider
    utilizing incentives.

    Comparing results across programs. Partners’ programs within this Cluster are very diverse; this is
    particularly true of the Health Care Access Strategy. Because the Commission enacted a responsive
    investment strategy, as opposed to a focused initiative in which funded programs share common activities
    and outcomes, it is not possible to tell a succinct, meaningful, collective account of the results of this F5SB
    funding stream. With the newly revised Strategic Plan implementation, more focus is planned for the
    future.



Recommendations
The following recommendations were developed based on 2007-08 fiscal year data.

    Continue to support the operation of regional SART assessment centers. Similar to last FY,
    screening data indicates a high need for further assessment of children screened through the SART centers.
    With increased budget restrictions affecting counties throughout the state, First 5 San Bernardino’s
    support of the SART centers will become even more critical. Not only does an increase in centers allow for
    more screenings, but it also allows for the SART centers and partner agencies to expand the message of
    early screening and intervention to other areas of the County. This strategy continues to be a strong model
    for a promising system of care for young children.

    Continue to improve outcome measurement reporting and data collection. This year presented
    many challenges for data collection in the Health and Well-Being Cluster. Barriers to implementing and
    maintaining data collection methods among diverse programs continue to make it challenging to
    accurately report a complete picture of the role that CFA and HCA Strategies play. It is recommended that
    the evaluation designs and reporting activities be reviewed and revised as part of the new Strategic Plan to
    ensure that the Commission can adequately represent the results of its investments.


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    Continue to strengthen the data collection associated with the Assessment, Referral and
    Treatment portions of the SART model. While much of the work of the SART partners is to screen
    children and women for needs and concerns, another important piece is the provision of more in depth
    services beginning with a more thorough assessment for those identified as at-risk. Once needs have been
    identified, children and/or women are referred to service providers in the community, including the
    current partners. It is important for the SART partners to continue a conversation about the role of data
    collection and the evaluation of the model, as well as all of the components, not just screening.




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         Chapter 3 Early Care & Education

Key Findings
    The School Readiness Initiative provided services to approximately 23,000 children and families, many of
    whom had a high level of need (i.e., low income and lack of basic resources).
    Children participating in SR programs showed positive developmental progress on all of the established
    domains of the DRDP-R. The largest increases in scores were found in effective learning, and personal and
    social competence. The majority of all children also met or exceeded the cut-off scores on each domain of
    the ASQ. The communication domain had the greatest number of children who increased in
    developmental progress from pre to post.
    Parents who participated in SR programs showed an increase in knowledge, confidence, and behavior.
    Parents also increased the frequency of which they participated in school readiness activities at home with
    their children, including practicing name writing, making opportunities for child play dates, and playing
    rhyming games.
    School Readiness programs provided opportunities for over 2,000 clients to receive screenings and
    assessments related to dental, vision, and hearing.
    Most preschool teachers reported having kindergarten transition plans in place for their students and
    providing meetings with parents to discuss kindergarten transition.
    Over 6,000 ECE providers enrolled in classes or trainings to enhance their knowledge and skills about child
    development, potentially benefiting their care center or practice.
    Over three-quarters of ECE providers indicated that the F5SB supported training programs helped them to
    work more effectively with the children they care for; acquire new knowledge about the development of
    young children; and learn new ideas for planning activities for young children.


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    Introduction to Early Care and Education


E    ach year, a half million children enter California kindergarten classrooms 1 but not all arrive with the
     necessary skills that make them ready to learn, and many perform at significantly lower levels than other
     children their age. 2 The need for a comprehensive approach that engages children, families, and early
     education settings is evident in the widening gap in literacy and numeracy scores by the third grade.
Research indicates that a comprehensive approach helps ensure that children enter kindergarten ready to
learn. 3

There is a wealth of literature that supports the fact that early                  “[First 5 has supported]
childhood learning and educational opportunities directly                          great programs for
impact child outcomes related to success in school and life.                       preparing kids for school.
Specifically, research has shown early childhood interventions                     They have an emphasis on
yield short and long-term benefits in child behavior, academic                     school preparation, and
achievement, delinquency, and labor market success. 4                              working with preschools has
Additionally, research has demonstrated that by offering parent                    been important for the
education and support services, in conjunction with early child                    citizens of San Bernardino
care and education, there is a direct positive impact on the
                                                                                   County.”
developmental progress of children. 5, 6
                                                                                                             - Stakeholder
There is also a tremendous need for affordable and quality early
care and education, as many state-funded preschools have
waiting lists and other center- and family-based care centers are expensive. 7 In fact, data from the First 5 San
Bernardino 2008 Family Survey Report indicated that 45.2% of respondent’s children had never spent any time
in a group child care setting or preschool. 8 The quality of early care and education programs, as well as the
quantity (i.e., workforce supply), also have room for improvements. Early education teachers or caregivers are
not required to have advanced degrees and the annual turnover rate is quite high, estimated at 22% in 2006. 9


1
 First 5 California. School Readiness 2001. 20 March 2001: 2 Accessed 17 August 2006. http://www.ccfc.ca.gov/pdf/sr5.pdf
2
  Ibid.
3
  Ibid.
4
  RAND Corporation. Proven Benefits of Early Childhood Interventions. 2005.
5
  U.S. Department of Education. No Child Left Behind: What Parents Need to Know. Accessed 15 December 2005.
<http://www.ed.gov/nclb/overview/intro/parents/nclb_pg5.html>
6
  U.S. Department of Education, Office of Planning, Budget, and Evaluation; Office of Educational Research and Improvement
(ED). Preparing Young Children for Success: Guideposts for Achieving Our First National Goal. An America 2000 Education
Strategy. Washington, DC: Author, 1991.
7
  Children Now. California Report Card 2006-07: The State of the State’s Children. Accessed 12 November 2007.
<http://publications.childrennow.org/assets/pdf/policy/rc07/ca-rc-2007.pdf>
8
  Bockmann, S., Sirotnik, B., Aldana, L. 2008 First 5 San Bernardino Family Survey. Institute of Applied Research and Policy
Analysis, California State University, San Bernardino. 2008.
9
  Center for the Study of Childcare Employment, Institute of Industrial Relations, University of California at Berkeley. California
Early Care and Education Workforce Study: Licensed Child Care Centers and Family Child Care Providers. Berkeley, CA:
California Child Care Resource and Referral Network, July 2006.
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To help enrich early learning environments for children, First 5 San Bernardino (F5SB or the Commission)
invested in a number of programs during the 2007-08 fiscal year that promote the early care and education
(ECE) of children. The Early Care and Education Cluster includes the following programmatic “Strategies” as
indicated in the Commission’s Strategic Plan: 10
       School Readiness
       Child Care Quality Standards
       Child Care Capacity
       Child Care Access
       Child Care Advocacy
       Play Spaces for Children

In F5SB’s Strategic Plan, the ECE Cluster is slated to represent 25% of the total Commission investment
portfolio. 11 As such, the ECE Cluster was earmarked for $9,750,000 during FY 2007-08. The amount of money
actually allocated through contract awards and those monies expended during the fiscal year can be seen in
Exhibit 3.1. Partner agencies in the ECE Cluster utilized 81.8% of their awarded resources; and those
expenditures represent 79.7% of the potential resources that F5SB could have had in the community through
ECE programs.

                     Exhibit 3.1 2007-08 Early Care & Education Cluster Investments
                                                                                                                   % of Total
                                                                                            % of Awards
 Total Allocation Contract Awards               % Awarded             Expenditures                                 Allocation
                                                                                             Expended
                                                                                                                   Expended
     $9,750,000            $9,490,139               97.3%                $7,767,596             81.8%                79.7%


Of the Strategies listed above, F5SB invested in School Readiness, Child Care Quality Standards, Child Care
Capacity, Child Care Access and Play Spaces for Children. Each of these Strategies and their activities and
outcomes are described throughout the remainder of this chapter.

Linkages to the Strategic Plan

As seen in Exhibit 3.2 below, the Early Care and Education Cluster connects to the first three Desired Result
Areas in the Commission’s Strategic Plan, and is primarily focused on Desired Result Area 2: Children are
Ready to Enter and Succeed in School. The Commission-Level Outcomes (CLOs) listed below are the most
common outcomes that the Cluster’s Strategies work towards; however not every partner agency within the
Cluster links to each indicator and there are some programs who strive to meet additional outcomes, such as
increasing nutrition, positive discipline, etc. 12




10
   First 5 San Bernardino. Strategic Plan: Investing in our Children Prenatal Through Age Five. June 2006.
11
   Ibid.
12
   For a list of all of the F5SB Desired Result Areas, Objectives and Commission-Level Outcomes, see Appendix C.
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               Exhibit 3.2 2007-08 Early Care & Education Cluster Linkages to Strategic Plan

        Objective                    Commission-Level Outcome                         Strategy Area(s)
                                  Desired Result 1: Children are Safe and Healthy
                             2.1 Increased number/percent of children with
     2. Children are         health insurance and ongoing relationship with     School Readiness
     healthy, well-          health provider
     nourished and           2.2 Increased number/percent of children
     physically fit          receiving annual dental screenings and             School Readiness
                             appropriate follow up care


                        Desired Result 2: Children are Ready to Enter and Succeed in School
                             4.1 Increased parents' time spent reading,
                                                                                School Readiness
     4. Children live in     singing, and telling stories to their children
     a home                  4.2 Increased number/percent of parents using
     environment             developmentally appropriate activities to          School Readiness
     supportive of           support the school readiness of their children
     learning
                             4.3 Increased family literacy skills               School Readiness
                                                                                School Readiness
                             6.1 Increased number/percent of qualified
                                                                                Child Care Quality Standards
                             childcare providers regarding the
                                                                                Child Care Capacity
                             developmental needs and milestones of
                                                                                Child Care Access
                             children
                                                                                Play Spaces for Children
                                                                                Child Care Quality Standards
     6. Children have        6.2 Increased length of time childcare providers
                                                                                Child Care Capacity
     access to high          stay in the childcare field
                                                                                Child Care Access
     quality early
     childhood               6.3 Increased number/percent of parents
     development             informed of, and number/percent of children
                                                                                Child Care Access
     programs                enrolled in, high quality subsidized child
                             development programs

                             6.4 Increased number/percent of childcare
                                                                                Child Care Quality Standards
                             providers who work with parents to affect
                                                                                Child Care Capacity
                             parents' knowledge and skills regarding school
                                                                                Child Care Access
                             readiness

                             7.1 Increased number/percent of children
     7. Children                                                                School Readiness
                             exhibiting age-appropriate development
     develop within
     normal ranges in        7.2 Increased number/percent of children
     all domains             exhibiting healthy cognitive and social-           School Readiness
                             emotional behavior

                   Desired Result 3: Families are Safe, Healthy, Nurturing and Self-Sustaining
     11. Families are
     stable and have
                             11.1 Improved parental ability to access and
     the capacity to                                                            School Readiness
                             coordinate needed services for their children
     meet the needs of
     their children



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     School Readiness

First 5 California spearheaded                           First 5 California Result Areas
the School Readiness                               and NEGP Elements for School Readiness
Initiative in 2002, advocating
                                              State Result Area                        NEGP Element
a three-way partnership
approach between families,        1) Improved Family Functioning          Parent and Family Support
communities, and schools, all 2) Improved Child Development               Early Care and Education
of whom play an important
                                  3) Improved Child Health                Health and Social Services
role in nurturing and
teaching children. The School                                             Schools’ Readiness for Children
Readiness Initiative is a         4) Improved Systems of Care
                                                                          Program Infrastructure, Administration,
funding partnership between                                               and Evaluation
First 5 California and First 5 San Bernardino, wherein First 5 California matches funding for the programs.
The Initiative is based on the First 5 California School Readiness Framework, redesigned and implemented
during 2006, 13 and the National Education Goals Panel’s (NEGP) “Five Essential and Coordinated Elements.” 14
All School Readiness programs throughout the State are required to encompass each of the State’s Result Areas
and NEGP Elements.

The School Readiness Initiative (SR) strives
to improve the outcomes of children in                      2007-08 School Readiness Partner Agencies
elementary schools with low Academic                 Barstow Unified School District                     High Desert
Performance Index (API) scores by
                                                     Chino Valley Unified School District                West End
developing children's physical, social,
emotional, and cognitive development in              Fontana Unified School District                     Central Valley
the early care and education environment.            Hesperia Unified School District                    High Desert
The SR Initiative also supports families in
                                                     Lucerne Valley Unified School District              High Desert
preparing their children for entering school
through parent inclusion, education, and             Montessori in Redlands*                             East Valley
support services.                                    Needles Unified School District                     Mid Desert
                                                     Ontario-Montclair School District                   West End
The F5SB School Readiness Strategy is built
                                                     San Bernardino City Unified School District         Central Valley
on the First 5 California modeled initiative,
which links the State Result Areas and               San Bernardino Valley College                       Central Valley
NEGP Elements to the local Desired Results           Silver Valley Unified School District               High Desert
and Objectives. During FY 2007-08, F5SB              Snowline-Joint Unified School District              High Desert
(along with the State matched dollars)              *Not a State matched SR program
awarded $5,287,681 to eleven traditional SR

13
   The First 5 Evaluation Framework Workgroup. Statewide Evaluation Framework Final Report. Accessed 22 June 2006.
<http://www.f5ac.org/files/First%25205%2520Framework%2520Report%2520Final%2520v2edit-102705.pdf>
14
   Early Connections: Technology in Early Child Development. Five Areas of Child Development. 2005. Accessed 17 August 2006.
<http://www.netc.org./earlyconnections/index1.html>
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Annual Evaluation Report FY 2007-08                                                           January 2009                47
programs and one non-traditional program (i.e., Montessori in Redlands is not receiving State funds). 15
Approximately $4,759,916 of the 2007-08 SR allocation was expended (90.0%). Five of the SR programs in the
West End and Central Valley regions of the County have been partner agencies since 2004, while six
redesigned SR programs in the Desert regions and one non-traditional program in the East Valley completed
their first full year during 2007-08 (see program listing on previous page and Appendix A for more
information on each program).

Key Elements and Activities

The SR programs vary in their designs, generally categorized as either classroom-based or center-based.
Classroom-based programs typically provide services to a group of children (and oftentimes parents) in the
structured setting of a classroom, and are characteristic of preschool-type programs. Center-based programs
differ from classroom-based programs in that the services may not be as structured, may be a drop-in type
facility, and may include a case management model.

The SR programs serve clients in four key ways that are linked to the local and State Commission’s result areas:

     1.   Early Childhood Development: The partner
          agencies work directly with children enrolled in                     “I think the School Readiness
          preschool classrooms and parent/child programs to                    programs have made a big
          prepare them for preschool and/or kindergarten.                      difference in the lives of
          These programs typically work with children to                       children and their parents.”
          assess and support their developmental growth
          through a combination of standardized assessment                                                 - Stakeholder
          tools and interventions to address areas in which a
          child is not typically developing.

     2.   Parent Education and Support: Parents are served directly by the programs through classes,
          workshops, and resource centers. The primary objectives are to increase parental knowledge of
          developmental milestones and encourage them to spend more time with their child engaged in school
          readiness activities. In addition, SR programs offer parents information about resources in their
          communities and assist them with links to needed services.

     3.   Health Services: Programs connect children to insurance and a medical home, as well as needed
          health services such as dental and vision screenings and follow-up treatment.

     4.   Improved Systems of Care: First 5 California requires all SR programs to improve or enhance their
          early education systems. During 2007-08, F5SB SR programs provided teacher trainings, participated
          in articulation planning meetings, and provided kindergarten transition activities for the children and
          parents they serve.



15
  The one non-traditional SR program (i.e., Montessori in Redlands) was awarded through Community Investments made by
F5SB in 2006. This program was determined to best fit into the SR strategy based upon its similar activities and outcomes. This
program is not part of the State SR Initiative and therefore does not receive State matched dollars.
Prepared by Harder+Company for First 5 San Bernardino
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Summing It Up: School Readiness

Demographic Profile

Partners in the SR strategy directly served approximately 23,300 clients during FY 2007-08. 16 As seen in
Exhibit 3.3, the large majority of all clients participating in SR programs identified as Hispanic/Latino (82.8%);
while Whites and African Americans consisted of 8.1% and 5.8%, respectively. Additionally, English was the
most common primary language spoken by clients in SR programs (55.7%) (Exhibit 3.4).

        Exhibit 3.3 2007-08 SR Participants:                             Exhibit 3.4 2007-08 SR Participants:
                   Race/Ethnicity                                                 Primary Language
         (Aggregate and Core n=23,154)*                                   (Aggregate and Core n=23,221)*

                                     African
                       White,       American
                       8.1%                                                Spanish,
                                     , 5.8%
                                                                            43.7%
                                                                                                                 Other,
                                                Other,
                                                                                                                 0.6%
                                                3.3%




                                                                                                       English,
                  Latino,
                                                                                                        55.7%
                  82.8%

*Total client n=23,392, excluded 238 records with declined or    *Total client n=23,392, excluded 171 records with declined or
missing ethnicity data                                           missing language data

Of the total clients served during FY 2007-08, approximately 5,000 clients (about 22%) were intensively served
(or “core”). Intensively served clients were those who received multiple services over a period of time and for
whom client level and outcome data was obtained. Parents who enrolled their family in SR programs for
multiple services were asked to complete intake forms that collect additional demographic data about
themselves and their child(ren). For 2007-08 SR programs, a total of 2,832 parent intakes and 3,256 child
intakes were reported. 17




16
   The total number of clients served includes parents, children and other family members as reported by the data system and
includes a summation of both intensively and non-intensively served clients. The number may include duplicated clients, as
clients may be served by different components of programs, as well across programs. This number does not include providers
who may have been served by SR programs through trainings, workshops, etc.
17
   Intakes could be completed more than once if parents or children reenrolled in a program throughout the year.
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Annual Evaluation Report FY 2007-08                                                               January 2009                   49
These data indicated:

     Gender/Age: Parent or primary caregivers were primarily females (89.2%) and an average age of 32
     (ranging from 13-79). 18 Both genders were equally represented among children served, with 51.8% male
     and 48.2% female clients. Children were an average age of 3.6. 19
     Household Size: Most households were two-parent households (74.4%) and included an average of 4.8
     people, with a range of 1 to 14 people. 20 On average, households had 1.5 children under age 6. 21
     Educational Attainment: Parents noted a wide range of educational achievement. While 35.4% of parents
     had completed some college or received a college degree, a large proportion of the parents (44.4%) served
     by SR reported not completing high school, indicating a population in need of basic education.
     Household Income: Many of the intensively served clients were struggling financially, suggesting that
     these programs reached a segment of the population that is most in need. A review of client data by federal
     poverty 22 and self-sufficiency levels in San Bernardino 23 shows that almost half of those SR families with 3-
     5 people made less than the federal poverty level and the majority (between 80-90%) made less than what is
     needed when living in San Bernardino to meet basic needs such as housing, child care, transportation, and
     food (see Exhibit 3.5).




                            Exhibit 3.5 2007-08 School Readiness Family Income
                                            Approx. Percent of SR 2008 San Bernardino Approx. Percent of SR
 Persons in     2007 Federal Poverty
                                           Families Below Poverty Self-Sufficiency Income Families Below Self-
  Family           Income Level
                                                   Level*                 Level**          Sufficiency Level*
      3                 $17,170                     40.0%                      $47,000                      80.0%

      4                 $20,650                     40.0%                      $60,000                      84.0%

      5                 $24,130                     46.0%                      $75,000                      90.0%
*These are estimates, as parents were asked to select an annual income range, rather than an exact income.
**These are approximate calculations based on average dollars needed, despite household makeup and the age of family
members.




18
   Median and Mode = 31.
19
   Median and Mode = 4.
20
   Median = 5, Mode = 4.
21
   Median and Mode = 1.
22
   U.S. Department of Health and Human Services. The 2007 HHS Federal Poverty Guidelines. Accessed 28 October 2008.
<http://aspe.hhs.gov/poverty/07poverty.shtml>.
23
   Insight Center for Community Economic Development. California Family Economic Self-Sufficiency Standard by County.
Accessed 28 October 2008. <http://www.insightcced.org/index.php?page=ca-sss>.

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Annual Evaluation Report FY 2007-08                                                            January 2009             50
Types of Services Received

Over 23,461 SR clients received documented services. Most activities included early education and parent
education programs, as seen in the tables below. 24

Improved Child Development                             Exhibit 3.6 2007-08 Number of SR Clients Receiving
School Readiness services related to                               Child Development Services
improving child development
                                              Service                             Children          Parents            Total
include full-time and part-time
preschool, kindergarten transition            Preschool                              708              2,188            2,896
activities (like kindercamp), and             Special Needs Intervention              79                92              171
other child development activities,
                                              Other Early Education                 3,094             6,608            9,702
such as parent and child activities in
school/community centers.                     Total                                 3,881             8,888           12,769

Exhibit 3.6 displays the number of approximate unduplicated clients served through child development
services. A total of 12,769 clients were served – over 3,000 children and 8,000 parents.


Improved Family Functioning
As noted earlier, parents play a critical role in their children’s      “The parents of children 0-
readiness for school. Services provided through SR programs to          5 are not fulfilling their
support families include a variety of parent education classes,         children’s needs. Many DO
literacy programs, case management, and general resource and            NOT know how to parent.
referrals. Family support services were delivered in several            Children need guidance, all
formats this fiscal year. Some classes or groups were held as           people need guidance.”
“drop-in” or one-time classes, while others were sequential,
requiring enrollment and consistent participation in classes over a                 - F5SB SR Partner
certain period of time. The subject matter of classes also varied
and included topics such as child development, discipline, and nutrition.

Approximately 7,987 clients received
                                                       Exhibit 3.7 2007-08 Number of SR Clients Receiving
services related to the improved
                                                                   Family Functioning Services
family functioning result area, the
majority of which were related to              Service                           Children          Parents             Total
parent education (97.1%), as seen in           Resource and Referral                 50                56               106
Exhibit 3.7.
                                               Family Literacy                       64                64               128

                                               Parent Education                    2,599             5,154             7,753

                                               Total                               2,713             5,274             7,987




24
  The types of services were categorized and defined according to First 5 California. Source: First 5 California Children and
Families Commission.

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Annual Evaluation Report FY 2007-08                                                                 January 2009                51
Improved Child Health
The School Readiness Initiative provides a variety of health and social services to participating children and
families, following a “whole child” approach to preparing children for kindergarten. These services may be
funded directly by First 5 School Readiness funds (e.g., the SR contract may fund 50% of a school nurse) or SR
programs may tap other available services (such as the F5SB-funded dental program through Arrowhead
Regional Medical Center). Health services included a variety of screenings (e.g., dental, hearing, language and
speech, and vision), health plan enrollment, and activities that support nutrition and physical fitness.

Exhibit 3.8 displays the number of clients receiving various screenings, as well as health access services.

                 Exhibit 3.8 2007-08 Number of SR Clients Receiving Health Services
              Service                                   Children          Parents          Total
              Oral Health                                  838              1,110          1,948

              Health Access                                20                23              43

              Nutrition and Fitness                        15                14              29

              Other Health Screening /Assessment           239              446             685

              Total                                      1,112             1,593           2,705




Making a Difference: School Readiness in Action

The overarching goal of the School Readiness Initiative is to
increase the school readiness of children in low Academic           “If children get early
Performance Index (API) performing schools through a                intervention, their chances are
variety of complementary approaches, including direct               much higher…if you can get
education services to children, parent and family support,          them into preschool and you
health services, and improving connections between early
                                                                    provide health and dental care
care environments and staff with kindergarten and
                                                                    that is more comprehensive –
elementary school systems. It is hoped that these combined
                                                                    you have more chance for
activities will improve child and family outcomes.
                                                                    success.”
As noted earlier, F5SB’s SR programs focus on a variety of
objectives that are related to the Commission’s Strategic                                    - Stakeholder
Plan and Evaluation Framework. Specifically, SR programs
work to achieve outcomes that are encompassed in F5SB’s and the State’s Result Areas. To measure the
collective impact of the programs on these areas, SR partner agencies collected child, parent, and staff data.
Exhibit 3.9 presents each Result Area, along with outcomes and data collection methods which are further
described in the following pages.

In addition to the use of surveys and assessment tools, Harder+Company conducted one case study with a SR
client in spring of 2008, as part of a participatory photography project entitled, First 5 San Bernardino



Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                     January 2009             52
Community Storybook 2nd Edition. 25 The purpose of this project was to engage a client and SR program staff
member to reflect on how First 5 services have been a benefit to families and the community through the use of
interviews and photography. Lucerne Valley Unified School District was the site for the case study. The case
study and a brief description of the program can be seen later in this chapter.


                            Exhibit 3.9 2007-08 School Readiness Evaluation Design
F5SB Desired Result Area F5CA Result Area                       General Outcome(s)            Method(s)

1) Children are Safe and                                        Increased health & dental     Child intake (pre) and exit
                                 3) Improved Child Health
Healthy                                                         insurance; recent dental care (post) form


2) Children are Ready to    2) Improved Child                                                 Child assessment tool: DRDP-
                                                                Developmental progress
Enter and Succeed in School Development                                                       R or ASQ (pre/post)

3) Families are Safe, Healthy,                                  Increased/improved parent Parent Survey (retrospective
                               1) Improved Family
Nurturing, and Self-                                            knowledge, attitudes,     pre/post); Parent Activities
                               Functioning
Sustaining                                                      behaviors                 Survey (pre/post)

4) Systems are Responsive to                                                          SR Coordinator, Preschool
                                                         Stakeholder collaboration to
the Needs of Children,       4) Improved Systems of Care                              Teacher, Other SR Staff
                                                         build/articulate SR systems
Families, and Community                                                               Surveys (one point in time)




                            Evaluation Limitations Specific to School Readiness

           Generally speaking, the 2007-08 SR evaluation had the same limitations as those mentioned in the
           Introduction chapter of this report, including inconsistencies of data entry and quarterly reporting
           by partner agencies which compromises the usability and validity of the data.
           The child assessment tools selected are different, despite measuring essentially the same behaviors
           and skills. The DRDP-R uses scales and the ASQ uses cut-off scores. Consequently, results cannot
           be discussed by common domains across instruments, but rather must be presented by individual
           instrument.
           The implementation of a modified version of the DRDP-R by F5SB is useful to the partner agencies
           who want a shorter, more resource-efficient tool to assess children. However, because the tool has
           been modified, the modified and full versions cannot be combined to create one set of domain
           scores and must be discussed separately (such as noted above with the DRDP-R and the ASQ).
           While the ASQ is an empirically tested instrument, it is designed to screen children, and is not an
           evaluation tool to be analyzed by statistical comparison at two points in time. However, it is a
           widely-used instrument available to determine a child’s developmental level at age-appropriate
           intervals, and is appropriate for use at parent-child centers.
      With these limitations in mind, results are suggestive but not conclusive of child outcomes.


25
     For more information on the participatory project and the Community Storybook, see Appendix B.

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Improved Child Development

The centerpiece of the SR Initiative is direct education services for children. In order to meet the F5SB Strategic
Plan Objective “Children develop within normal ranges in all domains,” programs are required to complete a
developmental assessment on each child shortly after enrollment, as well as at the end of the program or
program year, in order to track individual developmental progress. 26 The baseline measurement also assists
programs with determining specific areas of need for each child participating in their program.

Most classroom-based programs used either the                       Child Screening & Assessment Tools
full version or a San Bernardino-specific
modified version of the Desired Results                             DRDP-R: SR programs primarily used the
Developmental Profile-Revised (DRDP-R), a                           DRDP-R Preschool Instrument, designed for
teacher observational assessment for children. 27                   children ages 3 to pre-kindergarten. The 39-item
Parent-child centers, in which program staff may                    instrument informs on four result areas of child
not regularly observe the child, utilized the Ages                  development (i.e., personal-social competence,
and Stages Questionnaire (ASQ), which can be                        learning, motor skills, and safety/health) using a
self-administered by the parent and/or the SR                       5-point rating scale. Teachers assessed whether a
staff. 28                                                           child was (4) integrating, (3) building, (2)
                                                                    developing, (1) exploring, or (0) not yet at the
Desired Results Developmental Profile – Revised                     first level. The F5SB modified version uses 20 of
Two SR programs reported child assessment                           the 39 items, and each result area is represented.
results using the full version of the DRDP-R
(fDRDP-R) for a total of approximately 98                           ASQ: The ASQ is an empirically tested
matched pre and post scores. Six programs chose                     developmental screening system consisting of 19
to use the modified DRDP-R (mDRDP-R) and
                                                                    questionnaires that are age-specific between 4
submitted approximately 431 matched cases.
                                                                    and 60 months of age. Each questionnaire
Because of the inherent difference in the fDRDP-
                                                                    includes 30 items in which parent reports
R and the mDRDP-R, results have been reported
separately as seen in Exhibits 3.10-3.11. 29                        whether their child is performing the behavior
                                                                    (yes, sometimes, or not yet). The ASQ covers
This year’s data was analyzed differently than                      five key developmental areas: communication,
previous years. Not only was data analyzed on                       gross motor, fine motor, problem solving, and
matched cases, 30 the data was categorized and                      personal-social.


26
   For more information on the evaluation methodology, see Appendix B.
27
   Programs receiving California Department of Education funding are required to perform the full 39 item DRDP-R within 60
days of child enrollment and every 6 months thereafter. (California Department of Education. Introduction to Desired Results. 6
July 2007. http://www.cde.ca.gov/sp/cd/ci/desiredresults.asp). SR Programs not funded by CDE were permitted by F5SB to use a
modified version of the DRDP-R, consisting of 20 items, at the time of program enrollment and program end.
28
   Squires, J., Potter, L, and Bricker, D. The ASQ User’s Guide, 2nd Ed. Paul H. Brookes Publishing, Baltimore, Maryland, 1999.
In 2005, Harder+Company sought recommendations from key developmental psychiatrists – Gary Resnick of Westat and Todd
Sosona of the California Institute of Mental Health – for a tool appropriate for center-based interventions that could map to the
DRDP. The ASQ was suggested.
29
   The modified version of the DRDP-R included a shorter list of items than the full version to create mean domain scores (20 out
of 39 items); and therefore the results of the two versions are not combined. The modified version includes at least one item per
developmental domain.
30
   The amount of valid responses varied and those that were invalid or that did not contain matching pre or post scores were
removed from analysis. In previous years, pre and post scores were not matched by case and were analyzed as separate samples.

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Annual Evaluation Report FY 2007-08                                                               January 2009                 54
analyzed as intended by the authors of the DRDP-R. In previous years, Harder+Company had created DRDP
domains to match the established ASQ domains. This year the analysis is in line with the DRDP-R four
domains of child development – personal and social competence, effective learning, physical and motor
competence, as well as safety and health.

Exhibit 3.10 and 3.11 present the findings of the fDRDP-R and mDRDP-R by domain and the average change
from pre to post assessment. Scores are assigned from 0-4, with 0 being low and 4 being high. Due to revisions
in the analysis, direct comparisons with the previous program year cannot be made.

Key findings of the DRDP-R include:
    For both versions of the
    instrument, the scores
                                                  Exhibit 3.10 2007-08 Change in Full DRDP-R Scores
    significantly increased from pre                            from Pre to Post (n=98)
    to post, though the fDRDP-R saw                                    Average Mean Average Mean                 Mean
                                           Developmental Area
    larger increases on all domains                                        at Pre      at Post                 Difference
    compared to the mDRDP-R.               Personal & Social
                                                                              1.71              3.33             +1.62*
                                           Competence
    The largest increases in scores for
                                           Effective Learning                 1.59              3.31             +1.72*
    both the fDRDP-R and mDRDP-
    R were found in effective              Motor Skills                       2.15              3.56             +1.41*
    learning, and personal and social
                                           Safety & Health                    1.89              3.48             +1.59*
    competence.
                                           *Changes are statistically significant at p < .001
    Pretest scores were higher for
    children assessed with the
    mDRDP-R, while the fDRDP-R
                                              Exhibit 3.11 2007-08 Change in Modified DRDP-R Scores
    scores indicate higher posttest
                                                              from Pre to Post (n=431)
    scores.
                                                                       Average Mean Average Mean                 Mean
    Less than half (45.2%) of the          Developmental Area
                                                                           at Pre      at Post                 Difference
    children assessed with the             Personal & Social
                                                                              2.07              2.97             +.90*
    mDRDP-R showed progress on             Competence
    all four domains, compared to          Effective Learning                 2.02              2.86             +.84*
    85.7% of all children assessed
    with the fDRDP-R.                      Motor Skills                       2.65              3.42             +.78*

                                           Safety & Health                    2.89              3.43             +.56*
The results as a whole indicate that      *Changes are statistically significant at p < .001
children participating in ECE
activities in the SR programs are increasing their mastery of each developmental area.

It is interesting to note however, that those children assessed with the fDRDP-R saw a higher increase in
developmental skills than those assessed with the mDRDP-R, a finding that mirrors results from previous
years. It is likely that programs using the fDRDP-R are serving children much more intensely, and therefore
the increased movement on the scales would be expected. This suggests that increased exposure to SR
programs may increase the benefit to children.




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Annual Evaluation Report FY 2007-08                                                             January 2009                55
Ages and Stages Questionnaire
During FY 2007-08, ASQ data were reported for four SR programs, totaling 459 matched scores. 31 The ASQ
analysis included utilizing the scientifically set cut-off scores for the ASQ’s age specific instrument, preserving
the design of the tool while comparing children’s status “above” or “below” the age-specified cut-off score at
each point in time. 32 The ASQ provides results for five developmental domains: communication, gross motor,
fine motor, problem solving, and personal-social.

Key findings of the ASQ, as seen in Exhibit 3.12, include:
     In all five ASQ domains, the majority of children were assessed at being above the cut-off point and
     continued to be above the cut-off point at retest.
     Interestingly, there were some children who failed to meet the fine motor skills cut-off score at post after
     meeting the developmental domain score at pre (2.0%).
     The communication domain had the greatest number of children who increased in developmental
     progress from pre to post, while the gross motor domain showed the highest number of children meeting
     the developmental milestone.
     There were statistically significant increases in meeting/surpassing the cut-off scores for communication,
     problem solving and personal-social.
     Between 2% and 14% of children did not meet the cut-off score at any given ASQ screening, indicating
     need for further assessment.


The results suggest evidence of age-appropriate development for the majority of all children at pre and post;
while many children (64.5%) showed progress in all five developmental areas over time.

            Exhibit 3.12 2007-08 Percent of ASQ Scores At or Above Cut-off at Pre and Post for
                               each ASQ Developmental Domain (n=459)
                                     98.9%                                                                  97.4%
                                95.9%                                                96.1%
                                                                                                    93.9%
                                                       92.2%                 91.9%
                 91.3%
                                                            90.2%

         86.1%                                                                                                              Pre
                                                                                                                            Post




      Communication*            Gross Motor             Fine Motor              Problem          Personal-Social*
                                                                                Solving*

       *Changes are statistically significant at p < .001

31
   The amount of valid responses varied and those that were invalid or that did not contain matching pre or post scores were
removed from analysis. In previous years, pre and post scores were not matched by case and were analyzed as separate samples.
32
  “Above” the cut-off score indicates the child is at or above the skills expected for their age; “below” the cut-off score indicates
the child may be behind for their age, and is recommended for further assessment. In this analysis, the cut-off scores used are
specific to each instrument used for the screening.

Prepared by Harder+Company for First 5 San Bernardino
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Improved Family Functioning

The SR Initiative includes a Parent and Family Support Services element to improve parenting skills, literacy,
and access to needed services. Most SR programs focus heavily on providing services that incorporate parent
education about child development, along with actual child development activities. Such programs include
teaching parents and caregivers the importance of spending more time with their children engaging them in
activities that will prepare them for school. These activities meet the following F5SB Strategic Plan Objectives:

     Children live in a home environment supportive of learning
     Parents practice developmentally appropriate parenting skills
     Families are stable and have the capacity to meet the needs of their children


In order to measure these objectives, SR programs were asked to administer two instruments to parents who
engaged in parent education and support activities: 1) Survey of Parenting Practice, and 2) Parent Activities
Survey. Additionally, parents were asked to complete a Satisfaction Survey which captured parents’ feedback
about their child’s’ SR program. Each of these surveys’ results follow.

Survey of Parenting Practice
The Survey of Parenting Practice (SPP) is administered at the end of a program and includes a series of
statements about knowledge, confidence, ability, and behaviors related to parenting. 33 When completing this
survey, parents responded to questions thinking about “now,” after completing the parent education activity,
and “then” before the activity. Ratings range from zero to six, the higher the rating, the more knowledge,
confidence, ability, or frequent behavior. This method of “retrospective” comparison allows for respondents to
more accurately provide baseline data, compared to traditional pre/post methods, when participants tend to
rate themselves higher at pre. 34 In the course of a class, parents learn more about child development and often
come to realize how much there is to know.

Nine of the 12 SR programs had SPP findings during 2007-08,                    “Our families and students
representing 970 parents.                                                      receive great benefit from this
                                                                               program - thanks for the
Overall, parents increased their ratings on all items on the                   support!”
survey. 35 Exhibit 3.13 shows the mean “then” and “now”
outcomes for all 12 survey items, as well as the mean
                                                                                                        - F5SB SR Partner
difference between the two. Below is a brief description of
findings based on the knowledge, confidence, ability, and behavior scales.




33
   Shaklee, H. and Demarest, D. University of Idaho Survey of Parenting Practice Tool Kit, 2nd Ed. University of Idaho Extension,
College of Agricultural and Life Sciences. Boise, Idaho. 2005.
34
   “Pre-test overestimation is likely if participants lack a clean understanding of the attitude, behavior, or skill the program is
attempting to affect.” Pratt, C., McGuigan, W. and Katzev, A. (2000) Measuring Program Outcomes: Using Retrospective Pre-test
Methodology. American Journal of Evaluation. (21) 341-349.
35
   Increases in ratings could also be due to participation in the early learning environment, interaction with teachers and other
factors.

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     Parental knowledge: A parent’s knowledge of child development is the basis for sound parenting
     practices. 36 SR parents increased their ratings on all three knowledge statements. Of all 12 survey
     statements measured, the change in parent ratings was the greatest for the two statements, “My knowledge
     of how my child is growing and developing” and “My knowledge of how my child’s brain is growing and
     developing.”
     Parental confidence: Building on a foundation of child development knowledge, parenting confidence is
     formed by feedback and recognizing strengths in parenting. 37 Parents increased their ratings on all three
     confidence statements, with the greatest increase in those that have confidence in helping their child learn
     at this age.
     Parental ability: Parents bridge the gap between theory (knowledge and confidence) and practice through
     trainings in child development and therefore an increase in their ability. 38 Parents increased their ratings
     on all three ability statements. Out of all twelve items on the survey, “My ability to keep my child safe and
     healthy” had the highest mean “then” and “now” scores, and thus showed the least improvement (though
     still statistically significant).
     Parental behavior: Knowledge, confidence, and abilities all add up to parental interaction with their
     children and other families. 39 Parents who were in all SR programs reported increased behaviors related to
     school readiness, such as reading and parent-child interaction, as well as an increase in connectivity with
     other families with young children.

                Exhibit 3.13 2007-08 Change in SR Survey of Parenting Practice Results
                                       from Pre to Post (n=970)
                                                                   Mean “Then”          Mean “Now”            Mean
     Survey Item
                                                                      Score               Score             Difference
     My knowledge of how my child is growing and
                                                                         4.39                5.09               +.70*
     developing.
     My knowledge of what behavior is typical at this age.               4.32                4.89               +.57*
     My knowledge of how my child’s brain is growing and
                                                                         4.35                5.04               +.69*
     developing.
     My confidence in myself as a parent.                                4.68                5.32               +.64*
     My confidence in setting limits for my child.                       4.62                5.17               +.55*
     My confidence that I can help my child learn at this
                                                                         4.72                5.40               +.68*
     age.
     My ability to identify what my child needs.                         4.66                5.30               +.64*
     My ability to respond effective when my child is upset.             4.65                5.24               +.59*
     My ability to keep my child safe and healthy                        5.16                5.64               +.48*
     The amount of activities my child and I do together.                4.61                5.18               +.57*
     The amount I read to my child.                                      4.15                4.77               +.62*
     My connection with other families with children.                    4.33                4.86               +.53*
     *Changes are statistically significant at p < .001


36
   Shaklee, H. and Demarest, D. University of Idaho Survey of Parenting Practice Tool Kit, 2nd Ed. University of Idaho Extension,
College of Agricultural and Life Sciences. Boise, Idaho. 2005.
37
   Ibid.
38
   Ibid.
39
   Ibid.

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Annual Evaluation Report FY 2007-08                                                                 January 2009              58
Parent Activities Survey
New for FY 2007-08 was the utilization of the Parent Activities Survey. Many SR programs work extensively
with families to build their capacity to support their child’s school readiness. The Parent Activities Survey was
developed to measure a change in parent behaviors over time as a result of their participation in the SR
programs, specifically related to:
          Frequency of interaction with their child, such as playing, reading, singing, keeping a regular routine, etc
          Practicing of literacy techniques with their child
          Provision of learning materials for their child

The survey was administered at the beginning of the parent component and at the end, resulting in a pre/post
design. Six SR programs collected the survey for a total of 353 matched cases.

As seen below in Exhibit 3.14, parents were asked if they make certain learning materials available to their
child. Between 85% and 97% of parents said they made these items available to their child at post, with the
largest increase in parents who allowed their children to have scissors (11.5%).

            Exhibit 3.14 2007-08 Percent of SR Parents Making Child Learning Materials Available
                                          at Pre and Post (n=353)

                           97.1%
         96.3% 96.8% 96.3%
                                                 95.1%                                                      Pre
                                            93.7%                   93.4%                                   Post


                                                                                     87.1%
                                                                                                      85.3%

                                                            81.9%             81.7%
                                                                                               78.7%



             Paper           Crayons           Books            Scissors         Puzzles           Blocks



Best practices in promoting a child’s literacy includes not only reading books aloud, but also appropriate
sharing of the contents of books with their child. As seen in Exhibit 3.15, parents should hold a book upright in
the child’s view, track words with a finger as the words are read, discuss pictures and the topic of the book with
their child, and point out letters and words. These literacy activities help to engage children in the story, as well
as help them become familiar with the process of reading. 40 While parents increased these activities over time,
there were still a large percentage of parents who did not always practice these techniques (between 44% and
55%). SR programs should make the importance of these practices more prominent in their parent education.




40
     National Association for the Education of Young Children. http://www.naeyc.org Accessed 2008 September 8.

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Annual Evaluation Report FY 2007-08                                                              January 2009       59
    Exhibit 3.15 2007-08 Percent of SR Parents “Always” Practicing Literacy Techniques with Child
                                      at Pre and Post (n=353)


              66.9%                 64.8%                                                                       Pre
    61.8%
                          56.7%                          56.2%                                                  Post
                                                                               54.8%
                                                50.1%                 51.4%
                                                                                                     45.6%
                                                                                            41.8%




       Hold book            Track words        Discuss pictures        Discuss book        Point out words
        upright                                                            topic




The Parent Activities Survey also asked the frequency in which parents promote other behaviors that support
their child’s development, as seen in Exhibit 3.16. Highlights from this portion of the survey include:



    Exhibit 3.16 2007-08 Percent of SR Parent Behaviors Supporting Child School Readiness
                        (at least 4 days a week) at Pre and Post (n=353)
                                                                                                          2008 F5SB Family
 Parent Behavior                                            % Pre          % Post        Difference
                                                                                                              Survey*
 Practice writing name with child                           63.6%           77.5%           13.9%                      -
 Make opportunities for child to play with other
                                                            65.2%           77.0%           11.8%                      -
 children
 Play rhyming games with child                              46.8%           56.6%            9.8%                      -
 Tell stories to child                                      48.7%           57.8%            9.1%               86.9%**
 Play with child                                            78.9%           87.2%            8.3%                    96.9%
 Read aloud to child                                        51.0%           56.6%            5.6%               86.9%**
 Practice alphabet with child                               77.0%           81.9%            4.9%                      -
 Sing songs with child                                      78.7%           81.0%            2.3%                      -
 Practice counting with child                               84.7%           86.6%            1.9%                      -
 Hold/cuddle child                                          97.2%           98.8%            1.6%                      -
 Follow a bedtime routine for child                         93.9%           94.8%            0.9%                    95.5%
 Eat with child                                             98.3%           97.4%           -0.9%                      -
 *The response category presented here for the 2008 F5SB Family Survey includes “at least several times per week”.
 **Telling stories and reading stories were combined in the same question in the 2008 F5SB Family Survey.




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     Behaviors that had the greatest increase included practicing name writing with child, making opportunities
     for child play dates, and playing rhyming games with child.
     Those behaviors that the most parents stated doing at least 4 days a week at post included
     holding/cuddling their child (98.8%), eating meals with their child (97.4%), and following a bedtime
     routine (94.8%).
     The behaviors that the least amount of parents stated doing at least 4 days a week at post included playing
     rhyming games (56.6%), reading aloud to child (56.6%) and telling stories to child (57.8%).
     Four of the items were compared to the data reported in the 2008 F5SB Family Survey. 41 All four of the
     behaviors were more frequently reported by families responding to the Family Survey, particularly the
     reading and telling stories. SR programs should continue to stress the importance of reading to their child
     everyday.


Parent Satisfaction Survey
Parent satisfaction is a critical element identified by First 5 California’s redesign. To measure this, SR providers
implemented a modified version of the “DRDP Satisfaction Survey”-- a survey developed by the California
Department of Education that many school-based sites already utilize. 42 The survey is a series of satisfaction
questions about components typically included in early care and education programs. Key findings, as seen in
Exhibit 3.17, include:

     The majority of parents (88.2%) completing this survey
     noted being “very satisfied” with the overall quality of               “The DRDP-R parent satisfaction
     their SR program.                                                      survey done annually provides
     For each program component, the overwhelming                           us with information about our
     majority of parents reported they were “very satisfied”                program through the eyes of the
     or “satisfied.”                                                        parent. We have adjusted our
     The items with the highest ratings were the programs’                  parent workshop subjects as a
     promotion of learning and development, as well as the                  result of this information.”
     safety practices used in the programs.
                                                                                                   - F5SB SR Partner
     The items with the lowest ratings were parent-centered,
     including interaction with other parents through
     parent groups and parent involvement.




41
   Bockmann, S., Sirotnik, B., Aldana, L. 2008 First 5 San Bernardino Family Survey. Institute of Applied Research and Policy
Analysis, California State University, San Bernardino. 2008.
42
   California Department of Education. “Desired Results Reference Materials and Forms.” 2003. Accessed 10 July 2006
http://www.cde.ca.gov/sp/cd/ci/drdpforms.asp

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Annual Evaluation Report FY 2007-08                                                                January 2009                 61
 Exhibit 3.17 2007-08 Percentage of SR Parents Who Were “Very Satisfied” by Component (n=1650)

                          Parent involvement                                               71.5%

                  Parent gr oup opportunities                                               72.8%

                     Equipment and materials                                                         84.2%

             Meeting individual child's needs                                                        84.6%

        Intraction between staff and children                                                        85.2%

                   Languages spoken by staff                                                         85.8%

                           Respect for culture                                                       86.0%

                Program staff communication                                                          86.0%

                                Daily activities                                                      88.0%

                               Safety practices                                                        89.2%

                        Promotion of learning                                                          89.9%

                      Overall program quality                                                         88.2%




Improved Child Health

In order to provide optimal health and social services to children participating in the School Readiness
Initiative, each program offers some type of health screening(s) and/or assistance with health insurance. By
providing these direct services or referrals, SR programs are striving to meet the F5SB Strategic Plan Objective
“children are healthy, well-nourished, and physically
fit.” More specifically, SR works towards two
Commission-Level Outcomes that also meet State                    School Readiness Health Services
reporting requirements:
                                                                    In addition to dental screenings, some
      Increasing the number of children with health and             SR programs provide other health
      dental insurance                                              services such as vision, speech, and
      Increasing the number of children receiving                   hearing screenings.
    annual dental screenings and appropriate follow-              As reported in the “Summing it Up”
    up care                                                       section, over 2,000 clients received
                                                                  services related to screening and
To collect this information, parents enrolling their              assessment.
child in SR programs were asked health questions at
the time of intake and exit. For FY 2007-08, there were a total of 973 matched cases (pre + post responses) used
to inform the health status of children served by SR.

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Annual Evaluation Report FY 2007-08                                                   January 2009             62
According to the 2007 California Health Interview Survey (CHIS), 6.5% of children 0-5 in San Bernardino
County were uninsured (compared to 4.3% for the State of California). 43 The 2008 F5SB Family Survey yielded
slightly lower numbers, with 5.4% of interview respondents indicating their child did not have health
insurance. 44 According to the 2007-08 SR intake and exit surveys, there were a higher number of children in
these First 5-funded programs that were uninsured (between 10-12%) as compared to the other sources of
County statistics. Though the rate of uninsured was higher, the number of clients who stated their child was
insured increased by 1.5% between enrollment and exit from the program, as seen in Exhibit 3.18 below. This
finding suggests that the SR programs are reaching those most in need and may have played a role in
facilitating health insurance enrollment for some families, either directly or indirectly.

                                     Exhibit 3.18 2007-08 School Readiness Health Service Outcomes
Oftentimes, health insurance                                                   (n=973)
does not cover oral health
                                   Indicator                                      Intake % Exit %   Difference
services. According to a
recent report by Children          Child has Health Insurance                       88.3%  89.8%      +1.5%*
Now, 80% of children 0-5 in        Child has Dental Insurance                       82.2%  84.2%      +2.0%*
San Bernardino County have
dental insurance, 45 while         Child has Annual Dental Check                    48.1%  64.3%      +16.2%*
previous figures from the          *Changes are statistically significant at p < 001.
2003 California Health
Interview Survey (CHIS) were somewhat higher (88.0%). 46 Because of the importance of oral health, parents
were also asked if their child participating in SR programs had dental insurance. The rate of dental insurance
by SR clients was just slightly higher than the rate reported by the Children Now results, and increased by 2.0%
from intake to exit, to 84.2%.

While clinical guidelines for pediatric care recommend children have a dental exam every six months, Healthy
People 2010 sets the more modest goal of annual dental visits, aiming for 56% of children and adults to have
visited the dentist within the past year. 47, 48 A 2006 statewide study found that 69.9% of kindergartners had
been to the dentist within the past year, 12.9% had been to the dentist before but it was more than a year ago
and 17.2% had never been to a dentist. 49 And recent CHIS data shows that 41.1% of children 0-5 in San



43
   Center for Health Policy Research, University of California, Los Angeles. California Health Interview Survey. 2007. Accessed 16
November 2008. <http://www.chis.ucla.edu/>
44
   Bockmann, S., Sirotnik, B., Martinez, J., and Ruiz, C. Brief Report, Phase 1: 2006 First 5 Family Survey. Institute of Applied
Research and Policy Analysis, California State University, San Bernardino. 2006.
45
   Children Now. “2007 California County Data Book.” 13 June 2008.
<http://publications.childrennow.org/publications/invest/cdb07/cdb07_sanbernardino.htm.>
46
   Center for Health Policy Research, University of California, Los Angeles. California Health Interview Survey. 2003. Accessed 10
November 2008 <http://www.chis.ucla.edu/>
47
   Healthy People Objective 21-10 includes children over age two. Both the American Academy of Pediatric Dentistry and the
American Academy of Pediatrics recommend children begin annual dental exams by their first birthday. Therefore, by age two, a
child should have had an exam within the past year.
48
   Office of Disease Prevention and Health Promotion. “With Understanding and Improving Health and Objectives for Improving
Health.” Healthy People 2010: Volume II. Washington, DC: U.S. Department of Health and Human Services, 2000. Accessed 13
July 2006. <www.healthypeople.gov>
49
   Dental Health Foundation. Mommy, It Hurts to Chew, the California Smile Survey: An Oral Health Assessment of California’s
Kindergarten and 3rd Grade Children. Oakland, CA: Author, 2006.

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Bernardino County have never been to a dentist. 50 For SR clients, while only 48.1% of children had had a
dental check in the last year at intake, there was a large increase (16.2%) in the number of parents who stated
their child had a dental check in the past year at the time of exiting the SR program. Unfortunately, there were
large percentages of SR children who had never been to a dentist, including 41.0% of those at intake (a similar
finding to the CHIS results), and 26.1% of those at exit.

For the health related indicators, the data continue to show room for improvement, particularly in the area of
dental insurance and dental care. First 5 should continue to emphasize the importance of activities that
increase children’s access to medical and dental services through
the SR programs.
                                                                                    “Because of parent
                                                                                    feedback, we now have
Improved Systems of Care
                                                                                    open continuous
Improving ECE systems is an important element of SR that                            enrollment for families
addresses planning and communication between school                                 with children who will be
administrators, kindergarten teachers, preschool teachers, ECE                      entering kindergarten the
providers, School Readiness program staff and parents. It also                      next school year.”
involves professional development programs, as well as
                                                                                                     - F5SB SR Partner
infrastructure, administration, and evaluation.

Prior to FY 2007-08, there had not been a concerted effort to pursue and document activities that affected the
SR and ECE system in San Bernardino County; however, this year, SR programs collected information from
preschool teachers and other SR staff (including specialty service providers) about professional development,
interaction with parents and kindergartens, kindergarten transition activities, and school readiness awareness.
Three surveys were implemented at one point in time during spring 2008, and were administered with as many
appropriate staff as possible: School Readiness Coordinator Survey (n=8); Preschool Teacher Survey (n=81);
and Other SR Staff Survey (n=32). 51

This section explores improvements to the system of care through four core areas, as reported in the surveys:
connecting preschool and kindergarten teachers, experience level of the SR staff, parent interaction with staff,
and enhancing sustainability and developing community partnerships.

Kindergarten Transition
Perhaps one of the most important components of SR systems                       “The Kindergarten /
improvement is enhancing communication between the SR                            Preschool transition
programs, elementary schools and parents. This                                   collaboration continues to
communication is vital to ensuring that early childhood                          improve each year.”
education programs support children as they develop the skills
critical for school readiness, and that schools support the                                       - F5SB SR Partner
transition needs of families and children as they enter

50
   Center for Health Policy Research, University of California, Los Angeles. California Health Interview Survey. 2007. Accessed 10
November 2008 <http://www.chis.ucla.edu/>
51
   These surveys were based on the NEGP “Ready Schools Checklist”: National Education Goals Panel, along with edits made by
Harder+Company and F5SB and SR partner staff. “A Self-Inventory for Ready Schools.” Ready Schools, Washington, D.C. 1998.
Accessed 10 September 2007. <http;//www.negp.gov/Reports/readysch.pdf>

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kindergarten. 52

During FY 2007-08, there was an increase in kindergarten transition activities, as all SR programs were asked
to add in specific Performance Targets focused on systems improvement efforts. These activities involved
working directly with children and parents/guardians, as well as meetings and information sharing between SR
program staff, kindergarten teachers, and other district staff.

The critical component of kindergarten transition activities is effective communication between ECE staff and
kindergarten teachers. This activity is crucial to ensuring a smooth transition for children entering elementary
school. Survey responses from preschool teachers and other SR staff - specialty service providers 53 - showed
that the interaction rates between SR personnel and kindergarten teachers were relatively limited for a number
of key activities, including meetings/trainings with kindergarten teachers, transition meetings with
kindergarten teachers, and kindergarten visits for parents and children; though there was a high rate of hosting
transition meetings with parents to discuss kindergarten (see Exhibit 3.19).


                           Exhibit 3.19 2007-08 SR Staff Interaction with Kindergartens


             Preschool Teacher (n=81)
             Other SR Staff (n=32)                                                         96.0%
                                                                                  87.7%
                                  74.7%
          70.3%
                                           63.2%                                                          63.5% 60.0%
                                                          52.0%


                   25.0%

                                                                    6.7%


        Meetings/Trainings Transition Plans for Transition Meetings Transition Meetings Kindergarten Visits
        with Kindergarten Students Entering with Kindergarten          with Parents     for Parents/Children
             Teachers         Kindergarten      Teachers Regarding      Regarding
                                                Individual Children   Preparation for
                                                                         Entering
                                                                       Kindergarten



Another critical step to ensure that kindergarten teachers obtain preparatory information about children is the
use of transition files. As noted in Exhibit 3.19 above, only about half (52.0%) of the preschool teachers said
that they met with kindergarten teachers to discuss individual transitions for children, yet 70.7% of preschool
teachers stated creating transitional files for each student attending kindergarten (not in graph). Whether these

52
   Halfon, Neal. et al. Reaching Back to Create A Brighter Future: The Role of Schools in Promoting School Readiness. UCLA
Center for Healthier Children, Families, and Communities, May 2001. Accessed 10 September 2007
<http://www.ccfc.ca.gov/PDF/SRI/stuart-reaching-back.pdf>
53
   Specialty service providers are any staff funded by SR, but not a teacher. This includes school nurses, behavioral specialists,
speech and language specialists, parent education facilitators, case managers and administrative staff.

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transitional files were actually shared with kindergarten teachers is unknown. Additionally, only 38.5% of
preschool teachers noted sharing student DRDP-R scores with kindergarten teachers. Sharing files, along with
assessment results would give kindergarten teachers important information about a child’s developmental
strengths and areas where a child might need more focused assistance and attention.

Staff Education and Experience
Survey results showed that preschool teachers and other SR staff were relatively experienced, with 63.3% of
preschool teachers having been employed as a preschool teacher for over 5 years, and 43.9% having worked at
the SR program for over 5 years. Other SR staff were less likely to report longevity, but 21.9% had been working
at that program for more than 5 years. Exhibit 3.20 shows that most preschool teachers (82.2%) and specialty
service providers (82.8%) were educated at or past the Associate degree level. Nearly a third of both preschool
teachers and other staff were currently in a college or university degree program during 2007-08, as well (30.1%
and 31.2%, respectively). Participation of ECE staff in AB212 and CARES (stipend programs to support
continuing education) was reported by 74.0% of the preschool teachers and 21.9% of the other staff. 54

                                    Exhibit 3.20 2007-08 SR Staff Education Level


                    Preschool Teachers (n=81)
                    Other SR Staff (n=32)                 41.1%
                                                                          37.0% 34.5%
                                                                  27.6%
                                                                                                 20.7%
                           13.8%       16.4%

                                               3.4%                                       4.1%
                    1.4%

                   Some College        ECE/Child          Associates       Bachelors    Masters Degree
                                      Development          Degree           Degree
                                         Permit



SR programs also offer staff a variety of training opportunities. Most preschool teachers (95.0%) and other SR
staff (93.8%) noted being offered opportunities to attend professional development activities and most
participated (between 90-96%). Those preschool teachers that participated attended an average of 4.9 activities,
while other SR staff participated in 3.1 activities throughout the fiscal year. All staff felt their professional
development was applicable to their SR programs.
                                                                          “Our preschool program, as well
Parent Interaction with Staff
                                                                          as our infant/toddler program ,
Parent involvement in the learning environment is vital to a
                                                                          have a parent advisory council
student’s success. In FY 2007-08, most SR preschool
teachers responding to the Preschool Teacher Survey
                                                                          which is comprised of parent
indicated that they met with parents during the first week                representatives from each site.”
of school (87.2%), and most met with parents prior to the                                  - F5SB SR Partner
first day of school (75.0%). The most common on-going

54
     For more information on CARES, see this Chapter, page 72.

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parent involvement activity during the school year was to provide referrals to parents for other needs, invite
parents to participate in the classroom, followed by inviting parents to attend one-on-one parent conferences
(see Exhibit 3.21). Also, according to the 2008 F5SB Partner Survey, some SR programs sought to include
parents in their administrative and planning activities, such as a parent advisory committee. 55

                                 Exhibit 3.21 2007-08 SR Activities Involving Parents

                   Other SR Staff (n=32)
                   Preschool Teachers (n=81)
                                                                             37.0%
                                               Home Visits                 31.6%
                                                                                                88.9%
                                        Parent Workshops
                                                                                            77.8%
                                                                                        68.0%
                                       Parent Conferences                                         92.5%
                                                                                              84.0%
        Invited Parents to Participate in the Classroom
                                                                                                   94.8%
                                                                                                   96.3%
                     Provide Parents Referrals/Linkages
                                                                                                  92.3%

                      Met with Parents Prior to First Day
                                                                                                87.2%

                             Met with Parents First Week                                   75.0%




Community and Institutional Partnerships
The SR programs leverage existing ties with district schools and other First 5 funded and non-First 5 funded
community partners to enhance the system of care. Interaction with and support from elementary schools and
stakeholders are two important aspects of sustaining early care and education programs.

SR Coordinators were asked to rate how involved various stakeholders were during 2007-08 in regards to the
planning and governance of their program(s). Involving these partners in the planning and governance
activities is important for building buy-in for the existence and continuation of programs. As seen in Exhibit
3.22, most coordinators reported that very few of their
stakeholders were actively involved in the planning or            “We began a Preschool
oversight of their program. The most involved players             Collaborative team consisting of
included representatives from child care resource                 district and local agency
agencies, parents from diverse backgrounds, and local             representatives aimed at
county office of education staff. District staff were rated       identifying young children with
lower in terms of active involvement, though 100% of the          special needs in an efficient and
coordinators reported that school administrators and              positive way.”
teachers were “very” or “somewhat” supportive of their
                                                                                      – F5SB SR Partner
program.



55
     For more information about the F5SB Partner Survey, see Appendix B.

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When the coordinators were asked about moderate or major challenges to implementing or operating their
program, the most frequent responses included:

        School district policies, procedures and relationships (66.7%)
        Lack of staff time (66.7%)
        Inadequate funding (50.0%)
        Conflicting professional or          Exhibit 3.22 2007-08 Groups Involvement in SR Program
        group culture (50%)                                Planning & Governance (n=8)
                                                                                                        Percent
                                          Group/Stakeholder
                                                                                                    “Very Involved”
                                          Representatives from child care resource agencies                62.5%
A Final Word on School
                                          Parents from diverse cultural and linguistic
Readiness                                 backgrounds
                                                                                                           57.1%

                                          Local county office of education staff                           57.1%
The School Readiness Initiative has
had a positive impact on improving        Kindergarten teachers                                            50.0%
children’s readiness for school,
                                          Parents of children 0-5                                          50.0%
parenting practices and staff
development. Children exhibited           Local preschool and/or early childhood educators                 50.0%
improved outcomes in all                  Representatives from universities and/or community
                                                                                                           50.0%
developmental domains; parents            colleges
exhibited improved outcomes on all        Representatives from health and human service
                                                                                                           42.9%
                                          agencies
four parenting practice topic areas;
                                          Representatives from Part C infant/toddler programs
and staff participated in numerous        (Early Head Start)
                                                                                                           40.0%
professional development activities.
                                          School Principal(s)                                              37.5%
In addition, School Readiness
programs have connected to larger         Other school district staff                                      37.5%
systems through community
                                          School District Superintendent                                   25.0%
partnerships. These partnerships
have resulted in better transitions       Representatives from Head Start                                  25.0%
and greater ease for families trying to   Representatives from Part B preschool programs
                                                                                                           20.0%
navigate the system of care.              (special education for 3-5 yrs)
                                          Parents of children with disabilities or special needs           16.7%




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                          School Readiness in the Rural High Desert:
                              Lucerne Valley Linking Families

   Jessica and her husband are young parents, operating their own business in Lucerne Valley, a small,
   rural agricultural and mining town in the high desert of San Bernardino County. In a town with very
   little resources for families with young children, Jessica was excited and relieved to find the local
   First 5 School Readiness program, called SMILE (Smart Motivated Individuals Learning Education),
   operated through Lucerne Valley Unified School District.

   Jessica’s son, Aiden – 3 years old, never had many opportunities to interact with other children his
   age and Jessica was running out of ideas of how to entertain him.

            “I didn’t know how to teach him. I had him
            when I was 18 years old and I didn’t really         “He’s so sure of himself now. He
            know how children learn. And I didn’t have          could rule the world. And he
            many others to ask.”
                                                                wasn’t like that before.”
            “Our biggest challenge was boredom. It’s
            amazing how much energy it takes to raise a                     —Jessica, F5SB Parent
            toddler. They have to be entertained
            constantly and there are only so many times
            you can play with the same toy… over and over again. When we come here, there is a new
            activity or thing to do everyday.”

   Jessica and her family cannot afford to put Aiden into a child care facility where he could be exposed
   to a variety of early learning or social integration activities. Because the Lucerne Valley SMILE
   program is free, this program fills a needed gap for families like Jessica’s. If not for this program,
   Aiden would stay at home and have little interaction or structured activities, as Jessica and her family
   work everyday out of their home. Jessica states, “Everyone in our household is an adult. I wanted him
   to be involved with other kids. He was only one and a half and he started to become an adult
   himself, and I didn’t want that.”

   The Lucerne Valley SMILE program provides free classes and activities for parents and children ages
   0-5 to learn, grow, and develop. These opportunities increase children’s likelihood for a smooth
   transition into school, as well as ensuring children’s readiness and willingness to succeed in the
   future. Classes are separated by three age groups and provide free play, as well as a variety of
   structured activities such as reading, crafts, singing, and learning labs. In order to build literacy and
   readiness to learn, children receive a new book to keep once a month and are also given a small
   educational incentive each time they complete “homework.”

            “This program is very much about learning to get along with others, learning to have fun and be
            a child, with the addition of learning labs where they have specific activities. The program
            teaches them to get ready to be in school.”

            “They get books to keep and they get to add it to their “library” at home. Aiden loves the First 5
            books! They are special and can’t be combined with his other non-First 5 books. They have
            special meaning for him.”




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   Because Aiden was not regularly exposed to other young children, he was very shy when he started
   the program. But since Aiden began the program he has started opening up and socializing with
   other children. “He was really shy at first. He’s a pretty docile and laid back kid. Before he didn’t want
   to join in – he’d hang onto my pant leg and observe, but not join. Now he’ll see children his age and
   initiate playing with them.” Jessica also notes that Aiden really enjoys reading and
   frequently asks to go to the library where he can read even more books.

   In addition to early education activities, the SMILE
   program ensures that a variety of health screenings are        “My son loves to read because
   made available for the children, including dental,             of this program. I am amazed
   hearing and vision screenings. The program will also           how he has become so
   refer parents to other community resources as needed.          intelligent and really quick!”
   Jessica says, “We don’t have health insurance since we
   are self employed. Aiden has Medi-Cal, but this
   program has really helped. He has received many                                 - Jessica, F5SB Parent
   health screenings – like dental and vision – all for free.”

   Though the program provides tremendous benefits to children, Mary Rodriguez, Program Director,
   reports that the most important aspect of the program is the parent involvement. She reports that
   parents are learning how to better interact with their children, as well as how to utilize the lessons
   with their children at home.

            “We have parents who think they don’t need to do anything about their child’s education until
            they turn 4, but we tell them that they need to be thinking about education from birth. There is a
            lot they can do from the minute they are born to ensure development.”

   Jessica agrees. She reports learning methods of interaction and bonding that she can practice at
   home and continue to ensure Aiden’s appropriate developmental and social growth. Jessica has
   found that the program has given her new ideas for keeping Aiden stimulated, as well as taught her
   how to be a better and more involved parent. “The program teaches me that you don’t have to
   always be perfect and do things by the book. The stress of being a perfect parent is normal but isn’t
   necessary, because things happen and you need to just try your best.”

   Additionally, the program has created social outlets for both Aiden and Jessica’s family.

            “It was really hard to meet people here. I didn’t really have any friends. Its not high income and
            there are a lot of drugs here. It is hard to know which parents to trust, but by coming here you
            meet parents who also are involved with their children and you befriend people you want your
            kids hanging out with. It’s a really nice program to get the community involved and together.
            That helps increase trust and reduce crime in the community.”




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     Child Care Quality Standards, Capacity &
     Access
In addition to funding comprehensive early education programs for children and their families, F5SB also
recognizes the importance of supporting Early Care and Education programs and providers that work towards
improving standards in the field. F5SB invested in three Strategies during 2007-08 that help meet these goals: 56

     The Child Care Quality Standards (CCQS) Strategy
     seeks to promote quality standards for ECE services,                      “My knowledge of children
     increase the number of trainings for ECE providers,                       (how they think, learn, get
     increase the number of ECE programs that meet national                    motivated, appreciated,
     accreditation standards, and provide technical assistance                 respected and loved) has
     and financial assistance to child care providers.
                                                                               increased and I feel a lot more
     The Child Care Capacity (CCC) Strategy provides                           confident about my relations
     technical assistance for prospective child care providers                 with them.”
     in obtaining licensing and certification.
                                                                                                         - ECE Provider
     The Child Care Access (CCA) Strategy expands existing
     financial support and subsidies to include more families in quality child care.


During FY 2007-08, five partner agencies were funded within these strategies (3 CCQS, 1 CCC, and 1 CCA as
seen in text box). These projects were awarded a total of $3,352,458 and expended approximately $2,975,529
(88.8%).
                                                         2007-08 Child Care Strategy Partners
As noted at the beginning of this          Partner                                               Strategy
chapter, the CCQS, CCC, and CCA
                                           Christian Counseling Service,
Strategies strive to meet F5SB                                                                     CCQS
                                           Strengthening the Preschool Child
Commission-Level Outcomes within the
                                           San Bernardino County Superintendent of Schools:
Objective, “Children have access to high Desert Mountain SELPA                                     CCQS
quality early childhood development
                                           University of California, Riverside: CARES              CCQS
programs.” In order to increase the
number of high quality programs, the       University of California, Riverside: CONNECTIONS         CCC
five contracted programs included the
following elements for ECE providers: 57 San Bernardino County Superintendent of Schools,          CCA
                                                  KidsNCare

     Recruitment for training and capacity building
     Training to increase knowledge and skills and enhance practices
     Facilitation of college degrees, teaching credentials, and child development permits


56
 For the purposes of this chapter section, these three strategies will be discussed together.
57
 The CCA program also assists parents in selection and financing of subsidized child care, as well as tracks child outcomes.
These findings are not presented here.

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          Stipend and textbook assistance for successful students


During FY 2007-08, over 6,000 ECE providers were served in some capacity through these programs in order
to enhance early learning environments.

SBC-CARES
The San Bernardino County -                                              The History of CARES
Comprehensive Approaches to Raising
Educational Standards (SBC-CARES)                        The California Compensation and Retention Encourage
program, which began in FY 2002-03,                      Stability (CARES) initiative originated in 1997 in
continued its efforts to improve the quality             response to a major child care crisis throughout the
                                                         State. At that time, child care centers and family child
of local childcare and encourage
                                                         care homes struggled with high turnover rates and
professional development by providing
                                                         under-qualified staff. The Center for the Child Care
monetary stipends to ECE providers for                   Workforce, along with a coalition of other service
completing college units. CARES is an                    providers, developed an initiative which would
inclusive program, available to both Family              increase highly skilled providers and staff retention
Child Care and Center-Based Providers.                   with the use of rewards. This would be accomplished
                                                         by compensating providers for their experience and
CARES provides stipends to teaching and                  providing payment of incentive stipends in support of
                                                         ongoing education. Since its inception there has been
administrative staff to reward and encourage
                                                         an increase in professional development activities
educational attainment, thereby increasing
                                                         offered to child care workers, in community college
quality care for children. Re-designed by                enrollment, and in the number of new providers
First 5 California in 2005, CARES                        applying for child development permits. While the
participants are assigned to one of the                  California Department of Education allocates stipends
following five tracks to work toward a                   to state-subsidized child care providers, First 5
CARES Stipend: 58                                        California and local First 5 Commissions provide
                                                         incentives for non-subsidized child care workers. Most
     1.     Family, Friend & Neighbor                    all of California’s 58 counties have implemented the
     2.     Entry Level (less than 6 units)              CARES program model and have modified it to best
                                                         serve their communities. First 5 California renamed
     3.     Permit Level (6 units or more)               CARES as Comprehensive Approaches to Raising
     4.     Degree (B.A. and M.A.)                       Educational Standards.

     5.     Professional (CARES Advisor for              Source: First 5 California. CARES Training and Technical Assistance
            lower track participants)                    Project: CARES History. 2007. <http://cares.w4qcc.org>


Program Findings
   During FY 2007-08, there were approximately 2,211 providers who attended orientation and completed an
   application to participate in SBC-CARES.
          Approximately 83.4% or 1,843 Family, Friend, and Neighbor caregivers, as well as early care professionals
          who applied to participate in SBC-CARES, actually attended courses.




58
 First 5 California. CARES Training and Technical Assistance Project: About the Project. 2007. Accessed 14 September 2007.
<http://cares.w4qcc.org>

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SBC-CONNECTIONS
Another program that complements SBC-CARES is the San Bernardino County-Changing Our Normal
Networks, Early Care Training and Infrastructure, Outgrowths and New Strategies (SBC-CONNECTIONS)
program. SBC-CONNECTIONS is an educational program designed to recruit new child development
students and support early care professionals, including teachers and caregivers working in license-exempt
settings. This program teaches the skills necessary to advance young children’s development, improve the
quality of care, and encourage progression along the child care career ladder.

Program Findings
   During 2007-08, approximately 4,784 providers applied to participate in SBC-CONNECTIONS, of which
   4,424 (92.5%) successfully enrolled and attended trainings.
       367 SBC-CONNECTIONS participants completed the required training and obtained a Child
       Development Permit from the State of California.


Other Programs
Other partner agencies in these Strategies are more limited in scope related to provider activities and outcomes.
These programs included the following:
          Desert Mountain SELPA provided training to 253 preschool teachers on Theraplay activities (i.e.,
          structured, nurturing group play involving children and adults that fosters self-esteem, sense of
          belonging, and trust). 59
          Christian Counseling Service trained 44 preschool teachers in Parent-Child Interaction Therapy (PCIT)
          activities to utilize with special needs children in the classroom. 60
          KidsNCare trained 23 ECE providers to enhance their child care environment through the use and
          increase of scores on the Early Childhood Environmental Rating Scale (ECERS).



Making a Difference: Child Care Provider Programs in Action

One of the primary goals of these five programs is to improve the
quality of local child care programs and encourage professional           “[This program taught me
development. Prior to this fiscal year, limited data was available to     to] recognize the
assess the efficacy of these programs. In 2007-08, three of these         importance of
programs agreed to administer a common survey to ECE                      unstructured play.”
providers (i.e., ECE Provider Survey) who attended F5SB-
supported child development and education classes at a free or                            - ECE Provider
reduced cost. The purpose of the survey was to supplement the
pre-existing data (limited to the number of providers participating in trainings) and to gain further insight into
these programs’ outcomes.

A total of 102 child care providers completed the survey and results can be seen below. Additionally, as part of
the Community Storybook, 2nd Edition, an ECE provider was interviewed via a case study to determine how the

59
     The Theraplay Institute. Accessed 16 November 2007. <http://www.theraplay.org/additional/group_theraplay.htm>
60
     For more information about PCIT, see Chapter 2: Health and Wellbeing.

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SBC-CONNECTIONS program assisted her in her practice. The case study can be seen within this chapter, as
well.

ECE Provider Survey
Of the childcare providers that participated in the survey, the majority of respondents identified as being
Hispanic or Latino (67.7%). The primary language spoken with children in the participant’s class or site was
English (52.2%), but notably, the second most frequent response was English and Spanish equally (37.0%).

                                                              When asked how long the participant had been
           Retention of ECE Providers
                                                              working in the child care education field, many of
   Over half (55.3%) of the participants who                  the participants (29.7%) reported that they had
   completed the survey had been working at                   worked in the child care field for 1-5 years, though
   their current job for more than four years.                the percent of participants that have worked in the
   The majority of respondents reported that                  field for 5-9 years and 15-24 years were about equal
   they did not plan on leaving their current                 (22.0%), illustrating that this survey captured a wide
   position within the next 6 months (86.8%).                 range of experience levels of child care providers in
                                                              San Bernardino County.

As the ECE field tends to experience high rates of turnover, the statewide CARES effort strives to retain child
care providers within the field. Over half (55.3%) of the participants completing the survey had been working
at their current job for more than four years. The majority of respondents reported that they did not plan on
leaving their current position within the next 6 months (86.8%). These data may be evidence that these
programs have had positive effects on retention in the ECE field. Further investigation would be necessary to
make conclusions on direct effects of the program and short and long-term retention.

To assess the need for child care, survey respondents were asked if they had a waiting list during the last year.
Of the 57.3% of providers that responded that they had a waiting list, most (62.8%) stated that that a larger
space or bigger site would have enabled them to serve more children, while fewer responded that more staff or
financial resources would assist them (see Exhibit 3.23). This suggests that while sites have a variety of needs,
space may be more important than money when expanding capacity for child care in San Bernardino County.

                  Exhibit 3.23 ECE Providers Preferred Resources to Expand Child Care

                              62.8%


                                                        32.6%
                                                                                20.9%




                              Space                     Staffing                Money




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Furthermore, 73.0% of all respondents reported that they had enough resources and/or trained staff to provide
desired child care services. Of the respondents that reported they did not have enough resources, 66.7% of
respondents reported that they were in need of more education materials and 60% were in need of new or
improved play equipment (Exhibit 3.24).

                                 Exhibit 3.24 ECE Provider Resource Needs

                           66.7%
                                             60.0%

                                                               33.0%
                                                                                  26.7%




                           More              New or    Training for self       Training for
                        educational      improved play                          other staff
                         materials         equipment



As seen in Exhibit 3.25, a variety of questions were asked to assess the effects of the programs. Key highlights
include:
    85.9% of respondents reported that the program helped “a lot” in working more effectively with the
    children in their care.
    76.0% of respondents reported that the program helped “a lot” in acquiring new knowledge about the
    development of young children.
    75.8% of respondents reported that the program helped “a lot” in learning new ideas for planning activities
    for young children.
This is evidence that the programs are achieving one of their primary goals: to provide training to increase
knowledge and skills and enhance child care practices.

                                            Though the programs were effective in helping participants in a
   “[Because of this                        variety of areas, there were some areas that the program was not
   program,] I make more                    effective. About a quarter of respondents reported that participation
   contact with parents and                 in the program did not help them earn a raise (27.0%), or increase
   have discussions about                   their level of responsibility/receive a promotion (22.5%). The
   their child’s                            frequency of these responses may be due to the possibility that
                                            taking educational courses may not be sufficient to get a promotion
   development.”
                                            or gain more responsibility. Alternatively, further investigation into
                    - ECE Provider          the rank and/or role of the participant would help clarify if the
                                            participant was already at the top level of responsibility for their site.

Also, one third (34.2%) of respondents reported that participation in the program did not help to increase the
number of children they cared for. Possible factors that contribute to the frequency of this response include but
are not limited to:


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      Lack of space: 62.8% of respondents who reported they had a waiting list also reported that space was an
      obstacle when expanding childcare services to more children. Further education does little to address
      capacity issues.
      Understaffed: Participants may not have had the staff necessary to serve more children at their site. Of
      the participants who reported they had a waiting list, 34.2% reported that the lack of staff was an obstacle
      to serving more children.
      Complexity of child care recruitment: Some participants may not have had the internal capacity to
      market themselves appropriately. Appropriate marketing would allow the community to be aware of
      their service.


                                  Exhibit 3.25 2007-08 ECE Providers:
                             Impact Based on Program Participation (n=102)*
                                                                                        Some or a
   Participation in the program helped me to…                              A lot                        Not at all
                                                                                          little
   Work more effectively with the children I care for                     85.9%           10.6%              3.5%
   Acquire new knowledge about the development of young
                                                                          76.0%           20.8%              1.0%
   children
   Learn new ideas for planning activities for young children             75.8%           27.4%              2.1%
   Gain a more professional self image                                    67.1%           27.1%              4.7%
   Complete more education                                                61.5%           33.0%              5.5%
   Feel more valued by co-workers, supervisors and/or parents             54.7%           36.0%              7.0%
   Move up in responsibility or get a promotion                           43.8%           32.5%              22.5%
   Increase the number of children I care for                             32.9%           31.7%              34.2%
   Earn more money or get a raise                                         29.7%           41.9%              27.0%
   *Responses that were “unsure” are not shown here and sum of responses may not equal 100%




On the following page, Exhibit 3.26 shows the percent of responses to questions that assessed the increase of
activities at the participant’s child care site. Following participation in the program, participants most notably
reported an increase in providing positive reinforcement (79.3%), providing physical activities for children
(78.4%), and encouraging parents to read to their children (77.9%).

In contrast to the increase of specific activities discussed above, fewer effects were seen in actual environmental
changes to the child care class or site due to provider participation (Exhibit 3.27) Nonetheless, 63.4% of
respondents reported they had improved safety at their site and 61.4% reported that they had provided more
nutritional snacks to the children after participation.

Though the survey participant rate was considerably low (n=102) compared to the number of ECE providers
served among these programs (estimated at over 6,000), FY 2007-08 marked the first year attempting to
implement a survey among this population in San Bernardino County. Overall, the survey results indicated
that these provider programs, aimed at increasing knowledge and enhancing child care practices, had the
desired effects. By continuing to collect these data in the coming fiscal year, it is hoped that a more
representative sample can be collected to show more robust outcomes.

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                                   Exhibit 3.26 2007-08 ECE Providers:
                         Increase of Activities After Program Participation (n=102)
   Because of participation in the program, I’ve increased the                          Some or a
                                                                           A lot                          Not at all
   following activities:                                                                  little
   Praising children’s good behavior                                       79.3%              17.2%           3.4%
   Providing physical activities for children                              78.4%              19.3%           2.3%
   Encouraging parents to read with their children                         77.9%              17.4%           4.7%
   Redirecting children’s behavior                                         75.3%              22.5%           2.2%
   Reading to children                                                     74.7%              20.7%           4.6%
   Providing opportunities for children to write/draw                      74.7%              19.5%           5.7%
   Providing educational material to parents about health, safety,
                                                                           64.7%              29.4%           5.9%
   nutrition, school readiness, or other parenting skills
   Providing parents referral resources for other needs                    63.1%              28.6%           7.1%
   Discussing with parents the child’s transition into preschool or
                                                                           62.7%              28.9%           8.4%
   kindergarten
   Providing parents guidance in child’s behavior                          61.9%              30.9%           6.0%
   Sending home activities for parent-child interaction                    60.2%              32.5%           7.2%
   Having one-on-one meetings with parent about child                      55.3%              33.0%           11.8%




                                Exhibit 3.27 2007-08 ECE Providers:
                 Changes to Child Care Site Based on Program Participation (n=102)*
   Participation in the program helped me to make these                                 Some or a
                                                                           A lot                         Not at all
   changes to my child care class or site:                                                little
   Increased space for outdoor activities                                 64.6%           25.6%               7.3%
   Improved safety                                                        63.4%           24.4%               11.0%
   Provided more nutritional snacks                                       61.4%           20.5%               16.9%
   Increased space for indoor activities                                  59.3%           28.4%               11.1%
   Secured more play equipment                                            58.0%           25.9%               13.6%
   Implemented new health practices                                       54.2%           30.1%               13.3%
   *Responses that were “unsure” are not shown here and sum of responses may not equal 100%




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           Improving the Quality of Child Care: SBC CARES/CONNECTIONS

   Jagruti has always had a passion for children, actively taking care of her own younger siblings and
   her children while living in India. Jagruti moved to the United States with her family in 2000, wherein
   she decided she wanted to open her own child care facility, specifically a daycare in her home.
   Jagruti found her niche when she enrolled in early care and education classes through San
   Bernardino County (SBC) CARES/CONNECTIONS Projects (operated through University of California,
   Riverside-Extension) in 2001, earning her Associate Teacher and Site Supervisor Child Development
   Permits. After volunteering and working in various child care centers, Jagruti successfully opened
   her own family daycare in 2005.

   The SBC CARES/CONNECTIONS Projects provide a variety of training opportunities, as well as
   incentives, stipends, and tuition assistance for child development students and early childhood
   caregivers in order to recruit and retain local child care
   workforce, as well as improve and enhance early
   education settings. Of the incentives Jagruti received       “The classes reinforced my
   while participating, she notes, “Receiving monetary          beliefs that my immediate
   help in the way of getting refunds for fees and books        responses to them, providing
   was a great help. This acted as a good incentive to take
                                                                loving care, and maintaining
    more classes.”
                                                                their schedules work wonders!”
   So serious is Jagruti about her chosen profession, that
   although she received a college degree in Food /                        - Jagruti, ECE Provider
   Nutrition from India, she is also currently working on
   her Masters in Child Development at the University of La Verne, teaching for the SBC CARES/
   CONNECTIONS Projects, as well as serving as an active board member and secretary for the
   Arrowhead Association for the Education of Young Children, a local division of the state and national
   association. The SBC CARES/CONNECTIONS Program Director, Dr. Margi Wild, says, “Jagruti loves
   being a child care provider, but she also loves being involved with what’s happening in the field –
   learning new things, and teaching others what she knows, like infant massage.”

   On a typical day at Jagruti’s daycare, she teaches and
   bonds with approximately three infants and a varying          “When I first met Jagruti, she
   number of toddlers. The children lovingly call her “Masi,”    was a student… but now she’s
   Hindi for “Aunt.” She has an assistant help her on busy
                                                                 really a professional. She’s
   days, but she likes to keep her daycare small (typically
   caring for less than the maximum 14 children). When           come into herself, realizing her
   asked to describe the impact of the SBC CARES/                strengths. She explores every
   CONNECTIONS Projects on her practice, she reports             avenue to better and further
   that she is appreciative for all that she learned, and the    herself.”
   mentorship and guidance she received through the
   program and Dr. Margi Wild, who provided her with
   many opportunities. Without those opportunities, she              - Dr. Margi Wild, F5SB Partner
   would not be successfully living out her passion.

   Jagruti declares:

            “We need a more educated workforce to bring up the standard of the child care profession, which
            gets more respect like other professionals and we’re not just ‘baby-sitters’. These programs
            helped me to become more professional and parents respect us for being professionals.”



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     Play Spaces for Children
Another F5SB Strategy aimed at improving the quality of early education programs for children includes
renovation and/or enhancement of play spaces at licensed center and home-based child care facilities. F5SB’s
Strategic Plan specifies that the priorities for the Play Spaces for Children (PSC) Strategy include:

       Technical assistance and matched funding, particularly in the Desert and Mountain regions
       Spaces adapted specifically for special needs children


As part of the implementation of this Strategy, F5SB                        Make A Difference Day
invested a total of $32,151 in twelve (12) play spaces as
part of the local Commission’s participation in the                   All across America, millions of people
National “Make A Difference Day” 61 event held in                     demonstrate their commitment to the
October 2007.                                                         community when they work side by side
                                                                      for a good cause. Make A Difference Day
The 2007-08 First 5 San Bernardino “Make A Difference                 was created by USA WEEKEND magazine
Day” (MADD) effort took a slightly different approach                 in partnership with The Points of Light
than previous years. The process for participation and                Foundation. On Make A Difference Day,
                                                                      multinational corporations and mom-and-
establishing eligibility included attendance at mandatory
                                                                      pop businesses alike use skills and
workshops, pre-registration, completion of a community                resources to contribute where the need
project (for MADD) and submission of a Request For                    exists. Projects often include employees,
Application (RFA) documenting the project. F5SB Staff                 family members and community non-
mailed announcements regarding this investment                        profits addressing a range of social
opportunity directly to 1,200 child care facilities. Four             concerns, strengthening ties between
mandatory MADD RFA workshops were held in August                      companies, non-profits and the
and September 2007 in various regions of the County.                  community.
Over 150 participants attended the workshops. As a
result of these efforts, 98 child care centers pre-registered to participate and 94 child care centers actually
completed a project. Out of these 94, 59 applications were received and reviewed. The civil projects reported by
the child care centers consisted of community activities such as book fairs, food drives, graffiti and litter
removal, home baby-proofing, and renovations, repairs and beautifying of neighborhood spaces. Of particular
interest, one of the events included a fall carnival and resource fair at the National Orange Show for local
families, particularly those affected by the devastating October 2007 wildfires.

The application review process yielded 15 child care centers being recommended for a play space. The 15
candidates included both center based and home based child care centers across the County. Out of these, 12 of
the centers 62 began working with a consultant to design the optimal play space within each physical
environment. The installation of these play spaces was still underway at the time of this writing.




61
     Make A Difference Day. Accessed 22 November 2008. <http://www.usaweekend.com/diffday/index.html>.
62
     Three of the child care centers eligible to receive play spaces dropped out of the process.

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 Conclusions and Recommendations
First 5 San Bernardino invested valuable resources in a variety of programs to increase the number of children,
families, and providers who have access to services that support the early care and education of children. Some
of the primary 2007-08 findings of the Early Care and Education Cluster include:

F5SB partners increased the number of children who are exhibiting age-appropriate
development and healthy cognitive and social-emotional behavior.
    From fall to spring of FY 2007-08, children showed positive developmental progress on all of the
    established domains of the DRDP-R as a result of participating in a SR program. The largest increases in
    scores were found in effective learning, and personal and social competence.
    From fall to spring of FY 2007-08, the majority of all children met or exceeded the cut-off scores on each
    domain of the ASQ. The communication domain had the greatest number of children who increased in
    developmental progress from pre to post, while the gross motor domain showed the highest number of
    children meeting the developmental milestone.

F5SB partners increased the number of parents who use developmentally appropriate
activities to support the school readiness of their children.
    Results from the Survey of Parenting Practice showed an increase on all parent knowledge, confidence, and
    behavior questions after participating in a SR program. Parents had the highest increase in their knowledge
    of how their child is developing, how their child’s brain is developing, and in their confidence in helping
    their child learn.
    On the Survey of Parenting Practice, parents rated themselves highest on their ability to keep their child
    safe and healthy.
    Results from the Parent Activities Survey indicated that those behaviors that had the greatest increase in
    parents performing the activities at least 4 days a week included practicing name writing with child,
    making opportunities for child play dates, and playing rhyming games with child.
    The majority of parents stated holding/cuddling their child, eating meals with their child, and following a
    bedtime routine at least 4 days a week.

F5SB partners continued to link families to health services.
    School Readiness programs provided opportunities for over 2,000 clients to receive screenings and
    assessments related to dental, vision, and hearing.
    Many SR providers assisted families with health insurance enrollment and provided referrals to other
    community providers for other short-term and long-term needs.
    There was a slight increase in families who said their child had health insurance (1.5%) and dental
    insurance (2.0%) after participating in SR.
    There was a 16.2% increase in the number of parents who stated their child had received an annual dental
    check up after participating in a SR program.




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F5SB partners worked to enhance the School Readiness system of care.
    The majority of parents (88.2%) were “very satisfied” with the overall quality of their SR program.
    Most preschool teachers reported having kindergarten transition plans in place for their students and
    providing meetings with parents to discuss kindergarten transition.
    Many teachers and other SR staff received trainings or attended meetings to develop policies/programs or
    to enhance curriculum that includes kindergarten transition activities. All staff felt their professional
    development was applicable to their classrooms.
    SR staff offered many parent involvement activities during the school year, including providing referrals to
    parents for other needs, inviting parents to participate in the classroom, and inviting parents to attend
    one-on-one parent conferences.

F5SB partners increased the number of child care providers qualified regarding the
developmental needs and milestones of children.
    Over 6,000 providers enrolled in classes or trainings to enhance their knowledge and skills about child
    development, potentially benefiting their care center or practice.
    Over three-quarters of ECE providers who participated in a survey indicated that the training programs
    helped them to work more effectively with the children they care for; acquire new knowledge about the
    development of young children; and learn new ideas for planning activities for young children.
    Over three-quarters of ECE providers who participated in a survey reported an increase in providing
    positive reinforcement, providing physical activities for children, and encouraging parents to read to their
    children, as a result of participation in training programs.

Challenges
While the ECE Cluster experienced many successes, there were also some challenges. First 5 San Bernardino is
learning from these challenges and working to adapt program efforts accordingly. Some key challenges
included:
    Variation in SR activities. While the 2006 State Framework helped to align SR program activities, there is
    still some variation in activities and data collection procedures across programs. For example, not all
    programs implemented the same activity to meet the improved systems of care result area. Additionally,
    programs were providing different types of health services that were not reported in a standardized
    fashion.

    Variation in SR child assessment tools. Not all SR partners used the same child assessment tool, as
    there were two versions of the DRDP-R and the ASQ utilized to assess children’s developmental progress.
    The variation in these tools required an analysis plan for each, and thus resulted in limitations in
    understanding impacts of SR on child development as a whole. It is recommended that a standardized tool
    be used in the future, or at a minimum all classroom-based programs use the full version of the DRDP-R.

    Variation in Child Care Strategy programs’ service delivery and data collection. Programs assigned
    to the CCQS, CCC, and CCA Strategies were lumped together for this report, though vary in their
    programming and consequently, their evaluation plans. This year included the first attempt to tell a
    relatively cohesive story with the use of the ECE Provider Survey, though only a small number of providers



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    participated. This survey should be used more consistently by all programs in the next fiscal year.

    Outcomes with room for improvement. There were a few key outcome areas where the data show
    room for improvement. These areas should be examined more deeply to determine the cause and ensure
    improvement in the next year.

             o   Dental care: There were large percentages of SR children who had never been to a dentist,
                 including 41.0% of those at intake, and 26.1% of those at exit.
             o   Parent activities: Many parents were not exhibiting consistent, key behaviors to assist the
                 school readiness for their children. These included playing rhyming games, reading aloud to
                 child, and telling stories to child (57.8%). SR programs should continue to stress the
                 importance of reading to their child everyday.
             o   SR staff and kindergarten teacher collaboration: There were some activities that were
                 infrequently reported including meetings/trainings with kindergarten teachers, transition
                 meetings with kindergarten teachers, and kindergarten visits for parents and children. The K-
                 12 and pre-kindergarten environments are substantially different, highlighting the
                 importance of information exchange between kindergarten teachers and specialty service
                 providers. Providers working directly with children could provide critical information to
                 kindergarten teachers, which will assist children to succeed in the kindergarten environment.

    Gaps in investments for the ECE Cluster. While the SR Strategy is well developed, the other strategies
    are not as comprehensive in scope. There is also one Strategy within the ECE Cluster, as designated in the
    Strategic Plan, which has not been pursued by F5SB. With the Strategic Analysis process conducted earlier
    this year, these gaps could be filled by eliminating or collapsing Strategies, as well as funding more
    programming to meet goals.



Recommendations
The following recommendations for the ECE Cluster were developed based on FY 2007-08 findings:
    Continue to improve process and service reporting. Though the data submitted this fiscal year
    improved in both quantity and quality compared to previous years, challenges continued in reporting due
    to inconsistency in data requirements and data entry. Through continued refinement of the reporting
    requirements, the data system, and training and technical assistance for partner agencies, ECE programs
    can improve the quality of data and the reporting of intended results.
    Increase the quality and quantity of outcome data. This year marks the first that the number of
    matched cases (i.e., answers at both pre and post for the same client) was substantial enough to allow SR
    outcome data to be analyzed using pre/post matched cases. Matching responses enables the analysis to tell
    a more robust story about the programs’ impact. Despite the increase in matched cases, there were a
    number of SR clients who did not have data at pre and post, and therefore were not used. Additionally, for
    those surveys completed only once (including SR and ECE Provider Surveys) the response rates were not
    as high as they could have been. Commission staff should continue to work with these programs to
    emphasize the importance of their participation in data collection, as well as help to increase the number
    of clients who respond to surveys.



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    Encourage collaboration between ECE programs and other First 5 partners. Programs in the ECE
    Cluster noted not having enough opportunities to learn about other F5SB programs and how they can
    collaborate. Other F5SB partner agencies both within the ECE Cluster and outside the Cluster offer
    services that could benefit children, families, and providers that are served in the ECE Cluster. First 5 San
    Bernardino should work to facilitate more networking opportunities for their partner agencies.

    Assist in sustaining existing programs over time and fund new programs to fill gaps. Both state
    and local First 5 funding for the School Readiness Initiative is only dedicated through 2010, and First 5
    California is embarking on a strategic planning process that will determine whether or to what extent SR
    funding will continue. Since the inception of the SR Initiative, the Commission expected that school
    districts would locate additional funding to sustain and expand the SR programs in their areas. At this
    important time, First 5 California, First 5 San Bernardino and the SR school districts must work together
    to address the timeline of SR funding and plan for changes in funding. School districts must actively seek
    additional funding and/or examine shifting existing district funds to sustain and even expand their
    programs. F5SB should require SR programs to design and implement a sustainability process, similar to
    the process the Family Support partner agencies have embarked upon. Additionally, there are gaps in
    services and investments according to the ECE priority Strategies set forth in the F5SB Strategic Plan. The
    Commission should determine whether these Strategies are still a priority and if so, how they can move
    forward with developing and supporting these types of programs.




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                   Chapter 4                      Family Support

Key Findings
    The Family Support Cluster improved data collection over the last fiscal year allowing for a clearer picture
    of the client population served by the partner agencies. Improved demographic data revealed partner
    agencies continue to reach ethnically and linguistically diverse populations. The Family Support Cluster
    provided services to over 50,000 clients.
    The population of core clients served by the Family Support programs continues to reflect low-income
    clients with a high level of need. Over 40% of clients of the Family Support cluster reported an annual
    income of less than $10,000.
    After participating in Parenting Education programs, parents report an increase in their parental
    knowledge as measured by the questions: My knowledge of how my child is growing and developing, My
    knowledge of what behavior is typical at this age, My knowledge of how my child’s brain is growing and
    developing
    Resource Center clients made statistically significant improvements on 23 of the 35 Life Skills Progression
    Instrument items with the greatest change seen on the Relationship scales where clients were asked about
    relationships with family, friends, their children and service providers.
    Resource Center parents are struggling to meet basic needs and many of them are underemployed or
    unemployed. Increased collaboration among First 5 San Bernardino funded partners as well as
    collaboration with other community organizations would benefit these families who are struggling with
    multiple needs.




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    Introduction to Family Support


T    he last fiscal year has brought with it incredible stressors for families and children. With changes in the
     economy, increased unemployment, and decreased housing security, San Bernardino County has been
     hard hit by the economic downturn. San Bernardino was featured in a USA Today article highlighting
     communities affected by the foreclosures. The article stated that “…lenders filed close to 24,000 notices of
default last year (2007), up nearly 150% from 2006.
And 7,727 homeowners lost their homes through
                                                                  “I think they’re doing a really good
foreclosure — roughly one in 20 sales and up nearly
720% from the previous year, according to DataQuick
                                                                  job, with the Resource Centers, it is
Information Systems.” 1                                           wonderful . . . where people can
                                                              just come in and get the
During difficult economic times, the number of                information that they need.”
families who rely on public assistance and social
services often soars, while service providers struggle to                                      - Stakeholder
extend support in the face of dwindling resources.

First 5 funded Family Support partners play a critical role in assisting families with basic needs and support,
perhaps now more than ever. Interviews and conversations with stakeholders this year seemed incomplete
without asking how they think local services are impacted by the economic situation. It is, of course, the issue
that is on everyone’s mind.

This chapter focuses on the role and impact of the F5SB Family Support Cluster, which is comprised of two
complementary strategies:

    Resource Center (RC) Strategy: Expands and creates resource centers customized to local needs.
    Parenting Education (PE) Strategy: Implements accessible parent education based on proven practices.


The Family Support Cluster continued to provide assistance with basic needs, as well as parenting education, to
families throughout San Bernardino County during 2007-08. With the current financial situation, these two
Strategies have become even more important to parents and children. Through the use of the Resource
Centers, families will continue to access referrals for immediate needs, as well as receive more intensive case
management to assist them as they work towards self-sufficiency. Parenting Education classes also continue to
assist families. According to Prevent Child Abuse America, a potential risk factor to child abuse is parents who
“seem to be having economic, housing or personal problems.” 2 Partner agencies are often able to recognize the
signs and understand that financial problems can translate into family tension. The Child Welfare Information


1
  Knox, N. Foreclosures plague San Bernardino, CA. Accessed 11 October 2008.
<http://www.usatoday.com/money/economy/housing/closetohome/2008-01-28-san-bernardino_N.htm>.
2
  Prevent Child Abuse America. Accessed 11 October 2008.
<http://www.preventchildabuse.org/help/remember_risk_factors.shtml>.

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Gateway identifies risk factors associated with child abuse and several of these risk factors, specifically social
isolation and less social support, can be addressed by Parenting Education programs. 3

During the 2007-08 program year, the Family Support Cluster was comprised of 24 partner agency programs
and was allocated $11.7 million. This represented 30% of the total Commission investment. The amount
allocated through contracts and expended for the year is presented in Exhibit 4.1. The partner agencies in the
Family Support Cluster utilized over 93% of the amount awarded (over $7 million) through contracts.



                         Exhibit 4.1 2007-08 Family Support Cluster Investments
                                                                                                             % of Total
                                                                                         % of Awards
    Total Allocation   Contract Awards         % Awarded            Expenditures                             Allocation
                                                                                          Expended
                                                                                                             Expended
      $11,700,000         $ 7,201,487             61.6%               $6,725,798             93.4%             57.5%




Linkages to the Strategic Plan

As seen in Exhibit 4.2, the Family Support Cluster connects to the first three Desired Result Areas in the San
Bernardino Strategic Plan. The areas of primary focus for the Family Support Cluster are Desired Result Area
2: Children are Ready to Enter and Succeed in School and Desired Result Area 3: Families are Safe, Healthy,
Nurturing and Self-Sustaining. The Commission-Level Outcomes (CLOs) listed below are the most common
outcomes the Strategies works toward; however not all partner agencies work on all indicators. 4




3
  Child Welfare Information Gateway. <http://www.childwelfare.gov/can/factors/environmental/social.cfm>. Accessed 11
October 2008.
4
  For a list of all F5SB Desired Result Areas, Objective and Commission-Level Outcomes, see Appendix C.

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                      Exhibit 4.2 2007-08 Family Support Cluster Linkages to Strategic Plan
                                                                                                                Strategy
      Objective                               Commission-Level Outcome
                                                                                                                 Area(s)
                                    Desired Result 1: Children are Safe and Healthy
   1. Children are
                             1.1 Increased utilization of prenatal care                                    RC
   born healthy

   2. Children are           2.1 Increased number/percent of children with health insurance
                                                                                                           RC
   healthy, well             and ongoing relationship with health provider
   nourished and             2.2 Increased number/percent of children receiving annual dental
   physically fit                                                                                          RC
                             screenings and appropriate follow-up care

                             3.2 Increased number/percent of parents trained in child related
                                                                                                           PE
   3. Children are           safety and put this knowledge into practice
   raised in safe and
                             3.3 Decreased number/percent of families with reoccurrence of
   nurturing                                                                                               PE
   environments              identified child or domestic abuse (repeated 10.3)

                             3.4 Increased parent-child bonding and attachment                             PE

                         Desired Result 2: Children are Ready to Enter and Succeed in School
   4. Children live in
   a home
                             4.1 Increased parent time spent reading, singing, and telling stories
   environment                                                                                             PE
                             to children
   supportive of
   learning

   7. Children               7.1 Increased number/percent of children exhibiting age-
                                                                                                           PE
   develop within            appropriate development
   normal ranges in          7.2 Increased number/percent of children exhibiting healthy
   all domains                                                                                             PE
                             cognitive and social-emotional behavior

                     Desired Result 3: Families are Safe, Healthy, Nurturing and Self-Sustaining
   8. Parents are
                             8.1 Increased sense of social support and belonging among
   mentally and                                                                                            RC
                             parents
   physically fit
   9. Parents
   practice                  9.1 Increased number/percent of parents understanding
   developmentally           developmental milestones and practicing parenting skills that are             PE
   appropriate               developmentally appropriate for their child
   parenting skills
                             10.1 Increased number/percent of parents practicing positive
   10. Children are                                                                                        PE
                             disciplinary skills
   free from any
   form of abuse             10.3 Decreased number/percent of families with reoccurrence of
                                                                                                           PE and RC
                             identified child or domestic abuse (repeated 3.3)

                             11.1 Improved parental ability to access and coordinate needed
   11. Families are                                                                                        RC
                             services for their children
   stable and have
   the capacity to           11.2 Improved parental ability to meet the basic needs of their
   meet the needs of                                                                                       PE and RC
                             families
   their children
                             11.3 Strengthened nuclear and extended family relationships                   RC




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Summing it Up: Family Support Cluster

During FY 2007-08, the Family Support Cluster provided services to approximately 50,292 clients. 5 This is an
increase of nearly 10,000 clients over FY 2006-07. In response to recommendations made in last year’s report,
First 5 San Bernardino has made significant improvements in the collection of demographic data.

Demographics
In 2006-07, over one-fifth (20.6%) of clients did not report ethnicity. However in 2007-08, ethnicity data was
available for over 95% of participants. Over half (56.9%) of the participants who identified an ethnicity
identified as Hispanic/Latino. This is illustrated below in Exhibit 4.3.

Data for language was also much more complete than the previous fiscal year. In 2006-07, almost three-
quarters (73.5%) of clients served declined to report primary language. This year however, data was available
for 96.6% of clients with only 3.4% declining to report their primary language. This is a drastic improvement
and better informs First 5 San Bernardino of the families being served by the Family Support Cluster. This also
allows for identification of language needs. Of those that reported a primary language for FY 2007-08, two-
thirds (66.1%) reported English as their primary language. This paints a drastically different picture from FY
2006-07, in which the limited data suggested that Spanish was the primary language of clients with 61.5% of
clients reporting Spanish as a primary language. This year’s data is illustrated below (Exhibit 4.4).

        Exhibit 4.3 2007-08 FS Participants:                              Exhibit 4.4 2007-08 FS Participants:
                   Race/Ethnicity                                                  Primary Language
         (Aggregate and Core n=47,859)*                                    (Aggregate and Core n=48,595)*

              African
                                         Other,                                    Spanish,
             American
                                         5.5%                                       33.1%
              , 13.0%
                                                                                                                Other,
                                                                                                                0.8%
    White,
    24 .6%




                                            Latino,
                                            56.9%                                              English,
                                                                                                66.1%


*Total client n=50,292, excluded 2,473 records with declined or   *Total client n=50,292, excluded 1,697 records with declined or
missing ethnicity data                                            missing language data




5
 Number may include duplicate counts as clients may have received services through multiple service providers. Also, number
includes parents, children and other family members.

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Core Clients
For FY 2007-08, core client data was available for 4,428 clients. “Core” clients typically receive more intensive
services and/or are served for a number of sessions. In the Parenting Education component this may be
someone who has attended a series of parenting classes. For the Resource Centers, a core client might be
someone who has participated in intensive case management.

The Family Support Cluster core clients were mostly female (88.3%) and a little over half identified their
ethnicity as Hispanic/Latino (53.9%). The majority (66.8%) identified English as their primary language. A
comparison of core clients with all clients served (as presented above) reveals that the core clients were
representative of the client population as a whole. For example, both the core and aggregate client totals show
that approximately two-thirds of the clients reported English as a primary language.

Education and Household Income
The Family Support Cluster also continued to reach low-income parents and those with limited levels of formal
education. In 2007-08, almost half (49.9%) of core parents had not completed high school and over three-
quarters (77.6%) reported an annual income of less than $25,000, approximately 58% of the median annual
household income for San Bernardino County. 6 There was also an increase in the percentage of parents that
reported income of less than $10,000. In FY 2006-07, 29.8% of families reported less than $10,000 and in FY
2007-08, 43.3% of clients reported this range of income. This was an increase of 13.4%. Data from 2007-08 are
represented in the tables below (Exhibit 4.5 and Exhibit 4.6).

               Exhibit 4.5                                             Exhibit 4.6
    2007-08 Family Support Core Client                      2007-08 Family Support Core Client
             Education Level                                          Income Level
Education Level                    Valid Percent         Income Level                  Valid Percent

Less than 9th grade                    15.7%             Less than $10,000                43.2%

9-12th grade, no diploma               34.2%             $10,000 – less than $15,000      18.6%

High School Grad/Equivalent            24.3%             $15,000 – less than $25,000      15.8%

Some college, no degree                18.2%             $25,000 – less than $35,000      11.3%

Associate’s degree                      2.6%             $35,000 – less than $50,000       6.7%

Bachelor’s degree                       2.7%             $50,000 – less than $75,000       2.9%

Graduate/Professional degree            2.2%             More than $75,000                 1.5%

TOTAL                                 100.0%             TOTAL                           100.0%



Service Delivery
Since its inception, First 5 San Bernardino has been responsive to the communities it serves. The varying
geography and population density present a challenge to determining the best service delivery method for all
partner agencies. Instead, First 5 San Bernardino continues to work with partner agencies in developing

6
 In 2004, the median household income in San Bernardino County was $43,179.
<http://quickfacts.census.gov/qfd/states/06/06071.html> Accessed 11 October 2008.

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programs that are responsive to community needs and allow for variations in delivery. As one stakeholder
noted, “We know our community, we know this is what we can do and with this funding we would be able to
reach ‘x’ number of people. They said go for it! It really came from the ground up.” This ground-up approach
has resulted in the implementation of several methods of service delivery to address the needs of clients
throughout the County. A notable shift was seen this year in the area of case management services, where there
was an increase from 3.1% in FY 2006-07 to 22.0% in FY 2007-08. Again, this is in part, attributable to
improvements in data collection during FY 2007-08. As seen in Exhibit 4.7, partner agencies have utilized
mobile services and phone consultations, but the most frequent methods continue to be classes/workshops
(28.6%) and in-person consultation (40.2%).

               Exhibit 4.7 2007-08 Family Support Service Delivery by Modality (n=43,126)*
                                                                                                            40.2%

                                                                                        28.6%
                                                                  22.0%



                               3.5%             5.4%
           0.4%




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As mentioned above, there has been a substantial increase in the number of clients receiving case management
services. This may be due in part to the change in instrumentation for the Resource Center partner agencies
(described later in this chapter and also in Appendix B). The transition to a more structured evaluation
instrument may also have led service providers to identify their services as case management rather than in-
person consultation. There was also an increased concentration of service delivery methods with most services
being provided in-person through in-person consults, classes/workshops and case management services. This
data suggests that the partner agencies are increasing their focus on providing direct services rather than
participating in outreach activities.

Geographic Distribution
The Family Support Cluster continued to provide services in all regions of San Bernardino County. While
services continued to be more concentrated in the Central Valley, this region also has the highest population
density. First 5 San Bernardino has continued its focus on providing services to high priority zip codes
throughout the County.




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            Linkage and Advocacy: Montclair Community Collaborative
For many parents, the process of identifying their child’s special needs and obtaining help can be
complicated and confusing. There are often several systems to navigate and many barriers can pop up
along the way. Limited resources such as time, money, and reliable transportation, often prevent parents
from accessing the services and assistance they need for their child. Rosa, a single mother with 4 children,
experienced several barriers when trying to access speech services for her daughter. However, her
determination to find the appropriate resources to help her and her family actually brought more benefits
then she had initially expected.

Rosa had been feeling helpless for some time. She could        “Nobody would speak up,
not understand what her daughter was trying to say and         nobody. There are a lot of
ultimately realized that her daughter had a speech             Hispanics in that school and
problem. She also discovered that her daughter was             nobody speaks up because
being ostracized at school by her own teacher, who sat
her at a separate table because she could not understand
                                                               they say they are
her. Rosa immediately requested a speech therapist to          afraid...that is what made me
provide assistance to her daughter. Despite her formal         speak out of all those
requests, through letters and talking to the school’s staff,   changes.”
her voice was not heard and her daughter was not                             - Rosa, F5SB Parent
receiving the help she needed. Further complicating her
efforts, Rosa was struggling as a victim of domestic
violence and did not have her husband’s support in resolving issues related to her daughter.

Feeling ignored and powerless after several requests, Rosa demanded to speak to somebody else at the
school. She was desperate for help. At that point she received the business card for a case manager at
Montclair Community Collaborative (MCC) where she was told she could find some help for her daughter.
Rosa immediately called MCC, who offered to send a case manager to her home when Rosa was not
working. At first, Rosa was worried because she thought her kids would be taken away if the case
manager found something wrong. To her surprise, the experience was the complete opposite and help
was offered immediately.

During the interview, the case manager helped identify the challenges Rosa was experiencing and offered
help in a number of different ways. First and foremost, the case manager became actively involved in
providing advocacy and resources regarding her daughter’s education. Rosa’s daughter started receiving
the much needed speech therapy through the center. However, the assistance did not stop there and the
case manager continued to be actively involved in advocating for Rosa’s daughter, by accompanying Rosa
to parent-teacher conferences and providing ongoing support.

Rosa was so pleased with the help she received, she has come to see her case manager as a family
member:

        “If it would not have been for her [Case Manager], nothing would have been done. I see her as a
        different person, not a service person. I see her as another member in my family that helps out when I
        need it.”




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Besides the educational support, Rosa has participated in counseling and parenting classes. She noted
that the counseling has helped her tremendously in many aspects of her life, particularly in her parenting
skills. Prior to these classes, Rosa felt frustrated and constantly yelled at her children. However since
participating in the parenting classes, she feels much more confident and equipped with information
about parenting techniques. She learned new ways to discipline her children and gives them “time outs”
instead of yelling.

Rosa has also received help with basic essentials such as housing, clothing, toys, and food. She is
extremely pleased with the help because she feels more confident and determined to succeed. She feels
like she is a better mother and a better person overall. Rosa recalls changes that she has seen in her
family, but more importantly, in herself. She states, “All these services have made me change; be a little bit
stronger, before I would just sit on the stairs and just cry...now that I can give my kids more and more I see
myself different…I see that I can still go to school, I can continue going with the help of other people .”

Rosa’s positive attitude and confidence have also had an impact on her family. Her children are more
respectful and their grades have improved tremendously during the last year. Her children no longer
taunt her and are now obedient and respond when she calls them. The services have benefitted the entire
family and they are now in a much better place physically, mentally, and academically.


          “They would miss a lot of school before I did the parenting classes. I
          was the person that said ‘oh, if you do not want to go, just stay
          home.’ Now they go to school every day, they have perfect
          attendance, they have their honor roll certificates; it has changed
          my life a lot.”
                                                              - Rosa, F5SB Parent




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Annual Evaluation Report FY 2007-08                                                    January 2009              93
    Parenting Education
As mentioned previously, there have been several additional community factors affecting parents in San
Bernardino County this last year. With the economic downturn and rising unemployment, it has become even
more challenging to provide the stability and predictability that children need to thrive in their daily lives. As
parents struggle with finding new jobs and affordable places to live, good parenting skills and techniques can
help them better manage the challenge of parenthood in difficult economic times. Parenting education classes
teach crucial skills and provide a greater understanding of the significant role parents play in their “children’s
developmental years and …as their children’s only continuous source of guidance.” 7 The Parenting Education
Strategy not only provides the parenting education classes, but also the support for parents struggling with
changes that are often beyond their control.

First 5 San Bernardino defines the Parenting Education
                                                                              2007-08 Parenting Education
(PE) Strategy as: “Implementation of quality, evidence-                        Partner Agencies/Programs
based, accessible parent education and enhancement;                 Bear Valley Community Healthcare District, Moms on
which includes topics of child development, parenting               the Mountain (MOM) Project*
skills, and bonding/attachment; and increases the times             Foundation for CSUSB, CUIDAR
of availability, locations and types of interactive                 High Desert New Beginnings
programs.” The vision for the PE programs is that they
                                                                    Inland Temporary Homes
meet the following criteria:
                                                                    Knotts Family Agency
     Programs are evidence-based
                                                                    Morongo Basin Mental Health Services*
     Parenting Education instructors/educators are well
     connected with the community and culturally                    Para los Niños*
     competent                                                      Rim Family Services, Inc., Rim Family PAT Program
     Programs have stringent measurements of parental               SBCUSD Adult School
     behavior change                                                Volunteers of America*
     Programs focus on parent behavior that                         Westcare Arizona*
     corresponds to child development milestones
                                                                  *Also funded as a Resource Center
     Programs include the following components of
     instruction/education:
              o    Child development milestones
              o    Effective parenting
              o    Attachment
              o    Parent/child literacy
              o    Child health and safety

During FY 2007-08, 11 agencies were funded under the PE strategy, and of these, 5 also provided a Resource
Center program (seen in text box above). For more specific program descriptions, see Appendix A.

7
 Debora C. Johnson, Betty C. Harrison, Michael F. Burnett, and Peter Emerson. Deterrents to Participation in Parenting
Education Family and Consumer Sciences Research Journal, Jun 2003; 31: 403 - 424.

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Key Elements and Activities

The PE programs varied substantially in primary focus and educational modality.

Content of Parenting Education Programs: Programs delivered services with a wide range of topics,
including child development milestones, early literacy (including language development), discipline
techniques, and parent empowerment. Programs included topics directly related to parenting skills and child
development, as well as ancillary topics such as anger management and family budgeting.

Method of Providing Parenting Education: Parenting Education programs used different methods to provide
instruction, such as classroom-based programs that required parents to come to a central location, individual
education in a home setting (i.e., home visiting), as well as one-on-one case management at an organization.

Many PE programs utilized evidence-based or promising curricula. Some of these included:
    1234 Parenting
    Active Parenting Program                                          “We start by connecting with the
    Community Parent Education (COPE)                                 parent. We have to connect with
    Home Instruction for Parents of Preschool                         that parent. And after we connect
    Youngsters (HIPPY)                                                with them, we stress the
    Los Niños Bien Educados                                           importance of a relationship. You
                                                                      have to have a relationship with
    Love & Logic
                                                                      your child through out life.”
    Narrative Parenting
    Nurturing Parent                                                                     - Family Support Partner
    Parent-Child Interactive Therapy (PCIT)
    Parents As Teachers (PAT)
    Positive Discipline Model
    Strengthening Families Program
    Systematic Training for Effective Parenting (STEP) – Early Childhood
    Triple P – Positive Parenting Program

Summing it Up: Parenting Education

Over the 2007-08 fiscal year, the PE programs continued to reach a wide variety of clients throughout the
County. This year, data was available for 6,070 clients in the PE programs. 8 This was a greater number than
available in the prior fiscal year and again, demographic data was more complete this year compared to the
past. A comparative look at FY 2006-07 and FY 2007-08 data suggests a shift in the ethnicity of the clients
served in PE. In FY 2006-07, the majority of clients identified as African American (60.6%), while this year (FY
2007-08) the majority of clients identified as Latino (60.5%). This data can be tracked over time to ensure that

8
 Total includes core and aggregate clients and may include duplicates as parents may have received services from more than one
agency or program.

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the numbers reflect the target population including the demographics of San Bernardino County. Language
data for FY 2007-08 was very similar to that of the previous year with 58.4% of clients reporting English
(compared to 63.7% reporting English in FY 2006-07).


Making a Difference: Parenting Education in Action

This section highlights the outcomes from the Parenting Education programs for FY 2007-08. Starting in FY
2007-08, the Parenting Education Strategy began using a new instrument for evaluation purposes. The Survey
of Parenting Practice (SPP) 9 was developed at the University of Idaho and has been utilized as a universal tool
for home visitation and parenting classes that use a variety of formats and curricula. The survey is a
retrospective pre-post test format and contains 12 questions which are divided into four areas of parenting
practice: knowledge, confidence, ability, and behavior. 10 When completing the survey, parents respond to
questions and consider two time periods - “now” which is after completing the parenting education activity,
and “then” before the activity. Ratings range from zero to six, with the higher rating indicating more
knowledge, confidence, ability, or increased frequency of behaviors. By utilizing this method of “retrospective”
comparison, respondents may provide more accurate baseline data as compared to traditional pre/post
methods when participants tend to rate themselves higher at pre. 11

Survey Respondents
The SPP was implemented by all 11 PE partner agencies for a total of 929 completed surveys. Demographic
data for the respondents was very similar to that of the general PE clients discussed above. The age distribution
of SPP respondents was concentrated between ages 25-34 (37.5%) and 35-44 (22.2%). Also represented were a
small percentage of respondents (4.7%) who reported being under age 18 and respondents age 65 and older
(10.7%). These percentages may represent special populations served by the PE partner agencies including teen
parents and pregnant teens, as well as kinship caregivers or guardians. 12

SPP Linkage to the Strategic Plan
The Parenting Education partners’ programs link to several of the Commission’s Strategic Plan’s Objectives
and Outcomes. These Desired Result Areas (DRA) and Objectives are linked to corresponding questions on
the Survey of Parenting Practice (SPP). The Desired Result Areas and Objectives include:
          Desired Result Area 2: Children are Ready to Enter and Succeed in School
               o    Objective 4: Children live in a home environment supportive of learning
          Desired Result Area 3: Families are Safe, Healthy, Nurturing and Self-Sustaining
               o    Objective 9: Parents practice developmentally appropriate parenting skills
               o    Objective 10: Children are free from any form of abuse
               o    Objective 11: Families are stable and have the capacity to meet the needs of their children


9
  Shaklee, H. & Demarest, D. (2003). Survey of Parenting Practice Tool Kit. Boise, ID: U of Idaho Extension Services.
10
   For more information on the SPP, see Chapter 3: Early Care and Education, or Appendix B.
11
   “Pre-test overestimation is likely if participants lack a clean understanding of the attitude, behavior, or skill the program is
attempting to affect.” Pratt, C., McGuigan, W. and Katzev, A. (2000) Measuring Program Outcomes: Using Retrospective Pre-test
Methodology. American Journal of Evaluation. (21) 341-349.
12
   Client n values for demographic data ranged from n=896-925.

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SPP Results: Matched Client Data Analysis
As indicated above, this year the PE partner agencies collected survey data for 929 clients who participated in
any parenting education program provided by a partner agency. Analysis of this data revealed statistical
significance on all 12 items with the greatest mean change seen in the area of parental knowledge. 13 Exhibit 4.8
below shows the mean for each item at time indicated as “then” as well as “now” as well as the difference in
mean.

                                 Exhibit 4.8 Outcomes for Survey of Parenting Practice

     Survey Item                                             Mean “Then”          Mean “Now”         Mean Difference       Number
                                                              (Before PE)          (After PE)
     My knowledge of how my child is growing
                                                                   2.87                4.33               1.46*             929
     and developing
     My knowledge of what behavior is typical at
                                                                   2.77                4.20               1.44*             929
     this age
     My knowledge of how my child’s brain is
                                                                   2.77                4.22               1.46*             929
     growing and developing
     My confidence in myself as a parent                           3.14                4.46               1.31*             929
     My confidence in setting limits for my child                  2.97                4.29               1.32*             929
     My confidence that I can help my child learn
                                                                   3.05                4.47               1.42*             929
     at this age
     My ability to identify what my child needs                    3.05                4.38               1.33*             929
     My ability to respond effectively when my
                                                                   3.00                4.29               1.29*             929
     child is upset
     My ability to keep my child safe and healthy                  3.47                4.59               1.12*             929
     The amount of activities my child and I do
                                                                   2.89                3.96               1.07*             929
     together
     The amount I read to my child                                 2.67                3.72               1.05*             929
     My connection with other families with
                                                                   3.02                4.12               1.10*             929
     children
     *Statistically significant at p < .001, with alpha set at .05 and .004 (Bonferroni’s Correction).


DRA 2 - Objective 4: Children live in a home environment supportive of learning.
In order to address this Objective, the Survey of Parenting Practice asked questions regarding parent behaviors.
The two questions addressing this are “The amount of activities my child and I do together” and “The amount
I read to my child.” By encouraging parents to participate in developmentally appropriate play with their
children, parenting education programs are supporting an increase in opportunities for learning, particularly
through play. Both questions showed a statistically significant improvement with parents reporting an
increased frequency of these activities. While both areas increased, the results also indicate that this is an area
where more programs can continue to support improvement since the mean for the “now” responses (3.96 and
3.72 respectively) still do not reflect a high frequency of parent behaviors.

DRA3 - Objective 9: Parents practice developmentally appropriate parenting skills
Most PE programs include activities that are linked to this objective and there are several questions on the

13
     Paired sample t-test.

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Survey of Parenting Practice this area of parental knowledge. To support this objective, PE programs continued
to provide education on developmental milestones and support the early development of children in San
Bernardino County. Three questions from the Survey of Parenting Practice correspond to the area of
developmentally appropriate parenting skills. These items are:
               My knowledge of how my child is growing and developing (mean change 1.46)
               My knowledge of what behavior is typical
               at this age (mean change 1.44)
                                                                “The parenting education is
               My knowledge of how my child’s brain is          ongoing. Every year it’s just
               growing and developing (mean change
                                                                remarkable, all the different the
               1.46)
                                                                stories I hear. I would say that
There was a statistically significant change in the means       their biggest impact this last year
for all of these items. The knowledge items showed the          has been being able to provide
greatest mean change, reflecting parenting education            the outlets for providing
goals to improve parental knowledge of child                    parenting education.”
development, as well as parenting skills to encourage
                                                                                             – Stakeholder
appropriate development.

DRA3 - Objective 10: Children are free from any form of abuse
While there were not any questions on the survey that directly asked about the use of corporal punishment or
punitive methods of discipline, there were two SPP questions that best identify protective factors against child
abuse. These items are “My confidence in setting limits for my child” and “My ability to keep my child safe and
healthy.” By setting limits, parents are better able to manage their child’s behavior and may reduce the
likelihood of their own frustration escalating. On both of these items, the data suggests that parents felt both
more confident in limit setting and better able to keep their child safe. Both items demonstrated a statistically
significant improvement in the means (1.32 and 1.12 respectively). However, the item measuring parental
confidence saw a larger increase (from 3.14 to 4.46).

The importance of providing education to parents that will result in their using non-punitive forms of
discipline remains for families in San Bernardino County. As was documented in a National Benchmark
Study 14 completed in 2000, “parents of young children and other adults believe that it is appropriate to spank a
child as a regular form of punishment” even while they recognize that spanking has negative consequences. By
focusing on more appropriate forms of discipline such as limit setting, parents can be presented options for
their own behavior.

Parenting Education programs can also continue to support the increased ability of parents to keep their child
safe and healthy. While this item can be subject to broad interpretation, increasing a parent’s self-report of
their ability to keep their child safe is an important accomplishment for the PE partners. This item had the
highest mean of the entire survey at the “now” point with a mean of 4.59 where 6 is the highest possible
response.




14
 CIVITAS Initiative, ZERO TO THREE, BRIO Corporation, & DYG, Inc. (2000) What Grown-Ups Understand About
Children: A National Benchmark Survey.

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DRA3 - Objective 11: Families are stable and have the capacity to meet the needs of their children.
As mentioned in the introduction to this chapter, family instability, be it emotional or financial, continues to
be identified as a risk factor for child maltreatment. By working to help families remain stable and capable,
Parenting Education programs are also working towards an amelioration of risk factors.

This item was measured utilizing four items on the Survey of Parenting Practice. The items are:
                        My confidence in myself as a parent
                        My confidence that I can help my child learn at this age
                        My ability to identify what my child needs
                        My ability to respond effectively when my child is upset

All four items demonstrated a statistically significant increase which suggests that as a result of participation in
Parenting Education classes, parents felt more confident about themselves and their ability to help their
children. The greatest increase was seen on the item “My confidence that I can help my child learn at this age”
(mean change was 1.42 from 3.14 to 4.47). Again, while change was seen on all 4 items, there continues to be
room for improvement. Parents can score each item on a 1 to 6 six scale and most items continue to be in the
3-4 range.

Conclusions for Parenting Education Findings

The Parenting Education Strategy began using a new instrument for measuring outcomes during FY 2007-08.
The Survey of Parenting Practice used items to measure the areas of knowledge, confidence, ability and
behaviors, and for this FY, the data demonstrated a statistically significant improvement on all items of the
survey. The greatest improvement (mean change) was seen in the area of parental knowledge. Given that one
of the primary goals of the parenting education programs is to increase parental knowledge, the findings
suggest that the PE partners have implemented programs that address this goal and parents are receiving
information they find helpful. Comparison of this data over time will allow for more accurate conclusions to be
made about the Parenting Education programs as an initiative. While all items showed increase, the starting
mean for many of the items was 3 or below, indicating low levels of knowledge and confidence by parents own
rating. This may help Parenting Education providers identify areas where curricula could continue to develop
and expand.




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                           Mother to Mentor: Knotts Family Agency

   In this day and age, the demands of parenting are high. As the economy fluctuates, job stability may
   be threatened, but the needs of the family remain constant. Raising children as a single parent is
   difficult and overwhelming. Luckily, the single parents of San Bernardino County have a great
   resource in Knotts Family Agency. They understand the needs of children as well as the demands on
   parents and have developed programs to address both of these areas.

   One parent who has benefited from the services available at Knotts Family Agency is Ebonique. A
   college student trying to finish her education, Ebonique became a single mother and anticipated
   some of the challenges. She went to Knotts Family Agency for help. Since this would be her first
   child, she had a lot of questions about being a mom. “I didn’t know how long I was supposed to
   breastfeed. When is it ok to say no? When it makes most sense to read to her…” Ebonique also had
   some basic needs that she was struggling to meet. She needed transportation to doctor
   appointments, school, and groups. She was living at her grandmother’s house with little income and
   did not know how she was going to make ends meet.

   Knotts Family Agency has a long history in its            “Our thing is use the resources
   community. It serves the needs of families with           you have in the community and
   pregnant moms and children 0-5 through a variety          make that work.”
   of services including the Narrative Parenting Villages
   program, which Ebonique began to attend. There she
   received mentoring and support alongside other                             - Knotts Staff Member
   parents seeking assistance in raising their children.
   When asked about her experience with the program, Ebonique responds, “A lot of women are single
   mothers themselves. So it helps to have those women who have that first hand experience with being
   alone and what they did. They are making it and have made it. They want to show me how to do it on my
   own as well.”

   Beyond community, Knotts also provided Ebonique with the resources to be successful as a mother.
   “Knotts came once a week, asked if there’s anything I needed as far as resources. They helped a lot with
   resources- numbers I can call, people they can call for me. [Knotts] helped with child readiness and offered
   transportation to village meetings.”

   Carol, the assistant supervisor for the            “They will give you resources that you
   Narrative Parenting Villages program,              can call if you can’t make rent or bills.”
   worked closely with Ebonique. She recalls
   the process of helping Ebonique meet
   some of her basic needs. “I think living with                             - Ebonique, F5SB Parent
   her grandmother and transportation
   were obstacles. Trying to go to school and find a part-time job so that she wouldn’t be dependent on
   someone else. She’s mastered all that very well.” By supporting Ebonique as she moved towards
   increasing self-sufficiency, Knotts Family Agency provided not only short term solutions, but long
   term planning as well.

   Today, Ebonique is a mentor at Knotts Family Agency where she helps other mothers in the same
   way she was helped. With Knotts’ commitment to the local community, it is no surprise that
   Ebonique’s mother also received services from Knotts and has also become a mentor. Knotts has
   been able to create a community of care using a family oriented approach which has been proven to
   be effective in assisting multiple generations of families like Ebonique’s.

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     Resource Center
The Resource Center (RC) serves as a one-stop shop where parents can receive assistance for a range of
immediate and short-term needs. When an organization is not able to provide the service directly, it may
provide referrals and link parents to additional community resources. First 5 San Bernardino defines a
Resource Center (RC) as: “A facility (fixed or mobile) to which children, prenatal through age five, and families
come for services or referrals they need to thrive.” To meet the definition of an RC, two basic components must
be present:
            Referral and linkages
                                                                             2007-08 Resource Center
            Case Management                                                 Partner Agencies/Programs
                                                                Bear Valley Community Healthcare District, Moms on the
                                                                Mountain (MOM) Project*
The Resource Centers have also developed a strong
                                                                Building a Generation
reputation in San Bernardino County as a place
where parents can begin making connections with                 City of Montclair
community resources. The on-site screening and                  Community Hospital of San Bernardino
assessment process allows for families to identify and
receive immediate assistance with basic needs such              Morongo Basin Mental Health Services*
as food, housing, and medical care resources. While             Para los Niños*
the ability to meet immediate needs is critical, it
                                                                Priscilla’s Helping Hands
often presents a challenge for data collection. With
the implementation of a new instrument for                      Rebuilding Mountain Hearts and Lives
evaluation during 2007-08, data may be more readily             San Bernardino Superintendent of Schools
available for analysis and program improvement as
programs begin to maximize its use (this evaluation             St. Mary’s Medical Center
tool is described more later in this chapter, as well as        Vista Guidance Centers, Barstow Collaborative
Appendix B).
                                                                Volunteers of America*

During the 2007-08 program year, 13 agencies were               Westcare Arizona*
funded under the RC strategy. Of these, 8 functioned           *Also funded as Parenting Education
exclusively as RC programs, while the other 5 also
implemented a Parenting Education component. 15


Key Elements and Activities

As described above, the Resource Center Strategy contains two major areas of intervention and service
delivery. These include making referrals and linkages as well as more intensive case management.

Referral and Linkage
Often times, families are initially introduced to First 5 services through a request and referral for assistance.
First 5 San Bernardino states the “referral is only a start - we are not interested in referrals alone. We are
interested in the positive result of a referral that in the first instance is a connection to a needed service or


15
     For more information on these programs, see Appendix A.

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program.” 16 When a family requests resource information, the information given is the first step in a process of
assuring linkage to the service. F5SB states that an acceptable referral and linkage program must have the
following components:
     Connections or access to other operating referral and linkage services
     Demonstrated capacity to follow up a referral to ensure there is a connection made
     Demonstrated capacity to capture, track and analyze information to improve performance over time 17


Case Management
Case management is the other essential component for the RC strategy. The desired outcome for these case
management services is strengthening a family so that it becomes self-sustaining. First 5 San Bernardino
describes this as a family “which uses its own capacity to get and use outside resources to solve problems and
ultimately thrive.” 18 The Commission defines a successful case management component as containing the
following elements:
     Family-centered: The focus on clients is not limited to a single member of the family, but includes all
     family members
     Driven by family need: One size does not fit all (there will be different focus points and different
     intensities for different families), and all clients/families will be served only to the extent needed (varying
     intensity and duration)
     Holistic: Case management considers/deals with all applicable factors utilizing the approach that works
     best with individual families
     Collects and uses data and information: Case management programs must have and use the ability to
     verify and track results for clients to ensure their progress

In order to assure that partner agencies are delivering case management with a similar outcome identified for
the families served, First 5 San Bernardino seeks to support programs that are strength-based, utilize best
practices, and work to move families to self-sufficiency as quickly as possible.

Summing it Up: Resource Centers

During FY 2007-08, client data was available for 44,222 clients in the Resource Center Strategy. The
demographic data collected revealed an increase in the percentage of complete data during FY 2007-08 with
98.3% of race/ethnicity and 99.4% of language data available for analysis. The data showed that the majority of
clients identified as Hispanic/Latino (56.6%) with an additional 24.7% of clients identifying as White. African
American clients represented 13.4% of the participants. Also, 66.8% of clients reported English as a primary
language, with an additional 32.4% reporting Spanish as their primary language. This data suggests that the
population of Latinos served by First 5 San Bernardino is not a predominantly Spanish-speaking population
but one that identifies with English as a primary language. This is useful information and could be used to
inform the development of additional classes and services for the population represented in these statistics.



16
   First 5 San Bernardino, Pathway to Desired Results: Resource Center Strategy
17
   Ibid.
18
   Ibid.

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This year, partner agencies in the Resource Center Strategy began utilizing a new instrument to collect
outcome data. The Life Skills Progression Instrument is a 43 item instrument 19 developed for use with high
risk clients in home visiting programs. 20 It has been used with various communities and measures increases in
parental skills that are shown to be beneficial in increasing client self-sufficiency. For the purpose of the
evaluation, only items 1-35 of the LSP were used. 21

This change in data collection tools was also connected to the Resource Center’s increased commitment to
provide ongoing case management to clients. This resulted in some changes to service delivery compared to FY
2006-07. As can be seen in Exhibit 4.9 below, there was a significant shift away from providing resources and
referrals to providing more targeted and intensive parent support programs.

                  Exhibit 4.9 2007-08 Resource Center Direct Services by Service Area
           Service Category                             FY 2006-07          FY 2007-08         Percent Change
           Community Resource and Referral                 43.7%                  *                     *

           Parent Education Classes                        24.3%                4.0%                 - 20.3%

           Other Health Education                          11.0%                6.1%                 - 4.9%

           Provision of Basic Needs                         9.3%                  *                     *
           Targeted Intensive Parent Support
           Programs (including case                         9.1%                89.9%               + 80.1%
           management)
           * None reported in FY 2007-08


This shift in service delivery reflects a more structured case management program utilizing a structured case
management instrument. While RCs continued to provide some parenting education classes, the primary focus
of the services over the last year was the provision of ongoing case management services through the service
category of Targeted Intensive Parent Support Programs.

It is important to note that there may be other contributing factors that would explain the shift in service
categories. With the implementation of a new instrument, it is possible that changes were made to the data
system for the partners so that partner services were more clearly defined and therefore more clearly and
accurately tracked. It is also possible that partner agencies began to define their services differently and this led
to an increased report in the Targeted Intensive Parent Support category.




19
   Wollesen, L, and Peifer, K. (2006). Life Skills Progression™ (LSP): An Outcome and Intervention Planning Instrument for Use
with Families at Risk. Paul H. Brookes Publishing Co., Inc.
20
   For more information on the LSP, see Appendix B.
21
   Items 36-43 were removed from analysis as they are child outcome measurements, which most RC partner agencies do not
complete.

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Making a Difference: Resource Centers in Action

The Life Skills Progression (LSP) instrument has been
beneficial for agencies that have implemented the use of
                                                                                    Life Skills Progression (LSP)
the instrument as an evaluation tool as well as part of
their intake assessment. As mentioned above, the LSP is a
                                                                                             Instrument
43 item instrument that measures skills on 6 subscales
which are further explained in the text box at right. Only                   Contrary to many instruments used for
                                                                             evaluation, the LSP was developed in the
35 of the items were used for this analysis.
                                                                             field to be used primarily for clinical and
                                                                             outcome use. The LSP has 43 items that are
This year, LSP data was collected from 1,344 clients.
                                                                             divided into six subscales. These subscales
Since the LSP is utilized to measure the increase in skills                  are:
over time, the RCs are instructed to collect client specific
data every 6 months. Data was available at intake for                        1.   Relationships
almost all clients; however, since many clients drop out of                  2.   Education and Employment
programs or fail to return, there was a much smaller                         3.   Health and Medical Care
amount of client data available for this second collection                   4.   Mental Health and Substance Abuse
point. 22 This Intake (or Pre) data and Time 2 (or Post)                     5.   Basic Essentials
are presented below for all clients who completed the LSP                    6.   Child Development
at either point.
                                                                             Five of these subscales are used in the
This year it was also possible to conduct analysis using                     analysis of RC Outcome data. As Resource
                                                                             Center services are primarily focused on
matched pre and post data. The results of this analysis are
                                                                             direct services for families, the child
also presented in the Matched Client Data Analysis
                                                                             development scales are not used for this
section following the Cross-Sectional Analysis.
                                                                             analysis.

LSP Outcomes: Cross Sectional Analysis (Findings
for All Resource Center Clients)

Data representing five of the LSP scales is presented as a cross sectional analysis for Resource Center clients as
a group. These items link to:
           Desired Result Area 1: Children are Safe and Healthy
                o     Objective 1: Children are born healthy
                o     Objective 2: Children are healthy, well nourished and physically fit
           Desired Result Area 3: Families are Safe, Healthy, Nurturing and Self-Sustaining
                o     Objective 8: Parents are mentally and physically fit
                o     Objective 9: Parents practice developmentally appropriate parenting skills
                o     Objective 10: Children are free from any form of abuse
                o     Objective 11: Families are stable and have the capacity to meet the needs of their children



22 Time 2 data category includes data identified a both Midpoint and Post.


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Data was separated into two categories based on the “target areas” defined for each item. The LSP is scored on
a 5 point scale where 1 is defined as high risk and 5 is defined as stable. 23 These definitions change for each
item and the target areas change as well. Data was analyzed using the categories of “below” and “at or above
target.” What is demonstrated in the Exhibits below is the percentage of all Resource Center clients as a group
who reported being “at or above target” at Intake and Time 2.

The LSP is completed by an agency service provider (usually the case managers or resource managers) with the
client. In some cases, these questions are asked directly to the parent and parents provide the response.
However, in other cases, the instrument has been used to guide an interview or assessment that may be scored
later based on the clients responses in the assessment process.

DRA1: Objective 1 - Children are born healthy.
This item assesses the use of prenatal care during pregnancy. The target behavior is defined as the mother
receiving prenatal care in the first trimester of her pregnancy and keeping most appointments. At the point of
intake, 70.8% (n=404) of clients provided responses that placed them at or above the target area. At Time 2,
79.2% (n=168) of clients provided responses that placed them at or above the target area. While there was an
increase in the overall percentage, the number of clients (n value) was much smaller at Time 2. Data for
Prenatal Care at Intake and Time 2 points are presented here in Exhibit 4.10.

                                      Exhibit 4.10 2007-08 LSP: Adequate Prenatal Care


                                                     Intake (n=571)          Time 2 (n=212)

                                                                                  79.2%
                                                           70.8%




                                                                 Prenatal Care



DRA1: Objective 2 - Children are healthy, well nourished and physically fit.
To address this objective, parents were asked four questions about medical insurance and medical care for their
children. The questions included information about child well care and child dental care, which were defined
as a child having a medical or dental home and receiving preventative checkups. Also included were questions
about child sick care and child immunizations. As this data represents all Resource Center clients, there were
varying n values for each item and each data collection point. Data is shown in Exhibit 4.11.




23
     Following the analysis recommendation developed by the authors of the LSP,


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                         Exhibit 4.11 2007-08 LSP: Child Health and Medical Care
                                                             Intake   Time 2
                                                                                               97.1%
                    91.9%                     93.4%                                   89.2%
            79.8%                    82.7%                            79.1%
                                                             66.2%




           Child Well Care           Child Sick Care        Child Dental Care      Child Immunizations



As demonstrated above, a high percentage of parents already had a plan for their child’s health care at time of
intake. Still, increases were seen on all four items. On three of these items, clients reported over 90% at or
above target by Time 2. When looking at preventative care for the children (child well care), there was an
increase of 12.1% from Intake (79.8% or n=796) to Time 2 (91.9%, n=464). While a smaller percentage of
clients reported their children had a dental home as compared to a medical home, the item of child dental care
showed the greatest percentage increase – a 12.9% increase from Intake (66.2%, n=532) to Time 2 (79.1%,
n=330). On the item of child sick care, parents reporting they received timely care for their sick child and
followed up when necessary, increased 10.7% from Intake (82.7%, n=777) to Time 2 (93.4%, n=464). On the
final child health item, child immunizations, a very high percentage (89.2%) of parents reported they were
either up to date with all immunizations or had appointments scheduled that would allow them to be back on
the physician recommended schedule at Intake (n=931). By Time 2 (n=484), there was a 7.9% increase to
97.1%.

DRA 3: Objective 8 - Parents are mentally and physically fit.
In order to assess and address parent needs, this objective uses items from the LSP Substance Abuse and
Mental Health subscales. As parents are better able to access and utilize services to address their own needs,
they will be better prepared and equipped to help their children. The items on this subscale address issues of
substance abuse as well as areas such as self-esteem and depression. For many clients, this may be a difficult set
of questions and some partner agencies may have been reluctant to ask them if they are not direct providers of
substance abuse services or mental health services. This subscale in particular has raised requests for additional
training from partner agency staff in the areas of mental health and interviewing skills. This instrument may
serve as a valuable resource to providers that serve clients struggling with substance abuse and/or mental health
issues and are unsure of how to track these effects on the family. In these cases, the LSP may provide data that
will help agencies better identify and serve the needs of their clients. Data representing all at or above target
data for mental health and substance use is presented below in Exhibit 4.12.




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                       Exhibit 4.12 2007-08 LSP: Mental Health and Substance Use

                                                                                           Intake    Time 2

                                                                                              93.6%
   Substance Use/Abuse
                                                                                          90.5%
                                                                                                       99.3%
        Cognitive Ability
                                                                                                     97.8%
                                                                                                    97.1%
             Self-Esteem
                                                                                            92.5%
                                                                                                     98.6%
           Mental Illness
                                                                                                    97.4%
                                                                                               94.1%
     Depression/Suicide
                                                                                      88.3%
                                                                                         90.2%
            Tobacco Use
                                                                                   86 .1%



As illustrated above, most of the clients that completed the substance abuse and mental health items were at or
above the target area at Intake and therefore there was little change at Time 2. With varying n values for each
item and each data collection point, it is difficult to identify where clients are making improvements in these
areas using cross sectional analysis. For this area, it would be more useful to assess the client matched data that
will be reported later in the chapter to examine changes for individual clients. For example, the item where the
percentage increase was the greatest was the depression/suicide item, where the target would be a client
managing depression or reporting no depression. For this item 88.3% of clients reported being at or above
target at Intake (n=1,000). And while the percentage increased to 94.1% (increase of 5.8%) by Time 2, the n
value dropped to n=477, less than half of the client numbers available at Intake. Due to the high number of
drop-offs from Intake to discharge, it is not possible to make a conclusion about the effect of the programs
being offered. Also, the high number of drop-offs may represent the population for whom these services are
most important, therefore skewing the data to represent a less severe population.

Another important issue to consider when assessing this data is the type of intervention being used by each
Resource Center. While some of the programs have mental health services available to parents, other programs
do not and may only be able to provide referrals. With individualized knowledge of the Resource Center
programs, First 5 San Bernardino may consider identifying which items will be used for evaluation of the
Resource Center as an initiative and which items might be better utilized for a program level evaluation.

DRA3: Objective 10 - Children are free from any form of abuse.
To address this objective, analysis was conducted using the Discipline item on the LSP scale. This item asks
about the parent’s history of physical abuse or neglect as well as the use of age-appropriate discipline methods.
The target area is defined as parents who practice age-appropriate discipline “at least sometimes.” Due to the
nature of this item, parents may not be comfortable answering this item honestly at intake and staff may not
get an accurate assessment of the home situation. For FY 2007-08, there was a 10.5% increase in parents who
reported being in the target area by Time 2 (Exhibit 4.13).


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                              Exhibit 4.13 2007-08 LSP: Appropriate Discipline


                                           Intake (n=879)     Time 2 (n=484)
                                                                  90.1%
                                               79.6%




                                                     Discipline



DRA3: Objective 11 - Families are stable and have the capacity to meet the needs of their children.
This objective links to several Commission-Level Outcomes that focus not only on the parent’s ability to
address his/her child’s needs but the family’s ability to access resources and strengthen relationships. Data from
various subscales of the LSP was used to assess questions related to this objective and are presented by
subscales as appropriate.

The LSP begins with many questions assessing client relationships with family, significant others, support from
friends, as well as areas that relate to their children and their ability to seek and obtain support outside of their
family and friends. Data from these questions is presented below.

Relationships with Family and Friends: One of the Commission Level Outcomes identified by First 5 San
Bernardino is the strengthening of nuclear and extended family relationships. To assess a parent’s progress in
these areas, three items on the Relationships with Family and Friends subscale of the LSP are used. These items
are shown in Exhibit 4.14.

                     Exhibit 4.14 2007-08 LSP: Relationships with Family and Friends
                                                   Intake     Time2

                                   82.3%
                           74.6%                            73.5%                  72.6%
                                                   66.5%
                                                                          56 .4%




                         Family/Extended          Boyfriend, FOB,          Friends/Peers
                             Family                  Spouse

As illustrated above, there were increases in all areas with the highest percentage increase in the area of
relationships with friends/peers. At time of Intake (n=1,210) only a little more than half of the clients (56.4%,
n=682) reported being in the target area, defined as having “a few close friends or an extensive social support

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network.” However, by Time 2, 72.6% (n=483) of the parents reported having friendships from which they
could get support, representing an increase of 16.2%. This measure may be more affected by Resource Center
partner programs which have a strong parent support component.

Relationships with Child(ren): The items from the LSP scale represented in the Relationships with Child(ren)
chart (Exhibit 4.15) address areas related to a parent’s relationship with his/her child. These items are also a
reasonable target for Resource Center services to influence over time. The greatest change in this area was a
29.1% increase on the item asking about a parent’s support of his/her child’s development. As illustrated below,
only slightly more than half of clients provided responses that put them in the target area at time of Intake. The
clients who reported being below target at Intake would have reported they were “open to child development
information, or had limited knowledge or poor knowledge of child development.” Given that many of the
Resource Centers provide case management, as well and Parenting Education programs, this in an item that
could be affected by participation in the program.

                           Exhibit 4.15 2007-08 LSP: Relationships with Children
                                                  Intake    Time2
                                   93.4%                                          91.0%
                           84.7%                           84.1%
                                                                         77 .4%

                                                  55.0%




                             Nurturing             Support of            Friends/Peers
                                                  Development



Relationships with Supportive Resources: In an effort to improve a family’s level of self-sufficiency, one of the
attributes to consider is a client’s motivation to seek out and access the recommended services. For many
clients, the RC may be their first effort to access community resources and their experience with staff and
services may affect their willingness to seek help in the future. As can be seen from the items represented in this
subscale (Exhibit 4.16), the LSP also captures information on the relationship between the client and home
visitor. While several of the programs within the Resource Centers provide home visitation, this title is meant
to reflect the relationship with the staff member providing the primary contact with the client. The other two
items on the scale, use of information and resources, are also indicators of improved self-sufficiency as they
indicate that a parent is receptive to resource information and then takes the steps necessary to utilize this
resource. The Use of Resources item identifies those at or above target as a parent who identifies needs and
uses resources with little support or independently. This item saw the greatest increase with a 19.8% increase
from Intake (66.1%, n=775) to Time 2 (85.9%, n=525).




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                   Exhibit 4.16 2007-08 LSP: Relationships with Supportive Resources
                                                    Intake     Time2
                                   91.6%                     89.8%                 85.9%
                           77.6%                    76.5%
                                                                          66 .1%




                        Relationship with      Use of Information        Use of Resources
                        Home Visitor/Case
                            Manager



Education and Employment: The Education subscale includes questions related to a parent’s ability to be self-
sufficient by asking about educational level and employment history. These items help in identifying some of
the barriers parents face when moving towards self-sufficiency, but these are not necessarily items that can be
affected by RC services. In order to measure outcomes, these items should be matched to partner
organizations that provide employment or educational services as part of their program.

                          Exhibit 4.17 2007-08 LSP: Education and Employment
                                                    Intake     Time2




                              56.3%        5 4.9%
                                                                              46.7%
                                                                  39.7%




                                   Education                           Employment

The data in Exhibit 4.17 demonstrate a high need for both education support and employment services. For the
Education item, this chart shows that even at Time 2, only 54.9% (n=265) of clients had graduated from high
school either through GED or a diploma. Also by Time 2 , only 46.7% (n=230) of clients were employed
including seasonal and part-time workers. This demonstrates that of those that completed the Time 2 LSP
item, 53.3% of clients were still “unemployed, unskilled or had no work experience.” This is a significant
percentage of clients served by the RCs and suggests additional provision of these types of services or the
strengthening of relationships with organizations in the community that provide these types of services.

Health and Medical Care for Parents: While there are several programs available for children to enroll in
health insurance programs (state funded or through First 5 funding) the same options do not exist for adult
clients. When a parent is sick and cannot access health care, she/he risks infecting the child and incurring lost
days of work. As evident from the data described previously, the parents represented in this sample are already


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struggling with limited incomes and job opportunities given their level of formal education. On this item, the
target area includes adults who seek medical care and have a medical home and there was an increase of 13.7%
from Intake to Time 2 (Exhibit 4.18).

                                 Exhibit 4.18 2007-08 LSP: Parent Sick Care


                                         Intake (n=984)    Time 2 (n=450)

                                                              77.6%
                                              63.9%




                                                 Parent Sick Care



Basic Essentials: One of the most important roles of the Resource Centers is in helping families meet basic
needs. Last year’s report demonstrated a significant need among the clients receiving services from the
Resource Centers. In FY 2006-07, almost 25% of clients were struggling with food insecurity. This year’s
analysis demonstrates that a high percentage of clients were already within the target area for the housing,
food/nutrition and transportation items at Intake (see Exhibit 4.19).

                                 Exhibit 4.19 2007-08 LSP: Basic Essentials

          97.1%             95.8%                                                 Intake    Time 2
     91.9%
                       86.7%                  86.1%
                                         79.9%                  76.9%
                                                          64.7%
                                                                                 53.0%            49.8%
                                                                            41.7%            44.6%




       Housing       Food/Nutrition Transportation Medical/Health            Income           Child Care
                                                     Insurance




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A closer look at the data suggests an explanation as to why these percentages may be so high. Since the LSP
instrument was developed for families receiving intensive home visitation services, the target scores seem to
assume that many of the families will be receiving support through government entitlement programs. This
provides families with a certain level of independence and ability to meet needs. This is a different perspective
than what was asked last year which focused on the parents own perception of their challenges. With the data
currently available, it is not possible to determine if any of the 86.7% of parents reported being in the target
area for food/nutrition at time of Intake (n=1154), accessed emergency food or additional food programs while
still receiving benefits.

While an increase was seen on items in the Basic Essentials scale, this continues to be an area clients identify as
crucial to their own participation in the services they receive. In a focus group conducted with mothers
receiving services in rural San Bernardino County, most identified basic needs such as diapers or
transportation as the most beneficial services they received. Several mothers mentioned that the diapers and
clothes for their newborns were a motivating incentive for them to continue to engage in the program and seek
ongoing services.

The item that stood out on this scale as one that could be impacted by increased collaboration among First 5
initiatives is the need for access to quality child care. The target area includes those that are able to access high
quality day care and those that make use of friends and family who provide a stable environment but with
limited developmental support. This is an area where those First 5 partner agencies providing child care
subsidies or professional development for child care providers may be able to find parents who are interested
in either pursuing careers in child care or are re-entering the workforce and need child care.

Overall, these Basic Essentials items may serve as the primary outcome measurements for the Resource
Centers. As data for these scales continues to be collected, it will be important to track these percentages over
time and take into consideration programmatic and socio-economic factors.

LSP Outcomes: Matched Data Analysis

As mentioned previously, FY 2007-08 was the first year for the use of the LSP for the RC partners. Fortunately,
the RC partner agencies were able to collect matched data for several items on the LSP. Analysis for this data
revealed that there was a statistically significant change on many items for which 200+ matched sets of data
were available (see Exhibit 4.20 on the following page). While the n value for many of the items is small
compared to the total number of clients served by the RC Strategy, this data suggests that clients who remain in
services until a Time 2 are more likely to demonstrate an increase in skills measured by the LSP. Since data for
Time 2 includes both midpoint and post, further analysis could be strengthened by standardizing the intervals
for when the LSP is administered, particularly at Time 2.




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                    Exhibit 4.20 2007-08 Life Skills Progression – Matched Data Results
                                            % Within Target   % Within Target   Percent
                                                                                                n value
                                            Range at Intake   Range at Time 2   change
 Relationship with Family & Friends
  Family/Extended Family                         71.5%            81.5%         10.0%*           520
  Boyfriend, FOB, or Spouse                      63.1%            74.1%         11.0%*           509
  Friends/Peers                                  62.7%            72.5%          9.8%*           549
 Relationships with Children
  Nurturing                                      87.1%            93.7%          6.6%*           364
  Support of Development                         64.1%            84.5%         20.4%*           368
  Safety                                         83.4%            92.0%         8.6%**           325
 Relationships with Supportive Resources
  Relationship with Home Visitor                 79.9%            92.5%         12.6%*           533
  Use of Information                             77.7%            90.0%         12.3%*           521
  Use of Resources                               68.5%            85.5%         17.0%*           530
 Health and Medical Care
  Parent Sick Care                               63.5%            77.7%         14.2%*           310
  Child Well Care                                77.2%            91.9%         14.7%*           372
  Child Sick Care                                82.4%            92.9%         10.5%*           340
  Child Dental Care                              64.8%            80.9%         16.1%*           236
  Child Immunizations                            87.1%            97.0%          9.9%*           333
 Mental Health and Substance Abuse
  Substance Use/Abuse                            85.9%            95.1%          9.2%*           283
  Tobacco Use                                    82.8%            92.4%          9.6%*           290
  Depression/Suicide                             88.0%            93.3%         5.3%**           342
  Self-Esteem                                    92.7%            96.5%         3.8%**           396
 Basic Essentials
  Housing                                        89.8%            97.2%          7.4%*           460
  Food/Nutrition                                 87.3%            96.1%          8.8%*           463
  Transportation                                 76.1%            86.5%         10.4%*           415
  Medical/Health Insurance                       66.5%            76.5%         10.0%**          489
  Income                                         41.4%            54.1%         12.7%**          399
 *Statistically significant at p<.001
 ** Statistically significant at p<.05




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As can be seen in Exhibit 4.20, 23 of the 35 items that were used for analysis demonstrated statistical
significance. Of notable mention is that almost all items (9 out of 11) in the Relationship Scale demonstrated a
statistically significant increase. This suggests that clients are better able to utilize and access support from
family, friends and service providers by Time 2. For many of these scales, matching client data was available for
less than 50% of clients for which data was available at Intake. Further analysis at the program level might help
agencies determine where the drop off occurs and if there are any retention efforts that could be implemented.
Also, by looking at who remained in the program until Time 2, data might reveal that some agencies are
already successful with retention.

Another area with a noticeable improvement was on the Health and Medical Care Scale. Resource Centers have
assisted clients in improving heath care for not only their children but for themselves as well. Matching client
data showed that by Time 2, parents had achieved over 90% in the target area for all areas related to medical
care for their children. Parents also made an improvement in securing dental care for their children. This may
be as a result of Resource Center collaboration with Oral Health providers within San Bernardino County.

There are several questions that should be considered by both the RC partner agencies and First 5 San
Bernardino in order to frame the results of this analysis. These questions include determining which items on
the LSP link to the program models of the Resource Centers. For example, one cannot link a client’s
improvement on the substance use item if the program does not provide substance abuse treatment. Instead,
one might be measuring change affected by another partner agency rather than the Resource Center. This
observation results in the recommendation that the Resource Centers all collect data for the items that are
linked to the RC program model, those that the initiative is trying to affect through its interventions.
Additional items can be collected for program level evaluation, as many of the RC programs work with target
populations and may be providing a service not provided at another RC, such as on-site job training. Once the
RC partner agencies and First 5 determine the collective items, the initiative level evaluation will more closely
reflect the services provided. This will also lighten the load for many partners who report having difficulty
completing all 35 items on the scale. Identification of “the minimum” scales to be completed may also improve
data collection at Time 2.

Conclusions for Resource Centers Findings

The evaluation data for the FY 2007-08 revealed an improvement in the quantity and quality of outcome data
for RC clients. While there continue to be struggles with the collection of Time 2 data, this year was an
improvement over the previous year and provided much more data for analysis. The first year of use of the LSP
instrument has provided a wealth of information from which to make additional refinements. First, the cross-
sectional analysis demonstrated several barriers that continue to affect San Bernardino County parents
including poor employment opportunities due to limited levels of formal education. This data can be used to
develop programs or link to other providers that have employment and skill building programs that help move
parents towards self-sufficiency.

Second, analysis of the LSP items revealed that the Resource Centers would benefit from the identification of a
set group of items that would be collected and analyzed for an initiative level evaluation. This is important
since not all RCs provide the same service and may not have the same interventions available. For example,
some Resource Centers have identified target populations, such as mothers struggling with substance abuse, so
that one would expect their program evaluation to include items that assess substance abuse and mental health.


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Thus, it would not be accurate to group these clients with clients who had not been offered these services and
expect to see similar outcomes. If First 5 San Bernardino is able to determine which items will be used, it will
also help alleviate some of the pressure partner agencies are feeling to try and collect data for all 35 items. It
would also help both First 5 and partner agencies to concentrate technical assistance and training to these
specific items.

Another important point to consider when looking at both the cross-sectional and matched data analysis is the
significant drop-off of clients from Intake to Time 2. For matched data, the most matched cases were on the
Relationship scales with 520 matched cases out of a total of 1,178 responses available at Intake. Even on this
item, the matched data represents only 44.1% of the total clients available at Intake. Further program level
analysis of client drop-off may help in developing retention strategies for clients.




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  Conclusions and Recommendations
First 5 San Bernardino funded 24 partner agency programs in the Family Support Cluster during FY 2007-08.
Overall, the available data demonstrated increased in parental knowledge and confidence, as well as
improvements in parental skills related to accessing and utilizing community resources. The following is a
summary of findings and recommendations informed by the 2007-08 FY data.

F5SB and partner agencies improved data collection for both aggregate and
core client data.
    Improved data collection allowed for a more accurate description of the clients served by the Family
    Support Cluster. Demographic data was available for a much higher percentage of clients as compared to
    last year. For example, in FY 2006-7, primary language data was available for only 26.5% of all clients. In
    FY 2007-8, data was available for 96.6% of clients. This increase was also seen with ethnicity and service
    delivery variables.

F5SB continues to reach a growing number of low and very-low income clients.
    The population of core clients served by the Family Support programs continued to reflect low-income
    clients with a high level of need. The percentage of clients who reported incomes of less than $10,000
    annual income increased substantially over the previous fiscal year.

Parents participating in Parenting Education programs demonstrated an
increase in parental knowledge
    Analysis of the Survey of Parenting Practice data showed an increase on all three items related to parental
    knowledge (My knowledge of how my child is growing and developing, My knowledge of what behavior is
    typical at this age, My knowledge of how my child’s brain is growing and developing).

Resource Center participants made statistically significant improvements on 23
items measured by the Life Skills Progression Instrument
    For clients who stayed in services long enough to complete a Time 2 Life Skills Progression instrument,
    improvements were seen on 23 of the 35 LSP items. The greatest change was seen on the Relationship
    scales where clients were asked about relationships with family, friends, their children and service
    providers as well.


Challenges
While the Family Support Cluster succeeded in many ways, it also continued to face several challenges. First 5
San Bernardino remains committed to using these challenges as learning opportunities and is working with
partner agencies to use data for program improvements.

    Challenges with collecting accurate exit data. This area of data collection improved during the last
    fiscal year for both the PE and RC strategies. However, this continues to be a challenge, particularly for the
    RC partner agencies. Data available for matched case study showed a decrease of almost 50% of clients


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    from Intake to Time 2. The RC partners may benefit from a program level analysis of the data in order to
    develop and implement retention strategies for their individualized programs.

    Comparing results across Resource Center programs. Given that RC programs provide unique and
    tailored services to meet the needs of their clients, it is often difficult to collectively evaluate the
    comprehensive nature of the RC strategy. The change in instrumentation for the PE programs has made
    this analysis more comprehensive. However, with all the items on the LSP, the evaluation of the RCs has
    become difficult for some service providers and may not accurately depict the success of others. This is
    further discussed below in the Recommendation section.


Recommendations
The following recommendations were developed based on 2007-08 FY data.

    Consider identifying a standard number of Life Skills Progression (LSP) Instrument items that
    will be collected and analyzed for an Initiative level evaluation. The LSP has many items for which
    Resource Centers do not have specific interventions. However, there are several items that are connected
    to all RC programs. F5SB and RC partners should review all LSP items and identify those items that will be
    used for an initiative level evaluation. This would also alleviate data collection pressure for many agencies
    that report having difficulty collecting data for all 35 items.

    Encourage collaboration between RC agencies                “I think we need to work together
    and other First 5 San Bernardino funded                    towards the same goal. I think
    agencies. Analysis of LSP data revealed several
                                                               when you try to stretch too thin
    items where services are already provided by other
                                                               what happens is you’re not able to
    F5 funded partner agencies. For example, there was
    very little improvement in the area of child care          provide enough to the commitment
    but there are several F5 funded programs that are          you’ve already made and
    child care focused. By connecting these programs,          everybody suffers. I think you’re
    child care outcomes may be better for parents              better off focusing.”
    involved with RCs.                                                                 - Stakeholder

    Encourage collaboration between RC agencies
    and employment and education partners in the community. While there was improvement on a
    large number of LSP items, one area where there was little to no improvement was the education and
    employment scale. In the current economy, parents are already struggling economically and with limited
    job opportunities. However, the data analyzed for these parents revealed that there is a need for additional
    services in both of these areas if parents are to become more self-sufficient. With no increase in job skills or
    education level, many parents will remain in low paying jobs or lose jobs altogether due to the economic
    downturn.




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                 Building a Generation: Reaching School Communities

   When children start kindergarten, they enter a new environment filled with new teachers, new
   classmates, and new classrooms. They are often excited and maybe even a little nervous. But
   children are not the only ones being introduced to a new environment. For many first time parents
   whose child has just started school, the school is a new entity in the parents’ life as well. In an effort
   to engage these parents and help them in accessing community resources, Building a Generation
   (BAG) in collaboration with First 5 San Bernardino, houses several Resource Centers at local
   elementary schools. These on-site Resource Centers are often more accessible to community
   residents and can offer programs to not only serve the needs of the family, but serve and support
   the educational needs of the child as well.

   When Iliana, a married mom with two energetic little boys, first heard of the BAG Resource Center, it
   was through a school flyer describing the services offered at the site. At the time, she was looking for
   help regarding health insurance for her sons. They did not have medical insurance and Iliana knew
   that it was important for them to get regular check-ups. Through the process of receiving assistance
   for health insurance enrollment, Iliana was introduced to other services provided by the RC. As Iliana
   says, “I really didn’t know what I was getting myself into. But I always like to get my kids involved. These
   things really work.”

   While there are several services provided by BAG, including referrals, nutrition education, safety
   education, and linkage to other First 5 funded services, two really stood out for Iliana and her family.
   The first of these programs is referred to as the “Tubs” program by parents and staff. The Tubs
   program is just that – large plastic tubs filled with activities that assist with the development and
   strengthening of reading skills, writing skills, and motor skills. They often also bring families together
   and strengthen bonds. Iliana reports that this program made her more patient. “I wanted [my son] to
   learn things really fast, because that’s how I work. But he doesn’t work like that. He would set his own
   pace and struggle sometimes. That’s why the tubs work - because we have it for two weeks. If I think he is
   struggling in math, then we have it for two weeks - to work on it.” After two weeks of having the Tub at
   home, families can bring it back to the site and check out another Tub. The staff member mentioned
   that this program was very successful at the site with many families participating over the entire
   school year.

   Another program that really appealed to Iliana and her
   family was the Story Time put on my BAG at the school.      “Taking them to story time,
   This family night brought together families from the        it’s really not a big deal to
   school community for a night of reading and the
                                                               them…to them it’s like ‘oh,
   support of family literacy. While parents received tips
   on how to encourage their child to read and how to          we can do arts and crafts.
   support literacy in the home, children were engaged         That’s fun!’ But they’re
   in an arts and crafts activity often linked to a book from  really learning something.”
    the evening. Another important part of the program
   for Iliana was that each child received a free book at
   the end of the night. These books were taken home                        - Iliana, F5SB Parent
    and began to build the foundation of a home library
   for her family. This program also helped many families who in struggling economic times would not
   have the same access to books as other families might.



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   When Iliana initially walked into the Resource Center, it was for assistance with enrolling her sons in
   health insurance. However she has received much more. From participating in the Tubs program to
   attending Story Night with her family, Iliana speaks very positively of her experience through
   Building a Generation’s RC. Not only has she been able to connect to the school but through these
   connections she has supported her son’s educational achievement and brought education into the
   home in fun and exciting ways. She continues eager to teach her sons. And this enthusiasm appears
   to have rubbed off on her kindergartner.

   As Iliana reports “it’s nice that he’s teaching - he is already teaching his [little brother] how to do it.”



                               “He was really proud that he was able to
                               connect the two pictures that sound the
                               same. It was the first time we had ever
                               done it. I told him, just sound out the two
                               pictures. If they sound the same, then they
                               connect. He tried really hard.”

                                                                - Iliana, F5SB Parent




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        Chapter 5 System Integration and
                     Community Engagement

Key Findings
    F5SB and its funded partners continued to demonstrate their commitment to continuous quality
    improvement by using data and client feedback to enhance and modify their programs and services
    delivery.
    Many partner agencies continued to use program models or strategies for service delivery and
    measurement based on promising or best practices. These practices should continue to be shared and
    expanded.
    There was an increase in the number of partner agencies who reported implementing cultural competence
    strategies this fiscal year, including providing training for staff, making materials available in multiple
    languages, and employing bicultural and bilingual staff.
    Although F5SB has increased the awareness of the needs of the 0-5 population, 2008 Family Survey
    findings suggests a need for continued effort by F5SB to raise awareness, as nearly half (45%) of
    participants were still unaware of F5SB.
    Fewer partner agencies succeeded in securing other funding this past year. F5SB should continue to
    expand its efforts around sustainability to include the development and implementation of sustainability
    efforts.
    First 5 funded partners and stakeholders have expressed the importance of F5SB as a leader and convener
    in the County. In particular, funded partners appreciate opportunities to come together with other
    agencies providing similar services to discuss strategies, lessons learned and solutions to common
    challenges. F5SB should consider implementing a quarterly convening series.

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     Introduction to System Integration &
     Community Engagement


S    ince 1999, First 5 San Bernardino
     (F5SB) has continued to grow and
     evolve as a funding agency and advocate
     for children and families. In the early
                                                                  First 5 San Bernardino Values
                                                          In 2005, First 5 San Bernardino developed the
years, the Commission sought to meet                      following core set of values to guide their efforts in
                                                          serving children and families:
community needs by quickly dispersing
funds to a wide range of providers. Over                       Integrity & Accountability: The Commission and
time F5SB has become more strategic in its                     staff will be open, fair, equitable and transparent
funding practices and more focused on                          with one another, the community, and funded
building a sustainable foundation that                         partner agencies. It will continually inform the
                                                               community of progress and serve as a resource
supports positive long-term outcomes for
                                                               for information on children ages 0 to 5.
children 0-5 and their families. In addition
to funding direct services to benefit children                 Inclusive & Responsive: The Commission and
and their families, the Commission also                        staff will continually work to ensure the inclusion
pursues two key Cluster areas to support the                   of diverse communities and will strive to engage,
system of care for young children:                             listen, and respect the ideas and advice of First 5
                                                               stakeholders.
                                                               Impact & Outcomes: The Commission and staff
       System Integration: Systems are
                                                               will identify strategic funding opportunities to
       responsive to the needs of children,
                                                               ensure positive outcomes for young children and
       families and community
                                                               their families. It will continually evaluate its
       Community Engagement:                                   effectiveness and pursue strategies that will make
       Communities are engaged and                             a unique and lasting contribution to San
       empowered to meet the needs of their                    Bernardino County.
       children and families
                                                               Leadership & Innovation: The Commission and
                                                               staff will be pro-active in creating positive
                                                               change, supporting innovative models, and
Through a review of directly funded                            serving as a catalyst for coordinating and
programs, stakeholder interviews, a funded                     integrating existing services.
partner survey, interviews with staff, and a
review of secondary resources, this section
highlights the key findings related to system’s improvement and community engagement activities pursued by
the Commission (see below textbox for a definition of “stakeholder”). 1 It provides a macro picture of the
Commission’s progress and how program partners and key persons in the San Bernardino community view the
system of care for young children and perceive the Commission’s progress toward meeting its Desired Results.




1
    The funded partner survey was completed by 43 programs (57.3%). For more information, see Appendix B.

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                Who were the stakeholders interviewed for this report?

   Stakeholders are individuals who are asked to provide insight and perspectives about the value the
   Commission brings to the County as a funder and advocate for children and families. Stakeholders
   include, but are not limited to, social service agencies and providers both directly and not-directly
   funded by First 5 San Bernardino, including partner agencies, foundations, advocacy groups and
   policy makers. Stakeholder interviews were conducted over the phone using a standard protocol.
   During July 2008, 20 interviews were conducted with stakeholders. General guidelines for selecting
   diverse participants included:
       Should be in a position to speak on the issues facing the San Bernardino community.
       Should have knowledge or experience that can speak to the community's perspective of F5SB.
       Should represent the diversity of the community including geography, type and size of agency,
       type of services, population served (ethnicity, income, primary language).




  During the 2007-08 fiscal year, First 5 San Bernardino also contracted the Institute of Applied Research and
  Policy Analysis at California State University San Bernardino to conduct a countywide survey of families,
  with children 0-5 (entitled F5SB 2008 Family Survey). With a baseline study conducted in 2006, this 2008
  follow-up survey provides valuable population-based data that provides context to the Commission’s work
  and measures public awareness about First 5 San Bernardino. Highlights from this study will be discussed
  further in the Community Engagement section of this report.




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     System Integration
Across the State, First 5 Commissions such as First 5 San Bernardino have adopted a systems approach that
moves the role of the Commission beyond merely being a funder of direct services for young children. This
approach seeks to utilize Commission funds and staffing to address three System Integration Strategies as
indicated in the Commission’s Strategic Plan: 2
          Information Sharing
          System Integration Advocacy
          System Access

In the Commission’s Strategic Plan, the System Integration Cluster is slated to represent 10% of the total
Commission investment portfolio and was earmarked for $3,900,000 during FY 2007-08. 3 The amount of
money allocated and actually expended by the Commission on the Cluster is seen in Exhibit 5.1. It is of note
that the Commission only awarded 8.8% and only expended only 7.5% of the earmarked funds. This is a
similar finding to last year, suggesting that a more focused attempt to effectively utilize funds designated for
this Cluster may be needed. With the newly revised Strategic Plan being implemented in the next fiscal year or
so, this area of interest will likely change in its priorities and goals.



                          Exhibit 5.1 2007-08 System Integration Cluster Investments
                                                                                                                    % of Total
                                                                                                % of Awards
    Total Allocation      Contract Awards           % Awarded             Expenditures                              Allocation
                                                                                                 Expended
                                                                                                                    Expended
       $3,900,000              $343,080                 8.8%                 $291,444               84.9%             7.5%



To understand the impact of its efforts, First 5 focused on several critical objectives that it believes strengthen
systems and developed corresponding indicators to measure the success of its efforts (see Exhibit 5.2 below).




2
    First 5 San Bernardino. Strategic Plan: Investing in our Children Prenatal Through Age Five. June 2006.
3
    Ibid.

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                                     Exhibit 5.2 Desired Result 4:
                Systems are Responsive to the Needs of Children, Families, and Community

        Objective                 Commission-Level Outcome                            Partners

                           12.1 Increased number of funded partners that
     12. Systems
                           initiate family-centered approaches to service
     support families
                           delivery


     13. Systems are       13.1 Increased number of funded partners that
     results-based         utilize their results to improve service delivery



                           14.1 Increased capacity to serve target
                           community


                           14.2 Demonstrated coordination/integration
     14. Community         with other services to benefit families
     has access to                                                                 All Cluster Areas
     services              14.3 Demonstrated efforts to sustain operations
                           through leveraging                                             +

                                                                               Commission Operations &
                           14.4 Providers exhibit high standards as defined          Activities
                           by best practices in their field
                                                                                          +

                           15.1 Increased number of agencies that include        Community Partners
                           families in planning and enacting child’s care
     15. Families,
     providers and         15.2 Increased number of providers that
     stakeholders          collaborate with other agencies to provide
     collaborate on        additional services to children
     the well-being of
     the child             15.3 Increased number of stakeholders involved
                           in First 5 that collaborate for the benefit of
                           children ages prenatal through age five


     16. Systems
     sustain programs      16.1 Increased number of other funders
     and services          supporting programs that achieve desired
     achieve desired       results for children ages 0-5
     results




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Both F5SB’s partner agencies and the Commission directly pursue activities to address these objectives and the
results of these activities are highlighted below. 4

Utilization of Results to Improve Programs
First 5 San Bernardino is committed to the effective use of data, information, and evaluation results to improve
service delivery (CLO 13.1).

To assess partner agencies’ progress toward utilizing                 “I’ve been involved in a lot of the
results to improve programs, partners were                            meetings and I’ve heard of the
specifically asked via the 2008 Funded Partner Survey
                                                                      different surveys and I really
whether they used direct feedback from clients to
                                                                      believe they’ve done an excellent
make improvements or changes to their program and
                                                                      job.”
service delivery methods. Approximately 86% of the
survey participants stated regularly soliciting client                                                    - Stakeholder
feedback or conducting client satisfaction surveys.

Participants were further asked to provide examples of any changes or program enhancements that were made
as a result of client feedback. Examples of changes included:
     Changed schedules, meeting times, or service hours to better accommodate clients
     Redesigning course content or providing additional topics to meet client needs
     Improved service procedures like cutting back on wait times
     Trained staff on multicultural issues

Stakeholders also expressed that F5SB does a good job of modeling the use of results, data and feedback to
improve their efforts and strategic decision-making. For example, one respondent reported that F5SB has held
focus groups in the community and felt that F5SB has given serious consideration on how to meet the
communities’ needs. Along the same lines, another stakeholder shared, “I have never heard of something that
has been brought up as a concern that hasn’t at some time been addressed.”

Service Capacity to Serve Target Community
First 5 San Bernardino seeks to increase the service capacity of county providers to better serve target
communities (CLO 14.1). For example, F5SB offers regular trainings and other capacity building events to both
its partner agencies, as well as other community-based organizations. Survey participants were asked a series of
questions in the Funded Partner Survey to assess both quantity (staffing levels) and quality (trained, qualified
and culturally competent staff) necessary to effectively serve diverse populations.

Staffing Levels
During the 2007-08 fiscal year, 93% of the agencies reported that they had sufficiently trained staff to respond
to the demand for services in their respective communities, an increase from the previous year in which 85% of
agencies reported sufficient and trained staff. Despite the relatively high percentage of organizations that



4
 The three Strategies within the System Integration Cluster are not well formed at this time and therefore the Strategies are not
described at length in this report, rather this chapter includes findings related to Desired Result 4: Systems.

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reported that they had sufficient and trained staff, the number of agencies that reported waitlists was 54%, an
increase from 42% in the previous year, indicating a continuing demand for services.


Children with Special Needs
Approximately 51% of participating agencies reported that their programs and services have been adapted to
respond to children with disabilities and other special needs, a decrease from the previous year in which 76% of
agencies reported that their programs and services had been adapted for children with special needs. Further
study would be necessary in order to understand the reason for this decrease.

Examples of adaptations and strategies to meet the need to serve special needs children that organizations
provided included:
    Having staff trained and/or specialists on site to work with children with disabilities and other special
    needs
    Instruction for families of children with disabilities on strategies to help their children do well at home and
    school
    Strong partnerships with the school district(s) and providing referrals to other organizations in the
    community

Organizational Commitment to Culturally Competent Services
To assess organizational commitment to provide culturally competent services, participants were asked to
indicate whether their agencies had (1) offered cultural awareness training for staff during the past year, (2)
incorporated language about culturally competent services into their mission statement, (3) implemented
policies or strategies to recruit and retain bilingual and bicultural staff, and (4) developed materials that are
linguistically and culturally appropriate for their target populations.

Survey results highlighted the efforts of partner agencies to provide their clients with culturally appropriate
services. Exhibit 5.3 presents the results of the survey and compares them to previous year’s findings. As the
graph demonstrates, there was an increase in each of the cultural competence indicators from 2006-07 to 2007-
08, with the greatest increases being in staff training in cultural awareness and linguistically appropriate
materials; albeit, these findings are still less than findings from fiscal year 2005-06. Bilingual and bicultural staff
recruitment, however, has continually increased since 2005-06. Despite these overall increases, the relatively
low percentages of some culturally competent findings suggest that the Commission could further support
funded programs in developing agency-specific culturally competent practices.

Culturally Diverse Populations
Partner agencies were also asked whether their programs have been designed or adapted to meet the needs of
specific ethnic or cultural groups. Approximately 64% of participating agencies reported that their programs
had been designed or adapted to meet the needs of specific ethnic or cultural groups. This is a relatively large
decrease from the two previous program years, 2006-07 (84%) and 2005-06 (82%), in which the data remained
relatively stable. Further study would be needed to explain this drop. Examples of design/adaptations included:
    Materials translated in Spanish and cultural modifications to curriculum
    Classes offered in Spanish or interpretation services provided
    Cultural sensitivity training for staff


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    Bilingual and bicultural staff, outreach workers, and facilitators



   Exhibit 5.3 Indicators of Organizational Commitment to Culturally Competent Services by Year
                                                           93%           91%
                                                                  81%                  FY 2005-06
                                                                                       FY 2006-07
                                                                                       FY 2007-08
                                         58% 60%
                                   48%
                       43%                                                       44%
           41%
                                                                                             36%
                 29%                                                                   32%




         Cultural awareness      Bilingual/ Bicultural Materials in multiple Culturally competent
          training for staff     recruitment policies      languages          mission statement




Further supporting the partner survey results, stakeholders indicated a need for further outreach to diverse
communities. One stakeholder stated, “I don’t think the Hispanic needs are clearly identified and responded to.
They are underserved and under represented and they do not have a loud voice. And they are a huge
population in our county”. Other stakeholders also suggested more outreach to African American, Asian
American, and Latino populations in order to strengthen these communities. In addressing these gaps in
services, one stakeholder responded that F5SB needed to be more proactive in community needs. “They listen
to the community needs, but they don’t go out there to find out what is out there. They have a directory for F5
services, but not others. This is an important missing piece. They need to do a better inventory of existing
services and working with those programs to really find out what’s missing.”




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Service Coordination and Integration
First 5 San Bernardino seeks to be a catalyst for
service coordination and integration to benefit
                                                        “I know that there are other
young children and families (CLO 14.2). This
includes, but is not limited to, the formation of
                                                        collaborative projects in certain
partnerships, collaboration, and development            communities, but as a county they have
of existing and new referral networks.                  truly become a leader, to the point
                                                        where other counties in the state and in
According to stakeholders, F5SB continues to            the nation are looking at San Bernardino
play an important role in connecting                    County because of the efforts that First 5
agencies/programs to one another and                    has started.”
increasing collaboration in the county. One                                           - Stakeholder
stakeholder described F5SB as a leader when it
comes to collaboration and another stakeholder echoed a similar sentiment stating that F5SB is the
“foundation” for collaboration, particularly given its emphasis and expectation that funded agencies seek
opportunities to collaborate. An example of this is the countywide coordination effort of Children’s SART,
which F5SB continued to fund in FY 2007-08, through Children’s Network. Children’s Network was
responsible for facilitating workgroups and providing technical assistance to the SART partners throughout the
year.

                                                                     Formal & Informal Partnerships
               2-1-1 San Bernardino County:                          F5SB encourages networking and serves as
                 Creating System Linkages                            a resource for agencies looking for
                                                                     referrals and connections. One
        2-1-1 is a central and comprehensive, phone and              stakeholder described regularly receiving
        internet-based, social and health services resource          phone calls from partner agencies that
        system available 24-hours a day.                             were referred through F5SB and another
        2-1-1 San Bernardino County (2-1-1 SB), operated by          stated “They are good at referring to other
        Inland Empire United Way, was funded in-part by              county agencies.” This program year, 78%
        First 5 San Bernardino during 2007-08 (F5SB
                                                                     of respondents reported that they had
        investment = $208,334).
                                                                     cultivated new partnerships with other
        Eighty-five percent (85%) of F5SB funded partners            programs or agencies. This is a decrease
        referred clients to 2-1-1 SB.
                                                                     from last program year when 86% of
        Between January 2007 and August 2008, there were             survey respondents stated they had
        a total of 58,350 calls to 2-1-1 SB.*                        cultivated partnerships with other
        Callers to 2-1-1 SB most often needed financial              programs or agencies.
        assistance (22%), shelter (10%), food (10%), or other
        organization information (10%).*
                                                                     Referral Networks
                                                                     Survey respondents took advantage of a
   *Source: Inland Empire United Way. 2-1-1 San Bernardino County,
   Second Anniversary Report. 2008.                                  strong referral network with 98% of
   <http://www.ieuw.org/211Reports/2-1-                              respondents reporting that they referred
   1%20San%20Bernardino%20County%20Second%20Anniversary%20           clients to other resources or service
   Report.pdf >
                                                                     providers in the community. This
                                                                     represented a slight (2%) decrease from
                                                                     last year’s survey. Additionally, 56% of


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agencies reported having a system to track and determine whether successful linkages were made (an 8%
decrease from last year). Respondents identified a number of barriers to successful referrals including a lack of
appropriate resources in their area (46%), agencies without the capacity to take more clients (36%), clients lost
to follow up (41%), and encountering an agency that refused to share information about a referred client’s
service utilization (23%).

Information Sharing
Participants were asked if program staff had opportunities to present or share “lessons learned” and/or
promising strategies with other providers in the County, state, or nationwide. Half (50%) of respondents said
that they had opportunities to present information about their programs and to share lessons learned with
other providers, a decrease from 57% in the previous year.
Respondents reported sharing information at a variety of
local, regional, and state conferences, board and council          “A lot of work needs to be
meetings, and F5SB partner meetings.                               done to build best practice use
                                                                   among service agencies in the
Several stakeholders indicated a need for F5SB to
                                                                    county. There is so much
strengthen its role as convener by bringing partners
                                                                    exciting research and if you
together on a more regular basis for information sharing
                                                                    really want to improve parent
and learning. “One of the things that we have done in the
                                                                    and child outcomes, First 5
past, and I haven’t seen as many recently, has been the
collaborative meetings,” one stakeholder noted, “… I’ve             should get this information
talked to some people who are just starting out, and some           out. There’s no denying that
of the things they are struggling with are things that we’ve        there are proven methods that
already been through and I really don’t think it would hurt         can improve programs and
for First 5 to enable a little bit more mentoring among             services.”
agencies; even having mentoring agencies.” Similarly,                                        - Stakeholder
another stakeholder suggested, “Something they could
think of adding is occasional cluster meetings of people that are serving in the high desert area. Just a get
together of how it is going with us and them and maybe share resources.”

Trainings & Capacity Building
During FY 2007-08, F5SB continued to provide trainings sessions and seminars designed to build capacity.
These events included training on assessment tool utilization such as the Life Skills Progression and the ASQ
and ASQ-SE.

Approximately 83% of respondents reported that they participated in First 5 funded and/or sponsored
workshops and events during the 2007-08 year. This was a decrease from 100% in the previous year. The
majority stated that the trainings were useful, with technical and content-specific trainings specifically
mentioned (i.e. DRDP-R training, training on LSP, ASQ and Persimmony training).

As in previous years, participants were asked to indicate all areas in which they would like additional future
training (see Exhibit 5.4). The desire for increased training and technical assistance from First 5 was relatively
high and distributed across a variety of categories. Sustainability training and assistance was at the top of the
list for most funded partners. Methods for effective collaboration and using data results were also of interest to



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many agencies (42% and 40%, respectively). It is worth noting that collaboration and effective use of data and
results are important components of sustainability.

                            Exhibit 5.4 2007-08 First 5 Partner Training Priorities


                        Sustainability                                                                 76%

           Methods for Collaboration                                         42%

                             Data Use                                     40%

               How to Make Referr als                                   37%

   Outreach to Diverse Communities                                  32%

      Culturally Appropriate Services                               32%

          Disabilities & Special Needs                        24%

        PTs, Milestones & Verification                  18%

                          Data System               13%


Respondents were also asked to choose the top two areas where they felt First 5 should focus its training and
capacity building resources. These results are presented in Exhibit 5.5. Forty-six percent (46%) felt First 5 could
help build capacity around data collection and using data for program improvement. That response was
followed by expanding opportunities for professional development of partner agency staff and expanding the
pool of regional professionals who can work with families and children 0-5. Approximately 10% selected
“other,” which included open-ended responses such as “build an endowment” and “fund operations instead of
programs.”

              Exhibit 5.5 2007-08 Resource Allocation for Training & Technical Assistance
                      46%
                                       36%              36%
                                                                       33%


                                                                                       15%




                   Collecting & Professional Development    Evidence-  Small start-up
                  using data for development    of 0-5    based models   support
                  improvement      for staff professional
                                                 pool




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Sustainability Efforts
First 5 San Bernardino encourages and supports partner agencies in sustaining operations by leveraging
funding from other sources (CLO 14.3). As part of the Funded Partner Survey, partner agencies were asked a
variety of questions about funding amounts, sources, and future prospects.

Funding Leveraged by Partners
During the 2007-08 fiscal year, 42% of participating
agencies reported success in obtaining additional grants or      “I think people are starting to
revenues from other sources. This is an increase from 33%        realize [sustainability] is not
in 2006-07. Of the agencies reporting securing additional
                                                                 just a word, it’s something we
funds, there was an increase in funding in almost all
                                                                 have to do.”
categories, particularly from county, private and “other”
                                                                                             - Stakeholder
sources (see exhibit 5.6). The “other” category included fee
for service, insurance reimbursements, fundraising events,
donations, and annual giving. While less than half of the respondents were successful in leveraging other funds,
the agencies that did have success, reported amounts ranging from $2,000 to $4.1 million. Based on the
information provided, an estimated $7.2 million was leveraged. It is likely that this includes social services that
receive “blended” funding from multiple sources.

Future Funding Prospects
Agencies were also asked whether they had identified other non-First 5 sources of support that can help sustain
their services or program (see Exhibit 5.7 for details). Data from the 2007-08 partner survey indicates that
                                                   agencies continued to struggle to identify and obtain other
     Definition of Sustainability*                 sources of funding. In FY 2007-08, 13% reported they had
                                                   other sources of funding that could sustain their programs or
   The ability to support positive                 services if F5SB funding was discontinued. This is a decrease
   outcomes for young children and                 from 19% in 2006-07. Partners reporting having identified
   parents over time and ensure long-              potential non-First 5 funding, however, increased from 31%
   term results through financial and              in 2006-07 to 38% in 2007-08. Most funded agencies
   non-financial resources.                        indicated that they depend in part or entirely on First 5 funds
                                                   to provide specific services. Over half (53%) would like
   *Source: First 5 San Bernardino Fact Sheet.     guidance and assistance from First 5 to research and identify
   <http://www.first5sanbernardino.org/excel-
   word/sustainability_fact_sheet.doc>             potential funders, partnerships or strategies to tap other
                                                   funding streams.

In general, stakeholders agreed that First 5 has been successful in spreading the message about sustainability.
However “operationalizing” sustainability and implementing sustainability plans pose a myriad of challenges.
Both stakeholder and funded partners echoed a need for more assistance from First 5. For example, one
stakeholder responded, “First 5 should be providing more concrete skill-building opportunities, rather than
just saying we need to find other money. They should be providing grant writing workshops, advisement
services, etc.” Likewise, another stakeholder reported, “These start-ups or smaller agencies that they fund don’t
have the capacity to write and bring in grants, these are inexperienced people.” One suggestion from
stakeholders included helping these agencies to use data for sustainability purposes stating. “If they looked
more clearly at what their programs are doing, they could pitch their results and need for the program and
explain how other agencies and communities benefit.”


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Additionally stakeholders suggested First 5 could assist partners by funding additional smaller agencies or
providing additional smaller grants for extended periods of time. Still, many stakeholders expressed that
sustainability was a difficult issue that many agencies struggled with and that First 5 was doing the best they
could.


                                    Exhibit 5.7 Future Funding Prospects

                                                        FY 2005-06                                   53%
                                                                                         48%
                                                        FY 2006-07
                           41%                          FY 2007-08
                                       38%
                                                                                               33%
                                 31%                                       30%
                                                          28%
                                                                     22%         23%
            19%                                 19% 19%
                  13%
       7%



    Secured Alternate     Identified          Unsuccessfully Have Not Looked              Would Like
        Funding       Alternate Funding          Identified    for Alternate             Guidance from
                                             Alternate Funding   Funding                     First 5



Bringing Other Funders to the Table
As mentioned in previous reports, F5SB continues to develop partnerships with other county agencies that seek
to streamline and integrate the services available for children. A perfect example of this is the Children’s SART
(Screening, Assessment, Referral and Treatment) program (see Chapter 2: Health & Well-Being for more
details on SART). This countywide effort seeks to systematically screen, assess, refer, and treat children for
developmental and social emotional delays and challenges, and utilizes multiple agencies to provide funding
and support for its operation.

Given the current economic downturn, the issue of sustainability is likely to take center stage for most non-
profit and public sector service providers. The need for diverse funding sources is more critical then ever. In
the midst of these challenging times, F5SB can play a critical role in helping agencies go beyond
“understanding” sustainability as a concept to truly implementing and operationalizing their sustainability
plans. As mentioned in previous years, there continues to be a significant need for capacity building and
technical assistance, a role F5SB is well positioned to play.




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                                   Operationalizing Sustainability

   As the economies of counties and philanthropic organizations continue to reflect the challenges
   being faced by the nation, there are several new conversations about the role and importance of
   sustainability. For many of the funded partner agencies in the First 5 San Bernardino Family Support
   Cluster, the move towards increased sustainability has been both fostered and supported by F5SB.
    From training and support to opportunities to hear other funded partners share their successes,
   F5SB has helped create an atmosphere where sustainability is part of the ongoing conversation.

   However, for a county such as San Bernardino where community need often far exceeds the reach of
   programs, there is often a struggle to reach the right audience for sustainability efforts. As
   mentioned in a conversation with F5SB funded Family Support agencies, sustainability efforts often
   take place far removed from the front line work of the program staff. As one staff member
   mentioned, “Sometimes we are not aware of what else is happening at the organization and we
   might be asking for a paper clip when someone else is asking for the box.” With organizations
   differing not only in size but scope, capacity, and visibility, there cannot be one approach. Instead
   F5SB has encouraged organizations to think of these strategies in the scope of their own
   organization. As one funded partner mentioned, “Sometimes we forget to look at in-kind donations
   or even things like food,” even when organizations realize that offering dinner is what often helps
   retain clients in services.

   While the conversation surrounding sustainability has begun, there is much more that can be
   learned and applied. And, based on conversations with funded partners, people are interested in
   listening, learning, and contributing.

   In future fiscal years, the concept of sustainability will continue to be a required element in partner
   agencies’ program target plans, ensuring this topic maintain a high priority for First 5 San Bernardino
   and its partners.




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     Community Engagement
The purpose of the Community Engagement Cluster is to engage and empower communities to meet the needs
of children and families. While raising community awareness is a fundamental goal, F5SB believes that
empowering and engaging the community as active partners will contribute to the long-term sustainability of
First 5 desired outcomes. To support communities, F5SB developed the Community Engagement Cluster that
employs three strategies:
          Community Education
          Technical Assistance
          Community Engagement

In the Commission’s Strategic Plan, the Community Engagement cluster is slated to represent 10% of the total
Commission investment portfolio. As such, this cluster was earmarked for $3,900,000 during 2007-08. The
amount of money actually allocated through contract awards and those monies expended during the fiscal year
can be seen in Exhibit 5.8. Partner agencies and Commission projects in the Community Engagement cluster
utilized 65.9% of their awarded resources; yet those expenditures only represent 18.8% of the potential
resources that F5SB set aside for these activities. This again suggests an area of focus for the Commission in the
next program year.

                       Exhibit 5.8 2007-08 Community Engagement Cluster Investments
                                                                                                                       % of Total
                                                                                                  % of Awards
    Total Allocation      Contract Awards            % Awarded              Expenditures                               Allocation
                                                                                                   Expended
                                                                                                                       Expended
        $3,900,000             $1,114,303                28.6%                 $734,364               65.9%                  18.8%



Exhibit 5.9 reflects how multiple partners and stakeholders contribute to the Commission’s goal of engaging
and empowering communities. This section of the report presents information and feedback from interviews
with community stakeholders and a review of funded activities that relate the Commission’s progress toward
the objectives listed below. 5




5
    Objective 19 is similar to Objective 14 under Desired Result 4 and is addressed in this chapter in the System section.

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                                   Exhibit 5.9 Desired Result 5:
         Communities are Engaged and Empowered to Meet the Needs of Children and Families

        Objective                 Commission-Level Outcome                            Partners

                           17.1 Increased awareness of parents and
     17. Parents and       communities of the importance of the first five
     communities are       years of life
     well informed         17.2 Increased engagement of parents and
     about resources       communities with early child development
     and early             activities
     childhood
     development           17.3 Increased awareness and utilization by
                           parents of available resources



     18. Communities       18.1 Increased opportunities to discuss
     collaborate with      community needs and resources with First 5
                                                                                   All Cluster Areas
     First 5 to identify
     needs and             18.2 Increased participation in planning efforts               +
     resources             around community needs
                                                                               Commission Operations &
                                                                                     Activities
                           19.1 Increased service capacity to serve target
                           community                                                      +
     19. Community-
     based service         19.2 Increased demonstration of cultural              Community Partners
     providers have        competency by service providers
     the capacity to                                                                      +
     address diverse
                           19.3 Demonstrated efforts to increase capacity
     community needs                                                             Families/Caregivers
                           to service and sustain operation through
                           leveraging funds, resources and support


                           20.1 Demonstrated coordination/integration
                           with other services to benefit children and their
                           parents
     20. Community
     members work          20.2 Increased number of First 5 agencies that
     collaboratively to    include families in planning and enacting their
     achieve collective    child’s care
     success
                           20.3 Increased number of stakeholders involved
                           in First 5 that collaborate for the benefit of
                           children prenatal through age 5




Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                January 2009          136
Communities are Aware of Resources & Importance of First Five Years of Life
Increasing community awareness about resources and the importance of the first five years of life is a critical
component of First 5’s work. The First 5 San Bernardino 2008 Family Survey, administered by the Institute of
Applied Research and Policy Analysis at California State University San Bernardino, asked families of children
0-5 whether they had ever heard of F5SB and whether their family had ever participated in a F5SB funded
program. Just over half (55%) of respondents reported that they had heard of F5SB, an 8% increase in
awareness since 2006 (47%). 6

Similarly, stakeholders stated that one of the main                        “They have been the leader
contributions of F5SB was an increase in awareness about                   in San Bernardino County in
the needs of children 0-5. “They bring issues to the                       getting accurate information
forefront that haven’t really been well known before. In                   out to families especially
terms of public awareness, they are pretty good about that.
                                                                           regarding the long term
[The information regarding children 0-5] wasn’t
centralized before, rather it was in silos. F5 should get some
                                                                           benefits of early
credit for bringing the key issues together and packaging it               intervention, both mental
for public use.”                                                           health and health.”

Although F5SB has increased the awareness of the needs of                                 - Stakeholder
the 0-5 population, Family Survey findings suggests a need
for continued effort by F5SB to raise awareness as nearly half (45%) of participants were still unaware of F5SB.
Less than one quarter (23%) of participants reported having participated in a First 5 funded program. Further
analysis revealed a relationship between level of awareness and various demographic factors. Those
participants with some college education were significantly more likely to be aware of F5SB than people with a
high school degree or less. Lower income participants were less likely to be aware of F5SB than higher income
participants. Two-thirds (66%) of Caucasians reported they were aware of F5SB compared to just over half of
African Americans (54%) and Hispanics (53%). Respondents who reported that English was the language most
frequently spoken in the home were significantly more likely to be aware of F5SB (60%) than those that
reported predominantly speaking Spanish in the home (49%). Furthermore, the age of the child was also a
factor as, interestingly, respondents with older children were more likely to be aware of F5SB.

Regional differences also have important implications for F5SB in terms of marketing. The greatest levels of
                                                       awareness could be found in the Mountains (72%)
                                                       followed by the East Valley (61%) where the majority
       F5SB Supports Local Media                       of respondents reported being aware of F5SB. In
                                                       contrast, little more than half of respondents reported
   In 2007-08, the Commission awarded a                being aware of F5SB in the West End (55%), High
   total of $51,420 to Clear Channel Radio             Desert (53%), and Central Valley (52%) regions.
   and NewsTalk 590 KTIE for radio spots and
   appearances at community events in order            Of the 55% of participants that reported being aware of
   to increase adult awareness of the                  F5SB, service providers (doctor, social worker, teacher,
   importance of the first five years of life.         etc.) proved to be the most important F5SB referral


6
 Bockmann, S., Sirotnik, B., Aldana, L. 2008 First 5 San Bernardino Family Survey. Institute of Applied Research and Policy
Analysis, California State University, San Bernardino. 2008.

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source with nearly half (46%) of participants reporting hearing about First 5 from a service provider. See Exhibit
5.10 for details on sources of awareness. This data suggest a need by F5SB to explore and utilize non-traditional
methods for reaching the “unaware” population.


                     Exhibit 5.10 Sources of Information Regarding First 5 San Bernardino*


           Service Provider                                                                                      46%

                           TV                               16%

                  Brochures                          12%

                       Other                       11%

             Word of mouth                       10%

      Other Advertisement                       9%

        Kit for New Parents                6%

                       Radio           4%

           Don't Remember             3%

                 Newspaper          2%

                     Website      1%

                        *This was a multiple response question, therefore percentages may not sum to 100%



During FY 2007-08, F5SB invested over $500,000 in sponsorships and other marketing events. The
Commission organized and/or facilitated a variety of outreach and community strengthening efforts including
dissemination of information through print materials (i.e., brochures, newsletters, resource directories), media
campaigns, community events (like fairs), and public speaking engagements. Topics covered in these activities
included many that are relevant to children 0-5 and their families such as school readiness, tobacco cessation,
breast feeding, prenatal care, community resource awareness, preventive health care for children, and positive
parenting practices. It is estimated that over 100,000 community members were reached through these efforts.

Additionally, F5SB provides local oversight of the distribution of a statewide First 5 California-sponsored
program – the Kit for New Parents. Since First 5 California launched the Kit for New Parents in 2001,
approximately 2.5 million Kits for New Parents have been distributed throughout California. 7 In 2007-08,
approximately 25,302 Kits were distributed in San Bernardino County (99.6% of the annual allocation of
25,412). Of the total distributed, 17,542 or approximately 69.3% were English Kits, and the remaining 7,760
(30.7%) were Spanish Kits.


7
    First 5 California. “Kit for New Parents Q & A.” Accessed 9 September 2008. <http://www.ccfc.ca.gov/kit/documents/QA.DOC>

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These Kits are a valuable, free resource filled with tips, advice, and resources for new parents and caregivers.
The Kit serves as an excellent messenger to the community about the importance of the first five years of life.
Besides the standard Kit content (i.e., DVD and brochures on parenting and how to raise a healthy child, as
well as other supportive materials), each Commission typically customizes the Kit to meet the needs of their
community and to market themselves locally. In April 2008, First 5 San Bernardino began including the “Little
Steps” books 8 as the customization piece in the County, spending approximately $46,000 to customize and
manage the local Kit project.


Policy, Leadership, and Advocacy
In addition to its role as a funding agency, First 5 San Bernardino also plays an important role as a policy leader
and advocate for children 0-5. Leadership and advocacy can be pursued on many different levels, such as
informing elected officials, advocating for additional resources, and promoting systems improvements among
key decision makers.
                                                                        Commitment to Results-based
Specifically in FY 2007-08, First 5 staff continued to
respond to efforts aimed at diverting First 5 funds
                                                                              Accountability
away from the counties in order to assist with the
general state deficit. While First 5 San Bernardino                      This year, the Commission invested
staff could not lobby, staff ensured all funded                          approximately $539,000 in their
partners and other community stakeholders were                           Technical Assistance strategy, which
educated about any legislation that had implications                     includes the tools needed to design,
for funding and promoted active letter writing                           document, and report results through
campaigns.                                                               organizational development,
                                                                         evaluation and data system
When asked about F5SB’s leadership role,                                 management.
stakeholders mentioned the Commission’s
commitment to promoting outcomes and accountability. Stakeholders stated that programs are becoming
more reliable as they are holding programs accountable and providing funds to programs that are “tried and
true.”

Given current economic conditions, stakeholders felt that advocacy was especially important. With an
increasing unemployment rate and more and more families losing their homes and struggling to meet basic
needs , stakeholders emphasized the need for F5SB to identify community leaders and get them on board with
advocacy efforts to help ensure “that [San Bernardino] receives every state and federal dollars that [they] are
entitled to.”

One provider highlighted how the lack of sufficient public transportation affected service delivery. “Public
transportation is very limited out here. We do have a public transportation system but it takes an all day
process to get across the valley. We need more vans and just more people to drive vans so that people can get
the services that they need…We need more concentration in the funding to actually be able to carry out the
services that are provided. We just can’t get to them and they can’t get to us!” Stakeholders stressed not only


8
 Briggs, S. Little Steps For New Parents: A Week-by-Week Guide and Journal for Baby’s First Year. Bright from the Start. 2008.
<http://www.brite1.com/index.html>

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working with local leaders but with congressional and assembly representatives in order to bring diverse
sources of funding to the county.


Communities Help Identify Resources & Needs
In previous years, First 5 San Bernardino has awarded programs through a “Community Investment”
approach, the result of community-based data collection conducted by the Commission. This process included
a series of “Community Conversations” that the Commission staff organized throughout the County in order
to discuss the most urgent needs in those areas. Overall, stakeholders applauded those past efforts and
recommended that First 5 continue to expand open dialogue at the community-level by working through
community-based organizations, faith-based communities and school sites. The Commission intends to
continue these types of activities in the future when seeking input into priorities, particularly when the
Commission implements its new “responsive fund” as part of the revised Strategic Plan. This process is
described more below.

Strategic Plan Analysis
During 2007-08, the Commission organized an advisory group, in order to review the 2006 Strategic Plan. The
2008 review process focused on strengthening and refining the existing Cluster and Strategy areas. By
reviewing program content and utilizing data collected over the last 3 years, the Strategic Analysis Advisory
Group developed recommendations on how to further refine and support a more integrated system of services
for families with children 0-5.

The Strategic Analysis Advisory Group was made up of 10 members, representing experts from various fields
relevant to early childhood and family care systems. The group met a total of ten times beginning November
2007 through August 2008. With a focus on strengthening each existing Cluster and Strategy area,
recommendations were put forth with new priorities and reallocation of funding.

Included in this plan, is the addition of a new category of funding, named Responsive. Responsive funds will, as
a whole, be given up to 5% of the total Commission’s allocation. While the Commission staff is developing
specific guidelines for this category of funding, the parameters for the funding have been broadly defined as
funds that can be used for new opportunities, urgent needs, and pilot projects. This will allow the Commission
to address urgent community needs and continue to develop resources in San Bernardino County.




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  Conclusions and Recommendations
First 5 San Bernardino and its partners have made considerable contributions to strengthen the systems that
serve children and families, as well as increase awareness and engagement among parents and members of the
community. This process will continue to require F5SB’s attention and nurturing to ensure that progress
continues, particularly in light of the current economic crisis. Throughout the evaluation, community
stakeholders and partner agencies were also asked to make suggestions and provide recommendations that
might help enhance and expand the important work carried out by First 5 San Bernardino. A summary of
trends and recommendations are presented here.

System and Community Trends
    Continuous Quality Improvement. F5SB and its funded partners continued to demonstrate their
    commitment to continuous quality improvement by using data and client feedback to enhance and modify
    their programs and services delivery. There is still interest among funded partners in discussing how to
    better use data for program improvement.
    Evidence-based Practices. Many partner agencies continued to use program models or strategies for
    service delivery and measurement based on promising or best practices. These practices should continue to
    be shared and expanded.
    Cultural Competence. There was an increase in the number of partner agencies who reported
    implementing cultural competence strategies this fiscal year, including providing training for staff, making
    materials available in multiple languages, and employing bicultural and bilingual staff.
    Community Awareness. Although F5SB has increased the awareness of the needs of the 0-5 population,
    2008 Family Survey findings suggests a need for continued effort by F5SB to raise awareness, as nearly half
    (45%) of participants were still unaware of F5SB.



Recommendations
    Capacity Building & Sustainability. Sustainability continues to be a central concern for most First 5
    funded partners, and will likely become even more critical given the economic downturn. Fewer partner
    agencies succeeded in securing other funding this past year. F5SB should continue to expand its efforts
    around sustainability to include the development and implementation of sustainability efforts. This might
    include more intensive training, coaching and capacity building to assist funded partners with the
    implementation of sustainability plans and the improvement of overall organizational effectiveness. This
    may also provide opportunities for the Commission to bring additional funding streams to the region.
    Concentrate Funds on Strategic Investments. It has proven challenging to demonstrate the impact of
    the Commission’s funding and activities within the System Integration and Community Engagement
    Cluster, given past funding approaches. As the new Strategic Plan is implemented, F5SB should consider
    funding contractors who will implement a well-defined set of similar activities filling a strategic priority,
    and utilize the new Responsive Funds to fill other urgent community needs, pilot projects or non-strategic
    activities.
    Strategic Media and Marketing. While F5SB has made considerable strides to raise awareness, there are
    still high need populations that appear to be unaware of First 5 issues and resources. This might necessitate


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    more strategic media and marketing efforts to specific geographic areas and target populations, such as
    Latinos and low income communities.
    Expand Role as a Convener. First 5 funded partners and stakeholders have expressed the importance of
    F5SB as a leader and convener in the County. In particular, funded partners appreciate opportunities to
    come together with other agencies providing similar services to discuss strategies, lessons learned and
    solutions to common challenges. F5SB should consider implementing a quarterly convening series
    (“learning communities”) which might include discussion topics of interest identified by funded partners.




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  Appendix A: Partner Agency Directory

Health & Wellbeing Cluster
Child and Family Assessment
A Special Place Children’s Museum                                                                    Contact Name:
Parent to Parent Support Group for Special Needs Children                                              T. Joset Mason
The parent to parent support group of special needs children offers a                                          Phone:
creative and educational experience that engages both parents and                                     (909) 881-1201
their child under the age of five. The support group meets one hour                                  Email Address:
once a week for eight weeks.                                                                  Mmason2369@aol.com
                                                                                                  Website Address:
                                                                                    http://www.aspecialplace1986.org

Blindness Support Services                                                                           Contact Name:
A Tactile Approach to Learning                                                                         Lolita Barnard
Blindness Support Services Children’s Department Home Visitation                                              Phone:
Program provides parents training and supplies to enhance the learning                                (951) 341-9244
of blind/visually impaired children from birth to age five. They work with                           Email Address:
parents and children together to help parents develop the skills and                   lbarnard@blindnesssuport.com
understanding of how and why different tactics help their children learn.                          Website Address:
                                                                                          www.blindnesssupport.com


Christian Counseling Service                                                                          Contact Name:
Parent/Child Interaction Therapy                                                                Sheryll Prinz-McMillan
Through this program, Christian Counseling Service provides                                                     Phone:
professional mental health services to families with children ranging in                                (909) 793-1078
age from birth to age five. The key service of this program includes                                  Email Address:
providing Parent-Child Interaction Therapy to families along with the        smcmillan@christiancounselingservice.org
continued training of staff in this therapy model. PCIT is used to                                 Website Address:
strengthen at-risk families and increase family stability overall.               www.christiancounselingservice.org

Jane Edmondson                                                                                        Contact Name:
Mountain Special Needs Network                                                                      Jane Edmondson
Mountain Special Needs Network (MSNN) is an organization located in                                            Phone:
the San Bernardino Mountain region, with the goal of reaching families                                 (909) 338-6308
with special needs children 0-5 (especially the target population of                                  Email Address:
children born within the autistic spectrum) to expedite the process of                       mtnsnnetwork@msn.com
early intervention, diagnosis, treatment, support and education. MSNN
will offer therapeutic services, support, referrals and linkage for
families/caregivers of special needs children. They will also provide a
special needs library to mountain families.




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Samaritan Counseling Center                                                              Contact Name:
Behavioral Education Management Services (BEAMS)                                              Karen Buck
The Samaritan Counseling Center’s Behavioral Education and                                        Phone:
Management Services (BEAMS) Program provides education and                                (909) 597-8570
support to parents of children who are challenged by autism and other                    Email Address:
developmental disabilities. By focusing on educating and mentoring                info@beamstherapy.org
parents, BEAMS achieves its goal of increasing the probability of a                    Website Address:
developmentally disabled child remaining in the family home by                    www.beamstherapy.org
reducing the child’s undesirable behaviors and improving the child’s
deficit behaviors.

San Bernardino County Department of Public Health                                       Contact Name:
Partnership for Healthy Babies/Perinatal SART                                               Bruce Smith
The mission of this community based public/private partnership is to                             Phone:
ensure that children and their families living in San Bernardino County                  (909) 388-0468
shall receive a comprehensive continuum of screening, assessment,                       Email Address:
referral, treatment and prevention services to ensure that babies are          bsmith@dph.sbcounty.gov
born free of exposure to alcohol, tobacco and other drugs so that
children are raised in a safe and nurturing home.

San Bernardino County Superintendent of Schools                                           Contact Name:
Children’s SART Desert Mountain SELPA                                                        Jenae Tucker
Desert /Mountain SELPA Counseling Center has provided school-based                                 Phone:
therapy to children for the past 15 years. Their core expertise is in                      (760) 242-6336
providing psychotherapy to children and their families through                            Email Address:
individual, group and family therapy. The children served through            Jenae_tucker@sbcss.k12.ca.us
Desert /Mountain SART include 0-5 years old living in foster care,                      Website Address:
children served through Public Health Nurses, two Head Start                   http://www.sbcss.k12.ca.us/
classrooms and two local pediatricians. Particular attention will be
focused on children with prenatal exposure to drugs and/or alcohol
and/or violence in their home.

West End Family Counseling Services                                                        Contact Name:
West Valley SART Assessment Center                                                              Eva Miller
West Valley SART provides comprehensive evidence–based screening,                                 Phone:
assessment, and treatment for infants and children up to the age of five           (909) 983-2020 Ext. 238
who exhibit significant early developmental, social-emotional, and/or                      Email Address:
behavioral problems. Such problems, if unidentified and untreated, are                Evamiller@wefcs.org
likely to result in serious school adjustment difficulties and significant              Website Address:
psychosocial, emotional and/or learning impairment. The program is                         www.wefcs.org
designed to have a capacity to screen 72 children per year using the
ASQ/ASQE protocol and to provide services beyond initial screening to
50 children per year.




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Health Care Access
American Lung Association of California                                                    Contact Name:
San Bernardino County Asthma Coalition                                                     Terry M. Roberts
The San Bernardino County Asthma Coalition provides the Physician                                   Phone:
Asthma Care Education (PACE) training to physicians practicing in San                       (909) 884-5864
Bernardino County in order to increase the number of physicians following                  Email Address:
the National Guidelines for the Treatment of Asthma. The Coalition further               troberts@alac.org
works with physicians by providing their staff with on site training on                 Website Address:
asthma, educational tools and materials for staff to use in educating                www.californialung.org
patients and their families. In addition, this program offers a Home
Visitation Program to provide help to families with asthmatic children 0-5
years of age who have persistent asthma and recent emergency room
visits and hospitalization due to asthma.


Asian American Resource Center                                                              Contact Name:
Traffic Safety Awareness                                                                         Jungmi Oh
The Asian American Resource Center provides the “Learning and                                        Phone:
Practicing Child Auto Safety” project. This project targets parents and                      (909) 383-0164
caregivers of children ages 0 to 5 in the hard to serve population of non-                  Email Address:
English speakers, including Asian/Asian American and Hispanic                          aarcoh@hotmail.com
immigrants and refugees. A certified Child Passenger Seat Technician                      Website Address:
demonstrates proper use of safety seat and verifies proper habits with                     www.aarc-ie.org
follow up phone contact.

Chino Valley Unified School District                                                         Contact Name:
Monte Vista Healthy Options                                                                      Zahira Orioli
Monte Vista “Healthy Options” is a collaborative effort between Chino                                 Phone:
Valley Unified School District, the City of Chino, the Chino Valley YMCA and                  (909) 721-9290
the Chino Valley Medical Center Charitable Foundation. Its goal is to                        Email Address:
improve health outcomes, enhance quality of life and promote human             Zahira_orioli@chino.k12.ca.us
dignity through health education, prevention and services across the                      Website Address:
healthcare spectrum.                                                                   www.chino.k12.ca.us

County of San Bernardino                                                                   Contact Name:
Arrowhead Regional Medical Center (ARMC) Dental Program                                        Carla Lidner
This program will ensure that at least 7,000 children (5 years of age and                           Phone:
under) residing in San Bernardino County will have the opportunity for                      (909) 580-6211
dental education, dental screening exams, dental varnishing and referral                   Email Address:
to treatment providers. In addition, at least 1600 parents will be educated               Clidner@aol.com
directly about oral health needs, and 100 pediatric physicians and/or                   Website Address:
residents will receive updated continuing education courses designed to        www.co.san-bernardino.ca.us
make them better able to treat very young children.

Great American Care Center (High Desert Youth Center)                                    Contact Name:
The High Desert First 5 Safety and Wellness Program                                    Marjori Chambers
The High Desert Youth Center provides free child safety seats to parents                          Phone:
having children 0-5 years of age. Eligibility for the free seats depends on               (760) 245-7103
mandatory attendance at a two hour class that addresses proper                           Email Address:
installation and usage of the seat.                                            Mchambers17@hotmail.com
                                                                                      Website Address:
                                                                                          www.hdyc.org




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                                                                                                       Contact Name:
Inland Counties Health Systems Agency
                                                                                                          Carmen Laird
Adelanto Community Tool Box
                                                                                                                Phone:
The Adelanto Community Tool Box “Salud de Familia” program will
                                                                                                        (760) 246-7874
provide a “single point of entry” to help low-income families in the
impoverished high desert community of Adelanto access health care                                      Email Address:
services and resources for themselves and their children. Since 1999 the                      claird@inlandagency.org
Community Tool Box has provided information, education and support                                  Website Address:
services for the most vulnerable individuals and families in Adelanto,                          www.inlandagency.org
establishing a reputation for excellence and developing a high level of
trust among community members. The Tool Box will collaborate with St.
Mary Medical Center and other community agencies to ensure families
receive the services they need using a case management approach, which
will include evaluation and follow-up. Families will work with the bilingual
Tool Box staff who will give them the tools and training they need to
become competent in accessing and coordinating needed services for
their children.

Inland Empire Health Plan                                                                             Contact Name:
Healthy Kids Program                                                                                    Thomas Pham
The Healthy Kids Program provides health benefits to children of families                                      Phone:
with income levels at or below 300% of the Federal Poverty Level. The                                  (909) 890-2000
health package includes developmental assessment, dental and vision                                  Email Address:
services.                                                                                           Pham-t@iehp.org
                                                                                                    Website Address:
                                                                                                        www.iehp.org

Kids Come First Community Clinic                                                                    Contact Name:
Kids Come First                                                                                       Beverly Speak
Kids Come First provides integrated clinical health services and health                                      Phone:
access and advocacy assistance to empower families to make good                                      (909) 673-9125
choices for the future of their children.                                                           Email Address:
                                                                                       bspeak@kidscomefirstclinic.org

Latino Health Collaborative                                                                           Contact Name:
The Latino Health Collaborative has implemented a Community                                                Ed McField
Leadership Academy to build the capacity of parents in accessing and                                           Phone:
navigating available health services for their children; strengthening                                 (909) 583-1689
parents’ knowledge base, leadership and advocacy abilities; and voice and                             Email Address:
provide support for parents in developing a community-driven public            esmcfield@latinohealthcollaborative.org
education health campaign. In collaboration with LaSalle Medical                                    Website Address:
Associates, parents and children can receive direct health services.                            www.latino-health.org



Loma Linda University Medical Center                                                                  Contact Name:
Just for Moms Comprehensive Tobacco Treatment                                                             Charity Thay
The Comprehensive Tobacco Treatment program addresses tobacco use                                              Phone:
in pregnant and postpartum women. The primary goal is for more                                         (909) 558-3264
pregnant and postpartum women to remain tobacco free for periods of at                               Email Address:
least four and eight weeks during their pregnancy and/or postpartum                                     cthay@llu.edu
period.                                                                                             Website Address:
                                                                                                         www.llu.edu




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Loma Linda University Medical Center/Children’s Hospital                                            Contact Name:
Perinatal Services Network (PSN)                                                                      Carol Melcher
This program is the lead agency for a twenty hospital, bi-county                                             Phone:
collaborative serving mothers, infants, and families. PSN engages hospitals                          (909) 558-3364
to improve outcomes for families by involving hospitals in standardized                             Email Address:
professional education, policy change, data collection, follow up support                         cmelcher@llu.edu
and collaborative meetings.                                                                       Website Address:
                                                                                                       www.llu.edu

Morongo Basin Mental Health Services Association, Inc.                                             Contact Name:
Prenatal Services                                                                                  Deborah Carter
MBMH brings culturally and linguistically appropriate services to pregnant                                Phone:
women and teens in the form of assessment and screening and child                          (760) 365-3022 Ext. 790
development classes to all mothers-to-be and substance abuse treatment                             Email Address:
and follow up services to those who are found to be using or abusing                        Deborahc@mbmh.org
drugs, alcohol or tobacco.                                                                      Website Address:
                                                                                www.morongobasinmentalhealth.com

Moses House Ministries                                                                             Contact Name:
Moses House Ministries provides case management, consultation,                                         Judy Morris
parenting and life skills education, mentoring, limited transitional housing,                               Phone:
and community referrals to single, pregnant women. In response to the                               (760) 955-1895
need for transportation in the Victor Valley, van and driver position for                          Email Address:
transporting participants improve mothers’ abilities to access and                      judymorris@dslextreme.com
coordinate needed services for their children as determined in their                             Website Address:
individual plans.                                                                            www.moseshouse.org

Mountains Community Hospital                                                                         Contact Name:
Rural Health Clinic Dental Program                                                         Michelle Laufman Monroe
Mountains Community Hospital Rural Health Clinic implemented a dental                                         Phone:
program to provide screenings, cleanings and basic dental care to low                                 (909) 336-9715
income, uninsured mountain residents and those with Medi-Cal or Inland                               Email Address:
Empire Health Plan.                                                                 Michelle.laufman@mchcares.com
                                                                                                  Website Address:
                                                                                                 www.mchcares.com


New House, Inc.                                                                                      Contact Name:
Substance Abuse Treatment Program/Clean and Sober Moms                                                    Lauri Shea
The Clean and Sober program is designed to motivate stages of change in                                       Phone:
the substance abusing pregnant participants’ recovery by developing                                   (909) 381-5396
therapeutic relationships that respect and build on the participants’                                Email Address:
autonomy. At the same time, this program also makes the treatment and                            Celtshea1@aol.com
education staff, along with the professional services of the doctor and
therapists, partners in the participants’ change process.




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Pregnancy Support Centers                                                                   Contact Name:
The Pregnancy Support Centers serves young women ages 13-25 who find                          Gail Mullennix
themselves faced with an unplanned pregnancy through the clinic                                      Phone:
Choices, a fully-licensed medical clinic offering pregnancy support                          (909) 864-5557
services. Services offered are a clinic for initial visits, case management to             Email Address:
assist with hospital arrangements/prenatal medical care, parenting                          gail@pscinc.org
education opportunities about delivery options and developmentally                        Website Address:
appropriate parenting skills; further classes will be given on breast feeding              www.pscinc.org
and life skills.

Reach Out West End                                                                          Contact Name:
Reach Out to Parents                                                                           Reme Tafoya
Program components include: substance abuse, tobacco and secondhand                                  Phone:
smoke campaigns designed to protect infants and toddlers from the                            (909) 982-8641
hazardous effects of secondhand smoke and tobacco and substance abuse                       Email Address:
by parents/caregivers. In addition, the “Big Steps for Little Feet” program      reme@reachout-westend.org
provides pregnant and parenting adolescents with increased prenatal                       Website Address:
education and care.                                                               www.reachout-westend.org

Rialto Unified School District                                                             Contact Name:
Comprehensive Dental Health Care                                                        Annette McCormick
Program consists of a comprehensive dental health program for Rialto                                Phone:
Unified preschoolers. Services include dental screenings, fluoride                          (909) 820-7785
varnishes, dental referrals, follow-ups and dental/health education.                       Email Address:
Parents also receive assistance with dental/health insurance, accessing            amccormi@rialto.k12.ca.us
insurance and building ongoing relationships with dental providers.                      Website Address:
                                                                                       www.rialto.k12.ca.us


SAC Health Systems                                                                          Contact Name:
Good to Grow                                                                                 Cynthia Rollins
Good to Grow (G2G) is a dynamic, interactive, whole child assessment                                 Phone:
under one roof. G2G creates a “health journey” for each child which takes                    (909) 382-7156
each 0-5 year old through a pediatric, nutritional, dental and behavioral                   Email Address:
health assessment. In addition, parents are educated about specific                         crollins@llu.edu
community services and enrolled in both a nutrition-oriented cooking                     Website Address:
class and scheduled for a community health nurse to make a home safety                 www.llu.edu/llu/sachs
inspection.


San Antonio Community Hospital                                                              Contact Name:
Healthy Beginnings                                                                                 Gail Titus
Healthy Beginnings is a comprehensive education and follow up program                                Phone:
for parents initiated during the first trimester of pregnancy and continuing                 (909) 920-6230
through the first year of the child’s life. The program will introduce parents             Email Address:
to care including Prepared Childbirth Class, Breastfeeding Class, Family                   gtitus@sach.org
and Friends CPR, Follow Up Clinic and Parent Review.                                      Website Address:
                                                                                              www.sach.org




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Veronica’s Home of Mercy                                                                       Contact Name:
Veronica’s Home of Mercy is a long term transitional home for adult                               Debra Olguin
pregnant women and their children as an alternative to substance abuse,                                 Phone:
domestic violence, abortion, and/or homelessness. The program consists                          (909) 888-9064
of immediate physical/medical assessment of mother, fetus, and                                 Email Address:
child/children. Mothers are educated about available services and families     olguingomezcontreas@yahoo.com
are provided with three meals a day, clothing, beds, childcare, and                         Website Address:
transportation.                                                                      www.marysmercycenter.org


Victor Valley Community Dental Service                                                          Contact Name:
The Victor Valley Community Dental Service Program (VVCDSP) provides a                             John Lindsay
positive, non-threatening first dental experience in conjunction with First                              Phone:
5 Arrowhead Regional Medical Center Dental Program. This program                                 (760) 951-9181
enables the VVCDSP to go to local remote area pre-schools, Head Starts                          Email Address:
and homeless shelters by the use of the Dental Mobile Van providing                           vvcdsp@msn.com
screenings and fluoride treatment. The VVCDSP also provides education
and referrals to children and their families.



Water of Life Community Outreach                                                               Contact Name:
The Well of Healing Mobile Medical Clinic                                                      Angela Coaston
The Well of Healing Mobile Medical Clinic is a Primary Care Clinic that is                              Phone:
licensed by the State of California. Medical personnel provide routine                          (909) 268-1086
health maintenance, immunizations, vision screening and education. They                        Email Address:
also provide parents with onsite education and referral services for                       acoast@adelphia.net
identified needs. Currently the mobile medical clinic services two locations
in San Bernardino and Seville Park in Fontana.




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Early Care & Education Cluster

Child Care Access
San Bernardino County Superintendent of Schools                                                         Contact Name:
KidsNCare                                                                                                    Janet Dole
This program will assist families with young children in finding quality                                         Phone:
childcare, paying for such care and receiving the guidance and tools                                     (909) 384-8014
necessary to be a successful parent. KidsNCare will assist these families in                            Email Address:
San Bernardino County over a three year period.                                              Janet_dole@sbcss.k12.ca.us
                                                                                                     Website Address:
                                                                                                    www.kidsncare.com



Child Care Capacity
Regents of University of California-Riverside Extension                                                  Contact Name:
SBC CONNECTIONS Project                                                                                Dr. Margaret Wild
The San Bernardino County CONNECTIONS Project is an educational                                                   Phone:
support program designed to recruit new child development students and                                    (951) 827-5995
support early care professionals, including teachers and caregivers                                      Email Address:
working in licensed and license exempt settings. This educational                                           wild@ucr.edu
outreach effort provides reimbursement of tuition and text book costs.                                Website Address:
                                                                               http://www.extension.ucr.edu/connections




Child Care Quality Standards
Christian Counseling Service                                                                     Contact Name:
Opening Doors for Families of Preschoolers                                                 Sheryll Prinz-McMillan
This program extends the basic concepts of attachment, attunement,                                         Phone:
positive reinforcement, nurturing and structuring age appropriate                                  (909) 793-1078
behavior to the preschool classroom with the intention of addressing the                         Email Address:
behavioral, psycho-social, and developmental issues of at-risk, special smcmillan@christiancounselingservice.org
needs children.                                                                               Website Address:
                                                                            www.christiancounselingservice.org




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Regents of University of California-Riverside Extension                                           Contact Name:
Comprehensive Approaches to Raising Educational Standards (CARES)                               Dr. Margaret Wild
The CARES program will implement a working model that is effective in                                      Phone:
recruiting, training and retaining the child care work force. The                                  (951) 827-5995
improvement of early education programs as a result of CARES will                                 Email Address:
prepare children to enter school, enhance health and safety practices,                               wild@ucr.edu
improve the quality of care, boost early care professionalism, and                             Website Address:
encourage progression along the child care career ladder-facilitating the      http://www.extension.ucr.edu/cares
completion of college degrees and early education teaching credentials.




San Bernardino County Superintendent of Schools                                                  Contact Name:
Desert Mountain SELPA Children’s Center                                                            Jenae Tucker
This project seeks to expand the existing SART services of the                                          Phone:
Desert/Mountain SELPA Children’s Center by focusing on early                              (760)242-6336 Ext. 405
intervention and prevention for children who are at risk for developmental          Jenae_tucker@sbcss.k12.ca.us
and social/emotional delay. The focus of the early intervention and                           Website Address:
prevention efforts will be on the provision of community-based group                www.dmselpa.sbcss.k12.ca.us
treatment services by providing training and coaching in Theraplay group
strategies to the 127 early childhood educators from the 43 public
preschool programs in our region.




School Readiness
Barstow Unified School District                                                                   Contact Name:
The School Readiness program established at Lenwood and Crestline                                    Teresa Healy
elementary schools provides an opportunity for 4 year olds to experience                                   Phone:
preschool and ensure that they will transition to kindergarten ready to                            (760) 255-6021
learn. Families with children 0-5 years old in these school attendance areas                      Email Address:
will be served in the Family Services Center; parents will be able to access          Teresa_healy@busdk12.com
and effectively utilize community/social service resources.                                    Website Address:
                                                                                          www.barstow.k12.ca.us

Chino Valley Unified School District                                                              Contact Name:
This program improves family functioning through parenting education                                Elizabeth Lara
and case management. Children attend school readiness classes and                                          Phone:
kindergarten prep, as well as receive comprehensive health and dental                              (909) 628-1201
screenings.                                                                                       Email Address:
                                                                                         Liz_lara@chino.k12.ca.us
                                                                                                Website Address:
                                                                                             www.chino.k12.ca.us




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Fontana Unified School District                                                                     Contact Name:
Fontana Unified School District’s Early Education Department provides                              Laurie Finucane
services to preschool children and their families at 26 elementary sites and                                 Phone:
one high school campus within the school district boundaries. Services                               (909) 357-5000
include health and social services, child development services, and                                Email Address:
parenting education. Over 2,000 parents and their children benefit from                            finuld@fusd.net
this program.                                                                                     Website Address:
                                                                                                      www.fusd.net
Hesperia Unified School District                                                                    Contact Name:
Hesperia Unified School District offers a School Readiness Program for the                              Amy Goode
community surrounding three school sites, Eucalyptus Elementary School,                                     Phone:
Joshua Circle Elementary School and Topaz Elementary School. In                             (760) 244-4411 Ext.7257
conjunction with the Hesperia Unified School District’s Ready-For-School                            Email Address:
Family Resource Center, HUSD offers a research based Preschool Program;                    Amy.goode@hesperia.org
health screenings for children, including dental, hearing, and vision;                            Website Address:
parent conferences and parent volunteer opportunities; and a Family                               www.hesperia.org
Literacy Program. Additionally, HUSD encourages Kindergarten teachers
and Preschool Program Instructors to attend in-service sessions and will
plan and develop transition activities for children entering kindergarten.




Lucerne Valley Unified School District                                                              Contact Name:
The implementation of a School Readiness Program at Lucerne Valley                                  Mary Rodriguez
Elementary School dramatically increases the number of children and                                          Phone:
families who are transitioning to school ready and willing to learn and                              (760) 248-7202
succeed. SMILE (Smart Motivated Individuals Learning Education) will                                Email Address:
provide the following services: classes for parents and children to learn,            Mary_rodriguez@lvsd.k12.ca.us
grow and develop through family literacy; four child health screenings:                           Website Address:
health, dental, hearing, and vision. The SMILE Program staff, Early                              www.lvsd.k12.ca.us
Education Staff and the Elementary School staff also meet 4 times per year
to address the needs of children 0-5 and their families to develop a plan of
action to improve the delivery and coordination of services.




Montessori in Redlands                                                                             Contact Name:
First Contact of Montessori in Redlands is an early assessment, treatment,                             Maura Joyce
education and training program for families of children with special needs                                  Phone:
ages 18 months to 5 years. First Contact screens children in their Toddler                          (909) 793-6989
(18 months-3 years) and Primary (3 years-5 years) programs to provide                              Email Address:
assessment, diagnosis. and early intervention strategies on site. Students     Maura.joyce@montessoriinredlands.org
are fully integrated into Montessori classrooms, so that by the age of 5.                        Website Address:
children are reading ready and able to successfully attend elementary                  www.montessoriinredlands.org
school with a minimum of additional help.




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Needles Unified School District                                                                         Contact Name:
The implementation of a School Readiness Program at Vista Colorado                                       Shannon Bailey
Elementary School dramatically increases the number of children and                                              Phone:
families who are transitioning to school ready and willing to learn and                                  (760) 326-5939
succeed. Needles Unified School District offers a School Readiness                                      Email Address:
Program that includes: A Family Literacy Program, Jumpstart School                      Shannon_bailey@needles.k12.ca.us
Readiness Program for children ages 3-5, and three child health                                       Website Address:
screenings: dental, hearing, and vision. Also, the Early Education Staff,                         www.needles.k12.ca.us
WestCare staff, and the School District Superintendent will meet four times
per year to address the needs of children 0-5 and their families to develop
a plan of action to improve the delivery and coordination of services.



Ontario –Montclair School District                                                                         Contact Name:
The Ontario-Montclair School District teams up with the Family Solutions                               Dr. Bonnie Mooney
Collaborative and the Montclair Community Collaborative to provide                                                Phone:
coordinated services at 3 Family Resources Centers, 34 School sites and                          (909) 459-2500 Ext. 6514
community centers in both Ontario and Montclair cities to empower                                          Email Address:
families to better prepare their children for Kindergarten. The following                 Bonnie.mooney@omsd.k12.ca.us
services will be provided: Community Parent and Me Program assisting                                   Website Address:
parents with school readiness skills as they interact with their children 0-5                        www.omsd.k12.ca.us
in a classroom setting; the community parent empowerment project,
“Padres Activos”, where parents come together for two program formats
to learn strategies for positive parenting behaviors and school readiness
techniques they can apply while raising healthy children in the home
environment; dental screenings for all preschool children; opportunities
for Kindergarten schools to develop transition plans.



San Bernardino Valley College                                                                              Contact Name:
The San Bernardino Valley College School Readiness Program provides                                          Justine Curley
free developmentally appropriate Pre-K activities and quality preschool                                             Phone:
experiences that promote increased child development and cognitive,                                         (909) 384-8647
social, emotional, and physical growth for children in Rialto and Colton                                   Email Address:
who do not have access to other low cost programs.                                               jcurley@valleycollege.edu
                                                                                                        Website Address:
                                                                                  www.depts.valleycollege.edu/childdevelo
                                                                                                                     pment
                                                                                                          Contact Name:
San Bernardino City Unified School District                                                           Cynthia White-Piper
The San Bernardino City Unified School District is the sixth largest school                                        Phone:
district in the state of California. It serves 67,000 students k-12. All of the                            (909) 388-6307
schools in the SBCUSD are Title 1 schools due to the poverty level of the                                 Email Address:
families it serves. SBCUSD offers a “Ready to Learn” project; monitoring of               Cynthia.whitepiper@sbcusd.com
developmental classroom procedures to insure that best practices are                                   Website Address:
utilized; child development classes for infants/toddlers/preschoolers of                           www.sbcusd.k12.ca.us
teen parents; child development classes for teen parents; health
screenings for children; full time case management for teen parents;
collaboration between SBCUSD Special Education Department and Child
Development/Pre-School Programs; and referrals of students identified
and/or those with possible special needs for special education evaluation.




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Silver Valley Unified School District                                                                 Contact Name:
Newberry Springs Elementary School located in the Mojave desert                                       Sandra Schmitt
educates 170 students from kindergarten through fifth grade and houses a                                       Phone:
Head Start program that serves 32 children. Silver Valley Unified School                               (760) 257-3211
District offers a School Readiness Program entitled Little Bobcat’s                                   Email Address:
Preschool which includes the following: a Family Literacy Program; a                   Sschmitt@silvervalley.k12.ca.us
School readiness program targeting children ages 3-5; three child health                           Website Address:
screenings: health, dental and vision; staff development for preschool                     www.silvervalley.k12.ca.us
educational staff.


Snowline Joint Unified School District                                                                Contact Name:
Snowline Joint Unified School District offers a School Readiness Program                             Patricia Kendrick
which includes the following: a Parent and Child Interactive Literacy                                          Phone:
Program entitled Junior Falcons, a preschool program targeting children                                (760) 868-5817
ages 3-4; three child health screenings: health, dental and vision; and                               Email Address:
district workshops and training on early childhood development and the         Patricia_kendrick@snowlineschools.com
teaching of literacy and numeracy skills for the early childhood instructors                        Website Address:
and support staff.                                                                          www.snowlineschools.com




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Family Support Cluster
Parenting Education (Only)
Foundation for California State University                                                    Contact Name:
CUIDAR                                                                                     Dr. Kimberly Lakes
This program includes a 10 week parenting education program to groups                                  Phone:
of parents throughout San Bernardino County. The program specializes in                        (909) 537-3266
providing parents/caregivers with the skills and techniques shown to be                       Email Address:
effective in dealing with behavioral problems in 3 through 5 year olds.                    Klakes@csusb.edu
                                                                                           Website Address:
                                                                                 www.calstate.edu/foundation

High Desert New Beginnings, Inc.                                                               Contact Name:
High Desert New Beginning will deliver services including parent centered                       Donna Roberts
home instruction (HIPPY). The program provides solutions that strengthen                                Phone:
families and help three, four, and five year old children realize success                       (760) 255-1346
beginning school ready to learn.                                                               Email Address:
                                                                                             hdnb@verizon.net

Inland Temporary Homes                                                                         Contact Name:
Inland Temporary Homes’ Family Development Program is an intensive,                           Leanne Drieberg
multi session approach to behavior change that yields sustained results                                 Phone:
with homeless families.                                                                         (909) 796-6381
                                                                                               Email Address:
                                                                                          Leanne@ithomes.org
                                                                                            Website Address:
                                                                                             www.ithomes.org

Knotts Family Agency                                                                         Contact Name:
The Narrative Parenting Process Model Program utilizes the strengths of                        Dr. Lewis King
the community organized into specialized care units called “villages.” The                            Phone:
villages offer resources for mentoring and support for parents who seek                       (909) 880-0600
additional assistance in raising their children age prenatal through 5 years.                Email Address:
                                                                                      Lking@kfpinstitute.org
                                                                                          Website Address:
                                                                                 www.knottsfamilyagency.org

Rim Family Services                                                                           Contact Name:
Rim Family Services provides the Parents as Teachers home visitation                         Kristine L. Scullin
parent education program for teens and low income/MediCal parents of                                   Phone:
children 0-5 in the Mountains Region.                                                          (909) 336-1800
                                                                                              Email Address:
                                                                                rimfamily@charterinternet.com
                                                                                           Website Address:
                                                                                   www.RimFamilyServices.org




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San Bernardino City Unified School District                                                    Contact Name:
SBCUSD Adult School                                                                               Alma Angelo
The San Bernardino Adult School Parenting Program will support 0 to 5                                   Phone:
year old children with child development activities that eventually get                         (909) 388-6000
them ready for kindergarten. The offering of on-site and off-hour childcare,                   Email Address:
combined with free transportation, has eliminated considerable barriers               Alma.angelo@sbcusd.com
for parents so that they acquire positive parenting skills as they further                   Website Address:
their academic or vocational goals while, at the same time, providing their              www.sbcusd.k12.ca.us
children with a quality, developmentally appropriate educational
experience.




Resource Center (Only)
Building a Generation                                                                          Contact Name:
Building a Generation (BAG) is a unique community based non-profit                              Melinda Corral
organization that exists to promote healthier communities by building the                               Phone:
capacity and effective functioning of families and resiliency in children.                      (909) 793-8822
This project offers Family Resource Center programs and services to                            Email Address:
families with children 0-5 years old in the East Valley Region.                mcorral@buildingageneration.org
                                                                                             Website Address:
                                                                                 www.buildingageneration.org

City of Montclair                                                                               Contact Name:
The City of Montclair is the fiscal agent for the Montclair Community                          Gabriela Layseca
Collaborative (MCC) First 5 Case Management program for young children                                   Phone:
and their families. Through the First 5 investment, MCC serves 0-5 year old                      (909) 445-1616
children and make early interventions before children are connected to                          Email Address:
services though school sites. First 5 Case Management provides mostly          Gabriela.layseca@omsd.k12.ca.us
intensive services for families in crisis and support for families with                       Website Address:
multiple complex needs.                                                                   www.ci.montclair.ca.us

Community Hospital of San Bernardino                                                            Contact Name:
This program serves families with children ages 0-5 who seek to improve                          Barbara Cozart
their health and living conditions. This program is offered by the                                      Phone:
Community Hospital San Bernardino through the Health Information and                   (909) 887-6333 Ext. 4731
Education Center and serves an average of 175 clients per month.                                Email Address:
Communication is maintained to assure that circumstances have                                 bcozart@chw.edu
improved and that the case manager’s assistance has met desired                              Website Address:
outcomes.                                                                                        www.chsb.org

Priscilla’s Helping Hands                                                                     Contact Name:
Priscilla’s Helping Hands provides comprehensive resource center services                   Marche Y. Haynes
to meet both the long and short term needs through referrals and linkage,                              Phone:
case management, home visits, prenatal education, parenting education,                         (909) 881-2800
and child development services. The program will serve 340 families per                       Email Address:
program year. The Resource Center is located in zip code 92404 and serves              Phhreach2@yahoo.com
a very high risk population.                                                               Website Address:
                                                                                      www.ecclesiachurch.com




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Rebuilding Mountain Hearts and Lives
Rebuilding Mountain Hearts and Lives provides Resource Center services                    Contact Name:
(resource and referral, and case management) for eligible families in the                     David Stuart
Rim communities that extend from Crestline/Valley of Enchantment to                                Phone:
Green Valley Lake. The program provides resource referrals, linkages, and                  (909) 337-9922
follow-up for pregnant mothers and families with children 0-5.                            Email Address:
                                                                                dstuart@heartsandlives.org
                                                                                        Website Address:
                                                                                   www.heartsandlives.org

San Bernardino County Superintendent of Schools                                            Contact Name:
Family Resource Program                                                                       Becky Thams
This project establishes effective connections/access linkage between                               Phone:
families and required social services that meet their needs. These families                 (909) 433-4618
have children enrolled in San Bernardino County Superintendent Schools                     Email Address:
State Pre-school and infant/toddler programs. The Family Resource             Becky_thams@sbcss.k12.ca.us
Specialists bring resources to families at the 39 State Preschool and                   Website Address:
infant/toddler classrooms throughout San Bernardino. Available resources
                                                                                      www.sbcss.k12.ca.us
include, but are not limited to: childcare funds, support for mental and
physical health, food, clothing, housing, family and social support,
vocation and transportation.

St. Mary’s Medical Center                                                                   Contact Name:
The Bridges program has been successful in utilizing a case management                     Laurie L. Roberts
model for service delivery. This approach is the strength. Their task is to                          Phone:
empower families to be better advocates for themselves and their children                    (760) 946-8799
as they learn to navigate community services that benefit them. The                         Email Address:
primary commission level outcomes the program hopes to impact are                 Lauriel.roberts@stjoe.org
increasing utilization of prenatal care, increasing the number of children               Website Address:
with health insurance and an ongoing relationship with a health provider           www.stmary4health.org
and improving parental ability to access, coordinate and utilize available
resources on behalf of their families.




Parenting Education/Resource Center (Combined)
Bear Valley Community Healthcare District                                                 Contact Name:
Mothers on Mountains (MOM) Project                                                        Marilyn Vecchio
The Mothers on Mountains Parenting Education Program offers a wide                                  Phone:
variety of parenting education classes to parents/caregivers of children                    (909) 585-5607
ages 0-5. They offer evidence based and research based prenatal and                       Email Address:
postnatal programs in the areas of parenting skills, child development,        Vecchio.marilyn@gmail.com
safety and health, and bonding and attachment. The mission of the M.O.M                 Website Address:
Project Parenting Education Program is to provide full spectrum                          www.bvchd.com
educational and support services from the moment that families discover
they are expecting through the vital, formative early years of their
children’s lives in order to help build healthy nurturing families, and
strengthen the community as a whole.




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Morongo Basin Mental Health Services                                                       Contact Name:
MBMH Resource Center                                                                        Deborah Carter
This Family Resource Center provides referral and linkage, case                                     Phone:
management, and one of two specialized parenting education programs,                        (760) 365-3022
depending on client need. Both parent education programs aim to                            Email Address:
improve and/or prevent family dysfunction using strength-based                        deborahc@mbmh.org
strategies with families. Locations served include communities in and
around Yucca Valley, Joshua Tree and Twenty nine Palms.

Para Los Niños (PLN)                                                                      Contact Name:
Para Los Niños provides comprehensive services, center-based and home-                        Maria Garay
based, and addresses multiple complex needs of children prenatal                                   Phone:
through age five and their families through case management, family                        (909) 981-5550
therapy, basic needs services, service linkage and parenting education.                   Email Address:
                                                                                  mgaray@paralosninos.org
                                                                                        Website Address:
                                                                                    www.paralosninos.org


Vista Guidance Centers                                                                      Contact Name:
Barstow Collaborative                                                                                John Pi
Through this program collaborative partners Vista Guidance Centers,                                  Phone:
Desert Sanctuary Inc and Lutheran Social Services provide resources and                      (909) 335-7067
parenting education services to families and their children ages 0-5 in                     Email Address:
need in the 92311 zip code area. Families in need of health, mental health,          John.pi@vgcenters.org
and parenting education services are engaged to participate with the aim                 Website Address:
of eventual self sufficiency. Services also promote school readiness among    www.vistaguidancecenters.org
children 0-5 and improve family functioning.

Volunteers of America, Inc.                                                                 Contact Name:
Resource Center                                                                               June Chandler
This program offers a Resource Center, which serves parents of children                              Phone:
prenatal through the age of five years in the Central Valley Region of San                   (909) 888-4577
Bernardino County. Services include case management, referrals, linkages                    Email Address:
and an opportunity for parents to participate in on-site education.                jchandler@voa-swcal.org
                                                                                         Website Address:
                                                                                        www.voa-swcal.org


WestCare Arizona, Inc.                                                                    Contact Name:
This project, located in Needles, provides a comprehensive resource center                   Patti Munson
for parents prenatal through age five. Services include case management,                           Phone:
referral and linkage, parenting education, substance abuse treatment and                   (760) 326-3135
education, and child development.                                                         Email Address:
                                                                                   pmunson@westcare.com
                                                                                        Website Address:
                                                                                       www.westcare.com




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System Integration Cluster
Information Sharing
Inland Empire United Way 211                                                                Contact Name:
211 San Bernardino County                                                                      Gary Madden
The 211 Program includes a countywide, comprehensive, searchable                                     Phone:
database of verified government and non-profit service providers and                         (909) 980-2857
programs available to First 5 partners and the public on a 24/7/365 basis.                  Email Address:
As part of this project, IEUW also operates a professional bilingual                     gmadden@ieuw.org
information & referral call center in conjunction with the 211 database.                  Website Address:
                                                                                             www.ieuw.org
                                                                                           www.211sb.com




System Integration Advocacy
San Bernardino County Children’s Fund                                                       Contact Name:
Countywide Coordination: Children’s SART                                                   Rebecca Stafford
Children’s Fund is lead agency for multi-disciplinary collaborative                                  Phone:
promoting the implementation of proven research based strategies for the                     (909) 383-9775
Children’s SART Model of Care to include prevention, intervention and                       Email Address:
clinical treatment services to minimize the negative impact to the child        rstafford@hss.sbcounty.gov
resulting from the mother’s substance abuse during pregnancy.                             Website Address:
                                                                             www.childrensfundsbcounty.org
A countywide process will be developed and implemented for screening
and assessing children at risk, and optimally treating those found to have
mental, social, emotional, and/or developmental delays.




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  Appendix B: Further Notes about the
  Methodology

T   he First 5 San Bernardino local evaluation is designed to utilize a mixed methods approach, which
    combines quantitative (numbers) and qualitative (stories) methods. This approach was developed for two
    reasons: 1) no single data collection method can capture the impact of F5SB and 2) readers interact with
    data differently - some are drawn to “hard” numbers while others connect more with stories.

As in past years, the evaluation is guided by the Commission’s Evaluation Framework (see Appendix C), which
provides a macro view of results to be achieved as defined by the Strategic Plan. This framework was developed
by Harder+Company and the Commission back in 2006 to broadly define objectives and indicators of success.
Using this Framework as a road map, the Commission selects from the Framework’s indicators when
developing new programs and Strategies. These indicators are then refined by Harder+Company and the
Commission staff in the context of the particular Strategy and included in outgoing Requests For Proposals
(RFPs). Each Strategy should have, at its center, a quantitative data collection strategy to gather information
about children, parents, and/or service providers who participated in First 5 funded programs. These data
collection strategies include aggregate chart data, parent surveys, and child observation tools. Additionally, the
report includes data from provider surveys, monthly or quarterly progress reports submitted to the
Commission, individual funded programs’ evaluations, and secondary indicator data (including data from the
First 5 San Bernardino Family Survey). These methods are complemented by qualitative methods to collect
data from different vantage points and perspectives. These methods include case studies, focus groups, and key
expert or “stakeholder” interviews to better understand the successes and challenges of different Commission
activities. Below is a detailed description of each method. Individuals desiring additional information about the
evaluation’s methodology are invited to contact Harder+Company Community Research directly at (619) 398-
1980.



Quantitative Methods

Quantitative methods include data collection techniques that provide numeric results, such as the number of
services or the percent of survey respondents, etc. Quantitative analysis for FY 2007-08 typically included basic
descriptive statistics and, as appropriate, chi-square and t-tests for statistical significance. Missing data, where
people left a question blank, were not included in the analysis. Although missing data can sometimes be a
meaningful statistic, readers are often confused by actual percent (which includes missing data) and valid
percent (which omits missing data). This report only presents valid percents, or the number of people that gave
an answer divided by the number of people that answered the question. Harder+Company sometimes also
removes “don’t know” responses from the valid response list, depending upon the measurement. Some
findings are noted as being “statistically significant.” This means that the groups being compared (most often
the comparison is between Time 1 “pre” and Time 2 “post” groups) are truly different from one another and
that the difference is not by chance alone. Statistically significant findings are identified in the exhibits with an
* and the p value is located below the exhibit.



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Funded Partner Quarterly Reports/Process Numbers

Each quarter, the partner agencies are required to submit a quarterly progress report to F5SB that indicates the
number of clients enrolled in each program component, as well as their demographic characteristics. These
reports, which also track client progress through program milestones towards Performance Targets, serve as a
means of contract monitoring and program level evaluation for F5SB and its partner agencies.
Harder+Company used these reports to generate numbers of clients served throughout the fiscal year, as well
as some specific program outcomes.

Client Intake

As each core client is enrolled (i.e., parent or child), program staff are required to administer a two part “Client
Intake,” consisting of: 1) a consent form allowing the release of client information to F5SB and evaluation
consultants; 2) a demographic questionnaire asking for client information such as household composition,
income, insurance status, age, race/ethnicity, and primary language. This information is then entered into the
data system on an ongoing basis by program staff and is used to report core client demographics for evaluative
purposes.

Strategy Specific Instruments

As the F5SB funding and services becomes more refined over time, the evaluation team is able to create a more
standardized approach to data collection for each Strategy in order to determine impact on the Commission-
Level Outcomes (CLOs) and Objectives of the Strategic Plan. Ideally, each Strategy has an evaluation design
and assigned data collection methods which include pre/post questions that are tied to the appropriate CLOs.
More details specific to the Strategies follow.

Child and Family Assessment – Children’s SART Initiative
Within the Child and Family Assessment Strategy, the Children’s SART initiative worked diligently to create
an evaluation design through the collaboration of an Evaluation Workgroup back in 2006. The full evaluation
design includes components to meet the needs of multiple funders, including F5SB. Children’s SART
information that is recommended reporting to F5SB is included in the Exhibit B.1.

Although the evaluation framework was developed and approved by the Children’s SART evaluation
workgroup, some SART Centers were still in a start-up phase in terms of implementing all elements, and other
SART centers were in a transition phase during 2007-08. Thus, of the indicators listed in Exhibit B.1, the SART
Centers only reported child screening data using the Ages and Stages Questionnaire (ASQ) and the Ages and
Stages Questionnaire – Social Emotional (ASQ-SE) during 2007-08. More effort should be placed on the
standardized collection and reporting of results related to the assessment, referral, treatment and parent
involvement components in the future.




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                       Exhibit B.1 2007-08 Children’s SART Evaluation Framework
               Objective                                   Indicator                        Instruments & Methods
SCREENINGS
Children are screened for special needs Number of children screened                   (Time 1) ASQ & ASQ-SE
identification and intervention
                                                                            Child behavior assessment tools (Time
                                                                            1):
                                        Number and % of children identified
ASSESSMENTS                                                                   • Child Behavior Checklist (CBCL)
                                        as needing assessment and who
Children are assessed for special needs                                       • Strengths & Difficulties
                                        receive assessment (by type and
in a comprehensive and timely manner                                            Questionnaire (SDQ)
                                        timeliness)
                                                                              • Eyberg Child Behavior Inventory
                                                                                (ECBI)

REFERRALS                                   Number and % of children who are in
Children identified with special needs      need of referral for treatment and       Outgoing and incoming referral
are appropriately referred in a timely      who receive such referral (by type,      tracking
manner                                      timeliness, and destination of referral)

TREATMENT                                   Number and % of children who are in
Children identified/referred with special   need of treatment and who receive
                                                                                 Treatment unit counts
needs are provided treatment in a           such treatment (by type of treatment
comprehensive and timely manner             and timeliness)

DEVELOPMENTAL GAINS
Children who receive treatment services Number and % of children who show
                                                                          (Time 2) ASQ and assessments as
for special needs have improved short- developmental gains as a result of
                                                                          applicable
term (6 month) developmental            treatment
outcomes
MENTAL HEALTH STATUS
                                            Number and % of children who show
Children who receive treatment have                                            (Time 2) ASQ-SE and assessments as
                                            improved mental health status as a
improved short-term mental health                                              applicable
                                            result of treatment
status
                                            Increased coping skills among
PARENT CONFIDENCE/COPING                    parents to improve parenting
Parents/caregivers feel emotionally &       behaviors (attitudinal domains such
physically able to meet child’s needs       as anger management and stress            Parent assessment tools might
                                            relief)                                   include:
                                                                                        • Pre/post Parent Stress Index (PSI)
FAMILY CAPACITY                             Improved parental ability to access         • Standardized pre/post test for
Families have enhanced capacity to          and coordinate needed services for             parent education classes; parent
provide for their children's needs          their children                                 empowerment survey
                                                                                        • Home Observation for
POSTIVE PARENTING
                                                                                           Measurement of Environment
Parents/care givers practice                Increased number and % of parents
                                                                                           Survey (HOME) by PHN
developmentally appropriate and             practicing positive disciplinary skills
positive parenting skills                                                               • Measures of parent competence
                                                                                           and attachment using EAS or
                                                                                           DPICS
BONDING & ATTACHMENT
                                          Increased parent-child bonding and
Children are raised in safe and nurturing
                                          attachment
environments




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ASQ: The ASQ system is composed of 19 age-appropriate questionnaires (from 4-60 months) and is designed
to be completed by parents or primary caregivers. 1 The questionnaire for the age group closest to the child’s
age should be used. Each questionnaire contains 30 developmental items that are divided into five domains:
        Communication
        Gross motor
        Fine motor
        Problem solving
        Personal-social

For SART, the ASQ should be collected at a minimum of at least two time periods to measure the differences in
developmental appropriateness over time. Data is analyzed to reflect the ASQ’s intended use as a screener for
developmental concerns at various ages by utilizing the scientifically set cut-off scores for each ASQ’s age-
specific instrument.

While the ASQ instrument used at pre or baseline is different than that used at post or follow-up (since the
ASQ is an age-based instrument that may modify the wording of some questions to be developmentally
appropriate), the result at each point in time indicates whether the child is developing appropriately for their
age by the same domains. Part of the challenge of using the ASQ as a measurement tool in parent-child settings
is the child and rater (the parent) are developing simultaneously. As parents learn more about appropriate
development by participating in the program, they may (and in fact are likely) to change as raters of their
children. For example, parents may actually “overscore” their child when they first take the ASQ because they
are not as familiar with what is “normal.” With parent training, their next assessment of their child may be
more moderate, tempered by a better understanding of child development.

In 2007-08, the SART ASQ scores were not matched by child, rather the amount of scores meeting or
exceeding the cut-off scores were aggregated at “pre” or Time 1. Some post scores were documented during
2007-08, though not enough to measure statistical differences. Therefore, only the pre scores were presented in
this report and indicate the developmental needs of children at the beginning of the SART process, rather than
change in development over time.

ASQ:SE: The ASQ:SE screening instrument was developed in response to requests from early childcare
providers looking for assistance in screening young children for social and behavioral problems. 2 The
screening instrument assesses several areas within the personal-social domain (i.e., self-regulation, compliance,
communication, adaptive functioning, autonomy, affect, and interaction with people) and has demonstrated
validity and reliability in 8 intervals with children ages 6 months – 60 months. 3 The ASQ:SE has been
implemented as a screening tool with preference being given to it being completed by a parent or caregiver.
This continues the developer’s idea that parents are able to accurately identify the behaviors of concern.

Similar to the ASQ above, the ASQ:SE (as part of the SART evaluation) should be administered at least twice
with each child to determine differences in behavioral/emotional development. In 2007-08, few ASQ:SE post

1
  Squires, J., Potter, L, and Bricker, D. The ASQ User’s Guide, 2nd Ed. Paul H. Brookes Publishing, Baltimore, Maryland, 1999.
2
  Squiers, J., Bricker, D. and Twombly, E. The ASQ:SE User’s Guide, Paul H. Brookes Publishing, Baltimore, Maryland, 2003.
3
  Validity and reliability: Investigated with over 3,000 children across the age intervals and their families. Reliability is 94%;
validity is between 75% and 89%. Ibid.
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scores were documented, and therefore, only the pre scores were presented in this report and indicate the
needs of children at the beginning of the SART process, rather than change in social-emotional domain over
time.

School Readiness
The School Readiness (SR) evaluation follows First 5 California mandated evaluation guidelines. Under the
First 5 California Evaluation Framework, adopted in spring 2006, School Readiness programs are required to
select at least one indicator from a menu of indicators for each State Result Area and report their progress
according to these indicators. Exhibit B.2 lists the general outcomes and data sources.


                           Exhibit B.2 2007-08 School Readiness Evaluation Design
F5SB Desired Result Area F5CA Result Area                     General Outcome(s)              Method(s)

1) Children are safe and                                      Increased health & dental
                               3) Improved Child Health                                     Child intake and exit form
healthy                                                       insurance; recent dental care


2) Children are ready to enter 2) Improved Child                                              Child assessment tool: DRDP-
                                                              Developmental progress
and succeed in school          Development                                                    R or ASQ (pre/post)

3) Families are safe, healthy,                                Increased/improved parent Parent Survey (retrospective
                               1) Improved Family
nurturing, and self-                                          knowledge, attitudes,     pre/post) ); Activities Survey
                               Functioning
sustaining                                                    behaviors                 (pre/post)

4) Systems are Responsive to                                                          SR Coordinator, Preschool
                                                         Stakeholder collaboration to
the Needs of Children,       4) Improved Systems of Care                              Teacher, Other SR Staff
                                                         build/articulate SR systems
Families, and Community                                                               Surveys


Child Intake and Exit: These forms were created to include specific questions related to the required State
health-related indicators for SR, including child status of health insurance, dental insurance and annual dental
check-up. School Readiness programs were required to collect this data from each parent of a core child. The
responses were matched by child. Basic descriptives, along with chi-square tests, were compiled to compare
differences.

Desired Results Developmental Profile – Revised (DRDP-R):
The DRDP-R is a developmental tool meant to be completed by teachers or providers based on observation of
a child’s developmental status. 4 The DRDP-R scores children’s skills on a scale of 0 to 4 (0=not yet at first level;
1=exploring; 2= developing; 3=building; 4=integrating – the most advanced score). Domains, indicators, and
example measures are outlined in Exhibit B.3.

SR partners providing classroom-based early care and education programs were to administer either the full
version or a F5SB-modified version of the DRDP-R to SR children in fall 2007 (pre) and spring 2008 (post).
This year, DRDP-R data was analyzed differently than previous years. Previously, the DRDP-R was matched to
elements of the ASQ in order to make some similar comparisons, though this was not the most appropriate use
of the DRDP-R. Instead, the changes in data use during 2007-08 bring the analysis in line with the intended

4
 California Department of Education. “Desired Results Reference Materials and Forms.” 2008. Accessed 10 July 2008
<http://www.cde.ca.gov/sp/cd/ci/drdpforms.asp>
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DRDP-R four domains of child development – personal and social competence, effective learning, physical and
motor competence, as well as safety and health. Matched scores for all children whose parents gave consent
were used in the analysis. The pre and post scores were compared using a paired sample t-test, which compares
the difference between the two mean ratings for each of the questions.

                            Exhibit B.3 DRDP-R Domains, Indicators and Measures
    Desired Result                                      Indicator                                Example Measure
                                                        Self Concept (SELF)                      Identity of self
    1.Children are Personally and Socially              Social Interpersonal Skills (SOC)        Expressions of Empathy
    Competent                                           Self Regulations (REG)                   Impulse Control
                                                        Language (LANG)                          Comprehends meaning
                                                        Learning (LRN)                           Curiosity and Initiative
                                                        Cognitive Competence (COG)               Memory and knowledge
    2. Children are Effective Learners
                                                        Math (MATH)                              Time
                                                        Literacy (LIT)                           Concepts of print
    3. Children Show Physical and Motor
                                                        Motor Skills (MOT)                       Gross motor skills
    Competence
    4. Children are Safe and Healthy                    Safety and Health (SH)                   Personal care routines



ASQ: The ASQ system is composed of 19 age-appropriate questionnaires (from 4-60 months) and is designed
to be completed by parents or primary caregivers. For more information on the ASQ developmental tool, see
page 163 in this Appendix.

Similar to the DRDP-R above, SR partners providing center-based early care and education programs were to
administer the ASQ to SR children at least twice in the program – once at intake or pre and once at exit or post.
Matched scores for all children whose parents gave consent were used in the analysis. The pre and post scores
were compared using a paired sample t-test, which compares the difference between the two mean ratings for
each of the questions.

Survey of Parenting Practice (SPP): In FY 2007-08, contractors continued to administer the SPP to parents
completing an educational or parent-child bonding component of the SR program. The SPP includes a series of
statements about knowledge, confidence, ability, and behaviors around parenting and is completed once at the
end of the program. 5 When completing the SPP, parents responded to questions thinking about “now,” after
completing the parent education activity, and “then” - before the activity. Ratings range from zero to six, with
the higher the rating, the more knowledge, confidence, ability, or frequent behavior. The post-test and
retrospective pre-test responses to each of the 12 items were compared using a paired sample t-test, which
compares the difference between the two mean ratings for each of the questions. Paired sample t-tests analyze
the results when the same person reports at two different times or conditions. A Bonferroni adjustment is an
analysis technique where the alpha level, or the chance of detecting a difference when one doesn’t really exists,
is decreased. 6 This is done to reduce the likelihood of getting a significant difference by chance alone (type 1


5
  Shaklee, H. and Demarest, D. University of Idaho Survey of Parenting Practice Tool Kit, 2nd Ed. University of Idaho Extension,
College of Agricultural and Life Sciences. Boise, Idaho. 2005.
6
  “Bonferroni.” Simply Interactive Statistical Analysis. Quantitative Skills Consultancy for Research and Skills. Accessed 6 August
2007. http://home.clara.net/sisa/bonhlp.htm
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error). This technique was recommended by the authors of the survey tool in order to increase the validity of
the findings. During analysis of the SPP, the alpha level was reduced from .05 to .004; statistical significance
was reported at this reduced alpha level.

Parent Activities Survey: New for FY 2007-08 was the utilization of the Parent Activities Survey, a survey
developed by Harder+Company Community Research with input from F5SB and SR partner staff. Many SR
programs work extensively with families to build their capacity to support their child’s school readiness. The
Parent Activities Survey was developed to measure a change in parent behaviors over time as a result of their
participation in the SR programs, specifically related to:
       Frequency of interaction with their child, such as playing, reading, singing, keeping a regular routine, etc
       Practicing of literacy techniques with their child
       Provision of learning materials for their child

The survey was administered at the beginning of the parent component and at the end, resulting in a pre/post
design. Responses were matched by client, and basic frequencies and percents were calculated to determine
differences. No statistical testing was conducted for this survey analysis.

SR Provider Surveys: For the first time, various SR staff persons completed surveys to determine progress in
system-level change in SR programming in 2007-08. These surveys were based on the NEGP “Ready Schools
Checklist”: National Education Goals Panel 7 , along with edits made by Harder+Company and F5SB and SR
partner staff. Three surveys were created and implemented at one point in time (May 2008):
       School Readiness Program Coordinator Survey: This survey aimed to measure Coordinators’ sense of
       support for their program from various stakeholders, as well as the type of activities conducted to
       improve their early care and education programming.
       Preschool Teachers and Other SR Specialty Staff Surveys: The Preschool Teacher and (other) School
       Readiness Staff Surveys collected information about interaction with parents of children in their
       program, professional development opportunities, and activities with preschool and/or kindergarten
       teachers to create transition plans and related activities.



Child Care Quality Standards/Child Care Capacity
During FY 2007-08, three of the programs funded under the Child Care Quality Standards (CCQS) and Child
Care Capacity (CCC) Strategies implemented an ECE Provider Survey. This survey was administered with any
child care student or provider receiving training or other technical assistance through the F5SB funded partner
activities.

The ECE Provider Survey was created by Harder+Company, along with F5SB and partner agency input. The
survey aimed to measure provider perspective on changes in their knowledge of child development, as well as
skills to improve their child care practice, as a result of the F5SB partner programming. The survey was
implemented in spring 2008 and given at one point in time, as providers completed a training course, or once
every 6 months as providers continued to receive technical assistance from the partner agency. Surveys were
completed either via paper/pencil or via the internet.


7
 “A Self-Inventory for Ready Schools.” Ready Schools, Washington, D.C. 1998. Accessed 10 September 2007.
<http;//www.negp.gov/Reports/readysch.pdf>
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Though the completion rate for this survey in 2007-08 was relatively low (n= 102) compared to the estimated
number of providers benefitting from these programs (over 6,000), it is hoped that the number of surveys
completed in the next fiscal year will increase.

Resource Center
Fiscal Year 2007-08 marked a new contract year for Resource Center (RC) partner agencies, and with that First
5 San Bernardino implemented a new evaluation tool with these partners.

Life Skills Progression: The Life Skills Progression (LSP) instrument was used by the RC partners in 2007-08.
The LSP describes individual parent and infant/toddler progress using 43 individual categories of life skills that
reflect the array of basic skills needed to live and parent well being (examples include parent’s skills in
relationships, education and employment, health and medical care, mental health and substance use, and basic
essentials). 8 The information summarized in the LSP provides clinically useful and succinct outcome
information about individual families and entire caseloads to home visitation and social services programs.
The LSP was originally designed for home visitation programs for parents with children 0-3, however, the tool
can be used for any case management program (with or without home visits) and with parents of children 0-5.
Each scale is scored on a continuum from inadequate (1) to competent (5), reflecting the characteristics,
development, and/or learning curve of the parent or child. Scores should apply only to skills, behaviors, or
attitudes occurring currently or over the last 6 months. This interval captures changes and keeps the profile of
parent skills and child development current.

The RC partners were required to complete LSP scales that were relevant to their program or their client’s
action plan (not necessarily all 43 scales). The LSP was to be administered by the home visitor/case
manager/program staff person working with the parent at a minimum of two time periods during the program
year, in order to show change in skills over time (i.e., program intake or “pre” vs. program exit or “post”).
Based on the LSP recommendations, all scale scores were recoded to “above” and “below” target. There were a
number of clients who did not have matching pre and post scores, and therefore a cross sectional analysis was
done of all clients to determine needs at pre and post (i.e., all “pres” were combined and all “posts” were
combined to show general trends at both time periods through basic frequencies). Additionally, cases that were
matched (i.e., clients that had both a pre and a post score on scale(s)) were also tested for differences using Chi
square and McNemar’s test and a minimum alpha level of .05.

Parenting Education
During FY 2007-08, F5SB partners in the Parenting Education (PE) Strategy changed the tool they used to
document outcomes of their programs.

Survey of Parenting Practice (SPP): Fiscal year 2007-08 marked the first year of a new cycle of PE
programming, and with the new contracts, the PE partners agreed to utilize the SPP with the parents who
completed their programs. For more information about the SPP, see page 165 in this Appendix. PE partners
administered the SPP in the same fashion as the SR partners. The data analysis process was also the same as
that used with SR SPP data, using a paired t-test.



8
 Wollesen, L, and Peifer, K. (2006). Life Skills Progression™ (LSP): An Outcome and Intervention Planning Instrument for Use
with Families at Risk. Paul H. Brookes Publishing Co., Inc.
Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                                January 2009            168
First 5 San Bernardino 2008 Family Survey

In order to measure important family and child indicators that are not readily available or accessible from
other sources, First 5 San Bernardino contracted with the Institute of Applied Research and Policy Analysis at
Cal State San Bernardino in 2007 to conduct a random digit dial interview with parents/guardians of young
children throughout the County. In total, 1,227 phone interviews were conducted throughout the County
during winter of 2008. This survey provides valuable community baseline data that can be tracked over time, as
well as compared to the Family Survey results from 2006.

Community Indicators

Community indicators are measurements that can be used to track large scale trends over time.
Harder+Company researched relevant data at the County and State level as appropriate and available.
Examples of such indicators are health insurance status and poverty level. Typical indicator sources included
the California Health Interview Survey (CHIS) 9 and the California Department of Health Services. 10



Qualitative Methods

Qualitative methods typically include data collection techniques which provide narrative and/or non-
numerical results.


Case Studies / Participatory Photography (Community Storybook )

The evaluation team conducted eight case studies to understand in-depth the value of First 5 in parents’ and
providers’ lives. These case studies included both an interview with the parent, often at the program facility,
and an interview with his or her primary case worker or service provider. Case study participants were selected
with input from Commission staff. Participants were chosen to represent strategies as well modalities of service
provisioning, and regions served. Case studies were conducted in English and Spanish. A list of all partner
agencies that participated can be seen below in Exhibit B.4. These case study write-ups can be seen throughout
the report.

In 2007-08, the participatory photography technique was used once again as an enhancement to the case study
methodology. Participatory photography tells a visual story combining words and images from the perspective
of the photographer/participant. Harder+Company Community Research has adapted the Photovoice
technique originally created by Caroline Wang at University of Michigan, Ann Arbor. 11, 12 According to Wang,
Photovoice is a technique that enables people to:
       Record and reflect their community’s strengths and concerns


9
  Center for Health Policy Research, University of California, Los Angeles. California Health Interview Survey.
<http://www.chis.ucla.edu/>
10
   California Department of Health Services. <http://www.dhs.ca.gov>
11
   Wang, CC. (1999). Photovoice: A Participatory Action Research Strategy Applied to Women’s Health. Journal of Women’s
Health 8 (2): 185-192.
12
   Since the term “Photovoice” is copyrighted, Harder+Company uses the generic term “participatory photography.”
Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                                   January 2009      169
         Promote critical dialogue about personal and community issues through discussion of their photographs
         Reach policy makers



                       Exhibit B.4 2007-08 Case Studies/Participatory Photography
Partner Agency Name                                             Program Strategy                  Region         Language
Building a Generation, East Valley Bridge to Success              Resource Center               East Valley       Eng/Span

City of Montclair, Montclair Community Collaborative              Resource Center                West End         Eng/Span

Knotts Family Agency, Narrative Parenting Villages              Parenting Education            Central Valley      English
Lucerne Valley Unified School District,
                                                                  School Readiness              High Desert        English
SMILE School Readiness Program
New House, Inc., Clean and Sober Moms                            Health Care Access            Central Valley      English
Regents of University of California, Riverside, Child Care Quality Standards/
                                                                                               Countywide          English
San Bernardino County CARES/CONNECTIONS Project      Child Care Capacity
SAC Health System, Good2Grow*                                    Health Care Access            Central Valley      Spanish
San Bernardino County Superintendent of Schools,
                                                             Child & Family Assessment          High Desert        English
Desert Mountain SELPA – Children’s SART
*The participant from this agency completed the case study, but did not complete the participatory photography component.


In the context of this evaluation, participatory photography is a parent-driven means of expressing the benefits
families have experienced from projects funded by First 5 San Bernardino. Facilitated by Harder+Company
Community Research, parent-photographers learned how to use a camera to tell their stories and document
changes in their lives. The 2007-08 case study/photography project engaged these parents and providers to
share stories that would be the basis for the creation of A Community Storybook 2nd Edition: Strengthening
Families, Strengthening Communities. The sequence of the project was as follows:

    1.     Introductory meeting/Case Studies: Parents at each site met with an evaluation team member for an
           introduction to the project. As part of that meeting, each parent and provider was interviewed
           extensively (i.e., case studies) regarding the program and their experiences.
    2.     Taking pictures: Participants were given digital cameras at the introductory meetings and spent two
           weeks taking pictures of what they felt expressed the benefit of their participation in the program.
           Participants then returned their film to the evaluation team for developing.
    3.     Individual meetings: Once the pictures were developed, members of the evaluation team met with the
           participants at each site to look at the photos and record the photographers’ comments to give context
           to the photos.
    4.     Creating the Community Storybook: Harder+Company and Studio M (graphic design consultant)
           took the participants’ pictures and quotes and created a collage for each site, as well as the content for
           the Storybook, using the photographs participants selected and their explanations of the photographs’
           importance.




Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                              January 2009               170
    5.     Exhibition at the First 5 San Bernardino Commission meeting: The collages and Community
           Storybook were presented as an exhibit at the September 2008 Commission meeting, where the
           participating families and partner agencies were formally recognized.


Participants received incentives for each meeting they attended ($20 each meeting for a total of $60).
Participants kept their cameras and were given a framed picture (8x10) of their favorite photograph. Each of
the participating programs also received a framed copy of the corresponding participant’s collage and copies of
the Storybook.


Focus Groups

Four focus groups were conducted across San Bernardino County during the spring of 2008 to hear directly
from parents and providers about First 5’s effect on their lives and programs (see Exhibit B.5).

                                       Exhibit B.5 2007-08 Focus Groups
                                                                                                            Number of
Partner Agency Name                               Program Strategy           Region          Language
                                                                                                           Participants
Christian Counseling Service,
                                               Child & Family Assessment   Central Valley     English           5
Parent Child Interaction Therapy
Moses House Ministries                            Health Care Access       High Desert        English           8

San Bernardino City Unified School District,
                                                 Parenting Education       Central Valley     Spanish           8
San Bernardino Adult School

St. Mary’s Medical Center                          Resource Center         High Desert        Spanish          11

The evaluation team contacted partner agencies and asked for their assistance in recruiting participants.
Agencies were chosen to represent a variety of strategies, modalities of service provisioning, and regions.
Individual participants were given a $20 incentive, and food and childcare was provided. For each focus group,
the evaluation team sought and usually recruited 8 to 12 participants. Focus groups were conducted in both
English and Spanish. Specific write-ups were provided for some of the focus groups, while others were used to
provide examples of outcomes when relevant to the section.

Funded Partner Survey

To understand the effect and value added of First 5 San Bernardino on funded programs as organizations,
Harder+Company, along with the assistance of F5SB staff, created and distributed an online survey to all partner
agencies. Surveys were sent to 75 partner programs during June 2008, and 43 were completed and returned
(57.3%). All regions within the County, as well as funded Strategies, were represented by the completed surveys.

The survey was developed to learn more about:

         The extent to which F5SB funds facilitated improving services to children and leveraged additional funds
         Partner agencies’ work towards systems integration and other F5SB systems-change goals
         Program experiences with F5SB staff and processes


Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                         January 2009            171
Key Expert (“Stakeholder”) Interviews

Interviews with key experts were an opportunity to speak with influential members of the San Bernardino
community, both within and outside of First 5 San Bernardino, who have insight about the system of care for
young children and the Commission’s work. The stakeholder interviews helped identify the successes and
challenges of the Commission in actively addressing and supporting system level changes in terms of capacity
building, partnership expansion and sustainability in programming for young children and their families. In
addition, all stakeholder interviews addressed:
      The perceived role and successes of the Commission in improving services to children and in forming a
      strong system of support for San Bernardino families of young children
      The impact of the Commission in raising awareness of early childhood issues and in increasing the sense
      of community, community engagement, and parent empowerment and advocacy
      Whether stakeholders have increased their commitment to the support of families with young children
      as a result of First 5

Key experts (including some partner agencies) were selected by strategy in collaboration with the First 5
Commission Staff. Harder+Company contacted the selected individuals from each entity five times before
abandoning the interview effort. In total, 20 interviews were conducted during June-July 2008.




Prepared by Harder+Company for First 5 San Bernardino
Annual Evaluation Report FY 2007-08                                                 January 2009            172
Appendix C: Evaluation Framework Logic Model
Desired Result 1: Children are Safe and Healthy
                                                                                                     Health & Family                                                                                                                                                                                                   System                                            Community
                                                                                                                                                                                                         Early Care & Education
                                                                                                     Wellbeing Support                                                                                                                                                                                               Integration                                         Engagement
                                                                                                                                                                                                                 Cluster
                                                                                                      Cluster Cluster                                                                                                                                                                                                  Cluster                                             Cluster




                                                                                                                                                                                                                                                                                                                                                                     Community Education
                                                                                                                                                                                   Child Care Advocacy




                                                                                                                                                                                                                                                                                                                                                                                                        Technical Assistance
                                                                                                                                                                                                                                                                                                          Information Sharing
                                                                                                                                                                                                                               Child Care Capacity




                                                                                                                                                                                                                                                                                                                                System Integration
                                                                                                                        Health Care Access




                                                                                                                                                                                                          Child Care Quality



                                                                                                                                                                                                                                                     Child Care Access
                                                                                                                                             Resource Centers




                                                                                                                                                                                                                                                                                       School Readiness
                                                                                                                                                                Parent Education
                                                                                                     Child and Family




                                                                                                                                                                                                                                                                                                                                                     System Access



                                                                                                                                                                                                                                                                                                                                                                                           Engagement
                                                                                                                                                                                                                                                                                                                                                                                           Community
                                                                                                       Assessment




                                                                                                                                                                                                                                                                         Play Spaces
                                                                                                                                                                                                              Standards




                                                                                                                                                                                                                                                                                                                                    Advocacy
                                                 Suggested Commission Level-Outcomes
Desired Result
                       Objectives                    (or Performance Target Areas)
     Area




                                          1.1 Increased utilization of prenatal care                                        X                    X
                 1. Children are born
                 healthy                  1.2 Reduced number/percent of pregnant women
                                                                                                           X
                                          abusing substances

                                          2.1 Increased number/percent of children with health
                                                                                                                            X                    X                                                                                                                                         X
                                          insurance and ongoing relationship with health provider

                                          2.2 Increased number/percent of children receiving
                                                                                                                            X                    X                                                                                                                                         X
             2. Children are              annual dental screenings and appropriate follow up care
             healthy, well-
             nourished, and               2.3 Increased number/percent of mothers breastfeeding                             X
Children are physically fit               2.4 Improved nutrition among children                                             X
Safe and
                                          2.5 Improved physical fitness among children                                      X                                                                                                                                              X
Healthy
                                          2.6 Decreased number/percent of households in which
                                                                                                                                                                                                                                                                                                                                                                         X
                                          an adult smokes


                                          3.1 Reduced number/percent of parents abusing
                                                                                                           X                X
                                          substances

                 3. Children are raised   3.2 Increased number/percent of parents trained in child
                                                                                                                            X                                       X
                                          related safety and put this knowledge into practice
                 in safe and nurturing
                                          3.3 Decreased number/percent of families with
                 environments             reoccurrence of identified child or domestic abuse (see          X                                                        X
                                          10.3)
                                          3.4 Increased parent-child bonding and attachment                X                                                        X



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Desired Result 2: Children are Ready to Enter and Succeed in School
                                                                                                    Health & Family                                                                                                                                                                                                   System                                            Community
                                                                                                                                                                                                        Early Care & Education
                                                                                                    Wellbeing Support                                                                                                                                                                                               Integration                                         Engagement
                                                                                                                                                                                                                Cluster
                                                                                                     Cluster Cluster                                                                                                                                                                                                  Cluster                                             Cluster




                                                                                                                                                                                                                                                                                                                                                                    Community Education
                                                                                                                                                                                  Child Care Advocacy




                                                                                                                                                                                                                                                                                                                                                                                                       Technical Assistance
                                                                                                                                                                                                                                                                                                         Information Sharing
                                                                                                                                                                                                                              Child Care Capacity




                                                                                                                                                                                                                                                                                                                               System Integration
                                                                                                                       Health Care Access




                                                                                                                                                                                                         Child Care Quality



                                                                                                                                                                                                                                                    Child Care Access
                                                                                                                                            Resource Centers




                                                                                                                                                                                                                                                                                      School Readiness
                                                                                                                                                               Parent Education
                                                                                                    Child and Family




                                                                                                                                                                                                                                                                                                                                                    System Access



                                                                                                                                                                                                                                                                                                                                                                                          Engagement
                                                                                                                                                                                                                                                                                                                                                                                          Community
                                                                                                      Assessment




                                                                                                                                                                                                                                                                        Play Spaces
                                                                                                                                                                                                             Standards




                                                                                                                                                                                                                                                                                                                                   Advocacy
                                                Suggested Commission Level-Outcomes
Desired Result
                       Objectives                   (or Performance Target Areas)
     Area



                                        4.1 Increased parents’ time spent reading, singing, and
                                                                                                                                                                   X                                                                                                                      X                                                                             X
                                        telling stories to their children
                 4. Children live in a
                 home environment       4.2 Increased number/percent of parents using
                                        developmentally appropriate activities to support the                                                                                                                                                                                             X                                                                             X
                 supportive of learning
                                        school readiness of their children (see 9.1)
                                        4.3 Increased family literacy skills                                                                                                                                                                                                              X                                                                             X

                 5. Children receive
                                         5.1 Improved screening, assessment, referral and
                 early screening and
                                         treatment of children for special needs identification           X                X
                 intervention for        and intervention
                 special needs
Children are
Ready to                                 6.1 Increased number/percent of qualified childcare
Enter and                                providers regarding the developmental needs and                                                                                                                        X                 X                                       X               X
Succeed in                               milestones of children
             6. Children have            6.2 Increased length of time childcare providers stay in
School                                                                                                                                                                                                          X                 X
             access to high quality      the childcare field
             early childhood             6.3 Increased number/percent of parents informed of,
             development                 and number/percent of children enrolled in, high quality                                                                                     X                                                                 X                                                                                                               X
             programs                    subsidized child development programs
                                         6.4 Increased number/percent of childcare providers
                                         who work with parents to affect parents’ knowledge and                                                                                                                 X
                                         skills regarding school readiness

                                         7.1 Increased number/percent of children exhibiting
                 7. Children develop                                                                      X                                                        X                                                                                                                      X
                                         age-appropriate development
                 within normal ranges
                                         7.2 Increased number/percent of children exhibiting
                 in all domains                                                                           X                                                        X                                                                                                                      X
                                         healthy cognitive and social-emotional behavior




  Prepared by Harder+Company for First 5 San Bernardino
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Desired Result 3: Families are Safe, Healthy, Nurturing, and Self-Sustaining
                                                                                                         Health & Family                                                                                                                                                                                                   System                                            Community
                                                                                                                                                                                                             Early Care & Education
                                                                                                         Wellbeing Support                                                                                                                                                                                               Integration                                         Engagement
                                                                                                                                                                                                                     Cluster
                                                                                                          Cluster Cluster                                                                                                                                                                                                  Cluster                                             Cluster




                                                                                                                                                                                                                                                                                                                                                                         Community Education
                                                                                                                                                                                       Child Care Advocacy




                                                                                                                                                                                                                                                                                                                                                                                                            Technical Assistance
                                                                                                                                                                                                                                                                                                              Information Sharing
                                                                                                                                                                                                                                   Child Care Capacity




                                                                                                                                                                                                                                                                                                                                    System Integration
                                                                                                                            Health Care Access




                                                                                                                                                                                                              Child Care Quality



                                                                                                                                                                                                                                                         Child Care Access
                                                                                                                                                 Resource Centers




                                                                                                                                                                                                                                                                                           School Readiness
                                                                                                                                                                    Parent Education
                                                                                                         Child and Family




                                                                                                                                                                                                                                                                                                                                                         System Access



                                                                                                                                                                                                                                                                                                                                                                                               Engagement
                                                                                                                                                                                                                                                                                                                                                                                               Community
                                                                                                           Assessment




                                                                                                                                                                                                                                                                             Play Spaces
                                                                                                                                                                                                                  Standards




                                                                                                                                                                                                                                                                                                                                        Advocacy
                                                  Suggested Commission Level-Outcomes
Desired Result
                       Objectives                     (or Performance Target Areas)
     Area



                                           8.1 Increased sense of social support and belonging
                                                                                                                                                     X
                                           among parents
                 8. Parents are            8.2 Increased coping skills among parents to improve
                 mentally and              parenting behavior (attitudinal domains such as anger               X
                 physically fit            management, stress relief)
                                           8.3 Improved nutrition and physical fitness among
                                                                                                                                X
                                           parents

             9. Parents practice           9.1 Increased number/percent of parents understanding
             developmentally               developmental milestones and practicing parenting
                                                                                                               X                                                        X                                                                                                                      X
             appropriate parenting         skills that are developmentally appropriate for their child
Families are                               (see 4.2)
             skills
Safe ,
Healthy,                                   10.1 Increased number/percent of parents practicing
Nurturing,                                                                                                     X                                                        X
                                           positive disciplinary skills
and Self-                                  10.2 Improved screening, assessment, referral and
             10. Children are free
Sustaining                                 treatment of families suffering from child or domestic
             from any form of
                                           abuse
             abuse                         10.3 Decreased number/percent of families with
                                           reoccurrence of identified child or domestic abuse (see                                                   X                  X
                                           3.3)

                                           11.1 Improved parental ability to access and coordinate
                 11. Families are stable                                                                       X                X                    X                                                                                                       X                                 X                  X
                                           needed services for their children
                 and have the capacity     11.2 Improved parental ability to meet basic needs of
                                                                                                               X                X                    X                  X                                                                                                                                         X
                 to meet the needs of      their families
                 their children            11.3 Strengthened nuclear and extended family
                                                                                                                                                     X
                                           relationships




  Prepared by Harder+Company for First 5 San Bernardino
  Annual Evaluation Report FY 2007-08                                                                                                                                                                                                                                                                    January 2009                                                                               175
Desired Result 4: Systems are Responsive to the Needs of Children, Families and Community
                                                                                                    Health & Family                                                                                                                                                                                                   System                                            Community
                                                                                                                                                                                                        Early Care & Education
                                                                                                    Wellbeing Support                                                                                                                                                                                               Integration                                         Engagement
                                                                                                                                                                                                                Cluster
                                                                                                     Cluster Cluster                                                                                                                                                                                                  Cluster                                             Cluster




                                                                                                                                                                                                                                                                                                                                                                    Community Education
                                                                                                                                                                                  Child Care Advocacy




                                                                                                                                                                                                                                                                                                                                                                                                       Technical Assistance
                                                                                                                                                                                                                                                                                                         Information Sharing
                                                                                                                                                                                                                              Child Care Capacity




                                                                                                                                                                                                                                                                                                                               System Integration
                                                                                                                       Health Care Access




                                                                                                                                                                                                         Child Care Quality



                                                                                                                                                                                                                                                    Child Care Access
                                                                                                                                            Resource Centers




                                                                                                                                                                                                                                                                                      School Readiness
                                                                                                                                                               Parent Education
                                                                                                    Child and Family




                                                                                                                                                                                                                                                                                                                                                    System Access



                                                                                                                                                                                                                                                                                                                                                                                          Engagement
                                                                                                                                                                                                                                                                                                                                                                                          Community
                                                                                                      Assessment




                                                                                                                                                                                                                                                                        Play Spaces
                                                                                                                                                                                                             Standards




                                                                                                                                                                                                                                                                                                                                   Advocacy
                                               Suggested Commission Level-Outcomes
Desired Result
                      Objectives                   (or Performance Target Areas)
     Area



                 12. Systems support    12.1 Increased number of funded partners that initiate
                                                                                                          X                X                    X                  X                                                                                                                      X                                                                                                                 X
                 families               family-centered approaches to service delivery

                 13. Systems are        13.1 Increased number of funded partners that utilize
                                                                                                          X                X                    X                  X                                                                                                                      X                  X                                                                                              X
                 results based          their results to improve service delivery

                                        14.1 Increased service capacity to serve target
                                                                                                          X                X                    X                  X                  X                         X                 X                     X                 X               X                                                                             X                    X              X
                                        community (see 19.1)
                                        14.2 Demonstrated coordination/integration with other
                                                                                                          X                X                    X                  X                                                                                                                      X                  X                        X                X                X                    X
                 14. Community has      services to benefit families (see 20.1)
                 access to services     14.3 Demonstrated efforts to sustain operations through
                                                                                                          X                X                    X                  X                  X                                                                                                   X                                           X
Systems are                             leveraging
Responsive                              14.4 Providers exhibit high standards as defined by best
                                                                                                          X                X                    X                  X                                            X                 X                                                       X                                           X                                                                     X
to the Needs                            practices in their field
of Children,
                                        15.1 Increased number of First 5 agencies that include
Families, and                           families in planning and enacting their child’s care (see         X                X                                       X                                            X                                                                         X                                                                             X                    X
Community 15. Families, providers       20.2)
              and stakeholders          15.2 Increased number of providers that collaborate
              collaborate on the        with other agencies to provide additional services to             X                X                    X                                                                                                                                         X                  X                        X
              well-being of the         children
              child                     15.3 Increased number of stakeholders involved in First
                                        5 that collaborate for the benefit of children ages 0-5                                                                                                                 X                                                                                                                     X                                 X                    X
                                        (see 20.3)

                 16. Systems sustain
                                        16.1 Increased number of other funders supporting
                 programs and
                                        programs that achieve desired results for children ages                                                                                                                                                                                                                                       X                                                      X
                 services and achieve   0-5
                 desired results




  Prepared by Harder+Company for First 5 San Bernardino
  Annual Evaluation Report FY 2007-08                                                                                                                                                                                                                                                               January 2009                                                                               176
Desired Result 5: Communities are Engaged and Empowered to Meet the Needs of Children and Families
                                                                                                       Health & Family                                                                                                                                                                                                   System                                            Community
                                                                                                                                                                                                           Early Care & Education
                                                                                                       Wellbeing Support                                                                                                                                                                                               Integration                                         Engagement
                                                                                                                                                                                                                   Cluster
                                                                                                        Cluster Cluster                                                                                                                                                                                                  Cluster                                             Cluster




                                                                                                                                                                                                                                                                                                                                                                       Community Education
                                                                                                                                                                                     Child Care Advocacy




                                                                                                                                                                                                                                                                                                                                                                                                          Technical Assistance
                                                                                                                                                                                                                                                                                                            Information Sharing
                                                                                                                                                                                                                                 Child Care Capacity




                                                                                                                                                                                                                                                                                                                                  System Integration
                                                                                                                          Health Care Access




                                                                                                                                                                                                            Child Care Quality



                                                                                                                                                                                                                                                       Child Care Access
                                                                                                                                               Resource Centers




                                                                                                                                                                                                                                                                                         School Readiness
                                                                                                                                                                  Parent Education
                                                                                                       Child and Family




                                                                                                                                                                                                                                                                                                                                                       System Access



                                                                                                                                                                                                                                                                                                                                                                                             Engagement
                                                                                                                                                                                                                                                                                                                                                                                             Community
                                                                                                         Assessment




                                                                                                                                                                                                                                                                           Play Spaces
                                                                                                                                                                                                                Standards




                                                                                                                                                                                                                                                                                                                                      Advocacy
                                                  Suggested Commission Level-Outcomes
Desired Result
                       Objectives                     (or Performance Target Areas)
     Area



                 17. Parents and           17.1 Increased awareness of parents and communities of
                                                                                                             X                X                    X                  X                                                                                                                      X                                                                             X                    X
                 communities are well      the importance of first five years
                 informed about            17.2 Increased engagement of parents and communities
                                                                                                                                                                      X                                                                                                                      X                                                                                                  X
                 resources and early       with early child development activities
                 childhood                 17.3 Increased awareness and utilization by parents of
                                                                                                                              X                    X                                                                                                                                         X                                                                             X                    X
                 development               available resources


           18. Communities                 18.1 Increased opportunities to discuss community
                                                                                                                                                                                                                                                                                                                                                                                                X
           collaborate with First 5        needs and resources with First 5
           to identify needs and           18.2 Increased participation in planning efforts around
                                                                                                                                                                                                                                                                                                                                                                                                X
Communitie resources                       community needs
s are
Engaged and                                19.1 Increase service capacity to serve target community
Empowered                                                                                                    X                X                    X                  X                  X                         X                 X                     X                 X               X                                                                             X                    X              X
                 19. Community-based       (see 14.1)
to Meet the
                 service providers have    19.2 Increased demonstration of cultural competency by
Needs of         the capacity to address                                                                     X                X                    X                  X                  X                         X                 X                                                       X                                                                                                  X
                                           service providers
Children and     diverse community
Families         needs                     19.3 Demonstrated efforts to increase capacity to service
                                           and sustain operations through leveraging funds,                  X                X                    X                  X                  X                                                                                                   X                                                                                                  X
                                           resources and support

                                           20.1 Demonstrated coordination/integration with other
                                                                                                             X                X                    X                  X                                                                                                                      X                  X                        X                X                X                    X
                                           services to benefit children and their parents (see 14.2)
                 20. Community
                 members work              20.2 Increased number of First 5 agencies that include
                 collaboratively to        families in planning and enacting their child’s care (see         X                X                                       X                                            X                                                                         X                                                                             X                    X
                 achieve collective        15.1)
                 success                   20.3 Increased number of stakeholders involved in First
                                           5 that collaborate for the benefit of children ages 0-5                                                                                                                 X                                                                                                                     X                                 X                    X
                                           (see 15.3)




   Prepared by Harder+Company for First 5 San Bernardino
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                                                                   Community Context Indicators
Community Context indicators are cross-county, preferably population-based, data elements that track if “big-picture” changes are happening for children ages 0-5 and their
families. These indicators were selected by TAT members in August 2004. These indicators should address or be a proxy to a Commission identified issue of concern. Depending
on the data, these indicators may be used for trend analysis and GIS mapping.

   Desired Result Area                  Objective (listed in Strategic Plan)                        Community Context Indicator                        Indicator Source*
                                                                                            1a. Infant survival rate                                Secondary data
                                1. Children are born healthy                                1b. Low and very low birthweightmps                     Secondary data
DR1: Children are Safe                                                                      1c. Adequate prenatal caremps                           Secondary data
and Healthy                     2. Children are healthy, well-nourished and
                                                                                            2a. Immunizations through 24 months                     Secondary data
                                physically fit
                                3. Children are raised in safe and nurturing
                                                                                            3a. Emergency visits/hospitalization                    Secondary data
                                environments
                                4. Children live in a home environment supportive
                                                                                            4a. How often children are read to                      F5SB Family Survey
                                of learning
                                5. Children receive early screening and                     5a. % of children who receive a developmental
DR2: Children are Ready                                                                                                                             F5SB Family Survey
                                intervention for special needs                              screening
to Enter and Succeed in
                                6. Children have access to high quality early               6a. % of children participating in preschool            Secondary data
School
                                childhood development programs                              6b. Head Start slots                                    Secondary data
                                7. Children develop within normal ranges in all
                                                                                            -
                                domains
                                                                                            8a. % of parents who are physically fit                 F5SB Family Survey
                                8. Parents are mentally and physically fit
                                                                                            8b. % of parents who are mentally fit                   F5SB Family Survey
                                9. Parents practice developmentally appropriate             9a. % of parents who practice appropriate
                                                                                                                                                    F5SB Family Survey
                                parenting skills                                            parenting skills
                                                                                            10a. Appropriate discipline                             F5SB Family Survey
DR3: Families are Safe,         10. Children are free from any form of abuse
                                                                                            10b. Reoccurrence of child abusemps                     Secondary data
Healthy, Nurturing and
                                                                                            11a. Foster care placement                              Secondary data
Self-Sustaining
                                                                                            11b. Teen births (15-19) mps                            Secondary data
                                11. Families are stable and have the capacity to            11c. Single parent households                           Secondary data
                                meet the needs of their children                            11d. Bonding and connection to child                    F5SB Family Survey
                                                                                            11e. Children living in povertymps                      Secondary data
                                                                                            11f. Mother’s educational achievementmps                Secondary data
DR4: Systems are
Responsive to the Needs                                                                     14a. Access to medical, childcare, and family
                                14. Community has access to services                                                                                F5SB Family Survey
of Children, Families,                                                                      support services
and Community
*Secondary data are county-level or population based data that are already collected by county or public entities. F5SB family survey is a Random Digit Dial phone survey of a
sample of San Bernardino families with children ages 0-5.
mps= mapping priority strategy used in developing target zip codes for RFPs


 Prepared by Harder+Company for First 5 San Bernardino
 Annual Evaluation Report FY 2007-08                                                                                                             January 2009               178

				
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