THE STATE OF FLORIDA’S CHILD 3/30/11 Update 2011 Facts and analysis about the well being of our state’s families and children by The Policy Group for Florida’s Families and Children Inc. 1 The State of Florida’s Child UPDATE 2011 PREFACE Formed in 2000, The Policy Group for Florida’s Families and Children Inc. is an independent, analytical group of statewide leaders that develops and supports public policies focusing on the well being of families and children and grounded in evidence-based research. Fellows of the Policy Group are nominated and selected through a process that considers the nominee’s historical contribution to the general welfare of children and families. The Policy Group promotes efforts that bring together diverse groups of stakeholders to research and develop policy; that inform key audiences such as professionals, state agency heads, legislators and funders; and that expand alliances and networks of voices who share the same vision. The Policy Group conducts policy analyses in domains where outcome measures reflect poor performance, and where measurable changes in context indicate need for review of current policy. We provide analyses so that Florida’s leaders know what policies, programs and practices make a difference, and we center our efforts on building upon and using the strengths, assets and resources that already exist in communities. Policy Group Fellows believe that an integrated system of services with a prevention focus is the best way to produce positive child and youth outcomes. This report, The State of Florida’s Child – Update 2011, focuses on child and youth outcomes in four key results areas. The report updates The State of Florida’s Child 1 and is predicated on shared results accountability for outcomes. The State of Florida’s Child – Update 2011 recognizes that: The Florida Cabinet for Children and Youth adopted The State of Florida’s Child report in March 2009, and spent significant time between then and December 2010 developing a process for shared efforts and results accountability. Likewise, statewide stakeholders have engaged in results accountability and united around shared indicators for their work. These seminal efforts must continue and adapt as data further reveals and measures their progress. It is more important than ever for stakeholders, families and communities to coalesce around shared goals for their children and consider their contribution – programmatic and otherwise - to these shared goals. This is more than just lip service; it’s willingness to be involved and accountable for work done by actively measuring and evaluating outcomes. The long-term view of what is best for the state’s children must not be subsumed by short-term politics, funding crises, individual interests or self-protection. Inherently, we all want a great state in which to live, work and rear children. To flourish, positive social policies require sustained attention and dedication to shared values that are meaningful and enduring. It is the intention of The Policy Group to continue providing leadership that is genuine, concentrates on shared values and principles, and focuses on what we and many others strongly believe will make our state the best in the nation for families and children. 2 These concepts should guide the consideration of this update and those to follow: It is imperative that the best information and data inform practice and policy. Many different state agencies may impact outcomes, and no single agency is solely responsible for a specific outcome. Likewise, no single program on the local or county level can significantly impact a specific outcome. Adequate and stable funding is essential to coordinating work toward shared outcomes. Creating more flexibility within existing funding categories is an important component of success. Early investments yield tremendous financial and social benefits. Family members must be involved to achieve optimal child well being outcomes. Outcomes and performance measures must be developed and implemented in a logical, reasonable manner so that they can be easily interpreted and used. Evaluation and data-driven decision-making are ongoing processes. The Policy Group intends to provide this type of results accountability update at least every two years. 2 The State of Florida’s Child 3 report presented indicators of child well being grouped in four goal (results) areas: Every Florida child will be healthy Every Florida child will be ready to learn and succeed Every Florida child will live in a stable and nurturing family Every Florida child will live in a safe and supportive neighborhood These goal areas provide a framework for understanding what children need to thrive and to contribute to Florida’s future. No single indicator fully measures progress; together, they speak volumes about our state’s children and about our investment of time and resources. The initial report provided baseline data as a starting point for understanding where the state stands, and that is generally at the bottom of the heap when it comes to our children, families, and our future economic prosperity. This report provides trend line data for the indicators. This allows further review and analysis of patterns of progress and decline, and identification of areas that need increased attention. Overall, the data show positive change in a few indicators, but no change or negative change in many others. The lack of progress or negative change is pervasive throughout the trend line data in this report. Troubling as this is, the data become even more ominous when the recent economic downturn is considered. A fuller discussion of this context occurs in the Analysis section on page 30, following the presentation of data. 3 HOW FLORIDA RANKS WITH OTHER STATES ON SELECTED INDICATORS The Annie E. Casey Foundation ranks Florida 35 th in the country overall based on several measures of child well-being – low birth weight babies; infant mortality rate; child death rate; teen death rate; teen birth rate; teens not in school and not working; children in families where no parent has full-time, year-round employment; children in poverty; and single parent families. 4 The ranking is based on changes in indicators over a 5-year period for some measures or data from the current year on other measures. (Data for the Percent Low Birth weight Babies, Infant Mortality Rate, Child Death Rate, Teen Death Rate and Teen Birth Rate lag one year behind the other measures.) ARROWS SHOW DECLINE OR IMPROVEMENT IN FLORIDA’S RANK SINCE THE 2009 STATE OF FLORIDA’S CHILD REPORT 4 BACKGROUND FOR THIS UPDATE The State of Florida’s Child report was presented to and adopted by The Florida Cabinet for Children and Youth on March 17, 2009. In adopting the report, the Cabinet also adopted a recommendation to engage in a results accountability process as the best way to focus collaborative efforts on achieving the goals for children and families. The Cabinet spent nearly 1½ years in thoughtful, guided discussion and decision-making leading to the selection of 13 “headline” indicators on which to focus efforts. In mid to late 2010, the Cabinet further defined four indicators, one from each goal area, that they believed were most important to be addressed first. Cross-agency state work groups were formed to provide more information and data on the four indicators: homeless children, abuse and neglect, kindergarten readiness scores and health insurance. Statewide, others also began exploring results accountability in their communities. Mark Friedman, well-known Results-Based Accountability (RBA) expert, was a frequent visitor to Florida, leading numerous workshops and training sessions on implementing RBA. Notable successes on the local level include The Broward Children’s Services Council, which has integrated RBA into its funding and accountability process; The Children’s Trust (Miami-Dade), which restructured its strategic plan using results accountability principles; and The Children’s Board of Hillsborough County, which is using RBA to frame both population level and performance level results, with a focus on turning the curve. The Children’s Board also has gone to a shorter term strategic plan with more leading indicators to focus work on achieve these results by knowing how well they are doing in advance of the headline indicators. Throughout the state, there is a growing recognition that by defining the outcomes we collectively want for our children and families, we can better measure our individual efforts and the strategies that contribute to the desired outcomes. And we can more accurately determine the impact of one outcome upon another, and who or what is accountable for results. To that end, there are some changes between this update and the initial report: • The 2009 report included 74 indicators in four goal areas. Since that time, the Florida Children and Youth Cabinet and others engaged in results accountability work have found that outcomes can be better measured and analyzed using a more streamlined and meaningful set of indicators. This report contains that set of indicators. The indicators in this report promote the ability to compare across communities within Florida and across states. • The initial report contained data at a point in time. This report provides trend line data for the indicators, so that the state and stakeholders can directly address these critical, results accountability questions: 5 o Is the trend line okay? o What are the causes/forces behind the trend line? o What would it take to change the trend line in a positive direction? o Who are the partners in this effort? o What works to change the trend line? o What is the multi-year action plan and budget to make this happen? • This report includes a brief summary of the research that answers the question, “why is this important?” for each indicator. By providing information on an indicator-specific basis, readers will be better able to understand relationships and make connections between and among individual indicators and goal areas. • It is important to know “what works” to improve trend lines. This information is available in the initial State of Florida’s Child, which is online at www.policygroup.org. TREND LINES Every Florida child is healthy Healthy children are the building blocks of a solid and productive society. 6 All children need basic health care. Many health problems that might otherwise threaten a child’s overall well-being and school achievement can be prevented or treated. Approximately 15% of all children nationwide have a chronic condition, and approximately a third of these are considered moderate to severe. 7 Eighty percent of all non-traumatic health care spending is attributable to chronic illness, a figure applicable to just 20% of all children. 8 The remaining majority of children have minimal, relatively low intensity/cost needs. All health care for children and youth should be prevention-based, family-focused and developmentally-oriented. 9 Indicator definition: Percent of live births with prenatal care beginning in the first trimester Source: Florida Department of Health, Florida Charts Note: Florida is among reporting areas that adopted the 2003 revision of the U.S. Standard Certificate of Live Birth in 2004 and 2005. According to Betty Serow, MPH, Ph.D., Senior Health Policy Analyst for the Florida Department of Health, this change meant that the baseline for this data effectively “started over” in 2005. WHY IS THIS IMPORTANT? Research has shown that access to primary care for women of reproductive age encourages early prenatal care, leading to better pregnancy outcomes and healthier children. 10 ! 78.5 76.8 75.9 76.9 78.3 0 20 40 60 80 100 2005 2006 2007 2008 2009 Percentage Mothers beginning prenatal care in the first trimester FLORIDA CHILDREN’S CABINET HEADLINE INDICATOR 6 Indicator definition: Live births weighing more than 5.5 pounds Source: www.floridacharts.com or through the NCHS Vital Stats system, www.cdc.gov/nchs/VitalStats.htm. WHY IS THIS IMPORTANT? Children who were born with low birth weight and fewer parental resources have poorer health, are less likely to work and have lower earnings as adults. 11 The risk of low birth weight babies for African-American women is greater in segregated neighborhoods than in less segregated areas. And, mothers of low birth weight babies are 27% less likely to be married than mothers of normal weight babies. 12 Indicator definition: Deaths occurring to infants under 1 year of age per 1,000 live births. The data are reported by the place of residence, not the place of death. Source: www.floridacharts.com WHY IS THIS IMPORTANT? The cost of intensive neonatal and basic health care for infants born with severe and life-threatening problems far exceeds the cost of prenatal care and other supports that can prevent these problems. While infants in every socio-economic category have better odds for survival than in past years, babies in households at or near poverty face greater risks than infants born to more affluent families. 13 91.2 91.3 91.3 91.2 91.3 0 20 40 60 80 100 2005 2006 2007 2008 2009 Percentage Infants born at appropriate birth weight 7.2 7.2 7.1 7.2 6.9 0 20 40 60 80 100 2005 2006 2007 2008 2009 Rate Infant deaths that occur before age 1 7 Indicator definition: Deaths occurring to infants under 1 year of age per 1,000 live births, by race. The data are reported by the place of residence, not the place of death. Source: www.floridacharts.com WHY IS THIS IMPORTANT? Non-white infants die before age 1 at more than double the rate of white infants. Indicator definition: Percentage of 2-year-old children fully immunized Source: www.floridacharts.com WHY IS THIS IMPORTANT? Progress toward immunization of all young children has stalled since 2004. Immunizations prevent a wide range of diseases, and are a good indicator of child health status. There is no difference in immunization rates by race, but children in poverty are less likely to receive the combined series vaccination. 14 86.6 85.2 85.7 85.6 81.9 0 20 40 60 80 100 2005 2006 2007 2008 2009 Percentage Children who are immunized 5.6 5.5 5.4 12 12.1 11.9 0 20 40 60 80 100 2000-2002 2003-2005 2006-2008 Rate Infant deaths before age 1 by race FL white FL non white 8 Indicator definition: Children 17 and under who were covered by health insurance at any point during the year Source: www.kidscount.org, from The Urban Studies Institute at the University of Louisville, analysis of data from the U.S. Census Bureau WHY IS THIS IMPORTANT? Children with health insurance have a better chance of receiving routine health care, thus avoiding preventable health care costs 15 !and increasing school participation and opportunities for learning. Hispanic children are much less likely than other children to have health insurance. There is little difference in the percentages of children of other races with insurance. 16 Indicator definition: Percentage of children 0 through 4 who are covered by Medikids and Medicaid Source: www.floridacharts.com WHY IS THIS IMPORTANT? The data show that the number of children served by KidCare (primarily low-income children) in Florida increased slightly in 2008, but decreased in 2009, which may mean more children are uninsured. However, in mid-September 2010, Florida reported that enrollment in KidCare has increased statewide by 15% in the 15 months since then Governor Crist signed a law making it easier for low-income families to get health insurance for their children. Maintaining eligibility, however, is difficult for many parents who cannot pay required fees. 84 83 81 82 82 0 20 40 60 80 100 2004 2005 2006 2007 2008 Percentage Children with health insurance FLORIDA CHILDREN’S CABINET HEADLINE INDICATOR 2.1 1.5 2.1 2.6 2.1 0 20 40 60 80 100 2005 2006 2007 2008 2009 Percentage Children under 5 covered by KidCare 9 Indicator definition: Percentage of children 0-17 who received health care in the past 12 months that meets the American Academy of Pediatrics (AAP) definition of medical home, defined as primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate and culturally effective Source: www.nschdata.org WHY IS THIS IMPORTANT? Children with accessible, coordinated primary health care have a medical “home” where all developmental needs can be identified and addressed. Indicator definition: Percentage of children who saw a doctor, nurse, or other health care provider for preventive medical care such as a physical exam or well-child check-up, during the past 12 months Source: www.nschdata.org WHY IS THIS IMPORTANT? Preventive medical care means problems can be identified and adressed early, when they are less costly and there is more opportunity for successful outcomes. 43 56.8 0 20 40 60 80 100 2003 2007 Percentage Children receiving care within a medical home 78.2 91.5 0 20 40 60 80 100 2003 2007 Percentage Children receiving a preventive medical visit in the past year FLORIDA CHILDREN’S CABINET HEADLINE INDICATOR [...]... (2011) The State of Florida’s Child Report: Update 2011 Auburndale, FL: The Policy Group for Florida’s Families and Children Inc © 2011 The Policy Group for Florida’s Families and Children Inc The Policy Group for Florida’s Families and Children is an independent, non-partisan 501(c)(3) non-profit policy research organization composed of local and state leaders who are working together to enhance the. .. and the children for whom they are responsible, carry the weight of the influence of child care/early education on children’s development The positive relationship between child care/early education quality and virtually every facet of children’s development that has been studied is one of the most consistent findings of developmental science.20 Staff qualifications are the strongest predictor of program... conduct their own child care licensing independent of the state As well, the calculation does not include those staff who work with mixed age groups or staff who work with children 5+ years of age) Source: Florida Department of Children and Families WHY  IS  THIS  IMPORTANT?  Staff qualifications are the strongest predictor of program quality and child outcomes.30 Yet most of Florida’s young children... www.childtrends.org/Files /Child_ Trends-2008_02_05_ConnectednessFS .pdf Child Trends Research-to-Results Brief: Ways to Promote the Positive Development of Children and Youth www.childtrends.org/Files /Child_ Trends-2008_02_27_PositiveYouthDev .pdf Child Trends Research-to-Results Brief: Practices to Foster in Out -of- School Time Programs www.childtrends.org/Files /Child_ Trends-2010_01_28_RB_Practices2Foster .pdf 29 ANALYSIS... indicators point directly at the impact that only one factor – the economic downturn - can have upon a child s well being: • • • • • • The number of Florida children in families with income above the poverty line is decreasing The number of Florida children with all available parents in the labor force is decreasing Florida median family income is decreasing The number of Florida children in low-income households... getting worse, and there is little that can be done about it Capture the positive social policies that support children’s flourishing Help society identify shared values and goals.64 Finally, the indicators presented here include headline indicators chosen by the Florida Children and Youth Cabinet and some of the indicators presented in the initial State of Florida’s Child report, but not all The indicators... learn, how they react to the events and people around them, and what they expect from themselves and others are deeply affected by their relationships with parents, the behavior of parents, and the environment of the home and neighborhoods in which they live.44 Safe and stable neighborhoods and communities engender better social interactions among residents and are healthier places for children to... www.naccrra.org/randd/docs/2008_Price _of_ Child_ Care .pdf 24 Schulman, K., & Blank, H (2008) State child care assistance policies 2008: Too little progress for children and families Issue brief from the National Women’s Law Center [Online] Available at: www.nwlc.org /pdf/ StateChildCareAssistancePoliciesReport08 .pdf 25 See reference #14 26 See reference #14 27 Matthews, H (2006) Child care assistance helps families work: A review of the effects of subsidy... exceed 30% of income is increasing The number of homeless children in Florida is increasing The number of children in poverty in Florida is increasing The recession does not completely explain the Florida trend lines on these indicators, but it does exacerbate already troubling circumstances that lead to poor outcomes across all areas for children, but particularly young children, low-income children... Available at http://www.childtrends.org/Files/ /Child_ Trends-2009_01_05_FR_ChildIndicatorGuide .pdf Also see Positive Indicators of child well-being: A conceptual framework, UNICEF Innocenti Research Center, 2009 [Online] Available at http://www.unicef-irc.org/publications /pdf/ iwp_2009_21 .pdf 33 PERMISSIONS AND DISCLAIMER The publications of The Policy Group for Florida’s Families and Children rely upon sound . areas. The report updates The State of Florida’s Child 1 and is predicated on shared results accountability for outcomes. The State of Florida’s Child – Update. THE STATE OF FLORIDA’S CHILD 3/30/11 Update 2011 Facts and analysis about the well being of our state s families and children by The Policy