Title: The First Steps Report
1The First Steps Report by Melanie Morris,
Esperanza Torres, Najja Webster, Amanda Zangara
1
2What Is The Report?
A data report on the status of San Franciscos
children, 0-5 years, headed by the San Francisco
Starting Points Initiative to assess the need for
services
3Why ?
National Educational Goals Panel Issued a report
in 1993 stating that nearly half of American
infants and toddlers start life at a
disadvantage and do not have the supports
necessary to grow and thrive.
4Who ?
A significant number of children under three
confront one or more major risk factors
Inadequate prenatal care Isolated
parents Substandard child care Poverty
The Carnegie Corporation, devoted to promote the
advancement and diffusion of knowledge and
understanding, expanded their efforts to
stimulate reform in policies and programs and to
mobilize community action based on the
recommendations of each Starting Points Task
Force
5The Carnegie Corporation, funded 14 national
sites for Starting Points Initiatives to inform
their policy recommendations San Francisco
Starting Points Initiative (SFSPI) began in 1996
SFSPI envisions retaining families in San
Francisco by improving the health and well-being
of young children and their families by
improving quality, availability, and
accessibility for local services
SFSPI provides data and evaluation services to
other agencies
6First Steps
In 2000, the San Francisco Children and Families
Commission contracted SFSPI to create a report
that provides hard data to assess the needs of
children years 0-5, and their families, in San
Francisco.
Rep rt 2000
7First Steps
The report is separated into five sections
General Landscape Child And Family
Health Early Care and Education Family Support
and Education Children and Families Needing
Enhanced Services Each section has five to
ten indicators
Rep rt 2003
8First Steps
The 2003 report includes indicators that had
not been in the 2000 report, these
include Immunization and Hospitalization Nutri
tion and Dental Developmentally Delayed Children
and Children with Handicaps Children with
Learning/Language Handicaps and Children with
Emotional/Mental Handicaps
It also includes a policy analysis section with
trends and quotes from community stakeholders
9Immunization
Child and Family Health
- Definition
- The immunization rate is the percentage of
kindergarten children whose school records
indicate that they were fully immunized by age
two. -
10Immunization
Child and Family Health
- Significance
- Protects children and their communities from
communicable disease outbreaks and substantial
health-care costs. - For every dollar spent on immunizations, up to
16 is saved in medical costs.
11Immunization
Child and Family Health
Where Do We Stand
- The San Francisco childhood immunization rate is
improving - In 1996, 60 of San Francisco children were fully
immunized - In 1999, 70 of San Francisco children were fully
immunized - And finally in 2002, 81.5 of San Francisco
children were fully immunized
12Immunization
Child and Family Health
- Where Do We Stand
- San Franciscos immunization rate is consistently
better than the States. - In 2002, the States immunization rate was 70
while San Franciscos rate was 81.5.
13First Steps
Child and Family Health
- Immunization rates vary by race
- Why do African Americans have the lowest
immunization rate? - Poor number of providers in predominantly African
American neighborhoods - Lack of racial diversity in health care providers
- Only 1 African American doctor in Bayview
Hunters Point
14Child and Family Health
- Where Do We Stand
- Currently, there is no standard method of
immunization data management - Current methods range from computerized databases
to written medical charts.
15Child and Family Health
- Where Do We Stand
- The combination of a reminder and recall system
is most effective in tracking patients in need of
immunizations. - What are the reminder and recall systems?
- The reminder system uses post card or recorded
phone messages to remind patients that they have
an upcoming immunization appointment - The recall system alerts medical staff to
patients that missed immunization appointments.
16First Steps
Child and Family Health
- Recommendations
- The increased use of the combination
reminder/recall system - 1998 study by Kaiser Permanente proved that a
letter followed by recorded message is the most
effective reminder for under immunized - Implementation of computerized immunization
databases a.k.a immunization registries - Computerized databases make the reminder/recall
effort less labor intensive
17Child and Family Health
- Examples
- MMR- Measles, Mumps, and Rubella
- New combination vaccine for Diptheria, Tetanus,
Whooping Cough, Hepatitis B, and Polio -
eliminates 6 of the 20 injections in a childs
first 2 years
- Recommendations
- New Developments in Combination Vaccines
- They decrease the number of needle pricks a
patient requires, thus the vaccine administration
is easier for the provider and patient
18Child and Family Health
- Definition
- Hospitalization is defined as the rate of
children aged zero through five that are
hospitalized per year. Causes of hospitalization
include - Falls
- Burns or Scalds
- Motor Vehicle Accidents
- Asthma
- Poisoning
- Suffocation
-
19Child and Family Health
- Significance
- Analyzing San Franciscos child hospitalizations
points to the failures of systems such as access
to regular health care, building inspection,
public education measures, and air quality
management. - The hospitalization of a child burdens the family
emotionally and financially. The economic burden
is often times passed on to the provider if the
child is uninsured.
20Child and Family Health
- Where Do We Stand
- In 2000, 125 children under five years of age
were hospitalized due to non-fatal injury. - Falls were the leading cause of non-fatal injury
hospitalizations in both 1999 and 2000.
21Child and Family Health
- Where Do We Stand
- San Francisco has the 4th highest asthma
hospitalization rate for children under 14 in the
state.
- One in six Bayview-Hunters Point children have
asthma while the national average is one in
twelve.
22Child and Family Health
- Where Do We Stand
- Current efforts in addressing hospitalized
children - Home visits for children hospitalized due to
injury - Looks for possibilities for poisoning, falls, or
other types of injury - 2) Very limited one hospital and one nurse to
refer all patients in need of home visit
23Child and Family Health
- Recommendations
- Preventative Measures
- Public education and outreach
- Increased funding and use of home visits of
hospitalized children. Currently only San
Francisco General Hospital refers patients to
health worker for home visitor
24Child and Family Health
Nutrition
- Definition
- The intake of fruit, vegetables, and grains are
necessary for the healthy development of human
beings - Since significant neurological and physiological
development occurs between the ages of 0-5, it is
important for infants and toddlers to have a
healthy diet - 0-5 is also an important stage for establishing
healthy exercise habits
25First Steps
Child and Family Health
Nutrition
- Significance
- Establishing healthy eating and exercise patterns
during the ages of 0-5 can provide proper growth
and development, and prevent future nutrition
related diseases - If children do not intake adequate nutrients and
engage in physical activities during these years,
they may show signs of cognitive impairment by
the time they enter elementary school. - Children who are overweight may face
discrimination, low self-esteem, and poor body
image.
26Child and Family Health
Nutrition
Where Do We Stand The WIC Program The Women,
Infants, and Children Program aims to help
pregnant women, mothers, and children eat well
and stay healthy. Per month, WIC serves an
average of 16,000 pregnant women, breastfeeding
women, and children. The program provides
supplemental foods (such as milk, cheese, cereal,
eggs, beans, peanut butter, and juice),
nutrition education, and referral to health care.
Approximately 50 of WIC clients are ages 1-4,
and 24 are infants.
27First Steps
Child and Family Health
Nutrition
- Where Do We Stand Overweight Children
- According to data from the Pediatric Nutrition
Surveillance System, San Franciscos percentage
of overweight status for children 3-4 is 14.2,
which is slightly higher than the statewide
average of 12.9. - 70 of all Child Health and Disability Prevention
Program Health Exams in San Francisco were
provided to Asian and Hispanic children in 1999,
revealing that Hispanic children have the highest
percentage of overweight status at 17.1 for ages
3-4. - Sufficient research on the numbers of overweight
children in San Francisco has not been collected,
although it has been identified by the Department
of Public Health and health professionals as an
issue that needs attention
28First Steps
Child and Family Health
Nutrition
- Recommendations
- More data must be collected on the nutritional
status of children 0-5 in San Francisco - Families citywide must be provided with more
information about nutrition guidelines and the
importance of proper nutrition for children. - Implement comprehensive health education programs
in preschools and child care programs - Provide support for communities to help children
be more physically active and create
neighborhoods safe for play
29First Steps
Child and Family Health
Nutrition
Whos Working on This
The Childrens Council of San Francisco currently
sponsors the USDA Child Care Food Program, which
reimburses childcare providers for two meals and
one snack, per child per day. Meals and snacks
must meet USDA meal program requirements.
Although providers are educated about the meal
pattern, parents are not. Information and
resources should be extended to families. The
providers are the conduits to working with
parents the good message should be
shared -Cheryl Magid, Child Care Food Program
Director
The Childrens Council also provides workshops
for Eating Right is Basic, a preschool
nutrition education curriculum that child care
providers and centers can use to introduce the
importance of nutrition to children.
30Child and Family Health
Dental Care
Definition Tooth decay, also known as caries or
cavities, is the destruction of the tooth enamel.
It occurs when foods containing carbohydrates are
frequently left on the teeth. Bacteria that live
in the mouth thrive on these foods, producing
acid as a result. Over a period of time, these
acids destroy tooth enamel, resulting in tooth
decay.
31First Steps
Child and Family Health
Dental Care
- Significance
- Early Childhood Caries (ECC) is a form of dental
decay in very young children. - ECC may result in missed school hours, and if
left untreated, can result in problems with
eating, speaking, and concentration in school - Problems caused by tooth decay can cause extreme
shyness, withdrawal, - and low self-esteem
- Poor oral health in children can negatively
affect adult oral health
32Child and Family Health
Dental Care
- Where do We Stand
- San Francisco is the only 100 fluoridated city
and county in California - In April 2002, San Francisco became the 2nd
county in the United States to adopt universal
health care for children through the Healthy Kids
program - 66 of public school children in San Francisco
have cavities, including half that are untreated - Oral screenings conducted by the Department of
Public Health in the 1999-2000 school year showed
that 20 of 544 preschool children had untreated
decay - Only 23.3 of children 0-5 eligible for Denti-Cal
saw a dentist in 2002 - Only 9 of dentists in San Francisco will accept
new Denti-Cal clients
33First Steps
Child and Family Health
Dental Care
- Recommendations
- Outreach efforts by dentists
- Inclusion of dental records in required health
records for public schools - Update list of dentists who accept Denti-Cal
patients and make available to Denti-Cal
recipients in order to increase accessibility - Address cultural barriers to accessing care,
which include language and a lack of education
regarding preventative dental care
There will never be enough dentiststhe medical
profession must get involved. Just a little more
involvement would help -Samantha Stephen,
Coordinator of the DPH Dental Prevention Program
We need to create an infrastructure to maximize
resources and triage them depending on the degree
of disease -Francisco Ramos-Gomez, DDS, UCSF
School of Dentistry
34Children and Families Needing Enhanced Services
Special Healthcare Needs
Federal Maternal and Child Health Bureau One
who has or is at increased risk for chronic
physical, developmental, behavioral, or emotional
conditions beyond that required by children
generally.
35Children and Families Needing Enhanced Services
Special Healthcare Needs
- Four major agencies providing services
- Golden Gate Regional Center (GGRC)
- San Francisco Unified School District (SFUSD)
- California Childrens Services (CCS)
- Community Mental Health Services (SFMHS)
- Other Agencies providing services
- San Francisco Head Start
- High Risk Infant Interagency Council (HRIIC)
- California Children and Families Commission
36Children and Families Needing Enhanced Services
Special Healthcare Needs
- Stein, R.E., Silver, E.J. estimate 13.7 of
children have special healthcare needs - Maternal Child Health Policy Research Center
estimate 16.9 of children have special
healthcare needs - California Children and Families Commission
estimates 18 of children have special healthcare
needs
37Children and Families Needing Enhanced Services
Special Healthcare Needs
- Estimated 5,637 to 7,406 children 0-5 with
special healthcare needs - 1,559 served by the four agencies
- Estimated 4,078 to 5,847 children unserved
38Children and Families Needing Enhanced Services
Special Healthcare Needs
39First Steps
Children and Families Needing Enhanced Services
Developmental Delays Disabilities
- Developmentally delayed delayed achievement of
one or more of the normal milestones of growth
affect speech, language, social or motor skills - Developmentally disabled a substantial handicap
in mental or physical functioning, and of
indefinite duration examples- autism, cerebral
palsy and mental retardation
40- 0-5 is when the brain develops the most
- Developmental delays can be modified with proper
intervention - Intervention is determined by assessment and an
Individual Education Plan (IEP)
41AssessmentProcess of identifying risk,
describing behavior and estimating the prognosis
for future development
First Steps
Children and Families Needing Enhanced Services
Developmental Delays Disabilities
- resulting in a cumulation of programatic plans
and implementation (IEP) - no national or regional standards for conducting
or reporting results
42First Steps
Children and Families Needing Enhanced Services
Developmental Delays Disabilities
- There can be other problems caused by the
underlying disease - developmental delays may be caused by or a sign
of a disability - early intervention can maximize a child with
disabilities capacity to live an independent
lifestyle
43First Steps
Children and Families Needing Enhanced Services
Developmental Delays Disabilities
Risk Factors
- Developmental delays
- - premature birth
- mother over 35
- prenatal brain trauma
- lack of prenatal care
- - fetal alcohol syndrome
- Developmental disabilities
- chromosomal disorders
- gene defects
- prenatal exposure to toxins or infections
- premature birth
- postnatal infections
44First Steps
Children and Families Needing Enhanced Services
Developmental Delays Disabilities
Where Do We Stand?
- Most common developmental delays are speech and
language delays - estimated 5 to 10 affected nationwide
- San Francisco, estimated 1,082 0-5 year-olds who
have or at-risk of forming developmental delays
45First Steps
Children and Families Needing Enhanced Services
Developmental Delays Disabilities
Problems With Counting
- No standard assessment or IEP process
- Classification differs among agencies children
don't meet eligibility requirements - No reporting system for number served or
demographics
46First Steps
Children and Families Needing Enhanced Services
Developmental Delays Disabilities
Problems With Counting
- Duplication of Services
- 246 children served by two of four major agencies
- 28 of these 246 children served by three of the
four agencies (2001) - Unserved children are uncounted
- estimates used to count unserved population
47First Steps
Children and Families Needing Enhanced Services
Developmental Delays Disabilities
Whats Next?
- Increase interagency interaction
- standardize reporting and data collection
- definitions and eligibility- catch ineligibles
- assessment and IEP formation
- The High Risk Infant Interagency Council provide
coordinated services in a timely and coordinated
manner" - coordinating referral services
- investigating risk factors and causes
48First Steps
Children and Families Needing Enhanced Services
Developmental Delays Disabilities
Whats Next?
- Infrastructure Expansion
- seek out children not being served (ChildFind)
- communication with primary pediatricians
- Leveraging Funds
- cuts to programs and research groups
- prop 10 funds may help
49First Steps
Children and Families Needing Enhanced Services
Developmental Delays Disabilities
Whats Next?
- Education and Outreach
- Parents
- rights
- availability of services
- Caregiver
- knowledge of a greater range of disabilities
- Dialog between parents and caregivers
50Children and Families Needing Enhanced Services
Physical Disabilities
Significance
- Assessment
- finds individual needs
- services aid development and to perform at
optimal ability - Many physical disabilities are incurable without
surgery but can be mitigated - IEP and proper educational placement
- abnormal positioning of the joints and disease
progression at times mitigated with medicine and
special exercises
51Children and Families Needing Enhanced Services
Physical Disabilities
Significance
- Family support programs
- parent reactions and interactions
- knowledge of programs and services
- medical and placement assistance
- About a third of children limited in major
activity (school or play) are poor - a quarter of them are uninsured
52Children and Families Needing Enhanced Services
Physical Disabilities
Where Do We Stand?
- Specific number of children difficult to
determine - lack of a standard reporting system for data and
demographics - uncounted population must be estimated
- categorization and terminology varies by
- different disabilities aggregated under different
titles determined by the individual agency
53Children and Families Needing Enhanced Services
Physical Disabilities
Where Do We Stand?
- 12 children age 0-5 with orthopedic impairments
San Francisco Unified School District (SFUSD) - San Francisco Head Start is now serving 5
children with motor impairments
54Children and Families Needing Enhanced Services
Physical Disabilities
Current Strategy
- High Risk Infant Interagency Council (HRIIC)
- standardize the assessment process and Individual
Education Program - lower the duplicated count
- better coordinate referrals and transitions
- Agencies provide family support services
- California Childrens Services
- financial assistance to families earning less
than 40,000/yr or spend more than 20 on medical
services
55Children and Families Needing Enhanced Services
Physical Disabilities
Whats Next?
- expand parent education and family support
- improve teacher preparation and in-service
opportunities - research and technical assistance on diversity in
the classroom - collect and share useful data
- examine relationship to prisons, after school
programs, dropout rates
56Summary
- Research
- Dental Health
- Special Needs
- Child Abuse
- Racial Disparities
- Family Violence
- Systems Level
- Coordination and Collaboration of Services
Providers - Targeted Funding
- Information Systems
- Service Delivery
- Need for more trained staff
- Need for culturally and linguistically competent
staff - Increase quality of service delivery
- Improve client/staff relationship using
family-focused approach